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Boston

Medical Library

Association,

19 BOYLSTON PLACE.

T H E

fnhjjntiMnt,

A MONTHLY REVIEW OF MEDICINE AND SURGERY.

EDITORS.

wA.M., M.D.,

PSSSOBOF

U S IT Y 0 F -MI'. HI Q A

M. D

COIili A BORATOK S.

Edward Kane. M. D., Detroit.

A. R. Terry, M.D., Detroit.

Frederick Stearns, Pharmaceutist, Detroit.

Prof. W. Carpenter, Burlington, Vt.

A. G. Mbrrett, M. D., New York,

L. Humphreys, M. D., South Bend, Intl.

IL 0. Hitchcock, M. D., Kalamazoo, Mich.

J. Andrews, M. D., Paw Paw, Mich.

M. M. Latta, M. D., Goshen, Ind.

H. R. Shetterlt, M. D., Grand Traverse, Mich.

Pi.E. Hattqhton, M. D., Richmond, Ind.

G. E. :. 1)., Stockbridge,Mich. |

J. Adams Allen, M. D., Kalamazoo, 1

D. Willard Bliss, M.D., Grand Rapids, Mich.
EDWARD Dorsch, M. D., Monroe, Mich.
Horace Nelson, M. D., Plattsburg, N. Y.

J. S.D.Taylor, A.M., Chemist, Plattsbui-:.?' Y.
W. G. Wheeler, M. D., Chelsea, M:
Charles P. Fanner, M. D., Buffalo, N. Y.
B. BARNUM, M. D., Schoolcraft, Mich.
Henri Erhi, M. D., Knoxville, Tenn.
I). B. Van Ti vi.,M. !>.. Bouth Bend, Ind.

E. Leach, M. D., Owasso, Mich.

Wm. Lewitt, M. D., Ann Arbor, Mich.

<-<^» •

DETRO IT:

PRINTED FOB THE PROPRIETORS BY li. BAENS.

daily TRIRENE office.

" 1857.

ustidiexh:.

Page.
Application of ice to tie Os Uteri in
cases of Uterine 1 lemorrhage, ... 48

A new Medical Journal 95

Another Precocious Discovery. ... 101
American Medical Association... . 10G
American Medical Education —

Government Schools, &c, 109

Abstract of Dr. Kane's Lecture... . 123

A Monument vs. a Coffin, 201

Agreeable mode of taking Senna. . 208

Anecdote of Peech, 211 .

Artificial Inspiration. 207

Anatomy of the Pleura. 270

Auscultation in Diseases of the

Ear, 275

Apparatus for Fractured Clavicle. . 282

.Esox — Corrcspondeuce, 291

American System of Medical Edu-
cation. .'54:7

Amputation at Ancle- Joint. 391

Abolition of Eees, . 485

Aconite as a Therapeutic Agent, . . 539

A ] lealthy Location, 550

A 1 >ictionary of Medicine 715

B.
Bromide of Potassium in Epilepsy, 59 G
Brown-Sequards New Journal. . . . 731

0.
Chapters from an unpublished work

on Hygiene. 16, 59

Chloroform in Cramp. 46

Caustic in Njcvus 42

s from Brief Xou-.-v. 70

Cooked or Paw Meat. 77

Convulsions 198

Caries of the Caucellar Structure of

the Femur 135

Creosote in Dysentery 157

Clinical Instruction in Michigan

University, 1G3

Claim of Priority in Discovery, . . . 266

Correspondence from "H," 284

Correpondence from A. (f. Merrett,

289, 419, 546

respondence, Juo. Avery, M.D.. 419

1 lie-by & Stearns. 421

ir/'Xelson. 548

- One Person/' .. . 605

W. L., 607

E. L., 609

E. C Gil

Cases — Rupture of Uterus and
Bladder; Singular case of Ty-
phoid, 322

Cases — reported to St. Joseph Co.

(Ind.), Medical Society. 361

Case of Huntington, 4Q6

Clinical Advantages. 419

Changes in Rush Medical College, 423
Chapters from an Unpublished Mo-
nograph 577, 427. 683

Chlorate of Potash in Pseudo-Mem-
braneous Angina and Cramp. . . . 4S0
Clinical Course in the University, 482

Case of Lithotomy 513

Correspondence, "Medicus," 546

Clinical Instruction in Medicine. . . 589

Cicuta Maculata, GO 5

Calorification, G22

Case of Transfusion. 659

Chloroform in Retention of Urine, 660

Cholera, 662

Cold Applications, 663

Cause ot Tuberculosis 722

Close of Volume m. 7 29

D.
Dislocation of both Clavicles, &c, .. 248

Detached Articular Cartilage, 269

Death of Marshall Hall, 48*?

E.
Editorial Change. 58

Etherization in Convulsions 89

Enuresis treated with Fluid Extract

of Pareira Brava. 202

.K-eulapius the Son of Apollo. . ... 207
Elements of Pathological Anatomy, 400

Excito-Secretory 418

Excision of the Head of the Femur. 596
Extirpation of the' Supra-Renal

Capsules, 59*7

Editorial Exit 729

!".
Fibrous Tumours of the Uterus— a
ease,

Fracture of the Cranium— operation
I Facts from Draper's Physiology, . . .

i Forthcoming "Works.

i Foreign Body in Abdomen,

; Fevers of the United States,

I French Homceopatliists in Trouble,
I Foreign Bodies in the Air-Passages,

Fermentation

140

172
208

277

414
476
675

Index.

in.

G.
Glycerine in Phthisis, T2

Gunu's Salutatory, 209

Glycerine Solution of Borax. 2S2

Glycerine a Preservative of Vaccine

Virus. 358

Gungha, Haschish or Canabis In-
dies, 390

Gymnastics for Paralytics, 412

Gun-shot Wound, G4l

Guaiac. in Cynanche Tonsillaris.. .. GG3
II.

Home from the Wars 96

Haschish or Cannabis'Indica. 143, 191
Horn ceopathy and Spiritualism.. ... 200

Habitual Constipation. 208

How a Doctor looks, ....*. 550

Hip-Joint Disease. 59T

Haemorrhoids 716

Iodiform, 112

Iodide of Potassium in Scarlet Fe-
ver. 204

Inguinal Hernia — complicated, 301

Important Eegal Decision, 3G1

Iodide of Potassium in Leucorrhoea

by Injections. 599

Itch cured by Liquid Sulphur. .... 1G2

J.
Jenner Monument, J 14

Large Ovarian Tumour. t8

Landolri's Treatment of Cancer, ... 84
Lectures for the use of Students

and Junior Practitioners, 91

Liquors and their Adulteration, ... 30T

Ligature of Common Carotid, 416

Medical Fees 88

Mortality of Boston in 1856.. 90

Malpractice, 215

Medical Xotes and Reflections. .... 262
Nuploid and Nuplo-Cystic Tumors. 2 \\\
Medical Plants of Michigan,.. .329. 395

Manual of Examinations, 844

Marshal] Hall's admission of Camp-
bells Claim, 353

Marshall Halls Ready Method, .... 359
Medical Education,. .353, 414, 543, 601

Medical Schools, 423

Medical College of Georgia, 423

Miueral Waters, 455

Msicellaneous, 488

Mechanism of Nervous Action,

. 551, 488

M< dical Responsibility, 595

Model Proscription, 673

McClintock's Quackery and Reward 357

X.
X. E. District Medical and Scientif-
ic Association, 56

New "Works Received. 176

New Mode of employing the Taxis

in Hernia, 198

New Method of Removing Tumors, 20 ■!

Notes upon Glycerine, 241

News Items 283

New Apparatus lor Fractured Cla-
vicle, 392

O.
On the links connecting the Veget-
able and Animal Kingdoms. . ..1, 117
On the Structure and Functions of

Insects, 9

Our Paris Correspondent. 55

Operation for the Removal of a
Uterine Tumor — Extirpation of
the Organ and its Appendages. 73
On the employment of Chlorate of

Potass 86

Obituary 10S

Oblique Fracture of the Femur. . . . 138
Oxide of Zinc in Night-Sweats. . . . 149

On the Use of Ergot ; . . .. 161

Ointment of Iodide of Potash 162

On the Constitutional Treatment of

Female Diseases 173

Oxide of Zinc in Profuse Sweats. . 199

Our Editorial Change 210

Observations on Peruvian Bark. . . 369

Organship 486

Ovariotomy 663

Practical Suggestions. 132, 1S1, 315, 506
Physician's Pocket Dose and Symp-

tomBook .188

Phvsic does Pay 205

Palmer's Letter 212

Proceedings of the American Med-
ical Association 216, 297

Proceedings of N. E. Medical

sociation . . . 295

Prophylaxis in Puerperal Fever. . . 27 T
Popular Lectures on Physiology ... 278

Paracentesis Thoracis 280

Palmer's Final Conclusions 35!)

Poison by Strychnine treated by

Chloroform 411

Pocket Instruments 122

Principles of Medicine 172

Practice of Surgery 475

Professional Honor 542

Pharmaceutical Association 618

Production of Leeches in Michigan, 655
Piivsiology of the Large Intestine.. 656
Post-Mortem of Marshal] Hall 660

IV.

Index.

Palmer's Artificial Limbs CT2

physiological Anatomy 1S9

R.
"Removal of the Medical Depart-
ment 49, 674, 723

Rush Medical College 108

Report of Committee on Registra-
tion 114

Remarks on Menstruation 155

Retained Placenta 155

Reform in Weights and Measures.. 5G9
Reproduction of Bones and Joints, . 591

Resection of the Elbow-Joint 598

Removal of a Foreign Body from

Beneitli the Heart 619

S.
Sequard's Theory of Special. Xerves 24

Supurative Anthritis 43

Significant Extracts 55

State Medical Society 58. 730

■ctions from Surgical Xores

67, 186, 257. 377, 469, 575

Strychnia — Uses and Abuses 79

Self-Stultification

Stramonium in Puerpural Convul-
sions Ill

Sickness and Death of Dr. Kane. ..112

Sterility Remedied 161

Specialities and Specialists

Startins Treatment of Small-Pox. . 203
Secondary Sy phi His — Xew Treat-
ment 204

Syphilization 212

Suicidal Monomania 272

Scarlatina 2S0

Scrofulous Bubo 466

Scarlet Ointment 550

Supra-Renal Capsules 594

Sympathetic Inflammation of the

' Eyeball 59S

Stearns" Circular 605

State Medical Society 58, 612, 672

St Mary's Hospital Report. ...... 664

Senior Editor of the Peninsular. ...

T.
Treat;:. cm of Neuralgia by the Va-
lerianate of Ammonia 47, ^7

To our Subscribers 58

The Last Diatribe from the " Citi-
zen of Illinois :'

j Transactions of the Michigan State

Medical Society 104

Transactions of the Indiana State

Medical Society 402

; Transactions of the Ohio State Med-
ical Society 586

; Transactions of the X. II. State

Medical Society 586

j Transactions of the American Med-
ical Association 647

Treatment of Rheumatism 158

. Treatment of Varicose Veins and

Ulcers 159

' Treatment of Boils 161

i The Scalpel for April 176

Treatment of Scabies 201

Tinet. of Iodine in the Vomiting of

Pregnancy 203

The Dark Side Of War 207

The Meeting at Nashville 211

To Contributors 283

The Excito-Secretory Function 361

il -; * System 3S1

The Microscope and its Revelations 397
The Approaching Session* of the
Medical Department of the Uni-
versity 422

To Subscribers — Impromptu 424

The Rights of Authors 407

Tubercular Phthisis 518, £.13, 705

Todd's Clinical Lectures 531

Treatment of Scarlatina 601

The Preparations of Garnier.Lamor-

eux & Co .' 604

Two Cases 614

Treatment of Sere Nipples 660

for "Vaccination 667

Vapor Ad 163

Voices Differing with Localities... 208

Vegetable Or 25S

Valvular Nature ef Hernia 273

Vaccination 471

o-Vaginj a 688

AV.

:nal Parietes. ... 271
"Wilson on Diseases of the Skin... . . 5S3
Vest on Diseases of Women 71 I

T.
•nine 661

1 THE

MEDICAL INDEPENDENT:

A MONTHLY

Review of Medicine and Surgery.

■ ■ — ■• ■ ■ - , -,„ . . . -.-=*>■

VOL,. 3. DETROIT, MARCH, 1857. NO. 1.

ORIGINAL COMMUNICATIONS.

ARTICLE I. — On the Links Connecting the Vegetable
and Animal Kingdoms. — Continued.

BY HENRY GOADBY, M. D., F. L. S.

Remarkable facts have been revealed by the Microscope of
late years, in regard to the reproduction of certain plants ; im-
pregnation has been supposed always to take place through the
agency of the pollen cells, which are known to be conveyed to
the other sex, by the agency of the winds, by means of insects,
and otherwise. It was not supposed that organs were deve-
loped in plants, by means of which sexual congress could be es-
tablished, as pertains to the higher animals , yet such is the
fact, and to a much greater extent in regard to number of
species, than might have been supposed.

In the lower vegetable organisms (Conferva) generation is
accomplished by the actual contact of the sexes — called Conju-
gation. The mode of communication is various, and subject to
great modification in the several species of plants subject to
this law ; in some it consists in the simple development of a
narrow neck, or bridge, as it were ; others possess a firm exter-

VOL. HI, NO. I — 1

Medical Independent,

Marcb

nal envelope, which cannot enter into coalescence with any
other ; and this membrane dehisces more or less completely, so
as to separate each of the conjugating cells into two valves. The
contents of each cell is thus set free, without any distinct in-
vestment, and blend with those of the other ; a mass is formed
by their union, which acquires a truly membranous envelope
—fig. 125,

Fig. 125.
Cosmarium boiryfis. — A, mature frond ; B, empty frond.

This envelope is at first very delicate, and is filled with
green granular contents ; by degrees the envelope acquires
increased thickness, and the contents of the spore-cell become
brown or red.

The mode in which conjugation takes place in the filamen-
tous, or confervoid species, is essentially different from the
preceding illustration. The filaments firstly separate into the
joints severally, of which they are composed ; when two cells
approach each other in conjugation, the outer cell-well of each
splits at that portion which adjoins the other cell, and a new
growth takes place, forming a more or less well developed tube
of connection-

-unitinsi: the cavities of the two cells.

Fig 126.

Fig. 12*. Fig- 126.

Didymoprhim Grevillii. — A, two cells in conjugation ; B, formation of sporan-
gium.

Through this tube the entire endochrome of one cell passes
over into the cavity of the other, and the two are combined so
as to form a single mass.

The Diatomacece are connected by many close affinities with
the Desmidiacece — the class of lowly organized plants to which
reference has been made, and hence the majority of naturalists,

1857.

Original Communications.

at the present day, believe them to be plants, notwithstanding
the assertion of Ehrenberg, and pertinacity with which he
clings to the assertion that they are animals.

They are composed of simple cells, like the Desmidiaceo?,
having an external coating which includes a mass of chloro-
phyll, or enclochrome. The chief point of difference between
these organisms appears to be that all the Diatoms possess a
superficial, external layer of pure silica, more or less covered
with external lines, or marks, of varying degree of minuteness,
and fineness ; and the endochrome, instead of being of a bright
green, is of a yellowish brown. This color appears to be due
to the presence of iron, which may be detected even in their
colorless envelopes.

A more important fact connecting the Diatoms with the
Vegetable Kingdom is, that they, in common with the Desmi-
diacese exhibit " conjugation." In Epithemia turgida, (fig.
127,) the endochrome of each of the conjugating frustules ap-

Fig. 127.

Fi<r. 127.

A, side view of double conjugation of Epithemia turgida ; B, front view.
pears to divide at the time of its discharge into two halves ;
each half coalesces with half of the other endochrome ; and
thus two sporangial frustules are formed.

This double conjugation seems to be the ordinary type of the
process among the Diatoms.

Some of the filamentous species exhibit a remarkable depart-
ure from the ordinary plan ; their component cells, instead of
conjugating with those of another filament, conjugate with
each other. The endochrome of certain frustules, after separa-
ting as if for the formation of a pair of new cells, moves back
from the extremities towards the centre, rapidly increasing in
quantity and aggregation into a sporangial mass, around which
a new envelope is developed, which may or may not resemble
the ordinary frustules. For the exposition of this phenomenon
sec iig. 128, where A. represents a simple filament, before any

Medical Independent.

Marci

change has taken place. B shows a filament developing spo-
rangia ; a, b, c, successive stages in formation of sporangia.

Tig. 128.

It is, however, in the true Confervacece, amongst the Desmi-
diacece that a true sexual generation has been discovered, and
which appears to be universal amongst these plants.

It is extremely interesting to trace the several stages through
which plants pass, before the completion of the act of sexual
congrees. In Zygnema quininum the (presumed to ho) first stage,
and here we quote from the authorities, is represented at fig. 129.

Fig. 129

It will be apparent that the cells at the extremity of the figure
represent the endochrome as uniformly occupying the greater
part of the cell ; the endochrome in the central cell, is shown
as twisted in the middle — a stage preparatory to the condition
shown in Hg. 130, where a perfectly spiral arrangement of the
endochrome has occurred.

Tig- 130.

It will be seen, moreover, that the cells in the first mention-
ed figure are greatly extended in length ; but neither is this
all : in fig. 130 we find that the filaments are double, and con-
nected, the one to the other, by peculiar processes expressly
developed for the purpose, and the cells are greatly reduced in

Fig. 131.

size. All the cells of the filaments in apposition, take part in
the sexual act simultaneously. The third figure of this series,

1857.

Original Communications.

131, shows a greatly altered condition of the endochrome ; that
which was spiral in the second figure, has become nearly sphe-
rical in the last The cells are shortened very considerably, and
the completion of the act of conjugation is made apparent — the
endochrome having passed from the empty cells in the upper se-
ries, to the cells at the lower part of the figure where the spo-
rangia are formed.

Three years and a half back, we collected from the " Grena-
dier's Pond/' Toronto, Canada West, a very beautiful Zyg-
nema, in which we believe the whole details are better, and
more completely displayed than in the figures we have quoted.

The first process, as represented in our preparation is shewn
at fig. 132, where the endochrome appears as a long, tortuous

Fig. 13 ••

filament, winding round the inner surface of the cell. In fig.
133 we see the coil gradually approximating, and in 134, it has
become perfectly solid, and cylindrical. In 135 the mass has
made one tivist, preparatory to the formation of the beautiful

Fig. 134.

spiral of the succeeding figure, 136. In this latter state, the
cells containing endochrome, have attached themselves, by

Fie. 1BU.

means of an imperfectly developed tube, to another filament,
the cells of which are empty. Throughout this series of figures
the cells are of large size, and the endochrome is constantly nu-
cleated. In the terminal figure, 137, great changes have

Medical Independent.

March

occurred ; to enable the enclochrome to pass through the (now)
well developed tube of connection, it has become perfectly spheri-
cal; the act is complete, for the enclochrome has passed from the
empty to the full cells ; lastly the cells themselves are reduced to
one-half their normal size. Shortly afterwards, the cells sepa-
rate, the tubes are absorbed, and the ball of endochrome grad-
ually loosens itself out, simultaneously with the growth of the
cell till our first fhrure be simulated.

Fig. 137.

In a pond on the island opposite to Toronto, we found the
most minute, delicate, and beautiful Conferva we have yet se'en ;
it was collected, too, at a most fortunate period, as we literal-
ly caught Dame Nature in the act of consummating a very
interesting process — the act of conjugation. It is shown in fig.
138, where it will be seen that the ball of endochrome is tightly
wedged in the tube, through which it is gradually passing ;
moreover, we learn a new fact in connection with this process,
from the present preparation, viz : that the cellulose of which
the tube is composed, is highly elastic, and although yielding to
the attempts of the endochrome to pass from one cell to the
other, it yet tightly embraces it in its transit ; this is made man-
ifest by the flattened sides of the endochrome, and the rounded
figure of its terminations — above, and below.

' o* r

1 •••()•.*■•-.

1 B0

()•'.

•••"();.":

()_

Fig. I'iti.

This species appears to differ from the other species of Con-
ferva, figured, in this : that all the nuclei are not employed in
the construction of the fertilizing mass, destined to pass into a
female cell ; on the contrary, we perceive that both the male

1857. Original Communication*. 7

and female cells possess many nucleated spots. All the circum-
stances considered, we regard the finding of it, in this partic-
ular stage of existence, a happy accident. It is invisible to
unassisted vision.

One important circumstance remains to be determined, (so
far as we know, not having " Kalfs Desmidiaceas7') ; and that is,
whether the male cells, emptied of their contents, as we have
seen, possess the power to reproduce the endochrome, by which
they would be fitted to perform the act of conjugation at a fu-
ture period ; or do they become effete, exhausted, and die off ?
Our proceedings in this country have hitherto been so remark-
ably erratic, that we have been unable to prosecute such
enquiries, which require time, and fixity of position ; but we
live in hopes, and should the day arrive in which we can say we
have a home, such enquiries shall be surely answered.

There is yet another, and a curious mode of conjugation, in
this order of plants, that remains to be noticed ; in Closterium
the process is somewhat different, as will readily be perceived
by consulting the accompanying figure of Closterium striatolum,
fig. 139, which represents two plants in the act of conjugation.

Fig. 139.

It will be obvious that the connecting membrane has been sup-
plied partly by both plants, and thus a communication has been
found for the transmission cf the fertilizing agent.

Our enquiries into the identity of the generative processes
of plants, and animals, is not yet complete ; in addition to the
actual connexion, already established, another most important
point of parallelism remains to be described. The discovery by
Leewenhoeck of (apparently) living animals, or animalcules, as
they were called, in the seminal secretion of man and animals,
opened up a new field for speculation and research. Little was
it supposed, at that time, that the fertilizing power of a plant
was equally due to the transmission by the male t j the female,
of a similar ciliated motive organism ! Modern discoveries,

8 Medical Independent. March.

aided by the Microscope, have fully demonstrated that such is
the case in a vast number of plants, and we shall proceed to
lay the evidence, strange as it may seem, before our readers.

In this connection, however, it may be well to premise that
many of the Desmidiacece multiply, as already shown, by the
subdivision of their endochrome into a variable number of
granular particles, called u gonidia ;" these gonidia are* fre-
quently found provided with vibratile cilia, and whenever this
occurs, they are endowed with the power of locomotion, and in
this case they are called "Zoospores/* Gonidia are set free by
the rupture of the cell- wall which contained them, and each
one may develop itself into a perfect cell.

These facts may be satisfactorily ascertained by consulting
the phenomena of the development of any of the Ulvaceous
plants ; to this group belongs the grass-green sea- weeds, known
commonly as " lavers." These plants multiply by binary sub-
division, they remain in firm connection with each other, and
form a regular arrangement, and well constituted mem-
branous layer. Each cell is found to exhibit a more or less
perfect division into four parts, previous to extension by dou-
ble subdivision ; the entire structure generally shows groups of
cells, each containing some multiple of four, fig. 140.

im iiiflf mm run s\m « ***fT

/mi il nil l»'» "•" •£"! '1'1'Zl

fl««m w muni iimiwnin ft«"< ™"

Fig. 140.

Most species of Ulva have a provision for the extension of
the plant by means of " Zoospores ;" the subdivided portions of
endochrome pass through an aperture in the cell wall, acquire
four (or more) cilia, by the vibratile action of which, they swim

Fig. HI. Fig. HI.

freely through the water. We present a figure of the Zoospores
of an Ulvaceous plant — Phycoseris gicjantea ; the Zoosporesare
shown provided with cilia (a), and the first stage of their de-
velopment at b. — fig. 141.

( TO BE CONTINUED. )

1857. Original Communications.

AKTICLE II.— On the Structure and Functions of In-
sects.— Continued.

BY HENRY GOADBY, M. D., F. L. S.

The next skeleton to be considered, in the order of sequence,
should be taken from the second Linnean order — Hemiptera.
These insects are properly, but vulgarly called, bugs, and, from
their natural habitat, Tree-bugs.

The entire order are suctorial; provided with a mouth of
specific, and peculiar organization, by means of wl Ich they are
enabled, firstly to pierce the cortex of plants, and secondly, to
possess themselves of the sap, which constitutes their proper
and legitimate food. Experience teaches us, however, that
whenever any indivMual of this order comes in contact with an
animal, especially man, that they greatly prefer his more nu-
tricious and highly eliminated fluids, to the more legitimate
juices of plants.

It is essentially necessary that, whatever be the kind of food
these creatures design to consume, they thoroughly insalivate it
— the reason for this, will appear in a subsequent paper — suffice
it for our present purpose to say that to this cause is to be at-
tributed the pain — the invariable concomitant of a bite. A
very great number of these creatures are aquatic— many 01
them of great size. The largest known Hemipterous insect —
Belostema grandis — which measures about two and one-half
inches in length, is an inhabitant of the fresh water pools ; the
bite of this creature is said to be very severe ; it is found in
this country, and presents peculiar charms to the Entomotomist
(insect anatomist,) by reason of a peculiar confirmation of its
respiratory organs.

No one better knows what may chance to result from a bite
of these insects, than the practical Entomologist.

Whilst engaged in collecting, it frequently happens, despite
his utmost care and vigilance, that he will be bitten by, either
a terrestrial, or aquatic bug, and then he will have to endure a
specific form of inflamation, depending upon the species that
has bitten him, for no two of them agree in this respect.

During our residence in Philadelphia, the son of a friend
was one day bitten by Reduvius; the consequence was a very
painful tumor, as large as a hens-egg, on his forehead, which
had be to removed by amputation.

VOL. Ill, no. i — 2

10 Medical Independent. March

The Cimex lectularius, or bed-bug, is said to have been intro-
duced into England, in the wood required to rebuild London,
after the great tire. It is asserted by Entomologists worthy of
credit, that it is indigenous to the south of France, where it has
been taken in the Woods.

As wood is undoubtedly its natural habitat, it is probable
that the same insect may be indigenous in this country.

Two remarkable facts in connection with this order, remain
to be noticed, the majority of them are, by far the most intensely
beautiful of any insects known to us. The colors of many of
them, defy alike description, or representation ; so beautiful
are they, that some ten years ago we mounted one of the most
extraordinary we have ever seen — Tessercdoma ametliistina — -in
gold, as a brooch, and a more elegant ornament cannot be im-
agined.

The peculiar and foetid odor emitted by the bed-bug, when
irritated, is well known ; in this there is nothing specific, all
animals, up to man himself, possess odoriferous, or (as they are
emphatically called in comparative anatomy,) * stink" glands.
The colored races of mankind, as compared with the whites,
are conspicuous for the remarkable pungency of their odorif-
erous glands ; by means of these glands, a dog is enabled to
track his master, and from the individuality of the secretion,
recognize him from every other man. All the Hemiptera, if
irritated, disclose, not only a very powerful and disagreeable
odor, but it is always of precisely the same kind — exactly sim-
ilar to that of the bed-bug, and this constitutes the second re-
markable fact to which we desire to direct attention. We
possess Hemiptera from all parts of the world, many of them
distinguished by the possession of pre-eminent beauty, but
they all have precisely the same smell ; the odoriferous glands
of other animals are easily found, but in this class, they have
altogether eluded detection.

The present skeleton was obtained from Halys mucorea, a
beautiful insect common in all collections of Chinese insects.
A, fig. 11, represents the upper part of the head ; it would be
vain to expect to find upper and under jaws formed on the same
type as those of the beetle, but instead, we find organs which,
although analogous, are essentially different in their structure

a, is the upper lip ;

1857.

Original Communications.

bi the upper jaws, analagous to the mandibles of" a beetle ;
c, the under jaws.

Fig. 11. Fig. 12.

B, fig. 12, shows the under part of the head which displays
the under lip, modified into the form of a tube, consisting of
three or lour joints, for the reception and protection of the two
pairs of jaws seen at A.

The jaws, in all the bugs, are merely four fine bristles ; some-
times two of them, and sometimes all four, have enlarged ter-
minations, variously modified, to enable the creatures to cut,
or pierce the bark of plants, or the skin of animals. But be-
fore this latter operation can be performed, it is essential that
the terminal portion of the tube itself be first inserted; when
this be accomplished, the bristles are thrust out, beyond the
tube, to stab the tissue to compel it to yield up its fluid ; when
the bristles are again in requisition .to pump up the fluid, in
this wise : place a bed-bug on the back of your hand, allow it
to insert its tube, and feed ; whilst thus engaged, carefully ex-
amine it with a Coddington lens. The tube is so transparent

Fig. 13.

that' it is easy to see through it, and a motion will be plainly
seen of the bristles workiog up und down within the tube, like

Medical Independent.

March

the rod of a piston within the barrel of a pump. By this
means, the fluid aliment is literally pumped up.

The pronotum, a beautiful shield-shaped bone, is shown at
C, fig. 13 ; it is of large size, the lower part of it being re-
quired to cover the four bones, lettered n, fig. 15.

The under portion of the prothorax is shown at fig. 14, D.
It will be seen that the omia are here of very different form
from those of Dyticus.

Fig. 14.

j, the omia ;

m} their sides forming articulating surfaces with the prono-
tum ;
k, the acetabula, ( sockets for the hips ) ;
I, prosternum.
The most conspicuous and remarkable bone in all these in-

Fig. 15.

sects, as wejl as the largest in the body, is the mesonotum, fig.
15, E. It has been already observed that the bones lettered n,
are covered by the pronotum ; the remainder of this bone con-
stitutes the post-scutellum, which is, in this order, of enormous
size — it covers, and entirely conceals the next segment.

The mesosternal segment is shown at lag. 16, F,

p, shows the shoulder blades ;

1857.

Original Communications,

q, the sockets for the legs ;
r, the mesosternum, and
s, the articulating surfaces.

Fig. 16.

The metanotum, fig. 17, G, is a beautiful bone, and displays
four articulating surfaces, in great perfection.

Fig. 17.

The metasternal portion, is shown at fig. 18, H.

Fisr. 18.

t, the omia ; u, the acetabula, and v, the metasternum.
The articulating surfaces of this bone are largely developed,
and well marked.

Fisr. 19.

The dorso-abdominal segments are shown at /, fig. 19.

Medical Independent.

March

These are chiefly remarkable for the series of small side bones,

which form the articulations with the ventro-abdominal plates.

This latter structure is displayed at J, fig. 20. The letter

Fie. 20.

w points to the spiracles, which are transferred from the dorsal
to the ventral plates.

In Dyticus, the dorso-abdominal plates were found to be
leathery, and soft, protected, too, by the wing covers ; here
there is no such protection, and the dorsal plates are crusta-
ceous. The spiracles, therefore, are transferred to the ventral
surface, for superior protection.

The Linnean Hemipterous order contained insects that
should not have been included in it, as we shall hereafter see ;
but as this Order is restricted by modern Entomology, one im-
portant character must always be present, and that is the ros-
trum or beak, in which the bristles constituting the jaws are
contained.

The Hcmelytrum (half crustaceous wing cover) is by no
means always present, on the contrary the wings of a large
number of veritable tree-bugs are constructed on a totally dif-
ferent plan. An example of this is to be met with in the so
called " seventeen years locust," which, although possessing
wings, all of which are composed of a delicately transparent
membrane, the superior, being much larger than the inferior
pair, is yet strictly Hemipterous.

1857. Original Communications. 15

To determine this question, it is only necessary to turn the
creature on its back, when, if it be a bug, the peculiar struc-
ture of the oral apparatus, lying straight down from the head,
between and beyond the first pair of legs, will sufficently iden-
tify it, as no other insect possesses a mouth of this form.

When it be necessary to Use this instrument, it is turned
out at right angles to the body, and the height of the legs will
generally determine the length of the rostrum, which is ex-
ceedingly various. In this position it is easy to insert the end
of the tube into the substance, vegetable or animal, that is to
be preyed upon. It should seem by the effects produced, that
the end of the tube is itself a cutting instrument, allied, prob-
ably, to a gun punch.

Some of the aquatic tree bugs, Notonecta glauca, especially,
are singularly mischievous, destroying an incredible number of
insects, merely for the pleasure of killing them. Times and
oft, have we collected this species, together with beetles, of all
sizes, and aquatic larva3 of several species of insects, and hav-
ing placed them all in the same jar, have found, to our dismay,
on returning home, every thing killed by the Notonecta, unless
they chanced to be too strong and heavy for them to manage.

We have watched them, and seen the entire operation, in
this wise : like other insects, Notonecta, must come to the sur-
face of the water, ever and anon, to respire.

The creature's back is shaped like the keel of a boat, and
hence it is commonly known as the boat-fly ; the abdominal
surface is perfectly flat — it swims, therefore with the back
downwards. Having inhaled an atmosphere, if it chances to
see another insect coming up to the surface of the water, with
the like object in view, it seizes it in its legs, and descends to
the bottom of the vessel, pertinaciously holding its victim till
the cessation of its struggles assure the assassin that its death
is accomplished.

If the hapless victim be so strong, however, that it can hold
out until the boat-fly itself has need to respire, the cunning
and cruel insect mounts to the surface, with its prey still firm-
ly clutched between its legs, and adroitly elevating its terminal
segments above the water for an instant, effects its object,
whilst it takes care to keep its victim submerged. A second
descent is usually too much, and the poor creature dies asphix-

16 Medical Independent. March

- -

iated. Liberating the dead carcass, the relentless Notonecta
seeks other prey.

It is highly probable, that while the insect is thus firmly
held in the embrace of the boat-fly, that the latter sticks his
beak into the former, and sucks his blood ; in this case the in-
sect would die of loss of blood, and from the poisonous effects
of the saliva. Notonecta is common in this country.

( TO BE CONTINUED. )

AKTICLE II. — Chapters from an Unpublished Work on
Hygieine. — Chapter II. — Continued.

BY A. R. T.

"He giveth His lelovpd sleep."

"To die ; — to sleep :— To sleep ! perchance to dream !"

Sleep. — This great restorer of exhausted energies, this refuge
of the afflicted, this lovely counterfeit of her stern brother Death,
is abused, like all the other good gifts of God. The voluptuary
woos her embraces, long after all the innocent of God's crea-
tion have sung their matin hymn, that he may have strength
to pursue his course of debauchery, which shuns the light of
day. The sluggard turns him once more, and yet again, on his
soft pillow, while his interests, temporal and eternal are going
to ruin ; and the drunkard snores off the fumes of the liquor
which has sunk him below the beasts that perish. Yet, what
richer temporal gift has a merciful Creator bestowed on man than
sleep ? Abuse, not use, has perverted it.

The number of hours, which should be devoted to sleep, has
been a subject of discussion among physiologists all over the
civilized world, and it is generally agreed that absolute rules
will not apply to all, in regard to this point, any more than in
regard to diet or exercise. This seems to be conceded on all
hands. That mental and bodily labor can be pursued toith less
exhaustion to the system, during the time the su?i is above the
horizon, than by artificial light. The stimulus of natural light
seems as necessary to the animal as to the vegetable world.
The man who turns day into night, and night into day, will
soon show the effect of it in a pallid countenance, and failing
energies. " Work while it is yet day," say the Scriptures,

1857. Original Communications. 17

metaphorically, and the saying is just as true in a practical
sense. Nature, has attached a penalty to the violation of her
laws, in this instance, as in all others, and it is sure to be en-
forced. " Early to bed, and early to rise, is the way to be
healthy, wealthy, and wise," says Poor Richard, and, like many
other of his sayings, it is very true.

The number of hours, proper to be devoted to sleep, varies
according to the age, temperament, occupation, and health of
the individual. Children and youths require much more sleep
than the adult and middle-aged, and when the advance of
years begins to sap the energies, failing nature requires more
sleep to restore the decreasing strength. Persons, who have
arrived at the age of three-score and ten, often sleep from fif-
teen to eighteen hours in the twenty-four. It would appear,
at first sight, that the laborer would require more sleep than
the literary man, of sedentary habits ; this, however, is not so ;
head-work is more exhausting to the nervous system than hand-
work, and the muscles will rest sooner than the brain. Other
things being equal, the student requires most sleep. But
whatever may be the length of time devoted to sleep, he who
values health and long life, should rise early.

A few words in regard to beds and bedding. It is too much
the custom in our country to use feathers, as a material for
beds and pillows. This is, without doubt, wrong. Feathers
confine and accumulate the heat of the body, and, although
they may be borne in winter, are utterly inadmissible in sum-
mer. Persons accustomed to sleeping on feathers, from child-
hood, are not aware how much more comfortable a harder and
cooler bed is. Let a person accustomed to hair matresses and
pillows, attempt to sleep, even for a single night, on a feather-
bed, and he will, probably, lie awake for the best part of it,
and get up in the morning, feverish and unrefreshed. For
sheets, the best material is linen, of not too fine a texture.
The wadded cotton coverings, commonly called comforters, in
this country, are open to the same objections, as are feather-
beds ; they are too warm ; changes, to meet moderate variations
of temperature, cannot be made with them ; blankets, although,
more expensive, are much better. Children, especially in hot
weather, are very apt to throw off the bed clothes, and thus,

take cold ; the best preventive for this, is a night-dress of flan-
vol. in, no. i — 3*

18 Medical Independent. March

nel or cotton, made in the form of waist and drawers joined.
The temperature of bed-rooms in the winter is a matter of
much importance, and there is a great variety of opinion, in
regard to that most conducive to health. Where a house is
warmed by a furnace, the temperature of a bed-room may be
regulated so as to vary very little from the time of retiring un-
til morning ; but where stoves, or open fires are used, there
must necessarily be considerable cooliug before morning, and,
of course, a liability to take cold. As a general rule for per-
sons in good health, cool bed-rooms will be better than warm
ones. Their ventilation will be hereafter spoken of, in the ap-
propriate place.

Itinerant lecturers on liygieine have, of late years, much
recommended the practice of sleeping in rooms with an open
window, at all seasons of the year. For persons engaged in
the ordinary pursuits of life, such a practice would, in most
cases, prove highly injurious, and, so far from adding to the ro-
bustness of the individual, would probably entail an endless
succession of colds and rheumatisms. In a chamber of decent
size, sufficient ventilation can be had without it.

The shortest period which can be safely appropriated to sleep
by the man in health, whatever may be his occupation, appears
to be from five to six hours, and few are willing or able to get
along with less than this. The man who is diligent, during his
waking hours, need not consider himself a sluggard, if he de-
votes eight hours, out of the twenty-four3 to sleep.

Ventilation and warming of houses are subjects of para-
mount importance, in an economical, as well as a hygieinic
point of view. Fuel is abundant and cheap in our country,
but yet it forms an important item in the expenses of every
family at the north. The cooking stove has greatly decreased
the consumption of fuel in the kitchen. In place of the wide
chimney, with half a cord of wood blazing in it, and a vvhirl-
wind rushing up its throat, there is the neat stove, burning a
few small billets, boiling, baking, roasting, and frying, all in the
compass of a few cubic feet, and with an economy and conve-
nience unheard-of a few years ago. This is all very well, but
it is to feared that the modern stove is not without some seri-
ous objections, on the score of health, wThen considered as a
means of warming. It is hardly possible to state all the ob-

1857. Original Communications. 19

jections to the stoves now generally in use, without going into
a consideration of some of the doctrines of the conduction and
radiation of heat, which would be quite incompatible with the
plan of an essay like this. A compend like the present must
rather state results than reasons. I shall endeavor to lay down
a few rules for the employment of stoves, founded not only on
theoretical deductions from the known laws of heat, but from
considerable experience and observation on the subject. Three
general rules should be observed in the use of stoves for warm-
ing apartments. First, the stove should present a large sur-
face to the air of the apartment ; as the air is heated, not by
radiation, but by actual contact and circulation. A small
stove, highly heated, is not only less economical than a large one,
heated to a more moderate temperature, but less wholesome.
The intense radiation from a highly heated stove dries the skin,
contracts the capillary vessels, and throws an additional burden
on the lungs, while the air of the room is comparatively little
heated, Second, the plates of the stove should be thick ; in
this way sudden variations of temperature by the decay of the
fire will be, in a measure, guarded against. Third, the stove
should be so constructed that the draft of air can be accurately
regulated. Good dry wood will consume slowly with a very
small quantity of air, and, in this way, supply the greatest
possible amount of heat ; as very little is carried oft in the
shape of hot air and steam, up the chimney ; while, when the
draft is strong, by far the greatest portion of the heat is lost in
that way. The Kussians have large brick stoves, which are
never heated to a high temperature^ and are only supplied with
fuel twice or three times a day, and by these means, an uniform
temperature, adequate to resist their rigorous climate, is easi-
ly maintained. Our Canadian neighbors, long ago discovered
the practical use of large stoves, with thick plates ; they are
constructed with two stories, and the genial temperature dif-
fuse by them is quite a different thing from the fierce and sti-
fling heat of a little red-hot spit-fire of a stove. Another
disadvantage of a stove very highly heated, is that the dust,
which always more or less floats in the air of an apartment, is
burnt, and makes a disagreeable smell.

Fire-places and grates, for burning wood and coal, are less
economical than stoves, but the ventilation afforded by them is

20 Medical Independent. March

more complete than that made by stoves, unless in the latter
case, a seperate plan for ventilation is adopted. Houses should
never be built without flues and fire-places for all the rooms,
even when stoves are to be used, for by them can ventilation
most easily be accomplished. Where stoves are employed for
warming, ventilation may be most easily accomplished, by an
opening into the chimney, near the ceiling ; this, in general,
will be quite sufficient. As to the various complicated and
expensive plans for ventilating dwelling-houses, and public
buildings, they are beyond the scope of a work like this ; but,
two general rules may be safely adopted : first, admit your cool
air, at a height not greater than four feet from the floor, and
make your escapes for the heated and foul air as high as pos-
sible.

As to the temperature of rooms, some little variation may be
necessary to meet the feelings of those employed in different
avocations. To the man who has been for hours taking active
exercise in the open air, in winter, that temperature will appear
suffocating, which to the sedentary man, the in-door mechan-
ic, and the sepnistress is only comfortable. Seventy degrees of
Fahrnheit's thermometer is as high an artificial temperature as
should generally be employed, and one a few degrees lower will
be found comfortable, by those who are much in the open air.

CHAPTER III.

Diet, &c. — As from the stomach, and the other associate di-
gestive organs, proceeds the food or nourishment of the blood,
and as from the blood are formed all solid and fluid constituents of
the human body, so it is obvious, that good food and a healthy
digestion are indispensible for the production of a healthy
body. In all parts of our happy land, abundance of good food
is procurable, and that within the reach of all who will take the
moderate pains necessary to earn it. But it seems as if, in pro-
portion to the abundance and excellencejof the staple articles
of food, cookery becomes bad. In our country, where the time
devoted to meals is generally so very short, it is peculiarly ne-
cessary that good cookery should step in as an auxiliary to our
overtasked stomachs. By good cookery, I am far from mean-

1857. Original Communications. 21

ing the preparation of rich and highly seasoned dishes ; these
should be eschewed by all who have any regard to their health
or comfort ; hut I mean that preparation of food, which fits it
for easy and painless conversion, first into Chyme, and then in-
to Chyle. There is a happy medium between food so unskil-
fully cooked as to be, for hours, an incubus on the stomach,
lying like a bad deed on the awakened conscience, and food so
skilfully cooked and elaborated as to do away with the process
of mastication. Mastication and the accompanying secretion
of saliva are as necessary to good and easy digestion, as is any
other of the processes usually looked on as contributing to that
end. This is one reason why soups are generally hard of diges-
tion. Our teeth were made to be used, and few persons are
aware how many ill consequences to the general health arise
from neglect and abuse of them. I have already briefly treated
of the means most likely to preserve these important organs.
Man is most clearly pointed out by his dentition and digestive
organs, as an animal intended by the great Creator to live on a
mixed animal and vegetable diet, and while this is undoubtedly
the diet best fitted to sustain, in their fullest health, both his
bodily and mental functions, yet such is his adaptability to cir-
cumstances, that he will live and thrive on either an exclusive-
ly animal, or an exclusively vegetable diet ; and such consum-
mate wisdom and goodness have been displayed, in adapting the
productions of the earth to man's peculiar wants, in different
regions, that the most unobservant cannot fail to be struck by
it. In cold inhospitable regions, man needs most animal rood,
and that cf a fatty kind, and consequently the continents, seas
and rivers, of the extreme north, teem with animal life. Wit-
ness the countless herds of Caribou, or Keindeer, which overrun
the so-called barren grounds of North America, the whales,
walruses, and seals of the Greenland and other actic seas, the
innumerable sea fowl, enveloped in a coating of fat, and the
myriads of delicious fish which almost block^ up the Siberian
and other rivers of the far north.

In temperate regions animal and vegetable productions are
more nearly balanced ; and why ? because by the alternations of
the seasons a mixed diet is rendered necessary, aud we may
here further trace the same adaptation ; animal food, which is
most necessary to man in cold weather, is, in the winter, in the

22 Medical Independent. March

best condition to be eaten, fattest and most tender, and the
converse is true in regard to vegetables in the summer, when
their abundance and variety furnish a bland, grateful and cool-
ing nourishment at a time when animal food becomes compar-
atively distasteful. On arriving in tropical regions, we find
that the quantity and variety of vegetable food is vastly great-
er than that of animal food. The birds, fish, and quadrupeds
of the tropics, are comparatively coarse and unpalatable, while
nature spreads her banquet of delicious vegetables and fruit in
rich and boundless profusion. The Eice, the Maize, the Plan-
tain, the Manioc, the Sweet potato, the Cocoa-nut, and other
species of Palm, the Chocolate-nut or Cacao, (called, by Lin-
naeus, Theobroma, or Food for the Gods,) and an almost endless
variety of delicious and wholesome fruits invite man to invigo-
rate his fainting frame, by their bland and unstimulating nour-
ishment, and cool his heated blood with their acidulous and re-
freshing juices. Thus, in every region, nature points out to
man, and holds ready for his acceptance that food most suitable
to keep his body in health, and fit him for the purposes of his
being.

These four general propositions might be laid down in re-
gard to diet.

1st. That the inhabitants of cold climates require more ani-
mal and fatty food than those of hot climates.*

2d. That in regard to the inhabitants of temperate climates,
more animal food is required in winter than in summer.

3d. That, (climate being the same), those who take violent
exercise need more animal food than the sedentary.

4th. That all other things being equal, adults need more an-
imal food than children.

The principles and premises, from which these propositions
have been drawn, are too extended and intricate for such a
work as this, it must suffice, that the conclusions have been ar-
ived at by the most eminent modern physiologists, and cultiva-
tors of animal chemistry. There are almost infinite varieties
in the dietetic rules adapted to different constitutions and cir-
cumstances, but with good common sense and judgment, any
one can, by a few simple rules, regulate his manner of living so

* Our distinguished countryman, and voyager in the Arctic Seas, Dr. Kane, has borne the
strongest testimony to the truth of this proposition, Fat seal and -walrus meat in abundance,

i tetter when raw and bloody than when cooked,) enabled him and his men to bid defiance to fa-
igue, cold and scurvy.

1857. Original Communications. 23

as to avoid that dire scourge of our country, Dyspepsia, and it
shall be the object of the writer, in this portion of the work, to
point out those simple rules.

The foundation of all correct dietetics is to avoid excess in
all things. Without this precaution all other rules are of no
use. The physician may give his best advice, and the apothe-
cary administer his choicest drugs to the glutton, or the intem-
perate, and it will be a mere patching up of a leaky kettle, a
prolonging of the ultimate catastrophe, when the whole shall
get beyond the reach of the tinker's art. No more food should
be taken than can be disposed of without oppression or pain,
and it is often of great importance to refrain from eating
heartily, when the frame is worn out with fatigue. Under such
circumstances the digestive organs partake of the general ex-
haustion of the system, and are not equal to grapple with a
full meal. A cup of tea or coffee, and a piece of bread should
be taken, and the hearty meal deferred until rest has recruited
the frame. These remarks more particularly refer to accidental
severe exertion in those unaccustomed to it. The hardy day-
laborer, the farmer, the mechanic, the sailor and the hunter are
inured to toil, and their food will invigorate instead of depress-
ing them, after the labors of the day are over ; but let the usu-
ally sedentary man beware of a full meal after violent exercise.

Another very important part of Dietetics is to adapt the di-
et to the age and constitution. The young require a less
amount of animal and stimulating food than adults ; and the
sedentary man less than the active man. The man inclined
to be fat should avoid fat meats and a large amount of vege-
table nutriment, his diet should rather consist of lean ani-
mal food and a small amount of nourishment in a small
bulk, and the man of delicate stomach should avoid all rich
and luxurious dishes.

All men are more or less self deceivers, and I will ven-
ture te say that no one who has had the command of abundance
of wholesome, well cooked, and nutritive food ever ruined
his digestion, unless he wilfully shut his eyes to some impru-
dence he has been in the frequent habit of committing. I now
speak of extreme cases, for there are many instances of dys-
pepsia, in a moderate degree, which seem unavoidable and
dependent on causes beyond the control of the sufferer. I

24 Medical Independent. March

would not wish a healthy man to be always looking for
" death in the pot" such a state of mind would, of course,
conduce to disease, but I do say that a moderate care in
respect to quantity and quality, and times and seasons of
eating, would save many a one from years of suffering. If
oppression in breathing, a sense of chilliness, or drowsiness,
and especially if all these combined, follow a meal, you may
be sure that you have transgressed the bounds temperance
and moderation, and that repetition of these transgressions,
continued for any considerable length of time, will result in
more or less disease of the digestive organs. I again repeat,
that each man's experience, carefully applied, will soon teach
him how to avoid a system of diet which is injurious, either as
to quantity or quality. These remarks are intended principal-
ly for those who are still in a tolerable state of health. For
the confirmed dyspeptic, the only resort is the skilful physician,
for the mind in this disease, while appaarently perfectly healthy
on all other subjects, often soon becomes incapable of judging
correctly on any thing connected with the bodily ailment. I
could relate numberless instances of the strange measures re-
sorted to for relief by those suffering from this disease ;* so
called — and the quantities of medicines poured into their un-
fortunate carcasses would almost exceed the bounds of the
bounds of the largest credulity.

ARTICLE IV.— Mr. B. Seguard's Theory of the Physi-
ology and Functions of the Medulla Spinalis, and
its Nerves : from the Lectures of Mr. C. Bernard,
Professor of Experimental Physiology in the Col-
lege of France, at Paris — Winter of 1856-57

Mr. Brown Seguard has created, among the scientific men
of Europe, and especially of France, an immense sensation, by
his new theory of the functions of the spinal cord,

Mr. Claude Bernard, Professor of Experimental Physiology
in the College of France, at Paris, has taken, as the subject of
his lectures, this winter, the Physiology of the Nervous Sys-
tem. He is one of the most prominent physiologists of Eu-

* I mean to intimate that many distinct diseases of the digestive organs are often
grouped under the name of Dyspepsia,

1857. Original Communications. 25

rope, and his opinion will, therefore, be of great value on this
most important matter. I intend a regular attendance upon his
course of lectures, and when he arrives at the physiology of the
spinal cord, I will send you his views in relation to Mr. B. Se-
guard's discovery.

In the mean time, a summary of the most striking points of
a report just made to the Biological Society of Paris, by Doc-
tor Broca, on M. Seguard's discovery, will be of some interest
to your readers, that society having admitted the truth of the
new theory on the spinal marrow.

When Charles Bell communicated to the Koyal Society of
London his first researches on the functions of the spinal nerves3
the physiology of the nervous system entered a new era. Pre-
viously it was a common opinion that the spinal cord was
nothing but a large nerve manifesting conjointly with the dif-
ferent nerves of the body, its action on the sensibility and
motion of the limbs. This was the only exact notion of the
properties of the nervous system. There were, indeed, many
other confused ideas among physicians, such as the one origina-
ting with Galen, who taught that the spinal cord was divided
into two parts, each part having under its control the corres-
ponding limbs. The decussation of the anterior pyramids dis-
covered by Mistichelli, was sufficient to account for the cases
in which it happened, that paralysis was seen in one part of the
body, when the disease existed in a different part of the brain.

There was, as we see, no science proper, which merited the
name of physiology of the nervous system, and it was impossi-
ble to explain those facts of daily occurrence in which were
observed, at the same time, and sometimes separately, the
appearance of sensibility and motion, those two great properties
of the nerves. Bell's discovery was, therefore, hailed with en-
thusiasm everywhere.

This great genius, guided by a few dissections, and by
numerous experiments on animals, ascertained that the diverse
functions of the nerves arose from the diversity of their origin in
the spinal cord or in the encephalon. He found that the posterior
roots of the spinal cord gave sensibility to the limbs, and that
the anterior ones were the agents of the contraction of the
muscles. This simple discovery was by itself a revolution in
physiology, and was sufficient to immortalize its author.

26 Medical Independent. March

But the human mind is prone to systems, it cannot follow
patiently the results of observation, and must substitute for
reality, the delusive deductions of theory. It very seldom oc-
curs that discoverers can refrain from generalizing, and the
erection of systems. Thus it happened with Charles Bell — not
satisfied with having discovered the properties of the anterior
and posterior roots of the nerves of the spinal cord, he deduced
from them a whole theory on the functions of the medul la. He
saw the connection of the posterior roots with the posterior col-
umns of the cord, and concluded, from that fact, that those col-
umns were the agents of sensibility. He observed the connection
of the anterior roots with the anterior and lateral columns, and
arrived at the conclusion that those columns were the conduct-
ors of motion.

This double conclusion seemed very natural, indeed ; it
wanted, however, the sanction which experiments alone can
give, in science ; but, unhappily, Bell had an instinctive abhor-
rence of experiments on living animals, he made few beyond
those upon which his theory was constructed. As those exper-
iments had not given him exact facts in sufficient number to
enlighten his mind, it was merely from deductions that he
erected his theory of the different properties and functions of
the spinal cord.

We have thus given a general idea of the doctrine of Bell,
as it was presented by him and his partizans to the world.
As soon as Bell's discovery was announced, the whole body of
physiologists and anatomists was aroused ; innumerable ex-
periments were made in all countries. Magendie. Herbert,
Mayo, Fodera, De Schoeps, Bellingeri, and others were among
the first to repeat the experiments of the English discoverer.

The functions of the posterior and anterior roots were gene-
rally admitted as true, but the case was far different in relation
to his theory of the spinal marrow. Let us report a few re-
sults obtained by physiologists on that subject. In some cases
it happened that men of high standing in science, were of the
opinion that the motor functions were uniformly disseminated
in all the columns of the spinal cord, the gray matter being
the only agent of sensibility. In other cases, the posterior col-
umns were admitted to have under their influence the contrac-
tion of the extensor muscles, when the anterior and lateral col-

1857. Original Communications. 27

nmns controlled the flexor muscles. It was even found, by
some, that each column was indistinctly sensible and motor,
but that the posterior one was usually more sensible than the
anterior, which was generally motor.

Baker discovered that sensibility and motion were at the
same time destroyed by a section of the posterior columns-
De Schoeps, by the same expeiiment, i. e., a section of the pos-
terior columns, noticed that motion was destroyed and sensibil-
ity preserved in the limbs. Fodera, on a section of one posterior
column alone, witnessed a crossing paralysis of sensibility, and
a direct paralysis of movement. The results we have reported
with a large number of others, too numerous for detail in the
limits of this article, did not explain the matter, and many
physiologists lost all hope of arriving at a certain conclusion as
to the functions of the spinal cord, repeating Boerhave's
celebrated sentiment, " quis died, hoc movet, hoc sentit."?

The subject remained in this undecided state, when Longet
bega.n his study of the physiology of the nervous system. This
gentleman, convinced that experiments always performed in
the same manner, must invariably give the same results, put
to himself the simple question, why have so many different no-
tions arisen on the same subject ? The answer to that question
was, that among many difficulties inherent to the study, the
most important one was the section of each column seperately,
and the impossibility, in many cases, of distinguishing move-
ments produced by the direct excitation of the spinal cord,
from those produced by the pain resulting from the opening of
the vertebral canal.

According to Longet's opinion, the simple opening of the
vertebral column, the simple contact of air with the exterior
surface of the dura mater, were sufficient to diminish the ner-
vous action of the posterior part of the body of the animals on
which that operation was made, in such a manner that it was
almost, if not altogether, impossible to observe either motion
or sensibility. M. Longet was thus brought to the conclusion
that the results obtained by the previous experiments of phys-
iologists could not be relied upon.

Instead of a partial, he made an entire section of the spinal
cord, and obtained by it an absolute paralysis of the posterior
limbs. He then applied electricity, first to the cervical or cen-

28 Medical Independent.. March

tral segment of the medulla, and secondly, to the caudal seg-
ment. He examined also in succession, and seperately the
posterior and anterior columns and the gray matter. This
mode of operating gave constantly uniform results ; let us see
what they were.

Galvanizing the posterior columns, he found that they had
no influsnce on the contraction of the muscles. That the gal-
vanization of the anterior and lateral columns produced no
sign of pain or sensibility whatever. That galvanism applied
to the central segment of the posterior column excited exces-
sive sensibility. That the same agent applied to the caudal
segment was productive of a very sensible motion — and finally,
that electricity applied to the grey matter had no effect on the
body of the animal undergoing experiments.

Made in this manner, experiments on the spinal cord always
gave similar results, and Charles Bell's theory, thus completed
and modified by Longet, was adopted as truth, and seemed be-
yond criticism. It was thought, for a time, that this part of
the physiology cf the nervous system had arrived at perfection.
The defective origin of the new doctrine was completely forgot-
ten, as well as the objections to which it had given rise, objec-
tions, however, which did not appear unfounded. Facts Con-
tradicting the doctrines were put aside, and all experiments,
the results of winch conflicted with this theory, were reputed
imperfect ones. More fortunate than a thousand of other the-
ories, this became classical, and at this day it is so universally
known that an analysis of it is hardly necessary — but I give
one for convenience of reference.

The spinal cord is at the same time a nervous centre, enjoy-
ing a proper activity, and a conductor destined to put in com-
munication with the encephalon all the systems of the body.
It owes these peculiar properties to the two matters which en-
ter into its composition. Phenomena of centrality, especially
reflex actions, are dependant on the grey matter, which is it-
self entirely deprived of sensibility or motion. The white sub-
stance of the spinal cord is nothing but the conductor of all
the impressions of the body ; the posterior columns being con-
ductors of sensible impressions, and the anterior ones conduct-
ing the motor impressions. Such, in few words, is the received
theory of the medulla ; it is simple and captivating ; we have
been taught it, and have taught it to others.

1857. Original Communications. 29

To-day we are bound to confess that it is any thing but true.
That M. Brown Seguard has completely overthrown it, by his
discovery of the properties of the spinal cord. Again, we are
convinced that theories, however admirable they appear, are of
little value, unless founded on postive observations.

M. Brown Seguard has been experimenting on the functions
of the spinal cord for a long period. It is now more than six
years since he published his first researches. At different times
he has performed before us, experiments, the results of which
were entirely contradictory to the admitted notions of the
properties of the medulla. But Charles Bell's doctrine was so
universally received among the physiologists, that those results
were hardly noticed. This neglect, however, did not discour-
age M. Seguard. He continued his experiments, varying them
ad infinitum. He made them in a form which left no basis for
objections ; and, having lately returned from America, he
deemed the moment had arrived for presenting to the scientific
public the resuhs of his experiments.

His first communication to the Biological Society excited in-
tense interest. He bodly stated that the section of the poste-
rior columns, those columns which were believed to be sensi-
tive, far from annihilating sensibility in the posterior limbs,
brought an exaggerated sensibility. That on irritating the
caudal segment of the spinal cord the pain experienced was far
superior to that excited by irritation of the cephalic segment,
contrary to the theory which gave to the latter the function of
conducting the impressions.

These results were so contradictory to all our notions, that
we determined not to be taken by surprise. "We, therefore, en-
gaged M. Seguard to repeat that fundamental experiment. He
complied with our desire, and performed the operation of cut-
ting the posterior columns of the spinal cord in two rabbits.
The result confirmed his declaration. Still, doubts existed in
our mind. We thought he might not have made an entire
section of the posterior columns, which are small and of diffi-
cult dissection in rabbits. We requested him to operate on
some larger animals, such as the sheep, dog, or horse. He
kindly acceded to our request, and those experiments and the
results observed, we proceeded to report. F. G.

Paris, January, 1857.

(to be continued.)

30 Medical Independent March

AKTICLE V. — Fibrous Tumors of the Uterus — A Case
— Extirpation by Incision, and Complete Recovery.

Few departments of pthaology, perhaps, have given rise to a
greater amount of solicitude, have elicited more perseverance
and ingenuity in research, and have been crowned with more
satisfactory results, than that which pertains to the uterus and
its appendages. Perhaps, too, but few organs or combinations
of organs are amenable to a greater variety of pathological ab-
normities. Among these, the production of morbid growths,
their influence, not only, upon the organs and functions, impli-
cated, but upon the economy, at large, and the therapeutical
measures, required for their cure, or, the surgical appliances,
that their extirpation demands, are not the least important.
Generally, they are designated by the terms, tumor, and poly-
pus— they are, also, denominated fibrous tumors, tubercles,
mucous tubercles, vascular polypi, &c., &c. Perhaps, a no-
menclature, that would present, to the mind of the investiga-
tor, as little complexity and embarrassment as any, would be
the following, viz : let polypus be the generic term, and the
growths, or morbid products, intended to be expressed thereby,
be designated by an expressive qualifying appellative, distinctly
indicating some obvious predominant characteristic. For ex-
ample, if structure be adopted as the basis of distinction, let
those that present the appropriate anatomical characteristics
be denominated fibrous, fibro-cartilaginous, &c., and such as
exhibit a marked mucous structure, i. e., evidences of being
constituted, entirely or chiefly of the mucous tissue of the ute-
rus, or of analogus structure, have the appellative, mucous, at-
tached, while those which offer a musular or fleshy organization,
might be defined by the qualifying or descriptive term, muscu-
lar or sarcomatous. Thus, the entire catalogue of known
abnormal products, might be specifically expressed according
to actual organization. We are induced to offer these sugges-
tions, from the consideration, that much confusion, manifestly
exists, in the language, used by different writers on these sub-
jects. One will treat of polypus, evidently meaning to include,
under this head, all, or most of the morbid growths, that are
found within the cavity of the uterus, or attached to the parie-
ties of the vagina. Another will speak of fleshy tubercle and
of polypus, without defining, with much care, the distinctive

1857. Original Communications. 31

characters, either of one or the other. Again, tumors of the
uterus, and polypus, neither being so definitely described, as to
enable the student to distinguish, without much labor and em-
barrassment, what precise structure is represented by either,
are spoken of by systematic authors. Still further, fibrous, and
fibro-cartilaginous, mucus tumors, and vascular polypi are ex-
pressions, that cccupy a conspicuous place, in the department
of professional literature, which treats of the abnormal pro-
ducts, of which, we are speaking. Now, if we rightly compre-
hend the subject, these several epithets, strictly construed,
mean nearly, if not exactly, the same thing, or a class of pa-
thological products, and we can but feel that the progress of
science is, in no small degree, retarded by the use of such vari-
ous terms, expressive of the same, or quite analogous growths,
or morbid organizations.

There is, not only much embarrassment to the practitioner,
induced by this manifest indefiniteness, in the use of technical
phraseology, in diagnosis, but like embarrassment results, as
regards treatment. Definiteness, in the use of appellatives is
indispensable, both as regards diagnosis and practice ; for, al-
though no intelligent practitioner will prescribe to a name, yet,
as the genius of technical language is to convey, so far as dis-
ease is concerned, the idea of a pathological condition, or an
abnormal state of some structure, organ or function, the mind
is aided and guided, thereby, in no inconsiderable degree, in dis-
tinguishing the character of the disease, under investigation
and in selecting the means of cure.

By fibrous and fibro-cartilaginous uterine tumors, then, we
mean a variety of polypus, that presents certain and definite
anatomical characteristics ; by muscular, fleshy or sarcomatous
tumors of the same organ, we would designate morbid growths,
of a remarkably different description, anatomically, and yet,
nothing more nor less than another variety of polypus. We
have deemed it incumbent, thus to digress from the main pur-
pose of our paper, with the hope of attaching more of explicit-
ness to this class of the morbid products, peculiar to the female
organs of generation. Fibrous tumors of the uterus are found
to vary, as regards the precise tissue, whence they originate, and
consequently, the precise locality in which they are to be met
with. They are to be found on the external, or peretoneal as-

32 Medical Independent. March

pect of the organ, originating in the cellular tissue or in the ute-
rine parieties, beneath that membrane ; shooting out from it
and occup)ring the cavity of the pelvis, in common with the
uterus and the urinary vescicle. In this situation, they are
likely to induce a conviction of ovarian disease, of some kind,
and give rise to a necessity for extirpation, by abdominal sec-
tion. They also embarrass, mechanically, or impede materially
the processes of micturition and defecation. Occurring, as they
frequently do, in the unmarried, by the alteration in form,
which follows, errors of the gravest kind are liable to be com-
mitted, and the reputation of the most lovely and the most
virtuous, ruined, and their peace destroyed, as in the example
so graphically and pathetically reported by the astute Professor
of Obstetrics and the Diseases of Women and Children, in the
University of New York. Of this variety, perhaps one of the
most interesting, both as regards treatment and its lesults, to
be found in the records of our science, is that reported in the
American Journal of the Medical Sciences, by Dr. W. L. At-
lee, of Lancaster, Pa., for April 1845. Another, of still more
formidable character, and involving both the uterus and its ap-
pendages, so entirely as to render their complete extirpation
necessary, is reported by Dr. Baker, of Knoxville, Tenn.,
in the January number of the Southern Journal of the Medi-
cal and Physical Sciences. The operation was made on
the 13th of November, 1856, and terminated in complete re-
covery, the patient being discharged, cured, on the 3d of Jan-
uary following. They are found located, also, between the
muscular laminre of the uterus, or deeply imbeded in the sub-
stance of its parieties. In this situation, if they attain to con-
siderable size, they may shoot up into the cavity of the abdomen,
giving rise to the same conviction and the same proceed ure as
in the former instance, or into the lower section of the pelvis,
protruding into, and distending the cavity of the uterus ; the
particular direction of the propagation, depending, perhaps,
upon the near proximity of their origin to one or other of the
uterine surfaces, and by consequence, the less or greater resist-
ance, from the involving muscular tissue. With neither of
these varieties is regularity of the menstrual function, incom-
patible, although it may be rendered irregular, and ultimately,
entirely suspended. Of this, however, we shall have occasion to

1857. Original Communications. 33

speak again. Nor is pregnancy incompatible with these patho-
logical abnormities. We met an example of this latter variety
in an athletic woman, in the spring of 1838. A foetus at, or
near full uterine period, had been expelled and the placenta
delivered. Expulsive efforts, however, were still continued,
and the practitioner, from what presented to the touch,
hoped, soon, to have the satisfaction of relieving his patient en-
tirely, by the delivery of another child. In this, he was dis-
appointed, and after an interval of twenty-four hours, our
presence was desired, in consultation. Examination revealed
a tumor, occupying the entire superior strait, and of much
more ample dimensions than the head of a large child. It was
firmly impacted, apparently, in the superior strait, dense and
unyielding. Contrary from what is generally true, there was
but little flooding. Uterine efforts were continued, with vary-
ing energy, during three days, from the time of our visit, when,
notwithstanding the use of anodvnes and nourishing food, the
patient sank, from exhaustion, and a post-mortem examination
brought to light the true nature of the case. Of this descrip-
tion, we do not doubt, was the case, reported by Dr. Power, in
the December number of this journal.

Again, they are found, (and these it is believed, are of most
frequent occurrence,) located on the internal surface of the ute-
rus ; generally beneath the mucous lining, but slightly attached
to the muscular parietes and easily disengaged, or, having
changed and appropriated the primitively enveloping mucous
coat, are firmly adherent to the muscular structure of the or-
gan. In the former example, the whole mass, after a section of
the investing membranous tissue, may be removed, by enucli-
ation, as in the case reported by Mr. Teal, in the Medical
Times and Gazette, for August, 1853. In the latter, this is
impracticable, and extirpation is to be accomplished, either by
ligature or excision. Of this latter variety, was the case soon
to be related. In examples of this description, the menstrual
function may or may not be morbidly implicated. Often it
continues normal, for a long time, or each successive recur-
rence may be slightly augmented, in quantity. Hemorrhage
may or may not be an attendant — at times it is of fearful por-
tent. Generally, however, it is believed, extended observation

will confirm the suggestion just offered, that, in the greatest
VOL. Ill, no. i — 4

34 Medical Independent. March

number of cases, it (the menstrual function,) is not materially
altered, while the general tone of the system continues at a
healthy standard. In regard to hiemorrhage, we have the
sanction of learned authority for the conclusion that it is, in
those examples of fibrous tumors of the uterus, in which they
occupy the fundus of the organ, or the body, and are imbeded
in its substance, that this symptom or consequence, more com-
monly occurs. In the first and last varieties, and if the tumor
be located near the cervix, or quite remote from the fundus, it

is a remarkably less frequent accompanyment.

With this last variety, pregnancy, if not incompatible, ip,

perhaps, not a common event. That it does, occasionally occur,
is not only established by observation, but confirmed by author-
ity, and there mav be much of truth in the declaration that,
" when they — the tumors — occupy the body of the uterus, they
do not present an obsticle to impregnation." Among the con-
sequences operated upon the action of the uterus, when preg-
nancy does occur, is abortion, and in most examples, flooding,
of a grave character afterwards, from inability of the organ to
contract. Even a repetition of pregnancies may characterize
cases of this kind. Summarily, it may be said, in the language
of an able writer, in reference to the uterus, itself, and its
functions, that " the mechanical obstacles, occasioned by
fibrous tumors, may be divided into four kinds. First, reten-
tion of the catam enia from obstruction of the cervix or os
uteri ; second, sterility, from the same cause and from obstruc-
tion of the fallopian tubes ; third, abortion, from impeded de-
velopment of the uterus, during pregnancy ; and fourth, diffi-
cult parturition, when the tumor, situated at the servix or os
uteri, has become sufficiently large to obstruct, or prevent the
passage of the child." Indeed, perhaps it is especially, during,
or soon after delivery, when pregnancy is complicated with this
variety of morbid product, that the most hazardous conse-
quences, are likely to follow, and such cases, observes an expe-
rienced writer, "are not absolutely of rare occurrence." Dan-
gerous or fatal peretonitis, rupture of the uterus, exhaustion,
from protracted labor and long continued and violent, yet inef-
fectual expulsive efforts, and uncontrollable flooding, though
delivery have not been accomplished, are the chief causes of
fatality, under these circumstances. Examples of a fatal ter-
mination, from each of the conditions, just referred to, will be

1857. Original Communications. 35

found detailed by systematic writers, and reported, from
time to time, in the periodical literature of our science. —
Above, we have alluded to the case, reported by Power, at page
219 of this journal, in which death was produced by rupture of
the uterus. Often, as the case progresses, and as the uterus
becomes distended by the augmenting tumor, constitutional
symptoms, somewhat analogous to those of pregnancy, mani-
fest themselves. Even, in certain examples, " the mammary
sympathies have been much excited and the breasts have been
swollen." Other constitutional disturbances, aside, perhaps,
from such as are dependent upon functional derangements, are
not common, until an advanced stage of their progress, when
the assimilative and nutritive functions, becoming implicated,
emaciation, greater or less, as the stage and the extent, to
which the functions, just mentioned, are involved, is a necessa-
ry accompaniment. Generally speaking, their progress is tar-
dy, in a remarkable degree — " months may elapse, without ap-
parent increase, and years, without the slightest inconvenience,
except such as have been already referred to as of a mechani-
cal character." There may be one, only, or many of these tu-
mors, and they may be of various sizes, and exhibit different
stages of advancement. So, also, the same tumor, in different
parts, may, and often does, present widely different conditions
of organization. One portion may be characterized by fully
developed muscular fibre, with vessels, conveying red blood,
while another, puts on evidences of more recent production,
being white, consisting of dense fibrilated or fibrilating fibrine,
and not yet of sufficient age, or maturity of structure, to allow
the circulation of red globules. An interesting feature of
these abnormal growths is, that they are not characterized by
a disposition to take on ulcerative action, nor to degenerate into
a malignant form of disease, though they may, and not unfre-
quently do occur, in constitutions of an obvious cancerous dia-
thesis. Their occurrence prior to puberty is found to be rare,
though Bayle alleges, they are oftenest met with, in females,
in whom evidencies of virginity are found. He also affirms,
that in twenty of one hundred women, indiscriminately select-
ed, after the middle period of life, the fibrous tumor, more or
less developed, will be found, imbedded in the walls of the ute-
rus. Commonly, as the tumor or tumors enlarge, and as the

36 Medical Independent. . March

uterus becomes distended, efforts are induced to cast off the
offending body ; hence pains or contractions simulating those of
labor, at intervals, and often, of marked severity, are a promi-
nent characteristic. Indeed, these are, not unfrequently the
phenomena, that first bring the case under professional super-
vision.

As regards diagnosis, it is sufficient to observe, that, in most
examples, it is not only obscure, but remarkably difficult.
Even examination, per vaginum, fails to reveal, with certain-
ty, the exact nature of the case — often to excite suspicion, un-
til the os uteri, being dilated, the tumor is discovered, either
by the touch or through the aid of the speculum, to be lodged
in its cavity, or having escaped, is found in the vagina. More-
over, if symptoms be assumed, as the basis of conclusion, it
will be found that most of them are equivocal ; inasmuch as
nearly all may arise from other causes or conditions of the re-
productive organs.

While speaking of diagnosis, we would not forget to observe,
that, when the tumor originates beneath the the mucous lining
of the uterus, or under a thin lamina of the muscular coat, is
located near the fundus, and when it has attained considerable
size, it may, from its weight, be productive of inversion
of that organ. This offers an exceedingly embarrassing com-
plexity and makes the diagnosis singularly difficult. It may
be true, likewise, that, though inversion may not have ta-
ken place, nevertheless, the the tumor and the inner surface of
the uterus being covered by the same membrane, it may be
mistaken for that morbid condition, and it is not improbable,
as suggested by reliable authority, that many of the cases of
amputation of the uterus, reported from time to time, have
been of this kind. None can question, then, the necessity of
great care, in the examination of this description of morbid
growths, nor of much caution in their diagnosis. Nor is it less
a duty to observe, that, in the first variety mentioned, if the
tumor be attached to the exterior surface, or originating be-
tween the muscular layers of the uterus, it propagates itself
into the cavity of the pelvis, it may, when it has acquired con-
siderable size, give rise to retroversion of the organ, again
complicating both diagnosis and treatment.

But there is another feature of this abnormity, having refer-

1857. Original Communications, 37

ence to prognos is, which, merits more than a passing remark.
The practitioner will always be enquired of, if there is not
much danger of this disease reproducing itself, at no distant
period, notwithstanding extirpation may have been successful-
ly accomplished. Impressed by an apprehension that such an
event is to be expected certain highly qualified therapeutists
have advised the application of nitrate of silver, to the
radical after the removal of the tumor, in the hope that
it would effectually prevent the dreaded recurrence. We
are not aware, however, that the recommendation has ever been
brought to a practical test, and it is believed that the suggestion
has its origin, in theory, founded on inference, rather than on
intelligent observation of the results of such proceedure, in
analogous cases. Fortunately, too, we believe extended re-
search will confirm the declaration of Clement, Puzos, and
others, " that the root of the, polypus, which remains, never
grows, again, after the general mass of the tumor, has been re-
moved." We regard this deduction, from experience, as of
great value, both to the practioner and the patient, since it
enables the former to impart encouragement with a good de-
gree of confidence, and thus, inspires the latter with an as-
surance of hope, which cannot fail to influence, beneficially,
the final result.

Having dwelt, thus, at length on the principal facts, that be-
long to this class of morbid uterine growths, we proceed to re-
port our case, whose history, treatment and result, together
with the microscopical character of the tumor, are as folljws :
On the 20th of October, last, Mrs. J., aged nearly forty-seven,
and her youngest child, being 16 years old, was attacked with
severe abdominal pains, recurring at intervals of ten to fifteen
minutes, and accompanied, as she believed, with copious flooding.

This state of things continuing, notwithstanding recumbency
and the use of certain domestic treatment, at about 1 o'clock
P. M., we were hastily summoned to her aid. We found her
suffering, as stated above, and obtained the following account
of her condition for some months preceding. She was of in-
dustrious habits, and had been engaged, as usual, in the cares
of her household, though latterly, with less than accustomed
energy. Her appetite had not been good during the summer,
and her catamenial periods had been of unusually frequent occur-

38 Medical Independent. March

rence, and greatly augmented in quantity. These disarrange-
ments she had attributed to the change, in this important
function, incident to her period of life, and, therefore, were re-
garded as of no special consequence. While she had not been
conscious of any existing disease, she had found herself gradu-
ally declining in flesh and strength, and her rest had not been
as refreshing as common. Observing the character of her pains,
during this brief historical statement, we were forcibly struck
with their likeness to those of .abortion, or even of labor at full
time, and asked permission, alter a few hasty enquiries, to ex-
amine the condition of the abdomen, which was readily grant-
ed. This revealed a uterine tumor of the ordinary size of the
gravid uterus, at the fifth or sixth month. Her attention was
was immediately called to the fact, by enquiring if she had sus-
pected pregnancy, to which she answered negatively ; and fur-
ther, while she had observed that, within a few weeks, her
clothes had been tighter than usual, she had not been aware of
the tumor, to which her attention had just been directed, nor
had she suffered any of the sympathetic influences, which, on
all former occassions, were present, when she was pregnant.
She was informed that she was pregnant, or, that some morbid
product occupied the the cavity of the womb, and a doubt was
expressed, whether, if pregnant, the product might not be
anormal — a false conception — a mole, or a hydatid, &c. It was
soon ascertained, too, that what she represented as serious
flooding, was a copious discharge of a seroid fluid, but slightly
tinged with blood. The pulse, though somewhat feeble, was of
normal frequency, and, in no sense, indicative of approaching
exhaustion. All things considered, it was concluded, whatever
the contents of the uterus, the indication was, to quiet, and
wait for further developments. No particular circumstance, at
this time, seeming to call for an examination, per vaginum,
rest was enjoined, and an anodyne prescribed. At evening, she
was found more comfortable, the opiate having allayed nervous
irritability, of which, there had been considerable, and greatly
mitigated the pain. The next morning, she reported a satis-
factory night's repose, was refreshed and quite free from suffer-
ing. The anodyne was repeated, and, the bowels, having been
rather torpid, a laxative was advised, which acted, in the course
of the day. She passed a comfortable night, and was soo^

1857. Original Communications. 39

able to be about her house, in a state of general health, quite
as comfortable as before. On dismissing her, she was requested
to examine her sensations, to determine, whether there were
any, even the remotest indications of quickening ; what the
mammary sympathies, &c, &c.

From this time, she passed on, quite as well as prior to the
attack above described, till the the 12th of November, when
we were again desired to see her in some haste. Obeying the
call, immediately, we found her in a condition, quite similar to
that of the former occasion — pain, however, was more severe,
and recurring at shorter intervals, and, if there was a differ-
ence, the watery discharge was more abundant. Now, it was
deemed advisable to examine, per vaginum. This only tended
to confirm the prior diagnosis — the neck of the uterus seemed
quite obliterated, and the os, closely agglutinated. In short,
no indication presented, save such as characterized impregna-
tion, of about six months standing. As already remarked, the
former diagnosis was confirmed ; the same indications of
treatment offered, the same course was pursued, and the same
result followed. At this time, she informed me, she was con-
vinced of pregnancy. She was quite confident she had been
able to recognize obscure motion, the breasts were quite tumid,
and the areola of deeper tinge, than natural, in the unimpreg-
nated state. Eest and anodynes, having quieted the dis-
turbance, she was soon able to resume the supervision of her
household though with less of personal comfort, than during
the former intervals, till the 28th of the same month, when
the phenomena, before described, were reproduced in a greatly
exagerated degree. Again, requested to visit Mrs. J. in haste,
we found, in addition to exagerated pain, that the vaginal dis-
charge had undergone considerable change, assuming a sanious
aspect, putting on a remarkably offensive odor, indicating that
some body or product was in process of decomposition. The
uterine efforts were affirmed to be more severe than she had
ever endured, in parturition ; the pulse was small and weak,
and general strength had somewhat declined. For the present,
the treatment, previously pursued was advised, with the ad-
dition of a vaginal injection of solution of chloride of lime.
She had a tolerably comfortable ni ^ht, and, during the 29th,
suffered much less than the day previous, and the discharge

40 Medical Independent. March

was considerably abridged. On the morning of the 30th, pains
of an urgently expulsive character recurred, and indications
were present, as far as could be inferred, without a vaginal ex-
amination, that a speedy termination of the case, by the ex-
pulsion of the contents of the uterus, of whatever kind, would
take place. Examination, per vaginum, revealed the presence
of a body, quite in the vicinity of the vulva, of an oval shape,
and as large as a child's head, of medium size. We soon con-
vinced ourselves that it was an abnormal product, of some
kind, and sought to bring it down, but our efforts were inef-
fectual. At this stage it was found impracticable to reach the
os uteri, and, therefore, to determine, with certainty, whether
it was one thing or another — an imperfectly developed product
of conception, or a tumor, attached to some portion of the
uterus. With a view to accomplish as much towards expulsion
and unquestioned diagnosis by the efforts of the uterus
alone, as possible, ergot was administered.

This produced its customary effects, and efforts to grasp it
with the hand and bring it down, were repeated. Failing in
this, the forceps were applied, and, by their aid, without the
least augmentation of pain, we soon succeeded in bringing it
exterior to the vulva. Now, for the first time, the os uteri
could be felt, at its right ilio-pubic aspect, but could not be
reached, at any other point, nor could attachment be distinctly
made out, although we had no doubt of its true character.
Convinced of the difficulty of our case, and the responsibility
attendant, we proposed counsel, leaving the choice to the pa-
tient, when Dr. M. Stewart was invited. Meantime, however,
an additional portion of ergot had been administered, and far-
ther tractile efforts had been made, which had been, in a de-
gree, effectual in bringing both the tumor and the uterus
into a favorable position for examination. On his arrival,
after hearing a history of the case, an examination, en-
abled him, with considerable difficulty, to find an attachment,
at the right ilio-pubic aspect of the os, and about half an
inch within its margin. After consultation, it was conclu-
ded to bring it down, as far as possible, and apply a ligature.
At the suggestion of a near relative of the family, Dr. J. A.
Brown was called in, who, aided by a detail of the main
features of the case, and an examination, concurred, both
in the diagnosis and in the proposed treatment.

1857. Original Communications. 41

Other engagements pressing, and, as there was no flooding,
nor urgent symptoms of any kind, requiring haste, it was pro-
posed to postpone farther treatment, till a given hour. On
meeting, at the stipulated time, it was found that the friends
had deemed it well to have the advice of Dr. Pitcher, whose
name, among others, we had proposed in the first instance.
He soon arrived, when, after examination and consultion, it was
concluded to bring the tumor down, to the lowest practicable
point, and extirpate, by incision. For this purpose, a fillet was
applied around the protruding portion, by the aid of which, in
the hands of Dr. Brown, the other prefessional friends kindly
aiding, by their encouragements — we were enabled to bring the
tumor, and with it, the uterus, to a point, so low, that we
could explore and trace, in a measure, satisfactorily, the extent
of its attachment. We have already stated that it was found
adherent to the right ilio-public aspect of the os, and a little
within its margin. From this point, it continued, by a broad
base, up the side of the uterus, across the entire breadth of
the fundus, and thence, along the opposite, or sacro-iscaiatic
aspect, to within about an inch or an inch and a half of the
os, in that direction. A short distance from the surface of the
uterus, either from intrinsic conformation, or from the the ten-
sion, operated by the tractile force, applied, its dimensions
were contracted to about the size of the wrist. Here, we re-
solved to sever it, and the operation was accomplished in the
following manner : The common round edged scalapel was
chosen, as the most convenient instrument, the blade of which,
to the distance of about one-third of an inch from its point, was
securely wrapped in a fillet. Then, passing the thumb and
index finger of the wright hand along the vagina, and towards
the sacral aspect of the tumor, with the scalpel so grasped be-
tween them, as to have the back rest on the finger, presenting
the edge upward and inclining toward the tumor, and likewise
passing the index finger of the left hand immediately beneath
the pubis and above the tumor, to a position directly over the
point of the instrument, with a repetition of cautious move-
ments of the knife upward, and making it meet the finger of
the left hand, at each time, thereby, effectually guarding all
parts, except the tumor, from injury, it was soon detached, and
our patient, and all present, relieved. The operation gave rise

42 Medical Independent. March

to no pain, evincing the complete insensibility of the part, and
throughout the whole proceedure, there was scarcely a gill of
blood lost, and that little oozed from the pendulous portion, in
the course ot the handlings during the day. The patient was
put to bed, the binder was applied, with a moderate degree of
tightness, an anodyne administered, and in all other respects,
she was treated as we are accustomed to treat, after child-birth.
She was kept under supervision, till the 25th of Dec, when,
no untward symptom having occurred, and physical strength
being satisfactorily restored, she was dismissed, cured. Since
that time, she is quite confident she has had one normal cata-
menial period, but it has not been repeated. We saw her a few
days since, and were informed that she scarcely has in recollec-
tion, a period of the same length, when she has enjoyed firmer
health, than since the date last referred to, and, certainly, judg-
ing from her appearance, we readily credit her report.

The tumor was eleven inches in circumference, at its largest
portion, and its length was ten inches. We cannot declare its
weight, as it was not convenient to weigh it, for some time af-
ter extirpation. We are indebted to our colleague, Dr. Goad-
by, for the microscopical examination of its structure, who
declares that the " colored portion," which constituted about
two- thirds of the whole mass, "clearly demonstrated that it was
a simple fibrous tumor" and that " the examination of its in-
terior, and every portion of the red structure, only confirmed
this truth." " The colorless portion," which was the superior
third, was " equally fibrous, but there was this striking differ-
ence— the colorless part of the tumor displayed only colorless
corpuscles. The necessary inference is, that the colored portion
was older and had become organized, whilst the newer colorless
part retained the primitive type of structure."

Detroit, February, 1857. K.

Caustic in N^-etus. —

Dr. Macke recommends the following caustic as a highly useful application
to naevi materni, especially in young children. Corrosive sublimate 4, collo-
dion 30 parts. It is to be applied with a small brush, and desiccation takes
place so rapidly that the action of the caustic does not extend beyond the
spots it is applied to. A solid e3char, one or two lines in depth, falls off in
from three to six days, and the pain induced is inconsiderable, and of short
duaation. — Revue Med.t 1856.

1857. Original Communications. 43

ARTICLE VI — Supurative Arthirtis — Kecovery without
Anchylosis, with Illustrative Cases.

BT H. WATSON, M. D.

Editors of the Medical Independent: — In the July number of
the Peninsular Jour, of Med., I noticed a communication on the
possibility of the preservation of the joint in supurative arthritis.
Two of the cases there related occurred to patients in a puerperal
state, and as the author admits, even not very well marked,
consequently any inferences from them, not absolutely conclusive.
The third case was different, and not liable to the objection, and
its history reminded me very forcibly of two cases which1 fell
under my own observation.

In March, 1826, George Wells, a healthy farmer boy, about
fourteen years of age, wounded his knee slightly, with an axe,
and by advice of a man calling himself a physician, the wound
was dressed by applying a piece of salt fat pork to it, confining
it with a bandage. Some six days afterwards, I found him
suffering with a severe pain in the knee, and a violent sympa-
thetic fever; the whole joint was hot, very much swollen, and
shining like a glass bottle. On removing the dressing and
attempting to flex the limb a little, a stream of sero-purulent
matter issued from the wound, as nearly as I can recollect, a
full teacup-ful. Dressing the wound with a plaster of simple
cerate, I covered the whole joint with a large blister, enveloping
the limb for six inches above and below the knee with a thick
bran poultice, opiates were administered freely, and such nour-
ishmer t as he could be induced to take. Under this treatment
he became more comfortable, but the purulent discharge
continued to be very copious for more than a month, averaging
each day a half a pint or more of thick yellow pus. On exami-
nation with a probe, there was no difficulty in passing it through
the joint and several inches in other directions; the constitu-
tional symptoms were proportionably severe. Kestlessness,
chills, colliquative sweats, and emaciation which ultimately
became alarming, were combatted with opiates, astringents,
quinine, cordials and animal broths. After two or three weeks
had elapsed, granulations could be discovered in the lips of the
wound, which at length became prominent, protruding like a
fungus — the discharge of pus, however, diminishing in propor-

44 Medical Independent. March

tion to their growth. These changes were accompanied with a
gradual subsidence of the hectic, and I had the satisfaction of
seeing him fully restored to health in eight or ten weeks after I
first took charge of him. The protruding granulations were
easily repressed and the sinuses up and down the limb were
gradually obliterated by the application of compresses. While
this process of granulation was going on, I every day flexed and
extended the limb, thus giving some motion to the joint, and
enjoined upon the attendants to do the same occasionally in my
absence. For several months the joint was less flexible than
before the injury, but by use, at length this stiffness was over-
come, and so far as comfort or use is concerned, the limb is as
perfect as the other. There is, however, some deformity apparent
to the eye, a deep depression exists where the wound was, with
a corrugation of the skin, owing, doubtless, to the absorption of
the fleshy parts and an adhesion of the skin to the bone.

The second case occurred in Springfield, Massachusetts. In

the winter of 1847, I was requested to meet Dr. S , of that

city, in a case of acute rheumatism, as the messenger informed
me. On my arrival, I found the patient, a fine little boy of
about seven years of age, in a perfect frenzy of excitement from
pain and spmpathetic fever, the countenance expressed the
most intense suffering, he was bathed in sweat, which actually
dropped from his face and hair, the pulse counted 140, and was
sharp and wirey; his parents informed me that he had not slept
five minutes at any one time, and had not been moved from
the posture he was then in, for more than four days, and that
any attempts to move him produced such dreadful screams that
they were obliged to desist. On raising the sheet, which was
thrown lightly over the limb, I found the leg flexed some fifteen
or twenty degrees on the thigh, and the whole limb from the
ancle to the hip very much swollen, end about the knee a good
deal discolored and shining. On inquiring if there had been
any injury, the parents denied any knowledge of an accident,
but the little patient himself at once told me that while playing
with his mate in the street, he had fallen and struck his knee
on a small stone, which hurt him so severely that he was scarcely
able to get home. Very little attention seems to have been
paid to his complaints, although the servants said that after the
accident he wholly refused to use the limb, and no physician

1857. Original Communications. 45

was called until four or five days after. Dr. S. pronounced it a
case of acute rheumatism, which he said was then prevalent in
the city, advised a covering of pelisse wadding and the use of
Tinct. Actia and camphorated Tinct. Opium, equal parts, in
small doses, regularly. This plan of treatment was continued
till I saw him some five or six days later. On examination I
could find no evidence of supuration at that time sufficient to
warrant an opening, but had little doubt there would be soon.
I persuaded Dr. S. to combine with his treatment the use of
enough sulphate of morphine, to allay the excessive sympathetic
irritation and pain, so that he might have some sleep, and to
apply blisters and poultices to the affected limb. Springfield
being about sixteen miles from my residence, I stayed through
the night with the fan ily, and was gratified to see the little
fellow sleep several hours in comparative ease, and I left him in
the morning, lying upon a fresh, clean bed, with a calm counte-
nance and a pulse of 110 in a minute. After this I saw the
patient only once in four or five days — Dr. Smith, of Springfield,
(afterwards lost in the Norwalk catastrophe) having been asso-
ciated with the attending physician in prescribing for the case.
An opening was made into the joint a few days after, and there
was a copious discharge of pus and sanies for several weeks,
extensivs sinuses formed above and below the joint, dissecting
the muscles, and requiring openings in various places, and the
poor little sufferer became almost a skeleton under the exhaus-
ting effects of the discharge, and the accompanying hectic. It
at length became a question with the other physicians, whether
a removal of the limb would not be necessary for tha preserva-
tion of his life, and at their request an eminent professor of
Anatomy and Surgery in one of our large Universities, was
invited so see him in consultation; he said there was extensive
disorganization of the joint, an absorption of the cartilages,
and probably caries of the femur and perhaps of the tibia, he
thought his life in great danger under any treatment — recovery
with anchylosis the best possible event, the preservation of life
at the expense of his limb, would in his opinion be a very for-
tunate termination. Ccnversing with the parents I found them
very unwilling to allow an amputation — my own opinion about
the ultimate result was less unfavorable, and I was very well
satisfied to trust the case to time, soothing topical applications,

46 Medical Independent. March

and the liberal use of wine, cordials, anodynes and food — the
event justified my anticipations, the local symptoms became
less severe, the constitutional affection gradually subsided*
One after another the abscesses and sinuses in the limb healed,
at least in part, and he recovered his flesh and strength pretty
rapidly. Instead of anchylosis the mobility of the joint was
preserved imperfectly, as the leg could be flexed on the thigh to
a right angle and extended so as to form an angle of 135 or 140
degrees without causing much pain. By persevering efforts the
use of the joint was materially increased, and although he has
never acquired the power of making the limb quite straight, he
now walks without a staff or any other support and can flex that
limb perfectly as the other. Considerable deformity is apparent
about the knee upon inspection, and there are still some openings
above the knee surrounded with callous edges, through which a
little thin ichor escapes, and several little spicula of bone have
passed out at these openings.

What the morbid changes were which took place in this case,
it is probably not possible to determine with accuracy, but that
the whole joint was for several weeks in a high state of high
inflammation, involving the synovial lining and the cartilages,
Beems to be very apparent. I have long been of the opinion
that by a proper course of treatment and especially by the per-
severing use of motion of the joint, at the proper time, anchylosis
may commonly be avoided, at least in a considerable proportion
of cases of supurative arthirtis.

Detroit, January, 1857.

Chloroform in Croup.

M. Passavant relates some trials that he had begun to make with chloroform
in croup. He had observed that in pnuemonia, under the influence of this
agent when inhaled, the viscid expectoration was discharged, enveloped, as it
were, in a liquid exudation, and from that fact he hoped, by the use of chlo-
roform, to be enabled to facilitate the detachment of the false membrane, in
croup. At intervals of greater or less length, chloroform was inspired for
about ten minutes. The result was surprising. Strips of false membrane,
many centimetres in length, were expectorated with violent efforts at coughing
These observations, however, are not sufficiently numerous to enable him to
decide definitively on the value of this treatment It cannot yet be determined
whether it merely favors the expulsion of the exuded membrane, or exercises
a favorable influence on the mass of the blood. It is probable that it has no
action on the spelling of the larynx in which tracheotomy is indicated.—
Archiv. Physiol. Heilk.—N. O. Med. and Surg. Jour.

SPIRIT OF THE MEDICAL PRESS.

Treatment op Neuralgia by the Valerianate of Ammonia. By Dr.
Declat.

We have prepared an abstract of an interesting translation from the Revue
Med. and Etrangue, which may be found in a late number of the Medical
Examiner, as it brings to our notice a new remedy, which may be of value in
the treatment of a class of diseases increasing in frequency and oftentimes
obstinate in their persistency. According to Dr. Declat, such cases will yield
to the influence of valerianate of ammonia; and as a proof of his statement
he gives the following cases:

Case I. The Marchioness of Fontanelle suffered with facial neuralgia for
six years, first appearing as she was cutting a wisdom tooth. Legrand and
Jobart (de Lamballe) ordered its extraction,which was done, causing agonizing
pain. The neuralgia still continued in spite of every effort of such advisers as
Sedillot, Velpeau and Jobart. Quinine, opium, belladonna, strychnia, iron,
gold and quinquina were employed, and external applications, such as blisters,
opium plasters, dulcamara, chloroform, collodin, aconite, &c. Everything
failed. Jobart applied tho actual cautery along the course of the inferior
maxillary nerve, and after applying the waters of Plombierre with partial
though temporary relief, tho Marchioness applies to Dr. Declat.

The first remedy used was fowler's solution, which was pushed until it pro-
duced constitutional symptoms, without success. The patient had become
almost insane from the agony, when an experiment was made with valerianate
af ammonia, on the 3d of January. A teaspoonful that night relieved partialy
and two toaspoonfuls tho next day, entirely banished the pain. The medicine
was discontiuued May 6th. Occasionally, however, Mad. Ferrand has "slight
twinges," but resorts to the specific, and always successfully. This lady seems
to have a hereditary right to neuralgia, ner mother having been a great victim
to the disease, whilst her brother, the Earl of Essex, has had ticdoloreux from
his youth.

Case II. M. Letellier, who had suffered horribly with pain in the head»
extending to the neck, and losing itself on the branches of the facial nerve*
was at Plombierre's when taken, and returned to Paris in great agony. Dr.
Louis tried blisters, sage, quinine -end morphia without any effect. He used
morphia to such excess as to remain in stupor almost constantly. Dr. Declat
administered the valerianate of ammonia in drachm doses, twice a day. In
five day 8 he was up, and in nine days all pain had passed away. He has
since stated that his cure was complete. — Phila. Med. $• Sur. Journal.

48 Medical Independent. March

Application of Ice to the Os Uteri in Cases op Uterine Hemorrhage.

Prof. D. W. Brickell in an article on Placenta Prsevia. in the November
No. of the New Orleans Medical News, speaks in the following language :
" In my intercourse with medical m^.n I have heard the application of ice to
the os uteri, in cases of dangerous flooding, condemned as rash, unnecessary,
and unsafe ; but such condemnation has only been expressed by those who
have never used it. I can only say, that I have now resorted to the remedy
four times — in every instance successfully — and so prompt has been the reliefi
that I can not help regarding it as a true sheet anchor in such cases. I
have never been able to theorize myself into the belief of its dangerous ten-
dencies. It is altogether probable that the continued application of ice to
the os or internal surface of the uterus, would be productive of serious conse-
quences, but not so with its transient application. "We apply ice to the ab-
domen to arouse the dormant energies of the uterus ; in ordinary cases the
susceptibility of the uterus to impressions directed through the sentient
nerves of the skin, is active, and the organ contracts ; but in another case,
the skin will not serve as a medium of impression, the peril is imminent, and
the organ must be reached more directly ; there is no time for waiting on
ergot, brandy, &c. ; the stimulus of the bare hand in the uterine cavity is cot
sufficient ; but a lump of ice carried quickly to or within the os, and in a
moment withdrawn, will meet the indication and save life. So far from ap-
prehending danger from its use, I have seen such prompt relief afforded,
that I should henceforward be more inclined to rely on tha application of
ice to the vagnia, than to the abdomen in ordinary cases of hoemorrhage,"

Large Oyarian Tumor Removed by Dr. Dunlap, of Ripley, Ohio.

On Friday, the 16th of December, ult., Prof. R. D. Mussey exhibited an
ovarian tumor to the class of the Miami Medical College, which was removed
on the 18th, by Dr. Dunlap, of Ripley, Ohio. The solid tumor weighed
100 lbs.; and besides this, some five pounds of fluid were lost in the operation.
This is, perhaps, the largest ovarian tumor ever extracted from the living-
subject. The patient, after the operation, did not weigh more than the tumor
removed ! She was doing well on the 20th — we have heard no subsequent
report. — Cincinnati Med. Observer,

EDITORIAL AND MISCELLANY.

w Proposed Removal of the Medical Department of the Uni-
versity."

Such is the caption of an article appearing in the Febuarry No. of the
Peninsular Journal, which, though anonymous, we may reasonable accept
as the lucubrations of the senior editor of that Journal. Its purport is a
vindication of what the writer terms " the Prasso Michigan System of
Public Instruction" in which he attempts to show that a removal of the
medical department to this city would destroy the symetrical proportions
of a system of universal education " borrowed from our Teutonic rivals in
education." The learned senior, as it seems, was prompted to offer this
exhibition of his logical acumen, by an article which appeared in our Janu-
ary issue, in which we presented some thoughts upon the same subject.
"We are exceedingly gratified, therefore, that we have been able to generate
an excito-motory influence, sufficient to call forth even an attempt at argu-
mentative reasoning in support of objections urged against a removal of
the medical department. Eminating from such a source, it must be con-
sidered as the most profound logic that can be made available in staying
a ruthless hand put forth to disturb the unity, harmony and integrity of a
system which requires a new coinage in nomenclature for an appropriate
cognomen. To say the least, it is an improvement on all former articles
from the same pen, inasmuch as the greater part of it is within the com-
prehension of all who will make the attempt to read it. Unfortunately,
however, for the moral force of the whole, the first paragraph contains a
statement which bears the impress of the vindicative spirit that gave it
expression. Its first allegation is that, " the Medical Independent was
designed, from its inception, to establish a claim to popular regard by
assailing the University." Now, the author of this assumption may be
honest in his convictions, and, inasmuch as he so often "sins through ig-
norance," and, so long as the allegation is perfectly harmless, we shall ex-
ercise a good degree of forbearance, attributing the error to a perverted
brain, rather than a disorder of the heart We are not at all surprised to

find this allegation, the leading proposition in the elaborate effort, for it ia
VOL. Ill, NO. 1—5

50 Medical Independent. March

perfectly consonant, with the puerility that characterises the mind which
gave it a conception. The strongest point which such a mind could make
would be to falsify our position, impugn our motives, and leave the main
issue to specious sophistry. But our position with regard to the Universi-
ty has been too well defined and understood to be compromised to any
alarming degree, by such a wilful perversion of truth.

The author of the article seems to be very much disturbed on account
of our allusion to the Prussian origin of our educational system, "placing
it before the public eye in such a light as to lead to the belief that it is a
recent exotic, and not a naturalized plant, genial to the soil of a healthy
and vigorous growth."

We have had to hear a great deal, from time to time, about the great
u Prussian System" upon which our system of education has been found-
ed, but hereafter it must be knjawn"~3s The. il^russo Michigan System."
No one will object to this/CQnipoiind coguo&en?, ^r if our State has failed
to carry into successful filiation, *a system " borfio^Ned from our Teutonic
rivals in education," the faultjusjwpt sin $&) (System,] but in its practical
adaptation to the educational interests^ of Jhe State/ It is only proper,
therefore, if the system *$$/foi\ed, to indicate^ tH enlace where it failed.

Now let us see how this "^^J^russ^ ilichigajr system is working, then
we shall be better able to appreciate the propriety of this change of cog-
nomen. The writer tells us that this li system consisted in the harmoni-
ous blending of the three degrees of education, found in the common
Bchools, the Gymnasium, or elevated academy, and the University, wherein
the highest degree of instruction is communicated, and that this whole sys-
tem is under the supervision of an officer of State, entitled the Superin-
tendent of Public Instruction."

He would have his readers believe that the three degrees of education
— the common schools, the academy, and the University— are blended and
working in unity and integrity ; ergo, to remove the medical department
of the University to this city would destroy the beautiful symetry of the
" Prusso Michigan System." But a very brief history of the facts, in re-
lation to the harmonious blending of these departments of education in
our State, as they now exist, obtained from our able Superintendent of
Public Instruction, leaves nothing for the argument of the writer, save the
embelishments of his pedantry. His conclusions would be more legiti-
mate if his premises were true.

How does he dispose of the stubborn fact that the academies of the
State are not only independent of the University, but have already be-
come formidable rivals in successful competition for its highest honors ?
Prom whence came a strong opposition which was well nigh successful in
defeating the measure recently brought before our Legislature, asking for

1857. Editorial and Miscellany. 51

another remission of the University debt fund ? The Colleges of Hills-
dale and Kalamazoo have refused to submit to what they consider the
domineering dictation of the University. These schools that were regard-
ed as the intermediate department — the " gymnasium or academy" —
practically ignore the existence of the University, or even a Superintend-
ent of Public Instruction. This looks marvelously like a harmonious
blending of, at least, two of the departments of this " Prusso Michigan
System1'' of education.

The erudite senior ought not to be ignorant of these facts, we therefore
infer that his presumption has led him into error in supposing that we
were.

But, touching the main question of removal of the medical department
to this city, he desires first to express his convictions of the paramount
importance of clinical observations to the medical neophyte as a means of
fitting him for the discharge of those duties which await him when he
enters upon the pursuits of professional life and to record his convictions
that these observations may be most successfully and profitably made un-
der the supervision and direction of a private preceptor."

He still clings to the ghostly remains of a defunct idea, a purpose as ob-
solete as the incantations of the Egyptian priests. Having once commit-
ted himself by virtue of necessity to the expressed opinion that the stu-
dent may have a substitute for clinical instruction while under the super-
vision of his preceptor, he finds it difficult to appreciate the advantages
of hospital instruction. If such are his real convictions, why not give us
the detail, expose the secret, and tell us how the country practitioner
can give his students advantages, equal to, or at all comparable with the
clinical instruction that may be derived from hospitals. Moreover, if such
were his real convictions, why did he propose, in the very inception of the
medical department, the establishment of a State general hospital, to be
located at Ann Arbor ?

After thus reiterating his peculiar views in relation to hospital instruc-
tion, he records a paragraph which exhibits so fully the depth and profun-
dity of his reasoning, that we cannot do better than extract it bodily.

" In discussing the expediency of breaking in upon the unity of the
University, and of taking the risk of detracting from the moral force of it,
as a whole, for the sake of a contingent advantage to enure to one of its
departments, there are several things to be kept in mind — such as that
the University has no " College hospital," like the institutions of London
and Paris, connected with St. Bartholomew's and St. George's, or La Cha-
rite and Hotel Dieu — that hospitals have had their origin since the incom-
ing of the Christian era, are based upon that beautiful requirement of the
author and finisher of our faith, that * we should do to others as we would
that they should do to us," and should be regarded as asylums for those
who are overborne by sickness and want, and not merely theatres for the

52 Medical Independent. March

exhibition of gladiatorial medicine, or the illustration of the principles
which pervade the beneficent science."

He first assumes that a removal of the medical department to this city,
would break the unity of the University, and detract from the moral force
of it as a whole. But it is not proposed to sever the department from the
University organization ; it would still be governed and controlled by the
Board of Regents. How, then, would its unity be at all disturbed, or its
moral force weakened ? Would it be thus affected if the buildings of the
medical department were one mile out of the village of Ann Arbor ? We
are next informed that the University has no " College hospital like the
institutions of Paris, London, &c. This is the most potent reason that
could be offered in favor of its removal. Hospital advantages are the life-
giving impulses of the New York and Philadelphia schools. We need not
go to the Old World for familiar examples illustrative of the utility and
success of medical schools, derived from hospital instruction. A State
general hospital is an indispensable adjunct to a State medical school, and
it would be provided with great facility if the medical department were
located where a State hospital ought to be located. But such an institu-
tion at Ann Arbor would be as much out of place as the medical depart-
ment is now. This will be at once conceded by every unbiased mind, ca-
pable of appreciating the wants and purposes of such an institution. But
let the writer answer this objection as he has done on the opposite page,
and in the very same article as follows : " As pertinent to the subject un-
der consideration 7 we are permitted to state that those devoted and self-
sacrificing women, the Sisters of the order of St. Vincent, in charge of
St. Mary's Hospital, in this city, have consented to open their house to
the graduates of the medical department of the University under the
guidance of a clinical professor, subject only to such regulations as will
occasion no embarrassment to the professor or his class."

This is not the first instance in which the arguments of the writer have
been found to contain their own refutation ; but he ought to have added
that by the action of the faculty in relation to this matter, they have prac-
tically admitted the importance of clinical and hospital advantages, and,
moreover, have already determined to make available such as are offered
in the city of Detroit. We rejoice that even this first step has been taken,
and if the Regents sanction the efforts of the Faculty, graduates, at
least, will have advantages such as the whole class ought to enjoy. We
have no fears that St. Mary's Hospital will furnish more glaring exhibitions
of " gladiatorial medicine11 than it has already done, or that any greater
violence will be done to that ■ beautiful requirement of doing unto others
as we would that others should do unto us," (under like circumstances.)

In our judgment, there has been too much partizan attachment to certain
ideal forms, having a magnitude beyond the compass of a practical

1857. Editorial and Miscellany. 53

adaptation of available means to the real wants and purposes of the vari-
ous interests connected with the University. Too much devotion to a ra-
tional abstraction, rather than the practical working of a system which
mav be intrinsically superior to all others. If the system adopted is so
arbitrary and circumscribed as not to admit of such modifications as are
necessary to the development and utility of any one or more of its de-
partments, the sooner it is abandoned, the better.

Some of the departments will, undoubtedly, flourish best at Ann Ar
tor — the seat of the University, but the medical department must, of ne-
cessity, compete with the other medical schools of the country, and to do
this successfully, it must offer equal, if not superior advantages. The most
flourishing schools of this country, and every other, are those which pro-
vide the best clinical and hospital advantages, while the most inferior in-
stitutions that are dignified with the appellation of " Medical College," are
located in small country towns, where clinical advantages cannot be ob-
tained aud cultivated. A lengthened term of study, and gratuitous in-
struction may be sufficient inducement to call together and graduate a
class, that will compare favorably in point of numbers with many other
schools, but not so fovorably, if compared with many others, in respect to
thorough practical instruction. Now, if a greater desideratum be added
to the already strong inducements offered by our medical department, who
can doubt, for one moment, that a corresponding increase in the number of
students- will be added annually to its catalogue ?

But let us see if the plan last proposed by the conservative faction of
the faculty is adequate to the real necessity of the case, or promises to ful-
fil the requirement. The proposition is, as we understand, to institute a
summer course, which is to be given in this city, in connection with the clin-
ical advantages to be derived at St. Mary's Hospital, and understood to be
the exclusive privilege of graduates. Whether before or after graduation,
however, we are not informed. " Under the guidance of a clinical pro-
fessor."

One man, then, is to represent all the departments of medical teach-
ing ! this is in perfect keeping with the one man power heretofore adopt-
ed in the medical supervision of that institution. It is a matter of no
surprise to us that this juvenile plan should be proposed by a man who
has always exhibited the selfishness of a medical demagogue ; but we
hope that the good sense of the other members of the Faculty will be
sufficient to save the medical department from making a burlesque of the
original design. Who is this Hercules that is to give clinical instruction
in all the departments ? We would rather introduce such a prodigy to
our readers than be a modem discoverer of a new complication of in-
guinal hernia !

Now it is very well known that a large majority of the medical stu-

54 Medical Independent. March

dents that find their way to Ann Arbor, are those who cannot, as well
afford to go to New York or Philadelphia. In other words, the differ-
ence between $10,00 and $75,00 or $100 is a controlling conside-
ration. Is it probable, then, that these students will be willing to
expend enough more for board and tuition to make their aggregate
expenses equal to a sum sufficient to give them the graduating honors of
New York and Philadelphia schools ? Moreover, it would only be con-
sistent with the elevated standard of medical education, which the Univer-
sity may justly claim in consideration of its teachers, and its lengthened
term of study, to say nothing of its munificent endowment, to provide the
whole class during each term of lectures with practical illustrations of
what they are taught by the advantages of a well furnished surgical clin-
ique, and cases under hospital treatment. To render a medical education
practical, to teach the student how to observe, and how to make his obser-
vations most useful and available, as in the development of the moral
character, it requires " line upon line, and precept upon precept." A fa-
miliarity with the physiognomy of disease, in all its varied aspects and
forms, is to be acquired, not from books or oral lectures, but by applying
the principles inculcated, to practical observations. Now, if the clinical
advantages offered in this city were judiciously cultivated, they might be
made, to say the least, a very respectable substitute for the " College Hos-
pitals" of older institutions. When such advantages arc appreciated and
wisely appropriated, increasing necessities will, of themselves, suggest and
lead to ample provision for the increasing demand of adequate facilities for
giving hospital instruction.

Now, it is because we have had the moral courage to speak plainly up-
on this subject, urging its importance, independent of private or sectional
interests, that we have been accused, by the urbane senior of the u Penin-
sular" of assailing the University generally, and the medical department
in particular. But since he has practically admitted the importance of
hospital advantages, we hope that he may live long enough to satisfy his
own mind that such advantages as are here proffered, though not equal to
those offered in the institutions of Paris, are, nevertheless, vastly superior
to the meagre bed-side teachings, which, at best can be offered by the
private practitioner. There is more than a natural "State pride" to
prompt our desire to see the University perfected in all its departments,
but more especially do we most earnestly desire to see the medical depart-
ment fulfil the object for which it was originated, and which its munifi-
cent endowment justly entitle its friends to expect and claim. If we " as-
saiV any thing in connection with the University it will be some mani-
festation of that selfish, illiberal policy or dormant conservatism, that
would sacrifice a public good for some paltry private interest. This much
we owe to the prerogatives of an independent Journal. B.

1857. Editorial and Miscellany. 55

Our Paris Correspondent.

We are happy to lay before our readers in the present No. the first of a
series of communications from a regular correspondent in Paris. The
writer is now enjoying the advantages to be derived from attendance upon
the hospitals of that city. We can promise to furnish, through his pen,
many items, gathered from the life of a medical student in Paris, that will
be found entertaining and profitable.

We shall spare no reasonable expense or practicable effort in making
our Journal worthy of a prominent position in the medico-periodical litera-
ture of this country, and to accomplish this object, we earnestly solicit the
continuance of that efficient co-operation which has already been extend-
ed to us through the contributions of some of the most studious observers
and accomplished writers of our profession.

Significant Extracts from our Exchanges.

It will be remembered that, in our last number, we made a gratuitous
insertion of apathetic appeal made by A. B. P., of the " Peninsular Jour-
nal," in behalf of his senior associate. We deem it but just and properf
therefore, to insert a few extracts from our cotemporaries, which our mod-
esty, under other circustances, would hardly permit us to record upon our
own pages. We have had many such complimentary notices, both from the
medical and secular press, to say nothing of the large correspondence of
our subscribers. They have served their purpose well in giving us the
cordial hand of fellowship, and kindly words of friendly greeting, strength-
ening our courage, and giving new zeal to our efforts.

But we need them not for advertisements, for if our Journal is not ac-
ceptable, and worthy of ample support without them, no approving
comments from friends could alone, entitle it to that professional regard
and confidence which we labor to secure and maintain.

" In its last number, the " Peninsular" appeals to the profession at largo to
share in its quarrel with the " Medical Independent. Under the present cir-
cumstances, we respectfully decline, so far as we may have been included in
that appeal. The parties to the libel suit in question are both medical gen-
tlemen, and both editors ; but here their equality ceases. One is at home,
wealthy, surrounded by Iriends — powerful. The other is a foreigner, a man
of the closet, a student whose name is only known in connection with his
reputation in natural science. He is poor, a stranger — powerless. Lot the
law decide impartially between these men. We will not risk an opinion."-—
Buffalo Medical Journal.

" The Medical Independent. — This valuable monthly has reached the fourth
number of the second volume, and improves as it grows older. Dr. Goadby's
articles on the " Links Connecting the Vegetable and Animal Kingdoms/'
continue, together with those "On thef Structure and Functions of Insects."
These facts are, many of them, positive advances in natural, particularly

56 Medical Independent March

microscopic science ; and very different from the usual rehashes of the
medical journals of the day. Dr. Goadby, in our estimation, has no superior
in microscopy in this country ; and perhaps not in Europe. He is an honor,
like Agassiz, to the land of his adoption. We are sorry to see that a petty,
and, we hope, temporary sectional feeling, of the narrowest kind, has been
operating to depreciate the character and scientific labors of Dr. Goadby.
The good sense, the arriere pense of our countrymen will come to the res-
cue, we doubt not, of truth and justice." — Philadelphia Medical and Surgi-
cal Journal.

N. E. District Medical and Scientific Association

The annual meeting of this Association was held at Mt. Clemens, Jan.
10th. The following officers were chosen for the ensuing year:

President, Dr. C. M. Stockwell, of Port Huron ; Vice President, Dr.
Chester McCallum, of Auburn ; Secretary, Dr. P. A. Knight, of Utica ;
Treasurer, Dr. John P. Wilson, of Pontiac.

Drs. W. C. Smith, of Troy, R. G. Jennings, of Lapeer, and 0. B. Reed,
of Newport, were admitted as new members, and Mr. G. F. Lewis, and Drs.
Bancroft of Romeo, Dennis Cooley of Washington, and Neil Gray of Ray,
as honorary members.

The following delegates were elected to the National Medical Association
■which meets at Nashville, Tenn., the first Tuesday in May : — Drs. J, P.
Wilson and W. C. Smith, of Oakland Co. ; S. L. Andrews and J. M.
Champman, of Macomb ; 0. P. Strowbridge and R. G. Jennnings, of La-
peer; 0. B. Reed and C. M. Stockwell of St. Clair.

The following delegates were chosen to the State Medical Society, which
meets at Ann Arbor the last Thursday in March: — L. A. Hubbard of
Macomb, J. P. Wilson of Oakland, A. R. Stone of Lapeer, and 0. B. Reed
of St. Clair.

The following standing committees ware appointed :

Action of Remedies. — Dr. Hubbard, Macomb, Dr. Paddock, Oakland.

Epidemics. — Dr. H. Taylor, Jr., Macomb, Dr. W. C. Smith, Oakland.

Surgical Practice. — Dr. Wilson, Pontiac, Dr. P. A. Knight, Macomb.

Obstetrics. — Dr. Kenney, Lapeer, Dr. Philips, Macomb.

Dr Phillips, of Oakland County, reported several cases of encephalug
which he had recently met with in his practice, and presented one very in-
teresting specimen which he had preserved for examination.

Drs. Stockwell and Andrews also reported cases of a similar nature.

Dr. H. Taylor made a report in the case of the post-mortem examination
of James Warner, whereupon

Dr. Jennings offered the following resolution, which after some discussion,
the Association not deeming it proper to act in the matter, it being of a

1857. Editorial and Miscellany. 57

personal nature, unless both parties were either present or represented, was

laid upon the table,

Resolved, That we exonerate Dr. Taylor from all the imputation cast upon
his character by Dr. Terry, by an article published in the Independent, relating
to the Medico-Legal examination of James Warner, Macomb County, before
the late Circuit Court of said county, and farther more, we believe Dr. Taylor
made a faithful and accurate autopsy of said case, and that we believe his conclu-
sions as to said Warner's death, were warranted by said autopsy.

Dr. Taylor offered the following resolution, which was adopted :
Resolved, That in the opinion of this Association it is a duty incumbent

upon the present Legislature of this State to pass an act for the Registry of

births and deaths.

It was Resolved, That the proceedings of this meeting be published in the

Medical Journals of this State.

The Association adjourned to meet at Port Huron, on the second Wed-
nesday in June.

Messrs. Editors : — Allow me to state, though your journal, that the
Northeastern Medical and Scientific Association held their late annual
meeting at Mt. Clemens, Macomb County, Janunry 10, 1857.

During the session a voluntary report was offered, and allowed to be
read before the the Association, upon the facts and evidence derived from
a post mortem examination made by a "Resident Physician" upon the
body of James Warner. The circumstances favoring us with this vol-
umnious report were, that Dr. Terry, of your city, did not come to the
same conclusion from the evidence given in the case as to the cause of
death ; and a somewhat severe criticism upon the testimony given in
Court, by the physician who performed the examination, appeared in the
December No. of your journal.

As this report elicited considerable discussion, the merits and claims of
the Independent were, to some extent, considered and tested before the
Society.

It appeared, from the general expression of different member, that, with
almost a single exception, your journal stands high in the estimation of
the medical department of our State.

Its freedom and boldness of expression, its practical knowledge, were
severally noticed, and from this fact alone, it was deemed an important or-
gan in disseminating useful and practical information throughout the
medical profession.

Although comparatively new, as an enterprise, the Medical Independent
has already acquired a position in the regard and confidence of the med-
ical profession in this State, which nothing, save the progressive spirit of
energy and independent expression of thought, in the hands of judicious
and competent men could accomplish, and it is sincerely to be hoped that

58 Medical Independent. March

it will soon possess a circulation to which its real merits most justly enti-
tle it.

As the Secretary was directed to furnish you a copy of the proceedings
of the meeting, and probably has done so ere this, I will omit further no-
tice of our doings at this time. Yours,

Member of the Association.

Editorial Change.

In consequence of other engagements, that will render it necessary for
Dr. Goadby to spend the greater part of his time away from this city, his
relation as Senior Editor of this Journal has, by mutual consent, become
dissolved. Hereafter, he will only be known, in connection therewith, as
one of the collaborators. The Journal loses nothing by the change, and
we are happy to say that his colleagues have given consent to change the
relation, only to enable Dr. Goidby to give more constant supervision and
attention to engagements elsewhere. His papers will continue to appear,
the same as though the change had not been made.

Michigan State Medical Society. — Correction.

The next annual meeting of this scociety will be held at the College
Building, in Ann Arbor, March 25, at 10, A. M., instead of the 24th, as
previously stated.

The reason for this change is, that notice has been received that com-
mencement will take place on the 26th instead of the 2oth.

Newspapers please copy. E. P. CHRISTIAN, Secretary.

In connection with the above notice, we desire to urge upon the profes-
sion the importance of this meeting. . We have a State organization that
only needs a little active working interest to make the society tfhat it
should be — an honor to the profession, and, at the same time, an efficient
promoter of its interests.

We earnestly hope that all parts of the State will be represented at that
meeting.

To our Subscribers.

We take this opportunity, in the commencement of the volume, to re-
mind subscribers of our terms of subscription. The only system that can

be adopted to secure the financial success of our Journal must necessarily
exact, and insist upon the prepayment of $2,00 per annum. We have
been obliged to make a few exceptions to this rule during the past year,
but justice to our publisher demands even a more rigid regard for the
plan adopted. If the Journal, therefore, is not received by those who
have failed to comply with our terms, it will require no great effort of the
imagination to furnish for themselves a good and sufficient reason.

2&X:E3X>XCXA.Xj T2JE2^»<&LFCT'lSSEE30BXwr

UNIVEESITY OF VERMONT

FACULTY.

Samuel W. Thayer, Jr., M. D., Gen. and Special Anatomy.
Walter Carpenter, M. D., Mat. M.edica and Therapeutics.
Orren Smith, M. D., Obstetrics, and Obst. Jurisprudence.
Henri Erni, A. M., M. D., Chemistry and Toxicology.
Edward Kane, M. D., Principles and Practice of Medicine.
David S. Conant, M. D., Principles and Practice of Surgery.
John V. Lansing, M. D.. Physiology and Pathology.
Joseph Perkins, M. D., Diseases of Women and Children.
Martin E. Thrasher, Paosector of Surgery.
Benjamin W. Carpenter, Demonstrator of Anatomy.

The next annual course of Lectures in this Institution will commence on Thurs-
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Fees.— Lecture Fees, $50. Students having attended two full courses, $10;
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of Prof S. W. Thayer, Jr., Burlington, Vermont.

S. W. THAYER, Jr., Burlington, Vermont,

Burlington, Vt, February 6th, 1857. Dean of the Faculty.

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VOL. 3. DETROIT, APRIL, 1857. NO. 2.

ORIGINAL COMMUNICATIONS.

AKTIOLE I. — Chapters from an Unpublished Work on
H ygieine. — Chapter III. — Continued.

BY A. R T.

Diet, &c. — I shall now make a few concise remarks as to the
most wholesome articles of diet, common in our country, and
observe on the times of day most suitable for eating, &c, &c.
Beef, mutton, pork, veal and poultry form, by far, the largest
portion of the animal food consumed in the United States, as
they do in most temperate regions of the globe. Fish and
game (except in particular localities,) afford but an unimport-
ant part of the animal diet. Oysters, and one or two other
Molluscous animals, are consumed in large, and yearly increas-
ing quantities ; and the recently improved facilities for trans-
portation have elevated them, from mere luxuries, almost to
the position of staple articles of diet, even in regions remote
from the ocean. Crustaceous animals, such as Lobsters, Crabs,
Craw-fish, &c., are (except immediately in the neighborhood
where they are caught,) to be looked on as luxuries, generally
hard to digest, to be avoided, except by the most healthy.

VOL. Ill, NO. II — 1

60 Medical Independent. April

Beef, mutton and poultry, when of a good quality, and properly
cooked, are the most easily digested and wholesome of the ani-
mal food in common use. Pork and veal are harder of diges-
tion, and, although easily managed by the perfectly healthy
stomach, often disagree with the Dyspeptic. Pork is supposed
to be especially deleterious in hot climates, and this fact is, by
many, supposed to account for the strict Mosaic prohibition of
it, as an article of diet. In some parts of South America, the
free eating of pork is supposed to produce a form of leprosy,
but this opinion wants proof. The flesh of young animals is
generally supposed to be harder of digestion than that of old
animals. Eggs are a highly nourishing, and, when properly
cooked, to most persons, a wholesome article of diet. Oysters,
Clams, Mussels, &c., are, especially when raw, very easy of di-
gestion by most stomachs, and are often a good diet for inva-
lids. Of lobsters, &c., I have already spoken.

Vegetables next claim our attention. Of all these, for wide
diffusion, universal use, and importance to man, Wheat stands
in the first rank, and its claim will not be disputed. It con-
tains every thing necessary to support and nourish man, in
perfect health and vigor, and when properly cooked, is, without
doubt, the most wholesome and the most nourishing of vegeta-
ble aliments.

Eye most nearly resembles wheat of all the Cereals, but is
inferior in all essentials of wholesome nourishment. In the
north of Europe, it is extensively used, because it thrives in a
higher latitude than is congenial to wheat. There is consid-
erable difference of opinion in regard to the comparative
wholesomeness of fermented and unfermented bread, and
many substitutes for yeast have been proposed, so that bread
:mio*ht possess the lightness of fermentation, without its sup-
posed deleterious properties. Most of these substitutes form,
when mixed in the bread, medicinal salts, the habitual use of
'which is likely to prove more hurtful than fermented bread.
The combination of soda and muriatic acid forms common
salt, and a light, wholesome, palatable bread can be made by a
careful apportioning of these with flour and water ; but a prac-
tical difficulty exists in the varying strength of the acid of
commerce, and, except under peculiar circumstances, there is
no probability that their use will ever supersede that of yeast.

1857. Original Communications. 61

The whole tribe of Tartaric acid, Cremor Tartar, Soda, and
other baking powders should be eschewed by the prudent. In
connexion with wheat, paste or pastry may be appropriately
spoken of. I would by no means utterly proscribe and condemn
all pastry, as is done by some, but still it should be used sel-
dom, and in moderation, and never as a supererogation to an
otherwise full and sufficient meal. It would always be we well
if the coming of the pastry could be considered in the eating
of the first course. Some other preparations, into which wheat
flour enters as a constituent, can hardly be too strongly repro-
bated. I speak of the rich cakes, compounded of flour, butter,
sugar, spices, and sometimes fruits. There seems to be a pecu-
liarly hurtful and indigestible compound formed, when flour,
su^ar and butter, or lard, are subjected to the process of baking,
and I do not hesitate to say, that a proper regard for health
should banish this compound from every well regulated house-
hold. Puddings, either with or without fruit, when not very
rich, are generally wholesome and easy of digestion, and, es-
pecially in families living in the country, are a desirable and
excellent addition to the ordinary diet of meat and vegeta-
bles. .

Hot rolls, and fried griddle cakes, waffles, muffins, and all
that tribe are trying to weak stomachs, but they will be eaten,
and moderation is the best precept.

Maize, or Indian corn, comes next in importance to wheat,
as a staple article of vegetable diet in our country, and by
many it is held in even higher estimation than that King of
grains. A vast variety of wholesome and palatable prepara-
tions are made from this grain, and to those who have been,
from childhood, accustomed to it, it possesses a sapidity and
flavor which is poorly compensated for by the comparatively
insipid wheat. As a food for the hard working man, for
the hunter, the boatman and the voyageur, it is, especially in
cold weather, almost equal to fat meat. This grain needs a
great deal of cooking to develope its full excellence, and no
one who has tasted the luxuries of hoe-cake, corn-muffin, se-
paun, hominy, (big and little,) mush and milk, &c, will forget
them, even among the refinements of an European cuisine.

Rice, in our Southern States, forms an excellent, wholesome
and nourishing article of diet ; bland and unirritating, it is

62 Medical Independent. April

peculiarly fitted for the inhabitants of warm regions. At the
South, it is commonly used as an accompaniment to meats,
either plain boiled, or in pillau, while at the North, it is more
used for puddings, &c. In both ways it is wholesome and pal-
atable.

Potatoes have long been considered an indispensible accom-
paniment of every dinner-table at the North, but the unfor-
tunate malady which has, for a few years past, affected the tu-
bers, has greatly depreciated the excellencies of the vegetable,
and enhanced its price. Although the potato is far inferior in
point of quantity of nourishment, either to wheat, rye, or
maize, yet the vast amount yielded to the acre, the ease with
which it was cultivated, its palatableness and wholesomeness,
rendered it a favorite, with both rich and poor, and to the poor
it was a choice blessing. But alas, the potato disease has
changed it from a cheap staple article of food, to a luxury. At
this time — 1857 — a dollar expended in the best white wheat
bread, will go farther to nourish a family, than twice the sum
spent in purchasing potatoes. But still, to the farmer, they
are a valuable crop, and, either for market, or for his own use,
richly repay the cost of cultivation, in most instances.

Peas and beans, in some sections of our country, form an
important portion of the diet of the rural population. Every
one has heard of the Pork and Beans of New England. These
two articles of diet do very well for the man of strong diges-
tion, but are to be avoided by the delicate and dyspeptic. Cab-
bage and turnips are closely allied in their chemical as well as
botanical relations ; they contain a large proportion of water,
and are, to most stomachs, hard of digestion, but when they
agree, they afford a wholesome addition to the stock of winter
vegetables. Pumpkins and squashes, prepared in various
ways, are both palatable and wholesome. Beet?, carrots, pars-
nips, artichokes, green pease, green corn, &c, are rather to be
regarded as occasional variations, than as staple articles of di-
et. The same may be said of that delicious and wholesome
vegetable, the tomato.

