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HARVARD 
MEDICAL LIBRARY 



m^i^ 




IN THE 



Francis A.Countway 
Library of Medicine 



BOSTON 



r 



■> 



THE 



TRANSACTIONS 



AMEEICAN 



MEDICAL ASSOCIATION. 



INSTITUTED 1847. 



VOL. IX. 



PHILADELPHIA: 

PRINTED FOR THE ASSOCIATION, 

BY T. K. AND P. a. COLLINS. 

1856. 



^ 






Bt a Resolation passed at the Session of 1851, the Committee of Publication 
were instmcted to print conspicuonslj, at the beginning of the volume of the 
Trans<iction8f the following disclaimer : — 

" The American Medical Association, although fonuallj accepting and publishing 
the Reports of the various Standing Committees, holds itself wholly irresponsible 
for the opinions, theories, or criticisms therein contained, except when otherwise 
decided by special resolution." 



,^{srv«A 



?if5-: I • .\r;r 



I 



CONTENTS. 



I 
I 

I 
I 
I 
I 
I 

I 

II 
I 
I 
I 
I 
I 
I 

I „ - _ ._ — 

i 
I 

' PAOB 

I Honms op thb Nihth Akvual Mebtiko of tbb Axebican Medical Association 9 

I Beport of the Committee of Publication 47 

> Report of tlie Treasurer 51 

• Address of George B. Wood, President of the Association .... 55 



Beport on Deformities after Fractures. By Fbakk Hastikos Hahiltok . . 69 

I Report on Hydrophobia 233 

I Rei>ort on the Causes which Impede the Progress of American Medical Lite- 

I rature 337 

i Beport of the Committee on Medical Literature 363 

I Report of the Committee on Plans of Organization for State and County So- 

' cieties 395 

t Beport on the Changes in the Composition and Properties of the Milk of the 
I Human Female, produced by Menstruation and Pregnancy. By N. S. 

Davis, M. D., &c., Chicago, Illinois 415 

Report on the Sanitary Police of Cities. By James M. Newvait, M. D., Buf- 
! falo, N.Y 429 

Report on Treatment of Cholera Infantum. By A. J. Fitlleb . . . 483 
I Report on the Use and Effect of Applications of Nitrate of Silver to the Throat 
, either in Local or General Disease. By Hobacb Gbees, M. D. . . . 493 

j Report on the Best Mode of Rendering the Patronage of the National Govern- 
I ment Tributary to the Honor and Improvement of the Profession. By 

i Joshua B. Flint, M. D 531 

j Report of the Committee on Education. By Wv. Hbebt Anderson, M. D. . 553 
I Report on the Medical Topography of the Eastern Shore of Maryland. By P. 

Wboth, M. D 563 

History of the Epidemic of Yellow Fever in Charleston, S. C, in 1854 . . 585 
I Report on the Epidemics of Louisiana, Mississippi, Arkansas, and Texas. By 
, Erasmus D. Fbnnbr, M. D., of New Orleans 621 

Report on the Meteorology, Mortality, and Sanitary Condition of New Orleans, 
for the years 1854 and 1855. By E. H. Barton, A. M., M. D. . . . 721 

Report on Strychnia : Its Physiplogical Properties, and Chemical Detection. 
By Lewis H. Stbineb, M. D., of Baltimore, Maryland .... 753 

Partial Report upon a Uniform System of Registration of Births, Marriages, 
and Deaths, and the Causes of Death. By G. S. Palmbb .... 773 

Prizb Essay. — On the Arterial Circulation: Its Physiology, and Chief Patho- 
logical Relations. By Henry Hartshome, M. D., &c. . . . . 779 

Flan of Organization of the American Medical Association .... 839 

Ofpicbbs of tbb Association for 1856 857 

List of Pbrmaxbnt Mbmbers 858 



MINUTES 

OFTHB 

NINTH ANNUAL MEETING 



OF THE 



AMERICAN MEDICAL ASSOCIATION, 

HELD IN THB CITT OF DETROIT, MICHIGAN, MAY, 1866. 



Detroit, May 6, 1856. 

The Association met at 11 o'clock A. M., in the " Firemen's Hall ;" 
tbe President, Dr. Geo. B. Wood, of Pennsylvania, in the chair, 
Dr. Danux Tilden, of Ohio, one of the Vice Presidents, on his 
right 

Dr. Wm. Brodis, of Detroit, Michigan, one of the Secretaries, 
present. 

The meeting being duly organized, the business first in order was 
stated by the Chair to be the reception of the Report of the Com- 
mittee of Arrangements. 

Dr. Z. PrroHER, Chairman of the Committee of Arrangements, in 
behalf of the Medical Profession of the city of Detroit, and of the 
State of Michigan, extended a cordial and hearty welcome to the 
members of the Association. 

The roll of delegates was then called, as far as it could be made 
* out, when delegates were found to be present from nineteen States, 
Min. Ter. and the U. S. Army. 

The number of delegates who had registered their names was 208. 

The following list comprises the names of all the delegates, per- 
manent members, and members by invitation, in attendance at one 
period or other, during the meeting of the Association. 
vol. IX.— 2 



10 



MINUTKS OP THE 



Maine Medical Assocwiion^ 



MAINE. 

A. J. Fuller, 
Q-. S. Palmer, 

K E. BOUTELLB, 

HoLLis Monroe, 
N. P. Monroe, 
Wm. H. Allen, 
Chas. E. Swan, 
Asx McAllister. 



NEW HAMPSHIEE. 

Staie Medical Society, \ Luke Miller, 

( HoSEA Pierce. 
Cenire District Med. Society, Thos. H. Currie. 

VERMONT. 

Addison Co. Medical Society, Chas. S. Allen. 

Graftm District Med. Society, \ l' ^' ^^]f^ 
•^ I Henry B. Brown. 



MASSACHUSETTS. 



MassacJmsetts State Med. Society, 



Worcester District Med. Society, 

Berkshire Medical College, 
Boston Lying-in Mospiial, 
Franklin County Med. SociUy, 
Berkshire Dist. of Mass. Med. Ass., 
Permanent Member, 



\ 



Theodore Kittredge, 
Edw. T. Eastman, 
John Qreen, 
Horace W. Adams, 
James Thompson, 
Wm. D. Lamb, 
Nelson Carpenter, 
.Jefferson Pratt, 
W. W. Comstook, 
Erasmus D. Miller, 
M. Bloomfield Leonard. 
Oramel Martin, 
Henry Sargent. 
H. H. Childs. 
Horatio R. Storer. 
Ashman H. Taylor. 
John P. Perkins. 
Eph. Lovbl. 



NINTH ANNUAL MBfiTING. 



11 



EHODE ISLAND. 
Sate Mtdioal Society^ J. E. Wakren. 

CONNECTICUT. 



/Stote Medical Society, / 

New ffaven ChurUy Med, Society y J 

LiickJUld OoufUy Med. Assoc., 



' 



Middlesex Cbunty Med. Society , 
New London County Med. Society, 
Norwich Medical Association, 
Med. Institution of Yale College, 



N. B. Ives, 

P. G. ROCKWILL. 

B. H. Catlin, 
Sheldon Beardslsy, 

C. A. LiNDSLEY. 

Wm, Woodruff, 
B. B. North, 
Balph DsHiNa. 
David Harrison, 

D. P. Francis. 
John D. Ford. 
Chas. Hooker. 



NEW YORK. 



SUde Medical Society, 
Academy of Medicine, 

New York County Med. Society, 

Oenesee County Med. Society, 

QueerCs County Med. Society, 

New York Medical College, 

Med Depart. University of N. Y.. 

BeUevue Hospital, 

New York Hospital, 

Eastern Dispensary, City of N. T"., 

Med Chirurg. Soc. German Phy., 

Montgomery County Med. Society, 



Oneida County Medical Society^ 



'{ 



Thos. W. Blatchfoed, 

C. B. Coventry. 
J. W. Green, 

J. Hancock DouglIs, 

J. McNULTY, 

J. M. Minor, 
n. c. husted. 
Wm. Rockwell, 
J. R. Van Klieck. 
S. Barrett, 
L. B. Cotes. 
John D. Shelton. 
Horace Green. 
A. C. Post. 
James R. Wood. 
Jno. Watson. 
IsADOR Gluck. 
G. I.E. Weber. 
U. Potter. 
J. V. Cobb, 
H. H. Pope, 

D. P. Bissell. 



12 



MINUTES OF THE 



King's CourUy Sospital, \ 

Rochester Medical Society^ j 

Oeneixi Medical College, 
Kappa Larnbda Society. 
Brooklyn City Kospiialj 
Erie County Medical Society, 
Society Statistical Med., 
Orange County Med. Society, 
Madison County Med. Society, 

Sovihem Central Association, < 

Wayne County Med Society, 
Monroe County Med. Society, 
Washington County Med. Society, 
Richmond County Med. Society, 
New York Statistical Society, 

Permanent Members, < 

By Invitation, < 



Thos. Turner, 
J. M. Ingraham. 
W. H. Briggs, 
L. McKay. 
J. H. Jerome. 
Jas. L. Phelps. 

D. G. Enos. 

Jas. M. Newman. 
J. A. Brady. 
A. H. Thompson. 
J. K. Chamberlayne. 

E. Daniels, 
S. West, 

Chas. H. Swaine. 
Chas. E. Pomeroy. 
W. W. Ely. 
P. V. K Morris. 
W. E. Anderson. 
Thos. W. Brinsmade. 
J. A. Morrell, 
Harvey Jewett. 
W. H. Reynall, 
R. K. Rodgers, 
Alex. Thomson. 



PENNSYLVANIA. 



{ 



State Medical Society, 

College of Physicians, 
Philadelphia County Med. Society, ] 
Med. Depart. Penna. College, 

Lancaster City and Co. Med. Soc., - 



Lancaster County Hospital, 
Berks County Med. Society, 



J. M. Gemmill, 
H. Orlady, 
Adam Sheller. 
Geo. B. Wood. 
Anthony E. Stocker, 
Caspar Wistbr. 
John Neill. 
John Ream, 
J. K. Raub, 
P. Cassidy, 

F. HiNKLE, 

Henry Carpenter. 
John L. Atlee. 

F. RiESER. 



NINTH ANNUAL MEETING. 



13 



EurUingdm OcmUy Med. Society, | 

Bucks Chunly Medical Society, 
Med. Depart. University of Penna., 
Beaver County Med. Society, 

Med. Society (Xty (f Beading, | 

Philadelphia Hospital, 



John MgCullooh, 

J. B. LUDEN. 

O. P. Jambs. 
Joseph Leidt. 
David Stanton. 
P. G. Bertolet, 
Wm. Herbst. 
BoBT. K Smith. 



NEW JEBSEY. 

L. A. Smith, 
J. Blane, 
Lewis C!ondict. 

Stmerset County Med. Society, S. K. Mabtin. 

Essex District Medical Society, Wm. Piebson, Jr. 



Medical Society, 



{ 



DELAWAEE. 
Wilmmgtm Medical Association, Jas. W. Thomson. 

MAEYLAND. 
Med. and Chirurgical Faculty, P. Wroth. 



SOUTH OAEOLINA. 

f B. W. Bradley, 

W. T. Wragg, 

J. S. Mitchell, 

E. S. Bailey. 

,-,x»,, ^TCf ran f Eli Geddings, 
Ifed. a>Uege o/the State o/S.O,[ Hbnbt R i^ST. 



Medical Assodatian, 



State Medical Society, 
University of Nashville, 



TENNESSEE. 

J Ira Conwbll, 
E. C. Foster. 

J. B. LiNDSLBY, 

Wm. K. Bowling. 



{ 



KENTUCKY". 

State Medieal Sodety, W. L. Suttok. 

Med. Depart Utdver. of Louisville, S. D. Gboss. 



14 



MINUTES OP THE 



Kentucky School ef Medicine^ 
Loutsvilh Medical HospiUx,\ 
U. & Marine Hospital^ 



J. B. Flint. 
D. W. Yandbll. 

B. J. BR£CK£NRID0B. 



OHIO. 



State Medical Society^ 



Medico- Ohirurgical Society ^ J 

Miami Medical College^ \ 

Hardin County Medical Society^ j 

Ohio Lunatic Asylum^ 
Athena, Morgan, and Washington j 
Medical Society, \ 

Mordg<mery County Med, Society, \ 

Dark County Medical Society, 
Stark County Med. Society, 

Medina County Medical Society^ \ 



C. Cochran, 
H. O. Mack, 
T. W. Gordon, 
Wm. Trevitt, 
0. eobbrtson, 
J. p. Henderson, 

E. Hills, 

A. Caret, 
W. W. Jones, 
J.A. Sayles, 
J. C. Magguin, 

B. Tafpan, 

F. T. HURXTHAL, 

B. Sheldon, 
J. N. Gard, 

G. F. Mitchell, 
Jno. a. Smith, 
a. musgrove, 
S. Bonner, 

W. L. SCHENCK. 
Wm. CLENDENNINy 

L. C. Rives. 
R. D. MussEY, 
Geo. Msndenhall. 
W. H. Philips, 
a. w. munson. 
Bichard Gundry. 
Isaac Heustis, 
Smith Branson. 
H. G. Carey, 

C. McDermot. 
Alfred Ayers. 
Lewis Slusser. 
Henry Spillman, 

E. H. SiLBY. 



NINTH ANNUAL MBETING. 



16 



Erie County Medioal Society^ 



^Vf j 



Union Med, Asaoc^ Northern Ohioj 

Miami Gouniy Medico- Chir. Society , j 

Morgan County Medical Society^ 
Ohio Medical College^ 
Permanent Mernber^ 

By Invitation^ 



A. Austin, 
Danl. Tildbsn, 

H. J. DONOHUE. 

L. D. Griswold. 

G. VOLNBY DOBSEY, 

B. Nkpf. 

T. W. White. 
S. G. Armob. 
R R McMeans. 
Jas. Bbonson, 
Benjamin Stanton, 
LEames^ 
Josh. Clements. 



INDIANA. 



State Medical Society, 



Huntingdon County Med. Society, 
Cambridge CHty Med Association, 
&, Josephs County Med Society, 

AUen County Medical Society, j 

Marshall County Medical Society, 
Grant County Medical Society, 
Putnam County Medical Society, 

Permanent Merribers, •< 

Members by Invitation, < 



George Sutton, 
David Hutchinson, 
D. Meeees, 
Wm. R Winton, 
R. A. Cameron. 
Wm. B. Lyons. 
S. S. Boyd. 
Louis Humphreys. 
b. s. woodwobth, 
H. P. Ayres. 
Joseph Brelsford. 
James S. Dicken. 
M. D. Darnall, 
Levi D. Sheets, 
Landon C. Rose. 
Calvin West, 
G. F. McCarthy, 
Thos. M. Franklin. 



S^ Medical Society, 



ILLINOIS. 

A. S. McArthur, 
S. T. Trowbridge, 
F. K Bailey, 
RuDOLPHus Rouse, 
S. Y. Baldwin, 
c. goodbrake, 
David Prince, 
H. Noble. 



16 



MINUTES OP THE 



Cook County Medical Society^ 

La Salle County Medical Society^ \ 

Jersey County Medical Society^ 

Rock Island Medical Society, 

Sienry County Medical Society, 
Madison County Medical Society, 
jEsculapicm Society, 
Hamcock Medical Association, 
McLean County Medical Society, 
Coles County Medical Society, 

Adams County Medical Society, 

St. Jamas' Hospital, 
Mercy Sbspital, 

Bush Medical College, 
Permanent Members, 



James Bloodgood, 
Henry Parkeb, 
E. Andrews, 
j. h. hollisteb, 
Wm. Varian. 

C. Hard, 
Philip Ejrwan. 
H. 0. Harriman. 
P. Gregg, 

Wm. a. Knox. 
T. D. Fitch. 
Hez. Williams, Jr. 
E. 0. Banks. 
Chas. Coolidge. 
A. H. Luoe. 
V. E. Bridges. 
S. W. Everett, 
Wm. 0. Harrington. 
De Laskie Miller. 
N. S. Davis. 
Jas. W. Freer, 

D. Brainard. 
A. B. Palmer, 
Edw. Dickinson. 



IOWA. 
Dubuque Medical Society, R. S. Lewis. 

oil Phys. & Surg., Iowa Univer.^ D. L. McQuGiN. 
Iowa Medical College, E. C. Francis. 

State Medical Association, John M. Adler. 



WISCONSIN. 



State Medical Society, 



Dane County Medical Society, j 



John B. Dousman, 
D. Cooper Ayrbs, 
C. G. Pease, 
Hats McKinley, 
Wm. H. Brismadb. 
C. B. Chapman, 
S. S. Thorn. 



NINTH ANNUAL MEETING. 



17 



MICHIGAN. 



State Medical Society, 



[ 



Detroit Medical Society^ 
^ Mary's Hospital^ 

Serapion Society ^ 

Orand River Valley Med. Assoc,, j 
Med. Depart. Univer. of Michigarij j 

Southwestern District Med. Society, 
Saginaw County Medical Society, 

Northeastern Medical Society, 



Shiatoassee County Medical Society, 
Van Buren County Med Society, 



M. A. Pattbrson, 
E. D. Cone, 
S. Denton, 

B. S. Rice, 
E. Wells, 

P. TiLLSON, 

J. 0. Gorton, 
H. P. Cobb, 
Geo. B. Russell, 
S. R. Arnold. 
Morse Stewart, 
J. A. Brown, 
L. G. Robinson. 
R. Inglis, 

E. P. CHRISTLiN. 

C. P. Seely, 

A. 0. POITER, 

C. p. Fanner, 
S, H. Douglass, 
P. Klein. 
Alonzo Platt, 
Chas. Shbpard. 

A. Sager, 

M. GUNN. 

B. Barnum, 

B. P. Wells, 
Leander D. Tompkins. 
John B. White. 
Cyrus M. Stookwell, 
Jarsd Kibbes, 

A. R. Stone, 

C. MoCoLLUM, 
W. H. Haze, 
M. C. Kinney, 
John S. Smith, 
Albert C. Lsete. 
E. Leach. 

H. C. Clapp. 



18 



MINUTES OF THE 



Calhoun CourUy Medical Society^ \ 
Michigan CerUral Medical Society, 

Permanent Members, 



By Invitation, 



Edward Cox, 
Simeon S. French, 

DWIGHT NiMS. 

Jas. a. Leasia. 
Z. Pitcher, 
Wm. Brodie, 
K D. Stebbins, 
A. L. Leland, 
Henry Taylor, 
J. Andrews, 
I. Paddack. 
S. B. French, 

W. O'DONOUGHUE, 

E. R Thornton, 

C. F. Ashley, 
P. N. Curtis, 
Dr. Saunders, 
H. F. Ewers, 
Alex. Ewing, 
M. H. Andrews, 
J. E. Coates, 

D. C. Briggs, 
Edward Cox, 
R K. Maniates, 
Wm. H. Stevens. 



MINNESOTA TEREITOEY. 
Union Med. Society of St. Anthony \ ^ ^ ^ 

and Mineapolis, f ^^^' ^. Le Boutillier. 

Med. Sac. of Minnesota Territory, Thos. E. Potts. 

UNITED STATES AEMY. 
Newport Barracks, Ky. Chas. Tripler. 



BBITISH PEOVINCES. 

E. M. HoDDER, Toronto, C. W. 
N. Bethune, « " 
"W. Haswell, " 

J. H. ElCHARDSON, " 



By Invitaiion, 



it 



NINTH ANNUAL MEKTINa. 



19 



By Invitation^ 



G. COATSWOBTH, Kings- 

ville, O.W. 

Jno. Tarquand, Wood- 
stock, " 

S. A, SOOTT, " " 

A. KDewson, Windsor, " 



Dr. Thomson, of Delaware, then moved that a recess of fifteen 
minutes be taken, in order that the delegations of the respective 
States might have an opportunity to appoint a member to serve on 
the Committee on Nominations* Carried. 

At the expiration of the recess, the Association was called to 
order, and the different State delegations then reported their choice, 
respectively, of delegates to serve on the Nominating Committee, 
which was constituted as follows : — 



N. P. MoNBOE, Maine, 
HOSEA PlEBCB, N. H., 
C. L. Allen, Vermont, 
H. H. Childs, Mass., 
J. E. Wakrkn, R. I., 
David Habrison, Conn., 
Wm. Rockwell, N. Y., 
Lyndon A. Smith, N. J., 
John Neill, Penna., 
J. W. Thomson, Del., 
P. Wroth, Maryland, 



E. GiDDINGS, S. C, 

J. Berrien Lindsley, Tenn., 

W. L. Sutton, Ky., 

Moses Gunn, Mich., 

T. W. Gordon, Ohio, 

W. R. WiNTON, Ind., 

H. Noble, HI., 

W. H. Brisbane, Wisconsin, 

C. W. Boutillibr, Min. Terr., 
Chas. Tbiplbr, U. S. a., 

D. L. MoGuQiN, Iowa. 



Dr. PrroHER, Chairman of Committee of Arrangements, recom- 
mended that, in conformity with the domestic and social usages of 
the place of meeting, the sessions of the Association take place 
in accordance with the following plan, and that they commence 
and terminate each day at the hours designated therein, as fol- 
lows : — 

Tuesday Morning Session, from 11 o'clock A. M. to 12J P. M. 

" Afternoon " " 2 " P.M. " 5 « 

Wednesday Morning " " 9 " A.M- " 12 J " 

" Afternoon, no Session. 
Thursday Morning Session, from 9 o'clock A. M. to 12 J P. M. 

Afternoon " « 2 « P. M. " 5 " 

Friday Morning « " 9 « A.M. 



20 . MINUTES OF THE 

The Committee under the resolutions* offered by Dr. N. S. Davis, 
at the last meeting, held in the city of Philadelphia, reported as 
follows: That in view of the present state of our professional 
literature, they feel reluctant to advise a departure from the present 
mode of laboring to promote a higher degree of culture in those 
preparing to become members of the medical profession, and to 
establish in those already engaged in its duties, a habit of recording 
the results of their observations. 

They think the effect of such a change as is contemplated in the 
resolutions of Prof. Davis, and the more amplified expression of 
this idea, contained in the address of the then President, Dr. Pope, 
of Missouri, delivered at Philadelphia, in 1855, can be easily fore- 
seen. 

To a few who are gifted with colloquial powers, and to others 
who have undergone the discipline required to fit them for public 
debate, the interest of the meetings conducted upon the plan pro- 
posed in the resolutions, would be greatly increased, but as the 
great body of the Association would, voluntarily it is true, be ex- 
cluded from participation in these exercises, the enthusiasm which 
now characterizes our anniversaries would subside, and with it the 
professional esprit du corps, which has been already developed 
through the instrumentality of the Association. 

We presume the objects for which this organization was effected 
have not been lost sight of by a majority of its members ; neither 

* WhereaSf The present mode of conducting the annual meetings of the Associa- 
tion affords but Uttle opportunity for the discussion of strictly scientific questions 
and papers, and 

WTiereas, This has been regarded as a serious defect in the operation of our 
organization, impairing its scientific character, therefore 

Resolved, That the daily sessions of the Association, during each annual meet- 
ing, be divided into two parts — ^the first to terminate at an hour not later than 12^ 
o'clock P. M., each day, and to be devoted, as heretofore, to the general business 
of the Association— the second, consisting of all the time during which it is 
deemed advisable to remain in session each day, after 12J o'clock P. M., to take 
the character of a scientific session, and to be devoted exclusively to the discussion 
of questions relating to the science and art of medicine. 

Retolved, That the Association, in Its capacity of a scientific body, having no 
power to act on any subject except of a scientific character, may continue in 
session, whenever thought advisable, a longer period than in its more general 
capacity. 

Resolved, That the foregoing preamble and resolutions be referred to the Com- 
mittee of Arrangements, with instructions to report on the same at the commence- 
ment of the next annual session. 



NINTH ANNUAL MEETING. 21 

can it be pretended that those purposes have been so far accom- 
plished as to justify us in laying it aside, or of diverting it from 
its original design* 

Your Committee feel that the Profession has no right to rail at 
the public for misappreciation of it, so long as we continue to admit 
men into its folds destitute of that knowledge, both in nature and 
degree, necessary to make a decent appearance in general society, 
or to fit a man for the more ordinary and less responsible pursuits 
of life. 

From the early records of the Association, it appears that this 
conviction on the part of the profession of the United States, con- 
nected with the design of reforming, in certain particulars, the 
medical schools of our country, led to its organization in 1847. 
And, until its mission in both respects has been accomplished, the 
Committee would reluctantly recommend the adoption of any 
measure tending, in their judgment, to divert it from the design of 
its creation. 

Thus far the influence of the Association has gradually extended 
itself into the rank and file of the profession. It has increased the 
number of writers, given an impulse to the medical mind, and en- 
couraged a useful and laborious class, qualified to observe, and 
willing to submit their observations to the public, because they can 
be incorporated into the body of the Transactions without being 
subjected to a sifting criticism. 

It is true that, in this way, articles have been printed that did not 
always enure to the credit of the Association, but, at the same time, 
and by that means, motion and fertility have been given to minds 
that would have lain fallow and unproductive, which the dread of 
the conspicuity belonging to a mental gymnasium would have 
driven into deeper obscurity. 

The Committee, however, whilst they would resist any tendency 
to radicalism in their own opinions, cannot dismiss the subject with- 
out expressing their belief, that, in order to secure the objects of our 
organization, it is as necessary to increase the breadth and depth of 
its base as to elevate the shaft designed to spring from it, for, with- 
out such preparation, the superstructure, however beautiful in 
aspect, would be of transient duration. Having arranged the 
hours for meeting and adjourning, so as to place it in the power of 
the Association to adopt or reject without inconvenience the reso- 
lutions of Dr. Davis, the Committee respectfully ask to be excused 
from submitting a distinct proposition on the subject. 



22 KINUTES OF THE 

On motion, tlie report was accepted. 

The President, Dr. Wood, announced the regrets of Dr. Francis 
West, one of the Secretaries, at not being able to be present at 
the meeting. Also of Dr. D. Humphbbys Stobbr, one of the Vice- 
Presidents. 

The Secretary, Dr. Brodib, read a letter from Dr. Graftois' 
Tyler, one of the Vice-Presidents, regretting his inability to be 
present, and expressing his abiding interest in the prosperity of th.e 
Association. 

The President announced the death of Dr. John C. Warren", 
of Boston, one of the former Presidents of the Association, 

Dr. H. H. Childs, of Mass., in a few brief remarks, paid a just 
and handsome tribute to his memory. 

Dr. Gross, of Kentucky, rose to confirm the remarks made by^ 
Dr. Ohilds, and moved that a committee of five be appointed by 
the Chair, to draft resolutions expressive of the feelings of this 
Association for the loss of their late associate, Dr. J. 0. Warren. 
Carried. 

The President appointed 

Drs. Gross, of Kentucky, 
" Childs, of Massachusetts, 
" Wood, of New York, 
" Pitcher, of Michigan, 
" Geddings, of South Carolina. 

In honor of the memory of Dr. Warren, the Association then 
adjourned. 

Afternoon Session, 2 o^cloch P.M. 

The Secretary read a communication from the Medical Depart- 
ment University of Nashville, and from the Tennessee State Medical 
Society, inviting the Association to hold their next meeting in 
Nashville, Tenn. 

Also, an invitation from the General Assembly, tendering the 
use of their chamber for the Association. 

All of which were, on motion, referred to the Committee on 
Nominations. 

The Committee on Nominations, through their Chairman, Dr. 
Thomson, reported, in part, as follows, which report was, on 
motion, unanimously adopted : — 



NINTH ANNUAL MEETING. 28 

PRESIDENT, 
ZiNA PiTCHSB, Michigan. 

VICE-PRESIDENTS, 
Thos. W. Blatchfobp, N. K, E. Geddings, S, Carolina^ 
Wm. K Bowlino, Tem^ Wm. H. Bmsbanb, Wisconsin. 

SECRETARIES, 
Wm. Bbodie, Detroit^ Michigan^ B. C. Fosteb, Nashville^ Tenn. 

TREASURER, 
Caspab Wistbb, Philadelphia, Pa. 

On motion of Dr. J. L. Atlbe, the President, Dr. Wood, was 
requested to read his annual address. 

The President then delivered the annual address, after which, on 
motion of Dr. Atlbb, of Penn., the thanks of the Association were 
unanimously tendered to the President, for his :able and interesting 
address, and he was requested to furnish a copy of the same to the 
Committee of Publication. 

Dr. TiLDBN, V.P., in the chair. 

On motion of Dr. Atlbb, a committee of three was appointed by 
the Chair to conduct the newly elected officers to their seats. 

(hmmiUee.—J>TB. Atlbb, of Pa., RrvBS, of Ohio, and Sutton, of 
Kentucky. 

The newly elected officers were then conducted to their respective 
chairs by the Committee. 

The newly elected President, Dr. Pitchbb, on taking his seat, 
returned his sincere thanks to the Association for the honor, con- 
ferred not only upon himself, but upon the Profession in Detroit 
and the State of Michigan ; expressed the abiding interest he had 
always felt for the Association's welfare and prosperity, and assured 
them that his best endeavors should be used to maintain its reputa- 
tion unsullied. 

On motion of Dr. Fbost, of South Carolina, 

Besolvedj That the thanks of this Association are due to the re- 
tiring officers, for the zealous and efficient manner in which they 
have performed their duties. 

To our late President, for the courtesy and ability with which he 



24 MINUTES OP THE 

has presided over our deliberations. To all the officers, for their 
attention to the laborious duties of their stations, not excepting our 
Committee of Publication, to whom we must feel indebted for the 
satisfactory form in which the volume of the Transactions appears. 

On motion of Dr. Gunn, of Michigan, 

Resolved^ That the resolutions adopted by the Association at its 
session in St. Louis, in 1854, requiring the Committee of Publica- 
tion to be selected from the place where the meeting should be held, 
be repealed. 

Dr. Jas. L. Phelps, of N. Y., offered the following preamble and 
resolution, which, after a motion to lay on the table, were adopt- 
ed: — 

Whereas^ The pleasure and satisfaction of attending the delibe- 
rations of this Association would be greatly enhanced, the duties of 
the secretaries and reporters facilitated, and order, at the same time, 
secured by the observance of two things, to wit : First, that the 
audience be put in possession of the name and residence of the 
Speaker; and, secondly, that they be enabled distinctly to hear 
what he has to say : Therefore, 

Resolved^ That no one be permitted to address the Association, 
except he shall have first given his name and residence, which shall 
be distinctly announced from the Chair, and the member be required 
to go forward and speak from the stand, and not more than ten 
minutes at one time. 

Dr. Gross, of Kentucky, stated his readiness to make his report 
" On the Causes which Retard the Progress of Medical Literature." 
On motion, it was made the special order for Wednesday, at 10 
O'clock A. M. 

Reports of Standing Committees being in order. Dr. A. B. Palmer, 
Chairman of Committee on Prize Essays, reported : That the Com- 
mittee had received four papers for consideration, and that they had 
given the preference to one bearing the title of "The Physiology of 
the Arterial Circulation, and its principal pathological relations," 
and bearing the following motto: Una est Veritas. 

On motion of Dr. Atlee, the report was accepted, and the Essay 
referred to the Committee of Publication. On breaking the seal of 
the accompanying packet. Dr. H. Hartshorne, of Philadelphia, was 
found to be the successful competitor. 

Dr. Blatchford, of N. Y., Chairman of the Committee on 
" Hydrophobia, and the Connection of the Year with its Preva- 



NINTH ANNUAL MKKTING. 25 

lence," read his report thereon, and submitted the following resolu- 
tion, which was adopted : — 

Resolved^ That the Secretary transmit to the Governor of each 
State, a copy of the statistical part of this report, with the respect- 
ful request that he would bring the subject before the Legislature 
of the State over which he presides, that, in their wisdom, they 
may devise and unite upon a plan by which Jhe evil may be miti- 
gated, if not removed. 

On motion of Dr. Atlkk, the report was referred to the Commit- 
tee of Publication. 

The Committee on Nominations reported Nashville, Tennessee, as 
the place for the next meeting of the Association. 

Dr. Gboss moved to amend the report, by inserting Louisville 
in the place of Nashville, which, after some remarks, was lost. 
The report was then adopted. 

The Committee of Publication made their report, through th& 
Treasurer, which, on motion, was accepted, and referred to the Com- 
mittee of Publication, for 1856. 

The Committee of Publication submitted the following resolution,. 
which, after some remarks, was adopted : — 

Reaolved^^hsX hereafter, commencing with the session of 1856, no 
report or other paper shall be entitled to publication in the volume 
for the year in which it shall be presented to the Association, unless 
it be placed in the hands of the Committee of Publication on or 
before June 1. 

Dr. Atlek oflfered the following resolution : — 

Resolved, That the Committee of Publication be required to retain 
at least five complete sets of the Transactions. Carried.. 

Dr. Wood, of Pa., moved to refer the nomination of Standing 
Committees to the Nominating Committee. Carried. 

On motion of Dr. Wood, the Committee on "Deformities after 
Fractures," of which Dr. F. BL Hamilton, of BuffUo, N. Y., is 
chairman, was continued. 

Dr. Bbecksnridge, of Ky., Chairman of Committee on Medical 
Literature, for 1856, stated that he was ready to report; also, Dr. 
Palker, Chairman of Committee on ^'Plan of Organization for 
State and County Medical Societies." On motion, these reporta 
were made the order to follow that of Dr. Qross, at 10 o'clock 
Wednesday. 

On motion of Dr. Smith, of New Jersey, that portion of the 

VOL. IX.— 8 



26 MINUTES OF THE 

resolution requiring members, when speaking, to take the stand, 
was rescinded. 

Dr. WiSTER, of Pa., Treasurer, made his annual report, which, on 
motion, was accepted, and referred to the Committee of Publication. 
Dr. GuNN, of the Committee of Arrangements, reported the follow- 
ing names of members by invitation : — 
Dr. P. N. Curtis, of Tecumseh, Michigan, 
" Calvin West, of Hagerstown, Indiana, 
" James Bronson, of Newton Falls, Ohio, 
" Benjamin Stanton, of Salem, Ohio, 
" Eames, of do.,* 

" R. K. Maniates, of Marshall, Michigan. 
Which report, on motion, was adopted. 

The President read a communication from Dr. StillIi, Chairman 
of the Committee appointed last year to consider the subject of 
extending the lectures of each chair in medical schools over a 
period of two years, asking to be continued, which was, on motion, 
granted. 

An invitation was received from the American Association for 
the advancement of science, to meet with them in Albany, N. Y., 
in August next, at which time, also, the Dudley Observatory will 
be inaugurated, and an address delivered by the Hon. Edward 

EVERETI. 

On motion, the invitation was accepted. 

The Association then adjourned, to meet to-morrow morning at 
9 o'clock. 

Wednesday, May 7. 
The Association met at 9 A. M., the President in the chair. The 

minutes of last meeting were read and approved. 
The Secretary read communications from 
Dr. Sem MES, Chairman of Committee on " Coroners' Inquests." 
Also from Dr. J. Taylor Bradford, Chairman of Committee on 

" Treatment of Cholera." 
Dr. D. Mbrs2>ith Beese, Chairman of Committee on the " Causes 

of Infant Mortality in Large Cities, &c." 
Dr.E.R.PKASLEE, Chairman of Committee on "Inflammation, &c." 
Dr. J. W. Corson, on the "Causes of the Impulse of the Heart, &c." 
Dr. M. Stephenson, on the " Treatment best adapted to each 

Variety of Cataract, &c." 



NINTH AIWUAL MEETING. 27 

Dr. J. C. Hutchinson, on the " Anatomy and Histology of the 
Cervix Uteri." 

Dr. J. Beech, Chairman of Committee on "Medical Topography 
for the State of Michigan." 

All asking to be continued, and which, on motion, were referred 
to the Committee on Nominations. 

A communication was received from Dr. F. H. Hamilton, of 
Buffido, asking that the minutes of 1855 be amended, so as to con* 
tinne him as Chairman of a Special Committee on "Deformities 
after Fractures," he being continued, but the minutes not so ex- 
pressing it 

On motion of Dr. Bbodie, the minutes were ordered to be so 
amended. 

Dr. Atlee offered the following resolution : " That Dr. Hamilton 
be permitted to use that portion of his report on "Deformities after 
Fractures" already published by the Association, to be incorporated 
in his work on the Deformities after Frcudures cmd DialoocUions. 

On motion of Dr. A. B. Palmeb, the resolution was referred to 
a committee of three, consisting of Drs. A. B. Falheb, J. L. Atlee, 
and B. Hills. 

The Committee of Arrangements reported the following gentle* 
men as members by invitation : — 

Dr. Edward Cox, Battle Creek, Michigan, 

" S. B.French, " " 

" W.O'Donoughue, " " 

" S. A. ScoiT, Woodstock, C. W., 

" E. R. Thornton, Belleville, Michigan, 

" Foster, Unadilla, " 

" Holly, Shiawassee, " 

" W. H. Stevens, Saline, " 

" Thomas M. Franklin, Laporte, Ind. 

On motion, the report was accepted. 

Dr. GuNN moved that those gentlemen from the British Provinces 
who are here by a general invitation, be admitted in a body, and 
requested to take seats on the platform for the morning's session. 
Carried. 

Dr. E. M. HoDDEB, of Toronto, C. W., 
« N.Bbthune, " " 

" W.Haswell, " " 



28 MINUTES or THE 

Dr. G. CoATSWORTH, Kingsville, 0. W^ 
" J. H. Richardson, Toronto, " 
" J. Tarquand, Woodstock, " 
" A. K. Dewskn, Windsor, " 

were conducted to the chair, and received by the President, who 
said " that he was happy to be the instrument of celebrating the 
nuptials by which we effect a scientific reunion of the two members 
of the Anglo-Saxon race on this continent, which have been so long 
separated by political relations having their origin in the separa- 
tion of the American Colonies from the British Crown." 

Dr. HoDDER, in behalf of the Canadian delegation, thanked the 
Association for the courtesy and kindness extended to them. 

On motion of Dr. Sutton, of Kentucky, one thousand copies of 
the address of the late President, Dr. Wood, were ordered to be 
published for the use of the permanent members of the Association. 
Carried. 

On motion of Dr. J. B. Lindslby, of Tennessee, 

Resolved^ That a committee of three be appointed by the Chair, 
to prepare a suitable minute in reference to the death of our late 
Secretary, Dr. P. Claiborne Gooch, of Eichmond, Virginia, who 
fell a martyr while contending with the pestilence in Norfolk, in 
1855. 

The President appointed as such committee — 

Dr. LiNDSLEY, of Tennessee, 
" Thomson, Delaware, 
" Mendenhall, Ohio. 

Dr. Gross, of Kentucky, from a committee appointed to draft 
resolutions relative to the death of Dr. J. C. Warren, reported the 
following resolutions : — 

Whereasy It has pleased Almighty God to remove from the scene 
of his earthly labors our late fellow member. Dr. J, C. Warren, 
of Boston, formerly President of this Association, and for many 
years Professor of Anatomy and Surgery in Harvard University; 
And whereas^ It is just and proper that when a great and good man 
dies his memory should be cherished by his fellow-citizens, and 
transmitted unimpaired to posterity for the encouragement of future 
generations, therefore — 

Resolvedy That this Association has learned with deep regret 
the news of an event which has deprived the American medical 
profession of one of its oldest, most useful, and most illustrious 
members; American Surgery of one of its greatest ornaments; 



NINTH ANNUAL KESTING. 29 

science, of one of its best friends, and hnmanitj one of its noblest 
bene&ctors. 

Resolvedly That the life of Dr. J. 0. Warren affords an example 
of a man who, notwithstanding the possession of ample riches^ 
devoted himself heart and sonl for upwards of half a century to 
the caltivation and advancement of his profession, and to the good 
of the human race. 

Resolved^ That this Association deeply sympathizes with the family 
of Dr. Warben in their bereavement, and that the Secretary be 
requested to transmit to Uiem a copy of these proceedings. 

On motion, the above preamble and resolutions were adopted 
by a silent vote. 

Dr. Gross then read his report " On the Causes which retard the 
Progress of American Medical Literature," and recommended the 
adoption of the following resolutions:^— 

Resolved^ That this Association earnestly and respectfully recom- 
mends: 1st The universal adoption, whenever practicable, by our 
schools, of American works as text-books for their pupils. 2d. The 
discontinuance of the practice of editing foreign writings. 8d. A 
more independent course of the medical periodical press towards 
foreign productions^ and a more liberal one towards American ; and 
4th. A better and more efficient employment of the facts which are 
famished by our public institutions for the elucidation of the nature 
of diseases and accidents, and indirectly for the formation of an 
original, a vigorous, and an independent national medical literature. 

Resolved, That we venerate the writings of the great medical 
men past and present of our country, and that we consider them as 
an important element of our national medical literature. 

Resolved^ That we shall always hail with pleasure any useful or 
valuable work emanating from the European press, and that we 
shall always extend to them a cordial welcome as books of reference, 
to acquaint us with the progress of legitimate medicine abroad, and 
to enlighten us in regard to any new facts of which they may bo 
the repositories. 

Dr. Phelps, of New York, moved that the report and resolutions 
be adopted. 

On motion, the question was divided, when the report was 
adopted. 

On motion, the 1st resolution was amended so as to read ^^jmC^ 
for"fi&jraZ." 

On motion of Dr. Davis, the resolutions were laid on the table, 



80 MINUTES OF THE 

until the report of Dr. Bbkckenbidge on "American Medical 
Literature" should be read. 

The Secretary read a communication from Dr. Jewett, Chairman 
of Committee " to procure Memoirs of the Eminent and "Worthy 
Dead," with such reports as he had received ; which reports and 
communications were referred to the Committee of Publication. 

Dr. Breckenridge read his report on " American Medical Litera- 
ture," which was, on motion of Dr. C. Hooker, of Connecticut, 
received and referred to the Committee of Publication. 

The President then gave an invitation to the Association, to an 
excursion on the Steamboat Western World, at 3 o'clock P. M. 
After which the Association adjourned. 

Thursday, May 8, 9 o'chch A M. 

Third day, morning session. 

The Association was called to order by the President. 

The minutes were read, corrected, and approved. 

A communication was read from Dr. P. Wroth, of Maryland, 
relative to his report upon the "Medical Topography of the 
Eastern Shore of Maryland." Also one from Dr. Thomson, of 
Kentucky, relative to his report on "Chloroform," asking to be 
continued. On motion, both were referred to the Committee on 
Nominations. 

The Secretary read a letter from Dr. E. S. LemoinS, inclosing 
an autograph letter from M. Dubois, of Paris, Secretary of the 
"Imperial Academy of Medicine," thanking the Association for 
copies of its Transactions, from vol. i. to vol. vii., inclusive. On 
motion, accepted, and the autograph returned to Dr. Lemoine. 

A communication was received from J. C. Holmes, Esq., Secretary 
of the Michigan State Agricultural Society, presenting to the Asso- 
ciation twenty-five copies of the iVansadions of the Society for 1868, 
and also the same number for 1854. 

Dr. Brodie moved that the thanks of the Association be returned 
therefor, and that one copy be presented to each State represented. 
Carried. 

On motion, Dr. McGuGiN, of Iowa, was appointed to represent 
that State in Committee on Nominations. 

On motion of Dr. Atlee, of Pennsylvania, 

JSesolved, That the President shall be authorized annually to 
appoint delegates to represent this Association at the meetings of 



NINTH ANNUAL MEETING. 81 

the British Association, the American Medical Society at Paris, and 

such other scientific bodies in Earope as may be affiliated with ns. 

Dr. IsADOB Gluck, of New York, presented the following: — 

Whereasj A Medical Congress is to be held in Europe during 

the present year — 

Resolved^ That the American Medical Association send to that 
Congress four delegates representing the four sections of the Union. 
On motion of Dr. Davis, laid on the table. 

Dr. Clbndenin, of Ohio, oflFered the following resolution, which 
on motion was referred to the Committee on Nominations. 

Besoluedj That a committee of one be appointed for a period of 
three years, with instructions to report at each annual meeting of 
this Association, to investigate the Etiology and Pathology of Epi- 
demic Cholera, and that said committee be allowed to add any other 
members he may think necessary to further the objects of their 
appointment. 
Dr. Mendenhall, of Ohio, offered the following resolution : — 
Besolved, That the Secretary be instructed to strike the name 
of C. H. Cleveland from the list of Permanent Members of this 
Association. Adopted. 
Dr. Atleb, of Pennsylvania, offered the following resolution : — 
Besolvedj That the name of Ja3. McClintock be stricken from 
the list of permanent members. Adopted. 
On motion of Dr. Bissell, of New York, 
Resolved^ That this Association has learned with deep regret the 
death of one of its members. Dr. T. Eomeyn Beok, of Albany, New 
York, whose whole life has been devoted to the attainment and pro- 
motion of medical and general sciences ; and that we do hereby ex- 
press our high appreciation of the excellencies of his character, dis- 
tinguished by its simplicity, integrity, and firmness of purpose, and 
by the extent and variety of his acquirements in medicine as in 
almost every other department of scienc-e. 
On motion, 

Resolved^ That the above resolution be referred to the Committee 
to procure Memoirs of the eminent and worthy dead, and that they 
be requested to procure a suitable memoir of the late Dr. Beck, to 
be published in the Transactions of the Association. 

Dr. GuNN, from the Committee of Arrangements, presented the 
following gentlemen as members by invitation. Dr. Ashley, of 
Ypsilanti, Michigan; Dr. H. F. Ewejrs, of Union, Michigan; Dr. 
Alex. Ewing, of Dexter, Michigan; Dr. Eeynall, of Dansville, 



82 MINUTES OP THE 

New York; Dr. G. F. McCarthy, of Indiana; Dr. M. H. Andrews, 
of Jonesville, Michigan; Dr. J. B. Coates, of Kalamazoo, Michigan; 
Dr. Wm. H. Stbbbins, of Saline, Michigan; Dr. D. L. Briggs, of St. 
Joseph County, Michigan. Accepted. 

On motion of Dr. Wister, of Pennsylvania, 

Resolved^ That the invitation to gentlemen of the medical pro- 
fession of the neighboring British provinces, extended to them by 
the American Medical Association at its session in Philadelphia, be 
renewed for the meeting at Nashville, Tennessee, in 1857. And that 
this Association may be safe from the introduction of unsuitable 
persons, it is recommended that gentlemen, presenting themselves 
from the British provinces, should be provided with a letter of in- 
troduction to this Association ifrom one of the following gentle- 
men: — 

Drs. Jno. Tarquand and A. Soott, Woodstock, Canada West; 
Drs. E. M. HoDDER, N. Bethune, J. H. Eichardson, Bonell, 
Haswell, Widmer, Beaumont, and Herrick, Toronto, Canada 
West; Drs. O'Eielly, Craggib, Duggan, Hamilton, do.; Samp- 
son, Kingston, do.; Geo. Holmes, London, do. Adopted. 

Dr. Phelps, of New York, offered the following: — 

Whereasy It has pleased an All-wise but Inscrutable Providence 
to visit the city of Norfolk, Virginia, with a desolating pestilence, 
equal, or surpassing, anything in ancient or modem times, and by 
which, in a few weeks, forty physicians, either residents, or those 
from abroad, who had promptly rushed to the rescue, among the 
number of whom was our late Secretary, P. Claiborne Gooch, 
M. D., of Eichmond, Virginia, were swept away, therefore 

Resolved^ That such an instance of signal and unflinching devo- 
tion to the cause of science and humanity demands at the hands of 
this national Association a passing expression of their high admira- 
tion of this, another memorable instance of the unparalleled sacrifices 
of the profession to the interests of the healing art and of our race. 

Resolved^ That this minute be incorporated in our Tramadions, 
Adopted. 

On motion of Dr. A. B. Palmer, the Et. Eev. S. A. McCrosky, 
Episcopal Bishop of the diocese of Michigan, being present, was 
invited by the President to take a seat on the platform. 

Dr. MussEY, of Ohio, one of the former Presidents of the Associa- 
tion, was also invited to a seat on the platform. 

Dr. Stooker, of Pennsylvania, moved to amend the Constitution 
as follows: — 



NINTH ANNUAL MEETING. 83 

Article S. Strike out all after the words "first Tuesday in May," 
and insert as follows : — 

The Association shall meet biennially in the city of . The 

place of meeting for the intermediate year shall be determined by 
a vote of the Association. 

Article 4. In first paragraph, second line, instead of the words 
"two Secretaries" insert one permanent and two assistant Secre> 
taries. 

In 4th paragraph, 5th line, strike out the words the Secretary, 
&c^ and substitute "The permanent Secretary shall preserve the 
archives and unpublished transactions in the permanent place of 
meeting of the Associf^ion. His expenses for travelling to and 
from the place of meeting, and while in attendance upon the same, 
shall be de&ayed by the Association. 

Laid upon the table for one year under the rule. 

Dr. DoBSBY oflfered the following:— 

Resolved^ that in May, 1858, and every third year thereafter, this 
AjBSOciation meet in Washington, D. C, and that the present officers 
be requested to correspond with the Board of Managers of the 
Smithsonian Institute, in regard to furnishing necessary rooms for 
the keeping of the archives of the Association. Laid over. 

Dr. L. D. Sheets, of Ohio, offered the following: — 

Resolved, That it is derogatory to the dignity of the medical pro- 
fession to notice the works of irregular practitioners in our medical 
periodicals. Adopted. 

On motion of Dr. Watsoi^, of New York, reports of Committees 
were made the special order. 

Dr. Co VKNTBY, of New York, moved to reconsider the vote mak- 
ing the report of special committees the order, for the purpose of 
taking up the resolutions attached to the report of Dr. Gross, " On 
the Causes which retard the Progress of American Medical Litera- 
ture." Carried. 

Dr. Watson, of New York, moved to reconsider the vote by 
which the report was adopted. Carried. 

Dr. Watson then moved that the report be accepted. Carried. 

On motion of Dr. Atlse, of Pennsylvania, the report and resolu* 
tions of Dr. Oross, and the report of Dr. Bbbgesnridge, of Ken^ 
tacky, upon Medical Literature, were referred to the Committee of 
Pablication. 

The Special Committee to whom was referred the communication 
from Dr. Hamilton, of Bufialo, New York, reported as follows:— 



84 MINUTES or THE 

That they have bad the same under consideration, and heg 
leave to present the following. The facts seem to be that, two 
years since, Dr. Hamilton was appointed a special committee of 
this body to report upon "Deformities after Fractures." A portion 
of the report was presented last year and published in the Trans- 
actions. Another portion is now in the hands of the Secretary, and 
the concluding part is promised, if the Association desire it, for tbe 
next year. Dr. Hamilton states that he is now preparing for the 
press a volume on "Dislocations and Fractures," of which he wisbed 
the several parts of the paper presented, and to be presented to 
this body, to constitute a considerable portion, and be asks tbe 
Association to consent to this use of what he acknowledges its pro- 
perty. 

While the Association, in accordance with a resolution passed 
two years since, has reason to regard all papers presented to it as 
its own property, and subject entirely to its control ; still, as there 
can be no desire to restrict the diffusion of knowledge, or make any 
exclusive or undue use of the voluntary labors of any, and as 
the publication of this matter in another form will do no injury to 
the Association, the Committee are of the opinion that leave should 
be granted to Dr. Hamilton to make such use of the materials in 
question, as he has so respectfully asked. The passage of the fol- 
lowing resolution is therefore recommended. 

Eesolved, That leave be granted Dr. F. H. Hamilton to make 
use of the materials of his report on "Deformities after Fractures," 
which is in course of presentation to this Association, in his antici- 
pated work on "Fractures and Dislocations;" provided that this 
work be not published until after the completion of the report in 
the published Transactions of the Association. 

Signed A. B. PALMER, 

JOHN L. ATLEE, 
R. HILLS, 

Committee, 

On motion, the resolution was adopted. 

Dr. A. B. Palmer, Chairman of the Committee "On Plans of 
Organizations of State and County Medical Societies," read his re- 
port with accompanying resolutions. 

On motion of Dr. Atlee, the report was accepted, and referred to 
the Committee of Publication, and the resolutions laid on the table 
for future consideration. 

Dr. N. S. Davis, of Illinois, Chairman of the Committee "On the 



KINTH ANNUAL MEETING. 85 

Changes in the Composition and Properties of Milk by Pregnancy 
and Menstruation," read his report, which on motion was accepted, 
and referred to the Committee of Publication. 

Dr, Lewis H. Steineb, Chairman of Committee on " Strychnia, 
its Chemical and Toxicological Properties," presented his report 
througb the Secretary, which on motion was accepted, and referred 
to Committee of Publication. 

Dr. Chakles Q. Chandler, of Rockfort, Missouri, Chairman of 
Committee on " Malignant Periodic Fevers," presented a substitute 
for his report, which on motion was referred to the Committee of 
Arrangements. 

Dr. H. A. Johnson, of Chicago, Illinois, on the " Excretions as 
an Index to the Organic Changes going on in the System," asked for 
further time. On motion, was referred to the Committee on Nomi- 
nations. 

Dr. James M. Newman, of Buflfalo, K York, Chairman of Com- 
mittee on the "Sanitary Police of Cities," read an abstract of his 
report, when, on motion, the report was accepted, and referred to the 
Committee of Publication. 

The Association then adjourned to 2 o'clock. 

Afternoon Session. 

The Association met at 2 o'clock, the President in the chair. 

The reading of reports from Committees being resumed. Dr. 
A. J. FuLLEB, of Maine, read a report on the " Best Treatment of 
Cholera Infantum," which, on motion, was accepted, and referred to 
the Committee of Publication. 

Dr. R Green, of New York, on the "Use and Effect of Nitrate 
of Silver to the Throat," read his report, which, on motion, was 
accepted, and referred to the Committee of Publication. 

Dr. J. B. Flint, of Louisville, Kentucky, Chairman of the Com- 
mittee on the " Best Mode of Bendering the Medical Patronage of 
the National Government Tributary to the Honor and Improvement 
of the Profession," reported, which report was, on motion, accepted, 
and referred to the Committee of Publication. 

Dr. Thomson, Chairman of the Committee on Nominations, pre- 
sented the following report for Chairmen of Special Committees for 
1857 :— 

Dr. E. R. Peaslee, of Brunswick, Maine, on "Inflammation, its 
Pathology, and its Relation to the Recuperative Process." 

Dr. H. Hutchinson, of Brooklyn, New York, and Dr. Chas. E. 



86 KINUTES OF THE 

Isaacs, of New York City, on the " Anatomy and Histology of the 
Cervix Uteri." 

Dr. J. Taylob Bradford, of Augusta, Kentucky, on the " Treat- 
ment of Cholera." 

Dr. MiiRK Stephenson, of New York City, on the "Treatment 
best adapted to each Variety of Cataract, with the Method of 
Operation, place of Election, Time, Age, &c." 

Dr. J. W. Corson, of New York City, on the " Causes of the 
Impulse of the Heart, and the Agencies which Influence it in Health 
and Disease." 

Dr. D. Meredith Reese, of New York City, on the " Causes of 
Infant Mortality in large Cities, the Source of its Increase, and the 
Means for its Diminution." 

Dr. J. Foster Jenkins, of Yonkers, New York, on "Spontane- 
ous Umbilical Hemorrhage of the Newly Bom." 

Dr. Henry Carpenter, of Lancaster, Pennsylvania, on the " Use 
of Instruments in Obstetrical Practice." 

Dr. Alexander J. Semmes, of Washington, D. C, on the " Mea- 
sures to be adopted to Remedy the Evils existing in the Present 
Mode of Holding Coroners' Inquests." 

Dr. J. Marion Sims, of New York City, on the " Treatment of 
the Results of Obstructed Labor." 

Dr. J. B. Flint, of Louisville, Kentucky, on the " True Position 
and Value of Operative Surgery as a Therapeutical Agent." 

Dr. G. VOLNEY Dorset, of Piqua, Ohio, on the " Causes and 
Care of Indigestion, especially in Relation to the Therapeutic Indi- 
cations to be derived from the Chemical Compositions of the De- 
posits of the Urine." 

Dr. C. B. Coventry, of Utica, New York, on the " Medical Juris- 
prudence of Insanity, and the Testimony of Skilled Witnesses in 
Courts of Justice." 

Dr. Jo»PH Leidy, of Philadelphia, Pennsylvania, on " Human, 
Animal, and Vegetable Parasites." 

Dr. M. D. Darnall, of Bainbridge, Indiana, on the " Value of a 
Strict Attention to Position in the Treatment of Diseases of the 
Abdomen." 

Dr. George Sutton, of Aurora, Indiana, on " Milk Sickness." 

Dr. Clark G. Pease, of Jonesville, Wisconsin, on the "Blending 
and Conversion of the Types of Fever." 

Dr. B. S. WoODWORTH, of Fort Wayne, Indiana, on the " Best 



NINTH AKJfUAL MEETING. 8T 

Substitutes for Cinchona and its Pl*eparation3 in the Treatment of 
Intermittent Fever and Malarious Neuralgia.'^ 

Dr. Fbanklin Hinkle, of Marietta, Pennsylvania, on the "Use 
of Cinchona in Malarious Diseases." 

Dr. Henry F. Campbell, of Augusta, Georgia, on the "Nervous 
System in Febrile Diseases.'* , 

Dr. John Neill, of Philadelphia, Pennsylvania, on the " Laws 
Governing the Absorption and Deposit of Bone." 

Dr. John W. Green, of New York City, on the " Intimate Effects 
of Certain Toxicological Agents in the Animal Tissues and Fluids." 

Dr. George Sucklt, U. S. A., on the " Medical Topography and 
Fauna of Washington Territory ." 

Dr. James Cooper, of Hoboken, New Jersey, on the "Flora of 
Washington and Oregon Territories." 

Dr. Chas. E. Isaacs, of New York City, on the "Intimate Struc- 
ture and Pathology of the Kidney." 

Dr. Israel Moses, of New York City, on the "Diseases Inci- 
dental to Emigrants from Temperate Climates, in their Transition 
through Central America." 

Dr. T. W. Gordon, of Georgetown, Brown Co., Ohio, on the 
" Etiology and Pathology of Epidemic Cholera," to be continued 
three years, and with power to add any other members. 

Dr. H. A. Johnson, Chicago, Illinois, on the "Excretions as an 
Index to the Organic Changes going on in the System." 

Dr. D. D. Thomson, of Louisville, Kentucky, on the " Remedial 
Effects of Chloroform." 

Standing CommitUes. 

Commiliee of Publication. — ^Dr. Francis G. Smtth, of Pennsyl- 
yania, Chairman ; Dr. Caspar Wistbr, of do. ; Dr. Wm. Brobis, of 
Detroit, Michigan; Dr. R. C. Foster, of NashviUe, Tennessee; Dr. 
Sakl. 'L. Hollingsworth, of Pennsylvania ; Dr. Saml. Lewis, of 
do. ; Dr. R F. Askew, of Delaware. 

Committee en Prize Essays. — ^Dr. Wm. K. Bowlino, of Tennessee, 
Chairman; Dr. E. B. Haskins, of do.; Dr. Thomas Lipscomb, of 
do. ; Dr. A. H. Buchanan, of do.; Dr. B. W. Avent, of do.; Dr. 
W. A. Cheatham, of do. ; Dr. Paul F. Eve, of do. 

Committee of Arrangements. — Dr. C. K. Winston, of Tennessee, 
Chairman; Dr. Ira Conwbll, of do.; Dr. Wm. D. Hagoart, of 
do. ; Dr. J. L. C. Johnson, of do. ; Dr. F. A. Bamsay, of do. ; Dr. 
Georos Grant, of do. ; Dr. J. B. Lindslet, of do. 



88 MINUTES OF THE 

Oommittee on Medical EduccUwn. — ^Dr. E.Geddinos, of South Caro- 
lina, Chairman ; Dr. 0. W. Le Boutillieb, of Minnesota Territory ; 
Dr. G. F. Mitchell, of Ohio ; Dr. S. W. Clantok, of Alabama ; 
Dr. S. W. Butler, of New Jersey. 

Oommittee on Medical Literature, — Dr. R. HiLLS, of Columbus, 
Ohio, Chairman.; Dr. D. W. Yandbll, of Kentucky ; Dr. R. R. 
Pobtbr, of Delaware ; Dr. H. A. Johnson, of Dlinois ; Dr. Charles 
E. Swan, of Maine. 

To fill vacancies in the Committee on " Medical Topography and 
Epidemics" : — 

New Hampshire.— Y . P. FiTCH, M. D., of Amherst. 

dife/om/a.— Robert Murrat, M. D., U. S. A., of Fort Miller. 

To fill vacancies in the Committee on ''The Registration of Births, 
Marriages, Ac." : — 

Ckmnecticut. — Wm. B. Casey, M. D., of Middletown. 

Fcrrwon^.— Adrian T. Woodward, M. D., of Castleton. 

Virginia. — R. W. Haxall, M.D., of Richmond. 

Califorma. — Arthur R. Stout, M. D., of San Francisco. 

The Committee also recommend the continuance of the " Com- 
mittee to Procure Memorials of the Eminent and Worthy Dead ;'» 
and that the report, as far as prepared, be referred to the Committee 
of Publication. 

On motion, the report/ was accepted and adopted, and referred to 
Committee of Publication. 

A communication was presented from W. H. Anderson, M. D., 
Chairman of Committee on " Medical Education," expressing his 
regrets at not being able to attend the meeting, and accompanied 
with his report. On motion, the report was accepted, and referred 
to the Committee of Publication. ^ 

A report was received from Dr. P. Wroth, Chairman of a Com- 
mittee on the " Medical Topography of the Epidemics of Maryland," 
on the " Medical Topography of the Eastern Shore of Maryland," 
which, on motion, was accepted, and referred to Committee of Pub- 
lication. 

A report was received, by abstract, from Dr. Fenner, of New 
Orleans, on the "Medical Topography and Epidemics of Louisiana," 
which, on motion, was received, and referred to the Committee of 
Publication. 
On motion of Dr. A. B. Palmer, 

Resolved^ That the volunteer communications in the hands of the 
Committee of Arrangements, be referred to a special committee to 



NINTH ANNUAL MBBTING. 89 

be appointed by the Chair, at the place of publication of the Trails- 
actions^ and if, in their judgment, the papers are worthy, they be 
referred by them to the Committee of Publication, to go into the 
Transactions of the Association. 

Committee appointed — 

Dr. A, Stillb, of Philadelphia, 
" S, Jackson, late of Northumberland, 
" J. B. BiDDLB, of Philadelphia. 

The authors and titles of the voluntary communications, presented 
for the consideration of the Association, and so referred, were as 
follows: — 

Dr. C. Q. Chandler, of Rocheport, Missouri, on " Sulphate of 
Cinchonia in Periodic Diseases." 

Dr. IsADOB GLiiCK, of New York City, on " Formation of Gun- 
shot Wounds, &c." 

Dr. J. P. Hackenbbbg, Ohio, on "An Improved Method of 
Applying Compression to the Scrotum." 

A member of the Committee on " A Uniform Method for the 
Eegistration of Marriages, Births, and Deaths," stated that the Com- 
mittee were unable to report, owing to the death of their Chairman, 
Dr. Wilson, of Connecticut. 

On motion, the Committee on " Medical Literature for 1855," was 
ooQtinaed another year. 

Dr. Gboss, of Louisville, Kentucky, tendered, in behalf of the 
medical profession and citizens of that city, an invitation to the 
Association, to meet there in 1858. Ordered to be placed on file. 

On motion of Dr. Dobsky, of Ohio, 

Resolved^ That the Committee on the " Etiology and Pathology of 
Cholera," be instructed to memorialize the Congress of the United 
States, requesting that honorable body to grant every necessary 
assistance that can or will promote the object for which the Com- 
mittee has been appointed. 

The Secretary read a letter from the Royal Medical and Chirur- 
gical Society of London, England, thanking the American Medical 
Association for their present of the eighth volume of their Trans- 
actions. Accepted, and ordered to be placed on file. 

On motion of Dr. Wisteb, of Pennsylvania, 

Resolved^ That a committee of three be appointed by the Presi- 
dent, to correspond with the proper officer of the Smithsonian In- 
stitute, inquiring into the possibility of procuring a chamber in 
that Institution for the use of this Association. 



40 MINUTES OF THE 

The President appointed as such committee — 

Dr. Caspar Wister, Philadelphia, Pennsylvania, 
" Hall, Washington, D. C, 

" John Neill, Philadelphia, Pennsylvania. 

The President gave notice to the members of the Association, 
that receptions would be held at the Hon. Henry Ledyards', 
Mrs. Canfield's, Hon. Chas. Howard's, and at his own house, and 
that the ladies of the members of the Association were respectfully 
invited by the Hon. Chas. Howard and lady, during the evening. 

The A^ociation then adjourned till 9 o'clock, Friday morning. 

Friday, May 9. 

The Association met at 9 o'clock A. M. The President in the 
chair. The minutes of last meeting were read, corrected, and 
approved. 

The following additional members, present by invitation, were 
reported : Dr. Saunders, of Monroe, Michigan ; Dr. R.K. Rodgees, 
of Suspension Bridge, New York. Accepted. 

Dr. Palmer, of Illinois, presented the following resolution, by 
request : — 

Resolved^ That the name of Richard Coolidge, M.D., U.S. A, 
be substituted for that of Dr. Finley, on the Committee of " Medi- 
cal Topography and Epidemics." 

On motion, the resolution was adopted. 

A letter was read from Thos. Dillard, M. D., U. S. N., declining 
to serve on the Committee of " Medical Topography and Epidemics," 
saying that he could not act, in consequence of receiving no appoint- 
ment as delegate to the Association from the Chief of Bureau of 
Medicine and Surgery. 

On motion, the excuse was not accepted. 

On motion of Dr. Atlee, of Pennsylvania, 

Resolved^ That all voluntary communications hereafter presented 

to the Association, shall be referred to a special committee of 

to be appointed by the President on the first day of each annual 
meeting, whose duty it shall be to examine such communications, 
and report upon the propriety of the presentation and reference to 
the Committee of Publication. 

The Committee appointed to prepare a suitable minute, having 
reference to the death of P. Claiborne Gooch, M. D., late Secre- 
tary of this Association, beg leave to report the following preamble 
and resolutions : — 



NINTH ANNUAL MEETING. 41 

Whereas^ The exhibition of high courage and of self-sacrificing 
devotion to the good of others is ever honorable to a profession by 
whose members it is manifested, and worthy of their remembrance 
and emulation, 

Resolved^ That in the death of Dr. P. Claiborne Gooch, of 
Richmond, Virginia, who nobly volunteered his services during the 
pestilence at Norfolk, we recognize a loss to this Association, the 
profession, and to the country. 

His arduous and successful labors as Secretary of this meeting at 
Charleston and Bichmond, merited the regard of this Association. 

The zeal, ability, and industry, manifested by him as founder and 
editor of the Stethoscope^ the first medical periodical established in 
the State of Virginia, showed his devotion to the cause of medical 
progress and activity ; and the manner of his death gave signal 
evidence that he was one of whom his country might well be proud. 

Resolved^ That a copy of these resolutions be transmitted, by the 
Secretary, to the relatives of Dr. QoocH. 

On motion, the preamble and resolutions were unanimously 
adopted. 

On motion of Dr. Palmer, of Illinois, 

Resolved^ That the Committee of Eegistration of Marriages, &c., 
have leave to make a partial report, which is hereby referred to the 
Committee of Publication. 

Dr. Denton, of Michigan, offered the following resolution :-^ 

Resolved, That a committee of three be appointed, whose duty it 
shall be to enlist some enterprising publishers, and aid in collecting 
and arranging material for an American Medical Directory. 

On motion of Dr. Watson, of New York, laid on the table. 

Dr. Leidy, of Pennsylvania, offered the following : — 

WherecLs, It is the object of this Association, in the award of 
prizes for communications on subjects appertaining to medical 
science, to encourage the progress of the latter, and as this result 
cannot be better entertained than through original investigation 
and discovery — 

Resolved, That, hereafter, an annual prize of — dollars be 

awarded for the best memoir or essay founded on original investiga- 
tions of the author, and, in case of no memoir or essay being pre- 
sented worthy of such award, the prize money to be appropriated 
towards the expenses of publishing and illustrating such memoirs 
or essays as may be subsequently deemed worthy of an award. 

VOL. IX. — i 



42 KINUTES OF THE 

On motion of Dr. Palmer, 

Resolved^ That the above resolutions, together with the suggestions 
in the report of the Committee on Prize Essays, as to whether any 
means can be devised to cause an increase of the number of essays 
presented, be referred to a special committee, to report at the next 
meeting of the Association. 

Dr. Leidy, of Pennsylvania, 
" G. B. Wood, of Pennsylvania, 
" Chas. D. Meigs, of Pennsylvania, 
were appointed as such committee. 

Dr. H. H. Childs, of Pittsfield, Massachusetts, presented an in- 
vitation to the Association to join the Massachusetts Medical Society 
at its next annual meeting on the last Wednesday of May. Accep- 
ted. 

Dr. KoBERT K. Smith offered the following : — 

Resolved^ That a committee be appointed, to report to the next 
meeting of the American Medical Association, a classification of 
those diseases which involve a derangement of the mental mani- 
festations. Carried. 

Dr. Smith was appointed Chairman of the Committee, with power 
to select his associates. 

On motion of Dr. Smith, 

Resolved^ That the amendment to the Constitution proposed by 
Dr. Chas. Hooker, at the meeting of the Association, in Philadel- 
phia, 1855, be laid on the table until the next meeting of the Asso- 
ciation, as Dr. Hooker had left the city. 

On motion of Dr. Atlke, 

Resolved, That the Committee of Publication be requested to 
transmit, annually, to the Epidemiological Society of London, Eng- 
land, a copy of our Tramactions. 

On motion of Dr. Gunn", of Michigan, 

Resolved^ That any new medical Institution not heretofore repre- 
sented in this body, be required to transmit to the Secretary, with 
the credentials of its delegates, evidence of its existence, capacity, 
and good standing. 

On motion of Dr. MoGuqin, of Iowa, 

Resolved^ That a special committee be appointed, to report ou the 
subject of " Stomatitis Materna." 

Carried, and Dr. McGuaiN appointed Chairman. 

On motion of Dr. Bailey, of Illinois, Dr. Davis was requested 
to continue his observations on the subject of the " Changes Pro- 



KIKTH ANNUAt* MBBTINO. 48 

duoed in the Composition and Properties of Milk by Pregnancy and 
Menstruation. Also, the ^ Best Substitute for the Mother's Milk 
when Weaning becomes necessary before the Child is Eighteen 
Months Old," and report at the next meeting of the Association. 

A communication was received from the Committee on Railroads, 
and read. On motion, the Committee was continued till next year. 
Carried. 

On motion of Dr. Atlbb, the resolutions of Dr. Palmer, laid on 
the table, were referred to the Committee of Publication. 

On motion of Dr. J. L. Phelps, of New York, 

Baolvedj That with a view to harmonize, as far as may be, dis- 
crepancies, whether real or imaginary, that a committee of three be 
appointed to consider, examine, collate, and discuss, points admitting 
of doubtful import or construction, whether relating to our intel- 
lectual, moral, or physical natures, so far as they may be identified 
with the interests of medicine and the profession, and, also, as they 
may stand aflfected by any legal or organic limitations and provi- 
sions of our own compact, and hence elaborate and deduce such 
general principles and legitimate conclusions and practice as shall 
be warranted by a liberal, just, and comprehensive view of the 
whole subject, and report at the next annual meeting of the Asso- 
ciation. 

On motion, laid on the table. 

On motion of Dr. Atlee, of Pennsylvania, the thanks of the 
Afisociation were returned to the officers of those railroads that 
had evinced a liberality in conveying delegates to and from the 
Association. 

On motion of Dr. J. L. Phelps, of New York, 

Resolved^ That the thanks of this Association are due, and are 
hereby tendered to the Fire Department of the city of Detroit, for 
the use of their large and conunodious Hall, so amply furnishing to 
us accommodations for the convenient transaction of business. 

Resolved^ That the urbane deportment and elegant hospitalities of 
the profession and private individuals, as well as the polite atten- 
tions of citizens generally, demand of this Association a high appre- 
ciation of the cultivated manners of this city of the West, and 
which has tended greatly to enhance the pleasure of the session 
here of the delegates from abroad. 

Dr. Palmer, of Illinois, offered the following resolution, which, 
on motion, was xmanimously adopted : — 



44 HINUTES OF THE NINTH ANNUAL XESTING. 

Baolvedy That a vote of thanks be presented to the piess of the 
city of Detroit, which has taken so much interest in reporting the 
proceedings of the Association. 

On motion, the Association adjourned sine die. 



WM. BRODIE, ) c. . . 
E.G. FOSTER, f'*^^'"^- 



EEPORT 



THE COMMITTEE OF PUBLICATION 



THE TREASURER. 



REPORT OF THE COMMITTEE OF PUBLICATION. 



The Committee of Publication respectfully report: — 

That immediately after tlie adjournment of the Association, at 
Philadelphia, contracts were made for the paper, printing and dis- 
tribution of the Transactions; that the volume was put to press 
towards the end of May, and the first copies issued on the 10th. of 
the following November. 

In view of the large number of delegates present at the last meet- 
ing, it was thought advisable to increase the size of the edition of 
the eighth volume. Eleven hundred copies were accordingly print- 
ed, a large proportion of which have been disposed of. 

The aggregate expense of printing, illustrating, and binding the 
volume, was nineteen hundred and twenty-two dollars seventy 
cents ($1,922 70), the details of which will be found in the Trea- 
surer's report. The large amount of tabular matter (including rule 
and figure work), contained in the present volume, has made the 
amount of expenditure much greater than it would have been under 
other circumstances. 

The distribution of the volume was effected, in every possible 
instance, by express, and where a number of volumes were required 
at any one point, they were sent in large packages, and the services 
of a resident member of the Association solicited to superintend 
their delivery. Where it was impossible to deliver by express, a 
circular was addressed to each member entitled to a copy, request- 
ing that post-ofiSce stamps should be forwarded for the prepayment 
of postage, and the delivery, in these cases, was accomplished by 
mail. 

The following gentlemen have rendered essential service to the 
Association ; some in procuring subscriptions to the volume, and 
all by cordial co-operation in its distribution. Dr. C. Hooker, 



48 KEPORT OP THE 

Conn.; Dr. Alden March, Albany, K Y.; Dr.J.L. ATLEE,Penna.; 
Dr. W. Brodib, Mich. ; Dr. C. B. Gibson, Richmond, Va.; Dr. E. L. 
Beadle, K Y.; Dr. H. W. Desaussure, S. C; Dr. C. A. Pope, 
Mo. ; Dr. D. H. Storer, Mass. ; Dr. T. G. Richajbdson, Ky. ; Dr. J. 
MoRAN, R. I. ; Dr. J. Miller, D. C. ; Dr. F. E. B. Hintze, Md. ; Dr. 
L, P. Bush, Del. ; Dr. Z. Pitcher, Mich. ; Dr. J. B. Lindsley, Tenn. 

The Committee would be unjust as well as ungrateful, did they 
fail to record their acknowledgments to those gentlemen who so 
generously lightened their labors by the valuable assistance which 
they voluntarily rendered. They desire, also, to urge strongly 
upon the Association the importance of securing efficient co-opera- 
tion in every State, by the appointment of committees whose duty 
it shall be to aid in procuring subscriptions and circulating the 
Transoxtums, The Committee would especially commend Connecti- 
cut for her services, as heretofore, in this particular. 

Not a little embarrassment was experienced by your Committee 
in restoring to the list of permanent members the names of those 
who had been left off by order of the Association for non-payment 
of assessments. They have endeavored, however, in accordance 
with the resolution of the last session (vol. viii. p. 29), by careful 
comparison of the various lists, to supply all omissions. 

The Committee were reluctantly obliged to omit from the Trans- 
actions two valuable reports on epidemic diseases. But as they had 
not been presented to the Association and acted on by that body, 
they felt that they had no alternative. The reports were those of 
Drs, L. H. Anderson, of Ala., and E. D. Fenner, of New Orleans. 

The following resolution, passed at the last session, is again 
brought before the Association, with the recommendation that it be 
strictly enforced as an essential means of securing the early appear- 
ance of the forthcoming volume : — 

^^Resolvedy That hereafter, beginning with the session of 1856, no 
report, or other paper, shall be entitled to publication in the volume 
for the year in which it shall be presented to the Association, unless 
it be placed in the hands of the Committee of Publication, on, or 
before, the 1st of June." 

The following schedule exhibits the number of volumes of the 
Transactions on hand at the close of the last session, those disposed 
of during the year, and those now in the possession of the Asso- 
ciation. 



COMMITTEE OP PUBLICATION 



YoL L On hand at the date of last report 
Bispoeed of during the past year . 
Bemaining 



Vol. n. On hand at date of last report 
Beceived in exchange during past year 
Disposed of during past year • . 
Semaining 



Vol. nX On hand at date of last report 
Beceived in exchange during past year 
Disposed of during past year 
Bemaining 



Vol. IV. On hand at date of last report 
Beceived in exchange during past year 
Disposed of during past year 
Bemaining 



Vol. V. On hand at date of last report 
Disposed of during the year 
Bemaining 



Vol. VI. On hand at date of last report 
Disposed of during the year . 
Bemaining 



Vol. VTL On hand at date of last report 
Disposed of during the year . 
Bemaining 



Vol. Vm. Whole number published 
Disposed of to Members and Med. Journals at 

home and abroad 
Bemaining 



49 



46 copies. 

5 
41 

12 
2 
5 
9 

81 
1 
5 

27 

11 
1 
5 

7 

828 

12 

816 

105 
89 
66 

184 

64 

120 

1100 

749 
851 



Some of the leading journals abroad have expressed a strong 
desire to complete their sets. It rests with the Association to de- 
tennine whether the missing numbers shall be supplied. 

From the foregoing schedule it will be perceived tbat only seven 
complete sets of the Transactions are now in the possession of the 
Association. The Committee therefore renew the recommendation 
embraced in the resolution appended to the last report, that " no 



50 RBPOBT OF THE OOMMITTBB OP PUBLICATION. 

copy of eiliher of the eight ▼olumes which is neceaaaiy to the ooni> 
plete sets now remaining shall be disposed of separatelj, or with 
any number of volumes short of a complete set." 
All of which is respectfully submitted. 

FRANCIS G. SMITH, Ja, CKn. 

CASPAR WISTER, 

S. L. HOLLINGSWORTH, 

FRANCIS WEST, 

SAML. LEWIS, 

H. F. ASKEW, 

WM. BRODEE, 

Committee of Pvhlicatian. 



REPOBT OF THE TREASURER. 



The Treasurer respectfully reports: — 

That the resolutioa passed at the meeting in St. Louis, requiring 
of delegates tlie prepayment of the yearly assessment, lias proved, 
after a year's experience, of great advantage to the Association. 
By the operation of this rule the treasury is assured of the posses- 
sion of a sum of money for the purposes of the Committee of Pub- 
lication, upon which this Committee may with confidence draw, 
and likewise receive some indication there&om as to what number of 
volumes of the Transactions will be required for the supply of members 
of the Association. That this supply is more restricted to the number 
of delegates present than would be the case if greater exertion 
were used throughout the country by members of the Association 
to procure subsmbers to the volume, has been clearly demonstrated 
within the year, by the success of gentlemen who have interested 
themselves for its dissemination in certain localities. In order to 
promote a wider dissemination of the Ih^ansactions of this Associa- 
tion, and also to remove the uncertainty at present prevailing as to 
the conditions of membership, induced by the resolutions of the 
year 1854, making a yearly subscription to the IVansactions obliga- 
tory, it is recommended that the Treasurer be requested, at an early 
date after the adjournment of the present meeting, to address a circular 
to each permanent member, announcing the abrogation of the above 
resolution, and the consequent restoration to membership of all those 
dropped from the published list of that year, advertising also the 
practicability of procuring back numbers of the Transactions, with 
information as to the cost at which the series of volumes may be 
rendered complete, or an entire set furnished by the Association, 

CASPAR WISTER, Treasurer. 



60 BBPOBT OF THE CUMMITTBB OF PUBLICATION. 

copy of eiiher of the wght Tolumes which is neoessaiy to the com- 
plete sets now remaining shall be disposed of separately, or with 
any number of volumes short of a complete set." 
All of which is respectfully submitted. 

FRAJTCIS G. SMITH, Jr, CKn. 

CASPAR WISTBR, 

S. L. HOLLINGSWORTH, 

FRANCIS WEST, 

SAML. LEWIS, 

H. F. ASKEW, 

WM. BRODEE, 

Committee of PtAltcation. 



REPORT OF THE TREASURER, 



The Treasurer respectfully reports: — 

That the resolutiou passed at the meeting in St. Louis, requiring 
of delegates the prepayment of the yearly assessment, has proved, 
after a year's experience, of great advantage to the Association. 
By the operation of this rule the treasury is assured of the posses- 
sion of a sum of money for the purposes of the Committee of Pub- 
lication, upon which this Committee may with confidence draw, 
and likewise receive some indication therefrom as to what number of 
volumes of the li-amactums will be required for the supply of members 
of the Assooiatioru That this supply is more restricted to the number 
of delegates present than would be the case if greater exertion 
were used throughout the country by members of the Association 
to procure subscribers to the volume, has been clearly demonstrated 
within the year, by the success of gentlemen who have interested 
themselves for its dissemination in certain localities. In order to 
promote a wider dissemination of the Tramactwns of this Associa- 
tion, and also to remove the uncertainty at present prevailing as to 
the conditions of membership, induced by the resolutions of the 
year 1864, making a yearly subscription to the Transacticms obliga- 
tory, it is recommended that the Treasurer be requested, at an early 
date after the adjournment of the present meeting, to address a circula r 
to each permanent member, announcing the abrogation of the above 
resolution, and the consequent restoration to membership of all those 
dropped from the published list of that year, advertising also the 
practicability of procuring back numbers of the Transactions, with 
information as to the cost at which the series of volumes may be 
rendered complete, or an entire set furnished by tbe Association* 

CASPAR WISTER, Treasurer. 



52 BBPOBT OF THE TBEASUBSB. 

The American Medical Associaiion in 

Db. 
1856. 

To cash paid Dr. Jno. L. Atlee, of Committee on Wash- 
ington Monument Stone . . . $498 70 
" " " C.B. Norton for porterage, and packing vol. 

vii., in New York • . . . 8 00 

" " " J. D. Trask, for prize essay . . . 100 00 
" " " postage of Secretary .... 2 50 

" " " D. C. Baxter, for engravings of voL viii. . 72 75 

" " " postage of Chairman of Publication Com. 4 09 

« i« u Thomas Sinclair & Co., for lithographs for 

vol. viii., less 5 per cent., $106 50 . 101 20 
« u li T.K.& P. G.Collins, for printing and bind- 
ing 1100 copies vol. viii., less 5 per cent., 

$1,840 79 1,748 75 

« u u rp ij; 4 p Q. Collins, for binding 25 copies 
vol. vi., and printing notices, less 5 per 

cent., $4 75 4 52 

" " " H. Barnes, for distribution of vol. viii., and 

services as clerk 50 00 

" " " T. K. & P. G. Collins, for printing notices 1 25 

" " " Blanchard & Lea, for freight, porterage, 

boxes, &C., for vol. viii. . . . 34 99 

" " " postage, envelops, and stationery of 

Treasurer 6 99 

To balance 950 52 

$8,584 26 



BEFOBT OF THE TBEASUBBB. 53 

acoouvd vdih Caspar Wisterj Treasurer. 

Cb, 
1856. 
By cash received from Dr. Isaac Wood, being the 

balance in the Treasury, April 80th, 1855 . $1,015 26 
" " received from Dr. Isaac Wood, being the balance 

in the Treasury, of Prize Essay Fund, April 

80, 1855 100 00 

" " received from assessment and the sale of Trans- 

actions 2,160 50 

" " received from Dr. E. L. Beadle, for the sale of 

Transactions 12 00 

" ** received from Dr. Wm. Brodie, for the sale of 

Transactions 12 00 

" " received from Dr. A. March, for the sale of 

Transactions 24 00 

^ " received from Messrs. Blanchard & Lea, for the 

sale of Transactions 102 50 

" " received from Dr. Charles Hooker, for the sale 

of Transactions 168 00 



$8,584 26 

We, the undersigned, having examined the vouchers of the 
Treasurer, comparing them with his accounts, as rendered above, 
and having found them correct, have affixed our signatures in certi- 
fication ther6o£ 

FRANCIS G. SMITH, Jb., 

FRANCIS WEST, 

SAML. LEWIS, 

WM. BRODIE, 

S. L. HOLLINGSWORTH, 

H. F. ASKEW. 



ADDEESS 



OF 



GEORGE B. WOOD, 



PKESIDENT OF THE ASSOCIATION. 



ADDRESS OF GEORGE B. WOOD, 



PRESmBNT OP THE ASSOCIATION. 



Custom demands, as one of the expiring duties of yonr presiding 
officer, that ne should leave a legacy at least of good wishes, if not 
of something more valuable behind him. In compliance with this 
doty, I propose to say a few parting words, which, whatever else 
they may convey to you, will assuredly not interpret duly the senti- 
ments of him who utters them, unless they make you sensible of his 
grateful and most kindly feelings towards his fellow members, and 
of his zealous interest in the great objects of our Association. 

The present is a suitable occasion for taking a survey of the 
Association; for looking arouncf towards the boundaries of its 
labors, interests, and duties, and noting whether something may not 
present itself in the view, which may profitably occupy, for a few 
minutes, our serious and earnest attention. Let us first throw a 
comparative glance from the present backward to the past. Per- 
haps by so doing we may be better prepared to look forward intelli- 
gently into the future. 

Have the hopes with which the Association set out in its mission 
of self-imposed duty, been fulfilled ? Has the loud call which it 
sent forth through the natiou, startling the profession from its 
uneasy slumber, succeeded in awakening it thoroughly to a sense of 
its high responsibilities, and arousing a determined spirit of pro- 
gress? Or has it died away in gradually diminishing echoes, 
leaving but a drowsy memory of that spirit-stirring appeal ? Have 
the annual gatherings of the elect of the profession, their joint de- 
liberations in council, their various legislation, the practical inquiry 
set on foot or encouraged, not omitting their exploits at the festal 
board, and kindly interchange of thought and sentiment in social 
assemblage; have all these been without fruit? Have they been 

VOL. IX.~5 



68 ADDRESS OF 

the mere oourse of a phantom ship through the ocean of human 
events, leaving no track in its passage, and bearing do freight 
onward to its destinatioir? 

Were we to listen to the clamors of opposition, the whisperings 
of discontent, or the murmured disappointment of an over-excited 
expectation, we might be disposed to give to these questions an 
unfavorable answer; to cease our struggles for an unattainable 
good ; and with the wings of the spirit folded, and its head droop- 
ing, to submit in sadness to an inexorable destiny, chaining us in 
submission to all present evils, and jealous even of a glance towards 
the higher and the better. 

But happily, such is not the voice of a clear and unbiassed judg- 
ment It is true that the Association has not accomplished the 
whole of what it aimed at. Like all other young things, conscious 
of a stirring life within, and feeling no limits to its yet untried 
powers, it hoped and strove beyond the possible ; it struck in its 
soaring flight against the iron will of circumstance, and for a time, 
at least, fell back, stunned though not crushed, into humbler aims. 
Yet, even as regards medical education, which is the main point of 
failure, its efforts have not been all thrown away. Some advance, 
however small, has, I think, been already made ; and bread, more- 
over, has been cast upon the waters, to be found after many days. 

But outside of this vexed subject, much, very much has been 
accomplished. I will not appeal to the ponderous volumes of our 
Transactiana, They speak for themselves. To say that there is no 
chaff among their solid contents, would be to say what is neither 
now nor ever has been true of any large book, with one solitary 
exception. But I believe that all present will join me in the 
opinion, that one who searches these records, with a sincere and 
candid spirit, will find in them much that is good ; much that may 
warrant the self-congratulation of the Association for having origi- 
nated, or called it forth. 

But, whatever credit may be given to these living witnesses of 
our labors, one fact is evident, that the medical mind has been 
aroused; that the spirit of improvement has breathed upon the 
masses of the profession, and everywhere scattered germs, which are 
now developing, and will probably hereafter continue to develop, 
even in a still higher ratio, into earnest efforts for self-culture, and 
general advancement. 

Stagnation, in the moral as in the physical world, generates cor- 
ruption. Agitation, though^ often in its extremes a cause of evil. 



QSORGS B. WOOD. 69 

and sometimes of unspeakable present wretchedness, generally 
porifies in the end, and if restrained within due limits, is a source 
of unmixed good. The medical mind, anlerior to the birth of this 
Assoeiation, was in a state of comparative inertia. In all the de- 
partments of the profession, the educational as well as the practical, 
material interests began to predominate. There was danger that 
the profession might sink to the level of a mere business. Noble 
aims ; high aspirations ; the general good ; the spirit of self-sacrifice ; 
these began to be looked on as wordy inflations. The great strug- 
gle seemed to be, in the teaching department, to gather pupils ; in 
the practical, to gather patients; in both, to swell the pockets. 
Stagnation of the professional spirit was breeding noxious influence 
in its motionless depths. No wonder that quackery loomed up- 
ward, as regular medicine began to sink. There was danger that 
the public might be able to see little difference between them; and 
the £ict is, that the line of demarcation was not very distinct, even 
to the professional eye. They ran into each other, at their extremes, 
by quite insensible shades. 

But the Association arose, and a new spirit was awakened. 
Many had been watching this apparent abasement of the profession 
with sorrow; but they were powerless in their isolation. No 
sooner had the flag of the Association been given to the breeze, 
than they hastened to join its standard. From all quarters, and 
fiom the remotest bounds of the country, volunteers poured in to 
join this great crusade against the evils, which had been usurping 
the sacred places^of the profession. The mass of medical society 
was moved to its very depths. Hundreds upon hundreds came 
forth from their sheltering privacy, aud threw their souls into the 
grand movement which was to reconquer, to purify, and regenerate 
ihe prostrated glory of their calling. The feeble voice of opposi- 
tion was heard for a moment; but was soon drowned in the over- 
whelming shouts of the masses, crying out, Onward I Onward I 
Even the advocates of the material principle, who could not raise 
their souls above the level of dollars and cents, found it expedient 
to chime in for a time with the almost universal voice ; and to the 
enthusiastic it seemed as though a professional millennium was ap- 
proaching. I need not follow the march of the crusade. I need 
not recall the varied experience which has but confirmed that of all 
other revolutionary uprisings, that, except under the influence of a 
power higher than human, which can regenerate the hearts of men, 
whatever temporary change may be made in the surface o{ things, 



60 ADDRESS OF 

in mere form and arrangement, it is only by the slow working of 
time that radical and lasting reforms can be effected. Who ever 
beheld a great nation made by a written constitution? We have 
had paper republics as thick as the leaves in Yallombrosa; but 
where, and what are they now ? To make a great and free nation, 
the people must have the principles of greatness and freedom im- 
planted in their hearts. So is it with lesser Associations. It is 
vain to alter forms, unless the substance is altered too. The Asso- 
ciation has discovered this truth. It no longer seeks to work 
miracles, but is content with following the methods of nature and 
providence. It has done a great thing in beginning the movement 
It is doing what it can to further that movement, and to consolidate 
its results. 

Who is there that has lived and observed through the last ten or 
fifteen years, who cannot see that our profession has been moving 
onward and upward since its great awakening; perhaps slowly, 
perhaps now and. then halting, but on the whole advancing, and 
with an irresistible force, because it is that of the mass. It is not 
now a few leaders who are kindling by their own enthusiasm a 
feeble and temporary blaze of excitement in the multitude; drag- 
ging them forward as with cords by their own strong zeal and fiery 
spirit ; it is the inborn soul which is animating the great body, and 
carrying it forward in its legitimate course. 

Had the Association done nothing else, I will not say than origi- 
nating, but even than aiding and concentrating this rising up of the 
profession, it would have performed a service entitling it to ever- 
lasting gratitude, and to an imperishable name in the medical 
annals of our country. 

A great benefit conferred on the profession by the Association, 
was the preparation and adoption of a code of medical ethics. I 
need not say to you^ that this code is merely an expression of the 
great principles of truth, justice, and honor, in their application to 
the relations of physicians to one another, their patients, and the 
public. It is the voice of wisdom and experience speaking from 
the past, and meets a ready response in the breast of every man 
possessed of a good hearty a sound judgment, and correct moral 
principle. Should any one find a repugnance to the observance of 
its rules rising up within him, let him for a moment reflect, whether 
this may not spring from some evil source in himself; whether it 
may not be the result rather of an unwillingness to make what he 
may deem a sacrifice at their suggestion, than of a real conviction 



6E0BGS B. WOOD. 61 

of their iDJustice or impropriety. Which is more likely to be true; 
the unbiassed and unselfish judgment of the wisest and most expe- 
rienced in the profession, or an individual decision which may at 
least be suspected of a selfish badis, and of which no man, if his 
interests or feelings are in any degree involved, can say that it is 
quite pure; for no man can judge impartially in his own case. A 
becoming modesty would lead him to suspect that the fault might 
be in himself, and a becoming spirit to search into the secrets of his 
own heart for the root of the evil, and to pluck it out if discovered. 
I have no doubt that a full observance of these rules would tend, 
more than any one thing else, to maintain harmony in the profes- 
sion, and to elevate it in the public esteem. It would render im- 
possible those unseemly disputes, founded on petty jealousies, and 
supposed opposition of interests, which, probably beyond any other 
single cause, expose the profession to obloquy and ridicule. A 
copy of the Code should be placed in the hands of every young man 
about to enter upon the practice of medicine, with the urgent ad- 
vice that he should make it the guide of his professional life ; that 
he should not only regulate his conduct in conformity with its pre- 
cepts, but should educate his heart into a real preference for them. 
Would it not be an object worthy of the attention of the Associa- 
tion to provide for such a distribution ; at least, by the publication 
of a large edition of the Code, to put it in the power of individuals 
or societies, who might be disposed to engage in this work of bene- 
ficence, to do so with as little cost to themselves as possible ? I do 
honestly believe that, to a young physician going forth into a life 
full of moral conflicts, the wearing of this aegis would be one of his 
surest defences ; that, next to the holy Scriptures, and the grace of 
God, it would serve most effectually to guard him from evil. 

Not one of the least advantages of the Association is that, repre- 
senting as it may be said to do, the medical profession of the country, 
its voice, when nearly or quite unanimous, will be considered as 
that of the whole medical body, and thus have weight both in the 
community at large, and in the legislative councils of the nation. 
It is only thus that the profession can makd their special opinions 
and wishes known and felt. I have been told that the representa- 
tions of the Association had much weight in determining a satisfac- 
tory arrangement of the question respecting the relative rank of the 
Surgeons in the navy. It is to be presumed that the patriotic phy* 
sician who brought before Congress the memorable measure for 
establishing a general inspection of imported drugs, was materially 



62 ADDBBSS OF 

aided in carrying it through by the approving voice of the profes* 
sion, speaking in the memorial from this body. On another occa- 
sion, you were heard, through your resolutions, pleading in the 
Halls of Congress in favor of a great measure of honesty and 
justice, when you petitioned for an international copyright law 
between the United States and Great Britain ; and, should such a 
law ever be passed, it will not be claiming too much for the Asso- 
ciation to say that it will have contributed to that result Your 
resolutions, from time to time, in advocacy of a system of registra* 
tion of births, deaths, ko^ have probably also added something to 
the mass of influence which has brought legislation to bear on this 
most important subject, though, it must be acknowledged, hitherto 
but very partially, and, with some honorable exceptions, ineffec- 
tually. 

There is one other view of the beneficial influence of our great 
gatherings which I cannot pass unnoticed. 

The effect of isolation is well known in breeding excessive self* 
respect, distrust of others, and narrow, selfish, and sectional views 
and feelings. Man is naturally gregarious; and it is only in asao- 
ciation that his nature can receive its full development; that the 
seeds of the better qualities within him can be made to germinate, 
and the qualities themselves to grow up, under culture, into their 
j>ust magnitude and proportions. 

Our Association brings together many who would otherwise 
never meet, from sections remote firom each other, and differing 
much in views, habits, and feelings. We come, partly, at least, for 
relaxation from the cares and toils of business, prepared and de- 
sirous to be pleased. Each one naturally, and without design, 
turns out the fairest side of his character, "his silver lining to the 
sun ;" and all consequently make and receive favorable and kindly 
impressions. Each place selected for our meetings feels its charac- 
ter for hospitality involved in the reception of its guests, and every 
effort is made to extend all proper courtesies and kindnesses to the 
assembled representatives of the profession. In parting, therefore, 
we carry with us friendly remembrances of one another, and of the 
place of assemblage, to our several far separated homes. These 
remembrances serve as so many cords, not only to bind the mem- 
bers of the profession together in one harmonious whole, but also, 
intertwined with other similar agencies, to counteract the centrifugal 
tendencies of our political system, and to keep it moving onward^ 
each part in its due place, in that majestic course, which, while shed- 



QEORaS B. WOOD. 63 

ding beneficent influences throughout its own great circle, attracts 
the admiring and hopeful gaze of humanity everywhere. 

Having thus hastily scanned the present and past of the Associa- 
tion, let us turn our thoughts briefly towards the future. A few 
words will convey all that I have to address to your attention. 

It seems to me that experience should have taught us this one 
leeson; not to aim at once at sweeping changes; but, having deter- 
mined what great objects are desirable, to keep these always in 
view, and, by the persevering use of such influences as may be at 
our command, securing one point in advance before hastening to 
another, to move on slowly but steadily to our ends. These must 
ever be the improvement of the profession itself, the advancement 
of medical science, and the promotion of the public good, so fsir as 
that may, in any degree, be connected with our special pursuit. 
Each of these three points requires a brief notice. 

In the improvement of the profession, the Association has from 
its foundation recognized, as an essential element of success, a higher 
degree of qualification in those who are to become its members. 
But for the attainment of this object they can use no coercive mea- 
sures. The only power they can exercise is that of opinicm. Our 
only appeal is to the judgment and conscience of those con- 
cerned. But much may in time be done in this way. It is 
impossible that intelligent and honorable individuals, possessed of 
that share of conscientiousness which belongs to most men, and is 
certainly not deficient in our profession, should long resist such 
appeals, proceeding from a source so worthy of respect as this. Let 
us reiterate, from time to time, our convictions of the necessity for 
improved preparatory education, for a longer devotion to the 
proper studies of the profession, for a junction of clinical with 
didactic instruction, and finally for something more than a mere 
nominal examination before admission to the honor of the doc- 
torate, or the privileges of a license to practice; points which have 
ever been insisted on by the Association ; let us, I say, reiterate 
these convictions; and like slowly dropping water, they will at 
length, however gradually, wear their way through the hardest 
incrustation of prejudice, interest, indolence, or indifierence, and 
reach the conscience with irresistible efiect. While bringing to 
bear upon this resistance, the considerations of reason, duty, honor, 
and even an enlightened self-interest, we must carefully avoid all 
violence of procedure, as likely only to add the hostility of passion 
to other opposing influences^ By this course universal opinion 



64 ADDBESS OF 

will be gradually conciliated ; and interest itself will find its own 
ends best promoted by compliance with the general will. Already 
some advance has been gained in this direction; and the Association, 
by perseverance, may yet see all its reasonable wishes accomplished. 

In rdation to other measures for elevating the character and in- 
creasing the efiiciency of the profession, there appears to me nothing 
more at present for the Association to do, than to go on as it has 
begun. Its continued existence alone is a great good ; for it is 
annually bringing large numbers, simply through membership in 
its body, to participate in its feelings, and to acknowledge its obli- 
gations. Let us then maintain unshrinkingly the standard of pro- 
fessional honor and morals that we have erected, and decline asso- 
ciation with those who will not recognize that standard, or, having 
recognized, abandon it. Let us adhere unswervingly to the line 
which has been drawn between regular and irregular medicine, and 
treat the practitioners of the latter with the silent disregard they 
merit. This is the only course for the regular practitioner. To 
wage a war of words with quackery, is to do what it most delights 
in. It would be to contend, under the government of honor and 
principle, with antagonists who acknowledge no such restraints. In 
our private intercourse with friends and patients, we may explain 
the grounds of difference between ourselves and the irregulars, may 
demonstrate the absurdity of their pretensions,- the danger of their 
practice, and the iniquity of their conduct ; in short, may endeavor 
to enlighten wherever light is acceptable, or can penetrate. We 
may even, if the public interest seem to require it, put forth refuta- 
tions of false doctrine and assertion, and exposure of subterfuge, 
trickery, and imposture; but with the irregulars themselves we 
should enter into no relation, whether of friendship or hostility. I 
do not say that there may not be honorable and honest, though 
ignorant or bewildered men among them. But we cannot dis- 
criminate. With the presumed advantages of their association, 
they must be content to take also the disgrace. 

There is a point to which I would call the attention of the mem- 
bers of the Association individually. We have been called Alio- 
pathists^ in contradistinction to a sect of irregular practitioners who 
have taken to themselves the title of SomoRopathists; the latter term 
signifying that its professors treat disease by influences similar in 
their eflFects to the disease itself; the former that otJier, and of course 
dissimilar influences are used. It must be remembered, that the 
designation was not adopted by ourselves, but conferred upon us 



GEOBGE B. WOOD. 65 

by Hahnemann and his followers. The intention was obvious. It 
was to place the regular profession, and their own scheme, upon a 
similar basis. They practised on one principle, we on a different 
and somewhat opposite principle. They graciously allowed that 
oar principle was not altogether ineffective ; that we did sometimes 
cure our patients ; but theirs was sounder in theory, and more suc- 
cessful in practice. Now, by recognizing the name, we necessarily 
recognize the principle also, and thus put ourselves in a false posi- 
tion. In deciding between them and us, the ignorant masses think 
they are deciding between two systems, neither of which they un- 
derstand, but of which they must judge, upon the grounds of rela- 
tive success. Diseases often get well of themselves, if left alone. 
The genuine homceopathist leaves them alone, and they often con- 
sequently terminate in recovery. This success is magnified by 
methods well understood ; and multitudes are thus led astray, espe- 
cially among the delicate and refined, who abominate the taste of 
medicine themselves, and are equally averse to the task of forcing 
it down the reluctant throats of their children. But we are 7iot 
allopathists. The regular practice of medicine is based on no such 
dogma, and no exclusive dogma whatever. We profess to be intel- 
ligent men, who seek knowledge, in reference to the cure of disease, 
wherever we can find it, and, in our search, are bound by no other 
limits than those of truth and honor. We should not hesitate to 
receive it from the homoeopathists, had they any to offer. We 
would pick it up flx)m the filthiest common-sewer of quackery; for 
like the diamond, it has this excellent quality, that no surrounding 
filth defiles it, and it comes out pure and sparkling, even from the 
kennel. This is the light in which the medical profession should 
present itself to the community. We are men who have sought in 
every possible way to qualify ourselve^ for the care of their health. 
We present them, in our diplomas, the evidence that we have gained 
sufficient knowledge to be trusted with this great charge ; and we 
stand pledged before them to extend our knowledge' and increase 
our skill, as far as may lie in our power. Membership in our honor- 
able profession is the proof we offer that we are no false pretenders, 
no interested deceivers ; but upright men, intent on the performance 
of our professional duties. This the people can understand. But 
when we designate ourselves as allopathists, they may well ask, in 
what are you better than any other medical sect, than the homao- 
pathists, the hydrcpaihists, the Thomsoniana^ the eclectics f Let us 
discard, therefore, the false epithet. Let us not only never employ 



66 ADDRESS OF 

it ourselves, bat show that, when applied to us by others, it is inap- 
propriate and offensive, and that the use of it in future would be 
contrary to gentlemanly courtesy, and the proprieties of cultivated 
society. I say again, we are not allopaihUta; we are simply regular 
practitumers of medicine, claiming to be honest and honorable — ^in 
other words, to be gentlemen. 

The efficiency of our profession is to be increased not only by 
increasing its qualifications, but also by all upright measures calcu- 
lated to win the public confidence, and thus widen the field of our 
operations. In this respect, I do not know that the Association 
can do better than to persevere as it has begun; and, by the pro- 
priety and dignity with which it conducts its own proceedings, to 
show to the world the high influences under which the profession 
acts, and demonstrate that it possesses those qualities of self-govern- 
ment, so useftd to the medical practitioner, and so characteristic of 
the gentleman in all his relations. 

The improvement of the eeience of medicine has always been a 
favorite object of the Association. The appointment of committees 
to investigate and report on certain stated subjects, the reception of 
voluntary communications, the offering of prizes to competing con- 
tributors, and the publication of our Transactions annually, are the 
means employed for this purpose; and I have nothing better to 
suggest 

The remaining, point for consideration, is the promotion of the 
public good. Happily, such is the nature of our profession, that 
the more we improve ourselves, the better do we fulfil this great 
duty. But there is something else to be done. There are certain 
great interests of the community, relating to their health, of which 
medical men are the only good judges, and the various influences 
affecting which they only can duly appreciate. Upon these points 
it is our duty to be ever on the watch, and not only, like faithful 
sentinels, to give notice of danger, but, like heaven-appointed agents, 
as we are, to use our best efforts and influence to prevent or remove 
it, and, in every practicable way, to guard the public health. 

To the establishment of a general system of registration through- 
out the country, our attention has already been given. We should 
not relax our efforts, until the great end has been accomplished. 

There is another subject deserving of our most serious considera- 
tion. You are all aware what advances have recently been made 
by the smallpox in many parts of our country. Thousands are 
perisbiDg annually, for whose deaths we are, as a profession, ia 



GSOBGS B. WOOD. 67 

some degree aecotmtable. There ia no occasion for this mortality. 
Yaocination and revacoination, duly performed, and under proper 
ciicomstancefl^ are, I will not saj an absolutely certain, but a very 
nearly certain safeguard. I have never known of death from small- 
poz, after an efficient re vaccination; and only one instance of the 
occnrrence of varioloid. But the profession and the community 
have both been too careless upon this point Food for the pesti- 
lence has been allowed to accumulate ; and it has been rioting with 
fearful results in many parts of our country. The profession should 
rouse itself from this apathy, and warn the community everywhere 
of the danger, while offering them the means of security. We may 
be accused of self-interest in urging this measure of precaution ; as 
our own instrumentality may be necessary, and must be compen* 
sated where the means exist. But a moment's reflection must con* 
vince the most stupid that it would be much more to our pecuniary 
interest to attend a protracted case of smallpox, than to p^orm a 
trifling operation, which is to prevent it There are, however, many 
occasions^ in which it is necessary to do our duty at the risk of 
obloquy: and this is one. 

But perhaps I have been somewhat unjust to the profession. 
The people have, in many places, and probably, in some degree, 
in almost all, chosen other guardians of their health, and rejected 
our offered aid. It has happened to me to become acquainted with 
one neighborhood, in which smallpox has recently prevailed ; but 
not a single case occurred within the circuit of the regular physi- 
dan^s practice. Those families only suffered who had intrusted 
the care of their health to an empiric, who, for aught I know, may 
have been ignorant alike of smallpox and of vaccination. It is 
highly probable that many of those who now hear me could give a 
similar account of their own neighborhoods. The public should 
take this subject into their hands. Provision should be made, with 
legislative sanction, for universal vaccination. If the evil were 
confined exclusively to the negligent individual, the public might 
possibly have no right to interfere. But whole communities suffer, 
and government may and ought to step in for their protection. A 
man is prohibited by law from setting fire to his own house, because 
a neighbor's may suffer. Which is the greater evil, that our house 
should bum, or our families perish with smallpox 7 It might be 
impossible in this country to establish a system of compulsory 
vaccination; but legislation might go far towards attaining the 
same end without this obnoxious feature. Time, however, does 



68 ADDRESS OF GEOBGB B. WOOD. 

not permit me to follow this interesting subject in all its ramifica- 
tions. I must content myself with having introduced it to your 
notice. If the profession can do nothing more, they can at least 
raise a warning voice everywhere ; and this will be doing much. 

I must close with begging you to excuse the length into which I 
have been drawn in the discussion of the important points that 
have engaged our attention. I intended to be very, brief; but few 
men, when they have taken their pen in hand, can say to the flow- 
ing tide of their thoughts, " thus far shalt thou go, and no further." 
Allow me, in a few parting words, to thank you warmly for your 
attention, and to express the hope that our labors, during the 
present session, may tend to confirm the good that has been done, 
and to carry us still further onward in the great road of progress ; 
so that, hereafter, the meeting at Detroit may be remembered as 
one, at which we may all be gratified and proud to have assisted. 



REPORT 



OH 



DEFORMITIES AFTER FRACTURES. 



BY FRANK HASTINGS HAMILTON. 



PART SECOND. 



■'DiROSTioir, or ill oonformAtion of the parts, proceeds either from the neglect of the Chlmrgeon, 
vhea h« nukes less extension, joining together or binding than he onght to do ; or it is the fanlt of 
the PatieDt, when be stirs the broken part before the Callns is grown strong, or stands upon it ; or 
else it la the Iknlt la the baetare."<^6ouLTBTUS. 



PREFACE. 



Thi second part of my report on DeformUiea after Hxxcturea in- 
diides the consideration of fractures of the scapula, arm, forearm, 
and hand. It was my original intention to have completed the 
whole subject in a single paper, but I had then no proper idea of 
the amount of labor which was before me. Instead of one report, 
I shall be obliged to make three, for I have not yet considered firac- 
tores of the body and lower extremities. 

It is so natural for one to overestimate the importance of any 
work upon which he has been for a time especially engaged, that I 
distrust my own judgment in reference to the propriety of continu- 
ing the report beyond this year; and I beg that you will indicate 
to me frankly your desires upon this subject. In the mean time, 
whatever may be your commands, I am preparing to publish, on 
my own account, a Treatise on Fracturte and Dialocatione; and, as I 
shall wish to make use of the material which is already contributed 
by me to your Uransactionaj and which has become your property, 
I shall be obliged to ask your consent to such a diversion of your 
rights. 



72 REPOKT ON 



CHAPTER VI. 



SCAPULA. 



The following are the only cases of fracture of this bone which 
have come under my especial observation. In my visits to hospi- 
tals in this country and abroad, I have occasionally seen other 
examples, three or four of which I can call to mind ; but I did not 
make at the time any careful examination of them, and I am not 
prepared to record either their history or their results. 

Body. 

Case 1. Fracture and union without deformity or maiming. 

Willard Vaname, aged 55, fell on his back upon the sidewalk, 
breaking the scapula a little below the spine. The soft parts were 
swollen and tender, and prevented an examination sufficiently accu- 
rate to determine whether the fragments were displaced ; nor could 
I ascertain the direction of the fracture. Its existence, however, 
was rendered certain by an occasional distinct crepitus. 

I applied a broad roller about the arm and chest, and directed 
him to remain quiet a few days. Recovery was complete within 
three months. No muscular anchylosis. 

Acromion Process. 

Case 2. Fracture with ligamentous union. Functions of the arm not 
impaired. 

Samuel Denon Knight, of Buffigilo, aged 28 years, fell into the 
hold of a vessel, striking upon his head and shoulder. He was for 
a time insensible. Drs. Flint, Mixer, and myself in attendance. 
The next day we discovered the fracture of the acromion. It was 
broken transversely about three-quarters of an inch from the ex- 
tremity. The fragment was only slightly displaced, and motion, 
with crepitus, was distinct. He raised his arm to his head with 
some difficulty. 



DKFOBMITIBS AFTBR FBAOTURBS. 7S 

We adopted no treatment. Six months after the accident, I found 
him with the perfect use of his arm and shoulder. The fragment 
was united, but slightly depressed. 

Ckxracoid Process. 

Case 3. Fracture and no union at the end of three months; compli- 
cated tvith unreduced dislocation of the clavicle at its scapular extremity, 

John Wood, Jr., of Lancaster, Erie County, was struck by a 
board falling edgewise upon his shoulder, dislocating the acromial 
end of the clavicle, and at the same moment striking upon and 
breaking the coracoid process. 

The case was treated with a sling, axillary cushion, and roller. 
At the end of three months and five days, I found the apparatus 
still applied. The clavicle was uplifted from its socket, and the 
fragment of the coracoid process could be distinctly felt moving 
forwards or backwards whenever the humerus was moved in these 
directions. 

-Peft'y, 1856. The fragment remains displaced, with the clavicle 
also, and the functions of the arm are not impaired. 

Acromion Process. Cabinet Specimens. 

Specimen 1. A boiled specimen, taken from an .adult skeleton. 
The process is separated obliquely, at an angle of 45^, six lines 
from its extremity, and not united. The adjacent sur&ces are 
smooth and covered vrith compact tissue, as in pseudo-arthrosis. 
There is no appearance of ensheathing callus, except a very slight 
crest along the margin of the fracture. The history of the specimen 
is not known. (The property of the Wistar and Homer Museum, 
University of Pennsylvania, Philadelphia.) 

Specimen 2. A boiled specimen^ Adult. Separated nearly trans- 
versely six lines from extremity, and not united. Adjacent surfaces 
resemble specimen No. 1. History not known. (Wistar and Hor- 
ner Museum.) 

i^peamen 3. A scraped specimen. Adult. Separated nearly trans* 
versely at about one inch and a quarter from the end. Closely 
united by ligament, and fragment not displaced. No ensheathing 
callua These conditions were noticed before the specimen became 

VOL. IX.— 6 



74 BSPOBT asr 

dry, at which time there was distinet motion between the fragments. 
(Museum of the Massachusetts Medical College, Boston* No. 1869.) 

Specirnen 4. Dried. Adult. Separated in a direction slightly 
oblique, so that measuring on one side the fragment is twelve lines 
in length and on the opposite fifteen Hues. It is closely united by 
ligament and without displacement. (Mass. Med. Col. No. 1370.) 

Specimen 5. A macerated specimeu. Adult. The process is sepa- 
rated about one inch from its end, nearly transversely, and united 
by ligament without displacement. No ensheathing callus. Be- 
tween the fragments there was " almost a synovial cavity." (Mass. 
Med. Col. No. 1371.) 

Specimen 6. This is probably the mate of No. 6, and resembles 
it in all points except that ossification seems to have partly occur- 
red between the fragment and the body of the scapula, but by 
accidental violence to the specimen, the process has been broken 
off at or very near the line of ossification. (Mass. Med. Col. No. 
1372.) 

Specimen 7. Dried specimen from an adult. Separated trans- 
versely near its middle, and united by a ligament of about two 
lines in length. No displacement of the fragment. No ensheath- 
ing callus. (Museum of Charles Gibson, Richmond, Va.) 

Specim^en 8. Dried. Adult. Separation transverse, about one 
inch and a quarter from the end. Not united. (Charles Gibson.) 

Specimen 9. Adult male, aat. 40, a stout laborer. He was struck 
by a "powder blajst," breaking at die same time his humerus, the 
lower jaw, and the base of the skull. The periosteum was not 
broken upon its upper surface, so that no displacement occurred. 
The fragment could be turned up and baek as on a hinge. The 
patient survived the accident three weeks. (Stephen Smithy one of 
the Surgeons to Bellevue Hbsp.,. N. Y.) 

(hracaid Process. Cabinet Specmens. 