Fruits will next engage our attention. Of these, at the
North, the most abundant, and the most valuable is the ap-
ple ; and too much can hardly be said it its praise, either as
an article of wholesome food, available the year round, or as a

1857. Original Communications. 63

luxury. From the juicy and delicious, but perishable harvest
apple, to the glorious Newtown Pippin, which can be carried
in perfection to China, our country furnishes a vast variety of
the most delicious apples ; and, when ripe, either raw or cook-
ed, they form one of the most harmless and salutary articles of
diet. What school-boy in the country has not luxuriated in
his lunch of sweet brown bread and butter, and juicy pippins,
or seeknofurthers ? Pears, peaches, apricots, strawberries,
grapes, and the different wild fruits, are all salutary in their
seasons, but, as articles of diet, hardly deserve a mention. The
tropical fruits, although some of them are grown within the
bounds of our Southern States, are not within the scope of a
work like this.

Having now enumerated, and cursorily remarked on the prin-
ciple articles of diet in common use in our country, I shall dis-
cuss the times, seasons, and manner of eating, which appear
to be most conducive to health.

All are agreed that moderation in all things is commendable,
and in nothing is it certainly more so than in our diet. But,
what is moderation, and almost abstemiousness, in one man, is
excess in another. It does not take long for a man of any ob-
servation to find out what agrees or disagrees with him, and
what quantities of food, and what times ot eating, are most
salutary ; but still, there are certain general rules, which will
apply more or less to all, and it shall be my endeavor to lay
down these, for the benefit of my readers.

In regard to the times of eating, this must, in a considera-
ble degree, depend on the occupation, and previous habits of
the individual. The man who turns night into day, and day
into night, cannot breakfast and dine at the same hours as the
day laborer, nor can the merchant or professional man, whose
occupations are often continued far into the night, rise with
the lark, like the man who goes to roost with the chickens. As
it is admitted that early rising is one of the main conditions for
the maintenance of health, it becomes an interesting question,
how soon food should be taken after rising. My own experi-
ence and observation are against any long delay, and especially
against the taking of much exercise before breakfast. To
breathe the fresh air in fine weather, may be very well before
breakfast, but, especially in dyspeptic persons, much exercise is

64 Medical Independent. April

apt to produce languor and less of appetite. And now for the
materials of breakfast. A prudent person, who eschews late
suppers, will rise in the morning with an empty stomach, and,
even if he be in the habit of dining as early as one hour after
noon, a considerable time must elapse before the vacuum is
supplied, unless he eats a hearty breakfast. It has become too
much the custom to breakfast on a morsel of bread, and a cup
of strong tea or coffee, or even on the tea or coffee without the
bread. One of three consequences is very apt to ensue : either
the stomach becomes exhausted, and, to relieve the disagree-
able feeling, lunch, probably accompanied by a glass of liquor,
is taken ; 01 if this is not done, the appetite may be lost from
exhaustion before dinner time, and stimulus is required to re-
store it ; or, thirdly, the strong stomach may retain its vigorous
appetite, and take more food than is proper at dinner. In ei-
ther case, languor, sleepiness, and indisposition to exertion, are
apt to follow, especially in hot weather. A hearty breakfast is
the best material preparation for a day of labor, either mental
or bodily, and it is, of all the three meals, the one which can
most safely, to all constitutions, be made a hearty one. As re-
gards the materials for breakfast : Eggs, cooked in various
ways, form a staple of the breakfast table in most parts of the
civilized world, and, with good bread and butter and tea or
coffee, make both a wholesome and palatable meal, and one
which agrees well with most stomachs. Salt fish, as a relish,
with the indispensible bread in some form, is in extensive use,
and, when employed in moderation, is wholesome to the sound
stomach. Dyspeptics should use it with caution. To the man
engaged in active out-of-door exercise, and to the laborer, a
he irty meat breakfast is not inappropriate ; and, thank God,
we live in a country where the son of toil can command it, if
he wishes it. In the neighborhood of the sea shore, fish, both
shell and scale, form a palatable and excellent material for
breakfast. The whole tribe of hot rolls, muffins, waffles, grid-
dle-cakes, &c, I have already spoken of — they should be used
in moderation. As to buckwheat cakes, I am afraid I should
raise a storm about my head, if I were to say what I think of
them, and therefore I will refrain. It has been much the fash-
ion, of late years, to decry and condemn, in toto, tea and cof-
fee. That the immoderate use of strong tea or coffee may,

1857. Original Communications. 65

and does, injure the digestion and nervous system, I am not
prepared to deny. And that children will, as a general rule,
he better without them, I also believe. But that their mode-
rate use by adults, is, in our artificial and overtasked state of
society, not only harmless, but salutary, I, with confidence, af-
firm. They exert a mild soothing influence over the harrassed
and irritated nervous system, much safer, as well as more
pleasant, than that caused by alcoholic stimulus. Who is
there that has not felt his energies of mind and body both re-
newed, by a good cup or two of tea or coffee — and who ever
felt secondary languor following their use ? Even in those rare
cases where they apparently disagree, and unpleasant excite-
ment and wakefulness are produced by their use, the effect is
transitory. A cup of tea or coffee will often rouse the delicate
stomach to the digestion of some oppressive substance, which
has been eaten, much more certainly and safely than a glass of
brandy. If they are poisons, they are so slow that the life of
man is not long enough for them to produce their effect in.

The hour at which dinner should be eaten has been a sub-
ject of much, and, I think, of useless discussion. That noon,
or soon after, is the proper hour for the mechanic, the farmer,
the laborer, and also for the trader, and professional man, resi-
ding either in the country or in the smaller towns and cities of
our country, there can be no doubt. The comparatively early
hour of going to bed, of all these classes, seems to render it
necessary that the principal meal of the day should not be de-
layed until a late hour ; and as custom has fixed on the two
hours after noon as the usual limit of the dinner hour, in our
country, it is necessary to say little on the subject. But I can-
not here omit entering my protest against the too common
practice of making dinner almost the only meal of the day.
There are many who eat enormous dinners, and hardly eat any
thing at either of the other meals. There are various reasons
against such a practice. Persons engaged in active occupa-
tions, especially in hot weather, are more or less exhausted by
dinner time, and will be oppressed, rather than invigorated, by
a very full meal, while a moderate one will impart fresh vigor.
Again, immediate occupation, of either mind or body, after a
very full meal, in a greater or less degree, retards digestion,
and for our workaday generation, this is an important consid-
eration. A judicious division of the amount of food for the

66 Medical Independent, . April

twenty-four hours, I consider of quite as much importance as
care in regard to quality. A very pernicious practice, which
some indulge in, is sleeping immediately after a full dinner ;
many aggravated cases of dyspepsia, which have fallen under
my care, have apparently been produced by this practice. To
those who can afford the time, an hour's rest, with pleasant
conversation, or the companionship of a book or newspaper, is
very desirable after dinner ; but go hard at work rather than
sleep. The practice of dining at five, six, seven, or even eight
o'clock, will do very well for men of fortune and leisure, but in
that case lunch is necessary, and dinner should be the last
meal of the day. Merchants and professional men in large cit-
ies, whose business closes at five or six in the evening, may very
well dine after that hour.

The third meal of the day, called by some, tea, and by oth-
ers, supper,, is, by many, reduced to the mere cup of tea or cof-
fee, and this is often taken solely for the purpose of removing
the effects of a too hearty and ill digested dinner. In this case
a late supper is very apt to follow, to the destruction of quiet
rest and the signal injury of the health. Three temperate and
moderate meals a day, the first taken soon after rising, the
second soon after noon, and the third at least three hours be-
fore going to bed, form, in my opinion, the regimen in food
most calculated to preserve health. Late suppers are a prolific
cause of dyspepsia, and, in persons of a full habit, of conges-
tion of the brain. Many a man, who might otherwise have
lived for years, has been hurried off by an attack of apoplexy,
induced by an undigested hot supper, assisted by champagne
and brandy and water. Few extravagancies introduced by the
growing wealth and means of luxury now so extensively diffused
in our land are productive of more positive injury, in more than
one way, than the practice of giving luxurious hot suppers at
evening parties, accompanied by all the provocatives to excess,
offered by strong liquors, and delicious wines. The excitement
of lights, music, conversation, and dancing, are quite enough
for the young and joyous, and assemblies, which ought to be
occasions of harmless mirth and enjoyment, are converted into
mere sensual affaire of eating and drinking. And we may con-
sider ourselves well off if headaches and dyspepsia are the
the worst results of such excess. There is another point of
view in which such extravagant and luxurious entertainments

1857. Original Communications. 67

are to be seriously deprecated, and that is the emulation to
shine in the same way, which is too often created in the breast
of him or her, who is ill able to afford it. I affirm that the
giving of such entertainments is a serious check to the preva-
lence of unrestrained and pleasant social intercourse. The fam-
ily every way equal, and, perhaps, superior, to the family next
door, in every thing which gives the chief charm to social in-
tercourse, in education, refinement of manners, wit and amia-
bility, is deterred from inviting their friends to a musical,
conversational, or dancing party, because they cannot afford to
treat the company to Champagne, Roman Fundi, Pati de foie
gras, Game, Oysters, &c, dfce. And many people who are capa-
ble of being ornaments to society are prevented from mingling
habitually in it, by the absurd custom of making evening par-
ties mere feasts. The sum that is often spent on the one great
luxurious feast in the winter, would suffice to give half a doz-
en merry hops, with sponge cake, ices and lemonade for refresh-
ments, and well ventilated lungs, and cool heads for the guests
to take home with them. We are a great nation, and in
wealth and importance, every day growing greater, but there is
certainly among us too much tendency to the sensual and ma-
terial, and in nothing is it more prominently developed than in
our social intercourse. The French, confessedly the politest
nation in the world, manage these things quite differently.

(to be continued.)

AKTICLE II. — Selections from Surgical Notes.

BY PROF. GUNN.

Resections. — Case I. April 13, 1851. B., aged about 25,
presented himself at the college clinic, with a constantly in-
creasing osteoma of the body of the inferior maxilla. As the
tumor involved the whole thickness of the bone, resection be-
came an operation of necessity. Chloroform was used, and an-
aesthesia being complete, I commenced the operation by an
incision along the base of the jaw, extending from opposite the
lateral incisor to the angle ; another was made at right angles
from the anterior extremity to the mouth. The facial artery
was secured, and a flap, composed of the cheek, turned up, ex-

68 Medical Independent. April

posing the external surface of the jaw. The dissection was
then carried behind the bone, through to the mouth at the ante-
rior portion of the wound, a section made with Hey's saw, the
bone separated from the soft parts, and resected at the angle.
The flap was adjusted, and the wound healed by first intention.
Contraction of the internal pterygoid distorted the remaining
half of the jaw, giving a wry appearance to the face, and pre-
venting accurate meeting of the teeth. This difficulty was
so great as to prevent mastication, and the patient was obliged
to subsist on liquid food for many weeks, and a year passed be-
fore perfect control of the mutilated member was obtained.

Case 2. March 19, 1853. A gentleman, aged about 35,
brought a letter to me from Dr. Upjohn, of Hastings. He was
suffering from a carious condition of the body of the inferior
maxilla. The bone was much enlarged, and gave rise to a
foetid discharge. Eesection was here, too, an operation, not of
choice, but of necessity, and in the performance was almost
identical with the preceding case. The closure of the wound
was equally rapid and perfect. There was, however, no muscu-
lar contraction, and the patient retained full and perfect con-
trol of the remaining portion of the jaw, as evidenced by his
mastication of beef-steak at the table of his hotel one week
from the operation.

I have placed these two cases in juxta-position, not solely
from their similarity, but also from the discrepancy observed in
the power to control the balance of the member. The two
cases exhibit a parity in reference to general health, feasibility
of the operation, mode of its performance, and rapidity of cure ;
yet one requires a twelvemonth to learn to use the crippled
member, and the other uses it immediately with facility. Sim-
ilar will be our experience in observing the result of fractures
and amputations. Two patients may suffer from similar frac-
tures, experience similar cures, and one will walk easily and
gracefully, while the other will obstinately halt, to the torment
of his perhaps skillful and pains-taking surgeon. Two patients
may endure the loss of a leg, the stumps may be similar in
forrn, firmness and soundness: artificial limbs, equal in perfec-
tion and adjustment may replace the loss, and one will walk
almost gracefully without the aid of a cane, while the other
cannot trust himself without its additional support.

1857. Original Communications. 69

In the first case, which I have repeatedly seen since the ope-
ration, a firm cartilaginoid deposit took place along the course
of the removed bone. The second case I have never met since
his dismissal.

Case 3. During the winter of 1850-51, a young Irishman,
aged about 20 years, presented himself at the college clinic
with caries of the head, and necrosis of the shaft of the hu-
merus, involving the upper two-fifths of the bone. There was
also partial anchylosis of the joint, caused, as was afterwards
shown by the operation, by adhesions in the joint. I determin-
ed on resection, and the patient being chloroformed, I carried
an incision from the acromion to a point just below the deltoid
insertion, through fascia and muscle down to the bone, dissect-
ed the tissues from the bone, opened the joint — my progress
through which was much impeded by adhesions which nearly
obliterated the synovial cavity, dislocated the head, completed
the dissection and sawed through the bone at the deltoid ridge.
The sircumflex arteries only required ligature, and the wound
was dressed with sutures and straps. On the second day erysip-
elatous inflammation involved the whole arm, from shoulder to
hand, which subsided with a profuse discharge of foetid and ill
conditioned pus from the wound. Quinine, wine and animal
broth were freely exhibited, and union by first intention was
secured in the upper two-thirds of the wound, with healthy
discharge from the lower portion. Fourteen days from the op-
eration the patient was discharged, and returned to his home.

Case 4. Dec. 13, 1854. H., a lad 15 years of age. Caries
of the head and upper third of humerus. Freedom of mo-
tion in the joint, though the whole head seems to be in perfectly
softened condition. Operation similar to preceding case, except
that the main incision was met at its lower extremity by a short
transverse cut. Every thing progressed favorably, and on the
fourteenth day, the patient was discharged, and started on his
return.

These two cases are illustrative of the advantages of con-
servative surgery. In operating for caries we usually find
ourselves in the immediate neighborhood of joints, and while
we are generally called upon to sacrifice the whole joint extrem-
ity of the bene, we may by resections save a valuable member.
In each of the last two cases, by the use of a firm leather splint,

70 Medical Independent. April

embracing the shoulder and arm, the patients were enabled to
use the limb for most ordinary purposes. The first I have not
heard from since the summer following the operation, when he
was peforming heavy manual labor. The lad, 1 heard from a
few days since, and he is as useful as most lads of his age upon
a farm.

Detroit, March 16, 1857.

ARTICLE III. — Cases Drawn from Brief Notes.

BY E. M. CLARK, M. D.

Strangulated Crural Hernia with SlougMny of four inches
of Intestine. — Mrs. Marontet, aged 53, who resides on Belle
Kiver, Canada West, had suffered twelve days from strangula-
ted Crural Hernia of the right side ; during which time she
had no alvine evacuation, but had vomited daily more or less
stercoraceous matter. The abdomen was enormously distended,
pulse very feeble, skin cold and clammy, and the hernial tumor
gave distinct crepitus under the fingures. I at first declined
any surgical interference, but finally, at the urgent solicitation
of the patient, and her friends, I cut down upon the sac,
which, when opened, exposed a portion of sphacellated intes-
tine about four inches in length. In a few moments, by an ef-
fort to vomit, the insestine was torn open, and large quantities
of foecal matter were discharged through the rent, very much
to the relief of the patient. The intestine was firmly adhe-
rent to the ring, thus obviating all danger from discharge of
fcecal matter into the cavity of the peretoneum. The parts
were dressed with warm cataplasms until the slough separated,
after which, compresses were so applied, as in some measure to
control the alvine discharges. An artificial anus was made,
however, which I informed the patient she must rely upon du-
ring the balance of her life. Eight weeks later, somewhat to
my surprise, I learned from her son that my patient had en-
tirely recovered, the wound had closed, and her alvine evacua-
tions were made per rectum.

This case presented to us an interesting illustration of Na-
ture's surgery, and as such we deem it worthy of record.

1857. Original Communications. 71

Polypus of the Uterus. — Mrs. L., of East Saginaw, aged 40,
has been married three years, has had several miscarriages, oc-
curring in the early stage of pregnancy. August 20, 1855, at
about the sixth month of pregnancy, she was attacked with
labor pains, which progressed favorably for several hours, when
a very severe pain was followed by convulsion. Several hours
after this another such severe pain and convulsion supervened.
The attending physician then, on examination, discovered a
tumor about six inches in diameter, which had been expelled
beyond the vulva — the child still remaining in the vagina.

I saw Mrs. L. thirty-six hours subsequent to the expulsion,
and, upon examination, found it attached to the inner surface
of the uterus by a short pedicle of about an inch and a quarter
in diameter, and dragging so forcibly upon the parts as to oc-
casion great suffering. Her abdomen was tympanitic and ten-
der, pulse 130. I li gated the pedicle, and, with the knife,
severed the tumor, giving immediate relief to the patient. I
saw no more of Mrs. L., learned from her physician that the
ligature came off in due season, and the case went on favorably
to apparent recovery. Several weeks subsequent to this ap-
parent recovery, while making preparations to visit her friends
in this city — Detroit — she was taken suddenly ill, and died in
a few hours ! The tumor was of a dense fibro-cartalaginous
structure, and we may reasonably infer that by its size and
growth it had provoked the uterus thus prematurely to bring its
parturient labors to a close.

Abscess of the Liver, Discharging through the Lungs. — Geo.
L., of Detroit, aged about 28 — an engine-driver on the Michi-
gan Central Kailroad — has had pain in his right hypochondrium
for a year past, symptoms of suppressed billious secretion has
recurred from time to, which were generally relieved by the use
of mild mercurials. The pain, however, still continued and
increased, accompanied with a general appearance of fullness
or enlargement of the side affected. After suffering from this
pain about nine months he was obliged to abandon business.
He grew rapidly worse ; had chills and fever ; cough supper-
vened, which increased rapidly in severity, and attended with
mucous expectoration. There was, at this time, dullness on
percussion from two inches below the ribs upward to the fourth
rib. One day, during a severe fit of coughing, a large amount

72 Medical Independent. April

of pus was expectorated. It came so rapidly as nearly to pro-
duce suffocation. From this time lie sank rapidly. Hectic
symptoms increased, and large quantities of pus were expecto-
rated daily. I had suspected the existence of abscess of the
liver, and examined frequently, with the hope of rinding some
point of adhesion between the liver and parieties of the abdo-
men, where an opening might be made. I finally discovered a
point indurated to some extent, and situated near the anterior
extremity of the lower short rib, where I believed sufficient ad-
hesion had taken place to warrant an opening. I introduced
an exploring knife and reached the abscess. I then enlarged
the opening slightly, and drew off 16 ounces of pus, after which
I closed the wound by collodion. After an interval of two days
I drew off about 16 ounces more, and again closed the orifice.
I continued to draw of pus at intervals of one and two days
until the secretion had considerably diminished, and then left
it free to discharge as fast as collected. The cough and expec-
toration diminished rapidly, and under the liberal use of ton-
ics my patient soon recovered his health.

It is now about four years since Mr. L. suffered from this ill-
ness, and up to this time he has enjoyed excellent health.

Detroit, March, 1857.

Glycerine in Phthisis.

Professor N. S. Davis, of Chicago, reports his success in the employment of
this remedy, and furnishes the following recipes, viz :

In the early stage of tuberculous disease, and before the cough is accompa-
nied by much expectoration, he gives one tea-spoonful of No. 1, before each
meal and at bed time.

No. 1. 3 — Glycerine, § ij.

Iodide of Potassa, 3 j.

Sulph. Morphine, 2grs.
Mix.

"When the disease is further advanced, with copious expectoration and rap-
idly increasing emaciation, he prefers the following, No. 2.

No. 2. ^ — Glycerine, -§ Ij .

Syr. Iodide of Iron, § ss
Sulph. Morphine 2grs.
Mix.
Dose a tea-spoonful every four hours.

SPIRIT OE THE MEDICAL PRESS.

An Operation for the Removal op a Uterine Tumor, together with
the Extirpation of the Ii-ntire Organ, and its Appendages. By
William J. Baker, M. D., Knoxville, Tenn.

Matilda, a negress, servant of Mrs. Laura Bearden, of this city, married,
but without children, has been occasionally, since the year 1851, under
treatment for inflammation of the os uteri.

In March she became pregnant, but aborted in the latter part of April.
She has always suffered from dysmenorrhcea. With these exceptions, her
general health had been good, previous to October, 1855. About this time,
she states that she began to feel a lump in the right iliac region. Nervous
disturbance began also to be more distressing.

In June, 1856, was requested to see her. Found her suffering severe pain
in lumbar vertebrae and thence through the pelvis, with usual symptoms of
dysmenorrhcea ; the disturbance of the nervous system amounted to hyster-
ia. There was retention of urine, and the catheter was used, and a copious
amount of urinary secretion secured. The abdominal tumor was noticed,
and, upon inquiry, it was found to be of eleven months standing.

She had been under the impression that she was pregnant. It occupied
all the hypogastric region and a portion of both iliacs, inclining decidedly
to the right. It is firm to the feel, somewhat moveable, and reaches upwards
to within two and a half inches below the umbilicus. An examination per
vaginam reveals a slightly nodulated surface, far back between the promon-
tory of the sacrum and the uterus.

Tho womb is pushed forward, and is evidently retroverted. The os high
up behind the pubis.

The spoculum shows the tissue visible, to be in a healthy condition. The
os, however, cannot be grasped by tho valves of the speculum. From this
time forward she was under treatment, it being sought by remedial measures,
local and constitutional, to retard or check the growth. In every succeeding
menstral return, medical interference was necessary to paliate her sufferings.
Each timo the catheter was used to obviato retention, and purgative medi-
cines were indicated. The menstrual discharge continued for thirty-six
hours, but was in small quantity, and of a black appearance.

In August, another and serious inconvenience manifested itself, viz : con-
stipation, which rendered a frequent necessity of laxative medicines.

74 Medical Independent. . April

During the period the rectum became irritated, and in one instance, posi-
tive inflammation supervened.

From the 10th of October, constitutional derangement grew rapidly and
steadily worse. Previous to this time, she had enjoyed at least an immunity
from pain. Now it was constant, and frequently excruciating. The pain
was described as dull, heavy and aching in the pelvis, but sharp and lancina-
ting from the sacrum to the dorsal vertebra.

Depression in the tone of the nervous system was more rapid.

Hysteria exhibits itself frequently, and slight causes produce paroxysms.
The appetite is very much impaired, morbid and irregular, and she sleeps,
really, for nights successively, scarcely at all. The tumor feels in size
through the abdominal parietes, as the pregnant uterus of seven months.

There is a well marked protruberance in the right lumbar region. This
p-'otruberance can, by kneading, be moved over as far as the mesian line, a
distance of two and a half inches.

To the touch, the womb not only feels heavy, but offers to the finger a de-
gree of elastic resistance. It reveals also a gradually extending irregular
surface. The raammase are enlarged. The areola has increased in area and
in depth of color, and there is a secretion of milk. Depraved appetite and
longing is marked. She insists that she has felt motion as of a foetus in
utero.

A sound was introduced in the womb, to determine the size of its cavity.
It was introduced with diffiuulty, and met the walls of the fundus two inches
from the os.

Convinced that nature could not long resist the ravages of the above
mentioned 'conditions, but must soon yield to such mischief at work, an ope-
ration to remove the tumor was proposed. Diagnosis could not determine
whether or not the tumor had grown from the matrix, or some contiguous
point. It was certainly attached to the womb, but whether the base was
fixed from origin and growth was only conjectural. Drs. Rodgers and Saw-
yers having been called in consultation, examined carefully the case and con-
curred in the propriety of an operation for removal.

Friday, November 6. — Menstruation came on in usual quantity, and with
usual increase of grievances.

It was determined to operate on the following- Tuesday, November 13.
At 10 o'clock A. M , Drs. Rodgers and Sawyers kindly assisting, the patient
was anesthetized. Choloric ether was administered by Dr. Sawyers in the
outset, but its Action was very tardy, and chloroform was substituted. In a
few minutes thorough insensibility was procured, and the operation was
commenced by making an incision from the umbilicus to the pubes in the
linea alba. So soon as the division of the abdominal walls was complete at
the middle portion of the incision, the prtuberance of the tumor came out.
Upon attempting to lift it, a portion of the tumor wasfound to extend above
the umbilicus, whereupon the incision was extended one and one-half inches
higher, avoiding the navel. The upper portion of the tumor could now be
raised, and by turning out the bowels, it was discovered to be attached to the

1857. Spirit of the Medical Press. 75

sacral and lumbar vertebral regions by extensive and pretty firm adhesion.
It was also found that the ovaries and uterus were so involved that separa-
tion was quite impossible. Indeed, the uterine walls were hypertrophied,
and distorted, and had become heterologous, and a portion of the tumor.
The ovaries were involved only from contiguity, the peritoneal covering ad-
hering. Now, either the tumor must be returned, be but partially extirpa-
ted, or womb, ovaries and tumors, brought away.

After a few moments deliberation, it was determined to excise the whole,
accordingly, the serous adhesions were torn or dissected up. The ligaments
were severed until the mass was attached only by the vagina as a pedicle.
A needle, armed wth a ligature, was now passed through the cervix, and the
lateral halves constricted tightly. The cervix was divided immediately
above the ligature, and the mass removed.

The pedicle was brought to the lowest point of incision and secured. The
wound was closed by the interrupted suture.

There was probably left of the neck and cervix from the os to the ligature
half an inch — the section being made at a point just above the juncture of
the vaginal walls of the neck. During the process of the operation, but one
artery required ligation, viz : the spermatic of the left, when the broad liga-
ment was cut. There was no hemorrhage from that of the right side. The
venous hemorrhage probably amounted altogether to 3 x. The patient bore
chloroform remarkably well. The tumor and parts excised, weighed 46
ounces avoirdupois. It was of a fibrous nature, but its character will be
more definitely given, when it shall have been submitted to microscopic ex-
amination*

A glance at the condition of the patient, for several consecutive days, is
appended. As soon as she had come out sufficiently from the effocts of
chloroform, 100 m. tinct. opii. were administered and an opium to narcotism
treatment adopted. Peritonitis was, of course, anticipated, and dreaded. It
was sought by narcosis to control the peristaltic action, or to " put the bow-
els in splints." Ordered, grs. ij. opium, every 4 hours, together with tinct.
valerian 3 j. when necessary to quell nervous excitement.

November 14th, visit 8, A. 31. — Pulse 98 ; skin natural ; slight thirst ;
tongue looks pretty well ; has occasional spasm of the bowels ; kidneys active,
but urine of a darkish red color. Ordered a continuance of the opium.

4, P. Jtf. — Pulse 108 ; tongue rather dry, with a heavy coat ; skin hot and
dry ; some restlessness ; kidneys have acted freely ; urine improved ; some
distention of abdomen. Opium continued, Sodse bi. carb. given in drink.
Barley water allowed.

15th, 8, A. M. — Pulse 98; skin pleasant; slept more comfortably last
night ; tongue coated white, but cleaning ; kidneys acted twice last night ;
secretion more natural. Continue same prescription.

6, P. M. — Pulse 103 ; skin pleasant ; great tympanitic distention ; knees
drawn up ; nausea and jactitation ; incision is discharging pus, healthy iu its
character.

Fresh adhesive plaster applied ; cold cloths applied to abdomen ; opium
continued.

VOL. Ill, NO. II — 2

76 Medical Independent. April

16th, S, A.M. — Pulse 86 ; tongue more moist, but very white; secretion of
kidne\s improved in quantity and quality.

Some eructations with occasional singultus. Prescription continued.

November 17th, 8, A. 11 — Pulse 10S ; epigastric region much distended ;
frequent eructations ; abdomen less swollen, and softened; pus looks lauda-
ble, but has a fcetid odor ; breath offensive ; has had slight action from bow-
els ; kidneys doing well, ordered carbon 20 grs.; beef tea occasionally.

5- Chloride soda, |j»

Aqua destillata, 3 vij., to be applied to the wound.

Opium continued.

18th, 8, A. M. — Pulse 108 ; rested badly last night,, but was not in pain :
kidneys active ; abdomen reduced smartly : opium discontinued ; carbon and
mag. advised ; is allowed chicken water.

19th, 8, A. M. — Pulse 10S ; has had two actions from the bowels ; tension
and swelling greatly reduced ; pus is healthy and increased in quantity. Is
allowed light diet Mur. tinct. opii. to be given if there should occur pain
or restlessness.

20th, 5, P. 11 — Pulse 98 ; bowels and kidneys have acted ; wound dis-
charges freely ; appetite slightly improved.

On the 23d and 25th of November the sutures were removed. "Wound
healing nicely.

November 26. — It became necessary to adopt a tonic supporting plan of
treatment. Ordered 12 drops aromatic sulph. acid in an ounca and a half of
cold infusion of chamomile, three times a day.

November 29th. — The pedicle ligatures came away.

December 3d and 4th. — The days that menstruation should have appear-
ed there was marked increase in severity of symptoms. Pulse 100 to 104;
appetite failed ; there was distressing nausea and vomiting ; hysteria ; pains
in the abdomen ; diminished urinary secretion and retention. Her aspect
and condition were strikingly similar to that presented antecedent to, and
during menstruation.

December 5 and 6. — She had recuperated considerably, though it was
necessary for several successive days to use the catheter.

From this time forward there was only occasional and slight interruptions
to a gradua! yet steady return to health. The wound, three-fourths of it,
had cicatrized. At the point where the pedicle was attached, there was a
free discharge of pus, and on December 20th, a string of dead areolar tissue
was removed just from the locality of the pedicle. This core was, in extrac-
tion, broken in several places, but altogether measured four and a half inches.

January 1st and 2d, 1857. — Was rather more uncomfortable ; period for
menstruation.

January 3d. — Is free from uneasiness ; wound has healed almost entirely,
discharge is very small. Is allowed to sit up. but not to walk farther than
from the bed to the chair. She was to-day discharged. — Southern Journal.

1857. Spirit of the Medical Press. 77

Cooked or Raw Meat ?

If either of the writers who have recently published, in the Medical Jour-
nal, their reflections on the subject of raw animal food, entertain any reason-
able expectation of revolutionizing the habits of man as "a cooking animal,"
it is certainly to be hoped that their fund of argument ts not yet exhausted.
It is surely no reason that man should eat his meat raw, because he can, un-
less a farther motive can be adduced for it. Let it be shown, however, that
to cook is to impair the nutritive value of animal food, and that the condi-
ments of cooking are useless, or worse than useless, and we may be induced
to follow the advice of Mr. Webster, in another matter, and u conquer our
prejudices ;" or, even may join a regiment of raw and bloody reformers, if
one shall ever be mustered. At presont, we cannot " rest secure in the be-
lief that we civilized beings are going* counter to some of the primitive laws
of digestion."

What are the "primitive" laws of digestion ? The most primitive are
those deduced by experience, and not codified, so to speak, until long after
they had been obeyed as rules of action. In other words, experience regu-
lated the selection of food a long while before science came to explain why
and wherefore the rules were right. Experience may have gone wrong, but
where is the evidence that it did so ? It is not a new fact that Maine lum-
bermen, Arctic explorers and guests at Abyssinian hospitalities, consume,
among other things, meat not cooked ; and more may be admitted to the
same effect, as it is well known that there are whole tribes of savages who
take raw meat with evident pleasure. It is also within our own local obser-
vation, that an invalid will now and then try animal food raw, as an altera-
tive more promising than drugs. All this, however, proves nothing but man's
omnivorous capacity. In comparison with the accumulated evidence of
centuries, that man has always cooked his meat when he could, such individ-
ual exceptions are not safe indications of the primitive laws of digestion.
Not only has man acted on the laws that cooking is^useful, but his improve
ment of food is adopted by carnivorous brutes, who always eat cooked meat
when they can get it ; and man, again, following up their instinct, has learned
that in raising animals to the greatest advantage it is profitable to cook food

for them.

But the present purpose is to see what science, rather than experience,
teaches in relation to the nutrition to be derived from from animal food.
The bearing of the evidence from this source may be expected to show, at
least, that the laws of physiology and chemistry furnish no reason for chano--
ing our habit of cooking. On the other hand, not a little proof may be de-
duced from it that the nutritive element of meat is in larger proportion and
in better form in cooked animal food than in raw.

What is the process of human nutrition ? Omitting, at this time, bread,
" the staff of life," and kindred articles of food, it may be said, with sufficient
exactness, that all animal food may be divided into two dissimilar elements
fhat which is convertible into albumen and that which is not; or, in the lan-
guage of chemistry, in',o elements containing nitrogen and those entirely

78 Medical Independent. April

destitute of it. The former of these is convertible into blood ; the latter is
not. The one is the material for, and component of the tissues of the
body, and is digestible, or acted upon by the gastric fluid. The other prin-
cipal part of the food is fat, and underg.es no change in the stomach ; is
not affected by the gastric fluid, and passes on unaltered, except by minute
subdivision, as in ordinary officinal emulsions. It is a hydro-carbon, or fuel,
to be burnt -with the oxygen in the lungs, so much of it as is required, and
thus energize and convert into structure and sustain, the products of the
other portion of the food.

Is there, in physiology or chemistry, any evidence that cooking depreci-
ates the value of either of these as human ailment ? Careful analyses have
demonstrated that boiled meat, and especially the boiled flesh of the hog,
abounds considerebly more in nitrogen than the raw ; and as this is an im-
portant element in tissue-making pabulum, this evidence, so far as it goes,
is in favor of cooking. The only deduction from this, which now comes to
mind, is the opinion of an eminent chemist that " roasting and boiling alter
in no way the composition of animal food," so that adopting either conclu-
sion there is no reason, from this source, to believe that a loss is caused by
cooking.

If the conclusion is a reasonable one, that cooked meat is at least as nu-
tritive if not more so, than raw, when examined by physiological and chem-
ical science, the question may still be asked, do not the facts adduced by the
writers in the Journal tend to show that raw flesh will practically answer as
good a purpose ? There is no evidence, in these facts, of general application.
The inferences are drawn from peculiar and not universal circumstances-
Zeb. Mitchell k Co., living in the open air, with a good supply of albumen,
furnishing bread to eat, had come to quire a rapid generalization that a giv
en and small piece of raw fat pork " lasted longer" than one of the same
size when cooked. In other words, when it was not " tried out" by boiling or
f rving. there was less boiling or frying, there was less * fat in the fire" at
once. Wood, also, lasts longer than charcoal ; but is it a better heat gen-
erator ?

It is quite likely, in that moderately cold region, that if they had used no
ether food, they would in time have burnt up "the house I live in," and wished
their albumen-formed structure hand '; lasted longer." Dr. Kane, who was
also never without breadstuff, and respiring an atmosphere so cold that its
volume of oxygen was highly condensed, had a peculiar and imperative call
for large quantities of hydro-carbon to burn and save his body. Probably he
might have swallowed fat in almost any amount, that would " stay," short of
a dose of oil. At last, however, having so much oxygen to burn, he tells us
he felt an appreciable ,; decline of muscular power." The slight amount of
cellular tissue in which his fat was packed (about as valuable as the sawdusc
with which savages mix their tallow), furnished him with a poor supply of
structure-pabulum, and he may very well have gone into raptures about wal-
rus flesh, raw or cooked, if it would only save his body from the burning.
Like the Maine experience, his theory was formed under forced circumstances.
Highlj, however, as he lauds the raw "pachyderm," there is but little tempt-

1857. Spirit of the Medical Press. 79

ation for us to adopt it in this region, as he calls it " a glorious meal, such as
the compensations of Providence reserve for starving men alone."

The practical deductions from the occasional festive habits of the Abys-
sinians, who it seems eat both raw and cooked meat, are not at all unfavor-
able to the nutritious superiority of the latter. Not unlikely, as they ad-
vance in civilization, and become acquainted with M. Soyer, if not with tho
laws of physiology, they will adopt in full the experience of civilized man.
By that time, it is to be hoped that this science will havo settled ail about
the " digestibility" of fat pork, the fat of boiled bacon, &c, if the preceding
condensed view of its teachings be incorrect.

Something more than has already been adduced, it would seem, is wanting
to justify the recommendation of raw meat, in preference to that which is
cooked, for men in health. Every now and then impressible minds are
awakened to the possibility, perhaps probability, that the world always has
been, and is going on wrong ; but still it goes on, in this connection, in the
old domestic orbit. It was a simple device that deprived man of the dis-
tinctive appellation of being a featherless biped, but the feathers will bo
stripped from many a reformer's cap before man will cease to be u a cooking
animal." — Boston Med. $• .Surg. Journal.

Strychnia — Its Uses and Abuses.

This powerful alkali has figured very prominently of late before the pub-
lic; and has, in certain instances, been handled, medically, in a manner
somewhat remarkable. It is certainly not from any lack of caution as to its
use by writers upon Pharmacy and Therapeutics that its powers have been
at times very strikingly and dangerously manifested ; but it is rather owing
to its reckless employment or to an over-zeal in eliciting its effects, that ac-
cidents under medical management have happened. Those in the habit of
prescribing it, if well instructed, know that it is second only to prussic acid
in energy, when given in sufficient quantity to affect the system as a poison.
A girl, 13 years old, died in about an hour from taking, by mistake, three-
fourths of a grain divided into three pills ; and it has been asserted that
merely inhaling a little of it has proved fatal, Moreover, administered rcm-
edially, it sometimes has had an evidently cumulative action, and its effects
are very likely to break out suddenly and uncontrollably, unless the greatest
care is taken not to give too large doses, continuously. Yet there are in-
stances where, from having long given it ineffectually, tho practioner has
become impatient and added, very slightly it may bo, to the usual dose, with
the result of throwing his patient into strong convulsions. At other times
the increase of the dose has even been moro rash. Certainly this is an
abuse of strychnia.

We have lately heard of employing strychnia in some cases of insanity.
"We do not deny that there may instances where it is demanded — as perhaps
in certain concomitant paralytic states ; but we are not cognizant of any

80 Medical Independent. April

special action that is predicated of this medicine likely to benefit the mental
aberration. In a case of furious mania, recently for a short time under our
observation, we learned that strychnia had been administered on the out-
break of the affection. We are aware that it has been recommended ia cer-
tain cases of maniacal aberration — but, as we suppose, in such as exhibited
the moping melancholy form, and in hypochondriacal states. We fail to see
the indication of its employment in violent, active mania, in young, vigorous
persons. If we mistake not, there have lately been reports of similar treat-
ment in analogous cases ; if our distrust be only ignorance, we beg to bo
enlightened upon the point. Unless we are thus informed, we put this down
as another abuse of strychnia.

It is needless to refer to the frightful and cold-blooded murders, the de-
tailed circumstances of which have made communities tremble. In these
cases, the abuse of strychnia has had its uses, in that it has given to the
world the elaborate chemical reports and investigations required by the le-
gal necessities of the case. These will stand as invaluable evidence, and be
always looked upon as mines of information. In connection with this part
of our subject, we consider it an abvse of strychnia, as of any subtle and
potent poison, to have it so easily procured. Druggists should not be allow-
ed to vend this medicine, any more than arsenic, opium, prussic acid, &c, to
all applicants indiscriminately. Might not much of this abuse be done
away by refusing the sale to all who do not present a physician's prescription
or order ? We are aware that much has been written and said upon this
point, and also that nothing, of consequence, has been done. Often these
deadly articles are as heedlessly sold as the most simple remedies. The
small pecuniary gain to the apothecary, levies a large debt of responsibility
against him.

The legitimate vses of strychnia are well known. A powerful excitant of
the nervous system, without any specific action on the brain, has been long
acknowledged to be a very valuable remedy in certain paralytic conditions.
Combined in minute doses with purgatives, it hastens and increases their ac-
tion ; and it has thus been advantageously employed in some cases of amen-
orrhcea. or of suspended menstruation. We can testify to good service done
by it in this way. As a tonic, brucia, the other component alkaloid of nux
vomica, has been found perhaps more useful than strychnia. The latter is
often prescribed in dyspeptic states, such as are accompanied by pyrosis and
gastrodynia. Testimony is strongly favorable to its curative effects in asthma.
Externally, its employment for amaurotic troubles has been extensive.

To recur once more to the abuses of strychnia, or, which amounts to the
same thing, of the nux vomica, we cannot refrain from alluding to one which,
in view of the strength and unmanageable nature of the agent, should be
represented to the too credulous public in the way of caution. There are
those who, by the necessity of their position and avocations cannot have that
knowledge of, and familiarity with this and other giants of the Materia Med-
ica, which fit them for advising or regulating their use. Still, very many, in
every community, are willing to take, from such unskilled persons, compounds
containing unknown amounts of strychnia, &c., &c. Thus we have soidisarit

1357. Spirit of the Medical Press. 81

or retired clergymen advertifing that they will furnish a p»escription for a
preparation containing the active principle of St. Ignatius' bean, and the di-
rections for using the same. All such tamperers with human health and life are
accountable to higher tribunal than any earthly one, and those who aid and
abet them must bear them company thither. It being quite sure that the
adoption of these quack remedies by the people, only brings the honest phy-
sician more patients, we shall not be accused of covetousness in protesting
against them. We do not aspire to coerce people, even by argument and
the exposition of blood and unwarrantable assumption that seeks to medicate
— or rather to poison them — they are free agents, but certainly in no other
affairs do they act so inadvisedly or expose precious interests so recklessly as
in the care (as they understand it) of their health.

The proper uses of strychnia, as of all medical agents, are only thorough-
ly known by the educated physician. Why does any one desire — or dare —
having the manifest peril in view which its improper employment implies —
to entrust its administration to the unfamiliar — the adventurer — or still worse,
if possible, to their own judgment ?

And we even commend to Legislative consideration the dangers constantly
attendant upon the unrestricted sale of medicinal articles, a fractional part
of a grain of which sometimes takes life more quickly than the knife or the
bullet. The facility of procuring such materials arms the unprofessional
murderer quite as surely, if less covertly, than it does a Palmer. — Boston
Med. Sf Snrg. Journal.

Self-Stultifcation.

Homospothists, in this country at least, have hitherto contented themselves
with sly and cautious inuendoes, circulated secretly, and retailed among the
families they visit, in disparagement of medical science as held and taught
by the regular Faculty, and they have for the most part discretely refrained
from trusting themselves in print. One of their number has ventured to ap-
pear before the public, in a pamphlet of some thirty pages, a copy of which
has fallen into our hands. It is entitled "Observations on Membranous Croup
with cases, by George E. Belcher, M. D., New York.

On reading it we are constrained to say, that the author betrays an utter ig-
norance on the subject on which he presumes to be a teacher, to say nothing
of his lamentable deficiencies in philology, and his frequent employment of
technicals unknown to any of the languages of the earth. These latter defects
would be insignificant, however, if he had anything to say either novel or useful,
on the important topic upon which he has undertaken to write.

In the first place, it is manifest that he does not know what Croup is, but
is hopelessly ignorant of its causes, its nature, its source, its' symptoms, its com-
plications, its indications of cure, its remedies and its dangers. Of course he
fails in its definition, blunders in its etiology, ignores its differential diagnosis,
mistakes its symptomatology, is wholly obvious to the tissues involved, con-
founds it with other diseases essentially different from Croup, and by necessa-

82 Medical Independent. April

ry consequence, proves himself to be a "medical know nothing" in his relation
of cases and their treatment.

A meagre report of forty cases accompanies the pamphlet, twelve of which
are admitted to have terminated fatally! a ratio of mortality (thirty per cent)
which, with such cases as these were by his own showing, should write the epi-
taph of any physician of any school, who did not forthwith abandon so unsuc-
cessful treatment. But every reader of the pamphlet will percieve that many
of these cases, so far from being " Membraneous Croup," were not even Croup
at all, and would have recovered under any skillful mother's or nurse's domes-
tic treatment, if the Homcepath had only whistled every time he gave his glob-
ules or dilutions.

To demonstrate, in detail, the truth and justice of our wholesale imputations
of ignorance agaiust the author, would only require the transfer of his pamphlet
to our pages. But as our space is otherwise occupied, we can only allude to a
few features of the paper, which must suffice.

And first, listen to his definition :

1. " Croup is essentially an inflamation (or affection) of the air passages,
with hoarseness of a peculiar character, complicated with Laryngismus."*

This is "clear as mud," and false as it is clear. Croup is essentially Trachi-
tis, with fever, and to call any other " affection of the air passages " by this
name is a misnomer.

" Laryngismus " is another and different affection, nor is it a necessary com-
plication, as here represented. It is most freequently a spasmodic " affection/
dependent upon the extension of the irritation, by contiguous sympathy from
the tracheal tissue ; or it may be Laryngitis, and wholly distinct from the
Croup. The definition fails to make the necessary discrimination, and is
worthless, besides being false.

2. And now for causes of Croup. These are thus enumerated, viz:

"A slight catarrh, over play, gastric irritation, or any other cause which in-
duces congestion of, or renders tumid the air pussages."

Neither of the causes named are capable of exciting Croup, " or rendering
the air passages tumid," and this latter is not Croup. We shall presently see
what * air passages " the author inspects in Croup.

The " posterior nares," " fauces," " tonsils, pharynx, and lateral edges of the
tongue," or u perhaps near the orifice of the parotid duct," these are the " air
passages " which the author dwells upon as symptomatic of Croup, and he
even describes tha exudation as " limited to the buccal cavity and fauces."
Hence, in the cases he describes and calls " Croup," he says that he found u sore
throat, the fauces and tonsils red and inflamed, obstructed nostrils, tongue
coated with exudations of whitish yellow, extending to the tonsils, fauces," &.
and adds that " the child has fever and sore throat, the fauces are red, resem-
bling that of Scarlatina simplex," &c.

It can scarcely be necessary to quote farther in proof that the author con-
founds catarrh, quinsy, canker sore mouth, scarlatina, putrid sore throat, &c,
with pharyngeal, laryngeal and tracheal inflamation, and calls all of them croup-
And this when Croup is not attended by any sore throat, as all practical men
know, until, as in a few rare cases, the inflamation extends from the trachea to

1857. Spirit of the Medical Press. 83

other tissues, and in some cases ends in oedema of the glottis, one of the most
fatal results of Croup, and one of which the author manifestly knows nothing",
and for which he and his school have no remedy,? To look down a child's
throat, and seek for soreness and redness of the fauces and tonsils, or to ex-
pect these symptoms in sudden attacks of Croup, betrays an utter ignorance
of the disease, and an equal incapacity for its treatment. It is only in advan-
ced and chronic stages of the disease that its ravages are visible, and are then
secondary sequela, and complications, wholly distinct from Croup, and calling
for wholly different trea ment.

4. In the treatmont of Croup, this Homcepath directs the following formid-
able list of remedies, viz :

"Acconite, tartar emetic, stibium, spongia, hepar-sulph., sulph. acid, mere,
dulcis, arsenicum, cantharides, potass-bichrom, carbo-veg., merc-protouide,
bromine, belladonna, bryonia, kali bromid, tinct. iodine, ptusus I. cerasi, rhus-
tox, cololyntht nux vomica, chamomile, china, tinct. of opium, phosphorus! '' $*c.
and in his bad cases calls to his aid the topical application of the nitrate of
silver! with a sponge probang, by a convenient proxy, in addition.

It must be confessed that the infinitesimal doses he uses, of all these multitu-
dinous drugs, affect the patient no more than would a mark made upon Ins
cradle with a piece of green chalk ; and the disease is left to its fate. Yet
precious time is lost, during which the curable case becomes incurable, and
hence such practice must of necessity multiply the victims of Croup. And this
report of cases proves that those who escape are left to suffer for weeks and
months with anginose and other chronic sequela, when under rational practice
all these might be averted.

But enough has been said to vindicate our reprobation of the pamplet, and
the ignorance as well as presumption of its author in presuming to teach any
body the art of healing, of which he knows nothing.

But w hat will be the surprise of the reader when he learns that this pretend-
er complains lugubriously that a member of a * select society " called the " N.
T. Academy of Medicine," felt " bound in honor not to consult with him ! "
"We have shown enough to prove that such consultation would have been a
farce, and worse, a conspiracy to obtain money under false pretences, if any fee
was to be charged by either. We honor the honesty of the " good physician "
and the " select society," he represented, especially in these degenerate days,
when the fee is often preferred to the dictates of professional duty, and con-
science itself becomes the victim of " moral insanity."

No fee could tempt ns to consult with the author of this pamphlet, no matter
to what school he might belong, and such will be the professional judgement
wherever it may be read.

The following disgraceful paragraph is the only citation from the pamphlet
with which we will further polute our pages. It is a choice specimen of the
whole performance, not only in its ignorance but in its coarse vulgarity. It is
the report of a case on the 17th page.

A delicate infant, not over 9 or 10 months of age, of a delicate mother, in the
last extremity of Croup, with grayish white exudations lining the buccal cav-
ity, tongue, throat, &., had been attended by a very ' regular ' physician, who

84 Medical Independent. Apr!

Lad repeatedly vomited and cauterized it, blown powdered alum into its throat,
rubbed it with nasty liniment ; in other words, had done every thing that could
be done. I refrained myself from expressing any disapprobation of such, 'sci-
entific treatment,' but at the same time could not help thinking:, that any wise-
head of the strictest sect of ' rational ' physicians would in sympathizing consul-
tation have sagely noded approbation ; and yet have been horrified at a sug"
gestion to apply a gentle specific medicine. 1 gave it Potass bicrom., first in
solution, a small tea-spoon every half hour ; but the child could not stand such
'poisonous' treatment, and died in a few hours."

This is a vile caricature, in lieu of a scientific " report of a case," aud its irony
heartless " enough to make the cheek of darkness pale." If the case itself be
not a pure fiction to eke out the list, as we suspect, the story itself bears inter-
nal evidence of falsehood, while it betrays toward \he profession the malignancy
which fabricates calumny to serve its resentment. We content ourselves with
pronouncing the sneers at " scientific medicine," the "regular" and "rational"
physicians, &., and especially the treatment ascribed to such, to be a base and
unprincipled libel upon our profession. Surely ignorance and impudence can
no farther go. — Medical Gazette.

Landolfi's Treatment of Cancer.

M. LandohT mode of treating cancer having gained considerable notoriety
in Austria, he repaired some time since to Paris, in order to induce the Sur-
geons of that capital to endorse the favorablo opinions expressed by some of
the Vienna practitioners. The French Hospital Surgeons accordingly
appointed a committee of their body to examine into the ability of the claim,
and this was done by assigning M. Landolfi a certain number of patients at
the Saltpetriere. The committee, after watching the results of his treatment
of these cases, has just made its report, and the following are the conclusions
arrived at. From these it would seem that the remedy is destined to fall into
the oblivion that has entangled so many of its predecessors.

1. M. Landolfi's method is made up of both local and internal treatment.

2. Th* latter, which consists in the administration of the chloride of bromine
does not possess the slightest special therapeautical value in the treatment of
cancer.

3. The local treatment consists in the application of the following caustic :
Chloride of bromine, 3 parts; chloride of zinc, 2 parts; chloride of antimony,
1 part ; liquorice powder, 1 part.

4. Of these substances, the chloride of zinc and the chloride of antimony,
have been long known and employed as caustics. These two chlorides com-
bined in the same proportions as in Conquoin's caustic, form the only portion
of M. Landolfi's preparation that is really active.

5. The chloride of bromine only acts by raising the epidermis, and exposing
the denuded part to the action of the other two chlorides, a result easily
obtained by any vesicatory applied just before employing Conquoin's paste.

1857. Spirit of the Medical Press. 85

6. M. Landolfi's preparation is, in fact, only this caustic masked by a col-
oring and odorous bodv, which, although it leaves the causticity unimpaired,
destroys the precision of application. The chloride of bromine has only
spoiled the mixture by rendering it fusible, and more difficult to manage, and
much more uncertain in its results.

7. As the .caustic so modified does not secure the patient from erysipelas
or consecutive haemorrhage, it can be no longer affirmed that its employment
is exempt from danger.

8. Infinitely more painful than most others, this caustic induced most severe
suffering, which, in general, lasts for six or eight hours, and may be prolonged
for more than twenty-four hours. Opium and other naroctics are powerless
against these pains, while their duration forbids our even thinking of employ
ing anaesthetics.

9. The mode of application is quite vicious, and opposed to the rules of
art. In place of attempting to at once destroy the cancerous tumor, M.
Lando'.fi attacks it by partial and successive applications — a necessary conse-
quence of employing a rustic the extent of the action of which cannot be
calculated.

10. These successive applications, repeated on some patients fifteen or
twenty times, induce a total amount of suffering hitherto unheard of.

11. They prolong the treatment indefinitely, and infinitely delay cicatriza-
tion.

12. The incessant irritation thus induced is of a nature to favor a relapse,
as experience has only too well shown, and all who are imbued with sound
surgical knowledge.

13. This method, applied by the inventor himself to nine cases of cancer
of the breast and three cases of cancroid, has given the following results : —
Of the 9 cases of cancer of the breast, 2 have died, 4 have suffered a notable
aggravation of the disease, while in 3 cases in which cicatrization took place
the disease immediately appeared ; that is to say, in no case did a cure result.
Of the 3 cases of cancroid, a cure took place in 1; in another there was cica-
trization with re- appearance of the disease, and in the other an exacerbation
took place that necessitated the amputation of the limb.

To sum up, M. Landolfi's method can only be applied to certain cancers ;
it is more painful and more uncertain than several other modes of cauterization ;
and it is, in particular, inferior to Conquoin's method, of which it is only an
altered copy. Like all other methods of treatment, it may suceced in destroy-
ing certain tumors and cicatrization may follow; but it is' quite powerless for
the prevention of relapse, which it would seem rather to provoke, and so far
from forming a step in advance, it adds but another to the illusions that so
abound in the history of cancer. — Med. Times and Gaz. from Bull de Therap.

86 Medical Independent April

On the Emplotmtnt of Chlorate of Potass. By M. Isambert.

In this paper, M. Isambert, after giving the history of the employment of
tho chlorate since its discovery by Berthollet, its disuse, and recent revival by
Hunt and others, state that he has of late investigated its therapeutical action
in M. Blache's wards at the Children's hospital, and its physiological effects^
by experiments upon himself. Passing over these latter, we present the con-
clusion he has arrived at in regard to its medicinal employment.

1. Gangrene of the mouth. — On carefully examining Mr. Hunt's observa-
tions, he considers it very doubtful whether he always had to do with true
gangrene of the mouth, having rather confounded this affection with ulcero-
membranous stomatitis, in which the effects of the chlorate are truly remarkable.

In two cases of gangrene he did not find it very serviceabb; and West, who
carefully distinguishes between the two affections, seems to have come to the
same conclusion.

2. Ulcer o-membranous stomatitis. — This term, adopted by Killiet and Barthez
well explains the nature of the affection, there being, in fact, both ulceration
and the formation of false membrane present, the one predominating in some
cases, and vice versa. It is a most obstinate affection, having no natural ten-
dency to a cure, and being liable to a relapse. West first employed the
chlorate in this affection, and his success with it has been amply confirmed by
Blache, Herpin, Bergeron, and others on the continent. Eight cases which
have occujred to the author speak equally favorable. Relapse may, however
occur, though far seldomer than under any other remedy; and it should
therefore, be continued for some time after the fall of the false membrane. —
The chlorate, too, is powerless against alveolo-dental pyorrhoea, or ulceration
of the borders of the gum, with purulent issue from the alveoli, on pressure
being made upon the gum. The mean duration of treatment of these eight
cases was from three to five days for the production of the fall of the mem-
brane, and five to ten for a complete cure. When the cure was longer delayed
relapse had occurred, or the alveolo-dental pyorrhoea was present.

3. Aptha. — The vesiculo-ulcerative state of the buccal cavity to which this
appellation is now confined, is in general a very mild affection, and curable by
simple means. Sometimes, however, numerous and confluent humors ulcers
produce much pain, impede feeding, are veay tedious in healing, and induce
constitutional disturbance. In a case of this kind the chlorate effected a rapid
cure.

4. Muguet. — M. Legroux has tried it in several cases of epidemic muguet
at the Hotel-Dieu, but without any favorable result. During the trials it was
found to pass rapidly into the milk of the nurses, and in this way it may be
administered to infants.

5. Scorbutus. — M. Fremy has found the medicine of use in this disease ;
and thus we find the moderns returning by another route to one of the first
affections the chlorate was recommended for on the theory of deoxidizing the
the salt in the economy.

6. Diptheritis. — Observations commenced by M. Blache, and continued by
the author, leave no doubt as to the utility of the chlorate. In this affection

1857. Spirit of the Medical Press. 87

there is, however, every gradation, from the most simple to the most malignant
form, a sign of most unfavorable augury being found in the swelling of the
parotid and deep seated cervical glands — enlargement of the submaxillary
glands occurring in even the simplest forms. Of thirteen cases, the chlorate
was exclusively employed in four, and the cure was rapid, the cases being mild
ones. In two, although cauterization with nitrate of silver was employed at
the beginning, the success was attributable to the chlorate. In two others,
cauterization was simultaneously employed, but the cure was not more rapid
than in the others. The ninth case was a ve.ry severe one following scarlatina,
and the patient was cured by the chlorate and quinine, without the aid of
cauterization. The four others died, but they were cases of a very grave
description. The chlorate is, therefore, no heroic remedy, always curing angina
miligna, nor is its action immediate; for, although it appears in the saliva a few
minutes after administration, it requires at least twenty-four hours, and usually
three or four days, before it can effect its purpose. It should, therefore, be
commenced with early.

7. Croup. — The success attendant upon the chlorate in diphtheritis natu-
rally led to its employment in croup. The author relates four[cases in which
the chlorate seemed to have succeeded, and refers to eleven others, in which
tracheotomy was resorted to also, whether because the medicine did not seem
to be taking effect with sufficient speed, or that tracheotomy having been al-
ready employed, it was given as an adjuvant to prevent the reproduction and
extension of thto diphtheritis. Of these eleven cases, some of which were
very severe, there were ©ight recoveries and three deaths. Between the first
of January and the end of March, 1856, tracheotomy was performed in M.
Blache's wards, fourteen times, with nine recoveries and five deaths, all of the
children taking the chlorate either prior to or subsequent to the operation,
If this success be not due to the occurrence of a run of lucky cases, which oc-
casionally occurs in practice, the result is remarkable, as the proportion of
recoveries after tracheotomy, at the same hospital, has averaged during the
last six years has been but one -in four or five. When tracheotomy has been
performed, the use of the chlorate is especially indicated, where there is a
tendency in diphtheritis to extend to the bronchi, pharynx or nasal passages-
It should be combined with expectorants, and considerable doses given. — Gaz.
Medicate.

The Yalerinate of Ammonia in the treatment of Neuralgia.

The statements respecting the power of this new agent in the treatment of
neuralgia has excited considerable interest among medical men in this city.
Its value is being very freely tested by our most intelligent and judicious phy-
sicians, and we expect to bo able to report their experience at an early day.
To a limited extent we may say this experience already confirms the happy
results reported by Declat in the French journals. We stated last month in
a note from Dr. Eruhl, that the valerianate of ammonia was being prepared

88 Medical Independent April

■ — - "■ —_ ~ — — — ^ — » •

by Mr. Finnel, Druggist, cor. Third and Broadway, in this city. Mr. W. J.
M. Gordon is also preparing it, and we presume all our best druggists will
have it on hand if the experiments now making prove at all satisfactory. Wo
may be pardoned for repeating the formula for its use. The valerianate, of
course, is a salt, and it is administered in aqueous solution in the proportions
of half a drachm to the ounce of solution ; dose, a teaspoonful three times
a day. "We suggest, however, as valerianic acid saturated with ammonia, is
a more convenient preparation than the salt, that the former be adopted as
the basis of prescription, the remedy would be equally reliable and conveni-
ent for use, and would save the druggist some extra manipulation. It is, how-
ever, desirable to have a uniformity in the preparation, that we may not
prescribe with confusion. We propose, therefore, that our apothecaries keep
on hand an aqueous solution, each ounce of fluid to be equivalent to drachm

ss. of the valerianate of ammonia, and to be known as the Liquor Ammonite
valerianatis. — Cincinnati Med, Observer.

Medical Fees.

The subject of fees for professional services seems lately to be attracting
considerable attention among our brethren : We have read very fitting and
timely articles upon it in a number of our exchanges. We propose, there-
fore, to improve this occasion with a few remarks upon the same topic.
These remarks, however, are not intended 10 apply to such professional ser-
vices as rre necessarily of a charitable kind. God forbid that the humane,
benevolent character of our noble order should ever be lost sight of ! or that
ever a true physician should feel at liberty to refuse his attentions to any
from their inability to tender the honorarium. What we speak of now has
simply reference to such service as we expect to regard at any time as a
proper subject of remuneration.

We think it of easy demonstration that, in view of the capital invested,
the time expended, the exposures endured, and the money received, the phy-
sician is the poorest paid member of the body social or politic. We make
no exception — we speak with due reflection when we say the ditch-digger
receives better pay. And then, as has been properly remarked by the Med.
and Surg. Reporter, " small as doctors' bills are, it is considered a merit, by
a great many, to cheat them out of the whole or a part of their hard earn-
ings ; and yet when a doctor has money dealings with others, he is expected
to pay promptly to the uttermost farthing." It is generally agreed that the
remedy for this trouble is in the hands of the profession, and that it only
needs harmony of action to secure it. There is no doubt but that we shall
accomplish much more for ourselves individually, when we at last shall come
to recognize the truth that the medical profession, as a craft or fraternity, is
dependent for the prosperity of its individuals, upon the prosperity of
the whole. The remedy that is generally suggested for relief consists in a
revisal of our fee bills, conforming them to the advanced rates of living
We do not doubt but in many places this ought to be done ; indeed, in some

1857. Spirit of the Medical Press. 89

localities we know the fees are absurdly low. But still, we think the evil is
not so much in the rate of our fees, as in the way we collect them, or rather
dorit collect them. In almost every department of business, the credit sys-
tem is being abolished. The consequence is, that tradesmen adopting the
cash principle can afford to sell the wares at a reduced rate, and make a
greater profit. We have no doubt the public would find it to their interest
to adopt the same plan in compensating their medical advisers. On this
point we call attention to the remarks of our intelligent Boston correspond-
ent, in his letter published in the February No. of the Observer. He gives
an instance of a physician in that city, whose practice, too, is among a class
proverbially the worst pay for doctors of all others, who has adopted the
cash system, and is becoming rapidly wealthy, That is the plan puisued by
the Inhalers, Magnetic-Bath doctors, Fit Curers, and the like, and they
" clothe in purple and fine linen, and fare sumptuously."

We say, then, we believe the remedy consists rather in a revision of the
credit system, than in a revision of fee bills. Transient persons, office pre-
scriptions, and the like, should, at any rate, be cash. Regular patrons should
have their bills presented as soon as the treatment of a case is completed.
The service is then fresh, and gratitude for attentions at its night, Besides,
for the most part, there is no hardship in this arrangement to the public.
Make our arrangements accordingly, and it is quite as easy to find money
for a reasonable amount of medical as for our weekly marketing. What
locality will set a goodly example in this matter, and demonstrate its practi-
cability and mutual benefits ? A city like Cincinnati might do so with pro-
priety. What say you, brethren ?

This sanitory reform must necessarily be a gradual work, we suppose, but
we must ultimately come to it. As an individual, if we can receive prompt-
ly, without delay or dunning, remuneration for our services, we should be
contented with present fees. — Cincinnati Med. Observer.

In this State the average fees in country practice are fifty cents a visit;
twenty-five cents a mile for travel; twenty-five cents for prescription; five
dollars for obsteteric fees, and from three to five dollars for consultation.
Verity, a reform is needed, in this respect, in Michigan. How shall that
reform be effected ? — Ed.

Etherization in- Convulsions.

Dr. N. J. Knight communicates to the Boston Medical Journal his expe-
rience with ether in controlling convulsions, and especially the convulsions of
children, as follows :

" I think etherization, in cases of convulsions in children and adults, is not
fully known and appreciated. To every case of teething convulsions, in my
practice for the last three years, I have administered the pure sulphuric
ether, and immediate restoration has followed with the most pleasing effect.

A severe case of puerperal convulsions occurred in my practice last month.

90 Medical Independent. April

A lady who had, at three previous pregnancies, miscarried at periods varying
from four to seven months, was taken with the usual symptoms of abortion,
and sent for me in haste. Perfect quiet and an anodyne were prescribed ;
the alarming indications soon passed off, and I left. About three o'clock the
next A. M. I was sent for, and found the patient recovering from a convul-
sive fit. Bleeding, a cathartic, cold to the head, sinapisms, to the neck, legs,
etc., did not prevent the recurrence of three more convulsions in less than
ten hours, when I commenced the administration of sulphuric ether, and
although no more convulsions occurred, it was not until near the end of for-
ty-eight hours that tho nerves became so calm as to allow the ether to be
omitted altogether. Ten days from the first attack the lady was delivered of
a seven months' child, which had evidently been dead from the time of the
first convulsion.

I have had a severe case of convulsions of a married lady, this week, and
etherization shortly restored the patient to a healthy condition.

I consider ether really the only safe and efficient remedy for convulsions of
teething children, or adults, now kno»vn to the profession. Probably the
half is not yet learned that etherization can accomplish for suffering hu-
manity."— Cincinnati Med. Observer.

Mortality of Boston in 1856.

During the year 1856 — as we learn from the Annual Report of the City
Registrar, which was more particulary noticed in last week's Journal — therQ
were 4,263 deaths in the city of Boston, being an increase of 173 over tho
number recorded in 1855, but 188 below the record of 1854. The only epi-
demic was scarlatina, which proved exceedingly virulent during the latter
part of the year, having caused no less than 362 deaths, or 8.51 per cent, of
the whole number. It has been prevailing since March last, in which month
10 deaths occurred, and they gradually increased to the end of December, 115
fatal cases having occurred in that month. The greatest number of deaths
occurred in children between the ages of 3 and5, viz : 96. Between the ages
of 5 and 10 there were 78 deaths ; from 2 to 3, 76; from 1 to 2, 72 ; under 1,
28 ; from 10 to 15, 8. Of all the deaths from this cause, 95 are reported as
of native birth, 28 were foreign born, and 237, or 66 per cent, of the whole
number, were children of foreigners. The last two classes make 73.75 per

cent. The localities in which the disease prevailed most extensively are such
as we should expect, and show that an elevated situation, cleanliness and good
habits afford a strong protection against the virulence of the disease, as sure-
ly as filth, want of ventilation and a low situation, favor its prevalence and
severity.

The d oaths from consumption last year were 760 in number, being an in-
crease of 25 over last year's record, and making 17.87 per cent, of all the
deaths. Of those dying from this disease, foreigners make 63.81 per cent., and
as might be expected, the greatest number of oictims were from those quar-
ters of the city which are chiefly occupied by the ever-crowded, ill-ventilated
dwellings of the Irish, which people furnished 52.63 per cent, of the entire
number. — Boston Med, fy Surg. Jownnl.

NEW PUBLICATIONS.

Lectures on the Principles and Methods of Medical Observation and
Researche for the use of Students and Junior Practitioners — By
Thomas Laycock, M. D., F. R. S. E., F. R. C. P., Professor of the practice
of Medicine, and of Clinical Medicine, in the University oi Edinburgh, etc.
etc. Philadelphia, Blanchard & Lea, 1857.

To the medical investigator, who would be philosophical, and who has
accustomed himself to observe and to think, the work before us, will be
scarcely less than a cyclopedia — a treasury of logical professional thouo-ht,
and reasoning. Appropriated to a heretofore unoccupied field of research,
and designed to fill an obvious hiatus, in medical literature, it may in
truth, from its discursiveness of reasoning, and its copiousness as regards
number and variety of topics, with great propriety be denominated mul-
tum in parvo.

In all the past history of our profession, just such a work from the pen
of some one competent to the task, has been greatly needed, as a source of
encouragement to him who would base his learning on the sure foundation
of scientific deduction, and as an aid toward the consummation of the pur-
pose by which he is prompted. It is not ours to deal in fulsome laudation,
either of men, or their works. But in times like these, when perhaps not
less in the professional, than in the literary world at large, haste and super-
ficiality are made to usurp the place of " calm contemplation," and pro-
fundity of research, when we say in such times, and under such circum-
stances, we meet a production, that bears the impress of an honest desire
to advance the real interests of our science, which seeks to expuno-e lono-
cherished falacies, and give truth her legitimate prominence, we hold that,
to speak out, frankly and fearlessly the gushing sentiments of honest ap-
proval, (the fastidiousness of certain " bashful " editors, to the contrary,
notwithstanding,) is neither to depart from the proprieties of life, nor to
insult the good sense, of an intelligent public. Nor would we plight our
fealty to an assumption that it is not only the province, but the imperative
duty of the periodical press, to speak in terms of unequivocal criticism-^-
a criticism that is often founded, not so much upon profound knowl-
VOL. Ill, NO. II — 3

92 Medical Independent April

edge, either of the matters in question, or an intimate familiarity with
the drift and doctrines of the author, as upon personal spleen and
caprice, or an inordinate cacoethes carpendi. What ! would these wise-
acres, these would-be-paragons in scientific lore be ever looking on the lurid
aspect of life — has not the world a superabundance of gall and bitter-
ness, allready ? Ah ! my confrerres, let us contemplate, at least,
from time to time, if not constantly, the sunny side of the moral scene.
Let the amiabilities of our nature, which, at best, is not a whit too
amiable — the amenities of life predominate. Let us contribute our little
share towards this desirable consummation. Let us be benevolent, as well as
rigidly, exactingly just — in a word,

■ Let us laugh where we ciay," play critic when we must;"
a But justify the ways of God to man."

That the reader may appreciate the real character and worth of the pro-
duction, it will be necessary, only, to present the author's observations on a
few points.

And, first, of clinical medicine he remarks, "we are met to day in order
that, for the next three months, we may study, and practice medicine to-
gether, at the bed-side of the sick. To us all these pursuits are of singular
importance. To you, clinical study is the culmination of your academic
career ; and, upon the habits you may form, and the doctrines you may
imbibe, much of your success and happiness in the practice of your future
profession, will depend." Again. " I need hardly say one word in com-
mendation of clinical teaching. It is of sigular advantage in every way.
To the sick poor, especially valuable, because it secures to them at
small, if any cost, to their feelings, the most careful consideration of their
case. To the public, not less advantageous, because it is the best means
of advancing medical art, and training students- into good practitioners;
to the student : it affords him the opportunity of meeting disease, face to
face, not easily met with elsewhere, and, therefore, of vital importance to
vou, since it enables you to secure the great object of all your studies.
':T.hat object is the acquisition of those qualities, which, included under the
terms professional skill and tact, constitute the surest means of professional

success."

Now, how unlike, are the views of our author, as well as those of other
- -eminent men, and especially of the learned, and ardent Latham,
the flippant, yet puerile notions issued from a certain source, with an assu-
rance that verges towards arrogance, and would seek to give a tone and
a direction to the whole system of medical education, throughout a vast
region of country, to the effect that clinical instruction, as taught and man-
aged in our country, is altogether of minor consequence. How unlike that
other notion — if it (clinical instruction), be desirable at all, it may be best
pursued by students, in association with their preceptors, scattered all over

1857. New Publications. 93

the country. In our country! What is the significance of that expres-
sion ? Is it designed to traduce the character of the institutions of the
country. To cast odium on the reputation, influence and hard earned
fame of the learned men who have long been engaged in this important
department of medical teaching, the burning and shining lights of our own
beloved country ? Is it to attach an invidious consequence, thereby effect-
ing i: wisdom, above what is written " — to foreign institutions foreign
usages, in derogation to our own ? We pause for a reply. But further—
pursue clinical research in the office, and in association with the preceptor,
a country practitioner, who, though he may have learning and still of an
enviable grade, nevertheless, sees but few patients, comparatively, and these,
too, under the most unfavorable circumstances for close observation of the
phenomena of disease, by a young man who has scarcely learned the al-
phabet of professional nomenclature. But we dismiss the subject as too
preposterous to merit the dignity of a serious refutation. We leave it to
the silent indifference of an enlightened medical public

But the writer observes: u We are met, to-day, in order that, for the
next three months we may study and practice medicine together, at the
bed aide of the sick." This sentence is pregnant of meaning. And how
will it be received and appreciated by the reflecting non-professional read-
er, compared with that other, no less puerile proposition, emanating, it
is believed from the same fount of immaculate wisdom, viz: the appoint-
ment of. a single, perhaps remarkably experienced professor, to the
exclusive charge of a certain hospital, for the purpose of imparting clinical
lore, in all the departments of professional practice, to the advanced class
or classes of medical students. The language of our author implies em-
phatically, at least, the idea of rotation, in the important duties of the hos-
pital practice and clinical teaching. We think it implies more. That each
department, as practice, surgery and mid-wifery, has its proper officer,
who, for the period of three months, is responsible for the faithful perform-
ance of all the duties that belong to it. It implies most certainly, di-
vision of labor and duty, rotation in office, and diversity of professional
attainment — in a word, it implies professional progress.

Take another example. " Fallacies of Anatomical Etiology. A fallacy
in the determination of causation is very common in researches into the
anatomy of disease, certain observed conditions of structure are discovered
after death, and it is, at once, inferred that these are the causes of the
symptoms observed during life, or, in other words, constitute the disease.
In this way, the terms, phthisis, and consumption, originally used to ex.
press a wasting or diminution in bulk, of the living tissues, have come to
signify a certain kind of abnormal, structural change, viz: so called char-
acteristic deposit in living tissues, or tubercle. And, in as much as it is
usually found that the lungs are the seat of this deposit, pulmonary phthi-

94 Medical Independent. April

sis and tubercular phthisis have become convertible terms. But in truth,
the disease, etiologically, is that on which both the wasting and the deposit
depend, that is to say a morbid condition, existing antecedently to any
perceptible, structural change, and without which, neither the true phthis-
ical tubes, nor the true tubercular deposite, will occur. This fallacy is of
constant occurrence in anatomical researches into disease, and by insensi-
bly leading the minds of practitioners, rather than the processes of morbid
action, has seriously checked progress of practical medicine."

Thus significantly, and to the purpose in view, our author discourses on
this important subject : and the reasoning is so plain and the principles so
obvious that the veriest neophyte cannot fail fully to comprehend them,
while the man of experience and of reflection will at once be reminded of
the frequency that his own mind has been directed in the same channel;
that he has thought the same thoughts, and yet will be induced to wonder
that he has not given them form, and offered them to the world.

The physiognomy of disease, and of those conditions of the economy
that impress a remarkable proclivity towards a particular disease, or induce
a characteristic grade of action, diatheses, are considered at length and with
much care.

Of the physiognomy of the cancerous cachexia, the following is his mode
of remark:

* This may arise in any diathesis or cachexia, but it appears to be most
frequently associated with the strumous, about middle age, or later. The
deposite which characterizes it usually occurs in organs which are exempt,
in the earlier periods of life, from tubercular deposite. The characteris-
tics are, therefore, as to the features, rather of the strumous cachexia than
the arthritic. The complexion is muddy, waxy, or sometimes transparent;
the expression of the countenance gloomy ; the temper captious and melan-
choly; the muscular power enfeebled ; the appetite impaired ; the body pro-
gressively wasted ; the nights sleepless. It attacks middle age."

To the junior practitioner, and the student, such a summary, not only of
facts in pathology, but of the assemblage of external aspects, which charac-
terize this cachexia, is invaluable, whilst he who has toiled many years,
will find a revelation of observations, involving important truths, which he
has already recognized, and, perhaps, elaborated into aphorisms, or in regard
to which he has been culpably remiss.

Our limits will only allow us to refer to a few other points, which the
author has treated with characteristic acumen, and clearness. And among
numerous others, his instructions as to the mode of procedure — what to ob-
serve, and how to observe, in the examination of the sick; his clear and
analytical views in regard to the use and value of " clinical aids to the sen-
ses," as chemical tests, specula, the microscope, stethescope, &c, and the
fallacies to which they give rise, even in the hands of the most practiced,

1857. New Publications. 95

and, therefore, the most expert ; and the learned discussions in reference
to the nature and genius of the numerical and analytical, or strictly induc-
tive modes of medical research; their utilility collectively and their indi-
vidual advantages, as well as the fallacies, connected with each respectively.
These, with many other topics, treated either individually or incidentally,
are condersided with a definitness of purpose, a stretch of thought, an ex-
plicitness of expression, and a clearness of logical deduction, that indicates
the profound scholar, the true medical philosopher. We indulge the
hope that the work not only may find a place, ere long, in the library of
every physician who appreciates the truths of science, but that its teachings
and doctrines may be made available, by many, to the progress of rational
philosophical medicine.

Its style of execution, as a whole — typography, paper and binding — all
are in accordance with the finished workmanship of the publishing house
whence it emanates. K.

To be found at Raymond & Selleck's in this city.

A New Medical Journal.

We have received the second number of the "North American Medico-
Chirurgiccd Review ;" a Bi-Monthlyt edited by S. D. Gross, M. D., Pro-
fessor of .Surgery in the Jefferson Medical College, andT. G-. Richardson,
M. D., Professor of Anatomy in the Medical Department of Pennsylvania
College, Philadelphia.

This Journal now occupies that space in our Medico-periodical literature,
which was so well filled by the " Medical Examiner " and the " Louisville
Review?

The names of its editorial paternity, furnish the most reliable assurance
against loss, in the change, which this combination has wrought. If any
higher guarrantee is required, it will be found in its one hundred and sixty
pages, made up of " Analytical and Critical Reviews/' u Original
Communications," and its accomplished Editorial Department.

Its editors are so strongly imbued with that spirit of independence which
would vindicate and guard the claims of American medical literature,
that we are almost led to wonder why they should have borrowed even the
prestige of a name, however long it had sustained and honored English
medical literature.

But judging from the number before us, this Journal will be a worthy
representative of the progressive Medical talent of our country, and if it
recievesthat patronage which the labor upon its pages so richly merits its
editors and publishers will be duly rewarded.

Published by J. B. Lippincott & Co. Price $4,00 per snnum.

EDITORIAL AND MISCELLANY.

Home from the Wars !

After men have reached their dotage and become garrulous, the earlier
incidents of life are the idols of their memory, and if by chance they " have
been in the army " they improve every opportunity to relate some anecdote
connected with their " military life-time." If from want of success or rever-
ses of fortune, they are compelled to devote their remaining energies to
daily toil for subsistence, this same " when 1 was in the army" is apt to
become the talisman of their claim to popular regard, and public favor.
When such men are found in the ranks of our profession, this empty dis-
tinction is the substitute for real acquirement, and when they brtak that
silence which passes for wisdom, it is to tell, facetiously, some story " of
olden time " " when / was in the army." This for the most part — with
an " urbane " and dignified exterior — has been once too often a passport
to the highest honors of our profession. But thanks to " old Time " and
his "sickle," such distinctions belong only to the exterior, while, long years
of studious devotion to our science, earns the reward of a name that lives
long after army distinctions have vanished, and been forgotten.

The leading editorial in the March No. of the Peninsular Journal,
furnishes a good illustration of that senile vanity which has been cherished
and cultivated by the tinseled honors of a little military glory. After
exhibiting his familiarity with the the theory of shooting " great guns," he
tells a story which he says happened in his boyhood, and formed apart of
his " sporting experience" Jfow we should regret the necessity of charg-
ing the "urbane" senior, and president of the National Medical Association,
with such a low form of plagiarism , but this same story has been told
and illustrated in comic alminacs} and long since credited to the venerable
David Crocket. Several attempts have been made to give the story an
appearance of originality, by locating the place where, and stating the
time when it happened. Sometimes it has been told so as to give the
Irish brogue; again, in the dialect of the untutored African ; but now it
appears embelished with the profanity of the French idiom. In order that

1857. Editorial and Miscellany. 97

this " old army surgeon " may have all the benefit to be derived from
what he claims as original, we will give the story in his own language :

■ One day, it was the last time I saw him. and I hardly know now whether
to weep over bis memory or to laugh at his eccentricities, he had loaded his
piece with unwonted care, and taken deliberate aim at a grey squirrel perched
high upon a beech tree. He fired. The squirrel dropped the husk of a beech
nut, sprang to a higher limb, and began to chipper. My old friend exclaimed.
Sacre le diable! — for he swore in French — suppose you pe at dis end de gun, I
no t nk you jump so."

This all may have happened ; but we presume most of his readers have
long been familiar with the same story. Now a few words with regard to
its application, for it was intended to apply to us, in consideration of a
statement whieh we made in our February issue, respecting the manner in
which practical experiments were being made and published at St. Marv's
Hospital.

In illustrating what we considered gross and reprehensible assumption,
we alluded to certain facts which were given to us at Marshall. While
in that village, Dr. Maniates proffered to us the courtesy of a drive about
the town, and conversation having turned upon the merits and demerits of
the Peninsular Journal, he asked if we had noticed the report of a
case of Ascites, which occurred in St Mary's Hospital, in which Iodine
injections were employed. He denounced the treatment, giving us to
understand that he had been induced by the report which appeared in the
" Peninsular" to try the same remedy, and that the patient died from the
effect thereof. We were so confident that such were his representations of
the case, and his language and manner conveyed to us such decided dis-
approval of the conduct of the u Peninsular" or any other Journal that
would practically recommend treatment without more thorough and satis-
factory tests, that we felt warranted in making the allusion, even without
more direct authority. We have no desire to call in question the motives
which led Dr. M. to furnish amunition to load an old gun that was u once
in the army," nor to enquire of probabilities, with a view to ascertain
whether, after all, "hio-h esteem and admiration" for the learned "Senior,"
had not impaired his memory respecting the statements which gave to us
the most decided impressions. To say the least, however, we had a good
reason to expect after informing us of erroneous impressions, and having
received our pledge to publish his version of the conversation, that he
would consider himself and his injured friend avenged of all wrongs.
Notoriety thus obtained, and in such connection, can hardly be considered
enviable. R.

In consequence of the illness of Dr. Goadby, we did not receive
his contributions in time for this Number. They will appear in our next

98 Medical Independent. April

The last Diatribe from the " Citizen of Illinois."

In our February issue, we gave a truthful and explicit detail of the ori-
gin of our collision with the Peninsular Journal. It never has been
denied that the senior editor of that journal made the attack, and com-
pelled us, either to submit to his attempt to traduce the character and
professional attainments of our senior — Dr. Goadby — or to make a justi-
fiable defense. In the prossecution of that defense, we have made well
substantiated charges, in which we have shown abundant reason for the
course we have pursued. None of our readers can regret more than we do,
the necessity that has compelled us to devote so much space to a local and
personal controversy ; and if we have never duly appreciated the charac-
ter and acquirements of A. B. P., we are disposed to regard him with
grateful consideration, inasmuch as he has dismissed " the xvhole matter,
with the hope that no circumstance will induce him to recur to it again."
This is a wise conclusion, and will, no doubt, redound more to his credit,
than his voluntered service in the attempt to exhonerate his learned senior.

But justice to ourselves, and the vindication of truth, forbid that we
should allow his last effort to pass, without some comment.

In making certain explanations, which some of his personal allusions bad-
ly neeeed, A. B. P. has exhibited a strong tendency to violate some of the
ordinary rules of syntax; but inasmuch as he has made the correction,
charity prompts us to attribute verbal inaccuracies to his editorial associa-
tions. Now, with regard to what he calls a reason for the origin of the
Medical Independent, after making a patronizing appeal to Dr. Davis, ev-
idently for the purpose of manufacturing a little sympathy for his argument,
he then turns to another cotemporary, to whom he devotes the following
paragraph :

Does the editor of the JYeiv Jersey Medical Reporter think this a great
sin? If so, he must have altered his opinion, or else must think that it is
very proper and quite in keeping for R. to do a thing which in us would have
been despicable. We well remember with what indignation we read the
Reporters insinuations, that we were the author of that article, and felt in-
clined to say: "is thy servant a dog, that he should do this this thing?" It
will be remembered that at this time we were in the midst of a controversy
with Dr. D., as the exponent of the Rush Medical College, and all honorable
men can appreciate how shameful it would have been for us to thrust such
personal ridicule, founded on matters foreign to the subject at issue into the
controversy.

Dr. A. B. Palmer has manifestly forgotten his correspondence relating
to the rejection of the paper upon the " Biography of Living Medical men,"
and a few extracts from his letter, will enable Dr. Davis, and tae able edi-
tor of the JVew Jersey Medical Reporter, to judge whether he was
inclined, at that timex to say " is thy servant a dog, that he should do this
thing P

*V j'i i'i yi s'i i't s't *'c i'c i'$

"You ask my opinion of the article: I think it well written — in a clear

1857. Editorial and Miscellany. 99

agreeable style — the different points are well taken and sustained. I re-
gard it a decidedly readable article, and there is much, force in its views.
There are, however, different opinions respecting the propriety of presenting
before the public, biographical sketches of living individuals, who have suc-
ceeded in attracting the attention of considerable portions of men. Greely,
Bennett and Barnum, have each a volume devoted to their particulars — and
most persons see no impropriety in the affairs. These men have achieved
notoriety with the community generally, and the community seem gratified
in reading their lives.

st:**** ****

Now, for my own part, I am very much inclined to your view of these au-
tobiographies— for they very nearly amount to that. The case you have
cited as an illustration of your views, (I mean the biographical sketch) is one
got up, I think, with bad taste. Many may not think so, however; but if you
were editing a Medical Journal, and were disposed to express your views to
the profession, it would be highly proper for you to do so, as presenting one
aspect of the subject, and there cannot be the least objection to any journal
publishing it, that chooses to do so.

*****■&***

Besides, the article appearing in our Journal at this time, would loose much
of its general force. It would be regarded as an attack upon an individual
rather than the resisting of a general evil. These would be my reasonsfor
declining it, at least at present, and preferring if it appeared at all, it should
appear somewhere else. * * * * * * *

I can concieve of a contingency in the future, whieh would render me de-
sirous of publishing the article, either as original or as a selection."

In the first extract it will be observed that Dr. Falmer places the mem-
bers of the medical profession upon the same level with Barnum, Bennett
and Greely. These men have achieved notoriety, and therefore the commu-
nity are interested in reading their lives. Dr. Davis, and others, had
achieved notoriety, ergo, Dr. Butler thought the medical profession would
prefer to have the detail of their lives by installments, while the subjects
thereof were living. All this needs no comment from us ; but it will be
clearly manifest to all, that the whole tenor of Dr. P's. communication,
practically endorsed the paper which he rejected. After we were convinced
that the real objection to publishing the paper in the Peninsular at that
time, was on account of the " collision with Dr. Davis," we gave the enter-
prising editors, at least, credit for honorable warefare.

Now, let us notice his reasons for rejecting the papers offered by Dr.

Goadby :

" The other reason for the establishment of the Independent is, that we "re-
jected Dr. Goadby 's articles on subjects connected with the microscope." This
may have been a grevious sin, but if so, we must plead that it was one of the
head, rather than of the heart. We innocently thought that our readers who
are practising physicians — not mere curiosity seekers in the domain of insect
life — men who are engaged in the relief of suffering humanity, not intending
to establish hospitals for the treatment of sick insects — would not be inter-
ested in these papers sufficiently to read them."

This is certainly a very frank admission of the truth, for it was an error

of the head, and if that same head should be charged with having sufficient

knowledge of the microscope, and its practical utility, to appreciate the

100 Medical Independent. April

labors and writings of Dr. Goadby — the result of forty years investigation —
it could plead as " innocently " as when it offered the above reason for re-
jecting Dr. Goadby's proffered communications.

As high authority for the utility of his papers upon u The Structure and
Functions of Insects," we make the following quotation from Draper's
Physiology :

* Here at the very outset of our science, we must dismiss the vulgar error
that the physical conditions of existence vary in different tribes, and that man
is not to be compared with lower forms. We must steadily keep in view the
inter- connection of all, a doctrine which is the guiding light of modern physi-
ology, and ivhich authorizes us to appeal to the structure and functions of one
animal for the explanation of the structure and functions of another. The
more steadily we keep before us this philosophical conception of the inter-
connection of all organic forms, the clearer will be our physiological views."

Dr. Goadby's public and private lectures, together with his published ob-
servations upon subjects connected with the revelations of the microscope,
require no comment from us; not even a refutation of the calumnious insin-
uations which Dr. Palmer has so facetiously expressed.

But we will give our readers one more specimen of vapid sophistry
merely to exhibit Dr. P's power of " reasoning on the wrong side."

"We do not wish to be understood as speaking disparagingly of microscopy.
It is a beautiful and deeply interesting subject, and when properly conducted
and applied to physiological and pathological science may be made available
to the interests of the profession. But we have now so many excellent text
books on the subject, that we by no means require that elementary instruction
be given in a medical journal. We would as soon think of giving a series of
articles upon descriptive anatomy or chemistry. It is not the object of a
medical jouanal to give compilations of elementary scientific matter, and es-
pecially upon subjects so remotely connected with practical medicine. Any
new discovery in this or any other department of science, might, with pro-
priety, be recorded, but we deem elementary instruction in vegetable or animal
histology, and particularly in the histology of insects, quite out of place in
such a journal, even were it given by one acquainted with the general range
of Natural History, and the science of Medicine."

It is very evident that Dr. Palmer is ignorant of what Dr. Goadby has
written, otherwise he would never have pronounced his productions " com-
pilations" Can he point us to the same facts and principles recorded
elsewhere ? Many of our cotemporaries, in giving commendatory notices
of the Journal have spoken of the originality of Dr. G's papers in the
highest terms.

But Dr. Palmer thinks such matter out of place, in a medical journal;
indeed ! "What does he mean by " collatteral sciences " on the title page
of his own Journal ? If he would not publish anything " remotely con-
nected with practical medicine," why does he present in his March No., an
article on " Michigan Coal — Its analysis, and value for Gas." What
has this to do with practical medicine ? "The Birds of Michigan," too,
how is their classification connected with "practical medicine." This kind
of reasoning is a little below the standard of attainment usually accredited,

1857. Editorial and Miscellany. 101

even to a professor of materia medica, in a respectable medical school.
We confess that we looked for something higher, from the Medical Depart-
ment of our University, until we learned that, after publishing in his jour-
nal u the removal of an ovary complicating inguinal Hernia," Dr. P. carried
the tumor all the way to Ann Arbor, in order to learn from his accom-
plished collegue that " it might be a Detroit ovary , but they did rit find
such in Ann Arbor /"

Dr. Palmer has shown, beyond all question, that we are comparatively
" young, as regards age and experience in the profession ;" we claim noth-
ing more. u Experience is just what ails some men;" but we hope that
we should be able to distinguish between a diseased ovarium, and an en-
larged lymphatic gland, at all events, before intimating that we had prob-
ably discovered " a new complication of inguinal Hernia" we should exam-
ine the records.

We, too, here leave this subject, but if we are called upon to say
more in relation to it, or in answer to those who provoked the controversy,
it will be in self defense, or in vindication of established principles of med-
ical science, which have been disfigured by the blunders of ignorance, or
the arrogance of dogmatism. R.

Another Precocious Discovert.

" These men have obscured and confounded the natu e of th'ngs, by their false principles and
wretched sophistry." — Southey.

That same promising junior of the "Peninsular" who so recently, by
the aid of his senior, removed an enlarged lymphatic gland, and after " a
cursory examination of the literature of Hernia," did not find that a de-
scent of the ovary was mentioned among the complications of inguinal
hernia, has again "jumped at a conclusion." j^fter giving a report of
three or four M operations preceded by railroad injuries" he is led to
"believe " that <( it is generally conceded by most surgeons that recoveries
are the exceptions, when amputation has been submitted to, as a result of
a railroad injury." The two most obvious deductions to be made from
the young man's report, are: 1st, that he is very desirous of advertising
himself and his " senior," in a manner apparently legitimate and ortho-
dox. 2nd, That his operations have been uniformly unsuccessfid. These
inferences are too well established by the sophomorical detail of his obser-
vations, to require further comment ; but his egotistic assumption becomes
insufferable, when from his comparatively meagre experience he attempts
to establish a principle of surgery.

102 Medical Independent. April

He says, * it seems strange that the nervous prostration should be so
intense in all cases of railroad injuries of the extremities, and that there
should be such a similarity in injuries caused by fire-arms, and even if no
lesion should occur, of the condition found after severe shocks of electricity
in the form of lightning."

Passing over the elegance of diction and the gramatical construction of
this extract, we think he has exhibited a nicety of discrimination which
must require more than an ordinary familiarity with the general principles
applicable to mechanical injuiies, as taught by our text books.

The generally accepted doctrine is that the degree of nervous prostra-
tion depends upon the severity and extent of the injury received, together
with the condition of the general health at that time.

We want more than the ipse dixit of a mere solecistic tyro in surgical
practice, to convince us that there is anything intrinsically peculiar in a
railroad injury, that would be any more liable to defeat the conservative
ends of surgery, than in a corresponding injury from any other mechanical
force.

It it is by no means " conceded by most surgeons that recoveries are the
exceptions when amputation has been submitted to as a result of railroad
injnry." On the contrary it will be found by the testimony of all skill fu
and successful surgeons that recovery in such cases is the rule and not the
exception.

But let us analyse the cases that have been so specifically reported, and
see if we can discover the cause for this want of success, where operations
were " preceded by railroad injuries :" The first case happened to be suc-
cessful, albeit the man suffered the operation while in St. Mary's Hospital,
and the result must be attributed to the good condition of his general
health at the time of the accident, as well, also, to the fact that the ampu-
tation was a secondary operation.

With regard to the four cases of primary amputation which were made
in consequence of the accident, on the Great Western Railway, a few
years since, we have the best authority for saying that in three of the cases
the operations were made before proper reaction had taken place.

The last case mentioned was M , who was severely injured in the

foot by the cars of the Michigan Central Railroad, in July last, having
stepped out of the cars when asleep.

"He lay on the track all night, and the next day was taken to the Hos-
pital. Slight reaction took place. His leg was amputated below the
knee during the day. He died, surviving the operation only six hours."

For some reason the age of this patient was omitted, and, as the facts
show, is a very important item — he being about seventy years old. Now
what would a little good " common sense " lead any man to predict, as
the result of such an operation, made under such circumstances ?

1857. Editorial and Miscellany. 103

Our interest in this subject has led us to examine the surgical notes of
those who have had a large surgical practice during the last ten years, in
this city, and transcribe the following cases and their results from two
records :

1st Case. Where cars passed over both inferior extremities — amputa-
ed right leg below the knee , and half of left foot — recovered.

2nd Case. Where driving wheels of locomotive passed over a mans
foot — amputated at metatarsal joint — recovered.

3d. Case. Where train of cars passed over a mans arm while he lay
intoxicated on the track, causing very extensive laceration and fracture ;
amputation and recover?/.

Here are three cases out of four in one surgeons experience, where op-
erations from the results of railroad injury were successful.

The other record of capital operations following such injuries, show a
complete success in two cases out of three.

We do not wonder then, that this ostentatious aspirant for surgical fame,
asks u how long should the surgeon wvit after the injury is received be-
fore he should proceed to operate.

From the record of his experience, this is the most practical question he
could have asked; for he has evidently been too anxious to make capital
operations without due regard to the principles of conservative surgery.
He asks the question, however, as if he supposes that a definite and abso-
lute rule — applicable to all cases — can be given. The surgeon is to be
guided and governed in such cases by general principles. Age, sex, con-
dition of general health, together with the extent and severity of the injury,
present the chief considerations which suggest to the mind of the operator,
the judicious application of those principles.

The writer of that report ought to have asked whether he should ever
operate in such cases, before proper reaction is established ; and then con-
sult his own experience for the desired, and much needed information.

If Railroad Companies are unfortunate in having accidents requiring
Surgical treatment, it would seem from the report of Dr. B. that they are
sometimes equally unfortunate in the selection of their surgeons.

[Since writing the above, the "Report of operations preceded by Railroad
injuries" has made its appearance in the columes of the Daily Tribunel
one of our city newspapers. If the author of the article solicited its re-
publication in the columes of a daily paper, he ought to be elected as " one
of the secretaries " of some advertising quack association. If, on the other
hand, it was done without his knowledge or consent, then he deserves the
pityjof the whole profession.]

104 Medical Independent. April

Transactions of the Fifth Annual Meeting of the Michigan State
Medical Society, Held at Ann Arbor, March 26th, 1857.

The meeting was called to order at 10 o'clock, A, M., by the President,
Dr. J. H. Beech. The roll was called by the Secretary, and the minutes
of last meeting read and approved.

In consequence of the non-arrival of many expected members, the regu-
lar order of business was suspended, and the reading of the President's
address deferred, until 2 o'clock, P. M.

The Society then proceeded to the election of new members, when the
following gentlemen were proposed and elected : Dr. G-. E. Corbin of
Stockbridge; Dr. E. C. Dutton, of Eaton Rapids; Dr. Axford, of Detroit,
and Dr. Tanner, of Ann Arbor.

On motion of Dr. Beech, Dr. Wm. Sprague, of Coldwater, was elected
an honorary member, and on motion of Dr. Pitcher, Dr. G. B. Russel, of
Detroit, was elected an honorary member.

It was moved and carried, that a committee be appointed by the Presi-
dent, to nominate officers for the ensuing year.

The President appointed the following committee :

Dr. Arnold, of Monroe; Dr. Stockwell, of Port Huron; Dr. Axford, of
Detroit ; Dr. "Wheelan, of Hillsdale, and Dr. Collins, of Eaton Rapids.

Dr. Pitcher presented a paper from Dr. Morse Stuart, on the meterology
of Detroit, and moved that the same be read by tit'e, and referred to Com.
on Publication. Carried.

Dr. Pitcher also presented a paper, a statistical examination of Diseases
in his practice during the past year, which was, on motion, read by title
and referred to Com. on Publication.

Dr. Stockwell remarked that he believed a change of time for holding
the meetings, would result in bringing a larger attendance, and moved that
a committee be appointed to enquire into, and report upon the matter.

Dr. Wheelan also spoke in favor of changing the time, and advocated
holding the meeting in Detroit, instead of Ann Arbor.

Dr. Pitcher moved that the Committee be instructed to inquire and re-
port in regard to the expediency of holding biennial sessions at Lansing,
during the sessions of the State Legislature, and on alternate years, at such
place as the Society shall determine. Carried.

The President appointed the following committee on this subject : Dr. A.
B. Palmer, of Ann Arbor ; Dr. Stebbins, of Detroit and Dr. Stockwell, of
Port Huron.

The Society then proceeded to the election of delegates to the American
Medical Association.

On motion, Drs. L. H. Cobb and Z. Pitcher of Detroit, were appointed
to serve as delegates.

The Society adjourned to 2 o'clock, P. M.

1857. Editorial and Miscellany. 105

Afternoon Session, 2 P. M.

Meeting called to order by the President. Minutes of Morning Session
read and corrected.

On motion of Dr. Palmer, Dr. J. F. Weeds was elected a member.

The Society then listened to the excellent address of the President, on
some of the Hygieine and Medico-political subjects, demanding the care and
attention of I he medical practitioner.

Dr. Palmer moved a vote of thanks to the President for his excellent
address, and that he be requested to furnish a copy for publication in the
Transactions of the Society, which was unanimously carried.

Reports of Committees being in order, the Committee on Nomination
reported as follows :

For President^ Dr. Stebbins, of Detroit ; Vice President, Dr. Stockwell,
of Port Huron; Secretary, Dr. E. P. Christian, of Detroit; Treasurer, S.
A. Douglas, Ann Arbor.

Report accepted, and nominations confirmed by the Society.

The President elect, tendered his thanks to the Society, and begged
the privilege of declining, but on motion of Dr. Pitcher, was conducted to
the Chair by the Nominating Committee.

Dr. Palmer, Chairman of Committee on changing time and place of fu-
ture meetings reported as follows :

Resolved, That the Constitution be so amended, that Biennial Meetings
of this society shall be held at Lansing, during the Session of the Legisla-
ture, on the third Wednesday of January ; and the alternate meetings, at
such time and place as the Society, at its meetings not held at Lansing, by
vote, from year to year, may direct.

Report accepted, and Resolution unanimously adopted.

Dr. Beech moved that the next annual meeting be held at Detroit, on
the 3rd Wednesday of January, 1858. Carried.

On motion of Dr. Palmer, the following new members were elected : Dr
S. J. Redfield, J. B. Ford, G. B. Willson and H. M. Lilly.

Dr. Beech presented a paper — a statistical analysis and registration of
the diseases in his practice during the past year, with remarks, of which
he gave an extract, and the paper was referred to Committee on Publica-
tion.

Dr. Christian gave a synopsis of his report, which was referred to same
Committee.

The Society then proceeded to finish the number of Delegates to the
American Medical Association, and the following gentlemen were appoint-
ed :

Dr. Pattison of Tecumseh, Stebbins of Detroit, Downer of Northville,
Ewiug of Dexter, Gorton of Detroit, Douglas of Ann Arbor, Davenport of
Detroit and Landon of Monroe,

106 Medical Independent. April

Dr. Palmer moved that the appointed have power to appoint substitutes,
and also to fill up their number to ten, that being the number to which this
Society is entitled. Carried.

On motion, the following Committee was appointed by the President, on
Publication, viz: Drs. Palmer, Sager and Denton.

On motion of Dr. Christian, Dr. Stockwell of Port Huron, was ap-
pointed Chairman of a Committee to report at the next meeting on the
diseases and topography of the North-East section of the State.

On motion of Dr. Stockwell, Dr. Sager was appointed Chairman of a
Committee to report at next meeting on Puerperal Diseases.

On motion of Dr. Palmer, Dr. Dubois was appointed to report on Rheu-
matism.

Dr. E. G. Corbin was appointed to report on diseases and topography of
Eaton and Livingston counties.

Dr. Thompson, also, on diseases and topography of his section.

Dr. Collins on diseases and topography of his section.

Dr. Davenport on diseases and topography of Wayne Co.

Dr. Axford to report on Vaccination.

Dr. W. W. Hyppolite was elected a member, and appointed to report on
zimotic poisons of this State.

Dr. Palmer was appointed to report on diseases of children, and Dr.
Denton to report on diseases of the aged.

Dr. Denton, in behalf of the Faculty of the College, extended an invita-
tion to the Society, to an entertainment at the residence of professor Doug-
las, given in honor of the graduating class.

Moved by Dr. Beech that the invitation of the Faculty be accepted, and
the thanks of the Society be returned.

On motion of Dr. , it was resolved that the transactions of this

Meeting be published in the Peninsular Medical Journal^ and the surplus
funds be appropriated to that purpose.
On motion the Society adjourned.

E. P. Christian, Secretary

American Medical Association.

The tenth meeting of the Association will be held at Nashville on Tues-
day, May 5th, 1857.

All bodies entitled to representation in the Association would very much
further and facilitate its affairs by sending lists of their representatives at
an early period, to the undersigned.

Article Second op the Constitution:

" The members of this institution shall collectively represent and have cog-

1857. Editorial and Miscellany. 107

nizance of the medical profession in every part of the United States, and
shall hold their appointment of membership either as delegates from local
institutions, as members by invitation, or as permanent members.

" The delegates shall receive the appointment from permanently organized
Medical Societies, Medical Colleges, Hospitals, Lunatic Asylums, and other
permanently organized Medical Institutions of good standing in the United
States. Each delegate shall hold his appointment for one year, and until an-
other is appointed to succeed him, and shall participate in all the business
and affairs of the association.

Each local society shall have the privelege of sending to the Association
one delegate for every ten regular resident members, and one for every addi-
tional fraction of more than half this number.

The Faculty of every regularly constituted medical college or chartered
school of medicine, shall have the prevelege of sending two delegates. The
professional staff of every chartered or municipial hospital, containing a hun-
dred inmates or more, shall have the privelege of sending one delegate.

M The members of Invitation shall consist of practitioners of reputable
standing, from sections of the United States, not otherwise represented at the
meeting, They shall receive their appointment by invitation of the meeting
after an introduction by any of the members present, or from any of the ab-
sent permanent members. They shall hold their connection with the Asso-
ciation until the close of the annual session at which they are received, and
shall be entitled to participate in all its affairs as in the case of delegates.

" The pern- anent members shall consist of all those who have served in the
capacity of delegates, and of such other members as may receive the appoint-
ment by unanimous votes.

" Permanents members shall at all times be entitled to attend the meet-
ings and participate in the affairs of tho Association, but without the right
of voting ; and when not in attendance, they shall be authorized to grant let-
ters of introduction to reputable practitioners of medicine, residing in their
vicinity, who may wish to participate in the business of the meetings, as pro-
vided for members by invitation.

" Every member elect prior to the permanent organization "of the annual
meeting, or before voting on any question after the meeting has been organ-
ined, must sign these regulations, inscribing his name and address in full,
specifying in what capacity he attends, and if a delegate, the title of the in-
stitution from which he has received his appointment."

Resolutions passed at the Eighth meeting of the Association held at Phila-
delphia :

Resolved: That no state or local society shall hereafter be entitled to rep-
resentation in this Association, that has not adopted its code of ethics.

Resolved: That no state or local society that has intentionally violated or
disregarded any article or clause in the code of ethics, shall any longer be
entitled to representation in this body.

Rdsolved: That no organization, or institution entitled to representation
in this Assciation, shall be considered in good standing which has not adopt-
ed its code of ethics.

Resolutions passed at tho Ninth meeting held at Detroit :

Resolved: That any new medical institution not heretofore represented in
this body, be required to transmit to the secretary, with the credentials of its
delegate, evidence of its existence, capacity, and good standing."

Medical papers throughout the Uniqpn are respectfully requested to copy
the above resolutions at their earliest convenience.

Robert C. Foster,
Secretary A. M. Med. Ass. Nashville, Ten.
VOL. Ill, NO. II — 4

108 Medical Independent. April

Ob'tuart. — Died, in this city, on the 19th of March, Edmund G. Desxoters,
M. D., aged 34 years, 6 months and 16 days.

Dr. Desnoyers was a son of the Hon. Peter Desnoyers, of this Citv. He
pursued his medical studies with Drs. Terry and Russel, and graduated
with distinguished honors, at the Jefferson Medical College, Philadelphia,
in 1844, and was probably the first native of this State who graduated at
a regular medical school.

He was a gentleman of generous impulses : cordial in his social* relations,
and of accomplished talent. 2Sot finding the practice of medicine conge-
nial to his taste, he early devoted his attention to Chemistry and Pharmacy,
in which department he enjoyed the well deserved reputation of being one
of the most accomplished druggists. His untimely death is a severe afflic-
tion to a large circle of friends, and his loss to the profession calls from us
this tribute to his memory. R.

Rush Medical College.

We find a few editorial remarks in the last number of the Northwestern
Medical and Surgical Journal, which we desire to commend to the con-
sideration of those who oppose the removal of the Medical Department of
our University, from its pleasant country seat, to this city, where it may
compete with prosp>crous medical schools, on the ground of clinical and
hospital advantages. Especially do we coin mend the facts to those who
are fearful of u disturbing the unity, harmony, and integrity," or " weak-
ening the moral force of the system " of which our medical department
fonns a constituent.

The graduating class of the Rush Medical College, at the recent annual

commencement, numhered forty -one', and after particularizing somewhat

upon the exercises of the occasion — including a convivial entertainment

provided by the Faculty — the editor says :

""Without boasting, we may claim that few medical classes in this or any
other country, hare enjoyed better advantages for attaining knowledge: than
the one in attendance on Rusq Medical College, during the past session. For.
besides the ordinary college course, in which the material for dissection, and
the means of illustration in the several departments, were ample, the class had
easyaceess to two hospitals, well filled with patients. In one. regular clinics
were given on f.ur mornings of each week, and in the other sir mornings;
thereby enabling the class taking the hospital tickets, to be so divided as
to allow the most direct and free examination of patients. So complete were
these clinical arrangements, that scarcely a physical sign could be named,
arising from acute and chronic diseases affecting the viscera of the chest,
which was not carefully examined and listened to personally, during some
part of the term by, the seventy-two members of the class, who attended the
Mercy Hospital : while the opportunities for studying both operative surgery
and surgical diseases, such asopthalmia, syphilis, ulcers, fee., under Professor
Brainard, in the Marine, and Professor Freer, in the surgery wards of the
Mercy Hospital, were as ample as could be desired"

1857. Editorial and Miscellany. 109

American Medical Education — Government Schools, &c.

It is very obvious that the majority of the defects for which the medi-
cal profession is responsible, whether fouod in the philosophy of our
science or its ethical observances, is attributable to defective medical
education; in other words, to the meagre attainments which have consti-
tuted the requisite qualifications for a passport into the ranks of our pro-
fession.

This fact has been admitted long enough, it would seem, to have ac-
complished, ere this, some radical changes, and the adoption of a uniform
system, which would, in a great degree, control that morcenary compe-
tition which has offered diplomas — if not at wholesale prices — at least at
a disgraceful discount. We find in the last number of the " Novth
American Medico Chirurgical Review" a very able editorial upon this
subject, from which, with great pleasure, we make some extracts, and, we
doubt not, they will interest all of our readers, but more especially those
who desire to see the melical department of our University prosperous,
its standard elevated, and its advantages commensurate with its endow-
ment. The italics are our own, and are intended for reference or appli-
cation to the medical department of our University. The reader will find
therein a practical support of the views and considerations which we have
urged for the removal of the medical department to this city, where it
may possess the elements of vitality and progress.

"Necessarily, all faults in American Medical Education are chargeable to
two sources — 1, Errors in the system itself, and 2, Derelictions of duty on
the part of the colleges.

And, first of the system ; for although we have no law which governs our
action under penalties f >r non-observance, we have a plan of instruction
which is remarkably uniform throughout the country. In nine cases out of
ten the student enters the office of a practitioner in the spring, reads for
a year and a half, attends lectures for four or five months, reads again until
fall, when he again listens to lectures until the last week in February, and
then receives a diploma. His early education may or may not have been
good ; his diligence during his time of study may or may not have been
great; and every thing finally hinges on his examination for a degree. The
power rests in the college exclusively; if its standard is high it matters but
little about the preliminaries ; a good student becomes a good doctor of'
medicine ; while, on the other hand, a low student of graduation must inev-
itably fill the ranks of the profession with inferior men.

It follows from the above, and from other facts equally well known, that
the colleges are an autocracy, having in their hands the honor and true in-
terests of the profession. It is no logical sequence from this, that the system
is faulty. Such a power must rest somewhere, and the fewer repositories for
such a responsibility, the more readily can they be controlled.

Looking at the broad result, we have no reason for supposing that this-
trust is not faithfully fulfilled. We mean that in other countries, where
the colleges are hemmed in by other powers, where the professorships are
government offices, and the temptation to bid for large classes is removed,
the evils of which it is the habit of American journalism to complain exists in
spite of their more elaborate system. European education, coupled with

110 Medical Independent April

Old World habits of thought and action, produces a limited number of
splendid scholars ; but it is our honest belief, that for keen, practical, use-
ful, bed-side knowledge, no part of the world has a more competent
medical profession than the United States. We speak from a somewhat ex-
tensive acquaintance, both in city and country. Lying back behind all sys-
tems and schemes of government is one great influence which must not be for-
gotten. It was the frequent remark of a shrewd gentleman of extensive
knowledge of men, that " one must not expect all the Christian virtues for
eight dollars a month." There is no power of public law, or public opinion,
that can make a good physician, except it gives him a fair remuneration for
his services.

Talent is in the market, and, if commerce will pay better than professional
life, it will engage in commerce.

Without dwelling upon this idea, we wish merely to throw it out as sngges-
tive of another. All projects to cheapen medical education are eroneous.
We must, in considering this, disconnect our minds from European habits of
thought, and look to the broad, vigorous American character as the basis of
argument.

The government schools of Europe are founded on arristocratic institu-
tions, and are a part of a social system which permeates all ranks, and gov-
erns all conditions in life. It would be a miracle if such a plan could be
adapted to two races of people, living under such widely different influences.
Even in monarchial countries, where the foundational idea of education is the
same, we find wide variations in its development, which evidently depend on
national character. Thus, England has its medical departments in its Uni-
versities at Cambridge and Oxford, but their existence is hardly known. Rich
in endowments, surrounded by the prestige of Isis and Cam, they are feeble
nonentities in the strong medical life of England. The schools of London
competitive, expensive, comparatively poor in funds, but rich in clinical ad-
vantages, the energy of an immense City, and the talent drawn to them by
the great reward winch success in London implies, have dwarfed and over-
shadowed all other means of education. * * * *

We have said enough to indicate our belief, that the European system is
not to be desired on this side of the Atlantic. AVe want an American sys-
tem, one adapted to the national spirit, which would refuse even the price-
less blessing of education when offered as a charity. Indeed, this is a proper
-and manly pride in a country so rich as ours, where the young man who fails
can only accuse his own lack of energy or forethought. What modifications
of our present scheme of education are desirable ? .

Shall v»-e link in our State governments in their control, by establishing a
■supervisory board, having power to annul the diploma granted by the Col-
lege ? Such an idea has been broached, but it is only necessary to call to
mind the changeful, and too frequently venal source of appointment of such
a board, to see that instead of a conservative, it would be a radical move-
ment, calculated to encourage the evil it was meant to avoid. Or shall we
deprive the colleges of the power to grant diplomas, giving their function to
a State Board of Regents ?

One has only to think of the small political doctors who would be sure
to receive the appointment of Regent, to be convinced that the profession,
while it is too democratic for European methods, is too conservative for mod-
ern American politics.

So long as our political life is what it now is, and so long as public opinion
is stronger and less easily evaded than any other force which can be brought
to bear, we must trust to our present plan, or to some simple modification of
it. . The profession itself, speaking in its conventions, its societies, and
through its press, is the only authority which can, or ought to govern the col-
leges. There may be — doubtless are facts, and grave ones, in the manner of
granting diplomas to candidates for the doctorship ; but we do not believe
that these are inseparable from the system, or to be mended by any whole-

1857. Editorial and Miscellany. Ill

sale tinkering of so-called reforms. The very feature of which loudest com-
plaint is made — competition — is its best safeguard. We are sick of their cry
of "competition !" as if all heresy and schism were embodied in it. It is a
grand, noble feature in our schools ; and we hopo never to see the day, when
they shall be deprived of its healthy, life-giving stimulus.

We are too " intensely respectable." A school cannot flourish without adver-
tising ; and the common sense plan is to let the advertisements shoiv forth the
advantages claimed by the school. It is through these advertisements that com-
petition manifests itself and attains to its natural results — a perpetuation of
itself and a tendency to drive schools to add to their talent and increase their
advantages. We do not assert that the use of competitive means may not be
liable to great abuses; but eye hath not yet seen perfection, and we must look
to consequences, before we attempt to remedy even an acknowledged evil. It
is evident that, without competition, we should have fewer schools with great-
er powers, that, instead of struggling to employ a higher order of talent to fill
their museums, and surround themselves with abundant means of clinical instruc-
tion, we should have schools of doctrine, instead of instruction} and nests of
nepotism instead of hives of labor.

Even the control of a secular board of trustees is only desirable in the same
light that a veto power is necessary in the freest government. The most in-
telligent board is quite as likely to fill a chair badly, as well ; while the faculty
can have only one motive in choosing a colleague — the interests of the school
itself. The faculty should always possess the presidential power of nomiua<*
tion, leaving to the senatorial trustees the function of confirmation or rejec-
tion.

But, the reader will ask, what limit should be placed upon the privileges of
the colleges. We may answer that the most important interest of the profess-
sion at large, is in securing ample means of instruction for youig men enter-
ing on the field of practice. In our opinion, looking at the character and
wants of the American people, our present system does not need radical al-
teration; and at the present moment, the colleges should simply be made to
feel the pressure of professional approval or disapprobation, as either may
seem best. Let the State Societies watch the schools, aud assert their pre-
rogative of censure if they are unworthy. There is not a school in the country
so strong as to outlive the deserved and formal disapprobation of the Ameri-
can Medical Association. ******

It would seom that that school in a great city which should announce a
collegiate year, with terms and vacations of appropriate length, offering a
talent fully equal to that now concentrated in tbe winter term, with equal
clinical advantages, would at once assume a leading position. There are in
the country many students of sufficient means to avail themselves of such an
opportunity, and they might be concentrated. We can forsee many difficul-
ties in this scheme, but we do not look upon them as insuperable ; and let the
thing be once successful at a single point, competition and professional opin-
ion would drive every schoo^ having any claim to respectability, into a similar
arrangement.

Here is a practicable, tangible plan of reformation. Let us try and perfect
our present means of education before rushing blindly into the adoption of for-
eign and incongruous systems.

Stramonium in Puerperal Convulsions.

R. H. Salter, M. D., in a communication read before the Boston Society
for Medical improvement, and published in the last number of the Boston
Medical and Surgical Journal, has reported six cases of puerperal convul-
sions, in which he found the Tincture of Stramonium a prompt and ef-

112 Medical Independent. April

fectual remedy. In speaking of the ordinary practice of venesection in
those cases, he says:

"In reference, however, to the practice of bleedings, &c, it is not enough to
say that the patient has recovered. We want to know the form of convulsion
in which it was practiced, and the effect of such treatment upon the future
health of the individual. I cannot believe, even if the patient does survive
the remedial process, that such enormous bleedings — so large in some instan-
ces, that there is not pabulum vita enough remaining to feed a convulsion —
can be practiced without imminent peril to life, or in some way impairing the
constitution, and laying the foundation for future disease and suffering,

There are cases, undoubtedly, in which all the symptoms taken together,
would not only justify, but require, that a moderate bleeding should bo pre-
mised as a prepatory measure: as, for example, where we find during the
interval of the fits, by the state of the pulse, the evidence of phlogistic action
in the circulating system. Ergot and turpentine, also, will be found very
necessary adjuvants for fulfilling certain indications, and other articles might
be mentioned. But in no case are these remedies per se for convulsions. I
consider the tincture of Stramonium, properly administered, when these are
not contra-indicating circumstances, as a sine qua non, for the speediest, safest
and most uniformly successful for the relief of puerperal convulsions. '*

The dose which he administered, was a half ounce of the Tincture, re-
peated according to its effect in controlling the spasms. He also reports
two cases of the simple forms of convulsion, in which he found the same
remedy equally effectual.

Sickness and Death of Dr. Kane.

The death of the late Dr E. K. Kane, which took place in Havana on
the 16th of February, though not unexpected has still filled the minds of
all who knew him with deep regret that a career so brilliantly commenced
and so faithfully followed should be so prematurely terminated. It was
the fortune of the writer to attend him, in consultation with his regular
physician (Dr. La Riverend), during the last part of the sickness which
terminated his life. A few particulars of his case, gathered in that short
period, will, it is believed, derive some interest from their connection with
one so justly celebrated.

Dr. Kane inherited a decided predisposition to rheumatic affection, and
had from early life been subject to attacks of articular rheumatism. He
suffered very severely from this disease after his return from the first Arc-
tic expedition. The heart, also, had become involved, and he was thought
to have a considerable degree of hypertrophy, together with thickening of
the valves. So severely was he afflicted with articular rheumatism while
preparing for the last cruise in search of Sir John Franklin, that it was
often necessary to apply friction to the joints for an hour, before rising in
the morning, in order to enable him to ride to the Navy Yard, where the
" Advance" was fitting out.

Very soon after getting into the high lattitudes, however, these difficul

1857. Editorial and Miscellany. 113

ties subsided — a result which would hardly have been anticipated; but
which he had observed in his own case on his previous voyage. What his
sufferings and exposures were during his Arctic expedition, is well known ;
but it is proper to state that they were much more severe, and their effect
upon his constitution more disastrous, than would be supposed from the
few allusions made to his own case in the published account of the expedi-
tion.

On his return, his previous rheumatic and cardiac troubles had become
complicated with scurvy ; though very much exhausted and worn out by
the hardships he had undergone, he allowed himself no time for repose,
but labored incessantly in preparing the account of his expedition for pub-
lication. This fatigue, together with the great change in climate and
habits brought on a severe relapse of his constitutional disease, aggravated
by the newly acquired scorbutic taint. He received little or no benefit
from the treatment of his disease while in this country, and was advised
to try a change of climate ; accordingly, after the publication of his book,
he sailed for England. Here his health became much better, all his symp-
toms were much improved, and he considered himself nearly restored to
health. As, however, there still remained some traces of scurvy about him
his physicians advised him to spend the winter in the West Indies, for the
benefit of the climate and fruits

Since his return from the north, there was a somewhat remarkable
change in his ability to bear the motion of the ship ; he had become un-
usually sensitive to sea-sickness, which was brought on by even a slight
rolling of the vessel. The voyage from London to St. Thomas was, how-
ever, well supported ; while there, his health continued to improve, and at
the end of six weeks he sailed for Havana. The ship in which he took
passage was overtaken by a severe storm ; he was very much affected by
the motion of the vessel, and in the effort and strain of vomiting ruptured
a bloodvessel in the brain. Entire insensibility followed, and continued for
several days after his arrival in Havana. A partial recovery took place
after a few days, but the right side was found to be completely paralyzed.

During the months of December and January and until the 10th of
February, he slowly rallied from this attack, and was able to walk a little
about his room and to drive out. He recovered the use of the right hand
and wrist to a great degree, and shortly before the second attack was able
to rotate the fore-arm. His mind was perfectly clear, although there was
some loss of control over the memory. When he endeavored to recall any
circumstance which had transpired, several others, more or less connected
with it, were remembered, from which he was unable to isolate the partic-
ular fact desired. Of this difficulty he was himself perfectly conscious.

On the 10th of February, at the morning visit, he appeared more cheer-
ful than usual, and conversed a good deal with those about him. About

114 Medical Independent. April

1 1 o'clock, however, lie was suddenly seized with a severe attack of appo-
plexy, which deprived him entirely of consciousness. There was at first
considerable spasmodic contraction of the muscles, which simulated in
some degree a fit of epilepsy. These symptoms soon subsided, leaving him
with almost complete paralysis of the entire body. The iris responded to
light, and the muscles of the pharynx acted when stimulated by fluid
introduced into the mouth. The pulse was feeble, and varied from 120 to
140 beats. The skin was moist and cool. He remained very much in
this state until his death, which took place on the fifth day after the seiz-
ure. In this interval, however, he seemed to have recovered some degree
of consciousness, and several times signified assent to a question by turn-
ing his eyes toward the speaker. There was some motion of the lips
when a spoon was placed in the mouth, and once or twice he was able to
make sensible pressure with the right hand. There was no indication of
suffering during his last hours, and he died apparently from simple exhaus-
tion.

The tenacity of life in this case was quite remarkable, A constitution
broken by chronic disease of many years' standing — a series of hardships
and exposures almost unheard of, with all the depressing addition of care
and responsibility — followed by an affection which for some months threat-
ened his life ; add to all these an attack of appoplexy, paralyzing entirely
the right side, and in two months after a relapse affecting his whole body,
and one can hardly conceive how life could have been sustained for so
long a period as five days after the last shock.

The treatment in this case was quite simple. On account of his pre-
vious illness and the scorbutic taint in his system, it was thought unsafe
to resort to the active measures usually pursued in such cases. After the
first attack, small doses of ext. nux vomica with quinine were administered.
These were suspended after a time, through fear of increasing the cardiac
disease, and a high tonic and anti-scorbutic course was followed. After
the second attack, a few leeches were applied, together with cold applica-
tions to the head. — Boston Med. Sf Surg. Journal. F. S. A.

REPORT of the Committee on State Affairs in favor of a law for the Regis-
tration of Marriages, Births and Deaths, in the State of Michigan.

The Committee on State Affairs, to whom was referred the various petitions
which have been presented, praying for the passage of an act requiring a Reg-
istry of marriages, births and deaths within this State, have had that subject
under consideration, and beg leave to submit the following report :

A law for the registration of Marriages has now a place upon our Statute
book. But so imperfect is this law in some of its features, that it has been
almost wholy neglected or disregarded, by those entrusted with the duty of
carrying out its provisions, though subject to a heavy penalty for such neglect.

1857. Editorial and Miscellany. 115

So little attention has been paid to it that the records in the Clerk's office for
the county of Wayne — the most populous county in the State — show, as we
are informed, that only 41 9 marriages were recorded in that office for the
year 1856.

In some cases the distance of the parties from the county seat may account
for a neglect to comply with the law ; in others, disinclination on the part of
the clergymen solemnizing the marriage, to demand the legal fee required
to be paid' for recording the marriage, under the registration act. But what-
ever the causes, they are alike injurious in their results. There should be
required a better reason than either of these, or any other which is believed
to exist, for disregarding a law so eminently calculated to guard the interests
of community by rendering perpetual the evidence of the marriage and fam-
ily relation. It is to be presumed that similar neglect prevails in other por-
tions of the State. It is to remedy the defects of the law so as hereafter to
compel a more general compliance with it, and to couple with it a provision
also requiring a careful and faithful registry of all the births and marriages
in the State, that the action of the Legislature it now required.

The beneficial result of a uniform and general system of registration of
marriages, births and deaths has been fully realized by many years of experi-
ence in several States of the Union. The law has been as strictly and uni-
formly enforced in such States as any other statute. Wherever it has been
longest in operation and most generally enforced, there its advantages are
most obvious, and its requirements most popular.

A very natural and laudable desire exists even amongst the citizens of
our republican country, to know something of their ancestry, and not alone
from a feeling of mere curiosity, but often as a matter affecting their mate-
rial and pecuniary, as well as their moral interests and affections. Questions,
too, in this ever-changing age, are c nstantly arising in communities and
families, as to the age of individuals, upon the relation of which, may depend
many important interests and rights, political, social and pecuniary, all of
which can be easily solved through the information to be procured from an
efficient registry. Township officers would also be materially assisted in de-
termining vexatious questions as to the settlement and support of paupers,
and would be better enabled to avoid expensive litigation growing out of that
subject. The equitable descent and distribution of the estates of intestates
would be more cetainly secured, and the prompt and more certain identifica-
tion of individuals, when, from similarity of names or other causes, it would
otherwise be difficult, would be another important benefit. The progress of
population for purposes of political economy, developing the operations of
certain fixed laws relative to the subject, could be ascertained and defined at
stated periods by the proposed measure.

Considerations equally cogent, would seem to require a similar registration
of births and deaths. Statistics of mortality, showing the extent and causes
of deaths in different localities, have been demonstrsted by the experience of
those states and countries, where such a law exists, as of the first importance
in many respects. In determining whether death, in certain cases, results
from natural causes or otherwise, whetb r by disease or violence, murder or
accident, it has been frequently found of the greatest moment in the trial of
important causes in the courts.

_ For ascertaining the relative number of deaths occuring in the vari )us sec-
tions of this State, and their causes, and by comparing the numbers in certain
given localities, elicidng inquiry as to any disparity that may exist, whether
it is caused by stagnant water, or a violation of any of the other laws of
health, thus suggesting the remedy to be applied for removing disease, an
act for the registration of deaths would be found of great value. Much in-
formation would also be elicited as to the influence of occupation upon health,
in regard to hereditary taint, such as consumption, scroufula, &c. and would
show the urgent necessity of endeavoring to remove such cause when within
the reach of medical science ; and it would do much, too, to awaken the pub-

116 Medical Independent. April

lie to the necessity of preventing the introduction of pestilential diseases, a
premonition of which may be afforded by the record of increased deaths from
maladies usually accompanying fatal epidemics. Of the facilities it would
afford for the collection of information as to the usual and physical causes of
mortality with a view to the use of the necessary means for their eradication
or amelioration, we need not speak. This consideration of the subject will
suggest itself to the mind of every intelligent roan.

Statistics of registration in various European, as well as in those States in
which the experiment has been tested, show that both in different localities,
and different occupations, the difference has been very great in the destruc-
tion of human life. They have thus been led to adopt measures of equaliza-
tion, so far as the improvement of the sanitary condition of the country can
produce that result ; and already with the happiest effect by the prolonga-
tion of life in a very perceptible degree. A similar system in this S:ate can
be made to answer a similar useful purpose, and with an amount of labor and
expense quite insignificant compared with the benefits which would be de-
rived by our citizens in the general improvement of their health and prop-
erty.

One of the most eminent philanthropists of the age, has said that nume-
rous and momentuous as are the questions which present themselves for
solution at the present day. and urgently as many of them demand our con-
sideration, not one of them can fairly be brought into competition with the
great question of sanitary reform. Look at if simply as a question of hu-
manity, and it will not suffer by a comparison with the highest efforts of the
philanthropist; reg rd it as a great act of justice, and it must be acknowledged
that here, too. it presents peculiar claims to consideration. Measure it by the
rule of man's economy, and it will be found without a rival. View it in its
moral relations and re-actions, and we know not if the great question of edu-
cation will not sink before it. An eminent English statesman has also de-
clared it to be a subject of infinite importance to the security of property —
important to ascertain the sanitary state and condition of individuals and
communities under various circumstances — important to enable the country
to acquire a general knowledge of the state of population.

There are many almost equally weighty reasons that might be urged in fa-
vor of a registration of births as well as marriages and deaths. Not the least
of these is the facility it would afford in collecting: statistics of population, in
ascertaining the relative number of births to deaths, and of males and females.
To the political economist, these are inquiries of much interest, as they are
of great importance to society, not it is true, in a pecuniary point of view,
but as contributing largely to the fund of human knowledge, upon a ques-
tion that closely concerns its interests in other respects. But this discussion
of the subject is so intimately interwoven with the other two. and forms
so necessary a part of a system, that we will not dwell further upon its advan-
tages.

The publication of the statistics, which tvould be collected by a well ma-
tured and rigidly enforced registry law. would serve as an annual lesson on the
laws of human life in their operation upon ourselves, a kind of practical phy-
siology, taught in all our towns, and at every fireside, far more instructive
and impressive than any derived from books, teaching the principles and laws
of life developed by our natural constituion, as actually existing under sur-
rounding influences, and pointing to the means for their improvement and
modification.

Your committee therefore submit herewith a bill, embodying and intended
to carry out these views, and recommend that it be enacted into a law.

HIGBY & STEARNS

WHOLESALE &

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Manufacturers of

Pure Comical & parntarfttttcal prtjwato

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OF THE

TJNIVEBSITY OF VERMONT

FACULTY.

Samuel W. Thayer, Jr., M. D., Gen. and Special Anatomy.
Walter Carpenter, M. D., Mar. Medica and Therapeutics.
Orren Smith, M. D., Obstetrics, and Obst. Jurisprudence.
Hi^-ri Ekni. A. M., M. D., Chemistry and Toxicology.
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The next annual course of Lectures in this Institution will commence on Thurs-
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Fees. — Lecture Fees, $50. Students having attended two full courses, $10 ;
Marticulation. $3; Graduation, $18. Anatomical material furnished at cost.

Board, from $2 to $3 per week. Good accomodation for Students wishing to
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For further particulars, inquiries maybe made of Prof. Carpenter, E. Ran-
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of Prof S. W. Thayer, Jr., Burlington, Vermont.

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Burlington, Vt., February 6th, 1657. Dean of the Faculty.

H. & L. SIMONEAU,

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Assorted Sizes, etc., etc., in short, our assortment embraces

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style of the art, at New York Prices.

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THE

MEDICAL INDEPENDENT:

A MONTHLY

Review of Medicine and Surgery.

VOL. 3.] DETROIT. MAY, 1857. [NO. 3.

ORIGINAL COMMUNICATIONS,

Article I.— ON THE LINKS CONNECTING THE VEGETABLE AND
ANIMAL KINGDOMS.— Concluded.

BY HBKRY GOADBY, M. D., F. L. S.

Many of the plants belonging to the family ftiphonacece
attain a considerable size, and resemble the higher sea-weeds
in their mode of growth. They are inhabitants no less of the
fresh waters, than of the Ocean, and consist of large tubular
cells, which usually extend themselves into branches by which
they form arborescent fronds. The entire frond consists of a
simple continuous tube, the contents of which may be readily
pressed out by making an incision in the wall of the tube.
But a better example is met with in Vaucheria^ the majority
of its species being inhabitants of the fresh waters ; in these
plants the formation of gonidioe (zoospores) may readily be
seen, the entire process only occupying a short time. The ex-
tremity of one of the filaments usually swells up in the form of
a club, the endochrome accumulates in it, a separation takes
place, a new envelope is formed around the mass cut off by
division, and subsequently the membranous Avail of the invest-
ing tube gives way, and the zoospores escape, and swim off by
their vibratile organs.

VOL. II., NO. vi. — 1

118 Medical Independent. May

Branching filaments are often seen to bear at their sides glob-
ular or oval capsules, which are filled with dark endochrome ;
these have been seen to give exit to large bodies covered with
a firm envelope, from which new plants arise.

In the neighborhood of these "capsules" other projections
are usually found, which from their curved figure have been
called "horns," and these have been supposed to fulfill the
function of the anthers of flowering plants. Recent observa-
tions have demonstrated that these "horns" are antheridia,
which produce antherozoids in their interior ; the capsules are
germ cells, the aggregated mass of endochrome becoming, when
fertilized, the primordial cell of a new generation.

The antherozoids when set free from the antheridium, swarm
over the exterior of the capsule, and have been seen to pene-
trate its cavity, through an aperture which forms in its wall,
and to come into contact with the suriace of the endochrome,
over which they diffuse themselves ; there they seem to under-
go dissolution, their contents mingling themselves with those
of the germ-cell ; and the endochrome mass, which had no
proper investment of its own, soon begins to form an envelope,
which increases in thicknes and strength, until it has acquired
such a density as enables it to form a firm protection to its con-
tents.

The generative apparatus of the Characem consists of two
sets of bodies, both of which grow at the bases of the branches ;
one set is called the " globules,,, and the other the " nucules."
The globules are really antheridia ; the nucules contain the
germ-cells. The globules are nearly spherical, have an envel-
ope composed of eight triangular valves, which enclose a nu-
cleus of a light reddish color ; this nucleus is chiefly composed of
a mass of filaments rolled up compactly together ; and each of
these filaments consists of a linear succession of cells. In each
of these cells there is formed a spiral thread of two or three
coils, which, at first motionless, after a time begins to move
and revolve within the cell ; at last the cell wall gives way,
and the spiral thread makes its way out, partially straightens
itself, and moves actively through the water for some time, by
the action of two long, and very delicate filaments : these are
the antherozoids. The linear series of cells, containing anthe-

1857.

Orig inal Commanications.

119

ridia, are shown at A. fig. 142 ; and the antherozoids with
their filamentous appendages at B.

Fig. 142.

In the example given, we have seen the antherozoids, freely
liberated from the case or cell in which they were produced,
and herein consists a wonderful analogy between the produc-
tion of antherozoids in the vegetable, and spermatozoa in the
animal kingdom. To render this analogy still more perfect,
we shall adduce examples in which the antherozoids are dis-
charged from the plant, in their antheridial cases, or cells.
The generative filaments of Fucus platy 'carpus are found to dis-
charge only antheridial cells, the antherozoids being in every
stage of development, as shown in fig. 143. As they mature,
they burst their cell-wall, and move off with great activity.

<5c^

Fig. 143.

Notwithstanding the extreme interest of this part of our sub.
ject, we shall only offer one other illustration of it, but we be-
lieve this, to be too important to justify omission.

The mildew, which appears upon the straw of wheat, shows
itself externally in the form of circular clusters of pear-shaped
6pore-cases, each containing two compartments filled with spo-
ruies ; these arise from a filamentous tissue constituting the

120 Medical Independent. May

mycelium, the threads of which interweave themselves with
the tissue of the straw ; and they make their way to the sur-
face through the " stomata" (or breathing mouths) of its epider-
j mis. This constitutes the plant called

y . j piled uia graminiss represented in fig.

Ap zsss> ^ \4A, in which the arrangement of the

plant is shown, together with examples
of the liberated spore-cells.

The rust, which makes its appearance
on the leaves and chaff-scales of wheat,
has a fructification that appears to be
essentially different from that just des-
cribed, consisting of oval spore-cases
that grow without any regularity of ar-
rangement from the threads of the
rig. 144. mycelium ; and hence it has been sup-

posed to form a distinct plant, called Uredo rubigo. Kecent
observations, however, render it certain that " rust * is only
an early form of "mildew ;" the one form being capable of de-
velopment into the other, and the fructification characteristic
of the two supposed genera having been evolved on one and
the same individual. Another presumed species, Uredo sege-
tum, when it attacks the flower of the wheat, reduces the ears
to black masses of sooty powder, known as " smut," or " dust-
brand." The "bunt" or "'stinking rust" is another species of
Uredo ( U fostida), which is chiefly distinguished by its dis-
gusting odor. It may be considered certain that the admix-
ture of the spores of any of these fungi with the grains, will
endanger the plant raised froni them ; but it is equally certain
that the fungi have little tendency to develope themselves in
plants that are vegetating with perfect healthiness. It has
been ascertained, however, that there are very f tic wheat-grains
near the points of which one or two sporules of fungi may not
be found, entangled among their minute hairs ; and it is fair to
suppose that these sporules remain dormant, unless the plant
take on an unhealthy condition.

Such is a brief history of the remarkable processes belonging
to the fecundation of plants, as furnished by the best authori-
ties ; whose labors we have gladly availed ourself of to such
an extent as the circumstances connected with our special
wants rendered necessarv.

1857. Original Communications. 121

It is necessary, now to show, how far these facts can be appli-
ed to the animal kingdom. It has already been indicated that
considerable identity consists between the vegetable anthero-
zoids, and the spermatozoa of animals — it is proposed, now, to
investigate the latter subject.

The seminiferous tubuli of animals, contain an immense
number of cells; the contents of these in young, and immature
animals consist of fine granular substance, but as age increases
these granules change into a multitude of nuclei. Increased
age, produces a great change in these cells; they consist (at the
age of puberty) of an extremely small quantity of a viscid flu-
id, and innumerable minute, linear corpuscles having a pecu-
liar, vibratile or oscillatory movement. These constitute the
spermatozoa, spermatic animalcules* or spermatic filaments;
they are soft, homogeneous corpuscles, having a thicker portion
or a head, and a filamentous portion or tail ? These corpuscles
are originally formed within the cell, like the antherozoids
of plants, and when mature, they are liberated in both king-
doms, by the rupture of the cell-tvall. In animals, the disclo-
sure of the filamentous corpuscles, occurs in varying portion of
the generative organs — in man, however, it appears to take
place in the epididymus.

In examining microscopically the contents of a seminiferous
A tubule, the addition of water will dissolve the cell-
walls, and liberate the enclosed corpuscles. The
illustration of human spermatozoa is given in fig.
145,

It seems desirable at this point, to offer a resume
of what has gone before, in the past record of this
subject: firstly, the identity of simple memkrmte,\n
Fi(/A4». fotfr kingdoms, was established.

Then the nucleated character of cells in the two kingdoms was
discussed.

The uniformity of the production of Vibratile cilia, followed.

Starch and cellulose was demonstrated as common to both.

Fat cells were proved to exist, no less in plants, than animals.

Mineral matter (carbonate of lime) was found equally dis-
tributed.

Silica, even, whilst a constituent of plants, was yet found in
animals.

122 Medical Independent. May

Stomata, or breathing mouths in plants, identical with a
kindred structure in animals.

Cuticle in both kingdoms, identical.

Pigment cells, were next examined in both kingdoms.

/Spiral vessels of plants, and breathing organs of insects prov-
ed to be identical.

The character of the circulation of a fluid in plants, was next
compared with the circulation of the blood in animals.

Conjugation in plants was assumed to typify sexual congress
in animals, and lastly,

Perfect identity established between the antherozoids in
plants, and the spermatic corpuscles of animals.

The attempt has been made to show the remarkable identity
in the structure of certain tissues, common alike to the veget-
able and animal kingdoms,' so far as the revelations of the
Microscope extends, but here, the identity ceases — no real alli-
ance exists between plants and animals. That plants were
formed long antecedent to the production of animals, is univer-
sally admitted, and it would appear that the principles involved
in their production were so perfect, in the sight of Supreme
Wisdom, that the like structures — sometimes slightly modified
to meet a special want, sometimes existing in their full integ-
rity— may well be applied as the basis of animal tissues. Yet
a broad line of demarcation inevitably separates the plant,
from the animal ; ?7iicroscopically alike, there is yet a chemical
difference existing between them.

The fertilized germ of a plant, and the impregnated ovum of
an animal, are {inicroscopically) identical ; throughout the first
series of changes through which both are destined to pass, the
like thorough identity obtains, still no human skill, or ingenuity
could possibly elevate the germ of a plant to the production of
an animal, nor degrade the latter, to the condition of the for-
mer.

Just as impossible would it be to compel the seed of a plant
of one species to produce some higher or lower form of veget-
able existence, as to educate the germ of one animal to the
production of any other.

The seed of a plant, or the ovum of an animal is a something
purely sui generis; it contains within itself certain elements and
definite characteristics which even the microscope is powerless-
to discover.

1857. Original Communications. 123

But this theme must give place to another ; we beg to assure
our readers that the subject is not by any means exhausted ;
other parallelisms no less remarkable, yet remain — but a variety
of circumstances combine, to render it desirable to close this
series of articles, which have already extended beyond the
usual limits of journalism. This, therefore, will be all we have
to say at present, on the links connecting the vegetable anb

ANIMAL KINGDOMS.

Article IL— ABSTRACT OF AN INTRODUCTORY LECTURE, DELIV-
ERED BEFORE THE MEDICAL CLASS OF UNIVERSITY MEDICAL
COLLEGE, AT BURLINGTON, VERMONT, IN MARCH, 1857.

Gentlemen : — The importance of principles, of fundamental
propositions or doctrines, which, properly associated and com-
bined, or considered individually, may serve as guides in re-
search— as a basis on which to construct a system, or to found
practice, will not be questioned. Nor will it be doubted that
the same postulate is pertinent, and, therefore, applicable to all
the multiplied subjects of human thought and practical inves-
tigation, or indispensable to success in all the innumerous ave-
nues of human ingenuity and pursuit. But if there be any
department, to the successful cultivation of which principles
are indispensable in an extraordinary sense, and to the practi-
cal purposes of which they should be made inservient, as sub-
stantial foundations of deduction, it is emphatically that de-
partment which relates to, and deals with, the organic laws,
the constitutions and health, and, therefore, the happiness of
our fellow beings. It is the department which you have cho-
sen as the field of your enterprise and skill — as the source
whence you are to derave fame, that is ennobling, and, by
consequence, desirable, or infamy, that is degrading, crushing,
ruinous — and to cultivate which, and to qualify yourselves for
the intelligent performance of the responsible duties of your
future lives, you are associated here, and are to be associated
as friends and co-laborers, throughout the session that is before
us. As appropriate subjects for an introductory lecture to a
course on the principles and practice of medicine, I propose
to occupy your attention during the hour allotted to me this
morning, with a few considerations on diathesis — the scope of

124 Medical Independent. May

its meaning, the importance, nay, the dnty of considering it
with care in every case of disease which may present to us for
investigation and treatment, and the influence operated on our
therapia, and on our success in the contest with disease, by the
views we adopt in reference to it. And first of diathesis.
Literally, and briefly, it means "to place," or, "I dispose," —
disposition, tendency. Technically, it signifies a particular
condition of the economy, which engenders a marked procliv-
ity to certain forms of disease, rather than to certain others.
But these definitions we regard as quite too restricted, and we
propose to extend its significance. Considered more fully,
then, it embraces constitution — abiding or controlling affection
of the body. Applied to an individual, it involves the consid-
eration of some tendency of the constitution to respond in a
particular manner to the influence of certain agents, as in those
examples, in which ipecacuanha uniformly induces tiltilation
of the nasal passages, followed by sneezing, sense of suffoca-
tion, and more or less protracted cough — in which a paroxysm
of asthma is uniformly produced by the inhalation of certain
effluvia or gasses, generally iu nocuous — or by lodging in a par-
ticular apartment or locality; in which opium, instead of be-
getting quiet repose, gives rise to restlessness and vigilance —
or, instead of quieting gastric irritation, without exception, in-
duces nausea and vomiting or cerebral disturbance, amounting
to temporary mental aberation. Numerous other examples
might be referred to, in illustration ; but these will suffice to
render obvious the fact we desire to impress. Thus considered,
it is quite nearly allied to idiosyncraey. In this condition of
the economy it will be found, we believe, that the same cause
or event is uniformly followed by the same unvarying result ;
and, with slight modifications, as regards intensity, irrespective
of other causes and conditions.

Here, too, the constitutional peculiarity, proclivity, or ten-
dency, generally continues through life, although in certain,
perhaps less essential examples, exceptions to this proposition
will be observed. Many may present themselves to the recol-
lection, of the existence of predominent proclivities in early
life, which subside entirely, or are commuted or exchanged, in
the progress of growth and developement, and as life pro-
gresses. We have known many young persons who were
always made sick by indulgence in the use of cheese, even in

1857. Original Co? nmvni cations. 125

small quantity, by milk, by honey, &c, and yet, in after life,
have been able to make use of each, not only with impunity,
but with satisfaction. So, too, we have known persons in whom
an instinctive aversion to butter predominated, and who could
not taste it without being made oppressively sick ; and you
will have occasion to observe, in the course of your experience,
that certain individuals cannot partake of particular varieties
of fish, without the production of urticaria; so, also, strawber-
ries, raspberries, &c. A fact, quite analogous, will be found
to obtain, as regards actual disease,, certain forms of which, in
the first periods of life, being constantly present, as rachitis,
or recurring from time to time, giving rise to much suffering,
and, in subsequent years, subsiding entirely. Examples of this
last will be noticed in the marked disposition to cerebral irrita-
tion, in childhood, and to cutaneous affections. Considered in
reference to the species, or to people in certain districts, or
those of particular countries, diathesis manifests itself by indu-
cing a particular condition of vitality, and therefore of the
nervous system, or of the circulating fluids, the blood more
particularly, which, when appropriate exciting causes are
brought to act upon the vital susceptibilities, impresses a cer-
tain, definite type or order of succession of the several pheno-
mena of disease, or a marked grade of action, represented by
the different degrees of strength or weakness, which character-
ize the vital actions of individual functions, or of the aggre-
gate movements of the economy, not only when laboring under
disease, but during health, and that, too, whatever the organ
or tissue implicated, the cause or causes, or the general hygi-
enic conditions. Hence it is that, if any variety of disease, as
erysipelas, or influenza, occur as an epidemic, it will present
its several phenomena in a certain relation, one to another, and
successively, in obedience to laws which, within certain limits,
are definite and uniform, or it will assume an obvious and pre-
dominant grade. Hence the terms, sthenic, as expressive of
excess of tone or strength, and asthenic, as indicative of weak-
ness or diminished tone, and consequently a character of syno-
cha, cauma, or entony, or of asthenia, typhus or adynamia
will be present. There may, however, be a diathesis of an in-
termediate kind, in which neither the sthenic nor asthenic char-
acteristic is sufficiently affirmatively declared to hnpress upon
existing disease, a grade either of strength or weakness, but

126 Medical Independent. May

a grade differing essentially from each. Such, doubtless, was
that which characterized the synochus of Cullen's Nosology,
in contradistinction from synocha on the one hand, and the two
forms of typhus, which he recognized — typhus gravior and
mitior. To this predominant tendency or disposition is it
attributable that an epidemic of the same disease, i. e., charac-
terized by the same pathological condition of parts, and invol-
ving the same organs and tissues, though occurring at different
and remote periods, will exhibit remarkably different charac-
ters, as regards vitality, and therefore of type or grade, or both,
and require treatment differing in kind or degree, no less
remarkably.

Herein, it is believed, too, is the true explanation of the dif-
ferences in reasoning, in regard both to the real condition of
vital action, and, therefore, the real nature, the indications and
the treatment of acute rheumatism by Fordyce, Haygarth and
others. Thus it is, too, that in our own times, it is found that
recurring epidemics of scarlatina, rubiola, and at times variola,
erysipelas, &c., demand a more or less actively depletory and
contrastimulant mode of treatment, while on other occasions a
decidedly restorative system is imperative. The same is true
of pneumonia; nor is it less so of many other forms of disease,
and especially of most, if not all the palludal fevers — the vari-
eties of intermittent, remittent and vellow fevers.

But this determining disposition or habit of body does not
manifest itself alone during epidemics, nor is it applicable to
all cases of any given epidemic. Even when any form of dis-
ease occurs, sporadically, it will be found that, in one individual,
one grade will predominate, in another, a different, indicating
a difference in the two individuals, as regards tone or strength,
or, in the language of another, " the actual quantum of vital-
ity," and giving rise to a necessity for close and rigorous study
of each particular example and most obvious differences in
treatment. So, likewise, during the prevalence of a given ep-
idemic, while, perhaps, the majority of cases may be charac-
terized by a grade notably sthenic, or the contrary, a greater
or less number will be found to be exceptions to the predomi-
nant character, and, therefore, to require a kind of treatment
of an opposite description, or an intermediate grade may exist
in a proportion of the cases, giving rise to a necessity for a
system of practice neither strictly depletory nor exclusively

1857. Original Communications. 127

stimulent. But again, it is not less true that it is incumbent
upon the practitioner, during the prevalence of an epidemic
form of disease, if other forms offer for investigation and
treatment, to consider well the influence of the general cause,
in impressing upon all existing varieties the peculiar charac-
ter of grade, and it may be, of type, too, that belongs to it,
especially. Thus, if typhus fever prevail, or erysipelas, or
cholera, it will be observed that, if other varieties of disease
occur, they may, or will be likely to put on the grade, and to
some extent, the livery, of the existing epidemic. But this
prevalent disposition, habit, or proclivity, is often associated
with certain histological peculiarities or conditions of parts, as an
excess or deficiency of fibrine in the blood, or some physiolo-
gical predominance of function, as that of the nervous system,
the biliary, the circulating, etc., or some marked depravity of
one or more of the fundamental operations of the economy, as
the nutritive, the assimilative, &c, and, therefore, induces a
proclivity to the developement of some particular form of dis-
ease. Hence the phraseology — the rheumatic, the scrofulous,
the tuberculous, the cancerous and the calculous diatheses, and
the significant truths which they convey. These, respectively,
or some of then* at least, it is believed, have been satisfacto-
rily shown, by modern researches, to be dependent upon
conditions, either in anatomical structure or physiological en-
dowments, that are inherent in the constitutions of persons
characterized by one or another of the diatheses mentioned,
and, by consequence, not to any consideral extent amenable to
the ordinary cause of diseases. Other diatheses are recognized
by medical observers as among the prevalent tendencies, in
different classes of individuals, to particular forms of disease,
as the gouty, the scorbutic, haemorahgic, &c. Circumstances,
often transient in duration, may, and frequently do, induce a
condition of the economy, which amounts to a controlling ten-
dency to particular forms of disease. They not only give rise
to such special disposition to a particular variety of diseased
action, and of type, also, but they may impress a certain grade,
which, intelligently considered by the practitioner, cannot fail
to guide him to an appropriate course of practice. These may
be general in their influence, i. e., they may involve the con-
stitutional susceptibilities of the people of an entire country,
or of many countries successively, or they may be local, and

128 Medical Independent. May

therefore, confined to a district of limited extent. In this con-
nection, reference has already been made to epidemics of
various kinds, as cholera, influenza, pneumonia typhoids, ery-
sipelas, etc. So, too, local influences induce a like disposition
in the constitutions of the residents of certain sections of coun-
try, to the developement of various forms of diseased action.
Such are the biliary derangements, the intermittent and re-
mittent fevers of intertropical regions; the intermittent and
even remittents of higher latitudes, but of marshy districts,
and the cretinism of the low, moist and heated valleys of Alp-
ine countries. Indeed, most, if not all the various forms of
endemic diseases are legitimately attributable to such local
influences and their inevitable effect, a special diathesis. Nor
is period of life less cogent and specially operative in giving
rise to marked proclivities to diseases of different kinds and in
fixing a characteristic grade upon morbid action. Illustrations
of this proposition will be found in the great susceptibility of chil-
dren and young persons, to diseases of high excitement, con-
vulsions, <fec; of persons between the ages of eighteen and
thirty-five years to febrile diseases, and in the peculiar abnor-
mities of those in advanced life. In the former, high nervous
impressibility is the predominant constitutional characteristic,
in the latter, sluggishness of the circulation; and, therefore,
the great tendency to diseases, originating in passive conges-
tions, and the readiness with which hydropic affections are
induced. Sex, too, exercises a striking influence over the
constitution, not only as regards particular forms of disease,
but as regards grade, also. Hence it is, that males are remark-
ably more prone to maladies of an inflammatory kind than
females, while the latter, being vastly more sensitive and exci-
table, as also of comparatively lax and delicate fibre, tend
strongly to nervous, anaemia1, and, therefore, asthenic dis-
eases. The predominance of certain organs or functions of
the economy often induces a notable tendency to diseases of a
definite character and marked by an obvious grade, as the
brain, the liver, and the pulmonary or respiratory organ. Hence
the familiar phraseology of medical writers, not of the present
merely, but of all past time — the apoplectic, the biliary,
the phthisical habit, etc.

But, again, there may be an acquired diathesis, so far as a
condition that induces a proclivity to any single disease is con-

1857. Original Communications. 129

cerned, while the grade will depend upon other circumstances,
as of climate, vocation, general mode of living, &c. This will
be noticed in the readiness with which many diseases are re-
produced, under the influence of the slightest exciting causes.
Familiar examples of the truth contained in this proposition
will be found in the frequent repetition of tonsilitis in those
who have suffered from the disease. So, likewise, of abortion,
and of the variety of convulsive affections of children and
young persons, as well as of those forms of disease that are
characterized by periodicity, as neuralgia, hysteria and inter-
mittent fever.

There is, too, what we think may be regarded as a dyspeptic
dyathesis — a condition of the chylopoietic viscera, that tends,
with singular certainty, to engender, in not an inconsiderable
class of persons, the category of symptoms or phenomena,
which therapeutists have, by common consent, denominated
dyspepsia.

Whether this state of parts or of the vital susceptibilities
is an original, inherent endowment, or the offspring of errors
in the use of diet, and other irregularities, is not material. In
either case, the effect is the same, and appropriate exciting
causes uniformly produce the same, or quite analogous, symp-
toms. Considered in these various relations, the condition of
the economy," expressed by the term diathesis, has a near affin-
ity to predisposition. It differs, however, materially from the
latter term, in significance, for, while regarded as, in different
persons or classes of persons, a condition either anatomically
or physiologically, which, when certain exciting causes are
made operative, or appropriate coinciding conditions are brought into
existence, gives rise to a character of disease which implicates a given
set of organs, structures, or tissues, and offers hut little variety as re-
gards symptoms, progress, and termination, as a technical term of
comprehensive meaning, it embraces, as already suggested, the idea,
in addition, of type, or grade, or both, to neither of which predispo-
sition has any relation. Viewed in this aspect, it contemplates vitality
— the actual condition of life, or life force, as strong or weak, or in a
condition intermediate between the two, and hence, of all possible de-
grees of difference. We repeat, it covers and includes all the varieties
and modifications of vital energy, impressing upon every pathological
state an aspect and a character vitally important, to the success of
practice and to the progress and stability of medicine as a science.

130 M<di col Independent. May

There may be those, who are not inclined to attach so great a breadth
of meaning to the word as we have, in the foregoing remarks. We
feel convinced, however, that the doctrines we have put forth, will be
fully sustained by an extended and intelligent consideration of the
subject.

We deem it not inappropriate, here, to remark, that a well denned
diathesis often acts as a prophylactic against other diseases than that
to which the habit strongly tends. Hence persons, in whom an ac-
quired disposition to tonsillitis obtains, are seldom attacked with
bronchitis, pleuritis or pneumania, and a like fact will present to the
observing practitioner, as regards dyspeptic subjects, such being rarely
amenable to other diseases than those, in which the stomach and ealla-
titious viscera are principally implicated. Now. if we have suc-
ceeded in defining the true significance of the term, diathesis, the
importance, nay, the necessity, of studying its actual character, in
every case of disease, whatever it may be, pathologically, will be ap-
parent. Nor will it be questioned that it is equally necessary to
study, with special care, the general influence of the prevalent epi-
demic cause, upon every variety of disease that may occur while such
cause prevails. For, although there be a prevalent diathesis, during
the continuance of any given epidemic, as of variola, rubiola, scarla-
tina or erysipelas, and though a character of sameness may necessarily
impress itself upon the general treatment, we cannot doubt but the
experienced therapeutist will meet many examples of the same gene-
ral disease, so widely different in type, or grade of action, as to require
striking modifications in practice.

We come, now, to consider, briefly the influences operated upon our
therapia, by the views we adopt in reference to the subject under con-
sideration.

Such is the structure of the human mind, that, if it accept a par-
ticular hypothesis, or if it go beyond this, and constructs a theory in
regard to any subject or occurrence, and action follow as a necessary
sequence, that action will always accord with such hypothesis or theory.
This is inevitable if consistency be intended, and such generally is
intended. We repeat, then, the mind, in a normal state, cannot act
in contravention of itself. It follows, therefore, if the practitioner
accept, as a dogma, that, since a given period or event, the diathesis
of the species, or of the people of a country, or a restricted locality,
has undergone a marked and permanent change — if, for example, he
assume, with Tully and certain others, that, whereas prior to 1810,
when pneumania typhoids was epidemic throughout a great portion of
our country, or, to 1832, when cholera first appeared as an epidemic,
there prevailed a general sthenic diathesis, and diseased action assumed

1857. Original Communications. 131

an acute, inflammatory character, requiring active depletory measures
to subdue it ; but that, since one or other of these periods, the diathe-
sis of the people is changed — that it is, and has been, unvaryingly, and
without exception, asthenic — that there is, therefore, no such thing as
inflammation, in its primitive sense, it needs not the gift of prophesy
to divine what his general treatment of disease, and of all diseases .will
be, whether called upon to prescribe for an isolated case of some spo-
radic malady, or to contend with a destroying epidemic. Nor will
the influence differ, if he allow himself to believe that, since the preva
lence of erysipelas, epidemically, in 1843, a like change of diathesis has
taken place, and that certain desirable results 6f therapeutical mea-
sures are not to be attained. In either case, he will be inclined to
regard morbid action as a unit, and to treat all diseases in accordance
with some special plan, equally founded upon hypothesis or blind and
unexplained, perchance, unexplainable dogma, regardless of true patho-
logy, symptoms, progress or termination.

He is, in truth, on the high road to empiricism. Indeed this is but
one form of empiricism. It was on some not widely different dogma,
that the systems of Thompson, Hahnemann and Praesnitz were foun-
ded, and in the history of these truly empirical systems, the intelligent
observer cannot fail to perceive the real origin of all, — the history,
progress and results of all like systems that have preceded, or may.
in the progress of accumulating generations, succeed them. Denying,
emphatically, the truth of the dogmas above referred to, and holding
that the history of our science affords no foundation for the conclusion,
that any particular diathesis is universally prevalent, modifying and
changing permanently the character of morbid processes and action,
we deduce that the practitioner who allows his mind to be thus tram-
meled, perverted or resistlessly controlled, must, in strictness, be
looked upon and appreciated, as neither more nor less than an empiric.
He may have learning of a certain kind, — he may be characterized by
goodness of heart and gentlemanliness of deportment, even, but " the
leopard's spots are not, nor can they be changed," while he allows
himself to be thus inthralled. In medicine, if in no other department,
dogmatism leads to empiricism. From empiricism, the discent to
routineism, is direct, easy, and natural, and this stage ; not of progress,
but of retrogression, attained, constitutes the unqualified and complete
consummation, nay the culmination of opprobrious fogyism. Nor
is length of years essential to this reproachful, this debasing pro-
fessional attitude. He who allows such prostitution of the noble
powers conferred upon him by the God of nature, though young, is
not less an old, an unmitigated fogy, than is he who has transcended
the age of three score years and ten. K.

132 Medical Independent. May

Article III.— PRACTICAL SUGGESTIONS, NO. 1.

BY J. ADAMS ALLKS, M. D.

A catalogue of the diseases of Kalamazoo during the winter
just closed, would be but little more than a recapitulation of
those of the previous winter.

There has been nothing to characterize the season as unusu-
ally healthy or the reverse.

For the want of frightful accidents, devastating epidemics,
or remarkable cases, in which to find free scope for professional
ambition, and thus satisfy a laudable penchant for a " status "
in our glorious profession, we have been reduced to the inglo-
rious task of revising our modes of treatment of common place
disorders.

Can a man draw blood from a turnip, or strike sparks from
a cucumber ? If not, it would seem hopeless to venture any
inroad upon the cherished routine. Perhaps some great light,
better seen by the aid of three lesser, may again prompt our
assassination by resolution, if we even surmise the possibility
of useful innovation.

Men are oftentimes guided in practice by an obscure appre-
hension of principles they do not clearly apprehend, at others
their practical methods are utterly at variance with the truths
they unqualifiedly admit.

Both these propositions are emphatically true in medicine.
A priori of course we should never judge that substances
which form no part of the integral constituency of the human
body, would be useful in the cure of disease ; yet we have
used them by and with the advice and consent of the Delphic
oracle, Experience.

The great trouble is that the oracle too frequently gives ut-
terance to a conclusion, from an Enthymeme with the sup-
pressed premises not understood.

This is all the worse from the fact that experience accumu-
lates rapidly in every day diseases, whereas in rare cases even
its most servile followers fear a blind guide. Hence there is little
hazard in the assertion, though it may seem a " paradox " or

1857. Origi nal C omm un ica tions. 1 3 3

a "dogma," that the art of medicine lias in fact acquired
greater perfection in the treatment of rare and previously oc-
cult cases of disease than it has in cases of diurnal occurrence.

The former are treated in logical conformity to the estab-
lished and indubitable premises furnished by enlightened
physiology and pathology — the latter as predicated upon the
"undistributed middle'' of a lengthy and loose experience.

Per centages of cures or escapes, are all very well in their
way, but pray what do they prove I

The "pathists," of all prefixes, do even the same, as the
Egyptian enchanters imitated Moses. They bring their multi-
plication table also to show that they are by no means unskilled
in figures.

" Facies non omnibus una,

Nee diverssa tamen ; qualem decet esse sore-rum."

In our opinion the statements so broadly made, that the ad-
vance of discovery in physiology and pathology, with their
subordinate sciences, can do little, if anything, for the im-
provement of therapeutics, is a most unmitigated calumny upon
the art. It shows a hankering after the leeks and onions that
seasoned the flesh pots of the land where darkness could once
be felt, aud ever ought to be held in the extremest distance.
There is where the plagues were. And yet we are asked to
delve among the incongruous farrago of old prescriptions, to
find, if possible, something that is not merely ridiculous.

The great necessity now is to abstain from officious interfer-
ence by administration of drugs; #nd this is precisely what
physiology, (both normal, and abnormal,) especially teaches.
And here we may remark that physiology nowhere involves
that, as has been said, substances which form no part of human
tissues or fluids . are improperly employed for the relief of their
derangement. It does show most conclusively that foreign
articles, taken into the system, materially modify existing forms
and actions in the body, many of which modifications are es-
sential to the maintenance or return of health. And this they
may do without marring or changing, in the slightest degree,
the elementary composition of the fabric. Is the chemist una-
ble to explain tin's '. By no means — the parallel is found every
day in the laboratory.

But physiology gives more than merely the explanation of
probable modes of action of drugs.

VOL. III., no. in. — 2

134: Medical Independent. May

It points definitely to sound dietetic rules and regimen, with-
out the observance of which any system of medical practice
will sink to the despised level of ''exclusive," or "one idea."

Take, for instance, the report on the diet of the sick, made
by Dr. Hooker, before the American Medical Association, a
year or two since. That paper, in our humble opinion, was
alone equal in value to all the other productions of that learned
body since its creation. There is more practical force and
sound doctrine in it, than in any single volume or in any two vol-
ume treatise on mat. med. extant. Yet there are few who have
read — fewer still who have practiced by its precepts.

One-fifth of the race die of tuberculous disease — yet we go
on giving expectorants, tolerating inhalation, inserting the pro-
bang, and permitting hydromania.

Nauseating with 01. Jec. aselli — eschewing pork and fat
roasts of beef.

Thin skins, thin blood, and weak muscle, are pampered with
farina and confectionery.

Hydragogue drenches are followed by hydropathic soups
and diluted abominations.

Breaking down with Venesection, Gal. and Antim., to build
up with Bark and Iron.

Half moralist, half quackish, denouncing the healthful dance
and encouraging those —

" Doomed to force, by unrelenting knocks.
Reluctant music from a tortured box ;"

And so on through the long catalogue of irrational procedure.
It is easier for the physician to write a druggist's order, than to
make a check upon the intelligence of his patients.

Practically we have found that the languor and lassitude, the
headaches and stomach-aches, the " biUious symptoms," &c,
of a great variety of patients are readily controlled by simple
reference to the manifest rules of hygeme.

Glorious horseback riding has proved more efficient as an
emmenagogue than iron and aloes, bark, et id omne genus.
R. Air and exercise, food and sleep. S. To be taken accord-
ing to good sense. This is a prescription vastly better than the
mithridate or polypharmacy of Huxam.

The great trouble is that patients will insist upon having
something in the shape of drugs or active measures, however
preposterous they may appear.

1857. Original Communications. 135

Hence they are prone to quit calomel and jalap and go quix-
otting after infintesimals.

Every physician knows that his patients pay for drugs much
more readily than for advice. Ten to one, if no medicines are
dealt out, they take their hats and start for the office door with-
out ever thinking of any fee.

The true way is to charge that patient a larger fee who is
permitted to escape without medication.

The physician ought to aspire beyond being a mere dispen-
ser or adviser of drugs. If placed in the position of the celes-
tial physician, he would better understand his true mission. It
is said the mandarin pays the doctor for the time he is well, and
deducts for any sickness.

Would this rule work any change in our practice ?

Personally, I am a stickler for drugs, but believe that if they
do no good they do harm.

When sudden and violent changes impend the vital fabric,
there is no justifiable excuse for withholding the energies of
the materia medica ; but in a vast number of instances there
is no need of bottles, vials or gallipots.

Article IV.— CASES.

BY A. R. TERRY, M. P.

CASE OF CARIES OF THE CANCELLAR STRUCTURE OF THE FEMUR.

W. W., son of Capt, J. A. W., U. S. Army, a rather thin,
light complexioned boy of five years old, or thereabout, was,
in August, 1852, kicked by a young, unshod colt, on the upper
and outer portion of the left thigh. The immediate consequen-
ces of the accident apparently disappeared in a day or two.

In the March following he began to be lame, and the region
of the injury became painful. Hip disease was suspected. In
June a swelling appeared at the seat of the injury, (about two
inches below the greater trochanter) and extended gradually
down the thigh. The usual counterirritant treatment was
adopted, and he was kept from walking until the last of Sep-
tember. Fluctuation was discovered soon after, and the ab-
cess was opened early in December, 1853, about three inches
above the knee. The quantity of pus discharged I have no
means of knowing. I should have said that this occurred at

136 Medical Independent. May

Fort Belknap, where Capt. "W. was . stationed. For some
months the boy was apparently well, the opening having clos-
ed and the lameness disappeared.

On the 4th of February, 1854, the troops were ordered from
Fort Belknap to San Antonio, and, on the journey, the boy fell
and bruised his thigh on a stone. This caused the abscess to
form again, and it oj>ened spontaneously, about three inches
below the trochanter. While at San Antonio he had a severe
attack of remittent fever, and the leg became very much ema-
ciated. On the 16th of June he left San Antonio with his
parents, and arrived at Georgetown, D. C, on the 9th of July.
His health rapidly improved here, but a discharge still contin-
ued from the last opening. Professor Mutter saw him in Phil-
adelphia in xS ovember, and expressed the opinion that there
was necrosis of the femur, but advised to delay an operation
for some time, unless the health should materially suffer.
Prof. Mutter also saw him in Jan. 1855, and repeated the opin-
ion and advice

In the autumn of 1.855, I first saw, and examined him, in
conjunction with Dr. Pitcher. The thigh was somewhat
smaller than the other, and although he said it did not hurt
him to walk, there was an evident favoring of that leg ; a per-
ceptible limp. There was some pain, generally at night. Oc-
casionally this was severe. Quinine would generally relieve
it for a time. The fistulous opening was about three inches
below the root of the trochanter, its mouth surrounded with
flabby granulations. It discharged constantly a little ichorous
matter, and, at times, a little healthy pus. A probe introduc-
ed passed obliquely upward and outward to the bone, which
was found denuded and rough. The diagnosis was the same
as that by Dr. Mutter. Necrosis. Still, as although the thigh
was small and the tissues relaxed, no enlargement from newly
deposited bone could be perceived, it was determined not to
operate until either there was better evidence of a sequestrum,
or the health of the patient should suffer.

During the winter of 1855-6, the boy's health was tolerably
good, but in the spring of 1856, it perceptibly failed, and there
was an approach to hectic. Early in May Mrs. W. brought
her son to Detroit, and another examination was made by Dr.
Pitcher, Dr. Gunn, and myself. The diagnosis was the same
as that arrived at previously, necrosis of the femur near the

1857. Original Communications. 137

greater trochanter, and an operation was determined on. On
the 14th of May, assisted by Dr. Pitcher and Dr. Gunn, I per-
formed the following operation.

Partial Anaesthesia was procured by chloroform, the state of
the pulse precluding a further use of the Anjssthetic.

An incision was made through the Fascia lata and Vastus ex-
temus muscle, commencing about an inch above the fistulous
opening, and extending downwards about four inches ; this in-
cision was carried down to the bone. On examination, it was
found that (such was its obliquity upward) the whole of the
fistulous canal had not been included in the first incision ; it
was accordingly prolonged upward for more than an inch.
The ringer now being introduced, discovered a funnel shaped
cavity, with rough edges, about half half an inch below the
root of the greater Trochanter. This admitted the point of the
fore finder. ~No other denuded bone could be found.

A small gouge chisel and a mallet were used, and the bone
was chipped away around the cavity, until, in the cancellar
structure of the bone a small point of suppuration was found.
The pus was but a few drops in amount, but around it was a
gelatinous mass, with small spiculae of bone, the whole not
larger than a filbert.

The diseased part of the bone was all removed, as was a por-
tion of the cancellar structure around it. A tent, smeared with
Basilicon, was introduced to favor suppuration and prevent too
early closing of the soft parts, above the removed bone. The
rest of the incision was drawn together by interrupted sutures,
and dressed with adhesive straps. The next day the patient
had an epileptic convulsion, but, with this exception, no unto-
ward symptoms supervened. The tent was removed on the
fourth day, as free suppuration was established. A large por-
tion, of the wound closed by the first intention. About an inch
of the track of the old sinus remamed open for a good while;
but one or two applications of nitrate of silver closed this. In-
fusion of sarsaparilla with hvdrv date of potassa was freely
used, at intervals for some months.

The leg is now apparently sound, and has recovered its
plumpness, and the child is in better health than at any time
since the accident,

138 Medical Independent. May

CASE OF OBLIQUE FRACTURE OF THE FEMUR. PREVIOUS SPON-
TANEOUS DISLOCATION.

About the first day of March, 1S56, I was called to see J. S.,
aged 24, a machinist. In a friendly scuffle in a room, he had
fallen, and suffered an oblique fracture of the right femur,
about the commencement of the upper third. He informed
me that he had suffered from hip disease, when between seven
and eight years of age, which had resulted in spontaneous dis-
location, but without any external opening. He said that the
leg was supposed to be shortened about two inches, and that
the toe had been considerably turned in. On examination, the
dislocation upward and outward was easily ascertained, I an-
ticipated some trouble in making the proper extension, in con-
sequence of this state of the thigh. I used Liston's long
straight splint, with some modifications of which, I will hereaf-
ter speak, and found no difficulty in making the extension. I
took particular care to keep the toe well inclined outward, by
tying the upper edge of the lower portion of the splint to the
bed post. In this way, I could exactly regulate the inclination
of the toe outward. The cure progressed without any unto-
ward circumstance, and in forty days I removed the splint,
substituting supports of pasteboard, and got him on crutches.

When the patient was able to dispense with crutches, he de-
clared that the leg was considerably longer than before the-
accident. This of course I cannot believe, but it is certain that
there is no inversion of the toe ; and those who knew him be-
fore the fracture, say he walks much better than at that
time. By careful measurement, I have ascertained that there
is now very little over an inch of shortening, so that there was
probably a mistake in his statement, in regard to it.

I have been in the habit of using Liston's splint, in almost
all cases of fracture of the femur, for some years, with the
modifications alluded to above, and with uniform success. I
will now advert to them. In place of a roller around the leg
and splint, making the extension by means of turns through
the notches in the end, and over the heel and instep, I use sep-
arate strips of muslin around the limb and splint, each one tied
separately; and I use another method of extension, which I
will describe. The advantages of the separate strips of muslin,
are, that the surgeon can regulate the pressure on any particu-

■1857. Original Communications. 139

lar part, as may seem expedient, that the point of fraeture
can be easily examined, and that, in the event of increasing the
extension, the lateral pressure of the splint can be at once re-
laxed, and all this without raising or moving the limb.

The principal objection to the extension, as recommended
and figured in Liston's Surgery is, that by it, the foot is so ex-
tended in the direction of the axis of the leg, that in a few
hours intense pain is produced, and few patients can bear it
without frequent lettings-up. I have tried, in vain, to obviate
this while using the bandage for extension ; in passing over the
instep (if sufficient tension is used to make the necessary exten-
sion) it will extend the foot on the ankle, in the same way as
if, in standing, a man were to raise his heel two or three inches
from the floor, and point his toe downward. I have used two
methods of obviating this.

In one (after bandaging the limb from the toes to above the
fracture,) I put two thick woolen socks on the foot ; over these
I put a buckskin moccasin, extending well above the ankle
and tightly laced in front. To the sole of the moccasin, exact-
ly in the axis of the leg, are sewed two or three strong tapes ;
by tying these tapes to the notches of the splint, any required
amount of extension can be made, while the motion of the
ankle joint, within a certain limit, is not interfered with. The
principal objection to this method is, that a proper moccasin is,
often, not easily to be obtained. In other respects, I look on
it as the best method with which I am acquainted.

In the other method of making the extension, I have a narrow
bag made of strong muslin, about three-fourths of an inch in
diameter, and about 24 inches long ; this should be well stuffed
with wool or cotton, (wool is 'better,) and the ends sewed
together so as to make a circle. After well padding the heel
and instep, the circle is slipped over the foot, and tied by
strong twine opposite each ankle, so as to leave a loop on each
side of the foot, while the ankle is embraced by the part in-
closed between the ties. These loops serve for the attachment
of tapes which are to be tied to the notches of the splint for the
extension. Of course the stuffed bag must be made longer or
shorter, as the ankle is larger or smaller.

In both ways I have been enabled to make powerful and
long continued extension with very little pain to the patient.

14:0 Medical Independent. May

Article VI.— FRACTURE OF THE CRANIUM AND OPERATION.

BY JNO. AVERY, M. D.

On the 29th day of August last. I was called to see a lad
about 10 years of age. who, a few hours previous, had been
thrown from a horse, and sustained a severe injury of the head.
I saw him about three hours alter the accident, and found him
insensible, with the scalp much bruised, and tumiliel over the
right parietal bone. The extremities cold, respiration slow and
imperfect, pulse about 50 and intermittent. An examination
of the wound with the probe revealed the sharp edges of the
fractured cranium. Symptoms of prostration were so urgent
that an operation was not deemed advisable until reaction, in
some degree, could be established. With that view, friction
was directed to be made to the extremities with hot flannels,
and brandy sling to be cautiously administered every half hour.

Aug. 30th. 7 o'clock, A. M. Found the patient with a little
more fullness of the pulse, the temperture of the extremi-
ties slightlv augmented, and the patient extremelv sensitive to
the slightest touch of the wound, though still unconscious. I
determined to operate at once, assisted by Drs. E. Fish and
8. M. Bayard.

The patient was brought cautiouslv under the influence of
chloroform, the pulse becoming slightly accelerated during its
administration. Anaesthesia was complete, and the patient was
continued under its influence during the entire operation, which
lasted about two hours and a half.

Havino- shaved the hair from the entire right side of the
head, an incision was made, commencing just anterior to the
ear and continued to the sagittal suture, and another transversely
just above the temporal ridge. The flaps were turned back
and the fracture fully exposed, which was found to extend in
length from the base of the cranium to the sagittal suture, and
averaging about one inch in width, involving the parietal bone
and the squamous portion of the temporal. Six pieces of bone
were removed with the forceps and cutting pliers. A lateral
fracture was found reaching backwards to the lambdoidal su-
ture, with the superior portion oi the bone depressed and over-
lapping the inferior. An incision was carried along its course,

1857. Original (Communications. 141

and with much difficulty the fractured portions were brought
in apposition. The Dura Mater was found uninjured. The
bleeding was inconsiderable.

The wound was carefully sponged with warm water, the
flaps brought together and held in position with the interrup-
ted suture and a few straps of adhesive plaster, over which was
placed a slight compress and bandage. The operation was
borne remarkably well, and produced but little or no percept-
able effect upon the pulse. It still remains slow and intermit-
tent. The patient was placed warm in bed and ordered brandy
sling and carb. ammonia every half hour. Saw him again at
eight o'clock in the evening — pulse about 55 and intermittent
— pupils widely dilated and extremities cold. Brandy and
ammonia continued, with warmth applied to the extremities.

Aug. 31st, 8 o'clock, A. M. Found the patient with pulse
about 60, and the temperature of the surface slightly improved.
Continued the brandy every hour without the ammonia. Saw
him again in the evening and found reaction slowly taking
place; pulse 65, occasionally intermitting; pupils natural and
temperature nearly natural. Discontinued the brandy and di-
rected chicken broth to be given occasionally during the night.

Sept. 1st, 9 o'clock, A. M. The patient had rested well
through the night. Pulse about 75 and slightly* intermittent
Temperature natural. Continued the broth.

Sept. 2d. The little fellow looks bright this morning, and
converses with his mother — the first time he has spoken since
his injury- Pulse about 80, soft, and has entirely lost its in-
termittent character. Gave no medicines and nothing except
a little gruel ad libittim. Directed the dressings to be occa-
sionally wet with tepid water.

Sept. 3d. Patient much the same, and treatment the same
as yesterday.

Sept. 4th. Had been somewhat restless through the latter
part of last night. Pulse 95 ; surface hot and dry. Removed
the dressings. Wound looks healthy and is beginning to gran-
ulate. Moved the bowels slightly with the sulphate of mag-
nesia, and gave a Dover's powder at night.

Sept. 5th. Passed a comfortable night and is feeling quite
lively this morning. From this time on, convalescence was
steady and uninterrupted. On the 7th I removed the stitches.

14:2 Medical Independent. May

The wound was in good condition and the patient able to be
bolstered up in bed. In four weeks from the operation he was
walking about the room, and the wound; excpt its lower fourth,
entirely closed.

This case is interesting so far as it illustrates the recupera-
tive powers of nature, aided by a good constitution in the
young. Also from the fact that chloroform was administered
and borne with happy results, while the patient was laboring
under compression of the brain, with the circulation much ob-
structed and feeble. And perhaps, also, from the slowness
with which reaction took place, and when it did occur, that it
at no time was carried scarcely beyond the point of health.

Otisco, April 16th, 1857.

Iodoform.

A new preparation of iodine, discovered by Sevillos, and more especially
brought to notice by M. M. Dumas and Bouchardat, possesses properties
which promise to make it a valuable addition to our means of employingt
with benefit, this important therapeutic agent. It presents itself in a solid
state, in the form of small pearly particles, of a sulphur-yellow color, friable,
soft to the touch, and with a very enduring aromatic odor. It contains
more than nine-tenths of its weight of iodine. It is sweet to the taste, and
is not corrosive.

It destroj^s animals in a smaller dose than iodine, after having produced
more or less depression, and rarely produces vomiting. This depression is
followed by a stage of excitement, convulsions, contractions, &c. Iodoform
does not produce the least local irritation, not producing the slightest
increase of vascularity of the mucous membrane of the stomach and bowels.

Its therapeutic properties are thus arranged: 1. In consequence of the
large quantity of iodine which it contains, it can replace iodine and the
iodides in all the cases in which these are indicated. 2. It is absorbed with
the greatest facility. 3. It has the advantage over all other preparations of
iodine of never causing any local irritation, or any of those accidents which
render the suspension of iodine necessary in certain cases. 4. In addition
to the properties it enjojrs in common with iodine, it has advantages pecu-
liar to itself; it allays pain in certain neuralgic affections, and produces
a sort of local and partial anaesthesia of the rectum, when introduced into
that organ. 5. It may be given in doses of from five to fifty centigrammes
a day. 6. The principal diseases in which it has been employed with
advantage are endemic goitre, scrofula, rachitis, syphilis, certain affections
of the neck of the bladder, or of the prostate, and certain neuralgic affec-
tions. 7. It forms, with the greatest facilities, most important pharmaceutic
preparations. — Arch. Gen. de Med.

1857. Spirit of the Medical Press. 143

SPIRIT OF THE MEDICAL PRESS.

ON THE HASOHISCH OR CANNABIS INDICA.

BY JOHN BELL, M. D., DEKRY, N. H.

[Prom the Boston Medical and Surgical Journal.]

The various periodicals of this country have abounded, during the last
few years, with accounts of the Haschisch ; every experimenter giving the
history of the effects it has had upon himself. In most cases this has been
mingled with much fanciful and irrelevant matter. These notices have been
confined almost exclusively to the various popular literary journals ; but it
has not received the attention it merits in those exclusively devoted to med-
icine. Under these circumstances, the following resume of what has been
written on the subject, seen through the medium of personal experience,
ma}'' not be destitute of interest.

Among the nations professing Mahometanism, there are not a few sub-
stances used as substitutes for the alcoholic liquors interdicted by the
author of that religion. They are everywhere the most inveterate users of
tobacco, opium, coffee, and a variety of other narcotics less generally known.
Among these latter, no one has recently attracted so much attention as the
ffasc7iisch, Cannabis Indica, or Indian Hemp. It is only within a few years,
comparatively, that a knowledge of it has come to us ; but it has been in
general use for many centuries at the East, and reference is even thought to
have been made to it by the ancient classic authors. The novelty of its
effects, and its apparent harmlessness, have induced travelers in Egypt and
Asia to experiment upon themselves, and a knowledge of it has thus found
its way to the nations of the West. The defective pharmaceutic processes
employed by the inhabitants of its native countries, render its preparations
of very different strength, and admixtures of various foreign substances
make its effects uncertain. A specimen obtained from Damascus contained
about twenty-five per cent, of opium, a considerable quantity of camphor
and spices, and nearly half was a mixture of rancid butter and extract of
hemp. The substance widely known in this country under the Arabic name
of Jlaschisch, is obtained by boiling the leaves and flowers of the plant with
butter, and, when pure and carefully prepared, is a very active preparation.
The extracts prepared in this country from the Indian plant, contain all the
properties of the Ilaschisch, and are every way preferable to it. The com-
mon hemp, though believed by botanists to be a variety of the same species
as its Indian congener, is entirely destitute of the property which distin-

144 Medical Independent. May

guishes the latter. This difference alone, if found to be permanent, would
be sufficient to cause them to be regarded as distinct species.

The action of the drug is not confined to any single part of the system.
It is an efficient but slow cathartic, an active diuretic and sudorific, and a
most irresistible hypnotic in the latter stages of its action. But it is better \
known for its effect upon the nervous system ; it is for this object that it is
extensively employed in the East, and it is in this connection that it pos-
sesses its greatest interest. Abundant personal experience of it leads me
to think that its peculiar effects upon the nervous system are only a secon-
dary result of its action upon the mucous membrane throughout the whole
track of the alimentary canal. The slowness of its action, not commencing
in less than two hours after the dose is taken ; the sensation of dryness, and
afterwards the abundant secretion in the throat and mouth ; the heat thro'-
out the abdomen, and the soreness which persists for several days ; and,
finally, the absence of any symptoms of nervous debility, wheji the imme-
diate effects are gone, all point to this as its modm operandi. It would
seem as though it were absorbed, and that in this process of being thrown
off, it occasioned those phantasies which have caused it to be used as an
intoxicating agent. In the dose usually recommended, of from one to
three grains, it is absolutely inert ; five grains are the smallest quantity
from which any perceptible effects are to be expected, and generally more
will be required. Few persons, perhaps, who have read the brilliant " Con-
fessions of an English Opium Eater," have been without a fancy to experi-
ence the wonderful effects there described : all who have yielded to the
desire have been disappointed. If an}' one supposes the intoxication of
Hascli isch to be of the same nature, a few grains of the drug will most
efficiently purge him of the idea. ,On the first trial, one is generally fright-
ened at the intensity and violence of its action, and few will be disposed to
carry the dose beyond ten grains. Indeed, most will be amply satisfied
with having once experienced it. The following were the results of a mod-
erately large dose of Tilden & Oo.'s extract.

It was taken with coffee, winch increases the effects of the hemp, and at
the same time diminishes its duration, perhaps merely by promoting a more
rapid absorption. For two hours no results at all were experienced. At
this time a dryness seemed to commence at a particular spot in the throat,
and a feeling of warmth throughout the abdomen. These were not the
results of a disordered sensation, for a clammy mucous soon began to be
secreted, though the huskiness of the throat still remained. Up to this
time there was not the slightest excitement or confusion of thought. Sud-
denly, however, an idea having no connection with the train of thought
passing in the mind at the time, appeared, as though suggested by another
person, and then was gone again as suddenly as it came, leaving upon the
mind much the same feeling as when one escapes from a dream or a deep '
reverie. The same thing was repeated two or three times, at intervals rap-
idly diminishing in length. Even now I can hardly believe but it was the
result of strained attention to my physical sensations, for the gentle warmth
of the abdomen was rapidly becoming a burning heat — still, however, not
by any means unpleasant — and the dryness of the throat had extended to
the tongue.

1857. Spirit of the Medical Press. 145

I had taken the drug with great scepticism as to its reputed action, or at
any rate with the opinion that it was grossly exaggerated, and I accordingly
made up my mind not to be " caught napping" in this way again, and to
keep a careful watch over my thoughts. But while enforcing this resolu-
tion, as I supposed, I found myself, to my own astonishment, waking from
a reverie longer and more profound than any previous. From scepticism to
the fullest belief of all I had read on the subject, was but a step. Its effect
so far surpassed anything which words can convey, that I began to think I
was on the verge of narcotic poisoning ; yet, strange to say, there was not
the slightest feeling of inquietude on that account. I resolved to walk into
the street. While rising from the chair, another lucid interval showed that
another lucid interval had come and gone. While passing through the
door, I was aware of having wandered again, but how or when I had per-
mitted myself to fall into the revery, I was perfectly unconscious, and knew
only that it seemed to have lasted an interminable length of time.

These singular attacks of mental disturbance recurred oftener, and lasted
longer, till the lucid interval between was reduced to a mere instant's con-
scious duration of thought. This condition came on so rapidly, that in less
than fifteen minutes from the time of my being aware of the first mental
disturbance, the power of controlling the thoughts was almost completely
lost. All ideas of time and space were especially bewildered, and I real-
ized completely, for the first time, the ideas of some metaphysicians, that
time, properly speaking, has no existence except in connection with a suc-
cession of mental operations or sensations. The most trivial circumstance,
the slightest noise, gave rise to trains of thought, which went bounding
from subject to subject, completely emancipated from the rules which ordi-
narily govern the mental operations, till suddenly some other circumstance
would give an entirely new direction to them, and the last series of imagi-
nations would seem to have lasted from eternity, even while the eye was
fixed upon the clock, the hand of which had not perceptibly moved.

Now, a phenomenon still more singular began to exhibit itself. I felt
that, in spite of all exertions, I was beginning to receive the suggestions of
disordered fancy for real objective facts. Intellectually, I knew that the
spinal column could not be a barometer. An unpleasant sensation in the
lumbar region suggested the idea of a heavy column of mercury pressing
upon it, and, at the time, and under the circumstances, the transition to the
idea of the barometer was easy and natural. There was no ballancing of
arguments in the arrival at this conclusion ; there was no half-way period
of doubt and uncertainty, to emerge into full credence. At the instant the
idea occured at all, it commanded the assent with the same fulness as when
in perfect mental health, does the idea of our own existence. The thought
certainly occurred that it was a delusion, but it made no more impression
than the suggestion would, that the sense of sight was a figment of the
brain, and objects seen had no existence except in the imagination. This
belief was not a transient one ; it was the first hallucination to appear, and
continued with varying degrees of intensity, as the thoughts were more or
less occupied with other subjects, till all others had disappeared. The be-
lief in the reality of the delusion was never for an instant absent ; it per-

146 Mi ndent. May

vaded the whole being, and was often the point on which the thoughts
turned seemingly for a long time. The painful attempt to regulate these
disturbed states of consciousness, was soon given up. and, half voluntarily,
half by a species of moral compulsion, the whole pyschical nature surren-
dered itself, without further trouble, to the fullest and most complete belief
in the actual existence of a thousand hallucinations. During this time the
thoughts were becoming more and more disordered ; ideas, between which,
apparently, there was not the slightest connection, thrust themselves in,
till finally their rapid recurrence, and the loss of that sense of governing
the mind which we ordinar" - educed the belief that I was the

victim of diabolical agency — that some terrible demon had taken possession
of my whole intellectual being, and identified himself with every thought,
in the same way that a man might direct the physical movements of a child.
The feeling of utter powerl Go check the wild current of thought was

complete, and there was as as though, if there had been the abil-

ity, the will could not be exercised.

The firmest intentions were : n in an .ed to be

no difference between the idea and the expression of it in words. A mo-
ment was long enough to forget whether it had been expressed or not. The
sound of persons whispering in the room, brought with it the belief that
they were laying some plot. It was not a vague suspicion that they were
intending some injury, sue!, ispers and glances might excite in any

one ; but everything that they said — the particulars of the whole plot —
were present with the same vividness and overpowering conviction as they
always are in true halluc:

The id now arrh It was an hour and a half

since the first sensations of wandering and excitement commenced About
the same time : .fore it had completely subsided. The mental phe-

nomena in this stage were as remarkable as while the effects were coming
on. One after another the delu as they came:

not by any exercise of the gradual returning regularity of thought, but
suddenly, with a bound, so that it was surprising to have believed, a mo-
ment before, what now appeared so absurd

The whole time during which there is any perceptible difference from the
normal state, is from three to five fa :ording to the dose taken. The

hemp resembles in its action some other medicines which -are erroneously
called cumulative. That is, may be taken without producing any

perceptible action ; and on another occasion, a do-e only a grain larger will
act violently. Indeed, the effects of this agent seem to be of such a nature.
that there is no resting pla en its full action and none at all. A

delusion, of the truth of which we are only half convinced, would be no
delusion at all. Unlike opium, alcohol, and other narcotics of the order
Solanacere, it leaves behind it no mental confusion, headache, or other signs
of a direct and powerful action upon the nervous system. The secretions
of the alimentary canal, however, remain in an unnatural state for several
days, and there is a slight oppression felt in the abdomen, if the dose has
been at all large. During all the time of its action, there is a tendency to
laugh in spite of the delusions, which are almost, uniformly of an unpleas-

1857. Spirit of the Medical Press. 14Y

ant character. The feeling of buoyancy of spirits is somewhat the same as
is caused by a slight dose of alcoholic stimulant.

Amid all the strange vagaries of the Haschisch, the mind preserves the
power of taking cognizance of its condition, and to a certain extent of an-
alyzing its operations. The memory of everything said and done is nearly
perfect ; but of the multitude of thoughts, only those making a more than
commonly distinct impression are preserved.

Can this singular substance be put to any useful purpose, to illustrate
any of the varied mental phenomena of health and disease? Is it worthy
a place in the medical armamentarium, from its action alone upon the mind?

The great advances made in the philosophy of medicine during the last
half century, have been due almost entirely to the devotion with which
pathology has been pursued. Instead of the ill-arranged and ill-understood
assemblage of symptoms observed with scrupulous care, which went to
make up the idea of a disease, we now direct our aim to strip it of every-
thing fortuitous, and to fix in our mind the type of the malady — those
essential features which are uniformly the same under every variety of cir-
cumstances, and about which the more obvious symptoms cluster, like the
drapery about a statue. In diseases of the mind, this has not been done :
their seat and nature are too deep to be reached by the knife of the morbid
anatomist. Esquirol, after a whole life devoted to the study of this subject,
and after the most ample opportunities that have ever fallen to the lot of
any individual, says, that "pathological anatomy is yet silent as to the seat
of madness ; it has not yet demonstrated what is the precise alteration in
the encephalon which gives rise to this disease." Nor has greater success
obtained in the attempt to explain the relations and analogies of the various
forms of insanity. The cause of the latter failure is sufficiently obvious.
Theory has taken the place of fact. No competent individual who has ex-
perienced insanity in his own person, has written upon the disease. The
insane themselves can rarely give a consistent account of their disease, even
if they were qualified, by previous study and observation, to take the best
advantage of their own mental state. Even our own observation of the dis-
ease is rarely complete : the minor degrees do not come under the care of
the physician, and it is only when the more severe cases are evident to all,
that iriends will acknowledge its existence and submit the unfortunate pa-
tient to examination. How imperfect would be our ideas of grief, anger, or
pain, if we could only observe their outward manifestations, or listen to a
description of it by one who had suffered them ! And yet this is all, and
more than all that we can know of the intimate nature of insanity, of its
connections and analogies, unless we have suffered it in our own persons.
If we have never felt any of the passions, our diagnosis of them might per-
haps be as perfect, and the empirical treatment as successful, as now ; but a
vagueness would necessarily pervade our mind as to their nature, and we
should be liable to continual error in reasoning upon them. Southwood
Smith well observes, that the symptom of fever termed febrile restlessness
cannot be understood by any one who has not experienced it in person.

The most superficial observation of a case of mania, will not fail to show
many and strong points of resemblance to that of a person under the influ-

148 Medical Independent. May

ence of a powerful dose of Cannabis Indica. In both there is the same ex-
citement and abruptness of manner, the same rapidity and incoherence of
thought, the same false convictions and lesions of the affective faculties.
The following description, by Prichard, of an ordinary case of chronic ma-
nia, such as composes the greater number in the wards of every hospital,
might apply, without the change of a word, to the condition of a person
under the influence of the Hasch isch. " It is, however, a state of great intel-
lectual weakness, in which none of the operations of the mind are perform-
ed with energy and effect. The memory, the judgment, the powers of
attention and combination, are so much impaired, that the individual is
wholly inadequate to the duties of society, and incapable of any continued
conversation ; his actions and conduct are without steadiness and consis-
tency, his thought.- are deficient in concentration and coherence."

There is no really important point in which these manifestations differ
from the condition produced by the Hasciiixch. There is no error of judg-
ment, no delusion or lession of the will or moral faculties, which is seen in
the former state, but what might take its rise in the latter. In this question,
the difference of eause of the mental disturbance might at first sight appear
an insuperable objection to reasoning from one condition to the other. But
is insanity always produced by the same cause ? On the contrary, there is
no disease to which the human frame is subject, that acknowledges such a
variety. There is hardly a physical or functional lesion of an}T tissue or
organ, but may produce it by its reaction on the nervous s}'stem, and it is
difficult to say whether the best or worst proclivities of our nature are of-
tenest regarded as the productive agents of the same mental disease. If
opium and tobacco and alcohol may produce, by long use, without any appa-
rent disease, a mental state which deserves the name of insanity, why may
not the fantasia of hemp receive the same name ? What reason, then, is
there why we may not rely upon its revelations as so many views of the
hidden workings of the spirit, in that gravest of all diseases ? If this be
allowed, the Hasch isck may in a degree serves as a key to unlock some at
least of the mysteries of mental pathology. Why may we not thus possess
a means of studying the disease in question, better than we have of most
others ? We can apply to it the principles of experimental philosophy, and
test it by the best of means upon the best of subjects. The idea of this
application of the medicine originated with Dr. Moreau (de Tours), of Paris
a physician of large experience in his specialty, and whose work* on the
subject possesses the highest interest, as presenting many views of insanity
and kindred subjects, different from those commouly received.

In the study of insanity by this means, if there is any one fact impressed
upon the mind more strongly than another, it is that of the essential unity
of the whole psychical nature. It is impossible not to recognize the truth
that the ordinary language of metaphysics is not applicable to the explanation
of morbid mental phenomena. The popular division into the inte^ect, the
will, the instincts and the moral faculties, though having a show of preci-
sion, and absolutely necessary in common language, conveys too much.
Such divisions, are too distinct and disconnected to be true to nature. The
minute organilogical divisons and hasty generalizations of the phrenologists
are only the results of the same principle carried to a greater extent.

[To be concluded next month.]

* Du Haschisch, etde l'alienation mentale.

1857. Spirit of the Medical Press. 149

OXIDE OF ZINC IN NIGHT SWEATS.

61 S. L. ABBOT, M. D., ADMITTING PHYSICIAN, AND PHYSICIAN TO OUT-
PATIENTS OF THE MASS- GENERAL HOSPITAL BOSTON.

[Cnmmunicated for the Boston Medical and Surgical Journal.]

In a recent article in the Medical and Surgical Journal, on the treatment
of the Nights Sweats of Phthisic, Dr. Coxe, of New Orleans, gave his ex-
perience of the efficacy of various remedies, particularly of the sulphate of
zinc. He refers to the oxide of zinc, also, as recommended by Dr. Theophi-
lus Thompson, as the best remedy for this annoying symptom. From per-
sonal experience he cannot speak of its merits, but proposes to try it on the
first convenient opportunity ; he however, is inclined, on the evidence of
Prof. Wood, of Philadelphia, to regard the sulphate as the preferable form
in which to administer the mineral.

In the London Lancet of October, 1854, Dr. Thompson speaks of the oxide
of zinc, in combination with the extract of conium or hyoscyamus, as the
very best remedy for the night sweats of phthisis. He recommends it in
the dose of four grains of the salt to three grains of the extract, to be given
in two pills at bedtime. Since that time I have been in the constant use of
this remedy as occasion required, and|can say, from my own experience, that
I have rarely found an}' medicine meet so decidedly the symptom for which
it is given. I have so much confidence in it that I always prescribe it first,
and rarely meet with disappointment, I have made a synopsis of the accom-
panying cases from my note book, giving a condensed statement of the aus-
cultatory signs in each with the duration of the disease, &c, that the reader
may have an idea of the stage of the disorder at which the remedy was
administered. I have omitted, in most instances, any reference to the treat-
ment of other symptoms than the night sweats. The patients were all of
them under my care as out-patients of the Massachusetts General Hospital.
I find in my note-book many records of as many more to whom the remedy
was given for the same symptom, but the record is incomplete from the failure
of the patients to report themselves subsequently. The oxide of zinc,
as a remedy for the night sweats of phthisis, has been most favorablj-
spoken of several times, at the meetings of the Boston Society for Medical
Improvement, within the last year or two, by Dr. J. B. S. Jackson, also by
Dr. Wra. E. Coal, as well as myself. In no instance have I seen any ill
effects from its use. In two or three instances patients have thought it regu-
lated the bowels where constipation had previously existed. I have found
the same relief to follow its use in private practice as in the case of hospital
patients, but my notes of cases are not equally full. I give the cases in the
order in which they stand on my books, with the statement of the amount of
relief experienced as there recorded. They are all, with two or three except-
ions, cases of unequivocal phthisis.

No 1. — Mary S., aged 30; married. December 1st, 1854, Cough of
vol. in., no. in. — 3

150 Medical Independent. ^aJ

seventeen months' standing. Occasional haemoptysis ; sometimes blood
mixed with sputa. No appearance of catameriis since the birth of a child
nineteen months since. Child was weaned at sixteeen months. Profuse
night sweeats. Much annoyed by nausea ; vomits several times daily. Kept
awake at night by cough. A large cavity at the summit of the right lung.
Patient has taken cod-liver oil, but the stomach cannot retain it. R. Acid
gallici. gr. ij. before each meal. R. Zinci oxid., gr. iv. ; ext. hyoscyami, gr.
ij., in two pills at bed-time.

Tth. — Nausea less. Night sweats less, but not entirely checked- Bowels
moved two or three times daily since last visit. Sleep disturbed by cough.
Double dose of gallic acid. Add to pills one grain of opium.

14th. — Night sweats as at last visit. Nausea for last three days as bad as
ever. Bowels regular. Patient reports herself as having been very consti-
pated before coming under my care. Appetite poor. Continue treatment.
is*. Inf. gentian c, f dr i. bis die.

No. 2. — Martha. Ann. S,, aged, 23, Seamtress. Febuary, 12th, 1855. An
invalid for five years. Gave up work ten weeks since. Cough with free ex-
pectoration. Night sweats ; hectic ; emacation. Softening of tubercles at
both summits, with cavernous respiration and gurgling beneath right clavicle.
R. 01- morrhuse, f dr ij. ter- die. R. Zinci oxid., gr.iv. ; ext, conii, gr. iij.,
in two pills at bed-time

19th. — Night sweats much relieved. Nights easy. Continue. The use
of the pills was continued until death, as occasion required, with complete
relief to the symptom for which they were given.

No. 8, — John M., Jr., aged 22 ; currier. Feb, 13th, 1855- Ailing for
five months. Cough, with some of the rational signs of phthisis. Frequent
night sweats. Percussion less resonant in upper third of left front chest
than right, with prolonged expiration at summit and moderate crackle be-
neath clavicle after cough. AVavy inspiration decided throughout left lung.
Cod-liver oil and morphine were given, and nitrate of silver, gr. xl, aq. f oz.
i., was applied to the throat.

20th. — About the same- Continue. R. Zinci oxid., gr. iv. ; ext. coiin, gr.
iij., in two pills at bed time.

28th. — Night sweats less.

The patient returned occasionally until April 27th. The night sweats
were very much diminished under the use of the zinc. Other remedies were
employed, such as are usually given in phthisis, to relieve temporary condi-
tions. Cod-liver oil and stimulants were taken freely.

No. 4.— Richard W., aged 45 ; bootmaker. Feb! 23d, 1855 Cough of
sixteen months' standing. Rational signs of consumption. Occasional night
sweats. Extensive softening of tubercles throughout right lung, with evi-
dence of tubercular deposit at left summit.

March 18th.— Last three nights has had night sweats. R. Zinci oxid, gr.
iv. ; ext. conii., gr. iij., in two pills at bed-time. Other remedies were
ordered for other symptoms.

April 2d.— Night sweats but twice since 26th ult. The remedy was con-
tinued, pro re nata, until death.

1857. Spirit of the Medical Press. 151

No. 5. — Patrick H., aged 26 ; tailor. March 9th, 1855. Cough of 6 weeks
standing, with rational signs of phthisis. Night sweats. No marked differ-
ence on percussion between right and left chest in front. Respiration rather
feeble throughout front chest, with a slight click heard two or three times
after cough and forced inspiration at left summit. Left back decidedly less
resonant on percussion than right, at summit almost flat, with correponding
feebleness of respiration, but no rales. Cod-liver oil.

17th. — The same. Night sweats very severe. Take two pills of zinc and
conium at bed-time.

23d. — Night sweats as before. Substitute acid, sulph. aromat. gtt. xx.
ter die for pills. The patient did not return.

No. 6. — Cecelia R., aged 24; married. March 21st, 1855. Cough of
three months' standing, with rational signs of phthisis. Night sweats.
Feeble respiration, with prolonged expiration at right summit on forced
inspiration, without rales. Between right scapula and spine, a strong
mucous rale heard several times after forced inspiration, with cough. For
night sweats, two zinc and conium pills each night.

27th. — No night sweats since, until last night, when had a slight return of
this symptom, which subsequently continued to be fully under control of
the pills.

No. 7.— Bridget C, aged 14. March 23d, 1855. Cough of four weeks'
standing. Dyspnoena night sweats. Percussion at left summit behind,
quite dull. Very loud sonorous rales heard all over back, particularly
marked towards summits, without moist rales. Respiration at left summit
behind feeble.

In this case no relief was experienced from the use of the oxid of zinc ;
the dose, however, was not increased above four grains.

No. 8. — Catharine B., aged 21 ; tailoress. July 5th, 1855. An invalid
during past five months, but cough dates back but three weeks. Percus-
sion less resonant at right summit front than left, although not absolutely
flat. Respiration at both summits front rude ; at right apex feeble, with
prolonged expiration and a decided crepitus with inspiration. Similar signs
above spine of right scapula to summit, and between scapula and spine.
Percussion of left back more resonant than over right, with respiration
generally exalted, but not purely vesicular at apex.

August 12th. — Bad night sweats, &c. R, Zinci oxid., gr. iv., ext. hyosc-
pami. gr- iij., in two pills at bed-time.

16th — No night sweats last two nights. Continue, pro re not".

Sept- 10. — No night sweats since. Has taken no medicine since last
report.

No. 9. — Thomas L., aged 23 ; blacksmith. Nov. 20th, 1855. Cough of
two months' standing, without expectoration. Pain in left breast, &c
Dyspnoea. Respiration in lower half of left front chest feeble, but audible ;
in upper half inspiration loud, wavy. At right summit posteriorly expira-
tion abnormally loud and long. No rales.

March 4th, 1856. — Has lost considerable flesh, but has kept at work,
Frequent night sweats, with symptoms of advancing pulmonary disease^
Percussion dull at right summit front, with crackling at end of inspiration,

152 Medical Independent. May

and long and loud expiration. More or less crepitus throughout right front.
Respiration in left front exalted, wavy. Take pills of zinc and hyoscyamus
at bed-time.

5th. — Night sweats much less.

No. 10.— Catharine W., aged 21 ; boot-fitter. Jan. 24th, 1856. Cough
during past three months. Copious expectoration of thick, yellow matter ;
hectic ; profuse night sweats. Percussion slightly less resonant at left sum-
mit than right, but not flat. Rude respiration, with prolonged expiration
at summits front, most marked at left. Crepitus on full inspiration above
spines of scapulae. Cough mixture and pills of zinc and hyoscyamus, two
each night.

31st — JSfo night siceats aince taking pills.

No. 11. — Ann G., aged 35 ; married. Feb. 25th, 1856. Cough of six
weeks' standing. Cough dry, harassing. No record of auscultation. Se-
vere night sweats for a fortnight past. R, Zinci oxid, gr. iv., ext. conii, gr.
iij., in two pills at bedtime.

28th. — Nisht sweats diminished.

March 4th. — Night sweats diminished, but have not entirely ceased.

No 12. — Thomas K., aged 50 ; gardner. March 21st, 1856. Cough of
two years' standing. Rational signs of phthisis. Profuse night sweats
Cavernous respiration, with gurgling at right summit front ; crackling at
left summit. Pills of zinc and hyoscyamus.

April 1st. — Night sweats diminished gradually from the time when he
began to take the pills, and ceased entirely three nights since.

The night sweats were controlled subsequently by the use of the pills,
whenever they existed to an uncomfortable degree. The'patient found,
however, that his dyspcena was increased whenever the night sweats were in-
virely checked.

No. 13. — Edward S., aged 7. April 25th, 1856. Cough for a year past.
Free expectoration, particularly in the morning of thick, yellow matter ;
emaciation; weakness; irregular appetite; copious night sweats. Slight
difference of key on percussion in upper third front in favor of right, but
still considerable resonance over left. Respiration feeble in upper part of
left lung, except when forced. In right back, respiration somewhat rough,
particularly towards base, with a somewhat sonorous character to the ex-
piration. No moist rales heard' The patient was ordered to take cod-liver
oil, but no remedy was specially directed for the night sweats.

29th — Cough looser. Night sweats as before. Zinc and hyoscayamus
pills, two at bed-time.

May 5th. — Sweats much less. Continue.

12th. — Night sweats have increased. Continue oil, and take vin. ferri,
fz. i., tr. ferri mur., gtt. viij. ter die after meals.

2ist. — The same. Nothing further known of the patient.

No. 14. — Margaret S., aged 32 ; wife. April 28th, 1856. Ailing for six
months. Cough for the last three weeks, with some blood in the sputa
each morning. Night sweats- No record of auscultation. Tonic infusion.
Tr. ferri mur. gtt. xx. after each meal.

May 19th. — Cough as at first visit. Bloody expectoration twice since

1857. Spirit of the Medical Press. 153

visit. Night sweats as before. Substitute for iron drops pills of oxide of
zinc and hyoscyamus, two each night.

29th. — Night sweats have ceased. The subsequent record shows that the
sweats were always controlled by the pills.

No. 15. — Catharine L., aged 28 ; married. June 4th, 1856. Cough, &c.,
during past five months. Night sweats. Dullness on percussion at right
summit before and behind, with bronchial, almost tracheal respiration in
front, with more or less crackling in upper two thirds of right front. Reso-
nance of voice beneath right clavicle. Cod-liver oil and zinc and hyoscya-
mus pills. ■

11th. — No niglit sir eats since.

No. 16. — Emma M., aged 27 ; married. June 18th, 1856. General debil-
ity, following a profuse catamenial flow, with coagula, a fortnight since.
Has worked very hard. No cough. R. Ferri ammonio-citrat., gr. v. Syr.
limonis et aquae aa f zardr. ss. ter die. At bed-time two zinc and hyoscya-
mus pills. Drink ale.

21st. — Stronger. Night sweats less. Her subsequent recovery was
speedy.

No. 17. — Catharine H., aged 20; married. Sept. 12th, 1856. Cough,
with slight expectoration during past three weeks. Has raised accasionallj
a little blood. Night sweats. Rather rude respiration beneath inner half
of right clavicle, and also of the left, but not so marked. Fauces rather
red, and uvula long. Resonance of voice beneath clavicles. Palliative for
cough, and zinc pills, two each night.

26th. — No relief from night sweats.

No. 18. — Michael K., aged 22 ; plumber. Sept. 11th, 1856. Cough for
three months past. Rational signs of phthisis. Night sweats. Family
predisposition to phthisis. Flatness of right summit front and down to
third rib, with cavernous respiration and large bubbling after cough. Res-
piration at left summit characterized by a tardg expiration, as if from a
want of elasticity in the pulmonary vesicles, or an obstruction to the free
exit of the air — a sign which I have noticed not infrequently. Percussion
beneath left clavicle not fully resonant. Zinc and conium pills, two each
night. Cod-liver oil and Bourbon whiskey.

18th. — Stronger. Night sweats less. Continue, and take three pills each
night.

No. 19. — John B., aged 21; painter. Aug. 4th, 1856. Cough of seven
months' standing. Emaciation ; occasional night sweats. Pulse 99 after
examination. Dull percussion above and on right clavicle, with deficient
resonance below ; throughout rest of right front, fair. Corresponding dul-
ness of right back diminishing toward base. Crepitus after cough beneath
right clavicle. Feeble respiration throughout right front, with considerable
fine crepitus. Crepitus obscurely heard throughout right back, but respi-
ration in right back generally pretty clear. Vocal resonance strong at right
summit front. Cod-liver oil and palliatives for cough.

27th. — Expectoration much less, also night sweats. No chills as for-
merly.

Sept. 24th. — Symptoms much relieved until a week ago. Since that time

151 Medical Indepmdwvt. May

more profuse expectoration and night sweats. Continue. Alcohol amylici,
gtt vi. ter die. Zinc pills, two at bed-time.

29th. — Cough and night sweats less.

No. 20.— Michael I)., aged 36 ; tailor. Jan. 27th, 1857. Slight cough
more or less for three years. Expectoration slight, with occasional traces
of blood Anorexia. Bad taste and coated tongue. Bowels not moved for
six days. Chills and night sweat:-. Xo marked physical signs of pulmon-
ary disease. Cathartics, to be followed by tonics.

31st — Night sweats Less. Take two zinc pills at bed-time each night.

Feb. 3d. — As before. Increase zinci oxid. to gr. vi. each night.

4th. — Xo perspiration last night. Continue. Subsequent records con-
firmed the good effect of the zinc.

Xo. 8].— John McH., aged 25; laborer. Jan. 28th, 1857. Cough of
two month's standing, and rather dry. Expectoration scanty, of thick, yel-
low matter. Emaciation; anorexia; general weakness, &c.; copious night
sweats. Percussion, on, above and beneath right clavicle, less resonant
than over corresponding part of left chest, but not absolutely flat Respi-
ration correspondingly feeble, also, at right summit behind. Xo rales.
Take three zinc pills each night.
:h.— Sweats much less.

Feb. 2. — As before. Increase dose of zinci oxid., and substitute ext. gen-
tian for hyoscyamus in pills.

Xo. 22. — Mary L.. aged 32; widow. Jan. 29th, 1857. Night sweats for
seven months past. Slight cough, without expectoration. Xo d}spncea.
Xo record of auscultation. Take zinci oxid., gr. iv., each night, in two
pills.

31st. — Xo relief. Take three pills each night.

Feb. 3d. — Xight sweats much diminished. Continue.

10th. — Out of pills for some days; since when, night .-wcats have return-
ed Continue.

18th — Sweats checked by pill.-.

Xo. 23. — Mary M., aged 22; domestic. Feb. 10th, 1857. Cough of a
year's .-tanding. Profuse expectoration, fee. Daily chills and night sweats.
Percussion flat at right summit, with bronchial respiration and large mu-
cous bubbles beneath right clavicle on forced inspiration after cough. Take
Take two zinc pills each night, &c.

14th. — 2s<> night sweats since. Chills less. Continue.

Xo one can doubt, I think, on running his eye over the above case>, that
the night sweats were checked by the oxide of zinc. In some instances
they were immediately suspended after the first dose ; in most, they were
sensibly lessened, and there is hardly one in which two or three doses did
not have the desired effect. It is probable that a larger dose would have
acted earlier in the more tardy cases, if I had had much experience with
the remedy, or the patients had given me the opportunity of prescribing a
larger dose, by presenting themselves more frequently at the Hospital.

1857. Spirit of the Medical Press. 155

A Case proving that Menstruation is not only Ovulation, with or with-
out A SANGUINEOUS DISCHARGE ; BUT THAT IT IS, ALSO, THE PERIODICAL
EXFOLIATION OF THE MUCOUS MEMBRANE OF THE BODY OF THE UTERUS. BlJ

D. Warren Briclelh J/. D-

About six months ago, I was performing an autopsy in the dead house of
the Charity Hospital. On an adjoining table lay the body of a stout young
female who was said to have died of a disease of the heart. She had died
a few hours previously, and was still quite warm. The thorax and abdomen
were laid open. The body had been abandoned, and curiosity led me to
examine the internal organs of generation. The uterus and appendages had
been cut from the pelvis, and the anterior wall of the organ had been laid
open. The parts had been thrown aside as possessing no especial interest.
The moment I saw the organs I was struck with their being highly engorged
with blood, and the uterus was considerably larger than usual. The pelvis
was filled with blood which had flowed from the vessels when the organs
were detached. The next thing that attracted my attention was the most
palpable specimen of recent corpus luteum in one ovary. The corpus was
large and prominent, and the depression on its centre, exhibiting »the point
of escape of the ovule, was evident beyond all cavil. In this same ovary
one other Graafian vesicle seemed fully matured, the points surrounding it
being highly congested, but the ovule had not escaped. The other ovary
was generally congested, but there appeared to be no mature Graafian ves-
icle.

But the most interesting feature in the case was the complete absence of
the lining membrane of the cavity of the the bod<j of the uterus. The mo-
ment my e}re alighted on the inner surface of the organ, I recognized the
woodcut of Tyler Smith, in the Ma}*, 1856, number of the Lancet, (Amer.
edition,) representing the inner surface of the uterus of a woman who died
of apoplexy during the eatamenial flow. Nothing could have been more
striking than this resemblance; and if I had ever been skeptical in relation
to the observations of the author, I was now bound to admit his accuracy.
Down to the os uteri internum the mucous membrane was gone, and the
inner surface of the organ rough, with innumerable blood spots scattered
over it. All below the os internum was smooth, and in every respect natu-
ral in appearance. The difference in sensation conveyed to the finger by
touching the two surfaces was as palpable as the impression conveyed to
the eye.

The only doubt now remaining about the case was, whether it might not
be an uterus which had very' recently been delivered of an early ovum.
More extended examination, however, proved clearly that this was not the
ease. The vagina was very small, and its mucous membrane highly enrru-
gated ; and there was a well defined hymen. To adel to this the mamma'
showeel none of the changes generally proeiuced by early pregnancy.

The subject was, to all appearance, about eighteen or twenty years of age,
and quite robust. She was the subject of anasarca to a considerable extent,
and was said to have died very suddenly — her death being attributed to dis-
ease of the heart. 1 tried to get a more accurate history of her from the

153 Medical Independent. May

nurse of the ward in which she died ; but, as is too often the case, she only
knew that such a woman had been in the ward, had lived, and then had
died.

Tyler Smith says, " According to my view, the mucous membrane of the
uterus becomes excrementitious every month, and is discharged from the
cavity of the uterus in a state of disintegration, and the uterus forms a new
mucous coat, by a process similar to the reproduction of lost parts.'' Coste
and others speak of the exfoliation of the mucous membrane of the uterine
cavity under certain circumstances ; but, so far as I am aware, Tyler Smith
is the original advocate of the theory above laid down. After reading all
the observations I could procure on this interesting subject, I was altogether
inclined to adopt this theory, and the case I have thus described, only the
more strongly tends to prove its correctness. — N. 0. Med. News and II
Gazette.

Retained Placenta.

Dr. Putnam, speaking of retained placenta. (Boston Society for Medical
Observation, ) thought that bleeding was a much more prominent symptom
than pain. He had recentlv succeeded in removing, by means of ergot, a
placenta which had been retained for two months. (Generally speaking, it
is very difficult to effect the removal by means of forceps, unless the pla-
centa is very near the os uteri, and when in this locality it will sometimes
melt away.

Dr. E. H. Clarke thought it much better, in the management ol cases of
this nature, to employ ergot, or plugging the vagina, rather than traction.
He, reported a case, where a woman aborted at three months' term. The
foetus came away, leaving behind it the placenta and membranes. No flow-
ing ensued, and no result was obtained from the use of ergot. He ordered
perfect rest, and to be sent for if there was any hemorrhage. The next
day the patient took the cars, and went forty miles into the country, where
she made a visit of ten days' duration, walking and riding about ; she then
returned to the city. A fortnight after abortion, Dr. C. was suddenly sum-
moned to the patient, whom he found flooding so excessively that her sight
was gone, and her life in imminent danger. He immediately plugged the
vagina ; and, at the end of forty-eight hours, on withdrawing the plug, the
placenta followed it. The woman recovered. Tn this case there was no
pain, from the delivery of the foetus to the commencement of the hemor-
rhage. Ergot was administered, both in powder and in the form of the
saturated tincture ; it was not persevered in because of its non-retention by
the stomach-

Dr. Herrick related a case where he was called to a young woman, six
months advanced in pregnancy ; she had a slight uterine hemorrhage. He
put her on her back and administered morphia. Six hours afterwards, at
a second visit, she was sleeping quietly ; in the course of the night she
miscarried, but remained quiet until next day, when a severe flooding com-
menced. Dr. H.. on being called, found the os contracted on the placenta

1857. Spirit of the Medical Press. 157

He immediately plugged the vagina, and allowed it to remain undisturbed
for twenty-four hours. On removing the plug, at the expiration of this
time, the placenta was in the vagina. There was no further trouble.

Dr. Alley mentioned a case similar to the one reported by Dr. Clarke ; by
the end of the third day all the secundines were thrown off together, under
the influence of ergot.

Dr. Buckingham spoke of the management of retained placenta, and re*
ferring to the use of ergot, he called attention to the work of Murphy on
Obstetrics, approving of the distinction, drawn by him, of the two classes
of cases in which ergot should be given or not. In full-blooded and strong
patients it induces muscular contractions. Where feebleness and bleeding
exist, it is apt to produce a depression of the heart's action. From this
effect, many always combine camphor with it. Murphy advises the previ-
ous administration of opium, but as opium itself has similar effects, it
should be employed with great care. Dr. Buckingham asked Dr. Putnam
his opinion as to the safety of plugging the vagina in a miscarriage at five
or six months' period, with placental retention.

Dr. Putnam thought that there was no danger ; he looked upon it as the
best practice, and in twenty-four to forty-eight hours the placenta will be
expelled. He had even known of plugging at full term, when there was
severe hemorrhage, with great benefit. Dr. P. commonly employs a sponge
far this purpose, which has previously been soaked in a solution of alum,
which has the double advantage of making a firmer clot and preventing
annoyance from the decomposition of the fluids.

Dr. J. P. Reynolds approved of the India rubber vaginal plug. This
consists of two thin sacs, each of which is provided with a slender tube
about eight inches long, on the end of which is a metallic coupling with a
stopcock. One of. the sacs is introduced into the vagina, and distended to
any required size by means of air, or fluids, as preferred, driven through
the connected tubes from the other sac by the pressure of the operator's
hand.

Dr. Buckingham thought the chief objection was found when it is wished"
to remove a part of the plug only, so as to manipulate with instruments.

Dr. Ellis had seen in Vienna a somewhat similar plug used, the difference
being that the connecting tubes of the sacs were metallic instead of India
rubber, and thought that it was better on this account ; by means of the
inflexible tube the plug could be better retained in place, when expulsive
efforts of the vagina exist. — Boston Med. and Surg. Journal.

Creosote m Dysentery.

In a very wide spread epidemic, Dr. Andree found the aqua creosoti of the
Swedish Pharmacopoeia (1 err., ad 15 pwt. aq. dist.) very useful. A tea-
spoonful is given to adults every two hours, and a drop (for every year) to
children. It is useful only at an early stage, opium being the remedy at a
later. Dr. Hellmann has also found it useful; but some practitioners state
that those patients who take the aqua as a prophylactic of their own accord,
are oftenest seized with dysentery. — Schmit Jahrb.

158 Medical Independent. May

Alkaline Method of treatment in Acute Rheumatism. By James Gra-
ham, M. D.} Professor of Materia Medica and Tlierajyeutics, in the
Medical College of Ohio.

Dr. John H. Griscom, one of the Physicians to the New York Hospital,
has recently presented to the profession the results of his experience in the
treatment of acute rheumatism by the alkaline method, and these results
correspond so closely with my own at the City Infirmary, during my late
connection with that institution, that I venture to offer a few general remarks
on the subject.

Dr. Griscom' s statistics comprise twenty -six cases, and the average time
that his patients were under treatment was about thirteen days ; the dura-
tion of the whole attack averaging about twenty-one days. Dr. G. asserts,
that under the most improved plans of treatment heretofore pursued, the
average duration of treatment has been about six weeks. There is one
point to which this physician particularly alludes, in which his experience
is strongly corroborated by my own, viz., the freedom from cardiac and
other complications which attended the alkaline treatment. In not a single
instance did such complication manifest itself after the patient's admission
into the Hospital, and the testimony of the other physicians of the Institu-
tion establishes the same fortunate exemption.

I was first led to try the alkaline method by the perusal of Dr. Henry
William Fuller's most excellent work on rheumatism. Dr. Fuller, as many
are aware, maintains that in acute rheumatism the blood is contaminated by
a poison "which is at once the source and maintenance of the mischief;"
and he further asserts (p. 73) that this umteries marbi is an acid, or an acid-
ulous compound, which can be eliminated only by a free exhibition of alka-
lies and neutral salts. He admits, however, that purgatives, sudorifics and
diuretics, by promoting the various excretions, may assist in accomplishing
the object, yes alkalies are essential to prevent the further formation, and to
effect the elimination of the morbific element. The remedy preferred by
Dr, F. is the potassio tartrate of soda, which is readity decomposed in the
stomach, aets quite as energetically, and is much better tolerated than cor-
responding quantities of the alkaline corbonates. Fr. F. made some experi-
ments to determine the efficacy of impregnating the joints affected with
alkaline matter, and though these were not sufficiently extended to enable,
him to form a positive opinion, yet, on the whole "they proved extremely
Satisfactory. The most serious complication of acute rheumatism, it is
needless to add, is heart disease. The frequency with which this occurs,
may be inferred from the statistics collected by Dr. Fuller, during the pe-
riod he held the office of Medical Registrar at St. George's Hospital, London,
viz., from the 1st of January, 1845, to the 1st of May, 1848. Of 370 cases
observed by him, embracing all the examples of acute and subacute rheu-
matism admitted, the heart was healthy in 160 cases, in 32 probably healthy,
while in 187 it was temporarily or permanently deranged to a greater or
less extent. These statistics certainly present a most formidable aspect, as
some form of disease existed in about half the cases. Now, to preserve the

1857. Spirit qf the Medical JPress. 159

heart from mischief, according to Dr. Fuller, it is not only necessary to take
precautions against inflammation, but to maintain the solubility of the
fibrin of the blood, and for this purpose, I am satisfied we must rely on the
free administration of alkalies and the neutral salts — the experience of Dr.
Fuller, Dr. Griscom, as well as my own, having satisfactorily shown that
they surpass all other agents in preventing fibrinous deposits on the valves.
Dr. Griscom administered the sup. tart. pot. et soda in drachm doses every
hour, and ordered an anodyne lotion of carb. potas. and tinct. opii to be
applied to the joints affected. Alteratves and evacuants preceded the
employment of these remedies, according to the indications presented. The
severity of the symptoms was found to diminish as the urine became less
acid.

I am aware that Dr. Roderick Macleod, who, at the time of the publica-
tion of his work on rheumatism (1842), was also physician to St. George's
Hospital, has given the results of his experience in the treatment of rheu-
matism, based on 400 casses attended by him in bis public capacity, and
that he claims in favor of the bloodletting and purging treatment the average
duration attained by Dr. Fuller, Griscom. or myself. For example, of 266
cases, 148 were discharged cured within a month, 110 within a fortnight,
and 00 withen eight days. Dr. Hope asserted, that under a similar method
of treatment, in his practice, the cases were exceptional which were not
cured within a week. Dr. Corrigan, with large and repeated doses of opium,
has cured cases in nine days. Bouillaud, by copious and repeated abstrac-
tion of blood, required from one to two weeks for the same purpose, and yet,
if report be true, he lost six out of eighteen patients from cardiac disease.

But I have extended my remarks beyond the limits which I proposed.
My only object, in offering a few observations on the alkaline method of
treatment, is to bear my humble testimony in its favor, fully believing, its
I do, that it is capable of effecting a more speedy and perfect cure than any
other plan that has ever been adopted. To those who are skeptical on the
subject I would recommend the study of the facts collected in Dr. Fuller's
treatise. In this a comparative view may be taken, which, in my opinion,
must satisfy every unprejudiced mind. It will there be found, that the boas-
ted success of the authors whom we have mentioned, admits of considerable
qualification, and is in reality less than has been asserted. — Western Lan.-
eet

Best Treatment op Varicose Ulcers and Varicose Veens.

The treatment of varicose veins is a practical every-day subject, inferior to
none in interest for the hospital surgeon. Indeed, allied as this affection is,
externally, to questions of practical surgery on the one hand, and depending
for its causes on relations of the general venous system and general internal
health on the other, a wide field of speculation is afforded as to treatment.
In hospital practice, accordingly, as the practitioner may be more of a phy-
siologist and anatomist, or more or less influenced by the ordinary routine
of simple surgical treatment, ligature of veins, constitutional treatment, or

160 Medical Independent, May

means of Mocking up these vessels, will be trusted to, previous to healing
the varicose ulcer. A good deal of danger of ligature of veins is found to
originate in the fact that the vein is enlarged ; and the ligature, when it
should go deeper than the vein, will be found to have wounded or transfixed
the vein and caused phlebitis.

Mr. Paget's experience every year assures him more and more of the
superior value of the treatment of varicose veins by the caustic issue, or the
extemporized mixture of lime and potash. There is no mode of treatment
yet discovered, according to Mr. Paget, which is entirely free from risk ,
but from pretty extensive inquiries in the hospital practice of such surgeons
as Sir B. Brodie, Mr. Lawrence. Mr. Skey, various hospital surgeons in the
provinces, and in France and Germany, etc., Mr. Paget is inclined to the
impression that the treatment of varicose ulcers and varicose veins is most
safely and most effectually conducted by means of local applications of caus-
tic issues on the surface, which thicken the coats of the venous trunk.

A very well-marked ca>e of varicose ulcer of the leg, and leg and foot,
which incapacitated the poor young man from employment and deprived
his family of support, has been for some weeks in St. Bartholomew's, as well
as a second case, where the varicose vessel gave way, but has again healed
up. The former case i> that of A. D , a young and apparently other-
wise active and healthy man, aged 28. He has been all the present month,
(September) under treatment for a varicose condition of the veins of the
lower extremity : his disease consists rather of a very troublesome ulcera-
ted condition of the ankle and foot, which he cannot himself conceive to be
dependent on the state of the veins. The history he gives of the case is
not very defined, or is but a recapitulation of a set of abortive attempts to
cure his ankle by ointments, lotions, salves, etc., each in its turn recom-
mended to him as the most specific thing in the world for an inward disorder
of the constitution, but still only making the disease worse.

The form of caustic used by Mr. Paget consisted of pottas^a fussa dm ii,
quick-lime grii, separately in powders in small phials, and subsequently
mixed with a glass or asbestos rod at the bedside, with spirits of wine,
when used. A dozen or two of small pieces of common adhesive plaster
are next obtained, each the size of a penny, a small circular hole being cut
in each, of the size of a pea, or a silver threepence. One of these perforated
pieces of plaster is placed over each projection or varicose enlargement of
the vein, a very small quantity of the caustic paste is next applied with a
bone spatula to the skin over the vein, in the circular hole left in the plaster ;
ten to twelve or fifteen minutes will be sufficient time for the issue to pro-
duce its effect, at the expiration of which period, the whole limb is carfully
sponged with warm water, and all the plasters and caustic washed away.
Little else was necessary in this case, as in the general class of these cases,
the issue merely requiring simple dressing, while the ulcers in the ankle
went on healing ^>a?*/ passu.

As a local aplication to the ulcer during the action on the varicose vein of
the issue, any simple ointment or black wash is all that is required — Asm-
fiatiofi Medical Journal, Sept. 27, 1856.

1857. Sjnrit of the Medical Press. 161

Does Ekgot, when administered during Labor, injure the Fcetus ?

Dr. R. U. West has, in the Medical Times and Gazette, tabulated sixty-
nine cases of labor, in which ergot of rye was administered. The following
are a portion of his remarks in relation to this question :

With reference to the probability of the ergot causing the death of the
faetus, I may observe that, in the whole number of 69 cases, there were 9
stillbirths, viz., in cases. 2, 5, 16, 19, 23, 33, 39, 56, 67. All the other chil-
dren were born more or less lively and vigorous. Of case 25, where the
foetus survived its birth only half an hour, I ought to observe that the
mother usually gave birth to stillborn or -similarly feeble children. Cer-
tainly, her three previous children were in this condition, no ergot having
been given. From this list of 9 stillbirths, we may at once exclude cases
19 and 33, the putridity of the foetuses in these two cases having proved
that they had died some days before the commencement of labor. Cases 5
and 39 were attended with considerable hemorrhage during or immediately
preceeding the labor, a circumstance of itself quite sufficient to account for
the death of the children. In case 67 the death of the child was undoubt-
edly caused by pressure on the funis, during the difficult delivery of a
hydrocephalic head in a case of feet presentation. Four stillbirths remain
to be explained, viz., in cases 2, 16, 23 and 56. Do the cases just referred
to, when compared with the large number in which, under all sorts of unfa-
vorable circumstances, and with a duration of the labor proeess, under the
influence of the ergot, varying from a quarter of an hour to three and four
hours, the foetus was born lively and vigorous, prove anything whatever
against the ergot of rye ? I certainly think not. — N. Y. Journal of Med.

Sterility Remedied.

A correspondent of the New Orleans News and Hospital Gazette, directed
a negro woman to apply an infant to her breast with a view to cure her of
sterility. The prescription was followed for only four successive days,
during which time she conceived, and at the end of full term was delivered
of a fine child. This is another evidence of the remedial use to be made of
the close sympathy existing between the mammae and the uterus and ovaries.
Wishing to avail ourselves of this means for the relief of amenorrhoea,
lately, we used the gum elastic cup as very convenient of application, and
with good effect. This was done after sinapisms had failed. — Memphis Med,
Recorder.

Treatment of Boils.

Dr. Winslow, in the Boston Journal, gives his practice in the treatment
of boils. Many cases occur in which, one after another of these trouble-
some and painful eruptions came out, and the usual preseription — salts or
sarsaparila. Dr. W. says that his practice is to bleed, and give no med-
icine.

102 Medical Independent. May

Cure of Itcii in half an hour by Sulphur in the Liquid Form. — By

Dr. Edward Smith.

[Dr. E. Smith here draws attention to an article by Dr. Bourguignon in
confirmation of the value of sulphur, combined with lime, in a liquid form,
in the treatment of itch.]

The remedy is prepared by boiling one part of quick-lime with two parts
of sublimed sulphur, in ten parts of water, until the two former are per-
fectly united. During the boiling it must be constantly stirred with a piece
of wood, and, when the sulphur and lime have combined, the fluid is to be
decanted and kept in a well stopped bottle. A pint of the liquid is sufficient
for the cure of several cases. It is sufficient to wash the body well with
warm water, and then to rub the liquid into the skin for half an hour. As
the fluid evaporates, a layer of sulphur is left upon the skin. During the
half hour the acarus is killed, and the patient is cured. It is only needful
then to wash the body well and to use clean clothes. In Belgium the treat-
ment is introduced by first rubbing the body for half an hour with black
soap ; but this does not appear to be necessary. The only essential act is
that of the careful application of the fluid sulphur. The lime is of no im-
portance in the treatment except to render the sulphur soluable, and such
would proably be the case if potassa or soda were employed. The chief
point in the plan thus employed, which is an improvement upon the mode
of aplication of sulphur in substance with lard, is the more ready absorp-
tion of the remedy, and consequently the more certain and quick destruc-
tion of the insect, by using sulphur in a liquid form. In so disgusting a
disease, it must be of great moment to be able to cure it in half an hour.
— Association Med. Journal, March 8, 1856, p. 195.

The Vapor of Amylene.

This is the name for a new anaesthetic. Tt is said to produce insensibility
more surely and completely than chloroform, and to leave no bad effect.
There follows its administration no sickness nor vomiting. It has been
fairly tested in King's College Hospital, London. Amylene is a carburetted
hydrogen, Cio Hio, and is prepared by acting on amylic or fusel alcohol
with an excess of concentrated sulphuric acid, and then heating the two to
boiling ; and also by distilling fusil oil with chloride of zinc. It is color-
less— tho density of its vapor being 2. 45, and possesses an agreeable odor
— Southern Journal of the Medical and Physical Science.

Ointment of Iodide of Potash.

Ointment of Iodide of Potash may be prevented from changing to a brown
color, by adding to the lard or to the ointment a few drops of potash lye.
This, on the contrary, renders the ointment white and frothy — owing to the
saponification which takes place on rubbing the ingredients together. So
says the Chemical Gazette, of New York.

1857. Editorial and Miscellany. 163

EDITORIAL AND MISCELLANY.

OLINIOAL INSTRUCTION IN THE MICHIGAN UNIVESLITY.

The majority of our readers have an interest in the Medical Depart*
ment of our- State University, sufficient, at least, to cherish the hope
that its success and prosperity shall fulfill the designs of government,
and render it worthy of its munificent endowment; for whatever may
be its history, it involves alike the political economy of the State and
the honor of the medical profession. Its past history has demonstra-
ted the practicability of the original design of gos7ernment, in its estab*
lishment, and afforded ample protection against the subversive
attempts of empiricism, made through political intrigue and legislative
enactments. But while it has been in a great measure successful in
its practical working, has it taken that rank among the medical schools
of this country, which its financial resources and the patronage of a
State government, ought ere this to have secured % At the present
day no medical school is worthy of being considered among the first,
without affording superior advantages from clinical and hospital teach-
ing, and the resources for such advantages can only be made available
in the populous cities. It follows, therefore, that although the Medical
Department of the Michigan University may be pleasantly situated in
the beautiful rural village of Ann Arbor, and even offer gratuitous
instruction, yet while it is thus located, it can never become any thing
more than a respectable country school.

A little more than six months have now elapsed since we first pre-
sented our views of the importance and necessity of a removal of the
Medical Department to this city, where it may possess clinical and hos-
pital advantages, such as would place it at once upon a basis of
successful competition with other schools, and furnish to the medical
student that kind of practical instruction which is the sine qua non in a
preparation for the practice of medicine. In doing what we have
toward the accomplishment of this object, we presume that we have
incurred the displeasure of a few Ann Arbor landholders, editors, and
perhaps even the Chancellor of the University, to say nothing of the
vials of wrath which have been poured out of the " Peninsular Jour*

164 Medical Independent. May

nal" charging us with " assailing" the State University without sub-
stantiating the charge. But notwithstanding all this, it was soon
observed that the majority of the Medical Faculty were not only con-
vinced of the absolute necessity of increased facilities for affording
practical teaching, but were anxious that the department should be
removed as soon as practicable. Why then was not a plan matured
by which it should be speedily accomplished 1 The Board of Regents
acknowledging the utility and necessity of increasing the advantages;
of ^the school, have offered a compromise — to that spirit of progress,
which would labor to promote and perfect the Medical Department —
by instituting a summer course of " Clinical Instruction" at St. Ma-
ry's Hospital, in this city. Let us see how much of practical wisdom
and good policy has been displayed in the plan proposed, as indicated
in the official announcement which appeared in the April number of
the " Peninsular Journal" as follows :

School of Clinical Instruction, appurtenant to the University of
Michigan, In Detroit. — Our readers will learn by the following extract,
from the records of the Board of Regents, that this important want of the
medical neophyte is about to be supplied.

(extract.)

Resolved, That Z. Pitcher, M"! D., Em. Prof, of the Institutes of Medicine
and Obstetrics in the University of Michigan, be and he is hereby appointed
Clinical Instructor, to commence and perfect as far as practicable a course
of clinical instruction for the students of the Medical Department of the
Universit}'-, in accorcance with the views expressed in his letter of March
5th, 1857, addressed to the Chairman of the Committee on Clinical Instruc-
tion."

The necessity of giving daily attention to my private engagements will
prevent my devoting to the duties of this appointment, all the time that its
importance demands. I shall therefore associate with myself in the dis-
charge of these duties, Professor A. B. Palmer, of the University, from
whose zeal and recognized ability I expect to derive important assistance.

No student will be admitted to the privileges of this course of instruction
who is not a matriculant of the University, and who has not the preliminary
education required of candidates for the degree of M. D., and has not atten-
ded one full course of lectures in the Medical Department of Ann Arbor.
• Preference will be given to those students who have attended two courses
of lectures, the analytical course of Chemistry, under the direction of Pro-
fessor Douglass, included.

The authorities in charge of the St. Mary's House for invalids in Detroit
have consented to the opening of that institution to the students of the
Medical Department of the University, under the direction of a clinical
instructor. This house contains about one hundred beds, and furnishes
facilities for studying practically most of the usual varieties of disease, inci-
dent to this climate.

In the course of the summer, the Marine Hospital will also be opened to
them, where they can see the diseases and assist in the treatment of injuries
peculiar to seamen.

The time for commencing this course, not being designated by the Re-
gents, in the exercise of a discretion assumed to be conferred, I have thought
best to appoint the 15th of June for that purpose, reserving the right, unless

1857. Editorial and Miscellany. 105

overruled by the proper authority to vary the time hereafter, if that date
should be found to prejudice the operations of this, or any other sub-depart-
ment of the University.

t Z. Pitcher.

Detroit, March 28, 1857.

Here, then, is the Medical Department of the Michigan University,
" revised and improved " by the Board of Regents. To us it looks
very much like " the play of Hamlet," with " Hamlet" left out, and
before the last rendering is complete we venture to predict that it will
be more appropriately named the Regents folly — in one act!

But who are to represent the most practical department in this
clinical teaching ? Why are the " Professor of Theory and Practice,"
and the " Professor of Surgery," left out of the programme ? Both are
residents of the city, and both are zealous and competent teachers.
Why are these departments represented by an emeritus professor, assis-
ted by the Professor of Materia Medica ? This is the way by which the
Board of Regents propose to supply this " important want of the medi-
cal neophyte;" a professor in the institution is to be permitted to
discharge his duties by proxy. May not the Professor of Surgery or
Theory and Practice, with as much propriety associate with himself
some proxy, from whose zeal and ability he can derive important aid
in giving his winter course at Ann Arbor 1

If such are the only inducements offered by this " appurtenance " to
the University, is it reasonable to suppose that in addition to the six
months of laborious study through the winter course, they will come
here, into the city, during the heat of summer, to complete the curri-
culum ?

Can the Medical Department of the Michigan University, with such
comparatively meagre clinical advantages, hope to compete success-
fully with schools wherein the theoretical is associated and blended with
the practical ? The great utility of clinical instruction consists chiefly
in the fact, that it is made to illustrate principles, to familiarize the stu-
dent with the physiognomy, or sensible aspects of disease, as well as
its pathology, and the modus operandi of remedies.

A few years since Branches of the University were established in
different parts of the State, the constant nursing of which crippled the
University fund, and involved the institution in financial embarrass-
ment. We have reason to fear that this last experiment — this Branch
of the Medical department — has been established upon the same short-
sighted policy, the same want of practical knowledge and appreciation
of the real object to be accomplished.

There is one feature in the announcement of this summer arrange-
ment which may surprise some of our readers, and though we may
incur the risk of being considered invidious, its import gives additional
vol. in, no. in— 4

166 Medical Independent. May

strength to our views respecting this — at - best — doubtful experiment
of the Regents, and therefore it merits a passing notice. It is very
well known that the emeritus Professor who has received the appoint-
ment of " clinical instructor," has held peculiar views respecting the
utility of hospital advantages ; taking the ground that " clinical obser-
vations may be most successfully and profitably made under the super-
vision and direction of a private preceptor ," and that "a thorough know-
ledge of the principles and elements of the science of medicine should
precede any attempt at their practical application."

Noiv he speaks of these proffered advantages at St. Mary's hospital,
as an " important want of the medical neophyte."

What has so completely metamorphosed his published opinions on
this subject?

Why the Board of Regents should have chosen a man who has long
entertained and published opinions entirely apposed to hospital in-
struction, is a question which time will answer.

SPECIALTIES AND SPECIALISTS.

BY W. H. BYFORD, M. D., BVANSVILLE, INDIANA.

Specialty in medicine has reference to practice, in some praticular
disease, or the diseases of some organs, or class of organs. Obstetrics
or surgery either alone can not be considered a specialty, as the pro-
fession generally understands the term, because each embraces too
extensive a range of subjects. Perhaps obstetrics would come the
nearer. Diseases of the chest, eye, ear, in practice, and orthopceay in
surgery, may be considered specialties, with propriety. A specialist
is one who practices a specialty. There are two sorts of specialists, as
there are of general practitioners, viz : scientific and quack. The sci-
entific physician who is thoroughly educated in the profession and from
preference, accident or aptitude, devotes his attention to more particu-
lar subjects in medicine or surgery, and uses no improper or dishon-
orable means to procure business, is engaged in a proper and laudable,
pursuit, and while he is benefiting himself and the community in which
he practices, may do as good service in advancing the honor and inter-
ests of the profession — probably more — than one of the same capacity"
and acquirements whose attention is diffused over the whole expanse
of our vast science. This sort of specialist, is one of our common fra-
ternity, and his acquirements are amenable to every honorable profes-
sional requisition. He should be encouraged. The quack specialist
is simply a pretender,' an impostor, and abomination in the eyes of
every honorable man, in and out of the profession.

After all the discussion I have seen in the journals on the subject of
specialties, I think there is not so much objection to them as to the

1857. Editorial and Miscellany. 167

character of the specialist. The fact that quacks try and actually pass
off their imposture better in specialities than in general practice, would
seem in some measure to justify the too sweeping denunciations against
these particularities. Thesuccess too, which quack specialists some-
times meet with, may have the effect of seducing well informed, but
sordid men of science, from the sphere of professional propriety. But
while great evils result as things now stand, from the pretenders in
specialities, great good may and ought to come from the cultivation
by scientific men of knowledge of some particular subject connected
with our profession. Why is it that dishonest pretenders succeed bet-
ter in specialities than in general practice 1 The greatest field for im-
posture, certainly in the West, and I presume among other parts of
the country, is in diseases of the eye, and hence it may be well to look
at the causes of their success in the diseases of this organ. I do not
mean by success their excellence in cures, but in getting employment
and money. " Eye doctors" itinerant and local are common among
us all over the West, and it is a shame upon the intelligence of the
people to say, but it is true, that they cheat their patients out of more
than the man of science earns by his honest toil. Another question
by way of answering the first, which I know everybody wTho does me
the honor to peruse my communication, can answer as well as I can.
Is there not great deficiency of correct practical information on dis-
eases of the eye all over the West in the profession. Now I suppose
this to be answered in the negative. Then it is an evil we can not
correct perhaps at all, it is beyond our reach until the people are edu-
cated to know their interest better, and this probably experience alone
w ill do. If, however, the question is answered in the affirmative, then
the profession to a certain extent is responsible for it, and may apply
the remedy. And in this connection I will ask every graduate how
much time was yOu required to study diseases of the eye in the lec-
ture-room, or in any way at college. How many lectures did you
have, and how long were they on the anatomy, physiology and pathol-
ogy of the eye] How many questions were you asked about the im-
portant diseases of that complex and delicate organ 1 Ten per cent.,
five per cent., or even one per cent of the whole of these interesting
exercises \ If you are a practitioner I would like to know what pro
portion the teaching bears to the requisitions of your practice in this
respect] By the time these questions are all answered, I think we
may have an inkling of a part of the causes at least,, of the prevalence
of quackery in this specialty. Still looking at the question as answer-
ed in the affirmative, I would remark, that when all of the profession
are educated up to the times, on every subject connected with our
noble calling, there will be no room for imposture. Exposure and
discomfiture would almost, if not quite, immediately follow the at-
tempt to practice upon the community. We may trace back the evil
I think to the fountain head — our colleges and educators. And here 1
desire it to be understood that I do not blame our professors with the
present state of things, but inembers of the profession generally, for
not requiring a correction of the evil. As colleges are organized} each
professor has more work than he can do well. Let there be more

168 Medical Independent. May

chairs, embracing among them any portion of our science, that is of
sufficient importance to require a thorough knowledge of it, for success
in practice and the credit and improvent of the profession, and demand
a thorough acquaintance with all the different subjects taught, as a
condition of graduation. If disease of the eye, ear, or any other organ,
constitutes one tenth of a man's practice, how uncomfortable he must
feel, how unprofitable to his patients and discreditable to the profes-
sion he must be, if. deficient in this respect. It is all very well to
teach general principles. They are indispensable to the intelligent
explanation of the modus operandi of medicines and disease, but young
men must learn to apply them in detail, and this they cannot do un-
less our profession is taught in all its minutiae, and they will not, unless
their professional parchment license, as well as their success in practice
depend on it, Such teaching and requirements would, so far as prac-
ticable, do away with the demand for specialists, and effectually put a
step to the masrs of quack specialists. Now the specialties are a fruit-
ful field from which pretenders reap their richest harvests, and inflict
the severest injuries upon the honor and interests, of the profession.
They would also remove the temptation to scientific physicians who
might pursue any of them to overstep the bonds of professional pro-
priety. They would be held in wholesome check by the general
information of the profession, embracing an intelligent understanding
of any subject they might select, and they would be required to attain
a higher degree of professional knowledge before they could be enti-
tled^ preference in any branch. In this manner they would unques-
tionably be, as some now are, an honor to the profession, and a bles-
sing u/their kind. I hold that all members of the profession, individ-
ually and collectively, are alike responsible for the educational defi-
ciencies in the profession, and must move for educational reform
together, that the journals and their associations are the mediums
through which their influence should be felt in the proper places.
Much good has already been done, and is now going forward in the
broad current of literature which is flowing through them all over the
land, hut more is yet to be accomplished.

As my paper, Messrs. Editors, has already grown to larger dimen-
sions than I anticipated in the commencement, I will conclude by
expressing the hope, that these suggestions may elicit the services of
able pens, and more influential members of the profession, in what I
consider an interesting and important subject.

Editorial Comment.

The perusal of the above article has afforded us more than ordinary
pleasure. Dr. By ford has touched a key, which we think, will call
forth a vibration of approval, in the mind of every reflecting and hon
est practitioner. In medicine, as in every other department of human
research, whether in science, technically so called ; in ethics or theol-
ogy, it is profitable to pause, at intervals, and contemplate the actual
progress attained — the real improvement acquired. So, too, in the arts,
as well as in business,— in any and all the events of industrial pursuit.

1857. Editorial and Miscellany. 169

While the entire article is entitled to the serious consideration of
all who value science and desire the triumphant success of legitimate
medicine, certain portions of it merit more than a mere transient
thought. The author speaks emphatically, of the present mode of
teaching our science, in the colleges and schools ; of the paucity of
professorships, in most, if not all ; of the excess of labor, heaped upon
professors respectively, in order to comparative thoroughness, and the
remissness of the profession at large, in not demanding the correction
of existing and glaring defects, — in not claiming positive, practical re-
form. He goes further and suggests a plan, which we concede is both
plausible and practicable, and if carried into efficient, working opera-
tion, would doubtless accomplish much towards the desired object.
But is the proposed plan sufficient, of itself, to work the good results,
with the necessity of which Dr. B. is so fully impressed, and which
he so ardently and properly desires ? We confess we cannot think
so. To the following postulate wre grant our fullest assent : " I hold
that all members of the profession, individually and collectively, are
alike responsible for the educational deficiencies in the profession,
and must move for educational reform, together ; that the journals
and their associations are the mediums through which their influence
should be felt in the proper places." But is this all that the crisis
demands. Are not other influences and other modes necessary also1?
What, for example, would be the effect of a demand, emphatically
spoken, on the part of the people, for a higher standard of qualifications
in those to whose care they confide the weightiest responsibilities ;
their most sacred affections and regards ? If it were possible to reach
their judgments, and, thereby, so change their predilections, that in
choosing a family physician, they should select a man of acknowled-
ged attainments, instead of a stage driver or an ostler, we ask if the
desired reform, in professional education, would not follow, as rapidly
as time would allow? Would it not come from such a reformation
in public opinion and public practice as surely as an effect follows its
appropriate cause \

And is it impracticable to reach public opinion, and therefore prac-
tice on a subject conceded to be of such weighty consequence ? But we
do not propose to dwell longer on this point. We said other influences
and other modes, also. A few words in reference to modes, other than
those dwelt upon, somewhat at length, by Dr. B. And, first, of the
usage of colleges and schools, in regard to students and the granting of
diplomas. Now, nothing is more common than to be told by the
individual who has chosen to submit his life, and that of his family, to
the omniscient keeping of the homoeopath or hydropath, that " Dr. —
was regularly educated a physician" — the conclusion obviously exist-

170 Medical Independent. May

ing in the mind of the speaker, that tin fact enunciated involves a
special merit. Without attempting to shovv the fallacy of such con-
clusion, we regret to be obliged to admit that, in too many examples,
the alegation' is true, — that men, who have pursued a regular course,
so far as to have obtained the honors of a legitimate institution, and
not unfrequently, having pursued rational practice, for a time, greater
or less, seized by some fantasy, or having been Judases, abinitio, have
abandoned the " straight and narrow path that leads " to true honor,
and "given themselves over to believe a lie," and to practice decep-
tion. Nor is it our purpose to dwell on this forbidding feature of the
subject. What we would learn is, whether the legally organized insti-
tutions have it in their power to put a stop to, or to interpose a check
to such traitorous proceedings. We have thought it not only in their
power, but their imperative duty to make an honest, and an earnest
effort. But how is an object so desirable, to be accomplished 1 We
are not unaware that it is most difficult so to construct statutes and
by-laws as to provide against the devices and ingenuity of the sordid
and the dishonest. Some of the schools have adopted the'following
and, as far as we are informed as to the working operation of the
measure, with quite satisfactory results. It carries plausibility on its
face, and we have but little doubt if incorporated into the statutes of
all the medical institutions of the country, it would impart a powerful
impulse towards progress and reform.

It is to the effect that each graduate, prior to the receipt of his di
plonia, is required to execute a pledge, that he will, faithfully and
honestly adhere to the principles of medical science, as taught in the
halls of the institution, that he will do all in his power to promote
the interests and success of legitimate medicine"; and further, if he
diverge from the conditions of the pledge, by vicious or immoral con-
duct or by adopting any of the irregular systems of the day, or
otherwise, the authority granting such diploma, shall have power to
revoke and annul it. Would it not be profitable, also, to require of
students, at the time of matriculating, to execute an agreement or
other article, setting forth their intention, faithfully and without
reserve, to pursue, adhere to, and seek, by all laudable means, at their
command, to advance the interests of regular, scientific medicine, and
to allow no others to matriculate 1 With these articles incorporated
as already suggested, and consistently adhered to by corporate bodies
and faculties, it would seem that one avenue, at least, would be closed
to a species of charlatanism, that puts on, to some extent, the livery of
science, and therefore, of respectability. We do not undertake to say
that these innovations upon the general mode of managing such mat-
ters afford the best possible sources of hope in the premises. We

1857. Editorial and Miscellany. 171

have offered them, however, as among the practical measures which
merit trial. But this is not all. We would not overlook efficient
clinical instruction, as among the most available means, if not the sole
means, which can be made efficiently operative, — (so far as the pro-
fession in the abstract is concerned) — of correcting the evils contem-
plated in Dr. B.'s paper. That a higher standard of qualification in
the medical fraternity would, ultimately, command a greatly exalted
appreciation of scientific medicine, and by consequence of its votaries,
would seem to accord with the common principles, by which the mind
is governed in the exercise of its predilections and volitions. And
what more feasible procedure can be conceived for the attainment of
this desirable grade' of qualification, than that of associating clinical
teaching on a commensurate scale, with each school of medicine,
throughout the length and breadth of the land.

But, that it may be efficient, practically so, and therefore, produc-
tive of a fair proportion of the advantages of which it is capable, hos-
pital facilities are indispensable. Nor is a corps of competent teach-
ers, less indispensable. Teachers, qualified, not merely by the posses-
sion of a diploma, and a given amount of reading, but who have stood
at the bed-side of the sick, who have thus practically studied disease, and
are capable from actual experience, of interpreting accurately, its
several phenomena, deducing the appropriate indications of cure and
applying the remedial measures which science has furnished, to the best
advantage. But there is another feature of the present system touch-
ing the qualifications of the medical practitioner, which deserves a
passing remark. It has reference to the period of study requisite to-
an examination and admission to practice. We take it none will ques
tion that much more time than three years is necessary for the most
intellectual, even, to master and make his own the great and complex
principles of our science.

Would not an extension, then, of the reading term t<> four or five
years accord with the views of Dr. B. as a further means of correct-
ing existing evils, and promoting professional progress? We confess
we have long been of the opinion, that change in this direction is of
the first consequence. We have hoped too, that among the first ob-
jects to which our National Medical Association, now in session at
Nashville, Tennessee, would direct its earnest attention, would be
modifications and improvements in the present system of medical
teaching. Let, then, clinical instruction and hospital facilities, com-
mensurate with the objects sought, constitute a fundamental depart-
ment of every medical institution, and let faithful attendance thereon
be made a sine qua non to an examination, and the granting of a diplo-
ma ; and, moreover, let the term of study be extended, as above sug-
gested, and we would earnestly hope the impositions, most justly com-
plained of in Dr. Byford's well timed paper, would, at a period not
far distant, be among the rubbish and debris of by-gone ages.

172 Medical Independent. May

Facts from Draper's Physiology.

Man is fed with more than a ton weight of material in a year, and
in the same time wastes more than a ton away.

From the army and navy diet scales of France and England, which
of course are based upon the recognized necessities of large numbers
of men in active life, it is inferred that about two and a quarter pounds
avordupois of dry food per day, are required for each individual ;
of this, about three-quarters are vegetable and not animal. At the
close of an entire year the amount is upwards of eight hundred pounds.
Enumerating under the title of water, all the various drinks — coffee,
tea, alcohol, wine, &c. — its estimated quantity is about 1500 pounds
per annum. That for oxygen may be taken at 800 pounds. The
food, water, and air, which a man receives, amount in the aggregate to
more than 3000 pounds a year ; that is, to about a ton and a half, or
to more than twenty times his weight.

This enormous mass may well attract our attention to the expendi-
ture of material which is required for supporting life. A living being
is the result and representation of change on a prodigious scale.

It cannot be questioned that the materials which are rendered back
to the external world, after having subserved the purposes of the ani-
mal, and passed through its system, are compounds of those which
were originally received as food, drink and air, though they may have
assumed in their course, other, and perhaps, in our estimation, viler
forms. Recognizing as indisputable the physical fact that not an atom
can be created any more than it can be destroyed, we should expect
to discover in the substances thus dismissed from the system, every
particle that had been taken in.

What then is man 1 Is he not a form, as is the name of a lamp,
the temporary result and representative of myriads of atoms that are
fast passing through states of change — a mechanism, the parts of which
are unceasinly taken assunder and as unceasingly replaced ? The ap-
pearance of corporeal ideality he presents year after year, is only an
illusion. He begins to die the moment he begins to breathe. One
particle after another is removed away, interstitial death occurring
even in the inmost recesses of the bodv.

Exchange.

We welcome to our table of exchanges, the " St. Louis Medical and
Surgical Journal" — a bi-monthly ; edited by M. L. Linton, M. D.
and W. M. McPheeters, M. D. Its pages bear the impress of indus-
try, originality and the spirit of progress.

1847. New Publications. 173

NEW PUBLICATIONS.

On the Constitutional Treatment of Female Diseases. By Ed-
ward Rigbey, M. D. etc., etc., Fellow of the Royal College of Phy-
sicians, Senior Physician to the General Lying-in Hospital, Exami-
ner in Midwifery at the University of London. Philadelphia,
Blanehard & Lea, 1857.

We hail the production before us as the fruit of lengthened experi-
ence, and therefore, in its detail, based upon sound logical deduction.
The reputation of Dr. Rigbey, as an intelligent practical author is
neither a thing of yesterday, nor the offspring of some spasmodic
effort to make a book. His system of midwifery has long been regar
ded as among the most valuable productions of the age, whilst his
pamphlet on dysmenorrhea, published some years since, has ever
occupied a high place in professional literature. The latter, it will be
perceived, in a greatly abridged form, is incorporated into the treaties
we are now considering.