Specimen 1. Separated one in^k from extremity. Line of sepa- 
ration somewhat irregular. No callus. Fragment suspended by a 
dried tissue continuous with the periosteum. The acromion pro- 
cess has not yet become united by bone. The scaptJa is lai^ and 
evidently belongs to an adnlt^ (John NeiU, Philadelphia^) 

/Specimen 2. A dried specimen. Adult. Broken obliqudy near 
the end[. TJnited' by ligsonentous or fibrous tissue, of one line and 



DEFOBMITIES AFTER FBACTUBES. 75 

a half in lengtli, in a manner similar to specimen Ko. 1. The frag- 
ment is displaced a little forwards, as well as downwards. (Charles 
Gibson, Richmond, Va.) 

Specimen 8. This is a dislocation of the head of the humerus for- 
wards under the clavicle with fracture of the coracoid process. The 
head and neck of the humerus lay against the thoracic surface of 
the neck and belly of the scapula, and are firmly united to the sca- 
pula by an abundant ossific deposit. (Reuben D. Mussey, Cincin- 
iiati, Ohio.) 

Specimen 4. "No. 458, labelled * Fracture of coracoid process,' and 
whether by Dr. Warren, tlie founder of the museum, or by some 
former owner of the specimen, I cannot say; its history being un- 
known. There is a fracture not merely of the entire process from 
the body of the bone, but it encroaches somewhat upon the body 
and the glenoid carity. The fracture was quite recent, as it would 
appear bom an examinsd;ion of tlie fractured surface generally, and 
also from the edges, where it enclro^^ches upon the glenoid cavity. 
Commencing near the margin of this fracture, and extending out- 
wards upon the scapula, there appears evidetitly to have been an 
old fracture, which has united by bone. This fracture extends hori- 
zontally along the body of the bone for' nearfy two inches, then 
turns upwards at a right angle and extends about two-thirdis of an 
inch in that direction. Fpon the inner surfkce, the line of the old 
froctCETe does not quite reach the recent one apparently, though I 
presume that it extended rather further in that direction in the 
recent state t&an it appears to now. IJpoti this inner surface no 
new bone is thrown out along the line of the fracture ; but, on the 
other hand, this line is for the most part indicated by a very narrow 
and snperficial groove. Upon the outer or dorsal surfece, there is 
a deposit of new bone along the line of the fracture, quite small in 
Amount; but, on approaching the neck of the bone, this deposit 
increased tery considerably in amount, abd becomes" quite irregular. 
On lamination of the detached c6tB6oid proc^ssr itseU^ there is 
distinct evidence of an old firacture thaft mudt have involved its 
▼e^ base to^a^ the body of the bone; the* sur&ce adjacent to the 
fraetui^ being rough from inflammatory deposit. I have given 
these details because it is a complicated case; and, to give a gene- 
ral idea of it, as it appears to me, I should say that there might 
have been a fraetture of the^ bone some time within a year before th^ 
death of %h6 individutfl — ^a fracture involving th'e'base of the cora- 
e(Hd process; this fraeture had united by bonci and just before 



76 BEPOET OK 

death the whole process had been broken off, and so completely as 
to involve to a small extent the glenoid cavity." (Mass. Med. Col.; 
reported by J. B. S. Jackson, Boston.) 

REMARKS. 

Fractures of the scapula are exceedingly rare, and the observa- 
tions recorded by myself are too few to enable me to draw any 
valuable conclusions. I have sought, therefore, to supply in some 
measure, the deficiency in this portion of my report by describing 
briefly such specimens of these fractures as may be found in my 
own collection, or in the collections of other American surgeons. 

Cabinet specimens of fractures of the body and angle of the 
scapula being more frequently met with than specimens of fractures 
of either of the processes, or of the neck, I have omitted to collect and 
record them. I have, however, ftimished the following epitome of 
the opinions and practice of surgeons, relating to these latter acci- 
dents, as a risumi of what is at present known of them, both in 
relation to prognosis and treatment ; a mode of considering this sub- 
ject which, although it might scarcely be admissible in a systematic 
treatise, seems to me not inappropriate in a report, the object of 
which is rather to collect from every source facts, opinions and 
references, which others may hereafter render available. 

K the scapula "be broke in several pieces which are not likely 
to unite, incision is to be made, and the loose pieces are to be taken 
out, leaving the rest to nature^" " If the scapula be broke near 
the joint, it is for the most part incurable." {System of Chirurgery^ 
by Richard Boulton, p. 824. London, 1713.) 

Where the patient is not so fat or so muscular as to render it 
impracticable, the fingers must be thrust underneath, so as to elevate 
the depressed fragments, " which having replaced, with suitable 
bolstering and deligation, you are, as much as possible, to keep it 
up." A careful regimen is to be enjoined, with rest and proper 
therapeutics, " and when he has done this, as becomes him, I sM 
not any injustice that he should be paid for a cure, in which, if the 
work succeed, Nature rather than Art had the chiefest hand." {Art (^ 
Surgery^ by Daniel Turner, vol. ii. p. 260. London ed., 1742.) 

Elevate the head and shoulders, to relax the muscles of the back, 
and at the same time support the humerus so as to relax the deltoid. 
Retain the arm and shoulder in this position by suitable rollers. 
{System of Surgery^ by Benjamin Bell, p. 478. 8d Philad'a ed., 1806.) 



DEFORMITIKS AFTER FBACTUBB3. 77 

When the body is broken, " it is merely necessary to fix the arm 
to the side by means of a bandage, which includes the ann from 
the shoulder to the elbow." When the inferior angle is broken off 
the arm is to be pushed " inward, downward, and forward, where it 
is to be kept by a roller. The fragment is also to be kept back- 
ward as much as possible, with compresses and a roller. The arm 
is to be supported in a sling." {On Fractures^ by Joseph Amesbury, 
vol. ii. p. 684. London ed., 1881.) 

" It is sufficient to restrain motion ; and this is effected by pass- 
ing a bandage round the chest, over the scapula, and round the 
arm." {Elements of Surgery^ by Robert Listen, p. 470. Philad'a ed., 
18S7.) 

The elbow is to be lifted by a sling, and the arm and body are to 
be swathed with a broad roller. If the lower portion is disposed 
to become displaced, it may be supported by a pad. " It is seldom, 
however, that much advantage can be gained by this." * * * 
'^Little harm results if the fractured portions unite in the position 
into which they are driven at the time of the accident. * * * The 
free use of the shoulder-joint, however, is not recovered till some 
time after." {Treatise on Fractures^ by Edward F. Lonsdale, p. 191. 
London ed., 1888.) 

" When the lower angle of the scapula id broken off the hume- 
rus maybe brought forward across the chest, and the hand confined 
upon the opposite shoulder." " This position is adopted abroad ; 
but, in this country, when any part of the body of the scapula is 
fractured, we merely apply the spica bandage." Mr. Cooper re- 
gards this bandage as " of little or no use," and speaks of the sling 
which ifi employed with it, as "the efficient part of the apparatus." 
{Firsi Lines of Surgery^ by Samuel CJooper, vol. ii. p. 827. New 
York ed., 1844.) 

A simple roller to keep the arm against the body, and a sling. 
{Note to Chelius, p. 602.) 

A sling, with a bandage to confine the arm to the body, or with 
Desaalt's apparatus. {Operative Surgery, by Frederick 0. Skey, p. 157. 
Philad'a ed., 1861.) 

When the dorsum is broken Mr. B. Cooper employs a long roller 
which is made to cover the arm and secure it to the chest ; but 
when the fracture is at the inferior angle, he recommends that the 
arm be carried across the chest. {Surgery, by Bransby B. Cooper, p. 
227. Philad'a ed., 1852.) 



78 BSPOBT Olf 

'' A body bandage." {Surgery, by John Erichsen, p. 206. A men 
ed^ 1864.) 

" A broad flannel bandage, or riding belt, should be put around 
the body, and the arm bound to the side." " It is mth difficulty 
retained in situ" (Practical Surgery, by John Lizars, p. 182. 2d 
Edinburgh ed., 1847.) 

" It is sufficient to restrain motion, by wearing the arm in a 
sling, and by having a broad flannel bandage passed tightly over 
the chest, including the fractured bone." {Practice of Surgery, by 
James Miller, p. 311. Philad'a ed., 1863.) 

When the angle is broken off, or even though the fracture be 
considerably above the angle, if it is complete and transverse, it 
will be necessary to place one compress in front of the lower frag- 
ment, and one behind the upper, and then having pressed the arm 
downward, forward, and inward, to secure it with a roller, &c. K 
the body is broken otherwise, it will be sufficient to put the arm in 
a sling and to secure the arm to the body with a roller. {System of 
Surgery, by William Pirrie, p. 146. Philad'a ed., 1852.) 

Oarter recommends in all fractures, whether of the body, pro- 
cesses, or neck, that in order to accomplish the reduction, the elbow 
shall be carried from the body to relax the deltoid, and that the 
arm be then suspended and kept at rest in a sling. ^^In restitutiom 
attollendum brachium, ut DeUoides musculus sit laxus, dun^ digitie 
Chirurgi rqponcUur fraciura. Post repositionem diu non debet aeger 
conari elevare brachium, sed gerere dd?et brachium miidla admodum 
susierUatum." {Chirurgia Eepurgaia, auc. Johawais de Oorter, Lug^ 
duni Batavorum, p. 80. 1742.) 

Confinement of the arm to the side of the body, with a conical 
pad in the axilla, the apex of which should correspond to the axilla; 
the elbow lifted by a sling, or bandage, or both ; a figure of 8 
bandage upon the shoulder. Where the fracture is transverse and 
considerably above the angle, the hand may rest, if the patient can 
endure it, upon the sound shoulder. ^* If the fraoture is near the 
angle, the cure is always effected with some deformity; but which 
does not interfere with the motions of the arm." {CheUus^ Surgery, 
vol. i. p, 601. American ed., 1847.) 

In fractures of the body apply a simple bandage to confine 
the arm to the side of the body. In fractures of the angle the 
upper fragment is to be carri^ backward and downward by bring- 
ing the elbow forward and upward ; and the whole is to be secured 



DSF0BHITIS8 JlFTXB FBACTURES. 79 

by along roller. {Operative Surgery^ by A.Tavemier, p. 878. Philad'a 
ed., 1829.) 

Be}ecting all the complicated forms of apparatus, which he be- 
lieves to have been proved inefficieot, M. N^laton remarks : " In 
tnith we are forced to acknowledge that we have not any means to 
act upon the fragments ; all that we can do is to maintain their im- 
mobility, and npon this occasion IvnU rqpeaiwhai I said when treat- 
ing cf frodures of the davicle; aU cur retentive means being eqvjally 
insufficimij the best vdU be that which will cause the least pain ; a 
simple sling, which will embrace the elbow, the arm, and the fore- 
arm, will then goffice. I must, however, give the preference to the 
bandage of M. Mayor, because it maintains the shoulder more firm." 
{EUimens de Pathohgie Chirurgioale, par M. N^laton, tom. premier, 
p. 723. Paris ed., 1844.) 

Mayor employs the same apparatus which is recommended by 
him for fractured or dislocated clavicle, namely, a sling with two 
broad shoulder-straps, which are made to rest respectively upon 
the two shoulders; the elbow being carried forward across the 
body. {N^ouveau Systhne de DeUgation Ohirurgicale, par Matthias 
Mayor de Lausanne. Troisidme 6d,, p. 896. Paris, 1888.) See 
also Figs. 28 and 24, Plate 8. 

^* With all these precautions we can easily determine the exist- 
ence of a fracture ; but to know whether it is transverse or oblique, 
simple or multiple, is another thing. Often, indeed, when the dis- 
placement is nothing, or very inconsiderable, crepitation will de- 
clare a fracture to which the touch cannot assign its place ; and, 
finally, a fracture without displacement, and without crepitation, 
will be almost inevitably unrecognized. 

*'It is fortunate, then, that in these cases the mistake is. without 
importance, and the prognosis is scarcely more grave in fractures 
which are accompanied with the most striking displacement. B. 
Bell aflSrms that they determine, very frequently, in the move- 
ments of the arm a permanent stiffness ;^ but for myself I have 
seen nothing of this kind, and I have not even remarked an ap- 
preciable eonstraint in the movements with the subjects whom I 
have seen. 

^ Fractures without displacement require nothing but repose, and 

1 '^ It to always diflcoU te core, and indacee oommonl/ a pennanentlj stiff and 
vmrieldj state of the oomsponding arm."-^/^en qf Surgeiy, \fj Benjamin Bell, 
p.478,3dFhilad'aed. 



80 BEPOBT ON 

it is sufficient to hold the arm snug against the trunk with a body- 
bandage and a sling. 

^' When there exists displacement) the redaction has been effected 
in various ways. Pierre d'Argelata places a ball under the arm 
and brings again the elbow against the ribs. J. L. Petit directed 
that the arm of the patient should be lifted until the fold of the 
elbow was opposite the nose ; and, while an assistant maintained it 
in this position, the surgeon should adjust the fragments as well as 
possible. B. Bell recommended to elevate the head and the 
shoulders to relax the muscles of the back. Heister drew the arm 
forward ;^ Desault, for fractures of the inferior angle, carried the 
arm before the chest, holding it a little removed from the body, 
while the hand of the injured side was placed upon the extremity 
of the sound shoulder.* 

*^ Surgeons are not much better agreed as to the apparel to be 
employed. Paulus of jEgineta treated these fractures as those of 
the clavicle, recommending that the patient should be kept reclining 
upon the sound side. Albucasis applied upon the scapula a sort of 
etoupadcj above which again are placed compresses, and splints of 
wood or of leather. Desault employed a wedge-shaped cushion, of 
which the apex corresponded to the axilla, and the base to the 
chest, in Order to furnish a point d^appui for the arm ; the whole 
supported by a bandage six or seven ells in length, of which the 
first turn was intended to fix the hand of the injured side upon the 
sound shoulder. Boyer,' without having any regard to the dis- 
placement, occupied himself in maintaining the immobility of the 
bone; and, therefore, by appropriate turns of the bandage he 
secured the arm closely to the side of the body, carrying the elbow 
at the same time a little forward. 

> Heister adds, moreover, that we ought to applj proper oompresses and slips 
of pasteboard wet " cum spWitu vini vel oxycratOf** and fiimlj bound on with the 
steUate or four-headed hhnd&ge.-^Itutitutiones Chirurgiecd de D, Laurentii HiuUri, 
Pars Prima, p. 94. Ed. Amstelaedaini/l739. 

* Treatise on Fractures, Luxations, &o., by P. J. Desault, p. 64. Philad*a ed., 1805. 

* For yertioal fractures, or transverse and through anj part considerably above 
the lower angle, Besault's apparatus without the axillary cushion. To place the 
hand upon the opposite shoulder, is, however, '* unnatural and fatiguing." In 
fracture of the inferior angle, " the arm is to be pushed inward, downward and 
forward, the forearm being half bent." The arm is to be retained in this position 
by a body-bandage, seven yards long ; the lower fragment is to be supported by a 
compress and an additional roller, with a sling. — Boiftr on <Ae Bone*, p. 70. 
PhUad'a ed., 1806. 



DSFOBMITIES AFTEB FRACTURES. 81 

"Among sncli a diversity of practice, which shall the surgeon 
choose 7 Shall he attempt the reduction, and have we the means to 
accomplish it? 

"The three indications to fulfil will be to carry the inferior 
fragment backward and inward, the superior forward and outward, 
and lastly, to correct the overriding. The inferior fragment seems 
to be drawn away by the teres major; it is necessary, then, in order 
to relax this muscle, to approach the arm to the trunk, and even to 
incline it a little backward. The superior fragment appears to be 
under the predominating influence of the rhomboid, which is re- 
laxed by carrying the shoulder upward and backward. But as to 
the overriding, I do not see any means by which it can be over- 
come. 

" Position alone will not suffice to correct the two .first displace- 
ments; it will be found necessary to employ also adjustment with 
the hands, and further, the retentive apparatus must combine at the 
same time : First, means capable of holding the shoulder upward 
and backward, with the elbow near the body; and upon this point 
the reader may consult what we have said upon the subject of this 
indication when speaking of fractures of the clavicle. Second, of 
means suitable to replace the pressure of the hands — a compress 
upon the superior fragment, to press it forward against the other — 
graduated compresses beneath the same to hold it outward, and 
upon the outer side of the inferior fragment to hold it inward. 

" Such, at least,, are the means which a study of the actual dis- 
placements, and their most probable explanations, would seem 
to indicate ; but here, as in many other cases, nature makes light of 
cor theories ; and for myself I confess that in the few fractures of 
this kind that I have had occasion to treat, I have not been able, 
by any of the means which I have indicated, to reduce the displace- 
ments, much less to maintain the reduction. Indeed, I must say 
that the positions which seem the most rational, sometimes increas- 
ed the displacement, which was again diminished by other attitudes, 
variable for each subject. If, then, a surgeon shall ask advice with 
regard to the reduction, the only course which experience author- 
izes me to give to him, will be to try every possible attitude, until 
he has found the best, and then to maintain this position as long as 
may be necessary for consolidation. 

" But in the major part of these fractures, such excessive care is 
not demanded ; and in others, the reduction, often so impossible to 
accomplish, is of no very great importance, and I content myself 



82 BiiPOET OJf 

with holding the arm up vith an ordinary sling; while it is kept 
snugly against the trunk with a body-bandage." {Traiti det Frac- 
tures et dea Luxationsy par L. F. Malgaigne. Paris ed., torn. L 
pp. 508-5.) 

In cases of fracture of the lower angle, a thick oomiMresB is to be 
placed in front of the lower fragment, and there retained by an 
additional roller or a sling. * * * " It is hardly possible to restore 
the fragment to its former position." * * * Yet " they may be 
made to approximate so closely as to leave little or no deformity." 
'* Sometimes the patient recovers sooner when confined to bed 
during the whole treatment" {Surgery^ by Wm. Gibson, vol. L p. 
278. Philad'a ed., 1841.) 

A broad compress and a wide roller around the chest, with the 
arm in a sling and confined to the body. If the inferior angle is 
broken, the arm should be carried backwards, and confined by a 
broad roller with compresses, so applied as to support both frag- 
ments of the scapula. The whole arm is to be sustained by a sling. 
{Minor Surgery, by F. W. Sargent, p. 158. Philad'a ed., 1848.) 

In addition to the remarks made by these various writers, I find 
it only necessary to say that occasionally these accidents are so 
severe as to determine suppuration, and even necrosis of the bone^ 
requiring, therefore, more or less deviation from the rules of treats 
ment which have been suggested. 

I have been unable to find any other example of incomplete 
fracture of the iscapula than the one mentioned by M. Malgaigne. 
I have, therefore, had executed upon stone, a drawing of a speci- 
men contained in my own cabinet (PL 1, Fig. 1). The bone was pre- 
sented to me by Dr. N. 0. Powers, of Syracuse, and belongs to the 
skeleton of the Oneida Indian, "Nimbam," who was a great fighter, 
and who died when about 45 years years old, in consequence of 
severe injuries received in a street brawl; but his death did not 
occur until four or five months after the receipt of the injuries. 

In addition to this firacture of the right scapula, five of his ribs 
were broken, and both legs, all of which, except the scapula, had 
united completely by intermediate and ensheathing callus. He was 
under the care of Dr. Morrison, of Oneida Castle. 

The lithograph has been drawn with great fidelity, by Charles E. 
Lewis, lithographer, of this city. 

The scapula (see engraving) ia broken nearly transversely, com- 
mencing upon the posterior margin at a point about three-quarters 
of an inch below the spine, and extending across the body of the 



BEFORHITISS A7TEB FBACTUBES. 0$ 

bone one inoli and three-qoarters, in a direction inclining a little 
upward, iiregolarlj denticalate and without comminution. The 
fragments are in exact apposition, and, throughout most of their 
extent, in immediate contact. They are, however, not consolidated 
at any point, but upon either side of the fissure there is a ridge of 
ensheathing callus, of from one to three or four liues in breadth, 
and of half a line or less in thickness along the broken margin, 
from which point it subsides gradually to the level of the sound 
bone. The same is observed upon the inner as well as upon the 
outer sur&ce of the scapula. This callus has assumed the character 
<^ complete bone, but it is more light and spongy than the natu- 
ral tissue, and the outer surface has not yet become lamellated. Its 
blood-canals and bone-cells open everywhere upon the surface. 

Directly over the fracture, and between its opposing edges, no 
callus exists, but as the bone had lain some time in the earth before 
it was exhumed, it is probable that a less completely organized in- 
termediate callus had occupied this space, and that, owing to the 
less proportion of earthy matter which it contained, it had become 
decomposed and had been removed. 

One may notice heie : FirH^ -the existence of true ensheathing 
callus in a flat bone ; second^ its presence where there could have 
been no n)otion of the opposing fragments, and consequently no 
necemty for a " provisional splint." 

If by fracture of the ^' neck of t^e scapula'' ip meant a fracture 
which detaches the glenoid cavity from the body of the bone, it is 
certainly very rare, and, indeed, its existence is doubted by Sir Astley 
Cooper, South, Erichsen, and others. Mr. South pay^ th^re is no 
aoch specimen in any of the museums in London. Dr. Mott has 
said to me, also, that he has never seen a specimen, and that in the 
normal state of the bone he regards its occurrence as utterly im- 
possible. Such, I confess, is my own conviction. If, however, it 
is intended, in speaking of fractures of the " neck of the scapula,'' 
to refer only to fractures extending through the semilunar notch, 
behind the root of the coracoid process, and this ought to be re- 
garded as the only appropriate use pf the term, then its existence 
js certain, yet the fracture is pot pommon, Duverney has reported 
one case, the condition of which he proved, by ^n autopsy. The 
coracoid process was broken at the same time, but the fracture 
through the neck of the scapula was distinct from this.^ 

I am told, also, that Dr. Mott has in his possession a scapula 

> Tnil^ d#i Ffftctnrefi, etc., par J. Fr ^aXsfi^^^ Torn* i. p. §1^ 



84 REPOKT ON 

which appears to have been broken through its neck, and behind 
the root of the coraooid process, and which has united with very 
little displacement. 

Mr. Fergusson has given in his book a picture representing a 
fracture through both of the lines which we have described, but 
it is a mere " fancy sketch," and ought never to have been per- 
mitted to disfigure so excellent a treatise. 

Examples of fracture of the acromion process have been report- 
ed by Duverney, Bichat, Avrard, A. Cooper, Desault, Sanson, Nfla- 
ton, Malgaigne, Brainard,* and others. 

In the case mentioned by Cooper, it entered the articulation of 
the clavicle, and produced, at the same moment, a dislocation. 
Malgaigne says it occurs generally further up, and beyond the 
articulation, " near the junction of the cUaphysis with the epiphysis.^ 
" It generally breaks at right angles and vertically," but in N^laton's 
case it was oblique. 

There is some reason to believe, I think, that a true fracture of 
the acromion process is much more rare than surgeons have sup- 
posed, and that in a considerable number of the cases reported 
there was merely a separation of the epiphysis ; the bony union 
having never been completed. If such fractures or separations 
occurred in children, very little doubt could exist as to the nature 
of the accident generally, but the specimens found in museums, and 
the cases reported in the books have been mostly from adults. It 
is more difficult, therefore, to suppose these to be examples of sepa- 
rations of epiphyses, but I am inclined to think that in a majority 
of instances such is the fact. It is very probable, also, that in the 
case of many of the specimens found in the museums, the history 
of which is unknown, they were united by only cartilage until, in 
the process of boiling or maceration, the epiphysis became sepa- 
rated ; and being found in this condition; they have been mistaken 
for fractures. 

This supposition may explain the almost constant absence of dis- 
placement, and of ensheathing callus (except a narrow crest men- 
tioned by Malgaigne, the character of which must be doubtfuL 
Indeed, it seems to me more like the crest upon which a fibro-Iiga- 
mentous capsule or periosteum has been attached). 

In order to a better understanding of certain peculiarities of this 
fracture I shall quote from Malgaigne, who speaks more at length 

' Gaae of inppoBed fracture ; and piosecation of the surgeon for aUeged mil- 
pnujtioe.— Bofl. Med. Jaum., vol. Txxi. p. 501. AIbo, Illinoi$ MetL Jbiim., 1846. 



DEF0BMITIS8 AFTEB FBACTUBES. 86 

upon this subject than any other writer known to me; but to whom 
the probability of a disjunction of an epiphysis being mistaken for 
a fracture, does not seem to have occurred. 

"The prognosis given by authors is very contradictory. Heister 
and Boyer regard it as impossible to obtain an exact union, and 
without deformity ; but while the first believes that the elevation 
of the arm will always remain constrained, the second teaches 
that a slight deformity does not in any degree compromit the 
movements and the strength of the member" (p. 509). " And, in 
fact, with Desault^s patient, all constraint had disappeared at the 48th 
day. M. Sanson has even obtained a cure as complete in 80 days, 
in a case more difiScult; the acromion having been divided by a 
sabre-cut" (p. 509). 

" A. Cooper has noticed another danger ; bony callus, according 
to him, is rare in these fractures, and there results generally a false 
joint (pseudo-arthrose). He reports a case of this kind. MM. N^la- 
ton and Avrard have each seen another, and the bony callus is 
equally wanting in the pieces represented in vol. iv., Figs. 1, 2, and 
4, and upon another piece, in the Dupuytren Museum. Perhaps in 
these different cases we ought to accuse generally the bad compli- 
cations, or the indocility of the patients ; in fact, in the observation 
of Bichat, the consolidation was completed on the 82d day. One 
of the patients of M. Avrard having thrown off the bandages on 
the 10th day, recovered with a complete union. I have myself 
seen an example in which it was impossible by the touch to dis- 
cover the place of the fracture. I think that we ought to establish 
a distinction between fractures without displacement and almost 
without rupture of the periosteum, and those which are not thus 
conditioned ; yet even here the treatment employed, and the docility 
of the patient, no doubt, do much towards the result. 

" When bony callus is not formed, A. Cooper says that the frag- 
ments unite by a fibrous tissue. I have verified this mode of union 
upon the pieces represented in Figs. 1 and 2 ; but upon that repre- 
sented in Fig. 4, the fractured surfaces appear eburnated, as if they 
had rubbed one against the other, and I readily incline to believe 
that there had existed here a joint. 

" However this may be, it has happened to me to notice on all 
the pieces that I have seen, that the superior borders of the fracture 
are surmounted with little bony crests, of a recent formation, and 
of which the largest part pertains to the scapular fragment (see es- 
pecially Fig. 4), as if the work of ossification was more active on 



8^ RBPOBT ON 

this side, and the detached extremity of ihe acromion possessed a 
less degree of vitality. But another specimen in the Dupnytren 
Museum presents a strange phenomenon, which obliges us to modify 
this conclusion^ 

" The external fragment has a diameter almost double that of the 
other, so that while the upper surface is level, the lower surface 
projects considerably ; and it has thus led the person who made the 
catalogue into the error of supposing that the fragments were over- 
lapped. It is, however, a hypertrophy of the detached fragment, 
a phenomenon which has not, to my knowledge, been heretofore 
noticed, and which we shall again meet with in other fracturea" 
{Traiti des Practwrea et des LuxcUionSj tom. i. pp. 509-10.) 

Of the nine specimens reported to me, only one specimen seems 
to have been beyond doubt a fracture. The first six are pretty 
certainly only separations of the epiphyses. Of the specimens 1 
and 2, belonging to the Wistar and Horner Museum, Dr. Henry E 
Smith remarks, that they were found in the dissecting-room, and in 
hia opinion such specimens are not rare, and that they "are rather 
separations of the epiphyses than fractures, yet the surfaces of each 
portion are closed by compact bony tissue." 

Dr. J. B. S. Jackson, of Boston, to whom I am indebted for much 
valuable information pertaining both to the Museum of the Maps. 
Med. Col. and to the museum of the ^' Soc. for Med. Improvement," 
alluding to the specimens Nos. 8, 4, 6, and 6, speaks as follow?:— 
" Of fractures of the acromion process we have, I believe, none; 
but we have four specimens that might be well mistaken for this 
accident, and in regard to which I have a few words to say. 

" The acromion process ossifies in two pieces, which subsequently 
unite, and fitwdly co-ossify with the bone itself. Now, three of the 
specimens referred to, show, I believe, a non-union of this process. 
The fourth specimen^ which was the fifth in order that was met 
with, was found among some loose bones at the Med. College, and 
was at firdt thought to be a ease of old fracture united by bone; 
from the oii^cunistance, however, of the incomplete union of the 
epiphysis at the loWer angle and along the base of the bone, I was 
subsequently led to think that the union of the acromial epiphysis 
ite it may be called, might have recently occurred ; the bony union 
was strong and complete, but the line of divi£iion between the epi- 
physis and the bone itself, was quite marked. Not long after this 
scapula was found, there was found a second at the College (No. 5), 
and I think not far from the first ; and it was evidently its mate^ 



DBFOBMITI]a& AFTXB FBACTUBSS. 87 

jtidging from the sizd, form, color, and degree of ossifioation. The 
acfomion pfrocesB, however, was in this speoimen wanting. I pre- 
somed that it was not Mly oefisified, and, being ntfnnited, was sepa- 
ifated and lost W&en the bones were macerated. I should say that 
in the mnsenm of our Medical College are several collections of 
bones, from as many different subjects apparently, and it would not 
therefore be unreasonable to regard these two scapulas as mates. 
Last winter, t)r. Hodg^ our demonstrator, found in a dissecting- 
room subject, a^d one that he thinks must have been at least forty 
years old, the acromial process of each scapula fully formed^ but 
having no bony umon whatever with the bone itself. The union 
was ligamentous but strong and dose, yet Dr. H. thinks that in 
one of the q)eGknens there was almost a synovial cavity. I am not 
aware that this non-union of the acromial process in the adult sub- 
ject has ever been described, though I should think that it must 
kove been. It is obvious, however, that such a mistake as has been 
above referred to might very well be made." 

Mr. Lizai^ has vsmai^ked that '^in some individuals the acromial 
proceiBS eontinues an epiphysis during life," and Mr. Fergusson says 
^ the aeromiott may be broken, but the accident is of rare occur- 
rence." *♦♦**! have dissected a number of examples of appa- 
rent fracture of the end of this process; but in such instances it is 
doubtful if the mbvabk portion had ever been fii:ed to the rest of 
tbe bone*" 

In addition to flie specimens which X have iQready mentioned, of 
epiphyseal disjunctions, it has occurred to me to see the same in 
a number of instances, and in nearly every instance I have noticed 
iSie existence of a more ot less compact tissue' between the adjacent 
murfkoes, and of a sKgbS rising along the marginf^ of the fragments. 

I mn surprised that Mr. LLsars should have never seen a 
eafie, nor h&iad of a well authenticated example of fracture of the 
ooiaooid proceaal ^' The eoracoid process," he remarks, ^ is said to 
be broken o£^ be^ iMi I qtvestion- very mi^^b ; it must be along 
with ibe gleifoid davity, or' tiiere must be fractute of the neck of 
die scapula."' 

Three ci the ^>emmetLS;if^dOtded by me are fractures of the eora- 
coid process^ simply, and in only one case is the glenoid cavity at 
all implicated; nor even here is there a fracture of the ''neck of 
the scapula," nor is the " glenoid cavity" borne along with the pro- 

> Sp^^m of iMoUoal' Surgery, by John Unas. Edinburgh, 1847, p. 132. 



88 KKPORT ON 

cess. One example occurred in the practice of Mr. Arnott, at the 
Middlesex Hospital, London ; in consequence of which the patient 
died, and an autopsy disclosed the true nature of the accident^ 
Mr. South has reported, also, in the Land. MeoL-Chir. Bev.^ for 
1840,' a case complicated with partial forward dislocation of the 
humerus, fracture of the clavicle, acromion process, and of the 
olecranon process. The patient died on the fourth day, and Mr. 
South has published the result of the autopsy. He confesses 
frankly, also, that neither the fracture of the clavicle, nor of the 
coracoid process was discovered before death. Erichsen says there 
is in the museum of the University College, a preparation showing 
a fracture of the base of this process, implicating and extending 
across (not behind) the glenoid cavity.' Duvemey examined after 
death a patient who had a fracture of this process, and also a firac- 
ture of the neck of the scapula.* Boyer also examined one after 
death, and Malgaigne has seen two, of one of which he furnishes a 
drawing.* 

In addition to these actual specimens, several cases have been re- 
ported by gentlemen of unquestioned authority. The accident is 
certainly not common, and in a majority of instances where it is 
known to have occurred, the concomitant injuries have been so 
great that the patients have died. 

In specimens 1 and 2, belonging respectively to Drs. Neill and 
Gibson, the fragments are suspended by a ligament, and in specimen 
4, belonging to the Mass. Med. Col. Museum, and reported to me 
by Dr. Jackson, the process, broken at its base, had evidently 
united by bone. 

Of the treatment of fractures of the coracoid, or of the acroniion 
process, I have only one general observation to make. It is very 
obvious that in neither of these fractures can anything be accom- 
plished by splints, and probably quite as little by position. All 
that the surgeon can do is to enjoin rest, and, if necessary, to en- 
force it by suitable bandages, and to control inflammation. 

If the neck of the scapula is broken, whether the fracture be 
simple or comminuted, the rational indication seems to be to place 
a moderate compress in the axilla, and having disposed the arm in 
a sling, to secure the elbow snugly against the side of the body. 

' Fergnsson's Surg., p. 213. 

■ Vol. xxxii. New Seriea, pp. 41 and 2. 

* Science and Art of Surgeiy, bj John BriohBen, p. 207. 

« Traits des Fractmes, etc., p. 612. • Ibid., 512. 



DEFOBKITIES AFTER FRACTITBES 89 



CHAPTER VII. 

HUMERUS. 

Upper Third. 
SqparcUion of Epiphysis. 

Case 1. Separation of upper epiphysis. Nan-union. 

Mike Bovin, son of Peter B., cor. Washington and Tapper Sts., 
Buffalo, bbL IS months, fell sideways from a cradle, about the 20th 
of Nov. 1855, striking upon his left shoulder. 

He was taken to a German empiric, who called it a sprain, and 
applied liniments. Three weeks after the accident he was brought 
to me, and I found the arm hanging beside the body, with little or 
no power, on the part of the little patient, to move it. There was 
a slight depression under the acromion process, and considerable 
tenderness about the joint. The shoulder was not swollen, nor had 
it been at any time. 

On moving the elbow backwards and forwards, the upper end of 
the lower fragment moved in the opposite directions with great 
freedom, and accompanied with a slight sound, a sound not like 
the grating of broken fragments, but less rough. The freedom of 
motion was such between the fragments, that it would almost lead 
one to suppose that it was the head of the bone playing backwards 
and forwards in an elongated capsule. There was no overlapping or 
tendency to displacement. Bringing the elbow a little forward, 
tiecured apparently, complete coaptation of the fragments, and of 
this I judged by the restoration of the line of the bone towards the 
socket, and by the disappearance of the depression under the pro- 
cess, for the head of the bone could not at any time be felt. 

Five months after the injury was received, the fragments had not 
united, and the child was still unable to lift the arm, although the 
forearm and hand retained their usual strength and freedom of mo- 
tions. The same crepitus could occasionally be detected in the 
shoulder-joint) and the same preternatural mobility. The shoulder 
was neither swollen nor tender. 

VOL. IX.— 7 



90 REPOBT ON 



Surgical Neck, 

Case 2. Simple frdcture; never displaced. Union without deform- 
ity^ and treated without apparatus, 

Brisbane, of Batavia, »t. 65. Mr. B. fell through the trap-door 
of the Eagle Street Theatre, striking upon the axilla of the right 
arm. 

Dr. Sprague, of Buffalo, was called, and after examination pro- 
nounced it a fracture of the surgical neck of the humerus. At Dr. 
Sprague's request, I examined it, also, within an hour after the acci- 
dent. Crepitus was easily discovered, "which, with motion at the 
seat of fracture, seemed to render the diagnosis certain. There was, 
however, no perceptible displacement. We concurred entirely as 
to the nature of the accident, and dressed the arm with splints, 
rollers, &c. We subsequently learned that all dressings were re- 
moved at the end of the first week, and that they were not reap- 
plied, his family physician believing that the bone was not broken. 
No deformity ensued. 

The examination made by Dr. S. and myself at the time of the 
accident, was careful and satisfactory, and we have seen nothing in 
the result to change our convictions. 

Casb 3. Simple /racture ; never displaced. Union without de- 
formity, 

Alexander Balentine, set. 62 ; admitted to the hospital, Dec 19, 
1851. He had fallen upon the sidewalk, striking upon his right 
arm. Dr. Johnson, of Buffalo, had reduced the fracture, and ap- 
plied appropriate dressings. No union of the fragments had yet 
occurred, but as the surfaces were in apposition, it was only after 
considerable manipulation, and not until we bent the forearm 
upon the arm, and rotated the humerus by means of the forearm, 
that the crepitus becjame distinct, and gave unequivocal evidence 
of the existence of a fracture, and of its situation. 

The treatment, aft^r admission, consisted in the application of 
one gutta-percha splint, accurately moulded, and extending from 
above the shoulder to below the elbow, and encircling one-half of 
the circumference of the arm. The splint being secured with the 
usual bandages, &c. 

The result is a perfect limb. 



DEFORMITIES AFTEB FRACTURES. 91 

Cass 4. Simph fracture. Union tmth dtsplacemerU and deformity. 

White, of Bafialo, sdt. 12, fell 14 feet, striking on the front and 
ovteide of the left shoulder. Dr. P., of Erie Co., saw the lad with- 
in three hours (July 19th, 1858). He was brought to me on the 
4th daj after the accident The upper part of the arm was then 
very much swollen. I found the arm dressed as for a fracture of 
the middle or lower third of the humerus. It was shortened one 
inch. The elbow was inclined backwards, and there was a remark- 
able projection in front of the joint, feeling like the head of the 
bone. The hand and arm were powerless. I suspected a disloca- 
tion of the head of the humerus forwards; and having administered 
chloroform, I attempted its reduction with my heel in the axilla. 
While making extension I. felt a sudden sensation, like the slipping 
of the bone into its socket, but on examination I found the projec- 
tion continued as before. I then repeated the eflFort, and with pre- 
cisely the same result. 

I now applied an arm sling, and directed leeches and cold evapo- 
rating lotions. 

On the 26th, five days after the accident, it was examined by 
Drs. Mixer, McGregor, Joseph Smith, with myself. We still be- 
lieved it was a dislocation, and having administered chloroform, we 
again attempted its reduction. The same slipping sensation was 
produced as before, and the deformity was repeatedly made to dis- 
appear; but on suspending the extension, it as often reappeared. 

The character of the accident was now made apparent, and we 
proceeded at once to apply the splint and bandages suitable for a 
fracture of the surgical neck of the humerus, namely, a gutta-per- 
cha splint, extending on the outside, from the top of the shoulder 
to below the elbow, with an arm and body roller, secured with 
flour paste. 

On the 81st, twelve days after the accident, Dr. Wilcox, marine 
surgeon at Bufifalo, saw the arm with me. The fragments were 
displaced, the same as when I first saw it, and the same as when no 
apparatus was applied. We examined it again carefully and at- 
tempted to make the firagments remain in place, but we were unable 
to do so, except while holding them, and making extension. 

August 9th (21st day), Dr. Bowen, Pro£ of Anat. in Geneva 
Medical College, being present, I removed all the dressings. Motion 
between the firagments had ceased, but the projection and shorten- 
ing remained as before ; now, also, the irregular projections of the 
fractured bones were more distinctly felt 



92 BSPORT ON 

The dressings were never reapplied. Three months later no change 
had occurred. He could carry the elbow forwards freely, as well 
as backwards, the motions of the shoulder-joint being unimpaired. 

Cabs 5. Simple fracturej with displacement; resulting m defiyrm- 
ity and non-union. 

L. Brown, of Lockport, set. 43, was thrown from his horse in 
Feb. 1854, striking upon his right elbow. 

Dr. Maxwell, an experienced surgeon of Lockport, examined and 
dressed the fracture. Dr. Fasset was present^ and assisted at a sub- 
sequent dressing. Three surgeons who examined the arm before 
Dr. M., called it a dislocation. 

Twelve weeks after, the accident, Mr. B. called upon me. The 
right arm was shortened one inch; the elbow hung slightly from 
the body ; the upper end of the lower fragment was distinctly felt 
in front of the shoulder-joint under the clavicle, feeling very much 
like the head of the bone. The fragments were not united, but 
they could be seized easily, and made to move separately and 
freely. He stated to me that he was subject to rheumatism, and 
especially in the shoulder and arm of the side injured. He wished 
to know whether it could not be " re-set." 

Two years after, I was informed by Dr. Maxwell that the bone 
was still ununited. He was, however, able to write with that hand, 
having first lifted this arm with the other hand, and laid it upon 
the table. , He say^ the upper end of the lower fragment is in the 
axilla. 

Case 6. Simple fracture; probably impacted; resulting in drformity. 

Wm. Adams, of BuflFalo, set. 15, fell backwards, June 4, 1855, 
striking on his back and left shoulder. Dr. L. saw it immediately, 
and regarding it as a didocation, attempted its reduction. He sub- 
sequently repeated the attempt. I saw the patient, with Dr. L., on 
the 10th day. The arm was shortened one inch and a hal£ The 
fragments were displaced forwards, and prominent in front o^ and 
a Uttle below the joint. As in Case No. 4, it might easily be mis- 
taken for the head of the bone ; but the difficulty of diagnosis had 
been very much lessened by the subsidence of the swelling. There 
was no motion between the fragments ; nor could the deformity by 
any manipulation, or extension, be made to disappear. It was pro- 
bably impacted. 

March 23, 1856, nearly ten months after the accident, I found the 



PBFORMITIKS AFTER FRACTUBES. 93 

fragments remaining as when I first esamined it, and the arm 
shortened one and a half inches. The elbow hung a very little 
back from the line of the body. The upper end of the lower frag- 
ment was lifted to within one inch of the head of the humerus ; the 
upper fragment having its head in the socket, with its lower end 
directed forwards and downwards. The arm was, however, in every 
respect as useful as before it was broken. It was equally strong, 
and he could raise his arm as high, and move it in every direction 
as freely as he could the other. 

Cask 7. Supposed dislocation of the right humerus forwards^ with a 
fracture of the same hone at its surgical neck; also a. dislocation of the 
thumb and middle finger of the same arm^ toith a dislocation of the oppo- 
site shoulder. Union of the fracture unthout deformity. (See Transac- 
tions of their. T. State Med. Society, 1856, p. 44.) 

Michael Crichton, of BuflFalo, »t. 80. A laborer. These injuries, 
with several lesser injuries, were received in consequence of being 
caught in the machinery of an elevator. All of them, except the 
dislocation of the right arm, were treated by Dr. Sprague, before 
admission to the hospital. The patient having already suffered con- 
siderably, in the reduction of the dislocations and in the dressing of 
wounds, and being much exhausted, the treatment of the shoulder 
and arm was referred to me, by a note from Dr. Sprague, with a 
suggestion to defer this until after the patient should have become 
rested. I saw Crichton in his ward on the next day after the acci- 
dent, and found a fracture of the left humerus through its surgical 
neck. Of this no doubt existed, for the ends could be made to 
crepitate, and also to bend freely upon each other. I discovered, 
also, the head of the bone in the axilla, and supposed it was dislo- 
cated in that direction. The swelling was considerable, and only 
temporary dressings were applied. On the 28th, seven days after 
the accident, I consulted with Dr. White, and we concurred in the 
above diagnosis. On the 29th I consulted with Dr. Sprague, and 
we also being agreed in opinion, I proceeded with Jarvis^s adjuster 
to attempt a reduction of the dislocation. The patient was advised 
that we should probably not succeed. The extension was contintied 
nearly 80 minutes, and no change in the position of the bone was 
eflfected. It must be remembered that the fracture of the humerus 
was at a point so near the joint that it was impossible to seize upon 
the upper fragment, and we only hoped to succeed in the reduction 
through the aid of such soft attachments as might continue to exist 



94 REPOBT ON 

between the upper and lower fragments, and by pushing on the 
head of the bone as it lay in the axilla. Renouncing at length all 
expectation of ever reducing the dislocation, we adjusted the frac- 
ture of the humerus, and applied the usual lateral splints and roller, 
placing a moderate pad in the axilla, and then securing the arm 
tightly to the body. 

The patient was too iU to leave his "bed, and was laid on his back, 
with his left forearm across his chest. The same dressings were 
continued, with only occasional removals for the purpose of exam- 
ining the fracture, until the 1st of January, 1850, nearly six weeks, 
when the bandage and splints were finally laid oflF. The fracture 
was then united. I now discovered, also, that the head of the 
humerus was exactly in place, and so it has remained ever since. 

The motions of this shoulder are as extensive and free as before 
the injury, and much more so than the motions of the right shoulder. 
There is no depression under the acromion, or fulness in the axilla. 
In short the shoulder is perfect. Possibly what we supposed a dis- 
location, was a fracture of the neck of the scapula, allowing the head 
of the humerus with a portion of the scapula to fall into the axilla; 
and, if so, we must assume that by means of the axillary pad, and 
the band securing the arm to the body, the reduction was effected 
without our knowledge or intention. If this explanation is not 
adopted, we must believe either that the head of the dislocated bone 
xesumed its place in consequence of our manipulations, and without 
our knowledge, or through the subsequent pressure of the axillary 
pad ; or that Drs. Sprague, White, and myself with others, were 
altogether in error in supposing that the head of the bone was ever 
in the axilla. Which of these several suppositions is the most pro- 
bable, I shall not attempt to determine. 

Case 8. Simple fracture^ comj^licaied with fracture of the forearm in 
its lower third. Result perfect. (See Fracture of the Forearm, Case 31.) 

Matthew Eigany, set. 23. • Admitted to the hospital May 7, 1849. 
The accident had occurred on the 3d, by having had his arm caught 
in the crank of a hand-car, when the car was under full motion. 

A broad gutta-percha splint was applied to the palmar surface of 
the forearm and hand, and a broad splint to the dorsal surface of 
the forearm, and smaller splints were laid around the humerus ; the 
whole being secured by a roller. 

On the 6th of June, a starch bandage was substituted, the swell- 
ing having sufficiently subsided. On the 16th this was removed. 



DEF0BMITIE3 AFTEB FBACTUBES. 95 

and the patient dismissed, cured. There was no shortening of either 
the arm or forearm ; but the arm was very slightly bent at the seat 
of the fracture. 

Below Surgical Neck ( Upper Third), 

Case 9. FragiUtas osnum. Simple fracturey occurring at several 
dates. Union unthout displacement. 

The following account of this interesting case was furnished by 
Dr. Mixer, of Bufialo, who was the attending surgeon. I was per- 
mitted, however, myself to see the patient at different times, and to 
examine the arm. 

"I was first called on the 21st of January, 1851, to see John 
Thomas, a native of Wales, Eng., set. 54; a tailor by trade; light 
complexion and light hair; who had an hour before broken his 
right humerus at about the union of the upper and middle thirds. 
It had occurred while raising about 14 lbs. of clothing to a shelf as 
high as his head, and seemed at the time as though he had received 
a severe blow on his arm. 

" I found the fracture quite transverse, a ' pipe-stem' fracture. 
There was but little swelling or pain. After a few days I applied 
the starch bandage or roller, and union took place as promptly as 
in ordinary fractures, notwithstanding the seeming want of vitality 
in the bone. As a ihatter of precaution, I advised him to keep a 
part of the splint bandaged to the arm for one or two months. 
Again I was called to see Mr. T. June 11, 1852, and found he had 
fractured his left arm at about one-third the distance from the 
elbow, while taking down the shutters to his store. This was also 
transverse, or nearly so. I again applied the paste splints, and in 
due time he was well. In this, as in the first fracture, very little 
inflammation supervened. 

"Again, on the 15th of November, 1853, Mr. Thomas called at 
my oflSce to say that his arm had troubled him for two or three 
months, and that he was obliged to raise it with the other hand on 
the cutting table, yet that he found but little difficulty in cutting 
clothes all day, although it was not as strong as the other arm. On 
examining it I found the bone broken near the centre of the right 
arm, and so very flexible that I could bend it at an angle of from 
ten to twenty degrees. Here I expected great difficulty in effecting 
a union of the bones, as they had been in that condition two or 
three months ; and I so expressed myself to him. I immediately 




96 BEPOBT ON 

applied the same dressing as before, and union was effected in 
nearly the same length of time as before. I then had prepared a 
permanent paste splint, and recommended him to wear it constantly. 

" Soon after that, Mr. T. went into the country to reside, and I 
did not see him again until November 30, 1854, when he called to 
have me apply the splint to his left arm, as it had troubled him of 
late. 

"On examination, I did not detect any fracture; still the bone 
seemed quite sensitive, and he had the same rheumatic pains which 
had preceded all the other fractures, for two or three weeks. I 
applied the dressings, and have not seen him since, but have re- 
cently learned from his daughter, who resides in the city, that her 
father died of dysentery in October last." (1855.) 

Case 10. Simple ; slightly oblique fracture. Union perfect 

B. Franklin McCall, of Buffido, aet. 11. I dressed the fracture 

with four lateral splints. At the end of eight weeks it was perfectly 

united, and without deformity. 

Case 11. Simple oblique fracture. Union without shortening or 
deformity. 

James Cronin, of Buffalo, set. 80, very intemperate. He had bis 
left arm broken September 29, 1853, by a log which rolled upon 
him. The fracture was simple and oblique, and situated just in or 
above the insertion of the deltoid. It was dressed by Dr. Nott, of 
Buffalo, and on the third day Dr. Nott sent him to the hospital. 

On the night after his admission, in a fit of delirium tremens, he 
removed all the dressings, and on the following morning his arm 
was much swollen. The fragments were displaced, and the muscles 
were contracting violently. Having reduced the fragments as well 
as possible, I applied two broad and long splints of binder's board, 
securing them with rollers covered with flour paste. Notwith- 
standing the use of opium in full doses, he continued delirious, and 
on the fifth day of the fracture (October 4th), I found everything 
loose about the arm. I therefore again removed all the dressings. 
We now determined to make an attempt to accomplish permanent 
extension and counter-extension. For this purpose we lifted the 
elbow upwards and outwards to relax the deltoid, and then having 
made extension, we fitted carefully a large gutta-percha splint to 
the forearm and axilla^ in such a manner as that when the splint 
was secured to these several parts the arm could not fisdl to thaside 



i 



DEFORMITIES AFTER FRACTURES. 97 

of tbe body, and in proportion as it did fall downwards it would 
make extension npon the arm. This splint was well padded and 
secured with rollers. A pillow was also tied under the arm. 

(M. 6. The dressings remain in place and seem to accomplish 
everything we could desire. 

9^. He is still delirious at intervals. Dressings all loose, and 
have been for three days, requiring constant readjustment. We 
removed them and applied three lateral splints with a cushion in 
the axilla, and bandaged the whole snugly to the body. Forearm 
in a sling. 

19th, (20th day since fracture.) Removed dressings. Frag- 
ments not united. Applied paste bandage, &;c. 

Nov, 6. (38 days.) Removed dressings. Fragments united. No 
ensheathing callus ; no overlapping ; no deformity. This result is 
to me very unexpected and almost inexplicable. 

Case 12. Simple fracture and urdun delayed five months. Result 
fkoarly perfect. 

Henry Angles, of Tonawanda, »t. 88, broke left humerus ob- 
liquely, in upper third, by a fall from a hay rack, striking upon his 
elbow. 

Dr. F. Hoyer, of Tonawanda, dressed the arm on the same day, 
with two lateral board splints well padded and sufficiently long. 
Forearm placed in a sling. Dr. H. saw and examined the arm once 
or twice a week during the time of treatment. The dressings were 
first removed about the ninth day. The treatment was continued 
five or six weeks. Finding at tUs time that there was no union. 
Dr. H. removed the dressings entirely, and directed him to use his 
arm fi*eely. After about one week the splints were again applied 
in the same manner. Soon after. Dr. H. again removed the dress- 
ings, and they were not reapplied until about the 7th of October, 
1851. 

I saw Angles October 4, 1851, about four months after the acci- 
dent. The fragments had not then united, and were overlapped 
about half an inch. 

Within three weeks probably from this time union was tolerably 
firoL Nearly five months elapsed from the time of fracture to the 
date of itr complete consolidation. The shortening remained as 
when I saw it. He gradually regained the perfect use of his limb. 

The habits of this man were rather intemperate, and he had 
iotevnittent fever only a short time before the accident occurred. 



98 BEPOBT ON 

To these causes mainly the delay in union ought to be aj9cribed. 
Mr. Angles died about one year since. 

Case 13. Simple fracture complicated with abscess and tetanus. 
BesuUing in death. 

Samuel J. Mills, of Buffalo, 8Bt. 85 ; very muscular ; was cruslied 
under an enormous mass of iron, breaking his right arm just above 
the insertion of the deltoid. Dr. Mixer and myself in attendance. 
We could not at first discover crepitus. The muscles contracted 
with great force when the arm was moved, and swelling came on 
rapidly. 

We made as much extension as the patient would bear, and then 
applied three well padded lateral splints and secured them with a 
roller. The hand and the forearm were also covered with rollers. 

The left thigh was at the same time severely lacerated, and soon 
became very painful, especially along the course of the anterior 
crural nerve. 

On the seventh day I dressed the arm with gutta-percha splints, 
and paste rollers. On about the twelfth day, an irritative fever 
supervened with tetanic symptoms, and on the twenty-second day 
he died. In the. mean while abscesses had formed around the seat 
of the fracture and in the thigh; from the latter of which pus was 
copiously discharged for many days before his death. 

The autopsy showed both of the abscesses to be large ; and in 
relation to the femoral abscess, and the condition of the parts ad- 
jacent. Dr. Hunt, who conducted the autopsy, says : " Its entire 
length was about six inches. The internal saphenous vein was 
nearly obliterated by a deposit of lymph. The sheath of the femo- 
ral vessels was not ruptured; but upon laying it open the femoral 
vein was seen somewhat thickened, the artery round and elastic. 
Opposite the points of injury, the inner and naiddle coats of the 
artery were ruptured, leaving a ragged and lacerated opening. 
Below this the artery was imperforate. There was no clot, or other 
appearance of aneurism. The condition of the anterior crural and 
internal saphenous nerves was not noticed, though they were 
involved in the injury." 

And of the condition of the arm he adds : " The fracture was at 
the upper part of the insertion of the deltoid muscle. It was an 
oblique fracture, and a portion of the insertion of the deltoid was 
attached to the upper fragment ; but the greater part, to the lower 
fragment of the bone. The muscle itself was torn asunder in the 



DEFORMITIES AFTER FRACTURES. 99 

direction of its fibres, by the separation of the fragments. The 
upper portion rested its broken extremity against the skin of the 
anterior surface of the arm. 

" The lower fragment was carried npwards and outwards by its 
portion of the deltoid ; it was sharp and pointed, and the muscle 
closely embraced it I then detached the deltoid from its insertions, 
and reflected it. Its inner surface was smooth, without any mark 
of abrasion from the sharpened end of the bone. The cavity of the 
abscess was now exposed. This cavity, filled with pus, separated 
the deltoid from its relations with the shoulder-joint ; leaving the 
circumflex artery and nerve projected across the cavity of the 
abscess, unsupported by surrounding tissues. From the neck of 
the humerus downward, the cavity involved the ends of each frag- 
ment of the bone ; at the point of fracture, denuding the perios- 
teum. Thence it extended downward nearly to the elbow-joint, 
burrowing along between the brachialis anticus and the biceps 
muscles." 

Middle Third. 

Case 14. Fragilitas ossium. Simple fractvre {occurring ai seve- 
ral dates). HesuU perfect. 
John Thomas, »t 56. (See Case 9.) 

Case 15. Simple fracture. Union without drformily. 

E. F., aet 18, broke his left humerus in its middle third. Simple 
fracture. Dr. Stinberg, of Palentine, N. Y., dressed the arm. Twenty- 
five years afterwards, when I examined the arm, there was no evi- 
dence that a fracture had ever existed. 

Case 16. Simple fracture, occurring during hhor. Union mth* 
out d/formity. 

Catharine McKinney, of BufEilo, was bom June 8, 1855. The 
mother was in labor six or eight hours. Labor not severe. She 
does not know whether the midwife used violence or not. 

The child was wrapped up and not examined or washed until 
the third day, when the mother discovered that the left arm 
was broken completely, so that it moved as freely as the elbow- 
joint Dr. J. T. Lockwood, of Buffalo, was called, and applied 
lateral splints and bandages. On the seventeenth day after the 
birth of the child, Dr. Lockwood requested me to see it with him. 



100 KBPOBT ON 

The seat of fracture, the lower end of the middle third, waa then 
surrounded with a perfect ferule of ensheathing callus, which, 
owing to the softness of the flesh, could be very easily felt and de- 
fined. The fragments were united and in place. Dr. Lockwood 
said he found them firm on the 14th day. We reapplied a splint 
made of gutta percha. 

April 1, 1866. I examined the arm. The seat of firacture could 
not be felt, there being no overlapping or remains of ensheathing 
callus. The* arm is in every respect like the other. 

Cask 17. Fracture resulting from secondary lues. Perfect union. 

A. A., aged 45, had chancres two years since (1849). Has had 
no bubos or secondary symptoms until now. His gums are now 
spongy. Six months ago a pain commenced in the right humerus, 
and one month later, from a slight accident, the arm broke at the 
seat of pain. In four months it was united and perfect 

About four months since, the left humerus began to pain him in 
a similar manner, and he is apprehensive that it will break also. 

Cask 18. Simple fracture. Union with shortening. 

J. M. C, S9t. 6S, broke his right arm near its middle. It was 
dressed by a surgeon, in Mexico. Two years after the accident I 
saw him, in Auburn State Prison. The arm was shortened about 
one inch, and it was not as strong as before. 

Cask 19. Simple fracture. Shortened. 

Charles Clark, of Otisco, Onondaga Co., N. Y., aet. 88, broke his 
left humerus near the middle. Dr. Luther French, of Otisco, dress- 
ed the fracture with, splints, &c. The arm, after thirty years, is 
shortened half an inch, and a moderate displacement can be felt at 
the seat of the fracture. 

Cask 20. Simple fracture. Union with shortening. 

Sutter, of BuffiJo, »t. 18, broke his arm through nearly the mid- 
dle of the humerus. Dr. John A. Jeyte, of Bufialo, was called and 
treated the fracture. 

Five weeks after the accident, I measured the arm, and found it 
shortened half an inch. 

Cask 21. Simple fracture. Non-union of thefragmjenis. 

James Campbell, of Canada West, »t. 85, an employ^ on the 



DEPORMITIBS AFTER PEACTUBBS. 101 

BofiSsdo and Brantford Bailroad. His right arm was broken a little 
below its middle. Fracture simple. It was dressed by Dr. Jerron, 
a yery intelligent Canadian surgeon, at Brantford, 0. W. 

Five months after the fracture he called .upon me. I found the 
elbow fixed at right angles, with muscular anchylosis, and no union 
at the seat of fracture. 

He promised to return and place himself under my care, at the 
hospital, but he did not, and I have not learned the final result. 

Cass 22. Simple oblique fracture. Delayed union. Fracture 
made to unite after straightening the arm, <tc. 

Michael Mahar, laborer, aet. 85, broke his left humerus just below 
its middle, Dec. 14, 1858. The arm was dressed by a surgeon in 
Canada West, and who is well known to me as exceedingly "clever." 
After a few days from the time of the accident, "the starch band- 
age was put on as tight as it could be borne, and brought down on 
the forearm so as to confine the motions of the elbow-joint." 

Six weeks after the injury, Jan. 29, 1854, Mahar applied to me 
at the hospital. No union had occurred. The motion between 
the fragments was very free, so that they passed each other with an 
audible click. There was little or no swelling or soreness. In 
short, everything indicated that union was not likely to occur 
without operative interference. The elbow was completely anchy- 
losed. His health was unimpaired. 

I explained to my students what seemed to me to be th6 cause 
of the delayed union, and declared to them that I did not intend to 
attempt to re-establish adhesive action until I had straightened the 
arm. They had just witnessed the failure of a precisely similar 
case, in which I had made the attempt without straightening the 
arm, and without success. 

Feb. 6y 1854. I had succeeded in making the arm nearly straight. 
I now punctured the upper end of the lower fragment with a small 
steel instrument, and as well as I was able, thrust it between the 
fragments. Assisted by Dr. Boardman, I then applied a gutta 
percha splint from the top of the shoulder to the fingers, moulding 
it carefully to the whole of the back and sides of the limb, and se- 
curing it firmly with a paste roller. 

March 4. ^ot quite four weeks after the application of the 
splint) I opened the dressings for the second time, and carefully 
renewed them. A slight motion was yet perceptible between the 
fragments. 



102 BEPORT ON 

18ih. I opened tbe dressings for the third time, and found 
the union complete. This was within less than forty days. 

The patient was now dismissed. On the 29th of April following, 
the bone was refractured. Mahar had been assisting to load the 
" tender" to a locomotive. While the train was just getting in 
motion, he was hanging to the tender by his sound arm, when 
another laborer seized upon his broken arm to keep himself upon 
the car, and with a violent and sudden pull wrenched him from the 
tender, and reproduced the fracture. 

The next morning I applied the dressings as before, and did not 
remove it during three weeks ; at the end of this time the union 
was again complete. The splint was, however, reapplied, and has 
been continued to this time — a period of about six weeks. 

Case 23. Comminuted fracture. Union vnthout shortening. 
Peter McCarty, of BuflEalo. (See Fracture of Lower Third, Case 
32.) 

Above Base of Condyle {Lower Third), 

Case 24. Fragilitas ossium and simple fracture {occurring at 
several dates). Union unthout displacemerU, 
John Thomas, aet. 56. (See Case 9.) 

Case 25. Simple fracture. Union perfect. 

Emma Hollidge, of Buffalo, wt. 8, broke her right arm in Feb^ 
1852, two inches above the elbow. The fracture was dressed by 
Dr. Spragae, of Buffalo. Three months afterwards, Mr. Hollidge 
brought her to me to know whether the slight stiffness of tbe 
elbow which was remaining, did not indicate that it had been badly 
set. 

I discovered no other imperfection than the stiffness, and this I 
assured him would soon disappear. 

Case 26. Simple fracture. Perfect union, 

W. C, sdt, 4, broke his humerus through its lower third. It was 
dressed by a surgeon in Burlington, Vt. Twenty years after, I 
saw and examined the arm in the Auburn State Prison. The union 
was so perfect that the point of the fracture could not be discovered. 

Case 27. Simple fracture. Union nearly perfect. 

H. Copp, 8Bt. 18, had his arm broken, February 10th, 1864, by 



BSFOBHITISS AFTEB FRACTURES. 103 

the fall of a tree upon it. Dressed within an hour, by Dr. H., of 
Bofialo. 

Admitted to the hospital, Feb. 12, and dressed by myself with 
starch and pasteboard splints, on the 16th. 

March 10. Fragments united with very slight overlapping; per- 
haps one-quarter of an inch. Dressings continued. Dismissed. 

Case 28. Simple fracture. Result nearly perfect. 

Silas McNeal, of Orleans Co., »t. 82, broke his humerus through 
its lower third. Dr. Beecher, of Gaines, Orleans Co., dressed the 
arm. 

Fifteen years after the accident, I found the elbow a little stiff, so 
that he could not straighten it perfectly. In other respects the arm 
was as before the fracture. 

Case 29. Simple oblique fractwre. Result nearly perfect. 

James Gallon, »t. 40, of Albion, N. Y., fell from a wagon and 
struck upon his elbow, breaking the humerus obliquely, two and a 
half inches above the condyles. 

Dr. D. M. Hotaling, a very intelligent surgeon of Waterport, 
Orleans County, was called. Dr. H. applied three splints, carefully 
padded, which were renewed on the ninth day. The same splints 
were reapplied and continued in all forty days. 

At this time the elbow was stiff. The humerus united, but it 
was shortened half an inch, and slightly bent forwards at the seat 
of the fracture. His purpose in calling upon me was to know 
whether the elbow was not " spoiled," and whether he ought not to 
daim damages from the Dr. 

I could see no error in the treatment, and nothing unusual in the 
result, and so I informed him. The arm remained powerless about 
three months, and then gradually regained its wonted strength 
under the use of the cold douche. Four years after, he was work- 
ing as a tanner and currier, flexion and extension were nearly re- 
stored, and his arm was about as strong as before. 

Case 80. Simple fracture. Shortened; arm considerably weakened 
and wasted, 

A. G. EUwood, »t. 7, of Clinton, Oneida Co., N. Y. While wrest- 
ling, he fell vrith the weight of his body upon his left arm, breaking 
it at the upp^ end of the lower third. Dr. Gridley, of Clinton, 



r 

r 

r 



104 REPORT ON 

dressed the fracture, about three hours after, with splints and 
rollers. 

Fifteen years after the accident, the arm is shortened half an inch, 
slightly bent inwards at the seat of fracture. The arm is not as 
strong as the other, and it is considerably smaller. 

Case 31. Simple fracture. Union mih shortening. 

James Evans, sailor, set. 80, had his arm broken, Nov. 14, 1855, 
by the crank of a windlass, striking with great force against the 
front of his arm. The fracture was oblique, at the upper end of the 
lower third of the humerus. 

I found the humerus shortened one and a half inches. 

I reduced the fracture and applied a roller from the hand to the 
shoulder, and to the arm I applied three lateral splints made of 
binder's board. These I secured with several turns of a roller. 
The arm was then placed in a sling, a compress laid in the axilla, 
and the whole arm gently bound to the body. 

Dec. 5. The bandages are tightened by*a needle and thread. 

l^th. Dr. Samo, marine surgeon, removed the splints, but con- 
tinued the roller. The fragments were united, but overlapped one 
and a quarter inches. The superior fragment is in front of the 
inferior. 

Case 32. Comminuted fracture. Union withxmt displacement. 

Peter McCarty, of Bufl&Jo, aged about 30, fell, Oct. 8, 1855, into 
a ditch in the night, breaking his right arm at two points, one frac- 
ture being three inches above the elbow-joint, and one nine inches 
above. (See Fracture of Middle Third, Case 23 ) 

I saw and dressed the fractures thirty -eight hours after the acci- 
dent. Limb not much swollen. I applied a carefully padded, 
broad, and nicely moulded gutta-percha splint, which extended from 
the top of the shoulder to below the elbow, the forearm being 
placed in a sling at right angles with the arm. 

The fragments united in the usual time, and without shortening 
or deformity. 

Case 33. Compound fracture. Non-union. 

John Reynolds, of Hornelsville, »t. 30, broke his left arm, Aug. 
2, 1853, in jumping from the cars when they were moving at full 
speed. The fracture was at the upper end of thejower third, ob- 
lique and compound. There were two wounds near the lower end 



DEFOKMITIBS AFTER FRACTURES. 105 

of the humerus, through both of which a fragmetit protruded. Dr. 
Ward, of Hornelsville, first dressed the fracture with an angular 
splintw 

On the 5th of August, Dr. Van Curen, of Bath, took charge of 
the patient. Dr. V. found the arm very much swollen, and vesi- 
cated at several points. 

Dr. Van Curen applied also an angular splint, placing the fore- 
arm at right angles with the arm. 

This mode of dressing was continued six weeks, the wounds dis- 
charging all the time and being regularly dressed. No union 
having now taken place, Dr. Van Curen removed the angular 
splint, and applied three lateral splints to the arm. These were 
continued five or six weeks longer. The ends of the fragments 
were then rubbed violently together, and angular splints, made of 
binder's board, again snugly applied. 

Dee, 27. Reynolds came to the hospital, and, on the 81st, five 
months after the accident, I examined the arm, and found the frag- 
ments moving very freely upon each other and slightly overlapped. 
I made an incision to the bone at the outer margin of the biceps 
muscle, and, having thrust a small trocar, covered with its canula, 
between the ends of the fragments, I withdrew the trocar and left 
the canula in the wound; this I secured with a bandage. The 
house surgeon then applied a right-angled gutta-percha splint, care- 
fully moulded and padded. 

On the fifth day, the inflammation, swelling, and suppuration 
were such that I was obliged to remove the canula. On the four- 
teenth day, inflammation not having abated, we applied emollient 
poultices; and, on the fifteenth day, I opened an abscess in the arm. 

Jan. 18. The poultices were discontinued, and the patient was 
put upon generous diet and mineral tonics. 

22rf. I again punctured with a trocar the ends of the bones, and 
then applied splints, secured with bandages saturated with flour 
and the whites of eggs. 

On the Slst, the wounds were still discharging copiously. 

Feb, 12. Beynolds left the hospital. The bones were still un- 
united. 

Case 84. CompouncL, commirmted fracture^ complicated with dish- 
fxUian at the shouIder-joinL Union with deformity. Shortening and 
anchylosis. Dislocaiion unreduced 

John Phaley, fl3t, 25, broke his right arm, Sept. 15, 1852, at the 
VOL. IX.— 8 



106 BEPOBT ON 

upper end of the lower third, and also the left leg, in a railroad 
accident The fracture in the arm was comminuted. The right 
shoulder was also dislocated at the same time. He was seen first 
by Dr. Bogers, of Dunkirk; subsequently, on the second or third 
day, by Dr. Pratt, of BuflFalo. Twelve days after the fracture, I 
found him an inmate of the hospital. The arm was then much 
swollen, and powerless; the upper end of the lower fragment pro- 
jecting in front, and a sinus leading to the broken surfSnces. At the 
end of six weeks, he left the hospital. The fragments were then 
united, but the lower fragment lay in front of the upper. There 
was also a sinus at the seat of fracture, communicating with the 
fragment of dead bone. Forearm powerless and much swollen, and 
elbow anchylosed. Some months later, I removed a considerable 
fragment of bone, and the sinus closed. On the 8th of March, 
1853, about six months from the date of the accident, I discovered 
that the head of the right humerus was dislocated — a circumstance 
to which my attention had never been called before, and which 
neither Dr. Rogers nor Dr. Pratt had noticed. Two years after the 
accident, the head of the humerus could be felt and seen distinctly 
under the clavicle, having formed for itself a new socket. The del- 
toid was atrophied, and a marked depression existed under the 
acromion. Very little motion existed in the elbow-joint, which 
was bent at an obtuse angle. Motion in the new shoulder-joint was 
tolerably free, but accompanied with a grating sensation. His elbow 
hung outwards from his body, but not backwards. The arm was 
shortened one inch. He could use his arm and hand to cut his 
food^ but he carried his food to his mouth with his left hand. 

Base of the Condyles. 

Casb 35. Simple obUque fracture. Union without drformiti/ or 
shortening. 

Wm. Kane, of Buffalo, »t. 6, by a fall July 28, 1858, broke his 
right humerus obliquely, just above the condyles. Direction of 
fracture downwards and forwards. 

I saw the child soon after the fracture. The fragments were 
easily reduced, but imDoediately became displaced when left to 
themselves. I dressed it car^ully with a paste bandage supported 
by an angular splint. (Rose's splint.) 

Dr. Boardman, one of the surgeons of the BuflSdo Hospital, sub- 
sequently took charge of him, and on the following day, finding 



BEFOBMITIBS AFTER FRACTURES. 107 

that tbe dressing was inefficient, we applied paste bandages and 
felt splints. 

A good deal of inflammation and swelling followed the injury. 

Aug. 8. (Eleventh day.) Dr. B. permitted me to see it. The 
fragments seemed to be united. Arm still remained a good deal 
swollen. 

Three months after this I examined the arm before the medical 
students of the college. The union was firm, and the seat of the 
fracture could not be felt. Motions of the elbow-joint nearly 
perfect. 

March 20, 1856. He cannot bring this forearm to quite so acute 
an angle as the other, and when he straightens the forearm it falls 
a little further back. In all other respects it is perfect. The seat 
of fracture cannot be felt, and there is no shortening, 

Cass 36. Simple fracture. Result imperfect. 

Nicholas Lang, of Millgrove> N. Y., aet. 4, fell down stairs Sep- 
tember 9, 1855, and broke the right humerus just above the con- 
dyles. Direction of fracture, obliquely downwards and forwards. 
The fracture was dressed by Dr. Ernst Pupikofer, of Erie Co., N. Y., 
and oa the eleventh day he was brought to me. The bones were 
not then united. 

Union occurred in about four weeks, and the splints were en- 
tirely removed in about five weeks. 

Three months after the accident, the power of extension was 
nearly complete, bat flexion was restricted to an angle of about 
60®. Botation of forearm perfect. The utility of the limb is in 
no way impaired. 

Case 37. Simple fracture. 

Louis Kock, of Buffido, at 6, fell September 1, 1853, and broke 
the right humerus just above the condyles. Simple fracture. Dr. 
Mixer, of BuJBEalo, in attendance* 

I saw the patient with Dr. Mixer on the second day. The lower 
fragment was displaced backwards. I have only been able to learn 
that the fracture united in the usual time. 

Cass 38. Simple fractwe; ahorieneiy deformed and maimed. 

Frederick Niento, of Bufblo, sot. 60, fell on his right elbow 
March 5, 1861, and broke the humerus just above the condyle. 
Dr. Hauenstein, of Buffido, dressed the fracture. Seven months 



108 BEPOET ON 

I 

I afterwards he called upon me. It was then shortened half an inch, 

i and considerably deformed at the seat of fracture. The upper 

I fragment is behind the lower. There I'emains only a limited 

I motion at the elbow-joint. 

( Case 39. Simple fracture. Union vrith deformity. 

\ July 28, 1849. An Irish boy, about nine years old, was sent to 

\ me by Dr. Samo, with a fracture just above the condyles which had 

|, occurred two months before, in Ireland. It was dressed by an Irish 

\ surgeon, and attended by him about two weeks. 

The lower fragment was displaced backwards and united firmly. 
Motions of the joint were tolerably free. 

Case 40. Simple oblique fracture. Union with deformity. Paraly- 
sis and contraction of finger. Prosecution. 

Charles Farnham (son of Orlando Farnham, a very respectable 
citizen of Chautauque Co., N. Y.) ©t. 8, fell from a height of four 
[ feet, striking upon the floor, and breaking his left humerus just 

above the condyles. The direction of the fracture was obliquely 
% downwards and forwards. Dr. A. H., of Pomfret, was called, but 

V refused to visit the patient, declaring that he did not practice 

I surgery. Two other physicians were then successively called, but 

I they also declined positively, and Dr. H. being again earnestly 

pressed to go, consented, though very reluctantly. 

Dr. H. determined easily the nature of the fracture, but as the 
arm was already much swollen, he concluded not 1^ apply imme- 
diately any splints. 

On the third day he reduced the fragments as well as he could, 
and applied two right-angled splints, one on the palmar and 
\ one on the dorsal surface of the arm and forearm ; with suitable 

compresses, rollers, &c. Also two small lateral splints. 

These dressings he continued to the arm during a period of four 
[ or five weeks, when they were finally removed. 

June 19, 1850, about nine months after the accident, the lad was 
brought to me for examination. 

I found the fragments overlapped one inch. The upper fragment 
projecting in front, and the skin covering its sharp point being very 
thin and tender. The motions at the elbow-joint perfect. The 
hand was flexed forcibly upon the wrist ; the first phalanx of all 
the fingers extended, and the second and third forcibly flexed ; 
supination and pronation completely lost. The arm weak and 



' 



\ 



DEFOBMITISB AFTER FRACTUBES. 109 

painful. The ulnar nerve could be felt lying across the projecting 
end of the bone. 

In the hope that some favorable change might result to the hand 
by relieving the pressure upon the ulnar nerve, yet with not much 
expectation of success, I exposed the bone and removed the pro- 
jecting fragments with a chisel and saw. The ulnar nerve had to 
be lifted and laid aside. The wound healed kindly, but the hand, 
one year from this date, remained in the same condition as before 
the operation. 

The surgeon was subsequently prosecuted, but the case never 
came to trial. 

Case 41. Simple frixcture. Union vnih maiming and defoi'mHy of 
(he/orearm, 

B. G. McKay, of Skaneateles, aet. 4 ; left arm ; Dr. Samuel Porter, 
of Skaneateles, well known throughout all that region as an eminent 
surgeon, took charjge of the fracture. 

I examined the arm twenty-three years after, and found a de- 
formity at the point of fracture and at the elbow-joint, such as pre- 
vented complete supination of the forearm. 

The forearm was also deflected outwards from the line of the 
arm several degrees. The arm had always been weak. The ulnar 
nerve is morbidly sensitive to this day, and the ulnar side of the 
forearm, with the ring and little finger, have always remained numb 
since the accident 

Case 42. Compound comminuted fraeiure. Union vnih deformity^ 
Ac. 

Mary Cotesworth, of Buffalo, aet. 2, fell down stairs, and broke 
her left arm just above the condyles, in May, 1863. The bone pro- 
truded in front an inch or more. Dr. Hackstein dressed the arm 
with light dressings. Violent inflammation ensued, and several 
small fragments of bone came out: the last fragment about six 
months after the accident. 

Two weeks after the aceident| May 80, 1853, 1 saw the patient 
with Dr. Hackstein. The wound was discharging copiously. Elbow 
and arm much swollen. We dressed it carefully with a splint well 
padded, and laid along the under side of the arm and forearm. The 
wound ceased discharging soon after the last fragment came out. 

April 2, 1856, three years after the the arm was broken, I found 
the bone so smoothly united that I could not trace the line of fracture. 



110 REPORT ON 

The humerus was shortened half an inch. The elbow was partially 
anchylosed, the forearm being extended at about an angle of 15^ 
with the arm, and capable of being flexed through about 10** more ; 
it was also forcibly proned. The elbow was oocasioaaliy painfol, 
and the arm always weak. 

Case 48. Compound c&mmintUed/raeiure. Partial anehylosta, over- 
lapping^ Ac. 

James Ashman, aged about 85, of Paris Hill, Oneida Co., N. Y. 
Drs. Enight and Bly dressed the fracture. A small fragment came 
out. 

Three years after the accident, he was an inmate of the Buffalo 
nospital. The humerus was shortened three-quarters of an inch, 
and the elbow could be flexed and extended only through two or 
three degrees of a circle. 

Case 44. OhUque^ comminuted^ compound fracture. Union wiOumi 
deformity or shortening. 

Mr. , of Geneva, aet. 7. The bone was broken obliquely 

downwards and forwards. The lower end of the upper fragment 
was pushed through the skin an inch. Drs. Pierce and Ashly, of 
Lyons, N. Y., reduced and treated the fracture with a right-angled 
splint ; declaring to the parents that anchylosis was to be antici- 
pated. About one year after this a small fragment of bone escaped. 
After seventeen years, there remains no indication of where the 
fracture occurred, and the motions of the joint are perfect. 

Internal Gondyle. 

Case 45. Simpkfracture of apophysis. Result perfect. 

George Bull, of Buflalo, set. 6, fell, July 27, 1849, and separated 
the apophysis from the internal condyle of the right humerus. 
Fracture did not extend into the joint. The fragment was dis- 
placed slightly. 

I was immediately called, but applied no dressing. Aug. S, I 
applied a paste bandage. 

Dr. Silas Hubbard subsequently took charge of the patient. 

April 7, 1856. I find the arm in every respect perfect, except 
that the apophysis is carried backwards about two lines, and upwards 
towards the shoulder about three lines ; and it is a little more pro- 
minent than the apophysis on the opposite arm ; the right elbow- 



DEFOBICITIES AFTER PBACTURES. Ill 

joint measuring three inches and three-quarters in its transverse 
diameter, and the left three and a half. He says the arm was well 
in eight weeks. 

Case 46. Simple fracture. Result perfect. 

Bernard Smith, ast. 12, broke the internal condyle of the humerus. 
It was dressed by a surgeon. For six months or more, it was nearly 
anchylosed. The anchylosis gradually yielded, and thirty-eight 
years after the accident, when I ezamined the arm, the motions of 
the joint were perfect. It has, however, been occasionally painful 
to the present time. 

Case 47. Simple fracture^ probably not extending irUojoirU. Result 
perfecL 

Charles dark, of Buffalo, aet. 11, fell, October 9, 1848, and struck 
on the internal condyle of the left hamerus. He came immediately 
to my office. The internal condyle was loose, and motion produced 
a distinct crepitus. 

I do not think the firacture extended into the joint. He could 
flex and extend the arm perfectly, and rotate the forearm. 

I applied a right angled splint, which I removed at the end of 
five weeks. 

Three months after he could nearly straighten the arm, and all 
its motions were nearly pwfect. 

Case 48. Simple fracture. Anchyhsis^ etc. 

George Strong, of EUory Centre, N. Y., £et. 6, fell and struck on 
his elbow. 

The patient was seen by three excellent physicians in succession ; 
bat they did not agree as to the nature of the accident. The first 
two regarded it as a fracture, and applied splints. The third 
regarded it as a dislocation, and having removed the splints, and, as 
he supposed, reduced the dislocation, he put the arm in a sling. 

Three months after the injury was received he called upon me. 
The inner condyle was very prominent, and surrounded at its base 
with callus. The arm was nearly anchylosed in a rectangular posi- 
tion. Pronation and supination perfect. 

Case 49. Simple fracture^ with displacement ; temporary anchy- 
hmSj die. 
Ed. E. Kendall, of Phillipston, Mass., »t. 9, broke the inner con- 



112 BBPOBT OK 

dyle of the right arm. Dr. Stone, of Phillipston, was in attendance. 
Sixteen years after the accident, while Mr. K. was a student of medi- 
cine, I examined the arm. The internal condyle was displaced for- 
wards. For about one year after the injury the elbow was quite 
stifiF. Its motions are now perfect. 

Case 50. Simple fracture. 

Michael Kelly, of Buffalo, aet. 14, fell with his right arm under 
him. Dr. Ring was called. By request of Dr. Ring, I saw the arm 
on the same day. The inner condyle was movable, and occasion- 
ally we could detect crepitus. We dressed the arm with a right 
angled splint. I have not been able to ascertain the result. 

Case 51. Simple fracture of apophysis of condf/le. Resulting in 
deformity, 

Francis Clifford, of St. Catharines, C. W., 89t. 16, fell, in wrestling, 
with his right arm under him, Dec. 22, 1855. 

The arm was seen by Dr. Henry Goodman, of St. Catharines, C. W^ 
and treated by him. March 18, 1856, three months after the acci- 
dent, the lad was brought to me by his father, and they made the 
following statement: — 

"Dr. Goodman said the bones were dislocated inwards, and by 
pulling and manipulation he reduced them. The elbow was then 
greatly swollen. He applied no splints, but only treated the arm 
in such a way as to subdue the inflammation. 

"Subsequently it was seen by another surgeon, in Canada, who 
believed that the ulna was at the time of the accident displaced in- 
wards, and that it still remained unreduced. Dr. Theophilus Mack, 
a distinguished surgeon of St. Catharines, had also seen the arm, and 
did not think the ulna was now out of place, but that the inner con- 
dyle was broken off." 

I find a fragment — the apophysis of the internal condyle — broken 
off, and removed downwards towards the wrist one inch and a 
quarter, where it is immovably fixed. 

The elbow is partially anchylosed, so that it cannot be straight- 
ened completely nor flexed to a right angle. Pronation and supina- 
tion are perfect. Dr. Mack had endeavored to overcome the anchy- 
losis by moderate force applied gradually by means of a splint, but 
he had thus far been unsuccessful. 

The father had already commenced an action against Dr. Good- 
man for damages. 



DEFOBMITIBS APTBB FRACTUBKS. 113 

It is quite certain tliat the articular surfaces are not now dis- 
placed. Whether they were displaced originally it is, of course, 
impossible for me to say. Whether they were or were not, I do 
not understand how the surgeon is to blame for not recognizing 
this fracture when the limb was so much swollen, nor do I believe 
that he could have prevented the displacement of the fragment if he 
had discovered the fracture. It is very probable, also, that the lad 
will ultimately have a fair use of his elbow-joint; and all this I felt 
it my duty to state to the parties, to which the father replied only 
that he could not afford to have his son lose the use of his arm I 

Case 52. Simple fracture ; resulting in anchylosis^ <tc. 

Noyes Atwood, of Lancaster, aet. 11, fell from a horse, striking 
on his left elbow. Dr. Potter, of Lancaster, dressed the fracture. 
Five weeks after the accident he consulted me. The inner condyle 
is displaced upwards three-quarters of an inch. The olecranon pro- 
cess has followed this fragment. Large amount of callus in front 
at seat of fracture. The elbow is nearly anchylosed at an obtuse 
angle. 

March 10, 1856. More than a year after the accident, the elbow 
remains partially anchylosed. He cannot carry his hand to his 
mouth except by bending his head forwards. 

CaS£ 53. Simple fracture, tuith displacement, sUght maiming, dkc. 

Franklin, Barrows, of Attica, »t. 9, fell and broke left internal 
condyle. It was dressed by a regular surgeon. Six years after the 
accident, while Mr. B. was a student of medicine, I examined the 
arm. The internal condyle is displaced downwards towards the wrist 
half an inch. Cannot straighten the arm completely. Can only flex 
it slightly, the elbow being nearly fixed at an obtuse angle. The 
power of pronation and supination imperfect. He thinks the arm 
is as strong as before. 

Case 54. Fracture extending into joint ; complicated with displace^ 
mentqfulna. Result imperfect. 

Philip Yout, of BuflFalo, »t. 8, fell, July 8, 1849, striking upon 
the right side and arm. A Catholic priest first attempted to reduce 
it ; but on the morning following the child was brought to me. 

The elbow was then considerably swollen, and the diagnosis was 
rendered somewhat difScult. It became quite certain, however, 
when Mr. Otis and myself had completed our examination, that it 



114 EIPOET ON 

was a fracture of the internal condyle extending into idie joint. The 
ulna fell easily into the space between the fragments, and could only 
be retained in its natural position by force. 

I dressed the arm with an angular splint, constructed with a 
movable joint, and directed cold water to be applied to the dressings. 

On the 11th I removed the splint, finding it painful, and left the 
arm on a pillow with only cold water dressings. 

15^. I applied the starch bandage. The patient eventually 
recovered with a stiff elbow. 

I subsequently learned that this same elbow had been broken 
before, and that the joint had been partially anchylosed for some 
years. 

Case 55. Fracture eompliccUed with a dislocation^ slight maiming^ 
and deformity, 

David Hersee, of Williamsville, N. Y., »t. 18, fell from a tree. 
Dr. Ham, of Williamsville, in attendance. Dr. H. found a disloca- 
tion of the radius and ulna of the right arm, with also a fracture of 
the inner condyle extending into the joint 

Five years after, I found the radius and ulna in place, but the 
inner condyle displaced downwards and forwards half an inch. The 
condyle is very broad and flat. When the arm is extended, the 
forearm is deflected to the radial side. 

This arm tires sooner than the other. In all other respects its 
functions and condition are natural; but for about a year the elbow 
was quite stiff. 

External Condyle, 

Case 56. Simple fracture. Union unih deformity. 

Patrick Whalin, of Buffalo, aet. 4, fell on the door-steps in Sep- 
tember, 1854, breaking the external condyle of the left, humerus. 
The fracture extended into the joint near its "middle. He was taken 
to the hospital; Drs. Winne and Smith in charge. For several 
days measures were taken to subdue inflammation, but no splints 
applied. September 28, Dr. Smith applied two right-angled paste- 
board splints, well padded with cotton. 

One year after the fracture I find the external condyle very promi- 
nent, beihg thrust to the radial side of the arm, and neither forwards 
nor backwards. The whole forearm is strongly deflected to the 
ulnar side. All the motions of the elbow-joint are nearly perfect, 



DBF0BMITIB8 AFTER FRACTURES, 115 

as well as promation and supination of the forearm. The olecranon 
seems to have been carried a very little, perhaps three lines, inwards 
upon the inner condyle; while the head of the radios is carried to 
the radial side with the external condyle. The remarkable inclina- 
tion of the forearm to the nlnar side only exists when the forearm 
is extended upon the arm. When it is flexed no such distortion is 
present. 

Case 57. Simple fracture. Union with deformity. 

Rollin Banta, of Buffido, set. 5, fell, July, 1852, and struck upon 
the left elbow, breaking off 'the outer condyle of the humerus; the 
fracture extending obliquely into the middle of the joint. Dr. Mixer 
was called and dressed the arm. On the 80th of July, some three 
or four days afker the accident. Dr. Mixer requested me to see the 
case with him. The nature of the injury was apparent, and we in- 
formed the parents of the probability of anchylosis. 

Adjusting the fragments as well as we could, we applied a gutta- 
percha splint to the arm and forearm, having fitted it accurately and 
padded it sufficiently. 

I saw the lad again September 3, and we removed the dressings. 

April 1, 1856. Nearly four years after, I find the elbow admitting 
pretty free motion, so that he can straighten the forearm to within 
about ten degrees, and can fiex it nearly as perfectly as the other. 
Pronation and supination are perfect. There is, however, a con- 
siderable projection of the external condyle ; this elbow being half 
an inch wider than the other, but its circumference is the same. 
The whole forearm is deflected slightly to the radial side. He often 
complains of a pain in the middle of the back of the joint, in the 
seat of the fracture. The outer condyle is neither carried forwards 
nor backwards, but is only spread outwards, or to the radial side, 
carrying the head of the radius with it. 

When this arm first came out of the dressings we could see scarcely 
any deformity, but as the swelling gradually subsided it became 
more apparent, and it even led us to suspect, at one time, that the 
condyle was expanding under an inflammatory action. 

Case 58. Simple fracture. Union with deformity, 
Rachel Wright, of Buffalo, aet. 88, fell in March, 1852, striking 
upon her elbow. She was carried to the watch-house, and the arm 
was dressed by Dr. Gray. Subsequently she was removed to the 
almshouse, and Drs. Winne and Forbush were in attendance. 



116 REPORT ON 

Two months after the accident, I found the outer condyle removed 
half an inch from its natural position, producing at the elbow-joint 
a striking deformity. She was unable to straighten the arm 
perfectly. 

Case 59. Simple fractuTe, Union wi(h defoi-mity, 

John R. Dobbins, of Erie, 89t. 7, fell on left arm, in March, 1851, 
breaking the outer condylef of humerus. Dr. C. Brandis, of Erie, 
and Dr. Wood, of the navy, yere in attendance. 

Eleven weeks after the accident he was brought to me. The 
forearm was then nearly at a right angle with the arm, and the elbow 
admitted of only very slight motion. Pronation and supination 
were perfect. 

Dec. 20, 1855, nearly four years after the accident, I find the 
forearm not quite straightened out, but nearly so, and the motions 
of the elbow-joint very extensive. When he attempts to straighten 
the arm the forearm is deflected outwards. The head of the radius, 
also, seems to press forwards as if the condyle upon which it rests 
was carried in this direction. His arm is as strong and as useful 
as the other. 

Case 60. Simple fracture. Union with deformity^ <tc, 

June 22, 1847, a son of Daniel Hodge, of Bufelo, aet. 8, fell 
several feet, striking on the left side and arm. Dr. George Bur- 
well being called, requested my attendance, also, in consultation. 

We found a distinct crepitus in the elbow-joint, and the motions 
of the fragments were plainly felt. Flexion and extension at the 
elbow-joint were unimpaired. Eotation of radius not painful. 
Flexion slightly painful. When the external condyle was seized 
between the thumb and finger, and moved forwards or backwards 
the radius also moved with it. The external condyle projected 
laterally and a little backwards, so that the elbow measured one- 
quarter of an inch more in diameter than the opposite. 

We dressed the arm with Kose's right-angled splint, placing the 
splint at an angle greater than a right angle, and laying it upon 
the palmar surface. We used, also, pads with rollers, &c. 

August 18, two months after the accident, the fragment was 
united, but the elbow was quite stiff, allowing very little motion. 
The external condyle remains as at first. 

Case 61. Simple fracture. Union with deformity, 

E. R, set. 5, fractured the outer condyle of the humerus. It was 



DEFORMITIBS AFTBB FBACTURES. 117 

dressed, he says, by a surgeon. I examined the arm in the Auburn 
State Prison, in the presence of the prison surgeon, after the lapse 
of twenty years. 

The broken condyle projects unnaturally, and the humerus at 
this joint is half an inch wider than the humerus of the other arm. 
He cannot straighten the arm perfectly. Occasionally the joint is 
painful. 

Case 62- Comminuted fracture. Non-union of fragments^ hut no 
maiming. 

Henry Gilbert, of Evans, Erie Co., N. Y., set. 5, was thrown from 
a horse, August 8, 1855, breaking the external condyle of the hu- 
merus. Dr. , of Evans, dressed the arm temporarily and sent 

the lad to me. Dr. Boardman and myself examined and reduced 
the fracture, as well as we were able to do, about sixteen hours 
after the accident. We administered chloroform freely, to enable 
UB to make a more satisfactory examination. There were two frag- 
ments, and each quite movable. The principal fragment was thrown 
forwards whenever the arm was flexed to a right angle. We con- 
cluded, therefore, to drop the arm and forearm in a position nearly 
straight, or only slightly flexed. We employed carefully moulded 
and well padded gutta-percha splints, made fast with the paste 
bandages. 

April 10th, 1856, eight months after the accident, the motions of 
the arm are free and its strength unimpaired, but a fragment of the 
outer condyle is not united, except by ligament. It moves freely 
backwards and forwards when the arm is extended or flexed. 

Case 63. Sim^ple fradure. Complicated with dislocation of the 
head of the radius backwards. 

Frederick. Keaffer, of Buffalo, set. 11, fell from a load of hay. 
Dts. Blanchard and Tilden, both botanic and eclectic physicians, 
were first called. Dr. Rochester subsequently examined it. 

Six hours after the accident he was brought to me. Left arm 
very much swollen. The external condyle could not be distinctly 
felt,' but on pressing with my finger over its usual seat, there was 
a crepitus. The head of the radius was plainly dislocated back- 
wards, and separated entirely firom the condyle ; its smooth button- 
like head being very prominent. There was great lateral mobility 
of the elbow-joint. The forearm was prone and fixed in a position 



118 BBPOBT ON 

slightlj flexed. Every attempt to flex or extend it beyond this was 
very painful. 

The fall was received upon the back of the elbow. It is difiScult 
to conceive how a blow from behind should leave the head of the 
radius dislocated backwards, or how the radios could have separated 
from the broken condyles, but I think there is no doubt of the fact 
Such was the conclusion to which Prof. Rochester had previously 
arrived, after a very thorough examination, and after an attempt to 
reduce and retain the fragments in place, made while the lad was 
under the influence of chloroform. I administered ether, and after 
a fuU examination, attempted a reduction of the displaced radius. 
This was easily accomplished, but the bone was instantly displaced 
when the. pressure was removed. The inflammation was such as 
not to warrant the immediate application of splints. 

Dr. Blanchard subsequently took charge of him. 

Moy 17, 1856, about one year after the accident, I examined the 
arm. The head of the radius remains dislocated backwards. The 
external condyle cannot be distinctly felt, but so far as it can be 
traced nothing abnormal can be discovered. The motions of flex- 
ion and extension, of pronation and supination are as complete as 
before the injury was received, except that the forearm cannot be 
quite as perfectly extended. The arm is not quite as strong as the 
other. 

Bettvem the Condyles. 

Case 64. Simple fracture. Union with shortening and maiming. 

J. R. Snow, of East Vienna, Wayne Co., N. Y., set 8, broke the 
left humerus by a fall from a rocking-chair. Dr. Bush, of East 
Vienna, dressed the arm within an hour. 

Eighteen years aft;er the accident, when he was a student of me- 
dicine at Buffalo, I examined the arm. The humerus was shortened 
three-quarters of an inch, and the condyles separated half an inch. 
The internal condyle was particularly prominent. He cannot 
straighten the arm completely. Motion produces a grating sensa- 
tion in the elbow-joint, and occasionally the elbow-joint becomes 
tender and painful. The muscles on the arm are wasted, but those 
of the forearm are not. 

Cask 65. Simple fracture. Union with dtformity. 

Patrick O'Brien, of Buffalo, aet. 10, was kicked on his left arm 



DEF0EMITIK8 AFTfiB FKACTURKS. 119. 

by a hoise. Dr. M., of Montezuma, N. Y., examined the arm, 
and said it was ont of joint. After a full bleeding, he attempted 
reduction, and then applied woollen rollers. Twelve days after, he 
came under my care. The elbow was much swollen and slightly 
bent. On pressing the condyles together, a crepitus was distinctly 
felt. The ulna seemed slightly displaced inwards and backwards. 
Dr. Sprague concurred with me in the opinion that it was a frac- 
ture through the condyles into the joint 
I applied an angular splint, with compresses, bandages, &;c. 
On the 25th day (Aug. 14, 1848), the fragments were not in 
place, nor could they be made to keep their places. 

April 4, 1856. Seven years after the fracture occurred, he can 
extend the left forearm completely, but cannot flex it quite as much 
as he can the right. Pronation and supination perfect. The ulna 
is displaced inwards so much as to conceal entirely the prominence 
of the internal condyle. The head of the radius is in its socket, 
but the external condyle is pushed outwards, and with it the radius. 
The elbow is half an inch wider than the opposite. When he ex- 
tends the ann, the forearm is deflected inwards (to the ulnar side) 
at an angle of about 20^ or 26^, but when the arm is flexed, the 
forearm resumes its natural position. The humerus is shortened 
half an inch. It is occasionally painful across the back of the joint 
The arm is not quite as strong as the other, nor as large. He is a 
ship-builder, and works at his trade. 

Cass 60. (hmminuted frcu^ure. Onefradure being just above the 
condyles^ and amoiher extending into the joint in such a manner as to 
sqMraie the inner canda/le, BesuUing in dsfarmity and maiming. 

Mrs. A. B. Hali&x, of Buffido, »t. 44, fell upon the sidewalk, 
Jan. 22, 1850, and broke her right arm at the elbow-joint I was 
immediately called, and, although the elbow was considerably swol- 
len, the nature of the fracture was pretty evident. The fragments 
were easily reduced ; indeed, the condyle was never displaced. I 
applied an angular splint, with gutta-percha side splints, &c. ka. 
No efforts were spared with the limb to make it perfect. 

Seven months after the accident, the elbow was nearly anchy- 
losed at a right angle. 

April 8, 1856. Six years after the fracture, I examined the arm 
again. She could now nearly straighten the arm, and flex it almost 
as much as the other. She could also nearly shut the fingers, but 
not quite. No deformity at the seat of fracture, nor shortening of 



120 BEPOBT ON 

the humerus. There was, howerer, much tenderness over the point 
of fracture in the shaft of the humerus, and just above the internal 
condyle, and also where the head of the radius articulates. There 
was, moreover, a grating sensation occasionally in that joint. She 
experienced frequent pains in the arm, and especially along the 
back and radial border of the ring finger. Her hand was weak. 
During a year or two after the accident, her arm perished very 
much ; but it was now nearly, but not quite, as large as the other. 
I think, however, the inner condyle is about one-quarter of an inch 
lower (towards the wrist) than the corresponding process upon the 
opposite arm. Pronation and supination are perfect. 

Case 67. Compound comminuted fracture. Union tuith anchy- 
losis, Ac, 

Horace Utley, of Buffalo, set. 85. Mr. IT. was struck by the 
tongue of a carriage with which a couple of horses were running. 
The blow was received directly upon the back of the left elbow. 

Dr. Sprague and myself were in attendance. We removed some 
small fragments of bone, and then laid the arm and forearm upon 
a well-padded splint, to which they were only loosely secured by 
bandages, &c. We sought only to keep the limb quiet, and to 
combat inflammation. It was several months before the discharge 
of matter from the wound ceased. 

Seven years after the accident, the forearm was considerably 
flexed upon the arm, and almost completely anchylosed. 

April 8, 1856. Twelve years after the injury was received, the 
motions of flexion and extension are so far restored that he can 
extend the forearm to an angle of about 45°, and flex it to a right 
angle; at this point it seems to strike a solid body like bone. 
Rotation of the forearm is completely lost, the hand being in a 
state inidway between pronation and supination. Humerus short- 
ened one inch and a half. He has no pain in the arm or hand, nor 
is the arm weak. He says that during the first year there was no 
motion in the elbow-joint. No means have been employed to 
restore its functions, except passive motion, and subsequently con- 
stant use of the limb. 



DEPOBMITIES AFTER FRACTURES. 121 

Cabinet Specimens. 

Upper Third. — Anatomical Neck and Read of Humerus. 

Specimen 1. Boiled specimen. Adult. United by bone. Irregu- 
lar deposits of bone. Head of the bone flattened close to the tuber- 
osities. History unknown. (Henry H. Smith, Philadelphia.) 

Specimen 2. Boiled. Adult. Irregular callus. Shaft completely 
rotated by action of the scapular muscles, so as to turn the back of 
the humerus forwards. Tendon of biceps also displaced. There is 
also a firacture of the shaft near its middle. History unknown. 
(Henry H. Smith, Philadelphia.) 

Specimen 3. Dried. Adult. Partly through neck, and partly 
through the tuberosities. The greater tuberosity being attached to 
the shaft;, and the lesser to the head. United by bone, and with very 
little ensheathing callus. There is a slight impaction of the frag- 
ments. History not known. (Henry H. Smith, Philadelphia.) 

Specimen 4. Adult. Partly through anatomical neck. The frac- 
ture was produced by a severe injury. Suppuration ensued, and 
about one year after. Dr. Brainard removed the fragment. It was 
loose, necrosed, and partially absorbed or macerated. He has 
recovered a pretty useftil arm. (Daniel Brainard, Chicago, 111.) 

Specimen 5. Adult. Partly through anatomical neck. Injury 
produced by a railroad car. Suppuration. About three months 
after the accident, Dr. Brainard extracted the principal part of the 
head of the bone. Patient recovered with a very useftd arm. 
(Daniel Brainard, Chicago.) 

Specimen 6. Macerated. Adult. Broken at the junction of the 
head with the shaft;, and then irregularly transverse through the 
tuberosities, to a point half an inch below the greater tuberosity. No 
union. History unknown. (Charles A. Pope, St. Louis, Mo.) 

Specimen 7. Similar to No. 6, but fracture terminating three 
quarters of an inch below the greater tuberosity. No union. His- 
tory unknown. 

Dr. Pope remarks of the above cases (6 and 7): "These are not 
cases of detachment of the epiphyses, as the bones are evidently 
those of adults ; and there is at their lower extremities, above the 
condyles, no trace of an epiphysary line." (Charles A. Pope, St. 
Louis, Mo.) 

VOL. IX.— 9 



122 BSPORT OH 

Specimen 8. Macerated. Adult. Broken along the line of union 
of the head with the bodj, an^ also through the surgical neck. 
The upper fracture is oblique and the lower transverse, and both 
are united by bone. The upper fragment, or head, has snfiFered an 
extraordinary displacement or revolution, so that its articular sur- 
face is turned downwards against the head of the bone, and has in 
this position become firmly united to the shaft ; while the broken 
surface of the head is turned upwards, and is articulated with the 
glenoid cavity of the scapula. There is also a peculiar curve of the 
upper fourth of the shaft of the bone; the head, however, remains 
in the general axis of the body. History unknown. (Charl^ A. 
Pope, St. Louis.) 

Specimen 8. Dried. Adult. Fragment slightly displaced, but 
united by bone. (Charles Gibson, Richmond, Va.) 

SIpecimen 9. Dried. Adult. Fracture neatly transverse. The 
head has united by bone, but at right angles with the shaft. (Chaa 
Gibson, Richmond, Va.) 



DEFOBHITIBS AFTBB FBACTUBE3. 



12S 



UPPBR THIBB (SspARATiox of SpiPHmt)^ 



8-0 

IS 
as 









TEBAnoBrr. 



fli 



a e 

O O 

5" 



Bem&rkB. 



Il13n 

I 



5m.lM.iL. 

I I 



Simple 



aung, &e. 



K. U., 



I liiumnt niK bU arm. 

J 



lap. 



Stm^ioAL Nboe. 



S69y. 
I 
41Jy. 



543 y. 
616 y. 



7 30y. 
823 y. 



ly. 


M. 


B. 


Simple 


2m. 


M. 


R. 


Simple 


4 m. 


M 


L. 


Simple 


.?i 


2: 


R. 
L. 


ample 
Simple 


Ov. 
«w. 


M. 


L. 


Compli- 
cated 

Compli- 
cated 



No dressing after tbfl 

flret week. 
One loDg gatta p«rclia 

spUnt. 
One long gntta percha 

spUat, Ac. 



Lateral ^pU&ta, kc. 



Lateral splints, pad in 
axilla, Ac. 
Lateral spUntfl. 



u. 






U- 






u. 


21 d. 


lin. 


N.U. 

u. 


10 d. 


lin. 
l^in. 


u. 


6w, 




u. 


6w. 





Motloas of shoulder 
Joint nnimpaired, bat 
lower fragments pro- 
jecting forwards, oc. 

Motions of ahonlder 
joint unimpaired, but 
fragments projecting 
forwards. 

Motions of Joint per- 
fect. 

Very slight bend. 



P. 

Imp. 



fmp. 
Imp. 



SxAFT (UPPIB THIRD). 



m y.' S y. 



14'M y. 1 y 
IA18 y. 25 y, 
l« mnh 10 m. 



II y. 8w.lM. 
M. 



»y. 

12|38y. 
USSy. 



2m 

6ra. 
22 d. 



L. 



R. 



Simple 
trans- 



Simple 
Simple 
and ob- 
lique 
Simple 
andob- 

CitmptL- 
catcd 



Lateral splints and 
paste bandage. 



Uteral i|>Uats. 
Bjctenslon during three 

days; lateral splints; 

paste bandage. 
Lateral spUats. 



Lateral iplliiti; gnttfcN.U. 
percha and pattej 
«pUnt«. 



88 d. 
6 m. 



*ln 



A ease of fh^cilitas os- 
sium; 18 months after, 
he broke the left hu- 
merus in its lower 
third; again he broke 
his right arm In its 
middle after IS mos. 

Complicated with deU- 
rium tremens. 

Use of Umb peifaet. 



ileimiSaddar. 



P. 



Imp.! 



Imp, 



Ml DDLS THtOD. 



17 45y 



18 83y 
»13y. 



nssy. 

2235 y. 



saoy 



ly 



2y 

30 y 
ftw. 



2 m. 



M.lR. 
M.IL, 
P. L. 



M. R. 

mJl. 

M.i 



M.,R. 

M. L. 



Simple 
Siiapli; 
Sltnplfl 

aDd 

ti-Aiia. 

OOUKPiil- 

Sim He 

&nd 
trans, 
typhi- 

hik 
Simple 
Simple 
Briuplr 

and 
ebif^tuo 
Slmplp 
Simple 

Cutnoil- 
Dated 



Latfiral ^llnta. 
Lateral Npllnu, &e. 
Lateral ipHnts, 



Latent npllMm. 



ki flTHt, light a|gM 
splint: tab««qafiaiJy, 
Rtml^ht poKJtl&n. 

Long gTittm petcha 
spllDt, nling, 4c, 



0. 


Hd, 




tJ. 


4m* 








111. 








U. 







Afiehylofllii. 
UcftcQ delayed. 



P. 

Ittp. 
lm|i. 
Imp: 



Jmp. 



P, 



124 



REPORT OK 



ABOTi Bjua OF CoirpTLM (LOWKB THIRD). 






1^ 

1^ 




1 


1 


TBSATIIBIIT. 


EBSULT. 


•« 




^1 




ol 




1 


1 






1^ 


si 


ll 


Remarks. 


P. 


24 


My. 


ay. 


M. 


L. 


simple 


Lateral splinU. 


u. 






FragiUtas ossiom. 


25 3 y. 


3ih. 


F. 


R. 


Simple 




u. 








p 


26 4 y. 


20 y. 


M. 




Simple 




u. 








p 


27ll8 y. 




M. 




Simple 


splinU. 


u. 


30 d. 


iln. 




Imp. 


28 


32 y. 


1« y. 


M. 


R. 


Simple 


u. 






Slight anchylosis. 


Imp. 


29 


40 J. 


4y 


M. 




Simple 

and 
obliqne 


Lateral tpUnts. 


u. 


40 d. 




Elbow was stiff a long 
time; motions now 
nearly restored. 

Arm bent, weak, and 


lm^ 


30 


7 y. 


Ifiy. 


M. 


L. 


Simple 


Lateral splints. 


u. 




*ln. 


Imp. 






















some wasted. 




31 


30 y. 


Im. 


M. 


L. 


Simple 
and ob. 
Commi- 


Lateral splints. 


u. 


30 d. 


Uln. 




Imp. 


32 


30 y. 


2 m. 


M. 


R. 


Long gutta percha 
splint, sling, kc. 
Angular splint. 


u. 








P 


33 


30 y. 


6 m. 


M. 


L. 


nuted 
Com- 


5.U. 




*in. 


Unsnoeessful attempt 


Imp. 












pound 










to unite the bones by 
an operation. 




34 


25 y. 


2y. 


M. 


R. 


Com- 




u. 




1 in. 


With unrednoed dislo- 


Imp. 










pound, 










cation of shoulder 














commin. 










joint. 














and 
























compile. 














Babb op THB COVDTLn. 


35 


6 y. 


3y. 


M. 


R. 


Simple 


Felt and paste. 


u. 


lid. 






P. 


36 


4 7. 


3 m. 


M. 


R. 


and ob. 
Simple 




u. 


28 d. 




Partial ane%losis. 


Imp. 












and ob. 










1 


37 


6 y. 




M. 


R. 


Simple 




u. 








38 


60 y. 


7 m. 


M. 


R. 


Simple 




u. 




*ta. 


Upper firagment behind I«p. 
lower; anchylosis, ke. 1 


39 


9 y. 


2 m. 


M. 




Simple 




u. 






Imp. 


40 


8y. 


ly. 


M. 


L. 


Simple 
and 


Right-angled splint. 


u. 




lin. 


Great deformitj and Imp. 
paralysis of arm; pro-{ 
secntion. 












oblique 










41 


4y 


23 y. 


M. 


L. 


Simple 




u. 






Deformity; pain, Imp. 
numbness, Ac, after, 
23 Tears. | 

Anchylosis, ftc Imp. 


42 


2y. 


3y. 


P. 


L. 


Com- 
pound, 
ooTnin^Tt. 


SplinU, te. 


u. 


6m. 


Mn. 






















43 


35 y. 


By. 


M. 




C<MJiiii.ri 




u. 




lln. 


Partial anchylosis. 


Imp. 
























44 


7y. 


17 y. 


M. 




i.'inii- 




u. 








P. 










ocmmlii. 

1 














iHTUtirAL COITDTLB. 


45! 8y. 


7y. 


M. 




Stmple, 


FftsM bandage after 7th 


u. 






'p. 












Situ Me 


d*y. 










46*12 y. 


38 y. 


M. 






u. 




.1^ 


Anchylosis for 6 mot. , P- 


47 11 y. 




M. 


L. 


Rinipio, 
.p.^,by. 


Ri^ht angled splint, 


u. 






P. 

1 




















48 6 y. 


Sm. 


M. 




S1ml>lo 




u. 






Anchylosis. Imp- 












and \siUf 






^ 






49 


9y. 


ley. 


M. 


R. 




• 


u. 






Blbow stiff one rear; Imp. 
fragment displaced 
forward; use of arm 
now perfect. 1 


60 


14 y. 




M. 


R, 


etEDplt 












I 



SBFOBHITISS AFTER FBACTUBES. 



125 



Imtbrhal Cowdtlb— Cbn^nwed. 


1- -1 ? • 




•o 

-s 

,2 


1 




KB8UL1. 


g 




-5^ 

■M 




s| 


> 3 © 3 1 


o 


II 




1^ 


si 


ll 




Is. 


^•ItSJ^'l 


1 


1^ 




g1^§ 


1-2 




£^ 


5115 y.. Sm. M. 


R. 


BlmpU; 


No spUnta. 


U. 






Fragment displaced 


Imp. 




1 




apophysis 










downwards li inches; 
partial anchylosis; 

jprosecution, ke. 

Fragment displaced up- 
wards 1 inch; anchy- 




5211 y. 1 y.'M. 


L. 


Simple and 




U. 






Imp. 


; 1 




into Joint 












1 














losis. 




53 9 y. « y. M. 


L. 


Simple; 




u. 






Fragment displaced 


Imp. 








apophysis 










downwards 4 inch; 
anchylosis, ke. 




M 8y. 

1 


X. 


R. 


Simple and 
into Joint 


Angnlar splint, 
starched bandage, 


u. 






Anchylosis. 


Imp. 


MlSy.' 6y. U.\ 


R. 


Into Joint; 


u. 






Fragment displaced 


Imp. 








cii in plicat- 








downirards aud for- 










ed wMh ill*- 










Wftrd*ilD.;dftroriiilty. 




\ 






l^atloa 














SxnUM Coftntu. 


5fl 4 y. 


IJ. 


M. 


L. 


Simple: 
into Joint 




u. 






Condyle projects to ra- 
dial side; forearm de- 


Imp. 






































flected to ulnar side; 






















very little anchylosis. 




57 6y. 4y. 


M. 


L. 


Simple; 
into Joint 


Qntto perch*, Ac. 


u. 






Condyle proJecU to ra-llmp. 
dial side; forearm de- 
flected to radial side; 
anchylosis. 

Condyle displaced 6: Imp. 


5S S8 yJ 2m. 


F. 




Simple 




u. 






, 


















lines; anchylosis. 1 


50 


7y. 


4y 


M. 


L. 


Simple 




u. 






Condyle projects a lit-; Imp. 
tie forwards, and fore- 
arm is deflected out- 
wards; very slight an- 
chylosis. 


«0 


8y. 2m. 


M. 


L. 


Simple 


AngnlAT splint. 


u. 






Condyle projected to Imp. 
radial side and a little 
backwards; anchylo- 


«1 


5 y. 20 y. 


M. 




Simple 




u. 






Condyle projects to ra- Imp. 


{ 1 
















dial side; partial an- 


1 
















chylosis, Ac. 


«' 5 yJ 8m. 


M. 




Commi- 


With arm nearly N.U. 






One fragment not unit-Imp. 


, • 






nnted 


straight. 








ed; use of arm perfect. 




63 11 y.| 1 7 


M. L. 


Complicat- 




u. 






Motions of arm perfect, 


Imp. 


1 1 






ed with dis- 










but radius remaiiis 






1 






hnr^t^on *>f 










unreduced. 












mihai 






















backward* 
















Betted thi Cosutlm. 




«4 


3y. 


18 y. 


X. 


L. 


ilmple 




V. 






Arm ihnrleTiPd 1 lfn?h; Imp. 


1 


















latprDAl rondylq pro- 


1 


















j«t<; parllol aucby- 


1 


















lyifl*. 


«5iey. 

1 


7y. 


M. 


L. 


Simple 


AAgalar tpUnl. 


u. 






Ct>EidylM ttpread, aiul lup. 
Intern tl camlylp r*r-| 

fl«trd iawifdpi. 


66 44y. 


«r 


P. 


R. 


unted 


A ngtilarfpllftt; got- 
ta pereha^ he. 


u. 




mighl luifhrlosli, Ins. EmpJ 

I 


e? 35 y. 12 y. 


K. 


L. Compound, 




tJ. 




T^tlat aacbylMK il«, f mp. 


1 




com ml n, 








1 





126 REPORT ON 



REMARKS. 