That a great number of the maladies to which the female constitu-
tion is especially subject, originate in some general abnormity, seems
almost a self evident proposition. That treatment, therefore, to be
successful, ought to be constitutional, in its prominent tendencies,
seems not less evident. To illustrate the truth of both these postu-
lates, perhaps no form of female disease is better adapted than ame-
norrhcea and its associate, often, if not its cause, chlorosis. We concur,
therefore, in the doctrine taught in the following brief proposition, viz :
" Idiopathic amenorrhea, arising from suspended uterine function, with-
out the concomitant circumstances, just alluded to, is, to say the least,
a very rare occurrence." The circumstances referred to in the above
quotation, may be thus stated, " a previous delicate and unhealthy
childhood ; insufficient or improper food ; want of pure air and exer-
cise ; too close confinement to study in schools or to labor in manu-
factories ; depressing passions of the mind," &c. These circumstances
all point, in their deleterious influences, to the state of the circulating
fluids ; " deteriorated, from defective digestion and assimilation,'
which "deteriorated condition of the blood, probably becomes a cause

i'74 L edical Independent. May

in its turn, of impaired vital energy, the heart and brain being imper-
fectly stimulated." We think the practitioner of experience and ob-
servation, will, at once concede the truthfulness of the following.
uThe catamenial discharge may be considered as one, among many
Other functions, which indicate the state of the general health." And
again, " no function appears to be so subordinate to, and strikingly
influenced by the great processes of the system, as that of menstrua-
tion." If then, these positions be accepted as true, how strangely in-
fatuated, or singularly wanting in true pathological attainments must
he be who, in treating amenorrhce and its associated maladies, goes no
farther back than the mere suspension of the function, and seeks to
restore the patient to health through such measures only, as are sup-
posed to exercise a specific influence over the actions of the organs,
charged with the elaboration of the menstrual secretion — such as have
acquired the appellative, emmenagogue. How unsatisfactory, too, the
results of treatment founded on views so restricted, so at variance
with what obtains in the great majority of examples. Truly, in the
language of our author, " We are, therefore, justified in looking upon
the functional derangements of menstruation, not as specific local affec-
tions, but as the local manifestations of certain conditions of the sys-
tem." And again, the doctrine taught in the following quotation,
corresponds with what we have observed, throughout a somewhat
lengthened experience. " Our treatment ought, therefore, to be what
Is called ' constitutional/ or in other words, directed to the state
of the general health ; and, with certain few exceptions, the local
treatment of these derangements must be secondary to the consti-
totional." The second chapter is devoted to that painful abnormity
of the female constitution, which to a great extent, has been the
opprobrium of medical science, denominated dysmenorrhoea, and as
before suggested, is an epitome of his paper on the sanie subject, pub-
lished many years since.

Here, after having spoken with characteristic clearness of the con-
ditions of the economy at large, as also of particular organs which
give origin to this distressing malady, he remarks, " From the above
observations, it will be seen that functional dysmenarrhcea may occur
under at least five different heads, viz : 1st. Dysmenorrhea, connected
vith derangement of the digestive organs. 2d. Occurring in a gouty
or rheumatic habit of body. 3d. Dysmenorrhoea of an hysterical
character. 4th. In connection with some inflammatory action of the
Uterus, usually the os and cervix ; and 5th. Arising from ovarian
irritation. Now, although this division of the subject may seem to
;&ome rather complex, yet to the practitioner of enlarged observation,
we have no doubt it will not only appear plausible, but philosophical.

1857. New Publications. 175

Indeed this or some not dissimilar analytical mode of considering the
subject, seems essential to the success of practice, for, as stated by the
author, " in each of these forms, it will present certain modifications
and peculiarities, which are valuable guides for adapting our treatment
to the particular case, and without which, we cannot hope for success."
Without attempting a full and analytical review of Dr. Rigbey's trea-
ties, which our proposed limits will not admit, it will be sufficient,
after what has already been said, simply to refer to the remaining
topics treated of, in the order in which they occur. The book consists
of twenty chapters, and succeeding the two already referred to, they
are presented as follows: Menorrhagia, its varieties and treatment;
uterine and vaginal discharges, their varieties and pathology ; inflama-
tion of the os, and cervix uteri, its causes, symptoms and treatment ;
ulceration of the os and cervix uteri, symptoms, treatment, &c; dis-
placements of the uterus, including the varieties of prolapsus, and its
treatment; retroversion, antiversion and prolapsus vesicae, and the
causes and remedial appliances appropriate to each ; polypus uteri
and their varieties ; fibrous tumors of the uterus ; their symptoms
and treatment ; malignant disease of the uterus, with its varieties and
treatment, both constitutional and local ; cauliflower excrescence of
the os uteri ; its characteristics and management ; corroding ulcer of
the os uteri ; its symptoms and treatment ; pruritus pudendi, its varie-
ties and treatment ; vascular tumor of the orifice of the urethra, thick-
ening of the mucous membrane of the orifice of the "urethra, warty
vegetations ; vascularity, etc.; ovarian affections ; oophritis, with the
symptoms and treatment, both of its accute and chronic forms, displace-
ment of the ovary, and treatment ; and ovarian tumors, with their
varieties, symptoms and treatment, as well surgical as medical.

The reader will find this an extended field of professional research,
and that, while sufficient is said, and lights are afforded to guide the
practitioner to satisfactory results, both in diagnosis and treatment,
the work is not lumbered with extraneous matter. He will also find
that, in regard to the several maladies, of which he treats, the author
has presented, quite fully, the accepted literature of the age, and in a
familiar and agreeable style. The book is of moderate dimensions and
unpretending, whilst so far as mechanical execution is concerned, it
compares well with all others issued by Messrs. Blanchard & Lea.
We heartily recommend its perusal to all who would avail themselves
of the best sources of information, in reference to the class of diseases,
of which it treats.

For sale at Raymond & Selleck's, in this city.

176 Medical Independent. May

Through the politeness of Messrs. Raymond & Selleck, we have
been make the recipients of the following books, most of which, we
regret to say, came to hand at a period <|iiite too late for separate
notice.

Clinical Lectures on certain diseases of the urinary organs and on
dropsies : By Robert Bently Todd, M. D., F. R. S. The History,
Diagnosis, and Treatment of the Fevers of the United States : By
Elisha Bartlett, M. D. The Physiological Anatomy and Physiology
of Man : By Robert Bently Todd, M. D., F. R. S., and William Bow-
man, F. R. S. The Physician's Pocket Dose and Symptom Book :
By Joseph H. Wythes, M. D.; and Medical Notes and Reflections :
By Sir Henry Holland, from the third London edition*

We avail ourselves of this opportunity to tender our thanks to
Messrs. Raymond & Selleck. for the favors they have thus in kind-
ness, conferred upon us. and promise such notices of the above named
productions, as they respectively merit, at the earliest practicable
moment.

We have also received from another source, the Senate documents
of the United States, entitled " Statistical report on the Sickness and
Mortality in the army of the United States, compiled from the records
of the Surgeon General's office, embracing a period of sixteen years,
from January 1839, to January 1855, prepared under the direction of
Brevet Brigadier General Thomas Lawson, Surgeon General United
States Army, 'by Richard If. Coolidge, Assistant Surgeon United
States Army. Washington, A. 0. P. Nicholson, printer, 1856." This
too, will receive its appropriate share of attention at no distant period.

The Scalpel, for April, comes to us in its original octavo form,
well polished and sharpened, ready for use. It fully sustains the char-
acter ande position which its unique and entertaining originality has
deservedly obtained. Published quarterly, and edited by Edward IT.
Dixon, M. I)., No. 42 Fifth Avenue, N. Y.

Chlorate of Potass in Mercurial Salivation.

The Virginia Medical and Surgical Journal says : u- Several trials
made by M. Ricord, exhibit the power of this substance, not only in
checking mercurial salivation after the suspension of the mercury, but
even when this is continued and increased. Of still greater importance
is its prophylactic agency ; for in a considerable number of patients ,
some of whom were extremely susceptible to mercurialization, who
took the chlorate from the commencement of the course, no salivation
at all occurred. — St. Louis Med. and Surg. Journal.

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Henri End, A. M., M. D., Chemistry and Toxicology.
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The next annual course of Lectures in this Institution will commence on ThttRJ*
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THE

MEDICAL INDEPENDENT :

A MONTHLY

Review of Medicine and Surgery.

VOL. 3. DETROIT, JUNE, 1857. NO. 4.

lOriqwal Cantimmiratiotts.

Article I. — Practical Suggestions. No. II. By J. Adams Allen,
M. D.

To one who has carefully kept pace with the discoveries of
Physiology, there are few subjects which are of greater inter-
est than the relations of fat to the blood and the general
system.

The well known milky appearance of the chyle in the lac-
teals is clearly due to the particles of oil which every where
in solutions of albumen condense to themselves a vesicular
coating from that substance. Here is the first step in that
wonderful cytogenesis which eventually develops the blood or
" liquid flesh." The lacteal glands aid in the process by
bringing the chyle in intimate contact with developed blood.
The direct effect is unknown in its osence, and it is needless
to speculate upon it. The undeniable fact remains, that with-
out the aid of oil or fat there is no cell.

The albumcnoid vesicle containing fat, is impregnated or vi-
vified by the dotted particles derived from the gland. Some
escape, and dissolving yield up their contents to furnish nutri-
tion to their germinant fellows.

VOL. Ill, NO. iv — 1

182 Medical InSependent. June

The alkaline constituents of the blood, (chyle, or lymph) are
the means of this solution.

It would appear that fat is also necessary to the genesis of
fibrin, as that depends upon the perfection of the blood cor-
puscle.

The stomach of Alexis St. Martin is chargeable with beget-
ting great error in physiological notions. Digestion is perfect,
or the reverse, according as it occurs in its proper place. USTi-
trogenized food is freely dissolved and absorbed from the gas-
tric cavity, — oils and fats but to a very limited extent. It is
probable that the small amount here absorbed is received by
the minute villi as discovered by Dr. Neill (Vid. Am. Jour.
Med. Sci. v. xxi. p. 13). In like maimer the duodenal and
other intestinal mucus membrane by its blood vessels absorbs
such portion of the albuminous food as may have escaped gas-
tric absorption. Thus fats and oils are easily digestible in
their proper place, which is below the stomach even when as
readily examined as that of Alexis St. Martin.

Both observation and experiment show that there is within
the system a chemistry which will convert not only sac-
charine, but even nitrogenized food into fat when little or
none of that substance is taken as food. This phenomenon is
entirely analagous to the production of wax by bees fed al-
most exclusively upon sugar. They will produce three times
as much wax as the amount previously contained in their
bodies or in the food taken. But some little wax must be ta-
ken in, or they will not manufacture any.

It is cpiite clear that the liver is the fat laboratory in the ani-
mal man. The fatty matter of vegetables in. itself is insuffi-
cient to supply the requirements of histogenesis and repetition,
but its presence in the portal blood favors the conversion of
compounds which contain its elements, so that the bile and
blood of the hepatic veins contain a very considerable amount.
When this conversion is not required as in the case of animals
freely supplied with oily food, there is much less bile secreted.
Lehmen discovered that in animals undergoing starvation there
is an excess of fat and a deficiency of sugar in the portal vein,
but that the condition is inversely changed in the hepatic vein.
The degradation of tissue is usually, if not invariably, accom-
panied with fat deposit instead of the previous nitrogenized

185?. (hnginal Communications. 183

substance. Hence in the bodies of those who have died of
inanition it is always noticed that the gall bladder is full of
bile* — the blood bringing to the liver the result of fatty degen-
eration of the tissues, this being secreted partly with the bile,
and partly, perhaps, converted into cliolic acid and sugar.

The demand for sugar is for sustaining the animal heat, the
demand for fat is primarily for the evolution of blood-cells,
and secondarily for decomposition into cholic acid and sugar.
The fatty liver furnishes little bile but much sugar, — the sepa-
ration of the fat from the blood favoring the evolution of su-
gar, but the hepatic tissue having insufficient cell energy to
further eliminate bile.

It need scarcely to be remarked that fatty degeneration is
produced — "first, by a wrong or defective state or composition
of the blood; second, by an insufficient supply of blood;
third, by a deranged or obstructed influence of the nervous
system, (eventuating, of course, and being properly included
in the first cause) and fourth, by an imperfect, unhealthy or de-
clining state of the part to be nourished.

There is hence no difficulty in seeing that though the cells
of the liver may be gorged with oil, yet an insufficient quan-
tity finds its way to the lacteals and the blood. Meantime
sugar (liver-sugar) is produced in disproportionate amount, and
being oxidated upon all the respiratory surfaces and cells de-
velops more or less febrile heat.

In the healthy condition of the various organs when sup-
plied with their appropriate food, the production of the various
secretions we know to be uniform ; but man is exposed to al-
most every variety of condition and food. The proportions
must be maintained among the various constituents of the
blood, or disease will ensue.

From our present knowledge upon this subject we may look
upon the liver as a great regulator in the mechanism of nu-
trition.

It provides oil from substances which contain but its ele-
ments,— hence man can live without taking it directly as food,
but as other organs which are called to excessive labor, so this
in time must become diseased from this cause alone.

*Does not tliis explain why mechanical distension of the stomach, &c, with Innutritions sub-
stances relieves the sensation of hunger — the bile being thus poured out into the duodenum and
Us fatty portion absorbed ?

184 Medical Independent. June

It unquestionably derives some adeps from the disintegra-
ting blood cells brought by the splenic vein, the lisematin of
the old cells by deoxidation passing to the form of the color-
ing constituent of the bile, — the iron and oxygen in great part
passing to the nutrition of the younger corpuscles. It elabor-
ates liver-sugar for respiratory uses, and, finally, eliminates an
unstable chemical portion whose retention tn the blood vrould
be productive of serious mischief.

It has become quite fashionable of late to decry all allusions
to diseases of the liver as decidedly old fogyish or behind the
times.

Dexterity in percussion, and oracular shaking of the head
after applying the stethescope bauble, are deemed sufficient
substitutes for acuteness of penetration in discovering the
causes of disease.

The urine too has its worshippers and the test tube stand,
spirit-lamp and meter, (all well enough in their way) are con-
sidered worthy of supplanting the poor old liver of the
fathers.

Nevertheless the liver is and must remain one (if not th> \
of the most important objects of diagnostic and prophlactic
study. It is the prominent intermediate agent in converting
the inert and lifeless to the active and vitalized.

Basing therapeutics upon the views [herein set forth, it is
seen that the range of administration of the fats and oils be-
comes exceedingly widened. They are not directly calorifa-
cient, but they are necessary to the building up of heat car-
riers. They can thus be administered in a A'ast number of
cases where there is It eat of tic .surface, hut poverty of tin.
Mood. Thus in hectic and typhoid fevers and in the later
stages of all phlegmasiae, when, as the older writers would
say, there is heightened irritability with lessened tone.

Vegetable decoctions, wherewithal these diseases are con-
tinually plagued in common treatment, yield sugar and con-
sequent heat or vitiated secretions, — the fats and oils bring
livine cells into action whereby the regular transmutations
and development of each and every \\><\w arise.

In tuberculosis this is peculiarly the case. Tuberculosis is
the manifestation of diseased glandular action, in every case
intimately connected with the non-reception or development
of fat.

1857. Original Communications. 185

In the child the mesenteric glands and intestinal villi fail to
develop the corpuscle or receive the oil.

In later life more frequently vitiated appetite and faulty
teaching or habit disqualify the liver for performing its func-
tion.

The Vegetarianism, and the " low diet " dogma, implant
phthisis in the systems of thousands, and tamely call it " here-
ditary " as though vices are necessarily so.

Consider the vast amount of oil which is secreted upon the
investing integument and the waste to which it is subjected by
hydropathic scrubbing !

Look at the delicate skin of the consumptive and the rapid
oxygenation which is momentarily sapping the foundations of
life. Then the disordered appetite, which secundem artem
from a " dear dyspepsia grows a dire disease."

Inunction of oleaginous substances will, in the cases pre-
viously adverted to, afford vastly more relief than the water
douching and sponging so much practised. En jxissant^ — this
is a remedy of much greater efficiency than commonly sup-
posed. In all cases of poverty of blood corpuscles, but more
especially in tuberculous cachexia, it is of wonderful efficacy.

In scarlatina its power is well acknowledged, but its ration-
ale has not hitherto been satisfactorily explained. No other
remedy will like it prevent that rapid decomposition of blood
corpuscles so commonly followed in this disease by dropsy or
renal disturbance. The fat favors the development of ener-
getic blood cells from albumen which otherwise is strained off
in dropsical or urinary flux.

During its operations the lymphatics become true lacteals,
and the lymph will grow milky like chyle, though not to the
same extent.

Contrary as it may appear to received opinions, the emacia-
tion and flux of diabetes are alleviated by it. Internally ad-
ministered there is theoretic danger of conversion by diseased
hepatic action into sugar and cholic acid, but practically my
own experience is favorable to its free use in connection with
nitrogen ized animal food.

The catalogue of applications, both externally and inter-
nally, might be extended to the verge of nosology, but is suf-
ficient that we recognize the principle involved.

1S6 Medical Independent. June

There is no so called tan ic medicine which can exert more
than the merest modicum of the impression, capable of being
produced by this active class of alimentary articles.

The antiphlogistic regimen essentially consists in counteract-
ing the effects of the received adeps. Abstract oil and you
simultaneously take away red corpuscles or oxygen carriers
and fibrin producers. Bloodletting does the same. Cliola-
gogues. as mercury, &c, urge the bile too rapidly along the
intestinal tract to allow absorption of its hydrocarbon and re-
sulting increased activity of cytogenesis.

Moderately administered they promote it by augmenting
the conversion by the liver of this genetic medium and agent.
AVlien carried to excess there is resulting cachexia from pov-
erty of the blood in cells, and too abundant formation of liver
sugar and hence atonic fever.

111 warm climates the production of liver fat is nearly or
quite sufficient for the purposes of blood genesis. Here there-
is danger of excess as is shown by the ready and profuse flux
of bile. As with the formative cells of the vegetable king-
dom, there is rapid development and speedy decay.

The products of thi> decomposition readily accumulate, and
if not excreted produce their well known effects upon the
glands, blood, and nervous centres.

The dietetic and therapeutic principal is obvious.

The already extended length of this paper prevents further
consideration of the subject at present. In future papers, we
shall see that the presence or absence of oil neither produces
nor cures all diseases.

Kalamazoo, May 20th, 1S57.

Artiele II. — Selections from Surgical Notes. By Prof. Guitn.

Ueetural Stricture. — The following two cases, occurring
simultaneously, I select, because they are illustrative of the
treatment applicable to different degrees of urethral stricture.
A stricture which is permeable, can. in nearly all instances.
by patient perseverance, assisted in irritable cases by appro-
priate medical treatment, be dilated : and a cure thus effected.

1857. Original Cononanications. 187

will be so nearly permanent, as to require only an occasional
passage of the bougie. On the contrary, a stricture which
cannot be penetrated, demands an operation; and 1 hesitate
not in in such cases to recommend the operation, by ex-
ternal incision as the most efficient and certain method of
relief.

Cask I. X. Y., a professional gentleman applied to me on
the 17th of July, 1856, for relief from a stricture which he
had contracted several years previously, repeated gonorrhoeas
being the antecedents. The stricture had gradually increased,
until micturition could only be effected by an exceedingly fine
stream. The bladder was never completely emptied, and the
desire to urinate, was consequently, nearly continuous. My
first efforts were unsuccessful in passing the smallest sized in-
strument, but I finally succeeded in engaging the point of a
conical shaped gum bougie, and with gentle but firm and con-
tinued pressure carried it forward through the stricture. Its
presence was tolerated for ten or fifteen minutes only. The
operation was repeated the next day, and the instrument re-
tained for half an hour. From this time, the operation was
repeated every day for several days, the instrument being re-
tained for half, or three quarters of an hour each time. This
treatment was continued until a number three bougie could be
passed, when business took the patient from town, since which
the treatment has not been resumed. He can at the present
time, pass a comfortable, but not large stream, evacuate com-
pletely the bladder, and refrain from micturition as long as
most men.

Case II. J. IT., a middle aged laboring man, was suffering
from a stricture of the membranous portion of the urethra,
the origin of which lie traced to an exceedingly virulent gon-
orrhoea which he had contracted several years previously. The
stricture had gradually increased, until finally, he could pass
his urine only by drops. The desire to urinate was constant
and painfully urgent, and he was thus incapacitated for labor.
Repeated efforts, with intervals of time, varying from days to
weeks, failed to effect the passage of instruments. Softened
gntta percha bougies pressed firmly down upon the stricture,
showed, by their impress on the gum, an abrupt termination of
the canal, with an exceedingly small lateral offshoot. On the

188 Medical Independent. June

26th of July, 1856, assisted by Doctors Pitcher and Terry, I
cut down upon the stricture, by external incision, divided it.
and closed the wound over a catheter. Union by first inten-
tion followed, but the wound reopened on the 6th day, through
about one sixth of its extent, but readily healed by £ranula-
tion. On the ninth day I discovered a slough upon the under
side of the urethra just anterior to the scrotum, the separation
of which opened a passage into that canal. Its formation I
could not account for. as there had been no external pressure,
and the catheter was of moderate size.

With this exception, the recovery was rapid and perfect.
Under date of May 10th inst., he writes: "lam enjoying
first rate health and have been able to labor at all kinds of
work since last November."

87 Shelly strut. May '20th. 1857.

iiibliociraplucal llcrort.

The Physician's Pocket Dose and Symptom Book : containing the
Doses and uses of all the principal articles of the Materia Mediea
and chief officinal preparations ; also. Table of Weights and Mea
sures ; Rales to proportion the doses of medicine ; common abbre-
viations used in writing prescriptions ; Table of Poisons and Anti-
dotes : Dietetic Preparations : Table of Symptomatology ; Outlines
of General Pathology and Therapeutics. By Joseph IT. Wythes,
A. M. M. D., author of w The Microscopist," " Curiosities of tht
Microscope." etc.. etc.. second edition. Philadelphia : Lindsay ec
Blackiston. 1857.

Generally speaking we regard abstracts like the one before us as of
minor consecpience to the practitioner. Too often, they are permitted
te take the place of the more elaborate and instructive works, and
hence it will be noticed, that those who appreciate them. are. most
generally, quite superficial, if not rountineists. We would not be hy
p^critical ; but we greatly misapprehend the true character of the
knowledge, which is essential to constitute the competent, the ready,
and therefore, the successful practitioner, if the idea that seems to have
occupied the mind of the author, and which, doubtless, prompted its
publication, can be realized.

Verily, it looks remarkably like a desire to pocket the physician.
while the mere shadow of mortality, which wears the cognomen.

Bibliographical Record. 189

Doctor, may have his cranium filled with anything and everything,
rather than the fundamental principles of his science, or allow it to be
grossly, most inveterately jejune.

Again, if it were supposed that the prescriber, as would appear
from the title, were expected, on visiting his patient, to draw upon his
'• Pocket Dose and Symptom Book," to the exclusion of treasured
thoughts and reliable observations and recollections, we confess it
were to regard him as a sort of machine, and the business of prescrib-
ing nothing more nor less than a mechanical process. Regarding the
work, however, as containing valuable matter, which, at particular
times and in proper places, may be advantageously appropriated, we
must consider the title a misnomer.

Let the book, then, as the lexicon, lie on the table, ever convenient
for ready reference — to revive in the recollection, a name, a propor-
tion, or a formula and it will be in a position to accomplish all the
good of which it, or any like production is capable. Strictly speak-
mg, it is designed to subserve the purposes of a " vade mecum" and is
constituted as follows : — " A table ef weights and measures, rules for
proportioning doses, a list of common abbreviations, a table of poi-
sons and antidotes, a classification of the Materia Medica, an alpha-
betical list of the principal medicinal articles and preparations, a table
of symptoms of diseases and a brief outline of General Pathology
and Therapeutics.

The general arrangement is satisfactory, and the combinations and
formulae are reproductions, chiefly, of the officinal preparations of the
most approved pharmacopiaoe. The mechanical execution is neat and
substantial. K.

To be had at Ravmond & Sellecks.

The Piiyliological Anatomy and Physiology of Man. By
Robert Bentley Todd, M. D., F. R. S., Fellow of the
College of Physicians and Physician to King's College Hospi-
tal, and William Bowman, F. R. S., Fellow of the College of Sur-
geons, Surgeon to King's College Hospital and the Royal London
Ophthalmic Hospital, Late Professors of Physiology and General
and Morbid Anatomy in King's College, London. Complete in one
volume, with two hundred and ninety-eight illustrations. Philadel-
phia: Blanchard & Lea. 1857.

This large and ardently expected production is finally completed
and offered to the medical fraternity of this country in a beautiful and
imposing form. We said and really expected — it was so, for the
two following reasons ; first, the talents, attainments and facilities of
the authors were familiar to the professional public, and second, it was

190 Medical Independent. June

promised that the work, so far, at least, " as the more important
points " of anatomy are concerned, should rest upon original " inves-
tigations," and upon a repetition of experiments, or on new ones, in-
stituted for the purpose of settling questionable points, where topics
of sufficient importance and of absorbing interest should offer.

Two other considerations served to heighten the ardor of expecta-
tion that rested upon the professional mind, in reference to the forth-
coming labors of Messrs. Todd and Bowman. One was, the avowed
design of the authors, — " Following that great master, Haller " — i; of
giving a greater degree of prominence than had been usual in physio-
logical works, to anatomy ; and therefore, providing for ;t a more
thorough training in its several branches, descriptive, physiological
and comparative, necessary to the formation of those habits of mind
which best fit their possessor for the successful investigation and the
correct appreciation of physiological science." Another was, the pros-
pect that physiology was to be reviewed in its entirety, and rewritten
by men who were themselves enthusiasts in physiological research,
and whose position afforded them all the facilities necessary to the
promulgation of the great truths of the science, and, as far as possi-
ble, fixing them on the most substantial basis. This, in the judgment
of the best informed, has been regarded as a desideratum, somewhat
difficult to be accomplished, to be sure, and yet. from the difficulties
involved, only the more necessary — the more imperatively demanded.
The authors have deemed themselves called upon to offer an apology
for the delay in bringing the work to a close, not far from fourteen
years having elapsed since its commencement. In our humble judg-
ment, however, neither the profession nor science has suffered loss by
such delay. While it may be conceded that "the advances " in ana-
tomical and physiological science, " attributable " to their " own
labors " may be " small " when put in contrast with the immensity
of the field of research over which they have passed, and the hundreds
of others whose learning, ingenuity and skill have been directed to
the same objects; we think it will be conceded also, that, by reviewing,
rearranging and reuniting the whole, expunging what had become super-
fluous or irrelevent, and offering in a terse and agreeable style, only
what may be regarded as established — as facts in science, — they have
done incomparable service. In no department of medical science,
perhaps, are hasty conclusions, the semblance of principles, or the
substitution of hypotheses for truth, more pernicious than in physi-
ology.

Affording as it does, the only sure basis of accurate deduction, in
reference to normal function, it is the sole source of accurate reason
ing and deduction in regard to function, perverted and disarranged by

1857. Spirit of the Medical Press. 191

the causes of disease. Nor is it less essential to an intelligent and
truthful interpretation of pathology and therapeutics. All things
considered then, we scarcely question, the profession as a whole, will
regard it as fortunate that haste has not marked the progress of the
work. That Physiology as a science may even now be considered
perfect, is not assumed, but, that, in thus expurgating it of the super-
fluous, irrelevant, the doubtful and not unfrequently the fanciful, none
will question that it has more nearly approximated perfection. While
numerous other productions are before the profession, which are justly
entitled to high commendation, we deem it not invidious, either to
them or to their authors, to say that this, doubtless, is the most com-
plete work on physiology in the English language.

Neither analysis or review seems necessary to introduce it to the
professional public, since considerable portions of it have been in
progress of publication for some years, and the more studious of the
faculty are already familiar with its contents, its style and its merits.

It therefore only remains for us, in conclusion, — appropriating the
language of another. — to observe, that, inasmuch as to be an intelli-
gent and useful practitioner of the healing art, one must be well
versed in Anatomy and Physiology, and in the relation of these
sciences to each other, in his endeavors to furnish himself with this
most necessary information, the reader " will find the work before us
an invaluable aid." K.

For sale at Raymond & Selleck's, in this city.

pint of tire Prtral press.

On the RascMscli or Canabis Indica. By John Bell, M. D., Deny, N. II.
From the Boston Med. and Surg. Jour. Concluded.

A few words upon each of the kinds of psychical disturbances caused
by the Haschisch will conduce to the better understanding of its action,
and of its relations with the analogous, or precisely similar phenomena of
insanity.

Throughout the whole period of its effects, there is a sense of pleasurable
excitement. By the French authors who have experimented and written
on the subject,* this feeling is regarded as one of the most marked pheno-
mena of the drug. Doubtless this was the case with them : with myself, it
has never been so great as is generally represented. It is true there is a
strong tendency to laugh, but it is a laugh in which the feelings participate

* Annales Medico-psychologiques — pcteeim.

193 Medical Independent. June

to a very slight degree. It is the same to whatever subject the thoughts
are directed In delusions of an agreeable or disagreeable character, there
is the same smile. It is different entirely from that state of mental excite-
ment, attended with pleasurable emotions, which is met with in the first
stages of many cases of insanity. In such instances the sentiments of
pleasure are caused by the most sanguine anticipations of success in every
wild project. It is a feeling which would be very propper, did not its cause
show too plain ely the intellectual disturbances which pervades it. There
is nothing like this in the effect of the HasehUck. The face does not as or-
dinarily prove a true index to the mincL While the thoughts do not pause
long enough upon any subject for the feelings to be touched, the face is
covered with smiles. Disagreeable anticipations and a joyful expression of
countenance do not seem at all incongruous. It seems to be all on the sur-
face, leaving the depths below unmoved. The condition is much the same
as in dreams, when we are often surprised at oar own callousness to all
impressions of pleasure and pain : when good and bad fortune alike pa->
over us without exciting happiness or sorrow. Perhaps upon different
temperaments, the action of the drug may be essentially different. My own
experience of it has been sufficient to convince me that the sentiments of
happiness may be completely lost in the crowd of other phenomena. It
wonld have been hardly worth while to notice so slight a peculiarity, were
it not that one of the most interesting of its proposed therapeutic uses is in
connection with this property.

It has been proposed by 11 Morcau to take advantage of this reputed
action, to combat certain varieties of insanity connected with melancholy
and depressing delusions. If a series of hallucinations of a pleasing charac-
ter, or a state of pleasurable excitement, could be produced and kept up for
a length of time, the change might become permanent. The morbid chain
of thought might be broken, and the mird resume its healthy action upon
the withdrawal of the medicine. Used in this way. the drug would seem
to hold a middle place between medical agents as ordinarly used, and the
moral discipline which is principally relied on at present. This proposed
application is original with St Moreau. but the idea of superseding melan-
choly by exciting pleasurable emotions, is certainly as old as the time of
David, whose harp succeeded in driving the evil spirit out of Saul. Such
means, in cases of true insanity, have in practice fallen into utter contempt.
Music, per *t. never has cured an insane patient in our time-, or, as a late
writer say-, " music never cures insanity, except such case- as appear in the
comic opera." Music may be. and unquestionably is. of value as one among
the diversions and employments which take off the tedium of hospital life,
and///"'.' t'into occupy the space in the disordered mind, which would other-
wise be absorbed in diseased acts and reflections. M. Moreau reports sev-
eral instances of doubtful cures effected by the medicine, but confesses thai
his experience of its use is limited. The following cases from his work will
illustrate its effects upon the variety of insanity in question. " Two patients
suffering under melancholia, after five or six hour- experiences a lively ex-
citement, with all the characters of gaiety a ghtliness which we have
observed. One especially, tormented by terrors of imagination and melan-

1857. Spirit of the M('(Jical Prens. 193

choly delusions, who had not spoken ten words a day for more than nine
months, did not cease no chat and laugh and joke during the whole evening.
I rarely found in his words any connection with the ideas which habitually
occupied his attention. However, the excitement over, both fell again into
their previous condition.'1

The use of the Ilanchisch, with this view, has not been extensive in this
country — not so extensive as it deserves to be. It has been tried, however,
in several of the insane hospitals, but the results have not been encouraging.
Indeed, in most cases they have been completely null, so that the suspition
has been engendered that it does not possess the physiological action attri-
buted to it. Nothing could be more unfounded ; there is no article in the
whole materia medica which according to my observation, is more to be
depended upon to induce its peculiar effect. But it must be given in doses
much larger than those usually employed, that any effect may be experieced
from it. We could hardly expect that cases having. their orgin in extensive
physical disease, can be benefited in this manner. But in functional dis-
eases of the brain, it certainly gives promise of possessing powers more di-
rectly useful] than any other specific drug of the materia medica.

Every one is aware how much our ideas of time depend upon the rapid-
ity of thought, and the degree of attention we give to passing events.
While the mind is buisily engaged in conversation or reading, aa e seem to
lose all notion of the succession of events ; we live in a world of ideas, re-
taining, however, an intimate sensation of the fact that we are only think-
ing. In this state we take no note of the passage of time ; an hour is com-
pressed into a minute. In dreaming, the mind is just as busily engaged,
and yet we may magnify an instant into any conceivable limits. In the
state of reverie, the same thing occurs, though to a less marked degree.
The fact is familiar* to every one that we may be awakened by some noise,
and in the interval between sound sleep and complete wakefulness, we may
pass through a long imaginary conversation, or an extended series of eventsr
ending with some explosion or catastrophe, which on being completely awake,
we are aware is only the noise which has awakened us. Our ideas of time,
then, do not depend exclusively upon the succession of mental pictures.
They arc much more closely connected with the degree to which we inden-
tify ourselves with our thoughts. Just in proportion to their vividness and
the extent to which they overcome our attention to the fact that we are
thinking — not acting, just in such proportion does time correspond to what
it would be, were the subject of our thoughts real objective facts. This
sensation of the excessive duration of time, is perhaps the most remarkable
and obvious of the effects of hemp, and the extent to which it is experi-
enced may be regarded as the best means of regulating the dose. It is never
absent, throughout the whole duration of the mental disturbance, and the
deception is so complete and so disagreeable, that no one who'has taken it
needjeverbe in the slightest doubt as to whether he is experiencing its effects
or not. In the higher degrees of its action all definite ideas of time are lost.
Past, present and future exists no longer. The whole existence is concen-
trated in the train of thought we are engaged in. In dreaming, this change
in the ideas of time is not unpleasant, nor we cannot observe the discrepancy

1^4 Medical Iivdependent. June

between our present and former sensation. The following ease of insanity,
where all proper notions of time were lost, is abridged from Morean. " A
young lady, during the first few days of an attack of maniacal excitement,
believed that she had no longer any age. She imagined herself to have lived
at every historic epoch to which memory carried her. Those about her
were reproched with having stolen her measure of time. Her mother wa-
acknowledge as such no longer, for the reason that she could not have a
mother younger than herself." Another believed himself to be God, be-
cause he had existed from eternity. Under the influence of Hasehisehj the
ideas of time may be regulated by the intellect, and consequently one is
never led astray, except when the attention is directed to another subject :
while this is the case, the sensation of immense duration of time is continu-
ally and intimately present. Without having experienced it. no one can
form the slightest idea of its vividness and reality.

The errors in regard to space are dependent for their existence upon those
of time, and are of much the same nature. During the existence of the
tasia, an object does not appear more distant than under ordinary cir-
cumstances. But while the hand is stretched forth to take it. and we are
concious that the movement is executed with ordinary rapidity, such a
length of time has passed away, that only the exercise of reflection and the
direct evidence of the sense of sight, can convince us that the hand has not
moved through a space corresponding to the time it seems to have been
in motion.

The deception is never so complete as that in regard to time ; a glance of
the eve corrects it. but it rales again as soon as the head is turned. It is
in this circumstance that insanity differ- from the delirium of an ordinary
dose of hemp. In the former, and in cases of larger doses of the latter,
the sense of sight does not correct the delusion. The sensation coming from
the eve are overruled by the reality of those having their origin in the im-
agination. It is only during the occasional lucid moment- of Haseh U
that the judgment can be exercised, or the eye directed to an object to
appreciate its circumstances. Not that the muscles are paralyzed, but the
will does not put them in motion. As in an ordinary reverie, the vacant
.-tare shows that the mind does not take cognizance of the objects towards
which the eyes are directed.

The first effects of it upon the intellectual faculties, are a gradual Loss
power to direct the thoughts. The sense which is evei - t in mental
health, that we are responsible for what passe- in our minds, is lost This
loss is never partial as to any single thought. We do not perceive this
power to be gradually slipping away so that we can mark each step of it-
departure, but suddenly, like lightning, it occurs to us that, the moment be-
fore, some thought came into the mind by a channel very different from or-
dinary. To use a well-understood manner of speaking, we have nothing to
do with its presence — it came there of itself. In small doses, its effects are
limited to this degree of mental disturbance. If the quantity taken has
been larger, these attacks recur oftener and oftener. the experimenter
loosing and regaining the conciousness of directing the course of thought
many times in a minute. When under the highest degree of its action, the

185 1. Spirit of the Medical Press. 195

glimpses of the fact that our thoughts are not our own, are few in number
and momentary in duration. In this state of veritable mania, ideas come
and go with a rapidity completely inconceivable in ordinary mental conditi-
ons. Some glide through the mind without seeming to make any impress-
ion at all ; others become realities as perfect as though admitted through
the senses. Yet in all this overthrow of the governing power, there is a
certain degree of connection in the succession of ideas. But the attention
is so slightly concentrated upon even the most vivid of them, that the slight-
est occurrence, the movement of a hand or a word addressed to us, sweeps
them away in an instant. AV'e live in the thought that is uppermost at the
time ; those which are past are as nothing, and we take no thought of what
the future are to be. Intentions formed the moment before, are lost. If
we wish to say anything, the chances are equal that it will be forgotten —
hurried by the succeeding idea. Let one in this state attempt to write, and
he will produce a composition similar to what is often seen b}r those practi-
cally acquainted with hospitals for the care of the insane. Broken phrases,
words without the least connection, with occasionally a few sentences hav-
ing some obviously connected ideas at bottom, make a compound higley
characteristic.

The conversation is more connected than the writing, for it is better able
to keep up with the thoughts. Tn both there is some connection in the
mind of the individual ; while one word or part of a sentence is being writ-
ten, a multitude are gone, and when the pen comes to a stop, it goes on
again with the train of thought which is present at the instant, without en-
devoring to go back and take up the thread which is lost. In talking, one
feels compelled to finish the sentence without an instant's hesitation ; if the
word which expresses the meaning docs not occur, another is substituted
for it without reference to its signification. If we hesitate, the train of
thought is overwhelmed by the rushing tide of ideas, which never waits for
utterence. The connection between successive conceptions, however, is not
always perceptible to the individual, even in the slight degree referred to
above. A large portion seem to be mere isolated pictures, drawn alike from
memory, from imagination and from incidents which happen to be taking-
place at the time, but all strangely confused and equally transient in the im-
pression they make. This mental state is so similar to many cases of in-
sanity, that it would be difficult, if not impossible, to distinguish them
without having recourse to their duration and the causes which produced
them. The extreme rapidity and vividness of thought are absolutely iden-
tical with the most observable phenomena of that disease.

Mania is by far the most hopeful species of insanity, in respect to its
prognosis, while dementia is the most hopeless. It has been thought that
in cases of mental disease, tending to fall into the latter state, the powerful
stimulation of the hemp might perhaps arrest the downward course, and
place the patient in a state more amenable to treatment, and consequently
more hopeful, as regards chances of ultimate cure. With these ideas in
view, it has been administered in very heroic doses in all stages
of hebetude. But the mind in this condition seems to have completely lost
its wonted resiliency : it responds no longer to what were once powerful

196 Medical Independent. June

stimuli. In this state the hemp produces no perceptible effects, in the more
advanced stages, and only the slightest change in any. All hopes of benefit
resulting from its administration in these cases, have been abandoned by the
author, himself, of the proposition — a sure proof of its utter want of any
probability of value.

But the most interesting of the effects of the hemp are in connec
with the subject ol delusions. It is in reference to these that it can be pur
to the be^t use in agisting to understand the workings of disease. There
are very few cases of insanity but exhibit delusions at some period of their
course, and there are not few persons, ordinarly reputed sane, who are sub-
ject to them. A clear understanding of them will conduce, more than any-
thing else, to a full understanding of those mental states which are spoken
of under the collective term insanity. Their importance will justify a clo-
ser examination than any of the other morbid mental manifestations, can
by the drug of which we are speaking.

Before the time of Esquirol, all the mistakes of madness Avere include I
under one term. He saw reoson to divide them into two clas-es — illusions
and hallucinations : the first taking their origin chiefly in a disordered c
dition of the serses. the latter depending exclusively upon intellect
disturbance. These distinctions of the ?reat master have been adopted by
most succeeding an who have written upon the subject. Whether

these division- are founded in nature, and show evidence enough to demana
adoption, we shall presently examine. In the mean time, a few words
the origin of hallucination in addition to what has been said before. They
have the same relation to disorders of the intellect that ordinary- states of con-
oiousness do to healthy manifestations of that function. There is no wori
which give< any better idea of the process by which these figments of I
brain come to be regarded as facts, than there is of the way in which
come to believe so -trongly in our own exi-tence. or the exigence of the

There is certainly not the slightest similarity be-
tween hallucinations and ordinary mi>take> in regard to the existence
facts. One pre- - - the exercise of the memory: the other acts without

:t and even defies it. The circumstances under which they have their origin
are as varied as the hallucination themselves. Many seem to be purely
intellectual, at Least the chain which connects them with the external world
s too long and complicated to be followed. Some idea: disconnected per-
haps, or having a very loose connection with those preceding it, assumes
the attributes of reality, and for the future it is an idea no longer, but be-
comes a fact, and i> reas 1 acted upon a- such The great majority
of the hallucinations of the insane have this origin. Their fea-^ and suspici-
ons, their strange actions, their pride and humility, art often founded upon
-ome belief which they act upon but do not disclose. Perhaps in many in-
stances it is too vague to be nut into word-. A thought suggested by ano-
ther may be adopted in the same way and become a thought and finally a
belief of our own. Some >ensation of pain or uneasiness in a particular
part of the body turns the thought in that direction, and forthwith a delu-
sion is established. This is peculiarly apt to be the case in hypochond
where the stomach being in mo^t case- the present organ, is believed to

1S5T. Spirit of the Medical Press. 197

the abode of some reptile. Esquirol relates cases of a woman suffering
under chronic perionitis, who believed the Pope was holding a council in
her belly; of a military officer who had rheumatism in the knee, and belie-
ved there was a robber confined in it. These last, however, he gives as
instances of this variety of illusions, though in this he is not followed by
other writers, who confine themselves exclusively to the five senses.

The idea of illusions is perhaps too strongly fixed, by the ability and in-
fluence of writers who have acknowledged their existence, to be easily refu-
ted. There are certainly no such phenomena among all the varieties of
psychical disturbance caused by taking the hemp, though there are delusi-
ons which if observed in another and judged by the rales laid down by
writers on mental pathology, would be considered as striking instances of
them. There is never the slightest lession of the sentiment extremities of
the nerves, so far as I have experienced. The senses are as perfect as ever,
and the information given to the mind is as correct as though the latter were
in its natural condition. It is in the disordered state of the psychical sys-
tem that we must look for the origin of all insane delusions, whether hav-
ing reference to objects of sense or not. There is no ground for the distinc-
tion that has been made between hallucination and delusions. On thi>
subject Ray* says, ''that the functions of the senses are sometimes greatly
perverted, there can be no question ; but it needs more evidence than we yet
have to prove that such perversions have much if any part in producing
these illusions/' The principal arguments for the existence of sensory illu-
sions are of this kind : a person may have continually before him some vis-
ion, as long as his eyes are open, but upon shutting them the delusion dis-
appears. Or it may last during the day and disappear at night, or vice rer-
%a. ft is inferred from such cases, which are sufficiently numerous, that
the whole diffiulty is in the sentient, extremities of the sensory nerves, and
that as soon as these cea.-e to act, the object seen disappears. The true ex-
planation of these and similar cases seems to be this. The mere contact of
light with the retina gives rise to ideas, perhaps immediately, perhaps
through a crowd of others precceding them, which are taken for verities.
And all this, while the objects within view are <tjQn as well as ever. But the
>>ensation caused by sight are too feeble and receive too little attention to
compete with Toe vividness of those supplied by the perverted intellect.
The facility with which the evidence of the former is passed by, and cred-
ence given to the latter, is astonishing and inexplicable to one who has not
experienced it in his own person. Esquirol mentions the case of an individ-
ual who, under the influence of such a delusion, took a window for a door,
walked through it and was precipitated from the third story to the ground.
If there had been the slightest doubt in the minfl of this person, the uncer-
tainty would have saved him. He must have seen what was before him,
but pre-occupied with the notion of the door, the evidence of the eyes made
no impression. The hearing is passed by in the same way, but still oftener,
for sounds are rarely so continuous as objects of sight. A person under the
influence of hemp may carry on a tolerably well-connected conversation,
till suddenly he makes some remark which shows that it is made in refer-

* .Medical Jurisprudence of Insanity.
VOL. III. NO. IV 2

198 Medical Independent* June

ence to his own thoughts, 'rather than to anything which has been said be-
fore. He confounds what is passing in his own imagination with the
thoughts of others, and consequently attributes to them motives and inten-
tions which they do not possess. His memories of the past and anticipa
tions of the future are drawn from the same inexhaustible fountain. Add
to these false premises, false reasoning, warped affections and a disordered
will, and the picture of insanity is complete.

Any one who, under the influence of Cannabis Indica, has seen what the
human mind is capable of becoming, cannot but feel a lively interest in
those who are suffering under mental alieniation ; he cannot but look with
hope to it, as a means of more fully comprehending what is the most dis-
tressing of finite calamities, and he cannot but think that a substance, the
action of which is so powerful and unique, will be found, when fully under-
stood, to possess valuable therapeutic virtues. But this point can only be
set at rest by a series of experiments more careful and extended than has yet
been made.

New Mode of Employing the Taxis in Hernia. By B. G. Barley, M. 1).

"I have read in your last number a report of a lecture on the taxis in
hernia by Mr. Skey. I am induced to send you a mode of manipulation
which he has not mentioned, nor any one else that I am aware of, and
which I found very successful in a case I was called to see some time since ;
it may be of use to him as well as others. It was an inguinal herina; in a
young man, that had been strangulated for the greater part of a day ; size
not very large, but very tense, and hard attended with the usual symptoms.
— vomiting, confined bowels, &c. I tried the taxis, as it is called, but [failed
I then made him bend both his knees, and took one under each arm and
with his head hanging, I gave a good shaking as long I could hold him, tell
ing him to press up the tumor as well as he could himself. On letting him
down, I found the tumor not so low down in the scrotum as it was ; it was
soft, and holding it in my hand for a minute it went up. The rationale of
this proceeding is very easily explained, and is on the same principal which
succeeded in dislodging the half-sovereign from the larynx of M. Brunei,
when the surgeons were about to open his wind-pipe." — Dublin Med
Press, Feb, 4, 1857.

Convulsions.

•

Dr. McMeens, of Sandusky, Ohio, declares (Western Lancet) that he has
treated infantile convulsions arising from derangement of the digestive
organs with cannabis, with most satisfactory results. He considers this
agent counterindicated where there is much vascular disturbance or cerebral
complication ; in other cases it may be advantageously employed. These
views are illustrated by reports of four cases exhibiting the efficacy of the
hemp treatment.

t8j57. Spi i' it of the Medical Press. • 199

[Communicated for the Boston Medical and Surgical Journal.]

< >xide of Zinc for Profuse Sweats.

Messrs. Editors, — I was very glad to see, in your Journal of yesterday,
Dr. Abbott's report of cases of " Oxide of Zinc in Night Sweats," and I
hope that, like so many pictorial illustrations, they may tend more fully
than a general statement of the fact to impress upon the medical public the
great value of this remedy as a means of treating a most exhausting and
uncomfortable symptom. Dr. A. refers to my having spoken of it at the
meetings of the Medical Society ; I have done so several times during the
last two years, about which time I first saw it alluded to in Braithwaite's
Retrospect, and I have also frequenthT mentioned it, as I have had an op-
portunity, to physicians out of town as well as in town. From my per-
sonal knowledge of the remedy, I felt it to be my duty to do so, that it was
due to suffering humanity ; for I fully subscribe to the strong language in
which Dr. A. recommends it. During the last year T have been in attend-
ance at the hospital eight months; and, as there has been an unusually
large number of cases 6f phthisis, I have had most ample opportunities to
test the powers of the zinc ; and the result has fully confirmed the impres-
sions that I received of it the previous year. It was given freely whenever
there was perspiration enough to require treatment, and without any regard
to the stage of the disease. Seven grains were given in substance, and
generally at bed time, but in the course of the day if required ; the dose
being repeated in three or four hours if necessary. Sometimes ten grains
were given ; and I never heard the slightest complaint of any unpleasant ef-
fect from it. The medicine was given alone ; and if it has any efficacy in
checking perspiration, and on the other hand produces no disturbance of
the system, I see no reason why anything should be added to it. Conium
and hyoscyamus T have often used in various forms of disease, and in quite
as large doses as they are generally used ; and I have thought that bread
pills would have done as much. When we are testing a new remedy, at
least, it would seem best to give it in as simple a form as possible.

My object in this communication is not merely to add my testimony to
that of Dr. Abbott, but to say that perspiration may probably- be success-
fully treated by the zinc when it occurs in other diseases as well as in
phthisis. It may have been so used ; but if so, I have not seen any state-
ment to that effect. Seeing no reason why it should not be so used, I pre-
scribed it in two cases at the hospital during the past winter, and in both of
them with very mauked effect. The first was that of a healthy man who was
convalescing from intermittent fever ; he perspired veiy copiously for two
or three nights successively, and, having reported the fact, said that from
his previous experience he knew he should have a return of his paroxysms
if the symptom was not stopped. The zinc was directed, and it was stop-
ped from that time. Secondly, a strong, healthy man, under an attack of
acute rheumatism, had the profuse perspiration that so often accompanies
this disease. It is well known that the patient gets no relief from this
symptom ; and he certainly suffers enough when his wet clothes are being
removed. It seemed to be a fair case, then, for the trial of the zinc, and it

200 . Medical Independent, June

was directed. The perspiration was very greatly diminished ; and without
any unpleasant effect, of which their certainly might have been some ap-
prehension; the joints were no more affected, nor was the heart, of which
last there had been some disturbance early in the disease. I have also seen
perspiration checked under its use in a case of cancer of the womb.

The sulphate of zinc, to which Dr. Abbot refers, I have never used, nor
have I heard any one here speak of it from personal experience, as a remedy
for perspiration. It certainly would be proper to try it when the oxide
fails, which it does, however, very rarely. As to the other means of treat-
ing the symptom in question, I have failed so often with sulphuric acid that
T have not used it for a long time ; and I certainly intended to use it in suf-
ficient doses. The rubbing over the sm-face of the body with oil or a so-
lution of alum would, I should think, be a pretty severe penance in many
cases of phthisis ; though I am aware that both these means have been suc-
cessfully used here.

Trusting that the oxide of zinc will be fairly tried by the profession as it
has been recommended,

I remain yours, respectfully, J. P>. S. Jackson.

Boston, May 1st, 1857.

Sore Nipples.

M. Legraux, has found the following treatment very efficacious :

Colodion is rendered elastic by the addition of half a part of castor oil
and one and a half parts of turpentine to thirty of collodion. It is ap-
plied by means of a pencil over a radius of some centimetres around,
but not on the nipple. Over this is applied a piece of gold-beater's
skin, having some pin-holes opposite the nipple to allow of the passage
of the milk. This, by the drying of the collodion, becomes rapidly
agglutinated. Before suckling, the gold -beater's skin is moistened
with a little sugar and water, and becoming soft and suple, easily ad-
mits of suckling. If it is cracked, it must be replaced. — St. Louis
Med. and Svrq. Journal.

Homoeopathy. Spiritualism, and Suicide.

The Philadelphia papers announce the death by suicide, of a young-
man, a student in attendance on the Homoeopathic Medical College of
that city, who, having embraced the spiritual delusion, became enam-
ored of a married female, also a spiritualist, and failing to carry out
his criminal design of inducing her to forsake her lawful husband in
order to become his paramour, ended his miserable existence by tak-
ing hydrocyanic acid. This is but another and a melancholy evidence
of the evil effects of the so-called spiritual philosophy. It also shows
that there is a very strong affinity between the various absurd isms of
the day. When the mind embraces one capital error, it is rife for all
others. — lb.

1857. Spirit of the Medical Press. 201

A Monument vs. A Coffin.

During the prevalence of the yellow fever last Summer on the South side
of Long Island, two noble young physicians fell a sacrifice to their zeal in
the service of their afflicted neighbors. The names of Dubois and Crane
are enrolled with the names of those moral heroes who have died battling
the woes and sufferings of their fellow men. Their grateful townsmen of
New Utrecht intend erecting a monument at a cost of twelve hundred dol-
lars, in the grave yard where they lie side by side.

Among those who tied upon the outbreak of the terrible scourge in ano-
ther district, was a physician, who had enjoyed the support of a good prac-
tice, abandoning his patients, two of whom were lying ill of the fever. He
viewed from the distance of several hundred miles the ravages of death, and
heard the cry of help from his deserted home. The fever subsided, and the
timid ventured io return, among these our chicken-hearted doctor. So one
bright frosty morning this Fall, the rusty hinges of his office window
creaked as they admitted light to his neglected apartment. The cobwebs
were swept from the medicine bottles, which had stood for months un-
touched. " Mydragyri. submurias et PuJris Dotieri" looking out from
their dusty cases, would speak a rebuke that they had so long been left
without being sent upon an errand of mercy ; but all unconscious, the doc-
tor rubbed his hands with the satisfaction that he would once more be em-
ployed.

Thus a day was spent in delightful anticipations ; night came — so did the
morning; but what horror was depicted upon the doctors countenance as
he looked from his window; for lo ! there, suspended in the air, hangs a
coffin ; its polished surface and glittering plate, inscribed with Ins name and
departure, reflect the beams of the morning sun. Upon taking it down, he
found a note from his surviving townsmen inviting him to be at home that
night; as they intended to visit him, and place his remains in the mahogany
coffin sent him. We need scarcely add, that the doctor, considering his re-
mains in his own possession better off than in the hands of his " surviving
neighbors," made tracks, and has not been seen since in that locality. —
Amer. Med. Gaz.

Treatment of Scabies by Sulphuret of Calcium. — By W. II. Kestevan, Esq.

This treatment has been completely successful in every case in which T
have tried it. I have not kept an exact record, but should state the number
at between thirty and forty. At the parochial institution in which I have
had opportunities of putting it in opperation, the greatest satisfaction is ex-
pressed at getting rid of th«s old filthy proceeding of inunction with sulphur
ointment, and the saturation of blankets, &c, with the greasy mass.

Directly the slightest appearance of scabies manifest itself, I have the
part well washed with the solution of sulpheret of calcium for half
an hour, and then left to dry. This proceeding is repeated on the
following morning; and at night, or next morning, ablution with soft
soap is performed. Tt is very rarely that a third application is requi-

202 Medical Independent. June

red ; in most cases, the second is unnecessary, but . I enforce it in order
to make security doubly sure. When the washing has been thorough-
ly and effectually peformed, the apex of each vesicle appears of an
opaque yellowish white color, indicating that the sulphur has penetrated to
its contents, and has destroyed the acarus.

So speedy, cleanly, and effectual a method of curing so loathsome a disease,
is an immense boon, and connot be to widely made known. By its means
an offensive and often tedious plan of treatment is superseded.

The cases with which I have had to deal, it should be stated, have been
nearly all recent ; but I am informed'by my friend Dr. Fuller, of St. George's
Hospital, that he has scceeded by the same plan in curing a case that has
long resisted ordinary modes of cure. — Association Med. Journal, Jan 28,
p. 549.

Case of 'Enuresis successfully treated with Fluid Extract of Pareira Bra i

Sometime during the past summer a young man, aged. 24, carpenter by
trade, made complaint to me that ever since his bojdiood he had been
troubled with the bad habit of emptying his bladder while asleep in bed.
That at times it would leave him, but only to return, after a short respite,
with redoubled force. That he had tried, morally and physically, to over-
come it, but all his efforts had been vain.

At the time of his call his general health was not good, and consequently
my first treatment was directed to its restoration. There was no appear-
ance in the urine that indicated any organic affection of the bladder ; on
the contrary, in every respect it appeared healthy, and during the day was
not in any ways troublesome. Various remedies were ineffectually em-
ployed.

Having seen the following combination recommended, it was also used as
far as prudence could justify.

R. — Ex. belladonna.

ex. hyosciamus aa grs. xvi.

white sugar . . . dm. i.

camphor water . . oz. iss.; of which a tea-

spoonful was ordered just before going to bed each night. But no good
resulted.

Repeating his visit at an hour when I was specially employed, I handed
him a vial of Fluid Extract of Pareira Brava, which was standing upon
my prescription case for another patient, and directed him to take a tea-
spoonful three times a day, and requested him to call at the end of a week
if it did him no good ; but if so, to continue it till he had used all of it.
Some four months afterwards he called to pay his bill, stating that the lasf-
medicine had acted like a charm — to use his own words — that his affection
had been relieved after taking a few doses, and had not since returned ;
that he also felt better, both in mind and body than he had for }rears. In
this case, which I regard as one of atony of the bladder, the pareira brava
answered a good end in restoring tone to the organs, and relieving the pa-
tient.— South. Jour, of tin Med. and PJn/s. Sciences.

1857. Spirit qf ike Medical Press. 203

Mr Startin's Method for the Prevention of Pitting in Small-Pox.

"The plan consists in applying the acetuin eantharidis (P.L.) or any vesi-
cating fluid,* by means of a camel-hair brush, to the apex of each spot or
pustule of the disease, on all the exposed surfaces of the body, until blis-
tering is evidenced by the whiteness of the skin in the parts subjected to
the application, when the fluid producing it is to be washed off with water
or thin arrow-root gruel

"The vesication for each pustule should not be larger than the eight or
sixth of an inch in diamater, leaving intact the boundaries of the inflam-
mation, excepting where the malady has become confluent, when the entire
surface so affected shonld be vesicated.

"With respect to the best period of the eruption of small-pox for making
this application, although between the fourth and eighth days should be
preferred, the vesication has seemed to me to have been efficacious whenever
it has been practised before the slough has formed, evidenced by the secretion
of pus, which slough is at once the cause of the pitting, and the peculiar
characteristic of this formidable malady.

"The only after-treatment in these cases consists in puncturing the blisters
with a needle, in keeping the affected skin clean by means of arrow-root or
rice gruel (avoiding soap of every kind), and in bathing the eruption several
times a day by the aid of soft sponge or linnen wetted with the following
lotion : R. Sodas biboracis, scruples j ; Ammonias sesquicarbonatis, scru-
ples j ; Acidei hydrocyanici diluti, drams j ; Glycerini destillati, ounces
ss ; Aqua? rosae ad ounces viij. M. Ft. lotio.

" The pain attending the application of the vesicating fluid is xcry slight
and transient, disappearing almost simultaneously with the ablutions recom-
mended, nor does the blistering add much to the disfigurement, while it
relieves the pyrexia and cerebral symptoms, should they be present. The
rationale of the benefits arrising from the method appears to me to be com-
prised in John Hunter's observation, that ' if you can succeed in curing a
specific disease ;' which he calls k the mode of cure by an iritation different
from the disease ;'f for he holds elsewhere, that ' no one disease can have
two distinct and critical inflammations.' " — Medical Times and Gazette^
Febuary 31, 1857.

* It will be observed, that this practice of vesication is the opposite to that recommended by
the writers advocating nitrat of silver, who desires to avoid the blistering process,
t Hunter on the blood, vol. ii, page 131, et seq., vol. i, page 454.

Tincture of Iodine for Vomiting: in Prbgnangy;
Dr. Eulenburg, of Coblenaz, tells us, in the Gazi tte Medicate Etraugere,

that this tincture, even in small doses, is one of the best agents for the
relief of the vomiting, which so often distresses pregnant woman. He pre-
scribes it very diluted, as follows : tincture of iodine, one part . rectified
alcohol, four parts and a half ; mix. He directs of this diluted tincture
three drops in a little water. This remedy, in addition to its anti-emetic
effect,calms the often accompanying cardialgia. He has not derived the
same good effects, in these affections, from the iodide of potassium. — Med^co-
Chirurgical Review.

204 Medical Inch pendent. June

Secondary Syphilis treated by a new preparation of Iodine.

The object of the paper by Mr. Christopher is to introduce to notice a
new compound, which, combining the good effects to be derived from iodine,
is devoid of its disadvantages — a preparation which lie says, has proved valua-
ble in curing cases of secondary syphilis which had previously resisted the
beneficial action of iodine in all its usual combinations and forms — a prepa-
ration, moreover, which does not produce the evil effects of iodine in those
constitutions with which that substance is known to disagree. The prepa-
ration or compound is named "liquor cinchonse hydriodatus," and contains
in one fluid drachm of liquor, twelve grains of cinchonas flav., and one grain
and a half of iodine, in the form of hydriodic acid. Of this, the dose varies
from one to three drachms, from which Dr. C. has not found any of the evil
effects arise which smaller doses of other preparations oi iodine have been
known to produce. While using this compound in some of the successful
cases treated, he also employed the hot air bath, to which he attached much
importance, in order to produce profuse sweating, and always with marked
good effeet. Indeed, he says \ ic does not know a more potent remedy for
intractable and inveterate cases of secondary syphilis than this is. This
preparation is produced by exhausting the powdered bark with an aqueous
solution of hydriodic acid; then with water ; and the liquor is subsequently
evaporated to the above bulk. — Lancet.

Removal of Tumors by a New Method.

" \)r. Simpson, of Edingburg, has been experimenting on the removal of
tumors by a method novel in this country. He introduces a hollow acupun-
ture-needle, or very fine trocar, into their tissue, and injects a few drops of
some irritant liquid — such as a solution of chloride of zinc, perchloride of
iron, or creasote. The effect has beeii to destroy the vitality of the tumors
so treated, and they have been separated by a process of enucleation. We
have seen a somewhat similar plan adopted in Paris by M. Maisonneuve.
He has slender stylets made of a paste composed of Hour, water, and chlor-
ide of zinc- These are baked. A puncture is made in the tumor, the cau-
stic style is inserted, broken off, and left. We saw several malignant tu-
mors treated in this manner, and some cases in which a healthy granulating
surface was left after the seperation of tumors which had been destroyed in
this manner." — Times and Gaeette, Feb. 7, 1857.

[odide of Potassium in Scarlet Fever.

Dr. Charles E. Cady in a letter to the editor of the Philadelphia
Medical and Surgical Journal, highly recommends the Iodide of Pota-
sium in grain doses, repeated at intervals of two hours, in scarlet fever.
He has employed it in over one hundred cases, with uniform success.
It is worthy of a trial. — St. Louis Med. and' Surg. Journal.

1857. Spirit of the Medical Press. 205'

Houston, Texas. March 7th, 1857.
Physlc Does Pay.

Messrs. Editors: — The assertion is so often made in plaintive tones by the
desponding junior members of our profession, that " physic won't pay," I
have long since determined to ferret out the reason for the sad wail. I have
had my attention directed, with my hopes, to the race of M. D.'s who came
upon the rough sea of public life at the time I donned the armor, and all
the while have had Raphael's fear haunting my mind, a " fear that in life I
might be surpassed." I then have watched closely the struggles of my
compeers for supremacy, and oft-times have in great chagrin seen the
veriest charlatan rear his head in derision at the the beautiful and harmo-
nious laws of my much loved profession. I do not award to every regular
bred physician equal praise, for with sorrow I acknowledge I have seen few
men who fill the statue of a true physician. A true physician is a pecu-
liar man, and God's noblest work — well deserving the rich encomiums
passed on him by the savans of other days, while the usurper — the assassin
merits the condemnation of both heaven and earth.

Why is it that unthinking men stigmatize our profession because of its
not being a lucrative* calling, and why is it that so many fail and discard it
for the sake of gold ?

If you will cast your eyes around and observe the barter in human blood
— see the sacrilegious fiends prowling along the byways and alleys of our
cities — insinuating themselves into even the better circles of society, lay-
ing their ruthless hands on the home circle to blight it with the besom of
destruction ; see this and learn the deep laid scheme, the lust for gold, and
who would not be tempted to exclaim of the unthinking public, ' mene
tekel upharsin."

But there is a higher law which should actuate the true devotee of medi-
cal science. He should not look to an unappreciative people for commend-
ation— he should not expect to be hailed as a deity, or lauded as a prince,
for yet, the world is illy fitted to comprehend the holy mission of a Doctor.
Let him know himself — let him bear the impress — let him feel and know
that he hath a power within, principles to govern, a nerve to execute his
peculiar design in the great plan of universal good.

In this fast age, wealth is made the goal of life — men preach and pray for
gold — steal and murder for gold, while men of principle who are prepared
and willing to contend faithfully and honestly for position, are rarely met
with and still more rarely succeed. Merit is forgotten " and dies amid her
worshippers."

The chief aim of the young physicians of the United States is not to ex-
cel in doing good and in advancing medical science, but they spring into the
arena, untutored, unlearned, and in a swarming host infest our land with
their stupidity and knavery.

A few exceptions modestly peep out from the midst of chaos, to drag
through a long probation, to leave a single foot print on the sands of time
and die leaving the world but little wiser although a thought was born unto
them.

Our profession should not be sought as a lucrative calling, and all those

206 Medical Independent. June

who seek it as a trade, ought to be spurned from its portals. Such men
bedraggle its escutcheon in the gore of their victims, contaminate its purity,
bring obloquy apon the ''divine art," and leave a blood mark on the pag
of history which is damning to the struggling science.

Where can the man be found who, deserving merit, has failed in our pro-
fession ? Nowhere. To acknowledge a failure is to acknowledge a want ip.
efficiency and competency. But man)" men succeed who merit contempt of
the world. Grant it ; but it is because worthy men are few — the supply
being less than the demand.

Let the lovers of truth and science in our profession band themselves to-
gether and make it a business to expose the deadly schemes of empiricism,
and prune our vineyards of all the cumbrous otf-shoots which weigh down
the vine and bear no grapes. The uneducated pretender should be uprooted
and the money changers scurgeo> out of the temple.

I should like very much to know what definition would apply to the word
physician, in the United States. He is a protei-form animal of the com-
posit style — every thing and nothing; a heterogeneous mass of compound
incomprehensible inconsistencies. 1 wish every body would call me Mr.. I
am really ashamed of my title in many crowds I am caught in.

But how is physic to pay ? In the first place, none should be received
into the fold whose mental capacity is not beyond cavil. Second, on the
mind of the novitiate, this first great lesson should be indelibly stamped,
honorable medicine is devoted to the cause of suffering humanity and to
God. Third, pecuniary emolument i> not the object of life well spent, but
it is a blessing which tlows naturally as a consequence.

Let the young in the medical profession be properly imbued with the ho-
liness of their mission — the tearfulness of the responsibility resting bn
them, and the absolute demand for ceaseless vigilance and constant devo-
tion to the entrancing study of this strongly complicated human organism,
and my word for it they will find no time left at night to spend over the
card table or social glass, or in the day brooding o'er their failure in busi-
ness. The habits of men, in a great degree, control their .successes, and in
no calling in this more applicable than in our profession. He who suffer-
ing from want of appreciation — want of business, and a consequent want of
gold, can always find a hidden fault within himself — let him seek it there
and no longer burthen the passing breeze with his sad wail of imaginary
woe.

How strange it is. that the qualifications of doctor.^ are rarely questioned.
Even in the minor affairs in life, efficiency is the desideratum, but men
everywhere lay their bodies down at the disposal of any one sporting the
sobriquet Doctor- Gentlemen by birth and education, expose their bodies
and those of their wives and daughters to the contaminating touch of the
vilest scoundrel in Christendom, nor ask or care to know, from what ce^-
pool he hails. Let any man from the humblo<t. aye, the most degraded
walks in life don the title and seek a distant clime, and lie can securely slay
without molestation.

AVho in our day stops the bloody charlatan to demand his. diploma or
question his competency I Men have grown grey and opulent in our pre-

1857. Spirit of the Medical Pre%8. 207

fession, whose qualifications have never been gainsayed, when, were the
truth known, they have slayed their thousands trying to find out what Hip-
pocrates taught centuries ago. It is the duty of the young physician of
this day to array and expose these vile usurpers, and by their acumen in
scientific, honorable medicine, blast the upas which shades the lovely flower
from a careless world. Physic will pay the honest, earnest devotee.

T. S. D.
P. S. — Although Homoeopathy is laughed at, and hissed out of the better
circles of society throughout the world, yet I find it still struggling for
breath in this sunny clime. We hope to have the pleasure of seeing it
kick its last this year. It is a burlesque on common sense and we are dis-
posed to take the advice of your journal and not recognize its votaries either
personally or professionally. D.

— Nashcille Journal of Medicine and 8urgery.

Esculapius riiK Son <>f Apollo.

It is said that the great Boerhaavc was more proud of his success as a
flutist than of his scientific glories- Haller, the universal genius, was an
accomplished musician, and delighted in taking his part on the violoncello.
Orfila, in place of beeoming the founder of modern toxicology, had well-
nigh turned his magnificent baritone voice to profit on the stage. M. Ba-
taille, one of the most admired of the singers at the Opera Comvpie, is a
doctor of medicine ; and a young agrege of great promise, and possessed of
a beautiful tenor voice, has deserted the Academies of Science for that of
music. Quite lately too a Mr. Hans, a young man of twenty-one years of
age, has made a promising debut in Lablache's character in Norma, at the
Theatre Ttalien, and is engaged for the next season in London. He is the
son of the celebrated Rokitansky, of Vienna.- — Ibid.

Dr. Samuel Long, of Springfield, 111., reports, in the March number of
the Northwestern Medical Jonrnal, a case of ovariotomy, from which the
patient entirely recovered in three weeks, without a single untoward symp-
tom.

The Dark Side or War.

Colonel Tulloch. one of the two members of the Crimean Board of Inquiry
(the other is Sir John McNeill) in a pamphlet recently published, states that
the loss from sickness alone, during the winter of 1854-5, in the Crimean
army (including what took place at Scutari and during the passage), amoun-
ted to thirty-nine per cent, in the infantry, and in eight corps actually
amounted to seventy-three per cent. ; this being exclusive of men killed in
action, of who died of their wounds. By way of contrast it may be men-
tioned, that, in the naval brigade, which took a prominent part throughout
the whole siege, the deaths from sickness were under four per cent. This
terrible mortality was four times greater than that which occurred during

206 Medical Independent. June

the "VTalchercn campaign, whose horrors aroused the indignation of the
country, and produced a perfect storm in the Senate. Colonel Tullock in,
eloquent language, points out the causes of this heartless loss of lives : ''It
was," he says, "no foeman's hand, no blast of pestilence, but from the slow
though sure operation of disease, produced by means, most of which appear-
ed capable, at least, of mitigation." — North American Medico- Ghirurgical
Review.

Voices differing wjtii Localities.

Experience; says Fetis. has demonstrated that voices, like vineyards are,
in general, distributed in Fiance, by districts. Picardy furnishes finer basses
and in greater number than any other province ; and almost all the fine
basses, which have shown at the opera, and in the other musical establish-
ments, were from that province. Tenors, and' particularly those which are
called high cou/iter$,or counter-tenors, are to be met with in greater number
in Languedoc, and especially in Toulouse and its environs, than in any
other part of France. The voices of this kind in that country are of sin-
gular beauty, and the chance of preserving them after the change, is much
more favorable than elsewhere. Lastly, in Burgundy and Franche-Comte,
the female voices have more extent and a purer quality than in all the other
provinces. —

Agreeable Modi: of Taking Senna.

Dr. Lint liner say=. that senna leaves (one or two drachms to one or two
cups of water) should be allowed to infuse all night in cold water. With
the strained infusion coffee" is prepared next morning, as if with water ; and
an aperient which does not taste of senna and doe^ not cause griping is
thus produced. — Buchner^s Kepert.

Habitual Constipation.

Dr. Haughton says : "In obstinate cases of this kind you will find the
following a very capital pill : half a drachni of extract of colocynth, and three
grains of extract of nux vomica, made into twelve pills, one to be taken
nieht and morning." — St. Louis Med. Jour.

Fortiicomino Work.

We Are glad to learn that the Philadelphia publishers. Messrs. Lippincott
& Co., are about to issue a new work, entitled Surgical Case.s by Paul F.
Eve, M. D., Professor of Surgery in the University of Xashville. From the
ability of the author, we anticipate a valuable work from his pen. — Sf.
Louis Med. Journal.

1857. Editorial and Misoellany. 209

(irtotorial ani Wsttltm.

Salutatorv.t— With the present number, the subscriber assumes
joint proprietor-Miid editorship of the Medical Independent ; and before
retiring behind the editorial ;' we* he wishes, even at the risk of in-
curring the charm' of egotism, to appear before the fraternity and his
readers, in the first person singular.

From the sixth number, the Independent has been involved with a
contemporary, in a controversy, which has partaken largely of a per-
sonal nature. This controversy has been regretted by many, including
warm adherents of the journal and members of the profession at
large, and has frequently prompted the inquiry, so often provoked on
other occasions, " why will Doctors quarrel \ "

The harmony of the legal profession, forensic as it is in its practice,
is cited as presenting a striking contrast to the quarrelsome proclivi-
ties of our own. While, from my relation to both parties, I refrain
from interference. I remark in reference to the general subject, that
the answer and explanation lie patent upon the surface of facts pre-
sented in the contrast. From the nature of the practice, men desti-
tute of ability and acquirement cannot rise in the legal profession.
In whatever speciality the aspirant may engage, merit alone will ad-
vance him. The opinions of the counselor are to be tried by those
of counsel enlisted in opposing interests. The persuasion and logic
of the advocate, are met by their like. Legal opinions and logical
deductions are to be weighed in the scales of impartial justice, and
persuasive or peremptory eloquence in the influence it exerts, regis-
ters a just estimate of its force. Hence, in the law, men soon find
their true level, and standing competitors feel themselves peers. Mu-
tual respect, confidence and harmony are the natural results.

With the medical profession it is widely different. Jn practice, the
acquirement and skill of competitors are not brought in contact.
Medical practice is a broad field, in which truth and falsehood, educa-
tion and ignorance, refinement and vulgarity, dignity and buffoonery
are often competitors for patronage, and not infrequently the worse
leading the better in the strife. The public are not capable of judg-
ing correctly the merits of medical doctrines, or always, of medical
men ; hence, the crudities of Thompsonianism, the absurd vagaries of
homoeopathy and the sorry delusions of spiritualism, with their unlet-
tered and unstrung advocates, find patrons in all classes of society .
Such being the case, it is not strange that in the ranks of legitimate
medicine, where may be found men of almost every grade of endow-
ment and acquirement, competitors should frequently chance to be

210 Medical Independent, June

men unworthy, morally or mentally, of each other. Nor are the
consequences more strange ; distrust, jealousy and contempt nnturally
follow, and where these qualities prevail, bitterness soon reigns.
Misunderstandings, misinterpretations and aversion to explanations
are frequent, and thus when controversies arise, the^v are apt to as-
sume a personal and bitter character.

In the existing state of the profession, such controversies are not
altogether unproductive of good. To be deplored they certainly are.
not alone from the attitude in wnich the public behold us, but also
from the fact that they cultivate a spirit, which, from the peculiar na-
ture of matters already explained, is but too prone to manifest itself.
Still they are not destitute of good results. Entertaining these views,
and perhaps, not deploring controversy as deeply as some of my
medical brethren. I shall, notwithstanding, strive to avoid its tumult.
I shall not be the aggressor in personalities, but will manifest, should
occasion require, even a laudable tor! i in this respect, and trust

that the hind thus fraternally extended, may meet with a response,
prompted by fraternal hearts.

Books, writings, public teachings and existing evils are, I conceive,
legitimate subjects of criticism, and in the discharge of editorial du-
ties. I should deem myself highly culpable in shrinking from their
full performance. Adopting aa a motto, " full and exact justice to all
men." I will zealously labor in the editorial field, fur the true inter-
ests and progress of medicine.

Moses Gcnx.

OUR EDITOMAX CHAJJGK

We assume that the readers of the Independent will not expect to
learn from its pages all the reasons which have prompted us to make
an important change in its editorial supervision and proprietorship.
It is the result of deliberate reflection, having in view the perfecting
and permanency of an enterprise which though comparatively incep-
tive, has received from the profession distinguished favor and a liberal
support.

We who gave origin to the journal, and have labored thus far to
make it acceptable and profitable to our readers, congratulate our-
selves and our subscribers upon a change which has secured the talent
and energies of Professor Gunn. In.bringing this accession to our
forces, however, it is not proposed to make any radical change in the
position and general policy which has been maintained. The journal
will still be indepedent in the promulgation of truth, the vindication of
medical science and its ethical observances.- untrammelled by the lo-
cal interests of cliques or combinations.

1857. Editorial and Misdella/rvy. 211

We shall labor zealously to make its pages, so far as possible, a
medium for the dissemmination of original 'practical truths, and to
this end have secured the services of a good number who will be re-
cognized in our list of collaborators as writers of eminent ability and
experience.

Our senior, Dr. Kane, who has represented for the most part the
review department and contributed largely to the original communica-
tions, leaves the editorial chair to assume a relation which reflects no
less honor, and will involve no abridgement of his valuable services,
but will be more consistent with his professional labors. Under such
auspices we confidently believe that our readers will concur with us
in the opinion that the change will highly promote the interests of the
journal and the advancement "of medical science. R.

The Meeting at Nashville. — The last meeting of the National
Medical Congress, though not large, wTas highly respectable, both in
number and character, and was undoubtedly productive of as much
good as any previous session. There was, it is true, a paucity of re-
ports from the special committees, but that of Dr. Reese alone, was
richly worth the trouble and expense attendant upon the meeting.
There was a general prevalence of harmony, the only exception being
in reference to a subject, which has, we believe heretofore constituted
the only source of disagreement — medical schools. We shall allude
to athis subject hereafter. The election of Prof. Eve was most judi-
cious ; a clear voice, quickness of apprehension, promptness and cor-
rectness in decision, are qualities which render him a pleasing and ex-
piditious presiding officer.

For ease of access, Nashville was perhaps an unfortunate location
for the convention ; but once there, the vexatious delays on the route,
and the practical democracy experienced on Cumberland river steam-
ers, were forgotton in the beauty of the city and surrounding country,
and in the overflowing hospitality of its citizens. We cannot speak
in terms sufficiently expressive of the latter theme, but we shall ever
hereafter advise our friends to go to Nashville to learn hospitality.
We are glad we went to Nashville. G.

The late vicar of Sheffield, the Rev. Dr. Sutton, once said to the late Mr.
Peech, a Veterinary Surgeon : "Mr. Peech, how is it that you have not
called upon me* for your account ?" " Oh," said Mr. Peech, •• I never ask a
gentleman for money." " Indeed," said the vicar, " then how do you get on
if he dont pay ?" " Why," replied Mr. Peech, "after a certain time I con-
clude that he is not a gentleman, and then I ask him !" — Times & Gazette.

212 Medical Independent. June

Syphilization. — It seems that this idea, i. e. the cure of syphilis,
by inoculation with syphlitic virus, is obtaining foothold in high
places in some parts of continental Europe. Sperino at Turin, Gam-
berini at Bologna, Gulligo at Florence and Boeck, Professor of Medi-
cine in the University of Norway, have all been experimenting large-
ly since the rejection of this subject, by the French Academy of
Medicine, on its announcement to that body, by its discoverer, Auzias
Turenne. " As a prophylactic " its adoption is deemed " unjustifi-
able '.' but its curative powers are recognized by these experimenters.
The British and Foreign Medico-Chirurgieal Review analyzes two
works by Dr. Boeck, Clinical Observations on Syphilization, and Sy-
philization of Children, from which we gather that while Dr. B. will
not recognize its claims as a prophylactic, he feels " justified in trying
a new method of treatment, which has had reported success, even
though its operation may be inexplicable, and its adoption seem in
contradiction to common sense." He deem 9 it contra-indicated in the
primary, and though he does not think applicable to all forms of the
constitutional disease, he arrives at the following conclusions, from
eighty-four cases, treated by syphilization up to March, 1856.

" I. That in all cases, without exception, immunity to the venereal
virus is obtained sooner or later by inoculation with this poison.

II. That the symptoms of syphilis present at the commencement
of syphilization disappear during the employment of this mode of
treatment.

III. That tli" general health does not sutler in the least from syphi-
lization— on the contrary, if the patient has been in weak health before
inoculation, he most materially improves in strength and appearance
during the process."

When, three or four years since, we first heard syphilization ad-
vanced as a prophylactic and curative means, we said, what next !
We now repeat the exclamation, what next !! G.

DR. PALMER'S LETTER.

In obedience to the demand of Dr. Palmer, in the Peninsular for
May, we present the whole of the letter from which we have hereto-
fore only made extracts. There are portions of it which we would
gladly suppress, but inasmuch as he has thus publicly made the de-
mand, we feel compelled to yield, notwithstanding it contains compli-
mentary notices cf us, which our modesty would prefer, to leave un-
published ; lest we should again be accused of garbling, we, at the ex-
pense of private feeling, publish the whole letter, with the hope that
Dr. P. will be satisfied with its entiety.

Editorial and Miscellany. 213

We have but a few words to say with regard to our reasons for al-
luding to the letter in the first instance. We had no other means of
refuting Dr. P.'s statements respecting the rejection of the paper of-
fered upon the subject of " biography of living medical men." He
had given a false coloring to his expressed views of the article in
question, and appealed to Dr. Davis and Dr. Butler in behalf of his
position. Therefore we made a few quotations from the letter merely
to show that Dr. P. practically endorsed the views which we had pre-
sented and that his chief reason for rejecting it was on the ground of
a personal controversy with Dr. Davis at the time. We made only
such extracts from the letter as had particular bearing upon the point
at issue.

In calling for the letter therefore, Dr. Palmer is alone responsible
for the publicity of whatever else it contains of a personal character,
and his real motives in calling for the whole letter can be best under-
stood and appreciated by those most interested.

For the sake of our readers we hope that Dr. P. will not compel
us to recur to this subject again. R,

Chicago, Nov. 5th, 1855.
L. G. Robinson, M. D.,

Dear Sir: — Your note of the 3d inst., and the
article referred to in it were received, to day, and I take an early op-
portunity to reply according to your* request. Editors are very often
placed in very delicate situations — a fact which you may not fully
realize until you feel the responsibilities of such a situation by actual
experience and in making up your judgment of our conduct I hope
you will exercise the proper charity.

You ask 'my opinion of your article. UI think it well written in a
clear agreeable style — the different points are well taken and sustain-
ed. I regard it a decidedly readable article, and there is much force
in its views. There are however different opinions respecting the pro-
priety of presenting before the public biographical sketches of living
individuals, who have succeeded in attracting the attention of consid-
erable portions of men ; Greely, Bennett and Barnum have each a
volume devoted to their particulars and most persons see no particu-
lar impropriety in the affairs. These men have- achieved notoriety
with the community generally and the community seem gratified in
reading their lives. A history of the American Medical Association
has been written — it has honored Presidents. Those thus honored
.have by that fact, if by nothing else, obtained a degree of prominence
and notoriety with the profession, and judging from the expressions
in the Medical Journals of the country, the profession generally have

VOL. Ill, NO. IV 3

214 Medical Independent. June

been gratified by reading their brief biographies. So at least Dr.
Butler judged they would be as evidenced by his procuring those
sketches. Dr. Davis wrote the history in question, and was largely
^engaged in originating the association, is in fact regarded as its
founder, and in this way he has obtained notoriety with the profes-
sion. No man of his age in the profession in this country — favorably
or unfavorably, is more extensively known. It is true, his disregard
of conventionalities and evidence of defective early education, liter-
ary and social, rendered him an object of merriment with some in
the early part of his career, but by the force of his own talents and
industry — he has made his way to the respect of nearly all, and to
the admiration of many of the profession. It has been judged by
some at least, whose judgments are not entirely to be despised, that it
- is befitting that the curiosity of the profession should be gratified by
a biographical sketch of him. As I already intimated, there are dif-
ferences of opinion on the general subject of such biographies ; many
I presume, very many think and feel with you as expressed in the ar-
ticle, others think and feel differently. Many would regard your ar-
ticle as just and deserved, others would consider it as an uncalled for
personal traduction. Should it appear in the Peninsular Journal, its
editors, and particularly Dr. Pitcher and myself, would bear its re-
sponsibility. Now, we must be allowed to say whether we will or
not bear that responsibility, and in looking over the whole matter, we
think it not best for the interests of the journal — our own interests,
the good, the peace and honor of the profession, to take such a stand
I hope you will permit us without censure, or the questioning of the
correctness of our motives, to decline doing so. So much for the gen-
eral view of the subject. Now, for my own part, I am very much
inclined to your views of these autobiographies, for they very nearly
amount to that. The case you have cited as an illustration of your
views (I mean the biographical sketch) is one got up I think with bad
taste — many may not think so however — but if you were editing a
medical journal and were disposed to express your views to the pro-
fession, it would be highly proper for you to do so, as presenting one
aspect of the subject, and there cannot be the least objection to any
journal publishing it that chooses to do so. Now, for our own case:
I would not consent to have anything go into our journal when its
senior editor had expressed an opinion decidedly against it. He is
the older man, must take the leading responsibility, and must be sup
posed best qualified to judge of what is becoming. In the next place,
were it left to me alone, without any expression from him or any one
else, under our peculiar circumstances, I should decline to publish it.
I should do this principally on the ground of our recent collision

AW/'fo/'<<// and Misadlany. 215

with Dr. Davis. It would be said and believed that this article was
the offspring of that difficulty, and that we had resorted to this side
issue to wound our antagonist. It is true Dr. I), seemed inclined in
his article to wound me all he could, but I am unwilling to appear to
retaliate in this manner. Besides the article appearing in our journal
at this time would lose much of its general force. It would be re-
garded as an attack upon an individual rather than the resisting of a
general evil. These would be my reasons for declining it at least at
present, and preferring#if it appeared at all, that it should appear
somewhere else. In my collision with Dr. D. in our journals I feel
that I have sufficient advantage in the strength of my positions and
the weakness into which his passions betrayed him; and if the con-
test goes on I sl^ill choose to adhere to the issues already existing,
or which he may hereafter make. I can conceive of a contin-
gency in the future which would render me desirous of^niblishing the
article either as original or as a selection, but according to my sense
of propriety the time is not now. I hope you will sec sufficient mo-
tives for declining to publish, and further that you will not regard
these motives as improper. I have written thus at length because I
wish you to understand me fully. The Peninsular Journal Ave in-
tend shall be independent and out-spoken. It has heretofore shown
no particular disposition to shrink from issues presented, and while
we hope a proper prudence will be preserved, we hope timidity will
not be among its qualities. We shall be very glad to have you write
something else for us. Taking this article as a specimen of your
style, you could not write an article on any strictly medical subject
that would not be highly acceptable — or indeed upon any subject
which had not mixed up with it some personal bearing or affair.

Very sincerely yours,

A. B. Palmer.

Malpractice. — In Nfcw York, Mr., Courtney sued Dr. Henderson,
for damages done to his eyes. The defendant's counsel raised several
points, but it is sufficient to state the second one — ;; that an error in
judgment is not malpractice/' The court held this to be good law
whenapplied to a man skilled in anatomy, surgery, or physic, but that
it had no application in this case; that the defendant, knowing nothing
of anatomy, surgery, or physic, could have no judgment in the mat-
ter. The law contemplated a judgment founded upon skill and knowl-
edge in these sciences. That man who would hold a diploma with-
out any knowledge of these sciences, fend under such false pretenses
obtain a patient, and commence tinkering with the most delicate of

216 Medical Independent. June

organs, the eye, must be reckless indeed. An error in judgment of
a man skilled in a particular calling is not malpractice, unless it is a
gross error. A person attempting to practice- in physic or surgery,
without first having obtained a knowledge of such science, is liable
for all the damage that is the result of his .practice. The case was
given to the jury, who returned a verdict of five hundred dollars for
plaintiff. — Phil. Med. and Sur. Journal.

All honor to the enlightened expounder qf the law, who made this
wise and rational distinction. It is founded on plain, sound, common
sense ; so plain and forcible, that nice powers of discrimination are
not required to see the point ; yet it is directly at variance with the
general spirit of legislation on this subject, for the last twenty years.
Legislators have seemed to think that all laws regulating the practice
of medicine^ere for the protection of the profession and not the
public, and regarding the profession as a monopoly, they have thrown
open wide the doors for the admission of each and every one, who
chose to enter and assume the most responsible of all relations. Thus
the people, who should have been protected by judicious legislation,
have been left to the mercy of ignorant pretenders. So unlike the
spirit of past enactments, and so opportune is this wise decision, that
it brings refreshing hopes of better things. Perhaps, at the hands of
those learned in the law, the medical profession may yet receive that
honor, and the public that protection, which legislators have denied '
them. G-

23§p The proceedings of the American Medical Association have
crowded out some of our Book Notices, and other original communi-
cations, which will appear in our next, number.

From the Nashville Journal of Medicine.

AMERICAN MEDICAL ASSOCIATION.

TENTH ANNUAL SESSION.

Nashville, May 5, 1857.

The Association met at 11 o'clock, in the Representative Hall of
the State Capitol, the President, Dr. Zina Pitcher, of Michigan, in the
chair, and upon his right Dr. W. K. Bowling, of Tennessee, one of the
Vice Presidents. Dr. Wm. Brodie, of Michigan, and Dr. R. C. Pos-
ter, of Nashville, Secretaries, were present.

The meeting having been duly organized, the first business in order
was stated by the Chair, to be the reception of the report of the Com
mittee of arrangements.

Dr. C. K. Winston, chairman of the Committee of Arrangements,

1857. Editorial and Miscellany. 217

on behalf of the* committee and of the medical profession of the city
generally, extended a sincere and cordial welcome to the members of
the Association, in a few pertinent and appropriate remarks, as fol-
lows :

Mr. President and Gentlemen of the American Medical Association :

This, I believe, is the tenth annual meeting of this Association. As chairman of
the committee of arrangements and reception, I am charged with the agreeable
duty of welcoming you to the State of Tennessee and the city of Nashville. I only
regret that I have not language to express this sentiment with sufficient cordiality.
I only add, gentlemen, in common phrase, "You are moje than welcome."

You are the representatives of a profession, distinguished alike for its antiquity,
its scientific attainments, and its usefulness. It constitutes the true link between
science and philanthropy — science and philanthropy, moral, intellectual, and phys*
ical. You come from every portion of this glorious Republic — from the Kenebec
to the Rio Grande — from orange groves and golden sands, from mountains clad in
eternal snow, and valleys smiling in perpetual verdure. You come not for purposes
of self-aggrandisement or personal ambition, nor yet to advance the schemes of
parties or stir up the antipathies of sections. " You know no North, no South, no
East, no "West;" but you come as a company of philanthropists, a band of brethren,
that you may pour the acquisitions of another year into a common treasury, kneel
side by side at a common altar, and drink the lh4Pg water as it gushes from a com-
mon fountain. You have come to maintain the dignity, to elevate the ensign of a
profession, to which you have devoted your lives, and to which you have linked
your fortunes.

You are the cultivators of a profession eminently progressive, and admitting to
the fullest extent the spirit and genius of enterprise. So much may not be so fully
said of others. Who could expect, at this or any other day, to embellish the com-
mentaries of Blackstone,- or improve the pleadings of Chitty, or repoise the scales
of justice? "Where are the men with commissions never so divine who would
attempt to recast the logic which made Felix tremble, or adorn the doctrine of
justification by faith ? Who hopes now to shed additional light on the pathway to
the skies, or sing in strains more immortal, the triumphs of the cross? Not so
with Medicine. Yours is a rising orb, magnificent in its proportions — while others
have reached the Zenith, yours has but begun to mount the heavens — while others
have begun to fade, yours knows no eclipse, nor decline. You revere the names
of Hipocrates and Sydenham, of Brown and Cullen, with a host of others ; you
treasure up their maxims, and admire the genius with which they struck out new
truths, but you acknowledge no master, you fall down at the' feet of no Gamaliel '
You have come to the day of free thought, of free investigation, and free speech.
You call in question the most hoary, as well as the most recent fact, and you are
daily' revealing,, in floods of light, principles hid from the foundation of the world.

You are eminently the students of nature. While others may be led along dubi*
ous paths by mortal pedagogues, your teacher dwells in the realms of eternal light
and guides with hand unseen and unerring to essences and first causes. The for*
mative chiystal and germinal -dot are alike transparent before you. You are taught
the mysteries of the living principle ; the scalpel and retort are your companions,
while you revel in the wonders of the microscopic world. You understand, some*
what, the laws by which a mote or a mountain is formed, a monad or a man is
made. The spear of grass which lifts its head in the distant solitude, the lordly

218 Medical Independent. June

oak and imperial cedar, instruct you, while air. and earth, and sea, with the creep-
ing multitude, yield treasures at your command.

You are the veterans of a thousand battle felds, not of mortal strife where man
meets man in sanguinary conflict ; but where a secret and impalpable foe — a tyrant
who has reigned from Adam until now — disposes his secret forces and directs their
deadly shafts. When others have turned back affrighted and aghast, you, single-
handed and alone, have met "the pestilence which walketh in darkness," and the
destruction " which wasteth at noonday," despoiled them of " the armor wherein
they trusted." and have driven them ignominious, from the field.

Were the victories which you have won. the conquests which you have achieved
known, you would be crowned with laurels more unfading than those which
entwined the brows of Greek or Roman conquerors.

But more and better than all, you are the lovers of your race, the friends of hu-
manity. Scattered about all over this happy land, you emphatically :" go about
doing good." Your hearts beat in unison with human woe — your ears are open to
the cry of distress, whether it come from hovel or palace — you " wipe away the
orphan's tear and cause the widow's heart to sing for joy," — upon yoar heads daily
descend ';the blessings of those who were ready to perish." ,

To such a body of men thus actuated, thus coming, we extend a cordial wel-
come. We feel honored by your presence, and expect to be improved and elevated
by your intercourse. We throw wide our doors and invite you to the hospitalities -
of our homes, and to the kinder auctions of our hearts.

Dr. Winston then proposed that the roll of delegates, .who had
registered their names, should be read. The roll having been called,
it appeared that twenty States were represented.

Upon the suggestion of Dr. C. K. Winston, our venerable fellow
citizens, Drs. Felix Robertson, John Shelby, and James Overton were
made permanent members of the Association.

The following list comprises the names of all delegates, permanent
members, and members by invitation in attendance during the session :

Connecticut. — Charles Hooker.

New Hampshire. — Adoniram Smalley.

New York. — James R. Wood, 1). M. Reese, Geo, X. Burwell,
Alden March, Samuel St. John, ,

New Jersey. — Richard M. Cooper.

Pennsylvania. — "R. Dunglison, B. F. Schneck, Casper Wistar. P.
Cassidy.

Georgia.— Henry F, Campbell, C. R. Walton, N. F. Powers, A.
H. Means, Josoph P. Logan. M. IT. Oliver, Thomas S. Powell, J.
Gordon Howard, R. D. Arnold, Geo. P. Padleford, Pike Brown,
Jesse Boring.

Alabama.— (\ M. Merriweather. W. P. Reese, A. F. Allexander,
S. W. Clanton. W. II. Thornton, P. C Winn' T. Stith Malone' W.
J. Bass, G. D. Norris, J. F. Sowell, J. W. Morris-

Tennessee. — Frank A. Ramsey,. James Rodgers, R. O. Currey. B*
B. Lenoir, J. L. C. .Johnston, J. M. Boyd, Goo \. Grant, T. A.

Miscellany. 219

Atchison, S. S, Mayfield, J. D. Kellcy, T. L. Maddin, J. D. Winston,
J. E. Manlove, G. A. J. Mayfield, Richard Owen, W. P. Jones. J. P.
Ford, Robert C. Foster, Jno. II. Callender, Jno. H. Morton, A. H.
Buchanan, James W. Hoyt, N. C. Perkins, J. Berrien Lindsley, C.
K. Winston, Paul F. Eve, W. P. Moore, Milo Smith, Wallace Estill,
B. W. Avent, H. H. Clayton, H. M. Whitaker, H. B. Malone, T. M.
Woodson A.. B. Ewing, Robert Martin, W. K. Bowling, P. S. Wood-
ward, R. F. Evans, Thomas Lipscomb, M. Ransom, J. A. Long, Jno.
M. Watson, W. D. Haggard, Jno. S. Parke, D. B. Cliff, T. G. Ken-
nedyj T. R. Jennings, Ira Con well, ,J. S. Burford, W. H. Childress,
W. A. Cheatham, J. F. Towns, J. M. Brannock, B. O. Jillson, P. W.
Davis, G. F. Smith, W. D. Senter, J. W. McNutt, R, G. P. White,
J. P. Epperson, S. L. W^harton, T. C. Murrel.

Louisiana. — S. O. Scruggs. Robert A. New, Cornelius Beard, E.
D, Fenner.

Kentucky. — Samuel Annan, R. W. Gaines, J. B. Flint, J. W. Sin-
gleton, R. J. Breckenridge, S. C. Porter, W. S. Chipley, S. M. Bem-
iss, L. G. Ray, W. A. Atchinson, E. G* Davis, L. E. Almon, Jon. T.
Fleming, C. P. Mattingby, D. W. Yandell.

Indiana.— -W. II. Byford, W. W. Hitt, Isaac Mendenhall, T. Bul-
lard, N. Johnson.

Illinois. — J. C. H. Hobbs, A. H. Luce, James M. Steel, E. K. Cro-
thers, T. K. Edmiston, W. A. Hillsi.

Missouri. — S. Pollak, E. S. Eraser, Jno. S. Moore, C. A. Pope.

Michigan. — A. B. Palmer, L. G. Robinson, Zina Pitcher, W.
Brodie, L. H. Cobb, M. Gunn, Lewis Davenport.

Iowa. — Asa Horr, Wm. Watson, D. L. McGugin, J. C. Hughes.

Ohio. — Henry F. Koehne, J. Mosgrove, B. S. Browne, I). Ferris,
A. W. Munson.
Wisconsin. — Hays McKinley, J. K. Bartlett.

South Carolina. — E. R. Henderson, M. S. Moore. R. W. Gibbs,
R. S. Bailey.

Mississippi. — F. B. Shuford, J. S. Cain, J. T. Lowe.

Arkansas. — F. Grundy McGavock.

The President then stated that it was customary to take a recess of
fifteen minutes in order that the different State Delegations might ap-
point a member to serve on the Committee on Nominations, and the
Association took a recess accordingly for that purpose.

At the expiration of the recess the Association was called to order,
and the State Delegations then reported their choice respectively of
delegates to serve on the Nominating Committee, which was constitu
ted as follows :

Connecticut, Chas. Hooker ; New Hampshire, A. Smalley ; Indiana,

220 Medical Independent. June

W. W. Hitt; Wisconsin, J. K. Bartlett; New York, Jas. R. Wood;
Michigan, A. B. Palmer ; Missouri, J. S. Moore ; Illinois, T. K. Ed-
miston ; Kentucky, R. J. Breckinridge ; Arkansas, F. G. McGavock ;
Ohio, B. S. Brown ; South Carolina, R. W. Gibbs ; Alabama, W. P.
Reese ; Mississippi, F. B. Shuford ; New Jersey, R. M. Cooper ; Lou-
isiana, S. O. Scruggs ; Pennsylvania, P. Cassidy ; Georgia, Thos. S.
Powell ; Tennessee, J. B. Lindsley ; Iowa, Asa Horr.
On motion of Dr. Hooker, of Connecticut, it was resolved that the
President, Dr. Pitcher, be now requested to deliver his annual address.

Address of Zina Pitcher, M. D.' President of the American Med-
ical Association. Delivered on the occasion of the Meeting of the
Association in Nashville, May bth, 1857.

Assembled as we are here, under the auspices of the medical pro-
fession in Tennessee : meeting in presence of the citizens of this beau-
tiful city, honored by representatives from that better part of our
creation, who, like the Amarnt of Milton, throw their shadows and
shed their fragrance o'er the waters of the fount of life ; coming as
we have in considerable numbers from distant portions of the United
States, abandoning for the time being our private engagements, and
encountering on our way hither the hazzards incident to velocity in
locomotion, as if only to enjoy the social amenities and the pleasures
of professional re-union, these two questions naturally arise in the
minds of those who are merely witnesses of the spectacle presented
by our assemblage. " For what purpose is this convocation of physic-
ians 1 W^hat is there in the nature of their particular pursuit which
prompts them thus to relinquish its rewards, to forego the endear-
ments of home, when there is no visible manifestations on their part,
of a design to promote those objects which center in self-interest, to
advance the purposes of sectarian ambition or political partisan-
ship ?"

In the fulfilment of a duty incident to the position which I have had
the honor to hold for the past year, a year full of pleasant recollec-
tions to myself, I shall, whilst designing in brevity to follow the exam-
ple of my honored predecessors, attempt an , explanation of the phe-
nomenon we may be supposed to present to the mind of an intelli-
gent, but uninitiated observer.

Before entering upon the task I have assigned to myself, I beg you
to indulge -me one moment, in repeating to the Association my assu-
rances of gratitude for the distinction I have received at its hands, and
for the personal manifestations of confidence and the acts of courtesy
I have received from many of the individual members, the recollec-
tions ^of which will linger in my memory and lessen the concious-
ness of my weight of years, on the remainder of my journey down
the declivity of life.

The objects for which the Association was formed will ever enlist
my warmest sympathies and command my active co-opperation. I
congratulate you on the happy circumstances by which this anniver-
sary meeting is attended, on the evidences of vigor and the promises

1857. Editorial and Miscellany. 221

of longevity which this Association derives from its annual migra-
tions. God grant its existence may be prolonged by these annual
renewals of its vitality, so long as there are evils for it to reform, or
works of beneficence for it to accomplish.

To do what I have proposed satisfactorily to myself, would involve
the necessity of showing the relation which medicine has held to the
civil authority, to the ecclesiastical power and to the social cendition
of the people for all time antecedent to the date of this organization.
This review would also lead us to consider the relation which free
governments bear to letters, to science and the arts ; a field too large
for us to occupy on the present occasion. We shall endeavor, with-
out attempting all this, to present to your view the condition of the
profession at the time this organization sprang out of the antecedent
chaos, the cause or causes of that condition ; whether inherent and
incurable, or whether arising from intrinsic circumstances, which may
be remidied. and whether this remedy is to be found in public author
ity, or sought for in associated professional influence.

We remark first that a great and notable law marks and governs
all the works of creation. It is typified in the individual mind — in
our corporeal functions — in the movements of the race — and in the
revolutions of the heavenly hosts. — all are subject to this law of
periodecity, and this alteration of condition manifests itself even in the
domain of disease. We have seasons of activity and repose in the
-natural as in the moral world ; periods of illumination and obscurity —
'of activity and of rest : in the one case, producing day and night, win-
ter and summer, and in the other, those alternations Of social condition
which h#ve been spoken 'of as the Athenian age, the age of darkness,
literally a long and profound intellectual eclipse, to which has suc-
ceeded the active era of mental excitement and of material progress
in which we live, by which we are moved, the sun of which appears
not yet to have reached its.point of culmination.

In all the struggles which have marked the conflict between truth
and error, ignorance and knowledge, medicine has always taken a con-
spicuous part, having ever been a faithful auxiliary, when not a leading
element in every effort made to elevate and improve the condition of
mankind at one time allied to sacerdotal authority, as an indweller of
temples, and at anpther, incorporated into the body politic, or rather
engrafted upon the tree of State.

In the earlier stages of civil advancement, in all those territories
once composing the eastern and western empires, as is the case now in
Europt, where certain forms of government exist, the sovereign
authority prescribed the modes of worship, the forms of law and the
requirements of medical practitioners. Unless the vigorous conserva-
tism of these existing European governments is relaxed by the caprice
of vain and foolish princes, at the suggestion of wicked men or mis-
guided women, the right to exercise the functions of the physician is
only conferred on the most satisfactory proof of indefatigable culture.
And in the earlier pages of our own national history, we find the foot-
prints of our European ancestors in the records of those salutary laws
made for similar purposes, and transmitted to us by our political
progenitors.

222 Medical Independent. June

But in the process of time, when our form of government was
changed, when the repository of sovereignty become inverted, when
the power of the State passed from the few to the many, when the
State became nothing and the citizens all in all. when this sesresation
ol the sovereign power was rendered complete by the absolute freedom
of the elective franchise in many of the States, then our art ceased to
have a party in the commonwealth, as the law which became the
exponent of this new opinion, the expression of the popular intelligence.
eflaced from the publi 1 all legal traces of distinction between

the physician and the hypocritical pretender.

When the- a .: incentives to study were withdrawn, a

men, unprepared by mental discipline, rushed into the
professional arena, bearing down by their numerical force the few
remaining barriers which society was disposed to defend, notwith-
standing the abrogation of law.

The political r a which separated the American colonies from

Uie British crown, by loosening the connection between the Church and
"he State, insensibly Led the way to the more complete separation of
medicine from governmental control and political dependence. These
manifestations of popular absolutism, which swept away the preroga-
tives of the il professions, threatening to involve the

•" in the same uncharitable equality, were the remote causes of the
professional abas tad then reached, a humiliating conscious-

ness of which ; - I its members, who in the hope of reinstating its
departed dignity formed this Association.

Whatever effect this unrestricted distribution <>f political power
through all ranks of s :y. may have had upon the social body, it is
not our busi] ss to enquire, as ours is not a political institution, but
of its immediate influence in reducing medicine to a state of degrada-
tion, there is no reason for doubting the tact nor the propriety of this
exposition, for with physiciau s, logy is, often a key to diagnosis,
and without a true pathology, there is neither safety nor certainty in
"he therapeut

In treating of medicine in its social and political relations, it is not
my design, as I have no wish, even if the power were inherent, to
change our organization, or to advise an essential departure from our
plans of operation. I have presented the subject in this light more for
the purpose of reviving the courage of members who may have beg
to despair of success, because the objects we set out to accomplish,
have not been at once achieved.

Time must be given for results to mature, as all social institutions

of slow growth. Those who clothe and feed the members of them.

must become imbibed with a sense of their importance and necessity

for their advancement, as a means of promoting the public good, else

their co-operation cannot be secure. Hence our duty of endeavoring

move the social body and all its dependencies, like the horses of a
Grecian Chariot all abreast, striving at the same time to shield our-
selves against the propensity inseparable from the absolutism of a pure
democracy, to decapitate every object that raises its head above the
surrounding social level.

1857. Editorial and Miscellany. 223

We have stated with philosophical accuracy, but perhaps not with
strict regard to literal historic truth, that this Association was formed
to repair the evils resulting from the dissevered relation of medicine
to the State authority. Whatever formula we use in expressing the
idea, or by whatever rationale we explain our conception of the evils
said to exist, for which it was designed to furnish the remedy, the
records show that its mission was to reform the medical schools of the
United States, and to improve the preparatory education of students
of medicine.

The development of organic bodies depends upon the absorption
and assimilation of extraneous materials. If the' same law regulates
the growth of institutions, it becomes a matter of some interest to
inquire whether the schools are an out-growth of the profession, or
whether the profession is the product of the schools, for in either case,
there is a labor for us to perform, and the answer to this question
determines the place of beginning. ^j£:::i— ■-$■£■ r ^ ZSHmm.

Lest a doubt might arise as to the correctness of the opinion, we
wish to impress upon the professional mind, that society itself, and not
we alone, are amenable to censure for the abasement to which the pro-
fession of medicine had descended at the date of our associated exist-
ence, let us for a moment look into the records of the past, to see
whether we cannot find, an antecedent era, in which the world has been
subjected to similar moral cataclysms, by which ancient institutions
were broken up, their materials converted, into drift, to lay the foun-
dations of newer and more horizontal strata, from which we may draw
lessons of wisdom applicable to our own time and our own condition.

We believe that there is no period of ancient history into which
that of our art is intimately interwoven, presenting more analogies to
our own, and at the same time, so distinctly marked by strong antith-
esis, as that which intervened between the death of the Saviour and
Mohammed, when for more than five hundred years, a mighty strug-
gle was going on between that Divine word, " who lighteth every man
which cometh into the world," the spirit of the Indian religion and the
majesty of the Roman Empire, the latter aided by a fascinating phi-
losophy, made beautiful by the aesthetics of Longinus, each striving for
the possession of the human race.

Whilst the Empire thus labored to throw its Upas shadow over the
infant church, a social disintegration of castes, owing to these struggles
and the irruption of barbarian hosts from the north, took place, and a
consequent universal fusion of the races, languages and customs, pro-
ducing an excitation of thought, and a blending of people analogous to
the social fusion and the blending of types of disease, which we see
daily taking place in our own time and in our country. The minds of
men thus cut loose from their ancient fastenings, sought new affinities,
arranged themselves * in accordance with those difficulties into new
forms, many of whom wandered into unexplored paths, hoping with-
out the aid of a Divine guide to ascertain their relation to the unseen.

Thus also did the members of our own profession wander into
untried and forbidden paths, in pursuit of the ideal, up to the time this
Association was formed. A faithful picture of the last century of this

224 Medical Independent. June

historic period, presents the deepest contrasts of light and shadow that
can be portrayed in a single work of art. The darkest hue of vice
being drawn in the same pannel with the purest tints of virtue. The
church, young and vigorous, being soiled by its contact with a pagan-
ism inexpressibly wicked, against which it waged a war, unmitigated
by acts of mercy.

These outbreaks of emancipated human thought at each of these
epochs have had their use : have produced their fruits — late in arriv-
ing at maturity it is true — and especially so will it be with the germs
that are scattered in the midst of the confusion of our own times. 'An
abiding faith, that good seed, in spite of the tares that may choke it, or
the birds that may devour it by the wayside, will spring up and pro-
duce fruit in good season, has led me into this historical retrospect.

During the period to which we have alluded just sufficiently to
show what forces disturbed and broke up ancient civilization, we find
on closer examination, that the laws of the Empire relating to medi-
cine, though unrepealed, were not enforced.

These laws made it the duty of the provincial governors to send the
youth, subject to their jurisdiction, up to the city magistrates, where
they were required to submit to the most rigid system of surveillance
by the municipal authorities, their conduct as students, their deport-
ment as citizens, being subjects of official scrutiny. The medical pupils
under the training of the Archiatres, or State physicians, were fitted
for the performance of their duties in either the wards of the cities or
in towns or villages, whither they were sent by imperial authority, on
the requisition of the inhabitants, who ^paid for their services at a
stipu lated price.

Notwithstanding these requirements of law were left unrepealed,
the new opinions which had got possession of the popular mind, bteing
more powerful than statutes, when inforced by the Perabolani, a body
of religious medical enthusiasts, and various other pretenders, who,
impelled by the spirit which animates a people having just been taught
to exercise the privilege of judging in matters of faith, became pre-
sumptuous in matters of science, and applying this newly acquired
right of action to medicine, having numerical strength, they overrode
the prerogatives of caste, and trampled under foot the wisdom of all
preceding ages.

Whilst these conflicts of opinion" were being carried on in an age
that produced an Athanasius, a Jerome, a Chrysostom, and an Augus-
tine, and a system of Christian ethics which absorbed into itself all
that was valuable in the philosophies of Greece and Egypt, medicine
acquired celebrity from such names as Cacsarius, who became an
Archiater — Palatinus, Oribasius, whose works remain as monuments

1857v Editorial and Miscellany. 225

of his genius and proofs of his culture ; Actius, Alexander of Tralles,
and Paulus Eguineta, scarcely inferior in reputation to the father of
medicine himself. The lustre of these names seems but the more
expressively to mark the twilight of that night destined thence to
brood over Europe, whilst the materials 'of the ancient civilization,
broken into fragments by a rude and vigorous barbarism, were slowly
wearing away the chasacteri sties of the conquering hordes, and pre-
paring the way for its reappearance in new forms, through the instru-
mentality of the Free Cities and the feuj^l institutions of Europe.

During this general eclipse of letters, its occultation continuing till
the art of printing was invented, we have had furnished to us an op-
portunity of seeing how inadequate statutes alone are to the develop-
ment of institutions, and how impotent they are, even when aided by
professional co-operation, to resist the obstacles interposed by an
adverse public opinion.

If our design has been accomplished, we have shown that the work
of medical regeneration is to be commenced by the profession, whose
success is made dependent upon an intelligent concurrence of the popu-
lar judgment. But it must be remembered, that in attempting to
bring about essential changes in social life, in public policy, or in the
constitutional relations of the different States, by whose happy form
of union we are permitted to meet here to-day as fellow citizens of a
common country, we must keep in mind this fact, that all organic
nature is developed from embryonic existences — that all great changes
in opinion have had their origin in germs, planted long antecedent to
the production of fruit, and that advances in science and improvements
in the method of its application to art, have also had their seed time,
their period of growth, and must ever have their day of fruition.

History is filled with exemplifications of the truth of this remark,
and of evidences of the perpetuity of this law. The first step on the
road to the trans-Atlantic Telegraph was taken by Volta, when he
constructed the Voltaic pile — the next was the formation of the Gal-
vanic Battery. These inventions were followed by the discovery that
soft iron becomes a magnet when subjected to the action of an electri-
cal current, and resumed its normal condition as soon as the current
was withdrawn. Then it was proved that the magnetic action of a
current of electricity is not lessened in intensity by passing through a
long wire. Out of these antecedents, by the help of Grove's permanent
battery, the Magnetic Telegraph was developed and the art of magnetic
printing evolved.

But for the researches of Vesalius, who had traced out the course
of the lacteals, and splendid discovery of Harvey the circulation of
the blood might have been a long time postponed.

226 Medical Independent. June

Notwithstanding the perennial influence of those causes to which
we have ascribed the tendency to professional abasement, we have
met here to arrest and to counteract, there is in the condition of
things by which we are surrounded, much to inspire us with confi-
dence and to stimulate us to exertion.

We have not now, as did those who lived in the time of our histo-
ric analogue, to resist the pressure caused by the debris of an effete
culture. .

We have not to contend against the influence of those monstrous
forms of superstition whieh%rew out of the conjunction of Christian-
ity, when defiled by a co-partnership with the civil power, and the
decaying institution of its Pagan predecessor, when a phase of cre-
dulity was developed which would prescribe the contents of a mum-
my case, in preference to the kreasote involved in the process of the
manufacture of mummy, ooce an article of Egyptian commerce.

Those political causes to which we have alluded as tending to dimin-
ish the distance between our pre-existing social extremes, whereby
the medical profession lost its claim to legislative protection, have
already produced the signs of a growing national homogenity, by
fusing and re-casting into an American mould the various elements
of which the nation is composed.

Among these materials, so readily amalgamated, which by their
youth, energy and plasticity, give us our national character and nation-
al manners, there are some which need to be brought under the
hammer of the forge, as well as the heat of the furnace, before they
can be welded into the social mass. I alluded to a class of men,
wearing ecclesiastical habiliments, not wise enough to comprehend
that the professions are the growths of civilization, developed by the
wants and necessities ef society, each one having its part to act in the
drama of life, nor posse ssing that degree of self-respect, which would
prompt a man, not even claiming to be divinely called, to avoid the
contact of things proclaimed to be unclean.

When I speak of this class I do not mean the great body of Ameri-
can clergy — men who, instead of practising a heterodox medicine,
both practice and preach the precepts of their Divine Master as
things which appertain to man's social and everlasting peacer But I
mean a class, who, as if bitten by some moral Tarantula, become blin-
ded by a phrenitic distemper, and like the great adversary of the
Philistines, are ready to pull down the pillars of the temple, regard-
less of the ruin impending, whether the ruin involve a simple social
element or the integrity of the national fabric.

Having, then, in our favor the vigor and impressibility of a new
people, the resources of a new and rapidly developed country, the

1857. Editorial and Miscellany. 227

intelligence of a self-governing population, the augmentations of that
intelligence by the unrestricted importations of learned works and
the immigration of cultivated strangers, and the propulsion derived
from a free and active press, we have a right to expect success.
With such auxilaries, by a persistent assiduity on our part, we shall
at some future day enjoy the happiness of seeing our labors crowned
with the pageant of brilliant triumph.

The one thing already achieved, in the adoption and enforcement of
the code of medical ethics, is worthy of commemoration by the obser-
vance of an annual holiday. Till then we have suffered more from
quackery within the profession than from irregularities without. Now
that order of things is reversed.

From a survey, even of the surface of society, we learn how soon
the knowledge derived from medical sources strikes its roots into the
popular soil. Take as example the subject of organic chemistry, and
we shall see how rapidly its principles are passing into the stock of
general intelligence. The numbers are daily on the increase, in every
community, of those persons who know the necessity of nitrogenous
articles of diet when repairs are to be made in the fibrous and areolar
tissue, and how important an agency the carbo hydrogenous are sup-
posed to exert, by increasing combustion in the removal of certain
morbid conditions of the lungs. In this way the mutual relations of
the profession to the people is made apparent. The instruction com-
municated by the scientific physician is refunded to him in the mere
ased capacity of- the people to appreciate his worth.

We have spoken of the professions as the products of a general
culture, to which, in onr country, flp} must of necessity bear a fixed
and definite relation, and of the reciprocal influences they and the
society out of which they spring, exert upon each other. We have
shown in a single example by what apparently simple quotations in
scientific discovery, men are led to great practical results. As an
incentive to industry, and as a reason for confidence in slow but cer-
tain success, we will detain you one moment longer, in a hasty sketch
of the field of nature, such a scene being as suggestive of thought
and as f\Jl of instruction, as the examples furnished by the achieve-
ments oi art.

In adjusting our telescope, to study the features of some snow-clad
mountain, the organ of vision perhaps takes in the form of an enter-
prising explorer, whose feet still sparkling with ice as he descends
from its summit, will crush out the fragrance of the plants which
spring up to greet him as he walks downwards into the valley of flow-
ers. From the eminence attained by his enterprise he could trace the
eourse, and measure the elevation of the mountain chain, which give

228 Medical Independent. June

origin and direction to the rivers, effect the commerce, the languages
and migrations of men, fix the character of the vegetations, the abode
of its mammalia, and the habits of its population.

Subsidiary to the interest excited by this scene as a landscape, but
not subordinate in importance, lies the geographical formation of the
ranges which contain their mineral productions, give character to their
fountains and increase to the variety and beauty of the vegetation,
both on the slope of the mountains and in the valleys below.

Although a scene like this may excite emotion in the bosom of a
savage, and awaken a sentiment of adoration for the majesty . and
power which can give such grandeur to nature, and even pass from the
mind of an ordinary observer without any other expenditure of
thought, yet to master it as a subject of scientific study Would require
a prepatory knowledge of what is contained in the writings of Wer-
ner and Hutton and Miller on Geology, of Curvier and Buckland on
Paleontology, of Geoffrey, St. Hilliare and Agassiz on the races of
men and the migration of Animals, of M. Balbi on Ethnography, and
of Linnaeus and De Candolle and Torrey and Gray on Botany. And
to condense the whole into the congree of the " Cosmos " would re-
quire the genius and longevity of a Humboldt.

What is there then, gentlemen, left for us to do but to declare the
perpetuity of this Association, and renew our vows of fidelity to the
requirements of its constitution ?

In this proclamation and in these vows are involved the pledges,
that in our professional acts we will honor the principles of moral law,
which lie at the foundation of o^ code of Medical Ethics. That we
will use our individual intra enei^pid so try to direct the power of this
Association, as to secure a higher mental culture to medical students
and candidates for medical honors. When this is accomplished the
medical schools will rise in character as a correlative effect, and the
profession establish for itself a legitimate claim to public confidence
and popular esteem. Our custom of meeting in each successive year,
in a different State of the Union, prevents the decay of the body, by
the introduction of new material ; and we illustrate in this way the
doctrine of Zymosis, by the rapid assimilation of these ne^ elements
into the common mass. Another custom of the Association has done
much to bind it to the the individual States, that of shedding its honors
upon the profession of the State in which the meetings are held,
through which we hope to secure the sympathies of the people, and
enlist them as , allies in the warfare we are engaged in, against the
hosts of ignorance.

A departure from the established usage of the Association, in either
of these particulars, would mark the date of its decline both in vital

1857. Editorial and Miscellany. 229

force and mental vigor. Any restriction put upon its freedom of
motion, or attempt made to centralize its influence, would enstamp it
with the seal of decay.

But if the avenues to material success are so direct and brilliant,
that the talent of the country is tempted to take the shorter road to
wealth, whereby we fail in our attempt to lay the foundation of a
national medical literature, in holding up a higher exemplar to the
medical student, by teaching him the necessity of a thorough prepara-
tory discipline before commencing professional studies, and urging
him by the force of opinion, to master the elements of his profession
before assuming the responsibilities which attach to the discharge of
its duties, we may yet in one way leave our traces upon the national
character and our foot-prints on the national history, in the hallowing
of one day in our annual calendar, on the recurrence of which, we may
have, by the example of our patriotism, the stamp of nationality, in
bringing to our shrine no sectional passions, and so conducting our
proceedings that brilliant memories shall adorn our annals, the names
of our celebrities be embalmed as national benefactors, and the anni-
versaries of this Association, in honor of their services, shall form by
popular consent, one of the holidays of this glorious Republic.

Often in the crises of sectional commotion the moral necessity of a
common shrine,. a national feast, a place, a time, or a memory sacred
to fraternal sympathies and general observance, appals the. patriotic
heart with regret^ or warms it with desire ! Were such a nucleus for
popular enthusiasm, such a goal for a nation's pilgrimage, such a day
for reciprocal gratulation our own — a time when the oath of fealty
could be renewed at the same altar, the voice of encouragement be
echoed from every section of the confederacy, the memory of what has
been, the appreciation of what is, and the hope of what may be, simul-
taneously felt, what a bond of union, a motive of forbearance, and
pledge of nationality would be secured !

By the blessing of the Divine Founder of our holy religion, who,
nineteen hundred years ago, went up to Jerusalem with his disciples
to celebrate a national feast, may the proceedings of this body be so
overruled, that the recollections of this meeting at Nashville to-day.
when softened by the " moonlight of memory," may become a hallow-
ed event in the annals of our yearly migration.

On motion of Dr. Flint, of Ky., the thanks of the Association were
tendered to the President for his very able address, and the same was
referred to the Committee on Publication.

The chairman of the Committe of Arrangements announced that the
sessions of the Association would be from 9 A. M. to 2 P. M.
vol. in, no. iv — 4

230 Medical Independent. June

Judge Carton, of the U. S. Supreme Court, being present, was
invited to a seat on the stand.'

The Nominating Committee then retired for the purpose of nomin-
ating officers for the ensuing year.

The report of the Committee on Publication being called for, it
was read by Dr. Casper Wistar, of Pennsylvania, and on motion
was accepted and referred to the committee on publication.

Dr. Wistar also read his report as Treasurer, which was received
and adopted.

On motion of Dr. Flint, of Ky. Dr., R. T. Fleming, of Ky., was
admitted as a member of the Association by invitation.

The committee on Prize Essays being called upon to report, re-
quested further time, because of the late hour at which the essays were
handed in, which was granted.

The President informed the Association that Dr. F. Campbell
Stewart, of New York, Dr. Alden March, of New York, and Dr.
Pancoast, of Perm,, had been appointed to represent this Association
in foregin scientific bodies.

The committee on Medical Education was called, but made no
report.*

The committee on Medical Literature was called — no report.

The committee on Medical Topography and Epedemics being called,
a communication from Dr. J. C. Watson, of Maine, was read, asking
for further time to make a report, which was granted.

Dr. Arnold, of Georgia, offered the following resolution, which was
adopted :

Resolved, That the committee on Nominations be constituted a stan-
ding committee during the present session of the Association, to which
shall be referred all business of the Association on which an immedi-
ate vote is not required.

Dr. Jas. Mauran, of the committee on Medical Topography and
Epidemics for Rhode Island, being called for, the Secretary read his
apology, which was accepted.

Dr. Peregrine Wroth, of same committee for Maryland, sent in
his report, with accompanying reports of Drs. A. M. White and Ed-
mund E. Waters, which was received and referred to the committee
on Publications.

Dr. W. L. Sutton, of same committee for Kentucky, sent an apol-
ogy and asked for further time, which was granted. .^iaillk • -

The members of the same committee for the State of New Hamp-
shire, Vermont, Massachusetts, New York, New Jersey, Pennsyl-

♦Received after the adjournment.

1857. Editorial and Miscellany. 231

vania, Delaware, Virginia, District of Columbia, South Carolina,
North Carolina, Tennessee and Minnesota being called no reports
were made.

The delegates from Connecticut and Louisiana being absent for the
time, the consideration of their reports was postponed until to-
morrow.

A report from Dr. J. F. Posey, of Georgia, was presented by Dr
Arnold, and subsequently withdrawn by him for the purpose of pre
paring an abstract of it.

The committee on Nominations then appeared, and through their
chairman, Dr. J. B. Lindsley, reported the following officers of the
Association for the ensuing year, viz :

President. — Dft. Paul F. Eve, of Tennessee.

Vice Presidents. — R. J. Breckenbridge, of Kentuckey, D. M.
Reese, of New York, W. H. By ford, of Indiana, and Henry F.
Campbell, of Georgia.

On motion of Dr. Arnold, of Georgia, the report was accepted.

The chairman stated that the Secretaries will be selected when
it is ascertained where the next meeting of the Association will be
held.

Dr. Wister, of Pennsylvania, moved that a committee of three be
appointed by the President to conduct the newly elected officers to
the chair, which was carried.

The President sppointed as such committee, Drs. Wister, Arnrid
and McGugin,

The President elect being absent, the Association adjourned to
meet at 9 o'clock, A. M., to-morrow.

SECOND DAY.

Nashville, May 6, 1$57.

The Association met persuant to adjournment. The minutes of
yesterday were read and adopted.

The committee appointed on yesterday, Drs. Wister, Arnold and
McGugin, were then requested to conduct the newly elected officers
to their respective seats.

Dr. Eve, of Tennessee, in taking the chair, addressed the Associa-
tion in a few pertinent remarks, as follows :

Gentlemen of the American Medical Association :
It is with deep emotion that I attempt to return you my heart-felt
thanks for this distinguished honor. In elevating one so unworthy of

232 Medical Independent. June

this station, so ill-prepared to preside over your deliberations, or
carry out the great designs of this body, I must express the appre-
hension that you have done yourselves injustice, and, it may be, not
advanced its best interests. But, believing that this office should
neither be sought nor declined, when tendered as it has been, after my
. State has declined to take any part in the nomination of a presiding
officer, I enter upon the discharge of its onerous duties with much
diffidence, and shall have frequent occasion to throw myself upon
your considerate indulgence.

We are engaged, gentlemen, in a good and noble work. Life, the
greatest of human blessings, and health, the sweetest stimulus to
earthly enjoyments, are our end and aim. We live to secure the one
and to preserve the other. To promote these all important objects,
the medical profession of our country have, during the past twelve
vears annually appointed delegates to assemble and counsel how this
may be effected. And we are here to-day on one of these great fes-
tive occasions, and, amidst our mutual congratulations, these glorious
re-unions of good-will and fellowship among the brotherhood, must
not forget that to us is committed the health and lives of others. In
maintaining the honor and increasing the usefulness of medical sci-
ence, we become the best contributors to the welfare and happiness of
those around us. You have come up hither from the North and from
the South, from the East arid the West, and have done well neither to
count the cost nor calculate the sacrifice ; for the cause in which you
are engaged is worthy of you. You present again the sublime spec,
tacle of brethren from all sections of this widely extended Union,
congregated to devise the best means to relieve suffering humanity ;
and may I not add, we are here with

"Our souls by love together knit,
Cemented, mixed in one ;
One hope, one heart, one mind, one voice."*

Dr. Winston, of Tennessee, read the names of additional delegates
to the Association.

Dr. Hooker, from the committee on Medical Topography and
Epidemics for the State of Connecticut, being called on for his report,
arose and explained that it was his understanding that the committee
were to have three years in which to make their report, and at the end
of that time he would either be prepared or ask the indulgence of
the Association for further time.

The President, under a resolution passed at the last meeting, ap-
pointed Drs. Currey, Grant and Evans, a committee on Voluntary
Contributions.

Reports now being in order, the report of Dr. Posey, of Georgia,
was called for ; Dr. Arnold, of Georgia, read an abstract of the re

1857. Editorial and Miscellany. 233

port of Dr. Posey ; all of which, on motion of Dr. Palmer, of Mich-
igan, was referred to the committee on Publication, under a suspen-
sion of the rule.

On motion of Dr. Wood, of New York, the reports which were
presented yesterday were also referred to the committee on Publica-
tion, under a suspension of the rule.

The State of Ohio being called upon for a report upon its Medical
Topography and Epedemics, the Secretary read an apology from Dr.
G. Mendenhall, who asked further time in which to make a report,
which was granted.

The State of Mississippi, Missouri, Michigan Illinois, Indiana, Wis-
consin, Iowa, California, and the U. S Navy, being called, no response
was made.

A telegraphic despatch from Dr. S. M. Sims, of New York, who
was to report on the Treatment of the Results of Obstructed Labor 9
was received and referred to the appropriate committee.

A communication was received from the Southern Methodist Pub-
lishing House, inviting the members of the Association to visit . that
establishment, which was accepted.

A communication was read by Dr. Lindsley, of Tennessee, from
the Medical Association of Washington City, inviting the National
Association to hold their next annual meeting in that city. On mo
tion, the communication was referred to the committee on Nomina-
tions

A resolution was offered by Dr. Bartlett, of Wisconsin, tendering
a vote of thanks to the late President, Zina Pitcher, for the able man-
ner in which he has presided over the deliberations of this body,
which was unanimously adopted.

The reports of Special Committees for 1856-7, being next in order,
they were called in order as follows :

Inflamation — Its Pathology, etc. — Dr. E. R. Peaslee, Maine ;
asked futher time. Referred.

Anatomy and Histology of the Cervix Uteri. — Drs. H. Hutching-
son and Charles E. Isaacs, New York ; no report.

Treatment of Cholera. — Dr. J. Taylor Bradford, Kentucky; no
report.

Treatment best adapted to each variety of Cataract, etc, — Dr. Mark
Stephenson, New York ; further time asked. Referred.

Causes of the Impulse of the heart, etc. — Dr. J. W. Carson, of
New York ; a communication was received, and on motion of Dr.
Brodie, he was continued.

Causes of Infant Mortality, etc. — Dr. D* Meredith Reese, of New

234 Medical Independent. June

York, read an abstract of* his report, which was referred to the com-
mittee on Publication.

The venerable Dr. Shelby, of Tennessee, being present, was invi-
ted to a seat on the stand. His appearance was warmly acknowledged.

Dr. Hobbs, of Illinois, offered the following resolution :

Resolved, That a committee on Essays, (not including Prize Es-
says,) be appointed, to whom all essays prepared for publication by
this Association shall be referred, which committee shall transfer to
the committee on Publication, all Essays they judge worth publishing.
That said committee on Essays, make a full report of their proceed-
ings to the Association at its next annual session ; provided, authors
of rejected essays being informed of said rejection by said committee,
shall have the privilege of withdrawing their essays from the report
of the committee to the Association.

On motion of Dr. Palmer, of Michigan, this resolution was indefi-
nitely postponed.

The Secretary read a protest signed by Drs. Richard Arnold, J.
Gordon Howard, Pike Brown, and Geo. L. Padleford, against admit-
ting the delegates from Oglethorpe Medical College, as follows :

Nashville. May 5. 1857.'
The undersigned, members of the American Medical Association,
protest against the admission of delegates from the Oglethorpe Medi-
cal College of Savannah, on the ground that it is not a regularly or-
ganized college, it being a matter of public notoriety in Savannah, that
during neither of the two sessions of its existence, have all the chairs
been regularly filled. During its first session the chairs of Phisiologv
and Materia Medica were not filled, except by a very few lectures, by
the gentleman appointed to them, and the same thing occurred during
its last session as to the chairs of Materia Medica and Chemistry.
All of which is respectfully submitted.

Richard D. Arnold, M. D.

J. Gordon Howard, M. D.

Pike Brown. M. D.

Geo. P. Palelford, M. D.

After several resolutions were offered and some discussion,
On motion of Dr. Palmer, the whole subject was referred to com-
mittee of three to be appointed by the chair.

Dr. Brodie, of Michigan, moved as an amendment, that no Faculty
Member of a Medical College be appointed upon the committee, which
was accepted by the mover.

1857. Editorial and Miscellany. 235

The Chair appointed as'such committee, Drs. Wister, of Pennsylva-
nia, Bemiss, of Kentucky, and Gibbs, of South Carolina.

Dr. Felix Robertson, the oldest physician in Tennessee, being pres-
ent, was invitecLto a seat on the stand. He was greeted with marked
consideration by the Association.

The committee on Nominations was convened to transact important
business.

The calling of Special Committees was resumed :

Spontaneous Umbilical Hemorrhage, etc. — Dr. J. Foster Jenkins,
New York. Further time asked. Referred.

Use of Instruments in Obstetrical practice. — Dr. .Henry Carpenter,
of Pennsylvania. No report.

Measures to be adopted to remedy the evils existing in the present mode
of holding Coroner's Inquests. — Dr. Alexander J. Semmes, D. C. Re-
port presented with the following resolution attached :

Resolved, That committee of three, in each State, Territory, and the
District of Columbia, be appointed, and that said committee be, and
they are hereby authorized in the name of this Association, to memo-
rialize their respective Legislatures, to pass such laws as will best
carry into effect the objects of the foregoing report.

The report was referred to the Committee on Publications, and the
accompanying report adopted and referred to the committee on Nomi-
nations.

True position and value of Operative Surgery, etc. — Dr. J. B. Flint,
of Kentucky. Further time asked. Granted.

Causes and cure of indigestion, etc. — Dr. G. Volney Dorsey, of
Ohio. No report.

Medical Jurisprudence of Insanity, etc. — Dr. C. B. Coventry, of New
York. Further time granted.

Human, Animal and Vegetable Parasites, etc. — Dr. Joseph Leidy,
Pennsylvania. No report.

Value of strict attention to 2>osition in the treatment of Diseases of
the Abdomen. — Dr. M. D. Darnall, Indiana. No report.

Milk Sickness. — Dr. George Sutton, Indiana. No report.

Blending and conversion of the types of Fever. — Dr. Clark G. Pease,
Wisconsin. Communication sent, but not received. Postponed.

Best Substitutes for Cinchona,etc. — Dr. B. S. Woodworth, Indiana.
No report.

Use of Cinchona in Milarious Diseases. — Dr. Franklin Hinkle,
Pennsylvania. Report furnished. Referred to Committee on Public
•cation.

Nervous System in Febrile Disease. — Dr. Henry F. Campbell,

236 Medical Independent. June

Georgia. Verbal abstract of report given. Referred to Committee
on Publication.

Laws Governing the Absorption and Deposit of Bone. — Dr. John
Neill, Pennsylvania. No report.

Intimate Effects of Certain Toxicological Agents in the Animal Tis-
sues and Fluids. — Dr. John W. Green, New York. No report.

Intimate Structure and Pathology of the Kidney. — Dr. Charles E.
Isaacs, New York. Further time granted.

Diseaseases Incidental to Emigrants, etc. — Dr. Israel Moses, New
York. No report. N

Etiology and Pathology of Epidemic Cholera. — Dr. T. \V. Gordon,
Ohio. Partial report presented and referred.

Excretions as an Index to the Changes going on in the System. — Dr.
H. A. Johnson, Illinois. No report.

Remedial Effects of Chloroform. — Dr. D. D. Thompson, Kentucky.
No report.

Best Method of Causing an Increase in the Number of Essays, etc. —
Committee : Drs. Leidy, Wood and Meigs, Pennsylvania. No re-
port. Committee continued.

Changes produced in Com})osition and Properties of Milk, etc. — Dr.
N. S. Davis, Illinois. Communication read and further time granted.

Stomatitis Matema. — Dr. McGugin, Iowa. Further time granted.

An abstract of the report of Dr. Fenner, of Louisiana, upon the
Medical Topography of that State, was then read and referred.

Dr. Singleton, of Kentucky, offered the following resolution, which
was unanimously adopted :

Resolved, That in the death of Dr. Grafton, of Mississippi, the
American Medical Association has lost a talented and useful mem-
ber, and society a benefactor.

On motion of Dr. Whi taker, of Tennessee, Dr. JH. Ronalds was
expelled from the Associatiation for giving certificate contrary to the
rules of the Association.

Dr. Caspar Wister, chairman of the committee upon the admission
of the delegates from Oglethorpe Medical College, reported as fol-
lows:

Dr. W. Benson asserts that for the past session the Oglethorpe
school has been fully organized, that six professorships have been reg-
ularly filled, and that the occupants of these chairs have been in the
constant fulfillment of their duties, except in cases of illness ; such
instances having, however, at no time interrupted the regular course
of lectures, the professor absent having had his place supplied by his
colleagues. The seventh chair is admitted to have been vacant ; the
duties were discharged however, fully by other members of the faculty*

1857. Editorial and Miscellany. 237

Dr. R. D. Arnold prefers no charges beyond those admitted
above.

Therefore, your committee finding nothing that infringes upon the
strict letter of the law of the American Medical Association, in refer-
ence to the admission of members, we recommend that all further ac-
tion in this question be suspended.

CASPAR WISTAR,
R, W. G1BBES,
A. M. BEMISS.

The Secretary read the following preamble and resolutions, which
were unanimously adopted :

Whereas, It has pleased God to remove by death our fellow-mem-
ber, Robert M. Porter, and because of his devotion to the interests of
the Profession of Medicine, and his steady support of the American
Medical Association. #

Resolved, That this association learned with unfeigned sorrow of
his decease ; and that they have lost a firm and intelligent supporter,
and society a benefactor and friend.

Dr. T. Bullard, of Indiana, offered the following" :

Resolved, That in the death of Dr. John L. Mothersett, this Asso-
ciation has lost a useful member, and society a benefactor.

The Secretary read a commuuication from the Connecticut Medical
Society, asking that the time for holding the meetings of the Associa-
tion in northern cities be changed to a later period in the year. Re-
ferred over to the next meeting by the Constitution. Adjourned to
meet at 9 o'clock, A.M. to-morrow.

THIRD DAY.

Nashville, May 7, 1857.

The Association met pursuant to adjournment. The minutes of
yesterday were read and adopted.

Dr. Hoyte, from the Committee of Arrangements, read the names
of additional delegates to the Association, who had arrived since the
meeting of the Association yesterday.

The Secretary read a communication from Dr. Clark G. Pease, of
Wisconsin, which accompanied his report on " Blending and Conver-
sion of the Types of Fever."

Dr. Hooker, of Connecticut, moved that the report be referred to
the Committee on Voluntary Contributions.

238 Medical Independent. June

Dr. McKinley moved to amend by having a portion of the report
read, which was lost, and the motion recurring to refer the report, it
was carried.

Dr. Currey from the Committee on Voluntary Contributions, sub-
mitted the following report, which was accepted :

The Committee on Voluntary Contributions has examined the fol-
lowing papers, and reccommend them for publication in the Transact-
ions of the Association. :

1st. A new Principle of Diagnosis in Dislocations of the Shoulder
Joint. By L. A. Dugas, M.D., Professor of Surgery in the Medical
College of Georgia, Augusta : accompanied by four photographic
• plates illustrating the principle.

2d. Medical Statistics of Washington Territory. By George Suck-
ley, M.D., U.S.A., embracing, 1st, Geological Divisions of the Ter-
ritory ; its Geology, Meteorology, Fauna. 2d, White population and
its diseases. 3d, Native population : Diseases ; Medical Practice ;
causes of their rapid disappearance : concluding remarks.

3d. Medical Flora ©f Washington and Oregon Territories. By J.
G. Cooper, M.D.

All of which is uespectfullv submitted.

R. O. CURREY,
R. T. EVANS,
GEO. R. GRANT.

Dr. Yandell ottered the following resolution :

Resolved, That this Association re-affirm the principles respecting
the rights of constituent bodies announced in a report contained in
Volume V. of its Transactions, in the following terms :

" The Faculty of every Medical College, shall have the privilege of
sending two delegates to this Association, provided, that the said Fac-
ulty contain not less than six Professors, who give one course of in-
struction annually, of not less than six weeks, on Anatomy, Materia
Medica, Theory and Practice of Medicine and of Surgery, Midwifery,
and Chemistry ; and also that said Faculty requires that its candi-
dates for graduation, among other requisites, shall have attended two
full courses of lectures with an interval of not less than six months
between them, one of which courses must have been in their Institu-
tion.

Dr. Breckinridge in the Chair.

Dr. Buchanan proceeded to discuss the resolution, and at the close
of his remarks, moved to lay it on the table, which was subsequently
withdrawn.

1857. Editorial and Miscellany. 239

Dr. Boring offered the following resolutions in lieu, which he pro-
ceeded to discuss :

Resolved, That this Association has not the power to control the
subject of Medical Education.

Resolved, That the great objects of this Association are the advance-
ment of Medical Science, and the promotion of harmony in the pro-
fession.

Resolved, That the attempt upon the part of this body to regulate
Medical Education, having most signally failed in its object, and al-
ready introduced elements of discord, any further interference with
this subject would not only be useless, but calculated to disturb and
distract the deliberations of this Association.

Dr. Currey offered the following resolutions in lieu of the whole :

Whereas, The subject of Medical Education has been committed at
each annual 'Session to Standing Committees, and various suggestions
have been proposed, which the Association has adopted, and recom-
mended to private instructors and to the Medical Colleges.

Resolved, That a Committee of five be appointed by the Committtee
on nominations, as a Special Committee, to be composed of members
who are in no respect connected with any Medical School, to devise a
System of Medical Instruction, to be presented for the consideration o£
this Association at its annual Session in 1858.

Resolved, That the proposed system shall set forth a uniform basis,
upon which our Medical Institutions shall be organized, as well as have
reference to the best mode of securing the Preparatory Medical In-
struction to the Student, and that consequently the legitimate subjects
to be embraced in said system, will include Primary Medical Schools
— the number of Professorships in Medical Colleges, the length and
number of terms during the year, the requisite qualifications for grad-
uation, and such other subjects of a general character as to give uni-
formity to our Medical system and preserve harmony and friendly
intercourse in the ranks of the profession.

Resolved, That, upon the adoption of the proposed system by the
Association, all Institutions which may conform to it shall be entitled
to representation at the Annual Sessions of this Association and none
others.

The subject was further discussed by several members of the Asso-
ciation.

Dr. Reese, after some remarks, moved the indefinite postponement
of the whole subject, which was lost.

Dr. Arnold moved the previous question, which was lost, and the
discussion proceeded at considerable length, when

240 Medical Independent. June

Dr. Hooker moved the previous question on the resolutions of Dr.
Carrey.

The reading of the various resolutions being called for, they were
read to the Association.

The motion of Dr. HooTter being in order, the previous question
was called, and the resolutions of Dr. Carrey were adopted.

Dr. Lindsley, from the Nominating Committee submitted the fol-
lowing report :

Secretaries. — Robert C. Foster, of Tennessee. A. J. Semmes, of
Washington City.

Treasurer. — Caspar Wistar, of Philadelphia.

For the next place of meeting, Washington City.

STANDING COMMITTEES.

Committee' of Publication. — Francis G. Smith, oi Philadelphia
chairman ; Caspar Wister, of Philadelphia ; R. C. Foster, of Nash-
ville ; A. J. Semmes. of Washington City ; Samuel L. Hollingsworth,
of Philadelphia ; Samuel Lewis, of Pennsylvania ; H. F. Askew, of
Delaware.

Committee on Prize Essays. — Grafton Tyler, of Georgetown, D. C,
chairman: J. C. Hall, of D. C. ; J. F. May, of D. C. ; Thomas Mil-
ler, of D. C. ; A. J. Semmes. ot D. C : Joshua Riley, of D. C. ; W.
J. C. Duhamel, of D. C.

Committee of Arrangements. — Harvey Lindsly. chairman ; W. J. C.
Duhamel, Cornelius Boyle. P. H. Coolidge, G. M. Dove. A. Y. P.
Garnett. Wm. P. Johnston, of D. C.

Committee on Medical Education. — G. W. Norris, of Philadelphia,
chairman ; A. II. Luce of Illinois ; E. R. Henderson, of South Caro-
lina ; G. R. Grant of Tennessee ; T: S. Powell, of Georgia.

Committee on Medical Literature. — A. B. Palmer, of Detroit, chair-
man ; A. F. Alexander, of Alabama,; J. M. Mosgrove, of Ohio; P.
Cassidy of Pennsylvania ; S. Pollak, of Missouri.

Vacancies in Committee on Medical Topography and Epidemics. —
T. B. Shuford to fill the vacancy caused by the death of Dr. Grafton,
of Mississippi. C. W. Parsons, to fill the vacancy caused by the res-
ignation of Joseph Mauran, of Rhode Island.

SPECIAL COMMITTEES.

Sjjontaaeous Umbilical Hemorhage of the newly bom. — J. Foster
Jenkins, of New York.

Influence of Marriages of Consanguinity upon Offspring. — Dr. Be-'
miss, of Kentucky.

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THE

MEDICAL INDEPENDENT:

A MONT II L Y

Review of Medicine and Surgery.

VOL. 3. DETROIT, JULY, 1857. NO.

§xmml unumuutations.

Article I. — Notes upon Glycerine. By Frederick Stearns,
Pharmaceutist.

In a pure state, Glycerine forms a nearly colorless and very
viscid liquid : sp. grav. 1.27, without odor, of an intensely
sweet taste, mixing with water and alcohol in all proportions,
but insoluble in ether.

That obtained by distillation under the new patent process
of Price and Company (London) is entirely free from lead,
earthy salts, and from bad smelling volatile fatty acids, which
are present after the usual processes of refining, in ordinary
Glycerine obtained from lime saponification, and in the pro-
cess of lead plaster making.

The applications of Glycerine depend mostly on its remark-
able solvent powers, its property of absorbing moisture, ir>
bland and soothing character as an application to injured and
diseased surfaces, and its nutrient qualities. As a fat.tener it
is likely to be a useful adjunct to cod liver oil.

It has considerable power in preserving animal substances
from decay, and fixing their colors. The advantages of using*
Glycerine as a solvent and excipient are many.

Its solvent power very often equals that of water or alco-
hol, and even is sometimes greater; it can be mixed with

VOL. Ill, NO. iv — 5

M2 Steaenb on Glycevme. July

alcoholic and aqueous solutions, it is not subject to changes,
particularly it does not become rancid, its preparations may be
ased like any oily embrocation ; they will be readily absorbed
by the skin, which afterwards may be washed with a little
water. Wounds, after they have been dressed with such a
preparation, may be easily washed out with warm or even
sold water ; surgical instruments may be cleaned with much
fess difficulty.

It dissolves the vegetable- acids readily. By the aid of heat
one part of tannic acid may be dissolved in four parts of
Glycerine.

The Sulphurets of Potassium and Calcium dissolve in ten
times their weight of Glycerine. These solutions must be kept
from the air. and are readily decomposed by the addition of
water.

Iodine and the iodides generally, are readily taken up by

mis substance. The Iodide of Sulphur, insoluble in alcohol

»r water, dissolves one part in sixty parts of Glycerine. One part

©f Iodide of Potassium requires but three parts of Glycerine for

its solution.

Dr. Gage, of ]STew Hampshire, recommends an loduretted
(rlycerine in skin diseases, prepared in this way : one part of
Iodide Potassium is dissolved in three parts of Glycerine and
one part of Iodine added, which completely dissolves, in em-
ploying it the application of it is covered with a paper of gut-
t;a perch a to prevent the evaporation of the Iodine.

It is suggested that by dissolving in Glycerine, escharotics
and astringents such as Chromic Acid, Terchloride of Anti-
mony, Pernitrate of Mercury, Iodide of Zinc, etc., which are
used in venereal diseases, that their action could be made to
continue longer and be under the control of the physician
better than when used in aqueous solution.

Glycerine dissolves when heated l-40th of Sulphate Quinia,
which forms, upon cooling, a transparent gelatinous mass.

It forms solutions with most of the delliquescent salts, sul-
phates of Potassa and Silver, the alkaline chlorides, Potassa,
Soda, Baryta, Strontia, Bromine and even Oxide of Lead.
It dissolves or suspends the vegetable alkaloids in the same
manner as the aqueous liquids, the solutions may be used for
the same purposes as though mixed with oil. The salts of

1857. Stearns on Glya i iru . £43

Morphia, Brucia, Strychnia, Yeratria, and most preparations
of the same order dissolve in it completely even when cold,
all when hot, but when cold seperate into clots, which when
triturated with the supernatent liquid, give it the consistence
of a cerate very useful for frictions and embrocations.

One part of Bin Iodide of Mercury requires three hundred
and forty parts of Glycerine for its solution.

Five parts of Glycerine and one part of Gum Arabic form
a transparent mucilage. One part of Glycerine to three of
powdered Gum Arabic unites to a thick mass which when
spread adheres well and is very flexible, a few drops of Gly-
cerine added to the court plaster mass makes it pliant and pre-
vents the spread plaster from cracking.

Glycerine mixed with an equal part of tar, and strained,
forms a tar glycerole of a dark amber color, strong smell and
oily consistence, serviceable in some skin diseases.

Equal parts of Ammoniac and Glycerine unite to the consis-
tency of plaster, one part of the first to seven of the latter
forms a cream like glycerole which may be strained through
linen and does not separate.

Camphor is only soluble in it, one part to four hundred.

Glycerine, it is believed, would form a better absorbent of
the active principles of fresh plants than fats, in the making
of ointments, because in addition to the clorophyll, wax, aro-
matics, and coloring matter, which fats only take up, the Gly-
cerine would take up or dissolve, besides these the gum, su-
gar, tannin, extractive matter, watery juices, alkaloids and the
aroma.

One part of Glycerine added to fifty parts of Collodion im-
parts to it flexibility and elasticity.

As it is a solvent of Urea and Phosphate of Lime it is sug-
gested as a solvent of Urinary Calculi by injecting it into the
bladder, where from its blandness it should not cause irrita-
tion.

Lts properties of soothing and keeping moist the skin have
caused it to be used upon chapped hands and sun burnt faces.

It has been proposed as a substitute for syrup in preserving
fruits, and mixed with alcohol or pyroxylic spirit, as an eco-
nomical fuel tor spirit Lamps.

In the preparation of Beveral medicines, Glycerine may be

2Jr4 Stearns on Glycerine. July

substituted for sugar, preserving them from change and im-
proving the taste. Griffith's Iron Mixture is mentioned as an
example of this.

Glycerine was first introduced some ten years since as a new
remedy for certain cutaneous diseases, by Mr. Startin, its use-
fulness depending upon its bland nature and capability of re-
sisting evaporation at considerable temperatures. A lotion of
half an ounce to six of water effectually prevents the skin
from becoming dry, it is added with advantage to poultices
and also to baths.

Mr. Startin speaks of its use chiefly in psoriasis, pityriasis
lepra, and ichthyosis in which he describes it as producing ex-
cellent palliative effects, it keeps the part moist and prevents
the formation of scabs.

It can be used somewhat diluted with water in owns and
wherever it is desirable to prevent the drying iniiuence of
the air from irritating an exposed surface. Heretofore, the
principal reputation Glycerine has attained as a medical agent
is due to the remarkable effects said to be produced by it in
restoring the power of hearing in cases of confirmed deafness,
but the later experiments of Dr. Wilde fail to confirm its
value, though doubtless it is valuable in lubricating the audi-
toy canal in those cases of deafness where a dry condition of
that canal exists.

• As an internal remedy, Dr. Crawcour, of i^ew Orleans, in-
troduced it into use. He employs it in all cases where he for-
merly employed Cod Liver Oil and with better effect, it pos-
sessing all the remedial virtues of the latter, without disorder-
ing the digestion. It has been employed in phthisis and scro-
fulous disease with marked success. In addition to its antis-
trumous property, it aids in assimilating the Salts of Iron, es-
pecially the Iodide. The dose administered is from one to
three drachms, three times a day in water ; in those doses it
in a short period relieves the cough, improves the digestive
powers, and increases the deposition of fat.

Dr. Crawcour suggests that hot Glvcerine will dissolve Phos-
phorus in the ratio of two grains to the fluid ounce and con-
siders the resulting glycerole of Phosphorus as much supe-
rior to the common phosphorated oil, from the effect of this
solution upon himself he is of the opinion that in this form

1857. Stearns on Glycerine. !>45

Phosphorus more readily enters into the circulation and mani-
fests its peculiar stimulant action; lie thinks ten to thirty min-
ims sufficient for a dose. More recently Dr. W. L. Lindsay
(Perth, Eng.) in order to test the nutrient properties of Gly-
cerine tried its effects upon himself by taking two or three
spoonsful daily for several weeks, the result was a gain of two
pounds in weight in one month, on discontinuing the Glyce-
rine his weight gradually fell until after an interval of six
weeks he found himself one pound lighter than when he com-
menced the use of it. lie also tried it as a dietetic remedy along
with various articles of food. Pure Glycerine is so intensely
sweet that it cannot he used alone but should be diluted accord-
ing to the purpose for which it is prescribed. Coffee when
partially sweetened with Glycerine in addition to ordinary
sugar is pleasant and free from any peculiar taste. It can be
used to sweeten tea or milk though it is therein more readily
detected. Its admixture with water is palatable and is proba-
bly its most convenient form of administration. Dr. Lindsay
further observes, "I carefully observed its effects as a nutrient
and alterative in eight patients — four males and four females,
to whom it was given in doses of two or three tea or table-
spoonsful daily for the space of a month.

They were weighed at intervals to ascertain their gain or
loss of flesh ; for I found that apparent physical improvement
was not a reliable criterion of real physical growth — that a
most marked amelioration in the general health did not always
coincide with increased weight of body. All the patients be-
fore taking it weromore or less anaemic, emaciated and feeble ;
in all, their diet, exercise, and occupations, were otherwise the
same. At the end of the month all of them appeared greatly
improved in tbeir general condition; they seemed plumper
and Btronger, and the countenance, in some, was even ruddy."

The following formulae are from the Northwestern Medical
and Surgical Journal :

"For cases of tubercular disease in its early stage before
the cough is accompanied by much expectoration we frequent-
ly prescribe :

R. Glycerine — two fluid ounces.
Iodide Potassium — one drachm.
Sulph. Morphia — two grains.

24(> Stearns on Glycerine. Juty

Mix and give one teaspoonful before each meal and at bed
time.

If the disease is farther advanced and expectoration more
copious with rapidly increasing emaciation, we prefer the fol-

lowing

R. Glycerine — two Huicl ounces.

Syrup Iodide of Iron — one half fluid ounce.

Sulphate Morphia — two grains.
Mix, and give one teaspoon ful every four or six hours. v

Startin's formula for Glycerine Liniment :
Take Glycerine — one fluid ounce.

Powd'd Trascacanth — one fourth to one-half ounce.

Lime Water — lour fluid ounces.

Rose Water — three fluid ounces. M.

As a liniment or embrocation in prurigo, Ziehen strophulus,
lepra, psoriasis, pruritus, &c.

Startin's formulae for Glycerine Lotion :
Take Glycerine — one-half fluid ounce.

Diluted Nitric Acid — one-half to one fluid drachm.
Subnitrate Bismuth — one-half drachm.
Tincture Digitalis — one fluid drachm.
Rose Water — Seven and one-half fluid ounces.
M. As a lotion, (to be used by dabbing the part) for chap-
ped nipples or hands, fisures of the lips, irritation of the skim
of any kind, exposure to the sun, 'pityriasis, &c.

R. Glycerine— one-half fluid ounce. ' -

Powd'd Borax — one-half to one drachm.
Rose Water — seven and one-half fluid ounces.
M. Used (by dabbing the affected part) in Alopecia follow-
ing fevers; in dryness or want of action in the scalp, thinness
of the hair.

R. Glycerine- — one-half fluid ounce.

Aromatic Spirits Ammonia — one fluid ounce.
Tincture Cantharides — two fluid drachms.
Rosemary Water — Seven fluid ounces.
M. As a lotion to be used with a wet hair brush once or
twice a day in rheumatism or gout, neuralgic pains, sprains,.
bruises, .stiffness, &c.

1857. Stbakns on Glycerine. 24;

R. Glycerine — one-half fluid drachm.

( Jomp'd Soa]) Liniment — one and one-half fluid oz.
Extract Belladonna — one drachm.
M. As an embrocation to be used twice a day in the or-
dinary manner.

The writer of this article has prepared the following oint-
ments for chapped skin, sunburn, etc., which from their ele-
gant appearance and perfume have proved very acceptable to
those for whom they were designed :

Glycerine Creevni,
Take White Wax — three drachms.

Spermaceti — one < >unce.
Glycerine — three fluid ounces.
Oil Almonds (sweet) — six fluid ounces.
Exiract Orange Blossoms — one fluid ounce.
M. Prepare after the method of cold cream.

Glycerine Jelly.
Take Powd'd Gum Arabic— one-half ounce.

Simple Syrup (3 oz. sugar to 1 ox. water) — four fluid

ounces.
The yolks of three eggs.
Olive Oil (pale) — four fluid ounces.
Glycerine — two fluid ounces.
Rub the Gum and Syrup well together, then add the yolks
of eggs and when well mixed, add gradually the Glycerine
and oil, previously mixed together. Perfume to suit.

These preparations though properly belonging perhaps fa
the perfumer — form very agreeable methods by which to ob-
tain the soothing influence of Glycerine in all irritable state*
of the skin.

In conclusion, though a variety of uses, actual and possible.
tor Glycerine have been mentioned, yel in considering it*
power as a solvent, its bland nature, its freedom from all irri-
tant, exciting, acid, and fermenting properties, it is obvious
that but few of its uses have been as yet developed, and it is
believed that pure Glycerine is destined to become among th,
most valued of modern products.
162 Jeffer&yn Avenue, Jmi< S, 1857.

248 Kane's Case of Injury of Thorax. July

Article II. — Case of dislocation of both clavicles, at their
sternal extremeti.es, — Serious injury of the Pulmonary struc-
tures by depression of the Superior portion of the Sternum ;
Copious Ilwmorrhage* — Recovery — Remarks. Bv Edward
Kane, M. D.

On the 27th of August, 1849, at 4, P. M. I was hastily call-
ed to see a young* woman sixteen years old, to whom the fol-
lowing casualty had occurred. Returning from school in com-
pany with a number of others, she was met in the street, by a
drove of cows and young creatures, among which, was an ex-
traordinary sized Durham bull. It was during a season of
severe drought, and the cattle were on their way from a dry
hill pasture to the low grounds, a mile distant, where was
abundance of water. In their ardour to slake their thirst, they
were wild and uncontrollable, and happening to pass when
the children were returning from school, the young woman
was run against knocked down, and the bull stepped with one
of his fore-feet, upon the upper portion of her Sternum, sever-
ing it from its attachments to the clavieulse on either side and
chiving it down upon the apices of the lungs. The extent
of injury to the pulmonary tissue, from such an immense
weight upon that part of the sternum and the imminent
danger will be readily inferred. Not far from an hour clasped
before my arrival. I found her. sustained by friends, in a
semi-recumbent pasture, with a scarcely perceptible pulse,
heart's action, correspondingly feeble, surface, cold, counte-
nance tumid and mottled, as were the extremities, also ; great
difficulty of breathing, with loud tracheal rattle, florid and
frothy blood, discharged from the mouth and nostrils, in consi-
derable quantity ; expression of the countenance and eye,
fatuous, and the superior portion of the sternum depressed, as
was judged at the time, three fourths of an inch to an inch.
How much blood had been lost, prior to my arrival, I had no
means of determing, but basing opinion upon what was ob-
served on the ground, on her clothes, towels and in vessels,
furnished for the purpose of catching it, the quantity must have
been very great. She was not otherwise injured. To what
extent the lungs were inflated, at each inspiration, in other
words, over how great, a portion of them, the respiratory mur-
mur could be heard, could that be ascertained on account of

1857. Kane's Case— Treatment. 249

the extreme loudness of the treacheal rattle. Though con-
scious, intellect was almost annihilated ; certainly, the mind
seemed quite in the confused and unfeebled oondition of a
person in articulo mortis.

Treatment. — The indication was first, to free the chest as
completely as possible, from all constraint, by clothing, or
otherwise, in order that sufficient air might be admitted, at
each inspiration, to approximate normal hsematosis; to aid
the circulation, as far as practicable, by elevating the depressed
sternum to its natural position ; the most favorable posture,
both for the escape of the blood, which was soon observed to
be diminishing in quantity, and easy respiration; to augment
and preserve the animal heat, and particularly, in the extremi-
ties, and to support the feeble powers of the economy, by ap-
propriate diffusible stimuli. For the time, the dislocations
of the clavicular were matters of minor consecpience, and
therefore, were but little cared for, until reaction was produc-
ed, and the energies of the system satisfactorily restored. Car-
bonate of ammonia was. .administered, brandy and water also,
from time to time, and dry heat applied to the extremities un-
remittingly. The patient was placed in a reclining posture,
with an inclination towards one side, with the view of aiding,
as much as position could be made available to that purpose,
the escape of blood and tracheal secretions, and, by inserting
the finger, as far as practical, beneath the sternum, at the
slight depression, in its superior extremity, it was raised, to its
place, from which, as respiration became more free, aided pas-
sibly by tumefaction of the tissues within that section of the
cavity of the chest, it manifested no marked tendency to re-
cede. During the three succeeding days, her condition was
most critical. She was sustained, however, in the best man-
ner possible, by steady persistence in the use of the above
mentioned measures, bland but nourishing food, and absolute
quiet, both corporeal and mental. The haemorrhage subsided
gradually, and by the morning of the twenty-ninth, was com-
pletely suspended. On the thirty first reaction was, in a tolera-
ble degree, established, but it never arose to a point above the
normal standard. For a number of days, there was copious
expectoration, at first, of a bloody consistence and appear-
ance, but finally, of muco-purulent characteristics. By the first
of September, the condition of the patient was so far improved.

250 Kane's Case — Remarks. .July

that I deemed it proper to adjust the clavicular and seek to
effect their union with the sternum. For this purpose, the
double headed roller was used, after the manner of Charles
Bell, with nicely adapted compresses and cushions and the
arms properly supported in slings. I found but little difficulty
in retaining the dislocated bones in situ. The completest
state of quietude, compatible with the sufferings of the patient
was steadily maintained ; the general medication and nourish-
ment were adapted to the condition of the economy, and an
anodyne, interposed, from time to time, as pain jactitation,
and sleeplessness required. Under these measures, faithfully
carried out, I had the pleasure of seeing my patient improve,
from day to day, until, between the third and fourth week,
complete union having boon consummated, she was dismissed
cured. I had considerable solicitude about the ultimate
soundness of the lungs, apprehending that injury, so serious
had been inflicted, as greatly to interfere with normal respira-
tion and therefore, with the function of luematosis. Fortu-
nately, however, 1 was unnecessarily solicitous, since, in the
course of a year, she married, is now the mother of a number
of children, and at my last information, about one year since,
she was in perfect health. 1 have deemed the case of suffi-
cient interest, in several particulars, ami especially, as connect-
ed with grave injury of organs, that are intimately related to
life, and ultimate recovery, to warrant the subjoined : —

Ri marks — The extent to which organs and tissues, of the most
delicate structure, may be injured by external violence, by acute
or protracted chronic disease, compatible with life and ultimate
restoration, to a normal condition, or of the enjoyment of com-
petent health, under progressive disease of fatal tendency, is
not less a source of deep interest to the profoundly learned in
anatomical and physiological science than of wonder to the
uninnitiated, and inexperienced. A few examples may be
referred to, in illustration and, first, of such as are produced by
external causes. Only, a superficial acquaintance with the
history of surgery and surgical maladies will be sufficient to
convince the most doubting of the truthfulness of the above
suggestions. Without undertaking to illustrate, by a reference
to the records of military surgery, where in numerous, pertinent
examples may be found, it will be sufficient to refer to some of
the rarer cases, that are met with, in private observation, with

1857. Kahe's Cast -Remarks. 25

an allusion, merely, to one or two, winch occurred on the bat-
tle field. The brain is conceded to be among the organs,
most intimately connected with life and a healthful condition,
both of mind and body, But the recorded observations of
medical men show, not only, that the cranium may be fractur-
ed, portions of it depressed and driven down upon the sub-
stance of the brain, lacerating its dense fibrous envelope-, not
less than its more delicate membranes, but penetrating its vet}
substance, and yet under the skillful application of surgical
science, the parts are restored to a normal state, and health, as
well mental as physical, completely established. Indeed,
under such injuries, very considerable portions of its .substance
are, not unfrequently, removed, adhering to the depressed por-
tions of bone, or to slivers, projectiles etc., that have been driven
into the brain, and still the same fortunate results have been
known to follow. I knew a case, many year- since, in which a
lad was precipitated, with great violence, from a horse, against
the extremity of a large log, recently chopped, from which a
sliver, three fourths of an inch in diameter projected, was
driven through the right parietal bone into the hemisphere of
the cerebrum. It was reiribved, as also, spiculae of bone, with
portions of the brain of considerable size, adhering to them :
the patient was intelligently eared for, treated, and recov-
ered. Those, who are familiar with the literature of surgery,
for the few past years, will recollect the case, which occurred
in one of the New England States, of a railroad operator, who
while blasting rocks, had his tamping iron, twelve to eighteen
inches in length, and not far from an inch in diameter,— enter-
ing beneath the orbitar arch, — driven through the anterior
lobe of the cerebrum and passing out through the parietal bone
of the same side, lie recovered; and when 1 last knew of him •
something less than two years since — he was healthy vigorous
and robust. The annals of surgery are not wanting in in
stances of like import and equally satisfactory results.

Argument is not necessary to convince the least informed,
how essential to life and health, is the heart; yet. even it has
been wounded with penetrating weapon-, and if memory do
not deceive me, with bullets, while yet the patienthas QOtonlj
recovered, but enjoyed a, comfortable Btate of health for years,
thereafter. Most, doubtless, are familiar with the famous case
of Wm. Pool, of recent occurrence, in the citv of New York.

252 Kane's Com — Remarks. July

In this example, the bullet was lodged in the muscular parieties
of the heart. The patient, notwithstanding, lived twelve days,
and by the well informed in surgical pathology, and therapeu-
tics as well as physiology, normal and anormal, I shall not be
regarded as altogether fanciful or heterodox if I offer the beliet
that, but for an unfortunate visit by a jDerson, who was offen-
sive to him, the resulting passion and exertion, he might,
nay, probably would have recovered. Centainly, no grave
symptoms had manifested themselves, prior to the event, just
referred to. The post-obit examination revealed, not only
singular difficulty in finding the ball, lint the process of repa-
ration as having made considerable progress.

The stomach and alimentary canal too, are among the organs,
the integrity of whose structure and the healthfulness of whose
functions are scarcely less indispensable to perpetuated existence,
than those already mentioned ; and still, these may be punc-
tured, lacerated and torn, without the sacrifice of life or the
necessary ruin of health.

Surgical record i> not jejune of examples, illustrative of the
truth of this proposition. Nor are the secular journals defici-
ent in detailing the outline of eases, of almost daily occurrence,
in the scene- of dissipation and riot, of penetrating wounds of
the abdomen, in a greater or less proportion of which, the in-
testines are wounded, which result in recovery and the after
enjoyment ot comparatively good health.

In truth, if no other example were extant, than that of St. Mar-
tine, wherein some thirty-five years since, the stomach was
fearfully wounded, by an accidental shot- from a musket, is
sufficiently illustrative.

lie not only recovered, but, in spite of vicious habits and
variously modified management and experiments, for scientific
purposes, he has enjoyed sound health during all the long in-
terval, since recovery. I was accustomed to see him, almost
daily during most of the summer of 1833, — sometimes drunk
and sometimes sober; and again, not quite a year since, I saw
him, and while I regret to say he evinced unmistakable
evidence of persistence in his old and cherished vice, never-
theless, I was agreeably surprised to notice how slight were
the inroads made upon his constitutional vigour, by the con-
joint influences of the fistulous opening into the stomach.

1857. Kane's Cast — Treatment. 253

poverty, hard labor, poor living, continued intemperance and
accumulating years. Cases of serious lesion of die intestinal
canal are of frequent occurrence, in connection with strangu-
lated hernia, which, after operation, are recovered from, and
it were fortunate, if no instances could be brought forward, as
evidence of the culpable ignorance or the no less culpable care-
lessness of men. whotake upon themselves, the responsibilities
of physicians. A few months since, I was informed by an
intelligent practitioner, of a case, in a neighboring city, in
which, in attempting to deliver a foetus, with the blunt hook,
after embryotomy, about twelve inches of the rectum, — nearly
its entire length.— were torn away. It was a case, in which
consultation was had, at an early period. The patient, after
much suffering, recovered her health, with no worse conse-
quence than that of the performance of the function of defeca-
tion pervaginam. But few textures of the organism are morede-
licate than those of the lungs, nor are there any, perhaps*
whoso abnormities are more distinctive of life, and, whose
functions are more intimately related to existence, yet the}
may be punctured, with spiculse of bone, in cases of fracture
of the costsejwith deadly weapons and even perforated with
bullets. Persons may be shot through the chest, one or both
lungs being involved in the injury, and still, recover, live on to
good old age, and in the enjoyment of a tolerable share of
health.

I have met cases of attempted assassination, wherein, a lung
has been deeply wounded, copious quantities of blood dis-
charged; air escaping largely through the external wound,
while yet under judicious management, complete recovery
has occurred. In fracture of the ribs, I have known the pul-
monary structures to be seriously wounded andair effused into
the areolar tissue external to the costde constituting fearful
emphysema and giving rise to the gravest and most dangerous
form of dyspnea. In such even, recovery ha- followed and
good health ha- been attained. Like examples, doubtless, are
familiar to the observation of most practitioners of experience
Certainly, they are not ofunfrequent occurrence. It has been
my pleasure to have enjoyed the intimate acquaintance of a
gentleman, now, not far from Beventy years old, who, during
the last war of our own country with Great Britain, was shol
through the chest, while leading on his command at the battle

£554 K a n k's ( lose — Remark*. J uly

of Chippewa j, in Canada West, — the ball, entering one side
and passing out at the other. lie recovered; and daring the
long interval, that Las intervened, has enjoyed as good health
as falls to the lot of most men. Retiring from the army, he
qualified himself for the practice of law, which profession, he
pursued, with distinction, for many years. The only conse-
quence, which gave rise to any considerable inconvenience,
was a tremulousness, which, as age and its infirmities have in-
creased, rendered it difficult for him to write. The example
of the heroic Gen. Shields, who met a similar casualty at the
head of his column, in one of the hard fought battles of the late
Mexican war, will, at once, recur to the recollection of the
reader. The General so far as I am informed, though possibly
not feeling himself quite as competent, physically, to endure
severe and protracted muscular exertion, enjoys a comparatively
good state of health. But, secondly, if organs and tissues,
which are intimately connected with life, may be thus, injured,
by casualties and external violence and not he destructive of
life or ruinous of health, it is not less true that they may un-
dergo derangement of function and injury of structure, from
disease, acute and chronic, quite equal to such as have been
instanced, in the foregoing remarks, and yet, under the salu-
tary influence of intelligent medication, aided by ilie recupe-
rative powers of the economy, be restored to a normal condi-
tion— the entire organism may resume its wonted healthful
monuments and existence may be prolonged many years. A
slight reference, only, will be necessary, on the part of the
reader of observation and reflection, to acute inflammation and
its consequences, to revive in his recollection, pertinent illus-
trations. In this relation, it wdll be unnecessary to particula-
rize. Perhaps, however, examples of as marked significance,
as are to be found in the domain of professional literature, may
be traced, in the pathological results of chronic disease. A
few references will suffice. Possiblv the more common forms
of chronic disease of the brain are less frequently followed by
complete recovery, than are grave maladies of other organs,
whose integrity of structure and function are indispensable to
a comparative state of healthfalness, if not of life. Here,
however cases of deep interest may be found. Among others,
not less instructive the following mav be mentioned. A stu-
$ent of great physical and mental energy was attacked, dur-

1857. Kane's Case- — Remarks. 255

ing the summer of 1822, with acute disease, in which the cerebral
organs were chiefly involved. He was twenty years old.
After continuing, with fearful severity, for some time, it re-
sulted in hemiplegia of the right side. At the end of some
months, sensibility and muscularity were completely restored,
except in the muscles charged wifh the flexion and extension
of the foot on the tibia. In these, muscularity has been imper-
fect ever since, but sensibility has been perfect and his general
health, remarkably good. In the caurse of the next year, he
returned to the university, and, after completing his literary
course, read law ; in due time, entered upon the duties of his
profession and has ever held a commanding position at the
bar, having from an early period, been regarded one of the
first advocates, in the state, whose literature, and institutions,
he adorns.

In the summer of 1849, a laborer, after having wrought
at his vocation, — that of principal sawyer, in a large lumber
establishment, — was, suddenly attacked with the gravest form
of general paralysis. It was one of those, not altogether com-
mon cases, in with vitality was all but extinct. Sensibility
and voluntarity were completely annihiliated, — respiration and
circulation, alone continuing. In the course of a year, how-
ever, he so far- recovered, as to begin to walk, and, with some
hesitancy and difficulty of utterance, to converse. From this,
recovery progressed to such an extent, that all the natural func-
tions were accomplished with normal energy and he was able
to perform some light labor. I saw him, in the month of
April last, and discovered no other evidence of physical defect,
than incapacity for sprightly movement, muscularity not being
quite so perfectly restored in one limb as in the other, a tardi-
ness of utterance and difficulty in recalling to recollection, cer-
tain words, or, perhaps, in associating particular ideas with
their proper representatives. His personal appearance con-
sidered and the fact that the natural functions are normally
performed, he must be regarded as enjoying perfect health.
Examples of equal interest might be drawn from the history
of chronic hydrocephalus, but my proposed limits forbid the
further prosecution of this department of the subject. In the
heart, cases will be met with, of the profoundest disease, which
have progressed with singular tardiness, the patient, mean-
while, enjoying the plenitude ft health, until some unusual eX-

256 Kane's Com — Remarks. July

citerueut or indiscrete exertion or indulgence, as of mental pur-
tnrbation, shall call forth symptoms, that are characteristic and
declarative of the disease, or such as are anomalous, and, after
a more or less protracted c< uitinuance. terminating in death.
Under such exertion or excitement and when the malady has
advanced to a certain extent, death may occur suddenly and
without marked premonition. Instances of the former may
he found in works on diseases of the heart, and. particularly
in Latham and Graves1 clinical lectures.

Of the latter, the melancholy and untimely death of the
most eminent man of his own — I had almost said of anv age —
John Hunter, is an apposite instance. Of analogous conditions
and results, connected with chronic disease of the stomach and
alimentary canal, illustrations will offer themselves to him,
who has read and observed, in those exceedingly painful and
dangerous eases, in which perforation, from the gradual pro-
gress oi' ulceration has taken place. That recovery under
such unfavorable circumstances, does occur. I believe, is not,
now, to be questioned, and that comfortable health may follow,
rests on established data. I do not propose ro instance exam-
ples. To have mentioned the facts, fulfills my purpose. But
if the brain, the heart, the stomach and intestines may be thus,
seriously diseased and recovery, ultimately ensue, or if in either,
disease necessarily fatal, may pass on, to its final termination in
death, while plenary health may be enjoyed, up to the last
moment, or to a brief period prior to the sad event, it is quite
certain that the lungs may he as seriously implicated, and,
under appropriate treatment, recover, and a condition of satis-
factory health be established. h\ confirmation, I need only
refer to the softening of tuberculous masses, the cicatrization
and restoration of the pulmonary tissue to a condition of sound-
ness, and the ultimate correction of the tuberculous cachexia,
to an extent, at least, compatible with a good degree of vigor.
I might produce other examples, not le>s significant and in-
structive, as vomica*, empyema, gangrene pulmonum, etc..
but a reference, merely, will suffice, to indicate their ap-
positeness.

In consideration of the foregoing case, and observations, the
following conclusions may be deduced. First, it is the duty of
he medical adviser, though his case be fraught with the most

1857. G-uww's Surgical JVcies. 257

imminent danger, not to be too hasty in pronouncing an un-
favorable prognosis. Second, to study well, those portions of
professional literature, that contain the record of cases of dis-
ease, which are most fearful in their import ; to contemplate
and seek to understand the laws of life, and the strong ten-
dency, implanted in the constitution, to resist the influences of
hurtful powers, and by consequence, to effect restoration, when
injury has been sustained. Third, in the treatment of such
cases, to consider, most fully, the true therapeutical action of
the measures lie proposes to adopt, lest, by possibility, they
counteract the conservative and restorative movements of the
economy, and therefore, injure and destroy, rather than accom-
plish the good, he desires.

Article ILL — Selections from Surgical Notes. By Pbof.

Gttxx.

Abscess — Simulating Malignant Growth. — The cases here
selected derive their chief interest from the idea conveyed in
the head, under which I have chosen to couple them. In the
first, I was completely at fault in diagnosis, as were the intelli-
gent gentlemen who had preceded me in the examination ; in
the second, exploration alone, confirmed what I will not pre-
tend to call my diagnosis, for in fact it was only what I may
perhaps term a hopeful surmise.

Case I. On the tenth of May, 1856, Dr. J. A. Brown of
this city brought to my office a little patient only four months
of age. The left thigh was involved in an apparently diseased
mass which extended from the groin to the knee, projecting
more in front than elsewhere, preseting a lobulated form, with
a highly vascular, tense, attenuated and shining condition of
the integument. The mass was elastic, and had been grow-
ing since the child was three or four weeks of age. These
characteristics, together with the puny appearance of the
child left no doubt in my mind as to the medullary character
of the growth. The same view was entertained not only by
Dr. Brown, but by Dr. Louis Davenport who had also exam-
ined the case. I remarked however to Dr. B. that we would
explore the nuiss, and on introducing the exploring needle,
laudable pus issued from the wound. I then opened the ab-
scess and evacuated the pus ; the tumor collapsed and the

VOL. Ill, NO. iv — 6

258 Vegetable Organisms, c&c. July

skin resumed its natural appearance. The patient was from
Canada and I have never heard from it since.

Case II. Mrs. E. S., age about thirty, also suffering from
a disease of the left thigh, I saw for the first time on the 27th
Nov., 1856. The limb was much enlarged from the groin to
the knee, and like the preceding case, projected more in front
than laterally or posteriorly. The mass, which was elastic
to the touch, was smooth and uniform in its outline, as though
the adventitious matter was bound down by the fascia lata,
and the skin was vascular, attenuated and shining. It was
the seat of a dull heavy, though not severe pain, alternating
with that of a transient and lancinating character. The pa-
tient was much emaciated and worn down by months of suf-
fering from the disease, and so strikingly did the history of
the case portray the rise and progress of medullary cancer,
that her former attendant had communicated his convictions
to the husband and read to him a description of that disease.
I was then called to the case, found it as above stated, and in
the elasticity of the growth, detected that faint fluctuation
which characterizes a fluid greatly distending the walls of the
cavity in which it is confined. This obscure fluctuation led me
to hope for the presence of pus, though the history of the case
and aspect of the patient indicated anything else. The explor-
ing needle realized my hopes, the matter was evacuated, and
the patient has fully recovered.

87 Shelby street, June 6, 1857.

Article IV. — On the Occurrence of Vegetable Organisms
{Fungi) in Acid and Saline Solutions. By Henry Erni,
Professor of Chemistry and Pharmacy in the University of
Vermont.

It is an authenticated fact, that while certain poisons pre-
vent the propagation and development of particular species of
Fungi, other species seem to flourish well under the same cir-
cumstances, and hence are found in liquids containing Arse-
nious Acid and its salts, salts of Mercury, organic and mineral
acids. • Every attentive observer has seen that solutions of
Tartaric Acid in laboratories become mouldy, even when kept
in glass-stopped bottles; also dilute Acetic acid (vinegar).

1857. Terry's Case of Poisoning by Strychnine 259

I believe I have noticed it sometimes in dilute Oxalic acid.
In proportion as these Fungi propagate, the acid disappears,
and a mere watery liquid remains. In a series of experiments
on the cause of fermentation (published in the proceedings of
the American Scientific Association, New Haven, for 1851)
wherein Saccharine liquids were mixed with various poison-
ous compounds, the author witnessed, that whilst Arsenious
Acid, Salts of Mercury and Copper, — even Oil of Turpentine,
destroyed the yeast Fungus, other species of Fungi, for in-
stance, accumulated at times around solid pieces of Arsenious
Acid.

In the water of the Alabama, Genesee County (New York)
Mineral Spring, which I analyzed, and which from its contain-
ing a considerable quantity of free Sulphuric Acid, tastes
sharply acid, were found certain forms of Fungi.

Small quantities of Creosote are found to be among the most
active preventives of vegetable organisms, in any kind of
solution, Salts of Chromium (Chromate of Potassa) never
mould, and hence may well be used in a dilute form to pre-
serve Anotomical (Albuminous) preparations, such as brain,
&c.

Dr. Goadby, who has for many years devoted much attention to
this subject has found from observation that a saturated solution of
the Bichloride of Mercury (Corrosive Sublimate) will vegetate ; but
used in greatly diluted quantities vegetation appears impossible.
That from upwards of twenty years experience in the use of almost
infinitismal proportions of this Salt, combined with other agents, in
all climates, he has never known a single instance of vegetation to
occur.

There is no substance more liable to vegetate than flour paste, and
yet the doctor has kept his pot of paste for years free from vegeta-
tion by a couple of grains of Corrosive Sublimate, and therefore re-
gards this Salt of Mercury, — properly diluted, — as an exception.

Article Y. — Case of Poisoning by Strychnine. By A. R.

Terry, M.D.

In the summer of 1845, I was called on board the steamer

E , about half past eight o'clock in the morning, in

great haste.

On my arrival, I found a middle-aged man lying on the

260 Tekky's Vase of Poisoning by Strychnine. July

floor of the cabin on deck, and a physician, who had arrived a
moment before, in attendance. The man stated that he had
taken, just before breakfast, about half a teaspoonfull of
strychnine, and (after eating) as much more. He showed a
bottle marked "Sulphate of Strychnine, 1 drachm" from
which at least one third part had been taken, and said that he.
had bought and opened the bottle himself.

My friend, the physician first in attendance, would not be-
lieve that he had taken the poison, as the quantity alledged
was so enormous and no tetanic spasms had yet occurred : and
lie looked on it as the hallucination of a crazy man.

We gave him, within a minute of my arrival, a drachni of
Ipecac, which I had in my pocket. As the steamer was on
the point of sailing, the patient was removed on a litter, to a
small tavern a few yards distant, and laid on a bed, without
undressing him. He had been lying there from three to four
minutes, and I was mixing some mustard for an emetic, when
he suddenly threw up his arms, as if to keep off some fearful
spectre, his face assumed a look of terror I have never seen
equalled, and he shouted " It is coming, it is coming ! " and
was apparently dead in ten seconds. The convulsion arrested
the action of the heart and respiratory muscles almost instant-
ly, and the body was left drawn back from head to heels, and
as rigid as a bar of iron. The eyes were wide open, and the
pupils dilated to their utmost extent, giving an expression of
indescribable horror to them. This expression of the face re-
mained for some hours after death, but as the muscles gene-
rally relaxed it disappeared.

In the last and sole convulsion, there were no contractions
and relaxations, but every muscle was apparently contracted
to its utmost, — life being as effectually extinguished as if he
had been suddenly transmuted to stone.

I give this as a case where the action of the poison had prob-
ably been retarded by the taking of food immediately after
the first dose, and immediately before the second.

I will remark that when I first saw the patient, there was a
-light starting or twitching of the tendons at the wrist, as in
incipient s ubstdtus temdirmm.

There were reasons why no autopsy to ascertain the condi-
tion of the brain and spinal marrow could be had.

1857. Terry's C&se of Poisoning by Strychnine. 261

I have recently seen that the inhalation of Chloroform has
been employed in cases of poisoning from Strychnine. On
pathological grounds I should look for benefit from its use.
That the immediate^cause of death is from arrestation of the
action of the heart and respiratory muscles appears certain ;
and this from tonic spasm. Now if an agent like Chloroform
will counteract this spasm and allow circulation and respira-
tion to go on until the nervous centres have recovered from the
effects of the poison, it appears reasonable to expect a re-
covery.

The well-known case of the ass poisoned by the Wourari^
(which seems to belong to the paralysing narcotics, such as
Prussic Acid) may be held to have some bearing on the ques
tion. In this case, life was prolonged by artificial respiration
until the muscles had resumed their functions, and the animal
recovered.

In the case of poisoning by Wourari it was necessary to
keep up respiration until the paralysed muscles had recovered
their tone, and the effect of the poison had passed off.

In poisoning by Strychnine, an opposite effect is to be pro-
duced ; the spastic condition is to be counteracted, and no
agent seems to me to be as likely to answer the indication as
Chloroform. Were safe doses of Prussic Acid prompt enough
in their effect, good results might be expected frem its use.
But the Acid of the Pharmaceutists is so variable in strength,
that in sudden emergencies, we have to choose between the
dangers of an over dose and one entirely insufficient. This is
not meant as finding fault with the Pharmaceutists, — but the
Acid is so prone to decomposition, that, no matter how care-
fully it may be prepared, the strength is liable to variation.

It may be objected to the Chloroform treatment in poison-
ing by strychnine, that the contractions of the womb are not
interfered with, by its exhibition in parturition. But in an-
swer, it may be said, that it certainly does exert a depressing
influence on the muscles of circulation and respiration. I
think the subject worthy of investigation, and I hope to have
some light on it from experiments on brutes, which \ am about
to institute.

In this connection it may not be out of place to speak of the
facilities which evil-disposed persons have to procure deadly

262 Bibliographical Record. July

poisons. Druggists and Apothecaries (as a general rule) sell
the most active poisons to anybody and everybody who may
choose to buy them. I could refer to recent cases where they
have been sold under circumstances of gross carelessness ; but
I refrain, from the conviction that the attention of the sellers
had not been called to the probable effects of such want of
consideration.

The cheapness of one of the most active poisons (strych-
nine) puts it within the power of any wretch who can com-
mand a half dime to poison two better men than himself. A
Troy ounce (480 grains) of strychnine can be bought at whole-
sale for $3.50 — enough to fatally poison live hundred men.
That, among our Apothecaries, there are some honorable ex-
ceptions to the general recklessness, I am well aware, and they
will reap the deserved reward of their upright conduct.

Legislative interference is absolutely imperative to check
this dealing out of Death by the dose.

§il)liogra|I]itaI Retort

Medical Notes and Reflections. By Henry Holland, Bart., M.D., F.R.S., etc., etc.,
Fellow of the Royal College of Physicians, Physician to the Queen, and Physi-
cian in ordinary to his Royal Highness Prince Albert. Prom the third London
edition, Philadelphia. Blanchard &Lea, 1857.

With books, as with men, there is a something rather difficult to
define, at times, however readily cognizable, distinctly felt, and easily
described, which, on early acquaintance interests us and calls forth a
desire for greater intimacy or offends and repels us, and inspires aver-
sion, not unfrequently amounting to hatred or contempt..

With respect to the latter, (men) it may be, nay generally is, an
ease and delicacy, a gracefulness and benignity of manner ; unmistak-
able indications, often equivalent to evidence of commanding talents
and superior attainments, an engaging suaviter in modo, or, under
particular circumstances, the fortiter in re. It may be neither the
one nor the other, separately, nor all of these collectively, but the entire
assemblage, — the tout en semble of all that constitutes, the character
and the man. As regards the former (books) it is not less, ease and
<rrace of language ; beauty both of idea and composition, accompanied
by force of reasoning, appropriateness of terms and phrases, and acu-

1857. Medical Notes and Reflections. 263

rate logical deduction, evincing a high order of intellect in the author
and marks of correct mental and moral discipline. It may be neither
of these standing out prominently, and commanding our approval
and regard, nor even these, collectively, but a happy combination of
whatever belongs to style, to philosophy and learned argumentation,
equivalent to a delighting suaviter in modo, associated with strength
and boldness, quite tantamount to the fortiter in re, — a general char-
acter, a tout ensemble of everything in composition that is agreeable
instructive and thereforce convincing. Books too, like men, amuse
or enlighten us, are agreeable and profitable, or the contrary to some
extent, as we are constituted, mentally and morally ; in a Avord, as
our tastes and innate predilections, and, consequently, as we become
intersted and allow ourselves to associate with them on terms of in-
timacy and equality — in a measure, as we respect them and appreciate
their contents.

There seem to be,i n regard to men, certain natural relations or af-
finities, by which individuals are drawn together, as there are equally
natural aversions and repulsive influences, which keep them asunder.
The former may consist of congeniality of sentiments and princi-
ples ; of purposes aimed at, or accomplished ; of similarity of educa-
tion and habits, as also of condition and position in society, and a
thousand undescribed features or lineaments of person, manner and
character. The latter of the converse, — the negative merely of all
these. So, in reference to books, certain qualities attract, while cer-
tain others repel us. In the first instance, the attractive, the engaging
qualities may be quite analagous to those, which give rise to the affi-
nities of friendship among men. In the last, the repulsive traits or
qualities may consist of mere negations of the first, or of something
positive, in no sense differing in its influence upon the mind from an
obvious, tangible deformity. The work before us presents many
points of attraction, with as few perhaps that are repulsive, as can be
expected to attach to any of the productions of man. One of the
attractive qualities is found in the fact that it is the offspring of expe-
rience, which is but another name for extended and careful observa-
tion. Certainly, if we concede that the author is possessed of a sound
physical and mental organization, and that he enjoyed the advantages
of accurate and extensive educational training ; and moreover, if we
allow him to have been actuated by honesty of purpose and a laud-
able desire to enlarge the sphere and improve the character of scien-
tific medicine, we must also concede that thirty-six years of laborious
practice in an immense metropolis, where Schools of Medicine, Hos-
pitals, Infirmaries, and learned men abound, must have qualified him
pre-eminently for the task he assumed.

264 Bibliographical Record. July

But whatever opinion the reader may be inclined to predicate upon
the above suggestions, as regards the author's fitness for the work he
has accomplished, it is believed all doubts will be dispeled from his
mind when he considers, that during most of the long period to which
we have referred, Dr. H. has " been accustomed to preserve notices,
not merely of particular cases, but also of such general reflections as
were suggested to him, by actual observation." In the construction
of the present edition it will be observed by those who are familiar
with the two preceding, that considerable changes have been made, as
well in reference to the matter, as to the arrangement of the chapters.
Portions have been removed from this, and reserved for " another
volume, under the title of Chapters on Mental Physiology," while
other portions have been added, with the view of imparting more of
4i unity and completeness to the treatment of the subject." Further,
it has been sought " in the present edition, to bring the chapters more
into series, as regards the relation of their subjects, and to associate
certain pathological principles." with " various morbid conditions,
not usually thus connected in our systems of nosology."

It will be observed, therefore, that whilst the author has been in-
tent on the promulgation of truth, he has not been regardless of
method, but has sought so to arrange and associate the various topics
treated of, as to enable the reader to perceive and comprehend the
whole, with the least amount of labor. The wrork, with much appro-
priateness, begins with an essay on " Medical Evidence," than which
no subject in the whole field of professional research, is more import-
ant, scarcely so essential to the elucidation of principles and the pro-
mulgation of scientific truth, nor perhaps so universally overlooked or
neglected. In the progress of his remarks on this subject, when
speaking of the importance of the " advantage " possessed by the
profession now. derived from the " application " of the "numeri-
cal methods and averages to the history of disease," and certain diffi-
culties connected with the prosecution of medical investigations, he
observes, " In looking further to the chance of overeoming these dif-
ficulties in the future, regard must be had to the principle now veri-
fied in many cases, that, in proportion to the complexity of phenome
na, is augmented, also the number of relations in which they may be
surveyed and made the subjects of experiment. The application of
this principle to medical science, is every day becoming more appar-
ent. Every new path of physieal knowledge opened, each single fact
discovered, has given guidance more or less direct, towards the ob-
jects still unattained in physiology and the treatment of disease."

He next proceeds to the consideration of " Hereditary disease," —
a subject certainly of much difficulty and too often made the scape-

1857. Medical Notes and Reflections. 265

goat of ignorance, if not of culpable idleness. On this obscure topic-
he remarks, as a fundamental proposition, that, " one general fact, as
respects man, seems to be that so ably developed by Dr. Prichard ;
viz : that all original or connate bodily peculiarities tend to become
hereditary ; while changes in the organic structure of the individnal
from external causes during life commonly end with him, and have no
certain influence on his progeny." Speaking of the " researches into
what has been termed Embryology and the theory of types," origi-
nated strictly by " Hervey & Hunter," and the " boldness or even
rashness of some of the generalizations attempted, particularly in
the doctrine of fundamental unity of structure and design," of certain
French and German writers, he observes — t; 1 have never, as already
stated, seen cause to think the arguments of natural theology at all
affected by these incmiries, even when pushed to the speculations of
a primitive germ or original unity of type. Its truths are indeed, far
above the reach of what after all, are but subordinate researches, even
if they could, by possibility attain the proofs of what these terms ex-
press. The chain is lengthened and its parts are connected together
by new and unexpected links. But still it is a chain of designed or-
ganization throughout, and if we simplify the first of these links, it is
but to render more wonderful the number and perfection of the va-
rieties which are evolved, in definite forms from this elementary
structure."

Thus it will be perceived, however apparently infidel and incompati-
ble with revelation, the doctrines alluded to, when philosophically
construed, they but add breadth and scope to the fundamental prin-
ciples of Natural Theology ; they confirm and enlarge the great and

, noble doctrine of design. In reference to what is accepted with re-
gard to hereditary taint, or tendency to disease, the writer has
enriched his essay by a succinct statement of many pertinent exam-

* pies which are drawn from his own ample observation. Next to the
chapters, from which we have already offered examples of the writer's
style of composition and modes of thinking, succeed many others, on
subjects not generally treated of, at much length by systematic writers,
and with respect to which the reader is often at a loss to find as full
and satisfactory information as he desires. A few of them may be
mentioned, in the order in which they appear in the table of contents:
"Methods of Inquiry, as to Contagion ; On Diseases commonly occur-
ing but once in life ; On the connection and classification of certain
disease's ; On disturbed balance of circulation and metastasis of dis-
ease ; On the influence of weather, in relation to disease, etc. These
severally will be conceded to present fruitful fields of research, involv-
ing principles of great practical importance, as well as elementary

266 Bibliographical Record. July

doctrines in physiology. Interspersed among the remaining chapters
of the book, others will be found, relating to matters not commonly
dwelt upon in detail, by authors on practice, nor yet to considerable
extent in works on pathology. Among these we would call atten-
tion to that on pain as a symptom of disease, and to those also which
are devoted to the consideration "of points where a patient may
judge for himself ; to methods of prescription ; to some supposed
diseases of the spine ; the exercise of respiration ; some points in the
pathology of the colon ; the abuse of purgative medicines ; bleeding
in affections of the brain, and that on the use of diluents, all of which
abound in intelligent practical deductions, and learned physiological
suggestions. The remaining portions of the work are devoted more
particularly to topics and diseases, to which medical writers have gen-
erally given a larger share of attention than to the preceding;
more of every day occurrence and observation and with which of con-
sequence, physicians are more familiar.

The last chapter, however, contemplates " the hypothesis of ani-
malcule life, as a cause of disease, and particularly as connected with
cholera, the whole being closed with appropriate concluding remarks.
It gives us pleasure to add our testimony to the merits of the work,
and cheerfully to recommend it to the careful perusal of all who de-
sire reliable information on numerous points of great practical impor-
tance. To be found at Raymond & Sellecks, in this city. K.

A Claim of Priority in the Discovery and Xaming of the Excito-Secretory System
of Nerves. By Henry Frazer Campbell, M.D., Prof. &c. pp. 18.

This little pamphlet consists of a letter written to Marshall Hall,
claiming the priority expressed in its title. It was called forth by an
article in the London Lancet from the distinguished physiologist above
named, formally calling attention to the discovery and naming of this
system of nerves. Dr. Campbell has for the last few years been in-
vestigating this subject and has duly recorded his observations and
conclusions in such a manner as to give certainty to the claim which
he now makes. There is little doubt of his receiving due credit at
the hands of one who can so well afford to be just, as can Marshall
Hall. The letter is characterized by firmness and modesty, and re-
flects great credit upon the author, for qualities which spring from the
heart, as well as those which evince the ripened intellect. G.

1857. Artificial Respiration. 26*

Spirit of tin PiSkal $rcs$.

The Danger of all Attempts at Artificial Respiration, Except in th$
Prone Position. By Marshall Hall, M.D., F.R.S., &c, of the Institute
of France, etc. —

I have shown, in a previous paper, not the inutility only, but the danger
of the warm bath in the treatment of apncea or asphyxia, except in the
prone position.

If the asphyxiated patient be moved and placed in the supine position
in which no attempts at artificial respiration can be effectually made, what
is the condition of the rima glottidis, or entrance into the windpipe ? Is it
free, so that air may be pressed or drawn into it ? And if apparently free,
does it remain so at the moment when an effort to force or draw air into it
is made ?

1. Is the tongue so securely situated, all muscular energy having ceased,
as neither to fall backwards nor to be drawn backwards, and so close o?
obstruct the orifice and entrance into the windpipe ?

2. Is there no accumulation of mucus, or other animal fluid, or of fluids
from regurgitation from the stomach, which may also obstruct the glottis t
nay, more, which may be forced or drawn into the windpipe, inducing a
second and fatal suffocation ?

No one can say a priori, that one, or even both of those events may not
occur. These are' not only possible, but probable, — not onhj probable, but
inevitable under certain circumstances.

There is one fact of the utmost importance. When, from any circum-
stances, the nervous and muscnlar powers are in abeyance, nothing is so
common as regurgitation from the stomach, from change of position, com-
pression, &c. Under such circumstances, compression of the sides of the
thorax would certainly be apt to produce this effect. Now, in the supine
position, the matters so regurgitated would remain in the fauces, obstruct
the glottis, or; when tthe pressure was removed, be drawn into the wind*
pipe. Leroy's mode of attempting to effect artificial respiration, of which a
sketch is given by the Royal Humane Society in its reports, is utterly inef-
fectual ; but, if effectual, would be replete with danger. The only certain
safeguard against such a fatal accident is — the prone position. In this po-
sition, the tongue tends to fall forwards, and all fluids flow from the fauces
and the mouth, or are expelled by the first induced expiration.

All this is reasonable, a priori. But we must not rest here. Our appeal
must be to facts, not to mere notions. The facts must be ascertained by
careful examination of the dead subject.

1. What is the position of the tongue when the body'has been roughly
moved about and laid in the supine position, all cadaveric rigidity of the
parts being overcome by previous movement of this organ backwards and
forwards ?

2. What is the further position of the tongue in the supine position, at

268 Spirit of the Medical Press. July

xhe moment of attempted inspiration, first, by means of the bellows, or,
secondly, by the removal of the pressure on the ribs or sternum, and the
consequent dilation of the thorax ?

These facts may be ascertained by removing the tissues on one side of
the neck, so as to give a lateral view of the tongue, glottis, epiglottis, and
pharynx, and by replacing them by a portion of transparent glass of the
proper size and form, properly placed and carefully maintained in its po-
sition.

The first part of this examination has been already made : The subject
being placed in the supine position, and the lateral parts of the neck being
removed, so as to admit of observing the relative position of the internal
organs — the tongue, the glottis, the epiglottis, the pharynx, — it was seen
that obstruction to the entrance of air actually did take place.

I now propose to place a piece of transparent glass so as accurately to
close the cavity and allow of the observation, first, of the effect of position,
the supine and the prone comparatively, and then of any attempt to in-
duce inspiration.

A similar examination of this internal in reference to fluids present in it
(and we never can know when such fluids are present) 'is unnecessary :
fluids will gravitate to the lowest parts of a cavity, and will be drawn into
an open orifice, such as the glottis, under the influence of air forced or in-
haled into it. And such an event not only renders all attempts at inspiration
augatory, but induces a permanent because material obstruction of the en-
trance in the windpipe.

In confirmation of these views I again appeal to experimental facts: —

"The following experiment has been repeated mang tunes, and has been
witnessed by George AVebster, jun., Esq., of Dulwich ; Mr. Williams, su-
perintendent of the Royal Humane Society, Hyde-Park ; and other gentle-
men:

uThe dead subject being placed in the supiiie position, and pressure
made on the sternum and ribs, a little gurgling was heard in the throat ;
hut, the pressure being removed, there was no evidence of //aspiration."

Now let us contrast with these abortive attempts to induce artificial in-
spiration in the supine position, the beautiful and life-giving results — mspi-
ration and expiration — of alternate rotation from the prone position and
ropronation. I continue the quotation :

M The subject being then turned into the prone position, and pressure be-
ing made on the spine and the ribs, and removed as before, there were free
sxpiration and Aspiration."

Far more marked is the effect of pronation and rotation :

M The subject was turned into the prone position : considerable expiration
took place, which was much augmented by pressure of the hands on the
back. On removing this pressure a little inspiration took place. The body
being then rotated on the right side, considerable inspiration again took
place, whilst moving through one fourth of a circle ; on continuing the ro-
tation, inspiration continued until the shoulder was half-way between the
lateral position and the table, when it ceased."

1857. Articular Cartilage. 269

These are the original experiments. They are extracted from a little
pamphlet entitled " Abstract of an Investigation into Asphyxia," &c, and
now out of print.

I conclude by observing that the principle of prone respiration is of sncii
importance as to demand a new designation to impress it on the attentior.
and the memory : I propose to term it Pkenopncea.

The number of cases of apnoea and asphyxia, the effects of cMorofi
which have been arrested by the " Ready Method," and of which I have
received authentic details, now amounts to three. The last of these was
communicated to me by an eye-witness of the operatiou, which consisted
in tenotomy in a little bo}*, aged about four, under the influence of the anac:s
thetic ; suddenly the child turned pale and ceased to breathe, and looked as
if it were dead. Cold water was dashed on the face, and other ordinary-
measures were adopted utter])- in vain. The Ready Method was now in-
stantly adopted and efficiently applied : after the first inspiration produced
by rotation after pronation with pressure, the mouth was observed to open
and air to be inspired ; the movements were repeated, physiological respi^
ration commenced, the little boy cried, and all was safe.

I conclude the momentous subject by several aphorism* in regard to the
treatment of asphyxia : —

1. The effects of suspended respiration can only be removed . by the re-
newal of respiration.

2. Artificial respiration can only be certainly, effectually, and safely per-
formed in the prone position ; for,

3. In the supine position the larynx is apt to be obstructed by the fail-
ing back of the tongue and epiglottis, or by the accumulation of fluids al-
ready in the mouth or regurgitated from the stomach.

4. These fluids ma}- be fatally inhaled into the windpipe when /aspira-
tion is mechanically effected.

5. All other measures are subsidiary, even the rubbing the limbs with,
pressure upwards ; and all which exclude respiration are, ipso facto^ de-
structive ; the warm lath is of doubly fatal tendency, — first, by excluding
pronation and rotation, and secondly, by promoting the formation and the
circulation of the blood-poison — carbonic acid. — London Lancet.

Mr. T. P. Teale, of Leeds, reports a Case of Detached Piece of Arti-
cular Cartilage, existing as a Loose Substance in the Knee-Joint. — The
patient was a man, aged thirty-seven, in whom, from an injury of the knee,
a portion of the articular cartilage from the lower end of the femur, about
an inch in diameter, became detached as a loose body. Fourteen months
after the accident, this loose body was removed by direct incision. The
operation proved fatal, and there was found after death, on the under sur-
face of the inner condyle, a depression, exactly corresponding to the body
which had been removed. British and For. Med. Chi. Review.

$70 Spirit of the Medical Press. July

Anatomy of the Pleura. Dr. Charles E. Isaacs, Demonstrator of
Anatomy in the University Medical College, read an instructive paper on
the Anatomy of the Pleura.

The object of this investigation was to determine the extent of the pleura
above the clavicle, and its relations to important organs. Writers on ana-
tomy either do not allude to the subject, or speak so vaguely, as to convey
the impression that no definite knowledge exists in regard to it. Horner
says the pleura extends higher at the head of the first rib than at its ante-
rior extremity ; according to Cruveilhier, the pleura projects more or less
above that rib ; Sharpey and Quain state that it extends an inch, or even
an inch and a half, above the first rib. Harrison says when the lung is dis-
tended, the pleura may rise two inches above the first rib, etc., etc.

The statements of many other authors are given, all of which are equally
indefinite, while in such works as the Encyclopedia of Anatomy, Bourgery
and Jacob, Siowris Medical Anatomy, etc., no mention whatever is made
of the extent of the pleura above the clavcicle.

Struck with the discrepancies on this subject among authors, and aware
from repeated dissections of the great hight to which the pleura some-
times extends, Dr. Isaacs was led to the careful examination of a large
number of cadavers (one hundred in all), to determine if possible, the su-
perior boundaries of this investing membrane.

The method pursued was, to place the subject upon a firm table, and af-
ter exposing the thoracic cavity in the usual manner, by the introduction of
one hand into the cul-de-sac formed by the pleura above the clavicle, its
boundaries could be readily ascertained externally. Where this method
failed, needles were passed from without inwards, at points where it was de-
sired to obtain measurements, and their position in the cavity determined,
by the fingers introduced internally.

It was sought to establish the following points :

1. The hight of the sternal edge of the pleura above the clavicle.

2. The hight of its central portion.

3. The hight of its outer edge.

4. The distance of the sternal edge from the median line.

5. The distance of the outer edge from the median line.

In prosecuting this examination, it was discovered that the upper part of
the pleural cavity did not always present a dome-shaped form, as described
by anatomists, but that it sometimes forms cul-de-sacs, extending upward
like the fingers of a glove ; they are 'sometimes prolonged laterally, from
the right pleura across the median lide to the left side, and pass upwards
between the bodies of the cervical vertebrae and oesophagus, or, between
the latter and the trachea.

Dr. Isaacs peesented several tables exhibiting the results of his investi-
gations, of which we notice the following :

Comparative highth and width of the pleura above the clavicle in the
male and female, calculated from the measurements in forty-seven females.
The conclusions at which he arrives are, that the pleura is both higher

1857. Anatomy of the Pleura. 271

above the clavicle, and wider in that situation, in the male than it is in the
female.

The high extent of the pleura. — In one hundred cases, the pleura of the
right side rose two inches and upwards above the clavicle in fourteen ; on
the left in four ; on both sides in five ; in all twenty-three, giving the pro-
portion of nearly one in four having a high extent of pleura.

Low extent of the pleura. — In five of the one hundred cases, the pleura
did not rise above the superior margin of the clavicle ; being one in twenty
having a low extent of pleura. The sternal or inner edge of the pleura on
the right side extended aeross and to the left of the median line in eleven
cases, the greatest extent being one and one-fourth inches.

These eleven cases necessarily gave the widest extent of pleura at its su-
perior part, the average width being four inches. It is worthy of note that
this projection of the pleura across the median line was never observed on
the left side.

It was, also, generally noticed that, where the pleura extended high, the
subject had a long neck, and the reverse was the case in short, and espe-
cially bull-necked subjects ; in twelve cases marked as having long necks,
ten had a high extent of pleura ; in eleven short-necked subjects, the pleu-
ra was very low in three, below the average in eight. By the shape of the
neck, therefore, and probably by auscultation and percussion, it may be
possible to determine pretty accurately in the living subject whether the
pleura has a high or low degree.

The practical importance of this determination of the limits of the supe-
rior portion of the pleura is obvious. To the physician, it is important to
know these facts in the practice of auscultation and percussion, and in the
diagnosis of diseases of the apex and the lungs. To the surgeon this know-
ledge is of great value in the removal tumors, and in other operations about
the neck.

Dr. Isaacs ingeniously suggests that cases of sudden death during opera-
tions about the lower part of the neck, from the supposed entrance of air
into the veins, may be due to the opening of the pleural cavity. If the sur-
geon penetrated the neck two inches above the clavicle, it would have been
thought that there was no danger of wounding the pleura, and yet the re-
sult of these measurements show that the pleural cavity could be opened at
this hight. These facts are, also, important in the prognosis and treatment
of wounds in the neck.

In the second portion of his paper, Dr. Isaacs considers the surgical
anatomy of the upper portion of the pleural sac, or its relation with the
subclavian artery.

In its first division, or that portion of the artery lying within the scaleni
muscles, the subclavian always rests upon the pleura. The artery has nev-
er been successfully ligatured at this point, though the operation has been
performed nine times upon the right side, and once upon the left. The
failure is due to the extension of the disease to the coats of the subclavian,
and the proximity of the ligature to important anastomosing branches.

The second portion of the artery, or that lying between the scaleni, is,

272 Spirit of the Medical Press. July

also, always in contact with the pleura. The ligature has been successfully
applied at this point.

The third division, extending from the scaleni to the first rib, is that por-
tion of the artery which is most frequently ligated, and is. therefore, rela-
tively, of the most importance, although the subclavian in this part of its
course does not rest upon the pleura, yet, when the pleura rises high in the
neck, it carries the artery with it ; in the twenty-three cases in which the
pleura rose high in the neck, the artery was high in the third portion of its
course, and rested upon the pleura for a considerable extent, several exam-
ples are given to illustrate this fact. A knowledge of this relation of the
pleura to the subclavian artery at the point where it is most frequently
ligated, is of great importance to the surgeon.

This interesting paper will soon appear in the transactions of the Acad-
emy.— y. Y. Journal of Medicine.

Suicidal Monomania. — Psychology, connected with and deducible from
physiology, is beginning to be better understood, and to take its proper place
in general literature, and especially in biography and history. We may ad-
duce among other instances the following observations by Mr. Masson, Prof,
of English Literature in University College, London in his " Life of Chatter-
ton." The author had just before been speaking of young Chatterton's con-
cious sense of great injustice in passing off his own effusions as those of the
Monk Rowley of the fifteenth century, whose manuscripts, forged by
Chatterton himself, the latter professes to have discovered.

"After all, however, the most material fact in the case remains to be told.
Physical causes were at work. Bereft of the amount of actual food, and of
other comforts, necessary even with his abstemious habits, to keep body
and soul healthily together ; wandering about London in a perpetual state
of fever and excitement ; returning home to write night after night — with-
out rest or sleep — little wonder if he had overstrained his physical capabili-
ties, and if brain and nerve began to fail in their office. Whatever taint of
hereditary insanity was in him, derived from the old line of sextons who
had jingled in past generations, the keys of St. Mary's Church in Bristol,'
and walked at midnight through its aisles, and dug the graves of its parish-
ioners, or derived more immediately, from that drunken wild-eyed father,
whom he had never seen, but who used to tell his tavern-companions that
he believed in Corneilus Agrippa, the necromancer ; it had now, at last,
come out in a way not to be mistaken. From his childhood there has been
symptoms of it ; his fits of weeping ; his sudden paroxysm of passion ; his
long reveries, when he gazed at people, with seeming to see them ; his fre-
quent muttering aloud. Not till now, however, had these traits passed the
limits of what could be considered compatible with sanity. But now, al-
most certainly, these limits were passed. Noticing the strange haggard lad,
walking about the streets, muttering, perhaps, to himself, or making sudden
gestures, or looking at what was passing sometimes ascantly, and sometimes
with glances unsually keen and bright : even strangers could not but follow

1857. Spirit of the Medical Press. 273

him with their eyes, and wonder who he was, and where he came from.
Had the stranger been one accustomed to the ways of the insane, he would,
probably, at once have pronounced that his brain was affected. And had
the stranger been able, with this idea in his mind, to pursue his inquiries
farther, so as to ascertain what peculiar form or species of insanity had
taken posession of him, he would have found that it was that which physi-
cians recognize as the suicidal tendency. Physicians, as all know, do recog-
nize this as a form of madness ; and though they allow, that a perfectly sane
man may commit suicide after deliberately reasoning on the point, they
attribute a large proportion of the suicides to the action of a certain specific
impulse which reason cannot overcome. In Chatterton's case, as we have
seen, there has been premonitory appearances of the existence of this ten-
dency. The idea of suicide had from the first been familiar to him."

Our commiseration for the untimely end of this unfortunate youth must
not, however, blind us to the false pride and waywardness of his nature,
which, more than actual necessity, subjected him to the gnawing of hunger
and combined with the latter to derange a morbidly sensitive brain, and
drive its possessor to self-destruction* ..The act of the suicide may be the
result of a fit of temporary insanity,-, but no palliation of this nature ought
to be adduced for the often habitually wicked disregard of moral and natural
laws, and the voluntary nursing a belief in the venial nature of the crime
of self-murder, if not in the actual right that a man has thus to dispose of
himself. The judgment warped by such wretched sophistry, any slight
annoyance, whether bodily pain, mental excitation, or disappointment, will
serve as an excuse for the commission of suicide. Chatterton wanted "the
resources to be found in rectitude and gentleness of a mere worldly charac-
ter." Religion he had none. Professor Masson, in reference to the state
of destitution to which the young poet was reduced in London, where he
had gone with the hopes of bettering his fortune, makes the following judic-
ious remarks- They contain a lesson good for all times ;

"Quiet, plain scholars have lived, before now, in German or in Scotch
university towns, on boiled peas-cods for months, on a single guinea a quar-
ter, earned by teaching, without saying much about it. Had youths of
this type been in Chatterton's place in London, in Agust, 1770, they would
most probably have survived the crisis. They wouldjmave availed them-
selves gratefully, and yet honestly, of such small imedfate aid as those aunts
and other relatives, that we hear of so sightly in Chatterton's letters (one of
them, a carpenter, who had married one of his aunts) might, perhaps, though
poor, have willingly offered at the sharpest moment of the emergency ; and
even failing that, they would have conquered by sheer patience. How was
it then in Chatterton's case, ' the comforts of Christianity ' being placed
out of the question?" — North Am. Med.- Chi. Review.

On the Valvular Nature of Strangulated Hernia. — Incarcerated her-
nia, in Prof. Roser's opinion, essentially depends upon a valvular mechan-
ism. The obstruction of the contents of the intestine in the incarcerated
portion arises from the folds of the mucous membrane lying valve-like
vol. in, no. v — 7

274 Medical Independent. July

against each other, and preventing the passage of gas, fluids, &c. Looking
at the complete obstruction which takes place in the hernia, one might sup-
pose that the parts concerned are compressed as closely as in an artery
when tied. But all observation teaches us that no such pressure is here
exerted ; for while the venous circulation is only partially arrested, the ar-
terial remains uninterrupted. "Were it otherwise, indeed, the intestinal fold
would become rapidly gangrenous. The question is why, if there is space
enough to allow of the circulation in the part to continue, cannot we by
pressure return the contents of the intestine.

The nature of the obstruction may be shown by a simple experiment.
If a noose of intestine containing some fluid or air, be brought within a
ring about the size of the finger, and than pressure be made upon the apex
of the noose so as to force the contents against the compressing body, com-
plete obstruction to their passage will be found to prevail. And yet a
catheter may be passed beside the intestine, and, by drawing the latter a
little to one side, a considerable space will be perceived. If pressure be
made in front of the encircling ring, the contents of the intestine are forced
back ; but if we press at the end of the noose, the portion that lies next to
the ring is forced against the latter, and the canal is closed. If we open
the noose on its convex side, and fill it with water, we may observe the
valvular disproportion of the intestinal folds, which resemble the valves of
the aorta when acting under water.

Deferring to another occasion the exposition of this theory of the taxis
deducible from these views, Prof. Roser now points out the support they
give to the operation for hernia, without opening the sac — a procedure he
regards as one of the greatest improvements in surgery since the days of
Pare. He believes it has made little progress in Germany and France, as
compared with England, in consequence of the prevalence of a false theory
of strangulation of hernia and erroneous ideas on the surgical anatomy of
hernia. In respect to the first of these, too exaggerated an idea of the
constriction that takes place has been entertained, leading to a belief that
the mere dilation of the tendinous margins could not suffice for the return
of the distended and indurated hernia. The above experiment, which
proves the valvular nature of the obstruction, must surely give more confi-
dence in the efficacy of the external incision. "We have not space to follow
the author in his description af the anatomy of femoral hernia, and which,
indeed, essentially resembles that furnished by Cooper. — British and For.
Med.- Chi. Review.

Mr. Nathaniel Ward records a case of suicidal incised Wound of the
Abdominal Parieties, through which there was protrusion of the omentum
and transverse colon, and division of the latter to the extent of four-fifths
of its circumference. The edges of the wounded bowel were brought into
accurate approximation by an uninterrupted suture, and the operation was
followed by the administration of opium in large and repeated doses. Per-
fect recovery took place, the abdominal wound having healed on the thirty-
second day after its infliction. The patient was a female lunatic aged fifty-
one. — Il>.

1857. Spirit of the Medical Press. 275

Auscultation applied to the Diagnosis of Diseases of the Bar. — M. Gen-
drin has addressed a letter to the Academy of Sciences on the above sub-
ject. He says, — Mr. President : all physicians know that it is impossible
to define internal lesion of the organ of hearing. I call the attention of
the Academy to a mode of exploration which I have resorted to with suc-
cess during the last ten years. I listen to, by means of a stethoscope, or
my ear applied to that of the patient, the sounds which exist in the ear
produced by respiration, cough, the voice, labial hissing, &c. I take the
precaution to close the nostrils of the patient to make the sounds in the ear
more distinct. These sounds being modified by the pathological conditions
of the cavities and membranes, afford means of forming a correct diagnosis.
In the healthy condition each expiration causes in the ear a low or grave
and prolonged blowing sound, which ceases before the cessation of the ex-
piratory movement. If the membrane of the tympanum be perforated, this
sound becomes acute, dry, sometimes sibilant, and more prolonged. Should
the tube (the eustachian) be contracted, it becomes intermittent, and the
expiratory sound is divided into several successive sounds, which accompa-
nies in many cases the crepitant bubbles due to the presence of mucus in
the tube and drum. These crepitations are also observed in caries of the
internal ear, or of the mastoid cells : when a communication exists between
these and the tympanum ; but the sounds in these cases are grave and hu-
mid. The expiratory concussions in coughing are more distinct and
shorter, and concussions in coughing are an easier means of detecting anor-
mal sounds produced by the several internal lesions, than simple expiratory
sounds.

Inspiration can scarcely be heard in well cases ; but if the tympanum be
perforated, the tube remaining permeable, during inspiration, a decidedly
acute sibilant mixed with crepitations, of which the patient himself is often
conscious, is perceived.

The sound of the voice heard in the ear, appears more grave and a little
vibrating, it is interrupted by frequent intermissions, which separate the
words and even the syllables. When the tube is obstructed or the drum
occupied with mucus, it degenerates into a confused and inarticulate mur-
mur. The same phenomena are produced by pus or by central exostosis of
the bone. It is cut short by closure of the tube. It is whistling and ac-
companied with crepitating bubbles, when the membrana tympani is rup-
tured.

In health, the labial whistle is transmitted through the middle ear as a
sharp blowing, coming from a distance. It arrives feebly, is divided by
short intervals of silence, or nearly mute when the tube is strictured, and
is quite inaudible in obstructions of the tube. On the contrary when the
membrane is destroyed, the tube remaining previous, the whistle becomes
very acute, and appears near ; it sounds as if the patient whistled in the
physician's ear.

In most cases, anormal sounds may be verified by comparing the sounds
of one ear with the other ; for it is very uncommon to find both sides af-
fected in the same degree with the same lesion. — Revue Therapeutique.

We may add to the above, that during several years, eight or ten, we

276 Medical Independent: July

have been in the habit of resorting to auscultation in making out our diag-
nosis of internal diseases of the ear. We do not use the stethoscope, but
apply the ear directly to the ear of the patient, or use the otoscope which
in some cases is better. Drs. Toynbee, Williams and others of England
have been for several years using the otoscope, with which to learn the con-
ditions of the eustachian tube. We sincerely hope that the profession in
our own country will wake up to the importance of Aural Surgery. We
delivered courses of lectures on the subject, both in one of our medical col-
leges and in private for several years, and published a book, wh:ch the
great publishers of our city refused, because they could get the English
books on the subject for nothing, and doubtless because also, these were
better and more marketable. Would it not look a little more liberal on
their part to encourage American authorship in this line ; and will not the
young men now entering on the medical arena take up the gauntlet on this
subject, and study more fully the diseases of the Ears, and thus stop an-
other great avenue for quackery and imposture ? — (Ed.)— -Philadelphia
Med. and Surg. Journal.

On Myeloid and Myelo-Cystw Tumors of Bone; their Structure, Patho-
logy, and Mods of Diagnosis. By Henry Gray, F.R.S. — This is a very
valuable contribution to our knowledge of a class of tumors which have
but recently received attention. These tumors were first distinguished by
Lebert, and by him named fibre-plastic, and more lately they have been de-
scribed by Mr. Paget under the title of myeloid, from the resemblance of
their microscopic constituents to those of the marrow and diploe of the
bones, especially in the foetus and in early life.

Mr. Gray publishes the details of nine cases of this disease, and gives
the following summary result of his observations: —

*' 1st That the essential element consists, in all cases, of forms precisely
similar to what is lound in the marrow and other elements of bone, in the
foetus, and at an early period of life ; hence the name ' myeloid ' tumors.
In some instances, however, their structure is so intermixed with cysts,
that I would propose the 'myelo-cystic ' tumors to be given to them in such
cases.

2dly. That these tumors are, for the most part, limited in their develop-
ment and growth to the osseous tissue, or its investing membranes, the pe-
riosteum, and dura mater.

3dly. That they may probably occur in any bone.

4thly. That they ocsur in all the cases at present recorded at an early
period of life, and that their growth is generally much less rapid than that
of malignant disease.

5thly. That these tumors are not malignant, and when entirely removed,
never return.

6thly. That they present a near relation with fibrous and fibro-cystic
tumors, and cartilaginous and osseous." (pp. 124-5.)

Perhaps the most important among these considerations is the question
Of the malignancy of such tumors. Mr. Gray grounds his belief of their

1857. Spirit of the Medical Press. 277

non-malignancy upon their peculiar structure, distinct from cancer, their
slow growth, the complete absence of any affection of the lymphatic glands,
and of the malignant cachexia ; and upon the fact that the removal of the
limb, although in many of these cases through the bone in which the dis*
ease had originated, was not followed by a return of the disease after many
years. It is but right to state, however, that on this matter Mr. Gray dif-
fers somewhat from Mr. Paget. The latter, although he admitted that
these tumors are " generally of innocent nature," yet believed that in dif-
ferent persons they might pursue "very different courses, appearing in
some as an innocent, in others as a malignant disease."* Two cases are re-
corded by Mr. Paget, presenting the myeloid structure (and neither of
which, by the way, originated in bones), in one of which the tumor suppur-
ated, the glands became affected, and the disease returned six months after
removal ; while in the other, a myeloid tumor of the neck, similar deposits
were found 'after death, in one of the cervical glands and in the lungs.—
Brtish and Foreign Medico- Chirurg. Review.

History of a Case in which a Cedar Pencil was lodged in the Canity
of the Abdomen for Eight Months. By John Erichsen. — The pencil,
which was five and a half inches in length, had been employed by the pa-
tient to relieve a difficulty in micturition, but from some interruption had
slipped out of her hand, and upon her sitting down, had been forced through
the posterior and upper part of the vagina, and become lodged in the ab-
dominal cavity, perforating two coils of the small intestine. In this position
it remained for eight months, producing intense pain and repeated attacks
of peritontis. The point of the pencil could be felt, midway between the
umbilicus and the right Poupart's ligament. An incision was made down
upon this point, and the body removed ; but the patient died on the fourth
day of peritontis. This case resembles in many respects one recorded in
the thirty-first volume of the Society's Transactions (p. 315), by Dr. 0. W.
Lever and Mr. J. Hilton. — British and For. Med.-Chi. Review.

Prophylaxis of Puerperal Fever. — It is recommended by a French phy-
sician to administer quinine and sub carbonate of iron to lying-in women,
who are exposed to the contagion of purperal fever. He prescribes it —
eight grains of the former and thirty grains of the latter — daily.

* Lectures on Surgical Pathology, vol. ii, p. 228.

278 Medical Independent. July

Atonal anir IpMtag.

Popular Lectures on Physiology. — The Cincinnati Medical Ob-
server, in its late number, devotes its leading editorial to the adminis-
tration of a severe, but wholesome and merrited castigation of a pair
of lecturers on Popular Physiology, who are sowing broadcast over
the country, seed which will spring up and ripen into an abundant
harvest of moral degradation. Its sentiments are so in unison with
our own feelings, that we would have re-published the article entire,
but for the fact that we wish to avoid poluting our pages with the
names even, of this pair of ?mworthies. Their unmitigated quackery
sinks into a matter of minor importance, when viewed beside the in-
fluence of their teachings upon the morals of a large portion of their
hearers. In this respect, we class them with those who advertise rem-
edies, which " should be avoided during pregnancy." That they are
eagerly sought after by the masses, is no matter of surprise, for they
administer the kind of aliment which proves a sweet morsel to a vit-
iated and sensual taste ; but that they should receive the sanction of
educated and honorable medical men, and particularly that the medi-
cal press should ever endorse them, is indeed, to us, a cause of real
astonishment and regret. The Observer says : — " The influence of
such lectures is pernicious to those who hear them, and injurious to
the confidence which should exist in the public mind in regard to our
profession. We should go further and pronounce them corrupting to
the morals of the community. Let us illustrate : He delivered a
lcture to gentlemen only on the organs of generation of both sexes, and
one to ladies only on the same subjects, He gave the theory of gen-
eration— the method of conception — the time when a woman is apt to
become pregnant, and the manner of avoiding pregnancy.

In the large audiences who heard these lectures, there were many
yonng and thoughtless (they won't remain thoughtless long under such
teachings. — Ed. Ind.) boys and girls, and women and men who, ad-
vanced in years, yet are loose in morals. To tell a girl, or boy, or
both, that there is little danger of pregnancy from coition for a week
or ten days before the menses, is certainly, in our estimation, a sure
way of breaking down all purity, and, even more, of producing open
licentiousness. In our fashionable civilization, there comes within
every medical man's observation, a great amount of corruption. It
is no unfrequent thing to be asked for some remedy to prevent preg-
nancy, and still less so, for some remedy to produce abortion."

1857. Editorial and Miscellany. 279

In reference to instructing the public in medical matters, we also
fully endorse the Observer ; and in doing so, we confess that our views
have undergone a change on this subjet. In the enthusiasm of that
period of cur professional life, which we must term medical verdancy,
we were earnest and sanguine in our faith in popular medical training ;
but we have no longer any confidence in teaching the people a system
of physiology, much less, any general theory of cure ; it is necessa-
rily, all too imperfect, and realizes the truth of the maxim, that " a
little learning is a dangerous thing." In fact, until men within the
profession cease to illustrate the same truth, we had better labor with-
in our own ranks. The field is ample, and laborers are not over
abundant or industrious. Let us strive to elevate the standard of our
acquirement, and leave the public to educate itself. Let us refrain
from writing sickening dilutions of physiology for popular use, and
cease lecturing to youg ladies on their own formation. They will soon
find out that they possess a nervous system. Our grandmothers were
not afflicted with nerves, but, thank God, they gave evidence of the
possession, and use of the chief nervous centre — the brain. The public
needs rules to follow, not theories to speculate upon. We quote
approvingly still further : —

" We have in our public schools and academies a little physiology
and anatomy, taught to little boys and girls, with the result of making
little fools. So, too, the public who listen to the so called lectures on
physiology and phrenology, by traveling humbugs and quacks, are in
the main made incurably foolish."

***********

" No one ever hears of Bernard, Schmidt, Brown-Sequard, Car-
penter, or Jackson delivering lectures to the public on any such
subjects. We venture the remark that there are not five hundred
non-professional persons who would follow a scientific course of phy-
siological lectures for three months. But let some fellow, with more
cunning than honesty, come along and lecture on matrimony, love, the
organs of generation, pregnancy, etc., and half the town will rush to
hear him."

***********

" Let us think of what our profession once was, and, in refreshing
ourselves with this knowledge, we will find that the ripe medical
scholar, the profound man of experience and study, and the high-toned
gentleman, is far from exhibiting himself to the public in delivering
so called lectures on physiology." * * * * *

We appeal to the medical press : — Do not this and other existing
evils fall within the range of, and call for editorial comment 1 Is an

280 Medical Independent. July

editor's duty all performed when he has determined what shall appear
on his pages, and passed his judgment on publications ? or, is it not
editorial privilege, — aye, duty, to extend observation and fearless com-
ment over the whole subject of existing evils ? We thank the Observer
for calling attention to this most blighting evil,

Gr.

Scarlatina. — The mortality among children in Boston during the
past year, from the great prevalence of Scarlatina, can hardly find a
parallel in the history of that disease in this country. It has also
been universally prevalent in most of the northen and western
cities. A very practical question, therefore, presents itself, viz. :
has any improvement in its prophylatic or curative treatment been made?
In other words, are those physicians who have had the most favorable
opportunities for observing its phenomena, and the relative value of
the various remedial means adopted, prepared to shed even one new ray
of light upon the intrinsic character or therapeutical indications of this
desolating malady 1

There is evidently great diversity of opinion in the profession re-
specting its true pathology, or else we must believe, that much of the
treatment employed is altogether empirical. One physician attributes
great success in his treatment of the severer varieties of the disease
to the use of Nitrate of Silver, as a topical application to the throat ;
another finds the application of ice and iced water most effectual.
Another annoints his little patient from head to foot with fresh lard,
or bacon ; another paints the whole surface over with Tinct. of Iodine.

In the constitutional treatment of the different forms of the disease,
quite as much contrariety of opinion obtains. Judging from the obit-
uary records of the past six months, we have reason to infer that the
results of the different varieties of treatment indicate no flattering
progress in this field of practice.

From statistical results, founded upon experiment, what, may now
be considered the most rational and approved treatment of Scarlatina ?
We look to Boston for a reply. R.

Paracentesis Thoracis. — Dr. Bowditch has communicated to the
Boston Medical and SurgicalJournal another paper on this interesting
operation. His first article appeared in April, 1852, in the American
Journal of Medical Sciences ; a second in January, 1854, in the Amer-
ican Monthly ; the third, which has just appeared as above stated,
closes as follows :

" If these statements are true — and I am as convinced of their

1857. Editw*ial and Miscellcmy. 281

truth as I am of anything in my whole medical experience — I am jus-
tified in asserting, that a physician does wrong and acts foolishly who
allows any patient to suffer months or years of misery, or even death
itself, from pleuritic effusion, at any age — from any cause and with
any complications — without at least a trial of thorace tesis. I write
thus strongly because I fear that surgeons, of even the highest reputa-
tion, still shrink from performing this operation. This fear, 1 presume
is owing to their considering it as similar to the operation laid down
in all, or almost all, of their own manuals. From that operation
they ought in most cases to shrink. That which is here advocated is
of a totally different character, and is. so far as my experience goes,
harmless."

One peculiarity of Dr. Bowditch's operation consists in the use of
an exploring trocar. In his second article he thus describes it : " A
strong exploring trocar and canula have, in all the cases I shall pre-
sent, been introduced, usually between the ninth and eleventh ribs,
and below the angle of the scapula. To this canula, by means of an
air-tight apparatus, a strong suction pump has been attached, and the
fluid has been drawrn out, without the possibility of the introduction
of air while the aperture that has been left has been so minute that no
blood has foioed, and it has been immediately closed on the withdrawal
of the instrument." Another peculiarity consists in its application
to acute as well as chronic cases, whenever the pleural cavity is filled
with fluid, not waiting for all other remedies to fail before resorting
to the surgical mode of relief. There is no question in our own mind
as to the correctness of this practice. When acute pleuritis has re-
sulted in hydro-thorax, or empyema, the sthenic character of the dis-
ease has passed away, and were it not for the oppressed state of the
respiratory functions, under appropriate treatment, the patient would
generally experience a satisfactory convalescence. Thoracentesis af
fords relief from this oppression, without communicating to the sys-
tem more of a shock, than would the operation of venesection. Made
with an exploring trocar, it, or even the old operation delicately made,
does not involve any risk from the admission of air. Indeed, the
danger from this source, is, perhaps, greatly overrated. A distin-
guished physician of our acquaintance, ridicules the idea of such dan-
ger, and points, in support of his position, to the great number of
pleural abscesses, which are evacuated through the lungs, admitting air
and adding to the empyema, the complication of emphysema. We
have his promise of an original paper on this highly interesting sub-
ject. In our own teachings we have advocated the early operation,
and in cases of empyema have given preference to the old valvular
inscision. By it we obtain freer and more ready exit of pus, and

282 Medical Independent. July

have never experienced any difficulty in preventing the entrance of
air. The practical point, however, consists in the early resort to the
operation. It is free from danger and efficient in relief. G

Glycerne Solution of Borax. — Dr. Geo. T. Elliot, jr., recom-
mends (N. Y. Journal) "a solution of borax in glycerne, the former
being in the proportion of one third," in the treatment of thrush and
excoriated nipples. In the latter disease, he says, " it is advisable,
however, to teach the child to nurse through an artificial nipple while
cicatrization is taking place." He has also used it upon ulcerations
of the os uteri. Glycerne appears to be a rising star.

Since writing the above, we have received Mr. Steams' article on
the subject of Glycerne. It is an excellent paper, and prepared by
an educated and practical pharmaceutist.

New Apparatus for fractured clavicle. — Dr. Wheedon in the
Boston Medical and Surgical Journal calls attention to an apparatus,
which he thus describes :

" The apparatus consists of a short crutch, the shank of which is
made of two pieces of steel, so as to slide up and down, and adapt its
length to the heighth of the individual. At the top of the shank is
attached a crescent-shaped piece of wood, to be padded in the form of
a wedge ; and at the lower part of the shank is a small foot-piece
made to rest in the pocket of a broad leather belt, which is to be
placed around the waist.

It is applied in the following manner. The belt is buckled around
the waist, with its pocket between the auterior superior spinous pro-
cess of the illium and the symphysis pubis ; the foot-piece is then
placed in the pocket of the belt, the wedge in the axilla, and the arm
drawn over the wedge until the elbow touches the side, where it is
confined by a roller or other means.

All the indications required in the treatment of this fracture are
thus accomplished ; the shoulder is carried upward by the length of
the crutch, outward by the pad, and backward by the direction in
which the upward force is exerted."

If we were to criticise this mode of dressing fractured clavicle, we
should express a doubt of its security, because, as described, there is
nothing to prevent the belt from slipping around the body, and thus
failing in its support of the shoulder. As the result of our own ex-
perience, we have a decided preference for the neck yoke manufactured
by Day. It affords perfect security, without irksome confinement.

1857. Editorial and Miscellany. 283

To Contributors. — We are anxious and determined to issue tite
Independent promptly on the first of each month. The only -delay
thus far experienced, has been in the receipt of matter for the origftftft
department. Contributors are therefore requested to send in the**
papers so that they will reach us by the tenth of the month preceding
the issue in which they wish their articles to appear. This rule will
ensure the prompt appearance of the Independent.

With the present issue, we send bills to all such as have not paid
for the current volume. The Editors, being physicians and used to
the fare, can work without being paid, but the printers have no desire
to learn the lesson. Subscribers, therefore, will please send us t&£
amount of the year's subscription, and oblige, not only us, but render
justice to the followers of the immortal Franklin.

The August Number of the Independent will contain original papers
from J. Adams Allen, m. d., H. C. Hitchcock, m. d., Edward Dorseky
m. d., and Frederick Stearns, Pharmacutist. Mr. Stearns' paper Is
upon a subject of great interest at the present time, viz. : — Liquors
and their Adulterations." The system (for it is really a system) K>£
adulteration has been carried so far, and is practiced so generally, that
the information contained in this paper will prove of great practical
value.

News Items, from the London Correspondent of the Montrejul
Medical Chronicle. — " I have another death to record, but with feel-
ings very different from those which prompted me to do so in Scoresby^s
case. It is the death, not of an individual, but of one of the instru-
ments of a system which is fast on the wane, and will be shortly ree-
oned as one of the " strange things that were." The London Jlomtfc-
pathic Hospital, devoted to this delusion in London, has closed its doors!!
The Lancet says, while recording the melancholy event, that, "like all
quackeries, it has had its day : like all quackeries, it has been sup-
ported by the shallow, weak and credulous on the one side, and tht
charlatan and the rogue on the other. Such alliances are invariably
broken when either the eyes of the one are opened, or the capacity of
the other is not gratified." Poor Lord Robert Grosvenor, the cham-
pion of Homcepathy, has confessed himself diddled, and declares he
has been humbugged from first to last. He now employs a regular
practitioner."

284 Medical Independent. July

" The Iodide of Amonium — A chemical much used in photograpy has
been introduced into Therapeutics, by my friend Dr. B. W. Richard-
son, the Editor of the Quarterly Journal of Public Health. It is quite
soluable in water, not unpleasant to the taste, and a little more pungent
than Iodide of Potassium. It is given in doses of from one to three
grains for an adult. It possesses absolutely marvellous powers in
dispelling strumous enlargements much more rapidly than its sister
salt. It has been found of great value by Dr. Richardson in seconda-
ry syphilis chronic rheumatism, the primary stage of phthisis, and
various forms of scrofula. It may be used, also, externally in the
form of a linament with glycerine or soap linament as a menstruum.
It is thus early absorbed. In this manner (a drachm to the ounce of
glycerine) he treats enlarged tonsils in children, applying it by means
pf a camel hair brush every night.

From what I have seen and heard of this new salve from my friend,
jind with the experience I am already gaining of its value myself in
public and private practice, I do not hesitate to prophesy the most
valuble and important results from its use, and I loose no time in
drawing vour readers attention to it."

CORRESPONDENCE.

EIGHTH ANNUAL MEETING OP THE STATE MEDICAL SOCIETY OF

INDIANA.

Editors of the Medical Independent : — Perhaps a few random
notes, of the transactions of the State Medical Society of Indiana, at
its May session, may not be wholly devoid of interest to the patrons
and readers of the " Medical Independent." I have ventured to offer
vou the subjoined as a kind of medical " ollopod."

From the number of annual meetings held by our State Society, it
will be seen, that it has been organized over eight years. But little
interest was manifested by the profession at large in the State, in the
prosperity of the State Medical Society until some three years since,
when its constitution was so amended as to have its meetings held
regularly at the Capitol of the State, since which time the meetings of
the society have been growing in interest, and securing from year to
year, a better attendance of the members of the profession through-
out the State. The cause of this is doubtless from the fact, that more
than sixty of the ninety-one counties in the State are accessible from
and to the Capitol by railroad.

The membership of our State Society now numbers something
over four hundred, some less than one-fourth of this number only at-

1857. Editorial and Miscellany. 285

tended the May session of the present year. The number would
have been larger, but for a misapprehension on the part of some of
the members in different portions of the State, as to the time of
meeting, against a recurrence of which a sure provision has been
made.

The last annual meeting of the State Society was one of great
unanimity and good feeling. Besides the reciprocal professional
sharpening that all medical men in attendance upon such occasions
receive, the cultivation of their social relations constitutes one of the
most charming features of medical organization. Old friendships are
renewed and strengthened, and new ones formed, the pleasures and
enjoyments of which dwell greenly in the memories of the partici-
pants, as they severally tread the too often rugged pathway of profes*
sional duties.

The first report from special committees, was " on the effects and
comparative value of active blood-letting in Pneumonia," and was of
respectable merits, — brief and pointed, — eliciting some discussion, in
which those who participated took opposite ground, showing most
clearly in Pneumonia, as in almost all acute diseases, the modifying
influences of climate, locality, and the diseases preceding its preva-
lence, have in forming its peculiar type. In some portions of the
State where pneumonia prevailed more or less epidemically, its char-
acter was decidedly sthenic, absolutely demanding active depletion by
the lancet in the early stages of the disease, or the use of some active
and reliable arterial sedative, in order to procure a favorable issue in
the treatment, while in other portions of the State, where the disease
also prevailed as an epidemic, the treatment pursued, that was most
successful was almost in all respects the opposite, namely, that which
western practitioners sometimes term the " supporting plan of treat-
ment," in the use of antiperiodics, alteratives, expectorants, anodynes,
sedatives, and counter-irritants. The latter method was almost uni-
versally adopted in portions of the State where diseases are prevalent
of a malarious origin. 1 think it would be safe to state that the opin-
ion of a large majority of the members present, was in opposition to
active blood-letting in pneumonia, based upon individual observation
made in active practice during periods of frt>m five to thirty years.

The next report was from a member of the committee " on Purga-
tions in Dysentery " in which considerable ability was manifested*
The author advocated the use of mild laxatives, rather than active
purgatives, conjoined with mercurial altratives. In the discussion of
this subject, as in the treatment of Pneumonia, the effects of climate
and locality were again exhibited. In some Localities, where dy sen*
tery prevailed as an epidemic, the treatment consisted in simply

386 Medical Independent. July

^ emulging the liver by the use of the mildest mercurial preparations,
$Bd depleting the mucous exhalations of the intestinal canal, by using
s&inute and often repeated portions of Sulphate of Magnesia." while
tjk other portions of the State, where this disease also prevailed as an
epidemic, alterative mercurials combined with opiates,laxative portions
%<£ eastor oil, astringents and anodynes, and not unfrequently antipe-
sicdies and tonics were found to be necessary in treating successfully,
$iis often formidable disease.

The committee " on the effects of blood letting in common Epilep-
sy, Convulsions, &c." reported through their chairman, Dr. Hutchi-
son, that they had examined the literature of the subject, and find that
&one of the recent authorities have any confidence in blood letting as
ai remedy in Epilepsy, but on the contrary, an opposite mode of treat-
E^ent. The disease being one of debility instead of plethora, the
question was altogethe r a negative one, and unsuited to a report.

The committee " on the treatment of fractures and false joints,"
joade an able and interesting report through their chairman, Dr.
Meeker, of La Porte. The subject was treated with marked ability,
illustrated with cases, evincing a knowledge of all the modern improv-
ements and appliances now in use in this interesting branch of surgery.
The committee was continued, with instructions to prosecute their re-
searches upon this subject and report at the next meeting of the so-
Qiety.

The special committee " to memorialize our State Legislature, to
■pass a law for the protection of the citizens of the State against in-
competency in Physicians, Surgeons and Apothecaries," made a very
able report, expressing confidence in their ultimate success in procur-
ing the desired legal enactment.

The committee " on Practice of Medicine " reported through their
Qltairman, Dr. Cogly, of Madison. The report was very elaborate
and of great length, but was heard by the members of the society
"with marked attention. The author did ample justice to so wide and
•varied a subject as that upon which the report was based.

The committee " to present a memorial on vital statistics to the
State Legislature," reported that they had presented a memorial, and
& bill had passed its second reading, embodying such a law as was
disked for in the memorial, and that they were hopeful of its final pas-
sage at the next session of the legislature.

The committee " on Medical Education " made an able and com-
prehensive report, by their chairman, Dr. Fishback, of Shelbyville.
Tke report embraced a thorough examination of the entire subject of
medical education, pointing out the defects in the present system of
education, and taking high ground in favor of decided reform in

1857. Editorial and Miscellany. 287

teaching, both in our medical schools, and in our present mode of
private pupilage. A strong effort will be made until successful, at
the annual meetings of our society, to impress on all of its members,
a practical sense of the obligations resting upon every member of the
profession, and especially of the State Medical Society, to labor con-
stantly and thoughtfully in behalf of the needed reforms in medical
education, as well as in other respects, to make the society in the high-
est degree efficient for the attainment of the ends of its organization.
This is unquestionably the only true method of advancing the honor
and interest of the profession, and will be efficient, just in proportion
to the number and efficiency of individual members, who devote
themselves to the effort. Our efforts hitherto have failed to realize
our hopes, because they have been spasmodic, rather than steady and
persistant. It is a gratifying fact, that the past year has shown a much
larger number of the profession in this State sympathizing in these
views than at any former period. Persevering action is all we now
need for the slow, but certain accomplishment of our objects.

Several amendments to the Constitution of the State Society were
introduced at the last meeting, having a direct bearing upon the sub-
ject of medical education, but which will receive no definite action un-
til next meeting. The friends and advocates of the proposed amend-
ments have strong hopes of their final adoption. Among other pro-
visions contained in the proposed amendments, is to elect a board of
censors for the examination of all candidates for full admission into
the profession in this State, and to membership in the State Society.
The board of censors are required to meet as often as the society shall
determine, in different portions of the State. The examination to
consist of the ordinary oral examination in the various branches of
medical science, the presentation of a written the sits on some medical
subject, the detailed report of at least one case of disease, giving its
pathology and treatment, and if practicable, the applicant must ex-
amine and prescribe for at least one patient in presence of the board.
The examination and requirements are to be the same, whether the
applicant possesses a diploma conferred by a medical college or not.
The proposed amendments also require, that the applicant for mem-
bership in the State Society, shall not only pass an examination before
the board of censors, but must hold membership in some local so-
ciety, and the local society in which he holds membership must be
auxiliary to the State Society, having a provision in its constitution
for a board of censors, a part of whose duty shall be to examine all
applicants for admission into the office of any of the local society's
members as students of medicine. The local society snail also have
a provision in its constitution, making it a penal offence for any of

288 Medical Independent. July

its members to receive any one as a student not having a certificate
of qualifications from the board of censors.

The standard of qualifications in the examination of students, is
that recommended by the American Medical Convention of 1847.

Should our efforts to amend the constitution of our society, as pro-
posed in the foregoing, be crowned with success, we will have gained
— first, a close alliance between the local societies and the State So-
ciety, and also between the State Society and the American Medical
Association, — as the proposed amendments to the constitution of our
State Society, make it auxiliary to that institution. It is to be hoped
that in time, all the State Medical Societies will perfect this auxiliary
plan of organization, by which a closer union will be effected between
the local and State societies, as well as the State societies with the
National, so that opinions held and sentiments expressed by the most
remote local society, will be heard and felt at the great head of the
Medical Organization of the United States, and vice versa.

Second, — Reputable physicians will be compelled to organize them-
selves into local societies, and that colossal source from whence nearly
all unworthy members are furnished to the profession, will be cut off,
namely, the receiving of young men, by practitioners of medicine,
into their offices as students of medicine, whose primary education
and mental training have been anything but such as fit them to prose-
cute the study and practice intelligently, a science and art as intricate
as that of medicine.

A committee was appointed to prepare and present to the society
at its next meeting, a plan for an interchange of published transactions
of local societies within the United States. Should some arrange-
ment be perfected to bring about so desirable an object, it could not
fail to do much good. A mass of medical intelligence would be made
available to every member of the medical profession that now too
often finds but a limited circle of readers.

The committee " on Veratrum Viride " m^de a full and elaborate
report, by their chairman. Dr. Jameson, of Indianapolis, setting forth
its entire reliability as an arterial sedative, based upon the experience
of a large number of the profession in different parts of the State.
The properties of this agent were discussed at length by the members
of the society. All who had used it spoke of it in terms of decided
approbation, as an agent to control arterial action. Some claimed
for it, alterative and expectorant properties. ' None condemned it who
had used it, all agreed that it seldom failed to produce the desired re-
sults.

The committee " on Diseases of the Eye and Ear," reported through
their chairman, Dr. Parxin, of Indianapolis. The report was one of

1857. Editorial and Miscellany. 289

much merit. The want of correct knowledge by the profession gene-
rally of the diseases peculiar to those organs, and the often irrational
mode of treating them, by reputable members of the profession, was
pointed out, and the cause of this deficiency of correct practical infor-
mation on diseases of the eye and ear was traced to its proper source,
namely, the paucity of instruction given in our medical schools, to
their graduates, upon the anatomy, physiology, and pathology of the
eye and ear, and that the whole group of diseases peculiar to those
complex organs, were usually disposed of in one or two lectures, in
our medical colleges, if they are referred to at all. The reason why —
the lecture terms are too short, and consequently no time to dwell
longer upon that class of diseases, which too often fall into the hands of
specialist imposters. Is not the time near at hand when our medical
institutions will be driven by the public sentiment of the profession to
a prolongation of their lecture terms, and an increase of professor-
ships, as well as increased facilities for clinical instruction :'n all dis-
eases.

A preamble and scries of resolutions were adopted by the society,
upon the death of the distinguished and universally lamented Dr.
Kane.

The eighth annual meeting of the society closed on the evening of
the third day of its session, by an able and appropriate address from
the President, Dr.Meeker. The members in attendance left for their
respective fields of professional labor, feeling renewed in the spirit of
the profession, and the most sceptical were forced to acknowledge that
the medical world " does move."

In this necessarily imperfect synopsis of the transactions of our
State Society, many reports and papers of value, as contributions to
our noble profession have been passed over without notice, not from
any disposition on the part of the writer of this desultory article, to
make unjust discriminations, or invidious distinctions, but for want of
the facilities to do their authors simple justice, as none of the re-
ports or papers of the society were in his possession. Thirty dele-
gates were elected to the American Medical Association.

Soutli Bend, 2nd., June, 1857. II.

Editors of the Medical Independent : — Permit me to draw
your attention in a friendly manner, to the case of fracture of the
cranium reported in the May number of your journal.

Your correspondent in his concluding paragraph, remarks : M This
case is interesting so far as it illustrates the recuperative powers of
vol. in, no. v — 8

290 Medical Independent July

nature, aided by a good constitution in the young." So far, so good ;
for it appears that the symptoms of compression were not very
promptly relieved by the operation, since it required the aid of toler-
ably free stimulation for three days to bring the functions of organic
as well as of animal life up to their normal standard of action, and
to make manifest their freedom from oppression. Nevertheless, the
recuperative powers were the more worthy of credit, from the circum-
stance that in addition to the shock they sustained by the injury, they
were still further crippled by a protraction of anaesthesia during two
hours and a half, to say nothing of the operation.

As to the surgical merits of the operation itself, I have nothing to
say. but while it is doubtless a proper source of gratulation that the
patient survived the combined influences above referred to, the ques-
tion must have occurred to many of your readers, as to whether the
use of chloroform is indicated in cases of " compression " generally ;
and more particularly in such a case as the one now under considera-
tion, where the shock of " concussion " in an aggravated degree was
superadded upon the usual result of " compression."

Possibly a certain vagueness of expression in a preceding para-
graph, may have originated in my mind a misconception of the nature
of the case, and of the indications it afforded. I refer to a sentence
worded as follows :

" Aug. 30. 7 A.M. * * * * and the patient extremely sensi-
tive to the slightest touch of the wound though still unconscious."

It is difficult to conceive how a patient suffering from compression
should retain such acute sensibility, and yet remain unconscious ; in-
deed the terms imply a self contradiction, if the word unconscious as
here used is to be understood as synonomous with the term " insensi-
ble," as expressive, of the condition in which the patient was found
and described in the first paragraph of your correspondent's commu-
nication ; a construction the more legitimate, as we find the adjective
unconscious immediately preceded by the adverb " still."

I trust your correspondent will receive these brief suggestions in
the same spirit which prompts them, namely, a sincere wish that the
cause of science may be advanced by an interchange and comparison
of thoughts. A. G. Merrett, M.D.,

New York.

Surgical practice in cases of cranial fracture with depression, has,
within a few years, undergone a marked change ; formerly the rule to
elevate the depressed portion of bone, universally obtained ; at pres-
ent surgeons are guided in reference to this question, by symptoms

1857. Editorial and Miscellany. 291

of compression. If there is compression of the brain, the operation
is imperatively demanded ; if not, the surgeon should content himself
with merely removing, with the forceps, whatever loose pieces of bone
there may be in the wound, for experience has shown that very con-
siderable portions of the cranial walls may be depressed without
compressing the brain, and as the operation has for its object, the re-
lief of compression, it is contra-indicated, when symptoms of that
condition are absent. One of the most prominent symptoms of com-
pression would be such a perfect loss of sensation as to render the
patient entirely insensible to impressions attempted upon any of the
senses. Such a patient would be insensible to any injury inflicted,
consequently no anaesthetic would be required. Ancesthsia would be
a result of the compression, and would cease when compression was
relieved. In the case referred to, there were symptoms of concus-
sion, not of compression. According to modern surgery, the opera-
tion was contra-indicated, though the influence of old ideas is yet seen
in some modern works on surgery. G.

A Chapter from tEsox. — Thesis De Omnibus Rebus Et Quibusdam
Aliis. — In the treatment of Hydrocele I have found nothing so effectual
as carrying one or two loose linen threads through the sack, and then
tying the ends together and allowing them to remain until the requis-
ite amount of inflamation is created.

My own experience is, that the fluid ought not to be evacuated
prior to the introduction of the thread. It will drain off mainly into
the loose areola tissue and thence be absorbed. Not more than one
thread should be used in each puncture, and it is generally better not
to have more than one thread and a single puncture. The seton of
several threads together fails much too often to be relied upon.

Some seven or eight years ago, I had a case the result of which was
so entirely unexpected to myself and every one else, that I have
scarcely dared to mention it for fear it would be received as a
Munchausenism. A child between two and three years old was run
over by one wheel of a loaded gravel car, containing one yard and a
third cubic measure of gravel. It was one of the ordinary heavy
trucks drawn by horses, upon a temporary flat bar railroad. Being
sent for instantly, I accoutred myself with the supposed necessary in-
struments for amputation, and departed in high haste. On my arrival,
I found the evidence unequivocal that the wheel had passed over one
leg, striking it obliquely just above the internal malleolus and leaving
it about the lower part of the upper third. The mark of the flange of

292 Medical Independent. July

the wheel was left, by very slight abrasion of the cuticle and by a band
of black and blue — but the bone was uninjured and the trouble was so
trifling that in three days time, the little Emerald Islander was run-
ning about as well as ever. The weight sustained could not have
been less than a ton or a ton and a quarter. Wouldn't it have smashed
a yankee leg 1

In a case of old fracture of one of the lower vertebrae of two years
standing accompanied with caries and a large ulceration, complete
paraplegia, &c, an M. D. proposed, the patient consenting, to cutout
a portion of the diseased vertebra and thus remove the pressure from
the spinal cord.

If successful, wont it be a good case to report in the same collection
with the Cincinnati Surgeon's case — the one you recollect, Messrs.
^Editors, where the Doctor removed the entire liver without the pro-
duction of any considerable inconvenience.

Much has been said about Euthanasia, and some have even proposed
the administration of chloroform to facilitate " shuffling off this mor-
tal coil. Considering the unequalled ease with which medical societies
" wrap the drapery of their couches about them and lie down to plea-
sant dreams," what do you say to enrolling diseases under a Constitu-
tion and By-Laws %

Wouldn't patients get along with the " debt of nature'' with as much
sang froid as they do with the " fee bill % "

What is the function of the cerebellum 1

I have just dismissed a case {i.e., she died,) of tumor within the left
lobe of the cerebellum, about an inch and a fourth in diameter, under
the microscope seen to be tuberculous.

The earlier and indeed constant symptoms were those of cephalalgia,
often distinctly periodical and controllable to a limited extent by
ordinary antiperiodics. The catamenia appeared regularly. The mind
remained generally clear to the last. Partial paralysis of the right
arm and partial ptosis of both superior eyelids with strabismus late in
the disease. Aside from these, there were no particular nervous
phenomena, except persistent vomiting.

In the progress of the case the lungs became gradually and largely
infiltrated with tubercle. For a considerable time previous, (nearly a
year) she had been occasionally, forgetful and had experienced difficulty
in " collecting her thoughts."

About eight weeks ago, a stout athletic young man was caught by
the right arm between two cog wheels in a' flouring mill. The wheels
are about two feet in diameter, four inches wide, and the cogs about
five-eighths of an inch deep and with like indentations. The play of

1857. kihtorial and Miscellany. 293

the wheels is not more than one fourth or, at the most, three eighths
of an inch. The arm just above the elbow passed through this space.
A single cog was broken out and the arm may have been caught at
that point — supposing this to be the case, there was in one spot a space
of the depth and thickness of a single cog for the arm to rest in, and
the balance had to be compressed to the thickness of one fourth of an
inch.

Emphatically, the young man (or rather, his arm) was in " a tight
place." I saw him soon after. There was considerable systemic
shock, and he had bled freely. There was, of course, a compound
comminuted fracture. My lingers introduced at a large opening be-
hind, passed freely around the interior of the arm, when what was not
vacancy was mainly pumice. Fortunately the artery was uninjured,
and sensation and motion of the fore-arm and fingers were quite perfect.
On consultation, determined to try and save the arm. The displace*
ment seemed wholly to be produced by the deltoid. Rectified this as
nearly as possible by position — carrying the arm outwards and up-
wards. The tissues were so woefully " chewed up" that otherwise we
were content to wet it with cooling lotions, and, with plentiful doses of
morphine, let him alone.

Two weeks after, I removed some small fragments of bone and cut
off a long spiculum that projected from the end of the upper fragment.
The subsequent .treatment was beef-steak &c. Pasteboard and shin-
gles variously cut and carved to suit the exigencies of the various out-
lets of discharge, wrhich has been free but not profuse.

May 26th, called upon him as he was about starting for his home
nine miles south of Ypsilanti. Bone evidently pretty firmly consoli-
dated— motion in the elbow joint. The external wounds about healed
up, and every indication that a perfect cure will result. (Bye the bye,
much to my astonishment he paid his bill before he left.)

Per Contra. — A few years ago a fine athletic young man suffered a
severe compound fracture of the leg by means of the M. C. R. R. cars.
The soft tissues were torn off in front and to the inner side of the tibia
about eight inches in length by four in width. Some four inches of the
tibia was bodily knocked out. The artery could be felt beating freely
in the interosseous space — sensation and motion in the foot and toes.
The fibula was uninjured and not displaced. Ambitious of a display
of " conservative surgery" (especially as the patient would not let us
take the leg off) and with the approbation of distinguished counsel — I
made an effort to save the leg and the life. The case ran on apparently
very favorably for about a fortnight when symptoms of mortification,
much to my mortification) appeared. Counsel and self both recom-
mended amputation, which was accordingly beautifully and expedi-

294 Medical Independent. July

•? — ■

tiously performed by Prof. Gunn of the University, the patient being
gloriusly under the influence of chloroform. There seemed no remark
able shock, but the poor fellow gradually sunk and died in about eight
hoars after.

I may remark that tha " line of demarcation" was well defined and
the patient's strength apparently fully equal to the operation. Now
let me appeal to the theory of my dear and talented friend of the
Peninsular, whether this difference in result of my two cases was be-
cause one was " preceded by a railroad accident" and the other by a
pair of cog wheels in a mill ? I pause for a reply.

Looking at the two injuries, I had rather have taken the risks on
the leg, for the exsection was about as neatly done and the tissues did
not look much worse than after certain hospital operations I wot of —
whereas the cog-wheels beat even the digging for enchondroma we
have read about in the valuable periodical above alluded to.

I am happy to furnish this additional case to the list of my friend in
establishing that new principle in surgery. The railroad cars are still
ahead of cog-wheels and threshing machines.