Of sixty-seven fractures of the humerus, thirteen occurred 
through some portion of the upper third, ten through the middle 
third, and forty-four through the lower third. Or, if we reject 
fractures of the head and condyles, twelve occurred through the 
upper third, ten through the middle third, and twenty-one through 
the lower third. An observation which is in contrast with the 
statement made by Amesbury, and which has been repeated by 
Lizars, B. Cooper, Fergusson, Gibson and others, that the most 
common situation of fractures of the humerus is through the middle 
third of the bone. 

Of the fractures of the upper third, one was a fracture through 
the tuberosities, or a separation of the epiphysis. In this case union 
had not occurred five months after the injury was received, and the 
arm was nearly powerless. Seven occurred through the surgical 
neck, of which four have resulted in perfect limbs, and three are 
more or less deformed ; but of the whole number only five were 
ever displaced, and of these five only two are perfect. In two of 
the imperfect cases, both fragments are displaced forwards ; in one 
union has not occurred, and the lower fragment is also displaced 
forwards. In none of the cases, except where union has not oc- 
curred, are the functions of the arm impaired. 

The proportion of the cases in which the fragments were dis- 
placed at first, is much greater than was observed by Malgaigne, 
who remarks that in more than twenty cases that he had seen there 
were but two e2Lamples of sensible and recognizable displacement ; 
in a great majority of cases the fragments being retained in place 
by the resistance of the periosteum and of the long tendon of the 
biceps. 

In three of my cases the lower fragment is displaced forwards, 
and in one case the upper fragment is thrown in the same direction. 
Desault has seen them both thrown backwards, Dupuytren, Paletta, 
Buret and others, have seen them pushed outwards. Others still 
more frequently have seen the fragments directed forwards ; and 
Sir Astley Cooper declares that with infants this direction is con- 
stant ; a statement which Malgaigne calls in question, he having 
seen the lower fragment most often drawn inwards towards the 
axilla. Others have observed that the lower fragment is generally 
drawn inwards while the upper is carried outwards, an observation 
which I have not confirmed. 



DEFORMITISS AFTER FBACTURBS. 127 

With the exception of the two lads, one of whom was twelve 
years old, and the other fifkeen, all the cases occurred in adults, 
and two in the persons of old men. This accords more nearly with 
the observations of Malgaigne than of Sir Astley Cooper. Sir A. 
Ciooper declaring these fractures to be most common in infancy, 
while Malgaigne has never seen a case in a person under fifty-three 
years. 

In addition to these two forms of fracture of the upper end of the 
humerus, in illustration of which I have furnished the foregoing 
caaea, other forms have been described by surgeons, such as, 1st. 
Fractures of the anatomical neck (intracapsular) and not impacted. 
2d. Fractures of the anatomical neck and impacted. 3d. Fractures 
of the great tuberosity, or of both tuberosities. 4th. Extra-scapular 
fracture and impacted. 

I have recorded only one case of separation of the epiphysis, and 
seven of fractures of the surgical neck, but not one of either of the 
other varieties. The museums in this country, however, it will be 
seen, furnish several specimens of all these varieties, if, indeed, I 
except fractures of the great and lesser tuberosities, of which par- 
ticular accident I have no precise information or knowledge. For 
much that is new and valuable on this subject I will refer the 
reader to that excellent treatise on "Fractures in the Vicinity of 
Joints, Ac," by Dr. Smith, of Dublin; and I beg only permission in 
this place to quote a few of his conclusions, such as may be con- 
sidered pertinent to the object of this paper. 

"The fdUowing conclusions may, I think, be legitimately drawn 
from what has been stated in the preceding pages : — 

" When there is much displacement of the tubercle, in consequence 
of the rupture of the fibrous and tendinous structures which invest 
it, ligamentous union is more likely to be the result than osseous. 

"In the former it is generally ihe inferior fragment which pene- 
trates the superior, while, in the latter, the head of the bone is 
driven into the lower fragment. 

"The intracapsular impacted fracture is generally accompanied 
by a fracture of one or other, or of both tubercles, and is so far 
analogous to the extracapsular impacted fracture of the neck of the 
femur, with the fracture of one or other, or of both trochanters. 

"Each variety is capable of uniting by bone. 

" In the intracapsular variety, the circumstance of the fracture 
being accompanied by impaction, materially increases the proba- 
bility of the occurrence of osseous consolidation. 



128 REPORT ON 

" When osseous union occurs in this variety of fracture, the 
process of reparation is accomplished by the lower fragment prin- 
cipally. 

*'In the intracapsular fracture, without impaction, the head of the 
humerus may perish from want of nutrition. 

" In such cases, disorganization of the joint may ensue, as the 
result of the processes, by which the elimination of the dead bone 
is accomplished* 

" In the intracapsular fracture the head of the bone may become 
reversed in the articulation, and its cartilaginous surface be brought 
into contact with the broken surface of the lower fragment. 

*' In the intracapsular impacted fracture the deformity is greater 
than in the extracapsular. 

" Each variety of the impacted fracture unites with deformity. 

"In the intracapsular impacted fracture, the removal of tbe de- 
formity would diminish the probability of the occurrence of osseous 
consolidation. 

"The chief diagnostic signs of the separation of the superior epi- 
physis of the humerus, are, an abrupt projection beneath. the oora- 
coid process caused by the upper end of the lower fragment, and 
the immediate recurrence of the deformity when the means employed 
for its reduction cease to be in operation. 

" There is no fracture incidental to the upper end of the humerus, 
in which it is more difficult to maintain the fragments in their proper 
relative position. 

" The supposition that, in this injury, the tubercles form a portion 
of the lower fragment, involves an anatomical error, the line of juno* 
tion of the epiphysis with the shaft being below these processes." 
{A Treatise on Fractures in the Vicinity of Joints^ &c., by Bobeit 
Wm. Smith. Dublin, 1854, pp. 207^.) 

In two of the cases of fractures of the upper end of the humerus, 
mentioned as being found in our museums, suppuration ensued, and 
the necrosed bone was successfully removed by that distinguished 
operator. Dr. Brainard, of Chicago. In Specimens 6 and 7, also, 
no union occurred, but union by bone occurred in the remaining 
six. 

Specimen 2, of double fracture, presenta a curious turning of the 
shaft of the bone upon its axis in consequence of the action of the 
scapular muscles. 

Specimens 8 and 10, owned respectively by Charles A. Pope, of 
St. Louis, and Charles Gibson, of Richmond, present the most lizarrt 



DBFOBMITIBS AFTEB FRACTUBES. 129 

displacements. In the one case the head is completely reversed in 
the socket, and in the other it is set at right angles with the shaft. 
Displacements which find their parallel in a specimen of impacted 
fracture which Dr. Smith laid before the Pathological Society of 
Dublin, in 1843, and which he has particularly described in his 
work on Fractures, &c., pp. 193-196. N^laton, also, p. 730, refers 
to a similar specimen which he has seen in the possession of M. 
Dubled. Smith mentions also a case, p. 197, in which the position 
of the head of the bone resembled specimen 10 ; and of this form of 
displacement, N^laton, p. 730, says: "Malgaigne showed lately a 
specimen to the Academy. Indeed, I think it is, probably, the same 
which Malgaigne has hinjself described on p. 529 of his volume on 
Fractures^ and which is represented in PI. V. Fig. 2, of the same 
volume." 

In specimens 1 and 2 alone is seen that irregular deposit of en- 
sheathing callus, or those osteophites which are so commonly found 
on the margin of the lower fragment when the anatomical neck is 
broken. It will be remarked that these are the only cases recorded 
as intracapsular. 

All of these fractures occurred in adults. 

Perhaps no place will be more appropriate than this to speak of 
the difficulty of diagnosis in fractures about the joints, and espe- 
cially in fractures occurring in the vicinity of the shoulder-joint ; 
a difficulty so serious as to materially embarrass the surgeon in his 
prognosis, and which, it must certainly not be denied, diminishes 
the value of my own conclusions, as based upon my recorded 
cases. It is only, after all, by an examination of a great number 
of cases both before and after death, that we shall ever arrive at 
a complete solution of these difficult questions. To this point 
already the labors of Sir Astley Cooper, R Smith, Key, and others 
have been especially directed, yet the constant mistakes committed 
to-day by the most experienced surgeons, not to speak of those 
acknowledged by Sir Astley himself, testify to the imperfection of 
our knowledge. 

Says Nflaton, speaking of the fractures of the neck and head of 
the humerus : " Mais il n'est peut-6tre pas possible de distinguer 
entre eUea les diverses vari^t^ de cette fracture; Boyer, qui a 
plosieurs fois constat^ par Tautopsie des fractures du col anatomique, 
dit que, pendant la vie des bless^ il lui avait et^ impossible 
d'assorer du lieu pr&is oil ^tait situ^e la fracture,"* 

> Bl6meii8 de Fathologle, torn. i« p. 7S1. 



ISO BBPOBT OK 

Says Mr. Johnson, in a review of a memoir entitled Duj^gwms €f 
DuhcatioM and Fractures of the Upper Extremity of the JSumaruSj by 
M.Le Baron Dupuytren, *^ It is perfectly undeniable that fractures of 
the upper extremity of the humerus, and dislocations of the head 
of that bone, especially dislocations into the axilla, are at timea 
confounded with, and mistaken for each other, even by those whoee 
experience is great ; we allude to our hospital surgeons. If aaoh 
mistakes, then, occur with those whose opportunities of practice are 
considerable, d fortiori, how much more frequent must they be 
amongst those who have few or no such opportunities, and in 
country practice in particular. The question, indeed, need not be 
begged, for the fact, as so put, is unhappily notorious."^ 

Dupuytren reports several cases, from the practice of Hotel Diea, 
whifth illustrate the difficulty of diagnosis. In one case, a case of 
fracture near the head of the bone, with, also, actual dislocation of 
the head inwards and forwards, Dupuytren, who saw the patient on 
the first day, diagnosed a fracture only ; on the third day he was in 
doubt, and on about the eighth day he discovered the true state of 
things. It does not appear, however, that the dislocation was ever 
reduced. In a second case the surgeon who first saw the patient 
diagnosed a mere contusion. On the third day many at the Hdtel 
Dieu thought it a dislocation, but Dupuytren determined that it was 
a fracture of the head of the bone. In the third case, one year 
had elapsed since the occurrence of an accident which a sur- 
geon called a dislocation, and which he believed he had reduced, 
bat M. Breschet discovered that it had been a fracture, and that 
the fragments remained displaced. The fourth case was also 
supposed at first to be a dislocation forwards, which the surgeon 
believed he had reduced. Two other sui^ons subsequently at- 
tempted reduction, under the impression that it was an unreduced 
dislocation, and at the end of a month he came to Hdtel Dieu, where 
the accident was recognized as a fracture with displacement Case 
four was more remarkable still. The patient, Marie Valletier, fell 
and injured her left shoulder, on the 26th of Jan. A surgeon, to 
whom she applied the next morning, said that nothing was am]s& 
On the 28th, the surgeons at Hotel Dieu discovered the head of 
the left humerus in the axilla. M. Dupuytren now ascertained, 
also, that she had a dislocation forwards of the right humerus, and 
a fracture of the right femur, both of which had occurred twelve 

> MecU-Chir. Rev., yoI. zir, Analjt. Series (1828), p. 133. 



DEFOBMITIES A7TEB FRACTURES. 181 

j€aiB before, and having been overlooked by the surgeon, remained 
aniedaced. In the fifth case, on the third day after the accident, 
M. Dnpnjrtren himself believed at first it -was a dislocation, but 
finally ascertained that it was a firacture. Two more cases are re- 
lated, one in which the surgeons at Edpital St. Louis mistook a 
firacture for a contusion, and one in which a private surgeon com- 
mitted the same error, both of which Dupuytren corrected on the 
eighth day. To these the reviewer adds, also, two similar cases 
which had come under his own observation, in one of which the 
surgeon twice attempted reduction of dislocation of the shoulder, 
when, in feet, there was probably a fracture of the surgical neck. 
The fragments were left unreduced, and yet "this surgeon," he re- 
remarks, "deservedly ranks among the highest in town." An 
examination of the memoir shows, also, that even where Dupuytren 
was able to diagnose correctly these accidents, he was frequently 
unable to restore the displaced bones to position, or to retain them 
in place when reduced. 

Mr. Key, in the ninth volume of the same journal, has recorded 
a case of fracture of the cervix humeri, which had been overlooked, 
and in which there was considerable displacement and non-union at 
the end of six weeks. He also declares " that it sometimes re- 
quires a very accurate examination to detect fracture of the cervix 
humeri, on account of the little displacement which occurs." 

Says Mr. Smith : " It has been justly remarked by Dupuytren, that 
all solutions of continuity of bones in the vicinity of joints, give 
rise to numerous errors in diagnosis, and the observation applies 
with peculiar force to the injuries which occur in the immediate 
neighborhood of the scapulo-humeral articulation. 

" Much, it is true, has been already done, both in this country 
and abroad, towards elucidating their nature, but every experienced 
surgeon can recall to his recollection cases of injuries of the 
shoulder, in which he has felt the utmost difficxdty in arriving 
at a conclusion as to the nature of the accident."^ 

I have multiplied these quotations because it has occasionally 
happened to me to see the surgeon severely blamed for errors of 
diagnosis in relation to injuries about this joint, and also because 
I would like to impress upon surgeons the necessity of studying 
the diagnostic signs of these various accidents with great care. If 
any are inclined 'to this study, I would refer them especially to the 
memoir of Dupuytren, already quoted, to the excellent treatises of 

' Op. oit., p. 176. 



132 RKPOBT ON 

Sir Astley Cooper and Robert Smith, and to the two volumes of 
Malgaigne, which treat respectively of fractures and of dislocations. 

The remaining five cases of fractures through the upper third, 
occurred below the surgical neck ; of these, three cases are recorded 
as perfect, and two as imperfect. Of the perfect, Case 9 was a 
transverse fracture occurring from muscular action, and was con- 
nected with a fragilitas ossium. This patient had subsequently the 
same arm broken through its middle third (Case 14), and, still later, 
the opposite arm through its lower third (Case 24). There was 
no tendency in either case to lateral displacement, consequently 
no overlapping of the fragments, the soft tissues immediately 
about the bone being but little, if at all, disturbed. Case 17 oc- 
curring in the middle third, a result of secondary lues, presented 
also the same peculiar features. 

Of the two imperfect cases one was complicated, and the patient 
died of tetanus on the 22d day; and in the other, union was 
delayed five months, but the bone having finally united with slight 
shortening, the use of the limb was unimpaired ; so that of these 
five patients, all, except the one who died, recovered eventually the 
perfect use of their arms. 

Of the forty-four fractures of the lower third, ten occurred 
through the shaft at the base of the condyles, eleven higher up, 
eleven through the internal condyle, eight through the external 
condyle, and four across the shaft and through the condyles at the 
same time. 

Of the fractures of the shaft above the base of the condyles, four 
are perfect, and seven imperfect ; of the four perfect, one was a case 
of fragilitas ossium, already alluded to, and two occurred in infemts. 

Of the seven imperfect results, one is without union, five are 
with more or less anchylosis of the elbow-joint, and five are 
shortened. 

In Case 81 the lower fragment is in firont of the upper fragment 
The arm was broken obliquely at two points in Case 32, but it has 
united without shortening or deformity. 

Of the ten fractures occurring just above the condyles (" frac- 
tures de Textr^mite infdrieure de Thumerus" of Dupuytren, and 
"fractures sus condyliennes de Thumerus" of Malgaigne), eight 
occurred in children under nine years of age, and some of them 
may have been separations of the lower epiphysis. In five instances 
the upper fragment was found at the time of the fracture or sub- 



DEFORMITIES AFTEB PRACTUBES. 133 

sequently/in front of the lower; in one case only, Case 38, the 
opposite condition is remarked. 

Seven still continue imperfect ; and at periods, since the fractures, 
varying firom two months to twenty-three years, six are more or 
leas anchylosed. In one case only is the anchylosis complete. 

The eleven fractures of the internal condyle (" trochlea and epi- 
trochlea" of Chaussier) occurred in children between the ages of 
six years and eighteen ; of the whole number four are known to 
have been fractures of the condyle outside of the joint, or fractures 
of the apophysis, (" epitrochlea"), and four are known to have en- 
tered the joint (fracture of the " trochlea"). Of the fractures of the 
apophyses two are recorded as imperfect, because there remains a 
partial anchylosis ; and two as perfect, because no anchylosis exists. 
In three of the four cases there was, however, a permanent displace- 
ment of the apophysis. In one instance, it is displaced slightly 
upwards and backwards, and in two cases it is very much dis- 
placed downwards. 

This is the fracture, a fracture of the epitrochlea, which Granger 
first described in the Edinburgh Med, and Surg, Joumal^ and which 
he thinks is produced by inordinate muscular action, and not by a 
blow received directly upon the elbow. I do not clearly under- 
stand what direction the displaced fragments usually took in the 
cases seen by him, but I presume that they were carried directly 
downwards, or perhaps in some cases slightly forwards or back- 
wards, since while he always speaks of their being "retracted below 
the elbow-joint," he mentions also that in some cases the fragments 
rest m contact with the olecranon, and in some cases they are an 
inch removed from this process. It is only by this lateral, or 
backwards displacement, also, that any pressure could have been 
exercised upon the ulnar nerve, a circumstance which he met with 
no less than three times ; in each of which three cases there was a 
numbness of the parts supplied by the ulnar nerve, accompanied with 
vesications. In Case 45, reported by myself, the epitrochlea seems 
to be carried very slightly upwards, as well as a little backwards, 
bat in all the other cases the displacement is downwards. In no 
case have I noticed numbness or vesications from pressure upon 
the ulnar nerve. > Of the four which are known to have broken into 
the joint, all are imperfect and all had anchylosis of the elbow-joint, 

> " On a ParticnUr Fracture of the Inner Condyle of the HmneniB." B7 Benjamin 
Granger, Surgeon, Burion-upon-Trent. Op. cit., vol. xiv. pp. 196-201. April, 1818. 



184 BBPORT ON 

extending from three months to five years, or longer. In one ease 
the condyle is displaced upwards, and in one, complicated with a 
dislocation, it is displaced downwards and forwards. In one other 
case, in which the fact is not known whether the fracture entered 
the joint or not, the condyle is displaced forwards. In no one of 
all the six cases of displacement of the internal condyle or of its 
apophysis is the displacement backwards, except in Case 45 of frac- 
ture of the apophysis. 

B. Cooper, South, Sir Astley Cooper and others, speak of ftac* 
tures of the internal condyle as very common, and more so than 
fractures of the external condyle, while Malgaigne has never aem 
a case of fracture of the inner condyle, and regards its occnrre&ee 
as very rare. He has, however, seen occasionally fractures of the 
epitrochlea, an accident which one might well suppose would be 
not unfrequent, especially in children, since it is not completely 
united by bone to the condyle until about the seventh year, and it 
remains always quite prominent and exposed to injury, not to speak 
of its being sometimes broken, as Granger has suggested, by mus- 
cular action, in fieJls upon the hand. 

Of eight fractures of the external condyle (" condyle and epicon- 
dyle" of Chaussier), seven occurred between the ages of four and 
twelve years, and one at the age of eighty-eight. In only two cuss 
was the arm at the time of examination free from anchylosis (cases 
62 and 63). In the first case no bony union had occurred, and I 
have suspected that the restoration of tiie arm to its complete fono- 
tions was due, in some degree, to this mobility of the condyle; or 
perhaps it may have been only a fracture of the epicondyle, or of 
that portion <^ the condyle which lies without the capsule, in whidi 
case, either with or without bony union, the danger of anchjloas 
would be less than in fractures of the condyle communicating irith 
the joint. But Malgaigne has never seen an example of tiiis frac- 
ture, and notwithstanding considerable authority to the contararyi 
he doubts its possibility. In Case 68 the radius was also didocated 
backwards and has never been replaced, but the functions of ^ 
arm are completely restored. 

In two of the cases reported as anchylosed, I ought to zemaik, 
the arm was examined two months after the fracture, a period m 
near the time of the accident, that the final result could not be 
positively determined. 

The fragment has almost always been found a little displaced; 
generally outwards or to the radial side, so as to increase the 



DBFOBMITIX8 AFTBB FBACTUKES. 186 

l>readtli of tba elbow-joint ; in one instance the displacement is for- 
inrardS) and in one a little backwards. Bransby Cooper and Ohelius 
declare that the fragment is generally drawn upwards and back- 
'wards. I have seen nothing to confirm this statement, yet my 
obdervations are too few to authorize me to question its accuracy. 

In Case 66, when the arm is extended, the forearm becomes 
strikingly deflected to the ulnar side, occupying an angle with the 
humerus of about 16®. When the arm is flexed, the iine of the 
lM>ne is completely restored. 

In cases 67 and 69, the same phenomenon exists, except that the 
deflecti<Mi is to the radial side. 

Dorsey^ speaks of this lateral inclination as being always to the 
ulnar side, but does not designate to what particular fracture of the 
elbow it belongs. He has also described a splint, contrived by Dr. 
Phyaick, intended to remedy the deformity in question. (PJ. III., 
Figs. 1 and 2.) Chelius also speaks of the same deformity as occur- 
ring after firactures of the internal condyle ; but while I have not 
aeen the forearm thrown either way after a firactore of the internal 
condyle^ I have seen it, as will be observed, deflected to the radial 
side in two cases of fracture of the external condyle, and to the 
ulnar side in one case of fracture of the same condyle, and in one 
other case of fracture between the condyles. 

I am unable to find any explanation of the fact stated by Chelius, 
that the forearm is sometimes deflected to the ulnar side after fracture 
of the inner condyle, unless the entire trochlea has been broken off 
and carried upwards ; but the deflection to the radial side seems to 
be a natural consequence of the obliquity of the trochlea, when the 
support of the radius is lost, whether the portion of the humerus 
upon which it moves is displaced or not. The direction of this 
obliquity is such that the smooth surface of the trochlea presents 
stroD^y to the radial side ; and even in the normal state, extension 
of the forearm inclines the hand to the radial side. 

Of four fractures traversing the shaft and penetrating between 
the condyles (^'fracture des deux condyles"), all axe marked im- 
perfect la three anchylosis exists in some degree. As I have just 
mentioned, also, in Case 66, straightening the arm throws the fore^ 
arm strongly to the uhiar side. 

Malgaigne (pp. 658, 669) has spoken of a remarkable phenomenon 
which he has occasionally observed after fmctures about the elbow* 

■ ElemeBto of Bugery, Philada. ed., 1813, toI. i. p. 146. 



186 REPORT ON 

joint, and of which he cites two examples, both of which he has 
illustrated by accurate drawings : " C'est une hypertrophie osseuse 
qui renfle au contraire certaines parties voisines, soit des fragments 
mfimes, soit des os contigus." In one example this hypertrophy 
occurred in both condyles, and in the upper ends of both radius 
and ulna. He has not yet observed this phenomenon in the bones 
of any other joint than the elbow-joint. 

It is not improbable that the same expansion or hjrpertrophy 
occurred in Case 57 of fractures of the humerus ; a case of fracture 
of the external condyle. The specimen of fracture of the neck of 
the radius, of which I have given a drawing, illustrates "also this 
peculiar pathological condition. 

In fractures of the humerus, I have preferred generally a broad 
and thick splint of gutta percha, sufficiently long to extend from 
the neck to the wrist, moulded accurately, and applied to the shoul- 
der, arm, and forearm, while the limb is flexed to a right angle, and 
while extension is being made upon the humerus. This being pro- 
perly padded, and secured in place by rollers, I place the arm in a 
sling, beside the body. The sling must, however, be so arranged, 
by being looped under the wrist, and not under the elbow, as that 
the weight of the elbow and lower part of the arm may aid in 
making extension. In Case 11, 1 attempted permanent extension 
with a gutta percha splint in the axilla. Other surgeons have sought 
to make permanent extension in certain fractures of the humerus, 
by various contrivances. Mr. Lonsdale had constructed an instru- 
ment which might be lengthened or shortened to suit the case ; it 
was made of steel, and was worked with a screw operating upon 
cogs in a sliding bar ; resembling, in some points, the humerus por- 
tion of Jarvis's adjuster. I think the same apparatus might easily 
be adapted to any form of arm splint. 

In the second London edition of a series of Plates, illustratiDg the 
causes of displacement in fractures of the extremities, by S. W. 
Hind (p. 19), is a drawing of an apparatus constructed by the author 
for the same purpose, which is very simple, and in some respects 
more complete than Lonsdale's. Dr. Charles Winne, of this city, has 
also shown me one of Welch's angular splints, to which he has had 
adapted a movable crutch, and which, he informs me, he has em- 
ployed twice, in such fractures of the humerus as seemed to demand 
permanent extension, with very satisfectory results. 

I believe that all these contrivances may prove occasionally use- 
ful, but the common experience of surgeons has shown how difficult 



BSFOBMITISS AFTBR FBACTUBIS. 137 

it is to acoomplifih xnudi extension by means of pressure in the 
axilla ; a mode, too, which I think must be inadmissible when the 
fracture is near the upper end, since the pressure by the crutch head 
upon the pectoralis major and latissimus dorsi, which constitute 
the margins of the axilla, must tend to displace the fragments upon 
which thej act inwardly ; and which can seldom be applied with 
mucli force to fractures near the condyles, on account of the proba- 
ble existence of inflammation and swelling about the joint. 

Malgaigne, when speaking of the appi^atus contrived by Lons- 
dale, remarks: "Que le chirurgien ne perde jamais de vue que 
Tex tension permanente est une resource toujours dangereuse, sou vent 
inutile, et qui exige dans son application beaucoup de r&ierve et de 
vigilance." {Op. cU,, tom. i. p. 541.) 

Something may always be accomplished, when the pal^ent is 
walking about, by allowing the elbow to escape from the sling, so 
that its weight shall make constant traction upon the lower frag- 
ment ; and the plan which I shall hereafter suggest of treating cer- 
tain cases of delayed union, namely: extending the arm at full 
length by the side of the body, so that the lower fragment shall 
receive the whole weight of the hand and forearm, might, perhaps, 
prove more efficient than either of the modes described. 

The splints generally employed in this country, in fractures about 
the elbow-joint, are simple angular side splints, without joints, 
snob as those recommended by Physick* (PI. III., Fig. 1); angular 
pasteboard splints, felt, gutta percha, Ac, or angular splints with a 
hinge, such as KirkbrideV (PL lU., Fig. 8), Thomas Hewson's,^ 
Day's (PI. m., Fig. 5), or Eose's (PI. HI., Fig. 4), or the more 
elegant and perfect angular splint of Welch (PI. II., Fig. 2). For 
myself, I generally prefer gutta percha, moulded, and applied accu- 
rately to the limb; and this splint, or whatever other apparatus 
I employ, I take care to remove at a very early day — so early, 
indeed, as the seventh or eighth day, and to change the direction 
of its angle very frequently, giving each time to the elbow some 
passive motion. It is quite probable, however, that in a great ma- 
jority of fractures of either the outer or inner condyle, the patient 
would suffer much less, and recover with quite as useful and perfect 
arms, if no splints whatever were employed. Nflaton and Mal- 

^ Elements of Bmgeiy, by John Syng Dorsey^ Fhilada. ed., vol. i. p. 146, 1813. 
' Amer. Jonrn. Med. Soi., rol. xtI. p. 315. 
* Note to Amer. ed. of Briehsen'B Surgery, p. 211. 
VOL. IX.— 10 



138 BEPOBT om 

gaigne disoonrage their use in these fractures, since beyond the 
mere steadying of the elbow-joint, they can serve no practical pur- 
pose, and may, on the contrary, do considerable injury. Speaking 
of the fracture of the epitrochlea. Granger remarks : ^ This is the 
only instance of this accident out of five which I have seen, that the 
full range of flexion and extension of the forearm has not ultimately 
been obtained, or with so trifling an exception as not to be observar 
ble without close attention. 

I have purposely avoided saying one word about replacing the 
detached condyle, and for these re^ons : during the state of tume- 
faction which almost immediately follows this accident, no mechani- 
cal means could be successfully employed to retain these small 
fragments in place ; and after it has subsided, it is usually too firmly 
fixed to allow it to be moved. Something may perhaps be accom- 
plished by position and relaxation of the muscles, but I have found 
the effect of position also scarcely appreciable. In fact, I believe 
that, as a general rule, the less we interfere with the displaced firag- 
ments, the better for our patients, and for our own reputation. 

The following remarks on a new mode of treatment in cases of 
delayed union of the humerus were made by myself to the ''BuffiJo 
Medical Association," and published in the Bvffah Med. Jotam^ 
vol. X. p. 142; and, although I have not had any Airther opportanity 
to confirm the value of the suggestions there made, I still entertain 
a conviction that they will be found occasionally applicable. 

^'It has been observed by surgeons that non-union results more 
frequently after fractures of the shaft of the humerus than after 
fractures of the shaft of any other bone. This observation is con- 
firmed by my own researches. 

"Comparing the humerus with the femur, between which, above 
all others, the circumstances of form, situation, Jcc, are most neariy 
parallel, and in both of which non-union is said to be relatively 
frequent, Z find that of forty-nine fractures of the humerus, fbor 
occurred through the surgical neck, twelve through the condyles; 
and twenty-nine through the shaft. In one of the twenty-nine, the 
patient survived the accident only a few days. In four of the 
remaining twenty-eight, union had not occurred after the lapse of 
six months, and in many more was it delayed consid^ably beyond 
the usual time. Two of the four were simple fractures, and occur- 
red near the middle of the humerus; the third was compound, and 
occurred near the middle also; the fourth was compound, and 
occurred near the condyles. 



DBFORMITIXS AFTSB FRACTURSB. 189 

<<This analysis supplies us, therefore, with four cases of non-union, 
ilrom a table of twenty-eight eases of fractures through the shaft. 

**0f eighty-seven fhustures of the femur, twenty occurred through 
4he neck, one through the trochanter major, and one through the 
condyles. The remaining sixty-five occurred through the shaft 
and generally near the middle, and in not one case was the union 
delayed beyond six months. 

^To make the comparison more complete, I must add that of the 
twenty-eight fractures of the shaft of the hi^merus, six were com- 
pound ; and of the sixty-five fractures of the shaft of the femur, 
six were either compound, comminuted, or both compound and 
comminuted. The six compound fractures of the shaft of the hu- 
merus furnished two cases of non-union. The six cases of either 
oom}K>und or comminuted, or compound and comminuted fractures 
of the femur, furnished no case of non-union. 

*'I beg to suggest to the Society what seems to me to be the true 
explanation of these facts. 

^It is the universal practice, so fiir as I know, in dressing fractures 
of the humerus, to place the forearm at right angles with the arm. 
Within a few days, and generally, I think, within a few hours, afler 
the arm and forearm are placed in this position, a rigidity of the 
muscles and other structures has ensued, and to «uch a degree that, 
if the splints and sling are completely removed, the elbow will 
^remain flexed and firm ; nor will it be easy to straighten it. A 
temporary false anchylosis has occurred, and, instead of motion at 
the elbow-joint, when the forearm is attempted to be straightened 
upon the arm, there is only motion at the seat of fracture. It will 
thus happen that every upward and downward movement of the 
forearm will inflict-motion upon the fracture ; and, inasmuch as the 
elbow has become the pivot, the motion at the upper end of the 
lower fragment will be the greater in proportion to the distance of 
the fracture from the elbow-joint. 

" No doubt it is int^ided that the dressings shall prevent all motion 
of the forearm upon the arm ; but I fear that they cannot always 
be made to do this. I believe it is never done when the dressing 
is made without angular splints; nor is it by any means certain 
that it will be accomplished when such splints are used. The 
weight of the forearm is such when placed at right angles with the 
arm, and encumbered with splints and bandages, that even when 
supported by a sling, it settles heavily forwards, and compels the 
arm dressings to loosen themselves from the arm in front of the 



140 t REPORT OK 

point of fracture, aud to indent themselves in the skin and flesh 
behind. By these means, the upper end of the lower fragment is 
tilted forward. If the forearm should continue to drag up(»i the 
sling, nothing but a permanent forward displacement would pro- 
bably result. The bones might unite, yet with a deformity. 

"But the weight of the forearm under these circumstances ia not 
uniform ; nor do I see how it can be made so. It is to the sling 
that we must trust mainly to accomplish this important indication. 
But you haye all not\ped that the tension or relaxation of the sling 
depends upon the attitude of the body, whether standing or sitting 
— ^upon the erection or inclination of the head, body, or upper 
extremities. . It is probable, gentlemen, that you have made the 
same observation. 

"From this,' and many similar facts, I have been led to suspect, 
for a long time, that motion has had less to do with non-union than 
was generally believed. 

"I find, however, no difficulty in reconciling this suspicion with 
my doctrine in reference to the case in question ; and it is precisely 
because, as I have already explained, the motion, in case of a frac- 
tured humerus, dressed in the usual manner, is peculiar. In a 
fracture of the clavicle through its middle third (its usual situation]^ 
the motion is upon the point of fracture, as upon a pivot ; although, 
therefore, the motion is almost incessant, it does not essentially, if 
at all, disturb the adhesive process. The same is true in nearly all 
other fractures. The fragments move only upon themselves, and 
not to and from each other. I know of no complete exception but 
in the case now under consideration. 

" Aside of any speculation, the facts are easily verified by a per 
sonal examination of the patients during the first or second week 
of treatment, or at any time before union has occurred, both in 
fractures of the humerus and clavicle. The latter is always suffi- 
ciently exposed to permit you to see what occurs, and as soon aa 
the swelling has a little suicided in the former case, you will have 
no difficulty in feeling the motion outside of the dressings, or per- 
haps in introducing the finger under the dressings sufficiently &r 
to reach the point of fracture. I believe you will not fail to recog- 
nize the difierences in the motion between the two cases. 

"Such, gentlemen, is the explanation which I wish to offer for the 
relative frequency of this very serious accident — ^non-union of the 
humerus. 

"I know of no other circumstance or condition in which this bone 



DEFORMITIES AFTER FRACTURES. 141 

is j)ec!iliar, and wbich, therefore, might be invoked as an explana- 
tion. Overlapping of the bones, the reason assigned by some 
writers, is not sufficient, since it is not peculiar. The same occurs 
much oftener, and to a much greater extent, in fractures of the 
femur, and equally as often in fractures of the clavicle ; yet in 
neither case are these results so frequent. Nor can it be due to the 
action of the deltoid or of any other particular muscles about the 
arm, whether the fracture be below or above their insertions, since 
similar muscles, with similar attachments on the femur and on the 
clavicle, tending always powerfully to the separation of the frag- 
ments, occasion only deformity, but not non-union. 

" If I am correct in my views, we shall be able sometimes to con- 
summate union of a fractured humerus where it is delayed, by 
straightening the forearm upon the arm, and confining them to this 
position. A straight splint, extending from the top of the shoulder 
to the hand, made of some firm but moulding material, and made 
fast with rollers, will secure the requisite immobility to the fracture. 
The weight of the forearm and hand will only tend to keep the 
fragments in place, and if the splint and bandages are sufficiently 
tight, the motion occasioned by swinging the hand and forearm will 
be conveyed almost entirely to the shoulder-joint. Very little 
motion, indeed, can in this posture be communicated to the frag- 
ments, and what little is thus communicated, is a motion which ex- 
perience has elsewhere shown is not disturbing or pernicious, but a 
motion only upon the ends of the fragments as upon a pivot. 

"I do not £Biil to notice that this position has serious objections, 
and that it is liable to inconveniences which must always, probably, 
prevent its being adopted as the usual plan of treatment for frac- 
tured arms. It is more inconvenient to get up and lie down, or even 
to sit down, in this position of the arm ; and the hand is liable to 
swell. But I shall not be surprised to learn that experience will 
prove these objections to have less weight than we are now disposed 
to give them. Kemember, the practice is yet untried — if I except 
the case which I am about to relate, and in which case, I am frank 
to say, these objections scarcely existed. The swelling of the hand 
was trivial, and only continued through the first fortnight, and the 
patient never spoke of the inconvenience of getting up or sitting 
down, or even of lying down." (See Case 22.) 



142 BSPOBT 09 



CHAPTER VIII. 

RADIUS. 

TlTpper Third. 
Neck. 

Case 1. Supposed frtxcture. Bedtuitton and stibseqneni dCsplacement. 
Result imperfect. 

Elizabeth Fowler, of Phelps, N. Y., »t. 11, fell from a tree and 
fractured her right arm. Br. Bannister, who regarded it as a frac- 
ture of the neck of the radius, reduced the fragments, and applied 
two splints, with compresses, rollers, &c., and placed the forearm at 
a right angle with the arm. At the end of two weeks, the dress- 
ings were removed. She could then flex and extend the ann very 
weD. The forearm was again dressed, but only one splint was em- 
ployed. Twenty-eight days from the time of the accident, all 
dressings were finally removed ; and, at this time, no projection at 
the seat of fracture was noticed; The hand was, however, proned. 
From this day, the forearm was gradually straightened upon the 
arm for several days. It was then again flexed partially, but after 
this it could not be again made straight. (Such is the statement 
made by the father.) 

I examined the arm fifteen months after the accident, and found 
only slight power of flexion and extension ; but this power was 
steadily improving. The hand was forcibly proned, and could not 
be supined. A projection existed in front of the elbow at the sup- 
posed seat of fracture, which might have been the head of the radius, 
a callus over the seat of fracture, or the fragments displaced for- 
wards. I think it was the latter ; and, if so, it was probably pro- 
duced by straightening the arm on the fourth week, when the biceps 
was contracted, and whilst the bond of union between the fragments 
was not firm. 

Case 2. Supposed fracture^ probably complicated vnth fradttre cf 
the external condyle. Union with deformity. 
Gilbert Sole, of Darien, Genesee Co., N. Y^ »t. 8, fell, while 



DSF0BMITIS8 AFTIfiB 7BACTUBSS. 143 

sliding down a hill, in Dec^ 1864. No surgeon was employed until 
five weeks after the accident, when he was seen by J. C. Holt, of 
Bennington, Wyoming Co., N. Y. 

Ten weeks after he received the injury, his parents brought him 
to me. The left arm was then anchylosed at right angles. The 
fractured ends of the radius seemed to be displaced forwards, and, 
as I believed, could be very distinctly felt The hand was proned, 
and could not be supined. I think the external condyle was broken 
also, and slightly displaced. 

Cabs 3. Supposed fracture^ complicated toiih dislocaiioa of the upper 
end of the uha. Deformity and maiming. 

John B. Amsdel, of White's Corner, »t 25. It was treated by 
Dr. Nott, of Buffalo. 

I examined the ann six months aftier the accident. The upper 
end of the lower fragment appeared to be displaced forwards. Very 
little motion at the elbow-joint, and both pronation and supination 
are lost. 

Middle Third. 

Case 4. Simple fracture. Union imihoul deformity. 

David Shortwell, of Saratoga Co., set. 21, broke the radius near 
its middle. It was treated by a surgeon at Saratoga. 

Fifty years aft»r the accident, the arm was in every respect per- 
fect, except that the power of pronation and supination was re- 
stricted. 

Case 5. Simple fracture. Union tvith deformity. 

Wm. Lynn, of BuflMo, aat. 35, broke the radius, July 22d, 1850, 
near the lower end of the middle third. 

I dressed the arm carefully with two broad splints, on the same 
day on which it was broken. Five days aflier, I opened the dress- 
ings and found the fragments in place ; the same observation was 
made on the twenty-first day. At this time, I removed the dorsal 
splint, and continued only the palmar, thinking that the union was 
sufficiently firm to warrant this procedure. 

One week later, I found the splints somewhat loose, and the 
fragments projecting forwards. I requested him to permit me to 
straighten it by force, but he declined. I then applied a compress 
over and near one end of the salient fragments, and secured it in 
place with a splint and roller. At the next dressing, seven days 



144 REPORT OS 

later, I could not feel the projection; but a few days later it was 
very manifest. 

Twenty -two weeks from the date of the fracture, Lynn bad his 
arm nearly torn off in n railroad accident, and I amputated it near 
the shoulder-joinfc. 

On examining the radius, I found the projection was due to a 
forward displacement of the fragments, and not to a callus. (See 
specimen in my collection.) 

My impression is that the fragments were never completely 
replaced, or, if they were, that they soon became displaced. Yet I 
was very careful and diligent to accomplish a complete reduction, 
and to retain them in position ; and, if the displacement existed 
prior to the twenty-first day, it was overlooked because the effusion 
of lymph and serum among the tissues rendered it impossible to 
recognize it. I say this, because I am unwilling to admit anj 
degree of carelessness or lack of attention on my part Almost 
every day I had examined the limb, and as often as every fourth 
or fifth day I had removed and renewed the dressings. 

The probability is, nevertheless, that it did exist, and that only 
when the swelling subsided it became manifest It is not only the 
superficial swelling which has thus frequently deceived me, and 
induced me to think a limb was straight when it was not, but it is 
especially that deeper and more firm effusion in the immediate 
neighborhood of the fracture, and which often remains long after 
the superficial tumefaction has subsided. 

Lower Third {above line of Chiles^ Fracture). 

Case 6. Simple frtxcture. Result perfect. 

E. J. Schoonmaker, of Seneca County, N. Y., set 16, fell from a 
carriage, striking upon the back of his hand, and breaking the 
radius obliquely, about three inches from its lower end. The lower 
end of the ulna was also slightly displaced. A surgeon reduced the 
fracture within eleven hours after the accident, and applied 
splints, &c. 

Six years after this I examined the arm. The seat of fructore 
could be plainly felt, but the fragments were perfectly in place, 
7he arm is as perfect as before. 

Case 7. Simple fracture. ResuU perfect. 

Lyman J. Barrows, of Utica, set 12, was struck by the fore foot 



DEFORHITISS AFTEB FRACTURES. 146 

of a horse, breaking his left arm, and producing in the fall a dislo- 
cation of the left tibia, with a fracture of the corresponding fibula. 
The radius was broken four inches above the wrist. Dr. Ford, of 
Cazenovia, dressed the arm with an anterior and posterior splint. 

Ten years after, when Mr. B. was under my instructions as a 
student of medicine, the radius was slightly bent towards the ulna 
at the seat of fracture. In other respects it was perfect, and the 
arm was as useful as the other. 

Case 8. Simple fracture. BesuU perfect. 

Elisha Standish, of Livingston Co.,. »t. 89, broke his radius 
through the lower thinL 

It was dressed by a surgeon in Livingston Co., and eight years 
after I could find no traces of the accident. 

Case 9. Simple fracture. BesuU perfect 
Preston Brooks, »t. 15, broke the radius four inches above the 
wrist. Dr. Wallis, of Aurora, dressed the arm. 

Three months after, the seat of fracture could not be discovered. 

Case 10. Simple fracture. Union vdth slight displacement. 

Geo. Vogel, aet. 30, admitted to Buffalo Hospital Nov. 2, 1852, 
with a fracture at the upper end of the lower third of the right 
radius. The lower end of the ulna displaced to the ulnar side. 

I reduced the fracture as well as I was able to do, and applied a 
gutta percha splint, and secured it with a paste bandage. I was 
unable, at the time, to prevent the broken ends from falling against 
the ulna. 

The dressings were finally removed on the first of December. 
No mention is made of the condition of the fragments at this time, 
but I presume they were in the same position as when I dressed 
the arm at first. 

Lower Third. 
Near union of Epiphysis vnth Diaphysis {OoUes^ Fracture). 

Case 11. Simple fracture. BesuU perfect. 

Thomas Burton, of Buffalo, set. 22, fell, March 2, 1851, fifteen 
feet into the hold of a vessel. I was called about nine hours after 
the accident occurred. The left wrist was much swollen, and the 



14ff BBFOBT Oir 

radius broken about one inch and a half above the joint. Tfa* 
lower fragment was displaced forwards. 

I reduced the fragments and applied two broad, well-padded 
straight splints. 

Three months after the bones were united without displacement, 
but the wrist remained sti£ 

Case 12. Simple fracture. Result perfect. 

Harvey Hibbard, set. 14, broke the radius about one inch above 
the wrist. Dr. Henry Moore, of Manlius, N. Y., dressed the 
fracture. 

Twenty-four years after the accident I find no traces of it. 

Case 18. Simple fmcture. BeauU perfect. 

Stephen Goodwin, Esq., of Auburn, set. 15„ broke his lefk radius 
just above the wrist. 

It was treated by his £Either, who was a surgeon of great respecta- 
bility, in Ontario Co., N. Y. 

Twenty-five years after, I could find no taraoes of the accident. 

Cass 14. Simple fracture. ResuU perfect. . 

Mrs. John Little, of Buffalo, est. 43, fell, Feb. 9, 1852, and broke 
the radius about one inch from its lower end. The ulna was pro- 
minent below, and the hand fell backwards and to the radial side. 

Dr. John Trowbridge was first called, but on the following day, 
at his request,. I took charge of it. I reduced the fracture, and ap* 
plied two straight, broad, firm, and well-padded gutta percha 
splints. 

The result, after three months, was a perfect limb. 

Case 15. Simple fracture. BeauU perfect. 

Mrs. Ellen Boyle, of Buffalo, aet. 38, fell, March 20th, 1856, with 
her left arm under her back and side, breaking the radius about 
three-quarters of an inch above the joint. 

I was immediately called, and found the lower fragment carried 
back, the lower end of the ulna projecting in front. The wrist was 
already considerably swollen. I could not detect crepitus. By 
extension and pressure I reduced the fragments and applied a well- 
padded palmar splint, carved and shaped to the arm and hand. 
The next day I loosened the dressings. 

March 27. At my request Dr. Ellory P. Smith took charge of 



DSFO&MITIBS AF7BB FBACTUBES. 147 

Ae case, and after we had carefolly examined the arm and found 
the firagments still apparently in place, Br. Smith applied his 
emred splint constructed with a movable joint. 

April SOy 1866. Dr. Smith has just removed the splint. Arm 
is perfect, save that a stiffiiess of the wrist-joint still remains. 

Casb 16. Simple fracture, without displacement. Union without 
deformity or maiming, 

Jolm Ford, of BuflUo, set. 40, January 27, 1854. A block of ice 
fell upon his right arm, breaking the radius near its lower end. 
He came to me on the same day. Motion and crepitus were dis- 
tincty but there was no discoverable displacement of the fragments. 

I applied a curved splint to the palmar surface of the forearm 
and hand, which would incline the hand to the ulnar side. 

Five weeks and one day from the date of the accident, I removed 
all dressLDgs. The bone had united without deformity or maiming. 
No ensheathing callus could be felt around the seat of fracture. 

Case 17. Simple fracture. Jiesult perfect. 

A. Ellis, of Bufblo, aged about S5 years, fell, August 23, 1855, 
striking upon the palm of his left hand, and breaking the radius 
about one inch above the wrist-joint. 

Ellis came immediately to me. The fracture was nearly transverse. 
The lower end of the upper fragment was quite prominent in front, 
the lower fragment and the carpus being carried back and a little 
outwards. 

I reduced the bones easily by extension and pressure, and they 
showed no tendency to become again displaced. I applied a broad, 
straight, and well padded splint to the ptdmar surface of the forearm 
and hand. 

On the 19th day, I found the fragments firm ; but there was no 
ensheathing caUus which could be felt, nor was there any detected 
subsequently. On this day I removed all splints and other dress- 
ings, only enjoining upon the patient great care in the handling of 
the limb. 

Six weeks from the date of the accident, the wrist and hand were 
still somewhat swollen, and the joints stiff, but the fragments seemed 
in perfect line, and the hand not at all deformed. 

Casb 18. Simple fracture. Result perfect. 

Hugh O'Brien, of Buffalo, set. 87, fell from a wagon, October 27, 



148 BEPOBT ON 

1853. Arm dressed bj Dr. Mixer. Admitted to tlie hospital on 
the 2Bth, and examined before the class on the 29th. 

I foand the radius broken nearly transversely about one inch 
above the articulation. Fragments very nearly in perfect position. 
I dressed the arm with two broad, straight, and well padded splints. 

On the fourth day I removed one of the splints, and continued 
only the palmar. 

November 10, he left the hospital, but returned on the 14th (eigh- 
teenth day). The fragments were now united, and no deformity 
remained. 

Case 19. Simple fracture. United without deformity. 

Margaret Bead, 83t 60, fell, September 23, 1855, striking on the 
palm of the right hand, breaking the radius about one inch from 
the lower end of the bone. I found her in the hospital, at the com- 
mencement of my service, October 1, 1855, one week after the acci- 
dent. Dr. EUory P. Smith, hospital surgeon, had reduced the frac- 
ture, and dressed the arm. The arm was dressed with two of Day's 
splints, one on the palmar and one on the dorsal surface ; which were 
well padded, and neatly applied. Dr. Smith had not yet examined 
the fracture since it was dressed by himself, and he rec^nested me 
to open it. We found the fragments displaced, so that the hand 
fbll backwards and to the radial side, and the ulna was prominent 
below, 

I immediately proceeded to make extension, at the same time 
that I pressed the lower fragment forcibly forwards ; I succeeded, 
I think, in reducing the fragments. I then applied straight splints, 
well padded, instead of Day's splint 

On the 8d of October I loosened the dressings, which were qtiite 
snug, and found the fragments again out of place. Using still more 
force, and having again as I believe reduced the fragments, I dressed 
the arm as I had dressed it before. 

October 18. The fragments had united, and without displacement 
From this time only one splint waa used, and on the SOth, the other 
splint was removed also. 

She left the hospital November 4, with her hand and wrist slighdj 
swollen, and with considerable stiffness at the wrist and elbow joints. 

Case 20. Simple fmcture. Union with alight d^ormiiy. 
H. W. B., of Buffalo, set. 17, fell in a gymnasium, striking upon 
the palms of both hands. He was seen soon after by Dr. G^ who 



DXF0BMITIB8 AFTBR FBACTITBBS. 149 

belieyed he had sprained both wrists, and did not apply splints. 
The next day he came under the charge of Dr. White, of Buffalo. 

April 26^ 18oS. Dr, White brought him to my office. The frag- 
ments were then united. The ulna projected to the ulnar side, and 
the hand was inclined to the radial side. 

S^iemher 10. No change in the form of the arm. Its motions 
are, however, perfect 

Case 21. Simple fracture. Union with deformity. 

Mrs. Margaret Doyle, ffit. 26, fell, December, 1850, on the ice. She 
fell with her left hand a little back of her, but struck on the palm. 
A surgeon in Pittsford, Yt., dressed the fracture. He applied four 
narrow splints. Dressing continued eight weeks. 

I examined the arm April 1, 1866. The lower fragment is dis- 
placed backwards, and a little supined, and the hand falls to the 
radial side. The lower end of the ulna projects in front Prona- 
tiofi and supination are nearly perfect, but flexion at the wrist-joint 
is imperfect Her arm is very weak, and occasionally painful. 

Cass 22. Simple frojcture. Union tmih slight deformity. 

Mrs. Abner Birmingham, of Buffalo, sdt. 26, was thrown from a 
load of wood, August 12, 1868, breaking her right radius near the 
wrist The right leg was also severely injured, and was immediately 
amputated. 

I applied to the palmar surface of the forearm a broad gutta per- 
cha splint, and inclined the whole hand to the ulnar side. Two 
months later, the hand was found to be inclined to the radial side, 
and the styloid process of the ulna was prominent The wrist was 
also swollen in front, and above the annular ligament, the finger 
and wrist-joints were quite stif^ and she had no power of pronation 
or supination. 

One year later, all the functions of the hand were restored, but 
the inward inclination of the hand remains. 

Cass 23. Simple fracture. Union toith eligJU drformity. 

Henry Sherry, of Buffalo, set 46, broke the radius of the left arm 
by a fall upon the open palm, Feb. 2, 1864. The fracture was near 
the wrist 

Dr. Hackstein was called, and attempted reduction by powerful 
extension and counter-extension. He applied a palmar and dorsal 
splint Treatment continued five weeks. 



150 RSPOBT OV 

Eighteen weeks after, Sherry called upon me, compliuniiig of hu 
surgeon. The hand was inclined sHghtlj to the radial side, and 
the ulna was projeoting to the ulnar side. The wrist-joint remained 
rather stiff. 

Casb 24. Simpk fracture. Union vrHh deformiiy omd maiming, 

Charles Stratton, of Buffalo, a healthy and temperate laborer, «et 
86, fell forwards from a wagon, striking upon the palm of his left 
hand. The accident occurred Nov. 22, 1854. 

Stratton came immediately to my office, and I foimd the radios 
was broken a little more than one inch above the wrist-joint 1 
reduced the fracture, and applied a well-padded curved dorsal 
splint to the forearm and hand. I renewed the dressings on & 
24th and 27th ; and on the 29th, when I called, I found the arm 
much swollen. I could not ascribe this accident to the tightnefiB of 
the dressings, nor to any act on the part o£ the patient. Its dia- 
racter was decidedly erysipelatous. I removed at once all of the 
dressings, and, laying the arm upon a broad board, covered with.* 
cushion and a silk oil-cloth, I directed it to be kept wet with cold 
water. In a few days, the swelling subsided, and, finding that the 
patient was very careful with the arm, and that no displaoement d 
the fragments had occurred, the splints and bandages were not re- 
applied. At the end of five weeks all dressings were discondnaed. 
There was no ensheathing callus at this date, but the union irv 
firm. 

Jtme 1, 1856. Six months afker the accident, I found tlie aim 
perfectly straight, so that it was not possible to detect the plaoe of 
fracture. The wrist-joint still remained quite sti£^ and also tk 
fingers, so that he was unable to flex them but moderately. These 
was no swelling or soreness, but he was unable to use his hands 
for purposes of labor. 

One year from the accident he was stiU unable to work, but tbe 
hand was slowly improving. 

Cass 26. JSimple fracture. Union with defarfniiy. 

Mary Kelly, of Buf&lo, sst. 60, fell, March 18, 1856, up<Hi the 
sidewalk, breaking the left radius half an indi above tbe lower 
end. It was treated by Dr. Wm. Ring, of Buffisdo, with Da/s 
curved splint 

Mary called upon me, April 28, six weeks after the accideDi 
The splint had then been removed two weeks. The arm iru 



BEFOBICITIBS AFTXB 7BACTUBES. 161 

aiigbtlj swollen, and tbe wrist and finger-joints were sti£ The 
lower end of the nlna was prominent. The lower fragment, with 
the carpus, was inclined backwards, and the hand fell to the radial 
side. 

Gasb 26. Simple frtbdure, ResuU nearly perfect. 

Mrs. H., of Chicago, 111., set 56, fell, striking on her lefl hand, in 
1853, breaking the radius about one inch above the joint Dr. 
McYicker, of Chicago, dressed and treated the fracture. He applied 
pasteboard splints, and continued them six weeks. 

I examined the arm two years after the injury was received, and 
found the hand inclined to the radial side, and the ulna prominent. 
The motions of the wrist-joint are now completely restored; but 
she can only partially flex her fingers. 

Case 27. Simple fractture. Union with deformity. 

Joseph Brinstead, of Germany, aet 10, broke the radius of the 
left arm near the wrist-joint It was dressed and treated by a 
surgeon in Germany. Twelve years after the arm was broken he 
came under my care at the Buffido Hospital, and I found the fore- 
arm shortened an inch, with the ulna displaced do^mwards towards 
the hand. 

Case 28. Simple fracture. Result imperfect. 

Edson Knapp, of East Hamburg, N. Y., set 67, was thrown, Dec 
24, 1855, by a young steer, breaking the radius of the left arm one 
inch above the wrist. I saw Mr. Knapp twelve hours after the 
accident Wrist much swollen and very painful. Hand and lower 
fragments carried backwards and to the radial side. With mode- 
rate force, I brought the fragments into form. Not much tendency 
to displacement I applied a curved splint to the palmar side of 
forearm and hand, to which was subsequently added a dorsal splint 

The bones united in about the usual time, and with very little 
defonnity. 

Case 29. Simple fracture. Union mth slight deformity^ Sc. 

Mrs. S. Hooper, of Black Rock, »t 51, broke the right radius 
near the wrist in the spring of 1852. Dr. Dayton was employed. 

About one year after the accident, Mrs. H. called upon me. I 
found the lower fragment slightly bent backwards at the seat of 
fracture, and the wrist-joint remaining quite stiff The lower end 
of the ulna projects slightly to the ulnar side. 



152 BBPOBT OK 

She complained of her surgeon; but I soon persuaded her that 
other surgeons, for whom she professed to have a great respect^ 
were quite as unsuccessful in many cases. 

Cask 30. Simple frdcture. Union wiOh deformity^ Jtc. 

Mrs. A. N. Larreau, of Buffalo, set 26, fell upon the palm of her 
left hand, and broke the radius near the lower end. Dr. Barnes, of 
Buffalo, waa employed. 

I examined the arm about four years after the accident, and 
found the hand inclined to the radial side, and the ulna projecting 
to the ulnar side. She complains that her surgeon did not " set" it 
right. 

Case 81. Simple fracture. Union vdih aligJU deformity. 

Lucinda Adgel, »t. 48, broke her left arm Dec. 14, 1855, by fall- 
ing and striking on the palm of her hand. 

It was dressed immediately by Dr. James P. White, with two 
straight splints, and sent to the hospital. 

Dec. 20. I removed and reapplied the dressings, substituting pad- 
ded splints for those which were first applied. 

Jan. 15. The fragments were united, and all splints and bandages 
were removed, except during the night. 

21^^. She left the hospital. There remained, I think, a slight 
bend at the seat of fracture, the hand falling a little to the radial 
side, and the lower end of the ulna projecting slightly. The wrist 
also was stiff, and the hand swollen. 

Case 32. Simple fradwre. Urdon with very slight deformity. 

Mrs. Ann Hunt, aet. 43, fell, Jan. 4, 1856, striking on the palm (tf 
her left hand, breaking the radius about one inch above the wrist- 
joint. Dr. E. p. Gray, of Buffalo, dressed the arm immediatelj, 
and sent her to the hospital. 

I found the forearm covered with a roller, and supported by two 
of Day's carved splints — ^what Mr. Day calls a radial splint — ^being 
placed along the back of the forearm, by which the hand was 
thrown to the ulnar side, and a short caj*ved splint in fronts each 
padded with loose pieces of cotton batting. 

On the following day, finding the dressing very painful, I sub- 
stituted straight, broad, well-covered, and carefully padded splinta 
I did not again apply the roller to the forearm, underneath the 
splints. 



DEFORMITIES AFTER FRACTURES. 153 

Jan. 12 (eighth day). I found the fragments were not in place, and, 
as the swelling was then much reduced, I resorted to considerable 
force to restore them to position ; and, having succeeded, I applied 
curved splints to both palmar and dorsal surfaces, each of them 
being vety heavily and carefully padded. 

30iA. The bandages were removed, and tapes substituted. Bones 
firmly united, and, I think, in place. Splints to be removed during 
the day, &c. &c. 

JpriZ 1. She has been at work eight weeks. Bones united with- 
out deformity. Lower end of ulna projects laterally, but not in 
front. Pronation and supination perfect. Flexion of wrist-joint 
and of finger-joints not completely restored. 

Case 38. Simple fracture. Union with deformity and maiming. 

Hannah Davis, aet. 52, broke the radius very near its lower end. 
It was dressed by a surgeon in Pennsylvania. 

Three years after the accident, I saw her. She was residing in 
Bath, Steuben County, N. Y. Her hand was bent backwards and 
to the radial side. The lower end of the ulna was very prominent. 

The fingers were contracted, and the whole hand weak. I have 
not recorded, nor do I remember the treatment that was adopted. 

Case 84. Simple fracture. Union vnth deformity. 

Morton Williams, of BuflFalo, aet. 8, fell, in July, 1851, and broke 
the radius at the junction of the epiphysis with the shaft. Dr. 
Aldrich, a very intelligent young surgeon in a neighboring town, 
had charge of the arm. After lie lapse of several days, the lad 
was brought home and placed under my care. I found the dress- 
ings neatly and judiciously applied, but on removing them I dis- 
coTered the hand was inclined to the radial side, leaving the ulna 
projecting below. The lower fragment and the wrist were carried 
slightly backwards, and the lower end of the upper fragment for- 
wards. I attempted to restore the ftagments to position, but I 
found the union too firm. I then applied splints with compresses, 
firmly, and after a few days I found a slight improvement, but 
some deformity has remained. The motions of the wrist are perfect. 

Case 35. Simple fracture. Union with deformity. Prosecution. 
Mrs. Eajrmond, of Albion, N. Y., aet. 29, was turned over in a 
stage-coach and broke the radius just above the wrist-joint. Dr. 
VOL. IX— 11 



154 BBPOBT OK 

Haff, a surgeon of well-known skill, residing in Albion, was called 
and treated the fracture. 

About three months after, Mrs. Haymond called upon me to 
ascertain whether the arm could be improved, and whether I be- 
lieved the treatment had been correct. 

The hand falls slightly to the radial side, and the lower end of 
the ulna is prominent. The motions of the wrist-joint are not 
free. 

She subsequently commenced an action against the doctor for 
damages, but I am not aware that it was ever brought to triaL 

Case 36. Simple fracture. Union with deformity. 

Mrs. J. D. Bates, of Attica, set. 56, broke her right radius just 
above the wrist, in November, 1851. Dr. Boyce, of Attica, dressed 
the fracture. 

The arm was dressed with two straight splints with pads laid un- 
derneath, both on the palmar and dorsal surface of the wrist. Vesi- 
cations occurred under the compresses. The splints were worn 
more than ten weeks. 

Nearly four months after the accident, Mrs. B. called upon me. 
The hand then fell to the radial side, and the lower end of the 
ulna was prominent to the ulnar side. The hand was still swollen, 
stiff, and very weak. 

March 81, 1856. The hand has not improved much. She cannot 
bend the wrist-joint, nor can she supine the forearm. The fingers 
can be partially flexed, but not sufficiently to grasp anything ; in- 
deed, the whole arm is nearly powerless. She suffers almost con- 
stantly some pain in the wrist and hand. 

Simple fracture {not treated by a regular surgeon). Union with de- 
formity. (See Case 4, Fractures of Ulna.) 

Samuel Duckett, set. 14, broke his left radius just above the wrist. 
It was examined by an empiric (a German doctor), who said it was 
not broken, and adopted no treatment. 

Four weeks after the accident, he came to the hospital, with a 
fracture of the olecranon process of the ulna, which had oocuned 
two days before. 

The fragments of the radius are firmly united. The hand falls 
to the radial side ; the lower end of the ulna projecting remarkably. 
The power of supination and pronation is lost The hand is 
forcibly proned. 



DBFOBMITISS AFTER FBACTURES. 155 



Fractures commencing on the Radial Side of the Bone^ and terminating 

in the Joint, 

Case 37. Simple fracture. ResuU perfect. 

Waiiam Henry Valentine, of Buffalo, set. 13, fell, Nov. 10, 1855, 
from a tree, about twelve feet, striking upon the right hand and 
wrist. 

The bone was broken very obliquely from the radial side down- 
wards towards the ulnar side, and I think it entered the joint 
without entirely traversing the shaft of the bone. 

The hand fell to the radial side, and the lower fragment was dis- 
placed backwards. 

William was admitted to the hospital on the following day, at 
which time I reduced the fracture, and dressed the arm with a 
straight wooden splint on the palmar aspect, and a piece of binders' 
board on the dorsal, both well covered and padded. I applied, 
also, two extra pads, one over the lower fragment on the back of 
the wrist, and one over the upper fragment in front and near the 
middle of the arm. 

On the 7th day, I readjusted the dressings, and found the dorsal 
pad had occasioned a slight vesication. 

I examined the arm, April 22, 1856, five months after the acci- 
dent. The bones have united without deformity or maiming. 

Case 38. Simple fracture. Union vnthout deformity. 

George Mallory, »t. 88, fell, February 4th, 1856, striking on the 
palm of his left hand. It was dressed by Dr. Lay, of Buffalo, with 
Day's curved splints, well padded and neatly applied ; one upon 
the dorsal, and one upon the palmar surface. He was admitted, on 
the same day, to the Buffalo hospital. 

Feb. 7. Dr. Lemon, the house surgeon, finding these dressings 
becoming painful, removed them, and applied two broad, straight, 
and carefuUy-padded splints. 

This dressing was continued by myself, and by Dr. John Board- 
man, the hospital surgeon who succeeded me. 

March 27. The splints have been for some time removed. 
The wrist remains swollen and stiff. The lower end of the ulna is 
prominent, but the fragments of the radius seem to be in exact line. 



156 BBPORT ON 



Cabinet SpeciTnen of Separation and supposed Fracture of Oie Neck of 
the Radius. (See PI. I. Fig. 2.) 

This interesting specimen belongs to Dr. Robert Watts, of ISTew 
York, by whom it has been kindly sent to me for examination. It 
was found in the dissecting room, and beyond this its history is not 
known. It is the same specimen to which Dr. Parker has referred 
in a note to S. Cooper's Surgery, fourth Am. ed., vol. ii. p. 834. 

The bones appear to belong to an adult, the union of the epiphyses 
being complete, but the size would indicate that the person was 
rather below medium stature. The bones are dried and varnished; 
the interosseous ligament, and portions of the ligaments surround- 
ing the head of the radius being the only soft parts remaining. 

The radius is separated, transversely, four lines above the tuber- 
cle. The lower fragment is in no manner displaced, being neither 
drawn forwards, nor rotated outwards. Its broken extremity 
resembles somewhat a recent fracture, the bony cells, so near as I 
can judge in a varnished specimen, being quite open. Nor is there 
any appearance of callus around either fragment, unless it be in the 
presence of a very small deposit on the front of the lower frag- 
ment near the margin of the fracture, between which and the tubercle 
there exists an abrupt, irregular depression. It is most probable 
that the appearance of bony deposit is rather due to the removal of 
the bone below, which has produced a relative, but not absolute 
elevation above. 

The upper fragment is displaced in such a manner as that its 
upper surfece, which articulated with the humerus, is directed for- 
wards. A crescentic piece, however, has been removed from the 
anterior half of the head, which allows it to rest like a cap upon 
the upper end of the lower fragment. 

The two fragments are held together by a dried tissue, situated 
around and outside but not between the fragments, and Which does 
not seem to have been disturbed except in front, where it is entirely 
removed. 

The lesser sigmoid cavity, in which the head of the radius origi- 
nally moved, is narrowed in its vertical diameter, as if its lower 
margin had been pressed upwards, and there is a smaU fo&sa just 
below, against which the head of the radius now rests. 

The upper cap-like extremity, or articulating surface of the 
radius, is slightly irregular, as if portions of the synovial membrane 



DBFOBMITIES AFTER FRACTURES, 157 

had been removed by ulceration. The same appearances are pre- 
sented over the whole of the greater sigmoid cavity of the ulna. 

While, as I have mentioned, both bones are in their general di- 
mensions below the medium size for adults, their upper extremities 
are above the medium size, at least in their transverse diameters. 
Thus, comparing this radius with the sound radius of an adult 
before me, the sound radius measures around the bicipital protube- 
rance two inches and three lines, and the broken radius measures 
at the same point one inch and eleven lines; while the sound 
radius measures across its head, in its longest diameter, eleven lines, 
and the broken radius, in the same diameter, twelve lines. The 
same disparity exists between the upper end and the shaft of the 
ulna. 

My conclusion is, that this was not a fracture the result of any 
external or sudden violence, occurring in a bone previously sound; 
but that it was a case of ulcerative disease of the elbow-joint, 
accompanied with inflammation and consequent hypertrophy of the 
bon^, and also with caries, and resulting finally in a fracture or 
disruption of the bone through the neck. 

Cabinet Specimen of Fracture of the Neck of the Radius. Collection 
of Dr. T. D. Mutter, Philadelphia. 

The history of this fracture is unknown. The line of fracture 
seems to have passed through the neck of the left radius, just at 
the upper extremity of the bicipital protuberance. Union with 
deformity has resulted. Owing to the fracture having taken 
place within the insertion of the biceps, that muscle appears to 
have drawn forward and upward the lower end of the short upper 
fragment. In consequence of this movement, the articulating facet 
on the head of the radius is tilted backwards, so as no longer to be 
in contact with the humerus. As a secondary consequence, the an- 
terior edge of the head of the radius rests permanently against the 
articulating surface of the humerus. At this new point of contact 
a new surface of articulation is seen to have been formed, while 
the original articulating &cet is directed backwards, and lies at 
right angles to the one of more recent formation. At the inner 
edge of the new articulation of the head of the radius with the 
humerus, contact with the ulna has developed another surface of 
articulation. The upper and lower fragments are, as seen in the 



158 REPORT ON 

illustration, united at an angle, and the radius does not appear to 
have lost in length. (See Plate L Fig. 8.) 

Cabinet Specimens (f JFVactures commencing on the Radial Side of the 
Bone, and terminating in the Joint. 

Specimen 1. Dried. Adult. Oblique fracture extending into 
joint. Complicated with a fracture of the styloid process of the 
ulna. Found in the dissecting-room, united by bone. (PL I. Figs. 
4 and 6, palmar and dorsal surfaces of the same specimen.) 
(Henry H. Smith, Philadelphia.) 

Specimen 2. Dried and scraped. Adult United by bone. " It 
appears as if the styloid process and something more may have 
been broken off, not obliquely, but straight down into the joint 
It is an old fracture, and strongly united. The fragment stands 
off and outwards froln the bone, but it cannot be said that there is 
much displacement. There is also some appearance as if the firao- 
ture may have extended transversely or nearly so across the bone, 
about half an inch above the articular surface ; but this appearance 
is only seen in front" Jackson. (H. J. Bigelow, Boston, Mass.) 

Specimen 8. Dried. Adult. Broken almost perpendicularly 
into the joint Not united. Fragment lost. History unknown. 
(Charles Gibson, Richmond, Va.) 



DKFOBMITIES A7TBB FBACTUBBS. 



159 



UPPER THIRD (Nbck). 


Il 




1 


Right or loft Bide. 

Character of the 
fractare. 


TBBATlfSXT. 


\ 

BBSinUT. 


h 


When 

united. 

Amount of 

shortening. 


Remarks. 


II 

4 


in J. 


ly. 


F. 


R. 


Simple 


Forearm ben t at right 


U. 






Slight anchylosis, and Imp.| 












angles until 28th 








forced pronation of 














day, then straight- 






















ened out. 












2 8y. 


10 w. 


M. 


L. Complicat- 


Did not employ a 


U. 






Anchylosis; hand pron- Imp. 










edwith 


surgeon until afler 








ed. 










fnctnre of 


Are weeks. 










3 25y. 


6 m. 


M. 


CompUcat- 
'ed with dis- 




u. 






Anchylosis, and loss of Imp. 
both pronation and su- 
pination. 








location of 
















nlna 












MIDDLE THIRD. 


4 21 y. 50 J. 


M. 




Simple 




u. 






Perfect in every respect, P. 


1 


















except that pronation; 


1 


















and supination were a' 




















littie restricted. 1 


assy. 


6 m. 


M. 




Simple 


Palmar and dorsal 


u. 






Slight forward bend of Imp. 












splints. 








fragments. 




LOWER THIRD (Abote Ponrr of Ck>LLBB' Fractuiib). 




6 16 y. 6 y. 


M. 




Simple 




u. 








p. 


7 12y. lOy. 


M. 


L. 


Simple 




u. 






Frsgments bent sUghtiy 
towards ulna. 


p. 


S,39y. 8y. 


H. 




Simple 




u. 








p. 


9'l.'5y. Sm. 


M. 




Simple 




u. 








p. 


10 30y. 4w. 

1 ' 


M. 


R. 


Simple 




u. 








Imp. 


LOWER THIRD (Nbae ITiriow of Bpiphtbib with DiAPHTgia). 


ii'axy. 


3m. 


M. 


L. 


Simple; 
lower frag- 
ment dis- 
placed for- 
wards 


Straight splints. 


u. 






Arm straight, but wrist 
stiff. 


P. 


12Uy;24y. 


U. 




Simple 




u. 








P. 


iswy.aa y. 


M. 


L. 


Simple 




u. 








P. 


14«y. 


3m. 


P. 




Simple 


Straight spUnts. 
Smith's curred 


u. 








P. 


15 38y. 


6w. 


F. 


L. 


ffimple 


u. 








P. 


, 1. 










splint. 












16;40 y. 


ffw. 


M. 


R. 


Simple 


Curved splint 


u. 


36 d. 






P. 


17.Wy. 


6w. 


M. 


L. 


Simple 


Straight splint. 


u. 


19 d. 




Some swelling and stiff- P. 
noss remaining; no en-l 






































sheathing callus at any 
period. 




lS37y. 


18 d. 


M. 




Simple 


Straight splint. 


u. 


18 d. 




P. 


19" 80 y. 




F. 


R. 


Simple 


Curred splint one 
week: after this, 
straight splint 


u. 


25 d. 






P., 


20 17 y. 


em. 


M. 




Simple 




V. 






Imp. 


2125y. 


ay. 


F. 


L. 


Simple 


Four narrow splints. 


u. 






Hand falls to radial side; Imp. 


22'25y. 


ly. 


P. 


R. 


Simple 


Straight splint, but 
hand pressed orer 


u. 






Joint stiff, ke. 

Hand inclines to radial Imp. 


1 
















side; in other respects 


J 










to ulnar sida 








perfect 1 
Hand Inclines to radial Imp. 


23 45y. 


8 m. 


M. 


L. 


Simple 


Straight splints. 


u. 
























side; some stilThess of. 
Joint 1 
Erysipelas; stiflhess of Imp. 


24 36y. 


ly- 


m.;l. 


Simple 


Curved splint one 


D. 


5w. 








1 




week; afler this, no 








wrist and Angers; bone 


«.L 








splint. 








straight. 


25 Wy. 


6w. 


F. L. 


Simple 


Curved splint 


u. 






Hand fklls to radial side Imp. 


I 


















and back. 


I 



160 



BEFOBT 017 



LOWER TEIED (X 


EAx tJnioif or EMpavarn wim DTAPHr^rs))— C\?MM»n»«r. 


A 


fill 
sill 


1 


1 


II 


TESAT¥SJfT. 


EEftrLT. 






it 

1^ 


B«&l«r1u. 


*4 C> 

II. 


^ 


^df. 8 7, 




L. 


£implQ 


FawtolMjartl i«piiata« 


tJ. 




1 Hand f*U« 10 padUiiiidt- bap. 


Vi 


10 y. 13 7. 




L. 


Simple 




u. 






2?i 


1J77 


3m. 


SL 


h. 


Smple 


Cmrred ipiint. 


IT. 






"""■ 1.-P.I 


Sf 


■M J. 


ir- 




K, 


»mpl« 




IT. 






bae](T)u-dA; joint stiff . 


91) 


t^j. 


*r 




L, 


^midft 




TJ. 1 






HaDd (Alls to radial lisp, 
side. 


31 


i%j. 


fiw. 




L. 


eiffl^lfl 


Stm^t»t^iit<. 


U. 


n 4. 




Hand iniillii«« to radiU I»p. 


aa 


t3 7^ 


am. 




L. 


Blmpld 


CafTf>d flplLnt, ud 


U. 


Kid. 




Ulna projeria aJtibtly; Imp 
fttJghi ftUtnie^s of Joit:i 
Hand ben I rumdlftl sifJur Imp. 


aa 


Wi7* 


37. 






RbopI? 




D. 


























and biic k irard* ; flnge r* 






















contraded, Ac. j 


» 


SJ*^ 


ly. 






Simple 




0. 






Band lufUn^ to rmitta! Ita;^. 
Hide. 


a-i 


3^7" 








Simple 




V. 






Hand luclljua to nulial'l»p. 

Hldfl. k 


36 


56 7. 


57. 




R. 


Simple 


Straight splinta ten 
weekfl. 


u. 






Hand falla to radial Inp. 

side; wrist and atiK^r-| 
Joints Btiffi arm Tcry 
weak, &c. 


LOWER TI 


[IRD (Frac 


nrREB ooxMBxcnro oir 


THB Radial Sms op ths Bofx, ait^ 








TBRMIKATWO IS TH] 


B Joiirr). 


37 


13/. 


flai. 


M. 


R. 


Simple 


Straight splint. 


U. 






|p. 


^ 3S 7, 


2 m. 


M. 


L. 


Simple 


Straight spUnt after 


U. 






Fragments in perfect P. 














the thljrd da7. 








Iiu4\ but ulna prnjecti;! 
A ItHle. and Joioti re^ 
maia*tiff. 



KEMARKS. 



Of thirty-eight fractures of the radius, not one was attended with 
such a laceration of the soft parts as to render it compound. 
Twenty -three occurred in males, and fifteen in females; seventeen 
are known to have belonged to the left arm, and eight to the right; 
all have united. Three occurred in the upper third, two in the 
middle third, and thirty-three in the lower third. All of the three 
occurring in the upper third are believed to have been fractures of 
the neck. 

I am aware of the infrequency of the fracture of the neck of the 
radius, and of the diflBculty of diagnosis. Both B. Cooper and Mr. 
Smith have alluded to this difficulty of diagnosis, and the case 
reported by Dr. T. M. Markoe to the New York Pathological 
Society, and published in the April number of the Amer. Med. 



DEFORMITIES AFTER FRACTURES. 161 

Monthly for 1856,* will serve especially to illustrate the same point; 
in which case the signs of a fracture of the radius at its neck were 
such as to deceive that ezperienced surgeon, yet the autopsy dis- 
closed the fact that it was a dislocation of the head of the radius 
forwards, with a fracture of the ulna. Indeed, its existence as a 
form of fracture has been doubted by Sir Astley Cooper, and by 
others actually denied. I have seen no other specimens obtained 
firom the cadaver, except the doubtful one contained in Dr. Watts' 
cabinet, and of which I have furnished a drawing ; and the speci- 
men owned by Dr. Mutter of Philadelphia (PI. I. Fig. 3). Nor do 
I remember to have seen elsewhere a record of any other specimen. 
Malgaigne affirms, with his usual frankness, that although he has 
occasionally believed that he had met with it, the autopsy, when- 
ever it has been obtained, has shown that it was rather a subluxation 
than a fracture. On the other hand, Mr. South calls it " a not 
unfrequent accident," but, in confirmation of this declaration, he 
cites no examples. 

While, therefore, the presence of what appear to be the rational 
diagnostic signs has compelled me to record t];iree cases as fracture 
of the neck of the radius, I have not so much confidence in my own 
skill, nor indeed in the skill or judgment of any other man, as to 
think that we ought to affirm positively of these accidents, lest, as has 
happened many times before, in the final appeal to that court whose 
judgment waits until after death, our decisions should be reversed. 

When this fracture occurs, the upper end of the lower fragment 
is carried forwards by the action of that portion of the biceps which 
has its insertion into the tubercle; and the displacement in this 
direction must necessarily be increased in proportion as the arm is 
straightened. Such has been the character of the displacement in 
all of the examples I have seen, except in the case of the specimen 
in the possession of Dr. Watts ; in which instance the upper frag- 
ment alone has suffered a change of position, a malposition so 
peculiar as to have been determined, no doubt, by the same cause 
which produced the fracture. In the Mutter specimen, the lower 
end of the upper fragment is drawn forwards with the upper end 
of the lower fragment. 

Only one of the three cases reported was uncomplicated. Case 2 
being complicated with a fracture of the external condyle of the 
humerus, and Case 3 with a dislocation of the u^lna. 

> See also N. T. Jour, of Med., vol. xvi. (New Series), p. 271. 



162 KEPOKT ON 

In all of the cases, the upper end of the lower fragment remains 
displaced forwards, the hand is proned, and flexion and extension 
at the elbow-joint are imperfect. In the first case, the fragments 
were properly reduced by the surgeon, but a displacement occurred 
when the patient prematurely straightened the arm. 

I have seen, in Dr. Mutter's cabinet, two specimens of fracture of 
the outer half of the head of the radius. In one case, the fragment 
is slightly displaced downwards in the direction of the axis of the 
bone, and in the other, the fragment is thrown outwards, or to the 
radial side. Both are united by bone. 

Only two fractures have occurred in the middle third ; an obser- 
vation which is in striking contrast with the remark of Chelius 
that it is broken most frequently in its middle. In neither case 
has the result been entirely perfect, one case having left a slight 
impediment in the power of pronation and supination, and the 
other presenting a forward displacement of the fragments. 

Of the thirty-three fractures belonging to the lower third, twenty- 
six were near the lower end, or within from half an inch to one 
inch and a little more, from the articular surface ; all being included 
in those fractures called "Colics' fractures," and which may be 
either separations of the epiphyses or true fractures. 

CoUes described this fracture as occurring about one inch and a 
half above the carpal end of the bone ; but Robert Smith, of Dublin, 
who has carefully examined all the specimens he could find, about 
twenty-three in number, has never seen the line of fracture removed 
farther than one inch from the lower end of the bone, and in several 
cases it is within one-quarter of an inch of this extremity. Dupuy- 
tren has also described the fracture as occurring at from three to 
twelve lines above the joint. 

The observations of M. VoUemier also have shown that, instead 
of being oblique, as has generally been supposed, the fracture is 
almost uniformly transverse from the palmar to the dorsal surfaces 
of the bone, and only occasionally slightly oblique in its other 
diameter, or from the radial to the ulnar side. I have seen, how- 
ever, at the College of Physicians, of Philadelphia, a specimen of 
this fracture in which the line of fracture is transverse, from side 
to side, but very oblique from before backwards, and from below 
upwards. There is also a line of incomplete fracture extending 
into the joint, in the direction of Barton's fracture. It is united by 
bone, with the usual displacement backwards. 



DEFOBMITIBS APTBR FBACTUBES. 168 

The observations of both Smith and VoUemier have shown, 
moreover, that the displacement of the lower fragment is seldom 
sufficient to enable it to escape completely from the upper; and that 
when, in extremely rare instances, and in consequence of extraor- 
dinary violence, such complete separation does occur, a disruption 
of those ligaments which attach the lower fragment to the ulna 
occurs also, and the deformity becomes at once very great, so that 
it no longer presents the peculiar features of CoUes' fracture, but 
resembles rather a dislocation. 

In the so-called CoUes' fracture, the lower and outer border of 
the radius, or its styloid apophysis, is swung around or tilted, as it 
were, upon the ulna ; the lower and inner border of the same frag- 
ment being retained in place by the radio-idnar ligaments, which do 
not usually suffer a complete disruption, but only a stretching or 
partial laceration. The upper or broken margin of the lower frag- 
ment, and also the ulnar margin, undergo very little displacement ; 
while the lower or articular surfiace, and the radial margin are car- 
ried backwards, upwards, and outwards. 

Surgeons have spoken of a falling in of the upper end of the lower 
fragment towards the ulna, as an almost inevitable result of the 
action of the pronator quadratus, and against which tendency they 
have sought carefully to provide; but there is much reason to 
believe that any degree of displacement in this direction is a rare 
event, and that, when it does exist, it is in consequence mostly of 
,the direction of the force which has produced the fracture, rather 
than of the action of this muscle, only a few of the fibres of which 
are usually attached to the lower fragment, and in some instances, 
where the fracture is within a half or a quarter of an inch of the 
articulation, not any. Besides, there is actually in these latter cases 
no interosseous space into which* the fragment may fall, and its dis- 
placement towards the ulna becomes, therefore, impossible. 

Still, however, if one were disposed to speculate upon the condi- 
tion of these parts after the fracture, it might perhaps be easy to 
persuade ourselves that the action of the pronator quadratus upon 
*the upper fragment, whose broken extremity was not completely 
or at all disengaged from the lower, would carry both fragments 
together towards the ulna. But whatever might be the result of 
our speculations, still the feet, as proved by specimens, is not gene- 
rally so : and this is not the first time that facts and theories have 
disagreed. The truth is that it is exceedingly unusual to find in 



164 EBPORT ON 

any of the museums a specimen of this fracture having thus unitei 
They may be found constantly tilted back in the manner I have 
described, occasionally tilted forwards, and, still more rarely, slightly 
displaced upon their broken sur&ces antero-posteriorly ; but it has 
never occurred to me, except in one, or at most in two instances, to 
see a specimen in which the upper end of the lower fragment was 
thrown towards the ulna, so as in any measure to encroach upon 
the interosseous space. 

The almost uniform absence of this latter form of displacement 
may find its explanation in the direction of the force which gene- 
rally produces this fracture, in the occurrence of the fracture some- 
times at a point so low as to render its displacement in this direction 
impossible, and in the breadth of the bone at the seat of fracture, 
which does not permit it to fall laterally without actually increasing 
its length ; a circumstance which its secure ligamentous attachment 
to the ulna at its opposite extremities, and its complete apposition 
to the wrist and elbow-joints, do not allow. 

The mistake of those surgeons who have attempted to describe 
this fracture has originated in the appearance presented in nearly 
all recent fractures occurring at this point. The hand falls to the 
radial side, and seems to carry the lower end of the lower fragment 
with it, whQe the lower end of the ulna becomes unnaturally 
prominent in front and to the ulnar side; a condition of things 
which has naturally enough been ascribed to the displacement of 
the upper end of the lower fragment in the direction of the inter- 
osseous space. But this same radial inclination of the hand, and 
prominence of the ulna are present frequently when the radios is 
broken at its lower end and no displacement in any direction, has 
taken place ; and I have even observed it in simple sprains of the 
wrist, and in the hands of old or feeble persons where all the liga- 
ments have become relaxed. It is seen, however, in a more marked 
degree when the bone is actually both broken and displaced back- 
wards in its usual direction. In short, the deformity in question is 
due, in a large majority of instances, to the relaxation, stretching, 
or more or less disruption of the radio-ulnar ligaments, which per- 
mits the hand to fall to the radial side by a simple rotatory move- 
ment over its articular surface. For this reason, also, because these 
ligaments once lengthened or broken can never, or only after a 
lapse of many years, be completely restored, this deformity may 
be expected to continue, however exact and perfect may be the 
bony union. 



DEFOBMITIES AFTER FBACTUBES. 165 

It must be added, however, that, so long as the tilting remains, 
the articular surface is actually presenting somewhat to the radial 
side. While in the normal condition it presents downwards, for- 
wards, and inwards, it now presents, when the displacement is 
considerable, downwards, backwards, and outwards. 

Didaj maintained that there existed usually in this fracture an 
overlapping or shortening of the bone in its entire diameter, and 
YoUemier thought that the specimens which he had examined 
proved that an impaction was almost universal. 

Both of these opinions, it seems to me, have been successfully com- 
bated by Dr. Eobert Smith : the shortening observed by Diday being 
found only on that side of the bone to which the lower fragment 
inclines, and being the result of the motion of the lower fragment 
already described ; and the appearance of impaction being due to 
the ensheathing callus which is deposited usually, if the displace- 
ment is allowed to continue, in the retiring angle, opposite to the seat 
of fracture. 

These are questions, however, requiring for their decision a very 
careful study of specimens, and in relation to which further observa- 
tions may be necessary. 

Meanwhile there is no doubt that occasional examples may be 
found illustrating one or more of all these varieties of displace- 
ment, and that to the impaction is sometimes added a comminution 
of the lower firagment, the lines of fracture extending freely into 
the joint In PL I. Figs. 4 and 5, 1 have given a drawing of a speci- 
men contained in Dr. Henry H. Smith's cabinet, at Philadelphia, the 
direction of the fracture being oblique from the radial side and 
terminating in the joint. 

Dr. Robert Smith has described a fracture occurring at the same 
point,' and probably possessing the same characters as CoUes' frac- 
ture ; in which, the lower fragment is thrown forwards instead of 
backwards, and which has generally been the result of a fall upon 
the back of the hand. There is no such specimen, however, in 
any of the pathological collections in Dublin, nor has Dr. Smith 
ever seen a specimen obtained from the cadaver, although he 
reports a case which fell under his observation in practice. 

I have myself reported one such case (Case 11), but I regret to 

* Treatise on Fnctnres in the Vicinity of Joints, hy Robert Wm. Smith, Dublin, 
1854, pp. 162-3. 



166 BEPOKT ON 

say that my examination of the condition of the arm was not such 
as enables me to add anything to the information already possessed 
upon this subject ; indeed, until we shall have an opportunity of 
studying it in the cadaver, we cannot speak very definitely of its 
anatomical characters. 

Ndlaton* observes that all the varieties of this fracture which 
he has seen are often accompanied with fracture of the styloid 
apophysis of the ulna, and with a tearing of the triangular liga- 
ment. I am not aware that any other writer has made the same 
observation in relation to the frequent occurrence of a fracture of 
the styloid apophysis of the ulna, and I think the accident is not 
so common as the remark of Ndlaton would lead us to suppose. 

Fourteen of the examples of CoUes' fracture seen by me occurred 
in females, and twelve in males. Five in the right arm, and four- 
teen in the left. The youngest was eight years old and the oldest 
sixty-seven. 

In the first volume of the Philadelphia Medical Examiner (1888), 
will be found a description of a form of fracture occurring through 
the lower end of the radius, by J. Ehea Barton, of Philadelphia, 
which is probably much less common than Colles' fracture, and 
which had hitherto escaped the notice of surgeons. Its peculiarity 
consists in the line of fracture extending very obliquely from the 
articulation upwards and backwards, separating and displacing the 
whole or only a portion, as the case may be, of the posterior margin 
of the articulating surface. I have not recognized this fracture 
in any instance which has come under my own observation, nor 
have I been able to find a cabinet specimen in any pathological 
collection. 

In relation to the prognosis in firactures occurring near the lower 
end of the radius, it will be observed that of twenty-eight cases, all 
of which were simple, not one has refused to unite, but only eleven 
have left no perceptible deformity or maiming after periods ranging 
from five weeks to twelve years. Some of these are naarked as 
imperfect, notwithstanding the fact that the examination was made 
at a very early period after the union of the bones was consum- 
mated, and before the stiffness in the joints had been allowed a 
reasonable time to disappear; but I think it will be admitted that 
in this I haye done no injustice to the objects of my investigations, 
since I have not marked any case as imperfect, unless there remained 

> Pathol. Chirnrg., torn. i. p. 741. 



DKF0BMITIS3 AFTBR PRACTUBES. 167 

also a malposition, and generally, not unless the hand fell to the 
radial side; conditions which, my experience proves, are not ma- 
terially changed by lapse of time. 

In Case 27, there is an overlapping of the fragments and shorten- 
ing of the forearm one inch; the radio- ulnar ligaments being com- 
pletely torn asunder, and the ulna dislocated downwards to the 
same extent. In two cases stiffness of the wrist and finger-joints 
remains after one year ; in one case after two years; in one case after 
three years, and in two cases after five years. 

The deformity which has been observed most often, and indeed 
with only rare exceptions — ^being found in some degree, more or 
less, in several of those cases which I have marked as perfect — 
consists in a projection of the lower end of the ulna inwards, and 
generally a little forwards. In a large majority of cases, this is 
accompanied with a perceptible &lling of the hand to the radial 
side, while in a few it is not. After this, in point of freqttfency, I 
have met with the backward inclination of the lower fragment. 
Eobert Smith found this displacement almost constant in the speci- 
mens examined by him ; and it is very probable that nearly all of 
the examples examined by myself would present more or less of 
the same deviation upon the naked bone ; but in the living exam- 
ples a slight deviation would be concealed by the numerous tendons 
which cover this part of the arm, and perhaps by some permanent 
eflfusions, of which I shall speak more particularly presently. 

There remains for a long time, in a msgority of cases, a broad, 
firm, uniform swelling on the palmar surface of the forearm, com- 
mencing near the upper margin of the annular ligament, and ex- 
tending upwards two inches, or more. This swelling continues 
much longer in old and feeble persons than in the young and vigor- 
ous. It is pretty generally proportioned to the amount of anchy- 
losis existing at the wrist and finger-joints, and it disappears usually, 
pari passtij with these conditions. There can be no doubt that this 
phenomenon is due to an effusion, first serous, and subsequently 
fibrinous, along the sheaths of the tendons: and it is equally present 
after sprains and other severe injuries about this part, as in frac- 
tures. In many cases, however, its prolonged continuance and its 
firmness have led to a suspicion that the bones were displaced, a 
suspicion which only a moderate degree of care in the examination 
ought easily to dispel 

A similar effusion, but in less amount, is frequently seen also on 



168 BSFORT OK 

the back of the hand, below the annular ligament When both 
exist simultaneously, the appearances of deformity and of displace- 
ment are greatly increased. 

Here, then, we shall find a sufficient explanation of the anchylosis 
in the wrist and finger-joints, which, often for a time almost com- 
plete, continues occasionally many months, or even years, if indeed 
it is not perpetual : an anchylosis, produced not, as has generally 
been affirmed, by an extension of the inflammation to these joints, 
but simply by the inflammatory effusions and consequent adhesions 
along the thecss and serous sheaths, through which the tendons all 
pass in their course to the hands and fingers. The fingers are quite 
as often thus anchylosed as the wrist-joint itself a circumstance 
which is quite inexplicable on the doctrine that the anchylosis is 
due to an inflammation in the joints. Indeed, I have seen the 
fingers rigid after many months, when, having observed the case 
throughout myself, I was certain that no inflammatory action had 
ever reached them. 

Nor is it any more difficult to show, I think, that the anchylosis 
of the wrist-joint is not due to a malposition of its articular surfaces, 
as has often been asserted in the written treatises, and reaffirmed 
by excellent surgeons when recording their testimony under oath : 
for, if the anchylosis of the fingers in all these cases is known not 
to be the result of malposition of their joint surfaces, but only of 
inflammation of the tendinous sheaths, why shall we refuse to accept 
the same explanation for the anchylosis at the wrist? 

The most superficial examination of the mechanism of this joint 
ought to satisfy us that any moderate, or even considerable mal- 
position of the lower fragment, after a fracture of the radius, is not 
sufficient in itself to occasion anchylosis. It is true that the direc- 
tion of the articular surface of the radius is changed also, and that, 
while it was directed downwards, forwards, and to the ulnar side, it 
is now, perhaps, directed downwards, backwards, and to the radial 
side. But of what consequence is this, so long as the carpal bones, 
with wbich alone this bone is articidated, preserve their relations 
to the radius unchanged ? 

I suspect it will be found very difficult for any one, however 
ingenious, to offer even a plausible argument in defence of this 
doctrine of anchylosis, as applied to this fracture, so long and so 
positively affirmed that to-day it is thought to be established. 

But, if any other evidence than such as I have Aimished be 



DEFORMITIES AFTER FRACTURES. 169 

demanded, it may be supplied by the experience of most surgeons ; 
in examples of anchylosis without displacement ; in examples of 
displacement without anchylosis, but in which the anchylosis has 
yielded gradually to the lapse of time, while the displacement has 
continued. Examples also of all these results, so incompatible 
with the supposition named, hare been given in this repcHt. 

To what I have already said as to the prognosis in these accidents, 
I may be permitted to add the opinion of our distinguished country - 
man Dr. Mott, given in a clinical lecture before his Class in the 
University of New York. 

" Fractures of the radius within two inches of the wrist, where 
treated by the most eminent surgeons, are of very difficult manage- 
ment so as to avoid all deformity; indeed, more or less deformity 
may occur under the treatment of the most eminent surgeons, and 
more or less imperfection in the motion of the wrist or radius is 
very apt to follow for a longer or shorter time. Even when the^ 
fracture is well cured, an anterior prominence at the wrist, or near 
it, will sometimes result from swelling of the soft parts, &c." 

To which the reporter, himself a surgeon in the city of New 
York, adds: — 

"As the above opinion of Professor Mott coincides with my 
own observations, both in Europe and in this city, as well as with 
many of our most distinguished surgical authorities, I venture to. 
hope that it may assist in removing some of the groundless and ill- 
merited aspersions which are occasionally thrown (m the members 
of our profession by the ignorant or designing."' 

In fractures of the radius occurring at the neck, the forearm must 
be flexed upon the arm, and the hand supined. (See remarks on 
Fractures of the Radius and Ulna.) A single dorsal splint, properly 
padded, should support the forearm, while the surgeon, having laid 
a compress over the upper end of the lower fragment, proceeds to 
secure the whole with a roller. The forearm and hand being theit 
placed in a sling, the dressing is completed. 

Especial care must be taken to prevent the forearm being ex- 
tended before the bony union is fairly consummated, lest the action 
of the biceps, now contracted and shortened, should draw the lower 
fragment forwards, as it must inevitably do while the union is im- 
perfect; an accident which, there is reason to believe, occurred in 

■ Boston Med. and Surg. Journ., vol. zxv. p. 289, Oct. 1841. See also p. 294 ot 
same Journal. 

VOL. IX.— 12 



170 BKPORT ON 

Case 1 as late as the 28tli day, resulting ia a permanent displace- 
ment of the bone. 

If the patient is a child, or if there is any probability that these 
rules will not be faithfully complied with, it would be well to secure 
the arm in this position with a right-angled splint 

If the fracture takes place at or near the middle of the bone, the 
same rules of treatment, with only slight modifications, will be ap- 
plicable as In fractures of both bones. Two straight long and broad 
splints must be applied after being very carefully padded; jmd 
especial attention should be paid to the tendency of the fragments 
to become displaced forwards through the action of both the biceps 
and the pronator radii teres: a tendency which may, in some mea- 
sure, be provided against by flexion of the arm. Case 5 will illustrate 
this observation. 

It is only in the treatment of fractures occurring near the lower 
end, that modem surgeons have thought it necessary to introduce 
an essential modification; which consists in employing a pistol- 
shaped, instead of a straight splint, and by means of which the hand 
is thrown more or less strongly to the ulnar side. 

Heister* speaks of inclining the hand towards the ulna, while 
reducing a fracture of the radius, but when the reduction has been 
eflfected he recommends a straight splint. 

Among the first to advocate the permanent confinement of the 
hand in this position, were Mr. Gline, of London,* and M. Dupuy- 
tren, of Paris.^ Mr. Cline, and after him Bransby Cooper* and Mr. 
South,' recommend the ordinary straight splints for the forearm, 
but the rollers by which the splints are secured in place are not per- 
mitted to extend lower than the wrist ; so that, when the forearm is 
suspended in a sling, in a state of semi-pronation, the hand shall 
fall, by its own weight, to the ulnar side. 

Dupuytren,* and after him Chelius,^ adopt, in addition to the 
palmar and dorsal splints, the "attelle cubitale," or ulnar splint, which 
is a gutter composed of steel, iron, tin, or some other metal, and 
made to fit the ulnar margin of the forearm and hand, when the 

> De Lavrentii Heisteri, Institntiones Ghinirgics. Pars Prima, p. 202. Amster- 
dam ed. 

» Traits dea Praotures, etc., par MalgaigBe, torn. i. p. 614. Paris ed. 

* Dapaytren on the Bones. London ed., p. 140. 

* Lectures on Surgery, by Bransby Cooper, p. 232, Amer. ed. 

* Note to CheUus's Surgery, vol. i. p. 613. 
' Dupuytren on the Bones. 

' Chelius's Surg., voL i. p. 613. 



DEFOBMITIBS AFTBR PRAOTURBS. 171 

hand is drawn forcibly to the ulnar side. Blandin,^ N^laton,' and 
Gojraud,' also, under certain contingencies, employ the same. An 
instrument similar to this, also, but constructed of wood and gutta 
percha, and less curved down to the ulnar side, has been invented 
by Welch. (See PL 11., Fig. 6.) 

Most surgeons, however, employ either a palmar or a dorsal splint,' 
or both palmar and dorsal splints, constructed with a knee, or pistol- 
shaped, and they thus avoid the necessity of the ulnar splint. Thus 
Nekton,* Eobert Smith,' and Erichsen,* recommend this peculiar 
form only in the dorsal splint; while Bond,^ Hays,' and EUory P. 
Smith,^ place the pistol-shaped splint against the palmar sur&ce of 
the forearm and hand. 

A few modern surgeons have not seen fit to adopt this peculiar 
principle of treatment, or this form of dressing, under any of its 
modifications. CoUes'^ recommends a straight palmar and dorsal 
splint, and does not incline the hand. Barton" advises the same, 
and Mr. Skey," of London, having declared his preference for a 
couple of broad, straight splints, adds: "Great care should be taken 
to prevent the hand fiiUing, and this object will be attained by 
inclosing the entire forearm and hand in a well-applied sling." 

Professor Fauger, of Copenhagen, has undertaken to treat this 
fracture in some sense without any splint, the forearm and hand 
being simply laid over a double inclined plane, so as to bring the 
wrist into a state of forced flexion. " The hand having been brought 
into a position of strong flexion, the forearm is placed, pronated, 
on an oblique plane, with the carpus highest, the hand being per- 
mitted to hang freely down the perpendicular end of the plane." ^ 
M. Velpeau, in a report of his surgical clinic at La Charitd, for the 
year ending September, 1846, says this plan has been tried during 
the year, and "the result has not been very satisfactory. The 

1 Malgaigne, torn. i. p. 614. 

* Rl£m«ns de Path. Chir., par A. N^laton, Paris ed., torn. i. p. 747. 

* fljid., p. 746. 
« Ibid., p. 747. 

* Treatise on FractaiM, bj Robert W. Bmitbi, Dvjblin ed«, p. 168. 

* Snrgerjr, hy John Sriohsen, Amer. ed., p. 21 5« 

7 Amer. Joum. Med. Science, April, 1862. (See PL IV., Pig. 1.) 
> Ibid., Jan., 1863. (Bee PI. IV., Fig. 2.) 

* BnSa,\o Med. Joom., yol. iz. p. 226. (See PI. IV., Figs. 3, 4.) 
^ Lectures on Surgery, hy Abraham CoUes, Amer. ed., p. 326. 

" PhiUdelphia Med. Exam., 1838. 

»• operative Surgery, by Frederick C. Skey, Am. ed., p. 161. 

» London Lanoet, May 8, 1847. 



172 BBPOBT ON 

experiment, however, has not been decisive upon this mode of 
treatment."* 

Notwithstanding these exceptions, the practice seems to be pretty 
well established among the leading surgeons everywhere to employ 
in the treatment of this fracture the principle of adduction of the 
(hand, and always to the attainment of the same purpose, namely, 
rotary extension, by which they hope to retain more securely the 
lower fragment in place. 

We come now to consider how far this peculiar treatment is 
capable of answering the special indications of the case we are 
studying. 

It is assumed, as I have already intimated, that by bearing the 
hand strongly to the ulnar side, the fragments of the radius are 
brought more exactly into apposition, and more easily and effectu- 
ally retained ; an assumption, which supposes two things to have 
been determined: first, that there exists an overlapping of the frag- 
ments, either through the whole extent of their broken surfaces, 
or especially towards the radial side, or that the upper end of the 
lower fragment is inclined to fall against the ulna, or that all of 
these several conditions coexist ; and secondly, that if such displace- 
ments do exist, they can be remedied by this manoeuvre. 

The first of these suppositions seems to have been sufficiently 
considered, and fully controverted by all those gentlemen who have 
particularly examined the specimens contained in the various patho- 
logical collections, and to whose careful investigations I have already 
repeatedly adverted. My own observation confirms also their state- 
ments. With rare exceptions, none of these displacements have 
been found to exist, although, as has been observed, a casual inspec- 
tion of the arm when recently broken would often lead to an oppo- 
site conclusion. 

In regard to the second supposition, namely, that where such dis- 
placements do exist, a forced adduction will aid in the retention of 
the fragments, I shall have to speak more cautiously, because, so 
far as I know, my opinions have received as yet no public and 
authoritative indorsement. 

In order that adduction may prove efiective, there must be some 
point upon which to act as a fulcrum. It is of no use that we 
rotate the hand for the purpose of making extension unless there 
can be found a resistance or limit to the rotary motion. Such a 

> Boston Med. ftnd Sarg. Joom., vol. xxxr. p. 213. 



DBPORMITIES AFTKB FRACTURES. 178 

limit exiatSy no doubt, bat to determine its availability we must 
ascertain its character and position. 

It is not in the lower end of the ulna, for the ulna has no point 
of contact with the carpal bones, and when, in the natural state of 
these parts, the hand is inclined to the ulnar side, the lower end of 
the ulna rides freely downwards upon the wrist until arrested by 
the ligaments which unite it with the carpus, and by the capacity 
of the joint to move in this direction. When the lower end of the 
radius is broken, and the ligaments of the joint more or less torn, 
the ulna, although thrust downwards much further than it could 
ever descend in its normal state, still fails to find a support, and 
spreading wider and wider from the radius as it is thrust further 
upon the hand, no limit can be given to its progress in this direc- 
tion. It was thus that, in Case 27, 1 found the ulna carried down- 
wards one inch or more. 

If the fragments overlap each other in their entire diameter, it is 
very certain then that a fulcrum could not be obtained upon any 
point of their broken surfaces; and if the fracture is transverse in its 
antero-posterior diameter, and transverse, or only slightly oblique 
in its lateral diameter, when once replaced, the surfaces must of 
necessity support themselves, and the indication in question cannot 
be present. If, again, the direction of the fracture is from be- 
fore backwards and oblique, and reduction has been effected, no 
chance stiU remains to prevent the sliding off of the radial edge, 
if it is disposed to happen, by making use of the ulnar extremity 
of the broken surface as a fulcrum. If the radial side is inclined 
to fall o£^ what shall prevent the ulnar from doing the same? and 
how then can it, the ulnar side, be used as a fulcrum ? It only 
remains to suppose an impaction of the radial margin of the broken 
radius without similar impaction of the ulnar margin, or a fracture 
extending very obliquely from the radial margin into the joint, as 
the sole examples in which the lower fragment can find a sufficient 
fulcrum upon which the rotary extension may operate. The first 
of these examples I have supposed without being aware of the proof 
of its existence, and the second is probably rare. 

I have not spoken of the ligaments which bind the lower frag- 
ment to the lower end of the ulna, and the ulna to the carpal 
bones, viz : the radio-ulnar, and the internal lateral ligaments ; which 
in the normal state of the parts constitute the centre upon which 
forced adduction expends its power, and which still continue to be 
the point of resistance, when the radius is broken. And this brings 



174 BEPOBT OK 

me to the end and purpose of my inquiry. How feeble and uncer- 
tain must be a resistance which depends solely on these broken liga- 
ments I and how painful to the patient must be an extension, sufficient 
to overcome the action of nearly all the muscles of the wrist, which 
is borne entirely by a few lacerated and inflamed fibres 1 Even in 
health this position, when forced, cannot be endured beyond a fSew 
seconds, and it must be difficult to estimate the sufferings which the 
same position must occasion when the ligaments are torn and in- 
flamed. 

I am not to be told that surgeons have not intended to teach this 
extreme practice ; that they have never recommended forced adduc- 
tion, but only a moderate and easy lateral inclination, such as can 
be comfortably borne. If they have not, then, they should not 
have spoken of making extension by this means. An easy lateral 
inclination has no power to do good so far as extension is concerned, 
any more than it has power to do harm. But the fact is that while 
a majority of surgeons have no doubt used less force than was 
hurtful, some have used more than was useful, or safe 1 Indeed, the 
sharpness of the curve given to the splints figured and recommended 
by Dupuytren, N^laton, and others, sufficiently indicate that their 
distinguished inventors intended to accomplish by th^ means a 
forced and violent adduction. 

Malgaigne, speaking of other means of extension applied to the 
forearm, suggested by M. Godin, M. Diday, M. Huguier, and M. 
Yelpeau, intended to operate only in a straight line, and alluding 
especially to the modes devised by Huguier and Velpeau, remarks: 
^^ Sans discuter autrement le valeur comparative de ces deux appa- 
reils, je crains qu'ils ne soient bien penables k supporter pour les 
malades; et M. Diday nous apprend que, dans les essais qu'il a tent&, 
la douleur d^termin^e par Textension ^tait si forte qu'il fut oblig^ 
d'y renoncer."* Which renMxks cannot but apply with equal force 
to this, or to any other means of extension which may be adopted. 

After all, it must not be inferred that I have concluded to reject 
this mode of dressing in all of its modifications : for although I am 
far from being persuaded of its utility as a means of extension and 
retention in any case, yet I am not prepared to deny to it some very 
considerable value in another point of view ; and when judiciously 
employed it can certainly do no harm. It is, I repeat, for another 
reason altogether than the one heretofore assigned, that I would 

> Op. oit., p. 616. 



DEFOBMITIBS APtEB FBACTURES. 175 

recommend its continuance: a reason which I cannot so well ex- 
plain, or hope to render intelligible, except to the practical surgeon. 
This position throws the whole lower end of both radius and ulna 
outwards towards the radial margin of the splints, and by keeping 
the radius more completely in view, it enables the surgeon better 
to judge of the accuracy of the reduction, and to recognize more 
readily the condition and situation of the compresses, &c. This 
alone, I have always considered a sufficient ground for retaining 
the angular splint ; although, as may be seen by a reference to my 
cases, I have treated a number of arms satisfactorily with the 
straight splints alone. 

Finally, while surgeons have been seeking to ^complish an indi- 
cation, the existence of which is at least rendered doubtful, and 
by means which appear to me totally inadequate, if it did exist, 
they have probably too often overlooked or regarded indifferently 
an indication which is almost uniformly present, namely, to press 
forwards the tilted fragment by a force applied upon the wrist from 
behind, and to retain it in place by suitable compresses. And 1 
cannot help thinking that if they had regarded this as the sole 
indication, an indication generally so easily accomplished, they 
would have made fewer crooked arms, and have saved their patients 
much suffering, and themselves much trouble. 

It only remains for us to determine the precise form of splint 
which ought to be preferred, and to describe its mode- of appli- 
cation. 

The narrow " attelle cubitale" of Dupuytren, is inconvenient; nor 
can I give the preference to the curved dorsal splint recommended 
by N^laton, and employed by Robert Smith, Erichsen, and others. 
It is not to me a matter of entire indifference, in case only one 
carved splint is employed, whether this be applied to the palmar 
or dorsal surfaces of the forearm. Foreign surgeons, so &r as I 
know, have applied this splint to the dorsal surface, and the straight 
splint to the palmar; while American surgeons have adopted almost 
as uniformly the opposite rule — ^to whose practice, in this respect, 
I acknowledge myself also partial. It is to the curved splint rather 
than to the straight, that we mainly trust; not simply, or at all, 
perhaps, because of its form, but because the curved splint is also 
the long splint. This is the splint, therefore, which ought to be the 
most steady and immovable in its position. Now, the very irregu- 
larities of sur&ce upon the palmar aspect of the forearm and hand, 
instead of constituting an embarrassment, enable us, when the 



176 BBPORT ON 

splint is suitably prepared, and adjasted, to fix it more securely. 
Moreover, upon it alone, after a few days, the surgeon may see fit 
to rely, and in that case it ought to be applied to that surfSstoe of the 
arm which is most tolerant of continued pressure. The palmar 
surface, as being more muscular, and as haying been more ac- 
customed to frictions and to pressure, must necessarily have the 
advantage in this respect The palmar splint terminating also at 
the metacarpo-phalangeal articulations, instead of at the wrist, as 
the short straight splint must do when the hand is adducted, enables 
the hand to be flexed upon its extremity over a hand block, or pad 
of proper size. 

Such are the not insignificant advantages which we claim for 
this mode over that pursued by our transatlantic brethren. 

The block suggested first by Bond, of Philadelphia (PI. IV. Fig. 
1), is a valuable addition; since the flexed position is always more 
easy for the fingers, and in case of anchylosis this position renders 
the whole hand more useful. 

Dr. E. P. Smith, of Buffido, has modified and improved the splint 
invented by Bond, by substituting for the immovable, a movable 
knee, or joint, so that the angle of adduction can be increased or 
diminished at pleasure, and the same splint can be used upon either 
arm. For the body of the splint also, he has substituted for the 
inflexible wood, a thick, firm piece of felt, which having been 
warmed, may be moulded to the form and adapted to the length of 
any arm. This splint, as now described, is a modification of the 
splint invented by Dr. Smith some years ago, and of which he has 
furnished a description and a drawing, in the Sept No. of the 
Buffalo Med. Joum. for 1858. 

For myself, I am in the habit of preparing extemporaneously a 
splint from a wooden shingle which I first cut into the requisite 
shape and length ; the length being obtained by measuring from 
the front of the elbow-joint, when the arm is flexed to a right angle, 
to the metacarpo-phalangeal articulationa It ought, indeed, to &11 
half an inch short of the bend of the elbow to render it certain that 
it shall make no uncomfortable pressure at this point; and the 
direction to measure with the arm flexed, is of sufficient importance 
to warrant a repetition. The breadth of the splint should be in all 
its extent just equal to the breadth of the forearm in its widest part, 
so that there shidl be no lateral pressure upon the bones. If the 
splint is of unequal breadth, the rollers cannot be so neatly applied, 
and it is more likely to become disarranged. Thus constructed it 



DBFORMITIBS AFTKB FRACTURES. 177 

is to be covered with a sac of cotton cloth made to fit tightly, with 
the seam along its back ; and afterwards stuffed with cotton batting 
or with curled hair. These materials may be pushed in and easily 
adjusted, wherever they are most needed, from the open extremities 
of the sac. While preparing, the splint must be occasionally applied 
to the arm until it fits accurately every part of the forearm and 
hand, only that the stuffing must be rather more firm a little above 
the lower end of the upper fragment. The open ends of the sac 
are then to be neatly stitched over the ends of the splint This 
splint is now to be laid directly upon the skin without any inter- 
mediate compresses or rollers. (Fl. lY. Figs. 6 and 6.) 

The advantages of this form of splint are easily comprehended. 
They consist of facility and cheapness of construction, accuracy of 
adaptation, neatness, permanency and fitness to the ends proposed. 

The extemporaneous splint recommended by Dr. Isaac Hays of 
Philadelphia (PL IV. Fig. 2) is very similar, but it lacks the neat- 
ness and permanency of that which I have now described. 

In all cases it is better to employ, also, at least during the first 
fortnight, a straight dorsal spKnt, of the same breadth as the palmar 
splint, and of sufficient length to extend from the elbow to the 
middle of the metacarpus. This should be covered and stuffed in 
the same manner as the palmar splint, except that here the thickest 
and firmest part of the splint must be opposite the carpus and the 
lower end of the lower fragment. It will answer the indications 
also a little more completely if, at this point, the padding is thicker 
on the radial than on the ulnar side. 

Having restored the fragments to place, in case of Colles' frac- 
ture, by pressing forcibly upon the back of the lower fragment, the 
force being applied near the styloid apophysis of the radius, the 
arm is to be fiexed upon the body and placed in a position of semi- 
pronation; when the splints are to be applied and secured with a 
sufficient number of turns of the roller, taking especial care not to 
include the thumb, the forcible confinement oi which is always 
painful and never useful. 

I cannot too severely reprobate the practice of violent extension 
of the wrist in the efforts at reduction, and that, whether this ex- 
tension be applied in a straight line, or with the hand adducted. It 
has been shown that in a great majority of cases no indication in 
this direction is to be accomplished, and to pull violently upon the 
wrist is not only useless but hurtful. It is adding to the fracture, 
and to the other injuries already received, the graver pathological 



178 BEPOBT ON 

lesion of a stretching, a spFain, of all the ligaments connected with 
the joint. I am persuaded that to this yiolence, added to the un- 
equal and too firm pressure of the splints, are, in a great measure, to 
be attributed the subsequent inflammation and anchylosis, in very 
many cases. 