Speaking of the payment above alluded to, reminds that real estate
has gone up, provisions have gone up, horses and chaises have gone up,
and things generally have " riz," like well leavened bread, but doc-
tor's bills " go up" quite diversely. I was scant for office room, and
considering the most expedient course for remedying the difficulty
without a move and going up of rent, I hit upon a plan that I would
recommend to my professional brethren. An immense pile of " bills
receivable" (This is a " paradox"), and their correlative — " bills pay-
able"— (a " dog 7ii e") attracted my attention. Light burst upon me>
A blessing rest upon locofocos ! [matches I mean.) In their exit from
my sight, transformed into gas and vapor with the accumulated Dr.'s
(not doctors but debits) of years — they gave light. Rejoice with me, I
am relieved — my office is now large enough — 1 have room for even
waste paper which may be used.

Try it — Expertus loquor. Let your future bills be really honoraria-
Dum redeant Satumia regno.

Apropos of horses and chaises — are chaises professional ? Or parti-
colored horses ? Are they not contrary to the code of ethics 1 Are they
not unseemly and savoring of quackdom ? Do they not portend a
hankering after notoriety and in fact are they not advertising devices ?

An ancient whilome friend of mine hath sounded the alarm in my
ears, and I have laid it to heart. Do answer me this Indepen-
dently.

I will no chaises — Procul 0 procut 0 chaises ! The only legitimate
vehicle for a physician is one having three wheels only — for then it is

1857. Editorial and Miscellany. 295

expressive in its very construction of the tripod of old time — the three
Graces, the square root of the Muses — the three Fates, the heads of
Cerberus — the trident of Neptune, the forks of Jove's thunderbolt — the
three Furies. The Aristotelian number — containing within itself a
beginning, a middle, and an end.

Terna UU haec jyrimum triplici divtrsa colore
Licia circumdo, terque haec aliaria circum
Effigiem duco. Virgil, eclogv,s viij.

"Thrice is he armed (and wheeled) that hath his quarrel just !"

What is Janus beside one having three faces ?

This is a Not-ty subject and grows upon me, but I forbear.

Ever Yours, jEsox.

[We cordially welcome our able and pleasing contributor, not-
withstanding his sly allusion to the color of our pet horse. Long may
jEsox flourish, instruct and entertain. G.]

north east district medical and scientific association.

Pursuant to adjournment, a meeting of this Association was held at
the Huron House, Port Huron, Wednesday, June, 1857, Dr. Stock-
well in the chair, and Dr. Knight, Secretary.

The Association was called to order by the President, and the pro-
ceedings of the previous meeting were read and approved.

On motion, a committee of three were appointed to report names
of new members.

Drs. Andrews, Kibbe and Reed were appointed such committee.

The eommittee reported the names of Drs. Travers, Tucker and
Wilson of Port Huron, and G. W. Cornell of St. Clair, all of whom
were received as members.

On motion of Dr. Brownell, it was voted that the Secretary be di-
rected to correspond with the standing committees and ascertain
whether they have prepared reports upon the subjects assigned them
or not, and report at the next meeting.

Dr. Knight, a committee appointed to report upon Surgical Practice
made a report upon the same, which was accepted and adopted.

Dr. Andrews, a committeee to report upon meterological observa-

296 Medical Independent. July

tions, made a very interesting report up. >n the same, which was accept-
ed and adopted.

Dr. Andrews read from an ancient pamphlet, published by Mr.
Moses Willard, of Albany, N. Y., an interesting account of remitting
fever as it occurred epidemically in that city in 1809.

On motion, the matter of Dr. Buffuin was laid on the table until
the next meeting.

Drs. Stockwell. Andrews. Travers. Brownell. Cornell and Knight
made reports upon some interesting features of diseases which have
appeared in their several localities during the year.

Dr. Knight offered the following resolution :

Resolved — That when we adjourn, we adjourn to meet at Utica on
the last Wednesday of January next. Adopted.

On motion of Dr. Wilson :

Resolved — That a committee be appointed to prepare a system of
meterological observation and record of disease throughout the district,
in such manner that as far as possible, a knowledge of the influence
of meterological phenomena upon health may be developed. Adop-
ted.

Drs. Andrews. Stockwell. Wilson and Knight were appointed said
committee.

On motion, the Association proceeded to elect Delegates to attend
the State Annual Association, to be heid in Detroit in Januarv next.
The following persons were elected :

Drs. Cornell and Travers of St. Clair county.
" Knight and Chapman of Macomb "
" Smith and Wilson, of Oakland.
" Stone and Kinney of Lapeer.

On motion, it was

Resolved — That we tender our sincere thanks to our host, Mr. Da-
vison, of the Huron House, for the liberal hospitality we have this
day received at his hands.

On motion, the Association adjourned to meet at Utica, on the last
Wednesday of January next.

Dr. C, M. STOCKWELL, President.
Dr. P. A. KNIGHT, Secretary.

1857. Editorial and Miscellany. 297

From the Nashville Journal of Medicine.

AMERICAN MEDICAL ASSOCIATION.

tenth annual session.

[concluded.]

Nashville, May 7, 1857.

Functions of Different Portions of the Cerebellum. — E. Andrews;
of Illinois.

Causes of the Impulse of the Heart and the Agencies which In-
fluence it in Health and. Disease. — J. W. Corson, of New York
City.

Treatment of the Residts of Obstructed Labor. — J. Marion Sims,
of New York.

Treatment best adapted to each variety of cataract, with the method
of operation, place of election, time. age. etc. — Mark Stephenson, of
New York.

Human, Animal and Vegetable Parasites. — Joseph Leidy, of
Philadelphia.

Best Substitutes for Cinchona and its Preparation in the Treat-
ment of Intermittent Fever, etc. — B. S. Woodward, of Indiana.

Intimate Structure and Pathology of the Kidney. — Charles E.
Isaacs, of New York.

Etiology and Pathology of Epidemic Cholera. — T. W. Gordon, of
Ohio.

Inflammation of the Cervix Uteri. — Henry H. Miller, of Louisville,
Kentucky.

On Milk Sickness. — W. H. Byford, of Indiana.

Best means of causing an increase of the number of Essays. — Drs.
Leidy, Woods, and Meigs, of Pennsylvania.

Changes produced in Comp>osition and Properties of Milk. — N. S.
Davis, of Illinois.

Stomatitis Materna. — D. C. McGugin, of Iowa.

On Criminal Abortion, with a view to its generation suppression. —
II. N. Storer, of Boston.

The committee recommend that the committees ordered by the
adoption of the resolutions accompany rag Dr. A. J. Semmes' report,
be filled by the several State Societies.

On motion of Dr. Brodie. amended so as to refer the same to the
officers of several State Societies. Carried.

The committee also recommend the amendment of the third arti-
cle of the constitution, in relation to meetings, by inserting after the
words " first Tuesday in May," the words, or the first Tuesday in June,

298 Medical Independent. July

and also by inserting after the words " shall be determined," the words
with the time of meeting.

Special Committee on the present state of science, as regards the Pa-
thology and Therapeutics of the Reproductive Organs of the Female. —
D. Fordyce Barker, of New York.

On Moral Insanity. — D. M. Reese, of New York.

On Calculi and the Diseases of the Urinary Organs, in Iowa, Min-
nesota, and Nebraska. — Dr. J. C. Hughes, of Keokuk, Iowa.

On the nature, tendency and general treatment of Syjihiliiic Bubo. —
Moses Gunn, of Detroit, Michigan.

Organic Chemistry — its progress and relations to Physiology and
Pathology. — Prof. Samuel St. John, of New York.

On Medical Education. — By (Dr. Currey's resolution,) James R.
Wood, of New York ; Geo. R. Grant, of Memphis, Tennessee; John
Watson, of Few York ; C. B. Nottingham, of Macon, Georgia ; R.
La Roche, of Philadelphia, Pennsylvania.

To f 11 a vacancy in the Committee on Medical Topography and Epi-
demics.— Dr. J. L. Cabell, of Charlottesville, Ya.

Dr. March moved that the Report of the Nominating Committee
be taken up, and each subject to which it refers, be considered sepa-
rately, which motion prevailed. That portion relating to nominations
was then adopted.

The place of the next annual meeting of the Association being the
next subject in order, after some discussion, on motion of Dr. March,
the report of the committee was adopted.

Dr. Lindsley moved that, as Dr. Semmes, one of the newly elected
Secretaries was absent, Dr. Brodie, of Michigan, be elected Secretary
pro tern which was carried.

Dr. Pitcher offered the following resolution, which was unanimous-
ly adopted :

Resolved, That a committee of three be appointed, of which the
President of the Association shall be chairman, to communicate with
the Surgeon General of the Army, the chief of the Medical Bureau
of the Navy, and the Secretary of the Treasury of the United States,
with a view to secure the concurrence of these departments of the
Federal Government, so that its contributions to the Medical Topo-
graphy, the Yital Statistics, and the Sanitary Police of the nation may
be made tributary to the labors of this Association.

The Chair appointed as such committee, Drs. Z. Pitcher, of Michi-
gan, and R. II. Coolidge, of Kansas.

Dr. Bowling, Chairman of the Committee on Prize Essays, sub-
mitted the report of said committee, as follows :

1857. Editorial and Miscellany. 299

The Committee on Prize Essays report that four essays have been
received, each possessing great merit.

The Committee selected the following two essays for the two prizes^
provided for at the last meeting of this Association.

1st. One entitled "The Excreto-Secretory System of Nerves, Its
relation to Physiology and Pathology," with the following motto :

M Observation becomes Experiment when used in severe processes of
Induction" and signed Henry Frazer Campbell, Georgia.

2d. " Experimental researches relative to the Nutrition, Value and
Physiological Effects of Albumen, Starch and Gum when singly and
exclusively used as Food," with the following motto :

" Qum sequimur? quove injubes? ubi ponere sedis?

Da pater augurium, atque animis illabere nostris ! " and signed*,
Wm. A. Hammond, M.D., Asst. Surgeon, U. S. Army.

The President read an invitation to the members of the Associa-
tion, to visit the University of Nashville, in its Military, Literary^
and Medical Departments.

The Committee on Voluntary Contributions, reported in favor of
the publication in the Transactions of the Association, of the follow^
ing paper. " On the blending and conversion [of Types in Fever*1
By C. S. Pease, M. D., of Wisconsin. The report was adopted.

Dr. McMurray offerred the following resolution which was
adopted :

Resolved, By this Association, that the Committee on Publications
be instructed to append the Code of Ethics of the American Medical
Association to each volume of its present and future Annual Tran^
sactions.

The amendments to the Constitution proposed by Dr. Stocker>
of Pennsylvania, at the last Annual Session, were taken up and laid
on the table.

Dr. Lindsley offered the following amendment to the Constitution^
which was seconded by Dr. Gunn :

" In Art. II, omit the words ' Medical Colleges,' and also the words
' The Faculty of every regular constituted Medical College, or char-
tered School of Medicine, shall have the privilege of sending two del*
egates.' "

The amendment lies over until the next meeting of the Association
under a rule of the organization.

On motion of Dr. Palmer, the resolutions reported at the last An*
nual meeting of the Association, by the Committees on Plans of Or*

300 Medical Independent July

ganization for State and County Medical Societies, were taken up and
adopted.

The following resolutions were offered and adopted :

Bv Dr. Pitcher—

Resolved. That the members of this Association, as recipients of
the cordial, generous, and elegant hospitalities extended to them by
the profession and the citizens of Nashville, in placing on record an
expression of thanks for the social amenities they have enjoyed during
its tenth annual session, wish also to leave behind them the assurance,
that the recollection of their short sojourn in Tennessee, will be cher-
ished as dearly as the remembrance of the far off sound of water, by
xhe exhausted and way-worn traveler.

By Dr. Means —

Resolved, That the earnest thanks of this body be presented to the
authorities of the State and City, who have tendered this magnificent
State Capitol for their sittings during the present session.

By Dr. Currey —

Resolved. That the thanks of the Association be tendered to the Re-
porters of the City Press, for the accuracy and promptness with which
they have reported the proceedings of the Association, and to the Pub-
lishers, for the liberal supply of their morning papers during the Ses-
sions of the Association.

By Dr. Wister —

Resolved. That the thanks of this meeting be presented to Dr. Wm.
Brodie, for the efficiency with which he has discharged his duty as
Secretary.

By Dr. Byford—

Resolved. That the State and County Societies throughout the Union
be requested to recommend their members to purchase the Transac-
tions of the American Medical Association, and that their officers act
as agents for the same.

On motion of Dr. Guun. of Michigan, the ^Association recognized
the presentation of a pamphlet by Henry Frazer Campbell, M.D.,
claiming ;t Priority in the Discovery and naming of the Excito-Secre-
tory System of Nerves.'"

On motion of Dr. Byford, the Association then adjourned sine
die.

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MEDICAL INDEPENDENT:

A MONTHLY

Review of Medicine and Surgery.

VOL. 3. DETROIT, AUGUST, 1857. NO 6.

Original Cwmmufata.

Article I. Case of Hernia Complicated with Hydrocele and

Hematocele — Operation followed by complete cure of all.

By H. O. Hitchcock, M. D., Late House Physician to Bel-

levue Hospital.

In the afternoon of April 19th, I was called to see A

B , and he gave the following account of himself:

Age, 28, — always robust and healthy — a carpenter by
trade. Four years ago, while shingling a house, he noticed
a rather sudden increase in his left testicle. It was painless,
and gave him no discomfort, except from its size. He did
not carry up the shingles, and does not remember to have
strained himself in any way. ISTo venereal disease had pre-
ceded or followed it.

In one week after its commencement, the tumor was as
large, and much the same shape, as a goose-egg ; and such
have been its general size and shape up to the 18th of April
— a little larger at autumn, and smaller in the spring, — his
labor, during the summer and fall, being upon buildings, and
in winter, in the shop.

The tumor was larger at its upper end than at its lower. —

There was then, and has since been, a fullness at the external

abdominal ring, but not, as he thinks, along the course of the

inguinal canal. He could, at any time, increase the size of
VOL III, no. vi. — 9.

Hitchcock's Case of • Hernia. August

the tumor by straining, as at stool, or by coughing. The feel
of the tumor was, he says, as if there were water within. —
Sometimes it would " loosen up," and then become hard and
solid again.

While running a race, on the evening of April 18th, he felt
a sudden " giving away " in his scrotum, as if the former solid
tumor had broken.

There was no pain and no immediate enlargement of the
nirnor.

He walked to his boarding house, and went to bed. —
The tumor soon began to enlarge, and continued so to do quite
rapidly all night. Early in the morning, he went to the privy
and had a very small movement from his bowels. While at
stool, he noticed that the tumor was very considerably en-
larged, particularly at its upper part, and he then noticed a
decided fullness along the course of the inguinal canal.

When called to him, in the afternoon of the 19th, I found
him lying on his bed with a tumor between his legs of more
than 14 inches in length and 6 to 8 inches in diameter. The
penis was completely concealed. The left side of the scrotum
only seemed involved. There was much ecchymosis, especi-
ally at the lower and posterior part of the tumor. There was
uniformity neither in the surface, the feel or the percussion.
Attention was called to two large, roundish prominences, one
at the lower posterior part, left side, the other at the lower
anterior part, near the middle of the tumor. These seemed
quite hard and inelastic. Over some parts, the feel was
doughy — over others, as if there were a solid body within,
and over others still, as if air were beneath.

Percussion, in some parts, gave complete dullness — in oth-
ers, dullness less marked, while at the upper part of the tu-
mor, there was decided resonance.

The tumor seemed to grow, by a pedicle, out from the ex-
ternal abdominal ring ; and this pedicle was distinctly trace-
abler by the eye and the touch, along the whole course of the
inguinal canal

The patient gave no evidence of constitutional disturbance

1857 Hitchcock' 's Case of Hernia. 303

■ — skin moist and cool, pulse 70 and full, tongue clean, no
nausea, no pain at either abdominal ring nor in the tumor it-
self. Ordered, a cathartic of Sulphate of Magnesia.

April 20th. At my request, Dr. J. Adams Allen visited
the patient with me this morning. Patient has slept quietly
— bowels unmoved. Dr. Allen's diagnosis agreed with my
own — oblique inguinal hernia, with a large effusion of serum.
Ordered, a cathartic of castor oil. Taxis was commenced by
pressure from below, and a kind of milking process above. —
We could distinctly feel something pass under our hands;,
with now and then a gurgle ; and the patient could feel some-
thing "running into his belly," as he expressed it. By three
hours' work, the tumor was reduced in size just about one-
third. The reduction was much the most rapid at the com-
mencement of taxis ; afterwards, something seemed to impede
it, and finally completely to stop it, as if there was a clog at
one of the rings, or in the course of the canal. Taxis was re-
sumed in the afternoon and evening, with a similar, but not
so marked a reduction of the tumor.

Bowels still unmoved ; pulse a little quickened ; no pain ;
but little soreness from pressure at the external ring.

April 2\st. Patient is much as we left him last night —
bowels yet unmoved, though there has been considerable
rumbling in them ; pulse 80, full; skin moist; soreness less.

Taxis again resumed by Drs. Allen, Pratt and myself —
sensations, to both physicians and patient, same as yesterday,
followed by considerable reduction in the size of the tumor.

Again failing to completely reduce the hernia, we had re-
course to the warm bath and tobacco poultice ; but still there
seemed to be a considerable part of the hernia unreduced.

April 22d. Drs. Allen, Pratt, William and Charles Mot-
rom, with myself, found the patient, having had but little
sleep, with a pulse 90, and rather quick and small ; tongue
coated ; bowels still unmoved ; not much pain, but much
soreness at the external ring and along the canal. The tu-
mor is now considerably larger than the double fists of a large
man — of much the same shape as at first, with a very

304 Hitchcock's Case of Hernia. August

marked fullness at the external ring and along the inguinal
canal.

The injection of tobacco infusion was decided upon, and
when complete relaxation was produced, taxis was again em-
ployed. The same sensations as at first were felt by surgeon
and patient, and the tumor was sensibly reduced, but not al-
together— nor was the fullness along the canal at oil de-
creased.

It was agreed, by all the gentlemen present, that an oper-
ation was indispensible, and, at 2 o'clock p. m., the patient
was put under chloroform and the operation performed.

Some of the tissues were much thickened, as if they had
been the covering of an old hernia. On arriving at what we
all thought ought to be the sack of the hernia, we were com-
pletely surprised to be unable to feel, through its walls, any
contents other than fluid-.

The layers overlying this sack were completely dissected
from it, and we surrounded it. We found the cord behind it,
but no intestine within.

It was suggested that this was the intestine itself — it extend-
ed along the direction of the canal, just where the intestine
should be, — but where was the sack \ That we had not cut
it through we were very sure — and if we had, and this was
the intestine, there was such complete adhesion all around
that reduction was impossible. At this juncture, one of the
gentlemen present boldly advised that a "peek-hole" be
made into the thing before us. However, our incision was
extended a little higher, and the parts dissected away, when
lo! the suspicious-looking sack came abruptly to a ccecal end
above, nearly on a level with the internal ring. Bands of
fibres ran across it and along its middle, making its appear-
ance much like the ccecal extremity of the colon. An in-
cision into this sack showed it to be the upper extremity of
the tunica vaginalis, filled with blood — some fluid, and
much of it in dark, hard clots. About four ounces of blood
were evacuated, and the whole upper part of the sack cut off.

1857 Hitchcock's Case of Hernia. 305

The hernia was found to have been completely reduced by
taxis, probably after the tobacco injection.

The wonnd was now closed and dressed. The patient, with
10 grs. of Dover's powder, slept well through the night.

April 23d. Patient, in all respects, doing well — pulse 90
and full ; skin moist and cool ; no more coating on tongue
than yesterday ; no pain.

April 2Uli. Pulse quickened — 100, and rather hard ;
tongue more coated ; bowels still unmoved ; and patient has
a feeling of general uneasiness. Ordered 01. Ricini oz. iss.,
to be followed, in 3 hours, by a large enema — three pints—
of warm soap-suds.

April 25th. Patient much better this morning — the oil
and the enema were followed by two or three copious evacu-
ations— pulse 70, full ; tongue begins to clean oif and appetite
to return. Wound dressed this morning — nearly one-half has
healed by first intention ; but very little suppuration ; no sign
of sloughing.

The tumor, now about the size of a man's double fists,
ghows the same prominences as before described.

May 1st. Patient has gone on without one single unto-
ward symptom.

The prominences before mentioned were opened to-day, by
incisions of about an inch in length. The one nearer to the
left side of the tumor, and on its posterior aspect, was found
to be a true hematocele, the upper part of the sack of which,
probably, we had cut off in our operation. The prominence
near the middle of the tumor, and on its anterior aspect, was
found to be a true hydrocele, and unconnected with the hae-
matocele. It contained just about one ounce of clear serum.
Strips of lint were passed into these openings and retained
there.

May loth. Patient is nearly well — wound completely
healed. Suppuration has taken place in the cavities of the
hydrocele and hematocele, and the sacks seem completely
-obliterated. Tumor is now not so large as a man's single fist.

May 2$th. Have to-day fitted one of Marsh's trusses tc

306 Hitchcock's Case of Hernia. August

the patient, and he goes about his work, with an injunction to
be very careful. Tumor is now no larger than a common
fowl's egg, and this enlargement seems to be mostly in the
testicle itself, which is twice or thrice its normal size. The
thickening and induration of the walls of the left scrotum al-
most entirely gone. For the last three weeks, the tumor has
been painted with Iodine.

jRemarks. — This case presents us with several points of in-
terest, in its history, its treatment and its result.

It seemed to us, that the young man had had, for the last
three years, a hydrocele complicated with hernia.

It is probable, also, that there were two sacks of hydrocele
— for after one, and the main one, ha4 become an hemato-
cele, there was still a true hydrocele found.

This old hernia must have been an " encysted " hernia, as
Sir Astley Cooper has named it — i. e. the upper part of the
tunica vaginalis was divided across by a septum, and in front
was the hydrocele, and belrind this septum was the hernia.

In our operation, we did not come into the canal so that the
finger could be pressed upward, it being prevented by the
septum.

By the accident, not only was the hydrocele converted into
#n hematocele, but the hernia received a very large in-
crease. This, however, was entirely reduced by taxis, but at
the very last. The sack of the hematocele extended so far
up along the inguinal canal, that it completely misled us.

How could we have been sure that all the intestine and
the omentum had been reduced ?

The result in this case has been most happy and complete.
For three years, the young man had been unable to cross
his legs in sitting — now it is as easy for him to do so as for
any one ; and the size of the tumor is not more than twice the
natural size of the scrotum and testicles. There seems to be
no inclination for the hernia to descend.

Kalamazoo, June 22d, 1857.

1857 Stearns On Liquors and their Adulterations. 307

Article II. Liquors and their Adulterations. By Frederick

Stearns, Pharmaceutist.

Modern researches, in that department of chemical science
which treats of organic matter, have enabled the chemist to
isolate from fermented grape juice those peculiar principles
which give it aroma, bouquet, color, etc., and which serve to
distinguish it from other liquids. They have also enabled
him to procure, from the refuse of wine vats and by artificial
means, the materials necessary for the successful imitation
of every wine and distilled liquor known.

Formerly, pure liquors were mixed — that is, they were in-
creased in bulk by additions of distilled spirit, and then
brought up to the required standard by means of foreign
substances. Now, however, they are manufactured entirely.
The art of the "mixer" has become scientific by the aid of the
chemist, and he is & producer. Now, the "jobber," who is
skilled in all the mysteries of the trade, can stand beside a
cask of pure spirit (highwine), and imitate perfectly, with
chemical flavors, essential oils, etc., Otard or Schnapps, Jo-
hannisberg or St. Peray.

In our own country is this art of man ufactu ting liquors
carried to its greatest perfection — and it is the purpose of the
writer to show, in this article, some of the methods employed.

The high ruling prices of imported wines and liquors,
caused by the scant vintages of late years, has been the great
incentive to the artificial production of them here. It is even
asserted that foreign liquor-makers, not satisfied with sophist-
icating their own growths and distillations, import, from this
country, large quantities of alcohol, for the purpose of
making brandy, and of re-shipping it to the United States.

The substances in the grape, which impart color, bouquet,
taste and flavor to wine, are tartar, tannin, essential oil and
the coloring matter of the husk. These form but one per
cent, of it — the balance being alcohol, water and sugar. It
has been ascertained, that, in the process of fermentation,
not over a fourth part of these substances are taken up by the

308 Stearns On Liquors and their Adulterations. August

wine, and that the most valuable one — the essential oil — can
be obtained from the lees. This flavoring oil — the product
of the grape — is mixed with an artificially-produced senanthic
ether, and constitutes what is known, in commercial parlance,
as "Oil Cognac," and is used in manufacturing brandy.

This is found in market, varying much in quality of aroma
and appearance. That which bears the highest price (about
twenty -five dollars for a fluid-ounce) is of a pale amber color,
and consists almost entirely of senanthic ether, as produced
from the grape, and is used for imitating the finer kinds of
brandy. There is another variety — a mixture of essential oil
and senanthic ether— of a light green color, due to the pres-
ence of copper ; another is colored pink by cobalt ; others are
white, yellow or brown — the greatest difference being in the
quality of the senanthic ether.

The properties of pure brandy are subject to some variation,
arising from different growths of the vine. An experienced
dealer and judge can always recognize the products of differ-
ent provinces. Brandy is colorless when distilled, but ac-
quires a slight amber color from the cask in which it is kept,
or is colored by caramel (burnt sugar), which is said to ren-
der the spirit mellow and more palatable. Analysis shows
pure brandy to consist of alcohol, water, volatile oil, senanthic
ether, coloring matter and sugar. Some varieties also con-
tain a small portion of acetic ether and tannin.

Now, to show how closely modern manufacturers follow
the guide thus given by analysis, in producing a domestic ar-
ticle, I will state some of the methods employed.

The highest proof-spirit is employed for imitating fine bran-
dy, because less contaminated with the grain or fusel oil pres-
ent in the raw whisky, — the most of it being removed by
repeated and careful distillation. This spirit is reduced to
the standard required — being that of equal parts, by volume,
of absolute alcohol and water, called "neutral spirits," though
this term indicates a spirit of any proof, — and is converted
into brandy as follows :

A mixture (little over six ounces) of amber oil cognac, oil

1857 Stkakns (hi Liquors a tui their Adult* rations. 309

of bitter almonds and etherial oil of wine, XL S. P., put into
one hundred and seventy-five gallons of spirit, prepared as
above, produces, with the assistance of a little simple syrup
and more or less caramel, the finest varieties of pale. or dark
brandy. Sometimes a gallon of Malaga wine (a made-up
wine) is added.

It is well known, that oil of bitter almonds is one of the
deadliest of poisons, containing, usually, four times the
amount, bulk for bulk, of anhydrous prussic acid, that our of-
ficinal solution (U. S. P.) of that acid does. The etherial oil
is also highly poisonous.

A mixture, in all one and a half gallons, of acetic ether,
tamarinds, sour cherry juice and a little vjhite oil cognac
forms, when put into one hundred and thirty gallons of " neu-
tral spirits," pale or dark cognac, as may be desired, with car-
amel and simple syrup.

The green oil of cognac, with etherial oil, oil bitter almonds
and tannin — in all, nearly six ounces — converts one hundred
and fifty gallons of the neutral spirits into brand}'. A few
pounds of elder-flowers give it mellawness, and the tannin im-
parts roughness and age.

The pink or l/rovm oils of cognac, make * Rochelle "
brandy, when mixed in due proportion with acetic and peach
ethers. It only requires of them seven ounces, to doctor one
hundred and thirty gallons of neutral spirits — caramel as be-
fore.

It is, perhaps, well to remark, that manufacturers also re-
quire, in order to produce the variations of different pure
brandies, bruised French plums, for their acid and flavor /
wild cherry juice, for its astringency and bouquet; oak sha-
vings, for their astringency, color and odor ; catechu, for its
tannin and color ; powdered charcoal, black tea, ground
rice, peach ether (a compound of oil bitter almonds and dilu-
ted butyric ether), and oil grape — a compound of the organic,
radical amyle, possessing a strong, vinous odor. In connec-
tion with this substance, it is a. singular fact that amyle is
carefully separated, in one of its torn is of combination — that

310 Stearns On Liquors and their Adulterations. August

of fusel oil (hydrated oxide of amyle) — from the spirit, in first
preparing it for the manufacturer's use, only to re-enter it, in
another form, for the purpose of forming " Brandy."

Holland gin, when pure, is a spirit obtained by first fer-
menting barley and rye with hops, allowing effervescence to
cease ; then distilling, repeating distillation from juniper
berries, which last gives it its peculiar aroma and diuretic
properties. Age improves gin, imparting to it a smooth, oily
flavor, much admired by many.

Three-quarters of the gin sold is entirely innocent of any
knowledge of Holland. The English cordial gins, so much
used as medical agents for their diuretic and carminative
qualities, are all made up liquors.

There are, however, large quantities of gin shipped from
Schiedam — though not all of it, for bottling as " Wolfe's Aro-
matic Schnapps," the product of the three hundred or more dis-
tilleries of that village, beinir several millions of e-allons
yearly.

Manufactured gm is made as follows: A mixture of oils,
of juniper berry (freshly distiled) and angelica seed, in
equal proportions, together with rum ether, oil of lemon,
common salt, and simple syrup, is added to spirit of the
proper proof, neutralised by means of spirits of nitre. Some-
times oils of caraway seed and fennel seed, with peach
ether, are added to the above, to create an " Aromatic Gin,"
or to give smoothness \ richness and creaminess to the li-
quor.

Creosote is used to give to gin a certain degree of smokiness;
caustic potash is added to make it strong and biting on the
palate.

British " cordial " gin is sometimes made of oil of bitter al-
monds, oil of vitriol (sulphuric acid), spirits of turpentine, oil
of juniper, coriander seed, orris root, elder flowers, acetic ether,
and sugar, in proper proportions, macerated in proof spirit.

Common gin is a crude distillation of whisky, from a mix-
ture of spirits of turpentine and common salt with a dash of
juniper berries.

1857 Stearns On Liquors and their Adulterations. 311

Rum, vrhenpwre, is the distilled product of fermented re*
fuse sacharine matter which accumulates where sugar and
molasses are made. The hest varieties are obtained from the
West Indies, and are termed Jamaica, Santa Croix, and
Kingston — the Jamaica being considered the best. The pe*
culiar flavor of rum is due to the presence of a portion of
empyrumatic oil which forms and passes over with it during
the process of distillation.

Now, by distilling a mixture of black oxide of manganese^
sulphuric acid, alcohol and strong vinegar, a peculiar etherine
liquid is obtained, possessing the odor of rum in a remarka-
ble degree ; this, when mixed with essential oils, and colored
brown, is termed, commercially, " Oil Jamaica Rum ;" col-
ored pink, and entitled " Oil Kingston Rum," or left of its
natural color and it is " Oil St. Croix Rum."

A single ounce of the oil Jamaica rum, with a little essen-
tial oil of pimento (allspice), some acetic ether, a few pounds
of sugar and ten gallons of water converts one hundred gallons
■ of fourth proof spirit into " Jamaica ;" or, by using white or
pink oils, with some essence of lemon and spirits of nitre, the
same quantity of spirit is converted into Kingston or St. Croix
rum. Simple syrup, molasses, and caramel, are also used to
sweeten, give smoothness and color to this liquor.

It is often remarked that if habitual drinkers would confine
themselves to whisky — that pure drink — the probabili-
ties are that they would average longer lives and be less sub-
ject to the horrors. This might be true if Ifigh proof alcohol
was drank by them, properly diluted, but not when the com-
mon grain whisky of the still is used.

Common whisky contains a large percentage of corn or
fusel oil (an oxide of the organic radical amyle), being pro-
duced during fermentation, and of itself volatile, though less
so than alcohol, it passes over, in distillation, in large quan-
tities. Repeated rectification only partially removes it. It is,
in a pure state, highly poisonous.

I am credibly informed by an extensive alcohol distiller,
that, in running highwincs enough to product- three hundred

3i2 Stearns On Liquoiys and their Adulterations. August

barrels of alcohol, he separated at least a "barrel of crude fusel
oil, one table spoonful of which, if swallowed, would -produce
fatal effects.

In order to cheapen the production of whisky, and of course
at the same time lessen its wholesomeness, manufacturers are
accustomed to cover up the flavor of the grain oil which the
faw spirit contains — not remove it partially by rectification —
by adding strong flavoring materials.

Peach whisky is fashionable. Where does the peach come
from? When aqua fortis is distilled with benzole, a pe-
culiar substance is the result which resembles in odor the
oil of bitter almonds — this is the peavh part of the whisky.
Kaw grain whisky is readily converted into pineapple whisky
by adding a portion of an etherine liquid obtained by the
action of oil of vitriol upon butyric acid. Butyric acid being
the result of a fermented mixture of sour milk, chalk and
putrid cheese. The smoke of peat converts raw spirit into
Irish whisky.

Artificial flavors are sold for flavoring the spirit in imita-
tion of Mononeahela and Scotch whisky, and all that a barrel
of raw whisky requires to convert it into " Bourbon," is two
gallons of Jamaica rum, with a little oil of caraway and bit-
ter almonds.

So much for distilled liquors.

Wines, generally, are so doctored by foreign growers to
suit the vitiated taste of habitual drinkers of them, that after
the addition of liquor tonic (brandy), sugar, and coloring mat-
ter, the best of them would hardly be recognised when com-
pared with samples in their original state of purity.

All the best wines imported into the country contain a fair
share of brandy ; it is added to them previous to exportation,
for the ostensible purpose of making them stand the voyage
without fermenting, but, in reality, because the market de-
mands strong wines.

The manufacture of wines has reached the greatest perfect-
ion. Essential oils and peculiar etherine flavors are produced

1857 Stearns On Liquors and their Adulterations. 318

by the chemist, and with these and a hundred poisonous sub-
stances can wine — the produce of any variety of grape — be
imitated.

Port wine, which, in a pure state, is a sweet, rich, aro-
matic wine, of deep color and mild taste, is required by those
who use it habitually to be strong. The English, especially,
prefer the strong port, and it constitutes the variety termed
London dock, and is made by adding brandy, elder berry
juice, and sugar, to pure juice port.

Of the other varieties of port, though some may reach us
in a pure state, yet they are generally of a poor quality, be-
ing mixtures of wines of different growers, good, bad and in-
different.

Neutral spirit is the base of manufactured ports in this
country, containing, usually, 25 per cent,, by volume, of alco-
hol, flavored with " May wTine ether," colored with elder
berry juice, beet juice, or cochineal and caramel. The other
qualifications of pure port wine are obtained by suitable ad-
ditions of red tartar, catechu, tannin, sugar, honey and spices.

I understand that " British port " is manufactured of hard
cider, red Cape" wine, plum juice, red tartar, catechu, bitter
almonds, cochineal, caramel, raw spirit, logwood, sugar,
cloves, cassia and ginger, fined with bullock's blood.

I have seen a specimen of " Port wine " which is largely
sold in this city, which is nothing but fermented elder berry
juice, or elder wine.

Madeira wine, in apure state, it is asserted, is exported to
our shores in greater quantities than to any other country,
because Young America likes this wine for its flavor, rather
than -strength. In a pure state, and when old, it has a pun-
gent, bitter-sweet taste and nutty flavor ; it is very fragrant, and
is generally admired by wine drinkers. It is considered one
of the most valuable of medicinal wines. It is manufactured
from neutral spirit, to which a portion of good Madeira or
sherry is added, with ' sugar, coloring matter, and flavor-
ing, denominated "Ether of Madeira Wine," sold by im-
porters of these flavors. It is also made by fermenting a mix-

314 Stearns On Liquors and their Adulterations. August

ture of malt and sugar, and adding Cape wine, brandy,
sherry and port.

Sherry, it is believed, we also get a fair share of, in a pure
state — at least with nothing more than brandy in it, varying
in amount from five to ten per cent. It is pale or dark, ac-
cording to the amount of coloring matter it is allowed to take
from the husk of the grape. This is the wine directed to be
used in the manufacture of the medicated wTines of the United
States Pharmacopoeia, from the fact that it contains no acidity.

As a made-up wine it is manufactured similarly to Madeira,
and materials are used which will impart to raw spirit its
peculiar dry, nutty flavor. British sherry is a wine obtained
by fermenting sugar, ale-wort, raisins and yeast ; then bitter
almonds and orris powder is added, and the wine fined ; or a
spirit, obtained by fermenting parsnip juice with water and
sugar, is mixed with a poor grade of Madeira, cassia, cloves
and bitter almonds added, and the whole fined with isinglass.

Clarets are abundantly produced and consequently cheap,
though some of the favorite varieties rank among the highest
priced wines. They are as fully as abundantly manufactured
from rough cider, a red wine from the Cape of Good Hope,
catechu, spirits, bitter almonds, etc.

The less said about champagne wines the better, for there
is more — several times over — exported to America and Rus-
sia alone than the whole champagne district in France pro-
duces ; and in the immediate champagne districts are large
establishments for the manufacture of artificial champagne.
Our own countrymen are not at all behind in this branch of
industry — and I believe that champagne and Jersey cider are
now considered synonymous terms.

The Rhine wines, or " Hocks,'' as they are called, are nearly
all made-up wines, and by the same means that the other wines
mentioned in this article are manufactured. Some of the
brands of Rhine wines bear fabulous prices in districts where
they are produced and are never exported. It is the same
so try with all wines grown, all are subject to sophistication in
the hands of dishonest producers, or the demand being greater

1857 Allen's Practical Suggestions. 315

than the supply, tempts those skilled in the manufacture to
so make imitations of them.

Throughout Europe wine is considered by all classes a ne-
cessary of life, its use is habitually indulged in ; in fact, it
constitutes almost the entire food of a large portion of the
inhabitants of the southern part of the continent. It is a mat-
ter of fact, that but a tithe of the evils of intemperance are
produced by indulgence in the use of such alcoholic liquors,
when compared to those produced in England and America
by the habitual use of " stronger tipples ;" and while to the
larger per centage of alcohol in the liquors used here may be
attributed a portion of the difference in its effects, not a little
is due to the poisons with which the largest portion of the
liquor drank in our country is adulterated.

Article III. — Practical Suggestions, No. in. By J. Adams
Allen, M. D.

Ten years ago Typhoid Fever was quite unknown in south
western Michigan.

Physicians in extensive practice did not see a case in years,
and some even went so far as to deny that it could exist here.

I do not now recollect of having a case in my own practice
in this place prior to 1848. Of course it will be understood
that a broad line of distinction is to be drawn between true
Typhoid Fever, and the (unfortunately quite common) typhoid
symptoms, presenting themselves in badly treated cases of
remittent.

The type of fevers was periodical, and their treatment as
simple as the teachings of Scripture. The merest modicum of
experience and common sense, with a little Calomel and a good
deal of Quinine, was about all that was requisite. Unluckily
the latter articles were reversed in proportion, and of the first
two, the first prevailed over the second.

Profuse catharsis by Calomel and its adjuvants, and then

316 Alleys Practical Suggestions. August

excessive "alterative " use of the same, begat a vast number
of " complications" and a vast number of pseudo-typhoid
fevers.

Worse than the drugs of our brethren, even, the drastic nos-
trums of the newspapers raked through the bowels of suffering
humanity and the lacerated surface became prolific of mani-
fold diseases.

The choleraic diathesis which soon after supervened, proved
to patients that their intestines were not to be trifled with.
Then came Typhoid fever, and the irritable mucus membrane
and excitable nervous system proclaimed inexorably that the
rain of Cathartics was over.

Many would not see, they would only feel. They felt there was
wrong somewhere, and so they went blindfold into Homoeop-
ath v, and their aforetime uneasv bowels vearned with sensa-
tions delightfully new under the sugar pellets and diluted
nonentities of the ethereal practice. Some of them recovered
even in spite of the sin of omission, and as usual each case
thus fortunate was trumpeted as a triumph over the prior sin
of commission.

Personally I consider this trumpeting about as Milton did
that of Salmasius — ; the sound thereof most of all resembles
the results of accumulated flatulency.*

Agues are now infrequent — continued fevers are the rule,
and true Typhoid often met with. This change of the endemic
diathesis is one worthy of careful study. In my view it im-
presses great changes in treatment upon almost every case to
be met with in general practice.

All the phenomena of Typhoid fever tend to convince us
that it is essentially dependent upon a materies riwroi in the
blood. The results of treatment illustrate it, and I take for
granted that it is as well established as possible without its
being absolutely sequestered and demonstrated by the chemist.

A large amount of this maieries unattended by efforts at
elimination, involves the phenomena of Cerebral Typhus. A
large amount and excessive effort at elimination induces the

1857 Allen's Practical Suggestions. 317

graver forms of Typhoid (Abdominal Typhus); a lesser amount
and active exertion presents the more common mild forms.

It is quite unfortunate that under the general term, " in-
flammation/' are grouped a great variety of very different
conditions. The term in fact is as indefinite as that of " fever."
The intestinal affection in this disease is too frequently con-
sidered and treated as an inflammation, whereas it is no more
nearly allied to common inflammation, than the small pox
pustule and its surroundings are to the tumor, rubor, color and
dolor succeeding a healthy wound.

We are invited in practice to imitate the mode adopted by
the vis medicatrix natural in endeavoring to eradicate dis-
ease. A better plan is to watch the tendency to death, and
provide against it by such measures as scientific experience
may suggest.

The tendency to death in the greatest portion of cases which
have fallen under my notice has been by ulceration, haemorr-
hage or perforation in the ileo-coecal region. In every case
examined, post mortem, the Peyer's patches have been invol-
ved, as sufficiently described in the books.

None have recovered after perforation — three cases. Three
fourths have recovered after haemorrhage — eight cases. With
these exceptions the disease has proved very amenable to
treatment, and the results satisfactory.

I must be permitted to say that the so called complications,
gastritis, pneumonitis, meningitis, &c, have been infrequent
under my observation, though frequently my professional
friends have insisted that certain symptoms proved their exis-
tence. If these various organs were inflamed, the inflamma-
tion was of such a character as to merit quite a different name
and treatment. In my view, too much ammunition has been
wasted on " complications," especially by the book-writers.
They might as well devote their batteries to the gouty toe,
and neglect the gouty carcase.

Nothing is more true than the statement that in Typhoid
fever while there is life the case is not hopeless, and while
there is any disease there is danger. In the first case of per-

VOL III, NO. VI. — 10.

318 Allen's Practical Suggestions. August

foration of the bowel in my practice the patient had so far
convalesced as to be up and about, and there was absolutely
no external or rational indication of remaining disease — and
yet while at stool the pains of perforation came on and he
sunk and was dead in six hours. On the other hand I have
had patients apparently moribund recover, in very spite of
the prognosis.

The diagnosis is easier made than given. I rely upon the
group of symptoms in the outset, and the roseolar eruption
later as pathognomonic.

I. Languor, lassitude, mental hebetude, diarrhoea, epistaxis,
continued fever, slight bronchial cough.

IT. Roseolar Eruption — always present if carefully looked
for, tympanites, sudamina, deafness, dryness and redness of
the tongue, gurgling in the ileocoecal region (often with ten-
derness) upon pressure (French method), nervous symptoms,
delirium, subsultus, &c.

III. Gradual convalescence. Or deepening of previous
symptoms to constant delirium, coma, involuntary discharges,
retention of the urine, prostration, <fcc, &c.

Average duration of treatment, nineteen days. A few cases
will spin out to four or even six weeks.

Treatment. Xo emetics. Xo blood-letting. ~No active
cathartics, except in the cerebral form with torpid bowels —
rare.

First importance — quiet sleep at night . For this purpose
I prefer a single full dose of Pulv. Ipecac. Comp. The cases
are very few when a large dose of this will not secure sleep,
provided the patient does not fancy he has an idiosyncrasy
with reference to opiates. (Mem. The less a patient thinks
he knows about medicine, the more likely he is to be benefit-
ted.) Rarely some other narcotic may prove useful.

Second point — that the bowels move once a day and no
oftener. I prefer to check the diarrhoea Pulv. Opii and Acct.
Plumbi in moderate doses, p. r. n. To move the bowels 01.
Ricini vel Olivae with twenty or thirty drops of Sp. Terebinth.

1857 Allen's Practical 8uggesti(/as. 319

Practically in this disease I deem all saline cathartics objec-
tionable.

Third item — control febrile action by external sponging,
cool air, free ventilation, cooling diuretics and diaphoretics.
The diuretics are particularly preferred. Especially Acetas
Potassae: 1st because it is practically useful by experience,
2d, because it eliminates a larger amount of solid matter
through the urine than any other known article. For instance
this :

11. Acet. Potasae dr. ij — oz. ss.: Sp. Nitri Dul. oz. ss.:
Pot. Tart. Antim. gr. ij.: xVq. oz. iij. ss.

M. Two teaspoonfulls every three hours.

If it inclines to purge add Tr. Opi. Caniph. q. s. or Tr. Opi.
The hobby of the hour, Tr. Verat. Virid., may be substituted
for the Pot. Tart. Antim. either in or out of the mixture for
its known effects. In my opinion it controls symptoms well
but shortens no disease. It is hence infinitely inferior to the
Antimonial. It is more liable to leave a red tongue and aug-
mented intestinal disorder. It is neither restorative nor
depurative except in dangerous doses. In perhaps the ma-
jority of instances I rely upon the simple solution of the Acet.
Potassa* without adjuvants. Later in the disease Liq. Am-
nion. Acet. is substituted occasionally. In this connexion, I
beg leave especially to recommend free and constant use of
the Acet. Potassaa. Xo other diurtic or diaphoretic has any-
thing like its power as a febrifuge and eliminating agent in
continued fever. I cannot but believe from long and close
observation of its effects that it relieves the system of that
material which is tending to excretion by the ileocoecal region,
so prominently deranges and destroys the glands and other
structures of that part.

It lessens thirst and thus obviates the necessity so often felt
of deluging the stomach and bowels with diluents, eminently
nasty decoctions and shadowy soups. Hence diarrlnea les-

ftBj and tympanites witli the accompanying train of nervous

320 Allen's Practical Suggestions. August

symptoms abates. There will be less need of Valerian, and
Assafoetida with its after effect of horrible odors.

Fourth proposition — When the red tongue, especially if dry
and shining, appears, my experience adds nothing to the in-
structions of Prof. Wood as to the employment of the 01.
Terebinth, except a most cordial and hearty endorsement. It
is the treatment — and the ne plus ultra of satisfactory treat-
ment. In a very few cases, I have found that it would not be
borne, and these cases have responded readily to moderate
doses of mercurials — not carried to salivation. With this
latter exception I have found no use for mercurials in typhoid
fever.

Fifth — As " a looker on in Verona1' I have seen alcoholic
stimulants used freely in the Typhoid fever, but must enter
protest against them as a mode applicable to rustic constitu-
tions. The cachectic crew that throng the fever wards of
metropolitan hospitals furnish no standard by which country
practice is to be guided — especially as the results here would
speedily drive the practitioner from his " field of labor."

In the vast proportion of cases they are unnecessary and as
hurtful as they are to the healthy man. Their abstraction
when once commenced with, produces proportionately the
same effects as upon the habitual tippler. In my view, con-
sidering the terrible consequences attendant upon the use of
alcohol, it is the duty of medical men to avoid its prescription
except in cases clearly and distinctly demanding it. In my
experience it is of trivial value in the disorders now under
consideration, and liable to the production of serious mischief.
It will allay the nervous semptoms, it is true, but is not un-
likely to aggravate the intestinal ulceration. At the very best,
I have noticed that those who rely upon it, have very sick
patients and a multiplicity of " complications."

Patients rarely die of simple debility — the reason of death
is deeper, and we have no evidence, theoretical or practical,
that alcohol searches it out. A much more useful stimulant
is furnished in Carbonate of Ammonia, Aristol. Serpent, is
also very frequently quite serviceable. The stimulus they

1857 Allen's Practical Suggestions. 321

afford is more akin to the natural forces beyond this, and they
do not gorge the blood with carbon. But in the —

Sixth note — appropriate diet is beyond all other means the
real sustaining power. Concentrated nutriment is easier
digested than attenuated dilutions. Dish water slops will
nimble along the canal and so outward, in one perpetual flood.
Nourishment should be communicated so as not to require
mastication, but should be retained in the mouth long enough
to become fully insalivated. This simple thing alone will
moisten many dry tongues. While there is much activity of
febrile action it is^better to eat nothing, then farinaceous bo-
luses (not slops), then strong essence of beef (not " beef tea"),
then hashed beef, then sucli meat as the appetite craves and
the teeth are willing to thoroughly masticate, commingled
with bread &c, up to ordinary diet,

There is no objection to some condiments, as black pepper
and salt, A table-spoonful of essence of beef has more sup-
porting power than the same quantity of brandy — but dilute
it with slops, and it vnll go with the " chocolate."

When the blood begins to show signs of impoverishment,
not only mustnitrogenized animal food be freely administered,
but there will be a saving of alcohol and vital power by
mingling a generous proportion of animal fat. But upon this
point I need not enlarge as it was sufficiently set forth in No.
II, of this series. It is fearful to think of the number who
have died of inanition, whilst some old crone, or old crone's
adviser, has been assiduously skimming off the scattered
globules of oil from the boiled shadows of the valetudinary
soup maigre. Sick diet ! Lucus a non lucendo !

Seventh particular — The drinks should never go beyond
what will be speedily absorbed from the mouth, throat and
stomach, The patient will rarely suffer from thirst if treated
freely with the salt above indicated.

Eighth — last but not least, Free ventilation is all impor-
tant. Poor people recover in the country better than rich
ones. Because the healthful air and salutiferous light are not
excluded. No place outside of a hospital (the charnel house

322 Humphrey's Cases — Perforation of the Uterus. August

of typhoid fever) is worse for the patients than the close,
heavily curtained, heavily carpeted and cumbrously furnished
rooms of the affluent, No patients are so subject to pulmo-
nary complications as those who are carefully guarded from
" taking cold/' A feather bed is herein an abomination. The
entire paraphernalia of the couch should be changed daily.
One day for service and one day out of doors. The evacua-
tions are pestilential — out of doors with them instanter. The
emanations are pestiferous — dilute them with outer air and
sunlight. Have nothing in the room more than twenty-four
hours in succession which is capable of absorbing effluvia.

Do not keep out the blessed sunlight or pure air. Put on
a cheerful visage, even if playing Sir Oracle. The awakening
and sustaining pleasant emotions in the patient's mind is
worth more than a gallon of " Huxham."

The subject of medicinal tomes will be adverted to in an-
other connection hereafter, the length of this paper warning
me that it is a misdemeanor to trespass unduly upon the
columns of the Independent.

Kalamazoo. July Sth, 1857.

Article IV. Cases Reported at the April Meeting of the
St. Joseph County {Indiana) Medical Society. By L.
Humphreys, M. D.

Case I. Perforation of the Walls of the uterus and blad-
der, during parturition, from exostosis upon the body of
the pubic hnies — resulting in death. — Friday, February
13th, '57, was called to see Mrs. M., aged 23, who was in
labor with her first child, at full term. The patient was
of nervous-sanguine temperament — nervous predominating ;
complexion fair ; light hair and eyes — with decided scrofu-
lous diathesis. The patient had been seen two or three times
a day on the 11th and 12th, but the uterine efforts were so
slight as to require no assistance. On visiting her the after-

1857 Humphmey's Cases — Perforation of the Utei*us. 323

noon of the 13th, found the pains more expulsive, and an
examination of her vaginam revealed the os dilated to the
size of a half-dollar, hut rigid. During the afternoon and
night, the labor made a tardy progression — but not more
tardy than most frrst labors ordinarily do. At two o'clock
next morning — the rigidity of the os-uteri and soft parts
generally continuing — bled the patient freely from the arm,
after which pains of medium force took place, the mouth of
the uterus and soft parts becoming relaxed in a' good degree,
and labor, in the proper acceptation of the term, set in — the
former uterine efforts being only preparatory. The present-
ation was in every way natural — the occiput behind the right
acetabulem, and the os frontis resting against the left sacro-
illiac junction. At seven a. m., the membranes were rup-
tured, the fluid contents of the uterus escaped, and soon
after, the head became well engaged in the superior strait —
the vertical tumor of the scalp protruding into the inferior
strait and in the direction of the vulva. During the time
that the several examinations were made, per vaginam, the
presence of several sharp, spinous projections or elevations
was detected upon the posterior surface of the body of the
pubic bones. Throughout the day, on Saturday (and the
second day of the labor proper), the parturient process pro-
gressed slowly, each hour's uterine effort advancing its con-
tents, and giving promise of a happy termination. During
the night the pains continued much as they had been
through the day, with an occasional subsiding of their force,
and the procurement of rest, for an hour or two at a time, to
the patient, from the exhibition of anodynes. At six o'clock
on Sunday morning, the head was partially engaged in the
inferior strait, the tumor of the scalp resting on the perinseum
— producing, in some measure, the ordinary perineal tumor.
Prior to this time, the mind of the patient had been remarka-
bly cheerful and buoyant — nervous system calm and quite
free from undue excitement, considering the temperament of
the patient ; but now the nervous system became much ex-
cited, the brain keenly alive to impressions from noises of

324 Hitchcock's Cases — Perforation of the Uterus. August

any kind, the mind disposed to wander, pupils of the eyes
much contracted, anxious expression of the countenance, res-
piration hurried, — in short, the well-marked symptoms that
precede congestion of the brain were present. Add to this
nearly an entire suspension of the pains. Drs. Dayton and
Buchtel being in consultation, it was decided .to apply the
forceps, and terminate the labor as speedily as possible. The
patient was rapidly becoming delirous, and resisted any and
all attempts at instrumental delivery. Chloroform was given
carefully until the patient was fully under its influence.
Notwithstanding its full anesthetic effects, it failed to control
delirum and resistance, on the part of the patient, to any at-
tempt at successful manipulation. Repeated efforts were
carefully made, by the consulting physicians and myself, to
introduce and apply the forceps — which were only partially
successful, on account of the contortions of the patient's body
and limbs. As some exhaustion had been produced by these
efforts, it was deemed best to give the patient an anodyne,
and permit her to rest, before using any other efforts to ter-
minate the labor. The respiration, in the mean time, contin-
ued hurried, delirum more marked, the pulse rapid and fee-
ble, great physical inquietude, and disposition to change pos-
ition on the bed — in short, nearly all the symptoms that
accompany congestion of the brain, were present, with ten-
dency to sinking. Stimulants were repeatedly attempted to
be given, but without success, as the patient resisted all at-
tempts at the exhibition of any agent by the stomach. A fa-
tal termination of the case was now evident, and all future
efforts at delivery were abandoned as useless and unwarranted.
The patient continued to sink until death closed the scene
on Monday morning. It would be proper to state here that
the bowels and bladder of the patient were frequently and
freely evacuated from the commencement of labor, until de-
lirium set in ; that often during the parturient efforts, free dis-
charges of urine occured, so much so as to saturate the clothing
underneath the patient, as was evidenced by the unmistaka-
ble odor of that secretion.

1857 Hitchcock's Cases — Perforation of tlie Uterus. 325

Autopsy, twenty-four hours after death : Abdominal turno*
ATery large — rendered so by the contents of the womb and tfoe
presence of gas — the latter making a prolonged and forcible
escape at the point of first incision. The first object presented
was the bladder, much distended, containing considerably
over two pints of urine, which, after being drawn off, was fol-
lowed by a discharge of fully as much bloody serum. The
neck and lower third of the bladder were firmly pressed against
the pubic bones, at the symphysis ; on opening the bladder,,
the mucous lining and blood vessels upon its posterior surface
were congested and engorged, near to, and to the right of the
symphysis pubis ; the coats of the bladder and uterus were
punctured, the aperture being a little over two inches ia
length, and through wdiich the left ear of the child protruded
into the bladder. This opening was behind and opposite to
one of the sharp, spinous ridges or elevations before referred
to, on the body of the pubic bones, and had been produced
by pressure of the presenting part of the child against the
walls of the uterus and bladder, immediately over the sharp
bony elevation. The exostosis was not elevated quite one-
fourth of an inch above the surface of the bone. The fluid
contents of the womb had in part escaped through the aper-
ture into the bladder, and again back from that viscus in_te
the womb, and from thence out through the vagina, account*
ing for the frequent and copious discharges of urine, before
referred to, saturating the clothes under the patient. The ves-
sels and tissues of that part of the womb where the puncture
took place presented a deep, dark red color, furnishing incon-
trovertible evidence that it had been the seat of disease prior
to the parturient effort. The point where the perforation took
place had been the seat of severe lancinating pains several
weeks before confinement, particularly if the patient at-
tempted to walk or remain in a standing posture for any
length of time. Indeed, she was nearly disabled from walk-
ing for some weeks prior to her sickness and death. During
the patient's girlhood, she had suffered from displacement of
the uterus, and had often severe and prolonged attacks of leu-

326 Humphrey's Cases — Typhoid Fever, dec. August

corhoea. The child was perfectly developed and weighed ten
pounds.

Case II. Typhoid Fever accompanied with Gangrenous
Vesicles upon the skin, and extensive Ulcerations and Slough-
ing of the Cellular Tissue — resulting in death. — Mrs. H.,
aged forty-three, of nervous leucophlegmatic temperament,
was taken with the usual symptoms of typhoid fever, January
29th, '57. The patient had suffered from the premonitory
symptoms for near two weeks prior to that date, but did not
apply for treatment until that day : found much nervous irri-
tability— bowels constipated, skin dry most of the time ; occa-
sionally slight perspiration over the surface of the body,
tongue inclined to dryness, and slightly coated a light-brown ;
febrile movement mild, but almost continuous — pulse from
96 to 120 per minute — towards the termination of the case
much more frequent. The patient had suffered for many
years from indigestion and general bad health — great aver-
sion to the use of remedies — especially such as are termed by
the masses " strong remedies." Occasionally during the pro-
gress of the case there was delirum of a mild character, not
much subsultus tendinum and the typhoid symptoms were
not very strongly marked. Nothing occurred during the pro-
gress of the case out of the ordinary course of typhoid fever,
until near the close of the third week from the attack — when
a tumor or swelling, of about three inches diameter at the
base, made its appearance upon the right side of the trunk —
over and near the angles of the 8th 9th and 10th ribs of a car-
buncloid character. The central portion of the integuments
covering this tumor was quite black,and when the cellular tissue
became denuded, it presented a dry and blackened appearance,
secreting a dark sanious matter in small quantities, of a very
offensive character. Soon after the appearance of this tumor,
there appeared in various places over the surface of the body —
mostly over the abdomen — gangrenous pustules or vesicles,
having diameters of from one-fourth of an inch to two
inches ; there were from forty to fifty of these over the stomach
and bowels at one time — besides others situated upon other

1857 Humphrey's Cases — Typhoid Fever, die. 327

parts of the body — these all secreted and discharged more or
less matter of the character of that thrown off by the carbun-
cle. The edges of almost all of the ulcerated spots, were
more or less ragged and irregular — dark or purple in appear-
ance, the ulcer showing no disposition to healthy granulations*
and strongly disposed to burrow into the surrounding cellular
tissue. The local applications to the largest of the ulcers were
pulverized charcoal and peruvian bark, equal parts, moistened
with brandy and a solution of creosote, applied in form of poul-
tices, alternated with stimulating ointments. The integrity of
the surrounding tissues was maintained as nearly as possible
by the application of stimulating plasters.

The general treatment consisted, in the exhibition of stimu-
lants— such as brandy, wine, ale, and porter, alternated with
sulphate of quinine, and the various preparations of iron —
(principally the syrup iod. iron), the compound tinct. peruvian
bark, and occasionally alterative portions of mercurials.
Anodynes and nervines were, also, given as occasion required.
The exhibition of the oil of turpentine was also attempted in
various ways, but was not kindly received by the stomach.
Nourishing and to some extent stimulating diet was given at
regular intervals of time : stimulants — especially brandy and
wine — constituted the principal agents in the general treat-
ment: their effects were very satisfactory in contributing to
the comfort as well as the improvement of the patient — and
their use in very large quantities was absolutely demanded in
order to sustain the sinking energies of the patient's life forces.
The patient was more like a decomposing corpse than a liv-
ing woman, so extensive were the ulcerating patches upon the
surface of her body. Under this treatment, general and local,
there was a marked improvement in the condition of the pa-
tient— the ulcerating surfaces put on a more healthy appear-
ance— secreting an almost healthy pus, the ulcerated exca-
vations began filling up with healthy granulations, and
the appetite became much improved. Notwithstanding this
apparent improvement in the case, emaciation took place
rapidly, produced no doubt by derangement of the assimila-

328 Humphrey's Cases — Typhoid Fevei\ <&c. August

tive functions, and by the secretion and discharge of large
quantities of pus from a dozen or more large ulcerating
surfaces, and a great many small ones — and the formation of
new abscesses daily of greater or less magnitude, coming on
so stealthily, that no indication of their approach would be
given, until the existence of a sub-cutaneous marsh in the
cellular tissue would be indicated by a sense of fluctuation,
which, upon being punctured, discharged large quantities of
matter. The case terminated fatally on the night of the thirty-
seventh day of treatment — and about the fiftieth day from the
beginning of the attack. During the last two weeks of the
period of sickness, the stethoscope indicated considerable
bronchial affection — resulting at different times, in a profuse
secretion and pouring out of a thin tenacious mucus, which
sometimes seriously impeded respiration, and threatened the
life of the patient from suffocation — this continued to annoy
the patient to the end of life, and was one of the prominent
means of destroying life.

The functions of the skin, and of the mucous linings of the
air passages and intestinal canal, being so closely allied,
may we not infer, that if the ulcerative disease of the skin had
not taken place, some such diseased action of the mucous
linings would have been the result, illustrating the worst form
of typhoid secondary disease — in short, that the patient pre-
sented the appearance upon the external surface of the body,
that often results in typhoid cases upon interior mucous
surfaces — or in other words may we not look upon this case
as what is often the result of secondary typhoid disease the pa-
tient as it were turned inside out. Among other peculiari-
ties in this case — although the evidence is beyond question of
its typhoid character — the brain and nervous system were
but little involved. The patient had occasionally slight delir-
ium and towards the latter part of the term of sickness, some
nervous agitation and slight subsultus tendinum — sometimes
appearing sunk in stupor, yet no true coma — but rather the
stupor of exhaustion — for when aroused the patient's intelli-
gence was good. During the entire period of the case there

1857 Dorsch On the Medical Plants of Michigan. 329

were no maculae or petechia?. The extraordinary eruption of
gangrenous patches was in no way, of the character of ordi-
nary bed sores — it was not the result of pressure — they were
found in greatest abundance on the anterior part of the thorax,
and upon the abdomen. The vessicles became hard first at the
top — then black, and soon the mass dropped out — leaving an
excavation with ragged edges — looking as if it had been taken
out with a gouge.

The case was one of great interest to the consulting physi-
cian and myself. The contest between life and death, during
much of the period of sickness, was so evenly balanced, as to
render the prognosis extremely difficult. The patient finally
succumbed from exhaustion, brought on by the enormous
drain from the numerous ulcerated surfaces — and the deple-
tory effects of the pouring out of large quantities of mucus
from the linings of the air passages. Perhaps the absorption
of matter had its share in bringing about a fatal termination
of the case.

South Bend, Ind., June, 1857.

Article V. The Medical Plants of Michigan. By Ed-
ward Dorsch, M. D.

An old proverb says : " No prophet is appreciated in his
native place," — and the proverb is a true one, for we find it
so in scientific and every-day life. Our own manufactures
can not please the taste of our ladies, and we have to import
the laces of Brussels, the silks of Lyons and the shawls of
Cashmere. Our most velvety peach does not tickle enough
the palates of our gourmands, and ship-loads of pineapples
and bananas have to arrive from far-off regions, to quench
our thirst and delight our gustative nerve. As the traveler
sees a fairy-land in the distance, which induces him to rove
from shore to shore, our imagination covers all that comes
from remote regions with a rosy cloud, and our fancy, contin-

330 Dorsch On the Medical Plants of 'Michigan. August

ually wandering from pole to pole, makes us forget the rich
treasures Nature has placed within the reach of our hand.
We hasten over dreary deserts and scorched mountains, to
dig and wash the golden dust of California ; and the golden
grain, the real wealth of our country, is neglected, and rots
in undrained fields. Human nature, the great enigma not
yet solved, finds it easier and more desirable to toil for prob-
lematic gain, than to earn the daily bread quietly, using the
means which are most available. Indifferently we tread
under foot the modest violet with the sweet fragrance, and
stand admiringly before the green-house plant, which opens
a sickly calyx without perfume.

And so it is in the medical profession too. If we look in
our Materia Medica and Dipsensatory, we find the largest
chapters dedicated to foreign plants and products ; and in
our prescriptions, we hunt for the strangest names and the
rarest remedies We run to the drug-store for an East-In-
dian plant, and stumble over the root in our garden, which
possesses the same healing properties ; we pulverize, by the
sweat on our brow, the hard and worm-eaten root of South-
ern Africa, and forget the green vine, which climbs up to our
window, as if to induce us to try it.

Xot that I wish to declare war to all foreign drugs : bv no
means ! I am not Know-Xothing enough to expel these kind
foreigners, which heal our diseases, from the shelves of the
apothecary ; but I wish a place reserved for the children of
our woods and fields, for which Dame Xature was no step-
mother, and which are endowed with rarer qualities than we
usually suppose. Some of our drugs from abroad are becom-
ing dearer every year, and would it not be worth great effort
to find means of supplying them by native plants ? If our
beautiful asclepias syriaca with the milky juice and the silky
fibers, should prove to be an equal of the cinchona, why
continue to curse it as a useless weed, when it shoots up in
our garden-beds and in our orchard "{ Why should we buy
the vile pulverized rhubarb and jalap, which the drug-stores
offer (and which frequently do not operate), while the May-

1857 Dorscii On the Medical Plants of Michigan. 331

apple {podophyllum peltatum) grows in the shade of our
fences — not only offering a palatable fruit to our harvest la*
borer, but containing in the root a cathartic for the fever*
smitten, which finds hardly its equal in the whole materia
medica.

Certainly, many of our physicians have already used in*
digenous plants ; but they resort, in their practice, only to a
few favorites, and the difficulty of procuring them at the
apothecary's shop forces the busy practitioner to come back
to the common track. Surely, it would seem like arrogance
if I should pretend to say how physicians should prescribe,
and I do not feel at all inclined to do so ; but I may be al-
lowed to draw the attention of the faculty a little more to our
home treasures, by specifying the single plants, and the ben-
efits derived from them, as proved in my own practice, and
learned from other reliable sources. If other physicians fol-
low, in examination and experiment, we shall find, in a
couple of years, results which we have not dreamed of, and
can enrich the dispensatory with cheap and effectual reme*
dies. As I do not intend, at present, to write a systematic
treatise on this subject, it may be just as well to take up the
plants as season and occasion offer them, not regarding natu-
ral family and order. In future time, perhaps myself or
somebody else can rubricate them.

To begin with one of the most remarkable families of the
vegetable kingdom, the solanacese, which furnish so many
valuable remedies, I commence with a plant to be found in
all pharmacopoeias, but very nearly obsolete in America, — I
mean the dulcamara, usually called woody nightshade — bit
tersweet.

Everybody knows this delicate climber, with the clusters
of violet blossoms, and bright scarlet berries in autumn-
According to Wood's Class-book of Botany, the solatium
dulcamara is a flexuous, thornless shrub ; leaves ovate, cor-
date ; clusters cymose ; stem branching, several feet in
length, climbing about hedges and thickets in low grounds;
to be found from New England to Arkansas ; lower leaves

S32 Dorscii On the Medical Plants of Michigan. August

entire, the upper ones becoming auriculate or hastate ; flow-
ers drooping, on branching peduncles from the side of the
stem ; corolla of five reflexed segments, purple, with two
green spots at the base of each segment ; berries bright red.
It blooms from June to August. Linne placed it in the fifth
£>rder, petandria, monogynia. For the druggist, I may add :
the twigs or stems are round, the older ones covered with
brownish-green, the younger ones with pale yellow, some-
times gray looking, cortex ; fruit red, eliptic, smooth, two-
i-elled, many-seeded, juicy ; seed kidney-shaped. Fresh-
orushed leaves smell nauseous, benumbing \ taste bitter, af-
terwards sweet ; berries bitter and poisonous — stalks and
stems only are to be used.

Its chemical ingredients and properties can be found in
every pharmaceutical compendium ; and, e/ijxmant, I may
mention, that the picroglycion, detected by PfafT, seems to
be identical with Desfosses' dulcarin. The solanin, which
Desfosses prepared from the berries of solanum nigrum, from
the unripe fruits and young shoots of solanum tuberosum (pota-
to), is contained, in greater quantity, in the leaves of the dul-
camara, than in the stems. This may account for the nar-
cotic effects of this plant, if given in large doses, and its
singular operation upon the cerebral and spinal system.

According to the ingredients, we find in the dulcamara
two principles — the narcotic, represented by solanin, and the
saccharine, represented by dulcarin or picroglycion. The
first operates mostly upon the nervus sympathicus, with all
its ramifications, and shows, like other acrid narcotics, its de-
teriorating effect upon digestion and the whole tractus intes-
tinalis ; the other, sweetish-bitter, principle combines the
soothing, relaxing properties of saccharine matter with the
tonic power of bitter remedies, and acts principally upon the
amcous membranes, increasing the slow, and starting again
the retained secretions, correcting and improving the patho-
logical products of the mucous and sero-fibrous tissues.

(To be continued.)

1857. History, Diagnosis and Treatmen t of Fevers. 333

libliagrapfei gtoflrb.

The History, Diagnosis and Treatment of the Fevers of the United States. By
Elisha Bartlett, M. D., late Professor Of Materia Medica and Medical Juris-
prudence, in the College of Physicians and Surgeons of the University of the
State of New York, etc., etc. Fourth Edition — revised by A. Clark, M. D.,
Professor of Pathology and Practical Medicine, in the College of Physicians
and Surgeons of the University of the State of New York. Philadelphia :
Blanchard & Lea, 1856.

The extent, to which fevers prevail, the frequency of their recur-
rence and the bereavement and suffering which they occasion, all are
sufficient to keep alive an interest in, and attach a consequence to,
this class of diseases, which scarcely belongs to any other in the
domain of nosology. The past, of medical history, does not fail to
record its ravages, or to portray the obscurities in which it is in-
volved— much less, the difficulties attendant upon all investigations
concerning its nature. The discovery of the American Continent
imparted still greater interest to this variety of diseased action,
adding new complexities, by inducing, to some extent, new forms
or modifications,, and furnishing the great remedy — almost a panacea
— for the palludal variety of fevers, if not for diminished vitality, by
whatever causes produced. Its unbounded extent, its dense and un-
broken forests, the luxuriancy and vast variety of its vegetable pro-
ductions, the great diversity of its climate, its towering mountains
and immense valleys and prairies, as well as its mighty rivers and
inland seas, have given additional consequence to every fact and cir-
cumstance connected with fevers. Not only so, but the influence
operated upon the mind and affective faculties, and the innumerous
new and inviting avenues to enterprise and adventure, connected
with America and American society, tending to induce a highly im-
pressible condition of the nervious system, if not of the entire organ-
ism,— has furnished another element in the etiology of fevers, which
greatly enhances the importance of the general subject. These seve-
ral considerations seemed to give rise to a necessity for a new work,
exclusively devoted to this extended field of research — a work,
which should embody, in a somewhat analytical form, all the im-
portant facts, in reference to the etiology, the phenomena, the

pathology and the treatment of fevers, distributed over the great
VOL III, no. vi. — 11.

334 Bibliographical Record. August

commonwealth of professional literature. It was peculiarly fit, too,
that an American physician should assume the task, and, while we
indulge a just pride — something bordering on patriotism or national
complacency — that our countryman has felt himself competent and
has " played his part "' so well, we confess, we would have been
better pleased if he had treated his subject — as we think he should
have done — more philosophically, — less under the arbitrary dicta-
tion or controlling influence of a single idea. This suggestion may
require a word in explanation. We mean, simply, that while the
author has been sufficiently analytical and precise in his notices of
symptoms, pathology, diagnosis, die., to impart, to the reader, a tol-
erably distinctive view of the order of succession of the aggregate
phenomena of fevers : while the style of composition is neither tur-
gid nor remarkably labored, on the contrary, is chaste and rather
explicit, we fail to discover in the work that grouping of actual
phenomena, and that systematic generalization, which the mind, in
its search after truth, seems to demand, in order to a philosophical
comprehension of the subject before it ; of which, in our judgment,
it is susceptible, and which — if the writer had deemed it adivsable to
have investigated a little further, or, having investigated, could have
given credence, or duly appreciated — he must have discovered had
been, to a good degree at least, accomplished by another. We mean,
further, that we cannot tail to perceive that he has committed him-
self to a particular school ; and that, in the prosecution of his labors,
he has sought to bring every fact and circumstance into a coherent
and supporting relation to the special doctrines of that school, whilst
he neglects, touches but lightly, or entirely ignores, all those facts and
circumstances which tend, in the least, to contravene the doctrines and
reasonings which he has adopted as his own. We have been forci-
bly impressed with these considerations, in all our examinations of
the successive editions of Dr. Harriett's work, and nothing that we
have been able to discover in the one now under notice, tends, in the
least degree, to change our earliest opinions. Unfortunately for his
labors, and not impossibly for science, Dr. B. was not permitted to
supervise the issue of the edition before us. The relentless hand of
Death interposed to terminate a career, which if permitted to con-
tinue, might have developed results truly ennobling to the author,
and fraught with the weightiest consequences to mankind. And here,
we may be permitted to observe, that, too often to our u finite ken,""

1857. History, Treatment and Diagnosis of Fevers. 335

the monster's darts are permitted, providentially, to be pointed with
deadly aim at the loveliest and most deserving of our race. In the
language of the sentimentalist, " Death loves a shining mark ;" and
in this instance, there has been no departure from his characteristic
predilictions, so often emphatically declared. It was fortunate, how-
ever, that the author, in view of the approaching severance of the
link that bound him to " things terrestrial," should have made choice
of so worthy and competent a writer and teacher as his literary rep-
resentative, as he is, whose name occupies a place on the title-page.
Dr. Clark has performed his part with a candor and earnestness
characteristic of true friendship and, we have no doubt, of the innate
promptings of the man.

"We did not propose, when we sat down to our task, to attempt
anything like a critical analysis of the work. To do so successfully,
would require nothing short of a review of the entire subject — a state-
ment of the comparative merits of most, if not all, the doctrines and
theories of fever, which have been offered to the world. In short, it
were tojproduce a new work. But there are a few things, in refer-
ence to the first part of the treatise — that devoted to Typhoid Fever,
and on which the author manifestly expected his fame, as a scientific
medical writer, to rest — which may justly call forth animadversion.

He observes, " I have adopted the term typhoid fever, simply
because it is not particularly objectionable, and because it seems to be
coming into general use," — It is that, most commonly given to the
disease by the French, and has the advantage of marking the peculiar
lesion of the disease, while it is free from the objection of prejudging
by any implication, its nature or character." The following quota-
tion, from article second, presents the reader with another reason for
his choice of a name, " Since, however, it has been ascertained that the
disease differs, in many important respects, from the Typhus of
British writers, it has become manifestly necessary to apply to it
some other appellation ; and, in conformity to the example of Louis
Gerhard, Jackson and others, I have chosen that of Typhoid Fever"
Now it is granted that terms may be arbitrarily appropriated and
we concede it to be the prerogative of an author to attach such
meaning to the technical expressions, he chooses to make use of as
declare, most satisfactorily to himself, the ideas, the facts and the
principles, he proposes to promulgate. While, however, this much
is admitted, we insist that it is incumbent on him to have regard.

336 Bibliographical Record. August

somewhat, to literal construction and the actual relation of the thing,
principle or quality, to its representative. We take it, but few who
reason and are guided by sound logic and the analogies of language
will appreciate highly, the selection and use of a term of designation,
merely " because it is not particularly objectionable, or because it seems
to be coming into general use.''' Nor will such be more favorably
impressed with the term, as applied by the author, when informed
" It is that most commonly given to the disease, by the French," or
because one distinguished writer, or a few, even, have chosen it, if
neither literal construction nor the natural relation of the thing, rep-
resented to the term or expression that represents it, be left entirely
out of the question. If the term be used to express likeness, simi-
larity or resemblance — its true, literal meaning, — as in the case of
varioloid, it certainly is admissible, inasmuch as it leads to no ambi-
guity. Many terms, in medical nomenclature, are of like construc-
tion, as mastoid, hyoid, etc., which, kept closely to their primitive
meaning, are sufficiently definite and significant. So long then, as
the word Typhoid, is made to represent an individual of a family — a
variety or a species, we have no desire to institute a quarrel with it.
But when it is made the representative of a genus or of an individual,
sui-generis, it is manifestly a perversion, or, at best, it assumes the
character of a literary conventionalism. It is divested of its true
literal signification, and gives rise to embarrassment, if not to con-
clusions, which are calculated to mislead, in practice. But it is said
to have "the advantage of marking the peculiar lesion of the disease,
while it is free from the objection of prejudging, by any implication,
its nature or character." We are not altogether prepared to appre-
ciate the scope and meaning of the first of these postulates. By the
term lesion, we understand some u marked change in the exercise of
functions, or in the texture of organs." We suppose the author
designs it, in this connection, to represent the anatomical alteration
in the spleen, theagminated glands, or "eliptical plates of the ileum,"
and in the mesenteric glands, which he conceives to constitute the
marked characteristic of the disease ; " which disease, thus character-
ized and defined," he declares, " differs essentially from all others, in
its causes, in its symptoms and in its lesions.'''' How, then, it may be
asked, does the term Typhoid possess " the advantage of marking the
peculiar lesion of the disease? What is there about it, literally or
conventionally, whence the reader can possibly infer the pathological

1857. History, Diagnosis and Treatment of Fevers. 337

condition, which, under circumstances of constant and uniform occur-
rence, the author concludes " ought to be final and decisive in regard
to diagnosis." Certainly, we are singularly obtuse, if aught belongs
to it, which " marks the peculiar lesion of the disease." If derange-
ment of function be involved in the meaning of the word, it has
not appeared obvious to our vision. If so, it must include all, for it
is difficult to conceive, according to our observation, and it is believed,
according to all sound observation, of any disease, in which the func-
tions of the economy are so completdly and universally perverted as
in continued fever. The " advantage''' claimed, then rests, for aught
we have been able to discover to the contrary, on assumption, un-
sustained by proof. Nor are our perceptive faculties any more sus-
ceptible, in regard to the last of the two postulates, contained in the
foregoing quotation. It may not " prejudge by implication," or
otherwise, either "the nature or character" of the disease, if by the
clause, " nature or character," is designed to be understood, the
precise condition of vitality and the intrinsic kind of morbid action,
that obtains, during the continuance of the disease. But if the reader
can suppose, that this clause relates to the anatomical lesions refer-
red to above, we confess we are at a loss to conceive how he can do
otherwise than conclude, directly in opposition to the author, that it
does, emphatically, prejudge, not " by implication," but directly and
unequivocally, both the "nature and the character" of the disease. But
is it ascertained that the Typhoid Fever of Louis, Gerhard, Jackson,
Bartlett and others " differs in many important respects, from the
Typhus of British writers ?" And was it " manifestly necessary,"
therefore, to seek some other appellative, by which it might be des-
ignated % In reference to these points, it is believed that a searching
comparison of medical opinions and doctrines will scarcely sustain
the declarations of the text. Unquestionably much more is required
to be known of the intrinsic nature of continued fever, in its different
phases and complications, before it will be conceded it " is ascertain-
ed" etc. But that the reader may clearly perceive in how many
" important respects," these two alleged fevers do really differ, the
one from the other, and how thoroughly Dr. Bartlett was himself
convinced of such difference, let us compare, for a little, his defini-
tions of the two, as found on pages 170 and 327, of the edition,
before us.

Let the author speak for himself:

338 Bibliographical Record. August

" Typhoid Fever" he remarks, " is an acute affection, occurring
most frequently, between the ages of fifteen and thirty years, rarely
after the fortieth year of life ; attacking, at least, in cities and
amongst adults, in a large majority of instances, persons who are
recent residents."

" Typhus Fever is an acute affection, occurring at all ages of life,
attacking adults, — in cities, somewhat more frequently, persons, who
are recent, than those who are old and permanent residents."

Typhoid is, " occasionally, and under certain conditions, capable
of transmission from one individual to another."

Typhus is "often transmitted directly from one individual to an-
other."

Typhoid is " more common in certain countries than in others ; but
not confined, so far as is known, to any geographical localities or re.
gions."

Typhus is " very much more common in the British Islands than
anywhere else, although prevailing at times, in other countries."

Passing over those portions of the respective definitions, which re-
count the circumstances and symptoms, that are common to both,
and constitute the more ordinary sensible phenomena of continued
fever, as the influence of season, climate, crowded apartments, defect-
ive ventilation, chills, heat, thirst, state of the pulse, condition of the
skin, character of respiration, pain, condition of the sensations and
intellectual faculties, muscular strength ; secretions and excretions,
and others, marking likeness, rather than specific difference, we come
to the pathological summary, that belongs to each. And, first, of
what relates to the blood.

In " Typhoid Fever, the blood, when drawn from the body, having its
fibrin diminished in a degree, closely corresponding to the gravity of
the affection."

In " Typhus Fever, the blood being generally of a dark color,
often fluid, or grumous ; the coagula, when formed, soft and non-
fibrinous." Second, eruption, in Typhoid " in the course of the sec-
ond or third weeks of the disease, the skin particularly of the front
part of the body being usually, the seat of a peculiar eruption, not
commonly abundant, consisting of small circular or oval spots, of a
bright rose color, slightly elevated above the surrounding surface and
readily disappearing under pressure ; coming out successively one
after another, for several days ; remaining, usually, for somewhat

1857 History, Diagnosis and Treatment of Fevers. 339

more than a week, and successively and gradually fading away and
finally disappearing." In Typhus, " the skin of the body and extrem-
eties being, generally, the seat of an abundant eruption, coming out,
in most cases, between the fourth and seventh days of the disease, and
declining, at uncertain periods, during the second and third week, con-
sisting of small spots, generally somewhat obscurely defined and
irregularly shaped, not unfrequently grouped and confluent ; of a
dusky, dingy red color, not elevated above the surrounding surface,
and disappearing only imperfectly or not at all, on pressure."

Finally, changes of structure, In Typhoid, " the bodies of patients
exhibiting, on examination, after death, in only a certain propoition
of cases, various pathological changes in the brain, heart, lungs,
stomach and liver, but in most cases, enlargement or softening, or
both of the spleen, and in all cases, thickening or redness, or a mark-
ed deposition in the sub-cutaneous cellular tissue, or ulceration, or all
these changes of the eliptical plates of the ileum, with enlargement,
redness and softening of the mesenteric glands, corresponding,in their
position, to the altered intestinal follicles." In Typhus, " the bodies
of patients exhibiting, on examination, after death, no constant patho-
logical changes of any of the organs; but, in a considerable, though
varying proportion of cases, engorgement of the vessels of the brain,
with moderate sub-arachnoid serous effusion ; engorgement of the
posterior portion of the lungs ; redness of the mucous membrane of
the bronchia ; softening or mamellonation of the mucous membrane
of the stomach."

Here is opened a rich field for comment, but we forbear, leaving
it to the reader to determine how suggestive to his understanding,
the word Typhoid is, as marking " the peculiar leison of the disease"
how completely free it is "from the objection of prejudging, by any
implication, its nature or character ;" how well " it has been ascer-
tained that the disease differs, in many important particulars, from
the typhus of British writers ;" and therefore, how " indispensable" it
had " become to apply, to it, some other appellation."

We leave it to the reader, also to determine, how unqualifiedly,
the disease, " thus characterized and defined, differs essentially from
all others, in its causes, in its symptoms," and "in its lesions"

In passing, however, we remark that, in every class and variety of
diseases, it will be found that minor differences will obtain, as the
disease may present in different individuals, in successive seasons and

340 Bibliographical Record. August

during different epidemics. But would it be judicious, therefore, to
institute and attach a new name to each slight modification as it may
arise in practice % If the principal phenomena, those, which consti-
tute the essential characters of the malady, remain intact, notwith-
standing a symptom or two, adjunct to those which are pathognomonic,
and essential to the perfection of the picture, is wanting, or is but
obscurely shadowed in the outline, or though a pathological element
not previously noticed, but which, as the figure inherent in the stone,
requires the skilful hand of the sculptor to bring it out, perhaps only
needed critical search, in a particular direction, to make its exis-
tence obvious, or to prove irrefragably that it did not exist, is it not
far more consonant with sound logic, to leave it attired in the com-
mon every-day dress, with which all are familiar ?

In taking leave of this department of Dr. B.'s labors, we are un-
willing to deprive ourselves of the sentiments of the learned and
clsssical Watson, in reference to the nomenclature of continued fever,
as declared in the following :

" We hear, continually, both in and out of the profession, different
species of fever spoken of. By the public, typhus fever, brain fever,
bilious, putrid, low, nervous. And systematic writers are, to the
full, as particular : — mucous fever, ataxic, adynamic, gastro-enteric
&c. Now, admitting that fever shows itself, under various forms, I
am persuaded that the effect, upon the mind, of all this subdivision,
is bad and hurtful. It encourages a disposition, already too preva-
lent, to prescribe for a disease, according to its name. There is no
line of genuine distinction between continued fevers, that can be re-
lied on. They run insensibly into each other, even the most dissim-
ilar of them, and are traceable, often, to the same" general cause.

We have used the phrase " general cause," instead of the word,
contagion, of Dr. Watson, as being, more in accordance, we think,
with the accepted doctrines of American practitioners, in regard to
the source or sources, whence continued fevers originate. Omitting,
for want of space, a comparison of the merits of the different modes
of describing fever, as considered on pages 37, and 38, and the rea-
sons, assigned for preferring one to the other, we remark briefly, that
the reader will not fail to notice how completely the author is com-
mitted to the method and doctrines of a particular school — how de-
voted a worshiper he is. at the shrine of a cherished idol.

He will, also, if he seek an entire and therefore a faithful portrai-
ture of this fearful form of disease, question the propriety of adopting

1857. History, Diagnosis and Treatment of Fevers 341

a system, which necessarily excludes from the catalogue of approved
authors, such names as Huxham, Pringle, Hillary and others, as well
as their labors, which, it must be conceded, have subserved the pur^
poses of science, in all of past time.

Nor will he fail to notice the tribute, the writer, notwithstanding
the system of special pleading, to which he is compelled to resort, in
order to sustain even apparent consistency, reluctantly pays to the
method, thus, perforce, excluded, as declared in what follows. After
affirming the general truth that " each has its advantages and its dis-
advantages, its excellencies and its defects," he remarks, " By the first,
a more complete and integral picture of the disease is presented, at
once, to the mind, than can be done by the second. We are enabled
to see, at a single glance, the form, the outlines, the features, the
physiognomy of the disease." Nor is the same tribute less emphati-
cally,— though not so directly announced, when he declares, " The
disadvantages of the latter consist in the absence of that wholeness and
unity of impression, which are made by the former" and yet, he
chooses to "rely," almost exclusively, upon the last mentioned,
as the only one, capable of leading to these results, — " the point*
ing out of the characteristic features of each of the four great forms
of idiopathic fever," the establishing of " a clear and positive diagno*
sis ;" and the ascertaining of " the resemblances and differences, be-
tween them." The intelligent reader, will, likewise, be not a little
surprised that a writer, who aims at " no other excellence" and who
seeks " no higher merit than that" of producing " a methodical and
compendious summary of the actual state of our knowledge, upon two
most common and most important diseases" should deliberately ex-
clude from such " summary" that portion of the literature of his
subject, by which " we are enabled to see, at a glance, the form, the
outlines, the features, the physiognomy of the disease." He will be
led instinctively, to enquire if this be not a portion, and an important
portion, too, of our " actual knowledge" concerning idiopathic fevers*

Let us now, consider, briefly, certain symptoms, and also the
specific lesions, on which, both the author, and the pathological school,
to which he has attached himself, rely, as pathognomonic of typhoid
fever, — as the marked characteristics, by which it is to be recognized,
and distinguished from typhus.

It will be observed, we use the words typhoid and typhus, as we
proceed, in accordance with the language of our author and to avoid

842 Bibliographical Record. August

an otherwise tedious repetition of explanations. Having spoken,
already, of the more common, sensible manifestations of continued
fever, as the condition of the nervous system, the circulation, etc., and
expressed our conviction that they indicate likeness, rather than dis-
tinctiveness of character, it cannot be necessary for us to recur to them
again,further than by a few brief quotations,to suggest that according to
the author's own showing, if they mark difference at all, it must be ex-
ceedingly slight, — that, when the whole phenomena are considered, it
is rather apparent than real.

In chapter 8th, on the diagnosis of typhus fever ; as a preliminary
postulate, we read as follows :

" These forms of fever, if we choose, so to consider them, are still so
distinctly marked, they differ, in many respects, so constantly and so
widely from each other, that their diagnosis is none the less impor-
tant than it would be, under the other supposition, that they are es-
sentially dissimilar diseases."

Let us examine this point, for a little. By universal consent, scar-
latina is considered under three different forms. Now, does any
practitioner regard it as imperatively necessary for him to distinguish
the one from the other, as from rubiola, variola or erysipelas ? So
far as prognosis is concerned, and, to considerable extent, treatment,
we grant it :s important that the medical adviser should know whether
it is the milder, or the more grave and dangerous form of the disease,
with which he has to contend. Small pox is equally, by common
consent, conceded to present under, at least, two principle forms. But
does the practitioner's reputation, does science, the welfare of the pa-
tient and the protection of society demand as unqualifiedly, that the
one or the other should be designated, as the settlement of the simple
question, is it small pox ? Again, much stress is laid upon the rose
colored eruption, as pathognomonic of the typhoid form of fever.
Hence we read at page 132, " Almost always, the lenticular eruption
will be discovered, if it is timely and carefully sought for." Recur-
ring, also to the chapter on symptoms, we are told, " There is
good reason to think that this eruption is almost an invariable accom-
paniment of typhoid fever;" while on the same page, (63) the writer
is compelled to acknowledge that Louis, who sought it, with care,
** found it only in twenty-six of thirty-six fatal cases ;" and Dr. Hale
did not find it in twenty of one hundred and ninety-seven cases. We
are further told, in Dr. Jenner's own language, his " impression is,

1857. Ilistoiy, Diagnosis and Treatment of Fevers. 343

that the rose spots of typhoid fever, are more frequently absent from
patients, more than thirty years old, than from those of less mature
age." Must we then, give our adhesion to the confidence, imposed
by Dr. B. in a symptom or event, as uncertain as he himself reports
the so called typhoid eruption to be ? A symptom, whose presence
or the contrary, according to the " impression" of the observing and
intelligent Jenner, is less likely to manifest itself at one period of life
than another. Much stress is also lain, both in the general remarks,
on the diagnosis of typhus fever, and in the summary statement of the
differential diagnosis of the two forms, upon alleged differences in
the cutaneous eruption. But admit, to the full, all that the writer
has been able to adduce on the point under discussion, and it may be
pertinently inquired if more obvious differences have been shown to
exist, than are conceded to obtain in reference to the eruption, in the
different forms of scarlatina, or in distinct and confluent shall pox %

Here, it may not be out of place to remark that the most recent
investigations concerning the spots, observed in fever, as announced
by Dr. Kenedy, in the Dublin Hospital Gazette, justify the following
conclusions :

" First, that the idea of different poisons, as a cause of the several
varieties of rash, does not appear to be borne out by facts.

Second, that the analogies, derived from the study of the exan-
themata are opposed to the idea of there being more than one poison.

Third, that red and dark petechice may co- exist in the same patient,
At the same time.

Fourth, that either may precede the other ; — that some members
of the same family may exhibit spots — others not ; all being sick at
the same time.

Fifth, that they may be almost exclusively confined to the abdo-
men, or to the upper half of the body, or, exhibited in groups, on the
pectoral muscles, the front of the larynx, or strictly confined to the
knees or elbows.

Sixth, that abdominal lesion may exist with dark petecheae."

Further, if it be true, as, most unquestionably, it is, that, "in their
mode of access, typhoid and typhus fevers, in many instances, very
nearly resemble each other ; if there be" a pretty close correspond-
ence, in the number, the severity and constancy of the nervous symp-
toms, in the two diseases, notwithstanding the attempt to institute a
distinction, as shown in the following, — "The nervous symptoms, in

344 Bibliographical Record. August

typhoid fever almost always creep on more stealthily and gradually
than they do in typhus. This is especially true of the dulness and
stupor ;" is not the conclusion plausible, that differences, sought to
be founded on sensible phenomena, are more apparent than real ?

But certain anatomical lesions are finally rested upon as an ultima-
tum in diagnosis.

Hence the author observes, " I have said nothing, thus far, of the
lesion of the eliptical plates, as an element in the diagnosis of the fatal
cases. It has already been remarked that this lesion is characteristic
of this disease ; that it is invariably found in the fatal cases of typhoid
fever and that it is not found in fatal cases of any other acute
disease."

Based upon these positions, we are immediately met with the fol-
lowing deduction : — " If this is absolutely true, without exception and
without qualification, the presence or the absence of the lesion ought
to be final and decisive, in regard to diagnosis."

Our limits will not permit us to dwell, at length upon this impor-
tant portion of the discussion. In reference, however, to the unqual-
ified certainty of the positions, thus distinctly enunciated, we remark :
if it be true, as declared, on the same page, that Louis, himself, mis-
took a case of " softening of the central portions of the brain" for one,
which, during the life of the patient, he pronounced typhoid fever,
(the lesion of the eliptical plates not being found on examination
after death); if, an epidemic fe\er, most of the circumstances, connect-
ed with which, ' correspond,' " as Dr. B. admits, " to the phenomena,
which we have found to occur in typhus fever," exhibited, in all the
cases, in which " antopsies were made, the intestinal lesions, character-
istic of typhoid fever" and, moreover, if Dr. Lombard, who, " for six
years, had been familiar with the latter disease, in France and Swit-
zerland, and, who, in fatal cases, had invariably found the peculiar
lesion of Peyer's glands," on examination, postmortem, of the bodies
of persons, dead of fever, (both in the city of Glasgow and of Dub-
lin), and, with respect to which he declared " no doubt could exist as to
the presence of follicular disease, found the eliptical plates wholly un-
altered" the reader will be inclined to pause, we think, before he
gives his assent to the invariable truthfulness of the positions, quoted
above.

Nor will he be less in doubt, with respect to the conclusion of the
author, that '' the presence or absence of the lesion ought to be final and

1857. Examinations upon Anatomy, Physiology, <&c. 345

decisive in regard to diagnosis.'''' The volume consists of four parts,
devoted respectively, to the consideration of typhoid, typhus, period-
ical and yellow fevers. In each part, quite a uniform course is pur-
sued ; the several varieties of fever being treated of in twelve different
chapters, entitled as follows : — preliminary matters, symptoms, ana-
tomical lesions, causes, varieties and forms, duration, march and
complications, mortality and prognosis, diagnosis, theory, treatment,
definition and bibliography. As a general summary of the special doc-
trines of fever, as held by the school, of which the writer was an
industrious and distinguished member, the work is entitled to respect-
ful consideration, and will amply compensate the medical man of
ripe experience, no less than the student and the junior practitioner,
for the time and labor, expended in its perusal. In mechanical and
artistic execution, it bears the impress of skill and taste. It is cheer-
fully recommended to all who would revive their recollections of
fever. K.

To be found at Raymond & Selleck's, in this city.

A Manual of Examinations upon Anatomy, Physiology, Surgery, Practice of Medi-
cine, Chemistry, Obstetrics, Materia Medica, Pharmacy and Therapeutics. Espe-
cially designed for Students of Medicine. To which is added, a Medical Formulary.
By J. L. Ludlow, A. M., M. D., &c. A new edition, thoroughly revised and
enlarged. "With three hundred and seventy illustrations, pp. 816. Philadel-
phia: Blanchard & Lea, 1857.

Here we have it all — the whole science of Medicine in eight hun-
dred and sixteen pages ! What use of elaborate monographs can
there be, when the whole matter can be compressed into a single
volume 1 Cast aside your ponderous tomes, save library room and
consult the inspissated juice of medical elaborations. " Especially
designed for Students of medicine." Ah ! It is a dilution then,
designed for babes in knowledge 1 We confess ourselves unable to
decide whether this, and kindred works, are intended for concentra-
tions or dilutions. Superficial and utterly imperfect, they necessarily
are, and can be of no kind of use, except in aiding superficial and un-
qualified candidates in passing stereotyped examinations. They may
be of service to students of this class, while in attendance upon the
grinders who hang about medical colleges, and, for a consideration,

346 Bibliographical Record. August

endeavor to sharpen up dull intellects to the graduating standard of
keenness ; but of real merit, to recommend them to the genuine stu-
dent, who seeks after principles, on which to base his answers in pass-
ing an examination, they are, and from their nature must necessarily
be, utterly destitute. They contemplate, like " French without a
Master," a short road to erudition, carefully avoiding the rugged
passes by which the real student reaches those principles which consti-
tute his ark of safety in the storms of practical life. Their aim is
not the inculcation of principles, but the fixing in the memory an
answer to a specific question — a process confessedly occupying the
lowest rank in the whole range of mental effort. Knowledge, thus
acquired, is limited, and will not stand the test of critical examina-
tion ; it is evanescent, and vanishes before the signatures on the
diploma certifying to its possession are dry. Educators should
discountenance their use, and students who are fit to enter the pro-
fession should be ashamed to rely upon them.

With regard to the merits of the work before us, it is very credit-
ably illustrated, by very familiar looking cuts, which have undoubt-
edly been in much better company than they now are. They not
only illustrate the subject matter of the book, but also the ease of the
process, by which books of an inferior order, are produced from the
refuse material of standard and high-toned works. Were Blanchard
and Lea members of our profession, we could but express the regret,
that men who have so largely contributed in bringing out the best
specimens of medical literature, should aid in ushering before the
world, examples of this kind. They are, however, Publishers, and
only supply the demand ; they have their reward. Let educators see
to it, that the demand is high-toned, and verily they shall have their
reward also. G.

1857. Spirit of the Medical Press. 347

Sprit rf tk fttctol Dress.

77i6 American System of Medical Education. — Excellence of plan and
faultiness of detail are by no means imcompatible. Some bridges are built,
from the necessity of the case, of perishable material ; yet so cunningly are
they fitted together — without mortice or tenon — that any decayed piece
may be taken out and replaced by something better. Like such a bridge,
is the American System of Medical Teaching. It is a good bridge, it
carries safe over, but we must remove from it the rotten timbers, ere they
give way and crush us in the fall.

It requires no uncommon shrewdness to point out the shaky supports in
our construction ; to provide proper substitutes may call for a wiser fore-
thought and more careful deliberation, as to how and when our reform shall
be put in operation.

It is consolatory to notice the fact, that the faults of our system are not.
inherent, but have their origin in some departure from the simplicity of
the original idea. Thus, when the four months' course of lectures was
established, it was supposed that the alternation of eight months of read-
ing, with four of public instruction, would afford an agreeable variety to
the student, and allow him an opportunity of reversing the ordinary mode
of hibernation, by taking his full meal of mental aliment in the winter, and
retiring to suck his paws in a quiet office during summer. In furtherance
of this idea, it was ordained that a third course of lectures should be un»
attended by other expense than the marticulation and graduation fees ;
thus holding out a strong inducement to the tyro to sit at the feet ot his
Gamaliels three terms, instead of the obligatory two.

But here crept in a departure from the fathers, in the shape of sundry
double-barrelled schools, — this happened before the days of revolvers—4
wherein two courses of lectures were given annually. In these institutions,
the student was set up on the benches early in August, and regularly pep*
pered with medical lore six hours daily, until the close of November, when
he was turned loose to recover from his headache until March ; then sub-
jected to a repetition of the same old lectures from the same solemn profes*
sors, until the close of June, when, on some hot summer afternoon, he was
discharged with a diploma, just in time to reap the benefits of dysentery
and autumnal fevers.

This plan of instruction is still pursued in some rural institutions. Its
chief merit is in the abundant opportunity it offers for cheating as to time.

348 Medical Independent. August

and the convenience it affords for students rejected at some respectable
school ; permitting them to forget their disgrace, and placing their fortunes
in gentler hands, to graduate any how, at the end of four months from
the time of their rejection. Aside from these incidental advantages
they hold out the inducements of cheapness, and it must not be forgotten
that a systematic cramming for eight months in the year supposes remarka-
ble powers of digestion on the part of the student. Another pleasant
feature is, that it allows professors to earn more money with less work,
and particularly benefits those peripatetic philosophers, who go about doing
good and dividing the influence of their names in three or four differ-
ent schools, where, not unfrequently, they teach three or four different
branches.

Satire aside, this system of two terms annually, in which the same lec-
tures are repeated, is hurtful and injurious to the cause of education, and
a proper subject for the censures of the profession and the press.

Closely analogous to the double-barrelled colleges are the revolving pro-
fessors, those men so surcharged with science that no less than three or
four professorships, in different schools, can give vent to their erudition.
The revolving professor is an animal sui-generis. Not unfrequently he
teaches different departments in each of his schools ; his brain is multiloc-
alar, and the different sections of it are closely packed with as many kinds
of learning. This nomadic method of teaching is full of serious faults.
The influence of the teacher is divided among the various schools in which
he has chairs, so as to be nearly neutralized. He is only attached to a
school as his pecuniary interest may dictate, and is ready to leave it at any
time when it most needs his aid. Throwing aside these considerations of
interest, however, it is evident, that he who attempts to give more than one
thorough course yearly, attempts too much, especially if he essays more
than a single branch.

A scanty professional corps is another fault of some schools. In no form
of effort is a division of labor more productive than in medical teaching,
and without it the matter taught is bare, compendious, and lifeless, unas-
sociated in the speaker's mind with any effort of his own, or any attempt
to attain distinction in a subject of which he knows but little himself. The
teacher who is compelled to embrace within his course a large range of
subjects, must be a miracle of industry if he would undertake the conden-
sation necessary to teach them well.

Of all the serious faults connected with our system, the worst is the
attempt to dispense with clinical teaching. By this time the doctrine
should be established, that no school should exist without the advantage
of clinical instruction for its students. It seems absurd to argue this ques-
tion, but it is only a very few years since our national association published
in its proceedings an elaborate argument intended to prove that disease

1857. Spirit of the Medical Press. 349

could be taught as well in the lecture room as in the ward. The particu-
lar process of reasoning by which this marvellous result was reached does
not now recur to me, except that it was proposed to confine the duty of the
college to didactic instruction, leaving the student to his private instructor
for bedside teaching. We will not stop to discuss such a proposition, for
it is to me, and I trust to the readers of the "Review," sufficiently obvious
that no school of medicine should be established or maintained where it
has not the benefit of the admission of its class to some sufficient hospital.
I am aware of the objections raised, of that tender humanity which
repeats the old wives' story, that a hospital is designed as a safe refuge for
the sick, and not as a theatre for medical display and experiment. T
have seen all this and much more similar balderdash repeated during the
past month, in a medical journal of considerable pretension to character,
but 1 have no patience with it and no words to express my aversion to so-
narrow-minded a view.

I take the other ground. I assert that one great good to be derived
from a hospital, a good sufficient in itself to induce its foundation, is the
opportunity for observing disease collectively, and pointing out to the
student its various phases and conditions. T would go further : an obstet-
ric clinic is not in itself objectionable. It can be made so offensive and
vulgar as to shock the moral sense of the most obtuse, but it will not in
the hands of the good men who make up the list of our professors of obstet-
rics. But I can imogine something worse than vulgarity, — a young grad-
uate, without the vaguest knowledge of the practical manipulations of the
art, or the etiquette of the lying-in room, in charge of a . case of placenta
pnevia. I know of obstetric clinics where no sense of modesty, however
fine, is disturbed, and which still'afford to the advanced student abundant
means of practical instruction.

I repeat, that where the means of clinical instruction are not available,
no medical school should exist, and the attempt to maintain one is a quack-
ery, if to claim to perform that which one cannot do, constitutes the true
definition of quackery.

Thus far in my enumeration of evils, I have mentioned only those which
are limited to a comparatively small number of schools. Many of our col-
leges are entirely free from them, and everywhere these evils seem to be
on the decrease. But very few schools now hold two courses annually, and
some of the older colleges have taken the bold position of refusing to grad-
uate students who thus crowd all their public instruction into a single
year. Most of the schools, also, have learned that the itinerant professors
arc not the most desirable of colleagues ; and policy, if not the good of the
profession, leads them to insist on single chairs. In others, too, may be
noticed enlargement of the faculty, the separation of collateral from the
practical branches, as in the creation of distinct chairs of pathology ; and
vol in, no. vi. — 12.

350 Medical Independent. August

there are but few who now dare to take open ground against the necessity
of clinical instruction. That any should do it, is a disgrace to American
medicine.

The tendency, then, is toward reformation. But little talk is needed.
It is in the power of the better schools to either kill out or reform the
inferior order, just as the latter may be possessed of vitality. The noble
competitive element in our system is already doing this. Let colleges
which possess unusual advantages say so in their circulars, in any manly,
straight-forward way ; let them use the great engine of modern business,
the advertisement ; let them consider teaching as a business which ought
to pay if honorably conducted, and see to it that no absurd old fogyish
notions of dignity interfere with their just claims to consideration. There
are a dozen schools whose death is eminently desirable, and any honorable
means which will hasten their final departure will do a great public good.

I would that I could stop here, and feel that I had touched on all the
faults of our system ; I would that those nobler schools which perpetuate
the excellencies of the palmy past of American medicine, or those junior
institutions ennobled by true science, by energy, and by faithful labor,
were beyond and above the reach of the critic. In all of these there is so
much that is grand and honest, so much self-sacrifice, so much true zeal
for the honor of the profession, that I unwillingly touch on faults which
they possess, and which call for remedy. Fortunately for us, these are not
errors of the men of the present, but heir-looms of the past, come down
to us from primitive days and engrafted in our system in its feeble
infancy, when the wisest and the boldest of the fathers were compelled to
submit to their inexorable surroundings. I can speak here in kindly tones,
for I know that I address noble hearts, which only wait for the proper time
and opportunity to beat with one common throb in any enterprise which
promises good.

A reform, which will soon be loudly called for, and which is rapidly
becoming inevitable, is an extension of collegiate instruction through the
year ; the distribution of the various branches into regular terms appro-
priated to them ; and the diminution of the importance of the present
winter course, by reducing its number of daily lectures to the capacity of
the student.

I am aware that this is a broad and almost radical change, and that it
involves within itself many questions of the gravest importance. Let me
first sketch my ideal of a medical college, and then consider its advantages
and the arguments to be brought against it.

1. The establishment of a collegiate year divided into two terms, one of
four, and the other of five months. The first course to commence on the
first of March, and continue until the first of July; to be followed by a

1857. Spirit of the Medical Press. 351

vacation of two months during the hot season. The second course to begin
on the first of September, and hold till the close of January.

2. The same professorships as are now maintained in our best schools.

3. Dui ing the year two lectures daily, preceded by recitations. On no
account to exceed three lectures on one day, and the third to be a clinical
lecture, occurring, say twice a week. Dissections to be continued during
all suitable seasons, the time to be at the option of the student.

4. The spring and autumnal course to be dependent on each other. For
instance, let Materia Medica, Chemistry, Anatomy, and Physiology, be
taught in the spring ; and Practice, Pathology, Surgery, Obstetrics and
Jurisprudence, in the fall.

Such is a rough sketch of a plan. Its advantages are manifest. The
6tudent would commence with the collateral sciences in the spring, and be
fitted for the practical departments in the fall of the year. His time would
be occupied sufficiently to make his studies a constant occupation, but not
so much as to fatigue him beyond endurance, or deprive him of the neces-
sary hours for reading and recreation. The smaller number of branches
under consideration at one time, would prevent that strange confusion of
ideas which is the misfortune of our present crowded winter courses.
Finally, a repetition of three such years would send out well-qualified
practitioners, with their knowledge well arranged and practically useful.

To the teacher, other inducements will readily present themselves. It
would require no -more time than the present plan, while he could more
easily adapt his hours to his business convenience, than in the crowd and
hurry of the ordinary session, when he is necessarily compelled to yield
much to the convenience of his colleagues. Pecuniarily, the number of
students being equal and the fees being unchanged, he would receive the
same emolument for the same labor.

The difficulties in the way will be found in the competition of money-
seeking schools, which will cling to the old system and bid for students on
the plea of less time and expense. But let the leading schools of New
York and Philadelphia combine on such a plan, and they would soon crush
out all opposition. It is hardly to be expected that, the movement would
be unanimous, but there is much reason to suppose that it would be finally
successful. Another and more considerable opposition would arise from
the students themselves, or that large class of them who are in search, not
of an education, but a diploma. But the prestige attending graduation
from such a school would do away with this. The argument is money ;
and those that have money (I speak here on the supposition that the ex-
penses would be increased, simply by a prolonged city residence), will part
with it for the eclat of a thorough education, or for the better motive of the
education itself. Those that have no money get through now, with a sys-
tem nearly as expensive, somehow ; and I presume they will do so still.

352 Medical Independent. August

Let them run in debt, or carry along some temporary occupation. Such
must oftener beget success than failure ; and it is a peculiarity of poor but
high-spirited students that they seek the best advantages.

But supposing that it very largely increased the expense of an educa-
tion, what would be the general result '? Men of energy and character find
their way into the profession of law through greater difficulties than those
with which we propose to environ the entrance to that of medicine. And
others than men of energy and character had better stay out. I am aware
that the tendency of the day is to cheapen all forms of education, to throw
open every pathway to position and preferment. So far as this applies to
that degree of education necessary to teach the poor man his rights and
his duties to the body politic, all true men will go with this tendency ; but
this does not reach beyond a comprehensive and liberal system of com-
mon schools.

The further disposition to cheapen and make easy the pathway to the
learned professions is a specious theory, which flatters only to destroy. It
holds out inducements to the weak and indolent to assume the onerous re-
sponsibilities of a path of life beyond their abilities ; it does them the great-
est wrong that can by any possibility be done any man, by placing them
in a false position, when a lifetime must be spent in vain regrets over the
youthful vanity and folly which led them from the calm and peace of
humbler duties to a struggle for which they are incompetent.

One of the greatest evils of our profession is the lack of recognition of
its proper social position, and the low pecuniary estimate placed upon its
services at the bedside. Two causes exist for this ; one is the ease with
which the profession is entered, the hordes which crowd into it attracted
by its cheapness, and the competition for " custom," which naturally re-
sults. Another is the character of the men who make up its rank and file.
It is no use to say chat the profession is not properly appreciated. Taken
in the mass, it is. The verdict of Moliere has been confirmed by the
people, and the voice of an enlightened people is the voice of God, when
through centuries it utters one unchanging opinion. The fau It is in our-
selves, and we alone can remedy it.

I suppose that a temporary result of the scheme here proposed would be
a falling off in the number of students, but another and more important
result would be an increased respect in the public mind for our art, and an
increased emolument to the physician. Let it be carried out fully for a
few years, and we should fill the profession with gentlemen, who would
command social position, and elevate at once the character and the emolu-
ment of the physician. We should shut out the profanum rulgus, draw to
us men of liberal minds, and place the American profession beyond that of
any other nation in the prestige of its true nobility.

Finally, for I have occupied much space, all this can be done, but not at

1857. Editorial and Miscellany. 353

once ; time for the preparation of the public mind is necessary, the schools
should be brought to recognize the merits of the plan, and, above all, in
our hot haste for reformation, we should beware lest we endanger our pres-
ent grand old fabric.

The provision of partial summer courses, teaching some of the collateral
departments only and conferring no degrees, at once suggests itself as a
means, feasible at the present moment and likely to lead eventually to the
broad reform I hope to live to see. In the meantime let the censure of the
press and the profession fall heavily on all those inefficient schools which
fail to meet the present standard of excellence.

To return to the comparison with which I started. We must remove
one by one the timbers of our noble structure, replacing them cautiously
by better materials ; and in the end we shall altogether renovate it, giving
it strength, solidity, and permanence ; while, in the meantime, the rush of
human life shall pass by it uninterrupted and unconscious of a change. — »
JV. A. Medico- Ghirurgical Review.

Dr. Marshall Hall, of London, who recently laid claim to the discov-
ery of the excito-secretory function of the spinal nerves, and to the appli-
cation of that term, yields his claim in favor of Dr. Henry F. Campbell, of
Augusta, Ga., who, in a pamphlet recently published, demonstrates his
priority both as to the discovery of this peculiar function of the spinal
nerves, and to the application of the term excito-secretory. — Med. and
Surg. Reporter.

^itorial anir gtiscellann.

Medical Education. — This subject, which is one of abiding and
intense interest to the true physician and philanthropist, has been
invested with additional importance, by having been discussed and
referred to a special committee in the National Association, at its
late meeting. We therefore deem no apology necessary, for re-
publishing entire, from the North American Med. Chi. Review^ a
somewhat lengthy communication entitled " The American System
of Medical Education" but on the contrary, earnestly solicit for it
an attentive perusal ; while, from our identification with the incep-
tion and progress of the Medical Department of the University of

354 Medical Independent. August

Michigan, it will not be inappropriate for us to remark freely upon
such portions of the article as bear directly upon reforms which
should be effected in this institution.

In perusing the article, the reader will notice that clinical instruc-
tion is the first subject of prominent importance, to those interested
in the prosperity and usefulness of our State Institution. We
fully endorse all that the writer advances on this subject — even the
following sentence (with a qualification) : — " I repeat, that where the
means of clinical instruction are not available, no medical school
should exist, and the attempt to maintain one is a quackery — if to
claim to perform that which one cannot do, constitutes the true defin-
ition of quackery." Our qualification is this: — The maintenance of
a school in such a location is quackery if accompanied by the pretence
of affording perfect medical instruction. If, however, it is content to
rank as a school preparatory to more perfect institutions, it may be
honorably maintained without affording means of clinical instruction ;
but, if it aspires to a high rank among the schools of our country, it
cannot dispense with this all-important feature of a perfect medical
school.

The University of Michigan should aspire to place its medical
department in the foremost rank, and its medical professors have
Striven to give it such a place. They have felt that such a position
of the department was due, not only to the profession, but as an
integral part of a University organization, — that it was also due to
the body corporate. But they have labored under the disadvan-
tages of a country location, and their most strenuous efforts have
succeeded only in placing the department foremost, perhaps, in the
list of country schools. They have been embarrassed by the
attempt to elevate the standard of acquirement, without possessing
the great requisite for success — increased means of illustration.
Deeply feeling these disadvantages, five of the seven professors have
unequivocally expressed themselves in favor of transferring the
medical department to this city ; two, have as unequivocally opposed
such transfer, mainly, we believe, on account of legal difficulties —
certainly not from any want of appreciation of clinical advantages, if
we can judge from the language of one of them (the emeritus and
clinical professsor), in his introductory lecture to the clinical course.
Jle says : —

" Our meeting here to-day, we trust, will constitute an epoch in

1857. Editorial and Miscellany. 355

the history of the Medical Department of the University of Michi-
gan. From this humble beginning, we date the commencement of
legitimate clinical instruction in the University. And we take pride,
on this public occasion, of imputing to the Board of Regents the
honor of having taken the first step, by feeble instrumentalities it is
true, towards the restoration, in its primitive form, of the Hippo-
cratic method of teaching practical medicine in the United States."

The Board of Regents have endeavored, at once, to avoid the diffi-
culties of transfer, and to supply the deeply-experienced want. The
«' clinical course " in Detroit, constituting " an auxiliary to the medi-
cal department of the University " in Ann Arbor, is the fruit of such
endeavor. We mean to speak respectfully, but we must most seri-
ously question the wisdom of this step. We are happy to testify to
the zeal, faithfulness and general wisdom of the Board, whose term
of office is to expire with the current year. Under its administration?
the University has risen from a comparatively obscure, to a promi-
nent position ; and, in retiring from office, the Regents may justly
claim the reward due to faithful servants. But, though we commend
them for general wisdom, we cannot but express the belief, that a
desire to pursue the most pacific course, has led them to adopt a plan,
utterly inadequate to the demands of the profession, the age and the
absolute wants of the Medical Department. The reasons of this
inadequateness, we will endeavor to express, in the following brief
statement of facts :

First — The plan of clinical instruction adopted — constituting, as it
does, a part of the Medical Department — splits that department,
locating one portion in Ann Arbor and the other in Detroit, afford-
ing an example of divided strength and resulting feebleness. The
establishment of a portion of the department, will prove in the end,
quite as difficult as the transfer of the whole.

Second — Clinical instruction, according to the plan adopted, is
given only during three months of the year — from July to October,
— embracing the hottest portion of the year, and subjecting the stu-
dent to hard labor, when he requires relaxation. So necessary is
this relaxation, that nine-tenths of the students will avail themselves
of its advantages, in spite of any attractions, which Hospital or Col-
lege can offer.

Third — The organization is utterly incomplete, both as regards
numbers engaged in teaching, and time devoted to the clinical course.

356 Medical Independent August

There should be a division of labor, involving at least three elinical
branches of instruction, viz : — Surgery. General Medicine and
Diseases of Females and Children. The clinical course should be
continued for nine months of the year, and candidates for graduation
should be required to attend the full course. Any organization
which accomplishes less than this will fail to meet the demands of
the times and the wants of the students.

In view of the above facts, we unequivocally express our firm
conviction, that a city location alone will enable the Medical Depart-
ment of the University to assume a position of usefulness worthy of
its endowment. The legal objections too, are worthless ; for, if it
was legal to establish a part of the Medical Department away from
Ann Arbor, it is clearly legal to transfer the remaining part. That
it is a part of the Medical Department, is evident from the fact that
it is supported from the University Fund, was created and empow.
ered by the Board of Regents, and is open to students on the same
terms as the other portion of the Department at Ann Arbor. That
it is regarded as a part of the Medical Department, we have the
authority of the Clinical Professor. He says : — u From this humble
beginning, we date the commencement of legitimate clinical instruc-
tion in the University." Clinical instruction in the University IB
Detroit. If a part of the Medical Department may be here, why
not the whole ?

Another reform which the writer of the article suggests, and
which will undoubtedly be authoritatively called for, by the National
Association, consists in a diminished number of daily lectures, and
an extension of the lecture period through the year. The first of
these has been, since its organization, a distinguishing characteristic
of the Medical Department of the University ; and at their last meet-
ing, the Board of Regents was memorialized by the Medical Faculty,
to extend the period of instruction through the year, making the
Medical, co-extensive with the Academic Department. This exten-
sion of time, with a city location, where full means of clinical instruc-
tion would be available, would enable the Faculty to place the
Medical Department in the foremost rank of American Medical Col-
leges, and the school to offer to the student a perfect and complete
medical education. We earnestly invite the attention of the in-
coming Regents to these facts, and while we say to the old — Well
done, good and faithful servants, we would respectfully suggest to
the new Board that much remains for them to accomplish. G.

1857. Editorial and Miscellany. 357

" Dr. James McClintock. — One of the most painful events which
we have ever been called upon to record has recently occurred in
Philadelphia. Dr. James McClintock, formerly a well-known teacher,
a few years since sold his name to Thomas McElrath, of the New
York Tribune, and Burton, of Burton's Theatre, to be used adcaptan-
dum vulgus in the sale of a long list of nostrums, of which McClintock
furnished the recipes and got $5,000 therefor. The speculation
failed. The philanthrapist of the Tribune and the low comedian of
the Theatre, sunk $70,000 in the operation, and acquired a valuable
experience in quackery. McClintock was left upon his oars, and
finding himself poor, with a damaged reputation, he plays the " repent-
ent sinner," and gets the appointment of Resident Physician-in-Chief,
at Blockley Hospital, Philadelphia, a post of honor and profit. To
keep up the cant of returning to the fold and making atonement for
his errors, he publishes the recipes of his quack remedies in that very
appropriate receptacle, the Philadelphia Medical Journal. He sold
those recipes once for $5,000, and it would seem to the ordinarily
honest man that this latter proceeding betrays Messrs. McElrath
and Burton, as badly as the sale itself betrayed McClintock's honor.

The Assistant Physicians at Blockley, have all resigned — to their
honor be it spoken. They have taken a manly course in view of this
insult to the profession, this offer of reward to scape-graces. — Buffalo
Med. Journal.

It is much to be deplored, that there should be a difference of opin-
ion among our. cotemporaries, or in the ranks of our profession,
respecting the career and just deserts of Dr. James Mc Clintock. The
above succinct and truthful history of the man is enough to stigma-
tise his character for life. The penalty therefore for such an act of
professional perfidy, should have been a precedent for all time to
come, and as such, commensurate with the offence, for which, by the
united voice of the whole profession, he has for years, been adjudged
guilty. The fact that by his attainments, he had once occupied a
respectable position as a practitioner, and successful teacher, only
serves to aggravate the case, and render him the more obnoxious to
deserved censure. To recognize him as a returned Prodigal, to serve
up the fatted calf, and to clothe him wit li fine linen, in consideration
of apparent repentance, is in our opinion a sad perversion of divine
authority — an application of scripture which would be more pertinent
and available in an ecclesiastical court than in medical ethics. In
this connection we may be permitted to express our surprise, that
Bro. Reese of the Gazette should not have been influenced by the
spirit of that creed which has regulated his morals, ami led him to
proclaim the truth to others. Would his tenets admit a back slider

358 Medical Independent. August

into the fold without — nay ! do they not require — at least six months
probation ?

We would not say one word to deter any unfortunate, erring
brother, — who like a " Prodigal " had been starving upon the husks
of quackery — from returning to the chartered rights and privileges
of his professional Alma Mater. On the contrary, we hold that cases
occur in which it should be the pleasureable duty of every member
of our profession, when he has seen fruits idicative of repentance, to
extend the fraternal hand of fellowship and help to restore a profes-
sional exile to his forfeited position. But when thus restored, would
it not be reasonable to expect, that he would " choose a lower seat,"
and be content therewith until asked to come up higher ? Does any
one believe that if Dr. McClintock had been as successful in his
quack speculations, as he had dreamed, or if they had even secured to
him an income of $5,000 a year, he would ever have turned his back
upon the mountebank, to accept of even this post of honor ? We
confess that with all reasonable charity for his motives, we should be
incredulous. Moreover, what evidence have we that he will not,
even now, add the weight of his present position to the scales in which
are labelled bottles, and favorite prescriptions that have become the
advertised property of empirics 1 The prestige of a name, purchased
for $5,000 was found to be too much damaged by the negotiation ;
but we want good bonds with competent security, that this re-instate -
ment, does not involve pecuniary re-imbursement, for those who
failed to realize on the purchased birth-right.

Whatever may have been the local influences, or motives which
prompted honorable members of the profession to lend their aid in
securing for him this distinguished position, we have reason to fear
that it will excite general distrust and tend to engender local hostil-
ities. If such has been the premium offered to McClintock for his
re-generation, may not Brandreth, Ayers, et id omne genus — yet
hope to receive from the profession their reward ? R.

Glycerine is suggested as preservative of vaccine virus. The
fresh scab should be triturated with a little glycerine and kept
closely corked. It can then be used as required.

1857. hditorial and Miscellany. 359

Dr. Palmer's Final(!) Conclusions. — u * * * * and
now without the slightest feeling of bitterness, or the remotest con*-
cern for our reputation on account of anything the editors of the
Independent, or their co-adjutors may say or do, we dismiss the whole
matter, with the hope that no circumstance will induce us to recur to
it again. — (March No. of the Peninsular.) A. B. P."

"***** we think therefore, we can say that
this whole matter respecting the Medical Independent, and the con-
duct of its Editor, so far as our Journal is concerned is indefinitely
postponed. — (May No. of the Peninsular.) A. B. P."

"We still have great confidence in assuring our readers that
between this Journal, and the Independent, there will be no further
unfriendly controversy ***** * May we not
hope then, that in our columns the cessation of hostilities has come."
■ — (July No. of the Peninsular.) A. B. P(?)

How much longer the readers of the Peninsular are to be afflicted
with these stereotyped assurances and hopeful paragraphs, we dare
not predict. But, if we take the above quotations as the data for
prognosis, we shall be disappointed if every alternate number ofVoL
V., does not contain a doubtful compliment for us. We had hoped
however that Dr. Palmer would find his small duties as Professor
Proxy (to the clinical instructor in the University) sufficiently ardu-
ous, and to so occupy his mind that he would have no occasion to dig
«p old bones of contention, which we had once buried. But it is very
evident that nine " Medical Neophytes" are not sufficient to keep a
common man busy and prevent editorial hostilities.

With regard to his last allusions to the Junior Editor of the Inde*
pendent, we are confident that our readers would not consider them
worthy of perusal, and, we certainly do not regard them entitled to
comment. R»

Marshall Hall and his Ready Method. — The medical world has long
admired, in Marshall Hall, the profound physiologist — it is now deeply
indebted to him for practical directions, the benefits of which, cannot be
calculated with even an approximation to accuracy. So simple and effici^

360 Medical Independent. August

ent are his rules for establishing artificial respiration, that, when generally
understood and practiced, incalculable benefits to human life must result.
Already, in asphyxia of the recently born, have we been enabled to test
the merits of " the ready method ;" and the frequent occurrence of such
cases, together with accidents which are liable to attend the practice of
bathing in deep waters, so generally prevalent at this season of the year,
renders highly important the practical understanding of the correct mode
of procedure, not only on the part of physicians, but also on the part of
community generally. It is the duty of physicians, when epportunity
offers, to teach this method ; and editors of the secular press should spread
wide the information. In taking this ground, we conceive that we in no
way compromise the position we assumed last month, in reference to pop-
ular medical teaching ; for we now give, as we then expressed it, rules for
the public to follow — not theories to speculate upon.

Before laying before our readers these rules, it will not be amiss to
allude to the great variety of cases in which they may be put in force. In
apncea of the new-born, by submersion, by strangulation or by inhalation
of some of the gases, "the ready method" is the great and only reliable
remedy. In apnoea, by inhalation of directly poisonous gases, in advanced
stages of narcotic poisoning, or from the effects of electricity, it will con-
stitute, at least, a powerful adjuvant to other means. We herewith pub-
lish Dr. Hall's instructions, and earnestly request the public press to give
them a more extended circulation :

DR. MARSHALL HALL'S INSTRUCTIONS.

1. Treat the patient instantly, on the spot, in the open air, exposing
the face and chest to the breeze (except in severe weather).

I. — To Clear the Throat.

2. Place the patient gently on the face, with one whist under the fore-
head;

[all fluids and the tongue itself then jail forwards, leaving the en-
trance into the windpipe free.]
If there be breathing — wait and watch ; if not, or if it fail, —

II. — To Excite Respiration —

3. Turn the patient well and instantly on his side, and —

4. Excite the nostrils with snuff, or the throat with a feather, &c,
and dash cold water on the face previously rubbed warm.

If there be no success, lose not a moment, but instantly —

III. — To Imitate Respiration —

5. Replace the patient on his face, raising and supporting the chest
well, on a folded coat or other article of dress.

6. Turn the body very gently on the side and a little beyond, and
then briskly on the face, alternately; repeating these measures deliber-
ately, efficiently and perseveringly fifteen times in the minute, occasion-
ally varying the side ;

1857. Editorial and Miscellany. 361

[when the patient reposes on the chest, this cavity is compressed by the
weight of the body, and expiration takes place ; when he is turned on
the side, this pressure is removed, and inspiration occurs].

7. When the prone position is resumed, make equable but efficient
pressure, with brisk movement, along the back of the chest ; removing
it immediately before rotation on the side ;

[the first measure augments the expiration, the second commences
inspiration].
*** The Result is — Respiration ; — and, if not too late, — Life !

IV. — To Induce Circulation and Warmth —

8. Meantime rub the limbs upwards, with firm CxRASping pressure and
with energy, using handkerchiefs, &c.

[by this means, the blood is propelled alony the veins towards the
heart].

9. Let the limbs be thus warmed and dried, and then clothed, the
bystanders, supplying the requisite garments.

10. Avoid thf continuous warm-bath, and the position on, or inclined
to, the back.

The Excito-Secretory Function — Priority — A New Claimant.
— One of our collaborators, Prof. J. Adams Allen, claims to ante-
date either Drs. Stewart or Hall in the discovery of the above
named function. As he intends to present his claims formally, we
venture, upon a long cherished friendship, to make the following ex-
tracts from a private letter :

" But of this 1 am certain, every intelligent student who attended
my lectures will be astonished at Dr. Campbell or Dr. Hall claim-
ing as new what was from the year 1848 part of my current teach*

mg."

* * * * * * .* .*

" I considered it only a necessary corollary from previously well
known facts."

Important Legal Decision, Relative to membership of an incor*
porated Medical Society — John D. Hill vs. The Erie Co. Medi-
cal Society. — The Erie County Society derives its corporate powers
from the Legislature of New York, by virtue of a general law of 1813*
In his decision, Judge Marvin remarks : —

" By the 13th Section, the societies are authorized to make such
by-laws and regulations relative to the affairs, concerns, and property
of said societies ; relative to the admission and expulsion of members:
relative to such donations or contributions as a majority of the mem*
bers at their annual meeting shall think fit and proper ; provided that

362 Medical Independent. August

such by-laws, rules, and regulations be not contrary to, nor inconsis-
tent with, the constitution and laws of this State, dec."

One of the by-laws of the Society fixed a minimum price at which
its members might attend, professionally, the County Alms House.
Doct. Hill agreed to render professional attendance at a less rate ; for
this he was expelled. He then brought an action against the Society,
by sueing out a Mandamus.

Judge Marvin remarks in reference to this by-law : —

" The regulation was not only unauthorized by the law, but it is in
conflict with well settled principles of law. It was the result of a
combination to coerce the public authorities of Erie County and the
city of Buffalo, to make a certain compensation for certain medical
services, not less than a minimum sum fixed. Such a combination
is, I have no doubt, unlawful at common law. It is in restraint of the
right of the public authorities and the individual members of the society.

It is made the duty of the superintendents of the Poor to appoint
a physician for the Poor House. Act of 1851, 532. And yet if the
regulation of the Medical Society of Erie County, is to prevail and is
to be obeyed by the members of the society, the superintendents of
the Poor will not be able to procure the medical services of any one
of the members of the society without paying the compensation fixed,
and without any regard to the state of health of the County poor, or
the amount of services that may be required. A physician entirely
competent may be willing to render the services for half the sum
fixed in the tariff, and yet if he adhere to the regulation he must
decline the appointment. This entire regulation is in conflict with the
law of the land and cannot be sustained. It conflicts with the law and
its policy, in relation to contracts and trade. The law permits and
encourages great freedom in contracts and in trade, and is constantly
inviting competition. The skill of the professional man is his capital
in trade, and he has a right to employ it for a compensation, satis-
factory to him, and thus obtain a livelihood.

****** *

In conclusion :

1 . The regulation in question was unauthorised. 2. It was unreas-
onable. 3. It was against public policy and the law. 4. The dis-
franchisement of the relator was unauthorized and illegal.

It follows that he must be restored or recognized as a member of
the medical society and permitted without molestation to enjoy all
the rights and privileges of a member.

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MEDICAL INDEPENDENT :

A MONTHLY

Review of Medicine and Surgery.

VOL. 3. DETROIT, SEPTEMBER, 1857. NO 7.

imml (Lammumrations.

Article I. Observations on Peruvian Bark. By T. R.

Spence, M. D., Practical Pharmaceutist.

The great value, and superiority, of the salts of Quinia, in
the treatment of acute diseases of malarious origin, has tended
to withdraw attention somewhat, from the pharmaceutical
preparations of Cinchona which represent the several active
principles it contains, in their natural state of combination.

When the desired impression is immediate and energetic,
as in the interruption of the paroxysms of intermittent fever,
quinine is undoubtedly superior to all other forms whatever ;
but where the object is to prevent the recurrence of fever, or,
in the treatment of neuralgia, anemia, or general debility,
there are often good reasons for giving preference to some of
the preparations alluded to above, and this will be particu-
larly the case, where long continuance of the medicine is
desirable, as the functions of the stomach and bowels are in
general less deranged than in a similar use of the alkaloid.

The nomenclature of the varieties of Cinchona is governed
chiefly by the color, and the name of the district where origin,
ally obtained. No classification based on scientific principles
has yet succeeded, although various attempts have been made
to accomplish that end.

There are three principle kind-, thus distinguished in com-

VOI. III. NO. vii. — 13.

364: Spence's Observations on Peruvian Bark. Sept,

merce and recognized by the Pharmacopoea. The yellow, or
calisaya, the red, and the pale, orloxa. There are also the
Carthagena bark*, derived from the more northern ports, of
inferior value, but which are sold extensively for the other
varieties.

The true calisaya yellow, is produced principally in the
Bolivian district of La Paz, and exported usually from the port
of Arica, Peru. It occurs in quills and flat pieces of variable
size, and has a distinct and characteristic appearance. Quinia
exists in greater, and Cinchonia in less proportion, than in any
other bark, and with these are associated the other active
constituents, quinoidine, cinchonia red, kinic, and tannic
acids.

As there can be little doubt, that the salts of quinine are
more efficient, than those of cinchonine, there is I think good
reason to believe, that this is the best variety that can be
obtained. As it is used extensively in the manufacture of
quinine, it is in demand for that purpose and extreme care
consequently is requisite in purchasing, or a fictitious article
may be secured.

The true red bark, is imported in chests from Guayaquil]
and Lima, and also appears in quills and flat pieces, though
usually of less size than the former. It is particularly distin-
guished by its deep red color, either whole or in powder.
Considerable quantities of quinia and cinchonia are found to
exist with other principles, and it is a valuable variety, especi-
ally for the general purposes of a tonic.

The pale, or loxa, is or was exported from Loxa and Lima,
and is supposed to be the first introduced into Europe, there
known as crown bark. There is no doubt this was a very
superior article, quite equal at least to any since known, and
selected with great care for the Spanish market. i\o reliance
however, can now be placed on the pale bark of commerce,
being very cheap, and generally inert and worthless. It is
sold to a great extent for the yellow,, which can only be
obtained from commercial sources by adding the term cali-
saya to it.

1857. S pence's Observations on Peruvian Bark. 365

From considerable observation, I am convinced that a large
proportion of the bark used, consists of this, and other fictitious
varieties, often honestly supposed to be genuine, and it is not
suprising that confidence has been lost in preparations made
from such material.

The officinal forms of Cinchona in general use, are the
infusion, decoction, tincture, and compound tincture, (Hux-
ham).

The tincture represents three ounces of bark to one pint,
and is a useful addition to other mixtures, but from the entire
absence of aromatics, is not so pleasantly administered alone.

The compound tincture has a little more than one and a
half ounces to a pint, with the addition of orange peel, Vir-
ginia snake root, red saunders and saffron. It is a valuable
preparation, having a wide range of application, and is partic-
ularly adapted to low and typhoid states of the system.

There have been several proposed ferrated tinctures of bark ;
the following from Parri sirs Practical Pharmacy, constitutes
one of the most eligible :

" Tlnct. C Inchon. Ferrat.

\l. Tinct. Cinch, comp. four ounces,
Ferri Citratis, one drachm,

Acidi Citrici fifteen grains.

Triturate the citric acid and citrate of iron together, and
dissolve, in the tincture of cinchona.

The dose is a teaspoonful, containing two grains of citrate
of iron."

Considerable attention of late, has been given by pharma-
ceutists, to the fluid extract of bark, and several formulas have
been published. I propose the following process, which pro.
duces an elegant and efficient preparation.

Fluid hxtr act of Cinchona.

Take Calisaya Bark, coarsely powdered, — four lbs. avoird.

Dilute Alcohol — eight pints.
Macerate the bark with a portion of the alcohol, in a closed

366 Spence's Observations on Pewvian Bark. Sept.

vessel, kept in a hot water bath for 24 hours. Transfer to a
displacing apparatus, pour on the remainder of the menstruro
and pass it slowly through twice. Continue the displace-
ment, with dilute alcohol, until completely exhausted, and
remove the first quantity (eight pints), when recovered.
Evaporate this, by means of a water-bath, to six pints, and
the second quantity, in like manner, to four pints, and add
together. Allow it to remain quiet for about two days —
decant and filter, and dissolve in it

Refined Sugar — four lbs. avoird.

Collect the precipitate of cinchonia red, and resinous mat-
ter, and dissolve in it

Alcohol — one pint —
which is to be added to the extract gradually, with agitation.
I recover the alcohol used by distillation, which is an import-
ant consideration, in an economical point of view, though not
at all essential to the process.

It will be readily seen, that the first portion of the tincture
must be exceedingly rich, in the soluble principles of the
bark, and that the slight amount of heat required in the
evaporation, cannot deteriorate it in the least.

The tincture which follows, secures the complete exhaus-
tion, and containing much less of the extractive matter, can
be evaporated more safely.

The precipitate of cinchonia red, and resinous matter,
which is discarded in most formulas, or only partially incor-
porated, is of particular importance ; and the presence of the
small amount of alcohol renders less sugar necessary, for pre-
servation, than would otherwise be the case.

Each fluid-ounce will represent one half an ounce of the
crude material (which is the proportion recognized in most of
the formulas I have seen) ; medium dose, one drachm.

The fluid extract is advantageously used, also, in the pre-
paration -of the infusions, decoctions, — and in addition to
other mixtures.

The following articles T have manufactured for some time,

1857. Humphrey's Cases — Nasal Polypus. 3 67

and they have met with a favorable reception from many : —
Tincture of Calisaya — Aramatic.
R. Calisaya Bark, coarsely powdered, — one lb. avoird.
Ceylon Cinnamon, "

Cardamon Seeds, "

Jamaica Ginger, " of each 1£ dre.

Purest Deodorized Spirits — five pints.

Macerate and displace, and add —

Sherry wine — two pints.

Tincture Angelica — one fluid-drachm.

Simple Syrup — one pint.
Allow it to stand a few davs, decant and filter.
Dose — one-half to one table-spoonful.
This is an efficient preparation, and pleasantly taken.

Wine of Peruvian Bark.

R. True Red, or Calisaya Bark, well bruised, — six oz.
Sherry Wine — four pints.

Macerate, displace, and after standing a few days, decant
and filter.

Dose — one-half to one wine-glassful.

It may be sweetened to suit the taste, when taken. This
was intended as a substitute for the wrine and bark so fre-
quently used, and possesses the advantages of elegant appear-
ance, with equal and determinate strength.

164 Woodward Ave. Detroit.

Article II. Cases Reported to the St. Joseph County (Indi-
ana) Medical Society, at its July Meeting — 1857.
Case I. Nasal Polypus. — Reported by Dr. Humphreys. —
The following case is reported to illustrate the annoyance
that the practitioner is sometimes subjected to, when opera-
tions are required which, at first, may 6eem to be of a trifling
character and of easy accomplishment, but, in making the

368 Humphrey's Cases — Nasal Polypus. Sept.

necessary effort to accomplish which (always sanguine of
success), the operator often experiences only defeat and mor-
tification.

August, 1855. — I was called to see Elizabeth P., age be-
tween nine and ten, precocious in mind, and of scrofulous
diathesis. Found her suffering from polypus of the left nos-
tril, so completely obstructing the nasal cavities upon that
side as to prevent breathing through them. The pendant por-
tion of the polypus was even with the opening of the nostril,
and cartilaginous in its formation. The blades of the
straight polypus forceps were introduced upon opposite sides
of the tumor, which was grasped firmly, and by torsion
wrenched from its attachments (which latter were fibrous
and gelatinous within the cavities of the nose. The haemor-
rhage was considerable — but for a moment only. The anterior
nostril was free from visible obstruction, but no air could be
forced through that side of the nose — which afforded conclu-
sive evidence that there were other tumors, high up within
its cavities. Ordered- — astringent injections up the nostril,
and heard nothing from the case until Decomber of the same
year, when I was again called to see her. A pyriform tumor
was just visible within the posterior narisof the same side, be-
hind the soft palate, the attachment of which became relaxed
in damp weather, letting the base of the tumor down so as to
press upon the pharynx and soft palate, altering the tone of
voice, and causing difficulty, both in respiration and degluti-
tion. An effort was made to grasp the tumor with the curved
forceps, but was unsuccessful, the forceps slipping off: the
struggles of the patient, the small space in which to open and
close the blades of the instrument, and the absence of proper
assistants, caused me to desist from further efforts at that time.

January 2nd., 1856. — The patient much the same as when
last seen — the os nasi and ala of that side were pressed out of
their natural position. The tumor in the anterior nostril had
been re-produced, obstructing the nasal passage, so as to pre-
clude ligation of the posterior tumor, as an armed canula could
not be passed along the floor of the nostril. With proper as-

1857. Humphrey's Cases — Nasal Polypus. 369

sistance at this time, another determined effort was made to
grasp the tumor with the curved forceps, and by what sur-
geons term evulsion — (backward and forward movement) to
detach it, the situation of the tumor being such as to prevent
torsion. In this as before, the efforts were unsuccessful, ex-
cept in bringing away a small lobe of the tumor, which was
fibrous in structure. Though the patient was brought fully
under the influence of chloroform, and the jaws kept suffi-
ciently open by the introduction of cork between them, yet
time and again the forceps slipped off, from the difficulty in
keeping the blades upon the tumor, which difficulty was
greatly increased by the involuntary struggles of the patient%
This defeat was exceedingly annoying to me, yet I did not see
how it was possible to bring about a different result. Astrin-
gent injections were again ordered when the tumor's attach-
ments become relaxed which was alwavs its condition in wet
or damp weather, sometimes letting it so far down into the
pharynx, as to seriously impede respiration, by pressure upon
the Epiglottis ; especially was this the case when the patient
slept in a recumbent posture, producing a snoring sound like
respiration in croup — or stertorous breathing. At times the
patient could not lie down at all during the night, for fear of
suffocation. Soon after this, the family with whom the patient
resided, moved into the country, and I did not see her until
April of the present year, when I was sent for to see if " some-
thing could not be done to relieve her," I then learned that
her condition had been about as described at the last visit, up
to the day before the present visit, when, while spending the
night at the house of a neighbor, she was seized with a severe
paroxysm of coughing while asleep. The friends, upon going
to her bed, found the little patient silting up, breathing easy,
the front of her night dress saturated with blood — and unable
to articulate intelligibly, from the presence of Some foreign
substance in her mouth — so tilling up its cavity as t<» prevent
motion of the tongue in speaking. The little patient could not
open her jaws sufficiently wide to ascertain the contents of the
mouth. At this visit T examined her mouth by prying open

370 Humphrey's Cases — Fracture of the Skull. Sept,

her jaws, and found a polypus resting upon the dorsum of the
tongue, entirely filling up the cavity of the mouth — the base
of the tumor being in contact all around, with the internal
sides of the teeth. Some of the attachments of the tumor had
doubtless been broken up, and in the paroxysm of coughing
induced by the presence of blood in the mouth and throat
while asleep, the tumor had been forced from the pharynx up
into the mouth. Some effort was made at this time to remove
the tumor, but the jaws were opened with difficulty, the ordi-
nary straight polypus forceps, were not of sufficient strength
to retain a hold upon the tumor, and the absence of proper as-
sistance induced me to postpone for a few days any further
attempts at removing the tumor. The patient during this time
subsisted alone upon liquid diet ; no solids could be taken into
her mouth or masticated. Three days subsequent to this
visit, I returned accompanied by a proper assistant, and the
patient being secured in an armed chair — the jaws well opened,
the tumor was firmly grasped by the blades of the straight
lithotomy forceps ; the pedicle or attachment of the tumor
could not be seen, and the nature and size of it could only be
guessed at. After turning the tumor upon the axis of its
attachment, some twenty -five or thirty times, I had the un-
speakable satisfaction of seeing that which had so often inglo-
riously defeated me, ejected from its lodgement; every trace
of the growth behind the palate and posterior opening of the
nose, so far as could be examined, was removed, and no haem-
orrhage of consequence followed. The body of the tumor
was fibrous — its root ligamentous, about as large as the bar-
rels of two goose quills, and apparently as strong as cat gut.
Thirteen days subsequent to this, I removed two fibro-gela-
tinous polypi from the nostril, since which time no return of
the disease has taken place. The patient can breathe freely
through the nostril, and is in every way much improved in
health.

Case II. Fracture and Depression of the Skull — Recovery
without an operation. — Keported by Dr. Humphreys. —
Thursday, December 18th, 1856, was called at 7 o'clock P.

1857. Humphrey's Cases — Fracture of the Skull. 371

M., to see Wesley W , aged 25, of nervo-billious tempera-
ment, small stature, by occupation, a well digger and builder
of cisterns. Found a fracture and depression of the os
frontis — extending over the frontal protuberance of the right
side, the temporal ridge, outer third of the supercilliary ridge,
and the external angular process. The area of depression
measured three, by two and three quarter inches in diameter ;
depth of depressed bone at the point of greatest depression
from normal position, three quarters of an inch : depression
almost a perfect concave. The orbitar plate was also de-
pressed— producing pressure upon the eye ball, forcing that
organ from its natural position and causing it to protrude a
full half inch, accompanied with loss of vision in the eye at
the time. The wound of the scalp was but slight, from which
blood had flowed freely, but had about ceased at the time of
my visit. The patient complained of dull heavy pain in the
right side of the head. Pulse 47 per minute and rather full.
Respiration somewhat irregular and attended with sighing —
interior extremities cold — surface of the body cool — sensa-
tions of chilliness — no aberration of the mind, but full pos-
session of all the mental faculties. The history of the
reception of the injury by the patient was this : while enga-
ged at his work (some three miles from town) in digging a
well, when at the depth of thirty feet from the surface of the
ground, he was struck upon the seat of injury, by three pieces
of u well curbing " falling from the top of the well. The
" curbing " was of green boards, seven inches wide, and one
and one-fourth inches thick, by three feet six inches long. The
force of the blow did not take the patient from his feet, or
a knock him insensible ;" but placing himself immediately in
a " slip noose" of rope, he held on to it while he was drawn to
the top of the well. After an hour's rest, the patient was
placed upon a sled and brought to his residence in town. The
only result to be expected in this case was, that after re-action
took place, more or less coma would ensue from compression
of the brain, and the use of the trephine would become nec-
essary to relieve that organ. A mild anodyne, cold applica-

372 Humphrey's Cases — Fracture of the Skull. Sept.

tions to the head, and warm applications to the extremeties
were prescribed for the night, and instructions given to the
friends that if any untoward symptoms, other than those then
present became manifest, to apprise me of their approach.

Friday morning \Stth — The patient more comfortable — had
slept well the latter part of the night ; surface of the body
and extremities warm and moist, pulse from 48 to 50, and
full — respiration regular — great intolerance of light — the
parts about the injured eye much tumified — pain and soreness
of the head quite severe, the former not as intense as at the
evening visit. Ordered saline cathartics to be given, and re-
peated until the bowels are freely moved ; enjoined strict
quiet, light to be excluded from the room — continue cold
applications to the head, mild anodynes when needed, diet —
" water gruel." Decided not to make any attempt to elevate
the depressed bone, without symptoms should arise different
from those present. This conclusion was arrived at, from
the absence of all the indications for the use of the trephine,
as laid down by M. Bourgery, whose directions I believe are
pretty generally endorsed by surgeons as correct. First. The
tissue of bone was not broken up to any considerable extent ;
Second. There were no indications that the dura mater was
involved in a penetrating or punctured wound ; Third. The
entire absence of coma, and epileptic symptoms. The treat-
ment of this case, consisted of nothing more than that already
stated, keeping the bowels freely opened, cold-water dressings
to the seat of injury, enforcing strict quietude in a recumbent
posture, and the use of light diet — in fact, an almost " do
nothing" treatment.

The patient steadily improved from day to day, and in a
little more than two weeks subsequent to the receipt of the
injury, was walking about the streets. In a month's time
after the occurrence of the accident, he was again at his usual
avocation — digging wells &a Vision is entirely restored to
the eye, and that organ has receded in part to its position
within the orbit — leaving however the organ of language
(phrenologically speaking), much better developed upon that

1857. Butterworth's Cases — Uterine Polypus, <&c. 373

side, than on the other. The depression at the seat of injury
is not now so great as at first, but is yet a full half inch by
actual measurement at the most depressed point, from a nor-
mal position, and constitutes a marked feature in the appear-
ance of that part of the head — which would be readily noticed
by the most casual observer. The subject of this case, occa-
sionally complains of " dull headache," but the attacks are
becoming less frequent, as well as less severe ; and he is now
nearly exempt from any resulting difficulty or inconvenience
Irom the injury. Is it a physiological fact, that in injuries of
the head, in proportion as the animal predominates over the
mental organism, in that proportion will be the chances of re-
covery t If so, my patient is greatly indebted to that feature
in his constitution for his rapid convalescence without positive
surgical aid. The case illustrates very decidedly good results
of conservative surgery under proper restrictions.

Case III. I rterine Polypus — Ligation — Death — J*ost
Mortem appearances. — Reported by Dr. AV. W. Bvtter-

worth. June 25th, 1857, 1 was called to Mrs.M , a German

woman aged 36, and was informed she had been suffering
with more or less pelvic uneasiness and frequent hemorrhage
for nine years. The sanguineous drain had now reduced her
to almost a skeleton. A minute history of the case could not
be obtained, from my imperfect knowledge of her language,
but am led to infer that she had irregular periods of menstru-
ation most of the time.

An examination per vaginam, revealed a rather hard, round
tumor, tilling nearly the pelvic cavity, ragged at its apex and
undergoing there disorganization. The linger of the right
hand passed freely around the tumor as high as could be
reached, while the left hand pressed upon the hypogastrum ;
but no trace of the uterus could be found, nor the extent of
the growth be determined. The abdomen was full, even,
and hard, as high as the umbilicus. Jn the left i Iliac* region
was a slight tenderness, and to the touch, there was an indis-
tinct appearance of an adventitious growth.

274 Butter worth's Cases — Uterine Polypus, &c. Sept.

June 30th, 8 A. M. — Pain rather paroxysmal, simulating
the first stage of labor. Patient requires catheterism, which
is with difficulty performed ; clothes wet with a discharge of
blood and sanies of a gangrenous smell. At my request Dr.
Badger was invited in. The tumor was now driven, in
part, out of the genital fissure, the vagina yet full and the
position of the uterus still unknown. All the well known di-
agnostic signs failed us, though we were inclined to the belief
that we had a chronic inversion of the uterus to deal with.
2 P. M. There has been severe pains since morning, as her
nurse expressed it " like labor pains" — the protrusion from
the vulva was much larger. It was now quite surely a poly-
pus making its exit. The os uteri was still not within reach
of our explorations, and a part of the heterologe mass seemed
yet above the upper strait. Gentle traction was used to re-
lease its engagements there, and soon more of the ugly stran-
ger was outside the vulva, a fibro-celular tumor, attached by
its pedicle to what was supposed a degenerated cervix. A
ligature was applied to the pedicle, and unsuccessful means
used to sustain the patients flagging powers. She died twenty
hours after the application of the ligature.

AuTorsv, two hours after death. The tumor was irregu-
larly oblong. Though not measured it was estimated five
inches in its antero-posterior diameter ; in breadth at its upper
part, eight inches, and in its greatest length ten or twelve
inches. In growth it was fibrous, largely intermixed with
cellular substance. The upper half had probably been arrest-
ed in its longitudinal development by the pelvic brim, causing
it to spread out laterally. Its weight was six lbs.avoirdupois.
The pedicle was large, and attached to the left side or lip of
the nearly obliterated os. The uterus was contracted, hard and
nodulated, and thrown out from its left external angle was a
small pedunculated tumor, from which was again thrown out
another, each about the size of an almond.

The forcible extrusion of the polypus, had drawn by its-
pedicle, the uterus low in the pelvis, with nearly a complete

1857. Buchtel's Case — Dysmenorrhea. 375

inversion of the vagina. Our conclusions were, that in the
development of this pelvic usurper, the uterus had been
pushed above the superior strait, and that a good part of the
polypus, though starting within the vagina, was developed
above the pelvic brim, and rested on it. Where else could
have been its position ? One remarkable phenomenon con-
nected with this case, is the expulsive power of the vaganal
tissues. The pains were of such a character, as led us to be-
lieve that the tumor was intra uterine until after the post
mortem. This case is furnished as one of the curiosities of
herterologous growths.

Case IV. Dysmenorrhosa.-Rejyorted by Dr. Buchtel. Du-
ring the month of September 1856 — I was called on by Mrs.
C , aged 24 of nervo-billious temperament, who in-
formed me that for two years prior to that time she had
been a victim of that most painful of female diseases, dysmen-
orrha\i — that her life during that period had been so embit-
tered by frequent returns of the periods of suffering, as to
render its continuance scarcelv desirable. Her menstrual
periods came on at regular intervals of time, but were always
ushered in by chills, cold extremeties, great thirst, and sick-
ness of the stomach. Pains of the back — bowels — sides and
loins, most cxcrutiating — coming on at regular intervals, re-
sembling in intensity, the pains of labor or abortion proper.
The menstrual discharge small in quantity, never continuing
more than twelve or twenty-four hours — bowels always con-
stipated. In addition to the symptoms enumerated, the case
was complicated with severe leucorrhooa pruritus pudendi,
partial prolopsus of the uterus, hemorrhoids and general de-
rangement of the glandular and secretory systems. The pa-
tient had been under treatment during most of the period of
two years, part of the time by reputable physicians, but had
received no permanent relief, and scarcely any mitigation of
her sufferings. The case was one, in which, but little could
be hoped for from any plan of treatment, having in view per-
manent relief, or even a restoration to " tolerable health/' To

376 Buchiel's Case — Dysmenorrhea. Sept.

regulate the action of the bowels and improve the general
secretions — I prescribed pills of

Blue Mass — grains ii.

Extract Hyosci. — grains ii.

Pulv. Ipecac. — grains one-fourth.
Give one pill night and morning until six are taken — after
which, tincture of Guaiac. in tea-spoonful doses was given
morning, noon and evening, and at the expiration of one week
repeated the use of the pills as at the commencement of treat-
ment, increasing the quantity of the tincture of Guaiac. to half
a table spoonful three times a day. At the expiration of three
days the use of the pills was suspended and the following pills
given in lieu thereof:

Sulphate of Iron.

Gum Myrrh.

Extract Tarax. aa — grains ii.

Aloes — grain bs.
One and pill morning, noon and evening. This plan of
treatment was persevered in for full six weeks — when her
general health was ><> much improved, and suffering at the
menstrual period, so much lessened — that the tinct. Guaiac.
was suspended, continuing the Iron and Myrrh pills for six
weeks longer — resulting in complete restoration to health.
The patient was under treatment fully four consecutive
months, faithfully persevering in the use of the remedies pre-
scribed. At the approach of the menstrual periods, the Iron
and Myrrh pills and tinct. Guaiac. were suspended, and large
doses of camphor and opium were given, conjoined with the
warm bath — and the pretty free use of tea of Polygonum
Hydropiper. Between each menstrual period, vaginal injec-
tions of acetaete of lead and rain water were freely used. The
history and treatment of this case is given, not for any novelty
connected with it, but to illustrate the good results of a steady
persistent plan of treatment — by the use of such agents as
have an established reputation, exhibited in decided or even
in what would be considered by some practitioners heroic
doses. Mav not our want of success, often be from absence

1857. Gunn's Selection from Surgical Notes. 377

of that perseverance so necessary to attainment, in all the
pursuits of life ? Is it not too often the case, that we change
from a given plan of treatment to another, because we have not
patience to " bide our time" and wait for the frequent, slow
effects of remedies ?

South Bend, lad., July, 1857.

Article III. Selection from Surgical Notes. By Prof. Gunn%
Resection, of Elbow-joint. — Medication. — Amjyutation. —
Death. — Remarks on the relation which medication hears to
disease and cure.

Mr. S. was a resident of one of the interior towns of this
State, and the subject of ulceration of the cartilages, and ca-
ries of the joint ends of the humurus and ulna, as they enter
into the formation of the elbow joint. His general health
was not immoderately affected by the disease, but the loath-
some and crippled condition of the arm, with the fact that an
operation afforded the only means of cure, made him anxious
for its performance. Accordingly, on the 23d of January,
1853, the patient being under the influence of chloroform, I
resected the joint, removing two and a half inches of humu-
rus, and three and a half of the ulna, leaving the radius in-
tact. It is unnecessary to describe the steps of the operation
further than to say that, an incision at the back of the elbow
was made, corresponding in shape with the accompanying di-
agram ; 1, the ulnar nerve carefully avoided and the opera-
tion completed with reasonable celerity. Xo ligatures were
required. The wound healed kindly at either extremity, and
the middle portion, which corresponded with several fistulous
openings granulated and assumed a healthy appearance. Af-
ter the first two days succeeding the operation, oysters, beef-
steaks and ale entered generously into his diet, and the pa-
tient so far recovered as to leave for home at the end of three
weeks. At this time the improvement in the arm and gene-
ral health was such as to warrant the most sanguine hopes of

37S Gruirar'a Selection from Surgical Notes. Sept.

a cure : and there is no doubt, that under appropriate treat-
ment such a result would have followed. But anxiety to look
after his business, led to exposure, in consequence of which the
wound inflamed, and constitutional sympathy was manifested.
An irregular, of the herb order was summoned, who adminis-
tered the ever-present and all-powerful lobelia ! Profuse suppu-
ration followed the inflammation, lobelia was continued, and
under their coinciding tendencies, the patient gradually lost
strength, irritative fever supervened, and on the 30th of the fol-
following May I was summoned to the patient, to find the wound
nearly re-opened, the head of the radius protruding and cov-
ered with granulations. The bones were healthy, and there
was simply a profusely suppurating flesh wound, exhausting
the patient and attended by irritative fever. This condition
had continued for several week-, and been treated with low
diet and medicine ! There was now no hope, but in ampu-
tation and supporting treatment, and these afforded but little,
so much reduced had the patient become. I removed the
arm at its middle, and ordered London porter and the extract
of^beef. The wound healed perfectly, but the patient sank
two weeks subsequently to the amputation.

Remarks. — The above case affords a striking illustration of

the evil etiects of ill-applied and profuse medication. There
is not. in my mind, the least doubt that recovery would have
followed entire abstinence from medicine, and the continua-
tion of generous diet. The free suppuration which followed
the inflamed condition of the wound, was exhausting in its
tendency, and called for supporting treatment : it received the
reverse : the prostrating effects of the medicine favored the
formation of pus. and thus, in addition to its direct tendency,
contributed to exhaust the patient. It was a direct and abso-
lute a2:ent for evil. There was no indication for medicine:
yet how few have the courage to say as much to a patient !

" I felt some hesitancy in putting forth that look.'' The
'listinguished author ot^ " Xew Eemedies" spake thus in re-
terence to this work. The reason assigned for this hesitancy

1857. Gunn's Selection f rain Surgical Notes. 379

was, that he feared that he was encouraging the disposition
manifested by the profession to administer, and the people
to take, too much medicine. There is no no doubt as to the
fact, there is too much medicine swallowed. There is also no
doubt that physicians prescribe too much of the same article,
and too little of that which pertains to diet and regimen. They
rely too implicitly on the supposed curative properties of medi-
cines.

The reason of the disposition alluded to by Dr. Dunglison,
and which he feared he was encouraging, lies in an an alto-
gether mistaken idea of the relation winch a medicine bears to
a disease, and to the recuperative process. I unhesitatingly
make the assertion, that medicine never cured disease — that
there is no direct relation between a medicine and a disease —
that there is no mysterious curative tendency in any medicine.
There is only one curative tendency, and that lies in the or-
ganism— it is inate with the being — it is a necessary part of
its existence and undoubtedly is the same force which tends
to preserve it, and presides over its unceasing changes — it is
every where present in organic life — it heals over an abrasion
in the plant and closes up a wound in a man — it enables the
drooping flower to revive and bloom afresh, and the crowning
work of creation to arouse and throw off a syncope. The
means of calling this curative force into action are manifold,
but a cure is effected only through its agency. The most that
a medicine can do is to arouse it to action in some instances,
and favor its operation in others. There is no direct relation
between an inflammation and the lancet, or tart, antim., or
verat ver., or cal. and opium ; yet any of these agents may
not only be useful but absolutely indispensable, by so affect-
ing the system as to favor the operation of this venerable but
much ignored u vis medcatrix naturae" We bleed for acute
pleuritis, yet who will say that there is a din ctf relation between
the lancet and the disease? A recovery follows, but who will
say that the loss of twenty ounces of blood cured the inflam-
mation? It simply so impressed the Bystem as to favor the

curative effort of nature — an effort that will oftentimes be
vol. in. no vn — 14.

380 Guxx's Selection from Surgical Notes. Sept.

successful without aid, though at others imperatively requiring
it, and failing in its absence. The antagonism between qui-
nine and an ague, would seem to realize a direct relation be-
tween a medicine and a disease — in other words, the idea of a
specific ; but a strong mental emotion may accomplish the
same result. An old pioneer in this State suffered for many
successive years from an ague, which quinine finally failed to
cure. Other remedies, also, were at last powerless, and in
spite of all medication, each alternate day brought its par-
oxysm of chill, fever and perspiration. Pursuing his way
along a woodland path one day, his ague surprised him an
hour earlier than usual. Hurrying home as fast as his shiver-
ing, chattering condition would permit, his progress was sud-
denly interrupted by the appearance in his path of a huge
black bear. For a moment the two stood gazing at each
other, the man perfectly paralyzed with fear, after which the
bear trotted off, leaving the patient minus the chill, with the
sweating stage fully developed, without the intervention of
the fever. The disease was effectually broken up, and there
was no return of it for several years. What was the relation
between a dose of living black bear and the ague ? Direct ?
or indirect? Did it operate as a specific ? or, through the im-
pressibility of the system?

"Within the past few years many undoubted recoveries from
pulmonary phthisis have resulted from the free use of oleum
jecoris asselli, with and without brandy, and with appropriate
regimen. Do such results indicate a direct relation between
the remedies and the malady? Fat beef, butter and good
ale will succeed as often, and the explanation is to be found
in the physiology of nutrition, and the pathology of the dis-
ease. And in this connection may be expressed the belief,
that if the various forms of cancer are ever cured, it will be
through influences brought to bear upon the function of nu-
trition.

Divest medicine of the idea of its mysterious relation to dis-
ease, and the seductive charm which leads to its continual
dministra tion is lost, and much less will be exhibited. When

1857. Allen On the Excito-Secretory System. 381

the object is to restore suspended or impaired functions, or to
alter and improve the process of nutrition, by supplying or
withholding certain elements, and so ordering the regimen as
to derive the greatest possible good from such elements, med-
ication will definite, certain and moderate. If the object is to
effect a given result by operating on the impressibility of the
system, medication will be so conducted as simply to produce
a desired effect, leaving to nature the real curative work. Too
much medicine is administered by continuing its exhibition
too long. It is comparatively easy to learn when and how to
commence giving medicine, but hard to learn when to leave
off — so hard indeed that some men seem never to learn the
lesson. There is no course more injurious to the real benefit
to be derived from medicine, than the blind and unphilosoph-
ical exhibition of remedies by the clock. Doses should be re-
peated, or not, according to the effect produced, and not ac-
cording to the time which has elapsed. But I forbear, and
while I express an abiding faith in remedial measures, con-.
fess to a growing dread of hyper-medication. O^A

87 Shelly Street, June 23d, 1857.

Article IV. The Excito-Secretory System — Dr. II. F.
Campbell — Marshall Hall — Alleged Priority of Discovery.
By J. Adams Allen, A. M., M. D., Formerly Professor of
Therap., Mat. Med. and Juris, in the Indiana Medical Col-
lege ; and late Professor of Physiology and Pathology, and
acting Prof, of Mat. Med. in the University of Michigan.

It appears from a late number of the London Lancet that
M. Hall recognizes to a certain extent the priority of Dr.
Campbell. IJis words are these:

" I arrive at this conclusion : the idea and the designation of an
excito secretory action belongs to Dr. Campbell, but his details are
limited to pathology and observation. The elaborate experimental

352 Allen On th<: ExcUo-Secretory Syst> Sept.

demonstration of reflex exeito-seeretory action is the result of the ex-
perimental labors of M. Claude Bernard.

"My own claim is of a very different character, and I renounce
every other. It consists in the vast generalization of excito-secretory
action throughout the system.

*******

•• 1 trust Dr. Campbell will be satisfied with my adjudication.
There is in the excito-secretury function as applied to pathology, an
ample field of inquiry for his life's career, and it is indisputably — HIS
OWN. He first detected it. gave its designation and saw its vast
importa1

M. Hall thus far, freely and fully admits the priority of Dr.
Campbell, and the latter gentleman bases his claim upon the
date. May. 1850.

I shall undertake to show that this same doctrine was first
publicly announced and illustrated in my lectures at the In-
diana Medical College in November 1848, and thenceforth
continuously during the continuance of my public teaching
before the several cL - - t that College, and also the medical
classes of the University of Michigan until my connection with
that institution " expired by limitation" in 1S54. My own
manuscript containing this doctrine was written in May or
June 1848.

In pro«>f of this proposition I shall adduce the ancient man-
uscript which I have fortunately the means of proving as to
date, in the most satisfactory manner; and. secondly, the evi-
dence of students then in attendance upon my lectures, and
now some of them occupying high professional positions.

As the lapse of years has scattered the various class -
throughout different sections of the country, and the addresses
of but few are now known to me, I would crave permission to
take this mode of inviting all graduates or stu dents of the In-
diana Medical College during the session of 1S4S-9. and 1S^9-
50 to forward me their present P. O. address, that my claims
mav be fully substantiated bv their evidence.

Of this one thing I am fully convinced, that the enunciation
of the Excito-Secretory principle as new, will fall upon the

1857. Allen On the Excito-Secretory System. 383

ears of such students as have from time to time listened to my
lectures, with something like astonishment.

The manuscript itself was never more than a text to ex-
tended explanatory remark upon the subject.

I do not claim the nomenclature " ILxcito-Secrctory" as in-
vented by me, and shall take occasion in the proper place to
remonstrate against the limitation of the great phenomena in-
volved, by this merely arbitrary term. Analogically it is
convenient in contradistinction to the term excito-motory, but
mere analogy too often leads us into error to be a safe guide,
even in nomenclature.

What I do claim — is the great generalization, that t/ie excito
influence isfollovjed by a reflex change in which the effect is

NOT A MOTION but A MODIFICATION OF VASCULAR AND UNTKIENT

action. That this effect takes place by means of the double
nervous arc. A vast number of therapeutic phenomena are
thus explained.

As M. Hall is kind enough to allow Dr. Campbell the
credit of having discovered the " excito-secretory function, as
applied to pathology," perhaps he may be led to recognize
my own claim to the discovery of this principle as applied to
therapeutics. I shall not be content with this.

In my course upon " General Therapeutics" the subject of
" Counter-Irritation " came under review.

After considering the numerous cases wherein nature seems
to set up this process in the prevention of disease — or at least
where when the external disease subsides, internal derange-
ment quickly supervenes ; which, again, is relieved by re-es-
tablishment of the external difficulty, (e. g. ulcers upon the
legs.flstula in ano, otorrhcea, cutaneous eruptions «fcc, &c.) ■
I passed to consider the issue, seton, moxa, epispastic, &c.

After giving several hypotheses from various sources, of
their action therapeutically, and particularly Eberle's view,
the lecture proceeds as follows :

"This view," (Eberle's) " of the subject after all, that it is
the most plausible one which has been given, is fraught with
some difficulties. Why should a blister upon the thorax in

384 Allen On the Excito- Secretory System. Sept,

pneumonia be more beneficial than one upon the arm 1 Or
why should an epispastic over the abdomen in enteritis be
preferable to one upon the thigh ( The parts although nearer
together topographically, are anatomically much farther
apart. Hence, reasoning anatomically, or from the distribu-
tion of the blood vessels, we should be inclined to reverse our
application."

i% But experience, in this instance, as in many others con-
travenes analogy, and to its mandates we must succumb.
How is the anomaly to be explained ?"

" Certainly not by Hunter's * contiguous sympathy- for this
explains nothing : there is no short cut passage between the
outer vesicated surface, and the inner inflamed organ — neith-
er by anastomosing vessels nor nerves."

" * Hence the impression must be transmitted to the nerv-
ous centres, and thence reflected to the affected organ, m other
word*, the influence is primarily exerted upon the cerebro-
spinal system, and secondarily upon the internal affected
organ''

This is the gist of the whole matter, and the point consists
in the recognition of reflex cerebro-spinal action which in the
instances adduced give rise to a molecular or integral change
in the inflamed tissue — and not a muscular contraction.

In the oral elaboration of this principle was suggested an
idea which does not even now appear to have occurred to
either M. Hall or Dr. Campbell, viz : The motor effect is
merely secondary, and not a necessary part of the action of
the nervous arc.

The molecular or integral composition or decomposition at
the distal extremity of the reflex nerve is the real element —
the motion, secretion or change of vascular or nutrient action?
production or abatement of inflammation or other change of
the organ supplied by the nerve (reflex), being altogether se-
condly or incidental.

The effect is motory, if contractile fibre be present !

* Here is written upon the margin of the manuscript. u Origiml Explanation."

1857. Allen On the Excito-Secretory System. 385

The effect is secretory, ie secreting organs be supplied !

The eefect is sensation if sensitive neurine be reached !

The eefect is perception, or infellection, if the organ
thereof be in connection with the reflex nerve !

I have said that the term exci to-secretory is objectionable ;
the term excito-motory is equally so. The terms " external
and internal diastaltic action," are equally so. Whether in-
ternal or external the modus is the same.

Heat will melt iron, explode gunpowder, harden clay and
destroy or fix colors.

Are these several results indicative of any diversity in the
force of heat itself ? Are they not rather indicative merely
of variety in the bodies acted upon f

So is it with the excitor force which commands the tiny fi-
brillse and cells of the nervous arc. They receive and trans-
mit but the single impulse — and in a single manner.

The effect produced, then depends upon the structure and
condition of the organ reached.

The single tubule or firbre of nerve may whilst conducting
its peculiar impulse touch, here upon a muscular fibre and
call its contractile elements into energetic action, and there
upon a cell or group of cells and their growth,maturation and
dissolution are hurried on; and so on through the category of
vital changes.

But again, this influence is not confined to the mere increase
of action, as the term excitor might perhaps suggest.

The reverse may take place — the excitor may rather be-
come the depressor.

It would be as correct to say the depressor-motory, the de-
pressor-secretory, as to say the excitor-^67/?.

Physiology, Pathology and Theraupeutics are full of illus-
trations of this fact.

The excito-secretory function is not in fact distinct from the
excito-motory — neither is the depresso-seeretory from the de-
presso-motory.

We might with equal propriety speak of a modification in
essence of the electro-galvanic circuit when at one time, by

386 Allen On the Exeito-Secretory System. Sept

ingenious mechanism, it is caused to print a telegram, and at
another to decompose a mineral — at another to kindle the
Drummond light.

The 22d of December, 1845 the Surgical Xapoleon of
America uttered these words in a lecture which now (as they
did then), strike me as prophetic : " We have got to the end of
the vascular system — and just beginning the nervous system."

It is useless to lumber up our already Babel-nomenclature
with new and inexpressive barbarisms.

The terms excitor and depressor do not include the func-
tions of the first arm of the nervous arc. Pathologists and
therapeutists have been obliged to recognize something more
than the mere increase or diminution of action.

Qualitative changes are fully as important, if not more so,
than simple quantitative ones — and these cannot be pro-
perly designated by the terms proposed by Messrs. Hall and
Campbell.

There is the recipient segment, the impressible centre, and
the reflex conductor, in all the known machinery of the nerv-
ous tissue. The resultant effect depends upon the nature of
the structure acted upon.

In this view how important is seen to be the material con-
stitution of the parts acted upon !

The vis nervosa, or highest relation of force with which we
are acquainted, has not to do with intangible things, but re-
quires for its appropriate action the presence of particular
material structures, of particular chemical componds or ele-
ments, and a certain arrangement.

A clear comprehension of the phenomena of nervous action
demonstrates the necessity of something more than shadowy
remedies for existing derangements. But of this hereafter —
that the limits of the present paper be not too greatly ex-
tended

One thought more in connection with the views of M. Hall.

" There is" says he, " perhaps, not a point in the general cutaneous
surface in which tetanus — an excito-motor effect — may not originate ;

1857. Allen On the Excito-Secretory System. 387

there is scarcely a point in which internal inflammation — an excito-
secretory effect — may not be excited."

Turn now to any late treatise upon the physiology of mus-
cular contraction, and we find the doctrine of the inherent
" irritability" of the muscular fibre- — the nervous system
merely calls this into action — as it does any stimulus tending
to disturb its integral structure.

The reflected jjnpulse disturbs the molecular structure and
contraction results as it would from the application of a chem-
ical agent or mechanical appliance. If continuous, inflam-
mation or even destruction of the tissue may ensue.

"Where is the line of demarcation between the two effects ;
or, rather, is there any such line or real distinction ? Cor-
rectly speaking all nutrition is but secretion — all secretion is
but nutrition. Contraction (and therefore motion) is but an
incident in the nutrition or molecular change of muscle.

The nutrition of the liver or of any other glandular organ is
precisely identical in its ultimate elements.

The nervous act is in each instance the same.

Where then is the assumed distinction ?

It is perhaps safe to assume as probable that parts supplied
with cerebro-spinal nerves, exhibit more definiteness in their
reflex phenomena than those supplied mainly by fibres from
the ganglionic chain. But it remains to he proved that there
is any more real difference between these two classes of nerve
fibres, than exists between striated and non-striated' muscular
fibres.

For the present I leave the subject by soliciting attention
to the real point at issue, which is: that the afferent nerve, the
central organ, and the efferent nerve constitute the true sys-
tem : that the terms " excito-secretory and excito-motory
systems" are ill chosen and erroneous as respectively too lim-
ited in signification and tending to misapprehension of the
real simplicity of the true Bystem which I first publicly
pointed out in 184S.

388 Allen On the Exeito-Secvetory System. Sept

LETTERS IN EVIDENCE OF THE NATURE AND DATE OF MY PUBLIC

TEACHING.

(From Robert C. Kedizie, A. M., M. D.)

Vermontville, Mich. July 29th, 1857.
Dr. J. A. Allen.

Dear Sir : — Your favor of the 23d was received yesterday, and

I reply by first mail.

In reply to your inquiry, I would state that I remember distinctly
the matter to which you allude. Your reasoning*upon the therapeu-
tic action of a blister in pneumonia (also of a blister to the abdomen
in enteritis), I remember as distinctly as though I listened to you but
yesterday. Your accounting for it by the double nervous arc — anal-
ogous to the excito-motory arc, 1 remember with equal distinctness ;
though I think yon did not name it then the excito-secretory system.

* * I also remember your rejection of the proposition of

II contiguous sympathy.1'

I could identify your manuscript lectures in any court of justice in
the land. It would be impossible for them to be essentially altered
and I not detect it.

* * * * * * *

I should have noticed the injustice of Dr. Campbell's claim to pri-
ority, but the fact is &c, &c. (Here follow certain personal expla-
nations unnecessary to the present purpose. A.)

Ever Yours Truly, R. C. KEDZIE.

[Dr. Kedzie was a member of the class of 1849 at Laporte,
la., Medical College — afterwards a graduate of, and Demon-
strator of Anatomy in the University of Michigan. Dr. K.
had constant access to my manuscripts and took copious
notes.]

(From Joseph B. Hull, M. D.)

Lansing, Mich., July 28th, 1857.
Dear Sir : — I received yours of the 24th yesterday, and am glad
of an opportunity of referring to the instructions received whilst I
listened to your lectures both at Laporte (la. Med. Coll.) in '49 and
Ann Arbor in '50. I shall not be under the necessity of referring to
notes to refresh my memory upon most subjects treated of by you.

1857. Allen On the Excito-Secretw^y System. 389

In regard to the subject of controversy between Messrs. Hall and
Campbell about priority in establishing the doctrine of excito-secre-
tory nervous action — if they cannot date back of 1850, they certainly
cannot claim its introduction to the consideration of the profession, as
you in your lectures at Laporte in 1849 avowed the principle in treat-
ing upon the subject of counter-irritation.

You then rejected the theory of " sympathy of contiguity " and
attributed the effects of blisters upon the chest and abdomen in pneu-
monia and enteritis (as well as near other local inflammations) to the
production of an internal change in the vascular and nutrient action
similar to the excitor and reflex action of the nervous system, and I
think you explained the phenomenon by reference to the double ner-
vous arc. I hope you will succeed in placing the priority of broach-
ing the above principle where it belongs.

Respectfully Yours, J. B. HULL.

[Dr. Hull can also identify the manuscript.]

(From Chas. P. Marsh, M. D.)

Holland, Mich., Aug. 2d, 1857.

Dear Dr.: — In reply to yours of the 23d ult.

I can identify your manuscript lectures as written in the spring and
summer of 1848, and first delivered at the session of the Indiana
Med. College 1848-9.

I remember distinctly your explanation of the action of counter,
irritants by means of the double nervous arc. You rejected the the.
ory of " sympathy of contiguity'1 and claimed as an original view the
principle that their action was analogous to the excito-motory of M.
Hall, but that the reflex effect was not a motion but a modification of
the nutrition of the internal organ.

You gave many illustrations of this mode of action throughout the
entire course.

The same doctrine was also taught by you in the University of
Michigan, whilst I attended the sessions of '50 and '51, '51 and '52,
both in connection with your lectures upon Thrapeutics and Physiol-
ogy. *******

Yours Cordially, ( 'I1AKLES P. MARSH.

390 Merrett On Gungha, Haschisch. Sept.

Article V. Gungha, Haschisch, or Cannabis Indica. By
A. G. Merrett, M. D.

As the uses and actions of the Cannabis Indica (alias
Gungha, Bung, &c.,) are now being discussed, a few prac-
tical observations may not be unacceptable to the readers of
the Independent.

In general terms, then, it may be said to be a deliriant, and
as the profession has lately been favored with a long discourse
upon its psychical effects, I would dismiss this part of the sub-
ject by remarking that its influence upon the mind is most
undesirable, and I may say dangerous — inducing its unhappy
victims to perform that peculiar feat, which, in Bengal and
other parts of the East, is known by the elegant term, " run-
ning the muck" which simply expresses & penchant mauvaise
to disembowel each and every person the infuriate may meet,
until some plucky and charitable fellow commences the dev-
il's tatoo with a club upon the inebriate's head.

Fortunately, however, this notable evil is counter-balanced
by the powerful antispasmodic effect ot the drug. By its
influence, the agonizing countenance of a tetanic sufferer is
relaxed and softened, and this Protean disease (tetanus), in its
most aggravated form is made to loosen its Herculean grip.
For a period of three years I had an opportunity of watching
its administration in cases of tetanus in a Military Hospital
in Calcutta. In idiopathic cases, it most frequently resulted
in a perfect cure, and although the number of cures in trau-
matic cases was much smaller, yet enough recovered to vin-
dicate its superiority over every other remedy, and even in
the fatal cases, produced such a mitigation of suffering as to
justify its systematic and continued administration. Possibly
its success may be greater in tropical regions, but we are not
wanting in evidence of its value in more temperate ones.
Skey, in his " Operative Surgery," mentions, I think, two
cases, wherein it was successfully used. It is worthy of re-
mark also, that a tetanic condition begets a very marked
tolerance of the remedy, so that doses of from six to ten grains

1857. Barnum's Case — Amputation at the Ankle Joint. 391

of the extract every two to four hours were borne without
prejudice ; nor should it be forgotten that inhalation of the
smoke of the cannabis (by means of a dhoudeen) is almost
equally efficacious, the advantage of which, when the muscles
of deglutition are rebelliously spasmodic (as in the latter
stages of tetanus), must be quite obvious. The loss of an
incisor tooth for such a purpose, is gladly submitted to.

Its relaxant influence has been brought to bear successfully
upon the reduction of hernia by the taxis, and but for the
fact that Gunn and others have shown that muscular spasm
has little or nothing to do with impeding the reduction of dis-
locations, one might wish that the cannabis were made a sub-
stitute for jDulleys and counter-pulls.

It would be interesting to experiment with it in cases of
strychnine poisoning. Possibly some of your readers may be
zealous enough to victimize a canine friend to the cause of
suffering humanity.

Article VI. Amputation at the Ankle Joint. By B. Bar-
num, M. D.

On the 6th of May last, I was called by Dr. Beebee, of

Vicksburg to operate on a little patient of his, son of W

S , whose foot had been accidently amputated by his

brother while chopping at the wood pile.

The patient, a boy eight years of age, to protect a piece of
wood his brother was cutting, placed his foot under the fall-
ing axe, and received the full force of the blow at the ante-
rior articulations of the astragalus and os calcis, performing
Chopart's operation, save the flap, and making a complete
section of the stocking and boot. The haemorrhage had not
been copious, and though no ligatures were applied, had
entirely ceased before I arrived.

Preferring Syme's operation to PeregofFs, I determined to
remove the remaining tarsal bones. The patient came easily

392 Beech On New Apparatus for D dressing Clavicles. Sept.

■under the influence of a mixture of chloroform and sulphuric
ether — one part of chloroform to three of the ether.

I carried a transverse incision across the sole of the foot,
from the tip of external malleolus to the opposite point on the
inner side, and another across the instep, joining the ends of
the first incision. The os calcis and astragalas were readily
dissected away, and the malleoli removed with a saw.
Uniting the flaps with interrupted sutures and adhesive plas-
ter, a light dressing was applied to the stump.

Yisited the patient May 15th, one week after the operation.
Union, by first intention, had taken place at the sides. A
narrow line of sloughing at the anterior edge of the lower
flap — discharging freely, and wound* looking well.

I saw the case again July 27th. The stump had entirely
healed, presenting a firm and beautiful cushion, upon which
the weight of the body could be borne without the least in-
convenience. The limb is about one inch and a quarter
shorter than its fellow, and, with a suitable shoe, will serve
an admirable purpose for locomotion, and a living argument
in favor of conservative surgery.

Schoolcraft, Aug. 6th, 1857.

Article VII. A New Apparatus for Dressing Fractured

Clavicles. By J. H. Beech, M. D.

Having to-day received " The Medical Independent for
July," and observed a notice of a new apparatus for dressing
" fractured clavicle," with comments thereupon, I found my
controversial propensities aroused, inasmuch as it appears to
hold a doctrine, in my opinion, contrary to facts ; i. e., that the
outer end of a fractured clavicle should always be elevated-
From repeated observations of sound persons, I believe that
the "sternal end," is as often found highest as the " accromial
end."

On reading the article referred to, I took to the street and
shops for fresh observations. In a short time twenty-two

1857. Beech On New Apparatus for Dressing Olav teles. 393

adult males were examined from various classes, clergymen,
blacksmiths, shoemakers, farmers, butchers, foundry men, etc.
Among these the " sternal ends" of the clavicles were found
highest in nine. One presented a difference of nearly two
inches, in a well developed man. The " sternal end " was
lowest in seven cases, lwfive, the clavicles were perfectly hor-
izontal,— and one could not avoid a kind of fixy restraint in
which his " accromia" were sometimes slightly elevated and
sometimes as much depressed. In females and children, I
believe a larger proportion have the outer end lower than the
inner. If this is correct, there is no more propriety in ele-
vating, than in depressing the shoulder. Cannot the length
of the clavicle be preserved without either '( or with either as
the normal condition of the case requires ? It is useless to
preserve the length of measurements if the ends of the frac-
tured bone are forced apart, or if tilted by position or com-
presses, so as to unite at an angle. Much ingenuity has been
expended on the dressings with the materials of" olden time,"
but the new substances have not been tried in all shapes yet.
Allow me to describe an apparatus which I believe is indicated
and economical, and which will leave the shoulder to be
controlled in elevation, or not, as the case may require.

. Three pads, and two steel splints or " artificial clavicles"
constitute the essential parts, made as follows :

A sternal pad having a foundation of iron, presenting a
surface as large as the "manubrium sterni," moulded to fit
the " incisura semilunaris ;" and of sufficient firmness, to have
fixed to its outer surface, slides and pivots, screws, or ratchets
by which the artificial clavicles may he retained at any
required length. The fittings should be loose so that nothing
but length of " sterno-accromial " measurement should be
controlled. This iron foundation should be faced with gutta
percha of firm quality, about one-eighth of an inch thick, ex-
tending beyond the iron work and securely attached. The
inner surface of the pads should be coated with ichthyocolla.
Two other (coracoid) pads of the same materials made to fit
over the u coracoid processes" and adjacent parts, to wit: an

394 Beech On New Apparrtus for Dressing Clamcles. Sept.

iron foundation of from twelve to twenty lines diameter,
slightly concave, embeded in gutta percha plate a third larger
and coated with ichthyocolla as the other. On the convex sur-
face a socket, or pivot to hold the outer end of the artificial
clavicles, allowing considerable play.

The artificial clavicles should be of steel, about the size of
the springs of " Hull's trusses," or to " abdominal supporters'
according to the size of the patient to be dressed. They should
be nearly or quite straight, and notched or perforated to
accommodate the fittings on the pads, so as to be governed in
length, at the sternal pad independent of each other Several
sets of these might accompany each set of pads.

Application — Warm each pad by dry heat until they can
be moulded exactly to the inequalities of the individual case ;
the " sternal" to the " incisura semilunaris," " sterno-costal"
articulations, etc., as intimated above. When fitted and
partly cooled, moisten the ichthyocolla and apply in proper po-
sitions. Adhesive straps may be superadded to render the
whole secure if thought necessary. A strap of webbing might
be attached to the extreme upper and lower corners of the
sternal pad, passing around the shoulder as far back as the
middle of the scapula to guard against displacement of this
pad. Apply the splint on the sound side first, and fasten
where the natural length allows. Finally, carry the shoulder
of the injured side outward and backward at its natural eleva-
tion until the artificial clavicle or " splint " corresponds with
its fellow, or even a slight distance farther, if thought proper
to allow for gliding of tissues, &c. Let this be made fast and
the principle indications will be fulfilled. To this may be
added in unusual cases, the axillary pad and elbow bandage, or
other well known means. This dressing would allow free
inspection and treatment to the local injury, as the splints
would set nearly an inch from the skin. The patient need not
be confined, but wearing a light covering to the shoulders,
attend to light business or pleasure. The pads should be
cleaned and coated anew with ichthyocolla or other tenaceous
material after removal from a discharged case.

Coldwater, July 11th, 1857.

1857. Dorsch On Medical Plants of Michigan.

Article VIII. The 'Medical Plants of Mi chigam. . By Ed-
ward Dorsch, M. D. (Continued.)

The diseases, in which the dulcumara has proved as most
beneficial, are incipient affections of the chest, not alone com-
mon tuberculosis, but also inflammatory processes.

In the first stages of consumption, if the tubercles are allied
with scrophulous diathesis, if the patient feels once in a while
stiches through the chest, has a dry spasmodic cough, fre-
quent, irritated pulse, he will find much benefit by a combi-
nation of dulcumara, digitalis, island moss, and perhaps
acetate of lead. All the nostrums, based upon the narcotic
effects of morphine or prussic acid will not produce a more
soothing sensation upon the poor sufferer, than this simple
plant.

In pleuritis and pneumonia the dulcumara is indicated,
when the inflammation has been broken by bleeding, but a
dry cough annoys the patient, with little or no expectoration,
febrile pulse etc. Senega root, hyosciamus and golden sulphu-
ret of antimony are here the best adjuviantia. A decoction
(dr. vj — oz. j. for twenty-four hours), sometimes with small
doses of antimonial preparations, will effect almost always a
cure in those rheumatic pleuresies, which have a tendency
to critical sweats.

Chronic, long neglected catarrhs of the lungs, depending on
weakness and laxation of the mucous membranes of the
bronchia?, when ausculation shows more the whistling sound,
than rattling of phlegm — (" Respiration subsibilante" accord-
ing to Laennec) — find many times their end by dulcumara
and gum ammoniac. In the Policlinicum of Berlin, Prussia,
dulcumara is used with great success in whooping cough of
delicate children, usually mixed with taftarised potash as the
following prescription shows:

R: Extr. Dulcumar. — scruples j.

Kal. tartar. " ij.

solve iu
Aq. Fceniculi — ounces i>-.
Add Yin. stibiat. — drachms ss.
Syr. Alth. " iij.

M. and S. Every two Imurs, <>ne tea-Spoonful
vol. in. no vii — 15.

396 Dorsch On Medical Plants of Michigan. Sept.

Diseases of the skin — chronic cutaneous eruptions, indicate
often the use of this plant, if they are of herpetic, psoric or
syphilitic character, and combined, as we find them many
times with scrophula. It aids the healing properties of other
anti-herpetic or anti-syphilitic plants, as sarsaparilla and
guaiac, and seems to stand in similar relation to the mesentric
glands, as taraxacum and conium maculatum stand to the
liver. Children laboring under atrophia mesenterica can
frequently be saved by its dissolving qualities and the rational
use of calomel.

In primary syphilitic affections with phagedaenic ulcera-
tions, dulcumara acts as a purifier of the blood and does a
great deal of good ; if the patient, smitten with constitutional
syphilis, suffers with those " dolores osteocopi," which make
the hours before midnight as long as years, and a real hell for
the emaciated rake, Murray recommended it in the following
formula :

R: Stip. Dulcumar.
Ligu. Sassafras.

Rad. Sarsapar.
Had. Liquirit.

Had Gremin. aa — ounces j.

Ligu. Guaiac. — ounces ij.

Sem. Foenicul. — drachms iij.

Cone. M. and S. Tea.
Two heaped tea spoonsful to be decocted with one quart
water down to one pint and a half. Once in three hours a
wine glass full.

Pathological secretions from the genitalia, as gonorrhoea and
leucorrhcea, offer too, a broad field for efficiency of this drug,
which will do half the work of the balsam copaiva, if com-
bined with it.

Another group of diseases, rheumatism, gout, wants the
aid of this remedy, if the diaphoresis is suppressed, and ab-
dominal plethora goes hand in hand with languid secretion of
the liver and other glands of the abdomen. It proves to be a
great help to aconite and antimony.

1857. Bibliographical Record. 397

Great therefore is the sway of the dulcumara and manifold
its use. The best way to prescribe it is a decoction of the
stems, drachms ij. — drachms iv. for ounces vj. water, or its
extract scruples i — drachm ss. per diem. Externally it
might be used for warm application on ulcers and impetigi-
nous eruptions.

Finally I may add, that according to my experience, we
can hardly find a remedy equally efficient in chronic catarrhus
pulmonum, as already mentioned above, with the dulcumara.

{To be continued.)

Monroe ) August 8t7i, 1857.

iibltograj^ital $eror)>.

The Microscope and its Revelations. By William B. Carpenter, M. D., F. R. S.,
F. G. S., etc., with an appendix — containing the applications of the Microscope
to clinical medicine, etc. By Francis Gurney Smith, M. D., &c. Illustrated by
four hundred and thirty -four Engravings on wood. Philadelphia : Blanch ard
& Lea, 1856.

The growing interest in the Microscope, particularly in our
own country, as a means of improvement and discovery in natural
science, of diagnosis in medicine, and of accurate deduction in patho-
logical research, gave rise to a demand for such a wrork as the one
before us. Its " revelations " too, the certainty it confers upon
scientific investigations, the uses to which it may be advanta-
geously applied in popular instruction, and as a refined and elevating
amusement, all add an importance and value to the instrument,
beyond what characterizes any other age or period in the world's
history. In view of the foregoing considerations, a systematically
arranged treatise, on the " Microscope and its Revelations" as well as
the objects and purposes to which it may be applied, containing
definite instructions as to its use, was a desideratum on this side of
the Atlantic.

That these several matters might be intelligently set forth, a
historical account of the instrument, the modifications and the
improvements it has undergone, of what has been accomplished by

398 Bibliographical Record. Sept.

its aid, as also a reference to those philosophers who have distin-
guished themselves, and contributed to the advancement of
science thereby, would seem to have been an essential department of
the work. To all these the author has devoted an appropriate share
of attention. It is a handsome volume of seven hundred and twenty-
four pages, and comprising an introduction and twenty chapters,
by the author, arranged in such a manner as to present the several
topics treated of, in the natural order of sequence, and an appendix,
as shown by the title, by Francis Gurney Smith, M. D., the American
editor.

Throughout the book, the author speaks both the language of
philosophy and experience, and the entire text exhibits evidence that,
if it be regarded as a compilation, merely, Dr. C. is sufficiently
familiar with all that pertains to the subject, to select what is perti-
nent, and to present the several subjects of which he treats, in such
a manner as to render each, obvious to the comprehension of the
reader, — in a word, he speaks the language of a master. Whether
he has been as careful to render " honor to all to whom honor is
' justly ' due," may be a matter of some doubt. True, in his preface
he acknowledges his obligatition to certain respectable writers, and
sources of aid, but it is believed others might, with no less
propriety, have been mentioned. The paper, typography, binding,
and general execution, abating something for defects in many of the
illustrations, reflect honor upon the house whence it issued.

But we camiot close our notice of the production, without a word in
reference to the introduction and the appendix. Of the former, it is
not too much to say, we have seldom had the pleasure of perusing a
more finished essay. Whether it be contemplated as a historical
summary of the circumstances and events, that have preceded and
accompanied each " great advance " in astronomy and chemistry, or
any other of the natural sciences ; as illustrative of the powers
of the microscope, its vast contributions to the aggregate of human
knowledge or its modifications and improvements, and the immen-
sity of the field of research to which it is applicable, or as a
philosophical commentary upon the fundamental principles of educa-
tion, and its availability in promoting their development and
progress ; — in each and every particular it is equally admirable.

In reference to this latter topic, so completely do the reasonings of
the writer accord with those in which we have been accustomed to

1857. The Microscope and its Revelations. 399

indulge, that we contemplate them with no common pleasure.
Having dwelt at some length on the satisfactions derivable from mi-
croscopical investigations, the facility with which they may be made to
minister to amusement and the highest intellectual culture, and to the
formation of a taste for the beautiful in nature, he observes : " This
is no imaginary picture, but one which we have constantly under
our eyes, and no argument can be needed to show the value of such
a taste, to such, at least, as have set clearly before their minds, the
objects at which they should aim in the great work of education.
For we have not merely to train the intellectual powers and to
develope the moral sense, but to form those tastes — those " likes and
dislikes " — which exercise a more abiding and a more cogent influence
on the conduct, than either the reason or the mere knowledge of
duty. It is our object to foster all the higher aspirations ; to keep
in check all that is low and degrading."

But our author is not so completely a blind worshiper of the
"Microscope and its Revelations'''' even, as not to be aware that
much of untruth has been put forth by " microscopic observers ;"
hence he remarks, :i when, as frequently happened, phisiologists
began with theorizing on the elementary structure of the body, and
allowed themselves to twist their imperfect observations into accord-
ance with their theories, it was not surprising that their accounts of
what they professed to have seen, should be extremely discordant."
Having, for reasons which he seems to have regarded sufficient,
" omitted all reference to the applications of the microscope to patho-
logical inquiry," the American editor has supplied the hiatus by a
timely and exceedingly well written appendix, containing a summary
record of such " applications," and the important advantages, thus
far, resulting therefrom. Herein both the pathologist and the
therapeutist will find much valuable aid in regard to diagnosis and
the actual character of the diseased action, that presents for investi-
gation and treatment. Many appropriate cautions, will, likewise, be
found embodied in this part of the work, in reference to accuracy of
observation and deduction, and the hasty announcement of conclusions
from insufficient data, as well as with regard to blind and fanatical
confidence in microscopical developments, to the exclusion of other
long tried and approved methods of diagnosis and pathological
research. The writer would not have his readers adopt " the me-
chanical means necessary for arriving at truths.*' and repudiate " those

400 Bibliographical Record. Sept.

powers of observation and mental processes which enable us to
recognize, compare, and arrange the truths, themselves." In illustra-
tion he remarks, in the language of another, " you must not suppose
that an additional method of gaming information implies abandon-
ment of those, the utility of which, has stood the test of experience.
Men must learn the every day use of their senses ; must know how
to feel, hear, and see, in the same manner as they did before instru-
ments were invented. We don't see the stars less clearly by our
naked sight because the telescope is necessary for an astronomer.
Neither should a physician observe the symptoms of a disease less
accurately because he examined the chest with a stethoscope, nor a
surgeon be less dexterous with the knife, because it is only by means
of the microscope he can determine, with exactitude, the nature of a
tumor."

Considered in the aggregate, Dr. Carpenter's work must be regarded
as a valuable contribution to the literature of the age, and no doubt
will do much towards the consummation of that most desirable of all
events, the general diffusion of scientific truth among men.

To be found at Raymond & Selleck's, in this city. K.

Elements of Pathological Anatomy. By Samuel D. Gross, M. D., Pofessor of
Surgery in the Jefferson Medical College, of Philadelphia; and formerly
Professor of Pathological Anatomy in the Medical Department of the Cincinnati
College. Third Edition — modified and thoroughly revised. Illustrated by
three hundred and forty-two Engravings on wood. Philadelphia: Blanchard
& Lea, 1857.

In his preface, the author tells us that the " work has been
materially modified and fully brought up, in so far, at least, as
appertains to what may be considered as really worthy of acceptance,
to the existing state of the science of which it treats." " Histology "
and " diagnosis " have been omitted, " paragraphs and often whole
pages have been re-written " — " new matter has been introduced " —
" one hundred and thirty new cuts have been added," etc.

In the "general arrangement," which "remains the same," and
which is admirable, about one-fourth of the whole work is devoted to
the subject of general pathology. The great importance of this
subject, not only to the skilled in morbid anatomy, but also to him
who stops far short of accomplishment in this branch, renders accu-

1857. Elements of Pathological Anatomy. 401

racy of doctrine and clearness of description, qualities, to say the
least, highly desirable in a systematic treatise. With a high appre-
ciation of the merits of the work as a whole, and perhaps as great
admiration for the author as any one, we feel constrained to say that
he has not, in every instance, attained the latter of the above expressed
•qualities. For instance, in the chapter devoted to suppuration, he
fails to say what suppuration is, further than that it " consists in the
formation of purulent matter, and constitutes, strictly speaking,
merely the third stage of inflammation, inasmuch as pus is never
deposited when there is an entire absence of this state." Had he
•stated in this connection the ideas contained in his remarks on the
origin of pus, his instruction would have been more forcible ; but
^ven then it would have been defective, for he utterly fails to bring
out clearly the relation which pus bears to organizable material, or
to state the circumstances, local and constitutional, which favor its
formation. We hazzard the belief, that although the chapter is replete
with information, a good student may carefully peruse it, and yet
fail on examination, accurately to state in what suppuration really
co?isists. We must protest, too. against the loose way in which the
terms " effusion " and " secretion M of pus are used in connection with
the subject of suppuration.

In the chapter on ulceration, our author follows the beaten track,
and we cannot permit the present opportunity to pass, without
expressing the belief that needless obscurity prevails in teaching this
subject. He says :

" Ulceration may be defined to be molecular death of a part, or
mortification in miniature, attended with the disintegration and
gradual removal of the affected parts. It is synonymous with what
was anciently called erosion, and with what some modem pathologists
denominate ulcerative absorption. Of the intimate nature of this
lesion nothing is known with any certainty, beyond the feci that it is
essentially connected with inflammation."

\\ e demur to the first and last of the above statements, viz : That
It (ulceration) is " mortification in miniature," and. that " of its inti-
mate nature nothing is known with any certainty." To reverse the
order and commence with the last, it u known :

First. That ulceration is a destructive process, in which tissues
disappear.

Second. That this destruction of tissue sometimes takes place without

402 Bibliographical Record. Sept.

leaving any debris, other than fluids which are liberated, and sometimes
even the fluids disappear also.

Third. That it takes place in living tissues, and therefore must be
a vital process.

It follows then, that it is essentially a process of destructive absorp-
tion ; and that the first proposition, viz : That ulceration is " morti-
fication in miniature," is not true. Mortification may attend
ulceration, but constitutes no part of the process, any more than an
extensive mortification constitutes a part of the ulcerative process,
by which the slough is thrown off. There is such a thing as simple,
uncomplicated ulceration ; and when it is observed, there is no
difficulty in recognizing the nature of the process. The fact that it
may be complicated with a gangrenous tendency, or attended by an
effort at repair, in which the organizable material furnished, degene-
rates into pus, should in no way obscure the pathology of the simple
process of ulceration. We repeat, that authors are prone to write
too obscurely on this subject — we wish we could say this subject
only.

To return to the subject of this notice : It gives us pleasure to-
speak of the book as a whole, in commendatory terms ; a work on
our part, however, which the reputation established by previous
editions, renders entirely supererogatory. It contains a mass of infor-
mation, conveniently arranged for reference, and fully illustrated.

To be found at the House of Raymond & Selleck, in this citv.

transactions of the Indiana State Medical Society — Eighth Annual Session-
May, 1857.

We recognize in this association evidences of sturdy vitality and
development, akin to the material energy of its own great State.

There appears to have been a full attendance, and the list of new
members is a gratifying proof of professional interest in its well
being. We see on its rolls the names of many who have made their
mark on the times.

Very few of the various committees appointed at the previous
meeting are here ominously labelled — " no report."

Dr. T. J. Cogley reports on Practice of Medicine, and among
many valuable suggestions, we note a few :

1857. Transactions of Indiana Medical Society. 4-03

" If physicians would study medicine more and surgery less, it
would result in great good to a large portion of our race ; moreover,
a man cannot become a good surgeon, without first becoming a
skillful physician."

Good, but qualified thus, " medicine more, and surgery not less."
Dr. C. believes pertussis to be dependent on some peculiar affection
of the pneumogastric nerve, and recommends :

;' A uniform temperature, pure air. liberal nourishment, and above
all, sponging the chest several times daily with cold water ; the inha-
lation of choloroform greatly lessens the number of paroxysms of
cough ; belladonna is the best narcotic ; nitric acid the best tonic."

In Rheumatism he particularly commends alkalies, but does not
think they can entirely supersede other remedies. Quinine and
capsicum are urged in pneumonia typhoides. In Scarlatina Dr. C.
hits our idea in good part : " Bloodletting, antimonial emetics, strong
cathartics, and gruel, are, in my judgement, complications rarely
recovered from." Of Typhoid Fever : " Whenever we attempt to
cut short the disease, we do mischief; we can no more cut it short,
than we can cut short measels or small pox." Strangely enough, he
adds, " alcohol is probably an antidote for the poison in the blood l"
Dr. C.'s treatment of typhoid fever, in our opinion, is not to be
commended, and it is to be hoped he will revise it. The following is
the best resume of the treatment of intermittent we have seen :

" It always excites my surprise when I hear of physicians trying
to cure intermittent fever with anything but quinine; sometimes—
not invariably — it is proper enough, in the commencement, to give
an emetic, followed, if need be, by a cathartic ; but after that, all we
want is quinine ; from 15 to 20 grs. suffices for a tertian ; a quotidian
often requires more, and a case of remittent fever an indefinite
amount. It is never necessary to wait for an intermission before
commencing the quinine ; it does not aggravate a paroxysm of
fever ; it calms, and reduces it ; it is not capable, in malarious fever,
of acting as a poison ; yet there is no benefit derived from giving
more than three t<> six grains." Brief, comprehensive, and, what is
better, true.

The internal administration of chloroform in halfdraehm doses every
two or three hours, is advised in delirium tremens, but its inhalation
strongly objected to. In common with most of the enlightened mem-
bers of the profession at the present time. Dr. Cogley places great

404: Bibliographical Record, Sept.

confidence in the curative resources of Nature, and observes, Nature cures
diseases, and not we ; the province of the surgeon, or physician, beyond
which he cannot step one foot, consists in removing obstacles in her
her path. Evidently Dr. Cogley distrusts " perturbation," and has
not the fear either of the Fathers or the " Young Men." It is a very
creditable paper.

The report on diseases of the Eye and Ear. by Theophilus Parvin,
M. D., is demonstrative that the author is up to the times, and
contains many valuable suggestions.

Prof. Meeker's report on Fractures and False Joints is character-
istic of the man in every respect. Clear, practical, sound, and
suggestive, with no effort at display, and rather distinctly intimating
that the true cause of "mal practice" suits, not infrequently grows
out of the ignorance of the practitioner, as well as the vicious dispo-
sition of the patients. He rightly insists upon frequent visits after
reducing and dressing injuries, for the plain reason that it is easier to
get to place, than to keep in place. We cannot forbear wishing that
Dr. Meeker's ripe experience and sound judgment, may yet be put
in a more generally accessible form than that of oral lectures, to
which he has mainlv hitherto confined himself.

Charles Fishback, M. D., reports for the committee on Medical
Education. After enumerating the objectionable features of the
present system of professional teaching, he suggests practical modifi-
cations well worthy the attention of all interested.

1. A Free School.

2. Suitable preliminary qualifications.

3. Not more than thrpe lectures per diem, and each preceded by a
real examination — surgical and other manipulations — by each student.

4. Extension of the term to nine months, and three terms to
constitute a course ; one third of the last term in each year to be
devoted to a review of the entire course in each department.

5. Systematic study out of the lecture room — pharmacological
and minor surgery practice — to be insisted on.

6. Clinical practice, either in hospital or private practice, to be
seen and participated in, at least, the last year.

7. Certificates to be conferred only by a board of seven, chosen
from the ranks of the profession by the State Medical Society.

Here is something tangible, and though unprepared to give it
unqualified endorsement, we suggest that the profession " think of

1857. Transactions of Indiana Medical Society. 405

these things." Assuredly, something should be done other than
bringing mere railing accusations against some poor sinner against the
code of ethics.

The eulogy upon the late Elizur Deming, M. D., of Lafayette, by
Dr. Bobbs, of Indianapolis, is a graceful tribute to one of those men
in whom all the various elements of true manhood found their place.
We have met men in all positions of life, fortune, and fame, but
never have we seen another like him upon whom, especially,

" Every god did seem to set his seal,
To give the world assurance of a man."

The profound thinker; the accomplished scholar, overflowing with

the love of past and present time, and vet in the very profusion of
attainment, exhibiting evidences of the power of systematic command
over each in detail and all in order ; with the imagination exuberant
in poetic imagery, but the expression chastened by the most delicate
sense of appropriateness and good sense ; fluent beyond comparison
in language, yet never using a word which the most captious critic
would willingly spare ; with most exquisite humor and sense of the
satirical, and yet never losing a friend by the jest, or leaving a
poison in the wound from the arrow of his sarcasm. Of vast and
varied professional experience, and yet no closet student could
puzzle him with the ingenious speculations of yesterday's lecture-
room or journal : no fact of interest or occurrence of important
character ever seemed to escape him. Add to these, a commanding
person, an eagle eye, and all those social qualities which cement endu-
ring friendships, and such a man was Professor Deming. Had he
linked ambition to his faculties, no position, no distinction would
have been beyond his attainment Asa professorial colleague, no
man was ever imbued with a more catholic spirit. Recognizing the
independent working of his own mind, he had not a sha low of fear
that wherein his colleagues differed from himself, their opinions were
evidences of disrespect toward him. He rejoiced in their personal
and professional popularity, and contributed toward it by kindly
words and acts. His private correspondence is full of the frankness
of confident friendship, and sparkles in every line with the enthusiasm
of a genial spirit. Some fifty or si\i\ letfe rs addressed to the writer
of this notice, are, in our opinion, worthy of a place beside the most
finished and classic publications of epistolary correspondence. But
our thoughts run on too fast and too far upon this theme, we forget

406 Medical Independent. Sept.

that others who did not know him, may deem our eulogium rather
prompted by strong personal partiality, than by correct judgment.
We cannot believe this, for we knew the man ; though we loved him
as a friend, we almost worshipped him as the embodiment of our
ideal of the true physician.

The transactions close with the address of the retiring President.
Prof. Meeker. The condition of the profession is discussed by a
keen observer. We are especially delighted with his remark, which
we commend to those whom the coat fits : " From the fact that
reformers are themselves too often typical of Satan rebuking sin,
reform has become a convertible term with radicalism, anarchy, and
licentiousness." The address, as a whole, is sound, sensible, and
practical ; such a one as we had a right to expect from the author.

The world does move, brethren ! J. A. A.

Spirit of tin Pefel |im

The Case of Huntington. — If there be moral insanity anywhere, it is
likely to manifest itself in Wall Street. The wonder is that it should never
have been set up as a defense for the various iniquities committed there,
until it was interposed in the case of Huntington.

Fortunately, in that case it was interposed unsuccessfully ; for to have
sustained it would have been to shield undoubted crime, and to stamp the
evidence of non-experts with a sort of authority that it does not deserve.
Even the evidence of experts in insanity is to be received with extreme
caution, except in palpable instances, where the tokens of disease are con-
spicuous, or in cases where the observation of the witnesses has been pro-
longed and critical.

Huntington was tried for forgery in November, 1856, on one out of
twenty-seven indictments for a like offense. And yet it is doubtful, on the
admissions of his counsel as to the magnitude of his forgeries, whether
such an amazing mass of true hills covered half his crimes : and a conviction
and sentence following all would have incarcerated an antediluvian for a
good part of his natural life.

When the proof on the part of the prosecution was produced, it was of
such a character as to leave little doubt of Huntington's guilt, and to insure
his conviction. The plea of moral insanity was then boldly and unexpect"

1857. Spirit of the Medical Press. 407

edly set up, contrary to his own wishes, and upon the reluctant consent of
his family and friends. This is admitted by his counsel. The case was
desperate, and it is not to be wondered at that a desperate defense should
be urged, rather than none at all.

The plea being pleaded, it was necessary to sustain it by evidence, no
less than by boldness and ingenuity ; and it is to be regretted that med-
ical men, of professional eminence in a general way, but in no way
distinguished as experts, even in questions of general insanity, allowed
themselves to be made witnesses on a question the most subtle and
equivocal that pertains to that mysterious disease — a question of moral
insanity.

We do not propose now to treat, in any general and comprehensive
method, of moral insanitg, but hope to do so in an early succeeding num-
ber of this Journal. Meantime we give a brief notice of the case of
Huntington ; so remarkable for the temerity and pecuniary success of the
culprit, and for the audacity, under the circumstances, of this particular
defense.

Moral insanity interposed as a shield against criminal allegations should
always be fortified by such an array of testimony on the part of experts in
insanity as will command entire respect. Without intending any reflec-
tion upon the general attainments or standing of the medical witnesses in
behalf of Huntington, we may be permitted to suggest that neither suc-
cessful practice in the ordinary routine of medicine and surgery, nor pop-
ular and well-deserved reputation in a professorship of surgery, or a
medico-legal professorship, constitutes what, in any legal sense, is expert-
ness in insanity ; and we mean to say, very particularly and decidedly,
that no expertness is sufficient to detect moral insanity on such brief and
superficial investigations as were made by the medical witnesses in this
case of Huntington.

The testimony adduced by the prosecution was sufficient to make a pal-
pable case of guilt, unless the defense of insanity were established. All
that we have to do, therefore, is to examine that defense, and see whether
it is sustainable on the testimony.

Insanity, in its general aspects, is not a very difficult matter to prove.
We have thousands of unquestionable cases of that, as our asylums, and
poor-houses, and, we regret to add, even our jjrisons show. Of moral in-
sanity, taking the best definitions of the most distinguished experts for a
standard, we have not an unquestionable case in a thousand — indeed, none
unquestionable. There is no indisputable case, unanimously acknowl-
edged by those of the profession who are particularly experienced in insan-
ity. The whole question is in a state rather of agitation than of settlement ;
and when it is settled, if ever it is, no one can now safely prognosticate

408 Medical Independent. Sept.

whether moral insanity will be recognized as a disease any way distinct
from what is known to the law as insanity proper.

What, upon the proofs, was the character of Huntington's alleged in-
sanity ? He began by being a bad boy — rather worse, perhaps, than most
bad boys. He lied, cheated, and "made paper" rather precociously. He
failed in business, and helped others to fail in it who might have been suc-
cessful, unless he had precipitated them to destruction. If he were, by
any accident, insane, his insanity was of the vampyre sort, for he seemed
to gloat upon cemeteries, and speculations upon the disposal of dead bodies.
He had a fancy for grave-yards at so much a square foot, embracing Balti-
more and Buffalo in the wide range of his sepulchral visions. It bloomed
into a fancy for paper, that Wall Street would negotiate at so much a cy-
pher, with some numeral of value prefixed. It matured in all sorts of
extravagance, which such easy paper, and an unlimited credit as a success-
ful Wall Street financier would allow him to indulge. Bad in the begin-
ning, he went on to worse, like the ordinary herd of reprobates — those
lunatics alwa}'s at large, who wander about the purlieus of great cities, as
well as about some of the rural districts, seeking whom they may defraud.
Knaves, "confidence-men," and forgers are apt to be insane in that moral
way.

Improvidence as to the future for himself and family was deemed a
strong mark of insanity in his case. Every gambler, every burglar, and
every drunkard is just as insane in that particular. Spendthrifts, too, are
always reckless of the future. If they were morally insane, extravagance
would be no moral crime, any more than it is a legal crime. The tokens
of insanity exhibited by Huntington were of the sort which distinguishes
all reprobates, who, having no means, are willing enough to live, by hook
or crook, on the means of other men. There seems to be nothing more in
the case than that.

The icdictment was very ably tried by distinguished gentlemen of the
bar, and the result is well known. The plea of insanity was not sustained;
the culprit was found guilty, and is now serving the State in the prison at
Sing Sing, on a sentence of five years' imprisonment.

The justice of the verdict and sentence is apparent from the following
considerations :

1. Admitting the actual existence of moral insanity, there was no suffi-
cient legal proof of it.

Neither of the medical gentlemen called by the prisoner's counsel was
an expert in insanity. One was a general practitioner in medicine and
surgery, and a professor of surgery, and the other a practicing physician,
as well as a professor of obstetrics, diseases of women and children, and
of medical jurisprudence. The latter was for two years physician to the
New York City Prison, where he saw luuatics almost every day; and

1857. Spirit of the Medical Press. 409

as he was obliged to teach on the subject of insanity, he had, of course,
given it attention.

In the eye of the law, neither of these professors was qualified to testify
as an expert in insanity. Their opinions, as medical men, might be de-
serving of consideration and respect in a general way ; so might the opinion
of a village doctor, who had never known more of insanity than the single
case of his neighborhood offered to his observation. The opinions of doc-
tors are often sworn to before juries ; but the weight they have with juries,
and more particularly with judges, depends upon the opportunities they
have had for critical observation and special knowledge of the subject,
rather than upon their general reputation as men, as doctors, or as pro-
fessors. Expertness means something more than general skill, or the re-
putation of it ; it means the result of great observation and experience,
applied, in a somewhat exclusive way, to a particular subject. Dr. Mottis
an expert in surgery, and his testimony on a point of surgical practice
would doubtless be accepted as that of an expert ; in a case of poisoning it
might not; perhaps Dr. Chilton's would be more satisfactory. We recol-
lect a case of forgery that was tried a few years since, in which were called
as witnesses, persons who had for years been engaged in banks, and in
offices connected with the courts of justice ; and who had been, in those
vocations, under the constant necessity of examining hand-writing and sig-
natures to papers, and who were reputed to be skilled in the comparison
of hands, and the detection of forgery. On an appeal of the case, the tes-
timony of these witnesses was rejected by an eminent judge, because they
were not deemed to be, in a legal sense, experts. There are few men who
are experts in all branches of their profession ; and, in this country partic-
ularly, where every medical man is physician and surgeon, and perhaps
professor besides, and every lawyer is both attorney and counselor, expert-
ness, in the strict sense, is hardly to be expected. But we have no space
to pursue this point. There are real experts in insanity in this country,
as well as abroad, but none were produced to substantiate Huntington's
defense, and for that reason it was legally proper that it should fail.

2. Admitting that the medical witnesses were experts, they had not suffi-
cient opportunity to examine the accused and decide upon his case as one
of insanity, particularly of moral insanity.

One of the witnesses saw the culprit once only, but then had two inter-
views with him. They lasted altogether an hour and a half, one hour of
which was passed in conversation with him. The other witness had two
interviews on two several days, the first of three quarters of an hour, the
other perhaps as long or longer, but the duration of it is not specified.

Now here are three or four hours given to the observation of a case of
alleged moral insanity, the demonstrations of which are of the faintest sort,
and likely to be simulated, because both the doctors admit that the accus-

410 JItdical Independent. Sept.

od probably knew who they were, or at least that they were medical men,
scanning his conduct. The difficulty of detecting simulated insanity is
generally acknowledged by the profession, and there are cases on record
where months of close observation have been bestowed by skillful experts,
each coming to a different conclusion.

o. But, taking the testimony as it is recorded, there is no sufficient evi-
dence, whether it be considered psychologically, morally, or legally, that
Huntington ever was insane. There is abundant evidence, to be sure, that
he was a reckless man. But recklessness is not uncommon among those
who pride themselves, without much occasion for it, upon their sharpness
and shrewdness, and who would scorn — as Huntington had (or assumed)
the grace to scorn — a plea of insanity. It is not always easy to account for
the schemes and conduct of a villain, because villainy is not the normal
state of men, although it may seem to be fast getting so. If it is to be
palliated by scientific excuses of moral insanity, or other dubious apologies
for misconduct and crime, the period is not far off when each particular
offense against social law and order will have its particular form of insanity,
real or simulated, presented as a plea to ward off punishment, and when
the whole vocabulary of the dead languages will be in requisition to pro-
vide a nomenclature adapted to the multifarious iniquities to which men
are prone.

We should infer, from the proofs, that Huntington was not a very pro-
found villain, — that his intellect, indeed, was no stronger than his morals.
Long practice in his peculiar line of imposition does not seem to have sharp-
ened his wits in respect to the modes of self-protection ; but his feeling of
security, on the other hand, showed a pretty accurate knowledge of the
ways of Wall Street, where barefaced audacity is apt to win confidence in
a ratio to its boldness.

We have said that this case of Huntington was ably tried on both sides.
On the part of the prosecution particularly (considering the affecting cir-
cumstances under which the leading counsel conducted it, oppressed as he
was by a severe and most touching family affliction) it was tried with re-
markable skill. We speak, of course, with special reference to the cross-
examination of the medical and other witnesses on the point of insanity.
and the summing up on that defense, these particulars being more within
our province than the purely legal points of the case. Respecting these
points, however, we may properly say, that the instructions of the court to
the jury appear to conform to the judicial decisions now in force, and to
take a position on the point of moral insanity which must necessarily be
maintained by all courts and juries until a legislative act shall change the
existing law — a change which, according to our present convictions, is
rather to be deprecated than desired. We confess that we are not disposed
to regard that particular plea with great favor, so long as the question it

1857. Spirit of the Medical Pr< m . 411

involves is in dispute among experts in insanity, and especially so long as
it may be made a plausible pretext for shielding common wickedness from
merited punishment, and a substantial defense against all the crimes in the
calendar.

The ability with which the case is reported also deserves notice. Al-
though voluminous, it presents the trial in all its forms of opening, of testi-
mony, of argument, and of determination, as to questions both of law and
of fact, with great fullness and detail To read it is to be present at the
trial in every respect but sight and hearing. The value of such reports is
inestimable ; and although they appear bulky (this being four hundred and
fifty octavo pages, in large and small type), yet they enable those who are
distant from the actual scene to get a fair view of it, and to judge, perhaps
better than the spectators and auditors, of the weight of the testimony and
the justice of the decision. That the decision, in this case, was right, is,
in our judgment, unquestionable; and we fervently hope that like decisions
will always terminate like cases. — American Journal Insanity.

Poisoning by Strychnia treated by Inhalation of Chloroform. — Messrs.
Editors, — In the Journal for June 4th (page 368), I notice an extract from
the Pharmaceutical Journal, in which allusion is made to a case of poison-
ing by strychnia. It has been my opinion that the effects of strychnia
might be controlled by anesthetic agents, early resorted to, and so far as
a solitary case can prove anything in medicine, the following confirms that
opinion.

On the 24:th of April, about 12 o'clock in the night, I was hastily called
to visit a son of Mr. A. Fairchilds, who, it was stated, had taken poison. On
repairing to his residence, situated about one hundred rods distant, I met
Dr. P. Goodyear, who had been previously summoned. The patient, a lad
aged 15, had been suffering in the evening with toothache ; his father
designing to give him an anodyne, gave a portion of strychnia which he
had procured to destroy rats, and had accidentally placed in his wallet, with
some powders of sulphate of morphine, similarly put up. The boy retired
to an upper room, and very soon became affected with spasms, rose from
his bed, made an attempt to reach the door of his apartment, and fell upon
the floor, thus alarming the family. Dr. G., who resided near, was imme-
diately called in, and elicited the above facts.

The patient was at the time resting across his father's lap, with counte.
nance suffused and livid, eyes injected and protruding, pulse full and strong,
but irregular, surface bathed with perspiration, &c. Violent tetanic spasms
were occurring in rapid succession, like the effect of shocks from an elec-
trical battery. Occasionally they would relax for a moment, but the

VOL. Ill, NO. VII — 10

4:12 Medical Independent. Sept.

slightest touch upon the surface, or an attempt to present anything to his
mouth, seemed to redouble their violence. No effort had been made to
procure emesis, nor did that seem practicable, as deglutition was out of the
question, and the violent convulsive movements precluded the possibility
of effecting it by mechanical means.

Chloroform was at once administered by inhalation, and freely applied to
the spine. The inhalation was somewhat difficult at first, but as he came
gradually under its influence the spasms subsided, and in ten minutes he
was perfectly quiet. On suspending the remedy the convulsive symptoms
returned, but yielded again as it was resumed. Partial anaesthesia was
kept up for about four and a half hours, when it was discontinued without
any return of the symptoms. No other remedy was used, save an occasional
vdose of sulphuric ether, with brandy and water. The boy recovered ra-
pidly, complaining for a few days of a slight headache and a feeling, as he
expressed it, as though he had been intoxicated.

The poison was put up in a small paper, and, as it was thought a large
dose of morphine, it was divided, and one half administered. The remain-
der weighed nearly two grains, which was probably about the quantity
given. It had doubtless been administered some thirty or forty minutes
before medical aid was obtained. An unusually large amount of chloro-
form was inhaled, but from the necessarily wasteful manner in which it
was applied, we could not determine how much. IT. 0. JEWETT.

CortlandviUe, N". F., June 10th, 1857.

— [Boston Med. and Surg. Journal.

Gymnastics for Paralytics. — Mr. Editor : In one of my former letters
I gave a brief account of the success of Dr. J. P. Batchelder, of this city,
in restoring strength to the long-enfeebled limbs of a paralytic patient, by
persevering efforts at directing the will of the patient to the muscles, aided
by passive motion of the parts by the hands of the practitioner himself.
The case alluded to was exhibited to the Academy of Medicine last summer,
and was that of a young man whom Dr. B. had met accidentally in the
street, dragging his slow length along by the aid of stick and crutch,
whom he accosted, and found to be a hemiplegic of long standing, but more
sound in intellect, and in otherwise good health. In about three months,
by a system of muscular training, patiently practised, the integrity of his
motive powers (by which I mean both his will and his muscles) were so
completely restored that he was enabled to walk upright, briskly and
freely, unaided by any extraneous means, and was soon capable of earning
his own support.

I have had the pleasure of being an eye witness, during the past two

IS.") 7. Spirit of the Medical Press. 413

months, of some most striking instances of the happy results of Dr. Batch -
elder's system of Gymnastics for Paralytic*, among the patients of the
New York Hospital, some 6 or 8 of whom had been disabled from this
cause from one to eight months. In some of these the paralysis was the
result of lead poison, in others of apoplexy, in others of blows or other in-
juries on the head or spine ; but in each instance the original disturbing
cause had been removed, and the effects only remained — deficient muscu-
lar power from long inaction, and enfeebled will, or inability to exert the
one upon the other. All the patients of this class were freely given up to
Dr. B.'s care, and the ample wards and apparatus of the institution
afforded excellent scope for the trial. Dr. B. displays great ingenuity in
the contrivance and adaptation of means for straightening the crooked and
almost anchylosed joints, and developing the feeble muscles.

The effect of his perseverance has been equally surprising and gratifying.
Men who appeared to possess not the slightest power of muscular motion
in the affected limbs, in some cases who had been for a long time, and who
supposed they always would be bedridden, now, after a few weeks' train-
ing, not only get out of bed easily but walk and even run. Lifeless arms
are re-animated, and attenuated limbs become plump and strong. One
patient especially, who had been an inmate of the hospital since August
last, a victim of lead palsy, and who was literally immovable, except by
the nurses; whose fingers were crooked and stiffened into the most awk-
ward shapes, and whose feet were so extended, and the ankle-joints so
inflexible, that when placed upright by the strength of others, the ends of
his toes only could be made to touch the floor — this young man, when I
last saw him, was walking about the ward unaided, and was capable of
feeding and dressing himself, and expecting soon to return to work for his
own maintenance. Such are the results of a little common sense and per-
severance infused into reflections upon a trite and every day subject, which
the mass of practitioners have been too much accustomed to overlook.
The philosophy of this system of gymnastic training, and its applicability
to this class of subjects, is very simple and easily understood, but Dr.
Batchelder certainly deserves credit for thus arousing attention to it, and
for infusing life into the dry bones, both of patients and pactitioners.

I believe it is the intention of the worthy doctor to publish an account
of his cases, which 1 am sure will interest the world, and 1 therefore re-
frain from any more detailed description of his modes of procedure.

Next to the infusion into the dark and dormant brain of the idiot, of the
faculties of reason and memory, this power of restoring withered limbs ap-
proaches most nearly to the marvellous, and forcibly recalls to mind the
events recorded in the ninth chapter of Matthew, the third of Mark, and
the fifth of Luke. — Med. and Svrg. Rejwter.

414 Medical Independent. Sept.

Jenner Monument. — The statue of Dr. Jenner has been most success-
fully cast in bronze. A meeting of the committee will be called in a few
days to consider the appropriate site, upon which the character of the
pedestal must of course depend. The monument has always been de-
scribed and intended by the committee to be a tribute from all nations to
Jenner, as the benefactor of the whole race of mankind. The subjoined
analysis of the subscription list will show how completely this has been
carried out : — America, £340 (no return from New York) ; Sweeden and
Norway, £83 10s.; Holland and her colonies, £25 ; Russia, per Dr. Mar-
kus, £241 (this was returned as first list, but the war interfered before
anything further was sent) ; Sardinia, £93 ; Prussia, £28 ; Emperor of
the French, £20; sundry places abroad, £18 10s ; England, £196 (inclu-
ding £25 from Prince Albert. Total £1065. — Philadelphia Med. and
Surq. Journal.

French Homoeopath in Trouble. — The Cour de Cassation (Supreme
Court of Appeal) has just decided that homcepathic practitioners are not
at liberty to dispense their globules in localities where a pharmacien is
residing. Our readers are aware that no one can legally dispense medi-
cines in France, save the regularly-educated and diplomated pharmaciem
who is himself prohibited from practising medicine. — Philadelphia Med.
and Surg. Journal.

Oitorial anb glistellann.

Medical Education. — In our August issue, we laid before our
readers a selection entitled " The American System of Medical Edu-
cation" and indulged, in our editorial, in a train of thought called
forth by the wants of the Medical Department of the State Univers-
ity. We propose now, to continue the subject, by pointing out
some of the reforms, which are generally needed in the Medical
Schools of the United States — or, to adopt the figure contained in
the above-named article, to point out the shaky timbers in that
grand old bridge — American Medical Education. Fully agreeing
with the writer of the article, that the changes in this structure must
be gradual, we propose to direct attention only to the most defective
pieces — those which, if not replaced by better material, endanger

1857. Editorial and Miscellany. 415

the safety of the whole structure, and the precipitation of the passing
student into the foaming and filthy pool of quackish ignorance below.

First — The point which principally requires the attention of the
committe (of inspection) appointed by the National Association, is
either the entire absence or extremely shaky condition of the timber
— clinical teaching. It is absent in some instances, too small, too
short, too rotten and frail in others — perfect in none. The place
which it occupies in the structure is too unimportant. It should be
of sufficient length to span the last chasm over which the novitiate
passes to enter upon, and assume the life-important responsibilities
of professional practice; and it should constitute the grand support-
ing arch of this portion of the structure.

To drop the figure, clinical instruction is undoubtedly the greatest
present want of the American Medical Student. It is simply absurd,
to talk of making even moderately qualified practitioners of medicine,
without observation at the bedside. It is cruel to permit that observ-
ation to be made, for the first time, after the student has passed from
under the guidance of his instructors. Community have a right to
demand legal protection in this respect ; and shall it be said of the
medical profession, that it sets itself against the reform of an evil of
this magnitude ? This cannot be said — for the great body of medical
freemen is unanimous in its favor. A few country schools (and, to
the honor of the profession, but very few) assume to doubt the feasi-
bility of affording clinical advantages for all. But even their doubts
acknowledge its importance ; and, in regard to practicability, let the
National Association call for the measure, and let the leading city
schools extend, amplify and perfect their arrangements for clinical
teaching, and assumed doubts must vanish and opposition cease.
Professional sentiment on this subject is right and cannot be too
imperative.

We have plainly intimated, that sufficient attention was not given
to this branch of instruction, even in those schools which possessed
the necessary advantages. This statement is but too true, and upon
it arc based the attempts at argument of the few who assume to
doubt the practicability of general hospital instruction. But imper-
fectly, as in many instances, hospital instruction is carried out, its
advantages are such as can be supplied by no other means. Imper-
fect as it is, it affords an argument only in favor of amplification.
Let the present plan of hospital instruction be elaborated, and let one

4-16 Medical Independent. Sept.

year's attendance thereupon be one of the requisites for graduation.
Let no candidate for the Doctor's degree be admitted to an examina-
tion until he has complied with this requisition. A tithe of the
advantages to be derived from medical charities, are not yet realized
by the hospitals of this country. Let hospital attendance become a
requisite for graduation, and an adequate plan of hospital instruction
will be elaborated to meet the requisition.

Second — Lecture terms must be increased in length. Ours is a
progressive and accumulating science. The amount of instruction to
be imparted is constantly increasing ; and the idea of giving a com-
plete course on surgery, or practice of medicine, in one hundred
lectures, cannot be realized. This too. is true of several other
branches, grouped together under the professorial titles adopted in
our colleges. If four months were required when the present college
system was adopted, twelve are not more than sufficient now. Three-
fourths of that period, at least, should be adopted as the lecture term.

Third — Increased term of pupilage is another reform, in which
both community and profession are deeply interested. The same
reasons which we have advanced for extension of the lecture term,
apply to this proposition also. There is too much comprised in a
complete medical education to be acquired by ordinary men, in less
than four years. Every educated medical man feels the truth and
force of this position.

We cease here. We have pointed out those which appear to us
the three frailest timbers in the structure — clinical instruction, length
of term, and period of pupilage. Let them be replaced by material
of the highest order, perfect in adaptation and adjustment; and,
timber by timber, let us inspect, from our different stand-points, the
whole structure — so shall renovation be gradual, effective and har-
monious. G.

Ligature of the Common Carotid. — The last number of the New
York Journal of Medicine, contains a very elaborate and interesting
article upon " The Early History of Ligature of the Common Carotid
Artery" with a report of the operations in the city of New York, by
James K. Wood, M. D.. Surgeon to Bellevue Hospital. From it
we glean the following facts and conclusions :

Theirs/ operation of this kind on record, is to be found in a Ger~

1857. Editorial and Miscellany. 417

man translation of Bell's Surgery, in which case it was performed on
account of an accidental wound of the Artery, in the removal of a
scirrhous tumor, respecting which, however, no date is given.

The first authentic case, recorded is that of Mr. Fleming — an Eng-
lish Naval Surgeon occurring in 1803, and was reported in the
" Med. Chi. Journal" for January 1817.

The second authentic case, and the^rs^ operation of the kind in this
country, in ivhich the Artery was tied for the extirpation of a tumor,
was that of Dr. Cogswell — Hartford, Ct., and occurred only eighteen
days subsequent to the first recorded case by Fleming.

The first recorded case for Aneurism, was by Astley Cooper ; the
second by Dr. Amos Twitchell of our own country — (Keene, N. H.)
The first successful operation of the kind, for Aneurism, in this coun-
try was that of Dr. Wright Post of New York City, and was per-
formed January 9th, 1813.

The following table exhibits the number of these operations in
New York City, by whom and for what, they were performed :

NO. OF OPERATIONS.

Jas. R. Wood, M. D., Surgeon to Bellevue Hospital 9

Valentine Mott, M. D 44

Gurdon Buck, M. D., Surgeon to the N. Y. Hospital 4

John Watson, M. D., " tl " " 1

A. C. Post, M. D., Professor of Surgery in the Univ. Med. College . . 1

W. Parker, M. D. " " " Coll. Phys. and Surg's. 9

J. P. Bachelder, M. D., 1

Wm. H. Van Buren, M. D., Prof, of Anat. in Univ. Medical College . 5

W. Detmold, M. D., 5

T. M. Halstead, M. D.r 1

D. Meredith Reese, M. D., 2

Chas. E. Isaacs, M. D., Demonstrator Anat. Univ. Med. College 1

Tsaack Green, M. D., Late Surgeon to Bellevue Hospital 1

A. B. Mott, M. D., Surgeon to St. Vincent Hospital 4

J. S. Thebaud, M. D., 1

W. R. Donaghe, M. D., Surgeon to Dewitt Dispensary 1

Geo. T. Woodward, M. D., 1

Stephen Smith. M. D., Surgeon to Bellevue Hospital 1

92
Summary. — The common carotid was ligatured for the following

causes : —

Hocmorrhaye — Whole number nine, of which six recovered and

three died.

418 Medical Independent. Sept.

Malignant Disease of Head or Face — Whole number seventeen, of
which four resulted in the apparent cures of the original disease ; ten
were decidedly benefitted, growth of tumor being for a time arrested;
two died ; one not noted.

Atieurism by Anastomosis — Whole number ten ; of which four
were cured ; five were benefitted ; one died.

Aneurism of Branches of Carotid — Whole number four; all re-
covered.

Epilepsy — Whole number two : both benefitted but not cured.

Removal of Tumor — Whole number seven ; all recovered.

Secondary Hcrmorrhage occurred in five instances : slightly in two,
and severely in three : all recovered, the hemorrhage being control-
led by pressure.

Date of Separation of Ligature was noted in twenty-four cases —
maximum period, thirty-one days ; minimum, nine days, average
fourteen days and twenty-one twenty-fourths.

The article, as a whole, is a complete historic compend of this
branch of surgery in New York city, and among the ablest contribu-
tions to this department of medical literature. R.

Excito-Secretory. — Dr. Allen formally presents his claims of
priority, in this number of the Independent. It is very evident that
Dr. A. recognized and taught this principle as early as 1848. and to
those who know the man, his attainments and habits of thought, this
early recognition will be no matter of surprise. To us. the inde-
pendent discovery of this principle by Dr. Allen in the north-west,
by Dr. Campbell in the south-east, and by Marshall Hall in England,
illustrates the fact, that in the advance of science men are naturallv
led on to definite results — that based upon identical or similar
facts, correct rersoning will reach identical or similar conclusions.
It is none the less to Dr. Allen's credit that Dr. Campbell first
recorded his observations in printers ink — it is none the less to
Dr. Campbell's credit that Dr. Allen two years previously publicly
taught the same ideas. It will be observed that Dr. Allen carries
his generalization much farther than either Dr. Campbell or Hall,
and criticises the terms excito-motory and secretory. The article is
one of great merit, independent of the claim made. G.

1857. Editorial and Miscellany. 419

Clinical Advantages. — The following is a quotation from a pri-
vate letter, which was elicited by our remarks on Medical Educa-
tion in the August number. It is a practical illustration :

u Your remarks on Medical Education must meet with approba-
tion from every student of medicine who has commenced practice
without seeing the rules given him practically applied in the treat-
ment of disease, and in obstetrics. I draw this conclusion from my
own experience.'"

" My first obstetrical practice was in a case of placenta previa,
with breech presentation ; the labor was protracted, and I would
gladly have given my hat, boots, diploma — anything, even to the
nether garment, to have known at times what to have done. The
woman speedily recovered, thanks to God, and not to my judicious
management."

" I have since applied myself closely to rny profession, and think
I am a little better prepared to enter a sick room, than when I left
the University, a ; full fledged Doctor !' "

The author of the article which we republished last month, says,
in reference to an obstetric clinic :

" But I can imagine something worse than vulgarity — a young
graduate, without the vaguest knowledge of the practical manipula-
tions of the art, or the etiquette of the lying-in room, in charge of a
case of placenta previa. T know of obstetric clinics where no sense of
modesty, however fine, is disturbed, and which still afford to the
advanced student abundant means of practical instruction."

COERESPONDEN CE.

Editors of Medical Independent :

I find in the July number of the Independent an article from
your collaborator, A. G. Merrett, M. D., criticising the report of a
case of cranial fracture, furnished by me for the May number of your
journal. I should, perhaps, have let the article pass without comment,
receiving it in the same friendly spirit in which it was proffered, had
it not received editorial indorsement, accompanied by the opinion
that the symptoms in the case referred to. "contraindicated an opera-
tion."

As to the question whether "anaesthesia is indicated in eases of

420 Medical Independent Sept.

compression generally" I leave it to be answered by Dr. M. The
report does not claim it. It simply states the fact that it was re-
sorted to in a particular case, and so far as its effects were apparent,
they were manifested in an increase of vital action (as indicated by
the improved circulation), instead of " further crippling the recupera-
tive powers."

Perhaps the profession will not be slow to understand — though the
Dr. cannot " conceive," how sensibility may remain when conscious-
ness is suspended. I find a case reported in the July number of the
American Journal, by Dr. Packard of Philadelphia, in which, as in
the case reported by me, " Anaesthesia" was not " the result of com-
pression," and the same " acute sensibility" remained, and the patient
was etherized for the purpose of trephining.

Dr. Gunn, says, " at present surgeons are guided in reference to
this question," (fracture of the cranium*) " by symptoms of compres-
sion. If there is compression of the brain, the operation is impera-
tively demanded." The symptoms given in the case reported by me,
were, " extremities cold, respiration slow and imperfect, pulse about
fifty, and intermittent."! These taken in connection with a severe
injury of the head, with a portion of its walls depressed. I thought in-
dicated compression of the brain, and accordingly operated. Prof.
Gunn thinks they indicated '"''concussion not compression."

JNO. AVERY, M. D., Otisco, Mich.

London, (Eng.) July 16, 1857.
It may perhaps be a source of satisfaction to some of your subscri-
bers who are lamenting the distressingly healthy condition of the
Wolverines, to know that providential design or sanitary reform, or
both combined, have made many of their professional confreres in

* The question is, elevation of the depressed bone — not fracture of the cranium. — Ed.

[tAdd to these, " symptoms of prostration so urgent that an operation was not deemed advi-
sable until reaction in some degree could be established" — together with the " patient extremely
nensitive to the slightest touch of the wound," and we have an array of symptoms strongly
expressive of predominating concussion. We repeat tlie doctrine, that unconsciousness
(id est, want of perception of impressions upon any of the senses) will be in direct proportion to
the degree of compression ; and that when traumatic compression indicates an operation, no
anaesthetic will be required — insensibility will be present, and indicative of the degree of
compression. We do this too, in all kindness and respect, and with no other desire than to
promote truth; and we regret that our correspondent did not receive the " editorial endorse-
ment" in the " same friendly spirit" that he did the criticism. G.]

1857. Editorial and MiseeUemy. 421

London exclaim with moie truth than poetry " Othello's occupation's
gone."

f happen to be lodging adjacent to Cavendish Square where one's
eyes are dazzled with brass plates inscribed with the names of Paget,
Forbes, Winslow, Shaw, Westcott, et hie genus onme, and there,
horrible dictu, majestic torn cats prowl undisturbed in their amatory
or pedatory pursuits, apparently unconscious of their proximity to*
creniuses renowned for their sections whether vivos or mortuos. And
shall the truth be told 1 the Janitor who gives one access to the
sanctum sanctorum of Sir Benjamin Brodie was found dosing at
11 A. M.

London is out of town ; some for pleasure, others in pursuit of
what they would be more than pleased to regain — the health yielded
as tribute to fashionable life in the winter.

Saturday week, I visited old St. Bartholomews. In the operating
theatre, a young female was relieved of a carious inferior extremity,
flap operation — no tourniquet — the bone was sawed through imme-
diately below the trochanter — Stanley fecit — chloroform still in
vogue. The venerable Lawrence still at his post but evidently inclin-
ing to his mother earth. Paget, attenuated and over wrought, but
with the same thoughtful brow and pierceing eye. ETe is truly
Hunter the 2nd.

J had occasion to see a case the other day of irritable ulcer in a
varicose leg. After a variety of plans had been tried, my friend who
shewed me the case, thought of an ointment of Belladoma cum
Hydrarg. — the effect was excellent. He had formerly succeeded in
curing a chancerous sore upon the lip of a woman by the same means,
although it had baffled every other treatment.

There seems to be a want of co-operation among the profession in
England for self protection — envy, strife and jealousy, between men
and corporations. Let our American friends rejoice in the strength
of unity, and demand as a right, the protection we deserve.

Truly Yours. A. G. MERRETT,

Editors Medical Independent :

Gentlemen. — Allow me to call your attention, to the enclosed circular
and to the accompanying package of a new Pharmaceutical preparation
which finds much favor with many eastern Practitioners. Its pleasant

422 Medical Independent. Sept.

taste, elegant appearance and the complete solution of the various phos-
phates in it, render it an elegible and valuable preparation where its use
is indicated. Resp. Yours, HIGBY & STEARNS,

162 Jefferson Avenue, Detroit.

The circular issued by Higby & Stearns, and above alluded to,
sets forth the fact that this preparation was introduced by Professor
Jackson, of the University of Pennsylvania. That it is not intended
as a popular remedy, but is respectfully submitted to the Medical
Faculty as a Nutritive Tonic ; well adapted to those cases in which
there is an evident waste of the elementary matter in the system, so
often observed as the result of chronic disease. Hence its value in
cases which present a disordered condition of the organs of assimila-
tion— as in Dyspepsia, <ke. By careful manipulation the salts are
all held in complete solution. Each fluid ounce contains one and a
half grains of the Phosphates ofPotassa. Iron and Soda, and two
grains of Phosphate of Lime.

We have prescribed this remedy in a number of cases and are
much pleased with its restorative effects. — (Editors.)

Pocket Instruments. — Tieman has filled, under our direction, an
exceedingly compact case or pocket surgical instruments, one which
can be conveniently carried in the vest pocket, thus becoming the
Burgeon's constant companion. Of the selection of instruments, we
will only say, it is in accordance with our own taste, and answers
admirably ovr wants. But of the forceps we would speak more
particularly : our wish was to combine in one. the dressing, artery
and needle forceps, and Mr. Tieman has. with his usual skill, execu-
ted our idea to perfection. By letter he thus speaks of it : " The
idea is beautiful ; we might call it a universal forceps." * * *
" This will hold a blunt or sharp needle, or a plastic pin, as solid as
a rock, and can be used for ligating arteries, torsion, dressing, etc. ;
and the case will be one of the most compact cud most useful.'1'' An
artery needle accompanies the forceps. The case can be ordered of
Tieman, or of Higby & Stearns of this city, who keep a general sup-
ply of surgical instruments at New York prices. G.

The Approaching Session of the Medical Department — Means
of illustration. — Anxious to afford, as for as possible, practical it-

1857. Editorial and Miscellany. 423

lustrations of our teaching, we would remind the profession that
operations are made before the medical class free of charge, and solicit
their aid in directing the attention of those who require surgical
assistance, and who would be glad to avail themselves of the gratuity,
to this fact. Session opens on the first of October, and continues six
months. G.

Changes in the Faculty of Rush Medical College. — Three
vacancies having occurred in this institution, by the resignations of
Drs. John Evans, W. B. Herrick and H.'A. Johnson, the following
appointments to the vacant chairs have been made, viz : Dr. W. H.
By ford, M. D., of Evansville, Indiana, to the chair of Obstetrics and
Diseases of Women and Children. Dr. H. A. Johnson, leaving the
chair of Materia Medica, takes that of Physiology and Pathology.
Dr. John H. Rauch, M. D., of Burlington, Iowa, has been appointed
to the chair of Materia Medica, Therapeutics, and Medical Jurispru-
dence.

Medical Schools — Consolidation. — After some diplomatic nego-
tiations, an arrangement has been effected, whereby " the Medical
College of Ohio" and " the Miami Medical College" located at Cin-
cinnati, have become consolidated, under the name of the former.
Drs. J udkins, Comegys, Foote and Mendenhall, of the Miami School,
are members of the new faculty ; Drs. Amor, MarsWll, Warden and
Tate withdrawn.

Medical College of Georgia. — Dr. G. M. Newton has resigned
the chair of Professor of Anatomy in the Medical College of Georgia,
and Dr. Henry F. Campbell, formerly Professor of Surgical, Com-
parative and Microscopical Anatomy, has been appointed in his place.

Books Received. — We have received from the Publishers, Blanch-
ard & Lea, through the politeness of Raymond & Selleck, Gross*
Elements of Pathological Anatomy, third edition — Williams' Princi-
ples of Medicine, anew edition — Kirk's Manual of Physiology, new
edition — and Churchill on Diseases of Women, new edition ; all of
which will receive early attention.

424 Medical Independent. Sept

To Subscribers. — Those of our subscribers who have responded
to the bills sent out in the July issue, have our sincere thanks, and
the satisfaction to be derived from the thought, that they are aiding
us in an enterprise, which, we trust is a credit to the profession in
the North- West. To those who are yet delinquent, we would most
respectfully, yet earnestly present our considerations of profound —
need, reminding them that our terms are " in advance" and that we
Independently depend upon them for prompt remittances.

Impromptu. — The following, which we iind in the St. Louis Med.
Journal, was written by a patient of Dr. C. A. Pope, of St. Louis
and left on his table, accompanied by a fee. It serves to illustrate
the facility with which one may command the poetic muse, when he
really feels what he desires to express.

May 24th, 1857.

Dear Medico: 1 am off to-morrow for New York, via the Falls of
Niagara, where the water runs down hill with nothing on earth to
hinder it. I am sorry not to have seen you again before leaving.
But—

When sorrow's cloud is cast athwart

The sunshine of my mind,
When, I, with gloomy care distraught.

No recreation find ;
When sighing o'er my hapless lot,

And what I used to be —
I'll seek some quiet, tranquil spot,

And pass a small bougie.

Let strictures on my conduct pass ;

Unnoticed let them be ;
A stricture somewhere else, alas !

Is more deplored by me.
In hope that blight on manhood's bloom

I yet effaced shall see,
T'll hie me to my quiet room,

And pass a small bougie.

Good bye,

Ever truly, yours

We sincerly hope that there may soon be as little " to hinder" the
running of " the water down hill " in the case of the Doctor's poet-
ical patient as there is in Niagara.

THE

Medical Independent,

% PoniWg $rfmfo of Purine antr jiitrgtrji

EDITED BY

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MEDICAL INDEPENDENT :

A MONTHLY

Review of Medicine and Surgery.

VOL. 3. DETROIT, OCTOBER, 1857. NO. 8.

(©riflinal-Cammamratijons.

Auticle I. — Chapters from an Unpublished Monograph.
By H. R. Schetterly, M. D.

Examination of the Popular Theories of the Oiirulation.
— The simplest theory of the circulation is that adoj)ted by
Prof. Liebig. He asserts that the heart is both a suction and
a forcing pump. That is, when the auricles dilate, vacuums
are produced in their cavities, and the blood rushes from the
veins into these vacuums to fill them ; and, when filled, they
contract and force the blood into the ventricles, which are
then dilating and producing vacuums in themselves, that are
filled by the contracting auricles. And, lastly, when the
ventricles are full, they contract, while the auricles are again
dilating, — the right one forcing all the 'blood through the
pulmonary arteries into the lungs ; and the left one, having
received the same blood from the lungs through the pulmon-
ary veins and left auricle, forces it through the aorta to
every part of the body. According to this theory, thu
venous circulation is maintained by the suction of the auri-
cles, and the arterial by the contraction of both auriclee and
ventricles.

His words are: — "By the expansion of the heart — an
organ in which two systems of tubes meet, which are rami-

VOL. Ill, NO IX. — 17.

430 Schetterly On the Circulation. Oct.

fied in a most minute network of vessels through all parts
of the body, — there is produced a vacuum, the immediate
effect of which is, that all fluids which can penetrate into
these vessels are urged with great force towards one side of
the heart, by the external pressure of the atmosphere. In
a word, the heart is a forcing-pump, which sends arterial
blood into all parts of the body ; and also a suction pump,
by means of which all fluids, of whatever kind, as soon as
they enter the absorbent vessels which communicate with
the veins, are drawn towards the heart." The above is
from his treatise on Animal Chemistry. But afterwards,
when he wrote his treatise on the Motion of the Juices, he
states (p. 187), what every physiologist knows, that "the
" pressure of the gases, which pervade every part of the
" living body, exactly counterbalances the pressure of the
" atmosphere upon the external surface ;" and who does not
know that such pressure cannot produce motion in any
direction ? This theory is proved to be an illusion, by the
following facts : —

First — Dr. Arnott and others have proved, by experiments,
that suction cannot act through tubes so yielding as the veins
are, because the sides will flap together — i. e. be pressed
together by the atmosphere — near the place where suction is
applied to them. To remove this objection, Dr. Dunglison
observes that Dr. Arnott's experiments were made with veins
taken from 'dead bodies, and that it remains to be proved that
the veins in living beings would flap together ; but, on the
next page, he says— " Generally, when the chest is dilated
in inspiration, the vein " — the external jugular vein — " emp-
ties itself briskly, becomes flat, and its sides are occasionally
accurately applied to each other." Is not this a flapping
together ? — and in the living body too !

Second — Instances are on record, in which the muscular
tissue of the heart was found so much wasted by atrophy,
after death caused by other means, that it was difficult to
imagine how the heart could have exerted any force to pro-
pel the blood — though this atrophy must have been going on

1857. Schetterly On the Circulation. 431

for a length of time, and that, too, without exciting even a
suspicion that the heart was diseased. — See Carpenter's
Human Physiology.

Third — Infants have been born entirely destitute of a
heart, without the possibility of the twin fetus having had
any agency in maintaining their circulation ; and yet, their
own blood must have circulated in them without a heart ;
for, as the maternal blood is not conveyed to the foetus at all,
in any case, they could not have been nourished without a
circulation of their own.* Moreover, it is certain that there
is blood in motion, before a heart is developed, in every
embryo ; and Wolff, Rolando, Doellinger, Pander, Prevost,
Dumas, Yon Baer, Hunter, Gruithuisen, 3£altenbrunner and
others, saw globules of blood in motion in the incubated egg,
in the midst of cellular tissue of inflamed parts, in tissues
undergoing regeneration, and during the cicatrization of
wounds — even before vessels appeared in those parts.

Fourth — Sir E. Home has proved that "the nerves, which
accompany the arteries, regulate their actions ; and, through
their agency, the blood is distributed in different proportions
to different parts of the body." Accordingly, in local inflam-
mation— such as whitlow in a finger, etc., — the circulation
is greatly increased in the inflamed part, while the action
of the heart, and of other blood-vessels, remains entirely
unaltered. On the contrary, in senile gangrene, the circula-
tion ceases altogether in one or both legs, though it is proved
that no obstruction in the blood-vessels exists at that time.

Fifth — By the aid of a microscope, Drs. Haller, Spallan-
zani, Philip, Treviranus, Tiedemann and others, have seen the
blood moving in the smaller vessels of different animals, for
some time, after the larger vessels had been tied, or the heart
itself removed. Again, if a piece of a blood-vessel be cut
out, and an artificial tube be substituted instead of it, the

* See a case of this kind in the human foetus, by Dr. Jackson, of Boston, in the American
Journal of the Medical Sciences for February, 1830,— p. 862. Another, by Dr. Houston, in the
Dublin Journal of the Med. Sci., No. 29. Also, Prof. Graves', In the London Medical Qaiette
of June 30, 1833,— p. 562.

432 Schfiterly On the Circulation. Oct.

blood will not continue circulating through this tube for any
length of time.

It is almost needless to observe, that none of these con-
ditions could possibly exist, if Liebig's theory were true, —
i. e., if the contraction of the heart, or even of the heart and
blood-vessels, were . the true cause of the circulation. But
there are still other objections to prove this mechanical
theory illusory. It may, however, be added, that all these
objections may not only be reconciled with the electrical
theory, which operates through the medium of attraction and
repulsion, but that they all go directly to prove it true.

Professor Draper, of New York, proposes a chemical
theory, in his Treatise on the Organization of Plants. He
locates the propelling power of the blood in the pulmonary
and systemic capillaries. In the pulmonary capillaries, the
venous blood is changed into arterial ; and in the systemic
capillaries, the arterial blood is changed into venous. That
both these changes are effected by electro-chemical action,
is doubtless true ; but that this action generates a localized
power, that drives the blood out of these capillaries " with
an inexpressible force," as he asserts, is proved to be an
illusion, by the fact that the capillaries are not adapted to
sustain any force tending to burst them, — and infinitely less
are they adapted to resist an inexpressible force.

From the height to which the circulating pressure of the
blood raises a column of quicksilver in a hgemadynamometer,
when this instrument is attached to the arteries of horses and
other animals, Poiseuille has calculated that, in the arteries
of men, the blood generates a momentum equivalent to the
pressure of four pounds three ounces and forty-three grains ;
and he says this force is the same everywhere, in the smallest
as well as in the largest artery. Now, this fact proves,
beyond all cavil, that the force with which the blood circu-
lates is not a localized, not a propelling, but an attracting
force, — constant, and consequently everywhere the same, as
will appear in the next article. For a little reflection will
convince any philosophic mind, that the retarding causes of

1857. Schetterly On the Circulation. 333

the circulation — such as friction, gravity, curvatures in the
vessels, anastomoses, etc., — must inevitably diminisli the
force impressed Upon the blood, if that force were a local
one. And a local force, continually interrupted, — and this
is the kind of force assigned as the principal motive power of
the circulation, by all the popular theories, — must be vastly
greater than a constantly attracting force, which everywhere
overcomes retarding causes, either local or constant, as they
occur ; and, therefore, can nowhere exert any bursting force
or pressure against the sides of the blood-vessels.

Now, it is a hydrostatic law, that fluids press with the
same force in every direction, and this force is directly pro-
portional to the altitude of the column of the fluid. And
again, if there be a hydraulic force that propels the column
forward in the containing vessel, this force must obviously
be sufficient to overcome all retarding causes ; and when it
is applied locally, as all the popular theories assume it to be
in the blood-vessels, the sides of that part of the vessels
where it acts must sustain and resist all this force tending to
rupture them. Next inquire whether the capillaries are
adapted to resist any such force I

On this point, all modern Physiologists are agreed ; and
the following quotations, from Dunglison's Physiology, decide
the question: — " All the coats of the capillary arteries dimin-
ish in thickness and strength as the tubes lessen in size, but
more especially the middle coat, which, according to Wed*
emeyer, may still be distinguished, by its color, in the tran-
verse section of any vessel whose calibre is not less than
the tenth of aline; but entirely disappears in vessels too
small to receive the wave of blood in a manifest jet. But>
while the coats dimmish, the nervous filaments distributed!
to them increase; the smaller and thinner the capillary,
the greater the proportionate quantity of its nervous matter.
The coats of the capillaries, becoming successively thinner
and thinner, at length disappear altogether, and the ve&eefe
— many of them at least — terminate in meinbranele>s canals
or interstital passages, funned in the substance of the tissues. ,J

434 Schetterly On the Circulation. Oct.

But, although a part of the apparatus of the intermediate
circulation may be arranged in this manner, there are rea-
sons for the belief, that a more direct communication
between the arteries and veins exists also. The substance
of an injection passes from one set of vessels into the other,
without any evidence of an intermediate extravasation.
The blood has been seen, too, in living animals, passing
directly from the arteries into the veins." Leuenhock,
Malpighi, Cowper, Chesselden, Spallanzani, Hales, Thomson,
Cuvier, Pusconi, Doellinger, Cams, and many others, saw this
distinctly in the swim-bladders, gills and tails of fishes, in the
mesentery of frogs, etc., — which are transparent. So there
must be intermediate vessels after all, though their coats are
too thin to be seen, even with a microscope.

The reader can now judge, whether the capillaries are
capable of resisting the inexpressible force of Prof. Draper —
the " vis a tergo " of the ancients, who supposed the blood to
be forced through them by the contraction of the heart
exclusively, as Liebig still does. If not, then the Professor's
theory is nugatory, of course ; and so is every other theory
that requires the capillaries to resist half the force that pro-
pels the blood, according to the popular theories.

The principal functions of the capillaries are manifestly : —
First, the absorption of the elements of the previously vital-
ized matter, after it has been decomposed to yield force, by
electricity conducted to the tissues by the nerves with which
the capillaries are so abundantly supplied ; second, the depos-
ition of similar vitalized materials, prepared from food, in
their stead, and thus to enable the various organs to continue
performing their various functions. And the philosophic
reader can not avoid seeing that, for these functions, the
capillaries are most admirably adapted; but are entirely
unfit to generate mechanical power for propelling the blood.
These two functions are most admirably sketched by Dr. S.
Smith :—

" In every part of the body, in the brain, the heart, the
lungs, the muscles, the membranes, the bones, each tissue

1857. Schetterly On the Circulation, 335

attracts only those constituents of which it is itself com-
posed. Thus, the common current, rich in all the proxi-
mate constituents of the various tissues, flows out to each.
As the current approaches the tissue, the particles appro-
priate to the tissue feel its attractive force, obey it, quit the
stream, mingle with the substance of the tissue, become
identified with it, and are changed into its own true and
proper nature. Meantime, the particles which are not
appropriate to that particular tissue, not being attracted by
it, do not quit the current, but, passing on, are borne by
other capillaries to other tissues, to which they are appro-
priate, and by which they are apprehended and assimilated.
When it has given to the tissues the constituents with which
it abounded, and received from them particles which are
no longer useful, and which would become noxious, — the
blood flows into the veins, to be returned by the pulmonic
heart to the lungs, where, parting with the useless and
noxious matter it has accumulated, and replenished by
new proximate principles, it returns to the systemic heart,
by which it is again sent back to the tissues."