The first application of the bandage ought to be only moderately 
tight, and as the inflammation and swelling develop in these struc- 
tures with rapidity, they should be attentively watched and loosened 
as soon as they become painful. It must be constantly borne in 
mind that, to prevent and control the inflammation, in this fracture, 
is the most difficult and by far the most important object to accom- 
plish, while to retain the fragments in place when once reduced, is 
comparatively easy and unimportant. 

During the first seven or ten days, therefore, these cases demand 
the most assiduous attention ; and we had much better dispense with 
the splints entirely than to retain them at the risk of increasing the 
inflammatory action. Indeed I have no doubt that very many cases 
would come to a successful termination without splints if only the 
hand and arm were kept perfectly still, in a suitable position, until 
bony union was effected. 

I must also enter my protest against many or all of those carved 
splints which are manufactured, hawked about the country and sold 
by mechanics, who are not surgeons : with a fossa for each styloid 
process, a ridge to press between the bones, and various other curi- 
ous provisions for supposed necessities, but which never find in any 
arm their exact counterparts, and only deceive the inexperienced 
surgeon into the neglect of the proper means for making a suitable 
adaptation. They are the fruitful sources of excoriations, ulcera- 
tions, inflammations and deformities. 



DBFOBMITIBS AFTER FRACTURES. 179 



CHAPTER IX. 

ULNA. 

Upper Third, 

Olecranon Process. 

Case 1. Simple fracture. Union by ligament, BesuU perfect, 
Trulis Hanson, of Norway, Europe, set. 52, broke the olecranon 

process of the right arm by a ML It was treated by a Norwegian 

surgeon. 
May 30, 1855, one year after the accident, I found the fragment 

united by ligaments one-quarter of an inch in length, and the arm 

quite as useful as before. 

Case 2. Simple fracture. Union by ligament, BesuU nearly per- 
fect. 

John Carbouy, of Buflfalo, set. 18, works at the Eagle Furnace, 
fractured the olecranon process of the right arm. 

It was dressed by Dr. James P. White, of Bufialo, with a straight 
splint, &c. 

Nine years after the accident, I found the process united by a 
ligament half an inch in length, and he could nearly, but not per- 
fectly, straighten the arm. In all other respects the limb was as 
before. 

Case 3. Simple fracture. Union by bone, BesuU nearly perfect, 
Peter Chapin, ast. 14, fractured the olecranon process. Dr. Benja- 
min Smith, of Berkshire, Mass., dressed the arm. 

Sixty-nine years after the accident, I found the process united 
apparently by bone. He could not, however, straighten the arm 
completely, or supine it freely. 

Case 4. Simple fracture, with a fracture of the radius at its lower 
end. (See case immediately following Case 86, in Fractures of 
Radius.) BesuU perfect, 

Samuel Duchett, of Buflfalo, aet. 14, while suflfering from a fracture 
of the radius, fell upon the point of the elbow of the same arm. 



180 RBPORT ON 

Four days after this last accident, and two days after his admission 
into the hospital, the elbow was much swollen, but there was no 
crepitus, and he could nearly straighten the arm. On the sixth day 
we discovered, when the olecranon was seized and attempted to be 
moved, a distinct crepitus. 

We extended the arm, and applied a gutta percha splint, which, 
after the fifth day, was renewed daily, and its angle at the elbow 
changed. Twenty-two days after the fracture occurred, the splint 
was removed, and the fracture waa found united by bone, and the 
motions of the joint unimpaired. 

Case 5. Fracture, complicated vnth dislocation of the head of the 
radius foTXJoard, Union by ligament. Result imperfect. 

Charles Angel, of Livingston Co., N. Y., aet 15. 

This case was treated by Dr. Lauderdale of Geneseo. Six months 
after the accident I found the radius in place, and the olecranon 
process united by ligament. He could not straighten the arm 
completely ; the forearm remaining at an angle of 46^ with the 
arm. 

Below Coronoid Process {Upper Third). 

Case 6. Simple fracture. Result perfect. 

John Cavender, of Canada, set. 18, broke the ulna through its 
upper third. It was treated by Dr. Reynald, of Toronto Hospital. 

I examined the arm one year after it had been broken. The 
arm was perfect 

Case 7. Simple frojcture. Result nearly perfect. 

Rose Stanton, of Bu£&lo, set. 46, broke the ulna through its upper 
third. It was dressed by a surgeon in BuSBeiIo. 

Nine weeks after I found a slight forward bend at the seat of 
fracture, and the lower end of the ulna unusually prominent, to the 
ulnar side. The wrist was quite stiff. 

Case 8. Simple fracture. Result not perfect. 

Ellen O'Brian, of BuiSalo, »t 82, while carrying a tub in the 
winter, fell upon the ice and broke her left ulna at the lower end 
of the upper third. Dr. Bissel, of Buffalo, was called two days after. 
He applied two wide splints and a roller. 

Three years afl»r I found a marked deformity at the seat of 
fracture, and the lower end of the ulna projecting to the ulnar side. 
The arm was as useful as before. 



DEFORMITIES AFTER FRACTURES. 181 

Case 9. Compcmr^ fracture. JResuU perfect. 

Miss Short, of Buffitlo, sat. 7, fell and broke the ulna about four 
inches below the elbow-joint. The fragments penetrated through 
the skin on palmar surface of arm. 

I applied two straight splints, but the arm was so tender and 
swollen that I could not apply them very snugly. 

On the 28th day I removed all dressings. She could supine and 
extend the forearm perfectly. At the seat of fracture there was a 
manifest projection. 

One year after date I find the arm perfect. 

Case 10. Simple partial fracture. Complicated vnih dislocation of 
radius. Result perfect. 

Elizabeth Carmody, of Buffalo, set. 4, broke the ulna just below 
the root of the coronoid process. The head of the radius was also 
dislocated forwards. (Incorrectly reported in communication to 
N. Y. Med. Soc, as a fracture of the radius. See TVans. 1855, p. 53.) 

I reduced the dislocation easily, but could not bind the fractured 
ulna so as to make it straight. I applied on the palmar and dorsal 
surfaces of the arm and forearm, angular splints made of binders' 
board, well padded : but in no way could I, by pressure, or by 
bandaging, accomplish a complete restoration of the fragments of 
the ulna, and at the end of a year the projection at this point was 
manifest. The functions of the arm were, however, perfect. 

Case 11. Compound fracture. Complicated with dislocation of the 
head of the radius forwards. United^ vnth defoi^mity and displacement. 

John George Brindle, of Hamburg, N. Y., set. 17, was struck by 
a locomotive and severely injured in various parts of his body, 
June 5, 1855. I saw him with Drs. Smith and Adams a few hours 
after the accident The whole left arm was then greatly swollen. 
Crepitus was distinct, and we diagnosed a fracture of the ulna about 
three inches below its upper end. We suspected also a forward 
luxation of the radius, but in the condition in which we found the 
limb we did not think it best to attempt reduction. There was a 
wound which seemed to communicate with the fracture. The arm 
was laid upon a pillow and cool lotions were directed to be applied. 

Two months later I found the ulna united, with fragments bent 
forwards and outwards towards the radius. 

The head of the radius was dislocated, and lay in front of the 
lower end of the humerus. Forearm shortened three-quarters of 



182 BEPOBT OK 

an inch. He could flex his arm freely to a right angle, and a little 
beyond; could straighten it perfectly. Hand slightly proned and 
could not supine it completely. There is a remarkable fulness 
above the olecranon, on the back of the arm, occasioned by the 
shortening of the triceps. His arm is quite strong and useful. 

I am confident that any attempt to restore and retain the frag- 
ments or the dislocated radius in place would have occasioned great 
suffering, and probably the loss of the arm. 

Middh Third. 

Case 12. Simple fracture. Union with deformUy. 

Richard Coleman, of Buffitlo, set. 39, fell and broke the right nlna 
near its middle, Jan. 8, 1854. He called immediately on me, and I 
found the fragments displaced backwards. I pressed upon them 
forcibly, and then applied a palmar splint, broad and padded, to 
the forearm and hand. I took especial pains by compresses nicely 
adjusted to retain the fragments in place. The arm was placed in 
a sling. 

At the end of four weeks I removed the splints. The fragments 
were united and without any perceptible ensheathing callus, nor 
could I discover that the bone was not restored to its natural form. 

Sept 7, 1854. About eight months after the fracture, Mr. Ck>le- 
man died of cholera, and I was permitted to make an autopsy. 
(See specimen in my collection.) 

I found the fragments united with a very small amount of en- 
sheathing callus, and the bone slightly bent in the same direction 
in which I at first found them. 

Cask 13. Simple fracture. Result imperfect. 

Samuel Giffone, of Belgium, aet. 80, fractured the ulna through 
its middle third. It was treated by a surgeon in Belgium. 

Ten years after, I examined the arm. There was a slight bend 
at the seat of fracture, and supination was imperfect, the hand 
inclining to pronation. The strength of the arm was not impaired. 

Case 14. Simple fracture^ with dislocation of head of radius for- 
wards. BesuU perfect. 

Michael O'Brian, of Buffalo, set. 8, broke the ulna near its middle, 
and dislocated the head of the radius forwards. I reduced both 
fracture and dislocation and applied splints, &c. 

It resulted, after six weeks, in a perfect arm. 



DEFORMITIBS AFTER FBAOTUEES. 183 

Case 15. Simple fracture^ witk dislocation of the head of the radius. 
BesuU perfect 

Henry Gale, of Buffalo, aet. 9, fell from his bed. Dr. Austin 
Flint and myself in attendance. We found the head of the radius 
dislocated forwards and the ulna broken near its middle. The 
bones were easily replaced. We applied an angular splint to the 
arm and forearm, and at the end of two weeks we substituted pasteii 
board. The head of the radius remained perfectly in place, but tbd 
ulna became slightly bent at the seat of fracture. The motions of 
the arm were perfect. 

Case 16. Oompov/nd fradure^ with dislocation of head of radius. 
Result perfect. 

Charles Clinton, of Buffalo, set. 9, fell and broke the ulna near 
its middle, dislocating, at the same moment, the head of the radius 
forwards. The fractured ulna was pushed through the flesh and 
skin. 

Dr. White, of Buffalo, and myself in attendance. The fragments 
were easily reduced. In a few weeks the ulna had united without 
deformity; a slight prominence remained, however, in front of the 
head of the radius. 

More than five years later I examined the arm, and it was in all 
respects perfect. 

Case. (Not treated by a surgeon) Simple fracture. Deformity. 

Margaret Leary, aet. 26, fell down stairs and broke the ulna of 
the left arm. 

She was admitted to the hospital Nov. 21, 1853, suffering with 
excessive debility and a cold abscess near the shoulder-joint. She 
had not discovered the fracture of the arm. The ulna was broken 
near its middle, and the fragments displaced backwards. Crepitus 
and motion were still distinct. Owing to her very feeble and irri- 
table condition, I applied no splints. She finally recovered and left 
the hospital without any note being made of the result. 

Lower Third, 

The following two cases are copied from a report of my clinic as 
published in the Buff. Med. Joum., vol. iii. pp. 731-82. 

Case 17. Simple fracture. Result perfect. 

" Wednesday, March 2d, 1848. Mrs. , aged about 25, fell 



184 REPORT OK 

upon a log and struok upon the ulna about three inclies above its 
lower extremity. This occurred several days since, but she has 
not presented herself for treatment until to-day. 

*'The arm was dressed with a graduated compress laid along the 
palmar and dorsal surface of the forearm, especial care being taken 
to fill up the depression immediately above the ball of the thumb 
and little finger. Two broad splints were applied, one upon the 
dorsal and one upon the palmar surface, and over these was turned a 

roller. Dr. H omitted the roller usually applied from the 

hand to the wrist, remarking that a^ the object was solely to pre- 
vent oedema, it could be of no service above the wrist, and that it 
might often do serious harm by pressing the broken bones against 
each other; and this might happen too when the roller was not ap- 
plied at first unduly tight, since the subsequent swelling might be 
such as to tighten the roller injuriously at the seat of fracture. 
Omitting this first roller also we avoid all danger of that serious 
accident, a loss of the arm from sloughing, which has so frequently 
happened in the practice of the best surgeons. The circulation of 
the arm along its radial and ulnar sides is thus left wholly unin- 
terrupted." 

Two months from the time of the accident the arm was well, and 
perfect. 

Casb 18. Simple fracture. Result perfect 

Mrs. E. Smith, aged about 26. " Mrs. S. fell yesterday from a 
loaded wagon and broke the ulna of the right arm, at the sajiie 
point as the other patient ; indeed, this is the point at which this 
bone is most frequently fractured. The hand is also, as in the other 
case, forcibly proned." 

" The same dressings were applied, and the arm was laid in a 
sling against the side of the body, in a position midway between 
pronation and supination." 

Three months after, the recovery was complete. 

Case 19. Simple fracture. JResuU perfect. 

Phineas Williams, of Madison Co., set. 39, had his left ulna broken 
about two inches from the lower end, by a direct blow. It was 
dressed by Dr. Havens, of Hamilton, Madison Co., N. Y. 

One year after I found the bone considerably displaced at the 
seat of fracture ; in all other respects the arm was perfect. 



DEFORMITIES AFTER FRACTURES. 185 

Case 20. Simple fracture of ulnOj complicated with partial dish- 
cation of radius. BeauU not perfect. 

E. H. Bartlette, of Homer, N. Y., sat. 21, was thrown from a 
wagon striking upon the back of the hand and wrist of the right 
arm, producing a partial luxation of the lower end of the radius 
backwards, and an oblique fracture of the ulna near the wrist. Dr. 
Ashabel Patterson, of Homer, saw it about two hours after, and 
reduced both the dislocation and fracture. The bones were easily 
retained in place by Gibson's splints. The dressing was continued 
six weeks. 

Two years after the accident, whilst Mr. B. was a student of 
medicine under my instruction, I found the arm as strong and as 
useful as the other, but he could not supine it completely. The 
styloid process of the ulna projects so that the wrist is one-quarter 
of an inch wider than the oUier, and measures three-quarters of 
an inch more in its circumference. 

Case 21. Comminuted fracture compliccUed tmth disloccUion of the 
head of the radius. BesuU imperfect. 

John Lewis, of Montrose, Pa., »t. 25, broke his left ulna at two 
or three points, and at the same time dislocated the head of the 
radius forwards. Drs. Park and Patrick, of Montrose, were em- 
ployed. I examined the arm two years after and found it 
shortened one inch ; the ulna much bent forward below its middle, 
and the radius still displaced forwards. 

Case 22. Fracture complicated unth dislocation of the head of the 
radius forwards. Resulting in drformiXy. 

Oliver H Perry, of Erie Co., set. 26, fractured the ulna through 
its lower third and at the same time dislocated the head of the 

radius forwards. Dr. , of Aurora, was employed. Three months 

after the accident I found the radius unreduced, and the ulna bent 
at the seat of fracture. The motions of pronation and supination 
as well as of flexion and extension were nearly complete. 

CORONOID PROCESS. 

Cdbinjst Specimen. 

Specimen. Dried. Adult. Broken transversely near the ex- 
tremity. United by bone quite closely and not displaced. No 
ensheathing callus. (Charles Gibson, Bichmond, Ya.) 
VOL. IX.— 13 



186 



BEPOKT ON 



UPPER THIRD (OLECEAHCir Peocbw). 


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314y. 


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He could not straighten Imp. 






















the arm completely, nor 
























supine it freely. 




414,. 


Im. 


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u. 


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United In 22 days. 


P. 


5 15 J. 


6 m. 


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p 


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DEF0BXITIB8 AFTBB FBACTUBBS. 



187 



LOWEBTHIKD. 








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REMABES. 

Of twenty -two fractures of the ulna eleven belong to the upper 
third, fiye to the middle third, and six to the lower third ; or, ex- 
cluding the olecranon process and confining the analysis to the 
shall, the upper and lower thirds have each six, and the middle 
third five. 

Of fractures of the coronoid process I have seen no case of which 
I can speak at all positively. 

I know also of but one specimen in the museums in this country, 
and this has been reported to me by Dr. Gibson of Richmond, Va., 
as being in his collection. 

Sir Astley Cooper mentions that he has seen one specimen of this 
fracture upon the cadaver, broken oflF completely at its base and 
-united by a ligamentous substance, which rendered it movable upon 
the ulna, and permitted the ulna to slide backwards upon the lower 
end of the humerus whenever the arm was extended. It was ac- 
companied also with a fracture of the external condyle of the 
humerus.* Samuel Cooper, also, in his " First Lines," describes a 
specimen in University College Museum, in which both olecranon 



■ Treatise on DIbIoc. and Frao. of Joints, by Sir A. Cooper. Philada. ed., 1825. 
See also plate 17, fig. 2, of same toL 



188 BBPORT OK 

and coroDoid are broken off separately, and the radius is dislocated 
forward. 

I have mentioned all of the well-authenticated cases of which I 
have any knowledge, but reports of supposed cases are by no means 
infrequent. 

In addition to the cabinet specimen seen by Sir Astley Cooper, 
and which I have mentioned, he believes that he has seen one case 
upon the living subject Mr. Liston also reports the case of a boy, 
who, suspending himself by his arms from a high wall, broke at 
length the coronoid apophysis through the action of the brachialis 
internus I Dr. Fahnestock reports a case in the Amer. Joum. (f 
Med. Scu, vol. vi. p. 267, Dr. Cooper, of the Glasgow Infirmary, 
reports one case in the LondL Med. Chir. Rev. for Aug., 1829. Id 
the Amer. Med. Monthly for October, 1855, is an account of a trial 
for malpractice, in which a lad nine years old received some injury 
about the elbow-joint, which resulted in a maiming. Dr. E. B. 
Feaslee, Pro£ of Anat in Dartmouth Col., thought it " altogether 
probable that the coronoid process had been broken." Dr. Crosby, 
Prof, of Surg, in the same college, could not decide positively. 
" He had never found a fracture of the coronoid process ; still, it 
might exist here." Dr. Spalding, of Haverhill, was of the opinion 
that it was broken, and that there had been a dislocation of the 
elbow backwards. The defendant, Dr. Moore, claimed that there 
had been such a dislocation, and that either the trochlea of the 
humerus, or the coronoid process of the ulna, had been broken. 
The jury did not agree, and were dismissed, and before the next 
term of court a nonsuit was allowed by the court. 

The defendant, in his report of the trial, justly complains that 
Mr. Fergusson, in his Operative Surgery^ says (or is made to say) of 
backward dislocation of both bones of the forearm : " In such a 
case, the coronoid process will probably be broken." This was urged 
in the trial by plaintiff^s counsel as contradicting the medical testi- 
mony, and charging a conspiracy on the part of the doctors to 
defeat the ends of justice, in saying that the accident was veiy 
rare. 

Dr. Dorsey, in his Surgery, says that Dr. Physick once saw a case 
of fracture of the coronoid process ; that the forearm was kept fixed 
at a right angle with the humerus, and the tendency of the brachi- 
alis muscle to draw up the superior fragment was counteracted in 
some measure by pressure of the roller above the elbow, and '* that 
h perfect cure was readily obtained.^'' 



DBFORMITIBS AFTBB FKACTURES. 189 

In the first work referred to, Mr. FerguHBon'a Surgery^ perliaps 
the word "possibly" has given place to " probably." 

In the latter, it may well be doubted whether the case is fairly 
represented by Dr. Dorsey, it not having come within his own 
observation. 

In my report on dislocations, made to the New York State Med. 
Soc- in 1864, 1 have also reported the following case : — 

Gasb 17. With fracttare of the coronmd process, 

I have no notes of this case, aiid I am compelled, therefore, to 

recall it imperfectly from memory. , of Bufl&do, aged about 

25 years. I found this man upon a canal-boat, with a dislocation 

of the left radius and ulna backwards and upwards. Dr. 

had reduced it, as he believed, the day before, and soon after the 
accident. The bones were now displaced again, and the arm much 
swollen. 

By extension and counter-extension in my usual mode, I reduced 
the dislocation after a few minutes ; but I immediately discovered 
that on releasing the arm, the dislocation was reproduced. I re- 
peated my efforts to reduce and to retain it in place several times 
on this day and on subsequent days, but to no purpose, and the 
patient left me after a few days with the bones unreduced. 

The impossibility of retaining the bones in place when reduced, 
and the existence of an occasional slight crepitus in the first trials, 
determine me in recording it as a dislocation, with fracture of the 
coronoid process. 

Within the past year, another similar case has presented itself, 
in a child nine years old. The bones were displaced backwards, 
and could not be made to stay in place except by force. I suspected 
a firacture of the coronoid process, and having applied an angular 
splint, I left him in charge of an intelligent country surgeon, Dr. 
Morrow, with a request that he would permit me to see the child 
after recovery. 

On the 14th of May inst., he called upon me, and it is now evi- 
dent that the process was not broken. The radius and ulna are in 
place, the motions of the joint are perfect, and there is no evidence 
that the process was ever broken. I have no doubt it was not. 

I am pretty well convinced now that none of these cases were 
examples of fracture of the coronoid process, and that the radius 
and ulna will often become displaced spontaneously, after simple 
dislocations, and where neither the humerus nor the coronoid pro- 



190 REPOBT OK 

cesB is broken. There is too much disposition, I fear, on the part 
of all surgeons, to ascribe to extraordinary events, pbenomenA 
which are of difficult explanation ; from which imputation 1 do not 
hold myself excused. 

The case reported by Liston, in which the process was said to be 
broken by the action of the brachialis intemus, has led to a fre- 
quent repetition of the opinion that it may, and often does so occur; 
but malgr4 the testimony of Mr. Liston, of Mr. Miller and othera* 
I must be permitted to doabt whether this apophysis was ever de- 
tached by muscular action, since the brachialis intemus is inserted 
not upon the process but at its base. Dr. Henry H. Smith, of Phila- 
delphia, also, I believe, concurs with me in this opinion. 

Of the five fractures of the olecranon process, three were united 
by ligament, the length of which in no case exceeded half an inch, 
and two were united by bone. In all of the examples the motions 
of the arm were nearly restored after a time, and only two are 
marked imperfect. 

Of the six fractures, through the shaft of the bone in its upper 
third, only one is imperfect, and of the five through the middle 
third all are perfect, while of the six occurring through the lower 
third only one-half are perfect. 

Of the whole number, including the olecranon process, six are 
imperfect and sixteen perfect. Of the thirteen simple, uncompli- 
cated cases only one is imperfect. 

In seven cases, the fracture was accompanied with a forward dis- 
location of the head of the radius, in three of which it r^oaains 
unreduced. Of these seven cases, two belonged to the upper third, 
two to the lower, and three to the middle third. 

In six cases there remains some displacement at the seat of frac- 
ture, of which two are displaced towards the palmar surface, one 
towards the dorsal, and one outwards towards the radiua The lower 
end, or styloid process of the ulna, is thrown inwards, to the ulnar 
side, in three cases. In three cases the forearm remains slightly 
proned, and in two it is mentioned that this was the position of the 
forearm, at the time of the first dressing. In no case was the fore- 
arm supined. In no case have I detected anchylosis between the 
radius and ulna ; ucht has the power of supination ever been com- 
pletely lost. 

The principles of treatment in fractures of the ulna seem to he 
BO plain, and so well established, that I do not think it necessary 



BBFOBMITIES APTSB FBACTUBES. 191 

that I should say more than to refer you to the standard treatises 
upon surgery, for all the necessary information. 

Malgaigne has made one ohseryation, however, which, without 
having myself had an opportunity to confirm, I think it worth while 
to reproduce. Ordinarily the arm is to be placed in a position of 
semi-pronation, ** but when the displacement is very considerable, and 
threatens to destroy the interosseous space, we most have recourse 
to supination, and the complete apparatjos for fractures of the forearm. 
Supination is even sometimes necessary solely to insure contact and 
consolidation of the fragments." M. Fleary has published a case 
of this kind, treated by semi-pronation, in which the fragments 
remained ununited and displaced, and he could only maintain them 
in contact by placing the forearm in a position of supination. 

The surgeon must also be cautioned against allowing the arm to 
tail downwards between the splints, when the radius is laid upper- 
most against the body, in consequence of which, sometimes the 
fragments are forced into the osseous space, and the arm remains 
permanently bent. 



CHAPTER X. 

BADIUS AND ULNA. 
Upper Third. 

Cass 1. Simple fracture. Union perfect. 

John Winslow, of Buffalo, set. 16, fell from a fence, Sept. 25, 
1855, striking upon his hand, and breaking the radius and ulna at 
the junction of the middle and upper thirds. 

It was dressed at the hospital, on the following day, by Dr. 
Smith. 

October S. Not yet united. I dressed the arm with two lateral 
splints. 

This lad left the hospital on the 12th, seventeen days after the 
accident, and did not return. 

I have since learned that it united without deformity or maiming. 



192 B8P0BT ON 

Qm/pom^ fracture. No aurgioal treatment. Resulting in great 
deformity. 

Wm. Sharp, of Livingston Co^ »t 69, had a compound fracture 
of both bones near the upper ends. No surgeon vhu employed. 

Five years after the fracture I found the forearm shortened one 
inch ; the fingers very much contracted, and the power of supina- 
tion and pronation completely lost. The arm was very feeble. 

Middle Third. 

Case 2. Simple fracture. BesuU perfect. 

John Bowles, of Ireland, »t. 25, broke both bones. They were 
dressed by an Irish surgeon. 
After twenty-five years there existed no traces of the fracture. 

Qas&Z. Simple fracture. BesuU perfect. 

G€K>rge Booth, of Buf^o, adt 11. Broken through the middle 
third. Dr. George Burwell in attendance. Five weeks aft«r the 
fracture Dr. B. brought the child to me, the bones were united and 
straight. There was, however, considerable ensheathing callus at 
the seat of fracture. 

Case 4. Simple fracture. Result perfect. 

T. B. Seelye, of Geneva, N. Y^ «t. 11, broke the radius and ulna 
through the middle third. 

The fracture was treated by Dr. Asher Nichols. 

Eleven years after, the arm was in all respects as before the acci- 
dent. 

Case 5. Simple fracture. Result perfect. 

The late Prof. James Webster broke both bones of the right 
forearm near the middle, when about 10 years old. The arm was 
dressed and subsequently treated by the late Prof. Horner, of 
Philadelphia. 

Prof. Webster permitted me to examine the arm while he was 
my colleague at Bufiklo, more than SO years after the accident. I 
could not discover where the fracture had occurred. 

Case 6. Simple fracture. Result perfect. 

Margaret Casey, of Ireland, set. 9, broke radius and ulna near the 
middle. It was treated by Dr. Little, of Ireland. 



DEFORHITISS AFTEB FBACTUBES. 193 

Ten years after the accident I found th^ arm completely sound 
and with no traces of the fracture. 

Caq^ 7. Partial fracture, ResuU perfect. 

Charles AUender, of Buffalo, sat 2, fell from a chair bending the 
right forearm near its middle. He was brought to me soon after. 
The fragments were salient backwards. 

I straightened the arm by using considerable force, and the resto- 
ration was accompanied with crepitus. After two months I found 
the arm in all respects perfect. 

Cask 8. Simple fracture, RemU perfect 

Thompson Maxwell, set. 16, broke the right forearm near its 
middle, June 11th, 1868. It was treated, at first, by Dr. Gould, of 
Lockport. On the seventh day he came under the charge of Dr. 
George Burwell. Dr. B. found the whole arm inclined to the ulnar 
side from the point of fracture downwards. He straightened the 
arm and again applied splints, but at each subsequent dressing he 
found the fragments displaced in the same manner, and he as often 
restored them to position. 

Five weeks after the accident, July 18, 1858, by request of Dr. 
Burwell, he called upon me. The fragments were united, but with 
the same displacement mentioned already. There was no appear* 
ance of ensheathing callus. Pronation and supination, with flexion 
and extension, were perfect. 

April 16, 1856, nearly three years after, I find the arm per- 
fectly straight, so that I could not say where the fracture had 
occurred; all of its motions are perfect, but forced supination 
causes a pain near the seat of fracture. The arm is strong and 
larger than the opposite arm. 

Case 9. Simple fracture. Delayed umm. ResuU perfect. 

John L. Snedaker, of Clyde, N. Y., »t. 26, fractured both bones 
of the left forearm, a little below its middle. E. Darwin Colvin, of 
Clyde, a careful, and experienced surgeon, was in attendance. 

Dr. Colvin applied a palmar and dorsal splint, well padded and 
of sufficient length, extending from the elbow to the ends of the 
fingers. These dressings were continued eight weeks. At this 
time the ulna had united but the radius had not 

January 14, 1845, at the request of Dr. Colvin, the patient was 
brought to me. It was now three months since the fracture occurred, 



194 BBPOBT ON 

and no union had taken place between the fragments of the radius. 
At my instance, Dr. Colvin rubbed the ends of the bone violently 
together, and then applied a graduated compress upon both the 
palmar and dorsal surfaces of the arm, over which and completely 
ensheathing the radial border, a felt splint was carefully moulded, 
extending from the elbow to the fingers, and with an opening to 
receive the thumb; over this a roller was laid as snugly as the 
patient could bear« The arm was then placed in a sling. 

Three weeks from this time the arm was examined, and the union 
between the fragments was found to be tolerably firm. The limb 
was soon completely restored. Seven years later I found it still 
perfect in all respects. 

Case 10. Simple fracture. Result imperfect. 

John H, Landon, of Pennsylvania, broke both bones near their 
middles. 

The arm was treated by Dr. Canada, of Pa.; and after forty years 
I find that pronation and supination are imperfect, but that in all 
other respects the arm is as useful as the other. 

Case II.* Simple fracture^ and delayed union. 

Patrick Meehan, set. 80, Dec. 26, 1855, broke the radius and ulna 
of his right arm, a little below their middle. His arm was caught 
between a hand-car and a locomotive. Both fractures oblique. I 
dressed the arm soon after the accident, but in consequence of the 
severe contusion, the arm was already so much swollen that it was 
impossible to apply the dressings very snugly. 

The next morning he came to the hospital, and the dressings 
were tightened by stitching them over. 

January 2 (7th day). I opened the dressings. Fragments in 
place. Applied two broad, straight, carefully padded splints. 

V)ih. Eetightened dressings by stitching. 

16^A. Removed and reapplied same splints. 

30^. No union of fragments. Removed bandages and secured 
splints with tapes. The splints to be open most of the time. 

About the 11th of February, I applied a firm starch bandage. 
At this time the ulna seemed to be united but not the radius. 

April 15. Have continued splints to this time. Motion between 
fragments of radius still evident. Discontinued all dressings and 
directed cold bathings, &c. 



DEFORMITIES AFTEB FBACTURES. 195 

Case 12. Simple fracture. Delayed union. Deforraity^ dc. 

Henry Mangen, at Alleghany Co., N. Y., fell on the ice, Feb. 25, 
1854, and broke the left radius and ulna a little below their middle. 
Dr. L. M. Purple, of Wellsville, N. Y., dressed the fracture within 
an hour. 

He applied carved splints to palmar and dorsal surfaces of fore- 
arm and hand. At the end of three weeks the ridge, intended to 
press between the bones on the palmar surface, had produced a line 
of ulceration along the whole length of the forearm. Dr. P. had 
been very attentive, and examined the arm frequently. At this 
time a slight deformity in the bone was manifest. 

Two weeks later the case fell into the hands of Dr. Charles, a 
skilful surgeon, residing in Angelica, when the deformity had 
increased very much. Dr. Charles attempted to readjust the frag- 
ments, and seemed to have succeeded partially. He applied splints 
carefully, but at the end of a week it was as crooked as ever. By 
request of Dr. Charles the patient subsequently called upon me, 
June 27, 1854, about four months after the accident. 

The whole forearm below the fracture was inclined strongly to 
the ulnar side, the broken ends of the ulna overlapping about one 
inch and a quarter, and the ends of the radius much less. The 
radius was firmly united, but the fragments of the ulna were 
slightly movable. 

There was no appearance of ensheathing callus. 

Case 18. Simple fracture. Loss of the forearm by sloughing. 

John, adopted son of Mrs. McGrrath, alias Mrs. White, the 
"BuflFalo candy woman," set. 9. This unfortunate lad was a 
pauper, and had been by the county apprenticed to one of the worst 
women of the town. How much the boy was benefited and the 
county saved by this piece of economy, the sequel will show. 

Friday, July 2, 1847. John fell from the top of a ladder, about 
30 feet, to the ground, breaking his right radius and ulna in their 
middle thirds. The surgeon did not see him until four or five 
hours had elapsed. 

Dr. A. then carefully reduced the broken bones and applied two 
broad splints, one on the palmar and one on the dorsal surface, both 
of which were covered and padded. The splints were secured by a 
roller. 

The forearm was then placed in a sling, and he was instructed to 
remain quiet in the house. 



196 BEPOBT OIK 

Sd, Dr. A. visited the patient, and examined the condition of 
the arm and hand, and found everything in order. 

4^. Dr. A. did not call, but it being our national holiday, the 
lad spent the day in the street. On the 6th a medical student was 
sent to see him, bnt the student did not find him in. On the 6tli 
Dr. A. called. The arm and the hand ^yere then swollen and 
gangrenous, and on the same day I was requested to see the 
patient. 

I found him in a very dirty apartment^ lying upon a miserable 
bed. His right arm was resting upon a pillow, and gangrenoos 
throughout its entire length. The dusky color, indicating gangrene 
in its inception, extended in the form of a crescent across the 
middle of the chest. The thumb and fingers were black. Eis 
countenance was good, and his intellect clear ; his pulse 75 and 
soft ; tongue clean ; he had slept well the night before, and felt 
perfectly well. 

I examined the splints and found them neatly made and carefully 
padded. Dr. A. had assured me that he had not applied the ban- 
dage too tight, and I had no doubt that he had informed me cor- 
rectly, but I proceeded, notwithstanding, to interrogate those who 
were present at the time. M., a medical student, thought they were 
rather loosely than tightly applied. The boy and his mother said 
the same. The account which they gave of what, in their opinion, 
had produced the result, was as follows: Notwithstanding the 
surgeon's instructions that the boy should be kept in the house, he 
was out aU of the 4th and most of the 6th of July, running about 
the streets, firing crackers, &c., with his arm, most of the time, out 
of the sling and hanging by his side. His mother had locked him 
into the house alone, but he crawled out of the window. On the 
morning of the 6th the mother noticed that his fingers were black, 
but she thought they were blackened with powder. 

We ascertained also that the boy had a diarrhoea, which had con- 
tinued several days. 

We ordered, therefore, one-quarter of a grain of opium to be taken 
every four hours, and a yeast poultice to the arm. 

8th, The gangrene still extending, pulse 124; feels well. 

11^. Line of demarcation formed opposite shoulder-joint. 

It is not necessary to follow this case so minutely to its dose. A 
few days after, he was removed to the Almshouse, and the separa- 
tion continued until the arm fell off at the shoulder-joint, and he at 
length completely recovered. 



DEFORMITIES AFTER FRACTURES. 197 

Case 14. (hmp(mfyi fradwre. Union after ahtmt Jive months, with 
shortening, ike. 

Johanna Foley, of BuflFalo, »t. 22, broke her left ann in the upper 
part of the middle third of the radius and ulna. Accident occurred 
July 5th, 1855. 

One of the fragments was pushed through the skin. Violent 
erysipelatous and suppurative inflammation followed. 

The arm was treated at first by Dr. George Burwell, of Buffalo. 
On the 15th of July she was admitted to the hospital and came 
under the care of Dr. EUory P. Smith, one of the surgeons to the 
hospital. Only mild contentive measures could be employed for 
two months or more. 

At the commencement of my service, October 1, 1855, 1 found 
the fragment, not united, and the arm shortened three-quarters of 
an inch. I directed all dressings to be removed, and that the arm 
should be bathed with cold water daily. The patient was also 
directed to sit up some each day. 

On the first of November union had taken place. Elbow-joint 
was still stiff and the hand swollen. 

Dec. 20. Nearly six months after the accident, she is still slowly 
recovering the use of her arm and hand. Fingers, wrist, and elbow, 
still remain quite stiff, and some swollen ; yet she has been using 
passive motion since the first of October. 

Casb 15. Ommdnuted fracture. Union with shortening, <kc. 

A Frenchman, aged about 85 years, fell from th^ Erie Canal 
Aqueduct, at Eochester. The fractures were oblique and commi- 
nuted. Dr. , of Eochester, was called. 

The next day, I found the arm dressed with three short and nar- 
row splints, without compresses, and the hand laid upon its palm. 
The fragments were displaced, and it was impossible to restore them 
to position. They were, therefore, left overriding, the forearm 
being placed in two broad splints, with compresses, &c. The bones 
united, with a shortening of half an inch, and with slight deformity. 

Case 16. Partial fracture. No surgeon. Union with deformity. 

Maria Jordan, of Buffalo, aet. 4, fell on her hand, with the arm 
extended, and bent the radios and ulna near their middle. The 
mother immediately bent the bones back partly, and then called 
upon John W. Fox, a homoeopathist. He applied splints, &c. 

The mother brought her to me July 26, 1853. I found the bones 
much bent backwards at the seat of fracture, but firm. No en- 



198 REPORT ON 

sheathing callus. Hand proned, and she could not supine it com- 
pletely. 

Lower Third* 

Case 17. Partial fracture. Result perfect 

Madison, of BuflFalo, aet. 8, fell and partially broke both bones 
near their lower ends, May 2, 1849. Dr. Sprague requested me to 
visit the child with him. We straightened the bones easily. No 
splints were applied as we found no tendency to displacement 
The arm was simply laid on a pillow and kept wet a day or two 
with cool water. 

One month after, the arm was entirely well and without de- 
formity. 

Case 18. Partial fracture. ResuU perfect 

Elizabeth McLevy, of Buffalo. 8Bt. 18 months, fractured the radius 
and ulna of the right arm through their lower third, Aug. 15, 1849. 
The fracture was partial, being rather bent than fractured. The 
deformity was very marked. 

I straightened the bones and applied a paste bandage, splints^ 
&;c., but soon finding that the dressing could not be kept in place, 
and that, indeed, they were not necessary, I discontinued them. It 
resulted in a perfect cure, within a month. One year later I found 
the arm in all respects like the other. 

Case 19. Partial fracture. ResuU perfect 

Edward Lamphier, of BuflBilo, aet. 5, fell, Dec. 7, 1855, and broke 
the radius and ulna of the left arm. 

Fracture at the upper end of the lower third, simple and trans- 
verse. 

I found the lower fragments bent backwards and not overlapped. 
I straightened them with moderate force, and the restoration to a 
straight line was attended with a cracking sensation, as if some of 
the fibres of the bone had suddenly given way. The arm was now 
perfectly straight, and the fragments showed no tendency to become 
displaced. 

I applied a padded, straight splint to the dorsal surface of the 
arm. 

The following day Dr. Treat, of Buffalo, the family physician, 
took charge of the case. 

It has united without deformity. 



DSFOBMITIBS AFTER FBAGTUBES. 199 

Cask 20. Partial fracture. ResuU perfect 

Catbarine Winne, of Buffalo, aet. 6, fell on her right hand, Sept. 
14, 1854. I found the arm very much bent backwards horn a point 
about one and a half inches above the wrist-joint. Both bones 
were bent at the same point. 

I was obliged to use great force to bend the lower firagments into 
line. It was accomplished without crepitus; and when restored the 
fragments showed no disposition to become again displaced. I 
applied, however, a single firm, well padded splint on the palmar 
surface of the forearm and hand, and placed the whole in a sling. 

The result, after four weeks, was a perfect arm. 

Case 21. Partial fradure of the radius and complete fracture of the 
ulna. ResuU perfect. 

Horace Parmelee, of Buffido, set. 8, fell through an unfinished 
btiilding, May 28, 1855, and broke the left forearm about three 
inches above the wrist. The arm had been partly straightened by 
a gentleman before I arrived. I saw the lad witMn an hour. The 
firagments were salient forwards. With considerable force I bent 
the fragments into line, and the restoration was attended with a 
single audible snap and not a crepitus. The snap was felt and 
heard distinctly to proceed from the radius. I inferred that one 
bone had been completely broken off and the other only partially, 
and that in restoring the latter to form I had completed the separa- 
tion. There was no tendency subsequently to displacement 

I applied one dorsal splint and placed the arm in a sling. The 
bones were firm in about twenty-one days, and the arm perfect. 

Case 22. Simple fracture of ulna and bend of radius near their 
lower ends. ResuU perfect. 

Peter Dalton, of Buffalo, aet. 2, fell, March 1, 1852, breaking the 
ulna about an inch from its lower end and bending the radius at 
the junction of its epiphysis with the shaft. 

I saw it immediately, and with moderate force succeeded in 
bringing the fragments into line. I applied no splints or dressings 
of any kind. 

On the fourth day the child was examined by Dr. Pupikofer and 
myself. The fragments were not displaced. 

I drew the arm from the sleeve and put it underneath the waist 
of the dress. 

Four months later I found the arm perfect. 



200 BEPORT ON 

Casb 28. Simple transverse fracture of the radius^ with partial 
fracture of the ulna, BesuU perfect. 

Lad, living at Bnfialo, »t 14. Sent to my clinic, by Dr. George 
Burwell. His arm had been caught in some machinery three days 
before, but he had only to-day called upon the doctor. 

The radius was broken and slightly displaced. The ulna was 
only bent. I easily straightened both bones, and we then applied 
two broad splints with compresses, &c. 

It united in a short time without any deformity. 

Case 24. Simple fracture. BesuU perfect. 

Wm. Powers, of Ireland, sdt 11, broke the radius and ulna of 
the right arm just above the wrist. 

It was treated by Dr. Savage, of Waterford, Ireland 

Fourteen years after the accident I found the arm in no way 
deformed or maimed, except that he could not supine or prone it 
quite as fully as he could the other arm. 

Case 25. Simple fracture. BesuU perfect. 
Peter McEvoy, of Buffalo, 88t. 8, broke right forearm just above 
the wrist, Aug. 1, 1849. 
I dressed the arm, after reducing the fracture, with a paste bandage. 
One year after the accident the arm was perfect. 

Case 26. Simple fracture. BesuU perfect. 

Horace Chase, »t. 12, broke both radius and ulna, through their 
lower thirds. Dr. Toby, of Rochester, in attendance. 

After six years, I find no deformity except a slight forward 
inclination of the radius at the seat of fracture. 

Case 27. Simple fracture. Perfect union. 

An Irish lad, in Bochester, aBt. 7, fell from a tree and struck on 
his hand ; the fracture occurred just above the wrist, and was in 
both bones nearly, or quite, transverse, being situated at the junc- 
tion of the epiphysis with the diaphysis in the case of the radius, 
and a little above the epiphysis in the case of the ulna. It is not 
certain that the fracture was complete, as the fragments were never 
entirely displaced, but only bent forwards. The bones were easily 
reduced, and with two splints retained in place. 

I saw the lad after about three months, and there remained no 
deformity. 



DBFOBKITIXS AFTXB 7BACTUBBS. 201 

Casb 28. Simple transvene Jraekire. BeauU perfect. 

H. Tucker, of Fredonia, »t. 10. Fractcmo near the lower end. 
Dressed by Dr. WaUworth, of Fredonia. Mr. T. says that when 
the Dr. remoyed the splints there was so mnch deformity that he 
seriously thought of refiraetoring the bones, but he did not. Daring 
ahout four years, Mr. T. remembers that this deformity continued 
gradually to disappear. 

Eighteen years after the fracture, when I examined the arm, it 
was perfect in form and function, and it would be impossible to say 
where the fracture had occurred. 

Cahb 29. Simple fradure, EemU imperfect, 

Samuel Duckett, of Buffiilo, set. 14. Admitted to the Hospital, 
January 28, 1849, with a fracture of the olecranon of the left arm, 
and also a fracture of the radius and ulna, about one inch above the 
joint The fracture of the radius and ulna occurred four weeks before 
admission. Dr. F^ a (German Dr., said it was not broken. 

At the time of admisrion the hand was inclined strongly to the 
radial side ; it was also proned and could not easily be supined, and 
the lower end of the ulna projected to the tdnar side. No crepitus. 
The elbow was much swollen. I attooipted to reduce the bones 
but could not I applied, howeyer, a broad, straight splint to the 
arm and forearm, laying the arm straight upon a pillow. 

After several weeks the deformity at the wrist remained the 
same as at first. 

Casb 80. Simple fracture. JSeeuU perfect. 

Qeorge B. Parker, of Otsego, N. Y., when about 10 years old, 
broke his arm transversely. The bones were very much bent out 
of line at the time. It was dressed, and subsequently treated by 
Dr. Palmer, of Otaq;o. 

Thirteen years after the accident^ when Mr. P* was a student of 
medicine, I examined the arm. It was in all respects as perfect as 
the other. 

OasbSI. Sin^ fracture. Reduced c^ two weeks. Result perfect. 

Mrs. Bridget Burke, of BufUo^ »t 80, fell on the palm of her 
hand in the winter. Dr. Fdchmaker, a German Dr., and Dr. Davis, 
a botanic Dr., saw the arm within half an hour and again the next 
meaning. Both gentlemen believed it was a q>rain. 

Two weeks later she came before my class. Both radius and 

VOL. IX.— 14 



202 BEPOBT ON 

ulna were broken nearly transyerselj one inch above the joint 
The lower ends of the upper fragments projected in fronts and the 
hand was drawn backwards. The hand was inclined towards its 
palm, and could not be easily supined. I reduced the bones easilj, 
and, in the presence of mj students, applied one straight broad 
splint to the palmar surface of the arm and hand. 

Four weeks from this I removed the dressings for the last time, 
and found the arm straight. 

Cask 82. Simple fracture^ complicated tvith frcusture af humerus. 
ResuU perfect. 

Mathew Bigany, of Buffido, set. 28 (see Case 8, fracture of hume- 
rus). 

Cask 83. Simple fracture. Be/ractured after two weeks. JSesuU 
perfect. 

Lawrie, son of £. L., of Buffido, 89t 9, fractured both bones through 
the lower third. No surgeon was called until two weeks had 
elapsed. I then found the bones overlapped and quite firmly 
united, and also very much bent at the seat of fracture (see cast 
in my museum, taken at this time). With moderate force I broke 
up the callus and restored the bones to place. After one year no 
deformity remained. I am not certain, however, but that some 
overlapping and shortening of the limb existed. 

Cask 84. Simple fracture. ResuU perfect. 

Hiram Nichols, of Chautauque Co., N. Y., ask 16, fell upon his 
right hand, breaking the radius and ulna somewhat obliquely about 
three inches above the wrist. Dr. Brown, of Chautauque Co., was 
employed. The arm was dressed with two wide splints, &c 

Ten years after, when I examined the arm, the point of fracture 
could not be traced, but the lower end of the ulna projected to the 
Tilnar side one quarter of an inch. 

Cask 86. Compound fracture. Result perfect. 

Anna Fero, of Buf^o, set. 12, broke both bones of the right arm 
in 1861. The radius was broken about two inches^ and the uha 
about two and a half or three inches above the wrist The uloa 
protruded through the skin at the point of fracture. 

It was treated by Dr. C. H. Wilcox, of BuflWo. He employed 
a palmar and dorsal splint and also a right angled splint 



DEFOBHITIBS AFTBB FBACTUBBS. 203 

One year after the accident I could discover a slight elevation or 
ridge where the ulna was broken, but could not trace the fracture 
in the radius. 

The motions of the arm were perfect. 

Case 86. Simple fracture. Broken a second time at the same point. 
Result perfect 

Peter Tippeter, of Bufialo, sdt 82, broke his right arm in 1852, 
at the upper end of the lower third. Both fractures were exactly 
transverse and at corresponding points. 

It was dressed by Dr. Charles H. Wilcox, of BufBJo. It united 
readily, and three months after while at work, he fractured it at the 
same point. Motion and crepitus were distinct. 

Aft^er four months I find the arm perfect, and with a slight pro- 
visional callus at the point were the ulna was broken. 

Case 87. (hmpound fracture. JSesuU irnperfect. 

James Hoffman, of Buffalo, set 10, broke the right arm, both 
bones, about two inches above the wrist, June 20, 1862, the ulna 
protruding through the skin. 

The arm was dressed by Dr. Lewis, of Black Bock, but on the 
sixth day, by request of Dr. Lewis, I took charge of the case. 

I found the arm much swollen, and the fragments inclining to 
the ulnar side. The hand prone. I applied one broad gutta percha 
splint, padded with cotton wadding, to the back of the hand and 
forearm. 

Aftier several weeks the bones united with but very slight de- 
formity. 

Case 88. Simple fracture, complicated with partial dislocation of 
radius and ulna at (heir lower ends. Besult perfect. (Copied from 
report on dislocations, made to New York State Med. Soc. 1866, p. 
69 of Transactions.) 

Lewis Colligan, of BufGedo, aged 18 years. Dr. Spaulding, of 
WilliamsviUe, now deceased, was employed. Fourteen years after 
the accident I examined the arm. No evidence remained of the 
character of the injury but the shortening of the radiud and ulna, 
which shortening was, by very careful measurement, one-third of 
an inch. This would imply that a fracture had existed, as declared 
by Dr. Spaulding. The patient, also, an, intelligent man, remem- 
bers distinctly the circumstance, and that crepitus was heard and 



204 BBPORT ON 

felt. The partial dislocation of the bones forwards, he rememben 
also, as a circnmstanoe distinct from the fracture. But, in addition 
to this testimonj, and the testimony of his surgeon, who was a man 
of excellent reputation, there remained for a year a constant 
tendency to displacement in the same direction. Whenever he 
attempted to lift even the weight of half a pound with his hand 
supined, the lower end of the radius would spring forwards, and 
all power in the arm would be lost When this happened^ as it 
did quite often, he always reduced the bones himself by pushing on 
them. 

At the time of my examination, the arm was in erery respect 
perfect, exo^t that it was shortened. 

Case. &9. Cbm^xmnd ocmimmufeefynic^urtf. Umon v)i(h drforfniiy. 

Charles Oddl, a canal boat captain, sdt 86, broke bo^ radios 
and ulna near the upper end of their lower third, Nov. S, 1852. 
Fracture compound aod comminuted. 

The first dressing was made by Dr. Lewis of Black Bock. I 
dressed it myself on the foUowing day with great cam, using a 
broad, firm, and carefully moulded gutta percha splint^ which I 
applied to the palmar surfiMse. The wound was on the back of the 
arm. I dressed it again on the third day, and he then left for New 
York. 

Sept. 22, 1868, about seven weeks after the accidrat ooouned, 
Capt Odell called on me. The fragments were then united, bat 
from the seat of fiucture downwards the arm is very much bent to 
the ulnar side. The arm is, however, pretty strong. Since he left 
me it has been dressed by Dr. Parker, in N. Y., and by Dr. Ship- 
man in Syracuse. 

CA8B.40. Om^wnifraeiwe. BesuU not perfect. 

Bobert Oibb, of Buffitlo, est 85. A heavy piece of iron fell upon 
his right arm July 26, 1868. Dr. Green and myself in attendaoca 
The bones were broken obliquely near the upper end of the lower 
third. Wound on the palmar surfiice. Considerable hemorrhage. 
We applied a broad and carefully adjusted doi^ splint, and sub- 
sequently a palmar splint was also employed. Most of the dresB* 
ings were made by myself, and the arm was seen every day. The 
utmost care was exercised both by myself and my patient to make 
a straight and useftil arm. 

The ulna united in the usual time, but the radius was not finn 



DSFOBMITIBS AFTBB FBACTUBES. 206 

until about the 29th of Sept (nine weeks). At this time I ex. 
amined the arm very critically, and made a note that the limb was 
parfecdy simigfat, bat that there was slight ensheathing callus. 
GraduiJly, however, as the swelling continued to subside, we dis- 
covered that it was not straight. At the end of two weeks more 
the deformity was quite manifest ; the arm being inclined to the 
ulnar side from the seat of fracture, downwards. 

Three years after I find the arm looking much straighten 
Functions perfect, except that he cannot supine it completely. 

Casb 41. (hmpinmd fraciure, Ncn union of radius. Operation. 

L. B. of Auburn, set. 88, broke the radius and ulna of the left 
arm at the upper end of the lower third. Br. Bichards, of Cayuga 
Co., dressed the fracture. Two years after (1835) I found the ulna 
united, shortened, but the radius was not united. He had no 
power of supination or pronation. 

I exposed the broken ends of the radius, and removed a piece 
from each fragment with a saw. I then dosed the wound com- 
pletely and applied a splint In four weeks from this time the bone 
had united and was firm. 

The patient subsequently commenced an action against Dr. R for 
damages, but it never came to trial 

Casb. The following interesting case has been fhmished at my 
request by Dr. Winue, one of the surgeons of the Buffisdo Hospital 
of the Sisters of Charity. Dr. Winne has also kindly sent me a 
cast taken from the arm before the operation was made. . The frac- 
ture, as shown by the cast, was at the upper end of the lower third, 
and it i^pears to have been transverse, and at corresponding 
points in the two bones. 

I do not feel at liberty to introduce the case among my tables, 
since it never came directly under my own observation, and in 
admitting, it therefore, I should be obliged to deviate from a rule 
which I have established from the beginning, and which I regard 
as of much importance in determining the value of these tables. 

Buffalo, ICaroh 31, ISM. 

Db. F. H. Hamilton— 

My dsab Sib: I take the earliest opportunity to comply with 
your kind request to submit to your inspection the cast of the fore- 
arm of Henry Manger, and also to furnish you with the notes of 



206 RBPOBT ON 

the case taken by Dr. EUorj P. Smith at the time of the operation 
and subsequently. 

I can only add that at the time of leaving the hospital, he had 
acquired much control over the flexor and extensor musdes, and 
was rapidly improving some weeks after his dismissal. 

Respectfully yours, 

CHARLES WINNE. 

JVofeff of a case of angular d^ormity of ihehft forearm. 

" Henry Manger, set 28, was admitted into the Hospital of the 
Sisters of Charity June 24th, 1854, for the removal of a distortion 
of the left forearm, both bonea of which had been transversely firac- 
tured February 25, 1854. The radius formed the acute angle. On 
June 29th, Dr. Winne commenced the operation by an incision 
upon the most prominent portion of the radius, and having care- 
fully denuded the bone of its investing muscles, he removed a V 
shaped portion by means of the saw and cutting forceps. This 
accomplished, the ulna was found in contact with the radius, and a 
small and similarly shaped piece of bone was removed from it ; the 
arm was then made straight, wound dressed with sutures and adhe- 
sive plaster, and was laid in a well-padded wire splint, and the man 
placed in bed. B. Tr. opii wt xl. 

June ^Qih. No fever, pulse 85, tongue clean. 

July Ist Slight swelling, pulse 96, tongue white. 

Wound discharges small quantity of reddish serum, and has an 
erysipelatous look. 

B. Lotio nit. plumb. Elevate arm ; plasters and rollers removed. 

2d. Great tension of whole arm ; high fever; removed stitches 
from wound, and applied a yeast and Peruvian bark poultice. B. 
Pil. opii gr. ij. 

%d. Better ; fever abating ; odors less oflFensive. 

4^th. Erysipelatous appearance has declined in a measure ; fever 
abating; has had retention of urine froin eflfects of opium, which 
the house student injudiciously attempted to relieve by trying to 
pass a catheter, in which he failed ; patient was entirely relieved by 
warm fomentations, and a large warm and slightly stimulating 
enema. 

6iA, Wound granulating; poultice discontinued, and a weak 
solution of nitr. plumb, applied." 



DKFOBMITIES AFTKB FBA0TURS3. 



207 



UPPER THIRD. 


1 Ag* when tt 
occurred. 


,15 


1 


1 

1 

i 


1 


TKXATmilT. 


unuLT. 




§1 
I1 


2l 
1^ 


Remarks. 


-1 


116 J.I 


u. 




Simple 1 


U. 






1 ^' 


MIDDLS THIRD. 


2!«5y.25y. 


M. 




ample 




U. 








P. 


811m 5w. 


M. 




ample 




u. 


fiw. 






P. 


411y.lly.jM. 




Simple 




u. 








P. 


610y.30y. 


M. 


R. 


Simple 




u. 








P. 


6 Oy.ilOy. 


P. 




Simple 




u. 








P. 


7l2y. 


• 2m. 


M. 


R. 


Simple 




u. 








P. 


il6y. 


3y. 


M. 


R. 


Simple 




u. 








P. 


8«8y. 


7y. 


M. 


L. 


Simple 


8 broad splinto, 
felt,Ao. 




2&4 
m. 




Ulna united in 8 weeks, 
and the radius in 16. 


P. 


10 


40 y. 


M. 




Simple 




^. 








Imp. 


iiaoy. 


4 m. 


M. 


R. 


Simple 


2 broad iplints, 
paste, Ac 


U.A 
D.U. 


7w. 




Ulna united In 7 weeks, 
but radius had not in 4 
months. 


Imp. 


IS 


4m 


M. 


L. 


Simple 


Carred splinU. 


XJ.k 
D.U. 




lln. 


Lower fjragment bent to 
ulnar side; 4 months 
after firacture, ulna not 
united. 


Imp. 


IS 9y. 


2 m. 


M. 


R. 


ample 


2 broad •pUnts. 


N.U. 






Arm sloughed off. 


Imp. 


May. 6m. 


F. 


L. 


Gomponnd 




D.U. 


4 m. 




Union deUyed 4 months; 


Imp. 




















arm atlll swoll«nt 4e, 




lAUy. 


2m. 


M. 




Comml. 
nnted 


2 broad tpUnts, 
4e. 


tJ. 




Ita. 


aUght dflrurmity. 


Imp. 


« 




LOWER Tl 


ILED. 


16 3y. 


7y. 


M. 




P^trtlftl 


Ko splLnliu 


U. 








P. 


1718m. 


ly. 


P. 


R. 


Partial 


Splintat 4o.,fOT3 
or 4 days. 


u. 








R 


18 fty. 




M. 


L. 


PftrtiAl 


Single iplint 


U. 






Fragments were at first 
silent backwards. 


P. 


1» 6y. 


4w. 


P. 


R. 


Partial 


Single splint 


U. 






SaUent backwards; pro- 
bably at epiphysis. 


P. 


» 8y. 


2m 


M. 


L. 


Partial and 

complete 

Partial and 


Single splint 


U. 


Sid. 






P. 


n 2y. 


4 m. 


If. 




No spUnts. 


U. 






Ulna broken 1 inch fk-om 


P. 










complete 










its lower end, and radiiu 
bent at Junction of epi- 
phTsis with diaphyds. 
Radius broken, and ulna 


' 


ai4y. 




IL 




Partial and 


2 broad splints. 


U. 






P. 


J 








complete 










bent 




» 11 y. 


14 y. 


M. 


R. 


Simple 




u. 








P. 


«|8r 


ly. 


M. 


R. 


Simple 




u. 








P. 


»12y. 


6 7- 


M. 




ample 




u. 








P. 


» 7y. 


8m. 


M. 




ample 


TwospUats. 


u. 






Probably at lunetlon of 
epiphysis with diaphy- 
sls, and perhaps not 


P. 








































complete; fragments 






















bent forwards. 




riOy.lSy. 


M. 




ample 


Splints. 


u. 






Deformity remaining 4 


P. 


»14y. 3 m. 


M. 




ample 


Splints after fonr 
weeks. 


u. 






Deformed as in fhtctnre 
of radius. 


Imp. 


• lOy.'lSy. 


M, 




ample 




u. 








P. 


aoaoy. 


«w. 


F. 




Simple 


1 straight splint 
after id week. 


u. 








P. 


n»y. 


ew. 


M. 




GompUcftt- 
edwith 

fraetnroof 
hnmerue 


Qntta pereha and 
wooden splints. 


u. 








P. 






















» ©y. 


ly. 


M. 




ample 


Refraetnred after 
two weeks and 
splints applied. 


u. 








P. 


8»16y. lOy. M.| 


R. 


Simple 


Two wide splints. 


u. 






Ulna proiJeets. 


P. 


UUy. 


ly. 


F.I 


R. 


Compouad 


Three splints. 


u. 








P. 



208 



BEFOBT ON 













■s 


s 






muma. 


I 






1 


1 

1 


a 
^ 








Is 


ll 




Rem&rki. 


$1 


3& 


32 y. 


8lIL 


M. 


B. 


SUnple 




u. 






fnetnred at end of about 
4month«. 


36 


10 7. 


Sm. 


M. 


R. 


Compoand 


One gattap«reiL» 
aplint 


u. 






r 


87 


18 y. 


14 y. 


M. 


L. 


CompU- 

C"Hii|''.'(iiid 




u. 




iln. 


ji-.^ 


38 


36 y. 


7w. 


M. 




OntU perch A, kc. 


u. 






Lower fragment* Udla-liap. 












cummt' 










«d to hIdu- ildja, 1 












ntitwi 










1 


39 


35 y. 


Sy. 


M. 


R. 


CoDipoujid 


ibrwidipll^ii, , 


17- * 






mna nnlted soon, but tliel^^ 
rfcditw not noill tbe Stti 
week; Hjm IncliiiMi to^ 
aljiKT Bide rrom t«tM nfl 






























































fractare dowowu-ds. | 


40 


38 y. 


2y. 


M. 


L. 


Comptiuiii. 




ir,* 






trioa tiatled La otwallnpi 
















jr.u. 






tlmo, bnt radioe delmjed 
two yearv; opsfatioB, 
pTO«eoatloD, Ac 


_ 



Bema&es. 

Of forty fractures of the radius and ulna, one occurred throagli 
the upper third, fourteen through the middle, and twenty-fire 
through the lower.* In three instances the fracture was probably 
at the junction of the epiphysis with the diaphysis.* Thirty-three 
of these patients were males, and seven females. Fourteen are 
known to have occurred in the right arm, and seven in the left. 

Thirty-three were simple, of which number four were partial 
fractures of both bones, two were partial fractures of the ulna, with, 
in each instance, complete fractures of the radius, and one was a 
partial fracture of the radius with complete fracture of the ulna. 

All of the partial fractures belonged to the lower third, and oe- 
curred in children whose ages ranged from eighteen months to 
fourteen years. The frequent occurrence of partial fractures in the 
bones of the forearm has been noticed by many surgical writ^ 
but the remarks of Ndlaton, Malgaigne and others, that they occur 
more often in these bones than in any other, is not sustained by my 
experience. Thus of fifty-three fractures of the clavicle fourteen 
were incomplete ; while of forty fractures of the radius and ulna, 
broken conjointly, or of one hundred fractures of these bones boA 



1 ^ Oocurs moBt oommonly in the middle /^ Gheliiu, Tol. i. p. 612. 
' See Robert Smith, op. cit. p. 164, on ** Separation of the inferior epiphysis of the 
radius, with fracture o( the lower extremitj of the ulna.*' 



DEFOBKITIES AFTKB FBACTUBES. 209 

jointi J and separately, only seven were partial ; or to speak more 
precisely, and regarding each fracture of both bones of the forearm 
as two fractores, of one hundred and twenty fractures, only eleven 
were inoomplete. 

Five fractures were compound, one comminuted, one both com- 
pound and comminuted, one complicated with a fracture of the 
humerus, and one with a partial luxation of the lower end of the 
radius. With o^e exception, all of these more serious accidents are 
arranged among the fractures of the lowet third. 

In thirty-six cases bony union has been accomplished m the 
uaual time. In Case 9 the ulna united in eight weeks, and the 
radius in sixteen. In Case 11 the ulna had united in seven weeks, 
and the radius remained disunited at four months. In Case 12 the 
radiua was firmly united, when I examined the arm, four months 
after the accident, but the ulna was slightly movable. In case 14 
union was delayed in both bones nearly four months. In Case 89 
the ulna united in the usual time, but the radius not until the ninth 
week. In Case 40 the ulna also united in the usual time, but the 
radius was ununited after two years, and union was only then 
effected by an operation. 

Thus, in four cases the ulna united promptly, but the radius 
delayed, in one case the radius united wd the ulna delayed, and in 
one case the delay occurred in both bones. 

Twenty-eight have resulted in a perfect restoration, eleven in an 
imperfect restoration, and one in a loss of the arm. 

The prognosis in these accidents seems to take the widest range, for 
while a larger proportion than in the case of almost any other long 
bones united without appreciable deformity, a considerable propor- 
tion delay to unite or do not unite at all, and some, even where the 
fraoture is most simple, result in the complete loss of the Umb by 
gangrene. 

Of the occurrence of gangrene, and the consequent loss of the 
entire arm after a simple fracture, I have reported one example. 
A second example has occurred in the practice of Dr. Snell, a very 
respectable young physician of Brooklyn, N. Y., in which "a frac- 
ture of the humerus, involving the elbow-joint, occurring in a boy 
of slender stamina, resulted in the loss of a part of the hand by 
mortification, the little finger perishing from dry gangrene, and the 
adjacent parts afterwards sloughing by ordinary humid mortifica- 
tion." A prosecution ensued, in which Drs. Willard Parker and 
Prince declared their conviction that " these untoward consequences 



210 BBPOBT OK 

were due to the bandages having been applied too tightly;" while 
Drs. Valentine Mott, David L. Bogers, James B. Wood, Daniel 
Ajers, Edward H. Dixon, and others, believedv'Hhat the mortifica- 
tion of the fingers resulted from causes over which he had no 
control.''^ The jury returned a verdict against the Dr. for $3,000. 
It is understood, however, that a new trial will be granted, as the 
verdict was clearly against the weight of testimony. 

Dupuytren* reports two cases of fracture which resulted in gan- 
grene. In the Qrst case the radius was broken near the wrist, in a 
man forty-four years old. "An apparatus was applied but fisistened 
too tighUy, and notwithstanding the great swelling and acute pain 
it was not removed until the fourth day." The forearm was then 
" red, painful, and covered with vesications," &c. Amputation was 
performed above the elbow about six weeks after the accident, and 
the patient recovered. In the second case the radius was broken 
near its middle by a direct blow, in a man thirty-six years old. The 
fracture was simple. The surgeon applied the usual apparatus, 
consisting of pads, splints, &c., confined by a roller, which was ap- 
plied so tightly as to give rise to very great suflFering. Notwith- 
standing this the surgeon did not loosen the dressings, and on the 
fourth day, when he came to Hdtel Dieu, the hand and fingers were 
dead. Amputation was performed on the twelfth day at the elbov- 
joint, but the patient died on the twenty-second day after the acci- 
dent Dupuytren also mentions a case which had been observed 
by M. Thiery, where an apparatus had been applied to a supposed 
fracture of the radius in a young girl. After suffering excruciating 
torment, the forearm mortified, and amputation was the only re- 
source ; on examining the limb no trace of fracture could be dis- 
covered. 

Bobert^mith reports also the case of a boy, set. 18, who had a 
fracture of the lower extremity of the radius through the line of 
the epiphysis, caused by being thrown from a horse. A surgeon 
applied, within an hour, a narrow roller, tightly around the wrist 
On the following day the limb was intensely painfol, cold, and dis- 
colored. The roller was not removed nor slackened. On the fourth 
day he was admitted into Bichmond Hospital, when the gangrene 
had reached the forearm. Spontaneous separation finally occurred 
about two inches below the elbow, and the bones being sawn asunder, 
the boy recovered.^ 

I Amer. Med. Oazettei Jan. 1856. 

' On the Injuries and Dis. of Bones. London ed., pp. 145-6. 

• Op. oit., p. 170. 



DSFOBHITIBS AFTER FBACTUBS^. 211 

Dr. Smith says, similar cases have been recorded in the Gazette 
MSdicale. 

Malgaigne remarks, " when the displacement is considerable, or 
more especially when the outward violence has been excessive, 
we frequently see follow a very intense inflammatory swelling, and 
there is no fracture which complicates itself so easily with gangrene 
under the pressure of apparatus.*** 

Says Nflaton : "If we make choice of the apparatus of J. L, 
Petit, it is necessary that it should not be applied too tightly, for, 
as Professor Boux has long since remarked, fractures of the fore- 
arm are those which furnish the most of the examples of gangrene, 
in consequence of an arrest of the circulation. This is easily un- 
derstood, if we consider on the one hand the superficial position of 
the two principal arteries of the forearm, and on the other hand 
the disposition of the appareil, which must almost infallibly com- 
press the arteries to a great extent"* 

The cases recorded are not numerous: including the two men- 
tioned by myself, I have no certain accounts of more than six; yet 
this is sufficient to warrant a serious apprehension of so grave a 
reBult. 

I do not think this accident is the necessary result of any pecu- 
liar form of treatment, nor that it is always due to the negligence 
of the surgeon. It certainly was not in tiie case of the lad whom 
I saw, and I can easily suppose that in a majority of cases, it was 
due rather to the carelessness of the patient than of the surgeon. 
In some measure, doubtless, it may be due also to the severity of 
the injury and to the general condition of the patient A number 
of unfortunate circumstances may have concurred, and the inflam- 
mation and swelling may have been developed with a rapidity 
which no one could have anticipated. Tet, that it may be the 
result of maltreatment on the part of the surgeon, is undeniable. It 
is proper, however, to descriminate between the responsibility which 
attaches to the surgeon as the true exponent of the state of his art, 
and that which attaches to the art itself as taught by the masters. 

The old surgeons applied first a roUer to the hand and forearm, 
and over this their various splints. J. L. Petit thought he had 
made a valuable improvement upon this simple plan in laying over 
the roller a compress, supported by a splint, designed to press 
between the bones, and to antagonize thus the action of the roller 

> Op. oit, p. 689. * Op. dt., p. 737, 



212 BSPOBT OK 

in drawing the fragments towards each other. Duvemey believed 
that this object would be best accomplished by placing the pad 
against the skin, and unokr a ciroolar compress; while Desaolt 
declares all of these modes inefficient, and annoonces a method 
which he regards as accomplishing at once and comjdetely all of the 
indications; the sole peculiarity of which method consists in placing 
the graduated pads against the skin, and securing them in place by 
a roller.' Boyer* adopts the same method without any modifica- 
tions, and Mr. Hind, in his illustrations of fractures already referred 
to, has seen fit to recommend the same, at least in firactuxes of the 
radius. 

It is quite obvious that between these various methods there re- 
mains very little if anything to choose, the difEeienoes being too 
trifling and unessential to claim serious consideration. Each alike 
is inadequate to accomplish any amount of useful pressure between 
the fragments; each alike is calculated to bind the bones against 
each other, and each alike exposes to the danger of ligation and of 
gangrene. 

Says M. Dupuytren, " The practice of rolling the arm before the 
splints are applied, whether internal or external to the pads and 
compresses, is eminently mischievoos; and instead of fulfilling, 
directly counteracts, the indication which it is most important to 
keep in view, in the treatment of firactures of the forearm.''^ 

And notwithstanding the same sentiment has been reiterated by 
Yelpeau, Malgaigne, Ndlaton, Samuel Cooper, Bransby Cooper, 
Erichsen, Amesbury, Gibson and others, yet we find to-day the 
great surgeon of Heidelburg, Mr. Chelius, recommending the roller 
to be applied under the splints, after the manner of Desault : while 
Mr. Liston, Mr. Syme and Mr. Fergusson, who perhaps represent 
the Edinburgh School, use only pasteboard splints, above the oxn- 
presses, over which are immediately applied the roller; a praotioe 
which differs very little from that recommended by Desault, and is 
equally obnoxious to criticism. 

Among thi9 American surgeons I believe, the advice and practice 
of Dupuytren has received almost universal assent, only that we 
have always employed splints much wider than those recommended 
by this distinguished surgeon. I cannot therefore agree with my 
accomplished countryman. Dr. Beynell Coates, if in the following 

I ** Treatise on Fnustores &nd LazaUonB," hj P. J. Desaalt, Amer. ed., p. 166, 1805. 
' Leotures of Bojer on the Bones, Amer. ed., 1805, p. 86. 
* Op. oit, p. 147. 



DSFOBMITIXS AFTSB PBAOTUBES. 213 

paragraph he means to imply that American surgeons generally 
adopt Desanlt's treatment. Sneh at least is not my experience. '' It 
wonld be wrong," says Dr< Goates, " not to bear testimony, on every 
possible occasion, against the foUy so umversally prevalent, that 
indnoee snrgeons to apply a banda^ direcdy to the forearm before 
applying splints in injuries of this character. We have often asked 
for a rational explanation of this pi^actice, without effect. It is 
directly at war with the acknowledged indications in the coaptation 
oS the fragments, and when the object of the whole apparatus is to 
thrust asunder their extremities, it oommences by binding them 
together. Few plans in surgery are more generally followed ; none 
can be more absurd."^ 

Of the estimate placed upon the roller by M, Mayor, the reader 
will judge by a reference to the passage which I shall quote further 
on, when I d^all speak of the vfdue of the interosseous compresses. 
Amesbury and Bransby Cooper use no rollers at all — ^not even 
to secure the splints in place, the i^lints being made fi»t to the 
forearm by straps or tapes; a practice which, I am happy to say, 
lias foxmd hitherto, except perhaps among the English, very few 
followers. 

Mr. Amesbury and Mr. South also endeavor to give to their splints 
an appropriate shape, by having them constructed with more or less 
convexity. It must be noticed, however, that the practice of thdse 
two gentlemen is very dissimilar, for while Mr. South applies the 
oonvex surface of his ^lint to the interosseous space, Mr. Ames- 
bury reverses this plan, and applies the concave sur&ce directly to 
iheiAdn. 

As to the width of the splints, surgeons are also very generally 
agreed, at the present day, that they ought to be at least wider than 
the arm, so as to prevent the roller or the tapes from resting against 
the sides of the arm. 

I do not intend to deny peremptorily, and without qualification, 
the value of the graduated compresses, which, as we have seen, are 
usually laid along the interosseous spaces, to press the fragments 
asunder. It is necessary, however, to caution the surgeon against 
their injudicious use. M. Ndaton has well remarked of the 
apparal employed by J. L. Petit, that it must inevitably compress, 
to a great extent, the arteries of the forearm; and the remark is 
applicable, in only a less degree, to all (tf those other plans in which 

I Amer. Jour, of Med. Sci., vol. xrii. p. 147, 1835. 



214 BSPOBT ON 

the compress is employed. And I suspect that to this portion of 
the dressing, quite as much as to anj other caose, is due those 
frightfxd accidents of which we haye already spoken. The artenes 
are not only exposed, £rom their superficial position, to pressure 
from a compress, but, in addition to this, it will be noticed that the 
two principal arteries, the radial and the ulnar, are situated upon a 
broad, flat surface of bone, aXoug which this pressure must operate 
most disadvantageously. So early as the year 1833, M. Lenoir, in 
his inaugural thesis, at Paris (p. 19), called attention to this danger, 
and from time to time surgeons have continued to advert to it, but 
they have seldom given to its consideration that prominence which 
its importance deserves. 

I have observed another fi^^t in this connection. When this com- 
press is extended low down on the palmar surface, within an inch 
or two of the wrist-joint, it soon becomes excessively painful, and 
sometimes even- wholly insupportable, in consequenoe of the pres- 
sure made upon the median nerve; and I find myself always obliged 
to exercise great care in the adaptation of the pads at this point 
For this reason alone, I believe that in case of a fracture near the 
base pf the radius, the lower fragment, if it were thrown towards 
the ulna, could not be retained in its place by graduated compresses. 

In short, finding that broad splints, properly covered and padded, 
answer very well to crowd the muscles into the interosseous space, 
so far as it is proper to do so, and believing that this mode is less 
painful and less dangerous, I seldom resort to graduated compresses, 
nor can I appreciate their necessity, nor, indeed, their utility. Mr. 
Lonsdale also concurs with me in attaching very little value to this 
part of the customary appareiL But listen to the surgeon of Lau- 
sanne, M. Mayor: '' Que signifient les compresses gradu^ entre les 
OS de Tavant-bras afin de les tenir 6cBit6a I'un de Tautre? lb 
n'auront pas la tendance qu'on leur suppose, a se rapprocher sans 
cesse, pouru, 1°, qu'ils soient bien r^uits ; 2^, que pour les maintenir 
en position, on ne £Eisse par usage de liens circulaire prdables, et 
dont Taction est un vrai contre-sens ; et enfin 8^, qu'on &8se agir les 
moyens contenti& essentiellement sur les regions palmaire et dorsale 
de Tavant-bras."^ M. Mayor proceeds to declare these convictions 
to be the result of his own experience, both in the treatment of 

> BandageB et appareilB a pansements, cm nonyeftu sjBteme de delegation ehiiax- 
gioale, par M. Mathias Mayor^ <duniig. en ohef de lluNipital de Lanaanne, 8witle^ 
land, p. 846, Paria ed., 1838. 



DBF0BMITIS8 AFTEB FBAOTUBSS. 215 

aiiigle and oompound fractures of the forearm, and be is almost 
tempted to think that thej were merely invented to remedy an evil 
which a roller under the splint was intended to produce ; since, by 
dispensing with the roller, the indication for the use of the com- 
presses does not exist He further remarks : " Quoi qu'il en soit, 
le temps a consecrd ce moyen, et on sait assez ce que sont les habi- 
todeSy leur tdnacit^ et le respect, qu'elles inspirent.quand elles ont 
la Y&i4rable sanction du temps, j'allais presque dire de I'ayeugle 
routine." 

Surgeons have generally, of late years, after the splints have been 
applied, placed the forearm in a position of semi-pronation, or mid- 
way between supination and pronation, so that the radius should be 
uppermost; it being assumed that in this position the two bones 
were most nearly parallel, and least inclined to displacement Such, 
indeed, was the practice of Hippocrates, Paulus jEgineta, Celsus, 
Albucasis, and of most of the early surgeons ; but B. Smith, Lons- 
dale, South, and Nflaton hare called in question the correctness of 
this mode of dressing, at least as a universal practice. 

I have before mentioned, when speaking of fractures of the ulna, 
that M. Meuiy had, in one instance, been unable to bring the frag- 
ments into apposition, except by forced supination of the forearm, 
and in certain fractures of the radius the same position has been 
spoken of by Lonsdale, as being especially demanded. 

Says Mr. South : '' la fractures of both bones the forearm is best 
laid supine,"^ while M. N^ton declares that in fractures of the 
upper third it will be indispensable to supine the arm, both during 
the reduc^on and subsequent treatment ; but that in fractures of 
the two inferior thirds we may place the limb in a condition of 
semi-pronation.* 

It seems very probable, however, that both of these gentlemen 
have received their suggestions from Mr. Lonsdale,^ who has con- 
sidered the question very much at length, and who has finally 
declared his decided preference for the supine position in the treat- 
ment of all fractures of the forearm. His arguments are very 
ingenious, and aa applied to fractures of the radius above the in- 
sertion of the pronator radii teres, conclusive; and indeed they 
conmiend themselves very strongly to our judgment as i4)plied to 

> ClMliiui'8 SBigeiy, note p. 613. 

' Op. oit., p. 734. 

* Treatise on Fnetores, bj Edward F. Lonsdale, London ed., 1838, pp. 123-138. 



216 BEPOBT OK 

all fraotores of the forearm. Thej are suatained also by the 
lesolta of hia own experience, and I aee no good reasona why they 
shoald not be more thoroughly examined and tested by other 
snrgeona. The advantages which he claims for thia method are 
more perfect coaptation of the fragments, less liability of the fng- 
ments to encroach npon ibe interosseoua space, and consequently 
less danger of anchylosis between the bones, and of non-union of 
the fragments, more complete restoration of the power of sapioa- 
tion, less tendency to lateral distortion, or of a falling off to the 
ulnar side, and fitcility of application. 

My own cases treated by the uMial method haye shown that 
while supination is frequently impaired, and sometimes entirelj 
lost, pronation is rarely affected ; and that the danger of an inward 
(ulnar) inclination of the bones, a Tesult {probably of the weight of 
the hand acting upon the lower fragments as it lies suspended over 
the ding, is not inconsiderable. Hippocrates alludes to this latter 
accident, and there are three specimens in the Dupuytren Museum 
at Paris which furnish exti'eme illustrations of it ; the angles vary- 
ing from 186^ to 150^ 

Mr. Lonsdale ascribes the loss of the power of supination, whidf 
as has been observed, occurs so fi^uently after these fractures, not 
so much to the formation of a bony union between the two bones, 
the radius and ulna, as to the malposition of the lower fragment is 
its relation to the upper; an opinion which he makes to appear 
very probable, and which obtains additional confirmation from mj 
own experience, since I have not recognized this bony union in a 
single instance of the very many described as having lost in some 
degree the power of supination. 

If this plan is adopted, viz : laying the hand and forearm upon 
itd back, instead of upon its ulnar margin,- the elbow should remain 
at the side, the humerus falling perpendicularly from its socket; 
and the forearm should rest in the sling directed forwards from the 
body. But finally, whatever may be the mode of dressing, let me 
repeat the injunction to examine the arm frequently. No surgeon 
can do justice to himself or to his patient who does not look at the 
arm at least once in twenty-four hoxcrs during the first fortnight 
and in some cases the patient ought to be seen twice daily. 

When the fracture is compound, it is sometimes impossible to 
retain the forearm in the half-proned position ; since, when placed 
in this position, and only slightly supported, as it must almost 
necessarily be, it inevitably falls over upon its palmar surfiwc. 



DEFORMITIES AFTER FRACTURES. 217 

There can be no doubt in sucli a case that firom the first vre ought 
to place it upon its back in the position of complete or nearly com- 
plete supination ; and in a condition also of perfect rest For this 
purpose a single broad splint carefully cushioned and covered with 
silk oil-cloth, is the most suitable. Upon this the forearm is to 
be laid, and only very gently bound with rollers. If the patient is 
able, and wishes to walk about, the board may be suspended to the 
necki as reconmiended by M. Mayor. 



CHAPTER XL 



CARPUS. 



The few cases of fracture of the carpal bones which have come 
under my observation were, without exception, compound and 
complicated, and have resulted in the complete loss of the hand, or 
in some less serious, but never inconsiderable mutilation or maim- 
ing. 

In no case has a treatment been adopted which might be regarded 
as having reference to the fracture, or the purpose of which was to 
insure apposition and union of the fragments. 

It may be proper, however, in a matter so easily comprehended, 
to assume what one's personal experience has not actually proven, 
namely, that simple fractures of these bones will unite generally 
without much displacement, and without any very perceptible 
maiming. It is indeed quite probable that some degree of anchy- 
losis between their adjacent surfaces would occur, yet even in the 
normal condition they enjoy so little motion as to render it doubt- 
ful whether its complete loss would be very sensibly felt. 

In cases of compound and complicated fractures of the carpal 
bones, which accidents are sufficiently common, the surgeon has 
only, I conceive^ to follow carefully those general or special indi- 
cations which may happen to be present, the precise character of 
which it would be difficult to anticipate, and for the treatment of 
which it would be unsafe to attempt here to provide. 

VOL. IX.— 15 



218 BBPOBT ON 



CHAPTER XII. 



METACABPUS. 



Case 1. Simple froGture. Result perfecL 

Miss E^ of Erie Co^ N. Y., about 18 years old, fell Aug. 7, 1853, 
striking upon her right hand, with her fingers forcibly flexed. 

I examined the himd Aug. 8, the day following the accident, and 
found the metacarpal bone of the ring finger of the right hand 
broken about three-quarters of an inch from its lower or distal end. 
The distal end of the lower fragment was depressed, and a slight 
swelling existed over the seat of fracture. A feeble crepitus could 
be occasionally detected. 

I applied a firm pad against the palmar surface of the metacarpo- 
phalangeal articulation, and secured it in place with a palmar splint 

One month later, it was united, with only slight deformity. 

Cask 2. Simple fracture. Result perfect. 

Webb Spencer, of Bufialo, set 29, broke the metacarpal bone of 
the Utile finger of his right hand by striking with his deuched fist 
May 14, 1854. The firacture is about one inch from its lower end 

He called upon me two weeks after it had occurred. The fiBg- 
ments were not then united. The lower end of the distal fragment 
was depressed towards the palm of the hand. 

I applied a splint with compresses, &c. In two weeks it was 
united and without displacement 

Cask 8. Simple fracture. Result perfect. 

Michael Haamond, of Bufialo, about 80 years old, broke the 
metacarpal bone of the thumb of the left hand through its upper 
third. May 10th, 1852. Simple fracture. I dressed it with a care- 
fiiUy moulded gutta percha splint. In less than a month the finger 
was weU and straight. 

Case 4. Simple fractwre. Union with displacemsni. 
Thomas Rose, of Bufl&lo, set. 8, fell down stairs Sept 11, 1855, 
breaking the metacarpal bone of the index finger of the right 



DSFOBMITISS AFTBB FRACTURES. 219 

hand, half an incli fix>m its lower end. It was probably a sepa- 
ration at the epiphysis. The lower fragment projected into the 
palm of the hand. 

I saw the lad about sixteen hours after the oocurrence. I could 
easily replace the firagments, but they would not remain in place. 
There was no crepitus. I examined and dressed it very carefully, 
but after two months I find it still displaced. 

Cask 6. Simple/racture. Union not perfect. 

William Pimlott, aet. 27, broke one of the metacarpal bones, of 
the right hand, at the junction of the lower epiphysis with the 
diapbysis, by striking another man with his clenched fist. It was 
dressed by an apothecary in Ireland. Fourteen years after, I found 
the bone displaced backwards at the seat of fracture. 

Case 6. Compound fracture. HesuU perfect. 

Harvy Herse, of Bufl&Jo, set 21, cut, Sept. 6, 1851, the metacar- 
pal bone of the index finger, through its lower third. It was cut 
obliquely and nearly through its entire diameter, but not quite, the 
separation being completed by breaking. 

I tied a digital artery and applied splints, llie result, after one 
month, was a perfect finger. 

Case 7. Simple fmctwre. Result imperfect. 

T. B. of Buffiilo, »t. 18, broke the metacarpal bone of the ring 
finger of the right hand in March 1854, by striking upon a board 
with his clenched fist Fracture one indi from its lower end. 

I saw it one month, and again two years after it had been broken. 
The fingments were then firm. Indeed it seems to have been bent 
rather than broken. A manifest displacement still continued; the 
lower end of the distal firagment being dq>re8sed toward the palm 
of the hand. The bone also remained quite tender at the seat <^ 
fracture. 



220 



BBPOBT ON 



II 



II 



I 



IP' 



J§5 
^0 



Easurtt. 



5." 



27 y. 



Im. 

4w. 
Im. 
2m. 

My. 

Im. 



simple 
Simple 
Simple 
Simple 

Sbnple 



Gom- 
ponnd 
Simple 



Lower 
third 
Lower 
third 

Lower 
third 
epiph. 
Lower 
third 
epiph. 
Lower 
third 
Lower 
third 



Pad and splint. 
Fadandiplints. 

Ontta percha 
splints, ke. 

Gatta percha 
splints, ko. 



Splints, ftc 



Cotdd not keep tng- 
mentinplaoe. 



Bemains bent towards 
palm; still tender at 
seat of fraotore. 



P. 
P. 

lap. 

p. 

IDPL 



REMARKS. 

Of seven fractures of the metacarpal bones, one occurred in the 
first (metacarpal bone of the thumb), two in the second, and four in 
the fifth. Six occurred in the lower third, and one in the upper 
third. All except one were simple fractures.* Case 5 was a sepa- 
ration of the lower epiphysis, and confirmed the observations made 
by other writers, that such accidents are with dijEculty distin- 
guished from dislocations. Case 7 was a partial fracture. 

In cases 1, 2, 5, and 7, the fractures were produced by blows 
upon the knuckles with the clenched fist, and in each instance the 
fracture was through some part of the lower third of the fifth 
metacarpal bone of the right hand. 

The greater frequency of a fracture of the fifth bone has been 
noticed by both Chelius and N^ton. 

Dorsey, in his Elements of Surgery^ mentions also that he has 
known the metacarpal bones to be fractured in pugilistic contests. 

Of the whole number, three are now perfect and four imperfect 
The displacement in every instance was the same; the lower end 
of the lower fragment being thrown towards the palm of the hand: 
a direction which is due probably, in all cases where the frt^^ure is 
the result of a counter stroke, to the natural curve of the bones 
and to the direction of the force, and not, as Mr. B. Cooper has sug- 
gested, solely to the action of the interossel 



* See remarks on fractures of phalanges. 



DBFORMITIBS AFTER FRACTURES. 221 

The treatment whicli I hare myself adopted lias been very sim- 
ple. I liave endeayoredy firsts by foroe to restore the fragments to 
line, and then by oompresses and moulded spUnts, I have sought to 
keep them m place. 

My experience teaches me, however, not to be too sanguine of 
success. If the fractures had occurred in either the third or fourth 
metacarpal bones, both of which are less accessible than the first, 
second, or fifth, I should have anticipated some difficulty in restor- 
ing the fragments to place, and in keeping them there, but I confess 
I was not prepared for the embarrassments which have hindered 
my success in Cases 1 and 4 ; in the latter of which — ^a separation 
of the lower epiphysis — ^I had every opportunity which could pos- 
sibly be afforded, and yet I was unable to retain the fragments in 
any degree of proper apposition. 

The precise source of the difficulty in this case as well as in Case 
1, 1 am not prepared to explain ; but I suspect it may be found in 
the proximity of these fractures to the joint, and in the advantage- 
ous action of the flexor muscles operating both upon the lower end 
of the fragment, and upon the adjacent phalanges. 



CHAPTEB XIII. 



PHALANOES. 



Case 1. Simple fracture. BesuU perfect. 

A German lad, about twelve years old, had his fingers crushed, 
so that I was obliged to amputate the first finger. The second 
finger was also broken at the distal end of the first phalanx. I 
believe it was a separation of the epiphysis. Crepitus and motion 
between the fragments were distinct, but there was no displace- 
ment. 

I treated this fracture or separation without splints. Union 
occurred in a few days, and without deformity. 

Case 2. Simple fracture. ResuU perfect. 
Michael B., of Bufialo, set. 86 years, broke the first phalanx of 
his thumb, Dec. 1, 1854. Simple fracture. 



S22 BEPORT ON 

I applied a gutta percha splint. The fragments united in about 
three weeks, and without any perceptiHe ensheathing callus, and 
without deformity. 

Casb 8. Simple fracture. BesuU perfect 

Joseph Chiynier, set. 4, admitted to Hospital Dec. 24, 1849, with 
a simple fracture of the first phalanx of the ring finger of the left 
hand. Fracture at the junction of the epiphysis with the shaft) al 
the proximal end of the bone. 

The finger was so much swollen that we applied, at first, only 
simple dressings. 

On the fifth or sixth day a gutta percha splint was moulded to 
the finger. It resulted in a perfect cure. 

Case 4. Simple fracture of the index finger^ resulting in amputatioiii 
Stephen CliflEbrd, of Buffisilo, set. 25, broke the index finger of his 
right hand on the 1st of Aug. 1848, and was admitted to the Hos- 
pital on the 5th of September. Deep seated inflammation had fol- 
lowed the injury, which had been succeeded also by suppuration 
and sloughing of the skin, tendons, &c. I immediately amputated 
the finger at the metacarpo-phalangeal articulation. 

Case 5. Compound fracture. ResuU imperfect. 

John Thompson, of Buffalo, set. 7, broke the two phalanges of 
the thumb through their adjacent articular surfaces, Oct 28, 1851. 
The fracture was compound. I dressed the thumb carefully, witl 
a pasteboard splint. 

Union of the fragments was very tardy, and notwithstanding my 
utmost care, it united with a slight deformity, and with anchylosis 
at this joint 

Case 6. Compound fracture. Union with sligJU deformity. 

Emeline Knapp, of Auburn, N. Y., sdt. 6. Her hand was caught 
by a door thrown violently shut, breaking one of the phalanges of 
the little finger, and nearly severing the finger. 

I closed the wound and dressed the finger with a spUnt, &e. The 
bone united rapidly, but the distal fragment turned a veiy M« 
upon its axis in the splint, during the treatment, and the palmar 
surface was found at last presenting diagonally towards the risg 
finger. I dressed the finger often and was very assiduous in mj 
attempts to make it perfect 



DEFOBMITIES AFTER FBACTUBES. 228 

Casb 7. Ckmipcuvd fracture. Anchylosis. 

An Iriflh laborer, aged about 80 years. A bar of iron fell upon 
the socosd finger of the left hand, breaking one of the phalanges 
and exposing the adjacent articular surface. 

I dressed the wound with sutures, &c., and applied a gutta percha 
splint. 

The bone united with slight anchylosis and without deformity. 

Cases 8, 9, 10. Oompound fractures. Result perfect. 

, of BufiSsdo, aged about 25 years. His hand was caught 

between the bumpers while coupling oars, breaking and lacerating 
the first, second, and third fingers. 

I dressed the wounds and then supported the fingers with a 
single gutta percha splint. 

On the twenty-first day the first finger had united, and without 
any perceptible ensheathing callus. On the thirtieth day the other 
two fingers had united also. The union was in each case unac- 
companied by deformity. 

Case 11. Ccmpound comminuted fracture. Union with shortening. 

Robert Taylor, of AuburD, broke the second phalanx of the little 
finger at two points, and at the same time bruised it severely. I 
removed the intercepted fragment, of half an inch in length, and 
dressed it with a splint, &c. 

It united with shortening, but with no other deformity or maim- 
ing. 

Gases 12, 18, 14. Compound comminuted fraciu/re. Result perfect. 

Sept. 22, 1848. George W. A., of Bufl&lo, about 18 years old, 
received an injury upon his right hand from a buzz saw, laying 
open the joints of the first, second, and third fingers, and com- 
minuting the bones in the two last, so that several fragments were 
removed immediately, and two or three came out after the fifih or 
sixth day. 

I applied simple cold water dressings, and believing that the 
motions of these joints must be lost, I kept the fingers slightly 
bent 

The result has been a complete restoration of the functions of all 
the joints. 

I examined the hand six months after the injury was received. 



224 



EEPOBT ON 



Cask 15. Simple fracture. Result imperfect. 

An Irish laboring woman, aged about 85 years, fell down a flight 
of steps and broke the first phalanx of the thumb below its middle. 
Dr. Congar, of this city, was called, I think, on the following day, 
and found the fragments displaced and shortened upon each other, 
and by no effort which he had made could he succ^d in restoring 
them to place. On the same day Dr. Congar requested me to see 
the patient with him. 

The lower or distal fragment was displaced backwards, and was 
lying upon the dorsal surfietce of the proximal fragment, being 
overlapped apparently about one-quarter of an inch. 

Together, we repeated the efforts which Dr. C. had previously 
made, pulling upon the thumb with a sliding noose with all the 
strength of our four hands, but to no purpose. The firagments 
could not be reduced for one moment ; and we left the patient as 
we found her, only a little the worse for our violent and repeated 
extensions. 











• 






i 


g 




RBBULT. 




^1 


55 

'3 b 


1 


1 
1 


1 


1 


2 


TRSATMBRT. 








Is 


Bemarki. 


11 


1 


12 y. 


Im. 


M. 




Simple 


2d 


iBt 


Lower 

third 

eplph. 


No treatment. 


U. 








p. 


2 


36 y. 


3w. 


M. 




Simple 


Thumb 


l8t 


Gutta pereha 

■plint. 
Gutta percha 

splint 


U. 


21 d. 






p. 


3 


toy. 


Im. 


M. 


L. 


Simple 


8d 


I8t 


\Vl 


U. 








p. 


















epiph. 














4 


26 y. 




M. 


B. 


Com- 
pound 


iBt 














Amputation oa 
the 6th day. 


Imp. 


6 


7y. 


ly. 


M. 




Com- 
pound 


Thumb 


l8t 

2d 


Lower 
and 


Pasteboard 

splint. 


u. 






Anchylosis. 


Imp. 


6 


6y. 


2 m. 


F. 




Com- 


4th 






Splints, am. 


u. 






Lower fragment lap.] 












pound 
















turned on its 
axis. 




7 


30 y. 




M. 


L. 


Com- 
pound 
Com- 


2d 






, 


u. 






Slight anehyloaia. 


Imp. 


8 


26 y. 




M. 




Ist 






Gutta pereha 


u. 


21 d. 






p. 












pound 








spUnt. 












9 


26 y. 




M. 




Com- 
pound 


Sd 






Gutta percha 
splint. 


u. 


SOd. 






P. 


10 


25 y. 




M. 




Com- 
pound 


8d 






Gutta percha 
splint 


u. 


90 d. 






P. 


11 






M; 






4tii 


2d 






u. 






Shortened half an Impt. | 




























inch, a fragment 






























havinx been ron 
move«L 




12 


18 y. 


6m. 


JL. 


B. 


Com- 
pound 


l8t 






Cold water 
dressings. 


u. 






Motion of joimts 
restored. 


P. 


13 


18 y. 


6 m. 


M. 


B. 


Com- 
pound 


2d 






Cold water 
dressings. 


u. 






Motion of Joints 
restored. 


P. 


14 


18 y. 


6 m. 


M. 


S. 


Com- 
pound 


3d 






Cold water 
dressings. 


u. 






Motion of jolnto 
restored. 


P, 


16 


36y. 




P. 




Simple 


Thumb 


lit 


Lower 
half 










Could not redmee 
the fragments. 


lap. 



DEF0BMITIB3 AFTEB FBACTUBES. 225 

BEKABKS. 

Of fifteen cases of firactures of the thumb and fingers, three 
belonged to the former and twelve to the latter. Twelve were 
compound and four simple. Five occurred through the first pha- 
lanx, two through the second, and the situation of the remainder is 
not noted. In two instances the separation has taken place at or 
near the junction of the epiphysis with the diaphjsis. All of the 
firactures, except two, occurred in males. 

Of the whole number, nine are perfect and six imperfect. In 
Case 6, the lower fragment has turned upon its own axis, so that 
its palmar sur&ce presents obliquely to the adjoining finger. Several 
of the perfect results were from compound accidents and from acci- 
dents complicated with lesions of the articular surfeces — the form 
and motions of the joints having been completely restored. 

I have never seen a firacture of the fingers produced by a counter- 
force, but in all instances the blow has been received directly upon 
the part broken; which circumstance, together with the smallness 
of these bones, and the thinness of their soft coverings, renders 
them peculiarly liable to comminution and laceration. The ex- 
amples reported by me, however, give no correct idea of the relative 
firequency of these complications, since I continue to reject from 
my record all cases in which, from the nature and severity of the 
accident, no attempt has been made to unite the fragments. If frac- 
tures of other bones resulted as often in the necessity for immediate 
amputation as do fi-actures of the fingers, then would these reports 
determine in some measure the relative firequency of fractures in 
the several parts of the body ; but such is not the fact, since a very 
large majority of firactures of the fingers are accompanied with so 
much laceration and contusion as to render their immediate removal 
necessary, if indeed a complete removal is not already accomplished. 

The same remarks apply, with some qualifications, to fractures of 
the carpal and metacarpal bones, and to the corresponding bones in 
the lower extremities. 

The displacement has been, with but one exception, slight, and 
in the direction of the diameter of the bone. In several instances 
there was no perceptible displacement whatever, the existence of 
the fi'acture having been only detected by the preternatural mobility 
and the crepitus. In Case 15, however, a fracture of the first phalanx 
of the thumb, a displacement in the direction of the axis of the 
bone took place ; and notwithstanding the most persevering efforts 



226 BSPOBT ON 

on the part of the attending surgeon and myself, a reduction of the 
fragments was not effected. This example demonstrates the re- 
markable power of the muscles acting upon the ihumb; and since 
it is quite obrious that in this instance no other cause could have 
operated to prevent the reduction, it may possess some value in 
relation to the question which has been so much discussed, as to 
the nature and source of the resistance, in cases of dislocation of 
this member. 

Boyer, and after him Mr. Bransby Cooper, think that when the 
extreme phalanx is broken, from the small size of the bone, and 
from its having attached to it the nail and its mata'ix, it is better to 
amputate at once, as the process of reparation is extremely slow 
and uncertain. 

Whether in any of the cases treated by mysd^ or which have 
been particularly noticed by me, the fracture involved the last 
phalanx, I am not certain, but I believe that I have seen suocesaful 
attempts to unite this bone when broken, and I cannot but r^ard 
the rule made by these gentlemen as much too stringent Exam- 
ples must no doubt sometimes occur in which the fracture is so 
simple in its character as to render its prompt restoration pretty 
certain ; and even though the restoration prove tedious, this would 
scarcely be regarded as a sufficient justification for so serious a 
mutilation, since the loss of even an extreme phalanx is not only a 
deformity, but it must prove, in many occupations, a troublesome 
maiming. 

The rule ought still to be held inviolate, which surgeons have so 
often repeated, in reference to injuries inflicted upon the hand and 
fingers, namely, that we should save always as much as possible. 

It is remarkable too how much nature, assisted by art, can do 
towards the accomplishment of this purpose. If the bone of a 
finger is not only severed completely, but also aU of its soft cover- 
ings, save only a tendon or a shred of integument, a reasonable 
chance remains for its restoration. And it is no less interesting to 
observe what powers of reparation are possessed by the articular 
surfaces of these smaller joints, so that although they be broken 
into, or sawn into, or comminuted, and even although small frag- 
ments be entirely removed, a complete restoration of their func- 
tions may be hoped for. I have cited some such examples. It is 
true, however, that such fortunate results are very rare, and that 
they are rather to be hoped for than to be anticipated 



DSFOBMITIES AFTER FBACTUBE3. 227 

In regard to tareatment, it may be remarked that in recent cases, 
and where considerable swelling has not already supervened, the 
restoration of the fragments to position is, in general, easily effected ; 
yet even here it requires often a degree of eare, which one would 
scarcely have anticipated, to determine whether the fragments are 
exactly in line ; and since, in the case of these delicate bones, the 
slightest deviation from the natural position, determines in the end 
an ugly deformity, it becomes exceedingly necessary, especially 
with females, that we should examine the fingers carefully from 
day to day, so that, as the swelling subsides, we may discover and 
correct any displacement which may happen to exist 

As a splint I have found nothing so convenient as gutta percha 
or felt, moulded carefully to either the dorsal or palmar aspect of 
the fluger ; and the form of which I have generally found it neces- 
sary to change slightly as often as every third or fourth day, until 
consolidation was nearly or qidte consunmiated. 

If the fracture is near, or extends into a joint, the finger ought 
to be a little flexed so as to place it in the most useful position in 
the event that anchylosis should occur ; and as early as the end of 
the second week the joint surfaces should be slightly moved upon 
each other in order to the prevention of fibrous or bony adhesions. 
Nor is there much danger of preventing the union by disturbing 
the broken surfaces at this early day. Union occurs between these 
fragments very speedily, and I have never met with a case of non- 
union of the phalanges, nor do I remember to have seen a case 
reported. 

It is a lateral inclination of the lower end of the finger which 
it will be found most dif&cult to obviate, and which may, perhaps, 
in some cases, be most successfully combated by laying the two 
adjoining sound fingers against the broken finger, and then applying 
a moulded splint to the palmar surfEU^e of the whole. In other cases 
it will be more convenient to apply the splint only to the broken 
finger. 

Botation of the lower fragment on its own axis, such as occurred 
in Case 6, is especially to be guarded against, as the deformity which 
it occasions is more unseemly, and the impairment of utility more 
decided, than that occasioned by lateral displacement. 

It may be well also to remind the surgeon of the convenience of 
extending the splint beyond the end of the last phalanx, and of 
moulding it to this extremity in order that the finger may be pro- 



228 KKPORT ON 

tected against injuries, and that when, from time to time the splint 
is removed, it may be reapplied with more accuracy. 

In all cases the splint should be lined with cotton doth or a 
piece of patent lint, and secured in place with narrow and neatly 
cut rollers made also of cotton cloth. Boilers of this width should 
never be torn, but cut carefully with scissors. 



PI. 1 




C.E.Lewis DEL ■ 



DBFOBHITISS AFTSB FBACTUBES. 229 



APPENDIX. 



CONTAINING DBAWINGB OF SPECIMENS AND OF APPARATUS REFERRED 
TO IN THIS REPORT. 



PLATE L 



FiQ. 1. Inewifi^pkU Ihidure of the Seaptda. Copied from a specimen in 
mj poflsession. 

Fig. 2. Separation of the Radius at its Neck. Drawn from a specimen 
in the possession of Robert Watts, N. Y. 

FiQ. S. M-acture of the Radius at its Neck, Drawn from a specimen in 
the possession of T. D. Mutter, of Philadelphia. 

Fig. 4. Frcuture commencing on the radial side of the Radius and termi* 
noting in the Joint, Palmar surface. Drawn from a specimen 
in the possession of Henry H. Smith, Philadelphia. 

Fig. 5. Do. do. do. Dorsal surface. 



280 APPBHDII TO BBPOBT ON 



PLATE n. 

Fio. 1. WelchU Shoulder Splint,^ adapted to the top of the shonlder 
and outside of the arm. The joint is required to accommo- 
date the upper portion of the splint to the different positions 
of the shoulder. 

Fio. 2. Welches Elbow Splints. These are fitted to the two sides of the 
arm, and may be fixed at any degree of flexion or extension 
required by turning the screw, whidi serres also as a pivot for 
the hinges a a. The hinges may be tiaiisfenred to splints of 
different sizes, as required. 

Fig. 8. Welches Forearm SpUni (dorsal). 

Fia. 4. Wdch^t Forearm SpUnt (palmar). 

Fio. 5. Weleh^e &ra\ght SpUnt. 

Fxa. 6. Welch?i Ulnar SpUfU, fitted to the ulnar side of the forearm. 

'< These splints consist of light and elastic cases or coyerings, formed 
of very thin strata or layers of wood or 'cut yeneers,' cemented together 
by interlayers of gutta percha, of such thickness as is required to main- 
tain their form, and pressed into the form of the part for which they are 
designed. By this method of constructing splints, the fibres of the wood 
all run longitudinally or parallel with the surface, which giyes them great 
superiority to splints caryed from solid blocks of wood, however skilfnilj 
performed and fitted to the part ; for when so thin as to be elastic, thej 
are necessarOy liable to split and break, and do not retain their form 
when wet." 

> Inyented and manu&otured by Benjamin Welch, of LakeyOle (S«li8biu7)i 
Conn. 



Pi.n 






& 





C.C.L£WtS OCL. 



PI. in 






f^ ISL . 


i / 


^ "' 


«v »&• ^ 


S^ 










C.e. LEWIS DEL. 



BSFOBUITISS Af TBB FBAOTUBSS. 231 



PIiATB IIL 

Fig. 1. Elhciw Splints, recommended hy Physick, 

Fig. 3. PhyeicVe Splint, designed to preyent a lateral inclination of th^ 
forearm after fractnres at the elbow-joint. 

Fig. 8. ISrkbride^e EJhow SpUfU. 

Fig. 4. JtoeeU JBOow SpUm (jointed). 

Fig. 5. Day^s Elbow Splint (jointed). 

' Fig. 6. The author's mode of dressing, with gutta percha, in cases of 
fracture at or near the elbow-jomt. The splint is padded 
throoghont, and the dotted lines represent the saccessiye turns 
of a roller. The sling, employed to suspend the arm, is omit- 

, ted for the purpose of bring^g into view more distinctly the 

' outlines of the splint. 



282 APPENDIX TO REPORT ON BBFORMITIES, ETC. 



PLATE IV. 

Fia. 1. BancPs Splint^ for firactore of the BadioB at its lower eDiL 

Fig. 2. JETay^s Splint, for the same fracture. 

Fio. 8. Smithes Splint, for the same fracture (view of the palmar sorface). 
A. Forearm splint, made of felt, with incnrvated margins, x. 
Circular brass plate, which corresponds to one on the opposite 
side, and which connects the hand block b, with the forearm 
splint A. 

Fio. 4. Smithes Splint reversed. From this view it is apparent that tiie 
hand block d, moving upon the pivot x, is capable of describ- 
ing the radius of the circle o o. The nut f, which conununi- 
cates with the brass plate of the forearm splint b, retains the 
hand block at any desired angle. 

Fig. 5. The auihor^s Palmar Splint for the same. 

Fig. 6. The author's splints applied. The curved palmar splint is not in 
view-— only the dorsal. The dotted lines represent the roller. 
The sling is omitted for the purpose of bringing the other 
dressings more distinctly into yiew. 



PI. IV, 




C.E.LEWIS J)EL 



REPORT 



COMMITTEE ON HYDROPHOBIA. 



VOL, IX— 16 



REPORT ON HYDROPHOBIA. 



It will be remembered that, at the meeting of this A&sociation in 
St^ Louis in 1864, a communication was read from a gentleman of 
New York on the subject of hydrophobia, touching the popular 
belief in sidereal influence or hot weather as a predisposing cause of 
rabies canina ; that a committee was appointed to collect facts and 
report to a subsequent meeting. At the meeting in Philadelphia a 
report in part was read, but, inasmuch as the facts collected were so 
few, the committee at their own request were continued. We pro- 
pose, therefore, at this meeting to report the result of our labors. 

Since the last meeting of this Association, circulars inviting the 
necessary information have been extensively distributed, but your 
C!om2nittee are sorry to say the response has been but feeble* If 
your Committee could feel satisfied that want of material was the 
cause of silence, they certainly should not regret that the answers 
have been " few and far between." But we judge it to be otherwise, 
or else the periodical press is raising unfounded notes of alarm.^ 

A large proportion of the cases herewith presented have been 
obtained by personal application to individuals whose names were 
made public as connected with their occurrence. But notwithstand- 
ing the general backwardness of our professional brethren to forward 
communications, your Committee believe they are enabled to present 
a larger collection of cases of this terrible disease than has ever 
before been presented to the American public especially at any 
one time. Some of them will be found of exceeding interest apart 
from their scientific importance. The Committee, it will be per- 
ceived, have confined their inquiries to cases occurring only on 
this continent, and mostly to those affecting the human subject. 

1 '<One hundred de«r in Btainboroogh Park, England, hare died this spring of 
hTdropliobia."— Botton Poit, let May. 



236 REPORT ON 

The main object of our inquiry has been to ascertain, if possible, 
whether hydrophobia prevails more at one season of the year thau 
at another; whether the community is more in danger from the bite 
of rabid animals in hot weather and during " dog days," than during 
the colder months of the year; the proo^ therefore, of the existence 
of rabies canina in any place and at any time is what we seek; 
and whether the virus is communicated to man or brute, the fact is 
equally apropos to the task assigned us, though not of equal im- 
portance to the community where it exists. We have confined our 
inquiries to the United States, because we thought the &cts elicited 
would make a deeper impression upon the public mind the nearer 
they come to our own firesides, and because, as we shall see by and 
by, the investigation has already been undertaken in Europe, and 
the results given to the public. 

Hydrophobia, or rabies, seems, from the earliest records of the 
disease, to have been regarded as originating in the dog, or animals 
of the same genus; and hence the disease in the human subject 
was called canine madness by English writers ; and, although the 
disastrous effects of the bite of the dog have been observed for a 
period of more than two thousand years, and are so obvious as to 
have been almost universally admitted, the reasons why the dog 
especially should be capable of originating or developing the disease, 
have always been, and still are, subjects of doubt and speculation; 
and hypotheses have been framed as various and conflicting as the 
causes to which the disease has been attributed, and as unsatisfac- 
tory as the various unsuccessful means that have hitherto been 
proposed for its cure. ' 

The principal causes to which the origin of rabies has been 
ascribed, or which have been supposed to favor the development of 
the disease in dogSy are want of food, or extreme hunger; want of 
water, or violent thirst; putrid food; drinking stagnant water; 
climate; particular seasons of the year; intemperature of the 
weather, as the extreme rigor of winter, or the immoderate heat of 
summer; and, in combination with the latter, especially b. certain 
mysterious influence which Sirius, the dog star, is supposed to exert 
over the canine race. It is scarcely credible that such diflTerent 
and opposing causes should produce the same results without the 
co-operation of some other circumstances. The prevalent opinion 
seems to be, that the fiery dog star, who is in the ascendant in the 
northern hemisphere during the heat of summer, not only predis- 
poses doga more than other animals to become rabid, but that he 



HYDROPHOBIA. 237 

also gives intensity to the heat of the atmosphere, which, with the 
putrid or putrescent food and drink, or rather want of drink, excites 
a fever in his sjstem, and infuriates him to madness. Although 
this sidereal fancy is not endorsed by any medical authority, several 
authors assert and maintain the thermal hypothesis, and both appear 
specious and plausible from the fact of their concurrence with most 
of the other alleged causes of rabies. 

On the other hand, it is maintained by Le Eoux and others that 
rabies prevails most during the coldest weather of the winter sea- 
son, when, they say, wolves become mad from hunger and want of 
prey, on account of the deep snows, as well as from thirst, in conse- 
quence of the springs and streams being frozen over. Others, among 
whom are Boissier and Sauvages, assert that the disease occurs 
most frequently under both extremes of temperature of winter and 
summer ; while a fourth class, among whom is Andry, maintain with 
equal confidence, as the result of their observation, that " the months 
of January (the coldest) and August (the hottest) of the year oflfer 
the fewest cases of this disease," and that it is " during March and 
April there are most mad wolves, and that during the months of 
May and September the greatest number of dogs are afflicted with 
madness." 

The disease is of frequent occurrence in France and Northern 
Europe, as well as in the Northern States of this Union. On the 
continent of Europe especially is it so, as will appear from the fol- 
lowing curious statistical table of its ravages in Prussia : In 1810, 
there were 104 deaths from hydrophobia in that kingdom ; 1811, 
117; 1812, 101; 1818, 85; 1814, 127; 1815, 79; 1816, 201; 
1817, 228; 1818, 260; 1819, 866. Total, 1658. {Edinbwrgh Med. 
and Surg. Jour^^ 1824.) This considerably exceeds the number of 
authenticated cases known to have been put on record throughout 
the world when Dr. Hamilton wrote his book in 1798. The deaths 
were most frequent in the Provinces of Marienwerder (228) and 
Bromberg (162). In Breslau it was 90 ; in Opplu, 53 ; in Trier, 
46 ; in Aachen, 58. On the contrary, not a single case occurred in 
Stralsund, and it was rare (5) in Dusseldorf and in several other 
places. Hufeland observes that those provinces in which it is most 
abundant are contiguous to forests containing wolves, to the forests 
of Ardennes, of Russia, and of Poland. Hydrophobia is very rare 
in Sweden. In England and in this country, it seems to occur most 
frequently in cold or mild weather. Dr. Mease says: "During 
several hard winter months within my remembrance in this city 



238 BEPORT ON 

(Philadelphia), dogs very commonly went mad. TbSa was particu- 
larly the case in that of the year 1779-80, when more of those 
animals perished by the disease than for a long time before. 
Throughout Maryland, I am informed on very good authority, it 
was still more general." " In the winter of 1807," says Dr. Lips- 
combe, *' canine madness raged epidemically at Dover (England) 
and some of the neighboring towns ;" and " three men" are reported 
by Dr. Haygarth, of Chester, as having " died of hydrophobia at 
Wrexham, North Wales, in the aiUumn of 1778, and spread great 
alarm." Dr. White, of St. Edmundsburg, writes to Dr. Lettsom, 
under date of Joae 4th, 1792, as follows! "In the- last nine months, 
this part of the country has been terribly infested with mad dogs, 
during which time it has been my misfortune to be applied to by 
several persons who have* been bitten. Seven of these miserable 
objects were bitten by dogs. ♦ * * Three others were bitten by a aw 
that had the hydrophobia. All of these except two had the injured 
parts wholly diss^ted out three days after the bite, the wounds 
well washed first with oold and then with warm water, and the sur- 
faces touched with lunar caustic. One of the excepted two was 
bitten in the palm, and on the back of the hand ; as much of the 
wounded part as could be with safety was removed, and the process 
of ablution continued for two hours. ■ In the other instance, the 
tooth of the cow had penetrated the end of the finger, on which 
account I thought myself warranted to deprive the patient of the 
first joint. I was also consulted about a foal bitten by a mad dog 
about five days previously through the wing of the left nostril; the 
wounded part was cut out, and no other means were used. The 
animal remained well, while a horse, and cow, and two pigs, bitten 
by the same dog on the same day, to which internal remedies only 
were administered, all died within the month. * * * IVo 
persons on whom excision and .ablution had not been performed, 
and to whom medicine of false repute had been given, fell wretched 
victims to their credulity." (See appendix to Essay on ffydrophobiOi 
by James Mease, M. D.) 

This letter shows that during nine months, embracing autumn, 
winter, and spring, and excluding summer, with "dog days," there 
were at least seven mad dogs, probably more, one mad cow, and two 
rabid human beings in that part of the country during that period, 
all of whom died. It shows also the importance and prchabh effi- 
cacy of excision and thorough ablution of the wound several days 



HYDBOPHOBIA. 289 

after inoculation, of which additional examplea wiU be given in 
another place. 

Babies seems to be a rare disease in tropical climates.^ Savary 
says ; ** The disease is not known in the Island of Cyprus, or Syria 
bordering on the seaf^ "nor is it ever seen in Egypt," says Volney, 
which is confirmed by Larrey in his work on military surgery 
(voL iL p. 226, French edition). Prosper Alpinus, who resided in 
Egypt three years, as physician to the Venetian consul, says the 
same thing. Dr. Barrow says: "It is extremely rare at the Cape 
of Good Hope, and in the interior of Caflfraria." According to Dr. 
Mosely, the disease is unknown in the Inland of Antigua, and Drs. 
Hamilton and Mosely both state that " there was not a single case 
in Jamaica for a periodof fifty years previous to 1783." Dr. Tho- 
mas, too, who also lived in the West Indies a long time, never saw 
a case, or heard it spoken of while there. It is the testimony of a 
number of travellers that in all India, although dogs are quite 
numerous, the disease u^a^* equally rare ; we say it tuas, for Dr. Dan- 
iel Johnson says that rabies is now very common there. This appa- 
rent immunity from the disease in some tropical countries may, at 
first view, seem to be the effect of climate. That such is not the 
case, however, is probable from the fact that that disease has, in 
several instances, originated, or been developed there, and when 
existing has spread as readily by inoculation as elsewhere. - Such 
was the case in India, as stated by Dr. Johnson,- and also in the 
Island of Crete, where the disease was formerly of frequent occur- 
rence. The prevalence of rabies in Crete was the consequence of 
a peculiar occupation of the island. The inhabitants were dog- 
fanciers. They had many choice varieties of the animal, the breed- 
ing and sale of which for exportation were a source of considerable 
revenue. From the very. nature of the case, dogs were very nume- 
rous and well fed. Dog-fights, of course, must have been very 
common, and the disease was probably produced, as it is in all 
other countries, independent of climate. 

Although statistics of rabies go to show that, contrary to popu- 
lar prejudice, it occurs most frequently in cold cotintries, and during 
autumn, winter, and spring, still it appears that of the whole number 
of cases that occur out of the tropics, during the year, nearly an 
equal proportion occur during each month of the year, from which 
it may be inferred that the appearance and prevalence of the dis- 
ease, at particular seasons, and in certain localities or regions, are 

> See Dr. Green's testimonj in Case 102. 



240 RKPOBT ON 

accidental, and in no way connected with, or produced by, any 
thermal or sidereal influence. 

Allied to the hypothesis just considered is that of the spontane- 
ous development of rabies by "some peculiar influence of the air." 
It was maintained by Boerhaave, and subsequently by lipacombe, 
and Mosely. The latter says : " It generated the canine madness 
in the year 1783, in the West Indies, for it was general, and many 
dogs were seized with it, that had no communication with others, 
and some dogs which were brought from Europe and North 
America, and that were not on shore, went mad on their arrival in 
the harbors of the islands." But Dr. Hamilton says: "The dogs 
from the United States communicated the disease to those on the 
islands." In view of this solitary instance, as far as we know, in 
favor of the peculiar influence of the air, and that positively con- 
tradicted by equally, if not more reliable authority, and the proba- 
bility of the dogs on board of the ships having been bitten before 
they were shipped, and had the disease in a state of incubation, 
ready to break out on their arrival there ; and also the probability 
of intercourse between those on shipboard with those on shore; 
the agency of such an impalpable cause is not only doubtful but 
wholly inadmissible. 

That putrid meat, or want of food and drink, never generates the 
disease in the dog, has been satisfactorily proved by experiments. 
Dogs have been confined under circumstances supposed to fiivor 
the development of rabies, and fed altogether on putrid meat, for 
a considerable time ; or food and drink have been withheld from 
them, under similar confinement, so as to produce the most raven- 
ous hunger, and violent thirst, without ever producing the disease. 
In accordance with the results of these experiments is tbe testi- 
mony of travellers that "in Constantinople, where dogs are the 
only scavengers, these animals, half starved and gaunt from want of 
food, are constantly seen about the streets devouring greedily any 
putrid meat they can find." " In Egypt," says Larrey, " dogs stray 
away into the country, and feed on the carcasses of animals that 
have been left unburied;" and Dr. Barrow says the same of 
Oaflfraria and other countries where rabies is scarcely known ; not 
that dogs in those countries live entirely on flesh, but that the litde 
flesh they get iapiUricL 

After this brief and hasty examination of the evidence for and 
against the genbration or development of rabies, by the causes we 
have considered, we are driven to the humiliating acknowledg- 



HTDROPHOBIA. 241 

ment, frankly avowed by the authors of the article on rabies in the 
French Dictionary of the Medical Sciences, "that the true cause of 
the disease is not known, or very imperfectly understood." 

In view of the conceded inadequacy of all the external causes we 
have considered, to account for the origin of the disease, and the 
£act that nearly every case of genuine rabies has been traced to the 
bite of some animal, it is fair to conclude, it never proceeds from any 
other cause. In most cases (but not in all) the disease followed the 
bite of animals known to be rabid, or was communicated by inocu- 
lation of the virus into an abraded surface, proving to demonstration 
its contagious character. The communication of a disease from one 
person or animal infected with it, to another, is a fact so often 
observed in smallpox, measles, and syphilis, as well as rabies, as no 
loi^r to excite any wonder, but is regarded as the natural conse- 
quence of the operation of the law of contagion, and therefore is not 
the subject of our inquiry. But, as all contagious diseases must 
have an origin, and as in several instances rabies has followed the 
bite of dogs and other animals free from the disease, such cases give 
most decided intimations, if not positive proof, that the germ of the 
disease is in these animals, and that to them we should direct our 
inquiries. 

As there are several animals whose bite has been followed by 
rabies, a very natural suggestion is, that the germ or the faculty of 
exciting it to action must residt from some organic or physiological 
peculiarity common to, and characteristic of all these animals ; and 
such is the fact: they are all distinguished for the peculiar form of 
their teeth fitting them in a wonderful manner for seizing and hold- 
ing their prey, and for rending and tearing flesh ; they are all carni- 
vorous, and, from a law of their being, ferocious and irascible, and 
it is probable that their peculiar liability to rabies consists in a con- 
stitutional irascibility. 

The ferocity of all these animals in a state of nature is well 
known; that it is dependent on and modified by the food they live on, 
IB also certain* Witness, for instance, the difference between the 
fierce wolf and his kin, the gentle house dog, whose temper has been 
mitigated and subdued by mixed aliment, or, what is to the same 
purpose, the well-known fact that butcher's dogs, who live almost " 
exclusively on the refuse of the shambles, become very irascible, 
returning in some degree to their original savage habits, notwith- 
standing their domestication; while the wolf, kept in close confine- 
ment and fed upon vegetable matter, becomes tame and harmless. 



242 REPORT ON 

(See QodmarCs Nat. History, vol. i. p. 182.) The seeming immu- 
nity from rabies in some tropical countries to whioh we have alluded 
is probably due to the nature of their food ; the inhabitants them- 
selves use very little animal food, with a large proportion of fiirina- 
oeous articles and fruits, and their dogs are fed on the same alimcDt 
In a conversation with Dr. J. B. Flint, Professor of Surgery in the 
Kentucky School of Medicine, he stated to a member of your com- 
mittee that he spent a winter on the Island of Cuba, and the answer 
to his inquiries on the subject of rabies was uniformly, that dogs 
hardly ever become mad there, and the reason assigned was that, on 
account of the high price of meats, their dogs were fad exclusivdj 
on vegetable food, chiefly mi^h or cooked farinaceous plants or 
grains. 

The temperament of the dog is one of excessive irritability ; his 
nervous system is largely developed, and exerts an influence oyer 
all his actions ; his senses of smelling and hearing are very acnte 
and active ; his brain is seldom in repose, even when adeep, as Ac 
twitchings of his legs and the sounds he utters show that he is 
dreaming; and most of his diseases are attended by nervous excita- 
bility ending in delirium before he dies, indicating their cerebral or 
spinal character. 

The dog is more prone to anger than any Other domesticated ani- 
mal ] and the watchfulness for which he is so highly valued by man, 
as a faithful sentinel to warn his master of the approach of burglars 
or assassins during the night, results probably from this irritability 
of his temper, as well as from the acuteness of his sense of hearing: 
hence he is not only aroused from his sleep by the slightest noise 
(for the dog sleeps much, even when he is supposed to be awake), 
but he also becomes highly excited with anger at the cause of his 
disturbance. This irascible temperament varies in degree in difier- 
ent species of the genus, and in different individuals of the same 
species, and, as has been stated, is modified by his aliment. In some 
dogs it is so stroDg that they are enraged by the most trifling cause, 
80 that they are constantly in a state bordering on madness; affect- 
ing the very organs in which the virus of rabies is supposed to be 
generated, in such a manner as to exhibit one of the most promi- 
nent symptoms of the disease, i. e., the slaver from the mouth. 
Under this condition of the animal organs, it certainly seems highly 
probable that a rabific virus capable of originating the disease may 
be produced. In default of a more satisfactory solution of this diffi- 
cult problem, we propose, therefore, with due deference, this amstit^- 



HYDBOPHOBIA. 243 

tional irasctbiUty of the dog as the basis of a different, and as it 
seems to ns the true, etiology of canine madness. 

The term rabies does not necessarily imply disease, but violent 
passion or strong emotion; it is synonymous with rage, fiiry, or 
anger. From the resemblance of the paroxysms of rabies to the 
manifestation of those passions, the disease is called by the French 
la ragcy in contradistinction to hydrophobia, as a symptom often 
occurring in other diseases. An irascible dog or cat, enraged by a 
sadden provocation, bears the same relation to a rabid one that an 
irritable or passionate man, in a sudden tumult of anger, does to a 
maniac The difference in both cases consists chiefly in the nature 
and permanency of the cause. In rabies and mania the causes are 
morbific and permanent. The rage or fury of mere passion, being 
excited by a sudden and transient cause, is therefore of short dura- 
tion. In many cases of rabies in man, the symptoms of mental 
derangement are not constant, but the patient is, for most of the time, 
rational, except during the paroxysms and for a short time after 
coming out of them. • If then an enraged dog exhibits so many of the 
symptoms of rabies, especially the viscid frothy slaver so character- 
istic of the disease, and which all admit contains the virus, it is rea- 
sonable to conclude that the functional condition of the organs 
implicated in the disease, the^ very organs in which it is supposed 
the virus is generated, is in both cases very similar, and therefore 
capable of generating the virus. That the bite of such an animal 
should be followed by rabies is a most rational conclusion, and if 
such be the case, it is probably the only way the disease ever origi- 
nates. In support of such a conclusion we refer to several cases in 
this report. See Cases 2, 14, 23, 24, 80, 31, 34, 44, 63, 86, and also 
the following authors: — 

1. Morgagni relates a case of rabies " occasioned by the bite of a 
cat that was not rabid." 

2. Doctor le Dulx, a Batavian physician, states that " in several 
instances hydrophobia succeeded the bite of enraged animals," and 
says that "the bite of the common domestic cat rendered furious by 
provocation is well known to produce hydrophobia." {Transactions 
of the Batavian Society^ vol. v., quoted by Dr. White in his 'essay 
on hydrophobia.) 

8. Dr. Lipscombe says: "Dogs in various states and conditions 
are capable of producing the disease by the inoculation of their 
saliva," and " whatsoever is capable of exciting anger or agitation 



244 REPORT ON 

seems likely to contribute to the production of rabies." {History (f 
Canine Madness, page 41.) 

" From a very early period it has been a common notion that the 
bite of an animal is very malignant when inflicted in a fit of anger." 
(Morgagni, De Gausis et Sed Morh) In the French Dictionaiy of 
the Medical Sciences, is the case of "a child which died of rabies, the 
consequence of the bite of a dog which was not at the time of the 
bite, nor did it afterwards become, rabid." The same was the case 
with the dog that bit Dr. Neuman's patient, No. 6S. 

This view of the origin of rabies accounts for the frequency of its 
occurrence among wolves in the forests of Bussia, and formerly in 
the North of France, as stated by several writers. Wolves are 
known to be gregarious animals, and herd together. Even in 
pursuit of their prey, they seldom go singly. Two or more hungry 
wolves, after an exciting race, overtake and capture the object of 
their pursuit; each one, goaded on by a greedy appetite, tries to 
appropriate more than his share, and they fall out over the spoihi 
become enraged, and in the mJilee bite each other, and rabies 
follows. It explains too the sudden appearance of the disease at 
particular times and in localities where it had not been known 
previously for a long period, as has been the case the past winttf. 
For instance, two quarrelsome dogs engage in a fight, and beoome 
more and more enraged by the wounds mutually inflicted and re- 
ceived ; at last they become so infuriated as to pant and foam at 
the mouth; from the well-known effects of the passions on the 
other secretions, we may well conclude that the saliva or slaver d 
such dogs is of a morbific character, and that their bite at suck 
time may produce hydrophobia. There are instances of persons 
who, in their humane attempts to separate fighting dogs, have been 
bitten by them, and have afterwards died of rabies.' To the ob- 
jection that dogs frequently fight without any such serious conse- 
quences following, it is sufficient to say that the bite of dogs kno^ 
to be mad is only in a few instances followed by madness. 

Dr. Carpenter, in his work on Physiology, relates several aset 
showing the immediate depravation of the secretions by strong 
emotion or passion, one of which is so apropos that we must make 
room for it here. " A carpenter feir into a quarrel with a soldier 

' Instance Case 30, reported by Dr. Clark, of VToodbniy, N. J., and * asaHv 
calamity resulted to a gentleman of Compton Street, London, who was bitten ifl "" 
attempt to separate two fighting dogs, reported by Dr. Mosely. Indeed, i&<^ 
writers concur in the opinion that rabid dogs never fight. 



HYDBOPHOBIA. 245 

billeted ia his houae, and was set upon by the latter with his 
drawn sword. The wife of the carpenter at first trembled from fear 
and terror, and then suddenly threw herself between the combat- 
ants, wrested the sword from the soldier's hand, broke it in pieces, 
and threw it away. During the tumult, some neighbors came in 
and separated the men. While in this state of strong excitement, 
the mother took up her child from the cradle, where it lay playing, 
and in the most perfect health ; never having had a moment's ill- 
ness. She gave it the breast, and in doing so sealed its fate. In a 
few minutes the infant left oS sucking, became restless, panted, and 
sank dead upon its mother's bosom." {GarperUer's Suman PhysiO' 
hgy, p. 944.) 

Although not strictly within the scope of this inquiry, it will not 
be out of place to notice very briefly so much of the pathology of 
rabies as appears to be of practical importance. 

It seems to be still a question, what place rabies should occupy 
in a system of nosology ; some consider it an inflammatory disease, 
while a large number, among whom are Marcet, Portal, Mease, and 
others, view it in the light of a nervous affectum. M. TroUiet says : 
"Begarded in a certain aspect, rabies should be placed among 
nervous diseases, especially the first symptoms; but, considered 
with respect to the traces. which it leaves after death, it seems to be 
of an inflammatory nature. In effect, it presents itself at first as a 
manifest lesion of the function of the brain, the senses, and the 
nerves. But very soon a catarrhal affection of the air-passages 
supervenes, and finally a suffocation, and even true asphyxia." 
He says the salivary glands are always found in a healthy state, and 
hence concludes that the virus is not generated in them. From 
the evident symptoms of disease in the air-passages^ and their 
morbid appearance on dissection, he infers the virus is generated 
there, and is mixed with the frx)thy mucus of those parts, which 
together constitute the slaver that propagates the disease. 

The manner in which this singular virus operates, or the medium 
through which it produces its astonishing effects on the system, at 
periods differing so much in duration, in di£Eerent cases, is as great 
a mystery as ever. The &ct that the disease has been prevented 
by excision of the cicatrix after it had become painful, swollen, 
and discolored, a group of symptoms, known by the term recrudes- 
cence, and which is the harbinger of rabies, and always followed by 
the disease under any other treatment, is positive proof that the virus 
is not directly absorbed into the system. Hunter and Munro both 



246 BKPORT OS 

afSrin that " the disease may be prevented by excision at any time 
before the occurrence of the second inflammation." Dr. Maroet 
recommends "excision at any time before the general symptoms 
come on." Poiteau advises " a trial of it even after rabies has come 
on." A man had a painful cicatrix cut out 25 days after the bite, 
then volatile alkali was applied to the wound and a dressing of 
emplastr. vesicator. The man remained well, while several animals 
bitten by the same dog died of rabies within five months. {Jaumd 
Oinhrale de Mid.^ tome xxx.) D. Blane, an English veterinary sur- 
geon, although a believer in absorption, says: "The bitten part may 
be cut out at any time previous to the secondary inflammation, or 
at the end of one, two, or three weeks." The following is his theory: 
" The poison is immediately absorbed, and taken into the constitu- 
tion, but remains dormant until called into action ; and before it 
can produce any of its effects, it must raise a secondary inflamma- 
tion, in the original bitten part, and unless this inflammation takes 
place no mischief can ever ensue. Consequently, when the bitten 
part has been removed, no secondary inflammation can take place." 
Mr. Blane, according to his own account, enjoyed rare opportunities 
for observation in the English metropolis, and therefore speaks 
with great confidence : " That it is of no consequence that the 
excision of the part should be immediately effected, but, as second- 
ary inflammation may come on at any time, he advises to have it 
done as soon as convenient." {Essay on ffydrophobia, by D. Blan^ 
Professor of Animal Medicine, London.) Mr. Blane's practice, 
though in conflict with his theory, is no less valuable on that 
account. 

The application of caustics and cauteries to the cicatrix on the 
appearance of recrudescence, and keeping up a discharge from the 
part, is said also to have prevented the disease. 

Dr. Mease disproved and rejected the notion of absorption, and 
says : " I am disposed to embrace the idea of the operation on the 
nerves." He believes the poison lies dormant in the wound for some 
time. And at length, in various periods in different persons, begins 
to show its effects on the system at large. He quotes Morgagni in 
support of that view, and Salius, who says "the poison is carried 
by the nerves to their origin." Drs. Percival and Vaughan hold 
the same opinion. 

Dr. White, in the letter to Dr. Lettsom before referred to, remarks: 
" The first sensible mark of action is a pain in the injured part, 
and the consequent symptoms and sensations have a nearer rela- 



HYDROPHOBIA. 247 

tion to spasm tlian inflammation. The lymphatic system is not 
a£bcted as it is from the insertion of variolous or any other infectious 
matter carried into the habit by absorption. The virus probably 
Ues dormant^ till the pain in the bitten part comes on, and therefore 
excision and ablution might afford relief at that time, and even 
when the patient is afBicted with hydrophobia." 

Dr. Gilman says: "In the determination of the question as to the 
time when the extirpation of the parts infected may be performed, 
it is of great importance to consider whether the poison does not 
always remain in the substance where it is first diffused, until by 
inflammation or by some other cause a sufficient dose is generated 
to infect the whole system. Indeed, the notorious connection 
between a painful and inflamed state of the original wound, imme- 
diately preceding the constitutional symptoms, warrants the suppo- 
sition, and points out the expediency of removing or destroying 
the parts to the last." {Diss, p. 109.) "The pain in the bitten part, 
at the time the symptoms of hydrophobia come on, is felt in the 
course of the nerves, and not along the absorbents." {Dr. Marcet) 

Contrasting the effects of the poison of smallpox and lues vene- 
rea with that of rabies, Dr. Percival remarks : " Their progress 
into the course of the circulation may be readily traced, which is 
not the case with the poison of a mad dog," and then asks : "Are 
we then fundamentally right in the idea that the bite of a rabid 
animal operates by absorption ? Might not its effects be as well, 
if not better explained, by ascribing them to local nervous irrita- 
tion, propagated in different periods of time, according to the 
varying circumstances of sensibility and irritability to the brain, 
and from thence to the JSsiuces, gullet, and stomach ? are not all the 
symptoms of the nervous or spasmodic class?" 

"Many medical writers have despaired of excision unless it is 
employed within a few hours, and perhaps a few minutes after the 
wound, on the supposition that after a very short time the poison 
must have mingled with the blood of the bitten animals ; but it is 
well known that the poison lies hng dormarU and inactive in the 
part to which it was first applied, and, therefore, it is proper to 
perform excision, not only before the wound is healed, but even at 
any period before the constitutional symptoms have commenced." 
{Oases of Tetanus and Hydrophobia^ by C. H. Parry, 1^. D., F. E. S., 
London, pp. 182, 188.) 

"The hydrophobic poison requires a period of incubation, and 
often remains long undeveloped in the nest provided for it, when at 



248 REPORT ON" 

length circumstances favor tlie hatcliing process; the new brood 
leaves its birth-place in the cicatrix and carries destruction into the 
system. A consolatory inference from this view is that, if the 
nidus be wholly removed before the hatching is completed, the 
mischief may be entirely prevented." {Wood^s Practice^ p. 757.) 

These instances of and remarks on the probable success of ex- 
cision after long delays, like that of repentance at the eleventh 
hour, while they encourage us to hope, even to the very accesaon 
of the disease, should not, however, tempt or induce us to defer the 
operation for a moment, but it should be performed, when practi- 
cable, as soon as possible after inoculation. If the result of onr 
inquiry bQ not that of entirely correcting public opinion on this 
subject (and we are not vain enough to presume it will),, by showing 
that cold weather does not afford immunity from the contagion of 
rabies, and that danger is by no means confined to summer, we 
have the satisfaction of believing that our labors will not prove 
altogether abortive; we feel that we have done something towards 
correcting it. In addition to a result so much to be desired as 
correct views upon a subject of such vital import, your Com- 
mittee also feel no little satisfaction in being made the medium of 
placing upon record an amount of information regarding hydro- 
phobia in this country, which will enable some diligent student 
by comparison, analysis, and arrangement to arrive at a better 
knowledge than we now possess of this very singular disease. 

Besides those cases which your Committee have received from 
gentlemen, most of whom have been long and favorably known to 
the profession, they have received others from individuals profesang 
to destroy the latent virus by some secret remedy ; one individual, 
in particular, has furnished what he calls 89 cases, only one of which, 
he says, had hydrophobia 1 Of course your Committee could make 
no use of information from such souiwes. We think the cases 
reported sustain us in the opinion before expressed, that either 
excision or amputation of the part inoculated is the only reliable 
prophylactic, and affords the strongest ground of hope to any one 
bitten by a rabid animal, or one enraged, and that even that remedy 
is better late than not at all, as witness Dr. Jackson, Case No. 75. 

Tardieu's report, a short notice of which may be found in the 
July No., 1854, of the Amer. Joum. ifkl Sciences, is made up en- 
tirely of cases of hydrophobia in the human subject. He details 
48 cases occurring in Prance, in 1862, and has arranged them in 
groups corresponding to the four seasons of the year. The date of 



HYDROPHOBIA. 249 

inoculation was observed in 40 cases, 10 having occurred in the 
first quarter beginning with March, 16 in the second, 4 in the third, 
and 10 in the last beginning with December. "But," says he, **as 
this is an inquiry into the influence of temperature more particu- 
larly, would it not be more natural to divide the year into two equal 
parts, so as to include in each severally the extremes of high and 
low temperature. Then,' beginning with December and ending with 
May, we have just half of all the cases noted, and the heat of sum- 
mer, and the mild temperature of autumn, furnish the other half." 
This division might answer for France, but, with regard to the 
northern section of the United States, from which nearly all our cases 
are derived, we have really but four warm and eight cold, or cool 
months. All Tardieu's cases are traceable to the bite of the dog. 
Now, as hydrophobia in the human subject arises almost entirely 
from this cause, do not the statistics of the disease in dogs claim 
attention, at least more than the subject has generally received ? 

The date of inoculation and the period of incubation, or latency, 
are also important items of observation, inasmuch as from them 
alone are we to determine whether the disease is hastened or retarded 
by the temperature of the atmosphere. This report of Tardieu's, 
therefore, is not so complete as it would have been if the date of 
the bite and the accession of the disease had been noted in each 
case. Notwithstanding this, however, it is an invaluable paper. 

Hydrophobia is a disease about as rare as it is fatal.^ There are 
many physicians, and among them some of large practice, who 
have never seen a case of it, and especially is this true in regard to 
those in the southern section of the Union ; and as to its fatality, 
how few among us have ever yet been enabled to record the suc- 
cessful issue of a single case. Many physicians, and some of them 
gentlemen of intelligence, even doubt its existence as a distinct 
disease, a disease having a specific origin. Dr. Marriot, of London, 
has written a book to prove the impossibility of its being produced 
by the bite of a dog I 

It is therefore evident that no one practitioner sees enough of 
hydrophobia to enable him to judge correctly from personal ob- 

I " The sn'bjectfl of hjcbrophobia have fallen yictims nnder almoet every treatment, 
and if the genuine disease has ever been cnred, such cures are merelj insulated 
facts, from which no general principle can be deduced, for perhaps the means of 
onie in aU of them have been different, and the yery next case that occurred has 
been fatal under apparently the same treatment, and with apparently the same 
symptoms." — New England Jour.^ 1812. 
VOL. IX,— 17 



250 REPORT ON 

servation alone whether one month in the year more than another 
favors its development, or the warm season more than the cold. It 
is only by an esprit du corps of the members of the profession col- 
lectively, and united efforts as collaborators in the wide field of 
observation, that we can ever hope to arrive at a correct knowledge 
of its nature, and thus if ever reach the remedy so greatly desirei 

The history of the cases which have occurred in the United 
States, as well those which heretofore have been given to the 
public as those which we are now enabled to present, it seems to 
us furnishes statistics which should satisfy the most &stidious. It 
may be remarked, also, that in all but one of the cases reported as 
recovering after hydrophobic symptoms had manifested themselves, 
the period of incubation was very much shorter than in those 
cases which terminated fatally. Witness Cases 17, 77, 81, 90, 97, 
the average being only 15 days, whereas the general average is 66. 

From a reference to the tables annexed, it will also be perceived 
how strongly they confirm conclusions drawn from similar statistics 
in Europe. Dr. Radcliffe, of England, has made an analysis of 109 
cases of hydrophobia. In 84 the month is stated in which inocula- 
tion took place. Of these, January furnishes 8; February, U; 
March, 8 ; April, 6 ; May, 16 ; June, 5 ; July, 5 ; August, 5 ; Sep- 
tember, 6; October, 8 ; November, 5 ; and December, 6 : or the first 
quarter of the year, beginning with March, 80 ; second quarter, 16; 
third quarter, 14, and last quarter, ending with February, 23. 

Every investigation, and anywhere made, only proves that a 
belief in the influence of the "dog star," or climate, or season of the 
year, as inducing or favoring the production of rabies, is an utter 
fallacy, a mere astrological fancy, handed down it may be from 
remote ages, its very antiquity, perhaps, shielding it from the probe 
of investigation, but yet entirely unsupported by fiwjts. Laws 
based upon such an hypothesis are a reproach to the nineteenth 
century, and not only absurd, and their execution expensive and 
cruel, but positively injurious to the community, inasmuch as, during 
the colder seasons of the year, when Sirius is not in the ascendaatj 
they are off their guard, and thus, lulled into a false security, are 
consequently more exposed to danger. 

A reference to the tables will also show that very few cases of 
hydrophobia result from bites on parts of the body protected by 
clothing. The cases reported are almost uniformly from bites upon 
exposed parts of the body, such as the fingers, hands, face, nose, 
ears, &c. &c. They also show that it is not necessary that the 



HYDROPHOBIA. 251 

animal inflicting the wound should itself be diseased. Temporary 
anger, produced by harsh and cruel treatment, is noticed in several 
of the cases as preceding the infliction of the injury which resulted 
in all the symptoms of well-marked hydrophobia. 

In some few of the cases received, the period of inoculation is 
not mentioned; where this has occurred, your Committee have taken 
the usual average of determined cases, which is about 40 days, and 
counting backwards have assumed the date reached as the period of 
the injury ; this, however, occurs in but very few instances. 

The statistics also indicate with sufficient clearness the course 
which legislative and municipal authorities should pursue in refer- 
ence to this subject. They demonstrate that an attack of hydro- 
phobia is invariably preceded by the bite of a dog or other rabid 
or enraged animal, and that no one season of the year affords any 
immunity from the danger of inoculation. They confirm, too, as 
might have been expected, the results of the mortality statistics 
of the late census of the United States, carefully prepared by the 
superintendent of the census, J. D. B. De Bow, Esq. We there find 
that, during the year ending 1st June, 1850, there were reported 26 
deaths from hydrophobia, as follows: Georgia 1 ; Illinois 1 ; Louis- 
iana 1 ; Maryland 1 ; Michigan 1 ; New Hampshire 1 ; New 
Jersey 1 ; New York 8 ; North Carolina 1 ; Pennsylvania 2 ; Ehode 
Island 4 ; Vermont 2 ; Virginia 4 ; New Mexico 8. And the seasons 
of the year were as follows: 1st quarter, beginning with March, 7; 
second quarter, 7; third quarter, 8; and the last quarter, December, 
January, and February, 9 ; total, 26. 

It will be seen that several of the communications notice the 
existence of " dog laws" in their several localities in force mostly 
during the hot months of the year; but none of them embracing 
the whole year. 

Thus it seems to your Committee that a very strong case has 
been made out, though not as strong as it would have been could 
they have presented the Association with a longer catalogue of cases; 
for it is certain that with all their diligence they have collected but 
a small number of those which have occurred in the United States. 
Enough, however, is here presented if brought properly before the 
community, as it is in the power of this National Association to do, 
to produce results, under the operation of the law of self-preserva- 
tion alone, favorable to human life and happiness, however destruc- 
tive it might prove to the canine and feline races. The committee 
do not feel called upon to recommend any specific course of ac- 



262 BSPORT OK 

tion for legislators to pursue. They merely state fiacts as they find 
them, and &cts they think sufficiently suggestive. The simple 
question seems to be, Shall human or canine life be protected by the 
aegis of law? 

It will be perceived that, in order to bring certain classes of jEacts 
together for comparison and convenient observation, we have ar- 
ranged the cases in five columns. 1st, the number of the case; 
2d, the name and age of the patient, stating the part of the body 
injured, and the animal inflicting the wound, together with the 
authority; 8d, the time of the bite; 4th, the time when sickness 
commenced; and 5th, the termination. 

The cases presented for publication as part of this report are 
cases never yet published, and are furnished by those witnessing 
the facts they relate. The cases derived from books are duly 
credited. 



HYDROPHOBIA. 253 

-4 Schedule of Casen of HydraphoUa occurring in the United States.^ 



DBBCllIPTIOlt AHD AimiORITT. 



Boy 11 years old ; by raccoon, on thumb. Re- Oct. 16 Nov. 27 Dec. 3 

ported by George Russell, M. D., Lincoln, Mass. 
Boy 7 years ; by dog, enraged not mad, on little Sept. 17 Oct. 7 Oct. 11 

finger. By £. Coale, M. D., Boston. 
A youth 18 years old ; by dog, on wrist. By July 29 Nov. 4 Nov. 8 

Dr. Curtis, Lowell, Mass. 
Boy 7 years old; by dog, on eye and mouth. Aug. 13 Sept. 12 Sept. 16 

By Dr. Hayward, Am. Med. Joum., 1854. 
Girl 7 years old ; by dog, on hand, elbow, and Deo. 18 Jan. 20 Jan. 22 

face. By Dr. Cabbot, Am. Med. Joum., April, 

1854.« 
J. W. H., 15 yeara ; by dog, on calf of leg and Jan. 27 Feb. 26 Feb. 28 

ear. By Dr. C. D. Homans, Boston Medical 

Journal, March 8, 1854. 
A man, 23 years ; by dog, on hand. By J. S. Feb. 8 April 6 April 10 

Fogg, Boston Med. Joum., April 19, 18S4. 
Son of Wm. Craft, 8 years ; by d(^, on nose. Feb. 18 March 25 Miurch 27 

By P. Moulton, New Rochelle, N. Y. 
A man, 35 years ; by dog not mad. By Dr. Dec. 16 Jan. 16 Jan. 18 

Casselberry, Evansville, Indiana. 
A boy, 9 years ; by dog. By Dr. Casselberry, Jan. 1 Jan. 13 Jan. 17 

Evansville, Indiana. 
Mrs. B. RUey, 34 years ; by dog, on left arm. Nov. 3 Feb. 9 Feb. 13 

By Dr. W. L. Atlee, Philadelphia, Pa. 
Boy, 8 years ; by dog, on leg. By Dr. Blatch- Sept. Aug. 30 [Sept. 2 

fotd, Troy, N. Y., Boston Med. Joum., July 26, 

1854. 
Boy, 8 years ; by dog, on leg. By Dr. Blatch- Sept. Sept. 9 Sept. 11 

ford, Troy, N. Y., Boston Med. Joum., July 26, 

1854. 
Mr. House. 30 years ; by dog, not mad, on hand. Sept. 23 Nov. 9 Nov. 13 

By Dr. Blatchford, N. Y. Annalist, 1847. 
A man, 28 years ; by dog, on hand. By James Feb. 4 March 19 March 23 

Thom, M. D., Troy, N. Y., Boston Med. Joum., 

July 26, 1854. 
A girl, 6 years ; by dog. By Dr. Trail Green, March 11 April 22 

Baston, Pa. 
Mrs. S., 57 years old ; bitten on the finger. By June In 14 

Dr. Samuel Hart, Brooklyn, N. Y. days 

Several animals bitten by dog in Oswego ; all January 

died. By Dr. Hart, Brooklyn, N. Y. 
Cornelius Wurgeis, 22 years old ; by dog, on Nov. 12 Dec. 14 

hand. By Dr. T. Tumer, Brooklyn, N. Y. 
N. C, laborer, 45 yeai% ; by dog, on hand. By May 12 Aug. 9 

Dr. Turner, N. Y. Joum. Med., Nov., 1865. 
Mrs. Willard, of Buffalo ; by a cat, on hand. Jan. 21 March 24 

By Dr. G. N. Burwell, Buffalo, N. Y. 
Mr. Gould, of Hamburg, 57 years old ; by dog. May 14 July 2 

on arm. By Dr. G. N. Burwell, Buffalo. 
Jos. Mallet, of Providence, R. I. ; by his own Feb. 19 March 4 

dog, not mad, on lip. By Dr. F. H. Peck- 
ham, Providence, R. I. 



April 22 
WeU 

Dec. 19 
Aug. 30 
March 28 
July 5 
March 9 



' For the first seven cases, your Committee are indebted to the researches and 
kindness of our friends, Drs. J. B. S. Jackson and C. B. Homans, of Boston. They 
embrace, it is believed, all, or nearly all, the oases of hydrophobia recorded as 
oecurring in that vicinity. 

' See an interesting convenaiion on hydrophobia, in Am. Med. Joum., April, 1854. 



254 REPORT ON 

C<ue9 of Hydrophobia occurring in the United Sifafef— Continaed. 



24 



27 

28 

29 
30 
31 

32 

33 

34 
35 
36 
37 
38 
39 
40 
41 
42 
43 
44 
45 
46 
47 

48 
49 
50 



DBSCKIPnOir AJKh AUTHOEITT. 



Henrj Hopkins, 28 years ; by dog, not mad, on 

finger. By Dr. Stephen C. Qriggs, Proyidence, 

R. I. 
Mr. John White, of Camden, N. J. ; by cat, on 

forefinger. By Dr. Tho8. F. Gallon. 
Several hogs, cows, and horses, bitten by dog, 

and died xnad, in Spencer Coonty, Indiana, 

1839. By J. B. Sanders. 

Robert Adams, of LonisTille, Ey. ; on finger, by 

dog. By Dr. Hewett, Western Jonm. Med., 

Sept., 1849. 
Isaac Mnrphy, 25 years ; by dog, on hand and 

wrist. By Dr. C. F. Clark, Woodbury, N. J, 
A horse sickened in one week. Do. 
A pig ; by dog. By Dr. C. P. Clark. 
Areiy Newland, 15 years ; by small dog. By 

Dr. Ariel Hunton, Vermont. 
A cow ; by a dog, in Gaines, N. T. By Dr. J. 

H. Beech, Mich. 
A lady ; by a dog. Ten years after, broke her 

arm and died of rabies. By Dr. Beech, Cold- 
water, Mich. 
Michael Casey, 40 years ; by dog, on hand. By 

Dr. G. D. Ayres. 
Henry Uthoff, 28 years ; by dog, on hand. By 

Dr. Roelker, Cincinnati. 
Mrs. Jane Porter, 65 years; by cat, on hand. 

By J. E. Pearson, Vienna, Ala. 
Stephen Lee, 64 years ; by dog, on finger. By 

Dr. Fountain, Am. Med. Monthly, 1856. 
John Wolman, 38 years ; by dog, on finger. 

Phil. Med. Joum., vol. i. 1820. 
Edward Bransfield, 28 years ; by dog, on lower 

lip. By Dr. J. H. Griscom. 
A German, 45 years ; by dog, on hand. By Dr. 

J. L. Smith, N. Y. Joum. Med., Sept. 1855. 
Thomas Brothers, 28 years ; on tendo-Achillis. 

Philadelphia Med. Museum, vol. iii. 
Mrs. Rodgers; by dog in 1825, and again by 

dog, not mad, 1856. Dayton Gazette, Ohio. 
James Coho, 30 years ; not known to have been 

bitten. BulFalo Med. Joum., May, 1855. 
Laurence Mier, 34 years ; by his own dog, not 

mad. Buffalo Med. Joum., May, 1855. 
Dr. J. S. Hawley ; by same cat ^hich bit Mrs. 

Willard (see 21). Reported by himself. 
A lad, 8 years ; by dog. By Dr. Z. Pitcher, 

Detroit, Mich. 
A lad, 18 years ; by dog. Reported verbally by 

Drs. Donne and Flint, Louisville, Ey. Priap- 
ism prominent. 
Christopher Enowlson ; by dog, on arm. Eclectic 

Repertory, vol. ix. 
A boy, 6 years, son of Mr. H. Melendy ; by dog, 

on face. By P. B. Miller, M. D. 
A laborer ; by dog, on finger. By P. B. Miller, 

M. D., Mt. CaiToL 



July 23 



June 28 
Sept. 20 



May 16 



March 7 

March 7 
Jan. 1 
AprU 19 

Feb. 



May 31 

May 17 

Summer 

Mayl 

Nov. 2 

April 5 

Nov. 

June 10 

Jan. 15 

Probably 

Nov. 
July 27 

Jan. 20 

May 

Oct. 

Feb. 20 
March 6 
March 6 



Oct. 21 



Sept. 5 



July 25 



May 14 

March 14 
Jan. 29 
May 23 

6 days 



Oct. 23 



Sept. 9 

Died 

from 9 

days to 

4 weeks 

July 27 



May 17 

Shot 
Jan. 31 
May 25 

Next day 



Aug. 9 

June 30 

3mos. 

Oct. 1 

Nov. 28 

May 11 

March 16 

July 4 

March 21 

Jan. 18 

Sept. 14 

Parts ex- 
cised 
June 

Deo. 
June 3 



Aug. 13 
July 4 
days 
Oct. 10 
Nor. 30 
May 15 
March 21 
Well 
March 25 
Jan. 22 
Sept. 18 

June 
Dec. 

June 6 



March 20 March 23 

Parta ex-jWeU 
oised 



HYDROPHOB^IA. 256 

Ckises of JlydraphoHa occurring in the United Statet — Continoed. 



DBCKIFTIOJr Aim nrraoKiTT. 



51 Hones and cattle ; by dogs. By B. P. Miller, 
M. D., Monnt Carrol. 



62 
53 

54 



55 
56 
57 
58 
59 
60 
61 
62 



72 



Horses ; bj dogs. By Dr. Miller. 

Mr. Moor, 24 years ; by dog, on hand. Reported 

Terbally by Dr. Swing, Lonisville, Ky. 
A negress, 16 years ; by dog, on shoulder. Re- 
ported to Jas. Mease, M. D., by J. Shore, M. D., 

Petersburg, Va. 
Jas. Remington, 6 yean ; by dog, on face. By 

Dr. King, from Thatcher. 
Levi Woodruff, 43 yean ; by dog, on ear. From 

Thatcher. 
Black boy, 16 yean ; by dog, on foot. By Dr. 

Physick, from Thatcher. 
Son of Col. Swartout ; by dog, on arm. By Dr. 

Borrowe, from Thatcher. 
Son of Mr. Pylis, 14 yeare ; by oat, on toe. By 

Dr. Jas. Mease, from Thatcher. 
J. Opie, 13 yean ; by dog, on nose and eye. By 

Dr. J. R. B. Rodgen, from Thatcher. 
Son of Wm. Todd, 5 yean ; by dog, on cheek. 

By Dr. Rush, from Thatcher. 
Son of Mr. S. Weston, 3 yean; 31 wounds by 

dog. By Dr. Thatcher. 
Nicholas Lang, 10 yean ; by dog, not mad, on 

forearm. By Dr. Jas. M. Newman, Buffalo. 
A dog, bitten by same dog as above 3 days after- 
wards. By Dr. Newman. 
Ezra Sylrester, 73 yean; by dog, on finger; 

same dog as 62. By Thatcher. 
Mn. Bush ; by cat, on hand. By Thatcher. 
W. W. Inman ; excised on hand. 
Primus, colored ; by dog. 
Jack, colored ; by dog. 
Smith, colored ; by dog. 
Pigs, hogs, horses, cows, and men, bitten same 

time by same dog. Of the animals bitten, 15 

died mad. By Dr. Davis, New Jersey, N. Y. 

Med. and Phys. Journ., vol. ii. 
PhoBbe Powell, 21 yean old ; by dog, on wrist. 

Was cauterised, salivated, and paialyxed ; 330 

grains aoetate of lead, and ^iv of Goulard's 

tincture administered in 4 days, &c. &c. By 

G. E. Smith, M. D. Baltimore, N. Y. Med. and 

Phys. Journ., vol. v. 
Thos. Rodgen, 12 yean old ; by dog, on wrist. 

By Dr. Hartshome, Amer. Journ., Oct. 1848. 
David Lithgow, 30 yean ; by dog, on hand. 

By Dr. Jacksmi, Amer. Journ., April, 1849. 
Hn. Burrows, 30 yean ; by dog, on wrist ; part 

excised after three months. By Dr. Jackson, 

Amer. Journ., April, 1849. 
A carpenter, 35 yean ; by dog, on thumb. By 

Dr. Bums, Mass., Amer. Journ., April, 1850. 
Charles Baker, 20 yean; by dog, on thumb; 

opti oal. By Dr. Wilson, Amer. Journ., Jan. 

1851. 



Jan. 



Feb. 
Summer 

Sept. 1 



Oct. 28 jNov. 7 
March 17 April 13 
March 24 April 28 
April 11 July 3 



As above 
Summer 

Parts ex- 
cised 



July 14 
April 1 
Aug. 6 
Aug. 16 
Jan. 5 
Jan. 8 
Aug. 16 



.4 

Sept. 21 
Sept. 21 
Sept. 21 
Sept. 21 
Sept. 21 



Jan. 19 



June 27 
Feb. 10 
July 

June 
Biay24 



Nqv. 19 

July 10 

Sept. 9 

Nov. 3 

March 10 

March 12 

Nov. 14 

Oct. 19 
Recov'd 
Recov'd 
Recov*d 
Recov'd 



Feb. 7 



Died 

from 

20 to 60 

days 

Summer 

Not div. 

Nov. 10 
April 15 
April 29 
July 7 
Nov. 29 
July 15 
Sept. 13 
Nov. 9 
March 11 
March 12 
Nov. 21 
Oct. 25 



Aug. 17 
Biarchl6 
Oct. 27 

Oct. 28 
June 15 



WeU 



Aug. 21 
March 18 
WeU 

Oct. 30 
Well 



256 REPORT ON 

Cases of Hydrophobia occurring in ^e United States — Continaed. 



82 
83 
84 
85 
86 
87 
88 
89 
90 
91 
92 



93 

94 
95 
96 

97 

98 

99 

100 

101 

102 

103 

104 

105 



106 



DsacaiPTioK Ain> authoritt. 



J. Jameson, 12 years ; bj dog, on hand and little April 1 

finger. By Dr. C. A. Lee, Amer. Jonm., Feb. 

1837. 
Marcus Lovell, 4 years ; by dog, on cheek. By May 

Dr. C. A. Lee, Amer. Joum., Feb. 1837. 
John McCormick, 44 years ; by fox, on hand. March 

By Dr. C. A. Lee, Amer. Journ., Feb. 1837. 
J. Gould, 8 years ; by dog, on hand ; salivation. March 6 

By Dr. Hildreth, Med. Repository, vol. vii., 

1822. 
Boy, 8 years ; by dog, on cheek. By Dr. Gris- Oct. 8 

com, N. Y. Joum. Med., Jan. 1845. 
A soldier; by dog, on finger. By Dr. G. A. Fall 

Smith, N. Y. Joum. Med., Sept. 1845. 
John Tyson, 23 years ; by dog. By Dr. R. H. June 9 

Coolidge, N. Y. Joum. Med., Oct. 1839. 
Boy (Boston), 18 years ; by dog. By Dr. A. H. July 29 

Brown, Boston Med. and Surg. Joum., 1849. 
Miss Sarah Crehore, 28 years ; by dog, on ankle. Ang. 22 

By J. Perkins, M. D., Castleton, Vt. 
Wm. Hill, 45 years ; by dog, on Bcrotmn. Eclec- Oct. 25 

tic Repertory, vol. i. 
A little boy, 4 years old ; by dog, in hand. Bos- May 15 

ton Med. Joum., June 26, 1850. 
Miss Fulton (Louisiana) ; by dog. Boston Med. July 23 

Joum., Sept. 25, 1850. 
Mr. J. K. ; by dog, on leg. Boston Med. Jonm., June 13 

Oct. 1850. 
Child, 3 years old ; by cat, on forehead and eye. Nov. 13 

By Dr. W. B. Gould, Lockport, N. Y. 
Mr. White, 25 years ; no bite, saliva from mad March 

calf. By C. W. Higgins, M. D., Abbington, 

Mr. Clark, 55 years ; by oat, on hand. An- Nov. 10 

thority same as above. 
A horse ; assumed inoculation. Authority same. May 10 
A cow ; inoculation assumed. Authority same. March 5 
Mr. Hoar ; by dog, on hand. Boston Med. Joum., Feb. 4 

1854. 
Joshua Case, 17 years ; on leg, by dog. N. Y. Nov. 8 

Med. and Phys. Joum., vol. iii. p. 43. 
Girl, 15 years ; by dog, on cheek ; dog not mad. 

By R. D. Mussey, M. D., Ohio. 
Young man ; by dog, on leg or arm. By R. D. July 

Mussey, M. D., Ohio. 
Eliza Frame, ID years ; by dog, on finger. Ec- June 1 

lectio Repertory, vol. ix. 
W. T. Hazlam, 22 years ; by dog, on leg. N. Y. Feb. 4 

Med. and Phys. Journ., 1828. 
Miss Bassett, 12 ; by dog, on lip. By J. W. April 10 

Green, M.i)., New York. 
J. B., laborer, about 30 years; by dog. By J. March 

W. Green, M. D., New York. 

. Z., 54 years; by dog, on hand. By W. L. May 

Atlee, M. D., Penn. 
Robert Ferguson, 28 years; by dog, on finger. March 15 

By Dr. James P. White, Buffalo Med. Joum., 

voL i. 
Joseph Bell, 35 years ; by dog, on thumb. By Oct. 5 

Dr. Manley, Richfield, Spa. 



April 29 May 2 



July 
June 



3d day 
2d day 



March 15 Well 



Nov. 23 
6 weeks 
Jnly27 
Nov. 6 
Jan. 16 
Dec. 10 
June 
Sept. 3 
July 4 
Dec. 13 
March 29 

Dec. 10 

June 10 
May 5 

Nov. 17 
6 weeks 
Feb. 
June 28 
Nov. 4 
July? 
July 
Aug. 30 
April 21 



Nor. 29 
2d day 
July 28 
Not. 6 
Jan. 19 
Dec. 11 
Jane 
Sept*4 
WeU 
Dec. 17 
March 31 

Dec. 12 

Jnne 12 
Mays 
April 8 

WeU 

3d day 

4th day 

Julyl 

Nov. 4 

July 11 

2d day 

Sept. 3 

April 24 



June 16 Well 



HYDROPHOBIA. 



/ 

257 



Table shoxDing the month of Inoculation and Commencement of Sickness ; 
also the period of Licubation, and day of Death, 





Jan. 


Feb. 


Mar. 1 AprU. 


May. June. July. 


Aug. 


Sept. 


Oct. 


Nov. 


Dec. 


Total. 


Bitten 




11 


10 


13 




6 


12 


8 


8 


5 


12 


6 


8 


2 


101 


Sickened 


_ 


6 


5 


13 




6 


4 


9 


10 


5 


7 


6 


12 


5 


86 


Case. 


Sick. 


Died. 


'Case. 


Sick. 


Died. 1 1 Case, j Sick. 


Died. 


, Case. 


Sick.! Died. 


1 


42 


6th daj 1 27 


60 


2d day 


53 






79 


60 ! 3d day 


2 


20 


4th " 


1 28 


68 


3d " ' 


54 






80 


90 2d " 


3 


98 


4th " 


1 29 




1 


55 


10 


3d day 


81 


9 Well 


4 


30 


4th « 


30 






56 


27 


2d " 


82 


46 6th " 


5 


32 


2d " 


31 


34 


2d " , 


57 


35 


Ist " 


83 


42 2d " 


6 ' 


30 


2d « 


32 






58 


53 


4th " 


84 


48 2d « 


7 


57 


4th " 


33 




1 


59 


128 


10th " 


85 


101 1 2d « 


8 


35 


2d « 


34 


71 


4th " 1 


60 


101 


5th « 


86 


144 1 3d « 


9 


31 


2d " 


35 


44 


4th " 


61 


34 


4th " 


87 


42 


4th " 


10 


12 


4th " 


36 


90 


3d « ' 


62 


79 


6th " 


88 


30 




11 


91 


4th " 


37 


154 


10th " 1 


63 


64 


Ist « 


89 


42 


2d « 


12 


365 


2d " 


38 


26 


3d " ! 


64 


63 


Ist " 


90 


21 




13 


360 


3d « 


39 


36 


4th « 


65 


90 


7th " 


91 


30 


4th «* 


14 


41 


4th " 


40 


120 


5th " 


66 


45 


7th « 


92 


365 


2d « 


15 


41 


4th " 


41 


24 


Well 1 


67 






93 


30 


2d « 


16 


42 


Ist " 


42 


65 


4th day 


68 






94 


30 


2d " 


17 


14 


Well 


43 


60 


4th " 


69 






95 


60 


2d « 


18 






44 


50 


4th « 


70 






96 


60 


4th " 


19 


32 


5th daj 


45 


14 


j 


71 






97 


9 


WeU 


20 


89 


21st " 


46 






72 


19 


Well 


98 


45 


3d day 


21 


62 


4th " 


47 


60 


4th « 


73 


51 


5th day 


99 


210 


4th " 


22 


49 


3d « i 


48 


73 


2d « 


74 


35 


3d " 


100 


27 


4th " 


23 


13 


5th " 


49 


15 


3d « ' 


75 


90 


Well 


101 


274 


1st " 


24 


90 


2d « 


50 






76 


120 


4th day 


102 


90 1 5th " 


26 


69 


4th « 


51 






77 


22 


Well 


103 


120 1 2d " 


26 






52 






78 


29 


4th day 


104 
105 


90 4th " 
36 3d " 












1 








106 


249 Well 



Recapitulation of the inoculations for the four seasons of the 
year, as derived, 1st, from the returns in the Beport itself; 2d, from 
those in the United States Mortality Censxis; 3d, from Tardieu's 
Report for France ; and 4th, from RadcUff^s Report for England^ 
making together 246 cases, in which the month of inoculation was 
ascertained. 





Eoport 


U. 8. eensas. 


France. 


BngUnd. 


Total. 


Spring— March, April, May 
Snmmer — June, July, Augnst 
Autumn— Sept., Oct., Nor. 
Winter— Dec, Jan., Feb. 


31 
21 
27 
23 


7 
7 
3 
9 


10 

16 

4 

10 


30 
15 
14 
23 


78 
59 
48 
65 


102 


26 


40 


82 


250 



258 



BSFORT ON 



The average period of incabatioii in tlie 89 cases in whicli it was 
ascertained was about 70 days, a much longer period than is 
usually given. 



In 23 cases it was 30 days and under. 
« 11 « 40 " " 

"8 •' 60 ** " 

" 6 " 70 « " 



In 3 oases it was 80 days and under. 
"8 « 90 " •* 

" 2 " 100 " •* 

" 8 " 200 ** " 



" 6 



upwards of 200 days. 



The average duration of the disease in the 72 £Eital cases in the 
human subject was three days. 

5 died on the 1st day, 20 on the 2d, 12 on the 3d, 27 on the 4:th, 
6 on, the 6th, 8 on the 6th, 2 on the 7tli, 2 on the 10th, and 1 on 
the 21st. 

In 89 cases out of 100, the injury was from the bite of the dog. 
In 9, from that of a cat, and in 1 each from a raccoon and a fox. 
One supposed from the saliva of a cow, and one from that of a calf. 

In 40 instances the injury was upon the hand, in 15 on the fiEiee, 
in 11 on the leg, and in 9 on the arm. 

The Committee, in conclusion, would offer the following resolu- 
tion: — 

Resolvedy That the Secretary transmit to the Governor of each 
State a copy of the statistical part of this report, with the respectful 
request that he would bring the subject before the Legislature of 
the State over which he presides, that in their wisdom they may 
devise and adopt a plan by which the evil may be mitigated if not 
removed. 

All which is respectfully submitted. 

THOMAS W. BLATCHFORD, 
A. D. SPOOB, 

ChramUtee, 



HYDBOPHOBIA. 269 



CASES. 



Case 1. Sydrophobia from iJie bite of a Saccoon, Reported by 
Oeorge Bvssel^ M. J3., Lincoln^ Mass. 

On the 16th of October, 1822, a boy 11 years of age was attacked 
by a raccoon in the open field, and without any provocation. The 
animal was immediately killed by two men, whom the cries of the 
boy summoned to his assistance. The thumb, and skin, and 
muscles between the thumb and forefinger of the left hand of the 
lad were much lacerated. The wound was dressed by some one 
of the family, and was nearly healed on the 42d day after it had 
been received, when the lad was attacked with wandering pains ex- 
tending from his hand to his shoulder, neck, and head, and some- 
times to his back. These pains were considered by his friends as 
rheumatic. The next day, he complained of universal distress, 
a sense of sufibcation, and inability to swallow liquids. Domestic 
remedies were employed, and Dr. Bussel did not see the patient till 
the fourth day of the disease. He had then had no sleep for three 
nights. Pulse, 100; universal irritability of the system, with a 
sense of suffocation and stricture of the throat and chest — a con- 
tinued spitting of a thick, frothy, tenacious saliva — an inability 
to swallow liquids; an unusual wildness of the eyes, and ferocity 
of countenance ; bowels had not been open for three days ; intellect 
at times deranged, and he manifested a disposition to strike, but 
not to bite, persons who attended upon him; thirst very great, 
particularly for water, yet, when it was presented him, he was unable 
to drink, the mere sight of the water producing immediate convul- 
sions. Opium was administered in large quantities, but without 
any effect, the symptoms above described becoming more and more 
aggravated during the day, attended with great prostration of 
strength; vomiting of a thick, bloody matter; a quick, feeble, and 
intermitting pulse; coldness of the extremities; tongue very red, 
but perfectly clear; conjunctivas red; countenance cadaverous; con- 
vulsions almost continued. Death at 1 A. M. of the fifth day. No 
autopsy. 

Case 2. JReporied by W. K (hale, M. i?., Boston, Mass. 
John Fleming, a hearty full fed boy of seven years, born in Eng- 
land, but living in this country for four years, while on his way to 



260 REPORT ON 

school one day, threw a stone at a dog which was lying under a 
wagon, and it flew out and bit him slightly on the knuckle of the 
little finger of the left hand, and returned to lie down again. The 
wound was dressed very simply, and in a few days was entirely 
healed. Three weeks after this, on Saturday, Oct. 7th, 1848, the 
boy was reported as having been " out of sorts" for two or three 
days; he had also refused to drink water for twenty-four hours. 
At this time, the throat appeared somewhat swollen, and an active 
cathartic was prescribed. The next day, he was sitting up ; ap- 
pearance stupid, skin cool, pulse 80. Tongue a little furred. Medi- 
cine had acted slightly. Had rested but little, sleep being much 
disturbed. Some pain at epigastrium, also some headache at times. 
On being requested to wash his mouth out, he took a tablespoonful 
of water in his hands, held it about six inches from his mouth, and 
then suddenly threw it against his teeth with great violence, and 
swallowed it with a convulsive choking, falling back on the pillow 
and slightly screaming. Pediluvia and aperients were prescribed, 
and the patient left. The next day, though his sleq> had been 
much disturbed, he seemed much better, and swallowed with ease, 
was walking about the room. Tuesday, Oct. 10th, symptoms much 
more unfavorable; pulse 100, involuntary shivering; lies on back 
with head thrown back; attempts to swallow water, accompanied 
with violent spasms, principally opisthotonic ; answered questions 
naturally, but talked wildly when not spoken to; is picking the bed- 
clothes, &c. ; bowels had not been moved ; an active cathartic was 
ordered, and a blister to nape of neck. At 2 P. M., he vomited three 
or four times ; at 4 P. M., extremities cold ; pulse not to be counted. 
Countenance expressed great prostration ; spasms very frequent and 
easily excited; mind always wandering, though recalled for a mo- 
ment ; chloroform was administered, but its inhalation appeared to 
cause so much depression that its use was discontinued; two invo- 
luntary dejections; brandy and chloroform were administered every 
half hour internally, causing spasms, but not as much horror of 
the fluid. The spasms commenced with a general shiver, and then 
affected the muscles of the back and extensors. They were not 
very violent, but consisted simply in stretching the head, neck, and 
arm out, and stiflFening of the trunk ; they occurred about once in 
ten minutes; this state continued till 9^ P. M., when patient had 
become much weaker; convulsions not so violent; pupils wi3ely 
dilated ; some vomiting of frothy matter ; face at times bedewed 



HYDBOPHOBIA. 261 

with sweat; spasms slight but easily excited, as by £EuiniDg bim, 
&c. Death took place at 2 A. M., Oct. 11th. 

At the autopsy, all the organs of abdomen. and chest were found 
healthy ; right auricle of heart enormously distended with blood ; 
brain healthy; much venous congestion about spinal cord, but 
nothing else observed. 

Case 8. Reported by Br. Ourtis, Lowell, Mass. 

W. H. B., a stout healthy young man of 18 years, was bitten, July 
29th, 1848, by a strange dog, which immediately made his escape 
and has not been heard of since. The wound was near the right 
wrist, was simply dressed and readily healed. On Saturday, Nov. 
4th, 1848, he complained of pain in this arm, which was supposed 
to be rheumatic ; this continued without any other symptom till 
Tuesday at 4 P. M., when he said that water tasted badly, and at 
4J he was unable to swallow it. 

At 7 J P. M., countenance anxious ; cicatrix of wound somewhat 
elevated and reddish, not tender; no inflammation of skin about it; 
some pain in arm at times ; stomach nauseated. On being requested 
to drink, he took the tumbler in his hand and brought it to within 
half an inch of his mouth, when his head was thrown back spasmodi- 
cally and his hand forwards. On attempting it again, with much 
effort he got about a teaspoonful into his mouth, which, as soon as 
it reached his throat, was attended with the most violent convulsive 
catchings of his breath, with a sort of sobbing sound. Some milk 
he was able to swallow with much less difficulty, and he could also 
swallow bread. Currents of air produced no effect on him at this 
time. He was put under the influence *of chloroform. The next 
morning every unpleasant symptom had increased. Convulsions 
were more frequent and violent, but mind rational in intervals; 
complained of no pain but of a sense of suffocation ; great suffering 
from thirst; occasionally he would discharge from his mouth a 
viscid and very tenacious saliva, attended with convulsions of the 
utmost vehemence. The sight of water, or hearing the name of any 
liquid mentioned, was terrible to him. The sound of fluids in a 
neighboring apartment, a current of air, or the breath of his atten- 
dants agitating the atmosphere near his exposed surface, would 
produce a like effect. 

At llj A. M., he was placed under the influence of chloroform, 
from which he gradually reoovered and the convulsions commenced 
again. At 4^, ansosthesia was again produced and kept up with a 



262 BEPOET ON 

short interval till 5f P. M^ when he had sunk so low as to be per- 
fectly quiet. At 6 o'clock the sputa had increased in quantity and 
become less slimy, and far more frothy. The patient lay quiet, with 
stertorous breathing, countenance flushed, labored action of the 
heart, extremities cool, with symptoms of cerebral congestion. The 
discharge at the mouth also greatly increased and became bloody. 

Death occurred at 7f P. M., Nov. 8th, without a struggle. 

Autopsy^ 18 hours after death. Surface of body dark and mottled; 
extremities nearly black; depending surfaces also very dark; 
emphysema about the neck, over the thorax, and partly down the 
upper extremities. Blood, fluid everywhere ; no coagula. Spinal 
cord considerably injected and emphysematous beneath its arachnoid 
investment. Brain highly injected throughout, and bubbles of air 
were distinctly seen in its veins. Brain was of normal consistency, 
ventricles containing their usual amount of fluid. Cut surfaces of 
cerebral mass exhibited numerous red points. The trachea and 
bronchia were highly inflamed, and their mucous linings presented 
a purple colored or violet aspect. Epiglottis very large. 

Case 8. Exported by Dr. P. MouUon, New Rochelle^ N. Y. 

A son of William Craft, deceased, about eight years old, of 
nervous temperament, and residing in New Eochelle, was bitten 
slightly on the nose by a strange dog on the 18th day of February, 
1842. He was taken ill on the 25th day of March, five weeks after 
the inoculation, and died on the 27th, forty-eight hours after the 
attack. 

He was visited about two hours after he was bitten, and the bites, 
which were very superficial, were touched with nit. argenti. He 
afterwards took sulphur and Scutellaria lateriflora for some time, 
as a prophylactic, as recommended by a Mr. Lewis, formerly of this 
county. These articles were taken daily up to the period of attack, 
with the exception of a week or more, when the Scutellaria could 
not be procured. 

When I first saw him, after the attack, he had vascular excite- 
ment and great restlessness, which I believed might be caused by 
worms in the alimentary canal. I gave spigelia and senna, which 
moved his bowels, but gave no relief. 

In the evening of the same day, I invited Doctors E. W. Voris 
and Philip Davenport to attend him with me, as he showed decided 
symptoms of hydrophobia. It was supposed, by one of these gen- 
tlemen, that the symptoms arose from spinal disease, and he sug- 



HYDBOPHOBIA. 263 

gested the actual cautery along the spine. I went into his room 
alone, and desired him to try to drink some water out of a glass 
tumbler, for I knew he drank readily out of a cup, where he did 
not see the water, remarking to him that he might avoid a painM 
operation by drinking without agitation, or showing signs of dread 
on taking the water. He at once consented to drink, and raised 
himself up in bed to do so; but when he saw the tumbler of water 
brought near him, he exclaimed "01 not now!" and with great 
agitation and hurry removed to the far side of the bed, against the 
wall. 

He was directed to take a pill of camphor, assafcetida, and lupulin, 
or lactucarium, every two hours, if he continued restless. 

He took the first piU at 9 o'clock P. M., and rested quietly until 
near 11. When the second pill was given, he seemed wild, and, 
for a few minutes, quite frantic; and in this manner he spent the 
night, having long intervals of quiet rest between his paroxysms. 

Finding but little change in his condition in the morning, we 
agreed to try the effect of cold affusion, as practised by Dr. Amell, 
who published a case in the New York Medical and Physical Journal^ 
No. 9, 1824, page 48. 

We also agreed to give strychnia gr. -^^ every two hours, unless 
it produced some bad effect. 

Cold water was poured over him whenever he became much 
excited, with the effect of calming him, and arresting the fits of 
jactitation. No perceptible effect was produced by the strychnia; 
no spasmodic action, nor any other effect usually produced by it, 
resulted from its use. I was called away, and left him in charge of 
Dr. Voris, about 2 o'clock P. M., and did not see him again during 
the day, as a second urgent case called me into a neighboring town ; 
but I rode past the house where he was, about 7 o'clock, and, on 
inquiry, was informed that he was much better, and that he had just 
then taken a glass of water into his hand, of which he drank freely, 
ic. When I returned, in the night, I found him dead. A foam of 
very thin glistening bubbles was issuing from his mouth. He had 
been dead six hours. 

While I was with him, I noticed signs of nervous excitement 
most of the time, which was heightened into terror, at times, by the 
sight of water. At other times he would take a pitcher of water 
into his hands, put his hand into the water, and pour water from 
his hand on his head; but it seemed to be done at the expense of 
painful effort, and he would push the pitcher from him, with signs 



264 BSPOKT OK 

of dread, immediately afterwards. At one time he was : 

oa seeing a light spot on the wall, produced by solar rays admitted 

through a crevice in the window shutter, and said: "What fire is 

that?" 

Dr. Voris stated to me, at our next interview, that he gave the 
strychnia regularly up to the hour of his death, which took place a 
few minutes after I passed the house, about 7 o'clock ; that he had 
one of his paroxysms about that time, and he had him raised up to 
receive the cold affusion, when he appeared faint. He was laid 
down, and a little water was poured on him to remove the faintness, 
but without having the desired effect, and he died without a strug- 
gle, as if from syncope. 

It is remarkable that strychnia, in this case, did not produce 
marked effects. Spasm was not more manifest after than before it 
was given. We felt justified in giving so large a quantity to this 
child by the consideration — 1st. That the disease was not curable 
by any means known to us. 2d. That strychnia is a powerful 
agent, which had not, to our knowledge, been tried in hydrophobia. 
Query — was this hydrophobia rabiosa? I think it waa. 

Case 9. Reported by Dr. Isdoc OasseJberry^ of Evansville, Indiwia. 

Mr. S., aged thirty-five, of sanguine temperament, medium stature, 
was bitten on the evening of Dec. 16th, 1849, by a dog which at 
that time was not thought to be rabid. It was fighting the dog of 
Mr. S. at the time he was bitten. The wound was slight and 
healed readily, leaving a small hardened cicatrix. 

About thirty days afterwards, Mr. S. felt indisposed; but he 
attributed his indisposition to fatigue and exposure. 

During the night, he became much worse, and sent into the city 
for his physician. The physician visited him early next morning, 
and found him laboriug under the ordinary symptoms of hydro- 
phobia. During the day he was visited by several physicians of 
the city. His malady rapidly increased ; each paroxysm was more 
protracted in duration, and they were of more frequent occur- 
rence ; early the next morning he died. 

About one month, therefore, elapsed from the time he was bitten 
until he manifested indications of b^ing rabid, and he lived about 
thirty hours afl«r the first seizure. 

Mr. S. eiyoyed good health previously. The treatment employed 
was empirical. 



HTDBOPHOBIA. 265 

Cask 10. Repcrted by Dr. Isaac Casaelberry^ of Evansville^ Indiana. 

Master S^ aged 9, of nervous temperament, was bitten by a rabid 
dog about the first of January, 1860. He manifested indications of 
hydrophobia in twelve days. The symptoms, or rather the disease 
gradually progressed. His phyi^ician ordered him grain doses of 
opium, with half grain doses of calomel every three hours. This 
treatment was continued with but little change for four days, at 
the end of which time the little patient died. The calomel did not 
produce the ordinary constitutional effects of that potent agent, nor 
did it produce any constitutional impression. 

The same dog did not bite both persons. But the dog which 
bit Mr. S. also bit a young man in the same neighborhood, the next 
day afler he bit Mr. S. The young man was badly bitten on the 
leg, and the wound bled profusely. He has never manifested any 
indications of the affection. 

The city of Evansville is situated on the north bank of the Ohio, 
in latitude 88°. 

Mr. S. resided one mile north of an alluvial district, in which the 
intermittent form of fever prevails every autumn. He had suffered 
from this form of fever slightly during the autumn. The lad 
residBd in the city. What are called malarious diseases are not 
more prevalent in this city than in others on the Ohio, in the same 
latitude. 

Cask 11. Reportedly Washington L. Atlee^ M.D.^ Philadelphia^ Pa. 

On Saturday, the 9th Feb., 1889, 1 was called upon to visit Mrs. 
Elizabeth Keely. I found my patient to be an intelligent-looking 
woman, of spare habits, of ordinary stature, and about 34 years 
old. She told me that she had an attaick of rheumatism in her 
arm, and conq)Iained of pain the whole extent of her left arm, 
particularly in the shoulder. She informed m6 that she had felt 
tmweU for three or four weeks befbre, and that on Wednesday 
previous she had perceived some soreness on the back of the hand, 
which, continuing to increase, had travelled up to her elbow on 
Thnrsday, and, becoming more And more severe, had on Friday 
reached the shoulder. During the progress of the pain, having 
received a phial of British oil from a Neighbor, she rubbed it on 
her arm without receiving any reKe£ She then, of her own accord, 
applied a blister on the outside of her arm just below the shoulder, 
with no better success. On Saturday, the pain becoming worse, 
and advancing into the left side of the neck, and through the arm- 
VOL. IX,— 18 



266 REPORT OK 

pit into the left breast, she thought it advisable to oonsolt a physi- 
cian, and I was sent for. 

I found the symptoms as above described, with the pain more 
acute in the joints than in any other part of the arm, taking on the 
character of the local symptoms of acute rheumatism. Her coun- 
tenance was somewhat anxious, and her manner a little hurried. 
The tongue was lightly coated with a yellowish fur ; the pulse, 
skin, and other perceptible functions being natural I prescribed 
a blister to be placed on the spine between the shoulders, and 
four cathartic pills, composed of submur. hydrar., aloe socotor^ 
Gonvol. jalap., stalagm. cambog., sapo. castil., to be taken im- 
mediately. Upon taking leave of her, I directed her to send me 
word in the morning if she was not better, or sooner if she becaoae 
worse. 

On Sunday morning, the 10th inst., word came that she was no 
bet(ter. At 9| o'clock A. M., I visited her, and was informed by 
her husband that she had passed a bad night. Shortly after she 
bad retired to bed, she was aroused by a sense of suffocation, and 
tightness of the chest, with pain in the prsecordia, or at the lower 
part of the breast-bone. After this she could not sleep. Every 
few minutes throughout the night she would suddenly start up 
with a wild and anxious countenance, a sensation of smothering, 
and with feelings of great distress. On attempting to drink, she 
discovered that she could not swallow, and that every attempt 
excited spasms in her throat, and aggravated these distressful symp- 
toms. Her peculiar situation alarmed Mr. Keely very much, and 
he was on the point of starting for me several times in the night, bat, 
through fear of causing too much trouble, he did not inform me 
until morning. At the time I was there, she had become rather 
more calm and easy, though I observed occasionally a slight spas- 
modic action of her throat, and some hurry of speech. She picked 
up a bottle of spirits of camphor off the- stove and smelt it, and 
immediately she was seized with slight spasms of the chest and 
neck. On repeating it, the same results followed, when she gave the 
bottle to her little daughter, telling her to take it away. There was 
a wildness and an impatience depicted in her countenance during 
these spells totally different from anything I had ever observed in 
other spasmodic affections. Even after these spasms were oS, she 
had an expression of anxiety, and complained of great pain and 
soreness of the prsecordia, and weight on her breast, with an inability 
to swallow anything. The most distressing symptom was the pain 



HYDROPHOBIA. 267 

in the preeeordia. The blister had drawn well, but, instead of being 
placed over the spine, it had been applied midway between the 
shoulder and spine; and the pills had operated freely. Her tongue 
was still coated with a yellowish fur, and her pulse &ee from excite- 
ment. The pain in the arm was entirely gone, excepting a little 
uneasiness she experienced in the shoulder. 

It was during this visit that I was first informed that she had 
been bitten by a mad dog. She then resided in Philadelphia, and 
while walking along the street a dog rushed out and bit her in the 
back of the left arm, causing an extensive lacerated wound extend- 
ing down to the sinews. After going home she returned to the 
place where she received the injury to ascertain the condition of 
the dog, and discovered that he had been chained up for mad, and 
had just broken loose as she was passing by, and bit her and several 
others, and that he had afterwards been killed. She immediately 
consulted Dr. Pennypacker, of Philadelphia, who ordered her to 
soak the wound in salt water, and afterwards to apply to it a salt 
poultice. This was on Saturday the 8d of November last. On 
Monday following she called on Dr. George McClellan, who was not 
at home. On her way home she called at the house of a friend, who 
advised her to employ Stoy's cure. They informed her that about 
eighteen years before two of their children had been bitten by a 
mad dog, and the attack of hydrophobia was prevented by taking 
Stoy's medicine. They procured the medicine. for her, and she went 
through a full and regular course of it, commencing on that day. 
The medicine had the effect of producing copious vomiting on the 
two first days that she took it, but not afterwards. Shortly after 
adopting these precautionary measures, the family removed to 
Lancaster ; since their removal to this place, she enjoyed good health 
until about three or four weeks ago, from which time, until the 
period of her attack, she said she " was not very well" The wound 
had healed up well, but the scar always remained tender and livid, 
and she frequently felt a numbness in her arm accompanied by a 
sensation best understood by the term " asleep.'' 

After giving me this history of herself, she said she did not 
believe her present sickness proceeded from the bite of the dog. 
Knowing the powerful influence that the mind exerts upon disease 
of this character, I encouraged her in this idea, and was careful, in 
directing my inquiries to her, to avoid exciting in her any suspicion 
that I believed it. Although apprehensive of the nature of her 
disease, and strongly desirous of employing certain means of con- 



268 REPOBT OK 

firming mj opinion, I cautiously ayoided everything that would 
lead her mind to a different result. I think, however, that, although 
6he openly discarded the idea that her illness proceeded from the 
bite of the dog, her manner disclosed that she secretly believed that 
to be the cause. I prescribed a combination of submur. hydrar, 
pulver. ipecac, aa grs. v., to be taken every two hours. 

Upon my way home I met my brother, Dr. John L. Atlee, and 
told him my fears respecting my patient, requesting him to hold 
himself in readiness to visit her in company with me, in case I was 
more fully convinced of the character of the disease upon my next 
visit. 

At one o'clock P. M. of the same day, I visited her again. She 
received me tranquilly, and expressed herself glad to see me. Her 
symptoms were now more distressing than they were before. She 
had a more wild and anxious look ; her breathing was accompanied 
with a short convulsive sobbing inspiration ; and the spasms of the 
chest and throat were more violent, and came on spontaneously 
every few minutes. There was no febrile excitement Her tongue^ 
pulse, and skin continued the same. I examined the wound par- 
ticularly. It still retained its livid appearance, but it was entirely 
free from tenderness. She had taken one dose only of the medicine^ 
and that with the greatest pain and difficulty, and accompanied 
with violent spasm. She said it almost choked her when she 
attempted to swallow it. A short time after she had taken this 
powder, sickness of the stomach came on, and she vomited three or 
four successive times, egecting a quantity of slime. During the 
last act of vomiting from this powder, she threw off a considerable 
portion of blood. In consequence of the distress and diflSculty 
produced by taking this first powder, she had desisted from the 
attempt of taking any more, although she said she felt relieved 
after she had vomited. Her attention was now directed to her 
power of swallowing. She said she could not swallow. In reply 
to my several queries, she observed that she could not expl^n the 
reason of her difficulty to swallow; her throat was not sore; ^ 
could not say that she had any dread of fluids; she was willing and 
desirous of taking them ; yet, whenever she attempted it, she was 
seized with an intense sense of smothering and spasm of the throat 
which she could not control. Upon expressing my desire that she 
should overcome this spasmodic action of the throat by a strong 
effort of her mind, she replied, " Well, Doctor, I will tiy." She 
then took a cup containing a little toast-water off the stove, and, 



HYDROPHOBIA. 269 

clearing out her throat, she prepared herself for drinking. I now 
watched her with the moat intense anxiety. She carried the cup 
half way up to her mouth, then stopped. Her countenance at this 
time was most peculiar and indescribable. Her features were set, 
fixed. It appeared as if the energies of her mind were concentrat* 
ing themselves for some dreadful effort. She carried the cup near 
to her mouth, then stopped again. I could observe, on her fixed 
and determined countenance, a commingling of much excitement 
and alarip. / could there read the tmconqverabk dread of a fluid. 
She put the cup to her lips — and at once the horrors of hydropho- 
bia burst upon me. I shudder even now at the recital — but it 
qannot be described — ^it must be seen. The cup had no sooner 
touched her lips than she was thrown into violent spasms. First, a 
sadden, quick, convulsive inspiration^ accompanied by a noise as if 
the air was drawn forcibly through a very narrow chink, violent 
contraction of the muscles of the neck and face, and drawing up of 
the shoulders and breast, and great retraction of the pit of the 
stomach and abdomen. The skin of the throat in front of the 
larynx was corrugated by spasm. Her countenance expressed the 
greatest anxiety and distress, and her body was thrown forward by 
the spasmodic action. This dreadful agony lasted about half a 
minute. As soon as it was over, she said : " Doctor, I will try it 
again." Precisely the same scene followed. Again she tried it, 
and succeeded in getting about a teaspoonful in her mouth. Now 
making two or three efforts at deglutition without avail, with one 
desperate effort she swallowed it. 

It must be at once perceived that my patient was a woman of 
extraordinary resolution and firmness, and knowing this, I urged 
her to take her powders regularly in spite of the difficulty. She 
said, " Doctor, I suffer very much from the attempt ; but I will take 
them." Her husband remarked to me that he believed her illness 
proceeded from the bite of the dog. She replied, " No ; it's rheuma- 
tism ; 111 soon be better of the spasms." Although she seemed 
unwilling to permit her mind to believe it, yet I think she was 
perfectly conscious of the truth of her husband's opinion. 

After ordering a continuance of the medicine already prescribed, 
and the, application of a large blister along the course of the spine, 
commencing at the nape of the neck, I left her. 

At 8^ o'clock P. M., I visited her in consultation with my brother, 
Dr. John L. Atlee. The introduction of my brother produced no 
unusual agitation. She appeared glad to see us, and was quite 



270 BBPORT ON" 

observant of the common courtesies of life, getting up and ofiEering 
us chairs, and requesting us to be seated. She had taken another 
powder, but with great difficulty. This was succeeded by vomit- 
ing a large quantity of yellowish-green slime, and some blood, 
which entirely relieved her of the pain in the prsecordia. Since 
the vomiting had ceased, there had been no recurrence of the 
spasms, unless she attempted to drink, and then they were less 
violent. She expressed herself much better, and perfectly free Erom 
pain. The stricture and weight on her chest diminished, and there 
was less anxiety of the countenance. No febrile excitement — pulse 
in an upright position was 84 ; in a recumbent posture, 72 in the 
minute. The fauces or throat was free from irritation, except a 
narrow stripe of red on the edge of the right palatine aixjh, which 
appeared more like mere engorgement of the capillary vessels than 
inflammation. She had no soreness or pain in the throat. There 
was some tenderness, particularly during spasm, in both sides of 
the neck immediately below the mastoid process. There was no 
tonic rigidity of the muscles of the neck as occurs in tetanus or 
lock-jaw, and even during the paroxysms of spasm, the tension was 
confined to the respiratory muscles. We offered her different kinds 
of drink, all of which were followed by spasms, less violent, how- 
ever, than before. Cold drink caused stronger spasms than warm 
did. In consequence of the blister having been applied much 
lower down than had been ordered, and with a view, also, of ex- 
tending the decorticated surfaces for the purpose of introducing 
medicines into the system by means of the endermic practice, we 
ordered another blister over the back of the neck. Applied 1 gr.of 
acetate of morphia sprinkled on simple cerate to the blister on the 
shoulder blade. After administering another powder, which she 
swallowed with less difficulty, we left her. 

At 6 o'clock P. M. information was received that she was no 
worse. 

At 8J o'clock P. M. we saw her again. The change for the 
better was quite evident on our first entering the room. Both she 
and her husband expressed their gratification at her manifest im- 
provement. She had had no spontaneous spasms since our last 
visit, excepting one, and that came on while lying down. I would 
observe here that there was always a much stronger tendency to 
spasms when in a recumbent posture. Her spirits were much im- 
proved, and her countenance less anxious. The spasms caused by 
drinking were much lighter. There was no pain in the prsecordiaf 



HTDKOPHOBIA. 271 

and the skin was soft and moist, and pulse 96. The powder we had 
administered at oar last visit produced vomiting of the same kind 
of fluid without blood. She had taken another dose of it, about 
an hour before, which had not been followed by vomiting. She 
said she felt drowsy, and thought she could sleep. On handing her 
a piece of toast and requesting her to eat, she took a small bite, 
chewed it and swallowed it with tolerable ease, and repeated it two 
or three times. Observing that it was rather dry, we offered her a 
drink, but as soon as she placed it to her mouth, the spasms super- 
vened, though less violent than before. Toast soaked in water could 
also be eaten in small bits without spasms. She tried to drink 
repeatedly, and suoeeeded in getting a little down, and it was always 
attended with spasm. Noticing that the spasm commenced just at 
the moment she attempted to draw in the drink into her moutb, we 
suggested to her another plan : to open her mo>ith wide, permit us 
to lay a teaspoon filled with water full in her mouth, then close her 
Ups and refrain from sucking it out of the spoon. Having done 
this, and then emptying the spoon by inverting it, it was followed 
by a much lighter spasm than when drank from a cup. In drink- 
ing with a quill also, her spasms were weaker. It appeared as if 
the wetting of the lips and the effort of sucking in the fluid favored 
the production of the spasm. Ordered the blister to be dressed 
with basilicon ointment, and prescribed Submur. hydrar. grs. z; 
Pulv. ipecac, grs. iiss. 

On Monday, February 11th, 8 o'clock A. M., I visited her alone. 
She informed me that she had altogether during the night about 
one hour's unsound sleep, and more in the early part of the evening 
than afterwards. She was not able to drink all night, she could 
not swallow, and thinks her spasms, on attempting to drink, were 
stronger and of longer continuance. She endeavored to get down 
some drink by soaking it up with toast, but she could not. During 
the night, two spasms came on spontaneously while lying down. 
She said she was very bad early this morning ; she experienced 
feelings of intense distress, and was thrown into spasms whenever 
the door was opened and admitted the cold air ; felt her spirits give 
way, and her thirst was extreme. At this time she felt the spasms 
working in her, every four or five minutes, although they did not 
break out, producing great agony. She continued in this 'way 
until she made several desperate efforts to drink some warm co£fee, 
which she succeeded in forcing into her by means of a quill, to the 
amount of nearly half a pint. This was the largest quantity of 



272 REPOBT OK 

fluid she had taken since the spasms commenced, and it had quite 
a tranquillizing effect upon her, causing the great anxiety and 
distress to diminish. After this she washed her face with a cam- 
phor rag, and while doing it was affected with spasm. Ahhough 
she expressed herself much better than she had been earlier in the 
morning, I noticed more anxiety and wildness in her countenance 
than the evening before. Her pulse was not quite so full, the skin 
rather below the natural temperature, the tongue more thickly 
coated with the same kind of fur, the breathing seemed rather more 
difficult, and was interrupted by peculiar sobs and deep sigha 
While I was there, she picked up a cold handkerchief to wipe her 
mouth, and it brought on spasm as soon as it touched her fiace. 
She had taken two powders after we had left her last night, which 
produced vomiting of a yellowish, bitter and frothy fluid, and aome 
blood ; but she postponed taking any more after 12 o'clock in the 
night, in cpnsequence of the great difficulty she experienced in 
swallowing ^hena, and the sickne^ they produced, although she 
admitted that she was always relieved after vomiting. The blisters 
had drawn well ; the cuticle being raised throughout their whole 
extent I gave her another powder rubbed up i^ sugar, which, 
with the aid of coffee and the quill, she succeeded in getting down, 
not, however, without considerable difficulty. 

At 11 o'clock A. M. visited her with my brother. Her skin was 
of the natural temperature and moisture, pulse fuller, tongue the 
same, and countenance less anxious. She had had no spontaneous 
spasms since ; they still came on, however, on every attempt to 
drink. She complained that the heat of the stove sickened her, 
but she could not bear th^ doors open. On attempting to drink 
some coffee with a quill, she was thrown iAto a yiolent spasm, and 
succeeded in swallowing only a little. The poi^er which I had 
given her at my last visit caused her to throw off the 9ame kind of 
fluid, and a living lumbricus. We examined the blister that had 
been dressed yesterday by the Tnorphia, and thp morphia appeared 
to be absorbed. The fresh blister^ surfiice on the neck was now 
dressed with acetate of morphia, and, upon applying the cerate cold 
to the blister, it produced a paroxysm. Her bowels not having 
been moved since Saturday, we prescribed, in the form pf pill, 
Oleum tiglii, gtt. ij, every hour until the desired effect would be 
produced. 

At 3 o'clock P. M. visited her in company with Dr. E. Parry. 
Her symptoms were about the same ; pulsq 88. She had taken 



HYDROPHOBIA. 273 

only two doses of the oil, and without effect. Gave her another 
dose, which she swallowed with difficulty. When taking some tea 
after it, she was thrown into severe spasms, and said she did not like 
to see drink cofffie near her. Uniformly in taking drink she would 
hesitate, as before described, several times before she would place 
the cup to her lips, and as soon as she attempted to suck in the 
fluid, the spasms would commence. She had got into a doze about 
an hour before, and was awakened by her son suddenly entering 
the room, which produced a violent paroxysm. Applied morphia 
again to a blistered surface. 

At 6 o'clock P. M., received word that she was no better, and 
that the medicine had not operated. 

At 8 o'clock P. M., called again, with my brother and Mr. Lan- 
dis, a student Her pulse was 90 ; skin and countenance the same. 
The lower gums and the sides of the tongue appeared excited, 
resembling the mercurial blush, but it was not attended with the 
coppery taste and mercurial odor. She had had several very severe 
qpasms from cool air coming over her face, and also from her attempts 
to drink. She got a most violent spasm when the family were at 
supper, caused by the noise of pouring out tea. This spasm raised 
her off her seat, and was accompanied with a peculiar spasmodic 
noise, great horror of countenance, i^d a throwing of the hands 
about. We nqw spread SO grs. of submur. hydrar. on a small piece 
of bread, part of which she ate without difficulty, complaining of it 
being very dry. We offered her drink, but she did not appear 
to want the cup ; she took the quill out of the drink, and hastily 
drew the wetted end through her mouth, thus catching a drop. 
This was followed by light spasm. We then advised her to dip 
the bread in tea to moisten it, but she did not seem inclined to do 
it. Observing her dread of the fluid, I dipped it in for her, when 
she ate it. She said she had dozed a little, and she thought she 
could doze more through the night. She had taken since the last 
visit two doses more of the oleum tiglii, making in all 10 gtt., 
without any effect. Prescribed submur. hydrarg. grs. xv, pulv. 
ipecac, grs. iij, to be taken every three hours during the night. 

On Tuesday, February 12th, at one o'clock A. M., I was called 
up by a messenger, telling me that Mrs. Keely was much worse, 
and that I should hurry over. When I arrived there, Mr. Eeely 
informed me that, while he was lying dozing on a chair, she alarmed 
him very much by suddenly starting up, and flying across the room, 
with wildness and impatience, towards the front door. lie asked 



274 REPORT ON 

her what was the matter, and she replied she wished to lock the 
door, and then as suddenly rushed towards the back door. Mr. 
Keely said that, for a considerable time before this came on her, she 
had been engaged in prayer, and in hearing the Bible read, accord- 
ing to her request, and that she expressed herself sensible of her 
situation, and was anxious to prepare herself for the final resolt 
Before my arrival, and immediately after that spell, she had seyeral 
spasms more violent than at any time before. She had taken one 
of the powders with great difiEiculty, and in attempting to take an- 
other, it brought on very severe paroxysms, accompanied withejectio 
nrinffl. When th6 spasms became so violent, she requested her 
husband to tie her, no doubt fearing that in those moments of 
intense agony she might injure some one. When I arrived, hex 
children were in the room with her. She said that before she got 
so bad she had felt extremely happy, and had her children called 
up aronnd her, that she " felt as if she could go," and spoke a long 
time to her children and husband, as one taking an everlasting 
farewell. She told me she felt so much composed when her mind 
was engaged in such reflections, and desired that the Bible might 
be read again. I asked her whether I should read it for her, and 
she assenting, I inquired what portion of the Scripture she preferred. 
She replied: "The 52d chapter of Isaiah." I read that chapter 
slowly and distinctly for her, and when done, inquired if I should 
read on. She said : " I am afraid of tiring you ; but I would like to 
hear more." I then continued, and read eight or nine of the suc- 
ceeding chapters, asking her, at the end of every chapter, whether I 
should read on. I then observed that perhaps there were other 
portions of Scripture she would like to have read. She replied: 
" You are too kind ; but if you are not tired, I should like you to 
read of the sufferings and death of our Saviour." I then turned 
over to Matthew and read for her. During all this time, she remained 
perfectly composed and tranquil, although her spasms had been so 
violent before. Shortly after this, my brother arrived. Upon ask- 
ing her to let us see her tongue, she became greatly agitated ; her 
countenance became wild and suspicious; and with appearance of 
great dread, she said " she could not bear the candle." She was 
sitting with her back turned towards the candle, but she observed 
my brother reaching for it, and j although the candle was not touched, 
instantly she was thrown into the most violent paroxysm I had yet 
seen. Her head was thrown about from side to side in dreadful 
anguish, and fearing that she might injure those who were holding 



HYDROPHOBIA. 275 

her, I placed my hand upon her head to secure her, but her agony 
was very much increased, and she earnestly called out : " Take off 
year hand I take off your hand I" My brother remained until 8 
o'clock, at which time we gave her pulv. ipecac, grs. xx, acetate of 
morphia, gr. ss. 

She hesitated for a long time before she took it, saying, "I can 
take no more," and while preparing to give it to her, she appeared 
violently agitated, and was seized with incessant spasmodic sobbings. 
She at last consented to try it, but would not have it moistened; it 
was mixed up with dry sugar, and she took it, and succeeded in 
swallowing it with great difficulty, but without much spasm. I re- 
mained with her until 4 o'clock, and during this time she had seve- 
ral very severe paroxysms. They sometimes would come on spon- 
taneously ; others would be excited by walking through the room, 
and agitating the air. Her dread of fluids was so great that no 
drink was offered to her. During these paroxysms, which lasted 
from half to a whole minute, the inspirations and expirations were 
quick and spasmodic, producing a singular sound by the concussion 
of the sudden ingress and egress of air, which, to a warm and pre- 
possessed imagination, might seem to be a kind of barking. This 
no doubt has given rise to the vulgar idea that a barking like that 
of a dog is one of the symptoms of hydrophobia. The spasm gene- 
rally commenced with a sudden, forcible, and spasmodic spitting^ very 
quickly repeated, resembhng very much the spitting of an irritated 
cat, and ended with a deep inspiration or sigh. She frequently had 
very sudden convulsive sobbing inspirations, sometimes only one, 
at others two or three in rapid succession, and both in these and in 
the spasms, her countenance would get much more wild and 
anxious. Her skin was moist, pulse rather quicker, and she com- 
plained more of the heat of the room. Prescribed a powder like 
the last, to be given every two hours. 

Before I took my leave of her this morning, she seemed desirous 
of knowing my opinion of the result of her case. I told her that 
her disease was one of a very fetal character, but that we were not 
entirely without hope; that, in consequence of the manifest amend- 
ment that had occurred in her symptoms, we had good cause for 
encouragement; and that, if her constitution was good and the treat- 
ment persevered in, the disease might probably wear itself out, and 
the system afterwards be restored to health. She replied, she hoped 
that it might be so, but she expected a different result. I informed 
her that it was impossible for us to tell, at the present stage of her 



276 REPORT ON 

case, how her disease would terminate, yet, as there was great unoer- 
taintj, it would be better for her to prepare for the worst, and then, 
in any event, she wo^ld be safe. She assented to what I said, and 
observed that she was not fully prepared to leave this world, and 
felt desirous of conversing with some person concerning the salva- 
tion of her soul ; she said that, if her mind w|is fully prepared, she 
was sure that in her moments of ease between the spasma, she 
would feel resigned, and consoled with the idea that when she left 
this world of pain she would be happy in the other. Upon asking 
her whether she would like to receive the visits of a clergyman, she 
replied, "Ohl yea, I would be much pleased; but I am a stranger, 
and know no clergyman." I assured her that lyould make no differ- 
ence; that either of them would call to see her with pleasure ; and 
as she said that she belonged to the Presbyterian Church in Pliila- 
delphia, I would request the Rev. Mr. Pavie to see Jier. 

During this conversation, she was quito cialm and collected, and 
free from spasms. 

Before going horne^ I left two more powders like the last^ to be 
taken two hours apart. 

At 8 o'clock A. M., Mr. Keely called and stated that the powder 
we had given her at 8 o'clock sickened her very much and pro- 
duced some drowsiness, but no sleep. The other powders she found 
it impossible to take. 

At 9^ o'clock A. M., visited her again with my brother and 
Messrs. Landis and Maxwell, medical studenta. She had taken one 
powder this morning in her husband's absence. She was pretty 
much in the same situation as when we last left her, though she said 
she was worse, and the spasms stronger. The spasms appeared as 
if they were becoming more general, and they were now always 
accompanied with that peculiar noise. There was yet no tonic or 
tetanic rigidity of the muscles. The action of the heart was rather 
strong, and stronger than was indicated by th^ pulse at the wrist 
Prescribed a blister to the prsecordia. 

At 11 o'clock A. M., I called upon the Bev. Mr. Savie and re- 
quested him to accompany me to see Mrs. Keely. At the time we 
entered her room, the spasms were very strong, and she was sufEbr* 
ing much agony when X introduced Mr. Davie to her. Her 
paroxysms were now more violent and frequent than before, accom- 
panied with intense anxipty and horror of countenance, spasmodic 
noise, and an urgent desire for air, calling on those in the room to 
open the doors. During the spasms she requested those who held 



HTBBOPHOBIA. 277 

her to press strongly on the pit of the stomach. She complained 
of thirsty and desired to have something with which she could moist- 
en her mouth. She asked for coffee, bat, as it apjproached her, she 
was seized lirith strong spasms; by repe^ated efforts, however, she 
drew in a little through a quill, and succeeded in swalloTV-ing it 
Her respiration was frequently interrupted with convulsive sobs, 
and she was often hawking up, and spitting out, as if phlegm was 
always collecting in her throat She found it very difiBicult to speak, 
not appearing to have full control over the organs of speech ; it ap- 
peared as if the attempt at speaking produced a spasmodic restless- 
ness of the articulating muscles, which rendered it painful for her 
to speak. Becoming a little more composed, she apologised to Mr. 
Davie for not being khle to converse with him, but said she Was 
glad to see him. He was engaged with her in conversation and 
prayer about half an hour, which had a most tranquillizing effect 
upon her. During the whole of this period she was renlarkably 
calnt, and free from spasm, although her paroxysms before and im- 
mediately after were frequent and of the most violent character. 
It would appear, from this circumstance, as if the exercise of the 
mind in this disease had some mysterious connection with the pro- 
duction of spasm ; for, as the paroxysms were entirely suspended 
while the mind was engaged in this all-absorbing question, and as 
they recurred so soon as the mind was not thus exercised, it wotdd 
indicate almost as close a relation as cause and effect. The 
members of the profession will at once observe the correspondence 
between this circumstance in this case, and a distinguishing feature 
of chorea, viz : the act of volition being necessary to the convulsiVe 
movements. 

In consequence of the frequent occurrence of spasm, the blister 
was not applied to the prsecordia. She, this morning, again 
requested to be tied ; but as we found that she could be managed 
with safety, we considered it unnecessary and forbade it. Before 
leaving her, I applied more morphia to the blistered surface. 

At 2 o'clock P. M., called to see her again, with my brother. 
Her paroxysms had been frequent and strong since our last visit. 
She inquired of us whether bleeding would not weaken her, as if 
she desired it to shorten her existence. She said her "feelings were 
awfril ; no one knew, and wished it was over." She lamented about 
her children and husband — "that was her only trouble," and 
desired us to comfort Mr. Keely. We attempted to give her another 
powder, composed of sabmur. hydr., grs. xxx, pulv. ipecac, grs. v, 



278 BSPORT OK 

spread on bread. She ate about half of it, and after having chewied 
it for a considerable time, she attempted to swallow it, but could 
not, saying it was so dry that she could not get it to the right plaoe 
to swallow it Persevering, however, with very strong efforts, she 
succeeded in getting some down, and it was followed by a most 
violent paroxysm, raising her up on her feet, and producing, in the 
violence of the struggle, the most wild and despairing expression of 
countenance. During mastication, the tongue was frequently and 
suddenly protruded, appearing covered with a darker coat; and 
her lips became encrusted with a dark-colored matter. There iras 
incessant hawking up of the phlegm which collected in her throat, 
and spitting of it about the room. She complained of great dryness 
of the mouth, but would not moisten it; and strongly opposed the 
administration of more medicines, seeming to dread them. Talking 
was more and more difficult, and was interrupted by spasms of the 
throat, and convulsive sobbings. Pulse 100. Prescribed oleum 
cajeputi, drachms ij, pulv. opii, drachm i, to be mixed and rabbed 
in around the neck and breast. 

At 6 o^clock P. M., visited with Dr. Hopkins and Mr. Landis. 
Found her in a state of very great nervous excitement, her manner 
wild and hurried; would startle at the least noise or motion; had 
great dread of candlelight, and the snuffing of the candle produced 
great agitation ; incessant hawking, and vehement efforts to spit out 
the frothy phlegm ; and her &ce was turned away from those who 
sat in front of her, as if she dreaded the brilliancy of their eyes, (x 
the effect of their breath on her face, which produced spasm. When 
the spasms came on her, she would call furiously for air — ^for the 
doors to be open. Delirium appeared to be approaching. She said 
that Mr. Davie had been there in the afternoon, and she had been 
much comforted, and that she now was " willing and ready to go." 
In consequence of the vapor of the oleum cajeputi excitiDg spasm, 
it was discontinued. 

At 8 o'clock P. M., saw her again, with my brother, Drs. Hop- 
kins and Kerfoot, and Messrs. Landis and Maxwell. We entered 
the room with great caution and the utmost quietness, and although 
her back was turned towards the door, and a large quilt, hung npi 
intervened, she was instantly sensible of the increased number in 
the room, ^d was greatly agitated in consequence of it. The nerf- 
ous excitement and restlessness were extreme, her countenance was 
marked with great horror and dread, and whenever she was the 
least startled, it was characterized by unutterable anguish and terror. 



HTDBOPHOBIA. 279 

There was considerable delirium; the mind was wandering and 
imsteady, ideas incoherent, and she was much more talkative. She 
referred several times to the mad dog — " Yes, it was the dog ;" " I 
know it was the mad dog." And she would say : "Come, Mr. Keely, 
let's take a walk — let's go to the door — let's go down stairs, Mr. 
Keely — let's go to bed — let's go home," and so on in a wild and 
impatient strain. We talked to her about bleeding her, and, with- 
out replying to us, she said wildly : " Shall I, Mr. Keely ? You 
think I should, Mr. Keely ?" She appeared to think that we were 
going to injure her. There was a constant hawking and spitting, 
and her face was turned down, and away from us. She said she 
could not look any person in the face. While in this highly excited 
state, she said to her husband : " Mr. Keely, I want you to look me 
right in the face." Her face being turned downwards, and from 
him, he hesitated. Again she said: "Look me in the face, Mr. 
Keely." He leaned over to look her in the face, and, as soon as 
their eyes met, there was a simultaneous and frightful expression of 
horror — the wild anguish and terror in her countenance seemed to 
startle Mr. Keely, and he turned his head aside with strong marks 
of horror depicted upon his. All in the room appeared to feel the 
shock. We now succeeded in administering two grains of muriate of 
morphia, and also applied it over the blistered surface on the neck. 
Observing, heretofore, the tranquillizing effect which always followed 
the taking of drink, we urged her to try and swallow some coffee. 
She made repeated efforts, with persevering firmness, until she 
accomplished her object, which was followed by a considerable 
amendment of her symptoms. She drank more and more until she 
got down altogether about half a teacupful. In proportion as she 
took her drink, her wild, nervous, and delirious state subsided. 
She could now bear the full glare of the candle, and motion through 
the room produced much less disturbance. The hawking dimi- 
nished, and there appeared to be an improvement in all her symptoms. 
Expecting that the large dose of morphia she had taken might pro- 
duce a desire for sleep, we made a bed for her on the floor, and, 
after seating her on it, she appeared more composed and rational. 
After this, we offered her more drink. She took the cup, leaned 
over it, carrying her mouth towards the opposite side, and suddenly, 
to our great surprise, lapped up a mouthful with her tongue. This 
was followed by very little spasm. Her pulse was 115. After 
remaining with her until 10 o'clock P. M., and prescribing two grs. 



280 BSPORT OS 

of muriate of morphia, every three hours, we left her in a mad 
more composed state of mind and body thaa we found her. 

During our visit this evening, we proposed to her the operation 
of tracheotomy, but this was peremptorily refused by het husband. 
So far back in my professional life as I can i^ecollect of being able 
to form any opinion of this most horrible disease, I have always 
thought that this operation would be of invaluable benefit, and I 
had come to the determination of carrying it into effect the fiist 
opportunity that offered. This opinion is now firmly established by 
all the phenomena of this unfortunate case. Although the proba- 
bility is that the rapidity of the muscidar exhaustion, which super- 
vened upon this visit, would have rendered the operation in this 
instance and at this stage of the disease, useless, yet I am fully con- 
vinced that, if resorted to early in tbe attack, it would strip hydro- 
phobia of its greatest horrors, if it did not cure it. I would demand 
it upon myself, if I should be thus afflicted. The spasms of the glottis^ 
the constriction of the chest, the difficulty of deglutition, the sense 
of suffocation, and the intense anxiety and distress, would, in my 
opinion, vanish, and the administration of medicines and the taking 
of drink would be rendered comparatively easy. The operation is 
a simple one, and worthy of a trial. The horrid and incurable 
character of hydrophobia demands the experiment 

On Wednesday morning the 13th inst, at 7 o'clock A. M^ I 
visited her alone. I was informed that she had about one hours 
repose shortly after we left her last night, but the phlegm collecting 
in her throat had awakened her, and she continued awake during 
the remainder of the night. She took another two grain dose of 
morphia about 11 o'clock P. M., and remained tolerably composed 
until between 2 and 8 o'clock this morning. At 8 o'dock AM. 
she took another powder of morphia, but this did not tranquillize 
her, and she continued to get worse until I saw her. During the 
night she had swallowed three or four cups of coffee. I found her 
exceedingly nervous, and nearly constantly in a state of wild de- 
lirium, and there was added to the whole look an appearance of 
horror and despair exceeding anything I had seen either in mania 
or any other kind of delirium. She looked wildly and suspiciously 
at every one entering her apartment, and believed that those around 
her wished to poison her, and kill her, and spoke about the opera- 
tion. She was very talkative, her thoughts run wild, passing from 
one subject to another, sometimes serious and at other times sportire 
and humorous. She spoke also a great deal about her children, 



HYDROPHOBIA. 281 

and had a strcmg suspioion that "all was not right with them." She 
would wildly cry out, "Where's my children?" "Why don't 
Manassehcome?" "Where's Jackson?" " Where's Louisa?" "Bring 
them to me." "Ah! Keely! I knew it! I knew it!" "See, there 
hangs Louisa's apron." " Where's Jackson's shoes? all's not right 
with them." "Ah! Keely, I knew it!" Again she would break 
out: " Bring me my children, Keely! and if they kill me, let them 
be killed too, for I will not leave them here to be knocked about 
by strangers." She wanted to go home — to go down stairs — to 
dress and take a walk — and accused them of throwing handfuls 
of fur and black stuff in her face, and said that the fur was sticking 
in her mouth yet. She got up several times on her feet, but would 
sink down again from weakness and exhaustion. Once she sud- 
denly started up and rushed through the kitchen door, but was 
immediately caught, and she sank down from the exertion. She 
succeeded in swallowing a little cofifee, but was exceedingly sus- 
picious of everything offered to her, and would examine it over 
and over again, before taking it. She complained of the air being 
loaded with fur, and of it coming into her face. The hawking was 
still frequent, and she spit out a great deal of the frothy mucus. 
Her pulse was small, weak, and frequent, between 130 and 140 in 
a minute, and her extremities cold. I observed that her bed had 
beea much stained by the renal secretions during the night. Be- 
fore leaving her I administered another two grain dose of muriate 
of morphia, which after a short time was spit out again imbedded 
in the froth. 

At 9| o'clock A. M., called with my brother and Messrs. Landis 
and Maxwell. We met the Eev. Mr. Davie there. He informed 
us that he had not been able to fix her attention. Her mind was 
exceedingly wandering and delirious, and very much as it had been 
at my last visit. She was rapidly sinking, her hands and feet and 
£ace were cold, pulse scarcely perceptible, and the action of the 
heart very feeble. There were no paroxysms of suffocation, some 
spasmodic twitching, and copious expectoration of froth. We now 
gave her, at repeated intervals, about three ounces of wine, which 
had no stimulating effect There now appeared to be a general relax- 
ation of the muscular system, extending to the coats of the intes- 
tines — shifting of wind, and borborygmus, followed by copious and 
frequent alvine discharges — the first that had occurred since the 
spasms had connnenced. Her children were now brought in to 
see her. She looked at them awhile and said, "Take them away; 
VOL. IX— 19 



282 REPORT OK 

take them awaj.^^ About 11^ o^dock A. M^ she liad the last 
symptoms of a spasm, which, though not violent, harassed her a 
good deal. She now drank a little more wine, and then I Isud her 
down upon the pillow, after which she never moved. From thiB 
period on to the moment of her death, the phenomena of her case 
were singularly peculiar. Her body having been placed in an 
inclined position, her head was thrown back with her face directly 
upwards. Her mouth and eyes were open. There was not the 
least motion or disturbance of her countenance, no more action in 
her bowels, her pulse was lost, and there was not a muscle or a 
fibre seen to move, excepting those of respiration. The whole 
body and countenance seemed as passive as in death, and respira- 
tion was more like a mechanical than a vital action. She appeared 
as dead, and was only disturbed by the ingress and egress of air 
through the larynx. The depth of the inspirations became less and 
less, until at last they were lost in the larynx. The breathing was dear; 
there was no rattle in the throat indicating the collection of mucas 
>n the air-vessels. This peculiar kind of respiration continued 
without interruption for about one hour, accompanied, at eveiy 
expiration, with a very low moaning sound. The breathing now 
stoppedl^ and all thought her dead ; but in a few moments it com- 
menced .again, and went on as before. Again it stopped, and again 
commencec^ and so on for 27 successive times, continuing until 1 
o'clock p. M-, when we looked for its return, but in vain. The 
moment of 'dissolution was not indicated by any of the usual 
evidences of the separation of soul and body. She appeared to 
experience nothing of the agonies of death. Before, at the time o^ 
and after deaftb, her appearance was precisely the same, and, at ^ 
intervals of suspended respiration, life could not be distinguished. 

Throughout the whole course of the disease, after the spasmodic 
symptoms commeneedL, this unfortunate woman could not bear, 
except for a moment, a recumbent position. She sat on a chair the 
most of the time, and after the paroxysms became violent, was 
secured by a person sitting in front of her having hold of her 
wrists. There was not the least appearance of danger of her biting 
any person near her ; nor among the variety of motions which she 
made was there any whach looked like attempting to snap or bite at 
anything within her reach ; and they who were about her had no 
apprehension of her doing so. 

I have now concluded this most interesting case, and I have 
£pne perhaps more minutely into its details than was required. 



HYDBOPHOBIA. 288 

But as you desired a particular account of the case, I was anxious 
to give you a faithful history of it from beginning to end. This I 
was fully enabled to do, in consequence of taking notes of the case 
immediately after every visit. I am not conscious of having made 
one misstatement, either as respects her symptoms or treatment, 
or as regards the history of her own case as given to us by herself. 
All as it came to my knowledge, and in a conscious spirit of 
candor, is now before the public and profession, and if the latter 
can discover anything in the treatment or recommendations that 
can be avoided or adopted to the benefit of the community I shall 
rejoice in the discovery. It is most ardently desired that the pro- 
fession will be soon able to say to their suffering patients, in the 
language of the 52d chapter of Isaiah, "Loose thyself from the bonds 
of thy neckj captive daughter of Zion." 

^ Cask 16. Beported by Dr. Traill Oreen, JSaston, Pa. 

But one case of hydrophobia has occurred in this vicinity in the 
human species. Dr. E. Slough, of South Easton, who has furnished 
the information, attended the patient, a girl aged 6 years. 

Period of inoculation, March 12, 1848 ; attack April 23. 

Six weeks elapsed between the inoculation and attack. On the 
22d of April there was much fever. Hydrophobic symptoms ap- 
peared towards morning on the 23d, and death occurred towards 
evening on the same day. 

It was supposed. Dr. Slough informs me, that the termination of 
the case was hastened by the use of chloroform by inhalation. 

Case 17. Reported by Dr. Samuel Mart, Brooklyn^ %. I. 

The minutes of this case have been mislaid ; but I find data which 
I regard as rendering it nearly conclusive that the case occurred 
in June, 1831. 

My first visit to Mrs. S., about fifty years old, was late in the 
afternoon, and she presented the following appearances : she was 
sitting in a chair, her mind clear, rather composed, but her counte- 
nance expressive of great anxiety; she complained of alternate 
chills and heats, though slight, and the pulse was small and feeble, 
and but slightly accelerated ; upon the inner side of the right fore- 
finger, near its extremity, she exhibited a scratch, which that morn- 
ing had become painful, the pain extending up the arm; and the 
throat was somewhat affected, but deglutition not materially inter- 
rupted. The scratch upon the finger had nearly healed, but that 



281 BSPOBT ON 

day had opened again, and was much inflamed. It had not been 
troublesome, and she had not been interrupted in consequence of it 
from her usual domestic employments. 

Upon investigating the cause of this (to me unusual) devdofp- 
ment, I was startled by the following statement : A &vorite dog 
was drooping and seemed sick for two or three days, with a con- 
stant flow of saliva from his mouth, accompanied with great distress, 
and an utter inability to swallow either liquids or solids, notwith- 
standing he made frequent violent and apparently spasmodic efforts 
to do so. Fearing the animal would perish for want of food, be 
was confined, his mouth held open, and Mrs. S. (her hand being 
small) thrust a quantity of food into the oesophagus, which passed 
into the stomach; in withdrawing her hand, she received the 
scratch above mentioned from one of his teeth. In a little time, I 
think the same day, the dog disappeared, and was never seen by the 
family afterwards. 

No suspicions were entertained that the dog was rabid, and Mrs. 
S. had not experienced any solicitude in consequence of this, to her 
mind, very trifling and inconsiderable wound. 

As nearly as I can now ascertain, it was the fourteenth day after 
the above events occurred that I was first called. 

With these antecedents, and the symptoms before me, I could not 
doubt I had to contend with a most formidable and alarming dis- 
ease. Experience had uniformly demonstrated the complete un- 
certainty of remedial agents in hydrophobia, and I approached the 
treatment vrith anxious forebodings. BecoUecting a case in my 
father's hands arrested by mercury, and one successfully treated 
with the same remedy by the late Dr. Willoughly, I was led to 
adopt it in this case. The submoriate combined with opium was 
administered in as large quantities, and as frequently repeated as 
the system would retain, and saturnine- poultices with laudanum 
were applied to the wounded finger, but afforded no relict In 
forty-eight hours the specific effects of the calomel began to mani- 
fest themselves upon the glands, and the pain and all the unpleasant 
symptoms were mitigated. The ptyalism continued some ten days, 
when my patient became convalescent, and perfectly recovered. 

Case 18. Reported by Dr. Samuel Sart^ Brooklyn^ L. L 
I met with a rabid dog, in the town of Oswego, which had 
bitten several animals ; all of then^ I believe, died rabid. 
In 1847 or 1848, 1 had several interviews with the late Dr. Drake 



HTDEOPHOBIA. 285 

of Cincinnati, and at one of them, lie inquired whether hydrophobia 
was frequent among us ? I related the case of Mrs. S. He regarded 
it unequivocally a decided case of the above disease* 

Cask 19. Beporied by Thos^ Turner, U. i?., Brooklyn, K Y. 

Cornelius Wurges, a. German, »t. 22, was admitted to the hos- 
pital Saturday evening, December 17, 1855. He had been bitten 
by a dog at the extremity of the thumb of the left hand on the 12th 
cS November last According to his statement, the teeth of the 
aoimal had not broken the skin, but had Caused some blood, which 
he pressed out, to collect under the nail ; the dog was tied up for 
two days and then let go, and it is not known whether he had 
labies or not The patient was taken ill on the Tuesday previous 
to admission with chills and vomiting. Dr. Andrews, of East New 
York, was sent for. At first he supposed it to be a case of com- 
mencing remittent fever, but discovered that the man could not 
drink or eat, and when he attempted to do so, he was seized with 
spasms. At first he denied having been bitten, but at last admitted 
it when questioned closely. I first saw him on Saturday afternoon 
in company with Drs. Ingraham and Andrews; he was walking 
about the room supported on each side by an assistant; his limbs 
tottered under him, and appeared weak. He was quite talkative, 
&oe slightly flushed, tongue coated, pulse 120 and weak. Under 
the nail on which he had been bitten was a blue mark, such as is 
left after a bruise, and the whole thumb was hot and a little 
swollen. He complained of pain on the bend of the arm at the 
elbow and in the lateral region of the thorax on both sides. He 
made several attempts to drink some milk, but gave it up as im- 
possible. When brought to the hospital, he expressed himself as 
feeling better, and drank a spoonful of tea, but no sooner had it 
touched the pharynx than he sprang up from the bed and gasped 
for breath. He explained the difficulty by saying that his tongue 
had swelled, but nothing more than a greater amount of redness 
about the fauces could be observed on looking into his mouth. 
He complained of the pain when pressure was made on the larjmx, 
or on the side of the neck on a level with the angle of the lower 
jaw. The back was blistered by applying for 12 minutes two strips 
of muslin 18 inches long by 2 J inches wide, spread with vesicating 
ammoniacal ointment, leaving about one inch of the median line 
clear, and extending from the nape of the neck downwards. 

The vesicated surface was dressed with an ointment containing 



286 RBPORT OK 

gr. j morpb. sulph. He waa quiet until 9 o'clock, when he became 
very violent, requiring three strong men to hold him. He appeared 
auspicious and afraid the nurses intended to harm him, cried out 
that they were going to murder him, and shouted, at the top of 
his voice, "Watch! mad dog I mad dogP' While struggling widi 
his keepers, he seized one of them by the arm with his teeth, making 
an abrasion of the cuticle, and they stated that through the night 
he made several attempts to bite them. It was found necessary to 
tie his feet together, and confine him to the bed by passing a sheet 
over his chest and fastened to the bedstead on each side. He con- 
tinued in an excited state throughout the night, and up to 7 o'clodc 
in the morning. On Sunday morning he was quiet but much 
weaker, evidently failing rapidly. His pulse varied from 180 to 
150. The conjunctivae were injected, and the eyes had a glassy ex- 
pression. His face and body were covered with a profuse perspira- 
tion, and the feet were cold. He said the fingers of the left hand 
felt stifi^, and the hands looked blue as they do in some cases where 
the circulation is obstructed. He complained of pain at the epi- 
gastrium. When raised in bed, he spat out some tough white 
mucus. He was so sensitive to currents of air on his face, that the 
breath of those standing several feet from him brought on spasms, 
and he cursed them for throwing things at him. No other part of 
the surface was very sensitive when touched or blown upon. Some 
beer was brought to him at his request, and he tried to drink it, 
but was unable to get it to his lips. There seemed to be some 
regularity in the occurrence of the spasms, coming on every half 
minute. Chloroform by inhalation was tried with the idea that 
it would allay the spasmodic action ; but he died about 12 M. before 
it could be determined whether the administration of it would have 
been beneficial or not. At the post-mortem all the organs appeared 
healthy with the exception of the spinal cord, the papillae at the 
base of the tongue, and congestion about the fauces and epiglottis. 
From examination of the part bitten after death, it appeared most 
probable that the dog's tooth or teeth had passed under the naiL 

Cask 21. Reported by Dr. Geo. K Burwell, Buffalo, K Y, 
Mrs. Willard was bitten by a cat. She was seized with hydro- 
phobia about seven weeks afterwards, and ^ied. One symptom 
was very prominent during the last day's illness, viz: an un- 
controllable disposition to loud, rapid, and incessant talking; she 
would stop for nothing ; not to listen to any of us ; she was a very 



HYDROPHOBIA. 287 

pioQs woman, and, although glad to see her minister, she would not 
or could not stop this talldng for a moment, even while he was 
praying by her bedside. On being asked why she did so, she said 
she should choke to death instantly if she stopped it. It appeared 
to me that it was necessary to secure free expiration; she had no 
difficulty in making the inspirations, but she evidently felt that 
there would be no expiration without the articulation. 

Case 22. Heported by Dr. Qeo. K Bunvell, Buffalo^ N. Y. 

On July 4th, 1854, 1 went to Hamburg, ten miles out, to visit 
Mr. Gould, a farmer 69 years of age, laboring under hydrophobia, 
having already had it two days. He had been bitten on the arm 
by a strange dog. May 16, previous. What became of the dog no 
one ever knew; it was a stranger in the neighborhood; he was 
already having frequent spasms when I saw him. Despairing of 
all the ordinary remedies, I tried that of opening the trachea as 
recommended by Dr. Marshall Hall, but without benefiting the 
patient. In this case the first sign of a returning paroxysm was a 
hissing sound through the wound, during the expiration of the 
paHerU, suggesting the idea of a spasmodic closure of the rima 
glottidis. 

It was only while reflecting on the case, after I had left the 
patient, that I first drew the inference, from the fistcts mentioned in 
the two cases, that a paroxysm in hydrophobia afiTected, hindered, 
or impeded the expiratory act of respiration rather than the in- 
spiratory. 

Not having seen any cases since, I have not been able to verify 
or disprove this observation, and do not therefore yet claim it as a 
true one. I thought I would state it to you, begging you to inform 
me if it be an old observation (I have not been able to find any 
such statement in any of the treatises on the subject I have been 
able to examine), and if new, whether there is anything in the cases 
you have collected which would go either to refute or confirm it. 

Case 23. Reported by F. H. Peckham^ Providence^ B. I. 

Joseph MaUette, residing in Mallette St., Providence, B. I., was 
bitten Feb. 19th, 1853, by his own dog. The dog was not sup- 
posed to be rabid at the time of biting him, nor is there positive 
proof that he was afterwards, though circumstances go strongly to 
show that he was. The dog was a small house dog, a mixture of 
the cur and poodle. 



288 BKPORT OK 

At the time of biting his master, he was suffering from wonnds 
which he had received from fighting with other dogs, the day pre- 
vioas. As he was naturally cross and snappish, his master did 
not think it strange that he should bite him, as he was bathing his 
wounds, and might have hurt him. The dog had been severely 
bitten two or three weeks previous, but had nearly recovered &om 
those wounds. The day previous to biting his master and to being 
himself bitten, Mrs. Mallette noticed that while this dog was playing 
with the cat, as he was wont to do, and always seemed very fond of 
her, and was never known before to bite her, that he suddenly 
became enraged, and bit her quite severely. 

They had two other cats which were bitten by this dog ; all of 
which were killed after Mallette^s death. It was much to be regretted 
that the lives of the cats had not been spared, to see if hydro- 
phobia would have been developed. The dog disappeared the day 
after biting his master, and was not seen till some days after his 
death, when he was found dead under one of the neighbor's out- 
sheds, where he had probably lain for some time. Mallette was a 
Frenchman by birth, of a bilious sanguine temperament, aged 47 
years. He was strong and athletic, with remarkable muscular 
development. He had always been accustomed to the most active 
and laborious life, and had almost uninterrupted good health up to 
the time he was bitten. The bite was a very slight one, it was on 
the inside of the upper lip, about midway; the mucous membrane 
was only grazed off, so that there was but a slight oozing of blood. 
Mallette was unable to determine whether this was done by his 
own tooth or the dog's; as the dog's nose struck his lip when he 
snapped at him. The injury was so slight that nothing was thought 
of it at the time. In about eight or ten days after this, he felt a 
slight soreness and stiffness of the upper lip. This in a short time 
passed away, and he was well till March the 4th, when he com* 
plained of what he termed a "severe cold." He did not leave off 
his occupation (a truckman) till the 5th« On the 6th, his " cold" 
was so bad as to confine him to the house. 

He had at this time headache, pain in his back, and chills. In 
the aft;ernoon of this day, the 6th, he had paroxysms of sneezing, 
with profuse discharge from the eyes and nose. The sneezing was 
so violent as to create some anxiety, and lasted throughout the 
night. His wife administered a dose of castor oil, put his feet 
into warm water, and afterwards applied mustard poultices. The 



HYDROPHOBIA. 289 

sneezing stopped in tbe morning, bat he would now unconsciously 
draw a long sigh, and sob like a person suffering firom deep grief. 

On the 7th, after the sneezing had subsided, and the catarrhal 
Bjinptoms had disappeared, the sobbing and sighing continued at 
intervals from thirty minutes to an hour. 

In addition to these, he began to complain of a fulness of the 
stomach, with a sensation, every now and then, as though all the 
internal viscera were rising up. 

This feeling of rising, or "lifting up," as he termed it, was very 
annoying and distaressing to him. On this day (the 7th), at 9 o'clock 
A. M., he first experienced a difficulty in swallowing. At first he did 
not think much of it, and was not in the least suspicious of the 
terrible malady he was about to be afflicted with. His wife says 
Aat, when she saw he had the difficulty or inability to swallow, 
the thought came over her that it might possibly be hydrophobia, 
though she did not at that time mention it to him. About 11 
o'clock, he made another attempt to drink, but found he could not. 
There was, at this time, in addition to the difficulty of deglutition, 
a sort of spasmodic or convulsive action pervading the whole 
system, whenever there was an attempt to carry liquids to the 
mouth. The arm was particularly affected, and, as it were, thrown 
away from the mouth by some uncontrollable power, whenever an 
attempt was made to carry it there with drinks. 

This created some alarm, and they thought they would call their 
ftmily physician. Dr. Gteo. Gapron, who was my partner. 

His wife, now being more apprehensive than ever that the disease 
would prove to be what she had feared, inquired of him, previous 
to Dr. Capron's arrival, if he thought the bite of his dog had any* 
thing to do with his sickness. He replied no, as he saw the dog 
drink water after biting him. And she says she distinctly remem* 
bers seeing the dog drink after biting him. She said they were 
both of the opinion that a rabid dog could not drink water, and 
both, having seen the dog drink after biting him, were greatly con- 
soled, and their fears quieted by this belief. Dr. Capron visited 
him between 12 and 1 o'clock of the 7th, and received the foregoing 
history of his case. The Dr. said he found him calm, without fever, 
fl'ee firom pain, and with a pulse about natural. He greeted the Dr. 
oordially, and laughingly remarked there was nothing the matter 
with him, except he could not drink. The doctor spoke encourag- 
ingly, and said he would see him try. A tumbler of water being 
brought, he made the most determined and deliberative efforts 



290 RKPOBT OK 

to drink, but was unable to do so, owing to the spasms affecting his 
arm so that he could not bring the tumbler to his mouth. At this 
time there was no discharge or increase of saliva. 

The doctor spoke hopefully to him, and prescribed a warm pedi- 
luyium, with mustard poultices, as warm as he could bear them, to 
be applied to his feet and stomach ; the last with a view to relieve 
the sensation of " rising up,'^ which distressed him very much, and 
seemed to increase. He also prescribed a teaspoonful of the pul- 
verized skullcap (Scutellaria lateriflora), to be taken in molasses. 
(This herb at one time enjoyed considerable reputation as a medi- 
cine in hydrophobia. From extensive use in our practice, we have 
found it a very useful nervine and tonic.) 

At 7| P. M., Dr. Capron and myself visited him again. Dr. G. 
had related the case to me, and his strong conviction that it would 
prove to be a genuine case of hydrophobia. On our arrival, we 
found the doctor's directions had been faithfully carried into effeck 
The skullcap he had swallowed in. molasses, but it was with the 
greatest difficulty. The foot-bath at first excited him very much, 
but in a little while it wore of^ and he seemed more quiet under its 
influence. 

He had not been able to swallow any water, though he had 
repeatedly made the attempt His physical condition was much 
the same as when Dr. G. first saw him. He was free firom 
thirst, which, he pleasantly remarked, was very fortunate for hinL 
There was no mental excitement perceptible; neither was there of 
the pulse ; no unusual heat of the skin or drowsiness, though he 
had not slept since the night of the 4th. We had him try to 
swallow some water, with a view to test his ability, and to observe 
the effect that would be manifested. He made the most resolute 
and determined effort, but it was all to no purpose. No sooner had 
he taken the water into his hand than he began to tremble, and the 
whole nervous system seemed agitated with a slight convulsive 
action throughout the muscular system. 

During this time he was mentally calm and appeared perfectly 
rational. I do not think I ever saw one more calm and self-possessed. 
There was nothing evinced that showed he was mentally nervous 
or fidgety. As the water was brought to him in a glass, I did not 
know but the sight of it might have some influence, and I suggested 
his trying to swallow some water from a spoon put in his mouth 
by another individual. To this he readily assented. I took a 
spoonful of water, and put it to his mouth. It produced consider- 



^ HYDROPHOBIA. 291 

able convulsive action, but he finally succeeded in getting his month 
open so that I conld empty it in. 

With almost superhuman efforts on his part, and the most em- 
phatic encouragement on mine, he succeeded in swallowing some. 
It was, however, not without considerable choking, and a sense of 
suffocation. 

This was the last water he ever swallowed. It distressed him 
very much, and whenever the subject of drinking water was 
mentioned afl^r this, he seemed wild and delirious. It would cause 
him to shudder and tremble, with the appearance of terror or fright. 
We advised him to continue the Scutellaria, as he had been taking 
it, and in addition two grains of the extract of belladonna, every 
two hours, alternating with the skullcap, till he should sleep. The 
mustard poultices were discontinued, as they seemed to distress 
hinu He began now to be sensitive to moving bodies around him, 
and especially if they were coming towards him. 

In addition to the above, we advised chloroform liniment, with 
frictions to the spine. He took the belladonna through the night. 
This he could, in the form of a pOl, chew and get down. 

The Scutellaria had to be discontinued early in the evening from 
inability to swallow it. He slept none through the night, but 
talked deliriously about waters being forced down him, and that he 
should resist all such attempts, and that he would have satisfaction 
should the trial be made again. 

He would continue to sob, and seemed at times depressed, as 
though he had lost self-control. On the morning of the 8th, he 
seemed calm, and much physically as he was the day previous. 

He said he was desirous to make his will ; that he felt sensible 
he could not get well. A magistrate was sent for, and he made his 
will — calmly, and with the most deliberate composure, exhibiting 
no excitement or delirium. 

Once during the night of the 7th, his wife said, in talking about 
his inability to drink, he desired her to carry the light out of the 
room, and Bring him some water, that perhaps in the dark he might 
be able to take it. This she did, but it made no difference; when- 
ever water was brought in the vicinity of him, it invariably produced 
a sort of spasm, with a s6nse of suffocation and wildness that he 
oould not control. After the night of the 7th, he made no further 
attempt to swallow water. After making his will on the 8th, he 
seemed somewhat exhausted and unable to discharge the saliva from 
his mouth, or to swallow it. 



292 REPORT ON ^ 

His mouth soon became filled with a viscid mucus, and the periods 
of sobbing and depression became more frequent and of longer 
duration. 

He continued to take the belladonna till 12 o'clock of the 8lh. 
He seemed no better, but rather grew worse. 

The belladonna had not the least effect, though he must haye 
taken at least 17 grains. At this time (12 o'clock of the 8th), he 
refused to take anything, saying there was no relief for him till he 
was in his box (meaning coffin). 

Dr. C, proposed the use of chloroform to quiet him, and if 
possible to procure sleep. He consented to the trial of it, but no 
sooner did the doctor take it from his pocket than he saw it^ and 
was thrown into a fearfUl paroxysm of excitement and delirium. 
He ran to a bureau to obtain a pistol he had there, and declared he 
would shoot the doctor should he attempt to force water down him 
again. The doctor said he seemed so wild and furious that he felt 
almost afraid he might do some violence. 

From the effect the sight of the chloroform had on him, he took 
a great dislike to the doctor, and would not see him afterwards. 
Through the afternoon of the 8th he was wild, and raved about 
those who were "bent," as he said, "upon destroying him with 
water." 

It was only upon this sulgect that he seemed to talk much. 
When he did converse upon other subjects, he. seemed calm and 
rational ; his flesh was cool, pulse about one hundred. His coun- 
tenance began to exhibit the effects of the constant watchfulness^ 
and plainly showed that he was failing. The mouth was filled 
with viscid mucus, which ran out of the sides. The difficulty of 
spitting commenced on the 7th, and lasted till he died. 

Through the aftarnoon of the 8th and till 11 o'clock A. M. of 
the 9th, there was no marked change in his case, except early in 
the morning of the 9th he had what his attendants thought to be 
two slight convulsions ; these almost instantly passed otL He died 
easily, and apparently without much su&ring, on the 9th, about 11 
o'clock A. M. 

His death seemed to occur from exhaustion, and complete pros- 
tration of the nervous system. He slept none from the night of 
the 4th till he died, a period of about one hundred and forty hours. 
He drank no fluids or ate anything from. the 5th, a period of nearly 
one hundred and twenty hours. 



HTDBOPHOBIA. 298 

He had no movement from his bowels after the operation of the 
oil on the 6th. The secretion of nrine during the time was nearly 
natural, both as to appearance and quantity. 

He was bitten on the 19th Feb. 1858 ; the disease manifested 
itself ftilly on March the 6th following, being fifteen days after he 
Tvas bitten. He lived about nineteen days from the time he was 
bitten, and about three after the disease was folly developed. 

Case 24. Bepcrted by Dr. Stephen C. Ghriggs, Providence^ R. Island. 

On the 22d day of July last (1858), a dog belonging to Mr. Henry 
Hopkins, a waiter, aged 28 years, became quarrelsome, and bit another 
dog. Mr. Hopkins tied him up, and punished him, when the dog bit 
his master through the little finger. This excited no alarm, as he 
supposed the animal simply irritated at being taken from the other 
d<^. On the 24th, he unloosed it, and although he tried to coax it 
back, it immediately passed down the street, paying not the slight- 
est attention to the calls of its master. Since that time he has not 
seen or heard of the dog. Up to the 24th, he had had no suspicion 
but the animal was in perfect health. The dog that was bitten on 
the 22d died at the end of two weeks. It first became paralyzed 
in one of its fore legs; then in the other fore leg; and soon after 
in its hind legs ; then its jaws became paralyzed, and soon after it 
died. I cannot ascertain that it showed the usual signs of hydro- 
phobia. 

After his dog ran away so unceremoniously, Mr. Hopkins be- 
came alarmed, fearing the animal might have been mad. (His 
finger had been dressed simply as an ordinary wound.) He now 
read several works on hydrophobia, and tried some prophylactic 
treatment. After waiting three months, he dismissed his fears as 
groundless, and came to visit some friends in Killingly, Ct. On 
Friday, Oct. 21, during the day, he felt a slight uneasiness in the 
throat, as if something was there he should throw off. The sensa- 
tion was so slight that he did not mention it. He rested well that 
night till 4 in the morning, when he was suddenly attacked by 
vomiting. Said '' he was not sick at the stomach, but there was 
something in his throat which every few minutes made him heave." 
He continued so through the day. At about 4 in the afternoon 
they sent for me. I was not at home, and Dr. Hutohens went. 

Himself and friends now feared hydrophobia. Dr. Hutchens did 
not encourage this belief. He gave of croton oil four drops ; ap- 
plied a blister to the arm; a mustard paste to the stomach. 



294 REPORT OK 

At this time lie refosed drinks, as they produced a sensation of 
suffocation. 

I first saw him at 12, midnight. He was sitting up on a so&, 
supported by two of his friends, and occasionally leaning back on 
pillows piled up behind him. He was now fully conscious of his 
situation, but perfectly calm. His face flushed and anxious; liis 
breathing was a continual sighing, with an occasional gasp for 
breath ; very like a person who is wading down into cold water. 
Pulse 120, hard. Hands covered with perspiration and cold. At 
this time the sight of liquids would produce the suffocating spasm. 
The spittoon could not be brought near his face. The spasm 
also would be brought on by anything coming near or in contact 
with his face. The smallest lock of his hair falling down over his 
face, or any attempt to apply a handkerchief to his nose, would 
produce it. There were constant efforts to clear his throat of a 
thick stringy mucus. Almost every minute there was an effort to 
vomit. He could not swallow without the utmost difficulty. By 
great efforts he succeeded in swallowing two teaspoonf ds of cold 
water. Said it made his stomach feel better; it was soon rejected. 
The same with some grueL The suffocating spasms were iDcreas- 
ing with fearful rapidity. Up to this time he had not complained 
of pain in any part of his body. There was no pain or unpleasant 
sensation in the bitten finger ; no headache. When asked if he 
suffered from pain, he said "no:" he was easy, except this frightW 
sense of suffocation. 

Treatment. — Not knowing what to do, I did nolking. 

At 7 o'clock, Sunday morning, all his symptoms had increased 
in severity. There was 9iuch difficulty in understanding him, his 
words were so broken up by his sighing and spasms. At 10 o'clock 
the spasms had become so intense that it took two men to control 
him. He appeared perfectly conscious, but had no control over 
himself during the spasm. At his request the attempt was nor 
made to steam him. But the spasms increased in severity till S 
o'clock P. M., when he died from exhaustion, in the interval be- 
tween the spasms. 

To sum up : he was bitten on the 22d of July, complained of no 
unpleasant symptoms till Oct. 22, at 4 o'clock A. M., when he was 
attacked by vomiting, and died on the 23d, at 2 o'clock P. M^ j^ 
84 hours from the attack, and three months from the inoculaU(^ 

The dog was a large bulldog. Nervous temperament 



HYDROPHOBIA. 295 

Casb 25. Repcfried by Thmuu F. Otdlen, M, D^ Camden, K J. 

On Saturday, Sept. 8, 1855, the wife of John White, aged 50 
jears, came to ray office at 8 o'clock A. M., and desired advice for 
her husband, who was " sick." Upow inquiry, found that he com- 
plained of haying pains in his bones, back, neck, and head, weight 
in the epigastrium, was feverish and thirsty, but could not swallow 
without some difficulty, and that he had been troubled with a slight 
diarrhoea for two or three days. He had attended to his business 
(as slip tender) at Walnut Street wharf until 11 o'clock the pre- 
ceding night, when he came home. Such was the account I 
gathered from his wife. 

Knowing that his occupation exposed him to sudden atmospheric 
changes, as well that his residence was on the marshy shores of the 
Delaware, and also that he had had an attack of intermittent fever 
six weeks previous, I ordered him to take hyd. chlo. mit. gr. viij, 
to be followed in three hours by ol.' ricini 3j, and promised to see 
him in the morning. 

Saw patient at 7 A. M.; found his pulse and skin nearly natural; 
tongue much furred; pain in shoulders, back, head, and breast; con- 
siderable difficulty of breathing; thirst, and a disinclination to swal- 
low, as he said it " hurt and choked him." His breathing was so 
peculiar, and countenance so anxious, that I feared congestion of 
the lungs, or some serious lesion of the thoracic viscera; conse- 
quently I examined by percussion and auscultation, and found 
everything normal, except that there seemed to be somewhat more 
vigorous and laborious action of the heart than the pulse at wrist 
indicated. 

Ordered sinapisms to be applied to chest, and ext. senna fSss, 
as the bowels had not been moved. 

12 M. Bowels had been freely moved; discharges dark, glairy, and 
bilious ; pulse natural ; skin moist and relaxed. Breathiug more 
natural, interrupted at times, however, by a slight, hurried, dry, and 
smothered cough, during the supervention of which there was con- 
siderable restlessness, and a tossing to and fro in the bed ; when the 
tongue was protruded (to do which required a strong effort of the 
will), it was thrust out of the mouth with the velocity of a serpent's 
and drawn back very suddenly, the teeth closing in a measure on 
it Endeavored to examine the fauces, but this he positively re- 
fused to submit to, as he insisted that it would choke him. He had 
drank some water during the morning, but found a considerable 
difficulty in swallowing it, as well as the medicine, or any other 



296 BBPOBT OK 

liquid. At mj request he drank aome water, when he aeized the 
glass eagerly, gulped down two or three awallows, handed the 
glass hurriedly to me, and was seised with a paroxysm of coughing 
with restless tossings to and firo, ending highly excited. Made 
inquiries as to his having reoeired any injuries at any time lately, 
and was told both by himself and wife that he had received none; 
made an examination and found no traces of anything of the kind. 
As his feet and lower extremities were somewhat cool, ordered the 
application of dry heat, and as he was nervous and'restless, and his 
*mind highly excited, objecting strongly to medicines, directed that 
his room be kept dark, and perfectly quiet, and promised to see 
him at six in the evening ; at which time found his skin hot and 
dry, tongue more furred, pulse 80 per minute, same difficulty in 
protruding tongue. Bowels had been moved during the afternoon, 
pains in shoulder and chest, respiration hurried, and very much 
interrupted with cough of thd character spoken of before. Mind 
very much excited ; expressed fears that he would never recover. 
Made further inquiries as to his having been hurt, and was still 
answered in the negative. Ordered sinapisms to chest to be reap- 
plied, and pulv. Doveri gr. x to be given every hour until quiet or 
sleep was induced. 

10 o'clock P. M. Had taken pulv. Doveri gr. xx ; seemed more 
quiet and disposed to sleep, yet at times there was some nervous 
agitation. Directed a continuance of pulv. Doveri if restless, and 
tinct. assafoetid. and spt. aeth. sulph. comp. aa Sj. M. Sig. — ^A tea- 
spoonful every hour or two as necessary. 

9th (7 o'clock A. M.) Bested tolerably well during the night; had 
several hours of sleep, interrupted at times by restlessness and 
difficulty of breathing. There was considerable jactitation and 
nervous twitchings, especially in the arms, difficulty in swallowing, 
countenance sardonic, great fear of death expressed by patient 
Asked his wife if he had ever been bitten by any aniinal. (The 
question was not put to him on account of his extreme mental 
dejection, fearing its operation on his mind.) His wife said that he 
had not. Inquired of other members of the family, and could not 
hear of any bite having been inflicted. 

As every symptom pointed out the disease to be hydrophobia as 
described, and having never seen a case, J called in consultation Dr. 
J. S. Mulford, whose experience in that disease I knew to be con- 
siderable ; and upon our visiting the patient together at noon on 
that day, and pursuing our inquiries, the patient informed us that 



HYDROPHOBIA. 297 

he had been bitten by a cat on Walnut St. wharf about ten weeks 
before. He was able to designate the time by an accident that hap- 
pened in his son-in-law's family which I attended, and upon referring 
to my daybook, I found that the accident occurred seventy-two 
days prior to the first symptoms exhibited by the patient. The 
bite was received the evening before the accident. 

White stated " that whilst eatiug his supper he saw a strange cat 
running on the wharf. He called the cat to him and offered it a piece 
of cake ; the cat came to him and instead of taking the cake bit his 
finger, and ran away ; he never to his knowledge saw the cat after- 
wards." Showed two scars on forefinger of right hand, also a 
small dark spot on nail of same finger where the tooth had pene- 
trated. 

At this time (12 M. on the 9th) there was an increase in violence 
of all the symptoms. The answers to the questions of Dr. M. were 
given in the shortest and most crabbed manner, in fact, some 
questions he doggedly refused to answer at all. Cbmplained of an 
increase of pain in chest — the pain about backhand shoulders was 
entirely relieved — pulse 100 per minute. Bespiration difficult — 
tongue protruded with less difficulty, and in a more natural 
manner. 

A slight draught of air being directed accidentally upon the 
patient, produced convulsive action of the whole system, and pecu- 
liar spasmodic actionabout the glottis, followed by a cough, and a 
sudden and violent spitting of a thick tenacious saliva, which was 
secreted in great quantities. The discharge of this saliva occurred 
every few seconds. Upon being asked to drink some water, he 
refused in a loud tone, and with a very angry manner. Directed 
tinct. aconit rad. gtt. iii, with chloroform, gtt. xxz, every three 
hours. 

After Dr. }l. had left the house. White sent for me to come up 
to his room, when he told me that he had just swallowed two table- 
spoonfuls of water, and apologized to me in a very humble way for 
his abrupt manner. to Dr. M. and mysel£ At my request, he 
swallowed another tablespoonful of water, which was accomplished 
with great effi)rt, the patient sitting up in bed, anxious and agitated, 
and saying in a quick and hurried manner, " I'm ready ; I'm ready; 
Quick I quick I" gulping convulsively when the spoon was put in 
his mouth, and fidling back in a spasm upon the bed, tearing at 
his throat with his fingerS| endeavoring, as it were, to force the 
VOL. IX— 20 



298 BXPORT OK 

water down, by drawing hia hands down the outside of bis throat, 
from his chin to the pomnm Adami. 

6 o'clock P. M. Dr. Mulford and W. S. Bishop, U. S. N^ saw the 
case with me. AH symptoms aggravated, eye bright and glaring in 
expression, pupil much dilated, pulse 150 per minute. Bespi- 
ration 44 per minute. Experienced great difficulty in speaking 
and begged that we would not ask him any questions ; skin Bacdd 
and moist; continued spitting of tenacious saliva, which was 
ejected with much force. EEad taken but one dose of aconite and 
chloroform, but had swallowed some thin arrowroot grueL Directed 
blister to nape of neck, intending to apply morph. sulph. to denuded 
Bwrbce. Tinct. aconit gtt x, and chloroform 3i3s in starch 
water, every 8 hours as an injection. 

9 o^dock P. M. Great aggravation of all symptom& Inomense 
quantities of saliva had been discharged, and at times there was 
vomiting of dark-green glairy matter. He was perfectly furiouSy 
and very abusive to all his friends, and to myself in particular, and 
entertained the idea that we wished to murder and rob bim — 
threatened terrible vengeance if he ever recovered. Had poi^tively 
refused to have the injection given, the bare mention of whidt 
excited him to the highest pitch of fury. 

Tried the inhalation of »th. sulph. three parts, to one part chloro- 
form ; which he resisted with terrible threats, which were sometimes 
changed to pleadings that I would let him "alone to sleep, and 
come in the morning when he was rested.^ 

Upon reasoning with him, and assuring him that the inhalation 
would produce the sleep he so much wished for, he would consent 
to allow its application, but the moment the sponge was brought 
near him he became frenzied, and endeavored to injure those 
about him ; accordingly, he was secured in such a way that he was 
perfectly under control. At this time his pulse was 152 per 
minute, very feeble and irregular. Soon after ether was applied, 
he became calm; pulse fuller. After remaining quiet for a few 
moments, the convulsions returned, which were easily controlled 
by the application of the ether for a few seconds. ' 

The blister on the nape of the neck having been torn off by the 
patient, and it being inconvenient to replace it, it was applied to 
the epigastrium. Gave injection as ordered before, and directed 
its repetition every three hours, also ether by inhalation, only 
when convulsions returned with violence. Remained until one 
o'clock A. M., up to which time he was quiet Pulse 152 per 



HTDBOPHOBIA. 299 

minnte, very feeble and irregular; skin cool, flaccid, and moist; 
evidently sinking. About one hour after I left him he died, having 
had only slight tendency to spasms, which were not of a snfSciently 
severe character to demand etherization. 

The patient had only been ill sixty one hours, although during 
the afternoon and evening of the 8th he complained of feeling 
unwell, but not sufficiently so, as he thought, to warrant his leaving 
his work. 

The short duration of the attack can only be attributed to want of 
vital force in the patient. He was thin, cadaverous, and decidedly 
of a scrofulous diathesis, and had in early life suffered severely 
fipom white swelling. 

A constitution so depraved could not long resist any powerful 
malady, much less one so terrible as is hydrophobia. 

Case 26. Reported by Mr. J. Sanders, Gbverport, Ky. 

Sir : I just now noticed a call in the Lamsville Journal, for infor- 
mation in relation to any case of hydrophobia that may have come 
under the observation of any physician or other person, to be sent 
you as early as possible. I am no physician, but several cases of 
hydrophobia having come under my observation some years past, 
perhaps I can contribute a mite towards your " philanthropic ob- 
ject" 

In the fall of 1839, 1 was a resident of Spencer County, Indiana ; 
it was I believe about Sept. 20th a "mad dog," traversing the 
neighborhood, in one night did an immense amount of mischief, by 
biting hogs and cattle, and other dogs. The animals bitten were 
attacked in a short time afterwards with the terrible disease ; though 
not exactly in " nine days," yet none were attacked sooner than that 
period; the disease delaying to exhibit itself in some of these 
animals for three or four weeks. Of the hogs, their general actions 
after the attack was that of intoxication, no disposition to change 
place, yet in continual motion, turning about, taking a step or two 
forward, and then back again ; the head never in its natural posi- 
tion but elevated, and turned a little to one side, white froth about 
the mouth, no inclination to do any damage ; their attention cotdd 
be drawn in no way. Of the hogs attacked I saw several, they all 
acted precisely alike. Of the cattle I saw only one, a large fat cow; 
she seemed to be in the greatest pain; no disposition to change 
place, yet in continual motion; a white froth at the mouth, occa- 
sionally bellowing; no raising of the head high as in the case of 



800 BKPORT ON 

the bogs, but giving tlie head and neck the position the cow kind 
exhibits when about making battle. This cow frequent! j fell to the 
ground, but would immediately rise again. If any one approached 
her, she would make at him as if for an attack, but would fidl 
immediately to the ground, rise again, not renewing the attack as it 
were for that time. 

How long these animals would have continued in this state 
I cannot tell, for they were all shot soon after they were attacked. 
In these lines I have been as brief as possible ; if there is anything 
else you wish to inquire about as being characteristic of this dread- 
ful malady, write to me, and if I can refresh my memory sufficiently, 
I will give you the information with pleasure. The most remarka- 
ble feature in regard to the swine was elevating the head and turn- 
ing it a little to one side. In the case of the cattle, falling to the 
ground whenever they advanced a step or two toward any person 
for attack. The cattle seemed as though they would do injury if 
they could ; but the hogs showed no such symptoms. A small boy 
was bitten by this dog some miles from my residence, and died soon 
after in dreadful agony. I did not see the case, and can giYe no 
information about it as to how he was affected, how long after the 
bite before the attack, or how long after the attack before death. 
If this will be of any use to you iA your report, you are very wel- 
come to it. I am yours, very respectfully. 

Cask 28. Reported by Dr. G. F. Clark, Woodbury, N. J. 

On Tuesday, the 16th day of May, 1854, 1 was called to see a Mr. 
Isaac Murphy, near this place. He was a stout rugged-looking man, 
aged 25 years, a farmer by profession. I found him walking about 
the yard with his sister; he had a wild unnatural look, but was 
perfectly rational ; he told me he was taken unwell on the previous 
Thursday ; he had been bitten on the hand and wrist just 10 weeks 
previously, by a small Scotch terrier dog, brought home on that day 
by his motherin-law, Mrs. Driver, from Philadelphia ; no one ima- 
gining, at that time, the dog to be rabid, although Mrs. D. was 
told that this dog was an ill-natured cur, snapping at everything 
that came in his way; he eventually escaped, and was found fight- 
ing with the dog of a neighbor, who shot him, still without any 
suspicion of hydrophobia. 

Mr. Murphy ^s first symptom on Tuesday was in the cicatrix of the 
wound on the wrist, which began to swell and pain him. Being at 
work in a meadow, he took up portions of cold mud and applied to 



HYDBOPHOBIA. 801 

it, with temporary relief of the unpleasant feeling; on Friday the 
same unpleasant feeling extended to the arm, and next day to the 
side of the neck and head, and to the opposite arm ; this unplea- 
sent feeling gradually grew more intense, preventing him from 
deeping. On Tuesday morning he found some difficulty in swal- 
lowing his coffee; this difficulty he attributed to having drank 
pretty largely of sharp vinegar on Saturday and Sunday, which, he 
said, had made his throat sore. I proposed examining his throat, 
and brought him in front of the window, to seat him for the pur- 
pose, when he immediately started back, as though the light hurt 
his eyes, and with a peculiar catching of the breath, such as would 
be induced by throwing a handful of cold water, unexpectedly, 
into a person's face. I found the lining membrane of the fauces red 
and somewhat swollen, the tonsils were not enlarged, the uvula 
slightly enlarged, the velum a little thickened, and the posterior 
wall of the pharynx highly vascular. His pulse was quick and fuU, 
beating about 100 ; his eyes were bright and glassy, having a pecu- 
liar wild look, such as I have noticed in a rabid horse, which I had 
seen some months before. The cicatrix was elevated above the sur- 
fece, red and painfuL I immediately cut it out, although I thiiik 
now this was altogether unnecessary. I applied a blister over the 
part, gave him a purge of jalap and calomel, and advised him to 
drink as much brandy as he could, intending, if possible, to intoxi- 
cate. He was a temperance man, and objected, on this account, to 
taking so much brandy, and, besides, he had great difficulty in get- 
ting at it, as he expressed himself; while bringing the glass or a 
cup of liquid to his mouth, he would turn his hand away, and on 
getting it near his mouth, would seize it with both hands, and 
throw it suddenly down his throat, immediately throwing himself 
back, and gasping for breath ; owing to these causes, but little 
stimulus was taken. At 3 o'clock he was attacked with spasms, 
which continued for 2^ hours ; a teaspoonful of black drop (acet. 
opii) was then given ; a drachm of chloroform was poured upon a 
sponge, and held to his mouth and nose ; this at first startled him a 
good deal, and it was not without difficulty that he could be got to 
inhale it. It had, however, a soothing effect upon him, and the 
spasms left him. 

While the spasms were upon him, his muscular system was in 
most violent, irregular, and constant action ; at times his body 
would rest upon the head and heels, and immediately after be thrown 
violently forward. It was found very difficult to keep him on the 



802 BXPOBT OK 

bed ; a number of asaistants were required ; no offer to iDJure bun- 
self, or any of tbe bj-standers, was attempted at any time ; immenae 
quantities of thick, yiscid mucus were secreted from his throat, firom 
which he seemed in imminent danger of suffocation ; in his eSoha 
to relieve himself of this, it was thrown in every direction around 
the room. It was necessary for each assistant to have a towel to 
ward off this offensive matter. He seemed conscious of the impro- 
priety of this, but could not help doing as he did. After the 
spasms ceased he remained for 6 or 8 hours perfectly rational, talk- 
ing pretty calmly ; desired to see a young lady to whom he was . 
engaged, but on her approaching the door he motioned her to stop, 
and turning his back towards her, conversed quite rationallj with 
her for some time. A person coming suddenly into the room, even 
opening the door, or the slightest noise, agitated him very much. 
He was extremely anxious to leave the room he was in, and go up 
stairs to his usual sleeping room, but in every attempt, on approach- 
ing the door, he would start back, with that peculiar catching of 
the breath, as though the fresh air deprived him of the power of 
breathing; while free from the spasms he slept quite composedly 
for short periods. 

The spasms returned, after the interval named above, and were 
in all respects similar to the first Chloroform was the only thing 
that had any influence in quieting him; they continued for a longer 
time, but again left him with some delirium ; he again became ra- 
tional, and dept for a short time. He died at 10 o^clock next morn- 
ing (Wednesday). I was not present at the time, but arrived shortly 
after. Ko distortion of the features appeared as evidence of the terri- 
ble ordeal through which he had just passed. It was astonishing to 
see '* how calm was his slumber." 

Cask 29. Heported by Dr. C. F. Clark, Woodbury, K J. 

Mr. Driver, the brother-in-law of Mr. Murphy, was twice bitten 
on the hand, on the same day, and not an hour previous to Mr. M., 
by the same dog. He has had no attack of disease of any kind since. 
After Mr. M.'s attack was found to be hydrophobia, Mr. D. obtained 
from Philadelphia some nostrum said to be ef&cacious as a cure, as 
well as a preventive of this disease; I jdo not recollect the name 
of the discoverer; and put no reliance whatever in its power. Mr. 
D. describes it as excessively nauseous, smelling very much like the 
contents of a privy, and tastiQg accordingly. I had not faith enough 
in ]t to try it either way. 



HYDBOPHOBIA. 808 

You will observe that it was about the first of March when these 
men were bitten, a time of year when we have pretty cool weather; 
it was just ten weeks fix>m the inoculation to the invasion of the 
disease, and about this, I suppose, there can be no kind of doubt ; 
although this is the only case of hydrophobia, in the human being, 
that I have ever seen, I do not suppose there can be a doubt about 
the correctness of diagnosis. 

The first symptom was an inflammation of the cicatrix. Had Mr. 
Murphy applied then, I should certainly have practised excision, 
and then it might have been effectual^ It would be well, perhaps, 
to have this fact remembered, when a person has been bitten, when 
no suspicions exist ; the wound heals, and afterwards becomes pain- 
ful, red, and swollen; there ought to be no delay in having the part 
removed, if in a situation admitting of it. 

I have seen a number of cases of hydrophobia, in animals ; 1 
oow, 1 horse, and a number of dogs; the actions of dogs have not 
always been conclusive. I believe they always go away from 
home, and after a time exhibit the great secretion of macus about 
the mouth. I do not know anything as to the length of time 
between the inoculation and invasion of the disease in dogs. 

In the case of the horse which I saw, it was just one week from 
the time he was bitten to the attack of the disease. I saw him the 
next day after the attack ; there was then a slight foam about his 
mouth; he was. bitten upon the upper lip, which was slightly swol- 
len at the spot; he was constantly champing; no remedy was tried, 
except bleeding, but the blood was thick and dark, did not flow 
fireely, and soon stopped. I started the next day, with a good sup- 
ply of chloroform, to try it upon this horse; he was 10 miles from 
my residence, but on my way I learned that the owner had shot 
him, after spasms had come on, the previous evening. I do not 
remember the time of year when I saw this case in the horse ; the 
weather was cool, I think in the^ring. 

'case 80. Replied by Dr. C. F. Clark, Woodbury, N. J. 
A pig belonging to a Mr. James Dilks, of this place, was taken 
sick, and as it had been bitten two weeks ago last Sunday, by a 
strange dog, it was supposed to have the hydrophobia. This morn- 
ing on hearing of the case went to see it ; it was lying down, and ap- 

* iVbte by the Committee, — ^''Bzperienoe Ictads us to beliere tluit the ezoision of 
the bitten part, at mnj time before the general 'BTrnptoms of the disease hare ap- 
peared, wlU arert the disease."— Rodman, Nat. Eigtory, rol. i. p. 169. 



804 BSPOBT OK 

peared not to be suffering much; its moutli was surrounded with a 
white foam; on touching it with a stick it threw up its head violently 
from side to side, got up and staggered about the pen; on presenting 
a tin basin of water to it, it caught the basin in its mouth and bit 
upon it hard enough to indent it considerably, threw it violently 
aside, at the same time squealing as if in pain, exhibiting in its 
movements evidence, by its irregular gait, of spasmodic action of its 
muscular system. I have not a doubt of its being affected with 
hydrophobia. 

At the time this pig was bitten, there was in the pen with it 
another, the nose of which was entirely torn off by the same dog. 
It occurred early in the morning the dog was seen to leave the pen j 
no suspicion existed at the time of the dog being rabid, nor has the 
dog been recognized since to any certainty. How much more 
damage has been done is of course not known. 

On finding his pig so badly bitten, and it being fat, Mr. D. offered 
it to a neighbor if he would kill it, which he did, and it was con. 
sumed in his family. No little alarm was excited amongst them 
yesterday, on finding this other pig sick and exhibiting symptoms 
of hydrophobia. I do not think there is much cause for alarm ; the 
pig was bitten on Sunday morning, was killed on Monday, before 
the virus had time to penetrate the system, and it was not certain 
that the disease could be propagated by consuming the flesh even 
of a rabid anima], after it had been cooked, though I suspect very 
few would like to try the experiment. There are a good many 
rumors around the town to-day of dogs exhibiting signs of disease. 
I shall have an opportunity, before mailing this letter, to learn some- 
thing of their truth, alid communicate the result to you. I met Driver 
a few days since in Philadelphia in perfect health, I mean the man 
bitten at the time Murphy was, whose case I before communicated 
to you. 

1 thought the case of thia pig would be interesting, from the &ct 
of its occurring in cold weather, and from another fact, which I 
think is unusual; according to what I have seen, rabid dogs do not 
often worry the anirrvah they bile^ they only give them a snap and go on;^ 
but in this case, one of these pigs had his nose eaten off entirely, the 
other was bitten on the lip and ear, and a piece of the tip of the ear 
bitten off; this helped to lull suspicion; occurring, as it did, about 
the time Mr. D. had killed his hogs, it was supposed the dog had 

' ItaUcs by Committee. 



HYDROPHOBIA. 805 

been prowling around after something to eat, and had quarrelled 
tvith the pigs in that way. I begin to think the only effectual dog 
law, is one to exterminate them. Our corporation prohibits dogs 
running at large without muzzles in summer, but they are at perfect 
liberty now to bite whom they please. 

Sl^^. P. S. Pig died last night* one dog has been killed that 
exhibited signs of hydrophobia. 

Oasb 81. Reported by Dr. A. ffunton, Hydeparh^ Lamoille Co., Vt. 

The 24th May, 1840, 1 was called to a son of Thaddeus Newland, 
of Hydepark, Lamoille County, Vt. The name of the lad who had 
symptoms of hydrophobia was Arry Newland, aged fifteen. I was 
conducted to his room ; he was in bed ; I took hold of the sheet, and 
spread it up toward his face with a quick motion, to agitate the air; 
lie catched his breath and sighed deeply. 

This test, with the shudder at the sight of water, was satisfactory 
evidence of the character of the disease. Five weeks previous, the 
lad was bitten by a small dog, as he concluded accidentally ; as the 
dog was digging for a squirrel, the boy took hold of a root to help 
the dog, and was bitten. The dog ran to the neighbors, was cross, 
and showed so much fight, that it was killed. There was a sug- 
gestion that the dog was rabid, but the idea fSstded and was nearly 
forgotten. The Thursday and Friday before I saw him, he was 
noticed to be listless, dull and taciturn ; was asked if he was un- 
well; said not, but Friday evening he called for water; was pre- 
sented some by his mother; he shuddered, appeared perturbed, 
and refuaed to swallow. This was the first notice of the nature of 
the complaint. The father was called; other trials were made 
until they were satisfied the lad was rabid. He being very thirsty, 
some cider was put in a phial; an oat straw was inserted in it; he 
would sip enough from the straw to wet his mouth, I informed 
the father the disease was hydrophobia, and the child could not be 
cured; compared the case with inoculated smallpox; that the boy 
was inoculated with a specific virus; it is now operating in the 
system ; reason would teach any reflecting mind the disease could 
not be averted, and was incurable. 

To satisfy friends, I advised to give ^im a lobelia emetic, thinking 
it might obviate some regrets or misgivings in the family after the 
decease of the child. The tincture of lobelia being put in the phial 
with the cider, he sipped enough through the quill to cause emesis, 
after which his breathing was not as laborious ; he was more calm for 



806 BBPORT OK 

some two hours. To make my narratiye intelligible, I must digress. 
Two years previous to this, a Mr. Bichardson, of Elmore, was bit ou 
his hand by his fox-hound, supposed to be rabid (which probably 
was not the case); the news went to Montpelier, twenty mile& A 
Mr. Wright, a Thompsonian practitioner, hearing the circumstance^ 
rode to Elmore and tendered his services to Mr. Bichardson; he 
being a man of oommofa sense, did not employ him, neither did he 
try any preventive; he is still living. ELad he taken the lobelia and 
steam of Mr. Wright, he (Wright) would have had a tall plume 
added to his turban. This was known to the father of the lad, Mr. 
Newland ; his older sons had without his knowledge sent to Mont- 
pelier for Dr. Wright; he was not at home, he being a clergt/fmm 
was off curing souls, it being Sabbath, whether with steam or pepper 
I am not infotaied. 

A young ignoramus employed in Wright's sweat-house, made his 
appearance soon after I left. I much regret I did not see him. I 
wished to giVe him a short lecture he would not soon forget. It is 
said he introduced himself as Doctor Sartle. Mr. Newland asked him 
if he could cure the hydrophobia; he unhesitatingly answered ''yet." 
Newland was somewhat posted on the disease; I had left with him 
Thatcher on hydrophobia. He asked Sartle what he would use. An 
airb. What herb ? He declined to inform, fearing some of the rega* 
lars would know as much as himself. Newland informed the sage 
doctor, he should not give his child any medicine until he knew 
what it was; he then acknowledged it was lobelia. He was then 
asked if he had ever performed a cure ; he answered he had. Who? 
was asked. He was loth to give the name, but being urged he gave 
Mr. Bichardson. Newland informed him he knew that to be false. 
Mr. Newland informed the miserable (may I write it) deml, he had 
imposed on him, that he was convinced his child must die; he gave 
Dr. Sartle a parting blessing ; he departed I presume not feeling 
much elated. 

I tarried with the lad until Sunday noon; his appearance was 
quite similar to those afflicted with delirium tremens; he appeared 
to see some frightful object ; he desired on Sunday morning to be 
left alone ; he raised a window, crept out, leaped two fences, and ran 
some distance into the field. 

There was living in the family a young man, on whom I had 
performed castration ; this probably was known to the patient. I 
went into the room a short time before I left ; he sprang on the bed, 
leaned against the wall, looked lightened, and said to me, " You 



HYDBOPHOBIA. SOT 

old eu88j you want to cut out my b — . — x, don't you ?" When I left, 
I concluded he would live until noon on Monday ; I wished to see 
him again ; informed the friends I would see him the next morning ; 
started on Monday, but heard of his death. He would have turns 
of raving ; would strike^ but I did not see him attempt to bite. It 
required some strength to confine him. The probability is I have 
been more minute than necessary. K there is any useful infor- 
mation, regard it, and reject the rest. I should like to be informed 
of your reception of this. I am old, my mind is treacherous ; please 
excuse my imperfections. 

Case 82. Reported by Dr. J. E. Beech, OoldwcUer, Mich. 

My knowledge of hydrophobia is next to entire ignorance; but 
a few facts have passed under my observation which may aesist 
stronger evidence, although their own weight is diminished by 
not having been recorded at the time with dates and particulars. 
I think it was in February, 1842, a snutU dog came into the enclos- 
ure of Dr. Martin Mason, at Gaines, Orleans Co., N. Y., and flew at 
his cow, and I believe drew blood from one ear. It was only 
thought to be young and mischievous, and was not killed till it had 
travelled twelve or more miles east, if at all. I have an impression 
that some weeks afterwards a rumor came to that effect. One other 
animal was bitten in the immediate vicinity, and showing signs of 
disease of some sort about two weeks aft^ the death of the cow 
(which I will describe). Was killed. 

The said cow showed no signs of disease until six days after- 
wards. (I may be mistaken in the time.) Her quantity of milk 
was less on the evening of the sixth. The next morning she was 
heard before day, about two miles west of home, making a frantic 
moan or bellow, and was found to have been running in a circle of 
about three rods in diameter, and was foaming at the mouth; the 
eyeballs fiery and prominent. I saw her about nine (9) o'clock ; she 
was then unable to stand, but would show a disposition to hook 
and push on the nose with open mouth, which was interpreted as 
snapping, by the by-standers. I recollect well that a part of her 
circuit was through a deep snow-bank. She died about 11 A. M. 
There seemed to be no doubt in the minds of those who saw her 
that the disease was produced by the bite of a rabid dog, although 
poison, " phrenitis," and other causes were mentioned. 

I have known of the killing of several rabid dogs in the vicini* 
ties in which I have been, none of which have been in the "dog 



808 BKPORT OK 

days*' or hottest season. Yet all the others have been in warm 
weather. 

Cask 38. Reported by Dr. J. H. Beech, GoJdwater, Mich. 

A cousin of my mother was bitten, when a child, by a rabid dog. 
A quack remedy containing acetate of copper was administered, 
and as it did not kill, it was thought to haye cured h^. Ten years 
after she was so unfortunate as to break her arm, and died in a few 
days with marked symptoms of ^^rdbiesr 

I have no means of getting at the particulars of the case. 

Case 34. Reported by Dr. O. D. Ayres, Brooklyn, K T. 

Michael Casey, aged about 40, was employed as harness washer 
in a livery stable in this city. In April last, whilst endeavoring to 
catch a bitch pup about four months old, was bitten (not severely) 
on the fleshy part of the hand, between the thumb and forefinger. 
He treated the wound as a trifling affi^ir, and adopted no prophy- 
lactic measures. About three weeks after he was bitten, he was 
employed to bury two dogs which had been killed in the same 
vicinity, one of which was unmistakably rabid, and severely bit 
the other, covering him with saliva and blood. This dog Casey 
freely handled. The wound from the bite cicatrized, but as near 
as I can find out his hands at this time were abraded in several 
places. About ten weeks from the day he was bitten he exhibited 
the first symptoms of the disease, when about taking some soup. 
At the first spoonful, he complained of a sore throat, and spat it 
out, saying he could not swallow it. This was at noon on Thurs- 
day, the 9th August. On the 10th he kept quiet at home, refusing 
all food or fluids, although complaining of great thirst. On the 
11th (in the evening), I first saw him. His countenance expressed 
anxiety ; he was sitting up in bed. Pulse 80, but varied in fre- 
quency at short intervals. He complained of no pain in the head 
or arm ; tongue moist and slightly furred. The room was darkened 
and the windows closed, he having intolerance of light, and appa- 
rently great susceptibility to any currents of air; objected to being 
fanned, &c., yet did not complain of being cold or chilly. He 
begged for water, and after several ineflfectual attempts to drink or 
eten get the glass to his lips, I told him to open his mouth and 
close his eyes, and suddenly I threw a dessertspoonful of water in 
his mouth. This act was followed by a most violent choking spasm 
of the muscles about the throat; he swallowed but little of itj the 



HYDROPHOBIA. 809 

most being spilled oyer his chin. After a little, he said "he could 
take more, after he got a little used to the water," and asked for 
some to wash his hands in ; this act produced hurried inspirations. 
1 asked him to put a piece of ice in his mouth, but as his hand 
approached his mouth, his head apparently involuntarily receded 
from his hand, but when once in his mouth, he allowed it to dis- 
solve and swallowed it, not without difficulty, but with less spasm. 
Haying no convenience for his proper treatment at his house, and 
he being constantly annoyed by the visits of the curious, his 
removal to the King's Co. Hospital was advised, whither he was 
taken on Sunday morning, the 12th inst. On starting he appeared 
quite cheerful ; said he felt better, shook hands with his compan- 
ions, &c. Deglutition was about as diMcult and painful as the day 
before. After admission to the hospital he drank sbme brandy and 
water, and also a little gruel with difficulty, and was cupped on the 
cervical region of his spine. In the P. M. a dose of laxative medi- 
cine was exhibited, after which he slept some, but was restless, and 
talked wildly. About midnight he awoke. Complained of pain 
in the hand (in which he was bitten) and in his arm, which finally 
became paralyzed ; also of his throat, and was now constantly spit- 
ting out ishreds of viscid mucus. From this time he had occasional 
spasms (of his whole body), and died exhausted on Monday the 
13th August^ at 12 J o'clock P. M. 

Post-mortem appearances. — Aug. 16th. Externally, livid patches, 
particularly on posterior surface. Vessels of membranes of brain con- 
gested, but nothing remio'kable about the brain itself. The papilke^ 
especially of the back portion of the tongue, were enlarged and the 
parts about the epiglottis, larynx, and trachea, as well as the pharynx 
and oesophagus, were very red. Mucous membrane of the stomach 
softened, and at the greater curvature was abraded for some three or 
four inches in circumference, and diaphanous; lungs, with excep- 
tion of some old adhesions, normal ; liver large and flabby, and all 
the viscera much congested. The spinal cord, down to about the 
10th dorsal vertebra, was covered with an effused lymph. Ossific 
deposits were found in the aorta, and large quantities of sero-puru- 
lent matter escaped from the spinal canal when exposed. 

This man had been notoriously intemperate for some years past, 
cannot find out that he ever had delirium tremens. For some three 
weeks previous to his death, he had stopped entirely the use of 
stimulants. 

The same pup a few days before had bitten a boy, who was teas- 



810 BSPOBT oir 

ing him at the time. His wound was freely cauterized with arg. 
nit. immediately. Up to this time he enjoys his usual good health. 

The dog was killed immediately after biting the man, withont 
exhibiting any of the usual symptoms of rabies. SeTeral other 
dogs haye been killed in this vicinity this summer, all showing 
more or less the symptoms of hydrophobia. 

As to the dog laws, we have about the same laws here as in New 
York city, but they are very imperfectly enforced, if at alL 

Your letter should have received an earlier answer, but I was 
delayed in obtaining some of the data. If there should be any 
points in this case on which you would desire more explicit infor- 
mation, it will afford me much pleasure to collect them for yon. 

Gasb 86. Repwied hy Dr. RoeVeer^ (Xncitmaii, Ohio. 

Henry Uthoff, 28 f years old, laborer, married, a native of Prus- 
sian Westphalia, came to the United States in 1845; was a resident 
of Cincinnati since 1819; a middle sized man, rather slender, of dark 
blond hair, In'own eyes, of irregular habits, not a drunkard, but 
would drink too much when in jovial company, which wonld hap- 
pen sometimes once, sometimes twice a week; a trifler in talk and 
action, who would tell stories for the fun of it, hence not reliable in 
his words; was bitten May 17th, 1865, at about 4 A. M., while going 
to his work, by a strange dog, who wore a part of a chain around 
his neck. Whether the dog was mad remained unknown. Uthoff 
is said to have seized the dog by his neck and thrown him upon his 
back, upon which the dog bit furiously into his hand, and kept such 
a firm hold of it that Uthoff could not free himself of it until he 
seized the dog by the throat, and nearly strangled him. The dog 
never was seen again afterwards. Uthoff washed his hand in water 
and bandaged it, but never consulted a physician, although he was 
urged to do so. The wound continued sore for about four weeks^ 
when it healed up. Early in June he went to Illinois, from whence 
he returned on Friday, the 29th of June, at midnight He ate and 
drank, and went to bed. Saturday, the 80th, he complained of 
heaviness and weariness in his limbs, and feeling dick all over, which 
he ascribed to having taken cold on bftard of the boat He ate and 
drank but little. The following night he did not sleep, and talked 
loud, as if dreaming. On Sunday, July 1st, he complained of pain 
in the bitten arm, and of a prickling sensation running from his 
fingers up to the shoulder, for which he was advised, by his friends, 
to bathe the limb in warm water. When trying to do so he shod- 



I 



HTDBOPHOBIA. 811 

deied, and taraed off with aversion, without accomplishing it 
Daring the day he felt imwell, and weary, and heavy; had no appe- 
tite, still ate and drank something, and spent part of the day in 
company with his friends. The following night he was more rest- 
less, talked loud, as if dreaming, made queer noises, but could not 
turn over in his bed. Monday morning, July 2, he could not wash 
himself, shrunk back from water, and could not drink his coffee. Then 
he went about two miles to get medical advice; did not, however, 
represent his true case, but stated that he felt unwell, weary, and 
oppressed about his chest ; thought he had taken cold <m board of 
the boat, where he slept on deck, on his return from Illinois, and 
led, by his statement, to the supposition that he had contracted an 
intermittent In the afternoon, his landlord came and communi- 
cated his suspicion, and a part of the above history of the case. I 
saw bim the same evening, with a medical friend. He was perfectly 
rational, answered all our questions, told me himself that he had 
been bitten by a dog, and swallowed some water, by my request, 
although it cost him a great effort, and it was accomplished with 
great difficulty. Ice was put upon the nape of his neck, and chlo- 
roform and the tr. rad. aconit. applied to his throat, and, his tongue 
being very much coated, an efficient dose of calomel was adminis- 
tered, to act upon his bowels. The medicine acted well, but the 
applications could not be kept up, as he was excessively restless all 
night, and wanted constantly to run off, or jump out of a two-story 
window. Early in the . morning, July S, he washed himself, was 
perfectly quiet, rational, and dodle, but his eye was wUd, the pro- 
fuse perspiration continued on him, as well as the rapid pulse and 
the spasmodic contractions of his throat Towards noon, eight 
grains of the powdered root of belladonna were administered, as 
finesh as it could be obtained in the city, although it was not of this 
spring's growth, and ice ordered to be applied the whole length of 
the spine, which proved, however, impossible, on account of his 
restlessness. In the afternoon he drank water, but continued so 
restless the whole day and night as to keep about a dozen men busy 
in watching him, to prevent his running off, or jumping out of the 
window. In the morning of the 4th of July, about 4 A. M., he 
drank coffee, with some, but not a great deal of difficulty. At 7 
A. M., he was too much exhausted to leave his bed any more, 
although he sat up in it ; he hardly knew me ; he answered some of 
my questions, but it was with great difficulty that he could collect 
himself sufficiently; the profuse cold perspiration was running 



812 BSPOBT OK 

down his body; his hands were ice-cold, and their skin purple-bluish 
and corrugated, like a cholera patient's, in the state of collapse. He 
died at 9 A. M., the same morning, and was buried in the evening 
of the same day. 
Post-mortem examination was not made. 

Cask 86. Reported by Br, J. E. Pearaony Vienna, Ala. 

If there are extant anj municipal regulations or ''Dog Laws,^ 
in this State, I am not aware of it. This may be attributed to the 
yery singular fact, that there are no rabid dogs in Alabama I I have 
practised my profession twenty years in this State, and have heard 
of no case of hydrophobia, and have taken pains to get infornoation 
from others older than myself who have preceded me. In South 
Carolina, however, where we were frequently terror stricken by the 
unwelcome visitation of such guests, now and again a case did turn 
up to the alarm of the neighborhood and the discomfiture of the 
physicians, during my minority, in the little village of Monticello, 
Fairfield Dist., S. 0. 

A most excellent old lady, Mrs. Jane Porter, aged about 65 years, 
of bilio-nervous temperament, dark complexion, was bitten by a 
cat whilst she was visiting her garden in the summer, for the pur- 
pose of gathering vegetables for dinner. The cat was, it seemed, a 
constant companion in her daily walks, and owing to its peculiar 
friendship and sagacity before, this circumstance alarmed the hus- 
band, who immediately called in my brotjier. Dr. Geo. B. Pearson, 
who was then practising his profession in the village. He sus- 
pected the animal of hydrophobia after reviewing the circumstances, 
and proposed to put her under an alterative treatment, which he 
did by the administration of small doses of mercury, for three 
months. Under this treatment her health did not only continue 
good, but seemed to improve. At the end of which time he either 
concluded that nothing was the matter of a serious character, or if 
it had existed perhaps the mercurial had overcome it. In this, 
however, he was sadly mistaken; as soon as the alterative ceased to 
exert its influence upon the system she gave signs of hydrophobia. 
One morning while engaged in dishing out tea, she had constriction 
about the larynx and glottis. She arose from the table and sent 
for the doctor; being myself at his house, I walked over with him, 
who, on hearing the relation from herself of her feelings on pouring 
out the tea, requested me to hand her a glass of water, which I did. 
She raised it to her mouth, but immediately dashed it down upon 



UYDB0PHOBIA« S13 

the floor, and arose from her chair seemingly to get her breath. 
These symptoms from day to day grew more aggravated, and on 
the ninth from the attack; she left for the spirit land, with full con- 
fidence of rest in heaven, and had for the twenty-four hours pre- 
vious no distress either of mind or body, which period she spent in 
kind admonitions to her friends and neighbors to prepare for eter- 
nity. I recollect that during her illness she could not bear to look 
at a mirror, the light of day, or of any fluid or polished surface. 
Owing to spasmodic stricture of the throat occurring in paroxysms, 
she made a strange noise in attempting to breathe, which caused 
the ignorant to circulate a report that she barked like a dog and at 
other times mewed like a cat. I have been thus particular in de- 
tailing the above case, and perhaps unnecessarily tedious and unin- 
teresting; but as far as it goes, it proves the unmistakable origin of 
the disease, and the fact, too, that if not curable, it can be postponed. 
It also indicates that the isotherlnic condition of the year has some- 
thing to do with the causation of hydrophobia. The opinion has 
obtained that rabid animals are only to be met with in the summer 
solstice ; this is with me the result of observation and experience. 
One of my neighbors onee had a great many of his hogs and cattle 
bitten in the summer ; t saw the pigs sucking, and when the old 
sow or sows would take a suffocative paroxysm, which was pre- 
ceded by a terrible squealing, the little pigs would fly with conster 
nation until the fit was over. The cows lowed;most piteously. All 
died or were shot. 

Cask 89. Reported by Dr. J. JET. Qriscom^ New York. 

Edward Bransfield, aged 28, was brought to the N. Y. Hospital 
about 2 P. M. on Monday, 14th May, 1865, attended by two or three 
physicians and a crowd of curious people. On admission his face 
was flushed, the eyes wide open and pupils remarkably dilated — 
the whole expression indicative of terror and distress. He was 
suspicious and fearful, shrinking when the hand was laid upon him, 
but not dangerously disposed. 

He was received by the house physician, who placed him imme- 
diately in bed in a quiet room, under the care of a good male 
nurse, removed from his presence every person and thing that 
might annoy him, and administered immediately such soothing 
remedies as were admissible. He soon became tranquil, answering 
questions intelligently, and submitted without remonstrance to 
what was deemed necessary. He complained of a sensation of air 
VOL. ix.— 21 



1 



814 BXPORT OK 

blowing over himf the windows and doors being at the time dosed. 
Acoamulations of tenacious saliva troubled him somewhat, but 
when asked if he would take some water he quietly declined, say- 
ing he thought it hurt him. None was thw presented to him. His 
pulse on admission was 160 per minute and full, but at 8 o'ckwk 
(one hour afterwards) it bad deoUned to 136. The respiratiooa 
were 16 per minute. 

Soon after this an opium pill was ordered for him, and the nurse 
inadvertently brought in a tin cup full <^ water to assist him in 
swalLowing it He started up in bed with an expression of honor 
and apprehension, swearing fiercely, aiKl intensely enraged. The 
cup was instantly removed, and he was soothed and persuaded to 
take the pill into his mouth. He attanpted to swallow it, bofc 
fiftiled. He lay quiet for a moment, then started up in a yiolent 
rage to spring at the throat of the nuise, spitting vehemently, with 
furious voice and gestures. He was easily prevented from inflict- 
ing injury, but the assaults being repeated, was restrained by force. 
When he became quiet again, he said that in the paroxysm he was 
"not himself." 

On being gently &nned with the hand on his bare head (whieb 
was naturally devoid of hair), from such a position that the hand 
could not be seen, he burst into a violent expression of rage, swear- 
ing and exclaiming, " It was better to knock him in the head at onoe 
than do that way." These experiments were not repeated, and he 
was kept as calm as possible. 

It being at this season my tour of service at the hospital as 
attending physician, I was immediately notified of the case, but in 
consequence of other engagements did not receive the notice in 
time to reach him before 8 P. M. The foregoing statement is con- 
densed from the report furnished me by the house physician^ Br. 
Mills. I found the patient at the time of my visit on the bed, to 
which he was strapped to prevent injury to himself and others, per- 
fectly calm to all appearance, intelligeQt, and entirely submissive to 
treatment. He conversed freely though with some confusion of 
dates and facts respecting the time when he received the bite (be- 
tween four and five weeks previous), and other circumstances con- 
nected therewith, and of his own feelings then. The scar was Mpon 
the lower lip, perfectly healed and exhibiting no signs of irritation^ 
As he thus lay and conversed, no one could suppose that he was 
laboring under so fatal an infiuence, imless either the finger were 
laid upon the pulse, which now numbered nearly 160 and was foil 



HYDBOPHOBIA. 315 

and bounding, or he complained of the pain in hia throat and diffi- 
culty of swallowing. On examining his throat a degree of rednesR 
was observed in the fauces, accounting partially for the pain of 
dfiglutition. After giving further directions for his continued com- 
fort and the prevention of more convulsions, it occurred to me to 
test the truth of some of the popular notions respecting this dis- 
ease, especially in relation to that peculiar symptom from which it- 
derives its name, viz: The dread of water. The results of these^ 
investigations it is hoped may have the effect not only of correcting 
some false views on the subject, but what is more desirable, of 
hereafter alleviating the intense Bufferings of those afflicted with 
the disease, if indeed they may not increase the means and proba- 
bility of recovery. 

The most distressing part of the malady is undoubtedly the diffi- 
euUy and pain in swallowing^ arising &om sharp spasmodic action 
of die muscles concerned in this function, extending sometimes 
even to those of the neck and chest, and producing a feeling of 
alarming constriction of the organs of re^iratidn, causing almost 
complete though temporary suffocation, and thus aggravating if 
not actually exciting the convulsions, with the more or less violent 
contortions and discoloration of the countenance, protrusion of the 
eyeballs, and other active painful symptoms. It is a popular idea 
that all these are excited by the sight and even by the sound of 
water, and although an intense thirst almost universally co-exists, 
the friends and even the patient himself^ anxious as they are to 
alleviate it, dread even the presence or sound of water, much more 
its approach to the lips, lest all these horrible symptoms should 
ensue. My investigations, simple as they are, throw light on these 
points, and it is hoped will show how relief may be extended in 
fbture in those most distressing symptoms — thirst and parched and 
burning throat — if the means thus pointed out are sufficiently, 
promptly, and carefully attended to. 

That the mere emmd of water will not excite the paroxysm was 
proved in this case by the fact, that the noise of a stream 6f water 
in a doset was continually within reach of his eans, to which he gave 
no heed whatever while I was by him, though it is said that when 
he first heard it he was unpleasantly affected by it. Observing this, 
I then desired to try whether its actual taste, toOhout sivalhioing^ 
could not be safely borne; and to this end I induced the patient to 
take a mouthful, but to hold it in his mouth without attempting to 
Birallow. He did «o, and after retaining it sufficiently long to satisfy 



816 BBPOBT OK 

both him and myself at my direction he ejected it from his mouth, 
expressing gratification at its cooling effect 

One step further I determined to go, though not without some 
fear of producing a paroxysm of pain and perhaps a convulsion. 
I sent for some ice, and with a little persuasion placed a small piece 
in his mouth, directing him to allow it simply to trickle down his 
throat as it melted^ avoiding as before every effort at swallowing. 
A piece of about the size of a thimble was first tried, the cooling 
effects of which were exceedingly grateful, and he willingly accepted 
a second piece. It was very difficult for him to avoid deglutition; 
he did succeed, however, and all the ice descended to the stomach 
as it melted drop by drop, demonstrating in the most conclusive 
manner that water per se has no influence in the causation of the 
spasms, and that the disease is improperly named. It is not a hydro- 
phobia^ a dread of water ; it is rather a dread of swallowing ^ whether 
of water or any other liquid, or even of solid substances, as m j pa- 
tient said to me; and if that act can be avoided as in his case, relief 
may possibly be afforded in others by the administration of cooling 
and perhaps even more decidedly palliative remedies. In fact^ en- 
couraged by these observations, I directed the application of a 
strong solution of nitrate of silver to the fauces with the view of 
allaying the irritation apparent there, and this he bore with not 
more difficulty than is noticed in a majority of the cases in which 
this astringent is applied for other diseases. 

By these means, ^nd the administration of anodyne and nour- 
ishing enemata, the application of cool cloths to his overheated 
head, mustard poultices to his extremities, and dry heat to his gene- 
ral surface, and even by inducing him, a few hours before death, 
actually though slowly and with some difficulty, but not so as to 
bring on any general paroxysm, to swallow some ammonia and 
brandy, the patient was not a little comforted, and his passage to 
the grave made more quiet and less painful. Unhappily, there is 
yet no known antidote to this mysterious poison, and the symptoms 
can only be treated on general principles. The ebb of life was 
attended with no unusual phenomena, none of the unnatural sounds, 
barking, or frothing, or bitiog popularly ascribed to this disease, 
being noticed. The vital powers became gradually exhausted, until 
at 9f o'clock on the 15th, twenty hours after admission, he breathed 
his last. 

What the treatment was during the three days of his sickness 
prior to admission into the hospital I have not been informed, ex- 



HYDROPHOBIA. 817 

eept in being told by him that he had not been able to swallow any- 
thing. What effect an early adoption of the suggestions above 
made might have produced it is of course impossible now to say ; 
yet the thought is unavoidable that this mode of administering 
cooling liquids, carefully followed in the early stages of the malady, 
might sometimes have a very soothing and calming influence, and 
even pave the way for the introduction of more active remedies. 

Cases 43, 44, and 45. Reported by Dr. James S. Sawley^ Buffalo^ 
N. T. 

I inclose to you the statistics of three cases of hydrophobia which 
have &]len under my observation. 

James Caho ; the time of his inoculation not known ; attacked 
January 18, 1864 ; died January 22 ; was healthy and robust, but 
addicted to drink \ about 80 years old. 

Mrs. Willard ; bitten by a cat, January 21, 1854 ; attacked March 
24 ; died March 28 ; between 60 and 60 years of age ; feeble and 
supposed to be convalescing from protracted uterine disease. 

Laurence Mier, bitten, in the latter part of July, 1854, by his 
own dog, which he had cruelly beaten, a few days before. Attacked 
Sept. 14, died Sept. 18. The particulars of the cases of Caho and 
Mier may be found in the Buffalo Med. Jowma\ for May, 1865. 

I was myself bitten by the cat which bit Mrs. Willard. The 
wounds were carefully excised the same day, and no bad resiilts 
have followed. 

Case 46. Reported by Dr. Z. PUch&r^ Detroit, Mick. 

From the commencement of my residence at this place, as a 
citizen of Detroit, in 1836, 1 have seen but one case of hydropho- 
bia in the human subject, which occurred seven years ago, in the 
latter part of May or the first days of June, under the following 
circumstances : Two little lads, each about eight years old, were 
playing together on a small unfenced lot, across which the dog made 
his way, in passing from one street to another, which constituted 
two of the boundaries of the vacant common. On attempting to 
caress the animal, both of them were bitten, but whether the one 
that became rabid, or the one that escaped was bitten first, I could 
not ascertain. The cries of the children soon brought friends to 
their rescue, but the dog nevertheless made his escape. 

One of the boys was seen by a physician who applied chloride 
of lime to his wounds. He escaped hydrophobia. The other was 



'S18 BSPOUT ov 

taken care of in tlie family. His wounds healed readilj, but 
symptoms of water-dread showed themselves on the nineteenth day, 
and he died three days afterwards without medical treatment. This 
omission of all effort to arrest the disease was occasioned by tb^ 
timidity and nervousness of the child, which was partly natund 
and partly induced by the disease, and from one or the other cauBS, 
so highly developed that the approach of a physician would induce 
a paroxysm of suffering almost as surely as the sight of water. 
This account is as accurate as it is possible to make it, for the 
family (some of whom I have seen to day) kept no record of the 
case, neither did any of the physicians who visited it, like myself^ 
from professional motives, keep any memorandum of the occurrenoc. 

I have no knowledge of any other case, if such have occurred in 
Michigan, and I have made inquiries of my professional acquaint- 
ance for that purpose. 

As pertinent to your inquiry, though not containing all the in- 
formation you desire, I will state that in my early youth, when I 
resided in Washington County, N. York, I saw repeated instances 
of canine madness, some of which dogs thus mad, bit stock upon 
my father^s farm; all of which occurred late in autumn, when 
people were gathering apples and potatoes. I will also add, that in 
the month of April, 1881, at Fort Gibson, Cherokee Nation West, 
after a severe winter, which killed the cattle of the Cherokees, the 
prairie wolves who fed upon their carcasses became rabid and 
communicated the virus to some of their domestic animals, but 
not to any of their people. 

Oar "Dog Ordinances'' take effect in July and August of each 
year. 

Case 49. Beported by Dr. B. P. Miller, Mi. Carrol, Carrol do., IIL 
In the village and neighborhood in which I reside, rabid dogs 
have been very plenty since about the first of January, 1856. The 
cold has been intense through the months of January, February, and 
until about the 20th of March ; the temperature nearly the whole 
time was from 18 to 80 degrees below zero. Dogs through those 
m6nths have continued to be afflicted with rabies. 

Cattle and horses which were bitten by those animals, were 
attacked with the disease in from sixteen to sixty days after they 
were bitten ; death occurred in from one to three days after the dis- 
ease was developed in horses or cattle. I have not known of a dog 
being confined, and cannot say how long the dogs would live after 



HYDROPHOBIA. 819 

being attacked with the disease; the dogs hare been inyariably 
killed as soon as possible. 

I have had but two cases of the human subject bitten, in my 
practice; one, a fine, healthy boy, about 6 years old, of sanguine 
nervous temperament, son of Mr. Horace Melondy, of York Town- 
ship, Carroll County, 111. ; the other a hired man, in the employ of 
Mr. Melondy, of bilious nervous temperament; they were both bitten 
by the same dog, on the 5th day of March ; the boy was badly torn 
on the face : one tusk of the dog entered the orbit, near the inner 
canthus of the left eye, making a wound obliquely downwards, and 
cut about 1| inches long; he was also bitten through the lower lip, 
and in several places on the cheek. The hired man was bitten on 
the finger in trying to secure the dog. 

I was sent for immediately, and saw the subjects within four 
hours after they were bitten. I excised the bitten part as much as 
I could, and used nitrate of silver freely to the wounds, first wash- 
ing and syringing the wounds freely. After probing the wounds with 
aolid nitrate of silver, I pulverized the silver, and filled the wounds 
with the pulverized silver; as soon as the cauterized part sloughed, 
which occurred in two or three days, I again applied the caustic, 
continuing to wash the wounds &eely. I gave internally calomel, 
until slight ptyalism was induced, dressing the wounds, after the 
eighth day, with simple dressings ; the child's health continuing very 
good, wounds healed rapidly, no unhealthy appearance appeared 
at any time; complained of no pain or soreness in the wounds 
until Thursday, the 20th, fifteen days after he was bitten. In 
the afternoon he complained of darting pains from the wound near 
the eye, with twitching of the muscle of the eye ; through the nighty 
was restless, starting suddenly from sleep, complaining of pain in 
his eye. In the morning of Friday, felt better, and played as usual, 
and appeared to feel well, until about 4 o'clock, when he called for 
some water ; his mother gave him a drink, he hurriedly swallowed 
a mouthful, and complained that it choked him, and could not be 
induced to try to swfdlow any more; complained of soreness in the 
thix>at, and darting pains through the eye; complained of thirst, 
but the sight of water produced convulsive action, particularly if 
the water was in motion. If water was carried to him without 
ruffling the surface, he could look at it without any convulsive 
action, but shake the water, and spasm was the consequence ; we 
succeeded, however, in getting considerable fluid in to. the stomach, 
by placing a wet cloth over the mouth. The boy could compose the 



820 BEPOBT ON 

mind, so that wben the cloth was removed quicldj, and a spoonfbl 
of water poured into the mouth, he could swallow. If an attempt 
was made to give any more, convulsive action would be produced; 
but replace the cloth, and allow some time to elapse, the mind would 
become composed, the boy would request the cloth removed, and 
another spoonful of water poured quickly into the mouth he oouM 
succeed in swallowing it. From Friday until Thursday evening, at 
which time he died, the eyes were staring widely open ; in fict, 
there appeared to be an inability to close the eyelids ; he did not 
even wink ; there appeared to be a perfect rigidity of the muscled 
The spasms continued to increase in violence until Sunday, about 
4 o'clock, at which time he was taken with a violent convulsion, 
which lasted about one hour and twenty minutes; after which he 
gradually sunk, and ceased to breathe about 7 o'clock. 

Cask 50. Reported by Dr. B. P. Miller, Mi. Carroll, Carroll Oo^ HI 

The hired man was subjected to the same treatment, but the 
bitten part I was able to completely excise, and I applied the caustic 
freely; there has been no symptom of the disease as yet in the man; 
the wound has healed, and he has been at his ordinary avocation for 
some time. Several cows and quite a number of dogs bitten by the 
same animal have become rabid. 

There have been no dog laws enacted in my vicinity until 
recently. 

So far as my observation in relation to rabies goes, I have found 
in the region of country I live in, that the disease occurs more 
frequently in the winter and spring than at any other season of the 
year. The extreme cold of this winter appeared to have an influence 
in producing the disease, as the cases have been far more numerons 
this winter than in former years, and this winter has been fiir 
colder than any for a number of years ; in fact, to my knowledge I 
have not known the disease occur in warm weather in this country. 

If the Committee or Association in their deliberation or corre- 
spondence elicit any information in reference to the treatment 
either before or after the disease manifests itself, they will confer an 
obligation by forwarding me the results of their investigations. 

Case 68. Reported by Dr. Jas. M. Newman, Bvffah. 

This case occurred in the practice of Drs. Nichell and Weisa, 
German practitioners of this city, and no detailed record of the case 
was made at the time, my knowledge of the facts then being derived 



HTDBOPHOBIA. 821 

from the certificate of the cause of death filed in the city clerk's 
ofiSce, and from the statement of one of the Health Inspectors ; the 
latter I fortunately made a memorandum of at the time. For dates 
it will perhaps be the most certain to rely upon what written records 
we possess. 

The certificate of the caase of death, returns the following : The 
patient's name, Nicholas Lang, of German parentage; aged 11 years, 
6 months and 8 days; died 11th of March, 1854; disease, hydro- 
phobia; was bitten by a large dog nine weeks and three days before 
death. The symptoms continued for eighteen hours. Drs; Nichell 
and Weiss were called eight hours previous to death. 

The father makes the following statement. Ei9 son was bitten 
about six o'clock in the morning. The dog belonged to a neighbor 
or acquaintance, and was in the habit of coming to the house, being 
apparently attracted there by a slut, and in the visits was trouble- 
some to some fowls the family had in the yard. Upon this morning 
the father saw the dog coming to the house and called to his son, 
" that he would eat up the hen&" The boy sprang out of bed, and 
went to the door to frighten the dog away, and while in the act of 
so doing the dog sprang at him and bit him through the fleshy part 
of the left forearm. 

The wound was dressed with some application obtained from a 
midwife ; it healed up, and nothing was feared at the time. The 
father makes the length of the time of the continuance of the 
hydrophobic symptoms several hours longer than stated in the 
certificate. He says his attention was first attracted, upon the boy's 
complaining of some indisposition, to the condition of the woimds, 
which he describes as so looking, that he said to his wife that he 
was afraid the son's arm was going to break open again. The in- 
disposition increasing, and the manner and appearance of the boy 
being such as to excite his suspicions, after some little time he 
offered him a glass of water to drink, which instantly induced a 
paroxysm. Medical aid was then called. The same result of an 
effort to drink was witnessed by his medical attendants, and they 
had not the least doubt of the fearful character of the disease they 
were contending with. The boy had a strong desire to bite those 
about him, and warned them to guard themselves, and once snapped 
at his mother's hand, but fortunately missed it. A few minutes 
before he died, he asked for some bread and coffee to be given him, 
which he took, and his father thinks swallowed some, when he 
almost immediately sprang wildly up in bed, and fell back a corpse. 



822 B8POBT 09 

Case 64. Repotted hy Dr. Ja^ M. Newman, Buffah. 

A dog was bitten by the same animal about three days after he 
bit the boy. On the evening of the funeral of the boy, this dog 
exhibited symptoms of rabies, and was shot by its owner before he 
had an opportunity of doing any harm. 

The dog which had created all the mischief was preserved by 
his owtiQTf and notwithstanding the earnest entreaties of the &&iist 
after the death of his son, the owner steadily refused to destroy 
the dog, accompanying him about town except when he was kept 
concealed from Mr. Lang, until the latter, losing all patience, went 
at last to where the dog was, t<x>k him and hung hinL He says he 
does not now recollect how long this was after his son^s death, but 
thinks it was several weeks. From a memorandum I made directly 
after the occurrence, I find that the dog was killed on the 14th of 
April, 1854, thirty-four days after the death of the patient I 

Does the dog usually live so long after an attack of rabies? Has 
not his death generally been considered certain, and that very shortly 
after the development of the disease ? 

Cask 86. Reported by J. Perkins, M. D^ Oastleton^ Vt. 

Miss Sarah Crehore, of Newton Corner, Mass., of sanguine 
nervous temperament and healthy constitution, and cheerful dispo- 
sition, aged 28 years, was bitten by a large mastiff dog on the 22d 
of August. 1849. The wounds inflicted, two in number, were on 
the anterior part of the right ankle ; the inferior one, one inch, and 
the superior one, two inches above the articulation, both having 
considerable depth, and penetrating between the extensor tendons 
of the foot. The dog had acquired the character of ferocity by 
repeated attacks upon strangers who entered upon the premises of 
his master (in this instance. Miss C, with a friend, was crossing the 
garden of his master), but, as he was under perfect control of the 
family, was not suspected of madness. Yet, as he had in this way 
become very annoying (Miss Crehore^s wound being a severe one^ 
food was given him, which he ate in his usual manner; this yfBB 
regarded as proof of his freedom from the canine disease, and the 
dog was killed ; and, no apprehensions existing on this ground, the 
wound of Miss G. was only treated with simple dressings, and 
slowly healed so as to become completely cicatrized in four or five 
weeks. 

The following winter, Miss G. resided a few weeks in the family 
of her sister, in this place (Oastleton, Vt.), ap^mrently in perfect 



HYDBOPHOBIA. 828 

healtli ; but probably entertaining some apptebenmons in regard to 
the previous misfortune, which was inferred from her aversion to 
speak of the subject. 

On the 16th of January, 1850, the 127th day from the infliction 
of the wound, Miss C. read in a Boston paper the obituary notice 
of Mr. Bean (c^ Boston), who died of rabies camna six months after 
Teceiving the bite of a dog which was supposed (at the date of the 
bite) not to have been rabid. The patient was evidently alarmed 
by this perusal, appeared anxious, and shortly afterwards com- 
plained of severe pain in the lumbar region, and lancinating pains 
in the right ankle, knee, and hip. These were relieved by a lini- 
ment of soap, camphor, and opium. The following night was sleep- 
less, but quiet; her watchfulness was known by her fellow -lodger 
only by a frequent suppressed sighing, without complainiDg. She 
fleemed to sustain her-gloomy apprehensions in silence. 

On the morning of the 17th she rose dejected and nervous, and, 
jdthough she had not spoken of the subject of her solicitude, har 
friends, tacitly comprehending it, applied to me for professional 
advice, and, with the above history of the casq, suggested their im- 
pression that her illness might be due solely to excessive alarm, 
which might be aggravated by a professional visit. Yielding to 
the suggestion, I contented myself with prescribing a strong decoo- 
tion of valerian to be taken liberally at short intervals, and advised 
to various endeavors to dispossess the patient of the horrible idea 
which she evidently entertained; also a careful observation of 
symptoms and an immediate report if changed. The day was 
passed without appetite ; moderate complaint of pain in the back 
and limb, which were treated as before ; the patient being as usual 
about the house and employing herself with needlework. This 
condition being reported to me at 7 P. M., no change was advised 
in treatment. 

At 9 P. M., with some impatience, she asked for " some drink," 
saying she was " very thirsty ;" but when a tumbler of water was 
offered her, she recoiled from it with a shudder, and motioned it 
from her, and, after two or three spasmodic respirations, exclaimed, 
^' Ohj that dreadful disease is on meT and proceeded to express fully 
the fearful apprehensions which agitated her mind; but shortly 
afterwards, with great composure, she expressed her entire submis- 
sion to the dreadful necessity of the case. A message was sent me, 
but being out of town, I did not see the patient at this time. With- 
out repeating the attempt to swallow or complaining of thirst, she 



824 BBPOBT OK 

retired to rest with her sister at 10 P. M^ and remained qnieti 
silent, but sleepless, until S A. M., the 18th, when she snddenlj 
q)rang from the bed in great agitation and apparent alarm. She 
could not explain the cause of her excitement, but the few words 
spoken indicated no mental aberration. She was soon persuaded 
to return to her bed, and I was immediately in attendance. Found 
the extremities and surface of the trunk cool ; pulse 70, small and 
weak; bowels constipated; urine scanty and high colored; slight 
pain in the back ; " uneasy drawing" sensation in the right leg, and 
also in the prsdcordia. Speech earnest and hurried ; intellect appa* 
rently sane. No recrudescence of cicatrix on the ankle. Tongue 
covered with a thin, moist, ash-colored coat, darker in. the centre. 
Prescribed musk 20 grs., camphor 5 grs., in simple syrup, which 
was swallowed with some effort, attended by a slight spasm of the 
pharynx and sighing respiration. The patient also, in like manner, 
swallowed several spoonfuls of tea. Give calomel in pill, iv grs. 
each fourth hour, until dejection takes place; also continue vale- 
rian. 

This success in again swallowing liquids was evidently unex- 
pected to the patient, and appeared so to corroborate to her mind 
the advice of her friends, that her malady was not rabies canina, but 
a simple hysteria or nervous affection, as greatly to diminish her 
anxiety. This impression was followed by a tranquil sleep, which 
continued two or three hours. 

9 A. M. patient more cheerful ; surface warm; moderate per- 
spiration ; pulse 74 ; pain in back, and uneasy sensations in limb 
and prsBCordia diminished ; tongue unchanged ; sits up, swallows 
liquids from a spoon with less difficulty. Same medication con- 
tinued. 9 P.M. patient more quiet and cheerful; has swallowed 
with but slight inconvenience at three several times to-day, a cup- 
ful of gruel; takes liquids from a spoon with comparative ease; 
pain diminished ; pulse same in frequency, stronger ; tongue and 
skin as before ; has had free dejections from the bowels ; converses 
cheerfully. From this time forward Miss C. evidently believed that 
her disease was hysteria, or some anomalous nervous affection, and 
not rabies canina, and hence was relieved from the fearful fore- 
bodings with which it was ushered upon her. Discontinued calo- 
mel; give ^ gr. sulph. morphia; continue valerian, musk, and 
camphor. 

Patient retired to bed at ten ; desired to be left alone and with- 
out a light; was found asleep in half an hour; slept until 12; 



HYDROPHOBIA. 825 

awoke somewhat agitated, but slept again quietly nearly an hour, 
then awoke suddenly greatly excited ; seized and held witli great 
strength the nurse^s hands ; spoke loud and rapid, but distinctly and 
rationally for a few minutes, recognizing all in the room. Her 
speech soon became constant and increased in volubility, until it 
seemed impelled by a rush of incoherent recollections, pronouncing 
disconnected words, and at length disjoined syllables, and at last a 
rapid succession of inarticulate sounds. In this cotidition I found 
her at 2 A. M. the 19th. The saliva was abundant and constantly 
foaming on her lips or scattered around by alternate retchings to 
vomit, and spasms of the respiratory organs, mingled with attempts 
to speak. Pulse weak, 130; profuse perspiration; extremities 
cold; great heat of the head; wishes to get up; requires great 
e£fort to keep her on the bed; jactitation incessant; motions 
apparently voluntary, but accomplished with the rapidity and force 
of spasm. In short, the patient is in an a^ny of excitement, which 
is now aggravated by the sight^ of liquids and currents of air. 
With much difficulty, an uncertain part of Jgr. sulph. morphia was 
given. Attempted to administer sulph. ether by inhalation ; patient 
at first excited, followed by slight ansesthesia. After a little delay, 
administered chloroform in like manner, imperfectly at first on 
account of resistance ; attempts several times repeated through 16 
to 20 minutes, were at length attended with complete success; 
spasm and jactitation ceased ; patient became silent, drowsy, un- 
conscious. The last state continued but a few minutes, when she 
awoke as if from sleep. 6^ A. M. recognized those around her; 
wondered much at the disarrangement of her bed, dress, the pre- 
sence of her friends and physician, &c., about which she asked 
several questions, but appeared easily satisfied by the reply that 
she had a severe attack of a nervous disease ; she was evidently un- 
conscious of all that had passed for the last few hours ; she conversed 
rationally but with unwonted cheerfulness and exhilaration, ap- 
parently free from any unhappy apprehension ; pulse 110, mode- 
rately full, soft ; surface moist and warm ; muscular strength much 
diminished, but arose from her bed with the aid of the nurse and 
reclined on an easy chair ; took toast and tea without. inconvenience; 
patient thus reclining was expressing her pleasant anticipations of 
returning to her home, whither she invited her friend, who was 
arranging her hair, to visit her. In the midst of a sentence her 
voice fidtered, stopped, her head reclined, lips and nails were livid, 
and without a struggle she quietly ceased to breathe, about one 



826 BBPOBT OK 

minute after she ceased to speak, and at 7} A. M. of 19th Jan. No 
jM8t-mortem examination was permitted. 

Casb 91. Beparted hy Dr. W. B. OouH Lochport, K T. 

I was called to this case on the 18th of Not^ 1865, the day on 
which the child was bitten. 

The child was 3 years of age, a boj, was bitten by a rabid cat 
(as was supposed), having belonged to a fiunily whose dog had been 
killed after giving evident signs of having been rabid. 

I went prepared to cauterize the wounds, which were upon the 
forehead and inner canthus of the left eye ; but upon further in« 
quiry the parents thought the oat not mad, «id did not wish to 
have anything done. 

The child sickened on the thirty-third day after it was bitten, on 
Saturday, and died on the Wedn^ay following. 

I obtained the following history from his mother: — 
. The child appeared perfectly well up to the thirty-third day; it was 
then taken with vomiting, followed by fever, which lasted twenty-four 
hours. During the fever there was much thirst, and the child drank 
freely ; slept some the first night aftier the attack ; on the second 
day walked around the house, but was easily frightened ; appeared 
watchful ; if touched would start and scream out. From this time 
he could not partake of liquids or solids. On attempting to drink 
would experience a convulsive shudder, and was similarly afiected, 
but to a less extent, in any effort to partake of solids. Slept none 
after the first night, but was constantly shifting about from place 
to place, and much of the time talking incoherently. 

The day on which it died these symptoms were aggravated to 
paroxysms of raving, in which it appeared frantic. This would 
last an hour or so, succeeded by more or less quiet It had three 
of these paroxysms, the last of which was followed by constant 
efforts to shift about, talking and shrieking, until exhaustion and 
death ensued. 

The child took "Moore's medicine," in three days after being bit» 
ten, and continued it as long as deglutition could be performed. 
Did not see any effect from it whatsoever. Dr. Moore is an irr^u« 
lar practitioner, and claims to have a speoifio for hydrophobia. 

I did not see the child from the day on which it was bitten until 
it died ; I was then called to see it,, and was told it was dying ; Dn 
Leonard accompanied me. We found the child pulseless at the 
wrist, and in the greatest possible agitaticHi ; we administered chlo* 



HYDBOPHOBIA. 827 

Toform, whicli gave temporary relief. Death closed the painful 
aoene ia a short time. 

Casb 92. Reported by Dr. 0. W. fftgginSy Abingdon^ III 

The first case of which I shall speak, is that of a Mrs. White, 
living two and a half miles southwest of this place, age 25 ; tempera- 
ment nervous sanguine ; taken March 29, 1856. 

The attack was sudden ; previous to it, however, she appeared 
irritable and melancholy. When called to see her, she had well 
dbaracterized symptoms of hydrophobia. The sound of liquids 
would cause violent q>asms ; a current of air would also produce 
the aame effect ; so sensitive was she, that any one on approach- 
ing her, and causing an almost imperceptible motion of the atmo- 
sphere, would cause the spasms^ Saw her on the following day 
(March 80); symptoms had increased so much that she was unable 
to swallow either liquids or solids ; and I had at no time the oppor- 
tunity of administering anything, and could not get near her with* 
out causing spasms. She died next day, Sunday, Slst^ having been 
sick about forty hours. 

In regard to the manner of inoculation, I know of no other means 
than the following: About one year previous, a dog, belonging to 
the family, became rabid, and bit two calves; the dog died, and a 
^ort time afterwards both calves. One of the calves belonged to 
the cow which she was in the habit of milking, and my supposition 
is that the saliva of the calf came into contact with some part of the 
hand, which was abraded, and thence introduced into the circula- 
tion* 

Cask 9S. Reported hy Df. C. W. Higgins^ Abingdon^ lU. 

December 10, 1855. Called to see Zulick Clarke, the case to 
which you refer ; found him laboring under well-defined symptoms 
of hydrophobia ; made inquiries of the fitmily, and found that on 
the 10th of November, 1856, he was bitten on the right hand by a 
cat, which he was' obliged to choke otL He killed it immediately. 
At the same time his daughter, a little girl of 8 years of age, was 
bitten. The wound on his hand healed kindly, but that on the 
child suppurated and healed by granulation, and she has since felt 
no effects from it. The first symptom peculiar to hydrophobia, 
appeared on the 10th of December, about four weeks from the bite 
of the cat ; upon interrogating his wife, found he had been irritable, 
and complained of a pain in and difi^ulty of using the arm ; symp- 



828 BEPORT ON 

toms increased rapidly, until the 12tli, 10 o'clock A. M^ when death 
relieved him of further pain. Tried chloroform, which produced 
asphyxia. His age, 55 ; temperament, nervous-sanguine ; resi- 
dence, one-half mile north of this place. 

Cask 94. Reported hy Dr. C. W. Higgins^ Abingdon^ III 
Two other cases of hydrophobia have occurred in this place; 
one of a horse taken June 10th, 1855, sick about forty hours, died; 
do not know the manner of inoctdation. During the attack he 
would attempt to bite everything that came within his reach ; he 
succeeded in biting one man severely. I immediately cauterized 
the wound; no unpleasant effect has since been experienced from it. 

Case 95. Reported hy Dr. C. W. Eiggins^ Abingdon^ III. 

The other of a cow taken about a month ago ; lived twenty-four 
hours after the attack ; know of no means by which the disease 
was contracted. 

There is no dog law in operation in this vicinity: 

Cases 98 and 99. Reported by Dr. R. D. Musaey, OincmnaU, 0. 

I have been called to witness two cases of this terrible disease. 

1st. That of a girl 15 years ^old, bitten on the cheek by the family 
dog, not known to be mad. Six weeks afterwards she sickened, 
and died on the third day, with all the characteristics of hydro- 
phobia. 

2d. That of a young man ; I do not remember where be was 
bitten, whether on the band or leg, in July. Sickened the follow- 
ing February, and died the fourth day after the attack. 

Should I again be called to a person bitten by a rabid animal, I 
should apply to the wound very freely the tincture of iodine; 
especially if the wound was on a part which could not readily be 
excised. My son has tried it in several cases of bites from animals 
supposed to be rabid ; but inasmuch as not more than one in twenty 
of those bitten by rabid animals have hydrophobia, we cannot re- 
gard iodine as a sure prophylactic, without a far more extended 
experience. 

Cases 102, 108. Reported by Dr. Jno. W. Green, New York. 

Miss Bassett, est. 11 years 11 months, bitten on the lip by a small 
dog, on or about the 10th April, 1855, was sent to New Jersey, 
where she underwent some kind of prophylactic treatment, and was 



HYDROPHOBIA. S29 

pronounced out of danger by the empirio officiating. Brought home^ 
and on the 7th July, 1855, was attacked in the following manner : — 

About 10 P. M., Saturday. Bobtered up in bed ; great difficulty 
in breathing; constriction about diaphragm; pulse 120 to 125; 
tongue coated; difficulty of spitting, requiring great effi)rt; nothing 
said about her having been bitten; almost impossible to swallow 
either liquids or solids; skin cool; eyes wateiy and staring; had a 
lump, as she expressed it, in the region of the heart; was induced, 
after much persuasion, to swallow a teaspoonful of sol. tart. ant. et 
potass. Sunday, July 8th, 9 o'clock A. M.; has not slept ; obliged 
to stoop forward to breathe; tongue thickly coated; pulse 120; 
great difficulty in swallowing; antimony produced slight eijiesis 
during the past night; after midnight she refused to swallow; oom* 
plains of pain about the right eye ; oould not bear to be fanned or 
have a current of air upon her; shudders, and has spc^sma, if paper 
10 rattled near her, and requests that it be discontinued. 2| P. M.; 
no better; springs out of bed, froths at the mouth, and endeavors 
to bite those standing around her; was induced by a physician who 
saw her, to wash her hands in cold water, which produced convul- 
sions, and made her scream violently; has not slept. Monday, 9th, 
8 o'clock A. M. Violent convulsions; hands thrown up above 
Iier head, when she attempts to free the mouth of the viscid saliva; 
almost impossible to control her, or prevent her from jumping out 
of the window; has had, at intervals, 12 drops tinct. belladonna, 
in two-drop doses, during the last eight hours. 2^ P. M.; qniet, 
and amused herself by looking at her books and pictures; relieves 
herself of saliva with less difficulty; dislike to fanning still continues; 
cannot go outdoors; was more comfortable; conversed naturally 
with those around her. Could see water poured from a spoon with- 
out a spasm ; would not drink or take nourishment, the endeavor 
so to do producing spasm; pulse 112; walked about the room; 
stirred lemonade with a spoon, but did not drink. 

Tuesday^ July 10, 6 o'clock A. M. Learned that at 11 o'clock 
last night she drank warm lemonade, and after slept an hour ; ate 
ibis morning soft boiled eggs, soda crackers and tea; drank also 
lemonade. Tongue clean; pulse 120. At 7 A. M. washed her pet 
chicken's feet in warm water without a shudder. At 10 A. M. was 
moody and cross; wished to get out of sight. Head bent forwards, 
would not eat or drink, spit and bit at every one who approached ; 
could not control herself; complained of pain along the course of 
the spine ; great tenderness on pressure ; unable to swallow ; spasms 
yoL. IX,— 22 



8S0 BBPO&T ON 

ayery two or threo minutes; tried to bite. 8^ P. M. £al bfead 
and butter and drank tea from a eaueer. Pube 100, tongue dean, 
skin oomfortablj warm. Head inclined to tbe right aide; quite 
cheerful; ate some strawbemea brought by her medical atb^idant; 
went up stairs alcme ; shook hands with her friends who came to 
■ae her ; did not complain of her back. Takes the tinct belladonna 
at intervals; seems sleepjc Has lain in bed during the afternoon; 
drank a little wine and water. At 9} P. M., she became delirious, 
at 10 was put to bed. The spasmodic action was very seYere^ 
'^frothed at the mouth," and bit at her attendants. Battling and 
choking in the throat Tore away the clothing from about h& 
neck. Head and body hot; her mother attempted to wet the head 
with cold water but found it increased the violence of the parox* 
ysms so much as to oblige her to desist After 12 at night symp- 
toms all increased in violence; two or three men were required to 
hold her. She cautioned her father against coming near her, as she 
would bite him. At 3 A. M. she became blind ; frothy saliva ran 
from her mouth. Continually she attempted to tear everything 
within her reach, and clawed at the air. At five minutes past 5 
o^clock A. M., July 11th, she died ; cadaveric rigidity came on 
within a few minutes. No post-mortem could be obtained. 

The basis of the above is from a note received from Dr. Tree- 
man. 

Mr. Taylor, a patient of mine, residing at Morrisania, had two 
children bitten at the same time with the Bassett girl. As soon as 
she was attacked I had them sent away from the neighborhood ; they 
were taken to Long Island, about seventy miles from their home, 
and kept until all the excitement natural to such eases had passed 
away. Neither of them so far has exhibited any hydrophobia 
symptoms, and, as you can see, it is now over fourteen months sinoe 
the time of wounding. I shall keep them in view, and should any- 
thing occur will let you know. As to the Bassett casei I saw the 
patient myself on Monday, the 9th, about 1 o'clock P^ M. Found 
her sitting up amusing herself with her books and pictures. She 
appeared to me to be suil^ng from nervous exhaustion. She was 
wayward and expressed strong likes and dislikes to different per- 
sons ; said she was glad tp see me and would let me stay, but ''that 
other roan (alluding to another physician) must not stay."* The 
only experiments I made were rustling paper near her and fitaning 
her. The former produced great unea^ness, but no marked spaa- 



HYIXBOPHOBIA. 831 

modic action. She turaed to me and wished me to desist, as she 
said it made her feel badly. I then took up a magazine, engaged 
lier in conversation, and with the right hand (I was sitting at her 
left side) which was hidden behind her chair, commenced to fan her 
gently and from a distance, as I brought the paper nearer she be- 
came more and more agitated, until when quite near, she grasped 
the fan, was slightly convulsed, and she turned in an irritable man* 
ner to me, saying : " Stop that, you are blowing on me." 

I saw her again on Tuesday morning ; found her in the garden 
attached to the house. She was walking slowly about being sup* 
ported by her £ither; was told that she had drank lemonade and 
tea, and had eaten eggs, bread, etc. ; her general appearance was 
still very bad ; the last paroxysm was worse than any preceding 
one. The next day I received word that during the night she had 
had two paroxysms, and that death had closed the last one and her 
life at the same moment. 

Cash 103. Reported by Dr. Jno. W. Oreen^ New York 
I. B., a native of Ireland, aet. 30, was bitten by a small dog some 
time about the month of March. The wound remained open for 
six or eight weeks, when it cicatrized, to all appearance, soundly. 
Four months from this time he became careless (he was foreman in 
a large coal yard), listless, and was frequently reproved by his em- 
ployer, who did not suspect the cause. The day of his seizure he, 
in company with some of his friends, entered a saloon and called 
for beer; taking up the glass, he found he was unable to get it to 
his mouth, and finally was obliged to give up, notwithstanding the 
langh on the part of his companions. He returned to the yard, 
appeared very iH, and was sent by his employer to see Dr. David 
Green. He did so. Dr. Green supposed, from his symptoms, that 
he was laboring under the after effects of a "spree,"' prescribed for 
him with this idea, and was to call at his house in the evening. 
Upon calling at night found him restless, and walking the floor ; 
was told he could not take the medicine prescribed, nor could he 
swallow any fluid, the mere act of oflfering it to him produced a 
shudder. The Dr. then qnestioned him particularly as to his hav- 
ing received a scratch or puncture from a nail or other instrument, 
and was told immediately that he had been bitten by a dog, sick at 
the time, and that he had killed it. He was urged by Dr. Green, 
who was then convinced of the case being one of rabies canina, to 
send for his usual medical adviser, who lived at some distance. 



882 BSPOKT OK 

This was complied with, and the two physicians met late tbe same 
night. Every argument and all means were used to induce him to 
do something; but it was useless. He declared that it was unne* 
cessary, there was no hope for him, he must die. The nervous dis- 
turbance increased; he could not sleep, wias Tory restless, asked his 
employer to procure straps and confine him, should he be seized 
with convulsions, in order that he might not injure those about 
him. At 11 o'clock the next morning was attacked by a convul- 
sion ; four or five strong Irishmen seized him, threw him upon the 
bed, face down, and from fear of injury kept him there till the 
spasmodic action ceased ; when they loosed their hold the pati^it 
was dead I ! 

During my travels in the East, I ascended the Nile nearly to the 
second cataract The mud villages which adorn its banks are 
densely populated by a race of curs that seem to have little in 
common with the dog, as we are acquainted with him, except in 
name. It being a vulgar idea that heat is one of the exciting causes 
of madness in this animal, and as Egypt and Nubia are in such 
close proximity to the equator, I was struck with the idea that this 
would be a favorable spot for the origin of rabies. Although 
I made frequent inquiries, sometimes daily, I £xiled to become 
acquainted with one fiict of the kind. The disease seemed to be 
entirely unknown. 

In Turkey also, as is well known, there are large numbers of 
dogs which run wild about the streets. The Turks consider them 
unclean, and are not to be persuaded to touch them, yet they never 
injure them, but will throw them food at times. They are very 
ferocious, and yet cowardly. Should by any chance a strange dog 
make his appearance upon the quarter already occupied by two or 
three others, they will at once fall upon him, and tear him to 
pieces. It is told as a fact at Constantinople that a gentleman 
confided a valuable pointer to a servant for the purpose of having 
him exercised. When the servant returned, upon being asked what 
he had done with the dog, held up in answer his hind leg, whidi, 
he affirmed, was all he had been able to save of the unfortunate 
animal. At night it is dangerous to go about the streets without 
arms or a stout stick, as well as a lantern, for there are numerous 
instances where persons have been attacked while walking quietly 
along. Yet, with all this disposition to become irritated, I was 
unable to find a single case where rabies had ensued from their 
bite. 



HYDROPHOBIA. 888 

Cask 104. Heporled by Dr. W. L. Ailee, PhiJa^ Pa^ June 20, 1856. 

Some time ago I promised you some notes of a recent case of 
hydrophobia, and in order to make them more perfect I wrote to 
the physicians, whom I met in consultation, to aid me. I have as 
yet received no answer, but fortunately my young friend, T. M. 
Drysdale, M. D., had made some notes of the case, which he has 
had the kindness to hand me. He is a most accurate and reliable 
observer. 

I first visited Mr. J. L., $dt 64, Sanday, September 2d, 1855, in 
consultation with Drs. C. and G., and found him laboring under un- 
mistakable evidences of hydrophobia. I at once proposed trache- 
otomy in connection with other active means. It was, however, 
deferred until next day, when I visited him again in company 
with Dr. Drysdale ; prepared to perform the operation, but this 
was peremptorily refused by the patient and friends. Since my 
first visit he had been tranquillized for a couple of hours by the 
inhalation of my mixture of chloroform (one part), and ether (two 
parts), but was now more excited than ever. The following is a 
copy of Dr. Drysdale's notes: — 

'^ Case of J. L., sat. 54, Sept, 8, 1855. The patient was bitten in 
the right hand by a small strange dog, in May last, but enjoyed 
health until last Thursday, August SO, when, after rowing a boat, 
he was seized with severe pain in the bitten arm, tbe pain darting 
to the cervical regions, where it was particularly severe. The next 
symptom which attracted his attention was the difficulty of deglu- 
tition. This he first noticed in attempting to swallow a dose of 
Epsom salts, which a druggist had prescribed for him. ^ 

'' Dr. S. was consulted, and, although the man was but a moderate 
drinker, treated the case as one of delirium tremens. The family 
being dissatisfied. Dr. S. was discharged and Drs. C. and G. were 
called in. At their request Dr. Atlee was sent for, who found the 
patient in this condition: Agitated and irritable; when a glass of 
water was ofiered him, he was seized with spasms. Spasms were 
also produced by blowing suddenly in his fctce. 

"At 12 M. I accompanied Dr. A. to assist him in opening the 
patient's trachea. We found the patient walking about his garden, 
speaking rationally, and answering any questions put to him; but. 
his manner was restless, and when Dr. A. desired him to tell where 
he had been bitten two years before by a raccoon^ he at once lost 
self-control and became furious, refusing to allow any one to speak 



SS4 BBPOKT oir 

4o him. After h time li« gT^ew oalm, and Dr. A. told him what lie 
proposed to do, bat he refused conaenting to any operation. 

''The night before he had been very violent. He could iiol 
swallow anything while we were present, althongh he made stroog 
•efforts. A blister had been applied over the spine, and the denuded 
surface dressed with morphia and lactuoariam. Dr. Atlee recom- 
mended the use of enemata of beef tea, with fall doses of morphia, 
and the mixture of chloroform and ether to be inhaled. 

^^Sept. 4. Dr. Atlee sent word to me that Mr. L. was dead, and 
the family desired a post-mortem examination. Accompanied by 
Drs. Fleming and Jackson, I went to Mr. L.'s, where we met Dr. 
C, who gave us the remaining history of the case, as follows: Afi^ 
our visit yesterday, at about 1 P. M., he became exceedingly violent^ 
and towards evening ran out of the hoase, across the street uid 
home again several times. He now desired intercourse with his 
wife, which could only be prevented by removing her from the house. 
Dr. C. attempted to apply the strait-jacket, but failed, as his 
assistants were not strong enough. At night he became so violent 
that it was found absolutely necessary to use restraintj and Kr. C, 
with eight assistants, managed to get on the strait-jacket. It was 
now observed that his pantaloons were stained as if with semen, 
and when the patient attempted to urinate the penis was seen to be 
in the state of erection accompanied by all the signs of involun- 
tary emissions. 

"He accused the Dr. of having had intercourse with his wife; 
became convulsed, and, after foaming at the mouth, died insenBibk 
at 10 o'clock this morning. 

"6J P. M. Sect. Cad. Pharynx very much congested; larynx 
slightly inflamed, and together with the trachea covered wiUi a 
tough froth, about one-fourth of an inch thick ; the glottis was 
closed; abdominal organs healthy. This was all the examina* 
tion permitted." 

Case 106. Beported by Horace Manhy^ M.D^cf Richfield Spa^ 
N. T. 

Joseph Bell, of Columbia, N. Y., 85 years of age, a tanner. Ha- 
bits somewhat intemperate, but laborious in the discharge of his 
duties, and generally of sound health. On the 5th of October, 1886, 
he was bitten on the thumb by his own little dog. His son, 11 
years of age, and daughter, 18, were bitten at the same time by tbe 
same dog. Five or six dumb beasts were also bitten, and died from 



HYD&OPBOBIA« S8& 

hjdroplioliia. The son was attablcad wiili hydiophobift on the 12ik 
of June, 1837, and died in two days. This case I did not witness. 
Mr. Bell faimseilf was attacked oft the 16th of June, two days after 
die death of his #on, with evident symptoms of hydrophobia. The 
aymptoms and treatment here given are taken from notes made ad 
the time by myself and my friend, I>r. Oriffith. 

The first evidence of disease was a violent headache on rising 
finom bed ; he, however, went to his work in the tanyard as usoal, 
and in an hour appeared to be occasionally in deep study, and at 
times would start up affrighted, as if he thought something was^ 
about to fall on his head. In about aa hour more, he flew out of 
the tanyard, leaped over his garden-fence, stopped auddenly in' the 
garden, threw away his cravat and hat, ran about twenty rods, and 
again stopped, and stood musingly, as before. He soon ran again, 
and attacked the stump of an old tree, and tore it with violence. 
fie continued running and standing alternately until he was appre- 
hended, say about 10 o'clock A. M. The eight of water would 
invariably bring on a paroxysm of distress, and an attempt to noal- 
bw water would bring on a spasm of the throat, followed by violent 
raving ; when the paroxysm was oyer, he was quite rational, and 
woald warn his friends to beware of him, as he certainly should 
injure some of them. 

At this period, or rather as aoon as I was salasfied the oase was 
one of hydrophobia, I sent for all the physicians in our vicinity, 
to wit: Drs. Hannah, Griffith, Ethridge, Palmer, and Doolittle. 
The first four were soon in attendance, and three of them concurred 
with me in (pinion that the disease was hydrophobia. Dr. Ethridge 
thought it was delirium tremens, but all agreed that they knew of 
no certain remedy. I proposed to try a vapcr hath (he had already . 
been bled 80 ounces), and they all consented. Accordingly, steam 
was got up, and we kept him under a temperature of 140^ Fahren- 
heit for four hours ; sweating came on in half an hour, and when 
one hour had passed, we tried him with fluids. Water he could 
not yet bear, but swallowed a little sage tea, colored with milk. 
His thirst was excessive, and we now gave drink often, and the 
perspiration flowed profusely. After the sweat started, the spasms 
abated in violence and frequency, and by 9 P. M., he fell asleep, 
and during the night slept probably five hours. This process was 
followed for four days, that is, the, heat was kept high enough to 
keep up some perspiration, and when any signs of a returning 



9SA BRPOBT ON HTDBOPHOBIA. 

paroxysm was noticed, we raised the heat till the sweat flowed 
more freely. 

nUi, 7 A. M. Horrified at the sight of water, bat thirst abated, 
and he professed to be getting better ; thought he oould go to work. 
At times appeared flighty, and when the subject of the bite and 
other circumstances of his case were talked of was agitated. Be 
sighs often. An injection of salt and warm water was administered, 
which operated three times; evacuation dark and fetid; urine 
abundant, and deposited a sediment Complains of pain in the 

CU9, which looks purple; sweet oil applied, and pain abated. Tried 
eat toast, but could not ; drank during the past night a pint of 
water and a quart of sage tea; heat raised to 80, with relief. 

1 P. M. Symptoms improving ; complained of slight pain in the 
seat of the bite ; slight throbbing, extending to the axilla. 

18^, 9 A. M. Slept weU ; eyes less red ; no sighing ; had no 
pain except in the thumb, the seat of the bite ; talks freely about 
his case without agitation. When water was presented, said he 
could swallow it, but when the tumbler was handed to him, he 
rose and approached it obliquely to the right, and then to the le& 
He now began to shake violently, and attempted to swallow it sud- 
denly, but failed, choked, and averted his head ; tried again, and 
failed; flung himself on the bed very much agitated; his eyes 
rolled wildly ; breathing became laborious; sighed deeply, and the 
headache returned. The temperature was now raised to 80 again, 
and an injection of salt and water administered. 

12 M. Temperature continued at 80 till 10 P. M. More qui^; 
perspiration profuse ; discharged considerable saliva of thick con* 
sistence; evacuations more natural; pulse 76, soft and equable; 
. sighs not so often ; thirst moderate. 

19^, U A. M. Improving, rested well ; took him out of bed, and 
walked into the next room; says things and people look more 
natural. Dismissed cured ! 

Mr. Bell is yet alive and well (10th April, 1856). 

Dr. Doolittle, of Herkimer, did not see him till the second day, 
when his case was quite changed. He reasoned syllogistically, and 
said that hydrophobia was a fcUal disease; Mr. Bell was convales- 
cent, therefore Mr. Bell had not hydrophobia. 



REPORT 



OK THX 



CAUSES WHICH IMPEDE THE PROGRESS 



or 



AMERICAN MEDICAL LITERATURE. 



REPORT ON THE CAUSES 



IMPEDE THE PROGRESS OF AMERICAN MEDICAL LITERATURE. 



To Mrrite a report on the causes which impede the progress of 
American Medical Literature is no easy task. It requires labor, 
thought, judgment, courage. It is environed by many difficulties ; 
it involves serious responsibility. On the one hand, I find that the 
labor is much greater than I had anticipated ; and, on the other, 
that it is almost impossible to discuss the various topics embraced 
in it without incurring the risk of exciting displeasure, or of 
having my motives and feelings misapprehended and misrepre- 
sented. While I do not shrink from the former, I sincerely hope 
and trust that I shall escape the latter. While I shall present my 
views with great freedom, nothing is further from my intention 
than a desire wilfully to wound the feelings of a professional 
brother, or to cast any unjust reflections upon our medical schools, 
our medical press, and our medical charities. Duty, however, to 
this body, not less than to myself, requires that, in my attempt to 
unfold the causes under consideration, I should speak " the truth, 
the whole truth, and nothing but the truth," in regard to every 
subject which comes legitimately within the province of this re- 
port My motto shall be, ** My country first, my profession next.** 

Have we a national medical literature 7 If so, what are its nature 
and extent? 

It requires no labored argument to answer these questions. TTn- 
doubtedly we have a national medical literature ; but that its cha« 
racter and extent are not what they should be, or what we hope 
they ultimately will be, is equally true. It is an immature, an in- 
fantile literature, destitute of bone, and muscle, and sinew, gradually 
but steadily developing itself, and destined, ere long, to take its 



840 BEPOBT OK 

place by the side of that of other nations. Literature, regarded in the 
abstract, has, like the arts and sciences, naj, like govemments and 
nations, its rise and progress, its trials and difficulties, its pros- 
perity, its decline, and its donrnfall. It does not, Minerva-like, 
spring in fall vigor and perfection from the brain of the beathea 
^od. It does not send forth its rich and fertilizing influences at 
once upon a people. Its ascent is gradual, its growth tardy, often, 
indeed, almost imperceptible. To this rule the medical literature 
of the world forms no exception. What it is, and what it has been, 
it has become by slow degrees, by hard labor, by indomitable seal 
for the nationid welfare and the national honor. The medicsl 
literature of America was conceived in adversity, rocked in the 
cradle of sorrow, and reared on a diet of bread and water; and yet, 
as will appear by and by, it is not destitute of value to the pos- 
sessor, or without honor to the giver. Young as it is, and beset as 
its progress has been, and still is, with trials and perplexities, it is 
as a living fountain to our profession, from which all who thirst 
may drink and be refreshed ; as a mine of precious ore, abounding 
in the golden sands of science and erudition. If it lacks the stately 
proportions of the medical literature of some of the more refined 
and cultivated nations of Europe, it possesses the vigor of a healthy 
and steady growth, surely, though slowly, advancing to the full 
maturity of a sound and sturdy manhood. 

When we reflect upon the history of our country, its long depend- 
ence upon a foreign power, its struggles for liberty, and the vast 
toils necessary for the maintenance of its political existence, we are 
not surprised that its medical literature is still in its infancy, but 
that it should have any medical literature at all. Ages elapsed 
before England, France, Germany, and Italy, the most favored, 
learned, and scientific nations of the Old World, had even made a 
beginning in medical authorship. The medical literature of Great 
Britain dates no further back than the time of Harvey and Syden- 
ham, in the early part of the seventeenth century. Until the ap- 
pearance of those illustrious men, the pride and glory of English 
medicine, England had no medical writers who survived the gene- 
rations of which they formed a part ; and, even for a long time sub- 
sequently, she hardly produced a solitary work which is now re- 
membered except by its title. Bichard Wiseman was her first 
great surgical author, and generations passed away before she pro- 
duced a Pott and a Hunter. In anatomy, physiology, chemistry, 
materia medica, medical jurisprudence, toxicology, obstetrics, and 



AlCRBICAN MEDICAL LITEBAT^BE. 841 

•^ practical mediciDC, she had literally no great vorks until the com- 
« mencement of the present century. In pathological anatomy and 
general pathology she has not even yet a solitary treatise worthy 
f of her noble profession. The same is true, though not in an equal 
I degree, of th& medical literature of some of the other nations of 
I Europe. 

f Daring our colonial existence, medical literature and medical 

; science made no progress. The clerical and legal professions were 
; much more ably represented than the medical. The religious per- 
I aecutions of Europe indaced some of the most able and learned 
divines to forsake the Old World to seek an asylum and a borne in 
the New. They brought with them their piety, their zeal, their 
erudition, and their enterprise, which they devoted, without stint, 
without money, and without price, to the service of the church, of 
education, and of literature. They became the founders of some of 
our most valuable and distinguished literary institutions, and the 
authors of eminently creditable works on theology and history. 
The most important judicial offices were held by men of learning 
and legal acumen, sent hither by the British crown ; and many of 
the governors of the different provinces were Englishmen, distin- 
guished for their literary and scientific tastes and attainments. 
The medical profession, on the contrary, was at a low ebb. It had 
no antecedents, no present^ no future. The country, until a short 
time prior to the revolution, held out no inducements to the refined 
and educated physicians of Europe, to seek their fortunes in the 
wilds of the new world. Sparsely settled, overran by the Indian 
and the panther, destitute of roads and bridges, so necessary to the 
comfort and convenience of medical practitioners, and frequently 
visited by epidemics, as terrific as they were obscure and un- 
manageable, it attracted to its shores none but daring adventurers, 
little skilled in the art of healing, and still less disposed to engage 
in its exercise. Other avenues were more alluring to their ambition 
and their avarice. Nor were the native physicians in a condition 
to build up and sustain a medical literature. In the absence of 
medical schools, it was impossible for them to obtain an adequate 
medical education, except by going abroad, which few of them, in 
the then existing state of things, had an opportunity of doing. The 
consequence was that, until about the middle of the last century, 
few physicians of science, learning, or great respectability were 
found in the colonies. The first American medical college was 
erected in 176S ; and, although another was soon added, yet both 



84S REPORT 09 

were compelled to close their halls daring the BevolutioQ-; nor wis 
uy attempt made to revive them until after the establishment of 
peace in 1783. Up to this period, and, indeed, until 8h(»rtly aftef 
the commencement of the present century, hardly any work, do* 
serving of the name, had appeared on medicine finom, the pen of a 
native physician. The most valuable treatises then extaat wore 
Bard's Midwifery and Joneses Sitrgery, both greatly esteemed in 
their day on account of their practieal character. 

It cannot be supposed tha4 a nation, fresh from the bands of God, 
and just emerging from a long, bloody, and desolating war, would 
be in a fit condition for the cultivation of the arts aod sciences. lis 
time was fully occupied by more important business, the pucsuils 
of agriculture and the mechanic >arts, and the solution of the great 
and vital problem of self-goverhmenU It had to supply the means 
for the necessities of the body rather than for the necessities of tfas 
mind. Its citizens had no leisure for writing books, painting pio* 
tures, or fashioning men out of marbla God, the great architeet 
and chemist of nature, was their only artist They were in a transi- 
tion state, unable satia&ctorily even 4x> foresee their own destiny, bi^ 
gradually clearing away the stumps asid rocks of th^ mental aoil| 
to fit it for the reception of the seed which has since been sown, 
and which has produced such noble firuitage. They were preparing 
the way for those great and astounding enterprises, which, whila 
they have enabled them to tie together the beams and joista ef the 
republic with cords of adamaot^ have secured for them a strong and 
abiding rank among the nations of the earth* They were occupied 
^in infusing into each other a love of country, and into the diflEereiil 
professions a love of research and a spirit of kindness, which, we 
trust in God, will continue to animate theif successors in all tinM 
to come. In a word, they set each other in motion, and gave each 
other a proper impulse and a proper dixeetion, and thus iafhaed a 
quickening, vitalizing influence into the national mind. 

Under the genial influences here described, a more auspicious 
day soon began to dawn upon our eountry. Literary and acientifie 
institutions sprang up, as if by magic, in. eveiry section of the 
youthful Union ; the sword was transformed into the ploughshare^ 
the pruning knife, the sickle, and the pen ; men began to take a 
long breath, and to sigh for the labors of the closet; the spirit of 
composition descended upon them, and thus was. gradually laad^in 
1^ broad and substantial form, the foundation of a nation's litera* 
tnre. In this general upheaving of the mind, this outbucst of 



AMSBIOAN XBDICAL LITBBATUBB.^ . S43 

ficienca and of letterSy the medical profession largely participated, 
I as it had previouBly in the great struggle for American Independ- 
I eace. Aftedioal institutions, medical societies^ medical charities^ 
f aiMl, finaUy^ medical periodicals, sprang up in every direction, and 
» afforded employment and labor for tbe best intellects of the day. 
, Ab a neoeaaary result, book after book has appeared, until we ah^ 
, soon cease to be able to count ihenu 

The early part of the present century Bupplied us with the 
I vritinga of Bush and Barton, the System of Anatomy by Wistar, 
Borsey's Surgery^ so loEBg used aa a text-book in the University of 
Edinburgh, Chapman^s Therapeviics and Materia Medico, Coccc^a 
DiapeMoioTyj Thatcher^s Pfoctice of Medicine, and several ol2ier 
productLona of minor note. As yet^ the profession had not pro* 
daced one solitary great work on any subject Then appeared, in 
pretty rapid soocession, the valuable treatises of T. R. Beck, Gibson, 
Dewees, Homer, Eberle, Hare^ SUliman ; and, at a still later period^ 
thoae of Punglison, Wood k B&che, N. B. Smith, Meigs, Wood, 
Pickfton, Oliver, Faine, Condie, Bell, Warren, Stewart, Bay, Qer- 
bard, Bartlett, McGIellan, Pancoast, Morton, Miller, Mitchell, Frost, 
Henry H. Smith, aiKl others. The last few years have been una* 
anally prolific in valuable monographs, as is exemplified by the 
publications of the younger Meigs, the two Stilly Swett, Gaixio* 
ahaa, Friek, Prake, and La Boche, the last two of which may justly 
be regftfded as forming an epoch in the literature of the professka. 
If the preceding statements be true, no one acquainted with the 
subject can accuse the profession of the United States, of the pre* 
sent day, either of lethargy, idleness, ignorance, or indifference. 
The numerous works which annually issue from our press, the exist- 
eaee of for^ medical periodicals, nearly all of them respectably if 
not ably conducted, and the'suoceasful operation of nearly forfgr 
medical schools, which annually send forth upwards of one then- 
sand graduates, all attest, in the strongest possible terms, the aeal, 
the learning, the intelligence, and the enterprise of its members, and 
afford a guarantee that its greaA interests are safe in their handa 
Considered in its aggregate capacity, it unquestionably comprises a 
greater amount of talent^ erudition, science and activity tlmn any 
other of the liberal professions in America ; thus nobly reversing 
the order of things, in regard to these professions^ which existed 
prior to the Revolution. 

Having made these remarks, which seemed to me to be necessary 
to a more perfect apprecialdon of the main subject of this report, I 



844 ' BSPORT OK 

shall proceed to inquire into the catises which stiU obstract the 
progress of our national medical literature, and close bj makiog a 
few comments on the remedies which, in mj judgment, are neces- 
sary for their successful removal. These causes, although numerous 
and diversified, maybe grouped under four principal heads: 1. The 
identity of the language of this coxmtry with that of Great Britain. 
2. A disposition in the profession to patronize English works in 
preference to American. 8. A want of independence in our peri- 
odical press. 4. A lack of industry in obs^ving and recording 
facts in private and hospital practice. Let us examine these points 
somewhat in detail. 

1. One of the great disadvantages, as it respects the present 
subject, abstractly considered, under which the people of the United 
States are and have been laboring, is the circumstance that they 
speak the same language as the inhabitants of Great Britain, from 
whom, as from a common stock, they originally descended. It fol- 
lows, as a natural consequence of this identity of language, that th^ 
should feel a deep interest in the writers of that country, and a 
strong desire to become acquainted with their works, either by 
direct importation of them or through the medium of American 
reprints. As English books are very costly, on account of the 
heavy duty imposed upon them by government, the latter method 
is the one usually adopted. To so great an extent, indeed, does the 
practice obtain, that, for many years past, every English work of 
any note or merit, real or fictitious, has been issued on this side of 
the Atlantic within a very short period after its publication at home. 
This is true of every, species of literature,, general, medical, theo- 
logical, and legal; so that, if we had no native authors, the Ameri- 
can mind could hardly suffer for the want of proper nutriment 
fix>m this cause, so abundant and diversified is the foreign supply. 
The republication of British works has, for nearly half a century, 
been a source of constant occupation with some of the best firms 
of the Atlantic cities, affording a safe and profitable investment 
for their capital, and steady employment to many thousand per- 
sons. The business has, in fact, grown into a great and flourishing 
trade, requiring millions of dollars for its prosecution. Some of 
these firms have amassed great wealth, derived from no other source^ 
In the absence of an international copyright law, securing to every 
author a just compensation for his labors, the works thus furnished 
are generally sold at less than one-half of the price of the English 
editions; and hence it often happens, both in medicine and in other 



AMEBICAN MXDIOAL LITRBATURB. 846 

departments of learning, that they have a mucli wider circulation 
here than at home. Sometimes, in truth, English works, neglected 
or imperfectlj appreciated in Qreat Britain, are, perhaps, for the first 
time, fairly introduced to the notice of the public by and through 
the American press. It was thus with the writings of De Quincey, 
which were first collected and issued in a uniform edition by a pub- 
lishing house at Boston. Dr. Stokes' Ledures on the Theory and 
Practice of Phyaic met with the same courtesy at the hands of a Phi* 
ladelphia firm, having prior to this not even appeared in book form, 
but being safely locked up in an Irish periodical, published at 
Dublin. A number of other works, having a very limited circula- 
tion at home, have been largely read in this country. Mr. Fergus- 
son's Practical Surgery^ for example, has passed through at least 
one edition more in America than in England; and a similar com- 
pliment has been extended to another meritorious work, Watson's 
Practice of Medicine. Such marks of attention must, even in the 
absence of copyright remuneration, be extremely gratifying to the 
authors of Great Britain ; but the force of the compliment is weak- 
ened when it is recollected that these reprints are made indiscrimi- 
nately, and therefore without any special reference to their intrinsic 
merits. In a word, they are made simply because they serve to fill 
the pockets of those who incur the responsibility of becoming their 
sponsors. If they were obliged to purchase the copyright at a fair 
value, the number of American issues of British works would be far 
less than it now is. It is owing to this circumstance, one of the 
most remarkable anomalies of our age and country, that the litera- 
ture of the United States exhibits, even at the present moment, 
more of a foreign than of a domestic aspect, the number of English 
works circulated among us being greater than the number of native 
productions. 

It cannot be denied that this practice of republication is of great 
advantage to the public; for it serves to diffuse among the people, 
in a cheap and accessible form, a vast amount of knowledge that 
would otherwise be beyond their reach. It brings the works of our 
transatlantic brethren directly to our doors, at the same time that 
it serves to extend the name and fiatme of the authors. But, while 
it accomplishes all this, it unfortunately interferes, in the most 
positive manner, with the establishment of our national literature, 
considered in its widest as well as in its professional sense. It de- 
presses native talent, native genius, native aspiration and enterprise. 
It narrows the road of authorship, and besets it with obstacles and 
VOL. IX— 28 



S46 REPORT ON 

difficulties almost insurmountable by ordinary means. The man 
who attempts to scale it must do so at the risk of a long probation, 
without the praspect even of much ultimate pecuniary reward, 
when his reputation shall have been firmly established by the pro- 
duct of his pen. When his literary labors are completed, and he 
places his MS. into the hands of his publisher, should he be so for- 
tunate as to find one, he is pretty sure to be informed that there are 
already before the public so many works on the same subject as to 
render the success of his own too uncertain to justify the ofTer of a 
stipulated sum for the copyright of the first edition. Should the 
sale go off well, he may ultimately receive a few hundred dollars 
for what ought to have brought so many thousand, if the book had 
no foreign competitors in the form of reprints. In short, be finds 
his only recompense and solace in the prospective fame of his lite- 
rary labors* I do not now speak of the novelist, the poet, the tour- 
ist, and other writers* of light literature, who always find readers, 
however trashy their productions, but of men of science and letters, 
the solid and substantial authors of a country. These men must 
be encouraged, patronized, and sustained in their efforts to improve 
the literature of the nation, and thus advance its honor and glory. 
If it be said, in reply to these remarks, that every work must stand 
on its own merits, we do not perceive the force of the rejoinder. 
If the market is already glutted with foreign productions, it must 
be obvious that the wants of the public are, at least in part, if not 
fully, supplied ; and hence the native work, however meritorious, 
must labor under the disadvantage of a degree of competition, 
which, especially if we consider the additional disadvantage of its 
higher price, may throw it into the shade, or altogether prevent its 
success. If, for instance, an American physician were to write a 
work on surgery, his success would be sure to be tardy, because the 
country is already flooded with foreign treatises ; and so in regard 
to most of the other departments of the profession, as well as of 
literature in general. If the people of Europe spoke but one lan- 
guage, and there existed no international copyright laws, there 
would be comparatively few authors of any kind; the necessity for 
writing would be much diminished ; the same book would answer 
for all; and men of literary taste and attainment would seek other 
channels for the exercise of their talents. But such is not the &ci 
Every nation has a distinct and separate language; a distinct and 
separate literature. The works of Sydenham and Harvey, of Van 
Swieten, Bichat, Ilaller, Baglivi, and Scarpa can be read out of their 



AHSBICAN XSDICAL LITBBATURE. 847 

own countries by the mass of the profession only through the me- 
dium of a translation. Speaking, as we do, the same language as 
the people of Great Britain, and republishing, as we do, at pleasure 
any of their works that come within our reach, Shakspeare has 
more readers by ten to one on the shores of the Ohio than on the 
banks of the Avon. 

2. A second cause of impediment to the complete and satisfac- 
tory establishment of a national medical literature is the disposition, 
more or less strongly felt and evinced by the profession, to patronize 
foreign works, especially English, in preference to our own. On 
this subject no doubt exists. The disposition is exhibited constantly 
and in a variety of ways, as will be seen as we proceed with the 
discussion of the subject. 

In the first place, the fact here mentioned is evinced, most une- 
quivocally, by the use which is made of foreign works as text-books 
in our medical colleges and universities. Of the forty schools which 
at this moment exidt in the United States, there is not one which, 
so far as ray information extends, confines itself exclusively to Ame- 
rican works. In a number of them, indeed, hardly any other than 
English are employed ; and frequently, even when American are 
recommended, it is done in such a manner as clearly to indicate a 
preference for the former. Even in the Jefferson College, Philadel- 
phia, most of the members of whose Faculty are authors, several 
foreign works are mentioned in the list of text-books. In the insti- 
tution with which I have the honor to be connected, the principal 
text-books, until recently, were Wilson's and Quain's AnaUymy^ 
Carpenter's and Kirkes's Physiology^ Liston's Surgery^ Chailli^'si/ti- 
vnfery^ Ash well's Treatise on the Diseases of Females^ Pereira's Materia 
Medico^ Watson's and Stokes' Praciice. By a resolution of the 
Faculty, in 1854, it was agreed that, thenceforth, no European publi- 
cations should be recommended to our pupils as text-books. So far 
as I am informed, this is the only American School in which such 
an attempt has been made, although even here it has not been 
strictly carried out. 

Of the many strange and unaccountable things which charac- 
terize the present times, in this country, that of using foreign works 
as text-books in our medical schools is one of the most extra- 
ordinary. The fact implies, clearly and unmistakably, that Ameri- 
can teachers have either no confidence in American authors, or 
that they are sadly deficient in genuine patriotism ; or, what is still 
worse, and more to their shame, that they are influenced, in their 



848 BEFOKT OK 

conduct in this matter hj feelings of jealousy and ayarioe ; afraid 
lest, by recommending to their pupils the works of their countrj- 
men, their pupils should chance to discorer that their countrTmen 
can write books ; afraid lest, bj giving them this information, their 
pupils should stray off, and patronize the schools of which so many 
of these authors are members. K these are not the true reasons of 
this conduct, so disreputable to our profession, to our country, and 
to our age, I confess my ignorance and my inability to assign any 
other. 

During our colonial existence, and for more than a quarter of a 
century afber the American Revolution, which severed that exist- 
ence, we were necessarily dependent upon England for all our 
literature, medical as well as miscellaneous, and the debt thereby 
incurred forms no small item against us ; but the time has gone by 
when we require such assistance, and it is, therefore, clearly our 
duty to declare ourselves free and independent of our transatlantic 
brethren, as we did eighty years ago declare ourselves free and 
independent of the British crown. To continue longer in our 
vassalage is as incompatible with the genius of our government^ as 
it is disgraceful to us as men and physicians. But^ while we en- 
deavor to perform this duty, a duty in which all true patriots in 
the profession should cordially unite, let us not forget the debt we 
owe to the mother country, but use our best exertions to reflect 
back upon her the light of science and of literature from oar own. 
The thoughts and the actions of her gi'eat men, as expressed in 
their writings, have been, for generations, a portion of our daily 
intellectual nutriment. 

In the infancy of a nation which has no resources except the 
virtue of its citizens, and a doubtful tenure upon its soil, men are 
often forced to do that which, under opposite circumstances, would 
be repugnant both to their pride and to their patriotism. It was 
thus with our forefathers in regard to the adoption of foreign works 
as text-books in our seminaries, colleges, and universities; the 
exigencies of the times forbade any other course. And it was thus 
with Mr. Jefferson, when he was engaged, in 1819, in organizing the 
University of Virginia, which he afterwards fostered and protected 
with the care and affection which a fond and doting parent bestows 
upon his favorite offspring. Anxious to fill its various chairs with 
none but able men, he scanned with a scrutinizing eye the claims 
of his own fellow-citizens, determined to give them the preference 
over foreigners, provided they possessed equal or greater merit in 



AMSBICAN XSDICAL LITKBATUBB. S49 

their respective departments; bat to seek his teachers abroad if 
they possessed qualities superior to native Americans. Dr. Bow- 
ditch, who stood at the head of the mathematicians of the United 
States, haying declined the chair of mathematics, it was tendered to 
and accepted by Mr. Bonnycastle, an Englishman. Dr. Dunglison, 
also an Englishman, was invited to the chair of medicine, and Dr. 
Emmett, an Irishman, to that of chemistry. At present, all the 
chairs of that celebrated university, at least as respects its medical 
department, are occupied by native-bom citizens. This is as it 
should be. In the in&ncy of the institution the course pursued by 
Mr. Jefferson was eminently proper ; his object was to build up a 
great seminary of learning and of science, and to place it at once 
upon the best and surest foundation. This object accomplished, 
the importation of foreign professors ceased, and Americans now 
occupy their place. 

To institute a comparison between the medical authors of the 
United States and those of Great Britain, or, what is the same 
thing, between their works, hardly comes within the scope of this 
report ; but I may be permitted to refer to a few of our native 
treatises as worthy of being employed as text-books in our medical 
schools. To begin, where is there, it may be asked, in the English 
language, a medical dictionary at all comparable with that of Profes- 
sor Dunglison 7 or a treatise on physiology superior to that of the 
same distinguished author? Since the days of Kaller, I have hardly 
seen a more learned,* systematic, or comprehensive treatise on the 
subject in any language, certainly not in the English. It is all that 
such a work should be for the pupil and practitioner ; plain, simple, 
perspicuous, and perfectly methodical, with an amount of erudition 
as rare as it is profound and astonishing. Our works on anatomy 
are amply sufficient for all the purposes of the class-room, for which 
they have all been employed, to a greater or less extent, by some 
of our schools. The system of Wistar has maintained its place in 
the esteem and affection of the American student for nearly half a 
century, and, with the emendations and additions of Professor Pan- 
coast, bids fair to hold out half a century longer. Horner^s treatise 
has passed through numerous editions ; and the works of Morton, 
Richardson, and Handy are, in every respect, superior to that of 
Wilson, which figures so conspicuously upon the catalogues and 
annual announcements of our colleges. In practical medicine we 
have just cause to be proud of the labors of Eberle, Wood, Dun- 
glison and Dickson, to say nothing of those of Hosack, Dewees, 



850 BBPORT OK 

Thatcher and Bell, the latter of which, however, is too much mixed 
up with that of Dr. Stokes to give it a national air. In materia 
medica and therapeutics, the treatises of Chapman, Eberle, and 
Danglison, have long been held in the highest esteem. The second 
of these works was honored, soon afber its appearance, with a Ger- 
man translation, and its author with a membership of the Medico- 
Chirurgical Society of Berlin. The treatise of the late Dr. John B. 
Beck, a more recent production than any of the above, is, I con- 
ceive, a model for a text-book ; clear, graphic, concise, yet suf- 
ficiently comprehensive for all possible purposes to which such a 
book can be applied. In obstetrics we have the admirable and 
original works of Dewees, Meigs," and Miller, which all enjoy a 
European reputation, and a wide appreciation at home. On the 
diseases of children, the treatises of Eberle, Condie, Stewart, and 
Meigs are without rivals in the English language. In medical 
jurisprudence there was no work, until recently, that was at all 
equal to that of T. R Beck, the merits of which have been acknow- 
ledged even in Great Britain by several reprints, and in Germany, 
by at least one translation. The recent production of the late 
lamented Moreton Stills, on the same subject, is destined to attain a 
high rank in the medical literature of the country. The dispensa- 
tory of Wood and Bache is, beyond doubt, the most able work of 
the kind extant. If we have no great treatises on surgery, 
chemistry, toxicology, and some other subjects, is it to be supposed 
that we are incapable of supplying them? Certainly not. What 
has been done for the other departments of medicine may assuredly 
be done for these. We have the power ; it is only necessary to 
exert it. Ages elapsed before Great Britain produced one solitary 
great work on surgery, obstetrics, practical medicine, toxicology, 
chemistry, medical jurisprudence, and anatomy. The Universities 
of Oxford and Cambridge had existed for centuries before she even 
began to dream of a national medical literature. She has not even 
yet anything like a great medical and surgical dictionary, one to be 
compared, in point of extent and erudition, with those of France 
and Germany. In descriptive anatomy, until the appearance of the 
treatise of Mr. Quain, only a few years ago, she had never furnished 
one great, respectable, or reliable work ; and in materia medico, 
toxicology, juridical medicine and obstetrics, she was equally des- 
titute. In operative surgery she has produced nothing equal to 
the elaborate and beautiful work of Dr. Pancoast, with, perhaps, 



AMEBICAK MEDICAL LITSBATUBS. 851 

the Single exception of that of Mr. Fergnsson, so well known and 
so highly appreciated in this country. 

If we turn our attention to- specialties, we have no reason to be 
ashamed of our labors. The monographs of Gerhard, Swett, and 
Austin Flint; of Warren, N. R. Smith, and Carnochan; of Ray; of 
Bell; of Bartlett, Barton, Drake, and La Roche; are highly merito- 
rious, and eminently creditable to the country. The two latter 
evince an amount of research and erudition which have no parallel 
in English medical literature. 

With regard to American periodical literature, it is but justice 
to say that it is entitled to the highest praise. In point of extent, 
variety, and practical value, it is unequalled by that of any other 
nation. Nearly forty presses are employed in its service. Many of 
the best minds in the country contribute to its pages. If it be 
true that it i§ not all equally respectable in matter, taste, and style, 
enough is left, if we deduct the bad from the good, to satisfy the 
most fastidious, and to supply, in the most ample manner, the wants 
of the profession. The matter thus furnished, much of which 
is never seen by our transatlantic brethren, forms many volumes 
annually, and contributes, perhaps as much as anything else, to 
edify and enlighten the profession of the United States. It consti- 
tutes, indeed, a most valuable source of information. 

From the preceding facts, and the observations founded upon 
them, it will be perceived that, in most of the departments of the 
healing art, we have laid a deep and solid foundation for the super- 
structure of a permanent national medical literature. We have 
seen tbat there is no need of borrowing books from Great Britain 
as text-books for our medical schools ; we have shown that many 
of our writers are men of great talents and erudition, wielding a 
ready and prolific pen ; and we have endeavored to prove that it 
is due to them, to us, to our profession, and to our common country, 
to declare ourselves free and independent of all foreign nations, as 
it respects the elementary instruction of our pupils. 

Let us not be misunderstood. We would lay no embargo upon 
foreign works, or in any manner, form, or degree, disparage their 
merits, or discountenance their just claims upon the favor and 
patronage of the American profession. Literature, the arts and 
sciences, are cosmopolitan, acknowledging no " pent up Utica" as 
their home. Like the breezes of heaven, which fan and fertilize 
the earth, and refresh its laborers, they belong to no country and 
to no age, but to the whole world and to all time. We need no in- 



852 BBPORT OF 

temational copyright laws ; let there be a free interchange of our 
intellectual products ; let us not place upon them any restrictiona^ 
as we do upon calico and other articles of manufacture. The time 
will come, if it has not already come, when the medical profession 
of Great Britain will be glad to receive, in par exchange, the results 
of our mental labor for theirs. 

Intimately associated with this branch of the subject is another, 
hardly of less importance than that just discussed. I allude to the 
editing of British works by American physiciana So common is 
this practice that it now amounts to a trade. Pursued by young 
men and old men, men without reputation and men with reputation, 
it has become a crying evil, an evil which is directly instrumental 
in fostering and protecting British influence to the detriment of 
American authors. The main object of this practice generally is 
not to enhance the value of the reprint, but to promote its circular 
tion by imparting to it somewhat of an American air. The book 
is indorsed, and it accordingly goes before the profession under a 
new prestige. The name of the editor is supposed to be a guaran- 
tee for its excellence ; it serves the same purpose to the work that 
a letter of introduction serves to a traveller. It secures it notice; 
perhaps a cup of tea, and a permanent home. In this manner it 
often happens that works, destitute of real merit, or which Ball still- 
born from the British press, meet with a wide and rapid circulation 
in the United States, to the injury of deserving native authors, 
and the detriment of our medical literature. For fifty, a hundred, 
or two hundred dollars, men may be found, in almost every portion 
of the land, ready and willing to lend their aid and support to what 
the English press so constantly denounces and stigmatizes as lite- 
rary piracies. What is remarkable, is that this kind of labor is 
often much more remunerative than the authorship of original 
works, which, as is well known to those engaged in it, is seldom 
adequately rewarded on this side of the Atlantic. 

Now, I do not, as has been already seen, object to the republi- 
cation of British works, but I do protest, and that in the strongest 
terms, against this practice of editing them by members of our pro- 
fession. Let these works stand on their own merits ; it is due to 
their authors at least that they should not be mutilated and dis- 
figured with notes, annotations, and alterations. K they possess 
intrinsic, merit, they will be sure to find their way into the pro- 
fession, and to receive the favor and patronage to which they are 
entitled. K they do not, let them fall, as they deserve, stillborn 



AMERICAN MEDICAL LITXBATUBE. 858 

i from the American press. But whatever may be their fate, let us 

discoTintenance the humiliating costom of affixing our names to 

their title-page, and of ushering them into notice under the seal 

and sanction of our influence. If the diseases and accidents of 

I Great Britain were different from those of this continent, and, 

above all, if they required, a different or modified treatment, then 

I there would be some show of reason for this practice; but no man 

acquainted with the subject will plead such an excuse. Nor can he, 

I in extenuation of his conduct, excuse himself on the ground that a 

similar practice is pursued by the legal profession of this country. 

( Such a course is indispensable, on account of the references which 

( are obliged to be made to the decisions of American cases, and 

I which always greatly enhance the value of the reprint. Indeed, so 

. true is this that, as I am informed by intelligent lawyers, no Eng- 

, lish treatise on law, without such additions, would meet with any 

, circulation in its new home. 

J The practice here spoken of, so humiliating to our national pride, 

I and so opposed to every feeling of patriotism, has never met with 
^ any encouragement in Great Britain. The only American works 
, of any note that have ever been republished in that country, are 
. Dorsey's Surgery^ Beck's Medical Jurisprudence^ Bay's Treatise en 
Insanity^ and Warren's Observations on Tumors, If there were a 
, strict, or even a moderate share of reciprocity on the subject be- 
tween the two nations, much of the objection that now lies against 
. the practice would cease ; but English pride, English prejudice, and 
English patriotism would shrink from such an act. The practice, 
therefore, being one-sided, is disreputable, and should be discounte- 
nanced by all fair and honorable means. 

We now and then heart)f physicians who think that authors who 
are medical teachers should not be permitted to recommend their 
works as text-books to their pupils, on the ground, as they allege, 
that the practice is a serious evil, tending to trammel the student in 
his choice of books, and thereby promoting the publication and 
circulation of productions of inferior merit. It is difficult to dis- 
cover the force of such an objection, the direct effect of which is to 
disparage native authorship, to repress native enterprise, to mortify 
native pride, ambition, and patriotism. If the works of American 
authors are so indifferent, so worthless, or so utterly bad as not to be 
used as text-books in American schools, then i maintain that they 
ought not to be read and countenanced by American physicians. 
If they are good enough for the latter, they ought assuredly to be 



854 BEPOBT OK 

good enough for the former. Is this the estimate that should be 
placed upon the works of Chapman, Dewees, Eberle, Homer, Wood, 
Meigs, Miller, Dunglison, Pancoast, Gondie, Bell, Drake, Dickson, 
La Rr)che, and a host of others equally able and useful? Have not 
their merits been acknowledged everywhere, in Europe as well as 
in America? Who among us will rise up, and attempt to reverse 
the verdict that has been pronounced upon them by the profession, 
or undo what has been hallowed by the genius of medicine? In 
Germany the custom has long prevailed among teachers of medi- 
cine to prepare works expressly as textbooks for their pupils ; and 
there is no school in that country, from the most humble to the most 
exalted, in which the custom has not been attended with salutaiy 
effects. If, as a general rule, professors are not qualified to write 
text-books, who are ? They certainly, better than any other class 
of men, ought to be able to appreciate and supply the wants of 
their pupils. If they are not qualified to write, how can they be 
qualified to teach ? 

8. I proceed, in the third place, to notice the influence which is 
exerted upon American medical literature by the American medical 
press. That this influence is not imaginary, but real and positive, 
admits, I think, of easy demonstration. 

The number of medical journals now in existence among us 
cannot be short of forty, comprising every grade from the weekly 
to the monthly, the bi-monthly, and the quarterly. These periodi- 
cals are issued in various sections o? the Union, so that few even 
of the younger States are without a representative. It may be 
stated, in general terms, that they are edited with taste and ability, 
and that their pages afford evidence of research, erudition, and use- 
fulness. Their original communications are, for the most part, of 
a practical nature, comparing favorably, in this and many other 
respects, with similar articles in the medical journals of other coun- 
tries. But it cannot be denied that, in the department of criticism, 
they are generally deficient in boldness, force, and judgment, falling 
far below the common standard in the same branch of literature in 
Great Britain. The reviews are, with few exceptions, written 
without taste and without point, as if their authors were afraid lest 
they should be accused of unkindness, harshness, or ill-nature. 
They are characterized more by politeness than by a manly and 
independent tone, which is not afraid to utter its real sentiments 
and to affix the seal of its unbiassed judgment. They are marked 
by none of the masculine vigor which is so well calculated to impart 



AHERICAK MEDICAL LITERATURE. 865 

zest to the reader, and cause him to regret that ho is so near the 
end of his t<ask ; which infuses life and spirit into a journal, and 
makes it a welcome guest at the table of the physician ; which 
fashions and directs the dart, but blunts its point before it is per- 
mitted to strike its victim ; which metes out equal justice to all 
men who come within its vitalizing, soul-stirring influence ; which 
blends mercy with severity ; which, when occasion requires, wounds 
but does not kill. It is a criticism which is neither alkaline nor 
acid, nor yet wholly neutral, but so nearly neutral as to render it 
impossible to determine its real character. It is a jesting, good- 
natured criticism, which, for fear of doing mischief, or of being 
thought unkind, is bound in swaddling clothes, lest, by its sudden 
and inadvertent jerks, it should kick over the milk and water in 
the inkstand of the happy, self-complacent reviewer. In fine, it is 
an inert, a tame, a spiritless criticism ; a criticism without body, 
"without strength, without soul, deaf and dumb, and blind and halt. 
What the criticism of the medical press of the country should be 
mnst be apparent to every enlightened, right-thinking physician. 
It has an important mission to perform. It should be free and 
independent of all extraneous influence, foreign and domestic. It 
should eiercise its functions openly, boldly, vigorously; with an 
eye single to the honor of the profession and the glory of America. 
While it should ever be ready to rebuke egotism, presumption, 
and ignorance, however exhibited, or from whatever source ema- 
nating, it should also be ready to speak the word of gentleness and 
kindness to the brother who adds his feeble mite to the general 
stock of knowledge and experience. While it does not cover, as 
with a mantle, his sins of omission and commission, it should 
endeavor to point out his defects in the spirit of affection and en- 
couragement. It should hail his ejQTorts as a good omen, as an 
evidence of his zeal and devotion to the cause of science, as a desire 
to render himself useful, and not to bury his talent in the earth, 
and lead the life of a drone. It should encourage him to proceed, 
to renew his efforts, to try again. It should not aim to extinguish 
him by the discharge of its gall, by harsh rebuke, insolent assertion, 
or, worse than all, by faint praise, which has so often blasted the 
aspirations of genius, and damped the energies of mediocrity. 
Nor should it indulge in undue severity against the works of our 
European brethren, but extend to them a cordial, a hearty, a three- 
fold welcome. It should, in the discharge of its noble mission, 
institute a thorough examination into their merits, and award them 



866 BEPOBT OK 

praise or censure, aocording to the dictates of its honest conyictions. 
It should truckle to no man, clique, or faction ; it should be sub- 
servient to no interests, save those of truth and justice. It should 
be patriotic, and at the same time cosmopolitan ; local, and at the 
same time universal ; for time, and at the same time for eternity. 
Like the judge upon the bench, it should, in all doubtful cases, 
lean to the side of mercy, and never condemn without adequate 
testimony. It should be blind, yet far-sighted ; mild, yet stem and 
uncompromising, watching, as with an eagle's eye, the honor, dignity, 
and interests of American medicine. Such, I conceive, is the criti- 
cism which should animate and characterize the medical press of 
the country. Any other than this is illiberal, and unworthy of its 
high mission. 

I have said that the American medical press lacks independoDoe; 
and I may now add that this spirit, or, more properly speaking, 
this want of spirit, is nowhere more strikingly exhibited than in its 
reviews and notices of European reprints. That I may not make a 
charge, especially one of so grave a character as this, without 
reason, let me appeal to facts to verify and sustain my assertion. 

It is notorious that American publishers of foreign works are in 
the habit of sending copies of every book, as soon as issued, to the 
editors of our medical journals, with a view to an early notice. ITia 
object of this notice, of course, is, not to disparage but to praise the 
book, in order that it may thus find its way rapidly to the profes- 
sion. It is intended, indeed, by the publisher as an advertisement, 
to proclaim the peculiar fitness of the new candidate for public 
patronage. For this purpose the book is sent as a gratuity, and it 
is so regarded by the recipient. Thus, almost without his con- 
sciousness, he incurs an obligation, which he can only repay, not in 
kind but in form ; that is, by a laudatory notice or review. If ^^ 
fail to do this, he necessarily gives offence to the publisher, if he 
do not actually make him his enemy. That this is a natural 
consequence of this kind of intercourse between journalists and 
booksellers must, I think, be admitted by every one who has be- 
stowed any reflection upon the subject. How can a man be so 
ungracious as to disparage the present of his friend or even of a 
stranger? Will not his sense of politeness prompt him to speak 
kindly of it, even if it be comparatively unacceptable, unimportant, 
or worthless ? Does not the very fact that the book is a present 
frequently disarm just criticism ? 

But is editorial courtesy the only consideration which enteis 



AMIRICAN MXDICAL LITEBATUBE. 857 

into the meritB of this question? Has self-interest no part in it? 
Does not the journalist derive direct " aid and x>omfort" from this 
source? Does not every book thus received add one more volume 
to his library ? If an editor were charged with venality, or even 
with unconscious subserviency to the publishers of foreign reprints, 
lie would repel the assault, and no doubt very justly, as false and 
slanderous. And yet editors do not differ from other men. Self- 
interest governs, to a greater or less extent, the whole human race* 
A journalist may make it a practice to speak &vorably of every 
book that is presented to him, without any reference to pecuniary 
benefit, or without meaning or intending any harm to any one. 
He acquires a sort of habit, which, once established, his good nature 
induces him to continue ; and thus he may go on^ year after year, 
utterly unconscious of the injury which he is inflicting upon the 
profession and the progress of sound medical literature. 

Another editor, perhaps less kind, but more independent, and 
more considerate for the advancement of his profession, pursues a 
different course. He, too, receives presents of books, but, governed 
by opposite motives, he does not hesitate to estimate them at their 
true value, and to publish to the world the convictions of his judg- 
ment He commends their merits, while he fearlessly denounces 
their faults and their shortcomings. But if he had indulged any 
hopes of filling his library with books thus obtained, he is sadly 
disappointed. He is at issue with their very source and fountain. 
He has offended the publisher, and he must be prepared to sufiSer 
the consequences. No more books arrive ; he thinks it strange, but 
time only serves to convince him that he has committed eifaux-pas. 
The supply is cut off, and henceforth he is coippelled to rely upon 
other sources for his bibliothecal treasures. That this statement is 
not exaggerated is a fact familiar to every American journalist 
himself. A few years ago a certain firm in Philadelphia, who had 
always been in the habit of sending copies of their reprints to the 
Western Journal of Medicine and Surgery^ all of a sudden withdrew 
their favor, for no other reason, as was afterwards ascertained, than 
because the editor of that periodical had dared to speak disparag- 
ingly of one of their publications. Several instances of a similar 
character fell under my own observation during my brief connec* 
tion with the medical press at Cincinnati. A case in point, but 
relating to another department of literature, and causing a great 
deal of notoriety at the time, occurred at Boston, last autumn. A 
political newspaper, the Boston Traveller, having published a severe 



S58 REPORT ON 

critique on Mr. Longfellow^s Song of Hiawatha^ the publisben, 
Messrs. Ticknor, Field & Co., immediately withdrew their adver- 
tising patronage, and oeased to send their publications. It is well 
known that the late Judge Story, the pride and glory of our judi- 
ciary, was the author of a work on Bills of Exchange, one of the 
ablest and most learned of his world-renowned productions. It 
might naturally be supposed that, inasmuch as he was the founder 
and chief ornament of the Law School at Cambridge, this work 
would be used, after his death, as it had been during his life, as a 
text-book in that institution. Far from it. The work employed 
for that object is that of Biles, an English treatise, republished by 
a Boston firm, one of whom happened to be a member of the board 
of trustees of Harvard University. These facts, which might be 
multiplied indefinitely, speak volumes; they show the influence 
which the publishers of reprints of foreign works exert upon the 
press of the country, miscellaneous and professional, and prove, in 
unmistakable terms, the truth of the statements set forth at the 
commencement of these remarks. 

In making these comments, I beg leave to disclaim all intention 
of casting any censure either upon medical editors or on the 
republishers of foreign works. I have merely alluded to what I 
believe to be a habit into which some of the journalists of the 
country have fallen unconsciously in regard to the subject under 
discussion, and which they are unconsciously perpetuating- Nor, 
on the other hand, would I accuse the respectable body of repub- 
lishers of any wrong intentions in their efforts to procure from 
the periodical press favorable notices of their productions. It i« 
their business, as it is their interest, to promote the circulation of 
the works which they reprint. It is their pursuit ; they live and 
grow fat by it. The American medical profession owes these re- 
publishers an immense debt, for afibrding them, in a cheap and ac- 
cessible form, the works of our transatlantic brethren ; as they owe 
us an immense debt for purchasing these works, and promoting their 
circulation, by the influence which we wield through the press» in 
the lecture-room, and in our private intercourse with each other. 
Thus far, the obligation is mutual. But here let it cease. Let our 
journalists procure these reprints at their own expense, and we pre* 
diet that a healthier tone will soon become apparent in their critical 
notices and reviews. 

4. I notice, in the fourth and last place, as a prominent cause of 



t'- 



AMERICAN MEDICAL LITERATUBE. 859 

the impediment under consideration, the little use that is made of 
the advantages afforded by private and hospital practice. 

Every physician, however slender his talents or limited his oppor- 
tunities, has it in his power to make himself useful to his profes- 
sion. It is only necessary that he should carefully observe and 
faithfully record the facts that pass daily, for fifteen, twenty, or 
twenty-five years, under his eye to enable him to become a most 
valuable contributor to medical science and medical literature. If 
this habit were universal, the profession, and mankind at large, 
would not now have to lament the many imperfections and the 
many incongruities of the healing art. Many diseases which now 
baffle the skill of the physician and attest his impotence, wonld be 
rendered amenable to his remedies, and cease to be regarded as 
opprobrious. And what is true of individual observation and ex- 
perience, is still more true of combined observation and experience, 
those compound pulleys and levers of the human mind. Our 
country is rich in medical charities, hospitals, almshouses, infirm- 
aries, and asylums of all kinds. In the larger cities of the Union, 
institutions of this description exist that would reflect credit upon 
the intelligence and philanthropy of any nation in the world. They 
are, in feet, the palaces of the poor of our country. It is impossi- 
ble, from the want of statistics, to form an accurate estimate of the 
numbc^r of sick and wounded that annually enjoy the benefits of 
these eleemosynary establishments. It cannot, at a rough calcula- 
tion, be short of 120,000. The physicians, surgeons, and accouch- 
eurs who have charge of them must amount to several hundred, 
embracing a large share of the best medical talent and intelligence of 
the country; and yet what have these institutions done, what have 
these physicians, surgeons, and accoucheurs done for American 
medical science, American medical art, and American medical lite- 
rature ? Where are the trophies which they have brought from this 
great battle-field of disease and accident? Where are the legacies 
which they have bequeathed, or which they are ready to bequeath, 
to their profession and their country ? Can any one point to one 
solitary work, of any note or respect^ibility, that has emanated firom 
their pen, as the legitimate result and effect of the immense oppor- 
tunities which they have thus enjoyed? Where are the treatises 
which they have furnished us on clinical medicine, clinical surgery, 
and clinical obstetrics; on fevers, on eruptive diseases, and on dis- 
eas33 of the digestive organs, the lungs, the heart, and the brain; 
on wounds, fractures, dislocations, injuries of the skull, tumors, 



800 BBPORT ON 

aneurism, ampatations, reaections, and various other important sub- 
jects? Where are their works on pathological anatomy and animal 
cHemistry ? Echo, alas I echo, alas I answers, where, where I We have 
accomplished, literally and absolutely, nothing in any of these par- 
ticulars. Need we be surprised, then, when a recent English writer^ 
exclaims: "We may safely say there is no American school 
of medicine ; whereas there is a French, a German, an Italian, and 
an English. Our transatlantic o&pring reprint, translate, and pi- 
rate the medical works of other nations, but they produce litde of 
their own. Their pathology is chiefly French ; their therapeutics 
English." Mortifying as such an accusation is, it is certainly not 
wholly destitute of truth. 

Some of the hospitals of our country have been in suocessfd 
operation for upwards of a century, and yet, during all this time, 
they have literally been as sealed books to the bulk of the profes- 
sion. The only light that has ever emanated from any of them has 
been an occasional ray, apparently grudgingly bestowed, in the 
form of a contribution to some medical journal, more transient, 
perhaps, than the journal itself. We might, if it might not seem 
personal, point to some of these establishments where materials for 
the study of pathological anatomy abound that even a Bokitansky 
might envy; to some, where vast opportunities are constantly 
afforded for the study of all kinds of injuries, as wounds, fractures, 
and dislocations; to some, where syphilis might be investigated, in 
all its forms and phases, with the same facility and amplitude as at 
the Hopital du Midi in Paris ; to some, where there are annually 
upwards of seven hundred cases of parturition, and any amount 
and variety of diseases of women and children ; to some, where 
pulmonary, gastric, and intestinal affections are of constant occur- 
rence ; and, finally, to some, where eye and ear diseases are studied 
and treated as specialties. 

Of the 120,000 patients who, we have supposed, are annually 
admitted into the various hospitals, asylums, and other charitable 
institutions of the country, at least ten thousand die. The bodies 
of many of these are doubtless examined, but where are the records 
of the results? I am not aware that one solitary great and im- 
portant paper on pathological anatomy has ever appeared in our 
medical journals from the pen of a hospital physician, surgeon, or 
accoucheur. 

> Banking's HaU-Tearlj Abstnust, No. 22, p. 306, 1855. Fhilada., 1866. 



AMERICAN MEDICAL LITSBATTTRB. 861 

The preceding facts require bo comment; they speak for them- 
seWes. The patriotic physician, patriotic in a double sense, pa- 
triotic to his profession and to his country, may well exclaim, as 
he contemplates these things, "Watchman, what of the night?" 
When will official station and opportunities be turned to account? 
When will the light of medical science be made to emanate from 
these institutions, and to shed its quickening and exhilarating influ- 
ence abroad upon the medical profession and the world ? Had the 
opportunities above alluded to been properly employed, how rich 
ndght our profession now be in great works on pathological ana- 
tomy, medicine, surgery, and obstetrics I What light might we not 
now send by every steamer to Europe in liquidation of our literary 
debt I Our foreign bonds would soon be cancelled, and American 
repudiation would cease to be a byword among our transatlantic 
brethren. 

Having thus pointed out, as briefly as was consistent with the 
nature g£ the importance of the subject, the principal causes which 
obstruct the progress of American medical literature, let me con- 
clude by offering a few remarks respecting the best means for 
removing them. 

Our course in relation to this subject is sufficiently obvious. Our 
duty, indeed, is self-evident It is comprised in one solitary prin- 
ciple, namely, justice to ourselves, justice to our profession, justice 
to our country. If we discharge this duty faithfully and vigorously, 
as it becomes us as men, as physicians, as patriots, and as Christians, 
we shall be no longer subjected to the taunts and reproaches of the 
transatlantic press, when it asserts, in the very face of the constant 
and liberal use which it makes of our labors, that America has no 
medical school, no pathology, and no therapeutics, save what she 
borrows from France and England. We have simply to throw off 
the yoke which has so long gaUed and oppressed us ; to declare our- 
selves, as £Gtr as our schools are concerned, free and independent of 
the literature of Europe, from whatever quarter emanating ; to en- 
courage and foster our own authors ; and, finally, to make the best 
possible use of the means, private and public, which are at our dis- 
posal for the establishment of an original, a vigorous, and an inde- 
pendent national medical literature. In a word, it is only necessary 
that we should reclaim our heritage, which, Esau-like, we have 
well nigh sold for a mess of pottage to our European brethren ; to 
beat down Satan under our feet ; and to assert the rights, privileges 
VOL. IX.— 24 



862 BEPOBT ON AMSBICAN MEDICAL LITSBATUBS. 

and immunities which have been vouchsafed to us, to our profes- 
sion, and to our country, by an all- wise and beneficent Gtxl. 

In yiew of the speedy and successful accomplishment of these 
desirable ends, I beg leave to submit the following resolutions : — 

Resolved^ That this Association earnestly and respectfully recom- 
mend, first, the universal adoption, whenever practicable, by our 
schools, of American works as text-books for their pupils; secondly, 
the discontinuance of the practice of editing foreign writings; 
thirdly, a more independent course of the medical periodical press 
towards foreigh productions, and a more liberal one towards 
American ; and, fourthly, a better and more efficient employment 
of the facts which are continually furnished by our publio institu- 
tions for the elucidation of the nature of diseases and accidents, and, 
indirectly, for the formation of an original, a vigorous, and an inde- 
pendent national medical literature. 

Besolvedj That we venerate the writings of the great medical men, 
past and present, of our country, and that we consider them as an 
important element of our professional and national glory. 

Besolvedy That we shall always hail with pleasure any useful 
or valuable works emanating from the English press, and that we 
shall always extend to them a cordial welcome as books of reference, 
to acquaint us with the progress of legitimate medicine abroad, and 
to enlighten us in regard to any new facts of which they may be the 
repositories. 

S. D. GROSS. 

LouiSYiLLB, May 6, 1856. 



REPOET 



OFTHB 



COMMITTEE OX MEDICAL LITERATURE. 



REPORT OF THE COMMITTEE ON MEDICAL 
LITERATURE. 



Thb undersigned^ appointed by the American Medical Associa- 
tion at its seventh annual meeting to report on the state and pros- 
pects of American Medical Literature, in fulfilling that duty beg 
leave to say, that in the execution of their design they have had to 
contend with considerable difficulties. 

Not having had access to anything like complete files of the 
various journals of the country, nor having had submitted to their 
inspection very many of the medical treatises published during 
their committee-life, they can of necessity present only an imper- 
' feet resume of the actual issues from the press — ^while the general 
considerations touching the various branches of this important sub- 
ject have been so ably handled by previous committees, that there 
seems but little left for present discussion. So thoroughly, indeed, 
has the harvest been garnered, that the gleaners last sent into the 
field, scarcely dare hope to gather more than a few scattering 



From the earliest organization of this body, few subjects have 
engaged its more earnest attention than American Medical Lite- 
rature. The first meeting of a National Medical Congress, as a 
permanently organized body, was presented with a very able paper 
on this subject, and in the transactions of nearly every successive 
one are found elaborate reports relative to the same topic. Such an 
interest is natural, and such action is wise. Every man must feel 
that the usefulness at home, scarcely less than the honor abroad, of 
our medical men is deeply concerned in the successful accomplish- 
ment of the purpose originally contemplated in all this movement 
— the fostering, strengthening, and, as near as may be, perfecting our 
medical literature. Such an object is dear to our hearts, because 
its fulfilment implies, not only the existence, but the further deve- 



866 RSPOBT OF THS 

lopment of those mental powers, acquirements and graces, as well as 
the increased facilities for their attainment, upon which this result 
must depend. 

Owing to the feet before alluded to, viz : the incompletenesa of 
the files of the medical periodicals, which it has been in the power 
of your committee to obtain, they do not feel williug to attempt the 
discharge of that part of their duty, which should embrace an ex- 
amination of these publications, " in reference to the more impoTt- 
ant articles therein presented to the profession." They design 
noticing very briefly, such " original American medical publications, 
and American reprints of foreign works," as have feUen under their 
observation, and discussing the general condition and prospects of 
our medical literature. 

The original American works which have issued from the medical 
press during the last year are numerous, and some of them of per- 
manent interest and value. 

Those which have come under the observation of your Committee 
are the following : — 

A Systemaitc Treatise, Historical, Etiohgical and Practical, on the 
Principal Diseases of the Interior Valley of North America, as they ap- 
pear in the Caucasian, African, Indian, and Esqxdmavx Varieties (^ Us 
Population. By Daniel Drakb, M. D., Vol. II. 

Five years ago, in a notice by the Chairman of the Committee on 
Medical Literature, the 1st volume with this title was pronounced 
one of the great works of the day — an enduring monument o! 
fame. The general professional verdict at home has indorsed the 
sentiment, whilp some of the ablest and most candid critics abroad 
have reiterated it. It is greatly to be regretted that the author did 
not live to complete and peifect his work. No editors, hovever 
able, can supply the place of an author under such circumstances; 
hence, in spite of the fidelity, industry, and well-known ability of 
the editors,* there are, in some parts of the volume, deficiencies and 
other evidences of incompleteness, that would not else have ex- 
isted. 

A treatise, the result of thirty years' investigation and labor by 
an acute and philosophic observer, cannot fail to command attention 
— and, however much men may differ as to the value of such works 
compared to the more compact and practical ones on the same 
general subject already in existence, or however much they niay 

' Prof. S. Hakbitbt Smith, M. D., and Prof. Fbahcib G. Smith, M. D. 



COMMITTEE ON MEDICAL LITERATUBE. 367 

disagree with some of the author's views on pathology and thera- 
peutics, this will always be referred to, as containiDg a mass of facts 
and opinions, gathered with care from all parts of our broad con- 
federacy, not elsewhere on record. It will do honor to the memory 
of one who, during life, bore the character of a close reasoner, a 
profound thinker, an eloquent teacher, and a laborious cultivator of 
the great field of science. 

On the Nature^ Signs, and Treatment of Childbed Fevers, in a series 
of Letters addressed to the Students of his Glass. By Chas. D. Meigs, 
M. D. 

The accomplished author of these letters is so well known to the 
profession as an erudite scholar, a popular and successful teacher, 
and an able though somewhat eccentric writer, that his treatises are 
always sought after with avidity. His writings are extensively 
read, and they merit it. His professional standing is high, and 
deservedly so. However much his style may be carped at — and, as 
a model, it certainly is amenable to a somewhat sharp criticism — 
no one denies to him singular ability and great research. We can- 
not but think, however, that a large majority of the more intelli- 
gent and well-informed members of the profession will differ widely 
with him on the main views advanced in this volume. 

The doctrine that "Childbed" fever is always purely an inflam- 
matory fever, the proposition that it is never portable, and the pro- 
priety of employing the lancet in every form and variety of the 
disease, as the main curative agent, are dogmas, for the reception 
of which, we are sure the professional mind, in this country at least, 
is not yet prepared. 

A Practical TVeatise on Foreign Bodies in the Air-Passages. By 
S. D. Gross, M. D., Prof. Surg. IFniversity of Louisville. 

This is an octavo of nearly five hundred pages, the materials of 
which, as we learn from the preface, have been derived partly from 
personal observation, partly from the experience of professional 
friends, but mainly from the various medical journals of the United 
States, Great Britain, and the Continent of Europe. The work con- 
tains a minute account of about fifty cases that have never before 
been published. It is, we believe, the first elaborate monograph 
on the subject of which it treats that has ever appeared. It bears 
upon its face marks of the well-known industry of its author, and 



868 REPORT OF THE 

its want of condensation is amply atoned for b j the fiolness aad 
interest of its details. 

Pneumonia: Its supposed connectionj Paihological and Eiklogkal^ 
with Autumnal Fevers; including an Inquiry inio Ae Mcistenee and 
morbid Influence of Malaria. By B. La Bochb, M. D. 

The main object which the author of this dbgant treatise had 
in view, was to prove that the idea of the identity of pneumonia 
and autumnal fever " is founded on insufficient data, and is in £ict 
little more than a dream of the imagination." 

In this, as in his previous writings, he has shown himself a 
patient and cautious observer, an erudite student, and a man of 
refined and cidtivated taste. 

One of the most readable volumes issued from the press during 
the past year, is the AutMography of Charles CALDvrBLL, M.D, 
with a prefece, notes, and appendix, by Harriot W. Warner. 

The history of the life and experience of such a man, so recorded, 
cannot fail to interest every one. This venerable octogenarian, 
dying, has left behind him a name which will not soon be forgot- 
ten, A life of eighty years was to him a life of continued conflicts, 
and almost uninterrupted triumphs. Struggling with poverty for 
an education, he soon became a finished scholar. For more than 
half a century he maintained a reputation not often accorded to 
men by their contemporaries, for profound and varied learning, for 
elevated and noble thoughts, and a sincere and earnest search for 
truth. His mind, essentially reflecting and philosophical, led him 
as to some points, far ahead of his generation; while a fearless zeal 
seemed to make him seek rather than shun controversy. And if 
in later life he clung with unreasonable tenacity to opinions formed 
long ago, it was because able and prominent men so decidedly ex- 
pressed, and so long continued an opposition to views, the truth of 
which, to his perceptions, was as clear as the beams of the noonday 
sun. 

The writings of this eminent man are very voluminous, sufficient 
of themselves almost to make a small library. The mere list of 
such as have been published occupies several pages in the Autobi- 
ography, embracing "thoughts" on nearly every variety of subject, 
that the pen of a most industrious scholar could trace. 

Upon one other point let us do justice to the memoiy of the 
dead. To him rightfully belongs the honor of suggesting the idea 



COMMITTEE ON MEDICAL LITEBATUBE. 869 

and proposing the plan, whoever may have been first sucoessfriUj 
to put it in operation, of a National Medical Congress. Twenty- 
four years ago, in one of those great orations, he knew so well how 
to make, he said : " The physicians of the United States have it in 
their power to form a most magnificent and *nsefal institution in 
medicine the world has witnessed. It may be made to embrace the 
whole Union, and to confer on the profession, and on mankind, in- 
calculable benefits. Nor is there any difficulty in the enterprise, 
provided it be attempted with unanimity, vigor, and resolution, and 
under the lights that may be easily brought to bear on it It con- 
sists in the formation of a Medical Society in each State, under the 
authority of a law of the State, and composed of all the educated 
and respectable physicians that reside within, its limits. * * * 
Let these Societies be connected by a Diet, or Amphictyonic coun- 
cil, composed of a deputation of members from each, to meet as 
often as may be deemed requisite, and superintend the interests of 
the whole. * * * Under a wise arrangement and a skilful 
and vigorous execution, a blaze of medical light would ultimately 
issue from them, such as time has never witnessed. This light 
would arise from various sources, and be. diflFused in various ways. 
American medical literature, in general, would be greatly promoted 
by the arrangement proposed. Ami asked, in what way ? I an- 
swer, that by their frequent meetings, the Societies would render 
both reading and writing more fashionable, than they are at pre- 
sent. From certain well known principles which govern human 
actions, as well as from the result of all experience, in such cases, 
this effect could not fail to be produced. American periodicals in 
medicine would circulate much more extensively, and be better 
supplied with original and useful matter. * * * One part of 
the duty of the Diet, or General Council of the Societies would be, 
to propose Prize Questions, on suitable subjects : such a measure 
would be necessarily productive of many valuable essays. * * * 
In fine, by thus federalizing a scheme for the promotion of medi- 
cine in the United States, the medical statistics of our country 
might be developed to an unprecedented extent, and the profession 
placed on an eminence it has never before attained." 

Though these last tracings of his pen hardly bear the full impress 
of his bold and vigorous mind, they will be much read. Their 
discursiveness will be liked for the interest of the digressions ; their 
egotism pardoned for its harmlessness, and its thoroughness; their 



870 BEPORT OF THE 

occasional bittemeas forgiven, for his impression of the greatness of 
his wrongs. 

The Transactions of the American Medical AssocicUiofij Vol VIL 

Notes of M. BemareCs Lectures on the Blood. By Walteb L 
Atlee, M. D., is the title of an interesting duodecimo of 224 pages, 
recently issued. 

A Dictionary of Medical Semeiohgy^ Dental Surgery^ and the Col- 
lateral Sciences. By Chapin A. Harris, M. D. 

Nature in Disease. By Jacob Bigelow, M. D. 

Human Physiology. Designed for colleges and the higher classes 
in schools, and for general reading. By Worthington Hookeb, 
M.D. 

Principles of Physiology. (For similar purposes.) By J. C. Com- 
STOCK, M. D., and B. N. Cornings, M. D. 

Two elementary treatises which are calculated to answer as well 
(that of Dr. Hooker much better), the purposes for which they were 
written as any others we have seen. We cannot express a veij 
high opinion of the real value of treatises of this kind, yet it is 
greatly to be desired that some such work as Dr. Hooker's should 
replace the silly trash with which the juvenile mind was regaled, 
no long years ago. 

The Anatomy^ Physiology^ and Pathology of the Human JJseA; 
%mth the most approved Methods of Treatment^ including Operations^ a»i 
the method of making and setting Artificial Teeth. By Paul B.'Goi)- 
DARD, M. D., &c., aided in the practical part, by Joseph E. Parkbb, 
Dentist. 

Positive Remedial Agents; being a Treatise on the Non-AliahU 
Besinoid, and Concentrated Preparations of Indigenous and Foreip 
Medical Plants. By the Authority of the American Chemical Institute. 

Diseases and Injuries of Seamen^ &c. By G. R. B. HoBKEB, M. D^ 
Surg. U. S. N. 

On the Construction^ Organization^ and general Arrangement (^ Sos- 
pitals for the Insane. By Thos. S. Kirkbride, M. D., Physician 
to Pennsylvania State Asylum for the Insane. 

Reports from the Lunatic Asylums of Maine, Vermont, Massa- 
chusetts, Rhode Island, Pennsylvania, New York, New Jerser, 
Maryland (Mt. Hope), Missouri, Indiana, and Michigan. 



I 



COHHITTEB OK MEDICAL LITEBATUBE. 871 

An Examination of the Practice of Bloodletting in Mental Disorders. 
By Pliny Eable, M. D. A volume of 146 pages devoted to the 
discussion of the following question, viz: To what extent, in regard 
to both freqtiency and quantity, is the abstract of blood required in the 
treatment of Insanity t The final answer to this question is summed 
up in the following conclusions : — 

1. Insanity, in any form, is not, of itself^ an indication for blood- 
letting. 

2. On the contrary, its existence is, of itself, a contra-indication. 
Hence, the person who is insane should, other things being equal, 
be bled less than one who is not insane. 

3. The usual condition of the brain, in mania, is not that of active 
inflammation, but of a species of excitement, irritability, or irrita- 
tion, perhaps more frequently resulting from or accompanied by 
anaemia, debility, or abnormal preponderance of the nervous over 
the circulatory functions, than in connection with plethora and en- 
iuring vital power. 

4. The excitement, both mental and physical, produced by this 
irritation, can, in most cases, be permanently subdued, and its radical 
source removed by other means, more readily than by bleeding. 

5. Yet insanity may be coexistent with conditions — such as 
positive plethora, a tendency to apoplexy or paralysis, and some- 
times sthenic congestion or inflammation, which call for the abstrac- 
tion of blood. Therefore, 

6. Venesection in mental disorders should not be absolutely aban- 
loned, although the cases requiring it are very rare. 

7. As a general rule, topical, is preferable to general bleeding. 

8. In many cases where the indication for direct depletion is not 
irgent, but where bloodletting, particularly if local, might be 
>ractised without injury, it is safer and better to treat by other 
neans, equalizing the circulation and promoting the secretions and 
^cretions. 

9. The physical conditions requiring bloodletting more frequently 
^xist in mania than in any other of the ordinary forms of mental 
Jienation. 

10. Insanity following parturition, other things being equal, is to 
)e treated by bleeding less frequently than that which has its origin 
n other causes. 

11. If the mental disorder be the direct result of injury to the 
lead, the treatment must be directed to the wound, or its physical 
{fifects, not specially to the psychic condition. 



872 REPOBT OF THE 

12. In manj cases where insanity is accompanied by typboiu 
symptoms, and in some where the aspect is that of acnte phreDitifl, 
active stimulants alone can save the patient, and direct depletion 
from the circulation is almost certainly &tal.^ 

Report of the Select Committee of the Senate of the United States, on 
the Sickneaa and Mortality on board Emigrant Ships, HAMiLTOir 
Fisu, Chairman. 

A fitting close to this doubtless imperfect catalogue will be found 
in the bare announcement, for more would be superfluous, of the 
appearance of new editions of 

Woman: her Diseases and Remedies. By CHARLES D. MEiaa^ 
M.D., 2d edition; 

A Treatise on the Practice of Misdicine. By Geo. B. Wood, M. P, 
4:th edition, and 

jf%e Dispensatory of the United States of America. By Profit 
Wood and Bachs, 10th edition. 

The rapidity with which edition after edition of these works is 
disposed of, is sufficient evidence of the popularity which they enjoy, 
and, let us add, merit. 

The Dispensatory is better known, and more widely distributed, 
probably, than any other treatise which has ever been published in 
the country ; and your Committee cannot allow the opportunity to 
pass without expressing their high sense of the value of this admi- 
rable book. 

Besides these, are many smaller and less pretending treatises, ia 
pamphlet form, consisting mainly of republications of articles which 
had already appeared in some of the journals. Some of them are 
worthy of notice. 

One of them is entitled : Puerperal Fever as a Private Pestilenetf 
by Oliver Wendell Holmes, M. D., Professor of Anatomy and 
Physiology in Harvard University. Originally published some 
twelve years ago, this timely contribution to medical literature and 
scientific truth, has been again put before the profession, without 
alteration in itself, but with a full " Introduction," and a brief but 
comprehensive appendix. The aim of this paper is to establish 
clearly the point that puerperal fever may be, and, occasionally «t 
least, is carried from patient to patient, by medical assistants. If 

' New York Journal of Medicine. 



COMKITTES ON KEDICAL LITERATUBE. 373 

this proposition be not satisfactorily proved to every man who reads 
this little book with an unprepossessed mind, there is an end, to 
such an one, of all proofs on questions of contagion. So clear and 
concise is the argument, so pointed are the facts adduced, so direct 
and weighty are the authorities cited, that a conviction of the sound- 
ness of the view presented seems unavoidable. At any rate, even 
if such conviction fail, there cannot be the shadow of a doubt as to 
the propriety of the precautionary measures recommended. 

Another pamphlet-monograph, recently appearing, is a republica- 
tion, from the Western Journal of Medicine and Surgery^ of three lec- 
tures, by Henry Milleb, M. D., Professor of Obstetric Medicine 
in the University of Louisville, designed as a reply to the " Croo- 
nian Lectures," by Dr. West, of London, on the pathological rela- 
tions of inflammation and idceration of the cervix uteri. Dr. West 
and Dr. Miller represent, respectively, the views of two large and 
very respectable classes of practitioners ; the former teaching sub- 
stantially that inflammation of the neck of the uterus, to any great 
extent at least, is not common : is not ordinarily the cause of serious 
constitutional disturbance, and does not often require local remedial 
applications ; while the latter maiutains that such morbid action is 
common ; is not unfrequently the cause of grave symptoms, general 
and local ; and may be cured only, in most cases, by direct applica- 
tions ; the question of the propriety of the common employment of 
the speculum being largely involved in the issue. Without express- 
ing any opinion upon the merits of the subject, we must award Dr. 
Miller the praise of having made a reference of his views, which, if 
not absolutely convincing, is yet masterly and striking. 

Dr. Wh. M. Doling, of Alabama, has published an elaborate 
essay on the Mechanism and Momagemeni of Shoulder PresentationSj 
vhich is creditable to him as an observer and a writer. Giving a 
birresunU o{ what is taught by standard authors, and preferring 
the term spontaneoiLs evolution^ as taught by Denman, to that of 
spontaneous expulsion adopted by most writers since Douglass's expla- 
nation of the mechanism of the process, he asserts that neither of 
those heretofore given is correct, and attempts to show that rotation 
so filters the position of the foetus that the incurvation is towards 
the anterior, instead of the lateral portion of the child's body. His 
i^marks on the use of bloodletting, opium, and especially chloro- 
form, are eminently judicious. 



874 REPOBT OF THE 

IHfficuU Lobars and their Treatment. By Prof. M. B. Wright. A 
prize essay, reprinted from the Proceedings of the Ohio State Medieal 
Society. 

Oases of Polypus of the Womh, is the title of an inter^ting pam- 
phlet by Dr. Channino, of Boston, containing, besides the histoij 
of thirteen cases, some remarks in reference to the non-malignancy 
of these tumors, and their failure ever to reappear in the same spot 
from which they hare been removed. 

Pathology and Treatment of IrfarUile Laryngo-Tracheiiis^ or Orwp* 
By E. R. Peasleb, M. D. 

Remarks on Group, and its IVeatmerU. By Horace Gbssn, M.D. 

Exsection of the Sead cf the Femur, and Removal (^ the Upper Rim 
of the Acetabulum, for Morbus Ooxarius. By Lewis Saybs, M. D. 
An exceedingly interesting case, well recorded. Accompanying is 
a table, containing a brief abstract of thirty operations of this for- 
midable character by different surgeons, the result of which is tbna 
summed up : " Eecovered, 20 : of these 18 were completely success- 
ful ; 8 died of an intercurrent disease, at periods varying from three 
months to years after the operation ; 1 is reported as not having 
progressed favorably. The remainder were too meagrely reported, 
or too recently performed to decide correctly of the results. Died, 
10 : of these, 4 died within one week after the operation ; 1 on the 
twelfth day ; 2 in two months ; 1 some months after ; 1 unsuccessfoL 

Poisoned Wounds — Their distinctive features, classification, and a 
treatise on the nature and treatment of wounds resulting from the bila 
of venomous reptiles, experirr^enis, being a report to the Medical Assodor 
tion of Missouri. By A. F. Jeter., M. D., Chairman Com. 

Essay on a new Method of treating Serpent Bite, and other Poisoned 
Wounds. By DANIEL Braikard, M. D., Prof, of Surg, in the Medi- 
cal College of Chicago. 

A new Plan for treating Ununited Fractures, by Henrt H. SurtB, 
M. D., is another ingenious attempt to solve a difficult problem. 

Ethoplasty, or Old Ulcers treated by Anaplasty. By F. H. HaiultoK, 
M. D., Prof, of Surg., Buffalo. 



COMMITTEE ON MEDIOAL LITEBATURE. 875 

Discovery of the Cause^ Nature^ Cure, and Prevention of Epidemic 
Cholera. "By W. L. Knapp, late Prof, in University of Iowa, and 
Rush Medical College, &c. &c. 

This paper is an argument to prove the necessity of the presence 
of a scorbutic diathesis, before a person can be attacked with cholera. 
" It has," says the author, " been a hard and difficult task to divest 
my mind of the Mae notion of some specific poisonous influence 
overlaying scurvy, even since I have been fully aware of the scorbutic 
diathesis underlaying cholera. It may be difficult for others even 
yet to see clearly ; but if, as appears by our analysis, every case of 
cholera is a messenger of death riding always on the time-honored 
steed Scorbutus, it matters but little what be the theory as to the 
office or entity of the messenger; if we destroy the steed, the rider 
will get on but poorly. This we know how to do. But I can see 
no occasion now to search for the further cause of cholera, than the 
causes producing scurvy, no phenomena in cholera other than what 
harmonize with the well-known laws of scurvy, and nothing at 
the bedside after hemorrhagic action is arrested, but the physical 
evidences of scurvy. Neither do the books describe any anatomical 
lesions contradictory to this view." The article is a striking exhibi- 
tion of the completeness with which riotous theory may displace 
sober judgment. 

Congestion of the Brain in Cholera. By Jas. Newman, M. D. 
Observations on Asiatic Cholera as it appeared in Cincinnati, 1849- 
50. By Thomas Carroll, M. D. 

Simoda Cedron. — Under this title are republished in phamphlet 
form from the New York Journal of Medicine, some theoretical and 
practical views, by Dr. Purple, in regard to the fruit of this tree. 
The conclusions are, that it possesses decidedly antiperiodic proper- 
ties, that it is less likely than quinine to produce encephalic or 
neuropathic phenomena; that in periodic and yellow fever it is not 
far inferior to quinine ; that it possesses notable tonic properties, 
and that it may be obtained at a much smaller cost than quinine. 

Another form of periodical literature is found in the published 
Transactions of the various State and other Medical Societies. 
These are annually increasing in number and interest. Those which 
We fallen under the observation of your Committee are, 

Ohio State Medical Society (9th annual meeting). 



876 BEPORT OF THE 

Illinois State Medical Society (4th annual meeting). 

Medical Association of the State of Alabama (7th annual meet- 
ing). 

Medical Society of the State of New York. 

Medical Association of Southern Central New York (8th annual 
meeting). 

Medical Society of the State of N. Carolina (5th annual meeting). 

Iowa State Medical and Chirurgical Society (3d and 4th sessioDs^ 

Medical Society of the State of Pennsylvania (volume 4tli). 

College of Physicians of Philadelphia — Quarterly Summariea. 

These are, in the main, creditable to the physicians concerned, aa 
strictly professional records — some of them furnishing admiraUe 
essays and reports. If the members of these local societi^ would 
use their best efforts — would make a concise but suffidentlj M 
exhibit of the more important results of their observation — ^wooU 
discharge carefully the duties respectively assigned them, would 
regularly gather in numbers to exchange professional experieooe 
and friendly greetings, there could be no question that results for 
good would ensue, the greatness of which might surpass the expecta- 
tions of even the most sanguine. This kind of associated effort- 
the association and the effort both made stronger by harmony of 
feeling— cannot fail to do good whenever and wherever it is tried. 
The influence of county, district, and State societies, even as at 
present existing, many of them lacking energy, and almost vitality, 
because so many of their members are careless and indifferent, 
careless of attendance, and indifferent because they do not see anj 
immediate and happy results springing from their meetings — is yet 
powerful and beneficial. We trust the day is not far distant when 
this influence wUl be greater and more pervading, when every 
medical man will acknowledge it, and feel it his duty to contribute 
his share, no matter how small, to the permanence, eifficiency, and 
value of these institutions. 

Saiotaby Bepobts exhibit still another phase of our medical 
literature. These are generally of great interest, containing fac^ 
and statistics of importance in relation to topography, hygiene and 
mortality, both from endemic and epidemic diseases, principallyi 
however, from the latter. The only ones we have been able to 
examine are those of the cities of BuflSdo, Memphis, and New 
Orleans ; the first by James M. Newjca^, M. D., Health Officer; the 
second by Pro£ Ghas. S. Quintabd, and the third by a joint com- 



GOUHITTEE OK MEDICAL LITEKATURE. 877 

aission composed of Drs. Axon, McNeil, Biddell, Simonds and 
iXRTON. This commission was appointed by the Board of Health, 
^ through the urgent promptings of public sentiment," with special 
nstructions : 1st To inquire into the origin and mode of trans- 
nission or propagation of the late epidemic fever (1863). 2d. To 
nquire into the subject of sewerage and common drains; their 
idaptability to the situation of the city, and their influence on 
wealth. 8d. To inquire into the subject of quarantine ; its uses and 
applicability, and its influence in protecting the city from epidemic 
suid contagious maladies. 4th. To make a thorough examination 
into the sanitary condition of the city, into all the causes influenc- 
ing it in present and previous years, and to suggest the requisite 
sanitary measures to remove or prevent them, and into the causes 
Df yellow fever in ports and other localities having intercourse with 
New Orleans. 

These questions were referred to different members of the com- 
mission. Drs. Axon and McNeil discuss ably the first, relative to 
the origin and spread of the pestilence, deducing as conclusions : 
1st. That it was not derived from abroad, but is of spontaneous 
origin. 2d. That there existed very peculiar meteorological con- 
ditions known by general experience to be capable of producing, 
in co-operation with local causes, fatal and malignant forms of fever. 
Sd. That these conditions were present in a very exaggerated 
degree, and impressed upon the prevalent type of disease, suscepti- 
bilities and habits assimilating it to another and distinct form of 
fever; and 4th. That this showed in all those localities within the 
range of the meteorological state or influence, an infectiousness not 
necessary to, or characteristic of the fever, but purely casual and 
accidental, the result of physical causes, and which it loses as soon 
as these causes are changed or disappear. 

The result of Prot Riddell's investigation of the second, is a 
business like, practical, and yet scientific report on a general system 
of drainage and sewerage. 

Dr. Simonds, to whom was committed the third inquiry, con- 
tributes a forcible and ingenious, though by no means satisfactory 
defence of quarantines. 

The fourth, it will be seen, comprehended, or at least was super- 
visory, of dl the others, and has drawn from Dr. Barton a most 
voluminous report, in which will be found many facts of great 
interest and some very striking views, though a number of well 
directed efforts at condensation, and a little more attention to the 
VOL. IX. — 26 



878 BEFOBT OF THE 

choice of words, the localities of punctuation marks, and to the 
rules of grammar, would have somewhat improved the style of tbis 
paper. These faults are, however, redeemed by the great merits of 
the work iu other respects. 

The volume, which is one of no mean size (pp. 542, 8 vo.), abounds 
in tables, maps and charts, and is evidently the result of great labor. 
It evinces an unusual industry and a zeal which are really re&esh- 
ing and reflect credit upon the authors, especially Dr. Barton. We 
apprehend, however, that the conclusions of the Board will not 
command universal assent. Summarily they are two i. The one is 
that yellow fever is and always has been, here and elsewhere, a 
preventable disease. The other is, that the presence of two hygienic 
conditions is absolutely indispensable to the origination and 
transmission of the disease ; the one of them alTnospJieric ; the other, 
terrene. These must meet in combination. The term ierrenej as defined 
by Dr. Barton, embraces "every species of noxious effluvia, which 
filth of every description, and disturbances of the original soil, gene- 
rate and transmit." 

We scarcely dare congratulate ourselves upon the certainty of 
these things, and fear that Dr. Barton's name will not descend to 
posterity crowned with the glory that must surely be the reward 
of him who shall discover the cause, and provide infallible means 
for the prevention of such a scourge as yellow fever. 

Registration Reports. — None of these for the current year 
have fallen under the observation of your Committee. 

Among the American reprints of foreign works, will be found a 
new edition of The Principles and Practice of Obstetric Medicine (Bad 
Surgery in reference to the Process of Human Parturition. By f'BJSC& 
A. Ramsbotham. With notes and additions by Wm. V. Kbatixo, 
M.D. 

An elaborate and well-known work, of which it is scarcely 
necessary that your Committee should express a hearty commen- 
dation. Few men have had larger opportunities for observation, 
and few could use them to better purpose. This treatise is one of 
the best ever written on this branch of practical medicine, a brancht 
by the way, whose literature is rich and extensive. 

We are pleased to notice it prefaced by a well deserved dedica- 
tion to Prof. Chas. D. Meigs, and sorry that the author still holds 



COMMITTEE ON MEDICAL LITEBATURE. 879 

to Tiis ultra views on the use of ansBSthetics in natural labor ; for 
surely those views must be considered ultra, that lead to such 
strong condemnation of the use of these agents at any time, and in 
any quantity in the " ordinary pains of child birth." 

The Modem Treatment of Syphilitic Diseases. By Langston Par- 
KER, Surgeon to the Queen's Hospital, Birmingham. From the 
Sd London edition. 

The author of this work has devoted nearly a quarter of a 
century to the therapeutics of syphilis, more especially its con- 
stitutional forms. His experience has been large. In addition to 
the cases which have fallen under his notice, as surgeon to an exten- 
sive hospital, he has treated in private practice more than eight 
thousand. Such experience ought to be worth something. On 
many of the knotty questions of syphilis he agrees with Vidal de 
Cassis and Erasmus Wilson, rather than Bicord. In his mode of 
treating the disease in its constitutional forms, he is somewhat 
peculiar. While mercury is the staple of his treatment, he rejects 
its administration by the mouth, or by inunction, and relies on it 
in the form of vapor, diluted and made moist by admixture with 
the vapor of water. 

T?ie Science and Art of Surgery, being a Treatise on Surgical In- 
juries, Diseases and Operations. By Jno. Erichsen, Prof. Surgery in 
University College. Edited by John Brinton, M. D. 

It is in the republication of works like this that publishers 
confer a real benefit upon the profession. Plain, sensible, practi- 
cal and judicious, it has already won the esteem of discriminating 
surgeons, as a trustworthy and reliable summary of the science 
and art of surgery. Nowhere in the language can be found, within 
the same compass, so complete and satisfactory an exposition of 
the leading principles and soundest practice of this branch of medi- 
cine. 

The Microscopic Anatomy of the Human Body in Health and Disease, 
illustrated with numerous drawings in color. By Arthur Hill 
Hassall, M. D., &c. &c. Edited, with additions, by Henry Van 
Arsdalb, M. D. 

Manual of Human Microscopical Anatomy. By Prof. Kolliker, of 
Wurzburg ; an American edition of which has lately been repub- 



880 BEPORT OF THE 

listed, by Dr. J. Da Costa, from the English translation of Bnsh 
and Huxley. 

The Principal Forms of the Skeleton and the Teeth, By Pro£ R 
Owen. 

Principles of Comparative Physiology. By W. B. CABPEyrEB, 
M. D., F. R. S. (from fourth London edition). 

The writings of Carpenter are among the most popular in the 
whole range of science. Not himself a profound investigator of 
the laws of life, he has a most graceful as well as a very satisfectory 
way of collating and systematizing the results of the labors of others, 
and it is hazarding little to say that this faculty, possessed to such 
an extent, will always, with the mass of men, secure for an author 
a wider renown than falls to the more laborious explorer of the 
labyrinths of nature. 

Lectures on (he Diseases of Infancy and Childhood, By Chas. Wbst, 
M. D., F. R. S. Second American, from second London edition. 

An Inquiry into the Pathological Importance of Ulcerations cf ^ 
Os Uteri (Croonian Lectures, for 1854). Same author. I 



The Pathology and Treatment of Pulmonary Tuberculosis. By J0H5 i 
Hughes Bennett, M. D., F. E. S. E., Prof University Edinburgh. 
After pointing out clearly ^he pathology of the disease, the author 
proceeds to show : 1st. That tubercular diseases will heal of them- 
selves if the faulty nutrition of the system can be removed. 2d. That 
with this object our efforts should be directed to the digestive rather 
than to the respiratory system. 8d. That the kind of abnormal 
nutrition which exists is dependent on increased assimilation of 
the albuminous, and diminished assimilation of the fatty portioo3 
of the food. 

Clinical Lectures on Pulmonary Consumption. By TheopHUI^ 
Thompson, M. D., F. R. S., Physician to the Hospital for Consump- 
tion and Diseases of the Chest. 

AuscuUatian and Percussion. By Dr. Joseph Skoda. Translated 
from the fourth edition by W. 0. Maekham, Assistant Physician 
to St. Mary's Hospital. 

Without assenting to the truth of the teachings of this distin- 
guished diagnostician, or, indeed, expressing any opinion as to the 



COMHITTBS ON MEDICAL LITSBATUBE. 381 

value of his system and the correctness of his explanations, we must 
admit that his " Theory of Consonance" is original and ingenious, 
and his work worthy of a serious and candid attention. 

What to Observe at the Bedside^ and after Death (2d American from 
enlarged 2d London edition), is the title of a small but comprehensive 
volume, " published under the authority of the London Medical 
Society of Observation," containing fuU suggestions on almost 
every point that concerns the physician in his examinations, thera- 
peutic or cadaveric. If this same learned society, or some other, 
would only teach the juniors (and some of the seniors, too) Iiow to 
observe, as well as tohat to observe, the gratitude of the human race 
would be theirs. To observe minutely is one thing, and a very 
good one ; to observe intelligently and profitably, is another and a- 
better. 

A Treatise on Fracture in the Vicinity of the Joints^ and on certain 
Forms of Accidental and Consequential Dishcajtions. By Bobebt W. 
Smith, M. D. 

A Manual of Pathological Anatomy. By C. Hantield Jones, 
M. B., F. B. S., and Edwabd H. Sibvbking, M. D. 

A complete summary, and an excellent compilation; and honestly 
acknowledged to be only ^ compilation. A piece of frankness 
which some good book-makers here and elsewhere would do well 
occasionally to imitate. 

A Text-book of Practical Anatomy. By Bobebt Habbison, M. D., 
M. R L A. 

A Clinical Introduction to the Practice of Auscultation and other 
means of Physical Diagnosis in Diseases of the Lungs and Rea/rU By 
H. M. Hughes, M. D, &c. 2d American from 4th London edition. 

A Sand-book of Chemistry, Theoretical, Practical, and Technical 
By F. A. Abel and C. S. Bloxam. 

In a critical survey of our national medical literature, not only 
for the current year, but for years gone by, v/e have been strongly 
impressed by two antagonistic particulars respecting it: 1st, its 
general excellence ; and 2d, the depreciation which it has so often 
met with at the hands of some of our own brethren. It will be 
found that scarcely a solitJ^ry reporter to your body on this sub- 
ject, has failed to lament the low state and condition of our 



882 KEPORT OP THE 

professional literature, and to suggest explanations more or lea 
satisfactory, of such condition, and means more or less profound 
of remedying it. At the last annual meeting of this Association, 
on motion of a distinguished gentleman, himself an author of 
no mean repute, a special committee was appointed to report on 
the causes which tend to " impede the formation of a national 
medical literature." For years past, some of our journals have 
teemed with articles, editorial and communicated, whose set purpose 
seems to be to depreciate to the last degree the extent of American 
medical scholarship, and the value and trustworthiness of Ameri- 
can medical authority. • From the dignified reporters of the Asso- 
ciation to the silliest of anonymous scribblers, who bewail with 
grievous lamentations this national degradation; who declaim 
with fiercest invective against the pandering to foreign authors on 
the part of our medical readers ; who, rising with patriotic spleen 
into the regions of sublimated eloquence, as when the veriest ass 
becomes 

" A Pegasus, 
A ann-reared charger snorting at the stars, 
And kicking all the Pleiads at his heels,"— 

there are those who see nothing but a dishonorable lack of nation- 
ality in the fact that we do not discard foreign authors merely 
because they are foreign, and welcome with affectionate embraces 
native ones merely because they are native. They sorrowfully 
complain of the unworthy condition of our literature, and conse- 
quently of the general demerits of our authors. We cannot, upon a 
calm review of the whole subject, add our voices to this melancholy 
chorus. On the contrary, we look with just pride upon our national 
literature, even the medical part of it. It is true, indeed, that it 
scarcely represents the full professional merit of the country. It is 
likewise true that in it are exhibited many shallow thinkers, many 
careless observers, many loose compilers, many literary upstarts, 
many unworthy imitators, and some dishonorable plagiarists. But 
they know little of general or professional literature, who do not 
know that such characters are represented in every country, and 
every age, and who have not found, by personal experience, that he 
who seeks mental sustenance is apt to find more chaff than grain. 
It is not to be denied that our medical men seldom indulge in the 
abstruse metaphysical speculations so characteristic of the German 
mind ; that they do not exhibit the patient yet eager pathological 
research whfch marks the French ; and, in all fairness, it must be 



COMMITTEE ON MEDICAL LITERATURE. 883 

admitted that very many English works are superior to some Ameri- 
san treatises upon tha same general subjects. ' It is likewise true 
^liat, proportionally, fewer volumes, of a high philosophic or scien- 
tific cast, have appeared &om native, than from foreign authors. All 
bliis may be acknowledged without the slightest sense of national, 
professional, or personal humiliation. Be it remembered that the 
Literature of a people is connected not only with its talents, acquire- 
xnents, and charactOT,but with its stage of development and its state of 
existence. The present is, with us, emphatically an age of action, not 
of rej)Ose — of restlessness, not of quiet— of growth, not of maturity. 
The existence of the scholar is separate and apart &om that of the 
man of the world. Continually engaged in the great battle of life, 
every interest of the latter is absorbed in the struggle ; while, by 
the former, the noise of the strife is heard only in monotones, and 
scarcely heeded then. 

The least reflection will suffice to show any one that, until recently, 
in this country, circumstances have been unfavorable to the prose- 
cution of deep scientific investigation, or patient, prolonged, and 
philosophical research. The means which are at the command of 
so many in the Old World, have been here, in a great measure, 
wanting. The advantages for the investigation, on the largest scale, 
and in the most thorough manner, of the profounder problems of 
life and death, health and disease, which have surrounded, for cen- 
turies past, the favored and gifted men of Europe, as found in vast 
hospitals, in the aggregation of men, in the encouragement given to 
scientific pursuits, in the immediate rewards of success, and in 
incentives of every kind to avail themselves of the opportunities 
almost thrust upon them — these advantages have not always pre- 
vailed here, nor do they now, to as great an extent as abroad. Our 
national growth has been too rapid to admit yet of a full literary 
development. We have felled forests rather than trimmed the mid* 
night lamp — have reared great cities rather than studied great books 
— ^have built navies rather than written metaphysical philosophy. 
Brave hearts and strong arms, incited by a restless activity, have 
founded an empire, vast in extent, mighty in power. The period 
of repode has not yet come. The stillness of deep thought has not 
yet fallen upon us. The age of great scholars, and great writers, 
in our profession at least, may not yet have more than dawned upon 
us ; but it has dawned, with the promise of a glorious day. As 
Americans, we can justly boast of Jurists whose opinions command 
a world-wide respect; of Historians who rival the purest classic 



884 BSFOBT OF THE 

models of any age ; of Divines who adorn even the pnlpit ; and, we 
are proud to say, of Physicians whose names the medical world, at 
least, " will not willingly let die." If we have few Authors worthy 
of the name among us, let it be remembered that there are few such 
anywhere. If the relative proportion of such seem too small^ let it 
not be forgotten that whereas we see all of our own works, we see 
only the chcnce omes republished from abroad. I^ indeed, we are yet 
in a state of comparative literary inmiaturity, let us remember that 
we have hardly had time to complete our growth, and that all sys- 
tems o{ forcing are unnatural and unhealthy. If we have not wholly 
emancipated ourselves from traditionary dependence on foreign 
supplies, let us not forget that it is as unwise for a community as 
for an individual, to separate itself from its kind. If other people, 
older in their nationality than we, choose to east a slur upon our 
productions, and scoff at our efforts, let us remember that it is one 
of the prerogatives of age to contemn the inspirations of youth, but 
that a wise and true manhood judges neither nations nor men by 
the grayness of their beard. 

No depreciation of ourselves, and no impertinent sneers of otheis, 
can alter, in the slightest degree, our actual relations to the profes- 
sion or the world. 

The time has past when any man of character abroad, with a 
decent self-respect, will ask : " Who reads an American book ?" 
And though we annually send abroad self-important medical cox- 
combs, who, when asked what the American profession has done 
for the glory of our beneficent art, are so ignorant as to hide their 
heads with shame for want of answer,^ and so insolent as to report 
to your body their opinions in reference to the deplorable lack of 
knowledge, and the miserable shortcomings of their brethren at 
home ; yet no one whose estimate is worth one iota, here or else- 
where, pretends to deny to our countrymen in medicine, as in philo- 
sophy, not a few of the grandest and richest practical results yet 
achieved by the world. Need we point to some of the boldest suc- 
cesses of surgery ? to some of the most enduring triumphs of practical 
medicine? to the discovery of ansssthesia-— the veritable Letheoa 
which steeps in oblivion so much pain, and wraps in forgetfulnesa 
so many sorrows ? It were idle to do so. It were equally idle to 
deride or undervalue our national medical record. Nevertheless, 

* Vide memorial from American Medical Society Of Paris. Transactions A. M. 
A«i ^ol. Til. 



COMMITTEE OK MEDIOAL XilTEBATURE. 885 

it is not pretended that our medical literature is immaculate. And 
admitting an actual inferiority in some respects, and granting the 
complete inferiority assumed by some critics, it will not be amiss to 
examine the reasons more commonly urged as explanatory of this 
condition, and some of the means proposed to amend it. These 
may be substantially reduced to two. First, a slavish subserviency 
to foreign authors, and a consequent contempt for native ones ; and 
secondly, the non-existence of an international copyright law. 

The first could hardly be more forcibly stated than in a very 
elaborate report' presented two years ago to the Association by 
one of its special committees. "American physicians and sur- 
geons," says the reporter, " seem to glory in being the slaves of 
European authority in whatever pertains to their profession both 
in matters of opinion and practice. Like Esau, they have bartered 
away their birthright for a mess of pottage ; they are unwilling to 
learn anything that is purely American; they are too proud to 
acknowledge that anything good can emanate from a native author, 
and too stubborn to admit that one man knows more than another* 
They would rather at any time, lest they should seem to be indebted 
to their own countrymen, quote from Louis and Chomel than from 
Drake and Chapman, or Cooper and Brodie than Gibson or Mott. 
It is a bitter humiliation to find this tendency in our profession, a 
tendency so utterly at variance with the true spirit of patriotism, 
with our national pride and with our national advancement as a 
scientific and literary people. It is mortifying to see that every- 
thing in the shape of a foreign book, however shallow and indiffer- 
ent, is greedily sought and patronized, to the neglect of our own 
productions." 

Without noticing the significant fact that such complaints ordi* 
narily issue from those who are themselves authors, we suggest 
that, if it be universally, or even generally, true of American physi- 
cians, that they prefer foreign to native writers, it proves either 
that our medical readers have no judgment, or else that the foreign 
authors are really the best If the latter be the case, it is difficult 
to understand upon what principle of wisdom or patriotism we 
should prefer the meaner. He could hardly be called a wise man 
who would take for his daily diet peanuts instead of potatoes, 
because one grew on his own farm, and the other did not. But we 
are persuaded that there is an error of fact in regard to this matter. 

* On the Reenlts of Surgical OperaUons in ICalignant Disease, B. D. Gross, M. D. * 



886 KEPOBT OF THE 

We believe it will appear, upon investigation, that directly the 
reverse is true — ^that of the whole number of really standard works 
published, as large vl proportion of native as of foreign ones will he 
found in almost any physician's library — that this proportion usually 
augments, in an inverse ratio, to the number of volumes contained 
in the library, and, therefore^ as the greater number of medical men 
possess but few books, a majority must purchase and consult prin- 
cipally native works. 

It is easier to forget than to destroy the facts of history. If there 
be one thing which, above another, is noticeable in the records of 
our literature, it is the kindness with which the medical public has 
received American productions — ^shown not only by extending 
encouragement to the good, but by throwing the mantle of charity 
over the bad. " The writings of Dr. Benjamin Rush had a wide 
popularity, and were as much read by his countrymen as the pro- 
ductions of any contemporary European writer. Eberle was as 
successful as any medical author of his day. Edition after edition 
of his works was called for during his lifetime, and at least one has 
been published since his death. The first work published by Chap- 
man, his Therapeutics, attracted much attention, and was generally 
read. Dunglison has been eminently successful as an author, and 
his colleague, Prof. Meigs, has been hardly less so. Few books 
have had a more steady sale, or been more universally approved by 
the profession than the Dispensatory of Wood and Bache, and a 
later production of the former has taken its rank among the standard 
works on the practice of medicine. Pro£ Dickson, of Charleston, 
has produced works which have given him an enviable reputation, 
and are to be found widely distributed through the libraries of his 
brethren. Everybody knows how wide was the circulation of 
Wistar's Anatomy. Dorsey's Surgery soon made its way into most 
of the medical libraries in the country, and Gibson's Surgery has 
passed through numerous editions. The writings of Bartlett have 
met with universal favor, and have been profitable both to the 
author and his publishers. Homer, Godman, Warren, the Becks, 
and Dewees, have conferred honor upon their country by their 
labors, and an ample share of praise has been awarded to the pro- 
ductions of their pens. The great work of Dr. Drake, prepared at 
the expense of so much time and labor, was hailed by his brethren 
at home as a production which "did honor to American medicine."* 

' Western Journal of Medicine and Sargerj, June, 1854. 



COHHITTEB OK MEDICAL LITERATURE. 887 

There are few libraries in which Condie is not represented, and the 
names of Miller, of Gross, of La Roche, of Leidy, of Bell, are honor- 
ably known to the profession. The list, if necessary, might be easily 
extended. We tmst these considerations and these facts are sufficient 
to show the error of those who depreciate the value of native works, 
or underrate the good sense and patriotic instincts of their brethren. 

The second point refeiyred to, supposed to be explanatory of any 
existing shortcoming in our medical literature, is the absence of an 
international copyright law. 

This demands a more serious consideration, not only because the 
lack of such a law has been greatly deprecated here, as well as else- 
where, and because it is urged that its enactment would be fraught 
with such precious results to our literature, but because the subject, 
in some of its bearings at least, is misapprehended, if not wholly 
misconceived, even by some of those whose clamor is most vocife- 
rous for it. 

The question of international copyright is one of great difficulty 
and importance, and like every question which can be justly spoken 
of in that way, requires to be considered not only in a variety of 
lights, but is liable to determine us in opposite directions, according 
to the point of view from which we chiefly consider it. The private 
interests which are at stake might incline us to decide in one way, 
while the higher interests of society might compel us to decide 
diflferently. The interests of trade and the interests of knowledge 
might be supposed to conflict, and the pecuniary demands and 
rights of large and meritorious classes of persons to be inconsistent 
with the general progress of society. 

The law is urged essentially on two pleas : First, common honesty, 
as founded upon a supposed absolute right of property in ideas ; 
and second, sound policy^ as touching the protection and fostering 
of native authors, and through them strengthening and developing 
a worthy national literature. A calm consideration of the question, 
in its most obvious and important aspects, leads us to distrust the 
propriety and wisdom of any such law. 

In giving all their weight to the private interests which are in- 
volved in this question, and supposing there were no higher inte- 
rests than they to be considered, it is far from clear that even in 
that case, the authors of books are entitled to demand exclusive 
property in them from their own governments, much less that they 
have a right to claim such a monopoly from foreign states. In 
most countries, where any right of this sort has been recognized as 



888 BEPOBT OF THE 

existing in authors, and more especially in our conntrj, with a 
common consent, the right itself has been considered and treated as 
extremely limited, instead of permanent and absolute. It is hard 
to say that the exclusive right in the author is clear and just, and 
yet to say, it is limited to fourteen years, or to any other number 
of years ; and the moment such limitations are allowed, at the same 
moment the ideas of patronage and monopoly supersede the ideas 
of equity and of property in granting any such privileges at all. 
And in truth this limited right of exclusive property given by law 
to authors, has its true defence not in the notion of protecting pri- 
vate rights, which are by no means certain, but in the idea of pro- 
moting the public welfare by applying the stimulus of pecuniary 
reward to the production of original works. So that at last it is 
upon the ground of public policy, and not of private right, that 
States allow a monopoly for a limited period to be secured as a 
reward, not as a right, to the producers of books supposed to be 
original. And if this be the real ground of the proceeding-, it 
would seem to be perfectly clear that citizens of foreign states are 
destitute of the least pretext for making any claim of right upon 
other governments, and that every government has the plainest 
reasons of public policy for excluding all except its own citizens 
from such rewards. 

There are many considerations which appear to fortify very 
greatly the gravest doubts, whether copyright, or exclusive pro- 
perty for a limited period, is really politic and wise on the part of 
governments when dealing with their own citizens — much less when 
dealing with strangers. It is of itself, and however employed, a 
tax upon knowledge — ^an obstruction to the general progress of 
literature and science. If it be urged that it is correspondingly a 
stimulus to production, the answer is various, and apparently com- 
plete. For, let it be remembered, how immense is the proportion of 
this over-production which the public judgment condemns and re- 
jects as utterly worthless. Let it be remarked how difficult it is 
for the law to determine what books are really original^ and there- 
fore entitled, on any ground, to the protection demanded for all 
books making such a claim ; and how absurd and unjust it is for 
society to make itself a party to perpetual frauds and injuries, per- 
petrated upon the great thinkers and scholars of the race, through 
an endless succession of shallow plagiarists. Let it be remembered 
that the pursuit of literature is not a trade, but is a glorious calling, 
to which the poor stimulus of money patronage and legal monopoly 



COMKITTEE ON MBDIOAL LITEBATUBS. 889 

is more frequently a bondage than a nourishment. Let it bo borne 
in mind, that all books that live — all intellectual progress that is 
high and permanent, must forever be the creation of causes and 
impulses utterly dilFerent from all such as are involved in questions 
about copyright and monopoly.* 

In fine, let it not be forgotten that in a country and under insti- 
tutions like ours, they who are to lead the grand column of human 
progress, ought to be the very last to obstruct the power and free- 
dom of that progress by claims which when granted can never add 
to their ranks one illustrious name, nor when denied, can ever 
take from them a single leader capable of victory. Let these and 
manifold considerations like them, justly occupy our thoughts, and 
we can hardly fidl to see how absurd it is, to imagine that the true 
promoters of knowledge, the real utterers of words that men will 
not forget, have any interests which are identical with those, whose 
interest it may be to obstruct the widest freedom of knowledge. 

' SeYODtj jean ago, In a noble argoment on one branch of this snbjjeot, a great 
ctatesman (Lord Camden) said : — 

** Ify then, there be no foundation of right for this peipetaitj bj the poeiilTe 
laws of the land, it will, I believe, find as little claim to encouragement upon 
public principles of sound policy or good sense. If there be anything in the world 
common to aU mankind, science and learning are in their nature pMiei jurisy and 
thej ought to be as free and general as air or water. They forget their Creator 
as weU as their fellow-oreatures, who wish to monopolise his noblest gifts, and 
greatest benefits. Why did we enter into society at aU, but to enlighten one 
another's minds, and improre our faculties, for the common welfare of the species ? 
Those great men, those favored mortals, those sublime spirits, who show that ray 
of divinity which we eaU genius, are intrusted, by Providence^ with the delegated 
power of imparting to their feUow-oreatures that instruction which heaven meant 
for universal benefit ; they must not be niggards to the world, or hoard up for 
themselves the common stock. We know what was the punishment of him who 
hid his talent, and Providence has taken care that there shall not be wanting the 
noblest motives and iooentives for men of genius to communicate to the world 
those truths and discoveries, which are nothing if unoommunioated. Knowledge 
has no value or use for the soUtary owner ; to be ei^oyed, it must be oommuni- 
eated. ' Sdre tuum nihil est, nisi te scire hoc sciat alter.' Oloiy Is the reward 
of science, and those who deserve it scorn all meaner views. I speak not of the 
seribblers for bread, who tease the press with their wretched productions ; fourteen 
yean Is too long a privilege for their perishable trash. It was not for gain that 
Bacon, Newton, Milton, Locke, instructed and delighted the world ; it would be 
unworthy such men to trafllc with a dirty bookseller for so much a sheet of a letter 
press. When the bookseUer offered Milton five pounds for his Paradise Lost, he 
did not r^ect it, nor did he accept the miserable pittance as the reward of his 
labor ; he knew that the real price of his work was immortality, and that posterity 
would pay it." 



890 BEFOBT OF THE 

Aboye all, tliat the medical profession whose very miasioii is in- 
volved in the universal search, the universal recognition, and the 
universal dispensation of all knowledge, that by any means apper- 
tains to it, should suppose, that its rights, its interests^ or its honor 
did not clamorously demand unfettered knowledge. 

It is no doubt true, that all states should aim to do justice to all 
men everywhere. But it is none the less true, that the special and 
great end of every commonwealth is to promote in its own borders, 
and for its own citizens, the particular objects for which all govern- 
ments are instituted. Every people may hold in grateful remem- 
brance the benefactors of mankind; but it is only the people 
amongst whom they dwell, who can possibly bestow on them those 
more immediate rewards which appertain to high success during 
their brief existence on earth. It is quite absurd to allege that the 
people of the United States have any duty to perform towards the 
statesmen of other nations in the way of promoting them to honor, 
or the authors of strange lands in the way of advancing them to 
riches. We might as well pretend, that we here in America are 
obliged, in some mysterious way, to seek for the true heirs of Aris- 
totle, and make laws for their pecuniary benefit, or that we are 
obliged to do somewhat similar for those of Milton, La Place, 
Sydenham, or any other glorious name amongst the dead, as that 
we are under like obligations to living authors in foreign countries, 
to make like provisions for their pecuniary advantage. Such ideas 
are wholly chimerical : they form no part of the motive to human 
effort ; the pretended rights upon which they are obliged to rest are 
incapable of being even so much as stated in a rational manner; 
and the common sense of mankind, the well considered policy of 
states, and the calm dictates of philosophy, alike and utterly reject 
them. 

It is indeed possible that a very small portion of the more infe- 
rior authors of a particular country, might have a certain pecuniary 
interest in obstructing the republication of the works of foreign 
authors, better than their own, in the country in which they dwell: 
and so might plead their own poor cause, while they appeared to 
plead for the rights of foreign authors to protection, in what they 
call their literary property. But a question of this sort — in that 
aspect of it — rises no higher than a question of mere profit between 
a limited class of writers and a limited class of publishers ; in which 
the publishers have this advantage, that their interests happen to 
coincide with the interests of knowledge. 



COMMITTEE ON MEDICAL LITEBATUBE. 891 

As to the great mass of books, their fate is not unlike that of the 
great mass of men. No doubt there is a reason why they were born, 
and DO doubt there is a reason why they perish. This is their 
entire record, they were born and they have perished, and there 
was a reason, of some sort, for both events. Bat who cares to 
know anything further about them ? Who thinks it worth while 
to make laws either about their birth or their death, or the par- 
ticular course thereof 7 But in the mass of this perishing multi- 
tude, there are books which cannot die. It is of these only that 
there is any need that we concern ourselves, and the concern which 
we have with them, is that we master and cherish what is in them. 
Instead of obstructing their entrance amongst us, one of our 
highest duties is to hail and promote that entrance. Instead of 
increasing the difficulty of their widest circulation, our wisdom is 
to give them the freedom of the land. Too often it happens that 
the authors of such books are beyond the applause or the reproach 
of foreign peoples, long before their productions make free way 
among them ; and in cases in which it is otherwise, the fame these 
authors achieve, and the good their works do, constitute the true 
and great reward which strange nations can bestow. 

That men should live by literature, may be an advantage to 
mankind, but it is far from being one to literature itself. The 
progress of society necessarily involves, the development of a litera- 
ture peculiar to itself, and corresponding with that progress. The 
influence of all foreign literatures upon that which is national and 
peculiar in each particular country, is an element in human civil- 
ization which it is impossible to regulate by laws in any free 
country, half so beneficially as the laws of progress will regulate of 
themselves, if left to act freely. In the long run of human deve- 
lopment, society can no more Ml to produce its own authors than 
it can fail to produce its own rulers. The gradual and healthful 
process through which our literature has been passing for nearly a 
century, towards a perfect accordance with our ripening nationality, 
under the existing forms of civilization amongst us, has been pro- 
moted, if not achieved by the freest contact of the public mind, 
with all existing literatures. Nothing, assuredly, has occurred to 
make either the process, or the results yet attained, the slightest 
occasion of disquietude on our part. And perhaps there could be 
no stronger proof of the deep conviction of our people, that the 
interests of our national literature are inconsistent with the attempts 



892 REPORT OF THB 

80 long and so eagerly made, to rouse the country in favor of the 
scheme of international copyright, than the utter fiiilure of that 
attempt, even when it has had the whole field of agitation, un- 
questioned, to itself. 

What is to be gained, in the passage of such a law, by our medi- 
cal literature it is difficult to conceive. Whatever other results 
might ensue from the establishment of an international copyright, 
these certainly would, viz : a materially increased cost, necessarily 
followed by a diminished circulation of foreign works ; and, in 
order to supply the demand, a corresponding increase in the quan- 
tiiy of home productions, while an enhanced price would result 
from the application of this literary protective tariflP. Does any 
man in his sober senses consider either of these results desirable? 
Does any one imagine that an increase in quantity involve a 
relative improvement in quality ? Nay, by just so much as author- 
ship is made, by legal enactments, more profitable, will it not be 
likely to degenerate into hook making f Will it not cease to be a 
ealling and become a trade? Will the law add one whit to the 
zeal of any explorer of the labyrinths of nature? Will it make a 
single observer at the bedside more careful and reflective; any 
student in the dissecting-room more diligent and painstaking ; any 
thinker in his closet more profound and philosophic? Or is it 
credible that, as original works, the product of patient labor, rig;id 
investigation and deep thought, are excluded from any country, 
base imitators or unblushing plagiarists would be leas common 
than now? 

Finally, the commonwealth of letters is boundless, and men of 
science have a rigfU to a universal hearing. As no nation can 
possibly have the monopoly of learning or of wisdom, so no narrow 
sense of nationality should attempt, upon any plea or for any pur- 
pose, to shut out the productions of foreign authors; but every true 
man of letters should be known and honored everywhere. The 
annals of medicine abound in illustrious names. Let each par- 
ticular country rejoice in the glory of its sons ; but laborers in the 
cause of humanity belong to the race, Hippocrates, Celsus^ Boer- 

HAAVB, HaLLER, SYDENHAM, CULLBN, PaR^, BICHAT, £uSH, 

Physiok. 

The graves of snch are pilgrim slirines, 

To no oode or creed oanfined ; 
The Delphian vales, the Palestines, 

The Meccas of the mind. 



GOHMITTSE ON MEDICAL LITERATUBB. 893 

What then can be done to correct the faults of oar medical 
literature, however great or however small they may be? Is there 
a remedy ? 

In the course of time and through the unchangeable laws of 
progress and development — Yes. Through the agency of this 
Association? No. If indeed it were able to prevent individuals 
yet in the " tenderest immaturity of knowledge" thrusting them- 
selves forward as teachers; if it could make scholars of the ignorant 
and wise men of fools ; if it could repress ridiculous ambition and 
boundless self-conceit ; if it could persuade all writers to understand 
the difference between authorship and book-making; if it had the 
power to put down reckless plagiarists and shallow thinkers ; if it 
could keep men from writing books by way of advertising them- 
selves or their "schools;" if it coidd enforce a judicious excise on 
foreign importations, and wither that pestilent class of editors who 
" bring out" foreign works and divide glory with their authors, 
without shaftng labor, or adding one jot or tittle to our knowledge 
of science and art; if indeed it had infinite power to do impossible 
things, it might hopefully attempt any necessary literary regenera- 
tion. 

E.J.BRECKINEIDQE. 

J. B. FLINT. 

D. L. McGUGIN. 



VOL. IX— 26 



KEPORT 



COMMITTEE ON PLMS OF ORGANIZATION 



worn 



STATE AND COUNTY SOCIETIES. 



REPORT OP THE COMMITTEE ON PLANS OF ORGAN- 
IZATION FOR STATE AND COUNTY SOCIETIES. 



The Oommittee on Plans of Orgaiiization of State and County 
Societies respectfully report : — 

That they have had the subject assigned them under considera- 
tion, and are deeply impressed with its importance to the cause of 
medical improvement. Indeed, of the great desirableness of a 
thorough organization of our profession into State and County 
Societies, there can be no doubt among those who have given the 
subject attention. 

That the American Medical Association has ever appreciated this 
&ct, and the objects to be obtained by organization, is evinced by 
its repeated expressions and acts. In the preamble attached to the 
constitution ot this body, the objects of its organization are declared 
to be: "For cultivating and advancing medical knowledge; for 
elevating and advancing the standard of medical education; for 
promoting the usefulness, honor, and interests of the medical pro- 
fession ; for enlightening and directing public opinion in regard to 
the duties, responsibilities, and requirements of medical men ; for 
exciting and encouraging emulation and concert of action in the 
profession; aod for facilitating and fostering friendly intercourse 
between those engaged in it." And, in order that these great objects 
might be effected throughout the masses of the profession and the 
community — that all might participate in their advantages, the 
Association has held out, and in the appointment of your Commit- 
tee and through its efforts, strives still to hold out all possible 
inducements for the universal formation of State and County socie- 
ties, preferring that they should be auxiliary to this body, and 
directly co-operate with it, in its efforts at improvement. 

Your Committee are of the opinion that in no profession is there 



898 KSPOBT OK 

ao great a necessity for a thorough education and discipline of thofle 
entering it, and for all the aids which association may afford to 
improvement afterwards, as in that of medicine. In this, there are, 
perhaps, greater opportunities for tolerated empiricism, and stapid 
routinism, for baseless pretensions and reekless blunderings, than 
in any other. 

The people are more ignorant of the principles of medical scienoa 
than they are of those of i!he other learned professions, and, for this 
reason, are less qualified to judge of the acquirements of a physi- 
cian than of other professional men. The talents and acquirements 
of the clergyman and the lawy^ are brought to a more searching 
popular test than those of the physician. The clergyman's public 
ministrations are laid open to the appreciation of alL His audiences 
are, to a large extent, competent judges of his pulpit efforts, and if 
he manifest ignorance, stupidity, or superficiality; if he descends 
into monotonous mumblings in manner, or stereotyped common- 
places in matter, he forthwith falls in public estimation to the low 
level he deserves. 

The lawyer is brought to a still more severe test All his 1^ 
papers must be drawn up with the most scrupulous technical aoca- 
racy, or they will fail of their object, and be inevitably attended 
with palpaUe exposure and pecuniary loss. Here all great errors 
are open and apparent^ involving the reputation and standing of the 
practitioner: and, before the bar, the lawyer is brought in open 
conflict and comparison with a keen-eyed opponent, before a saga- 
cious court, fully understanding the principles which are discussed, 
and who indicates in his open decisions which party is in the rigbi 

With both these latter professions there is every inducement, of 
a personal and selfish character, to stimulate exertion, to induce the 
most careful preparation, and excite the most strenuous effort; and 
with on6 of them there are other peculiar and sacred motives, ex- 
tending fiEir beyond aU earthly considerations. 

The knowledge and abilities of the physician in the practice of 
his profession, are not tested in the same direct and open manner. 
The character of his business is such as more or less to conceal it 
from public gaze. He has to do with the hidden and secret springs 
of life. He does not come in conflict with the same eagle-eyed 
opponent, and his labors are not watched and decided upon by the 
same sagacious and discerning judge. The grave too often conceals 
his blunders, and few, or none, are competent to decide whether the 
protracted sufferings, the lost vigor, and the shattered constitutions 



PLANS OF OBOAKIZATION. 899 

of those who sarvivey are the neoeasary consequences of disease 
which conld not have been prevented, or are the results of inefficient 
or injurious treatment Indeed, so erroneous is the judgment of 
those by whom he is surrounded, that he is often praised for his 
errors, and censured for his highest skill. He sees the bold and 
unscrupulous pretender, ignorant alike of the diseases he treats and 
the remedies he employs, exalted in popular estimation for the 
occurr^ice of events to which he has in nowise contributed, and 
extolled for recoveries, of which the least that can be said is, his 
bad management did not effectually prevent them ; and the honest 
physician often feels that varied knowledge and consummate skill, 
so fiu* as popular favor is concerned, are of less consequence than the 
possession of other characteristics, of which, in the light of his con- 
science, he cannot certainly be proud. At least in this erroneous 
popular estimate — ^in this darkness which surrounds his perform- 
ances, there is an absence of many of those incentives to improve- 
ment which are present with the other professions. If the physician 
is not a real lover of science for its own sake, or a man of genuine, 
active, intelligent benevolence, he has comparatively little to stimu- 
late him to exertion ; and if not thoroughly instructed in the begin- 
ning, and if his ambition is not aroused and kept alive by constant 
professional intercourse with the more enlightened members of the 
fraternity; if his knowledge be not brought to the light, where it 
can be seen and appreciated, he is in imminent danger of fitlling into 
a state of mental indifference and inefficiency, of lagging sadly in 
the march of progress, and becoming a blemish rather than an 
ornament to the profession, which, in more than one sense, he fol- 
lows. Even the greatest lovers of science, and the best of men, 
require these stimulants for their full development. 

Besides the influence which association has upon individual 
growth and character, the nature of the science itself particularly 
demands the organization and concerted action of those who are en-, 
gaged in its cultivation. Medicine is peculiarly a progressive science. 
Though the &ct8 and principles upon which it is founded are among 
the fixed truths of nature, the eternal laws of God, yet all those 
truths and laws bearing upon the subject are not yet discovered, 
and the varying circumstances of the influences which surround us, 
and the varying conditions of the mystery of life, are ever produc- 
ing new and varied results, requiring continued observation, record^ 
and comparison ; and so innumerable are these hygienic, etiological, 
and therapeutical relations of external objects, and the peculiarities 



400 BXPOBT oir 

of organization and the vital force, that the science <^ health, of dis- 
ease, and of cure, becomes boundless in its extent, and indefinite in 
its progression ; and, as its greater development is so important to 
the interests of humanity, it imperatively demands, not only the 
arduous, but the systematized and concerted labors of its votariesi 

In considering specific laws of organization of State and County 
societies for general adoption, your Committee have experienced 
embarrassment. In the first place, they do not conceive that this 
body has the pow'er or the right to dictate positively to these socie- 
ties, the specific form of constitutions, in all their details, which they 
should adopt. This Association has doubtless the power to deter- 
mine who shall constitute its members, and could, by the exercise 
of that power, prescribe the character of the societies which should 
be represented here ; but, in the judgment of your Committee, it 
would be impolitic, if not wrong, to dictate any measures to socie- 
ties other than those which are vitally important in carrying out the 
great principles for which this organization was established. 

Almost aJl communities, of whatever degree of enlightenment, 
regard themselves as best qualified to frame, at least in the nudn, 
the instruments by which they are to be governed; and this is par- 
ticularly the case in our own country, where there is so much of the 
spirit of independence, and where, in our political relations, we have 
the example of the States forming their own constitutions, and 
enacting their own laws, with very limited restrictions on the part 
of the general government. Besides, many States and Counties are 
already organized into societies, some of them of long standing ; 
and, having become accustomed to particular forms which have 
served well their purpose, they would very reluctantiy abandon 
them for others they had not tested. Indeed, some societies are 
established by the laws of the States in which they are located, are 
endowed with certain legal powers and privileges, and provided 
with specific constitutions which could not be altered without 
statutory provisions on the part of those States. 

In view of these facts, your Committee do not deem it advisable 
to present, in detail, forms of constitutions for this Association to 
peremptorily prescribe to all State and County societies. They will, 
however, at the close of this report, present the outlines of a con- 
stitution for a State, and one for a County society, of the most simple 
form, as suggestive guides to those States and Counties where socie- 
ties are not organized, or where it may be thought their organiza- 
tions require remodelling. 



PLANS OF OBGAOTZATION. 401 

There are, however, some proviaions which your Committee deem 
essential to the carrying out of the leading specific objects of this 
Association, and, therefore, within its province to urge upon those 
societies which seek a representation here, if not to insist upon them 
"by all the power which it possesses. These are certain specific 
means for " elevating the standard of education'^ among medical 
men, and particularly of " preliminary education ;" and of '* culti- 
vating and advancing medical knowledge." The standard of edu- 
cation, and particularly of academic education, for admission into 
the profession, is universally acknowledged to be by far too low. 
Indeed, in regard to academic acquirements, there is, among the 
schools, scarcely a standard at all. This remark has not reference 
to exceptions, but is intended to have a general application among 
ns ; and we are sorry to learn, from a recent " Introductory Lecture 
to the Medical Session of the University of Dublin, by William 
Stokes, M. D., Regius Professor of Physic," that this state of things 
is Hot confined to our own country. In the lecture, he says : " I 
can speak on this subject" (of merely special or professional educa- 
tion, while neglecting general or academic) " with confidence, for I 
have now been more than twenty-five years occupied in the teach- 
ing of clinical medicine, and I know that some of our students 
have obtained their diplomas from various licensing bodies, without 
possessing the knowledge indispensable to a common clerk." 

As to the most efficient means of elevating the standard of educa- 
tion, preliminary and professional, which, at the time of its incep- 
tion, was the governing motive in establishing this Association, 
there seems at present to be some differences of opinion. Hitherto, 
the power of the Association, at least such power as is contained in 
recommendations and resolves, has been expended chiefly, though 
in most instances it must be confessed, almost vainly, upon the 
schools. These institutions have by most been considered as mainly 
responsible for the low standard of admission to the profession 
which all acknowledge to exist. They certainly have the power to 
make their own regulations; to dictate their own terms for the 
admission of students; to prescribe the extent of instruction given 
them, the length of time it shall continue, and the amount of know- 
ledge of every kind they shall possess before receiving medical 
honors. It is well known, and by none better than by those con- 
nected with the schools, that many students, without appreciating 
their best interests, will seek for the most .easy and rapid attain- 
ment of a degree ; and the schools being charged with the principal 



402 BBPOBT ON 

labor of funuBhing instmctioii, and being placed by their licenang 
powers as the guardians of the public and the profession, are re- 
garded as most solemnly bound to exclude all from the privileges 
and honors they are capable of bestowing, who will endanger the 
safety of the public, or the honor of the profession. 

In order to diminish the weight of this responsibility, especially 
in regard to preliminary education, some connected with the schools 
have charged the private members of the profession with derelic- 
tion of duty in receiving persons into their offices as students of 
medicine, without regard to their mental, moral, or educational 
fitness for becoming respectable physicians, and thus furnishing 
the schools with defective materials ; and private members have 
even been charged with encouraging students to attend those 
schools where diplomas are most easily obtained; and it is therefore 
contended that the professional standard is to be most efi^tually 
elevated by inducing private preceptors to allow none to come 
under their instruction who are not qualified by original capacity, 
by education and discipline, to do honor to the profession and serve 
useMly the community. 

Without attempting to shield the schools in the slightest degree 
from the responsibility which necessarily belongs to those who 
assume to qualify young men for the practice of medicine, and to 
judge of their fitness for doing justice to their calling — in fact, to 
induct them into the profession — ^your Committee are nevertheless 
of the opinion that there is much force in the charges against the 
body of physicians, and that they have responsibilities in this 
matter which they cannot evade. 

To bring the profession at large to co-operate in the elevation o! 
its own character, and believing that upon them and their action, 
more than upon corporations, must the reform which is sought 
ultimately depend; your Committee recommend that all local or 
county societies represented in this body, be directed to incorporate 
into their constitutions or by-laws, provisions for the election of a 
Board of Omsara, whose duty it shall be to examine all pensoos 
applying for admission as students of medicine into the offices of 
any members of such societies, and that no member shall admit any 
student into his office until he shall receive from the board of 
censors a certificate that he possesses a good moral and intellectual 
character ; a good English education, including a thorough know- 
ledge of the English language, and a respectable acquaintance with 
its literature and the art of composition ; a fiur knowledge of the 



PLANS OF OBaANIZATION. . 408 

natoial scienoes, and at least tbe more elementary mathematics, 
induding the main elements of algebra and geometry, and such an 
aoqoaintanee with the ancient languages as will enable him to read 
current prescriptionsi and appreciate the technical language of 
medicine. 

Your Committee hope that the propriety of this measure will 
be sufSlciently apparent to this body to secure its favorable con- 
sideration. Nothing need here be said of the importance of a 
respectable preliminary education and the possession of a good 
mental and moral character by those entering upon the study of 
medicine. With regard to education, it is well known that early 
deficiencies are seldom supplied in after life, and a want of mentid 
discipline and ignorance of language will obstruct often irremediably 
the course of successful study; and without the possession of proper 
mental and moral qualities, all attempts at obtaining respectability 
in the profession will of necessity be ftitile. Here is the great 
foundation of the evils under which we suffer, and the removal of 
this foundation is positively essential to the complete redemption 
and preservation of our body from degradation and dishonor. If 
the profession, to any considerable extent, be filled with men of 
feeble, unprovided, or undisciplined intellects, of indifferent morals, 
and of boorish manners, it will as a body receive, as it will deserve, 
the disrespect, if not the contempt of an intelligent community ; 
and in the pursuit of the science of medicine, as in everything else, 
there must be an adaptation of men and means to the object to be 
accomplished, and there must be a proper beginning to secure a 
successful issue. 

It is quite obvious that at the commencement of professional 
studies, at the point of determining a course for life, is the proper 
time for testing preliminary preparation, and general mental and 
moral fitness, and it is important for the schools to erect a standard 
on these subjects, only because it is neglected by those who have 
charge of students at the beginning of their professional course. 
But if this were not the most natural and proper time for such 
examinations, the fact that the schools have so generally and for 
such a length of time neglected the recommendations of this body, 
affords sufficient reason for directing the efforts of the Association 
to a point where efforts have not yet been proved to be useless. 
When the Jews would not receive the ministrations of Paul and 
Barnabas, the great apostle exclaimed: " Lo, we turn to the Qentilea" 

It has already been intimated that the cultivation and advance- 



404 BSPOBT ON 

ment of medical knowledge is another principal object of all our 
organizations. In a science like that of medicine, based less upon 
theoretical speculation and d priori reasoning than upon definite &&d 
observed facts, it is obvious that the most direct and certain mode 
of increasing its knowledge is by the careful observance and lecord 
of these &cto ; and it is equally obvious that the more numerous 
are the facts thus observed and recorded — the more they partake of 
the character of extended statistics — ^the more positive will be the 
knowledge obtained, and the more reliable the inferences drawn. 
Indeed, the most prolific source of error in medicine, both as i^gaidfl 
etiology and therapeutics, consists in drawing general condoaioDS 
from a limited and insufficient number of facts, or from &ct8 oo- 
curring under peculiar circumstances^ 

It has ever been a desideratum of the first importance, to obtain 
carefol, minute, and extended reports of the local prevalence of 
diseases, the peculiar characters which they may present, and the 
peculiar circumstances attending them, as regards their cause, their 
nature, and their treatment. Such reports not limited to public 
institutions or to large towns, which would be but imperfect, often 
erroneous guides to those in the walks of private practice and in 
rural districts, nor restricted to one season in which the "epidemic 
constitution" may differ from the next, but obtained firom a great 
variety of sources, extending over a lengthened period of time, and 
in a properly arranged and condensed form placed permanently on 
record, accompanied with full meteorological notations and topogra- 
phical descriptions ; and this going on from year to year through 
cycles of epidemic changes, would at length accumulate a mass of 
facts such as has never yet been afforded to medical scienoe, and 
&om which could be drawn reliable scientific and practical dedac- 
tions, valuable beyond the bounds of human computation. In the 
opinion of your Committee the accomplishment of this end should 
be among the chief purposes in all our associations. 

This great object, so worthy of a great effort, can alone be accom- 
plished by a full organization and a concert of action throughout the 
masses of the profession. In proportion to the extent of this work 
would be its perfection. As suggested in the remarks just made, 
inferences drawn from observations on these subjects, of one or a 
few, are liable to error from the existence of peculiar circurastances 
and fortuitous occurrences; but by the accumulated observations 
of many,* the errors from the few are corrected, and positive truth 
is approximated. 



PLANS OF OBGANIZATION. 405 

I Yotur Committee would therefore recommend that all local or 

i CSotintyand State societies, which are to be represented in this 
^ body, shall have incorporated into their constitutions or by-laws 
I provisions which shaU make it the imperative duty of all members 
^ of local or County societies to keep at least a brief record of all 
t cases in their practice depending upon local or general causes, and 
( report as often as annually the number or percentage of each 
I disease occurring during each month, giving the age, sex, and 
i hygienic conditions of the patients, the types of the disease, and the 
I general plan of treatment, together with iJie results, to a committee 
( of the society to which they belong, which committee shall collect 
: these individual reports, arrange them in due form, adding such 
remarks as may be necessary, and transmit them to a conmiittee 
of the State society to be added to other similar reports from the 
I various County societies of the State, and arranged in a collected 
: form and reported to a committee of this Association, to be again 
( collated or tabulated if necessary, and go in a condensed form into 
its published transactions. 

This plan, as will be seen, contemplates a mutual adaptation of 
I these different societies to each other, and to the accomplishment of 
the end in view. It makes the County auxiliary to the State 
Bocieties, and these, in torn, auxiliary to the National Association. 
It contemplates the creation of a new committee or committees, of 
i this body, which might perhaps take the place or perform a part 
of the duties of the present committees on epidemics, or if thought 
umre desirable, the reports from the sevend State societies might 
be sent to the Committee on Epidemics, for the States to which they 
belong. The object will be attained, if these accumulated facts 
are by any means placed in a proper form, easy of reference, upon 
the permanent published records of the Association. 

It may be thought that the recording and reporting of cases as 
contemplated in the foregoing plan, will involve more labor than 
the majority of members of local societies can be induced to per- 
form ; but your Committee are confident in the opinion that it will 
require comparatively little labor, and that when once engaged in, 
and the habit is formed, it will by no means be considered a burden. 
If a niargin be left upon ihe day-book or the visiting list, or a 
blank leaf be inserted, or a small casebook be kept, the name of 
the disease and such brief notes as are contemplated in the plan, can 
be easUy inserted, and these can be readily posted up, from month, 
to monUi| with such remarks as may indicate the topography, con- 



406 BXPOBT OK 

eerned, the state of the season, the general character ihe pardcnlii 
disease has assomed, the course pursued, and the results whkii 
have followed. 

The committees of the County societies will not find their laboa 
great, or their tasks irksome. The figures from the reports d 
individual members can readily be added togelher, and the per- 
centage of different diseases shown, and such general statemeati 
can without difficulty be made as the &cts demand. 

For the purpose of giving the facts respecting the prevalence of 
diseases their full value, the complete meteorology 'of the legm 
must be kept This needs to be done only by a single individual, 
for a considerable region, and there are other purposes than medi- 
cal, which call for the keeping of these records. The Smithsonian 
Institute, a few years since, undertook the accomplishment of this 
task on a large scale and in many localities, and it is hoped diat it 
may go on and fully succeed in so laudable im undertaking. 
Should it not, the united effort of the profession might, it is hoped, 
induce the local civil authorities of each township and oorporadon 
to make it the duty, for a proper compensation, of some of its 
officers to keep such a register and allow oopies to be taken for all 
useM purposes. 

For the purposes of our profession Ihey should be veiy foO. 
The temperature, the moisture, the direction and amount of winds^ 
the amount of sunshine and of cloudy weather, of rain and snow, the 
pressure of the atmosphere, its electrical state, so far as is possible 
the state of terrestrial magnetism, the indications of ozone, and 
whatever else of external circumstances may be supposed capahfe 
of affecting the human organism. 

It can but be seen that the value of the £acts which might, by 
the plan thus briefly pointed out, in course of time, be aocama- 
lated from every part of the country, would infinitely more than 
reward in its results the labor bestowed. 

Dr. Ghraves, of Dublin, some years ago proposed the establishment 
of medical observatories in different parts of the world, for the 
purpose of comparing epidemics and endemics of different regions 
with their meteorology, and the great Humboldt has urged the 
same idea. Your Committee propose, and ask this Association to 
exert all the power it may possess, to establish a medical obserra^ 
tory in every inhabited township throughout this vast oonntrfi 
adding thereby the force of great numbers to the strength of con- 
clusions. 



PLANS OF ORGANIZATION. 407 

To afford a partial illustration of the interest of tliis snbjeot, 
reference may be had to the work of the lamented Dr. Samuel 
Forrj, upon "The Climate of the United States and its Epidemic 
Influences, based on the Becords of the Medical Department and 
Adjutant General's Office of the United States Army." This little 
work, though embracing the diseases and partial meteorology of 
the military posts of the country only, is justly regarded as among 
the most valuable products of our indigenous medical literature. 
And here your Committee are constrained, for the purpose of doing 
jostice to an illustrious statesman of the recent past, to say, that 
daring his administration of the War Office, the meteorological 
observations upon which Dr. Forry's work is based, had their 
origin in the enlarged views of the late John C. Calhoun. 

But not only will these records be useful for the vast accumula- 
tion of facts which will thus be made accessible to future medical 
philosophers, and rendered available for a more thorough under- 
standing of the cause, prevention, and cure of disease, but their 
reading and discussion will add great interest to the meetings of 
societies, as well as utility to their operations, and, it is hoped, will 
thus cause those societies to be more regarded, and their meetings 
better attended. This is conceived to be an important olgect of the 
plan proposed. One of the chief difficulties in sustaining medical 
societies is ^the want of scientific interest given to their meetings, 
and the appearance of inutility which so often attends their opera- 
tions. In our practical times, that which is not palpably useful is 
not regarded as worthy of existence, and if no prominent object of 
practical utility is apparent in organizations of this kind, they will 
be regarded with indifference by practical men, and will fall, as 
many have fallen, into decay. 

Besides these advantages of the system proposed, the habit of 
careful observation and accurate record of cases which it requires, 
will have a most decided effect upon the professional improvement 
df individuals. By it their observing powers will be exercised and 
developed. Not forming erroneous conclusions in consequence of 
having distinctly remembered only a few of the cases occurring in 
their practice, which, from some attending circumstances, most 
strongly impressed them, while many others, possessing no leas 
importance, and perhaps attended with different results, legitimately 
leading to other conclusions, have beeu overlooked and forgotten, 
they will profit by their own experience, as well as by that of 
others, and, fiirthermore, will be excited to higher efforts by being 



408 BEPORT ON 

made lively working members of the societies to which they belong, 
and useful contributors to a great general result. 

Of the correctness of these views, and the abstract importance of 
this subject, your Committee conceive there can be no doubt. The 
only question that can exist, is, as to the complete practicability of 
the measure proposed — as to the possibility of bringing the masB 
of the profession to actually perform the labor required. While 
fiiUy appreciating the difficulties of changing to any important 
extent the habits of great numbers of men, and fully understandmg 
that great movements of this kind are not usually effected without 
much effort and time, yet there is believed to be in this proposal 
no insuperable obstacles to its complete success. 

Nothing certainly is in the way but an insufficient appreciation 
of the importance of the subject, an indifference to its demands, 
and habits of indolent procrastination on the part of medical men; 
and may we not hope that if the subject be properly presented bj 
individual and associated action, by the voice and by the press, 
there will be found sufficient love of science and improvement, of 
humanity and of truth, to sweep away all obstacles, and carry the 
American medical profession to one position of honor to which no 
other body of men has yet attained? 

In connection with the subject, the discussion of which is now 
concluded, and which is but one element, though one so important 
in the organization of State and County societies, your Committee 
would suggest that for the purpose of encouraging the production 
of papers of interest and value, that provision be made for trans- 
mitting those read before the County societies, which may be judged 
by them to possess peculiar interest or a high order of merit, to 
committees of the State societies, to be presented by them to those 
bodies, and if thought worthy, to be incorporated into their pro- 
ceedings, and also that each State society have the privilege at its 
annual meetings of sending what may be judged its most valuable 
papers to this body, to be considered by a committee, and if thought 
by them proper, to be presented at its meetings, and be published 
with its Transactions. 

Your Committee would also suggest that in arranging the details 
of the working of societies, attention should be paid to a proper 
division of labor. Special subjects should be referred to those 
members who, from their mental aptitudes, their previous studies, 
or their peculiar positions, are best qualified to treat then^ 

Regarding the Code of Medical Ethics of this Association as die- 



PLANS OF OBGANIZATION. 40> 

tetod by wifidom and justioey and believing it importuit ihat every 
member of tbe profession should be familiar with its high-toned 
SMitiments, and be governed by its pure morality, your Committee 
wotdd reoommend that it be adopted by all medical societies, and 
published with their constitutions and by-laws. 

La oondusionf your Committee beg leave to present to your con* 
Biderationthe following resolutions, containing a sunimary of the 
principal views embodied in this repcHi : — 

1. £e$olvedj That the American Medical Association, appreciating 
the vast benefits to the advancement of medical science, to the pro- 
fisssion, and to the interests of humanity, arising from the efficient 
organization of medical men, call with deep earnestness upon physi' 
cians everywhere throughout the country, to form themselves into 
County and State medical societies, 

2. Mesolved, That this Association earnestly recommend to all 
County Medical societies to incorporate into their constituticms or 
by-laws provisions for the election of a Board of Censors, whose duty 
it shall be to examine all persons who may apply for admission into 
the office of any member of the society as students of medicine, and 
also to incorporate provisions to prevent any member of such society 
from admitting as a student ai^y person who shall not first receive 
from the Board of Censors a c^ificate of a good moral and intel- 
lectual character; a good English education, including a thorough 
knowledge of the English language, and a respectable acquaintance 
with its literature, and with the art of composition; a fair knowledge 
of the natural sciences, and at least the m<»re elementary mathe- 
matics, including the chief elements of algebra and geometry, and 
such a knowledge of the ancient languages as will enable him to 
read current presoriptionB and appreciate the technical language of 
the natural sciences and of medicine. 

8. Resolved^ That this Association also earnestly reoommend to 
local or County societies to incorporate into their constitutions or 
by-laws provisions for making it the duty of each of their members 
to keep at least a brief record of all cases occurring in his practice 
depending upon endemic or general causes, and report at least an- 
nually to a committee of the society to which he belongs the num- 
ber or percentage of different diseases occurring during each month, 
together with the particular type of each disease, the chief modify- 
ing cireumstances under which it occurred, the general plan of 
treatment, and the results of the cases ; and also that these societies 
make provision for the election of such committee, whose duty it 
VOL. IX.— 27 



410 BBPOBT OK 

shall be to reoeive and collate sacb reports, arrangiDg them in doe 
forxxi) and adding such remarks as may assist to their proper under- 
standing, and to transmit them annnaUj thus arranged to a com- 
mittee of the State society to which the local or County sodetj 
shall be auxiliary; and this Association further recommends that 
the State societies make provision in their constitutions or by-hm 
for the appointment of a committee whose duty it shall be to reoei^ 
such reports from the local or County societies to again airange 
them with other reports from similar societies, placing them in a 
condensed or tabulated form, and report them annually with proper 
remarks to a committee of this Association to which the State socie- 
ties are recommended to become auxiliary. 

4. Besolvedf That this Association make provision for the recq>- 
tion of these reports from the State societies, by a conmiittee or 
committees, whose duty it shall be to arrange them in proper form, 
adding such illustrative remarks as may be deemed proper, and to 
report them to this Association, with a view of having them path 
lished with the other transactions of this body. 

9. Resolved^ That this Association recommend the adoption of its 
Code of Medical £thics to all societies auxiliary to it, and that they 
record or publish said code with their constitutions and by-laws. 

tf. Besolved, That, in the opinion of this Association, it would 
tend to the production of papers of greater merit, and increase tte 
interest of the meetings of local or County societies, if those papers 
possessing peculiar merit were referred to the State Society as marks 
of honor, and to be incorporated into their proceedings, if deemed 
worthy. 

7. Resolved^ That, in arranging the details of the practical workings 
of societies, due attention should be paid to a proper division of 
labor, special subjects for investigation and report being referred 
to members who, from their mental aptitudes, their previous studies, 
or their peculiar opportunities or positions, are best qualified and 
most inclined to do them justice. 

The following simple outline forms of constitutions for State and 
County .societies are attached, not as examples to be implicitly fol- 
lowed, but as affording suggestions for those engaged in forming 
new organizations, and, at the same time, for furnishing an oppor- 
tunity for presenting an illustrative detail of those features wHicb 
may be considered as comparatively novel, and which have been 
urged as important in the report These provisions, which are thns 
developed, may be ingrafted into the constitutions of societies 
already in existence, or enacted by them into by-laws. 



PLANS OF OSGANIZATIOK. 411 

PLAN OP CONSTITUTION FOR STATE SOCIETIES. 

Articlb I. 

This Society shall be called the Medical Society of the State of 
, and shall be auxiliary to the American Medical Asso- 



ciation. 

Abticlk U. 

The objects of this Society shall be the advancement of medical 
knowledge, the elevation of professional character, the protection 
of the interests of its members, the extension of the bounds of 
medical science, and the promotion of all measures adapted to the 
relief of suffering, and to improve the health and protect the lives 
of the community.^ 

Articlb IIL 

Should specify who are to constitute members, the mode of their 
election, paying initiation fee, &c. 

Articlb IV. 

Ofl&cers shall be President, Vice-President, Secretary and Trea- 
surer, and a Board of Censors, &c. Mode of election. 

Articlb V. 

JDutiea of Officers. — President, Vice-President, Secretary and 
Treasurer as usual. Censors depeuding upon the laws of the 
State, &c. 

Article VI. 

Meetings. — Time of holding, &c. 

Articlb VII. 
Respecting Funds. — How raised and appropriated. 

Articlb VIIL 

The Code of Ethics shall be that of the American Medical Asso- 
ciation. 

> This article and many of the other featores of this plan, are taken from the 
oonstitntion of the Medical Society of the State of Pennsylyania. 



41ft BKPOBT ON 

Abticlk IX. 

County societies may be formed auxiliary to this Society. Mode 
of formation. Who sball be members, &c. These tilings ofien 
depend upon the law of the State. 

Abucls X. 

There shall be a Standing Committee of this Society compoeed 
of such numbers and chosen in such manner as the Society may 
direct, whose duty it shall be to receive reports of cases of diaease 
occurring in each county from committees where County societies 
exist, as provided for by the County societies auxiliary to thiSi or 
from individuals where County societies do not exist, and to arrange 
such reports in a condensed or tabulated form, adding such general 
remarks as may be deemed necessary, and then transmitting tliem 
to the committee of the American Medical Association appointed 
to receive them. Such reports are to be read either in full or by 
abstract at some meeting of this Society, by the committee of the 
County society or the individuals reporting them, or by the oom* 
mittee of this society receiving them, as the society may direct. 

Abticlk XL 
Provision for amendments. 



PLAN OF CONSTITUTION FOR COUNTY SOCIETIES. 

Abtiols L 

Tms Society shall be called the County Medical So- 
ciety, and shall be auxiliary to the Medical Society of the State 
of . 

Article IL 

Should state the object of the Society. 

Abticlk IIL 

Members.— 0£ whom composed. Eegular practitioners, &c. How 
elected. 



FLAK8 OF OB0AKI2iLTIOSr. 418 



Abticus IV. 



It Bball be regarded as the imperatiye duty of each member of 
tliis Society to keep a record of aJl cases occorrmg in his practice, 
depending upon endemic or general causes (such diseases as the 
different forms of fever, of inflammations, diarrhoea, cholera, tuber- 
culosis, &c. &c.), together with the types they assume, the age, 
habits, and other hygienic conditions of the patient, and also the 
general course of treatment pursued, and the termination of the 
cases ; and to report at least annually the absolute number of each 
disease, or the percentage as compared with the whole number of 
cases recorded, each month being reported separately, to the com- 
mittee appointed to receive such reports, as provided for in Article 
X. These reports are to be read at some meeting of this Society, 
either by the individual reporting them, or by the committee re- 
ceiving them as the society may direct 

It shall be considered as a dereliction of duty, punishable as the 
by-laws may direct, for any member of this Society to admit into 
his office as a student of medicine, any person who shall not first 
present a certificate of qualifications as provided for in Article VL 
of this constitution. 

Abticlb V. 

The officers of this Society shall consist of a President, Vice-Presi- 
dent, Secretary, Treasurer, and three Censors. 

Abticlk VL 

Duties of President, Vice President, Secretary, and Treasurer, as 
usual 

It shall be the duty of the Censors to examine all persons ap- 
plying for admission to the offices of any members of this Society 
as students of medicine, and if found worthy, to give them cer- 
tificates of possessing a good moral and intellectual character ; a 
good English education, including a thorough knowledge of the 
English language, and a respectable acquaintance with its literature 
and with the art of composition ; a &ir knowledge of the natural 
sciences, and at least the more elementary mathematics, including 
the chief fundamental elements of algebra and geometry, and such 
a knowledge of the ancient languages as will enable him to read 
current prescriptions and appreciate the technical language of the 
natural sciences and of medicine. 



4u bspobt ok plans of organization. 

Articlb VIL 
Meetings. — When held. How called, &a 

abticlb vni. 

Funds. — How raised and expended, &c. 

Article IX. 

This Society shall adopt the Code of Medical Ethics of the 
American Medical Association. 

Article X. 

There shall be a Standing Committee of this Society, of such 
numbers and chosen in such manner as the Society by its by-laws 
may direct, whose duty it shall be to receive records of cases oc- 
curring in practice from the members of the Society, as provided 
for in Article lY. of this constitution, to arrange them in a con- 
densed form, showing for each month of the year the percentage of 
each form of disease reported, adding accounts of the localities 
where they occurred, the general habits, and other hygienic condi- 
tions of the people, the general meteorological characters of each 
month, and statements of the type or severity or other peculiarities 
which each particular disease may have assumed, the general coarse 
of treatment pursued, and the general results of treatment or the 
termination of cases; ajid to transmit such accounts annually to 
the committee for receiving them of the State Society to which 
this Society is auxiliary. 

Article XL 
Provisions for altering or amending this Constitution. 

A. B. PALMER, Chairman. 
N. B. IVES. 



REPORT ON THE CHANGES 



nr THB 



COMPOSITION AND PROPERTIES 



OF! 



MILK OF THE HUMAN FEMALE, 



MENSTRUATION AND PREGNANCY. 

BIAB BBOU TBI 

AMEBICAK MEDICAL ASSOCIATION, 
AnnjAi >BHn» of hat, im«. 

By N. S. DAVIS, M.D., &o. 

cmoAoo, nuorom. 



EEPORT ON THE CHANGES 



am 



COMPOSITION AND PROPERTIES OF THE MILK (ff THE HUMAN 
FEMALE, PRODUCED BY MENSTOUATION AND PREGNANCY. 



At the aamxial meeting of this Asaooiation in May, 1855, 1 had 
the pleasure of submitting a brief report on the best methods of 
preserring milk in a state, of freshness and purity during long 
periods of time, fand I now propose to occupy your attention with 
such £icts and observations as I have been able to collect concern- 
ing the other important topics referred to your Committee for 
investigation. 

The opinion has long been prevalent, both in and out of the 
profession, that the milk of mothers who have become again preg- 
nant during the period of lactation is not capable of affording a 
sufficient amount of healthy nutritive matter for the proper nutri- 
tion and development of the nursing infant. The number of 
recorded observations calculated to form a basis for this opinion is 
very small ; and so far as I have been able to learn, no attempts 
have been made, either by microscopic or chemical examinations, 
to ascertain the precise changes, if any, which take place in the 
milk in consequence of the supervention of pregnancy or menstrua- 
tion. In Hassall's work on microscopic anatomy, we find only the 
following paragraph : " The milk of women in whom the natural 
periods have returned during the course of lactation has likewise 
been oareftdly examined. Except in a single instance, however, it 
has not been found to present anything remarkable in its charac- 
ters. In the case referred to, it had degenerated to the condition 
of colostrum, and contained the granular colostrum corpuscles." 

Lehmann, in his work on Chemical Physiology ^ just issued from 



418 BEPOBT OK 

the press in this countiy, says, in speaking of tlie morbid changes 
in milk, that " Epithelial cells, mucous corpuscles, fibrinous dots, 
blood corpuscles, infusoria (vibrio bacillus), and bjssus (blue milk]^ 
are rare admixtures, purely accidental, or caused by pathologicfll 
affections of the mammary glands." 

Dr. Carpenter and other writers allude to the subject in the same 
general terms. Being unable to find already on record any num- 
ber of analyses of milk secreted during either menstruation or 
pregnancy, I have embraced every opportunity afforded me during 
the past year for making such analyses, both chemically, and with 
the microscope. 

Analyses of healthy human milk have been made by Simon, 
L'Heretier, Chevallier and Henri, Vernois, and several others; and 
the results obtained by them clearly establish the fact that the relar 
tive proportion of the constituents of healthy milk varies much in 
different individuals, and even in the same individual at different 
times, and under the influence of variations in diet, exercise, &c 

To obviate, as fieo* as possible, any erroneous inferences from tbe 
occurrence of these normal variations, I have in this report placed 
in comparison only the milk of the same female, taken at different 
periods of time, but under circumstances in regard to diet, exerdee 
&c., as nearly tmiform as possible. To determine the e£fect8 of 
pregnancy on the composition and properties of milk, I obtained 
from Mrs. G., an intelligent American lady, aged about 27 years, 
when in the eighth month of lactation she was again found to be 
nearly three months advanced in pregnancy, an ample supply » 
milk for examination. At the same time, a careful record waa 
made concerning her health and that of her nursing child. Sbe 
passed through the full period of pregnancy, underwent a safe 
delivery ; and when in the third month of lactation, free both from 
menstruation and pregnancy, she again supplied me with a soSor 
cient quantity of milk for a full examination. 

For another comparison of the same kind, I obtained from Mis* 
B., an Irish woman, aged about 85 years, when in tlie elefentk 
month of lactation, and the beginning of the sixth month of pW8" 
nancy, one specimen of milk, and another specimen after she had 
completed her period of gestation, and again arrived at the tonm 
month of healthy and uncomplicated lactation. 

To determine the influence produced by menstruation, I obtained 
from Mrs. W., an intelligent American lady, aged 26 years, when 
in the seventh month of lactation, free from menstruation, 9xA 



HILK OF THE HUICAN FEMALE. 419 

nuTsing a very healthy and well-nourished baby, an abundant sup* 
ply of milk. Four months subsequently, she began to menstruate, 
and continued to do so regularly, and the same time nurse her 
infant, until the fourteenth month of lactation. During the period 
intervening between the second and third menstrual discharges, 
slie furnished four more samples of milk for examination and ana- 
lysis. All the specimens of milk examined were subjected to the 
same processes, and with a view of determining in each, first, the 
microscopic appearances ; second, the relative proportion of cream 
mrhich would separate by standing ; third, the relative proportion 
of water and solid matter ; and fourth, the relative proportion of 
each of the following ingredients, viz : water, butter, or oil soluble 
in ether, casein, sugar and extractive matter, and salts. To accom- 
plish the first object, each specimen of milk, soon after its removal 
from the breast, was subjected to a careful examination under a 
good achromatic lens, magnifying 1000 diameters. The first two 
specimens, which were obtain^ from females in the state of preg- 
nancy, presented appearances strikingly similar. A carefully exe- 
cuted sketch of the field, as it appeared under the microscope while 
examining the milk of Mrs. G., is herewith shown in Fig. 1. To 

Pig.l. 




Jfri. T. 0., 8th moAtli Uotatton, 8d mo&tli of pngauay. 



420 . ESP09T osr 

fiusilitate the compariaon, I hare Tepfenwtod (Fig. 2) ^e appear- 
anoee of another specuaen of milk, oUaijoed firom Mi& G^. after abo 

Fig. a. 




Mrs. T. O., 3d month iMtatioiL. 

had nursed her second child three months, and was free from the 
influence of either pregnancy or menstruation. Several microscopic 
peculiarities were easily recognized in the specimen first examined. 

The globules or milk corpuscles were comparatively very few in 
number, and their size either very large or very small; the medium 
sized corpuscles being the most deficient. Of the larger sissed 
corpuscles some were distinctly oval, and most of them appeared to 
possess double cell-walls, one within the other, precisely as de- 
scribed by Turpin.* A few true colostrum corpuscles were also 
found in both the specimens of milk from the pregnant femalesL 
Only one of them was present in the field represented in Fig. 1. 

There was also observed in these specimens of milk a greater 
number of exceedingly minute globules of low refracting powar, 
which are supposed to be composed of casein by MM. Quevenne 
and Donn^. 

I Annales des Soienoes Natorolles. 



HILK OF THS HUVAK FEMALE. 



421 



In the plates tliey are mostly represented as small black spots. 

Another highly interesting pecoliarity noticed in the milk of 
Mrs. G^ while in a state of pregnancy, was the presence of a con- 
siderable nnmber of exceedingly snudl animaloula. Some of them 
appeared to be perfectly linear, like vibrios; while others were 
evidently enlarged at one end, somewhat resembling the human 
spermatozoa, though much smaller and the tail less filiform. They 
were all capable of an independent, though vibratile or wriggling 
motion, by which they were sometimes seen to move from one- 
fourth to one-half of the distance across the field. After repeated 
and careful observations, I am satisfied that the motions here 
described were wholly independent of any accidental motion of the 
fluid under examination. These apparent animalcula are very 
correctly represented in Fig. 1. They were also visible, though 
fewer in number and smaller, in the milk of the same woman when 
not pregnant, as represented in Fig. 2. Aside from this the milk 
represented in Fig. 2, presented no microscopic appearances differ- 
ent from ordinary specimens of healthy milk. 

In comparing the microscopic appearances of the two specimens 
of milk frirnished by Mrs. W., one before and the other after the 
retom of menstruation, three points of difference were noticed. In 

Fig. 3« 




Mrt. W., Tth moBtk laeUtioB, no iMutniAtion. 



422 



RKPOBT OK 



the latter, the true milk globules were decidedly fewer in number; 
a larger proportion of them were yeiy small ; and a small number 
of exceedinglj minute animalcula were visible. These differences 
are very accurately represented in Figs. 8 and 4. To ascertain the 

Fig. 4. 




Mn. W., 13th month Uetation, BMUtmated twl«. 



relative proportion of cream which would separate' spontaneous! j, 
a certain quantity of each specimen of milk was allowed to stand 
in an open tube 86 hours, when the thickness of the stratum of 
cream was readily determined by measurement The milk of Mrs. 
G. obtained when she was in the 8th month of lactation, and the 
8d month of pregnancy, exhibited a quantity of cream equal to ^ 
part of the whole bulk of milk. That obtained from Mrs. B. when 
in the 11th month of lactation, and the 6th month of pregnancy, 
exhibited cream equal only to ^ of the whole quantity of milk. 
The milk received from Mrs. G. during the 8d month of the 
2d lactation, yielded a proportional bulk of cream fully equal 
to I; and that obtained from Mrs. B. during the 4th month of 
the 2d lactation, gave ^'j. 

These are striking differences, and well worth careful considera- 
tion. The milk furnished by Mrs. W. when in the 7th month of 
healthy and uncomplicated Lactation, the same as represented in 



HILK OF THE HUKAK FEMALE. 428 

Fig. 8, also yielded an amount of cream equal to | of the whole. 
Two other specimens, furnished by the same woman during the 
18th month of lactation, after haying menstruated two consecu- 
tive months, yielded the one j\, and the other ^\ of their whole 
bulk, . . 

The following tables exhibit the results of nine separate chemical 
analyses, all conducted in the same manner. First, the milk of 
Mrs. B. when in the 11th month of lactation and the 6th month of 
pregnancy. 

Whole amount Proportloii in 

analyied 475 gn. 1000 parti. 

Solid matter by eyaporatSon 27.5 grs 67.90 

Water 447.5 gn 942.10 



Of the solid matter there ^ 

Batter or oil Bolable in ether 6 grs 12.63 

Sugar and eztraotiTe matter 10 grs 21.05 

Casein U grs 23.16 

Fixed salts 0.5 grs. • . . . 1.06 

Second, the milk of Mrs. B. when in the 4th month of her second 
lactation, uncomplicated by pregnancy. 

Whole amount Proportion in 

analjsed 830 gn, 1000 parts. 

Solid matter by evaporation 94 grs 113.39 

Water 735 grs 886.61 

Of the solid matter there was— 

Butter or oil soluble in ether 19 grs 22.92 

Sugar and extractiye matter 24 grs 28.50 

Casein 48 grs 57.90 

Salts 8 grs. . . . . 4.07 

Third, the milk of Mrs. G. in the 8th month of lactation and the 
8d of pregnancy. 

' Whole amount Proportion In 

analyzed 476 gn. lOOO parts. 

Solid matter bj eraporation 82 grs 67.36 

Water 443 grs 932.64 



Of the solid matter there ^ 

Butter or oil soluble in ether 8 grs. . • • . 16.84 

Sugar and extraotiye matter 11 grs. • • • . 22.10 

Casein 12 grs 25.26 

Salts 1 gr. . • • . 2.10 

Fourth, the milk of Mrs. G. in the 8d month of the second lac- 
tation, without pregnancy or menstruation. 



4S4 BXFOBT OH 

WholauBOunt PfopoitioBlft 

mnftlyMd 100 gn. 1000 inrts. 

Solid malter by eTapoiatioa 24 gts. • • . 117.07 

Water 181 gis 863.93 



Of the solid matter there ' 

Batter or oil eolable in ether 8 grs 39.02 

Sugar and eztraotiye matter 6.5 gri. • • . 31.79 

CaBein 8.5 gn. • • . • 41.46 

Salts 1 gr 4.87 

Fifth, the milk of Mrs. W., at the end of the 7th month ot lac- 
tation, without menstruation or pregnancj, the nursing child beiog 
very robust and healthy. 

Vliole tmouBt ProporflM la 

analTMd IfiOO gn. 1000 parte. 

Solid matter bj OTaporation 203 gn 135.34 

Water . 1297 gra. . • • . 8«4.€( 

Of the solid matter {here was — 

Batter or oil solable in ether 67 grs 44.67 

Sagar and exiiaotiVe matter 55 grs 36.66 

Casein 75 grs 60.00 

Salts 6 grs 4.00 

Sixth, the milk of Mrs. W., in the 18th month of lactation, and 
the third moDth of menstruation. The table presents the avenge 
results of four separate analyses. 

Wliole amoimt Proportion It 

«nal7i6d 1467 «». 1000 parti. 

Solid matter by eyaporation 137 grs. • . . • 93.38 
Water 1330 grs 906.62 



Of the solid matter there i 

Batter or oil solable in ether 44 grs 29.99 

Sagar and eztractiye matter 41 grs 27.94 

Casein 48 gn 32.71 

Salts 4 gts. . . . .2.72 

If we may deduce conclusions from the limited number of obfler- 
vations and analyses here detailed, we may find a yeiy definite 
answer to the question under consideration, so far as it relates to 
the changes in the composition of the milk. 

1st. The occurrence of pregnancy during lactation, prodnoes a 
very marked diminution of all the solid or nutritive constituents of 
the milk, such diminution continuing to increase as the pregnane/ 
advances. 

2d. In examining the separate proximate constituents, it will b6 
observed that a much greater relative diminution takes place in the 



KILK OF THB HUMAN FEMAL2. 426 

casein, the butter or oil, and the salts, than in the sugar and extract- 
ive matter. 

8d« There appears to be added to the milk secreted during the 
progress of ntero-gestation some of the granular bodies or colostrum 
corpuscles, and numerous minute infusoria or animalcular germs, 
which have been very rarely found in healthy milk. 

4th. Changes, the same in kind, take place in the milk secreted 
after the establishment of regular menstruation, but much less in 
degree ; and the relative diminution of the several constituents is 
more uniform. 

Changes in the Qualities of the Milk. 

These may^be inferred partly from the previously ascertained 
changes in its composition, and partly from a direct observation of 
its effects on the nursing child. 

From the comparatively small quantity of solid or nutritive mat- 
ter in the milk secreted after the commencement of pregnancy, it is 
evident that it is much less capable of furnishing to the nursing 
child a sufficient quantity of nutritive material for the healthy 
development of all its tissues; while the presence of granular or 
colostrum corpuscles, with or without infusoria, would greatly tend 
to establish irritation in the mucous membranes, manifested by fre- 
quent attacks of diarrhoea, more or less emaciation, and almost con- 
stant peevishness. These inferences drawn from a knowledge of 
the changed composition of the milk, are, to a certain extent at least, 
confirmed by direct clinical observations. Thus the child of Mrs. 
O., which was only about four months old when the mother again 
became pregnant, was perfectly healthy and well nourished up to 
that time. Soon after it began to be peevish and restless, with 
flatulency and occasionally green discharges from the bowels. 
These changes were at first slight^ but they gradually increased, tmd 
at the end of six weeks it was evident that the child had ceased to 
be well nourished. Its tissues had become soft and flabby, and the 
mucous surfaces irritable, as manifested by occasional vomiting and 
more frequent intestinal discharges of a green color and sometimes 
mixed with mucu& During the succeeding two months the child 
was subjected to several attacks of severe watery diarrhoea, accom- 
panied by so much emaciation, that the parents took it from the 
city into the country with the hope that a change of air would re- 
store it. While absent, however, it was attacked with cholera mor- 
bus and died in two or three days. To enable the reader to judge 
VOL. IX.— 28 



426 BBPOBT OK 

how &r the period of primary dentition and the season of the jear 
influenced the child, it is proper to state that at no time oonld I dia- 
.oover any evidence that the advancing teeth produced irritation, 
either local or generaL The mother became pregnant the last week 
in April; and the nutrition and general health of the nursing child 
became decidedly impaired, before the end of the June following. 
This was too early for the influence of the season to be felt nn&voT- 
ably; although the two following months (July and August) un- 
doubtedly increased the tendency to intestinal irritation, and proba- 
bly hastened the fatal termination. The child of Mrs. B. was abo 
healthy and well nourished until it was five months old, when the 
mother again became pregnant, which was in the month of March, 
1866. During the month of May, the moth^ applied to me for ad- 
vice, saying that for three or four weeks her child had been unusu- 
ally fretful and restless ; that it was troubled with flatulency, often 
rejected its milk by vomiting, and was " getting poor." I examined 
the child's mouth, but found no swelling of the gums or other indi- 
cations of irritation from teething. Although temporarily relieved 
by medicine from time to time, the child continued to fail in its 
nutrition and^ become more and more subject to diarrhcea and 
vomiting, until, during the latter part of summer, it presented the ap- 
pearance of extreme emaciation and anemia. The mother persisted 
in nursing it until the middle of September. Soon afier it was taken 
from the breast, it began to gain in flesh and strength, and con- 
tinued to do so for two months. At the end of this time it was 
attacked with symptoms of subaeute meningeal inflammation, and 
died in about six days with evident effusion of serum on the brain. 
I have been thus particular in stating the health of the children, 
as well as the season of the year when the mothers became pregnant^ 
in connection with the results of the analyses and microscopic eoca- 
miaations of the milk, that we might have all the drcumstances 
which could be supposed to exert an influence on the results. Since 
their second confinement both mothers have enjoyed good health; 
and at the time they furnished the last specimens of milk for exami- 
nation, the one in the third (see Fig. 2) the other in the fourth mondi 
of lactation, their nursing children were perfectly healthy and well 
nourished. Since this subject has been tmder investigation, I have 
met with four other females who had become pregnant while nuia* 
ing. In all but one, the children began to exhibit symptoms of 
imperfect digestion and nutrition within two months from the tiiae 
the mothers became pregnant, and continued to do so until thef 



^ILK OF THE HUMAN FEMALS. 427 

were removed from the breast. One of these mothers came to me 
for advice about the propriety of weamng her child, in November 
last. She said the child had not " grovm well^ for several months ;" 
that it was exceedingly fretM and restless, with frequent disorder 
of the bowels. I learned that she was then in the sixth month of 
pregnancy, and the secretion of milk in her breasts had been insuf- 
ficient for the child without the daily use of other milk. She agreed 
to procure for me a vial of milk from her breasts the next day, and 
then immediately wean the child. To her surprise, however, she 
foimd, on making the trial next day, that she had no milk in her 
breasts, being able to procure the discharge of only a very few drops 
of a watery fluid. The child was not put again to the breasts, and 
no more milk was secreted until after her subsequent confinement. 
Here was a case, in which the progress of utero-gestation seemed 
to cause the entire cessation of the secretion of the manmiary 
glands ; the woman being in the mean time in robust health. The 
child subsequently became healthy, and remains so at the present 
time. On the other hand, one of the four mothers to whom I have 
just alluded became pregnant about the sixth month of lactation. 
Her nursing child continued to enjoy good health, and its nutrition 
to remain nearly as perfect as before. The mother herself, however, 
soon began to show signs of anssmia, which increased so rapidly, 
coupled with much nervous irritability and tenderness of the mu- 
cous lining of the mouth, that she was compelled to wean her child 
at the end of the fifth month after the commencement of pregnancy. 
So far as I have been able to observe, the effects of menstruation, 
both on the quality of the milk and the health of the nursing child, 
are much less marked than those of pregnancy. The child of Mrs. 
W. maintained good health, and was well nourished throughout the 
whole period of nursing. During the last two months, however, 
after the menses had returned, it became habitually more irritable, 
and seemed to require additional nourishment. 

Investigations, such as I have entered upon, for elucidating the 
questions propounded to me by the Association, require much time 
and labor, though the results may be stated in a few words or fig- 
ures. The important practical bearing of the results obtained thus 
fiur, will be obvious to every intelligent physician. But the exami- 
nations and analyses, microscopic and chemical, should be multiplied 
until they are sufficient to render all conclusions drawn from them 
demonstrated truths. 



REPORT 



OVTHB 



SMITAEY POLICE OF CITIES. 



By JAMES M. NEWMAN, M.D. 



REPORT ON THE SANITARY POLICE OF CITIES. 



In the inyestigations made with a view to the preparation of the 
report npon the subject confided to the charge of jonr Committee, 
an examination of the materials previoaslj collected by others, dis- 
closed the &ot, that the subject has already been pretty thoroughly 
treated in former reports to this Association. 

The numerous able and voluminous reports made by the Yarious 
committees year after year, upon the subjects of epidemics and of 
hygiene, have aggregated a mass of observations and facts upon all 
the numerous questions included in the general subject of sanitary 
reform, so as to leave but little else to be accomplished in the direc- 
tions to be given the public in the matter of the preservation of the 
public health. 

In the first report of the Committee on Hygiene made to the Asso- 
ciation {Tramactions^ vol. ii.) they say : ^' The facts required by the 
Committee on Hygiene were for the most part unrecorded ; books 
were silent on the subject; and the data which they sought to pos- 
sess themselves of, were to fiow &om careful personal observation." 

Most assuredly such cannot be said now. For if the Association 
has, and should aocc^nplish nothing else, in this department of medi- 
cal inquiry it has, by the collection of statistics, and the histories of 
the diseases of our country, with their topographical dependencies! 
performed a labor of inestimable value. The influence exerted by 
these labors is being every day more and more fully developed, in 
the greater attention paid to the collection of vital statistics. The 
profession is everywhere fully awake to the importance of the sub- 
ject ; and our drowsy legislators are at last beginning to realize that 
tables and figures may be made able to read of other facts as im- 
portant as dollars and cents, and that other statistics besides those 
which treat c^ the value of lands, houses, and cattle, and (^ ships and 
merchandise, may disclose the real elements of a nation's wealth and 
prosperity. 

lu view of what has already been accomplished by previous com- 



482 BEPOBT ON 

mittees, the range of subjects treated in this report will necessarily 
be much more circumscribed than would otherwise be proper with 
a subject so broad as that embraced in the consideration of " thk 
SANITARY POLICE OP CITIES." It wiU be the eflEbrt to avoid repeti- 
tion, and consequently the customary considerations of cleanliness, 
ventilation, sewerage and paving will not be discussed except as 
they incidentally and necessarily spring up in the consideration of 
the subjects claiming attention. 

This report will be an effort to tabulate the effects of disease, and 
to exhibit by figures the ravages that preventable disease is commit- 
ting in our midst, and especially in our cities. The havocs of epi- 
demics and the deductions therefrom will occupy less attention 
than the slow, continuous, unceasing inroads of diseases less rapid 
and alarming, but as certain and fatal as they are insidious. The 
public mind has been accustomed to view the matter of sanitazy 
reform too much, if not alone, by the light of epidemics. They lose 
sight of the less violent, slower, but no less certain causes of sick- 
ness and death with which they are continuously surrounded. 
Death reaps a yearly harvest to the grave, and when it exceeds not 
the usual annual number, it is not heeded, and the inquiry \b not 
made whether a part of his trophies might not have been snatched 
from him ; it is only when his victims are largely in excess that 
public attention is arrested and alarm excited. How much perma- 
nent good is done sanitarily by the alarm excited by epidemics may 
admit of a question. Beformations are but seldom the resnlts of 
violent assaults. The public apprehension is excited at the recital, 
or witness of some fearful havoc of a pestilence, alarm is felt, and a 
thrill of horror may pervade the community ; but the effect ia lost 
in the tendency to shelter themselves under some assurance that the 
circumstances surrounding them are very different firom those 
which gave birth to the scourge. 

The fact, however, of an effort being made towards the sanitary 
improvement of our population, whether confined in cities or living 
in the country, implies also an admission, or at least a belief of the 
existence of diseases which it is in the power of man to more or 
less control and modify, and to ameliorate the conditions springing 
£rom these causes. Without such a belief, of course such labors 
would not be undertaken, for there would be the want of those in- 
centives so necessary to the successful accomplishment of any pur- 
poses. 

As cities have oftentimes been called plague spots in morals and 
politics, so are they often plague spots of a verity, and the most 



THS SANITABY POLICE OF CITIES. 433 

favorite haunts for the ravages of epidemics. The aggregation of 
masses saema to famish not only the numbers necessary to satiate 
the rapacity of a pestilence, but the very elements out of which 
to eliminate the disease itself^ or to furnish all the elements to 
nourish, develop, and perfect its growth until it has fuIfiUed its 
mission, or succumbed for a lack of victims susceptible to its attack. 
It is to our cities that we look for the frequent outbreak of epidemic 
diseases, and for their sad results. Crowds, poverty, and filth are 
all there, with their progeny of suffering and disease. And the 
philanthropist finds there always an ample field for the exercise of 
his broadest charities, and the most abundant employment for every 
labor in the behalf of his race. 

Life in cities has at all times been regarded of a less average 
duration than in rural districts. Figures have been compiled and 
arranged to show the average length of life in town and country. 
Such presentations are most interesting, and not without the fullest 
instruction. They teach, too, that cities vary among themselves in 
their amount of mortality, and in the average duration of life 
among their inhabitants, and that some other cause than that of 
mere aggregation is necessary in the work of destruction so con- 
stantly going on in their midst; that while each develops its mul- 
titudinous sources of disease and death, the intensity of the poisons 
80 developed differs and the fatality varies. 

It is assumed by statisticians that a mortality of two per cent., or 
one death in every fifty individuals, may be fixed upon as a healthy 
and nattiral standard of mortality. The ratio of mortality in cities 
is much above this. 

The following statements and figures are given to exhibit the 
relative proportion of deaths to the population of several of the 
larger cities. The contrasts thus furnished will the better enable us 
to judge of the loss of life resulting from causes at work within 
these crowded haunts of men. 

In London, there dies, annually, one in every thirty-nine of the 
population, making the large number of 60,000 deaths yearly. 

But to turn to the ravages of disease in our own country, we 
find the following statistics on record, declaring, with trumpet 
tongue, the augmented loss of life from city residence. 

The following table exhibits the ratio of deaths to the population 
of the city of New York, extending over a period of near half a 
century :* — 

> Citj Inapeotor'B Report, N. T., for 1853. 



4S4 



BSPOBT OK 



In 1806, A4s«iimi8 pwiod, the i»tio of destliB to the popnlatioEii, 1 to 32L98. 



« 1810, 

« 1816, 

" 1820, 

« 1826, 

« 1830, 

« 1836, 

" 1840, 

" 1846, 

« 1860, 






u 
u 



1 to 46.49. 
1 to 41.83. 
1 to 37.19. 
1 to 34.78. 
1 to 38.97. 
1 to 40.87. 
1 to 39.74. 
1 to 37.76. 
1 to 33.62. 
1 to 33.86. 



« 1863»Moomirated, « « « c. 

The annnal mortality of Philadelphia, for a period of fiyo 
years, was as follows :* — 



Tmt. 


Popnlmtloii. 


Total MorteUtj. 




1851 

1852 

1853 

1864 

1866 


409,000 
416,000 
425,000 
450,000 
600,000 


8,871 
10,258 

9,744 
11,784 
10,458 


1 to oToty 46.10 
1 " « 40.46 
1 « " 43.61 
1 « •* 38.10 
1 « « 47.81 



The deaths in Boston:* — 

In 1860, was 1 to every 37.84 of the population. 
" 1865, " 1 « « 39.88 « « 

In Pboyidekgs, B. L, the proportionate mortality to population 



wasr — 



In 1853, 1 death to eveiy 43.20 of the popnlation. 
" 1864, 1 «« « 36.67 « " 



Baltimore. — ^Deaths, population, and rate per cent, of mortality 
for thirteen years, 1836 to 1848, inclusive. Exclusive of stillborn.^ 



Taar. 


Population. 


Annual Mortality. 


MortaUty— 1 to 
every 


P«reent.oifMQr- 
taUty. 


1836 . . • . 


S3,919 


2,192 


42.76 


2.33 


1837 . 






95,266 


2,518 


37.80 


2.64 


1838 . 






97,547 


2,476 


39.39 


2.53 


1839 . 






99,986 


2,260 


44.23 


2.26 


1840 . . 






102,513 


2,046 


50.12 


1.99 


1841 . . 






106,087 


2,247 


46.76 


2.14 


1842 . . 






108,233 


2,477 


43.29 


2.31 


1843 . , 






112,021 


2,333 


48.01 


2.08 


1844 . . 






116,601 


2,666 


43.71 


2.28 


1845 . . 






121,161 


2,896 


41.81 


2.38 


1846 . . 






127,219 


2,996 


42.45 


2.35 


1847 . , 






133,679 


3,414 


39.12 


2.68 


1848 . . 






140,457 


3,861 


36.19 


2.76 



> For the mortnaxy statistics of Philadelphia, I aolcnowledge myself indebted to 
the courtesy of Dr. Wilson Jewell, of that city. 

> City Register's Report, Boston, 1856. 

* Second Rhode Island Registration Report, 1863-^4. 

* TransaotionB American Medical Association, toI. ii. page 673. 



THX SANITABT POLIOS OF CITIES. 



486 



At Chablbstok, S.C., "from a report of the Cily Register, gS 
the interments for the eighteen years, from 1828 to 1846, it appears 
that the annual proportionate mortality averaged 1 in 44.11; 
whereas, for the last eight years (1849), the average has been but 1 
in 52." 

Ib 1886, a eholen year, the mortality was 1 in 26.84. 
** 1S38, a jeUow feyeir year, tlie mortality ma 1 in 25.05« 
« 1839, " " " 1 in 35.38, 

Since then, by the sanitary impiOTement of the eity, for a period 
of eight years previous to 1849, the standard of mortality has been 
laised to 1 in 62.^ 

At Chicago, the comparative mortality for five years was as fol- 
lows:* — 



Tmt. 


Popnlatioft. 


▲nnoal mortality. 


Mortality— 1 In •Tory 


MortaUtj per Mnt. 


1846 .... 

1847 .... 

1848 .... 
•1849 .... 

1850 .... 


14,169 
16,859 
19,724 
23/47 
28,620 


327 

487 

514 

1,223 

1,334 


43.38 
34.61 
38.37 
18.84 
21.45 


2.80 
2.88 
2.60 
5.30 
4.66 



In Nbw Oblbans, the proportionate mortality, extending over a 
period of nine years, is as follows:* — 



Tear. 


Popi&latlon. 


Mortality. 


Death! to popalatioii. 


1846 

1847 

1848 

1840 

1850 

1851 

1852 

1853 

1854 


102,070 
108,699 
115,503 
122,511 
129,747 
138,599 
147,441 
154,132 
160,823 


4,220 
9,043 
8,026 
9,862 
7,819 
7,275 
8.670 
15,787 
10,564 


1 in eyexy 24.18 
1 « 12.02 
1 •' 14.39 
1 " 12.42 
1 « 16.59 
1 « 19.05 
1 « 17.00 
1 " 10.39 
1 « 15.22 



Proof is fonnd in the foregoing statistics of the greatly augmented 
loss of hnman life, consequent upon causes at work within our 
thickly settled cities. A sort of sliding scale will be noticed in the 
range of this increased mortality from year to year, even within the 

■ TransaotionB Amer. Med. Anoo., toL iL p. 579. 

* Ibid., vol. iT. p. 545. 

* In 1849, 681 deaths were by cholera ; and in 1850^ 473 deaths were by the 
same disease. 

* Barton's Report of the Sanitary Commission of New Orleans. Calculated from 
Chart A, and *' Comparatiye Tables," p. 461. 



486 BSPOBT ON 

same city; and at the same time from the favorable character of 
location, or from a more strict observance! of hygienic laws, that a 
marked advantage is enjoyed by one town over another in a 
decreased rate of mortality. But the most highly favored still fjedls 
below the healthy average. The elevation of the ratio of mortally 
to its normal standard anjnvhere and at any time is a very rare 
and exceptional occurrence, so seldom as to elicit surprise, and 
almost suggest doubts of the accuracy of the figures. 

If this augmented loss be beyond control and remedy, it is the 
penalty we pay for our civic enjoyments. If it be controllable by 
human means, and we leave those means unemployed, the loss is 
suicidal, and responsibility somewhere attaches. 

This waste of life is strongly set forth in the following curious 
calculations made in reference to London. This metropolis con- 
tains about 2,000,000 inhabitants, or about one-eighth of the popu- 
lation of England and Wales. Of this number, according to the 
Registrar General, more than 50,000, or 1 in 39, die annuidly. 

" But if the rate of mortality were 1 in 50, in place of 1 in 39, as 
it is in several large towns of England, and in the healthier parts 
of the metropolis itself there would be an annual saving of 10,278 
lives. In the metropolis there are about 266 deaths every week^ 
nearly 38 deaths a day, or considerably more than one every hour, 
over and above what ought to happen in the common course of 
nature. Now, it has been calculated that for every death which 
takes place, there are 28 cases of sickness which do not end fisitally. 
We have, therefore, 387,296 cases of sickness occuning in the 
metropolis every year which are unnecessary and preventable: 
13,832 lives could be saved — more than a third of a million of 
cases could be prevented."* 

In our search affcer the peculiar agencies manifesting themselves 
with such severity upon our urban populations, and so markedly 
abridging their span of life, we are almost intuitively led to fasten 
upon those diseases which are known to be developed by the 
malign influences resulting from the habits and modes of life to 
which they are exposed. To those diseases which are propagated 
from one to the other, or which are engendered by filth, or vitiated 
air, or both combined, and we encounter that class known by 
nosologists as Zymotics^ and which are infectious, or contagious in 
their character. 

1 Jomnal of Publio Health, vol. ii. p. 226. 



THE SANITABY POLICE OF CITIES. 487 

Zymotics have been broadly defined as those diseases "whicli 
are propagated by emanations, from the ground, from decaying 
animal or vegetable matter, from cases of previous disease, or from 
over-crowded human beings, diseases which are, or may be epidemic, 
endemic, or contagious."* 

The amount of mortality from this class of diseases, and the pro- 
portion borne by them to the entire mortality, are such as to arrest 
attention, and demand from us more than a passing remark. 

The total number of deaths in the United States for tiie year 
ending June 1st, 1850, was 328,028. Of which 181,813, or 40.80607 
per cent were zymotics.* 

If we deduct from the above 81,506 deaths caused by cholera, 
we have by causes ordinarily in operation 291,517 deaths, and 
100,807 deaths, or 84.4086 per cent., or over one-third produced by 
zymotics. 

In Massaohusetis, for thirteen years and eight months, 29.05 
per cent, of all diseases from specified causes were from zymotics.* 

In Rhode Island, from June to December, 1858, 88.194 per 
cent., and for the year 1854, 87.198 per cent, were produced by the 
same causes/ 

In New Yobe Cmr, the deaths resulting from zymotics were in 
the proportion — 

In jear 1852 of 30.39 per cent. 
" " 1863 " 26.93» " 
« « 1864 « 36.36« « 

In Boston and Lowell they bear the following proportionate 
rate of mortality : — 



Tmtb 18da to 1840. 

In Boston, 26.61 per cent, of aU deaths. 
« LoweU, 37.94 " « 


1841 to 1840. 
28.36 per cent. . 
86.47 ** 


1846 to 1848. 

29.96 per cent. 
48.83 << 


In Buffalo,^ 


the deaths and proportional mortality 


' were: — 


In 1864 . 
" 1866 . 


Total deaths. 
.... 2,936 
.... 1,866 


By symotiot. 

1,321 

669 


Per oeat. 
44.99 
30.11 









I Second Registration Report of Rhode Island, p. 69. 

s Mortality Statistics of the Census of 1860 of the United States.— Bj J. D. 
DeBow. 

• Thirteenth Registration Report, p. 168. 

• Second Registration Report, Rhode Island, p. 44. 

• Annual Report of Citj Inspector, N. T., for 1863, p. 226. 

• Annual Report of Citj Inspector, N. T., for 1864, p. 232. 

"* Transactions American Medical Association, vol. iL p. 604. 



488 



BKPOBT ON 



In Baltimore, for thirteen years (1836-1848), the proportionate 
mortality caused by zymotics was 28.627 per cent of the whole 
number of deaths reported, exclusive of stillborn. 

The yearly rates for the above period are thus exhibited :« — 



TMir. 


ZTmoties. 


Tear. 


Zymotics. 


1836 

1837 

1838 

1839 

1840 

1841 ..... 
1842 


25.228 per oent. 
30.619 " 
26.817 " 
26.548 " 
20.733 ** 
24.032 « 
28.825 " 


1843 

Xo44 . • . • • 

1845 

1846 

1847 

1848 


23.703 percent. 
30.206 " 
31.284 « 
29.205 " 
31.868 « 
34.939 " 



In Philadblphijl, for the last quinquennial period, the propor- 
tion borne by zymotics to the sum total of the mortality, was as 
follows :* — 



Tew. 


Total mortaUty. 


By xymotios. 


Per cent of zjmoticB. 


1851 

1852 

1853 

1854 

1855 


8,871 
10,258 

9,744 
11,784 
10,458 


2,213 
2,785 
2,422 
3,306 
2,460 


24.94 
27.14 
24.85 
28.05 
23.52 



Table exhibiting the Comparative Mortality of Zymotics in the several 
States of the Unions for the year ending June 1, 1850. Calcalated from 
De Bow's "Mortality Statistics of the CensQs of 1850. 





Deaths 


From 


Perct 




Deaths From Per ct. 


states and territories. 


from all 


zTmotio 
dUeases. 


zymo- 


Stotes and territories. 


from all zymotic zymo- 






tics. 




caoses. 


diseases, ilea. 

• 


Alabama . . . 


9,091 


3,029 


33.31 


Missouri . . . 


12,292 


6,832 156.58 


Arkansas . . 


3,021 


1,358 


44.95 


New Hampshire 


4,231 


1,582 37.39 


California . . 


905 


659 


72.81 


New Jersey . . 


6,465 


2,512 38.85 


Columbia, DiBt. of 


846 


289 


84.16 


New York . . 


49,600 


17,976 139.42 


Connecticut . . 


6,781 


1,987 


34.37 


North Carolina . 


10,165 


2,495 124.64 


Delaware . . . 


1,209 


461 


38.13 


Ohio .... 


28,967 


16,188 j 55.73 


Florida . . . 


931 


307 


32.98 


Pennsylvania . 


28,551 


11,645 40.78 


Georgia . . . 


9,925 


3,136 


31.59 


Rhode Island . 


2,241 


780 34.80 


Illinois . . . 


11,759 


5,858 


49.81 


South Carolina . 


8,047 


2,646 32.86 


Indiana . . . 


12,708 


6,331 


49.81 


Tennessee . . 


11,875 


4,524 ; 38.09 


Iowa .... 


2,044 


954 


46.67 


Texas .... 


3,057 


1,285 42.03 


Kentucky . . 


15,033 


6,895 


45.86 


Vermont . . . 


3,129 


951 30.39 


Louisiana . • 


11,956 


5,999 


60.17 


Virginia . . . 


19,059 


6,190 27.23 


Maine. . . . 


7,584 


2,654 


34.99 


Wisconsin . . 


2,903 


1,242 42.78 


Maryland . . 


9,621 


3,345 


34.76 


BfinnesoU . . 


29 


12 141.37 


Massachusetts . 


19,404 


7,189 


37.04 


New Mexico. . 


1,157 


336 


28.96 


Michigan . . . 


4,515 


1,428 


31.62 


Oregon . . . 


47 


23 


48.93 


Mississippi . . 


8,721 


3,639 


41.72 


UUh .... 


239 


149 


62.34 



> The ratios of Baltimore are calculated' firom Dr. James Wynne's "Sanitary Re- 
port of Baltimore," vol. 11. Trans. Am. Med. Association. 
* Dr. Wilson JewelL 



N 



THE SANITARY POLICE OF CITIES. 489 

We shall find a confirmation in the foregoing figures of the re- 
mark frequently made, that the best index to public health may be 
deduced from the proportion in which these diseases prevail. It is 
the property of zymotic diseases to prevail more at one season than 
another ; or more in one locality than another ; and to become epi- 
demic, endemic, or contagious under certain circumstances. 

It is admitted that these diseases, so fatal among us, are those 
r most amenable to hygienic laws. As will a residence without the 

' circle of their influence secure an immunity from attack, so would 

an entire removal of the causes of their development, of course 
insure their extirpation. An exemption of the race from the evils 
of their presence would be procured by the eradication of the ele- 
ments of these morbid actions. 
I, Upon the power of human agencies to control, limit and prevent 

those combinations which give birth to, and insure the full deve- 
lopment of these diseased actions, hinges, therefore, the whole 
:- question of the utility of the labors in the behalf of sanitary reform. 

I In the class zymotics are grouped, in conformity with the nosolo- 

\ gical nomenclature adopted by this Association, and now most 

I generally employed in recording American mortuary statistics, six- 

! teen distinct forms of disease, viz : cholera, cholera infantum, croup, 

diarrhoea, dysentery, erysipelas, intermittent fever, remittent fever, 
' typhus fever, hooping-cough, influenza, measles, scarlatina, small- 

pox, syphilis, and thrush. 

Several subdivisions are employed in most of the State and city 
mortuary reports for the purposes of more distinctly marking the 
ravages of some phase of disease, and imparting to them an en- 
hanced local value. We consequently find the above list extended 
by the additions of cholera morbus, typhoid, ship and yellow 
fevers. 

A separate examination of the prevalence and fatality of several 
of the most destructive of the diseases embraced in the above classi- 
fication, will afiford us an opportunity to enter into the discussion 
of the sanitary questions involved in their eradication, and will 
bring before us those subjects more pertinently applicable to the 
subject of inquiry intrusted to the Committee. 

Upon the very threshold of our subject we are compelled to bow 
before the hidden mysteries of the causations of disease, and confess 
the poverty of our knowledge, and the imbecility of our strength. 

The investigations of science have yet revealed nothing which 
enables us to discover the peculiar elements concerned in the pro- 



440 RSPOBT ON 

duction of siz of tHe diseases belonging to the class under consider- 
ation. Of the etiology of croup, erysipelas, hooping-cough, infla- 
enza, measles, scarlatina, we ar^ profoundly ignorant. All we 
know of them is, that while they perhaps are never absent entirely, 
they at times assume in the widely spread circle of their influencey 
and in the int^nsity of their action, every characteristic of the 
severest and most fisital epidemics. Four of them are undoubtedly 
contagious. Three of them secure the system against a repetition 
of attack. Four of them are pre-eminently diseases of early child- 
hood, and are among the most active agencies in the production of 
the terrible mortality of infantile life. 

The elements concerned in their development seem to be meteor- 
ological rather than terrene, depending upon some peculiar atmo- 
spheric conditions of which we are yet unable to take cognizance. 
City life seems to have but little influence in adding to their severity, 
and the sum total of their mortality is increased only by the greater 
number exposed. They extend to the remotest bounds of the 
country, and penetrate the most secluded hamlet with a severity as 
great, and a tendency as fatal as when developed in a crowded 
city. 

We only know that inasmuch as measles, scarlatina, and hooping- 
cough are propagated by contagion, that, as a sanitary measure, a 
removal beyond the sphere of infection would for the time being 
secure an exemption from attack ; but the extreme susceptibility of 
childhood to the specific contagion of these diseases, renders such 
a measure of but little avail except in securing a short truce to the 
attack, since it seems to be almost a law of its nature that it 
should suffer once an attack of these diseases. Croup and influenza 
leave us to look to atmospheric changes too occult for us to demon- 
strate their character, or from whence they emanate. 

With the balance of the diseases in our class scientific investi- 
gation has grappled, and endeavored to pierce the mysteries which 
surround them. But even with them, our boa^stings should be 
tempered with the greatest humility, as we have too often occasion 
to discover that our strength is but weakness, and that we can as 
yet penetrate but a very short distance within the veil which con- 
ceals the mysteries of epidemics and endemics from our view. 

The first disease in the alphabetical arrangement of our class is 
CHOLERA, a disease, as it were, of our own day, with whose birth, 
progress, and fearful march over the face of our globe we are all per- 
sonally cognizant. Twice has it come up from the land of its birth 



THE SANITABT POLICE OF CITIES. 441 

and oyerrun empires and states like a fierce army, and tbe sound 
of tbe footsteps of tbe last march has not yet died on the ear, and 
we have no assurance that tbe invader has yet entirely withdrawn 
from our shores, or that he may not again return to devastate our 
towns and cities. 

It is not our purpose to enter into discussion upon any of tbe 
I innumerable theories which have been proposed as to the specific 
I causation of the disease. While the fact is admitted of its epidemic 
[ character, and of its having as its remote cause some specific source 
(. of infection, which finds means of dissemination in tbe atmosphere, 
experience and observation go &r to prove, if they do not render 
I the proof certain, that terrene agencies enter largely into the causes 
^ which give the necessary intensity to the poison to develop it into 
^ action. The nicely poised balance existing between these two ele- 
^ ments, the meteorological and terrene, whose equilibrium, when 
,; disturbed ever so slightly, is productive of such deplorable results, 
is the problem now occupying the attention of the meteorologist 
^ and the sanitarian. 

^ Cholera is emphatically an epidemic of cities. It hovers about 

the haunts of men, and riots in the crowd. It dwells with the 
^ denizens of the city, and follows them on the travelled highway, 
and along the frequented watercourse. It lurks in the camp, and 
inarches with the army. It is where man is found in masses, and 
living under circumstances which in any manner will s^rve to de- 
velop the germ of the disease from a latent to an active state, that 
we read of the ravages of this pestilence. 

Its proclivity for an urban population, and its exemption of the 
dwellers in the country so constant as to scarce make an exception, 
points very strongly and forcibly to the hypothesis that with the 
former are found elements of some character necessary to a full 
development of the seeds of the disease, be they produced, or borne 
from what source they may. The pestilence has, too, its favorite 
haunts even within the town. In the crowded lane, and the filthy, 
over-populated street, reeking with foul emanations from the soil or 
neglected pavements, mingled with emanations as foul from the 
persons of the careless, negligent crowds, the disease reigns in 
savage triumph, and sways the sceptre of death over the devoted 
indwellers. 

In fact, the discussion of the causations of cholera in their ter- 
rene dependencies opens the whole of the oft-repeated stories of the 
influences which the violations of the most palpable hygienic laws 
VOL. ix.— 29 



i 



412 BBPOBT ON 

have upon tbe deyeloptnent and spread of this epidemic, and I 
confess that there is no little difficulty in any presentation at this 
day of these agencies, which will not necessarily inyolve the repe- 
tion of these thrice-told tales. 

It is too true, however, that these generally accepted facts are 
not productive of those results which we would naturally look for 
as the sequence of truths so readily admitted as to seem to render 
argument in their behalf unnecessary. It is true that the outburst 
of the epidemic, or an anticipation of it, will lead to a spasmodic 
effort at cleanliness, but the spirit of vigilance thus engendered dies 
too often with the causes which called it forth. There is an abisenoe 
of a continuous, systematic course of remedial measures calculated 
to remove at all times the fruitful soil in which the pestilence finds 
root, and develops itself into a full harvest A recognition so gene* 
ral as it has become of the influences exerted by the violation of 
sanitary laws in the development of cholera, and that it is chiefly 
among those exposed to such contaminations that the disease finds 
its chief victims, has undoubtedly done much to disarm the epidemic 
of the terror with which it was once regarded; but this very &ct is 
suggestive of the inquiry, whether it has not begot a false security 
in the public mind, and may, if it has not already done so, produce 
an indifference to the ravages it causes. Admit the fact that it 
pervades the lanes and alleys where poverty and misery hide, that 
it reigns in the hovel of the intemperate, and makes its home in 
the abodes of the poor and miserable, and the process is short to 
connect the causes and the sufferers together, and to argue that 
they are inseparable, and forgetting the humanity which dwells in 
the sons and daughters of poverty and misfortune, leave them to 
their fate, without an effort to alleviate their condition* The not 
unfrequent outbreaks of the epidemic in districts where, from a 
casual inspection, we should not look for its advent, however, serves 
to remind us that the flame which has been lighted in a hovel may 
spread a conflagration even to the palace. We should remember 
that the circle of its influence may radiate far fix)m the centre of 
its birth. 

The deaths by cholera in the United States, for the year ending 
June 1, 1860, and which nearly if not quite covers the epidemic 
period of its second visitation to our shores in 1849, were 81,506, 
as returned by the census report of that year. As large as is this 
aggregate, it is exceeded by the sum of the other forms of disease of 
the alimentary passages. 



THE SANITABY POLICE OF CITIES. 448 

We gather, from the same source, that daring the same period 
there were from 

Cholera infantum 8,960 deaths. 

Cholera morbiis 1,568 ** 

Dianhoaa 6,366 ^ 

Djsenteiy 20,556 " 

Thrush 424 " 

32,874 « 
Add by cholera 31,506 <' 



■ 64,380 « 

( And it is seen we have a total of 64,380 deaths from diseases of 

} the alimentary passages, being 19.93 per cent, of all the deaths 
g reported for the year. 

The prevalence of cholera is well known to add largely to the 
frequency, and consequently to the mortality of the other diseases 
of the intestinal canal, and we accordingly find a very large increase 
from diarrhoea and dysentery. This increase is not only in the 
immediate circle of the cholera influence, but far beyond it, where 
the cholera poison seems to have not sufficient intensity to develop 
itself into this specific form of disease, but is modified into some 
other variety of intestinal disease. Perhaps, within a cholera dis- 
trict dysentery may be regarded rather as one of the sequel® of the 
cholera influence, as one declines the other develops itself, and 
under such circumstances the severity of the disease and its ten- 
dency to a fatal termination is but a little less than cholera itself. 

The intimate connection between the causations of cholera and 
these other forms of disease is not only distinctly marked by the 
parallelism between the extent to which they prevail, and that 
diarrhoea is also the uniform precursor, or first stage of cholera, 
but that precisely the same circumstances by which and under 
which cholera is developed, are those which develop diarrhoea and 
dysentery. The same sanitary characteristics of locality may 
develop one or fdl of the several forms of disease, being controlled 
alone by individual susceptibility ; or a difference in the moral and 
physical condition of the parties may so far act as a modifying 
influence as to cause the substitution of one disease for the other. 

Fktib, in lis varied forms, is also one of the mighty agents in 
the constant destruction of life witnessed on every side. Too little 
care, as a general thing, is paid to accuracy of type in diagnosis to 
insure uniform correctness of classification, and no doubt the name 



444 BBPOBT ON 

of one fonn of the disease is frequently substituted for tbat of 
another, and there cannot consequently be that minuteness of 
detail arriyed at, desirable to assign to each distinct type its true 
percentage of mortality. But enough can be learned to prove the 
destruction annually caused by the diseases bearing the general 
names of fevers. 

In the " Mortality Statistics of the Census of 1850," we find the 
number of deaths caused by fever in its various forms, for the year 
ending June 1, 1850, returned as follows :— 

Fever, 18,108 

Fever, Intermittent 964 

Fever, Remittent 148 

Fever, Ship 240 

Fever, TTphoid 13,099 

Fever, TeUow 785 

Total number of deaths bj fever 33,344 

It will be seen that the number of deaths by fever was greater 
than those by cholera, during the same year in which the latter 
raged as an epidemic. It is perhaps not too much to say with these 
figures before us, that we had two epidemics abroad through the 
country, doing the work of death side by side. One was spreading 
consternation and alarm wherever it appeared; the other was silently, 
unnoticed, and unheeded, but just as certainly, filling the grave as 
the dreaded cholera. 

It is to be regretted that the above classification is not sufficiently 
specific in the characteristics of the different types of the disease so 
that each might have exhibited its due proportion in the scale of 
mortality. 

Fever stands prominently forth as one of the zymotics, and per- 
haps that term alone is the only one sufficiently comprehensive to 
embrace the conflicting views of the etiology of the various forms of 
fever. Without stopping to argue any of the theories of contagion, 
infection, or portability, it is sufficient for our purpose, to raise the 
inquiry and to arrive at the fact if possible, how &r any of the 
exciting or predisposing causes of fever in any of its forms may be 
dependent upon and controllable by human agencies. 

The fevers of our cities developed apparently in consequence of 
the violation of sanitary laws, assume generally the distinctive 
forms of typhus, typhoid, and yellow fevers. But like cholera, 
closely compact masses anywhere gathered together, and living 
under circumstances grossly in violation of the laws of health, are 



THB 3ANITABT POLICE OF CITIES. 446 

liable to and may at any time develop these forms of disease. 
We accordingly almost daily hear of the outbreak of fever in some 
of its forms, upon shipboard, within our jails and almshouses, and 
in the camp. As we trace it within cities, we find it developed 
tinder circumstances very similar to those which give birth to 
cholera, or which when united to the specific cause of that disease 
give it such a fearfiil potency. 

Typhus fever is especially rife in the densely populated portions 
of towns. We have here all the causes most favorable to the 
development of disease — numbers and the concomitants inseparable 
from dense crowds, filth, and contaminated air. The effects of density 
of population in the production of the disease has been made a 
subject of investigation in London, and the following facts arrived 



} at. 
f 



Bqti»T« ymrdi to 
each person. 

. 35 


Annual 
Mortality. 

3428 


Mortality from 
TTphos alone. 

349 


. 119 


2786 


181 


. 180 


2289 


131 



"The effect of crowding is shown by a table exhibiting the 
mortality, and the number of square yards of space to each person 
in three groups of metropolitan districts. 



i 1st grotfp of ten districts 

- 2d « " 

I 3d " " . 

i "Hence we perceive that typhus is nearly three times as fatal in 

; the first or crowded group as in the third or open one."* 

In a report upon Public Hygiene, made to this Association by 
; Dr. Joseph M. Smith, in 1850,* the subject of the sources of typhus 
J fever was made the theme of the paper. The design was " to show 
\ that the disease originates from human excretions." The report is 
valuable in exhibiting forcibly the sources of contamination existing 
within the human body, and the mass of eflFete matters thrown off 
I by the numerous emunctories daily. 

Dr. Smith claims, that it is to the excrementitious matters thrown 
, off from the lungs and skin that the poison of typhus is mostly 
traceable. He assumes as a basis of calculations, that the quantity 
of pulmonary and cutaneous excretions is 40 oz. daily, and that of 
this amount 10 dwt. consist of organic or animal matter, and upon 
these data enters into a number of curious calculations of the amount 
of effete matters thus thrown off in crowded jails, ships, camps, 
and badly ventilated houses. 

* Chambers's Information for the People, vol. ii. p. 551. 

* Trans. Amer. Med. Assoc., toI. iii. 



446 BEFOBT OK 

We make the following extracts from the r^K>rt: "Let ns 
suppose a family, one, of which there are hundreds of examples, 
consisting of ten adult persons, dwelling in a small, ill -ventilated 
house, and negligent of personal and domestic cleanliness; and 
further, that the time severally passed within doors by the tea indi- 
viduals, some of whom are constantly at home, while others are 
temporarily absent, amounts in the aggr^ate to twelve hours out of 
every twenty-four. The mass of effete matters thrown out bj the 
lungs and skin, by such a family within their dwelling in one month 
is 600 lbs., in six months S033 lbs. 4 oz^ and in one year 6083 lbs. 
4 oz.^ Though by far the greater part of these excretions consist 
of carbonic acid, water, and salts, yet the quantity of ejected animal 
matter is not inconsiderable. It amounts in one month to 6 lbs. 
8 oz.; in six months to 37 lbs. 11 oz.; and in one year to 76 lbs. 
oz. 10 dwt. In such circumstances it is, and especially in seasons 
in which the prevalence of typhus is favored by an epidemic 
influence, that the disease often spontaneously originates in the 
squalid homes of the poor." 

These calculations have been extended so as to embrace an entire 
city, from which we make the following quotation : — 

" The inhabitants of a densely populated town may be regarded 
as a single family, living in contiguous or narrowly separated apart- 
ments, any number or the whole of which may as certainly be 
rendered infectious by overcrowding, as the cells of a prison. In 
no mode perhaps can the danger from this source of disease be so 
distinctly impressed on the mind as by estimating the quantity of 
waste matters eliminated from the bodies of the people of a city in 
given times. If we assume as a numeral basis a population equal 
to 200,000 adults, it will be found, if calculated as in former ex- 
amples, that the entire pulmonary and cutaneous egesta amount in 
one month to 20,000,000 lbs.; in six months to 121,333,333 lbs. 
4 oz.; and in one year to 248,383,883 lbs. 4 oz.; and that the exhaied 
animal mcUter ahne amounts in the first of these periods to 250,000 
lbs. ; in the second to 1,516,666 lbs. 8 oz.; and in the third to S,041i 
666 lbs. 8 oz. 

''The health of a city depends in no small degree upon the dis- 
tribution of the inhabitants over an area of sufficient extent to admit 
of the free ventilation of every dwelling. When such a distribu- 
tion obtains, and attention is given to personal and domestic clean- 

I A month is reckoned as 30 days ; six montha as 182 days ; and one jear as 365 
days. 



THE SANITAEY POLIOB OF CITIES. 447 

liness, a population of 200,000 or any greater number, will be as 
secure against the invasion of typhus as are the inmates of a 
commodious, deanly, and well-aired private dwelling. But populate 
a town as densely as are the alleys and courts of many cities, and 
the consequence will be that the whole population will feel the 
influence of an iduhmiasmcUic atmosphere, and disease be co-exten* 
sively produced." 

It will be observed that the urinary and fecal excretions are not 
taken into the account as a source of contamination. These doubt- 
less should not be lost sight of entirely as a means of adding to the 
impurities and seeds of disease otherwise engendered by crowds, for 
although generally removed from the dwelling, it is only that they 
may become festering pestilential pits poisoning the atmosphere and 
tbose who breathe it. After making aU due allowances for errors 
almost inseparable from such calculations as have been quoted, I 
think we all will be willing to admit that Dr. Smith has proved 
that man may become a very dirty animal, and that we shall be 
ready most fervently to exclaim, " that cleanliness is next to God- 



Yellow Fever is also developed under circumstances similar 
to those which give rise to the several forms of disease we have 
been considering, but seems to require a much more elevated tem- 
perature &r the emanation of the poison. 

Decaying matters, vegetable or animal, filth of all kinds, exposed 
to an intense heat, such as is experienced under a southern sun, 
united to moisture, seem at least to furnish the pabulum for the 
development of the disease. I shall not stop to inquire whether 
the disease is ever, imder these circumstances, generated de novo; or 
whether it always requires the presence of a specific cause for the 
production of the disease. 

The recent labors of Barton and La Boche, directed toward the 
development of the etiology of yellow fever, leave but little at 
present to be added to the literature of the disease ; and experience 
and observation alone, it would seem, must hereafter add to our 
knowledge of the disease. 

We now approach the consideration of those municipal regu- 
lations which have for their object the correction of the evils whicli 
originate and propagate disease, or are in any ways inimical to the 
public health. With the masses in our cities, dependence upon 



448 RSFOBT ON 

the inSuence of personal appeals, or a reliance upon simple indi- 
vidual labor, will be ineffectual for the eradication of these evils- 
Enlightened individual labor, it is true, can accomplish much ; but, 
not to stop to take into consideration the fact that very many are 
so indifferent to the interests of their neighbors, that provided their 
own ends are attained, they are heedless of the jeopardy in which 
the health and lives of others may be placed; the larger part of the 
work to be performed is too great for personal effort. Concen- 
trated action, backed by law and the public purse, can alone accom- 
plish the greater part of the labor to be performed. 

The regulations of a city which look to the preservation of the 
health of the citizens are among the most important of all its 
municipal laws. The defect has always been in the poverty of 
such existing laws, and the laxity and indifference with which 
these, feeble as they have been, have been executed. Our health 
laws would seem, too often, to have had a place upon the statute 
books simply as a species of solace to the public, and as if in obe- 
dience to a sort of a half formed conception that something of the 
kind was necessary. But they have too generally been permitted 
to lie hidden from sight, and only been brought to light when 
some fearM calamity has fallen upon the community, and they 
have been aroused from their indifference, to make an exertion to 
correct the evils by which they are surrounded. 

Many of the evils from which our communities suffer have their 
origin deeper than can be reached simply by the broom and shovel, 
and corrected by the removal of a little filth from the surface of 
the street, or from the corner of some yard or vacant lot. Many 
of the evils have their roots in the social and moral position and 
condition of the citizens. To them they are chained by the force of 
circumstances, which they cannot control; poverty often binds and 
confines them within the poisoned circle, and unless relieved by 
the charities of the public exerted in their behalf, must forever so 
remain. 

All these matters legitimately come under the cognizance of an 
intelligent and liberal police, directed towards the sanitary im- 
provement of the public health. In the exercise of such authority 
and supervision, not only the removal of such existing evils as 
experience has proven to he injurious should be the labor per- 
formed, but every effort should be directed to the prevention of 
the development of these evils. Prevention as well as cure, and 



THE SAKITABY POLICE OF CITIES. 449 

prevention rather than cure, should be the^ end most earnestly 
sought after. 

Some of the sources of the malign inSuences existing within our 
cities, to the prejudice of the health of the indwellers, and resulting 
in disease and death, will claim our attention. Although neces- 
sarily compelled to be brief^ we shall give as fall consideration as 
possible to the influences exerted upon the public health by water, 
sewerage, paving, over-crowded and ill-ventilated houses, the 
removal of the soil, and such other subjects connected with matters 
under consideration as may present themselves during the discus- 
sion. 

Water is among the chief of man's every day's want, and to 
the dwellers within city walls it is among their greatest necessaries. 
But pure water, to the great mass, is among the luxuries scarcely 
attainable. I think I hazard ffothing in saying, that in every city 
in our country the supply of pure water is entirely inadequate to 
the wants of the inhabitants ; that, to a very large portion of the 
dwellers of every dty, the supply is not only in many instances 
impure, but entirely inadequate to purposes of domestic and per- 
sonal use^ so as to secure by free application, cleanliness and health. 
I make this remark, in full view of the numerous corner wells and 
pumps that grace the waysides, and the lordly reservoirs which 
are the glories of several of our cities. But the presence of these 
does not invalidate the statement. They furnish to the wealthy a 
full supply ; but to them only at the price and cost of a luxury ; 
but what city is without its streets and districts of inhabitants to 
whom their supply is most scanty, and where they are driven to 
seek for the water they daily use, to some filthy canal or creek, rich 
in the seeds of disease 7 

The sources of a city's supply of water are among the most 
interesting subjects which can present themselves to the considera- 
tion of the inhabitants, and is it not true that the matter never 
receives attention until by the force of circumstances the considera- 
tion can no longer be deferred ? 

A reliance upon wells, which until quite recently has been the 
chief source, is at best uncertain, and must eventually, in cities, be 
abandoned, in consequence of the contaminations of the soil inevi- 
table upon causes constantly at work therein. The earth must, 
earlier or later, depending upon population, become saturated with 
filth. The contaminations of privies and sewers, and the leakage 



450 BSFOBT OK 

of gas-pipesy must sooner or later render every city well a recap* 
tacle only for filthy water. A very little exercise of the imagina- 
tion will suggest how impossible it is to have, or to expect pore 
water with the close proximity there exists between oar wells and 
the sources of contamination alluded to. The well, sesspool, and 
privy frequently stand but a few feet apart, and the sewers beneath 
the streets are abundantly capable of discharging more or less of 
their contents in addition into the source from whence we derive 
one of the essentials of life. 

Where these sources of pollution do not exist to such a degree 
as to be a serious difficulty, it is not at all times practicable to 
obtain water fit for use. Almost every locality furnishes abundant 
examples of impure . waters, dependent upon some peculiarity of 
soil or rock. Many wells, in consequence of some geological pecu- 
liarity, are very evidently nothing more than receptacles for surfisioe 
water, which has percolated without filtering through fissures in 
the earth or rock. This difficulty exists especially in a day forma- 
tion. Clay is almost as impervious to water as the rock, and where 
a sufficient superstratum of sand does not exist so as to furnish a 
filter for the water as it descends from the surface, a well excavated 
in the dense "hard pan" merely serves to collect the fluid as it 
descends through and along the crevices which everywhere per- 
vade its substance. 

Every city must from necessity look to some source fi^m with- 
out the boundaries of infection for a supply of this essential of life, 
and the earlier it recognizes the fact, and enters upon some pro- 
vision for a compliance with this inexorable law, the better will it 
be for the wel&re of its population. Health will be preserved and 
life saved. 

The introduction of water from without a city by artificial 
means of any kind, involves a large expenditure of capital, and 
consequently the time and manner of supply has been most g^ie- 
rally left to private enterprise, the governing question in the under- 
taking being — "Will it pay, and how much?" So long as the 
matter of supplying our towns with water is left in the hands of 
companies, or individuals, just so long will the evils resulting from 
an insufficient supply of this element be only partially remedied ; 
the sources of disease and the class of persons most in need will 
never be reached. 

In the public park, the fountain may leap joyously upward and 
flash and sparkle in the sun as if its every drop were a jewel ; and 



THE SANITABY POLICE OF CITIES. 451 

in the hoases of the wealthy, water may flow in profusion, and 
beautify and adorn their grounds, and dispense to them all its 
blessings ; but to the great sources of want and disease it will never 
flow to wash away the festering impurities. A water company 
runs its pipes only into those streets which will pay ; the poor can- 
not pay, and no stream flows to gladden their sight, to allay their 
thirst; or bathe their bodies. Every drop that flows has its price, 
and as it falls is watched with as jealous an eye as if it were ex« 
pected that it would congeal into a diamond. 

Nor have we any right to charge upon them an excess of cupi* 
dity. The only incentive they had for the outlay of their capital 
in such an enterprise, was the prospect of profit. It is true, they 
saw and recognized the wants of the public, and out of this neces- 
sity sprang the means of a profitable investment of their money ; 
but they have only taken advantage of the market and are selling 
their wares at the highest price possible, with, however, this power- 
Ail advantage in their favor, that they generally have the monopoly 
of the market, and can use their advantage with cruel power if so 
disposed. 

The great error is, in municipal corporations permitting such a 
power being vested in individuals or companies. Water is next to 
air in importance, and they as the legal representatives of the public^ 
should reserve to themselves this monopoly, and make the most 
ample provisions for the supply of every inhabitant, rich and poor, 
witiiin the boundaries of their government. This principle should 
be recognized, and no town or city should hereafter permit this 
right to pass from their control ; and every municipal corporation, 
where this right is already vested in some other party, should seek 
tbe earliest opportunity for resuming the same, and becoming, as 
they rightfully should, the means of dispensing health and happi- 
ness among the citizens, without the debasing question of profit 
entering into every consideration. And then as a sanitary mea- 
sure, reverse the ordinary course of things, and let the pipes be laid 
and the water carried first, to the narrow streets and lanes, and to 
the abodes of the poor. Let the supply be abundant for their 
every necessary want. If you do not put water in every house, 
and it is not necessary you should, place it near to the hand of 
every person. Let the possibility of a wasteful use of it, be a 
question of secondary importance. Furnish them with the means 
of cleanliness and health, and then seek the broad avenues and the 
habitations of the wealthy. 



452 BEPORT OK 

Let the rich remember while they are waiting until their poorer 
neighbors are served, that their own safety is insured thereby ; for 
while disease, as has been shown, is engendered among the abod^ 
of the poor, the poison may distil over and invade the homes where 
every comfort that money can purchase is found. If no considera- 
tions in behalf of the sufferings of a common humanity are suffi- 
cient to dictate a course pointed out so plainly, let the question of 
personal interest and safety be presented and govern. Let them 
be humane and just out of pure selfishness, if no higher motive 
can actuate them. 

Pure Air is another of the essentials of health. As considered 
in its sanitary relations, it is generally discussed under the head of 
Ventilation. This subject has of late attracted much attention, and 
its importance is becoming more and more generally recognized. 
In practice, however, the application of the principles of ventilation 
is most defective. In our better class of dwellings some attempt is 
made towards this end ; and in our public buildings a show of 
insuring a change of air for the benefit of the inmates is made; but 
in both classes of buildings, the results obtained fall far short of 
the objects sought The true principles of ventilation are yet but 
imperfectly understood by the community, and the greater portion 
of the modes employed are defective, and serve more to amuse than 
to answer the purposes for which they were really designed. As 
the attention of the better informed classes of the community is 
directed to this subject, and as it has become fashionable to erect 
buildings with ventilators and other apparatus for insuring a cur- 
rent of air through the same, it is to be presumed that the evils, so 
far as they are concerned, will before long be remedied, and we 
shall not, therefore, devote time to their consideration. 

We shall give more particular attention to those dwellings where 
the influences of fashion and the lights of science do not penetrate, 
to those habitations where the seeds of disease and death are pro- 
duced and imbibed by the inhabitants with every breath. We 
shall not stop to enter into any argument to prove how much 
breathing space every human being needs; the quantity of oxygen 
destroyed at each inspiration ; or the number of cubic feet neces- 
sary to every apartment. We shall assume, as beyond a question, 
that a sufficient supply of pure air is necessary to every human 
being to insure the highest health ; and we shall also assume, as a 



THE SANITARY POLICE OF CITIES. 458 

fact beyond dispute, that in every town in our land are found 
buildings whicb do not furnish these requisites of perfect health. 

In every town (the larger it is, of course the more aggravated 
are the evils likely to be) are to be found habitations overrunning 
with inmates, apartments filled beyond all limit to their capacity, 
rooms in which more than one family not unfrequently are found 
herding together in violation of every law of decency as well as of 
health ; narrow, filthy streets and lanes crowded with high build- 
ings, confined courts, into which the sun never penetrates and the 
air never circulates, and where dense multitudes live, and breathe 
continuously an air of pollution, and die a death of slow poison. 
These facts are too notorious to require at this time the citation of 
specific examples to prove the assertion. Every sanitary report 
made to this Association contains abundant proof of the truth of 
the statement. Our object is simply to point out the manner in 
which this gross evil and wrong upon society, and the poverty- 
stricken especially, ia to be corrected. 

Our suggestion as the means of the sanitary improvement of this 
condition of things, is found in the single sentence — that the evils 
are to be corrected^ and to he corrected alone by the strong arm of the law. 

The ignorance of some, and the cupidity of others, will render 
any other measure ineffectual in correcting the pestilential sources 
of misery in our midst. Just so long as there are those whose 
poverty compels them to accept the miserable accommodations to 
be found in these wretched abodes, so long ^ill there be found those 
to take advantage of their necessities, and coin money from the 
sufferings of the poison-breathing inmates. The ingenuity of pro- 
perty holders in those localities where the poor most do congregate, 
seems taxed to the utmost to crowd the greatest number of human 
beings into the smallest possible space. Every additional tenant 
pays full tribute to their purse, and what matters it, if health, de- 
cency, and morality, all be corrupted and destroyed, if the poisoned 
heart's blood is turned into gold to add to their wealth. What 
wonder is it that such abodes become the home of the pestilence, 
and that, as if in revenge for their wrongs and sufferings, the plague 
should propagate itself far and wide throughout the boundaries of 
the town ? 

We want a strong municipal law, which shall plainly and dis- 
tinctly say in what manner our edifices shall be built, especially 
those which are to be situated under circumstances likely to develop 
disease, and to be inhabited by those whose pecuniary circumstances 



464 BSPORT OK 

and penoDal habits are liable to induce conditions from irhicb may 
arise sources of contamination ; a law which will prescribe the 
number of inmates to a building and to a room ; a law which will 
define and giye to each man, woman, and child, a sufficiency of air 
and breathing space. 

To the objection that may be made, that this would be an en* 
croachment upon individual rights, and would interfere with the 
interests of property holders, and subject them to expenses and 
untoward hardships, I would reply, that society has assumed to it- 
self this right in other matters ; that it has assumed to itself the right 
of protecting itself against the dangers and risks of oonflagrations; 
that it defines the mode in which our buildings shall be built so tf 
not to hazard the property of others ; that it does this at the risk of 
an increased expenditure to the builder, and a diminution of his 
profits, nor pays heed to any cry of hardship which may be raised, 
as it legislates for the safety of the public at large ; so, we contend, 
that the power which defines that our edifices shall be built fiie- 
proof, is equally potential to declare and insist that they shall be 
built disease proof. Law now defines the number of passengers a 
vessel may carry upon the seas, and sacrifices the profits of the 
merchant to the safety and welfare of the passenger. 

We have an approach to such a law in the authority which is 
vested in our Boards of Health, to enter in times of epidemics, and 
thin out an overpopulated house. But, as prevention is better than 
cure, the evil should be prevented, not simply corrected. No oppor- 
tunity for the development of disease should be given. Afiier the 
poison is imbibed, you probably will arrive too late with your 
prophylactics and antidotes, and death will do its work. 

Under the present order of things, a tax is just as efiectaally l^d 
upon pure air, and its free use prohibited by the narrow, pent-up 
apartments, ilLsupplied with doors and windows as are most gene- 
rally the dwellings of the poor, as if a tax collector called daily 
upon the inmates for the price of what they consumed. Air and 
.water are both made a luxury, and sold them at the highest possi- 
ble price. Epidemics alone do not make their homes in such abodes 
but scrofula wastes and deforms and destroys the form of child- 
hood, and gaunt consumption eats out the life of full grown men 
and women, and death in every form is the companion of the 
wretched inmates.^ 

> See Appendix. 



THE SANITABY POLICE OP CITIES. 456 

Sewsbaob and Paving are undoubtedly among the efficient 
means of adding to the health of a town. Sewers, if properly con- 
structed, afford the means not only of drainage for the soil and 
Temoving all excess of moisture, but they also furnish facilities for 
disposing of the waste water and fhiid filth which must necessarily 
be the product of a numerous population. If thrown upon the soil 
or pavement, these matters undergo the process of decomposition 
and evaporation, filling the air with their mephitio gases, and add 
their quota to the numerous other sources of contamination. 

Among the numerous improvements which constantly demand 
the attention of the mnnicipal authorities, sewerage and paving 
should receive their earliest attention, and a plan for reaching the 
entire extent of the town adopted and systematically and vigorously 
prosecuted. Upon the score of economy, sewers should be laid in 
the streets before the paving is laid down ; both works can in this 
manner be the most effectually performed. 

A great error is generally committed in not constructing the 
sewers of sufficient capacity for accomplishing the work they have 
to perform ; and, moreover, they frequently have not sufficient depth 
beneath the surfiice of the soil to fulfil the objects for which they ' 
were designed. They should in every instance be of sufficient 
depth to insure perfect drainage of the cellars of the buildings 
upon the street, and remove every opportunity for the accumu- 
lation of moisture beneath the floors. Side sewers should emerge 
in all directions, and furnish the most ample facilities for the in- 
habitants to employ them for all the purposes for which they are 
designed. 

Every inlet should be guarded by stench traps, and the greatest 
care taken for the prevention of the escape of any odors or gases 
from them, back into the streets or houses. The fact should not be 
.lost sight of, that by sewerage you have only removed your filth 
from the sur&ce to beneath the soil, and that, if improperly con- 
structed, the deleterious influences of the mass of filth accumulated 
therein may ascend to the sur&ce and exert still its deleterious 
influaices. Provision should consequently be made for the fre- 
quent cleansing of the same, by turning into them from time to 
time a supply of water sufficient to effectually wash them out and 
remove idl impurities. This is especially essential during the 
droughts and heats of summer. It is seldom during this hot season 
that there is sufficient rain to keep them clean, and the foul smells 
which emanate from them can scarcely escape the notice of any 



456 BSPORT OK 

wbo may be so unfortunate as to come within their vicinity. It is 
perhaps unnecessary to remark, that the discharge of these under- 
ground channels should always be into some watercourse of 
sufficient capacity and current to remove all the contents &r 
beyond the precincts of the town. 

Our sewers undoubtedly furnish the most simple and feasible 
means of getting rid of that great nuisance of cities, the night soil 
The disposition of this material is one of the most perplexing 
questions that present themselves to the consideration of the muni- 
cipal authorities. As it usi^ally exists it is a nuisance, it creates a 
nuisance to remove it, and it forms a nuisance where it is re- 
deposited. With a full supply of water and properly constructed 
sewers, its accumulation may be prevented, and the evil consequent 
therein avoided. 

I would add, as a conclusion to this branch of our subject, that 
the superintendence of the construction of all sewers, lateral as 
well as main, should he confided to the charge of the health officen of 
the town. 

The convenience of paved streets generally insures their con- 
• struction in the business portions of a town, and they are gradually 
extended with the increase of business and the wealth of the 
inhabitants ; but the importance of pavements to the health of the 
community is not, I think, generally recognized. Observation has 
abundantly proved the beneficial influence exerted upon health, by 
paved streets. Nor can it be otherwise, for in no other manner 
can a street be kept dry and clean, and all impurities be removed. 
With a street properly sewered and paved, and a good attention 
given to the frequent removal of all filth which may gather upon 
the surface, a most important end will be accomplished towards the 
preservation of the public health. The importance of paved streets 
to the comfort, convenience, and health of a community is so appa-« 
rent as to require no argument, and we shall dismiss the subject 
with this simple allusion to it 

I wish to call attention to a subject which seems, until quite 
recently, to have escaped notice. I refer to the influence exerted 
upon the health of a city by the upturning and removal of the 
natural soil, especially in times of epidemics. This breaking up 
of the earth is generally the result of those works of improvement 
and repair constantly going on in the midst of a city population, 
such as the preparations for paving, the building of sewers, the 
laying down of water and gas-pipes, the digging of canals, and 



THE SANITARY POLICE OF CITIES. 457 

basins, and tlie innumerable excavations, which are constantly 
being made. These labors, for convenience, are generally under- 
taken in the spring, and extended throughout the whole of the 
heats of summer and autumn, and the fresh earth in this manner 
exposed to the sun during the warmest part of the year. 

The question of the sanitary bearing of such labors upon a 
population is a most important one, for its definite decision would 
furnish a rule by which the authorities might be governed in the 
prosecution of their various enterprises. Since public attention 
has been called to this subject, it is certainly very important to 
decide how far such an influence is exerted, and whether such 
exposures of the soil to the heat of the sun and the influences of 
the atmosphere have the power, under ordinary circumstances, of 
generating diseases de novo, or whether a malign influence is exerted 
by them only in seasons of epidemics, when they add another to the 
numerous terrene agencies concerned in the development of the 
specific disease. 

It would seem hardly possible that the simple disturbance or 
upheaval of the soil should be productive of serious difficulty, and 
so long have escaped notice. Intramural excavations have been 
prosecuted from time immemorial, and such results would un^ 
doubtedly long since have been unmistakably recognized, and the 
consequences have been an abandonment of all such labors, or the 
depopulation long since of every city on the face of the globe. 
Perhaps the facts bearing most strongly in &vor of the deleterious 
influences of such causes, is the influence sometimes noticed in the 
production of malarious diseases in a newly settled country by the 
ploughing and turning up of the virgin soil ; and the production 
of the same diseases along the lines of the excavations and embank- 
ments of a railroad, or canal, which present the most exaggerated 
examples of earthwork and disturbance of the soil we possess. 
But in either of these examples the result is not uniformly the 
development of any such diseases ; and it may be well questioned 
whether in those cases of their production some other element is 
not also actively employed in the elimination of the malarious 
manifestations. 

In seasons of epidemics the question is not so difficult of solution. 
I think abundant evidence is already accumulated to fasten convic- 
tion of the disastrous influences exerted by the exposure of the 
upturned earth to the sun and atmosphere, during those months 
when there is present any epidemic tendency. 
VOL. IX. — 80 



458 REPORT OK 

Dr. E. H, Barton, in his " Report npon the Sanitary (Condition of 
New Orleans,"^ remarks: "That since 1796-7 to the present time 
there has been no great epidemic of yellow fever in this city, without 
an extensive breaking up, disturbance and exposure of the original 
soU of the country ; that this has consisted in digging canals and 
basins, or cleaning them out, either in the city or its immediate 
neighborhood ; digging and excavating the streets of the city for 
the purpose of laying down gas and water-pipes, and relaying the 
streets; digging and embanking for railroads, and similar purposes 
in the summer season ; and that the extent and malignancy of the 
disease have been pretty much in proportion to the exteut of these 
exposures" 

Dr. Barton gives corroborative testimony in support of this posi- 
tion, occupying in the details some six pages of his report.* The 
histories of the ravages of yellow fever subsequent to extensive 
excavations in Natches, Memphis, Mobile, Charleston, Natchitoches, 
and several other less prominent places are given. In all, the close 
connection existing between the amount of work performed and 
the extent of the prevalence of the disease is traced. 

Although Dr. Barton labors to excite public vigilance in the 
sanitary government of his city, and endeavors in the plainest and 
most forcible language to teach the doctrine of the local origin of 
yellow fever, and prove its home-birth, he does not regard the 
upheaval of the soil, or any other form of terrene agency alone, 
sufficient to develop that disease; but that certain meteorological 
conditions are necessary to propagate the disease. 

The distinctive doctrine of the report on the causations of yellow 
fever is thus enunciated :^ " That the emanations arising from the 
upturning and exposure of the original soil in the summer season, 
together with filth, under certain deiermincUe atmospheric coruUlms^ 
have been the main, if not the special cause of every epideniic 
yellow fever that has ravaged not only this city, but the south- 
western part of the United States for more than half a century." 

The close connection between severe outbreaks of cholera in locali- 
ties where there has been much disturbance of the soil, and the per- 
sistent sojourn of the disease in such vicinities, seeming often to ad- 
vance along the lines of the works and follow their progress as they 

> Report of the Sanitaiy Commission of New Orleans, p. 312. 

* Ibid., pp. 316-21. 

• Page 322. 



THE SANITAEY POLICE OF CITIES. 459 

are extended from day to day, has been noticed. The phenomena 
witnessed under such circumstances inculcate instructive lessons in 
the part borne by local causes in the development of this epidemic. 

A striking and melancholy example of the ravages of the disease 
under such circumstances, was witnessed at Buffalo during the 
epidemic visitation of 1852, upon one of our most cleanly, well 
built, and respectably inhabited streets. The history of the oc- 
currence was gathered at the time by Prof. P. H. Hamilton, and 
made the subject of a report to the Buffalo Medical Association. 
We shall make use of this report, giving its language when con- 
venient. 

The street is known as EUicott Street, is on the east side of Main 
Street, being the second street distant. The space of epidemic visita- 
tion was limited to two squares in length; the i^prth line being 
Eagle Street, the south line South Division Street; and was crossed 
at the centre by North Division Street; the entire limit being some 
five or six hundred feet in length. 

The topography of the territory is thus given in the report : — 

"Not inany years ago a marsh occupied the ground where this 
street is built, covered with a deep, soft, alluvial mould. The 
marsh extended from near Washington Street to about where now 
Michigan Street lies, and from Goodell to Swan. It had its outlet 
towards the comer of Swan and Michigan, or in that direction. 
This marsh was the result of a peculiar formation of the clay bed, 
which to the depth of ten or twenty feet underlies nearly all that 
portion of the city which is east of Main Street, and below High 
Street. The strata having a dip from Main and Michigan, from 
Goodell and Swan towards a common centre. To this clay basin, 
only partly filled in its deepest portions with sand, there was no 
actual outlet, except the slight depression towards the southeast ; 
and it remained, therefore, until intersected by ditches, the depot 
for all the surface drainage of the higher neighborhoods — a general 
receptacle for water, alluvium, and sewers. 

** Upon this soil much of that portion of the town is built ; for in 
paving the streets, with few exceptions, none of the surface earth 
was removed, but the sand was deposited for pavements above it. 
The streets thus became higher than the adjoining lots