Most Physiologists suppose that the vitalized matter disin-
tegrated in the production of mental, vital and muscular
force, is absorbed by the lymphatics. But this assumption
is obviously gratuitous, for the lymphatics exercise a selecting
power, as do the lacteals, and convey their contents directly
into the thoracic duct, or into the blood. The chyle and
lymph must, therefore, be analogous in composition ; but it
is extremely unlikely that matter wholly deprived of the
properties which the food acquired in the processes of diges-
tion and chylifl cation, can be again appropriated to nutrition,
without being again subjected to the operation of the same
preparatory influences ; and, preparatory to this subjection,
the elements disintegrated, and the compounds formed from
them in the living organism, must be again subjected to the
influences of vegetable life, as they were at flrst. It is far
more likely that the lymphatics absorb the liquid exhaled by
the 6erous membrane, which requires but little preparation

336 Schetterly On the Oireulatwn ,. Oct.

for nutrition ; and that the disintegrated materials are con-
veyed to the liver and kidneys by the capillaries and other
blood-vessels, which have no power of selection, to be again
secreted, and finally evacuated through the bowels and urin-
ary bladder.

In his Treatise on Human Physiology, Dr. Dunglison states
that "the action of the capillaries, and the contraction of the
arteries and veins, can alone be regarded as sources of motion,
the elasticity of the vessels being simply directors, not gene-
rators of force." To these he afterwards adds, as accessory
cause, "the suction power of the chest." which he thinks
produce- "an approach t«> a vacuum" in the chest, to fill
which. " the blood as well as the air. is forcibly drawn
towards that cavity." To the rush of the blood to fill this
supposed approach to a vacuum, lie attributes the dilation of
the external jugular vein during expiration, and its collapse
inspiration. He then adds that " expiration manifestly also
accelerates the motion of arterial blood, especially forced ex-
piration." Megendie. who investigated this subject by
experimenting on animals, has proved that the turgescence,
witnessed in the jugular, extends to all the veins; and that it
is caused by a larger quantity of blood being conveyed by
the arteries into the veins during expiration than during
inspiration. But, he says, ordinary respiration produces
neither the acceleration of the blood in the arteries nor the
turgescence in the veins, unless the animal struggles, and,
when it does so, both are greatly increased.

The truth, however, is, that when an increased quantity of
air is inspired, for whatever cause, the circulation is acceler-
ated, and when muscular motion (which always augments
respiration), is superadded to augmented respiration, this
acceleration becomes still greater ; but, when the vessels are
full of blood, the turgescence of the veins is not exhibited,
and takes place only alter copious depletion, or during the
anaemic excitement. The cause, however, of these phenomena,
is not tht approach of a vacuum in the chest; hut the in-
creased quantity of ehctricity inspired vnth the air, which

1857. Sohetterly On the Circulation. 337

is the pi^imary cause of all sanguineous circulation, propels
the blood with greater force, as is pi'oved by the fact that,
when the air is withheld, neither muscular motion nor any
other cause, can maintain the circulation after the aw, con-
tained in the lungs, is all consumed. And, accordingly, in
all cases of asphyxia, the circulation is first arrested in the
capillaries of the lungs, while the previously electrified blood,
that has just left them, continues to flow and empties the
arteries confessedly more completely than death produced by
any other cause, ever assigned by physiologists, can possibly
empty them. Muscular action doubtless causes an increased
rapidity of the circulation, either in all the muscles, when all
are exerted ; or in particular muscles, when these alone act ;
but, in neither case, can this increase take place without pro-
portionally augmenting respiration, at the same time.

The mechanical agency of the heart and capillaries has
been considered and refuted above ; and it only remains to
discuss the contraction of the arteries and veins. The insuf-
ficiency of the contraction of the heart to propel the blood
through the capillaries — especially when it passes through
three sets, as it does in the portal part of the circulation of
man and mammalia, and particularly in fishes, whose heart
possesses but little muscularity, — has long been justly doubt-
ed, and even been denied by some of the most eminent
physiologists. Hales, Hunter, and others, assume that the
arteries alternately dilate and contract ; for, say they, " we
feel it when they pulsate ;" while Bichat, Perry, Weitbrecht,
Lamure, Dcellinger, Eudolphi, Jgeger, Bostock, and others
could never see the alternate dilatation and contraction of the
arteries, though Hastings, Poiseuille, (Esterreichcr, Segalaa,
and Wedemeyer, say they did see it.

To settle this long disputed question, Dr. Perry made many
accurate experiments, the result of which is, that the arteries
do not alternately dilate and contract, perceptibly. But, the
most decisive experiments are those stated by Dr. Carpenter,
made by an eminent experimenter, whose name has escaped
recollection. He inclosed a part of a living artery laid bare,

338 Schetteely On the Circulation. Oct.

in a tube having a small glass tube rising perpendicularly
from its side. The space around the artery, in the large tube,
was then filled with colored water ; and between the pulsa-
tions of the arteries, fell above and below the part inclosed,
the water rose just perceptibly in the small glass tube, show-
ing that arteries do contract very slightly when the ventricles
of the heart do so, and expand again when they do. But
these alternate contractions and dilatations are produced solely
by the elasticity of the arterial tubes, which every experi-
menter asserts exists in their coats, or else there can be no
elasticity ; and, if so, then they " are simply directors, not
generators of force " according to Dunglison, Carpenter, and
others. Besides this, there is no evidence that the so called
muscular coat of the arteries, consists of contractile fibres.
Magendie, Nysten, and others, were not able to produce con-
tractions by applying the electrical and mechanical excitants
of muscular irratibility ; and the chemical analysis of Ber-
zelius and Young, also prove that the transverse fibres of the
arteries differ essentially from those of proper muscles. But,
lastly, in order to aid in propelling the blood forward, it is
most obvious that the blood-vessels should commence con-
tracting at the heart, continue their contractions gradually
along the arterial tubes, then along the capillaries, and then
along the veins ; for, unless this were the case, the contrac-
tions would evidently tend as much to keep the blood out of
them as to drive it forward, if this mechanical theory were
true ; but no such gradual contraction is attributed to them
by any physiologist. Dr. Dunglison says, "it is difficult,
indeed, to believe that a contraction in the capillaries does
not exist ;" and the fact that the blood continues to circulate
in them, after the heart has been removed, and even after
death, they take as proof that it does exist. But still, Thom-
son, Philip, Hastings, and others, assert that neither the
small arteries nor capillaries contract, except on the applica-
tion of cold, or of electrical or mechanical stimulants, and,
in this respect they differ from the larger arteries and from
veins. Wedemeyer repeated the experiments of Thomson,

1857. Schetterly On the Circulation. 339

etc., with the greatest care; and proved that u these vessels
do not contract so long as the circulation is allowed to
go'on in its natural state ; but so soon as excitants are applied
to them an alteration of their calibre becomes perceptible.
Alcohol arrests the flow of blood without producing much
apparent contraction of the vessels. Chloride of sodium, in
three or four minutes, caused the vessels to contract one fifth
of their caliber, which contraction is followed by dilatation,
and a general retardation and stoppage of the blood." Cold
water and cold air poured on the structure under examination,
produced even an entire obliteration of the vessels, as proved
by Hunter and Schwann, if persevered in. In from ten to
thirty seconds, and sometimes immediately, on the applica-
tion of the galvanic current, these vessels contract, some one-
fourth, others one-half, and others three-fourths of their
calibre ; but in from ten minutes to several hours, the vessels
resumed their diameters, and a second application of electri-
city produced little or no effect on them. Doctor Carpenter
asserts positively that the small arteries and capillaries do not
alternately dilate and contract naturally ; and that in them
the blood flows in a steady stream ; and Doctor Philip has
proved that stimulants, especially the electrical, applied to
the central parts of the nervous system, produces a manifest
contractile effect upon the action of the small arteries and
capillaries. This contraction of the capillaries is the cause
of chilblains, which are sure to take place when these vessels
become too small to transmit the blood corpuscles ; but previ-
ous to this the part about being frost-bitten shrinks. On the
coast of Terra del Fuego, December 21st, 1769, Sir J. Banks,
Dr. Solander, and others, took an excursion for plants ; and
the cold became so intense, when night set in, that most of
them were seized with an irresistable desire to sleep. Dr. S.,
who slept less than five minutes, almost lost the use of his limbs,
which shrunk so much that his shoes fell off from his feet ;
two of the men could not be waked again and perished.

The large veins (vena3 cavse), near the heart have a pulsa-
tory motion; and, in some animals, pulsate after the heart

340 Schetterly On the Circulation. Oct.

Las been removed, or after death when the heart has ceased
to pulsate ; and eyen when cut out of the body, these vessels
may be made to resume their pulsatory motion, by applying
stimulants, and especially an electric current, to them. These
facts have been observed by Steno, Lower, Borrachius,
Wepfer, Whytt, Haller, Lancisi, Muller, Hall, Flourens,
Allison, and others; and with them pulsatory motion is
synonymous with alternate dilatation and contraction ; but
this assumption is entirely gratuitous. That all pulsating
vessels are in motion, no one doubts ; but this motion consists
in their alternate shortening and lengthening, termed "loco-
motion." much more than in alternate dilation and contrac-
tion. Doct. Dunglison says : " It seems very doubtful*
whether the veins generally possess any sensible contraction
like that of the vena? cavae and pulmonary veins, near the
heart ; for. although irritated by mechanical and galvanic
stimuli, by Haller. Xysten, Muller, Allison, and others, no
motion whatever could be detected in them ;" and he states
the same doubt with regard to the heart and arteries, on the
authority of Ure, Bichat, Treviranus, and others. In all
these facts there is a perfect agreement between Drs. Carpen-
ter and Dungli>on. and yet both of them agree also in

gning the contraction of the arteries, the action of the
capillaries — through which Carpenter, however, says the
blood flows in a steady stream,- — and a certain degree of
contraction of the veins^. as among the principal propelling
forces of the circulation. That the veins are possessed of
some degree of elasticity, is generally admitted ; but even
this is very trilling. a> is manifest from their becoming vari-
cose in the lower extremities, simply, as it seems, in
consequence of th^ gravitating power, for a horizontal
position diminishes the varicosity. That nothing which can

sibly contribute to maintain the circulation, may be over-
looked, Dr. Carpenter invokes voluntary muscular motion,
because, in phlebotomy, the blood is made to flow more freely
by moving the fingers ; but, surely, the circulation goes on,
and often much more rapidly than in health, while the volun-

1857. Schetterly On the Circulation. • 341

tary muscles are perfectly passive. Some of the phenomena
stated will be explained in the article on the pulse, in which
it will appear that the pulsations are not caused by contrac-
tions and dilation of the blood-vessels.

There are other theories extant, intended to assign a cause
or causes of the circulation of the blood, — such as those of
Mrs. Willard and Dr. McKall ; — but this article is already too
lengthy, and they do not really require a systematic refuta-
tion. All the arguments advanced on this subject, in text-
books, have been pretty fully examined ; and it may safely
be said that the circulation may go on, normally, and does so
evidently, in human monstrosities, in the leech, and in other
inferior beings, without the aid of any of the causes exam-
ined. But even if any, or all, of these were true, tliey would
still be secondary or remote causes, all of thein being obviously
effects of another — a primary cause — of which there can be
but one. Hitherto physiologists have indulged largely in the
habit of imagining causes, because they were indispensably
necessary to even a plausible substantiation of their imagina-
ry theories; and there can be but little doubt that, in their
experiments, some of them fancied they saw the effects they
desired to see, but which had no real existence ; for, as an
eminent physiologist observes, there are more false facts in
physiology than false reasoning. It is high time that in
tracing effects to their causes, in every branch of science,
nothing be admitted as a- cause, until its existence be posi-
tively and indisputably proved, independent of its necessity
to the production of the effect in question, or of its necessity
to substantiate any theory.

The Circulation of the Blood is an Effect of El<<-incal
Action. — Every function of the living human and animal sys-
tem may be temporarily suspended, without extinguishing
life, except respiration, innervation, and the circulation of
the blood. These are so intimately associated, and rlnpnmfaitf
upon each other, that neither of them can stop for a quarter
of an hour, and generally not even live minutes, without a
cessation of the other two, also, and an irrevokable extinction

342 Schetterly On the Circulation. Oct.

of life. In all cases of gradual death (Asphyxia) the circula-
tion goes on in the arteries, which empty themselves quite, or
almost entirely, after death has become apparent: but, so soon
as respiration ceases, the pulmonary capillaries can no longer
transmit blood, which therefore stagnates in them, and conse-
quently accumulates in the veins that convey it to the lungs
to be arterialized, the pulmonary arteries — so called solely be-
cause they convey blood from the heart instead of to it —
performing the function of veins. But a stroke of lightning ;
a blow upon the abdomen seriously affecting the great gan-
glia of the sympathetic nerve ; a dose of prussic acid, or inspi-
ring sulphuretted hydrogen gas, produces death so soon that
the circulation is instantaneously arrested, and the blood con-
sequently stagnates in the arteries, capillaries, and veins, alike.
A stroke of lightning and a blow upon the region of the car-
diac or semilunar ganglion, obviously act upon the nervous
system, for, in these cases, there is often no appreciable injury
found after death in any part of the organism ; and Prof.
Liebig states that prussic acid and sulphuretted hydrogen de-
compose the peroxide and protoxide of iron found only in the
blood and chyle, and secreted with bile and milk. Hence it
it seems that iron exercises a very important function in the
circulating blood, serving, probably, to polarize the corpus-
cles, with the coloring matter of which it is found associated.
The reason why the circulation continues in the arteries for
sometime after death, and why it begins to stagnate in the
pulmonary capillaries first, is — the veins, having no nerves to
electrify them, are negative to the blood circulating in them,
and therefore attract it continuously to the lungs ; while the
lungs are electro-positive to the venous blood, and remain so
for sometime after death, and consequently continue to attract,
instead of repelling and expelling the venous blood, which,
being no longer electrified, remains unchanged when respira-
tion is interrupted, and therefore continues to he attracted.
Hence the stagnation in the pulmonary capillaries. On the
other hand, the blood that has just passed through the pul-
monary capillaries, has been electrified by the air contained

1857. Schetterly On the Circulation. 343

in the air tubes, is therefore electro-positive to the arteries,
and is consequently continuously attracted by them; and
therefore continues to circulate, and thus empties them in
cases of asphyxia. All this will be understood when it is re-
membered that, unlike electerized substances attract, while
like electerized repel, each other.

In the article on respiration it is shown that atmospheric air
is decomposed in the lung, and the oxygen and electricity there
6et free, enter the blood, while the nitrogen is re-expired with
the carbonic acid formed in the arteries and capillaries by the
combination of the oxygen with the carbon conveyed into the
blood by the lacteals. The electricity is then contained in
the blood ; and, as liquids are non-conductors of electricity,
except by carrying it (convection), this agent requires to be set
free from the blood for the purpose about to be explained.
Now, M. Dessaignes, Principal of the College at Yendome,
France, read a prize essay to the French National Institute in
1810, on the subject of Phosphorescence, Heat, Light, etc., in
which he proved, by numerous experiments, that electricity
(to which he attributes all phosphorescence, etc.) may be
pressed out of all bodies, whether solid, fluid, or gaseous.
Here, then, toe have the principal^ hinction of the heart, i. e.
to set free the electricity derived from the atmospheric air,
from the blood, by pressure; its other principal function being
to keep separate the venous from the arterial blood, sending
the former to the lungs to be arterialized, and distributing the
latter to every part of the body for nutrition, calorification,
secretion, and for all the other vital functions. That the for-
mer function, here assigned to the heart, is not imaginary, is
proved by facts — First. That some cold blooded animals have
no heart, and in all these the heart is a very feeble organ
compared with that of the mammalia generally. Second.
Almost, if not quite, all the Physiologists consider the relaxa-
tion of the muscles to be a passive function ; but an eminent
experimentalist whose name is stated by Dr. Carpenter, but
has escaped my recollection, grasped the heart of a living an-
imal, and found it to dilate (relax) with great force ; while

344 Schetterly On the Circulation. Oct

another experimentalist scratched the heart, after it had been
removed from the body, and it contracted with such force aa
to drive the needle deep into its own substance. Now, a
passive action can, in no case, manifest any force that has not
been impressed upon it by some motor power, and. in this
case, it must yield the previously received force in a straight
line with the direction in which it was impressed upon it at
first ; but, in case of the heart's relaxation, the relaxing force
manifests itself in the contrary direction. Consequently, the
relaxing force of the heart can be explained only on the prin-
ciple of electrical repulsion.

In the article on the nerves it is stated, on unquestionable
authority, that the arteries are so abundantly supplied with
sympathetic nerves, — principally arising from, or rather, ter-
minating in, the cardiac ganglion, — as almost to constitute an
additional coat to these vessels ; while the veins are almost
destitute of nerves. Dr. Carpenter says, the functions of the
sympathetic nerves so profusely distributed upon the arteries,
but not the veins, must be important, but remains to be dis-
covered, or in words to this eifect ; and, to discover these func-
tions, lias cost me some years of arduous, but very pleasant
labor.

The primary cause of the circulation has already been so
frequently and so plainly indicated that it is almost superflu-
ous to elaborate it more fully. The principal function of the
sympathetic nerves spread over the arteries, is to conduct
away from them, the electricity pressed out of the blood by
the left ventricle of the heart, to the nervous centres, to be
deposited in these for the uses of corporeal and mental action
and for carrying on the vital functions, as it may be needed.
Hence the arteries are continually kept in an electro-negative
state to the blood they convey, and consequently attract it
through their entire course, just as the latex-vessels in vegeta-
bles do, and by the same agency. The electricity being thus
continually conducted away from it, the electrical state of the
blood becomes more and more negative, after it leaves the
heart ; while the electrical condition of the vessels, themselves,

1857. Schetterlt On the Circulation. 443

remains every where the same. The velocity of the blood,
therefore continually decreases, in proportion a6 the electrical
condition of the blood and vessels become more and more
alike. In the capillaries, the blood desposites the electrified
materials prepared for nutrition ; and receives a quantity of
carbonic acid from the matter disintegrated to produce force,
in addition to the quantity generated by combustion in the
the arteries ; the greater part of both of which is expired
through the lungs, and the residue evacuated through the skin;
the other products of disintegration being conveyed to the
liver and to the kidneys, to be secreted by these organs from
the blood, and evacuated through the bowels and urinary
bladder. By the time the blood has passed through the ar-
teries and capillaries, it has lost its arterial character alto-
gether, has become venous blood, and undergoes no farther
change till it arrives again in the pulmonary capillaries. The
electricity set free from it, by the pressure of the left ventricle
of the heart, having all been conducted away from it while
passing through the arteries and systemic capillaries, the elec-
trical condition of the blood has become much lowered when
it enters the venous part of the capillaries. The veins, being
very scantily supplied with nerves to electrify them, are still
electro-negative to the blood circulating in them, and conse-
quently continue to attract it through their entire course, as
do the arteries \ but with a much diminished force, the elec-
trical condition of the veins and blood being more nearly alike
than in the arteries, causing it to move slower. Hence, the
reason why the arteries are so profusely supplied with sym-
pathetic nerves, and the veins so scantily ; why the venous
apparatus is more than twice as capacious as the arterial ; and
why bleeding (Haemorrhage) from the arteries is so much
more difficult to arrest than that from the veins, is very obvi-
ous, being merely a manifestation of adaptation of means to
ends.

That the electricity conducted away from the arteries by the
sympathetic nerves, is stored up for gradual use, in the nerv-
ous centres — in the brain, the sympathetic ganglia, and, per-
vol. in, no ix. — 18.

444 Schetterlt On the Circulation. Oct.

haps, in the spinal ganglia or spinal marrow, — is proved by
many facte. If this be not the case, then the reason why ex-
haustion follows severe corporeal or mental labor; why
strength is renewed by rest, and, especially, by sleep ; and
why sleep — a total cessation of muscular and mental activity,
and a consequent suspension of expenditure of force to give
time for accumulation, — is indispensable to health and activ-
ity, and even to the perpetuity of life itself, are all totally
inexplicable. True. Physiologists say these are required to
renew nervous energy. But what is nervous energy \ Can
it be demonstrated in any way except by explaining the igno-
tus per ignotum I Can the living system generate power by
any means, but by the decomposition of living matter ; or by
deriving it from an exterior source ( If produced by the for-
mer method, then rest and sleep consume part of the body,
which is contrary to known fact and to analogy ; if power be
derived from the latter source, then it must be front atmos-
pheric air, for food can only supply the waste of living matter
produced by disintegration : and, in this case, the source of
power must be electricity, for, it has been proved that neither
oxygen nor nitrogen can supply power, and the atmosphere
contains nothing, besides these three ingredients, that can
possibly give power. But Physiologists speak of this vital
power— be it nervous energy or electricity — as if it were cre-
ated by the living system. Is every living creature a niinia-
ture creator? I, for one, always thought there was but one
Creator, whose infinite omniscience shines so resplendent
throughout creation. What absurdity comes next ( u From
nothing, nothing can come." is an established maxim.

Again, Prof. Ure states the well known fact that. — ^Im-
mersion in cold water accelerates greatly the extinction of
life arising from suffocation." Xow. if the life sustaining
agent be electricity, this fact is easily explained ; for it has
been shown the water possesses a very strong attraction for
electricity and a capacity of receiving an indefinite quantity
from a lightning rod ; but, if this agent be nervous energy or
life itself, differing from electricity, then all is dark as Erebus.

1857. Schetterly On the Circulaticm. 445

Is nervous energy possessed of the same properties as electri-
city, to be abstracted from other substances by water &c?
If so, what evidence is there that they are not identical ?

It is well known that, when the spinal marrow is divided or
compressed, titilating the soles of the feet causes retraction of
the limb, without exciting consciousness. Sir A. Cooper divi-
ded the great sympathetic nerve by applying a ligature to it
in dogs, and found that but little effect was produced by doing
so, the functions of the vital organs, supplied by it, continuing
to be performed as usual, which proves that it does not derive
its influence from the brain. It is also well known that, in
oases of suffocation, life becomes irrevokably extinct in per-
sons who have spent their strength by violent exertion, much
sooner than in those possessed of full vigor, previously ac-
quired. Dr. Nysten's experiments show that the sympathetic
nerve retains its irritability much longer than the nerves of
animal life, and some parts of it longer than others, which can
be owing only to their possessing a store of motive power in
reserve. Experiments prove, accordingly, that, so long as the
divided portions of the sympathetic have ganglia, the portions
continue to act as usual ; but, the destruction, or even a blow
upon the region of a single principal ganglion, produces
instantaneous death. All the facts stated, go to prove that
the ganglia are depositories of vital agency constantly kept
in reserve ; not that the sympathetic is unimportant in the
living economy, nor that every part of it is a generator of
nervous influence, as Dr. Dunglison infers from Cooper's
experiments. And Dr. W. Philip " considers it as proved
by his experiments, that the ganglia communicate to the
nerves proceeding from them, the general influence of the
brain and spinal marrow." The mind can act upon the sym-
pathetic nerves, only through the medium of mental emotions ;
and, by this means it sometimes withdraws such an amount
of electricity from them, as to produce instant death, or
hopeless mental aberration, in other cases.

The statement that the electricity inspired with the air, is
pressed out of the blood by the contraction of the left ventri-

446 Schetterly On the Circulation. Oct.

cle of the heart, is not a baseless assumption. With a
microscope magnifying to three hundred diameters, Prof.
Wagner demonstrated that, in the large arteries, the blood
corpuscles have a whirling (rotary?) motion, forming a closely
crowded stream, in the middle of the vessels, without ever
touching their parietes. Between the main stream of the
blood and the inside of the vessels, he always observed a
distinct space containing liquor sanguinis. In this liquor a
few white corpuscles, which he considers to be lymph, move
on at a rate ten or twelve times slower than the red ones.
This clear space is seen also in the larger capillaries, but dis-
appears in the smaller ; and is not at all perceptible in any
part of the pulmonary circulation, in which the white and
red corpuscles proceed pari passu promiscuously. This
difference must mean something, and is therefore worthy of
notice. The pulmonary arteries and veins are not supplied with
sympathetic nerves in a manner at all analagous to that in
which the systemic arteries are, as it were, clothed with them.
The blood conveyed from the heart to the lungs, by the pul-
monary arteries, is venous ; and that returned from the lungs
to the heart, by the pulmonary veins, though arterial, can
not have the electricity it contains pressed out of it, till it
enters the left ventricle. In the venous blood passing through
the right side of the heart to the lungs, there is, therefore, no
electricity to be pressed out of it ; and, out of that which is
returned from the lungs to the left side of the heart, the elec-
tricity has not been pressed, and can not be conducted away
to its depositories, till it is set free from the blood by pressure.
Hence it appears that neither the pulmonary arteries nor
veins, contain electricity in a condition to be conducted away
to the nervous centres ; and, consequently, they are not sup-
plied with nerves for that purpose. Another manifestation
of the law of adaptation.

The microscope has also been used to observe the motion
of the blood in the capillaries of translucent animal tissues ;
and, in these observations, physiologists ignorant of the elec-
trical property of solar light, have been as much perplexed

1857. Schetterly On the Circulation. 447

as in observing the circulation of sap in vegetables. When
the focus of this instrument is concentrated upon a particular
spot, the tissue becomes electrified ^at once ; and, according
as the vessels and the blood become alike or unlike electerized,
the blood is repelled from, or attracted to, that spot. And,
if the focus be then moved from one place to another, the
motion of the blood becomes confused, so that no certain
conclusion can be drawn from such experiments. But the
effects produced by the microscope demonstrate the influence
of electricity upon the circulation ; and go so far to prove
that electricity is the agent that moves the blood. " Ubi irrita-
tio, ibi fluxus," and " Ubi stimulus, ibi afluxus," have been
maxims in physiology for ages ; but the fact is not yet recog-
nized that irritation or stimulation, applied to any particular
part, causes a flow of electricity from, or an afflux to, that
part from the nervous centres, rendering it either positive or
negative to the blood, which is consequently attracted or
repelled by, and therefore flows to or from the affected part.
The tissue of the irritated spot then becomes positive, and, if
the stimulus be soon removed from it, it will repel the blood
so soon as they become alike electric, and the blood will
return again when the effect of the irritation vanishes, as
shown by Fabre and Sarlandiere's experiments. All such
experiments show that the heart has no influence over the
circulation in the capilaries; and the automatic, or self motion
of the blood, proposed by Harvey, Glisson, Bohn, Albinus,
Rosa, Tiedemann, Treviranus, and half a dozen of other
authors, is absurd upon the face of it.

The reader remembers Dr. S. Smith's graphic and beautiful
description of nutrition. The reason why tissues select from
the same current of blood, the particular elements necessary
to replace the matter disintegrated from their own substance
— the brain, the phosphates, the bones, the lime, etc. — or to
be secreted by them and discharged from the body — the liver,
the superfluous carbon, and the kidneys, the alkalies, — has
never been even attempted to be explained, nor can it be on
any but electrical principles. But, when it is remembered

448 Allen On the Mechanism of Nervous Action. Oct,

that different organs, as well as different substances intended
to nourish the living system, are naturally electrified unlike ;
that like repel, and unlike attract each other ; and that the
capacity of different organs, as well as different substances,
for electricity, and the tenacity with which they retain it,
vary also, then the reason and the cause of this selecting and
rejecting power is very evident.

The explanation of the five insuperable objections urged
against the theories of the circulation, in the preceding
article is so plain that it is needless to subjoin it. But the
attentive reader can not have missed perceiving that, if the
theory of life advanced in these articles be true, there is
every where, and especially in the present one, an all perva-
ding adaptation of means to ends, which adumbrates the
infinite wisdom of the Creator; and which should be consid-
ered the strongest argument to substantiate the truth of the
electrical theory, and especially since the popular theories
refuted, exhibit no such adaptation any where.

Article II. Mechanism of Nervous Action. By J. Adams
Allen, A. M., M. D., Formerly Professor of Therap., Mat.
Med. and Juris, in the Indiana Medical College ; and late
Professor of Physiology and Pathology, and acting Prof,
of Mat. Med. in the University of Michigan.

In the September Xo. of the Independent I pointed out
certain doctrines which I have taught since 1848.

Briefly, I shall now explain certain incidents of those doc-
trines, then and since developed.

The readers of the London Lancet will recollect that TV.
Tyler Smith, in the year 1848, pointed out the remarkable
synergic relations of the three great organs of the sexual sys-
tem,— uterus, mammas and ovaria. Had he not been blinded
by the term " excito-motory," it seems impossible to believe
but that he would then have discovered the real mechanism
of the " synergies.'' (Yide Loud. Lan., Oct. 1S48, p. 327.)

1857. Allen On tJie Mechanism of Nervous Action. 449

One point only I here notice : — Tyler Smith urges in that
series of lectures, that the motions attributed to the fcetus in
utero, were, in fact, caused by motion of the uterus itself.
There is no nervous connection between the mother and child
— hence he argued the excito-motor influence, well known to
give rise to these movements, must act upon the muscular
tissues of the uterus. But careful investigation convinced
me that the fcetus was itself the moving object.

The corollary is clear — the nervous arc induced a change
in the blood which supplied the placenta, and this modified
blood caused muscular contraction in the foetus. The modus,
the same as though moving the muscle of the mother.

Why does parturition occur at a fixed period ?

Because the changes in the blood of the mother occasioned
by the full development of the foetus produce that particular
molecular change in the uterine muscle which necessitates
contraction. The molecular change is the cause.

The same blood-modification may occur from accidental
causes, or through the medium of the nervous arc.

Why does application of the child to the breast provoke
the mammary secretion ? Is it necessary to introduce the mo-
tor before the secretory effect ? Is it philosophical? Not at all.

Constant molecular changes, the necessary condition of life,
keep up what is called " passive contraction," or the tone of
muscle, but the exigencies of animal life require something
beyond this ; something which will intensify these changes
to suit the wants of the animal. The nervous system meets
this demand, but not by the introduction of new modes of
operation in the moving tissues. The molecular changes are
varied by the influence of the nervous system.

The various functions of vegetable life are carried on un-
der nearly identical conditions : the organs, therefore, have
no need of internuncii. But when animal life comes in to
vary the conditions, then internuncii become necessary. But
nature chooses uniformity, and thus no new machinery
or unparalleled apparatus is made use of. Synergic organs
reciprocally respond to the simple nervous arc.

450 Allen On the Mechanism of Nervous Action. Oct.

Much confusion has arisen among physiologists by vague
attempts to localize a particular nervous centre. The true
centre is the nerve-vesicle, and may radiate its influence to yet
another point, which again becomes a centre. The nerve fibre
creates nothing. Collectively the fibres serve the purpose of
bringing all the vesicles together, and yet keeping them
apart.

It is proved that nervous impulses will pass by vesicles in
contact as well as by nerves of commissure. The white fibre
insulates and localizes the effect — the gray more nearly anal-
ogous to the vesicle, diffuses it almost indefinitely. This is
shown by their several connections and by observation.

The points of contact of the so-called " sympathetic," and
the cerebro-spinal systems are limited, yet they do exist ; and
gray and white fibres may intermingle, as we see fibrillse of
striated and non-striated muscular tissue side by side.

The ganglionic chain is little connected with the cerebro-
spinal axis, simply because it is unnecessary, and nature never
does a needless work. But this shows no real diversity of
operation. As well might we exclaim against the optic
nerve and vesicles because they are not intimately connected
with a lumbar spinal nerve and its fused ganglion.

The outward expansion of the nerves of special sense, it is
now believed, consists of vesicular neurine. It is quite prob-
able that this is the general fact for all recipient nerves. The
peculiar structure of this vesicular expansion fits it for under-
going changes on the application of its particular stimulus,
and that only. Transmitted inward by the conducting tissue,
it develops there another change, which may be reflected to
several different points, according to the connections of the
central vesicles — the central vesicles, in the latter instance,
having the same relation to the second vesicular centre
reached, that the outward vesicular expansion had to the first
centre.

To take the optic nerve, for example, and trace the series
of operations which may result from its action :

1. Retinal change ; 2. central vesicular change at the " ori-

1857. Allew On the Mechanism of Nervous Action. 451

gin" of the optic nerve ; 3 a. " Reflex " npon the iris ; b. upon
the lachrymal gland ; c. upon the blood vessels of the eye ;
d. Through the gray vesicles of the central nervous gan-
glia (fused) of the base of the brain, and by commissural
fibres to gray matter of the convolutions, etc., of the cere-
brum ; e. ditto, to the cerebellar vesicles ; f. through various
nerves, vesicles and ganglia to muscular organs ; g. to secre-
ting organs.*

From careful study upon this topic, I am inclined to the
belief that the gray vesicles upon the convolutions and an-
fractuosities of the brain have a similar relation to the com-
missural fibres and central nervous vesicles (constituting the
true centres of volition, sensation, etc.) that the expansions
upon the optic, and other nerves of special sense, do to their
commissural fibres and the same centre.

The retinal cells respond only to their own stimulus ; and
their lesion, or that of their fibres, or central vesicles, gives
rise to the subjective phenomena of vision.

In like manner the superficial cerebral vesicles respond
only to their peculiar stimulus, and lesion of them or their
commissural fibres of connection, etc., gives rise to the sub-
jective phenomena of mind.

If there is anything of mind beyond the registered impres-
sions of sense, it finds the organs of communication with the
body through these vesicles, as light comes in by the retina,
and sound by the cells of the distal auditory expansion !

The force of mind once producing the vesicular change, the
mechanism of its action thereafter is altogether analogous to
that of physical stimuli !

In all are the commencing vesicle, the conducting fibre,
and the recipient vesicle, which latter becomes the commenc-
ing vesicle of a new chain !

A correct idea of the reflex phenome?ia of mental nervous
action, will explain, at once, about all of the real phenomena

♦It will be noticed that in deference to common usage, I employ different terms for muscular
and secreting organs, but it should be recollected that physiologically and histologically, they
are homologous.

4:52 Allen On the Mechanism of Nervous Action. Oct.

of " spiritualism/ ' table-tipping, mesmerism, somnambulism,
dreaming, etc.

Abstract metaphysics applied to psychology causes the
whole thing to evaporate in subtleties ; direct physiological
investigation brings the whole subject to the simplest possible
concrete.

I have said elsewhere that the "new principle," or "doc-
trine," is but a corollary from what was previously known.
This is true of all discoveries by the inductive method.

It was a known fact that diseases or disturbances of the
nervous centres, deranged both motion and secretion in the
parts supplied from those centres.

The term functional disease was either meaningless, or it
involved in many instances reflex phenomena.

The terms centric and ex-ceniaric causes of internal disorder
could find no other explanation.

The entire doctrine of " revulsion " was vague and indefi-
nite without this transparent statement.

The structure of muscular tissue, its cell formation and
relation to nervous tissue demanded this view.

The doctrine of "sympathies" was otherwise inexplicable.
The discoveries in cvtogenesis and histology, showing the an-
alogy of development, nutrition, and decay of muscular and
glandular organs pointed definitely to this idea.

Even though the opinion of M. Hall that muscular irrita-
bility is dependent upon the cerebro-spinal system be still
entertained, there is no escape from the conclusion that the
blood and fluids must be the medium of action.

In October, 1S49, in the case of a gentleman on trial for
homicide of his son, I gave evidence upon the question of
insanity, and argued the presence of diabetes as indicative of
disease of the nervous centre. The other indications, and the
event, confirmed the diagnosis. (Vide Bost. Med. and Surg.
Jour.. Vol. 42, p. 441.) Few writers, indeed, have been
found hardy enough to deny the influence of disease of the
nervous centres upon secretion. The corollary is obvious,
that nerves which induce changes in these nervous centres

1857. Allen On the Mechanism of Nervous Action. 453

will, secondarily, induce changes in parts receiving nervous
supply from those centres.

Irritate the ulnar nerve at the elbow, and sensation is
referred to the ring and little finger ; — continue the irritation
and actual inflammation will ensue in the parts experiencing
sensation. Where is the line of demarcation between the
sensory and secretory here ? There is precisely the same eifect
in case of reflected sensation elsewhere.

Probably the largest number of cases of neuralgia are
examples of what might be called excito-sensitory action.

Is there philosophical propriety in inventing the term ?

The central truth is that the nerve vesicle undergoing
change, induces changes in structures with which it is in con-
nection, by conducting nerve fibres, or vesicles — the expres-
sion or form of that change depends on the structure reached.

The nerve vesicle may be primarily undergoing change, or
by the medium of an incident fibre.

Letter from W. R. Marsh, A. M., M. D., Professor of Chemistry Materia Medica,
and Toxicology, Medical Department of Iowa University.

Keokuk, Iowa, August 13, 1857.
My Dear Doctor : —

Sickness at home, and the urgent pressure of other business must
be my apology for delay in replying to you.

To your interrogations I reply but briefly, because opportunity is
wanting for speaking more at length nowr, although should you wish
it, I will write more fully at another time.

First. The manuscript lectures to which you refer, and from which
the transcript mentioned is taken, were wrritten by you during the
summer of 1848, and publicly delivered before the class of the
Indiana Medical College during the session of 1848-9.

I am positive as to the date of the writing and the delivery, and
the identity of the manuscript, because I was then reading medicine
under your instruction ; and, as we were not merely teacher and pu-
pil, but intimate friends, it was permitted me to peruse your lectures
from day to day as you progressed with their preparation. During
the session of 1848-9 I occupied the same private room with your-
self, and it was my custom each evening to look over the lecture you
had given during the day, for the purpose of fixing the subject more

454 Allen On the Mecha/nism of Nervous Action. Oct.

fully in the memory, and also of correcting, if need be, my notes of
the same. Hence I could not but remember, and if I failed to do so,
the notes thus taken would be sufficient to revive remembrance.

Second. As to what you taught, I reply : That in addition to what
you had written in explanation of your views of the modus operandi
of escharotics and revulsives generally, you were wont to enlarge
extemporaneously, appealing to analogy and known facts to sustain
your position.

I may sum up your remarks, in brief, as follows :

Secretion by glandular or secernent organs is, in relation to the reflex
nervous system the analogue of motion in muscular tissue. Both
are operations of double nervous arcs. Impressions upon efferent
nerves, conveyed to nerve centres, produce changes therein, thence
the influence is conveyed through efferent fibres to the organ or
organs in direct nervous connection (through the double arc) with
the part where the first impression is made, and at the distal
extremities of these efferent nerves, molecular changes are produced.
These changes result in the production of motion, sensation, or secre-
tion, just as the organ has for its proper function the one or the other.
u Contiguous sympathy " may be thus explained, as also the " sym-
pathies " of organs topographically or anatomically remote. And I
remember you adduced as an argument in support of these views,
the selfsame instances advanced by Dr. Campbell — the " sympathies "
displayed in dentition ; as also the influence of impressions made
upon other parts, as the feet, mammae, etc., upon the menstrual secre-
tion. Here, both the motor and secretory influence were apparent
accordingly as the character of the uterus assumed more or less of
the office of a muscle or of a secretory organ.

The above illustrations, made by you, of your views, I give ; and
although imperfectly as representing the manner of your treating the
subject, yet I hope they will be sufficient for your present purpose.
The utmost brevity is all my time will now permit.

Third. You taught the same in the winter of 1849-50, but more
fully than in the preceding course. As to your after teachings, I
know nothing positively except as follows :

In the summer of 1851 or '52 you made me a visit, and while sit-
ting in my office with me, the conversation fell upon the comparative
pleasure in lecturing upon Mat. Med. or Physiology. I asked you
how it fared with your two enthusiasms, viz : your views of the

1857. Erni On Mineral Waters. 455

office of the reflex system of the nerves, and the catalytic action of
medicines, when you replied that you had a better opportunity in
lecturing upon both branches to develop the former fully to the
minds of the class, for that when upon the " excito-motor " nerves, it
was easy to show how motion and secretion were analogous results
of the same causes. You expressed yourself as more than ever
confident of the justice of your views, and expressed some astonish-
ment that writers upon therapeutics should have failed to notice a
matter so important in a pathological sense, and as an index of
therapeutic applications.

Finally, your teachings have so far influenced my mind, at least, as
to induce me to teach the same to our classes here in my lectures
upon therapeutics. To the fact that I was under your instruc-
tion from the first of my medical study, may doubtless be attributed
my not noticing the fact that it was something new in physiology,
although I was aware that the application of the idea, as made by
you, was new, and I have so remarked in my teachings, giving you
the credit.

Hoping that you may be able to prove to the satisfaction of the
profession, what I have no doubt you are entitled to, the credit of
being the first to arrive at and promulgate " the idea " although not
the " designation " of the " excito-secretory " system of nerves ;
and that you may be ever successful in your efforts for the good of
medical science. I am Sincerely yours,

WELLS R. MARSH.

Prof. J. Adams Allen, M. D., Kalamazoo, Mich.

(To he Continued.)

Article III. — Mineral Waters — Their Origin and Effects.
By Henry Erni, A. M., M. D.

All the water found in nature, is more or less impure — i. e.y
more or less impregnated with gaseous and mineral matter.
This is owing to the great solvent power of this fluid, which,
indeed, the hardest rocks can not, for any length of time,
wholly resist. Hence, our clearest river and spring water —
even the rain-water — admits of no exception, since the former,
passing, in its course, over various soils and rocks, acts upon

456 Erni On Mineral Waters. Oct.

. <»■ — — — — —

them ; whilst the latter washes certain ingredients from the
atmosphere. These saline parts, though popularly regarded
as foreign impurities, have nevertheless an important bearing
on vegetable and animal life, and hence must exert some
influence on our health. The sagacious experiments of Bous-
singault have shown that young animals, during their growth,
derive a great part of the lime necessary for the development
of their bony frames, from drinking water. A young pig took
up, during a three-months' trial, one third of a pound of lime
into its system ; and he calculated that all the cattle kept on
his farm swallowed about two thousand pounds of lime, mag-
nesia, common salt, etc., in the course of a year.

The great bulk of aquatic animals is confined, during the
act of respiration, to the atmospheric air dissolved in the
water, which (absorbing oxygen in a larger proportion than
we find present in the atmosphere) contains from 32 to 33
per cent, of this gas — which is a proof that nitrogen and
oxygen are not chemically united in the air, but uniformly
mixed by the diffusive power of gases.

One volume of water absorbs, according to Saussure, about
0.046 vol. of air ; and Humboldt and Guy Lussac found that
distilled water, saturated with air, yields, by boiling, a gas-
eous mixture, containing 32.8 per cent, of oxygen. In rain-
water, the amount of oxygen in the absorbed air amounts to
31 per cent. ; in snow-water, 28.7 ; the water of the river
Seine, from 29.1 to 31.9 per cent, of oxygen.

The absorption of gases by water increases with the ex-
ternal pressure, and with the reduction of temperature.
"Waterj at the height of from six to eight thousand feet,
retains only one-third of the quantity of air which it absorbs
at the level of the sea ; hence, in some of the Alpine lakes,
we find no fishes.

As to water-plants, they find, in the medium in which they
live, not only the necessary mineral constituents, already in
a soluble form, but the carbonic acid gas . diffused through-
out the water, decomposing by the action of sunlight, they
appropriate, as food, its carbon, whilst the oxygen is libe-

1857. Erni On Mineral Waters. 457

rated. There is, even under otherwise unfavorable circum-
stances, enough of nitrogenized matter present, to aid in the
support of vegetable and animal life. Thus, exposing fresh
well-water, in a bottle of white glass, to sunlight, it yields,
after a while, a green sediment, a microscopical examination
of which reveals the presence of convervse and infusoria, the
germs of which are never developed in the dark.

In the so called hard waters, we find chiefly carbonate of
lime and magnesia disolved in free carbonic acid gas, which
components are the cause of its peculiar taste, and its unfit-
ness for washing — decomposing soap. In letting such waters
stand at rest, but especially by boiling them (the free carbonic
acid thereby escaping), the earthy materials are precipitated,
or incrust the inside of our kettles and boilers. Hard waters,
likewise are not suitable for certain cooking purposes, as some
vegetables (peas for instance) can not be boiled soft in them.
Such waters, even where mere boiling would not answer the
purpose — as sea water, or water charged with gypsum — are
rendered " soft " when mixed with a little caustic potash, or
soda, which alkalies throw down magnesia and lime. Well-
water sometimes becomes contaminated with animal and
vegetable substances, as in the neigborhood of swamps, or
where, by chance, it comes in contact with refuse matter near
dwellings, farm yards, church yards, etc., rendering it there-
by very unwholesome, and even productive of fatal disease.
Hence to provide large cities with sufficient and wholesome
water, constitutes one of the first and most important tasks of
of their governing officers ; and as the pipes in which water
in such cases has to be conducted are metallic, we will say a
few words in reference to some waters on metals.

The water is usually brought from a considerable distance
in iron pipes, which do not, generally, in the least affect its
qualities, and we may therefore limit our remarks, simply, to
lead pipes, which, owing to their cheapness and flexibility —
tin being too expensive — are chiefly resorted to, for conduct-
ing water through short distances. As a general rule, we
find that the purer the water the more it acts upon lead.

±5> Erxi On Mineral Waters. Oct.

Thus a piece oi this metal dipped into distilled water becomes
converted into a white pellicle of white hydrated oxide, or
where the carbonic acid of the air has access, into hydro-car-
bonated lead. ^Vater distilled in a copper still provided with
a lead worm, or condenser, becomes qnite milky from the
lead it contains. ^Ve have always much to fear from well
and spring water coming from alluvial or modern geological
formations ; whilst those containing a considerable amount of
salts — such as sulphates gypsum u phosphates, also the com-
mon limestone waters — maybe passed with impunity through
lead pipes, for such waters precipitate on the inside of the
pipes notable quantities of incrustations, which prevent the
oxidation of the lead beneath. These general remarks may
q * have been superfluous, since they give a better insight
into the origin and nature of what are commonly called mln-
troJ. ' *, which more especially constitute the topic of the
present article.

It follows from what has been said, that strictly speaking,
all waters partake more or less of the nature of mineral waters,
but in the more common acceptation of this term we include
onlv such waters as contain a certain amount ot saline mat-
ter. There can be no doubt that the ingredients with which
waters are impregnated, render them, in many cases, highly
medicinal, and applicable to the one or the other class of
diseases, according to the therapeutic properties of its mineral
-dtuents, and hence many of our mineral springs may,
with great benefit, be resorted to by invalids. Alineral waters
were employed for bathing purposes by the Greeks. Hebrews,
and Romans. The former erected many ternples in honor of
springs considered healing by the power of the gods, whilst
the Romans built magnificent bathing houses, the ruins of
which still excite our admiration. ^sVe moreover know from
existing manuscripts, comprising regulations and directions
respecting mineral baths that they were pretty generally-
made use of in Italy in the year 1164. and somewhat later, in
Germany.

In regard to temperature, springs are divided into thermal,

1857. Erni On Mineral Waters. 459

or warm and cold ; we find the former most frequently in
volcanic districts, whilst in other cases, they originate at
great depths. Thermal waters vary much in temperature,,
from 15 to 100 deg. Thus the great Geyser, in Iceland,
at times ejects a stream of boiling water to the height of from
30 to 100 feet. This water — owing to the presence of carbon-
ate of soda and potassa — contains large portions of silica,
which separate only, after its total evaporation. Some physi-
cians state that thermal waters have a much greater specific
gravity than common hot water, i. e., such mineral waters
cool down more slowly than merely common water, which,
however, is not the fact. Mineral waters may, from their
prevailing constituents, be classified thus :

1st. Hepatic, or sulphurous waters.

2d. Chalybeate, or feruginous.

3d. Acidulated — carbonated.

4th. Saline.

a — Common salt prevails.

b — Magnesium (bitter waters).

1st. In Hepatic waters — sulphur springs — free sulphide of
hydrogen predominates, and there is likewise a metallic sul-
phide present, such as sulphide of potassium, or sulphide of
calcium. Such waters when exposed to the atmosphere,
separate finely divided sulphur — white sulphur springs — or
coming in contact with some of the heavy metals — iron,
magnesia, etc., throw down dark colored precipitates — red
and black sulphur springs.

We discover the free sulphide of hydrogen, however spar-
ingly present in the water, by boiling the latter in a flask, in
the neck of which we suspend a piece of paper, previously
saturated with a solution of some lead or copper salt, which turns
brown or black after a while. In order to prove that some of
this gas occurs in a chemical combination with some metal,
we heat the water until all the free gas has escaped, when
by introducing the same test paper into the liquid, the sulphur
if present will darken it. The origin of such springs is pretty
clearly understood — we find them coming from the beds of

VOL. Ill, NO ix. — 19.

460 Erni On Mineral Waters. Oct

rocks containing sulphates (gypsum) and much organic matter,
the latter causing the decomposition of the former. Thus by
bringing together in a well-closed flask a solution of sulphate
of soda and sugar, we find that after some time the organic
substance acts reducingly upon the sulphate, whereby carbonic
acid and sulphate of sodium are formed, and by the mutual
reaction of these, sulphide of hydrogen is disengaged.

2d. Chalybeate waters contain in general- proto carbonate of
iron, which is soluble in water charged with free carbonic
acid. The water is colorless and transparent when fresh ; but
after a while a dark substance is precipitated, composed of
hydrated oxide of iron, and usually mixed with carbonate of
lime, or some other carbonates. Though such waters have a
strong inky taste, still the amount of iron present, is, in most
cases, very small.

Tests: — The water is treated with acetic acicl (when
carbonic acid is evolved, and we get in solution proto
acetate of iron), and a few drops of ferro cyanide of potassi-
um— yellow prussiate of potash — added. After the lapse of
some time, the solution turns blue. This reaction is obtained
at once with ferro cyanide of potassium — red prussiate. Sul-
pho cyanide of potassium produces a red color. A solution
of galic acid, or a spirituous infusion of gall nuts, turns such
water purple, or even black.

3d. Acidulated waters are impregnated with an excess of
carbonic acid, which can hold considerable quantities of lime
and magnesia in solution.

Tests : — Tinct. of litmus — when added in small quantity —
turns red, from' the free acid, but changes back again after
some hours; boiled water does not show this change. A
darker red, which does not disappear, indicates the presence
of a metalic salt. The addition of lime water produces a
white precipitate, if carbonic acid be present, which, when
mixed with a larger quantity of the mineral water, is re-dis-
solved.

4th. Scdines. — In these, chloride of sodium prevails, the
amount of which varies from 1 to 23 per cent.

185T. Ekni On Mineral Waters. 461

Tests : — Nitrate of silver produces a white, curdy precipi-
tate, easily soluble, by an excess of ammonia. Probably all
such waters also contain iodide and bromide of sodium, which
are traced thus : The water must be concentrated by evapo-
ration, some nitric acid added, and afterwards some thin starch
paste, which latter is colored blue by free iodine. To detect
bromine, the water must be evaporated to at least one-fourth
of its bulk, when almost all of the common salt crystalizes ;
while in the mother liquor, remain the bromides. We now
add a few drops of chlorine water, then some ether, which
dissolving the free bromide, turns red. Starch is colored
orange-brown by bromine.

Magnesia, or bitter waters, contain, usually, sulphate of
magnesia ; sometimes sulphate of soda.

Tests : — Chloride of barium produces at once a white pre-
cipitate, in any free acid. Carbonate of soda throws down
carbonate of magnesia, but has no effect if sulphate of soda
is present instead of a magnesian salt. To find whether the
precipitate is carbonate of magnesia only, or composed both
of this salt and carbonate of lime, add sulphuric acid, which
re-dissolves magnesia, but not lime. Many other constituents
besides those enumerated are found in mineral waters, such
as lithium, barium, strontium, even tin, silver, etc., but no
peculiar effect can be ascribed to these.

As soon as the sanitary effects of mineral waters were
recognized, we find attempts to have been made to imitate
them by artificial means, in the laboratory. Thus Pliny
mentions, and gives directions, how to make artificial sea
water. In the sixteenth century Thurneyssen, and in the
eighteenth, Bergman and Hoffman experimented with, and
combined synthetically, the ingredients, found in certain
celebrated mineral springs. But it was not until the great
reformation in Chemistry by Lavoisier took place — who, finsl
introducing thebalance into chemical science, gave it a math-
ematical basis, from which date, its history as a science begins
— that mineral water could be quantitatively and corrccflv
compounded.

462 Ekni On Mineral Waters. Oct-

The experiments of Struve led him to establish, in the year
1818 to 1820, a Large hydropathic institution at Dresden,
where mineral waters were prepared and consumed in various
forms, and in consequence of its success, similar ones were
founded at Leipzig-, Berlin, Conigsberg, Hamberg, Petersberg,
Moscow, Odessa, Brighton, etc.

Such chemically compounded mineral waters, must of
course, qualitatively and quantitatively, be identical with the
native ones of the same class ; and since a chemist is enabled
to take into account, and even prevent the escape of gasses,..
or the gradual decomposition of certain constituents, he has
indeed, greatly the advantage over crude nature, where much
is left to chance in regard to the amount of mineral material
contained in the water, whilst he is provided with chemicals
and refined apparatus that must insure his success and render
his products constantly and invariably the same. Further-
more, it is worthy of consideration, that to visit distant min-
eral springs is at least very expensive, if not, in many cases,,
altogether impracticable for invalids. It is true that spring-
water can be exported, but when long stored up, as it will
happen in most cases, it becomes liable to changes, whilst
even then, we have no other guaranty of having procured a
genuine article than its exhorbitant price, which often gives-
the only passport to a ready sale.

From certain allusions and lauditory recommendations, it
appears that many physicians even, but especially the laity,
believe that natural mineral waters, differ from artificial ones,
and are endowed with pecul/ia/r and mysterious properties and
effects ; for how often do we meet with newspaper advertise-
ments and physician's testimonials, in which they speak of
the great healing powers of " nature s oirn ■■■ . ' .ations" of
the " wonderful prescriptions of nature" etc. Permit me to
cite one example :

A Professor of Chemistry, in extolling the virtues of a
chalybeate spring, in Tennessee, writes thus : " The peculiar
an4 distinctive virtues of a mineral water, without long and
repeated trials of its effects on various forms of disease, can

1857. Ekjsi On, Mineral Water*. 463

only be predicated upon a knowledge of the separate and
combined properties of the ingredients retained in solution.
But even with this knowledge, the efficacy of such ' natural
combinations ' would generally be underrated. Medicines
in the form of powders, or concentrated solutions, will fre-
quently pass through the alimentary passages with only
partial absorption. Mineral waters are more easily introduced
into the blood vessels, thence to all the minute branches of the
secretory apparatus, and in this manner their ingredients may
be rendered eminently active, while the same remedy,
administered in another form, would be wholly inert. A
long course of observation, under the most favorable circum-
stances, by an eminent physician — Dr. Johnson — led to the
■conclusion that ' saline and aperient mineral waters, will pro-
duce ten times more effect than the identical materials artifi-
cially combined. A grain of iron as it exists in chalybeate
wTater is more tonic than twenty grains exhibited according
to the pharmacopoeia.' lie continues : ' therefore the peculiar
medicinal properties of a mineral water are due to the sub-
stances in solution, and especially if they possess such increased
energy of action, it is certainly a matter of no small importance
that an analysis should be furnished of any spring offered to the
public, in order that the invalid might form some judgment
of its adaptation to his ease, or the physician prescribe intel-
ligently for the particular wants of his patient."

Now I confess that from the tried laws of endosmosis, I can
not conceive of any good reason why saline constituents in
the form of mineral water should pass easier into the blood,
or circulation, than when given in common solution. Have
such mineral waters a different density from artificially com-
pounded solutions^ Or are the >alts. acids, etc.. when in
"natural" solution endowed with peculiar chemical and
physiological properties, differing from the same salts, and
acids prepared by chemists^ That solid remedial agents,
powders, etc., must he capable of solution, however employed —
internally or externally — in order t<» enter into the general
circulation, is an established tact ; the same is true of plants;
no solids pass into the organization of vegetables.

4:64: Erni On Mineral Waters. Oct-

But, for instance, is the iron in the chalybeate water, which
the Professor examined, different from the iron in the liquid
prepared by art ? Or, is not the carbonic acid identical in
both cases \ Do not the same molecular forces come into play
wherever chemical reactions take place, whether in nature
or our work-shops \ Or, are what we consider to be chemical
facts and the laws which control them — established by men
of science after laborious researches and close induction,
thereby questioning nature as to the proceedings in her great
laboratory — a mere fiction, instead of imperishable truth?

The assumption of Dr. Johnson that " saline and apperient
inliural water iciU produce ten times more effect than the
identical materials artificially combined" deserves to be re-
garded as a relic of by-gone ages, and indicates the fact that
imagination guided his experiments (if he made any), instead
of sober judgment.

This would, indeed, be a valuable suggestion to homoeopa-
thy, which, administering infinitessimal doses, arrived at the
conclusion that, as the quantity of substance decreases, its
power increases. Such investigators might possibly succeed
in an attempt to reveal, by means of the microscope, the po-
sition of the several atoms constituting a chemical compound,
or to trace and exhibit the animalculae to which some epi-
demics— as cholera, etc.. — have been ascribed !

Speaking of mineral waters, the mischievous help-mate,
" vital power y ' elsewhere so conveniently applied to cloak
ignorance, can not be available, however much it may have
been said that many of natures productions can not be man-
ufactured, for within a few years many minerals have been
produced by art ; and the only obstacle to complete success,
is a want of more powerful agencies in the production of heat
and pressure.

If there was not a greater analogy between our reasoning
and truth respecting inorganic nature, how could we ever
hope to obtain a harmonious conception of the constitu-
tion of organic bodies? Experience shows that only since

1857. Erni On Mineral Waters. 465

the laws and modes of the combinations of inorganic chemis-
try have been made our guides, a true insight into the
composition of those bodies which are formed under the
influence of the so-called " vital power" has been acquired.

I believe that perhaps, in the majority of cases, mineral
waters act simply as follows : When taken freely they stim-
ulate the appetite, as common cold water would — either in
the form of a drink or a bath — by withdrawing a certain
amount of heat from the body, the loss of which lias to be
made up. Allowing, however, that mineral waters in many
cases do act chemically, and in some, that their effects are
different from what we might anticipate, judging from their
analytical composition, may it not be attributable to an im-
perfect analysis, or an oversight, on the part of the chemist,
of certain constituents, as, for instance, bromine, iodine,
boracic acid, now so frequently traced?

Finally, in accounting for the marvellous benetit which
persons derive from certain hydropathic institutions, we
must not underrate the superior value of diet and exercise, as
means of cure, nor neglect the reciprocal action of the mind
on the body.

A southerner, for example, who has indulged in high living,
consumed much meat and fat, surrounded by a warm, humid
atmosphere — respiration being carried on languidly, combus-
tible matter accumulates in the blood in more than due
proportion, the liver is compelled to work beyond its powers
in secreting bile, in consequence of which hepatic disease
ensues — he visits Saratoga, and is cured ; now, was it the
mineral water that produced the curative effect? or was it not
rather the change of climate, moderate exercise, a proper
regimen, escaping from the monotonous home-eee&es and
luxurious indulgences of a southern life I

Knoxclllc, Tcnn., Sept. 1857.

4:66 Merrett On Scrofulous Bubo. Oct

Article IV. Scrofulous Bubo. By A. G. Merrett, M. D.

"Facta non Verba."

The following case which came under my care during nay
recent passage from London to New York, will illustrate the
importance of inquiring into the cause of a bubo, when an
unfortunate presents himself with an enlarged condition of
the inguinal glands.

I. Price, mariner at 28, married, fair, with every indication
of a scrofulous diathesis, complained of a swelling in the
groin which disabled him from walking. On examining the
part, I discovered two very respectable enlargements, say
three inches long, one above and the other below Ponpart's
ligament, oblong in shape, of tolerable and uniform density,
not very tender on pressure, skin quite natural. The patient
declared he had. never suffered from lues or gonorrhoea. I
inquired if the cevrical glands had ever been similarly affect-
ed, to which he replied in the negative, but stated that the
axillary glands had some time previously inflamed and
suppurated. Upon viewing the axilla, I observed a small
valvular flap of integument, under which I indulged the
curiosity of passing a probe. The instrument (exploratory
genius !) found its way to that point of the integument below
the clavicle where the pectoralis major and deltoid enjoy an
identity of origin, where, also, a fistulous outlet had evidently
existed at some prior date. From the outlet of the sinus in
the axilla, a trifling amount of puruloid fluid still occasionally
oozed.

Now, no sooner did I thus perceive the true nature of the
bubo, than the difficulty of treating the case successfully, at
once occurred to me, for the preparations of iodine are gen-
erally unheard-of luxuries on board ship, as also anti-scrofu-
lous diet ; and I have long since been convinced that all
attempts to discuss such tumors are equally futile with our best
efforts to excite a successful (complete) destructive suppura-
tion by local measures, when unaided with appropriate
constitutional treatment.

1857. Merrbtt On Scrofulous Bubo. 467

However, from the limited armamentarium at my disposal,
I selected as a discutient, the lin. amnion, fort, which was
directed to be used assiduously. A smart purge was admin-
istered, total quietude enjoined, and the pot. nitr. used as an
ureal eliminative. These measures failing, after several days
use, to arouse the absorbents, I endeavored to prove the
vaunted pyogenetic powers of repeated hot poultices. Here,
again, I was baffled, but not surprised — no appreciable alter-
ation in density occurred. The idea then suggested itself to
me that some artistic and vigorous daubs with a pencil of
argent i nitras might excite an inflammatory action in the
integument which would involve the structures beneath. To
my delight, the patient complained of increasing pain from
day to clay, while the part began to present indications of a
respectable phlogosis, as the ancients termed it. In the
course of a week, by flexing the thigh upon the trunk, and
thus lessening the tension of the fasia lata, the tactus eruditus
became sensible of fluctuation. I then hoped by opening up
the abscesses to the influence of the air. and awakening their
chronic ideas, by the aid of a pledget of lint, that complete
disintegration of the gland- could be effected while yet suffi-
cient inflammation continued to erect a barrier of plastic
material around the degenerating mass.*

However, the patient declined my polite overtures, on the
ground that he had heard of "cords having been divided "

(qurev the spermatic cord ?) I therefore left him to his fate,
with the comforting assurance that tin; pus would surely
burrow, and not only undermine his abdominal and lumbar
muscles, but his constitution also. A few days then elapsed,
when I was informed that he was inclined to assent to my
sanguinary proposals. At that time I found that all action
had subsided, the area of fluctuation being surrounded by a

* Notk. — I have seen two cases of scrofulous ulcers whose fistulous edges and spreading
disposition have strongly impressed my mind with the importance of this induction — one in
India, in which the anatomy of the neck was spontaneously demonstrated, in the second, in
Panama, which exposed the injured region as clearly — beth the size of a saucer. True, an
abscess mvzt be opened, but when of m scrofaloos nature, the Imperative Deed ef constitutional
treatment should be borne in niin.l.

468 Merrett On Scrofulous Bubo. Oct.

dense wall of deposit, I accordingly fulfilled the indication
by the aid of a stout scalpel ; (tickling a bubo with a lancet
ought to be brought within the meaning of the act for the
prevention of cruelty to animals). A dossil of lint was then
inserted into each cavity, and simple water dressing applied.
As might be expected, the relief afforded was only temporary.
Pressure was tried, which failed to produce adhesion of the
walls on the one hand, or suppurative inflammation on the
other. The inclination remained, but will, we trust, be
speedily removed under the influence of the following pre-
scription.

R Potassii lodidi,

Tinct, Iiyoscy,

Tinct. Iodine, aa. dr. j.

Aqua Distillat. oz. xij.
Cuius capiat cochl. ij magna ter die.

To correct the anaemic condition resulting mainly from
confinement in a dark forecastle, I directed him to take pil.
ferri comp. gr. v. cum singulo dosi mistime ; and an aperient,
pro re nata

The occurrence of other surgical complaints in the site of
the inguinal glands, to wit : venereal and gonorrhoea!! bubo
render a diferential diagnosis necessary, to say nothing of an
arrest of the descent of one or both testicles, which I have
actually once seen treatetl, in Michigan, with tr. iodine for
a glandular enlargement (I beg pardon, the testicle is a gland);
but my chief object in recording the case (which has nothing
very singular about it) is to add my mite in establishing the
general law of surgical pathology, which states that in pro-
portion as the materials (elements) of a morbid growth are
heterologous in their nature, the greater the absurdity of
efforts at discussion. In this point the profession ought to be
quite clear and decided, for if true, it robs the charlatan of
his most favorite appeal to the ignorance and credulity of
patients.

The late expose of the cancer ward quackery at the Mid-
dlesex Hospital, however mortifying to those in authority, has
done good after all, and although it is true, the plan of Dr.
Fell was enucleation by escharotics, it is in principle the same
species of humbuggery with " discussion."

1857. Gunn's Selections from Surgical Notes. 469

Article V. Selections from Surgical Notes — Abscess of pos-
terior chamber of Fascia Lumborum. By Prof. Gunn.
In order to fully appreciate the peculiarities of this form of
abscess, it will he necessary for the reader to recall the anat-
omy of the posterior abdominal fascia, or fascia lumborum.
It will be remembered that this structure is composed of three
layers, the anterior of which, is attached to the anterior sur-
faces of the roots of the transverse processes of the lumbar ver-
tebra?, the middle, to the tips of the same processes, and the
posterior, to tips of the spinous processes. All three of these
layers become blended at the outer borders of the sacro-lum-
balis and quadratus-lumborum muscles, so as to form two
chambers, which constitute respectively the sheaths of these
muscles. Between the anterior and middle layers we have
quadratus-lumborum, and between the middle and posterior
layers, the mass of the sacro-lumbalis, and longissimus-dorsi
muscles. The middle and posterior layers, which constitute
the sheath of sacro-lumbalis and longissimus-dorsi muscles,
are very dense and strong. They are attached to the illiac
crest below, and to the ribs above, the posterior layer extend-
ing high up the back and over-laying the longissimus-dorsi
muscle. It will thus be seen that the posterior chamber is
co-extensive with the length and breadth of the muscular
mass, composed of the two above named muscles, for which

it constitutes a sheath.
An abscess occurring within this sheath, will naturally

present peculiarities, occasioned by the shape of the chamber,
distance from the surface, and the unyielding nature of the
tissue which forms its walls. These peculiarities consist
mainly in the absence of those physical signs which usually
indicate an abscess. Bound down by the posterior layer of
the fascia, there is but little swelling — a mere fullness of the
region, which, perhaps can only be seen by comparing the
two sides. Fluctuation will be very obscure in the early
stages, from the depth and small amount of pus; and in the
later stages, from over distention of the sheath which consti-
tutes the walls of the abscess. Diagnosis must be based, first,

470 Gunn's Selections from Surgical Notes. Oct

upon those constitutional symptoms which indicate the sup-
purative process ; and second, upon physical signs, modified
as above described.

Case I. The subject of this case was a middle aged medi-
cal man, engaged in an active country practice. He expe-
rienced on the 20th of Dec. 1850, while riding, pain in the
left side, but did not give up to it, till five days later, when
there was severe pain, refered to a point on the left side,
about midway between the umbilicus and the anterior sup-
superior spinous process of the illium, accompanied by deci-
ded febrile action. At a later period, the pain was refered to
the lumbar region of the same side. I visited him during the
first week in the February following, and found much emaci-
ation, rapid and feeble pulse (120), temperature of surface
variable, and dyspnoea in the recumbent posture. I learned
that with subsidence of the more active stages of the febrile
action, there had been rigors, which fact led me to suspect
suppurative action. On examination of the side and back, I
found a fullness of the lumbar region without discoloration of
skin. There was obscure fluctuation, but so obscure that I did
not make a 'positive diagnosis, though I expressed a belief
that there was purulent accumulation in the sheath of the
sacro-lumbalis muscle,and volunteered to introduce a bistoury.
My friend declined, and I did not see him again during his
sickness. In the course of four weeks, however, the nature of
the disease became apparent, and the abscess was opened about
two inches from the spinous row, and on a level with the
twelfth rib. It discharged freely for a few days and then
healed and has never troubled the patient since, though en-
gaged in the arduous duties of a country practice.

Case II. This case occurred in the person of a young Can-
adian of healthy appearance and good habits, having, from
the chronic nature of the abscess, never suffered from violent
constitutional disturbance. A lameness amounting to disa-
bility, attended by a slowly increasing fullness of the lumbar
region upon one side, had troubled him for some months,
when on the 21st day of June 1855, lie presented himself to

1857. (tunn's Selections from {Surgical Notes. 471

mc. There was then a diffuse swelling extending from the
illiac crest up the back, overlaying the short ribs, and yield-
ing only obscure fluctuation. The skin was natural in appear-
ance. I introduced a bistoury and evacuated several ounces
of ill-conditioned pus. A perfect recovery followed.

Case III. This patient was under the care of the physician,
who was the subject of the first record, and to his politeness I
am indebted for the following notes of the case :

" Patient was a young German 22 years of age. I visited
him first on the 8th of May 1857, and found him in great
pain, apparently in the lower part of the left lung, or in the
region of the kidney, with great difficulty of breathing and
some cough, much fever and thirst, pulse 120, skin very dry
and parched, and tongue coated. I examined the j)atient ex-
ternally and found no perceptible enlargement or swelling,
and no tenderness on percussion. The history which I re-
ceived from the family, was, that he had been complaining
some four weeks, of symptoms similar to those above described,
only less severe. He had been attended most of the time by
a German Quack ; part of the time for pneumonia, and part
of the time for something else, until he had concluded that he
did not know what was the matter with his patient, and had
given him up to die."

" I did not arrive at a clear diagnosis at first, but prescribed
veratrum veride in full doses, with laxatives. I visited him
daily and found that the veratrum in safe doses, would not
reduce the pulse much below 100. Ten days subsequent to
my first visit, I detected slight swelling and tenderness in the
side and near the back, and diagnosed incipient abscess ; con-
tinued cautious treatment, without much medication, until
May 21st, when I cut very deep, (one and one half inches) for
the abscess. The incision was made on a level with the last
rib, about two inches from the spine, and from it thick pus
was discharged for some days, after which it healed soundly
without further trouble."

87 Shelby Street.

4:7*2 Bibliographical Record. Oct.

tiibliograplntal iletort.

Principles of Medici ■: — an Elementary view of the causes, nature, treatment, diag-
nosis and prognosis of Disease. With brief remarks on Hygienics or the preserva-
tion of Health. By Charles J. B. "Williams, M. D.. F. R. S. A new Ameri-
can edition. Philadelphia : Blaxchard ft Lea. 1S57.

We regard the work, before us, as admirably adapted to sustain
the '; attempt" of the author t; to place, the practice of medicine on a
footing, somewhat corresponding with that of Philosophy, Chemistry
and other sciences, which equally depend on the accurate observation
and rational arrangement of facts."

Basing his reasonings upon extended and accurate knowledge of
the actions and relations of the living economy in health, he finds
himself guided to an intelligible construction and explanation of the
changes, both structural and functional, which are induced by disease ;
hence, medicine, as a science, is analytically studied and illustrated.

Principles, that are fundamental, are deduced from anatomical and
physiological knowledge of structure and function, as also, from an
intimate acquaintance with the causes of disease, as well as with the
agents, which the wisdom of learning and experience make available
in its removal.

These principles are sought and ultimately attained through an
.enlarged ': generalization of facts, observed in an extensive study of
disease itself," and, as exemplified in i; effects, manifested in the liv-
ing, or in the dead body.'"

But a synthetical method of teaching is pursued, not less earnestly
than the analytical ; hence, the causes of disease are studied and dis-
played in their complex operations upon the organism, and finally,
in the ultimate changes wrought in function and structure — all which
grouped, in accordance with natural relations, " constitutes the elemen-
tary forms of disease.'' Thus, it will be observed that etiology, or
the study of the ea uses of disease, very properly precedes and intro-
duces to the reader, all, of whatever character, which relates to, consi-
ders and illustrates their effects. In a word, the consideration of
" disease itself," whose ;; nature and constitution" thus investigated
and developed, composes the department of medical science -which is
known as u Pathology proper" To this department, the work is

1857. Principles of Medid/iu. 473

chiefly devoted. Other departments, however, are subordinately
considered.

Among these, " such an elementary view of principles, applicable
to the treatment of disease — technically denominated General Thera-
peutics— is introduced," as "reason and experience" have supplied.

The general phenomena of diseased action as manifest to the
senses, are studied in the same analytical way and with due regard
to clearly defined logical deduction. This constitutes semiology.

But to make the work more complete in itself, it was necessary to
treat, to some extent, at least, of the division and classification of dis-
eases—their relations and affinities as exemplified, not only in their
symptoms and physiognomy, but in the destructiveness wrought in
the tissues, and in the incident modifications or suspension of func-
tion. Herein, is Nosology.

Nor was it less imperative to trace, mark- out, and explain those
distinctive characteristics by which diseases are recognized and known-
This is Diagnosis, than which, perhaps, no department of the science
of medicine requires more laborious study.

And yet the work would be incomplete ; it would be partial and
unsatisfactory without a compendious notice of the characteristics
and signs, both individually and in the aggregate, by which the re-
sults or the termination of diseases may with a good degree of prob-
ability be foretold. Here is Prognosis, — a branch of our science
which involves no meager knowledge, not only of normal anatomy
and physiology, but of the anormal condition of each, and compre-
hensive and definite views in regard to which, are intimately related,
both to the reputation and personal comfort of the Physician, and to
the hopes and happiness, not less than the fears and poignant affliction
of those who confide in him.

It was necessary also, to consider to some extent, the rational
means of preventing diseases, in order to the construction of a gen-
eral system of scientific medicine, founded as the one under notice is,
on sound anatomical and physiological knowledge.

In this department of the work, the reader will find an intelligent
and satisfactory elucidation of Prophylaxis and its principal doc-
trines.

Finally, to finish the work, and, as intimately allied to the last
mentioned branch, Dr. Williams has treated his readers to an essay
on the " means, by which the structures and functions of the body

474 Bibliographical Reord. Oct.

may 'be kept in that normal state, which conduces to their continued
welfare.*'

This includes the principles and doctrines of Hygienics, a portion
of medical science of vast utility to the successful practice of medi-
cine and immensely important to the political economist.

We say important to the political economist — it is so; since it in-
volves and strictly speaking, elucidates, confirms, and establishes or
controverts and corrects all those doctrines and principles on which
are based, both the past and present practices of quarantine. In
short, everything that relates to the public health, not less than what
the medical practitioner may consider and apply in reference to indi-
vidual cases.

Thus, it will be perceived that a beautiful superstructure is reared
upon the most substantial basis, that of anatomy and physiology.

Again, it will be observed that whilst the author has appropriated
the treasures of his own large experience, both in private and hospital
practice, extending now over a period of more than thirty years, to
the elucidation of "the bearings of physiology and pathology onjyrac-
tical I medicine"' he lias not in a pharisaical spirit, hesitated to lay un-
der contribution, the labors of others, both predecessors and cotem-
poraries, who have been engaged in kindred investigations.

Hence, it will be found that in the exercise of a desire " to avoid
perplexing the reader with much discussion or detail, doubtful facts
and a variety of conflicting opinions have been withheld," whilst those
" facts only" which are " best ascertained and the views which seem
most tenable have been given."

In the preface to the first American edition, it was observed that
4i a work on General Pathology supplies a want in English medical
literature."

The truth of this postulate, it is believed, will be readily conceded
when the actual state of medical science is fully considered. True,
many works are extant as the " Elements de Pathologie Generale
of Chomel ; the General Pathology of Stille," and the Pathological
Anatomy of Horner, to which we would not forget to add the Morbid
Anatomy of Baillie, all of which must be regarded as valuable con-
tributions to professional literature.

So, likewise, the more recent productions of Rokitansky, Jones
and Seiveking and that of our distinguished countryman, Dr. S. D.
Gross, with others, scarcely less meritorious, are invaluable.

1857. Miller's Practice of Surgery. 475

But between these or any of them and Dr. Williams' treatise, the
reader will recognize a striking difference Whilst they generally
display with the marked accuracy, the anatomical character of diseases
as exemplified in their influences, both on the fluids and the solids of
the body, and of morbid products ; and whilst they institute ingeni-
ous and often satisfactory explanations of the numerous changes,
wrought by diseased action, they do not, nevertheless, so connect the
facts, derived from pathological research with the laws and principles
of therapeutics as to enable the practitioner to perceive, with tolera-
ble clearness of vision, the relation of cause to effect, both in regard
to the production and the cure of disease.

Indeed, it is this essential feature, rendering them eminently and
" intelligibly practicable" which distinguishes the labors of Dr. Wil-
liams from those above referred to, and in virtue of which, they
truly u supply a want in English medical literature." The Princi-
ples of Medicine have been in the hands of the Professional public,
since 1843, and during that period no less than three English edi-
tions have been exhausted, whilst the one under notice, is the fifth
that has been called for on this side of the Atlantic.

We need not dwell on the special merits of the production. To
those who have made themselves familiar with its contents, it is un-
necessary ; to such as have not, it is sufficient to say, by way of ad-
vice, procure it, study it and profit by it. K.

For sale by Raymond & Selleck, of this city.

The Practice of Surgtry. By James Miller, F. R. S., F. R. C. S. E.. Surgeon in
Ordinary to the Queen for Scotland, etc., etc. Revised by the American Editor.
Fourth American, from the last Edinburg Edition. Illustrated by Three
Hundred and Sixty-Four Engravings on Wood. Philadelphia : Blanchard
& Lea.

Miller's Practice of Surgery, which is really but a second volume
to a complete system of surgery, the first volume comprising Miller's
Principles, we have regarded as one of the best standard works of
this department of medicine; and we are glad that the demand for it.
calls for the fourth edition. Of the work we can only speak in terms
of commendation ; and of the way in which the American Editor
has discharged his duty as a whole, we would also express approba-
tion. American contributions and practices have been, generally,
fairly incorporated — but one exception to this rule seems to claim a
passing notice.

VOL III, no. lx. — 20.

476 Bibliographical Record. Oct.

In addition to the subject of fracture of the clavicle, we have
figured, Fox's apparatus, and also, that of Levis, of Philadelphia ;
and the editor says : " Some excellent forms of apparatus have re-
cently been described and recommended by Dr. Frank H. Hamilton,
in his able and instructive paper on deformity after fracture of the
clavicle, in the transactions of the Am. Med. Assoc, Vol. 8, 1856.
They may be regarded as modifications of the plan of Dr. Fox ; but
one of the most convenient as well as neatest improvements,
appears to be the ingenious and simple contrivance of Dr. R. J. Levis,
of Philadelphia, which is here represented," etc. Now this M ingenious
and simple contrivance " is certainly nothing more than a modification
of Fox's apparatus ; the principle is identical, and the mode of its
application is but slightly modified. A little partial we opine. The
most effectual, and tolerable to the patient, of all apparatus, is
entirely ignored. We mean the neck yoke. There is no difficulty
in treating fractures of the clavicle if the patient will but lie flat upon
his back till union has taken place ; but this they will not do, and the
great objection to most apparatus designed to keep the clavicular
fragments in place, lies in its intolerable irksomeness. The neck-
yoke well applied, is entirely free from this objection, and is more
efficient than any other means yet employed. It is certainly not un-
known, for it is extensively manufactured and sold by at least two
splint makers. Why has our editor ignored it 1

We repeat our expressions of commendation of the work, and of
the general manner in which editorial duty has been discharged.

To be found at the House of Raymond & Selleck, in this city.

A Practical Treatise on Foreign Bodies in the Air Passages. By S. D. Gross, M.
D., Professor of Surgery in the University of Louisville, etc., with Illustrations.
Philadelphia : Blanchard & Lea

The class of books, to which this work belongs, is but too limited.
Men investigate more thoroughly, and write more clearly upon sub-
jects, in which they have become deeply interested, than when
producing a systematic treatise upon some general department of
medicine. Hence monographs possess more clearness, precision, and
completeness, and are entitled to more deference, and will command
more obedience, than any other class of works. And all this, is
simply because concentration of force upon a single point, is more
effective, than when the same power is more widely diffused. It is
a good sign to see a library rich in monographs.

1857. Spirit of the Medical Press. 477

The work under consideration is an octavo volume of four hundred
and sixty pages, comprising seventeen chapters, each devoted to a
special division of the general subject. The nature of foreign bodies
liable to introduction, the effects produced — immediate and remote,
symptoms, diagnosis, prognosis, treatment — medical and surgical, and
the difficulties attendant upon the Operation, together with the topo-
graphical anatomy, are all minutely considered ; and when we reflect
that this is the first extensive monograph upon this subject ever
published, we have reason to be thankful to its author.

We cannot devote the requisite space to an extended notice, but
while we commend the work as a whole, we designate as possessing
peculiar interest, all that portion which pertains to the surgical treat-
ment proper. There is, perhaps, no operation which is more dreaded
than tracheotomy. The class of patients who require it, the gravity
of the cause which demands it, together with the uncertainty of
vascular distribution, all conspire to make the operation one of the
most vexatious, in the whole range of operative surgery. A treatise
which fully considers these difficulties, and instructs how best to
meet them, is necessarily one welcome to the surgeon. Such is the
character of that portion of the work to which we now refer.

The chapters devoted to laryngotomy, tracheotomy, and laryngo-
tracheotomy are all enriched by the detail of illustrative cases, which
give additional interest to this portion of the book. Gj

For sale at the House of Raymond & Selleck.

pint 0f tfo lltol |to$$.

Vaccination. — By L. A. Smith, M. D., Newark, N. J. — I have recently
looked over the proceedings of the late meeting of the Medical Society of
New Jersey, and the interesting address of the President on re- vaccination,
and have amused myself in jotting down my own experience, which I send
you.

I was vaccinated in 1810, and had a moderately sore arm, from which
matter was taken to vaccinate others. My first exposure to small pox was,
as far as I know, about twelve years after, when I had commenced the
practice of medicine, and from this I escaped. At that time I vaccinated
my first child, and re-vaccinated my wife and myself. With me the virus

478 Medical Independent. Oct.

took but little effect, and soon passed off. My wife had a pustule not
unlike other vaccine pustules at first, but more readily forming a scab,
which was gradually enlarged to the size of a shilling, and was a long time
in healing. This effect I have often noticed since, in other patients, She
was vaccinated when an infant, in the year 1802, by the late Dr. Abram
Clark, of this city, and, I have heard the doctor say, was the first person
vaccinated in this State ; and that he obtained the virus from Dr. Benj.
Waterhouse, of Cambridge. My child, vaccinated at the same time with
myself and wife, had the kine-pock perfectly, as did several other children,
proving the purity of the virus. Two years afterward, having occasion to
vaccinate my second child, I re-vaccinated all the members of my family.
The infant took the disease and passed regularly through it. All the rest
of us escaped with a slight local inflammation for a few days, I pursued
this course in my family at intervals of two to four years, till all of my
children, six in number, had passed the ordeal, and all, in my opinion,
were secure against small-pox. Some of them had small pustules, and in
one instance a bad sore, which was long in healing. To prove that the
taccination has not worn out, I have only to state, that T am very
frequently attending small-pox, and that my son, the second in the list
above mentioned, has been seven years in the practice of medicine, and
has been often exposed to small-pox in its most virulent form, among the
poor of the city, as AVard Physician, and we have both escaped.

That vaccination disarms small-pox of its virulence, reducing it to the
mildest form of varioloid, even after the contagion is in the system, has
been verified in my experience in no less than four instances. In all of
them, I knew the patients must have been thus exposed for some days, one
six, and by vaccination they all passed safely through the disease with but
little fever and short confinement, and fewer pustules than I have ever seen
in any other case of varioloid.

From my experience thus stated, in part, I have formed the following
opinions : —

1st. That a perfect vaccination affords a perfect protection from small-
pox, during life, and that if this be done in all instances soon after birth,
small-pox may be eradicated,, as Dr. Jenner supposed it would be.

2d. That in many subjects one vaccination is sufficient to eradicate the
susceptibility to the small-pox, while in others two and sometimes more are
required, and therefore it is important to re-vaccinate as long as an impres-
sion can be made. This in families can be done, as it was in my own, as
new members are added to their number.

3d. The vaccination will protect the life, and greatly mitigate the distress
of a patient who has already taken the small pox, if done in time to allow
the first disease to pervade the system.

4th. That the common idea that the sorer the arm, from vaccination, the

1857. Spirit of the Medical Press. 47&

better the protection, is a mistake, and that a very small pustule which
goes through the regular stages and produces a constitutional effect about
the ninth day, is more generally perfect than one that produces great
inflammation, pain and swelling of the limb, and affecting the glands.
Indeed, I am always suspicious of a case where this has occurred, and takfc
an early opportunity to re-vaccinate, and have often had my suspicions
verified by a good pustule.

5th. That the virus should always be taken before the areola forms, if
taken from the pustule, and with great caution, as it does, in some instan*
ces, interfere with its progress. My own practice has been to save thfc
scab and insert it in a pulverized form, by means of Fancher's Vaccinator
which is a very convenient instrument, and saves much time, and never
produces unnecessary inflammation.

6th. That the virus should never be taken from any but healthy infants
of healthy parents, and then there is little danger of propagating any other
disease, as many think may be and often is done.

7th. That eruptions often occur after the most careful vaccination, and
are owing to some peculiar idiosyncrasy, although the friends of the
patient believe that it was owing to the virus. Hence the importance of
the last rule, which may save the physician from blame.

8th. That a small scar, with pits or indentations around its border, is ft
much better evidence of the perfectness of vaccination, than a large,
smooth and glossy one, though many think that the bigger the scar the
better the vaccination.

9th. In re-vaccinating a patient who has a good scar, if the matter pro-
duce inflammation and itching for a few days and then dry up, I infer that
the first vaccination was perfect. If it do not produce any other effect
than is common to a slightly abraided surface, I infer that the virus is not
good, and immediately make another attempt with a new supply.

I could illustrate all these opinions, by reference to cases under my own
experience of 36 years, were it worth my while to write, or yours to print
them. In this time I have vaccinated many thousands, and have been &
careful and interested observer, and have yet to hear of the first instance
of any case of varioloid or small-pox in a person vaccinated by me satis-
factorily, except the four already mentioned ; and if these crude thoughts
assist any of the junior members of the profession in their search after tht
better way, I shall be more than satisfied. — Med. and Surg. Reporter.

480 Medical Independent. Oct

[Translated for the Boston Medical and Surgical Journal from the Gazette des MospitauxJ]

Chlorate of Potash in Pseudo-Membranous Angina and Croup. — Every
day supplies us with new examples of the efficacy of the chlorate of potash
in pseudo-membranous affections of the mouth. Dr. Garassa, of Calais,
informs us that since the month of November, 1856, he has had occasion
several times to employ this medicine, and that in two of the most grave
diseases of this description, pseudo-membranous angina and croup, he has
obtained the most satisfactory results ; out of twelve cases, he writes us,
he has had twelve cures.

The Calais physician has, moreover, ascertained, as was announced by
M. Isambert in his monograph on this subject, that the chlorate of potash
is perfectly harmless in its effects on the digestive organs. Taken in the
dose of from fifteen grains to five drachms, it produced no disturbance, as
he observed in experimenting upon himself. After taking five drachms of
the salt in twenty-four hours, the only phenomena which he experienced
were a tolerably adundant salivation, and a strong saltish taste. Young
patients to whom he gave it, took as much as from three to four drachms
daily, and in two instances only he observed it to cause vomiting of brief
duration. In another case the catamenia were suddenly suppressed in a
young girl of sixteen years ; she had taken two and a half drachms of
chlorate of potash for some patches of false membrane on the tonsils and
anterior surface of the soft palate. The chlorate of potash was always
given in solution with sweetened barley-water, in the proportion of from
one to two drachms of the salt to twelve or sixteen ounces of the vehicle ;
this was taken without repugnance by the children, and as much of it as
they would take was given them during the first twenty-four hours of the
disease.

The doses prescribed were from two to four drachms daily for subjects
between the ages of eight and twelve ; from one and a half to two and a
half drachms for those between three and eight years ; the quantity of the
salt being gradually reduced to one drachm daily. Each patient averaged
between five and seven and a half drachms of the chlorate during the
course of the disease. The cure was complete from the twelfth to the
fifteenth day. The false membranes were detached generally in twenty-
four or thirty -six hours ; the fever then diminished, and the respiration
became more free. Emetics were then given, which, by the mechanical
action of the vomiting, appeared to aid materially the separation and
expulsion of the lymph.

In the twelve cases treated by M. Garasse, cauterization with the nitrate
of silver was only employed once ; this agent appearing to counteract the
operation of the chlorate. So long as the false membranes were visible,
the medicine was continued, and was not omitted until they had completely
disappeared. Insufflations of calcined alum were then ordered, as an appli-
cation to the bright red patches which were to be seen in the places

1857. Spirit of the Medical Press. 481

occupied by the false membranes. One or two foot-baths, with mustard,
were ordered daily, and one patient had sinapisms applied to the legs. It
has been remarked that the chlorate of potash seemed to dissolve the false
membranes. M. Garasse has not observed this fact ; it has always
appeared to him that they preserved the same thickness which they had at
the time when the treatment was begun.

The following observation is offered as a specimen of those which have
been transmitted to us by I«f. Garasse.

Achille L., aged 11 years, of a miserable constitution, having a luxation
of the left thigh of long standing, with caries and abscess, was attacked,
March 2d, 1857, with pseudo-membranous angina. There was intense
fever, pulse at 140, the cervical glands were swollen, respiration difficult,
deglutition almost impossible, the soft palate, tonsils, anterior pillars,
and cavity of the pharynx, were covered with a thick layer of false mem-
brane. There was occasional cough, but no symptoms referrible to the
larynx or bronchi.

Treatment. — Three drachms of chlorate of potash in barley-water
sweetened with honey, to be drunk as freely as possible. In the evening,
the child was in the same condition.

On the 3d, the pulse was at 120 ; cervical glands still swollen ; respration
rather more easy ; the membranes still remain. Chlorate of potash,
drachms ijss. in twelve ounces of vehicle.

4th — During the night the child spit out several membranous strips.
The false membranes are separating; pulse 100; cervical glands less
swollen and less painful ; respiration easy. Chlorate of potash, oz. iss.;
sweetened barle}7 -water, oz. x.

oth — Evident improvement ; pulse 100. The soft palate, left tonsil and
a part of the pharynx are free from lymph. Chlorate of potash, oz. i., to
barley-water, oz. x.

6th. — Respiration normal ; pulse 80 ; the false membranes have disap-
peared, the parts which they covered being of a bright red color. Gargle
of salution of alum, chicken broth, wine of quinine.

7th — The child asks for food ; pulse 70. Same treatment.

1 2th — Complete recovery.

We take this opportunity to call attention to a pharmaceutical prepara-
ration which If. Detham, apothecary, of Paris, has invented, to facilitate,
the administration of this medicine to children, It consists in combining
the chlorate of potash, in the proportion of one-fifth part, with sugar, and
making it into lozenges, according to the following formula : — sugar, in
powder, 800 parts ; chlorate of potash, 200 parts ; gum tragacanth, aro-
matic water, aa q. s. Having made these ingredients into a homogenous
mass, it is to be divided into lozenges of about ten grains, each containing
three or four grains of the salt. We think this preparation will be found
useful. — Boston Med. and Surg. Journal.

482 Medical Independent Oct.

VERITAS ET JCSTITU, SlSK TIMORK.

The Clinical Course in the University. — The clinical course
in the University, established by the Regents at their Spring meeting,
commenced on the twenty-sixth of June, and closed on the twenty-
seventh of August: consequently, it had a duration of two months.
The number of students in attendance was nine. Of these, seven
remained through the whole two months — one. a graduate, left at the
end of the first month; and one. a novice, was admitted at the
middle of the term.

In our August number \w gave expression to the belief that a de-
sire to pursue the most pacific course, had led the Regents to adopt
a plan, utterly inadequate to the demands of the profession, the age.
and the absolute wants of the Medical Department. The above
statement of the number who availed themselves of the advantages
offered, and of the time devoted to this important branch of instruc-
tion, fully substantiates the position which we then assumed ; and we
propose now to consider, somewhat in detail, the demands and the
wants to which we then alluded, leaving the reader to compare
therewith, the facilities afforded by the clinical course in the Univer-
sity, which has lately closed. In doing this, we disclaim all intention
to reflect upon, either the Board of Regents, or the Professors, who
officiated in carrying out the plan adopted On the. contrary, we
would rather become the advocate of both. The Board of Regents,
though deeply anxious to supply an acknowledged want, upon the
eve of retirement, would hardly desire to take so important a step,
as the only alternative to the plan adopted, presented ; and the failure
of the course, resulted from an utter inadequateness of the plan, and
not from any fault of the gentlemen engaged in conducting it. Our
desire is to extend the benefits, and increase the usefulness of the
University. Our dearest aspirations are entwined with its interests
and prosperity, and we would advocate no plan, that we did not know
would redound to the increase of both.

The wants of the student call for the means of observing the phe-
nomena of disease, and the application of remedial measures, before
he passes from under the supervision of his instructors, and the
demands of professional sentiment are, that these means shall be

1857. Editm^ial and MisceUany. 483

supplied. Human life is the trust, and no one is fitted to receive
xty till he. has become familiar with the phenomena it presents in its
varied conditions of health and disease. For the acquirement of this
familiarity, time, and opportunity for observation are required. We
have before said that the Hospitals of this country did not realize
the full degree of benefit of which they are capable ; and we now
express the conviction that they never will afford such realization,
until thorough (both as to time and mode) clinical instruction becomes
a requisite for graduation. The time devoted to this branch of
instruction should be, not less than one year. The three principal
branches of practical medicine should be fully represented, viz:
surgery, practical medicine, and obstetrics.

A hospital can accommodate, for purposes of clinical instruction,
without detriment to the patients, as many students as its average
number of inmates : for instance, an institution with an average
number of one hundred patients, can afford thorough, practical
instruction for one hundred students. All this, too, without noise,
confusion, or injury to the sick. Furthermore, this number can be
better instructed than the few now are, by the commonly practiced
plan. No bed should be surrounded by more than four students;
and thus, each of these four would have ample opportunity for care-
ful observation. No student thould be permitted to study, to exceed
four cases of disease at a time ; these he should study thoroughly,
with note book in hand, and be required to investigate authorities on
the particular diseases under observation.

The working of a plan thus systematized, would be exceedingly
simple. As the physician enters a ward, the students would also
quietly enter, and each betake himself to the bed of the patient,
whose case he is first to examine. As the physician approaches a
bed, accompanied by the house physician, the four students would
have already preceded him — and now, it will be seen, that six persons
only surround the bed. Attention being called to the several points
of importance and interest, observation and record of these, and the
treatment adopted, are made by the students ; and as the physician
passes on to another bed, a portion of the four, present at the bedside
of the first patient, would change places also. Thus, without tumult
or confusion, all would have an opportunity, fully to investigate, each,
four wises of disease per diem. Time would thus, also, be afforded
for ample investigation of authorities, and eomparison with the

484 Medical Independent. Oct.

observations made at the bedside. In addition to this, attendance in
the operating theatre, and upon the examinations of, and prescriptions
for, out patients, conducted before the whole class, with attention to
post mortem examinations as opportunity offered, would complete the
curriculum of the hospital course, and afford the means of qualifying
students safely to assume the practical duties, as well as honors of
the doctorate.

In a previous number, we spoke of a division of labor in carrying
out a system of clinical instruction. Argument is unnecessary on
this point. It is a very compassable thing, to educate one's self up
to the practical point, in all the branches of medicine ; but it would
require Herculean strength and labor to qualify one for teaching a>
extensively. In division of labor there is a degree of efficiency,
attainable by no other means. Concentration vC effort begets strength,
and ensures accomplishment. Surgery, practice of medicine, and
obstetrics should all be represented, and each, by a devotee. Instruc-
tion would thus be earnest, forcible, and convincing.

We have said that attendance upon clinical instruction should be
one of the requisites for graduation. With the members of our
profession generally, we believe that this position will be readily
admitted to be correct. We do not allude to it, therefore, for argu-
ment sake, but with the view of applying it to the practical working
of the plan which we have sketched. About twenty-five per cent, of
a medical class, usually become candidates for graduation ; thus, in a
class of two hundred, fifty would, therefore, be compelled to enter
upon the hospital course. Add to this number, twenty-five per cent,
for those who would voluntarily avail themselves of the advantages
afforded by a two years clinical course, and we have sixty -three only,
out of a class of two hundred, who would require hospital accommo-
dations, a number very far short of the maximum capacity of even
a small hospital. By this sketch, will be seen the correctness of our
assertion in a previous number, that a tithe of the advantages to be
derived from medical charities, were not yet realized by the hospitals
of this country.

In medical schools properly located, i. e., in commercial cities, this
plan of thorough elementary and practical instruction, affording a
complete medical education, can be most fully realized ; and it is
needless to say, that its saving influence upon health and life, would

1857. Editorial and Miscellany. 485

be incalculable. Let thorough clinical training, then, become a
requisite for the Doctors degree ; and let not the University of
Michigan be backward in assuming this high toned and honorable
position. G„

Abolition of Fees. — The Trustees of the Medical Department of
the University of Iowa have abolished all Fees, save that of $10 for
matriculation, $5 for demonstration, and $30 for graduation.

This is the second free Medical Institution in the North- West.
We have always hoped and believed that such institutions would
accomplish great good. Our life has been devoted to free education*
We would that every State in the Union would make generous pro-
vision for the free education of her entire people.

Inquiry has been made of us, Whether finally the South-West
will not find it to her interest to make similar provisions 1 Whether
some Southern University, handsomely endowed, should not set the
Southern States (known to be slow in these matters) an example for
instance, first of free professional education ; Divinity, Law and
Medicine, and finally extend it to the Undergraduate Department.
We believe the scheme entirely practicable, and would esteem it
glory enough to devote the remainder of our life to the developing
of such a consummation. But the Trustees would have to yield all
power over the Medical Department except that which would enable
the Faculty to introduce men or measures not approved of by first
class Medical Colleges. And this the Trustees of the University of
Nashville did before we would agree to accept our present position
in it. — Nashville Journal of Med. and Surg.

There is a class of men, who always seem to be on the right side
of leading questions, and who speak out without fear, or being influ-
enced by associations or connections, which sometimes seem to warp
the judgment and control the actions of less independent men. Our
heart goes out towards such men — and such a man seems to be Dr.
Bowling. Zealous and outspoken, the above quotation is character-
istic of the man. A professor in the Medical Department of the
University of Nashville — a school pre-eminently successful, and
supporting its professors from ticket fees, — he " would esteem it
glory enough to devote the remainder of his life to developing " a

FREE SCHOOL.

As early as 1836, immediately upon coming into possession of
the land bestowed by the General Government, the Legislature of
Michigan framed and enacted the organic law of the University, pro-
viding for the organization of its several departments upon a free

486 Medical Independent. Oct.

basis. The College of Arts and Sciences went into full operation in
1841, and has yearly graduated classes to the present time. The
College of Medicine and Surgery was organized in 1849, and assem-
bled its first class (numbering 91) in October, 1850; and consid-
ering its country location, destitute of clinical advantages, its success
has been great. It leads, at present, country schools. To Michigan
then, is due the credit of acting the pioneer in a plan of free Univer-
sity education, the like of which the editor of the Nashville Journal,
a professor in an eminently-successful city school, would fain see
established in the University of Nashville. The University of Iowa
is the second on the list of free, schools. Success to ber, and to her
well-wishers. G.

Organship. — The Iowa Medical Journal, in a complimentary
notice of the Independent and the late changes in its editorial corps.

aays:

" But our wonder is, at the same time, slightly excited by this last
change, for it is somewhat notorious that the * Independent " has for a
considerable time been engaged in a sharp controversy with the
4 Peninsular Journal,'' the latter, the organ of the Faculty of the
University of Michigan, among whom Prof. Gunn occupies a place.
There has been not a little sharp shooting from both sides, and so far
as we could judge, the ' Independent " has never come out second best
We thought, upon seeing Prof. G.'s name upon the cover of the
''Independent! that resort had been had to the ordinary custom in
military practice — turning captured guns upon the enemy from whom
they were taken — and we opened the book rather expecting some
home shots. But we were mistaken, and found the gun had been
christened ' Peace Maker.' Henceforth, we opine, the war is ended :
but we do not know if we are hereafter to look upon both journals
as organs of the medical department of the Michigan University.'*

Whether we shall deserve the honorable title of " Peace Maker,'*
the future alone will determine. We engaged, with our editorial
colleague — the originator and proprietor of the " Independent " — in
Us management, uninfluenced by individuals or combinations, and
unknown to any save those immediately interested in the change.
There was no " diplomacy " on our part, and certainly none on the
part of the " Peninsular ;*" for to that journal, the change was
unknown, till fully consummated. A path of usefulness opened
itself before us, and we felt inclined to enter upon it.

With regard to " organship," the Medical Faculty of the Univpr-

1857. Editorial and Miscellany. 487

<sity of Michigan has possessed no organ — its wants have never
required such an instrument ; and whatever may have appeared like
*' organship" to that body, in any journal, was entirely gratitous and
assumed. The " Independent " is the organ of no school, faction, or
clique. We have no admiration for "organship," and cannot consent
to submit to its restricting influence. We edit an independent medi*
eal journal, and devote it to the cause of science and truth ; we know
of no higher mission in the whole range of our profession, and we
can consent to serve in none less elevated in its aim.

For the kind feelings expressed by our brethren of the Iowa
Journal, we are most grateful, and beg to assure them of a full
reciprocation. G.

Since writing the above, the Medical and Surgical Reporter has
come to hand, with its advice relative to the Detroit Medical Journals
and the University of Michigan. We refer its editor to the above,
for an answer. G.

Death 6* Marshall Hall. — Death, that most unsparing of
tyrants, has exacted from the greatest physiologist of the age, the
last debt of nature. Slowly, surely, and relentlessly, disease has
been undermining the earthly tabernacle of a mind which, for vast
powers, high purposes, and indomitable energy, has found no superior
in its native land for the last half century. On Thursday last,
August 11th, Dr. Marshall Hall died at Brighton, aged 67 years. It
is believed that his death was caused by exhaustion produced by a
stricture of the oesosphagus, of many years standing, accompanied,
latterly, according to the opinion of many eminent surgeons, with
malignant ulceration of the part* — London Lancet.

Why '? — Rhadamena palmata and Laminaria saccliarina, two species

of Algae, which are frequently used as food by the inhabitants of

Iceland, impregnate the body of each consumer with twro or throe

pounds of Iodine every year, nevertheless no Iodism appears, nor

ficrophulosis, or rhachitis either.

Sell midfs J "ah rbuecher.

Iodine Oil. — Ricord and Musset, in Paris, prescribe against
Bcrophulous bubo and periostitis, a solution of 50 centigrames iodine

488 Medical Independent Oct.

in 100 gram, olive oil, and give 20,-120 grm. per die. They consider
it more efficatious than oleum jecoris asselli. Ibid.

Spongia Fluviatilis. — Pulverized with vinegar and water as a
rubefacient, operates quickly and powerfully, mixed with oil cajeput
or turpentine, to be rubbed on the abdomen in cholera. If the pas-
sages are very frequent, add some tincture of opium. Against the
spasms, to be rubbed on the spine. If used in the first stages of

cholera, this disease is reported never to make progress. (?)

Ibid.

Phosphorus. — Phosphor, gr. ij., ol. terebinth, drachms iij., every
hour 15 drops in a mucilage, against intermittent fever of robust
persons of the lower classes, is recently considered a more reliable
remedy than quinine or Peruvian bark. Ibid.

Although already recommended by eminent physicians of the last
century in those cases of intermittent fevers, which always recur,
phosphorus became obsolete as an antiperiodic, and is used only in
paralysis, old rheumatic affections, in cases of neuralgia, and some-
times in typhus, but its great effect upon the ganglia and the cerebro-
spinal system, and its diaphoretic properties, entitle it to a fair trial.

We recommend it to the readers of the Medical Indepndent.

E. D.

Spasmus Glottidis has been cured many times in children by

R. Moschi

Acid, tannic, aa gr. 1-4. — ss.

M. F. pulv. Ibid.

Sugar Coated Preparations. — We invite the attention of the
readers of the Independent to the advertisement of F. A. Reichard on
the third page of the cover. The pills and granules which are there
advertized are completely enveloped by a sacharine coating, covering
entirely the taste of the medicine. The only objection to them,
which can possibly be suggested, is the resemblance of the granules
to homoeeopathic pellets. But the similarity ends with the physical
appearance, for the actual remedy contained within the coating will
be recognized by medical men as among the Sampsons of materia
medica. Messrs. Higby & Stearns dispense these medicines, and fill
wholesale orders.

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THE

MEDICAL INDEPENDENT:

A. MONTHLY

Review of Medicine and Surgery.

VOL. 3. DETROIT, NOVEMBER, 1857. NO. 9.

mini &Bmmmtm&.

Akticle 1. Mechanism of Nervous Action. By J. Adams
Allen, A. M., M. D., Formerly Professor of Therap., Mat.
Med. and Juris, in the Indiana Medical College ; and late
Professor of Physiology and Pathology, and acting Prof,
of Mat. Med. in the University of Michigan.

It is all-important, in our investigations of the nervous
system, to have exact and scientific ideas of the particular
points at issue. Neglect of this prime requisite, led the
enemies of Marshall Hall, through the British and Foreign
Medical Review and the Edinburgh Medical Journal, to
utterly confound the " mathematical " generalizations of that
great man — whose recent loss the whole medical world
deplores — with the loose speculations of Prochaska.

Prochaska ingeniously accounted for certain pathological
phenomena — coughing, sneezing, vomiting, &c. — by refer-
ence to reflex nervous action; but nowhere seperates the
movements thus produced, from those resulting from sensa-
tion and volition, and nowhere includes the great physiolog-
ical motions in his explanations.

Marshall Hall himself sums up his real objects as follows:

490 Allen On the Mechanism of Nervous Action. Nov.

" 1st, To separate the reflex actions from any movements
resulting from sensation and volition.

" 2nd. To trace these actions to an acknowledged sonrce
or principle of action in the animal economy, — the vis nerv-
osa of Haller — acting according to newly-discovered laws.

u 3rd. To limit these actions to the true spinal marrow,
with its appropriate incident and. reflex nerves, exclusively of
the cerebral and ganglionic systems.

" 4th. To apply the principle of action involved in these
facts to physiology — viz : to the physiology of all the acts of
exclusion, of ingestion, of retention and of expulsion, in the
animal frame.

"Finally, it is to these objects, taken as a whole or as a
system, that I prefer my claim ; and I do not pretend that an
occasional remark may not have been incidentally made by
some previous writer, bearing upon some one or more of
them."

Tims far, until the recent announcement of the excito-
secretory system, went Marshall Hall, and n<> farther. An
advance upon the doctrine of the %i true spinal " system, was
made by Todd and Bowman (vide Physiol. Auat., p. 288,
American edition), and is thus announced:

" It lb assumed that all spinal and encephalic nerves, of
whatever function, are implanted in the gray matter of the
segments of the cerebro-spinal centre, with which they are
severally connected, and do not pass beyond them. The
segments are connected with each other through the contin-.
uity of the gray matter from one to another, and through the
medium of commisural fibres which pass between them.
Through these means, motor or sensitive impulses are propa-
gated from segment to segment ; and a stimulus conveyed to
any segment from the periphery, may either simultaneously
affect the brain and cause a sensation, or be reflected upon
the motor nerves of that segment, and stimulate their muscles
to contract."

Nowhere do they speak of nutrition or secretion being
influenced by reflex nervous action, except as incidentally
and secondarily to motor effects.

It is a little singular to notice the observations of writers
thus confused by faulty appreciation of the real modus oper-
andi of the nervous mechanism. Thus, Pereira (Mat. Med.,

1857. Allen On the Mechanism of Nervous Action. 491

vol. I, p 163, 1852, American edition), speaking of the opera-
tion of medicines by nervous agency, says :

"The mode of action of those which act through the true
spinal system, is excited and reflex ; that is, an impression is
made on, and carried by the incident excitor nerves to the
nervous centre, which, by its peculiar power, affects a remote
part through the medium of its reflex motor nerves. The
mode of operation of those agents which act through the
ganglionic system, is excited, and, perhaps, may also be
reflex."

Prof. Paine says {vide Mat. Med., p. 10, 1848) :

" All curative agents operate upon the morbid properties
either directly or through sympathy."

And again :

" Kemedial agents operate directly upon the vital proper-
ties of the parts to which they are applied, and, through the
medium of those parts, upon remote organs, by the principle
of sympathy. The partial absorption of certain remedies, is
only a contingent result, and has little or no agency in the
physiological phenomena."

Sympathy, in physiology, pathology and therapeutics,
occupies precisely the position of phlogiston in chemistry,
and they may equally be considered as expressing scientific
principles — of one kind at least.

It is quite a different tiling to express definitely the precise
law of action in all cases, from merely indicating facts inci-
dental to the given law.

Thus, the modus operandi of an epispastic in pneumonia
or enteritis, or the relation of irritation of the fauces to the
muscles engaged in the act of vomiting, or the connection
between the process of dentition and derangement of intes-
tinal secretion, or the sequence of an interna] inflammation
upon an external burn, — may severally be sufficiently ex-
plained, to some minds, by vague invocation of nervous
action or "sympathy."

But, assuredly, when the phenomena are found to come
regularly within the line of physiological laws, and the full
relation of the particular organs is understood, the subject is
infinitely more satisfactory to the philosophical mind.

492 Allen On the Mechanism of Nervous Action. Nov.

And thus, again, advancing boldly another step towards
the primary simplicity of nature's operations, when we find
that the varied phenomena of motion, sensation, nutrition
and secretion — and even beyond this, of perception and
intellection, of conscious and unconscious mental action, — are
provided for by a simple arrangement, reducible to the dy-
namic cell and conducting fibre — is not this an advance of
which a whole country might boast ?

But what is the practical import of all this ? — it may be
inquired.

Without further comment, the inquiry might be dismissed
by saying, that the mechanic might as well ask what is the
use of understanding the construction of the machinery, the
derangements of which it is his duty to rectify.

What is the use of any discovery ? First, that immedi-
ately therefrom spring utilities ; second, that it furnishes a
stand-point for new discoveries, whence utilities shall hang,
" not singly, as before, but in knots and clusters."

Let us indicate a few from this one :

It explains the true relation between spasmodic and true
Croup.

It explains the frequent concurrence of disordered secretion
and spasmodic contraction ; pain and inflammation in the
same part and from the same cause.

It explains the vague term, functional derangement, by
substituting tangible phenomena.

It explains the general phenomena of revulsion.

It explains the relation of neuralgia to material (textural)
changes and disorders.

It explains the automatic action of mental faculties, here-
tofore, by loose speculatists, supposed to be evidences of
" spiritual " or " mesmeric " influences, external to the body.
It thus includes the phenomena of dreaming, somnambulism,
insanity, the " magnetic " or " medium " state, the " uncon-
scious cerebration" of Carpenter, and, in fine, a multitude of
phenomena, mental and sensational, never heretofore reduci-
ble to scientific series.

1857. Allen On the Mechanism of Nervous Action. 493

It explains the modus operandi of a vast number of
morbific causes producing diseases of parts remote from their
application, directly or by the blood. And so, also, of
remedial influences.

Truly, as I remarked in my first public lecture on this
important subject, "here is the science for a life's pursuit,
though the rest of the medical course be blotted from the
record."

"And here allow me to say, that the doctrine under
consideration does not resolve occult problems by the intro-
duction of new or unparalleled forces. Whilst it shows that
the reflex phenomena of secretory and sensitory (and, indeed,
of higher mental) actions are " analogous " to the " excito-
motory " of Marshall Hall, it shows, by a bolder generaliza-
tion, that all are reducible to a series more obviously
analogous to certain well-known physical operations.

The actual physical changes, at the extremity of a nerve
conductor, are productive of changes at its other extremity,
also of a physical character. The nature of the change is
determined by the structure in which that change taken
place.

Is there anything more strange in this, than in the electro-
galvanic circuit 1 The modus-operandl of conduction is
obscure, and, indeed, unknown — the same is true with the
connecting wires of a galvanic battery. There is no more
propriety in introducing the agency of a " nervous fluid,"
than of an electric or galvanic fluid. The term "polarity,"
in either case, is well enough — but, pray, what docs it
explain ?

In speculating upon this point, I have ever been forced to
fall back upon the now well-understood doctrine of the corre-
lation of physical and vital forces, and thus find a basis of
argument in the original nature of force itself, manifesting
itself by different phases, according to the material through
which it acts. Space and time will prevent my following
out the thought here, but, for the vindication of my own
somewhat chequered career as a professional teacher. 1 may

494: Allen On the Mechanism of Nervous Action. Nov.

say, that I indulged in private thought and public remark
upon this point, early in 1848 — long before Grove or Carpen-
ter brought the subject prominently before the profession.

May I indicate, here, that, between the doctrines of
Catalysis, Correlation of Forces and the Reflex Mechanism
Nervous Action, there are points of contact, which will
develop many a clue to the labyrinth of the sciences of Life
and Mind, Disease and Health.

Once more, let me beg that the profession, especially the
thinking part, may not confound mere vague ideas of
nervous action, sympathy, &c, with the clear, scientific
basis afforded by the reduction of reflex phenomena to the
changes induced in the organic cells and fluids, by propa-
gated influences from other changing cells and fluids — not
by any newly-invented laws, but by simple, scientific state-
ment of positive facts — rendered simple by their analogy to
well-known physical facts.

Postscript. — Whilst these pages are passing through the
press, I beg leave to add a few words, called for by a note
received from my learned and excellent friend, N. D. Steb-
bins, M. D., of Detroit. By him, I am informed that Prof.
Paine, of New York, will institute a claim in this matter,
antedating Marshall Hall, Prof. Campbell and myself.

Premising that I have never read any work by Prof.
Paine, or ever, directly or indirectly, received any clue to
the doctrines under consideration from him, except in so far
as they may have been suggested in his " Materia Medica
and Therapeutics " (published in 1848), from which extracts
are given in the foregoing article — I may here say, that, if
that work developes his principles, it must be clear, to any
philosophical mind, that he comes far short of the definite
idea involved.

His doctrines, therein set forth, — and so far as I am able
to gather them, at present, from others; not having his works
at hand, — bear about the same relation to these, that Hippo-
crates' crude hypothesis did to the discovery of Harvey, or

1857. Allen On the Mechanism of Nervous Aetimi. 495

that the speculations of Whytt and Prochaska do to the clear
expositions of Marshall Hall.

It would appear that the National Medical Association
was not extensive enough to contain a single individual who
could rise in his place and protest against the recognition of
Prof. Campbell's claim to priority of Marshall Hall, in favor
of Prof. Paine.

There was not a medical journal in the United States, but
rejoiced in the acknowledgment of Dr. Campbell's claim by
Marshall Hall — there was not one that raised the veriest
whisper of Prof Paine's prior discovery.

Dr. D. F. Condie, in his bibliographical notice of Prof.
Campbell's monograph (vide Amer. Jour. Med. ScL, July,
1857, p. 177), strangely enough, ignores Prof. Paine and his
prior claim.

The English part, at least, of Europe, stand surprised at
the magnanimity of Marshall Hall, in adjudicating priority
to Dr. Campbell ; but — notwithstanding Prof. Paine is an
honorary member of half the learned societies of the Old
World, and his books adorn the shelves of all lovers of the
"Curiosities of Medical Literature" — neither England nor the
Continent affords a single voice to cry " hands off" to Prof.
Campbell, when he stretches forth his digits for the laurels
belonging to Prof. Paine !

At the present time, I know of no writer who attributes
these doctrines to Prof. Paine. Why is this i Are medical
men so oblivious, that, when principles are clearly stated,
they cannot apprehend them ( Or are medical book-makers
so jealous of their discoveries, that they wrap them up in
such a guise that, when the discovery is made, like the
prophecies of the Python ic oracle, their involved sentences
may be translated to mean something to the point.

It is one thing to make propositions so general as to
include some truth with a great deal of error — and quite
another thing to lay down a principle which contains the
truth in its exactness, and nothing else. Oversight of this
single proposition may make the sweeping generalizations of

496 Allen On the Mechwniwi of Nervous Action. ^Nov.

Prof. Paine appear, to some minds, as containing the gist of
the recent discoveries; but as well might we say that the
"intelligent principle," of Stahl's hypothesis, included the
wonderful discoveries of Bell and Hall.

It is easy for a voluminous book-writer — who bases all
physiological, pathological and therapeutic actions of the
system upon the baldest vitalism, and rejects utterly all
reduction of the phenomena of animal life to the category of
physical actions, — to say that he recognizes, and has recog-
nized, " reflex nervous agency " — meanwhile incessantly
inculcatiug the idea of an abstract, recondite, unparalleled
" nervous power " (which no human definition or conception
can separate from the anima vitce of old hypothesis), and an
equally abstract, recondite and unparalleled "sensibility,"
altogether removed from the sphere of our investigations.

I need not take up the time or space of the journal, by
reiterating that the discoveries, now under discussion, have
nothing in common with the obsolete solidism of that school
of medical philosophers, of which Prof. Paine has the honor
of being the last, the greatest and solitary exponent. " Sol-
idism" was always verbose, and overpowered reader and
listener with a display of scholastic subtlety. Studiously
rejecting every advance, it clung to the effete dogmata of
past ages, and crammed margin after margin of ponderous
volumes with citations of sentences, either meaningless in
themselves, or capable of any interpretation.

The true doctrines oi the " Mechanism of Nervous Action,"
are not the mere detritus of old Solidism or Vitalism. They
are consistent only with what we may call the modified
Humoralism, now generally received by the profession. So
far from standing opposed to the application of organic
chemistry and collateral sciences to the explanation of phys-
iological and therapeutical phenomena, they reduce these
latter to subordination to those sciences, in as striking a
degree as electro-magnetism is subordinate to the science of
Inorganic Chemistry.

£>o far from explaining (or rather, cutting the Gordian

1857. Paine On the Bights of Authors. 497

knot of,) vital phenomena by the vis insita and occult " vital
properties," — the action of medicines by a similar invocation
of unknown powers, and so on ad infinitum, as is the custom
of the Prof. Paine school of vitalists, — all these phenomena
are comprehended in one grand system of natural science,
and are rendered cognizable by experimental methods.

The changes in the cells and fluids at one end of a con-
ducting nerve fibre, whether produced by causes within the
body or external to it, are manifested by a change in the
cells and fluids at the other extremity of the fibre, in a
manner altogether analogous (but by no means identical)
with the changes at the respective extremities of the wire of
a battery. What is there in this destructive of Organic
Chemistry and Hunioralism ? What is there in it akin to
the foggy vitalism of the old "sympathies" — always ad-
mitted to occur through the nerves \

The new doctrines are, in effect, a complete triumph of
Organic Chemistry and Hunioralism over the vague and
dreamy speculations of metaphysical vitalists, and he who
cannot see this, either does not understand the subject, or
shouts to hide his own confusion of ideas, as the Chinese do,
to hide a defeat.

Meanwhile, let me urge the attention of the profession, not
so much upon the point, Who fathers the idea? as upon the
more important question, Is the idea correct ? — at all events,
what is it ?

[To be Con trailed.)

Article II. The Rights of Authors. By Martyn Paink,
A. M., M. D., Prof, of Gen. Therapeutics and Mat. Med.
in the University of New York.

[The Editors of the Medical Independent will much oblige
Dr. Paine by inserting in the journal the following extract
from an Appendix to his "Institutes of Medicine" which is
now in the press.]

Upon all questions oi priority that concern the advance-

498 Paine On the Rights of Authors. Nov.

meiit of Science and Art, there is, doubtless, a general
understanding that the principle should not only be sacredly
observed, but that, whenever violated, there should be a
common effort to repair the injury. This is alike due to the
individual, to the principle, and to the common good. Xor
is it less the privilege of the individual, who may have good
reason to think that the principle has not been extended to
himself, to vindicate his rights, and to appeal to that sympa-
thy which forms the bond of union among honorable men.
It is a common cause, and not seldom demands protection.

The author of these Institutes (and it will soon appear that
he acted wisely) has sometimes thought it expedient to assert
his claim of originality, in advance, to many doctrines pro-
mulgated in the work; as, for example, all that is most
essential in the application of the nervous power, or reflex
action of the nervous system to pathology, and therapeutics,
and so much of what is most important in the natural state of
the functions. This may be readily seen by consulting p. 106,
§ 222 h, p. 107-116, § 225-234, p. 295, § 476 a, p. 318, § 493
d, 'p. 321, § 496-497, p. 323-340, § 500-514, p. 465-467,
§ 714-719, p. 506, § 803-804, p. 515-516, § 819 h, p. 661-663,
§ 894-896, p. 666-676, § 902 5-904, p. 679-680, § 905, a, p.
690-691, § 906 g, p. 693-695, § 917-923, p. 698, § 931-935,
p. 703-711, § 940-952, p. 746, § 990 1-2 b, etc., where all the
subjects relate to the reflex action of the nervous system, and
present the nervous power as an important vital agent in the
various processes of organic and animal life, in the production
of disease, in the operation of remedies, in all the results of
bloodletting, in the changes which take place in the secreted
and excreted products — having also originally set forth the
agency of the nervous power in voluntary motion (Index I.,
Article, Will), and as this power is the efficient cause of the
modifications of organic results under the influence of mental
emotions (Index I., Article, Mental Emotions, and references
at p. 867, § 1067). Indeed, as the reader will have seen, the
foregoing doctrines relative to the reflex action of the nervous
power, operating as a vital stimulus, or vital depressant, or

1857. Paine Nn the Eights of Author*. 499

vital alterative, as it may be modified in its nature by one
cause or another (§ 107-109, 227-230, p, 661-662, § 894 %
pervade this work. The same doctrines are at the foundation
of the author's " Medical and Physiological Commentaries"
published in 1840, while the present work was published in
1847. In the mean time he has also labored to inculcate them
throughout his course of medical lectures in the University of
New York — first on the institutes of medicine and materia
medica from the year 1841 to 1850, and subsequently, to the
present time (1857), on general therapeutics and materia
medica.

It may be worth saying, also, that the author preserves the
term " sympathy," though always meaning by it, as he strictly
defines, reflex action of the nervous svstem, and this whether
he employs the term " remote sympathy " or " contiguous
sympathy." The elements of sympathy, as set forth in the
work, are the nervous povier and sensibility. All this will
be readily seen by reference to Index I. Also, among other
general remarks of a similar import, the author has the fol-
lowing :

"Notwithstanding all the laws of sympathy that are ne-
cessary to the full interpretation of the remote effects of
morbific and remedial agents are as well established as anv
laws in physics, they have not been applied to these important
objects / but, on the contrary, those philosophers who have
contributed most to their critical exposition, overlook their
pathological and therapeutical bearings, and cling to the doc-
trines of humoralism and of the operation, of remedies by
absorption ; nor have they applied,, in the least, the nei^ous
power in a philosophical manner to an explanation of ths
natv/ral plienomena of sympathy (p. Ill, § 234 a).

When the foregoing works were first published, it was id
the midst of a universal prevalence of the chemical ami phys-
ical doctrines of life and disease, and the author stood alone
in the field of vital physiology, and in the application of the
reflex action of the nervous system in resolving the great
problems in physiology, pathology, and therapeutics. A few.

500 Palnk On the Bights of Author*. Nov.

however, had the quick sagacity to see its importance as pre-
sented by the author; and since the decline of organic
chemistry began, others have entered upon the inquiry, and
the most zealous have promulgated as original with themselves
many of the doctrines which belong to the author of these
Institutes, especially such as are relative to the nervous sys-
tem. But the author has relied upon his professional brethren
for ultimate justice: "Ultimum et unicum remedium."
"Jus aliquando dormitur, moritur nunquamP

But the author has lately seen so great an indisposition, in
certain quarters, to allow him any credit for his labors, that
he has concluded to make this expostulation, which refers,
particularly, to the following dispute about the authorship of
matters in which neither of the gentlemen has any interest,
but the writer alone of these Institutes. This rival claim
appears in an article published by J. Adams Allen, A. M., M.
D., in the "Medical Independent" for September, 1857, p.
381, Detroit, Michigan. Thus :

" It appears from a late number of the London Lancet that
M. Hall, (Marshall Hall) recognizes, to a certain extent, the
priority of Dr. Campbell. His words are these :

" i I arrive at this conclusion : the idea and the designation
of an excito-secretory action belongs to Dr. Campbell, and his
details are limited to pathology and observation. The elabo-
rate experimental demonstration of reflex excito-secretory
action is the result of the experimental labors of M. Claude
Bernard. My own claim is of a very different character, and
I renounce every other. It consists in the vast generalization
of excito-motory action throughout the system. I trust Dr.
Campbell will be satisfied with my adjudication. There is in
the excito-secretory function as applied to pathology, an am-
ple field of inquiry for his life's career, and it is indisputably
— his own. He first detected it, gave it its designation, and
saw its vast importance.'"

Dr. Allen then continues :

"M. Hall thus far freely and fully admits the priority of
Dr. Campbell, and the latter gentleman bases his claim upon

1857. Paine On the Rights of Authors. 501

the date, May, 1850. I shall undertake to show that this
same doctrine was first publicly announced and illustrated
in my lectures at the Indiana Medical College, in November,
1848, and thenceforth continuously during the continuance of
my public teaching before the several classes of that College,
and also the medical classes of the University of Michigan
until my connection with that Institution ' expired by limita-
tion ' in 1854. My own manuscript containing this doctrine
was written in May or June, 1848," — that is to say, mare than
one year after the publication of these Institutes.

" What I do claim is the great generalization that the excito-
influence is followed by a reflex change hi which the effect is

NOT A MOTION but A MODIFICATION OF VASCULAR AND NUTRIENT

action. That this effect takes place by means of the double
nervous arc. A vast number of therapeutic phenomena are
thus explained." [As the reader will find, very extensively,
in many chapters of this work, particularly in those upon
remedial action, therapeutics, counter-irrttation, cathar-
tics, etc. — Dr. A.'s capitals and italics].

Now the whole of the foregoing doctrine is impressed upon
the Medical and Physiological Commentaries, and upon half
of the pages of these Institutes, and has been always taught
extensively in the author's lectures since 1841.

Dr. Allen claims, also, the application of the principle to
therapeutics, and remarks that " in my course upon ' general
therapeutics ' the subject of ' counter-irritation ' came under
review," and concludes that " the impression must be trans-
mitted to tlie nervous centres, and thence reflected to tJie affected
organ. In ot/tsr words, the influence is primarily exerted*
upon the cerebrospinal system, and secondarily upon the in-
ternal affected organ. This is the gist of the whole matter,
and the point consists in the recognition of reflex cerebro-
spinal action, which, in the instances adduced, give rise to a
molecular or integral change in the inflamed tissue, and not
a muscular contraction. The oral elaboration of this princi-
ple was suggested by an idea p] which does not even now
appear to have occurred to either M. Hall or Dr. Campbell,

502 Palne On the Rights of Authors. Nov.

viz : The motor effect is merely secondary, and not a necessry
part of the action of the nervous arc?

Here, also, the whole of the foregoing doctrine appears
throughout these institutes. But they embrace a long chap-
ter particularly upon " counter-irritation^ in which it will be
seen that the author has employed nearly the foregoing
language of Dr. Allen, especially at pages 646, 647, § 893 e,
and with great elaboration and extensive application of the
doctrine throughout the work ; which had been also antece-
dently taught in his lectures for seven consecutive years
before Dr. Allen promulgated the same views.

To show still farther this partiality for the Author's writings,
or his lectures (then familiar to his large classes of students),
he will quote from Dr. Allen the following conclusions,
which he also places in capitals :

" tlie effect is motory, if contractile fibre be present.

" The effect is secretory, if secretory organs be suppleed.

" The effect is sensation, if sensitive neerine be reached.

" The effect is perception, or intellection, lf the organ
thereof be in connection with the reflex nerve."

"The effect produced, then, depends upon the structure and
condition of the organ reached?

" This influence is not confined to mere increase of action,
as the term excitok might perhaps suggest. The reverse may
take place — the excitor may rather become the depressor. It
would be as correct to say the depressor-motory, the depres-
sor-secretory, as to say the exciior-idem?

Now the author of these Institutes not only dwells emphat-
ically upon the depressing and sedative influence of reflex
nervous action, according to the nature of the remote causes
and special conditions of disease (p. 107-111, § 226-233 3-4,
p. 507, § 806, p. 661-662, § 894-895, p. 671-672, § 904 a, p.
735, § 978, and references in § 1067 a, &, as to mental emotions,
and in many other places), and upon its operation according
to the natural structure and special vital constitution of organs,
and their varying conditions (p. 59, § 129 g-i, p. 61-69, § 132-
156, p. 73, § 163, p. 109, § 229, p. Ill, § 233 3-4, p. 285, §

1857. Paine On the Rights of Authors. 503

555 d-f, p. 313, § 487 A, p. 353-362, § 525-529, p. 374-383,
§ 576-584, p. 415-417, § 649, p. 418, § 651 b, p. 421-423, §
657-658, p. 523, § 827 c, p. 542, § 854 bb, p. 613, § 892 1-2 b,
p. 641-650, § 893 e-4, p. 665-672, § 902-903 b9 p. 746, § 990
1-2 £, and the numerous references in those sections) ; but the
Author represents, also, the reflex action as variously alterative
in organic life, and this imputed attribute pervades the
author's writings. He enforces, everywhere, the doctrine
that the reflex action of the nervous power is the modifying
cause through which all the changes are effected by morbific
and remedial agents in parts that are not immediately con-
nected with the direct seat of their action ; and, farther, that
the principle is precisely the same when the nervous power
is brought into operation by direct influences upon the nerv-
ous centres (as in the case of their diseases, or when the
passions operate, or as the will determines voluntary motion),
as it is when it is brought into operation in that indirect
manner known as reflex action.

Indeed, every one of the foregoing doctrines, in all their
particularities, as quoted from the American claimant, are
taught, at great extent, in the volume before us, as may be
readily seen by consulting the references made in this protest,
and, more extensively, Index I., Articles Structure, Nervous
Power, Sensation, Sensibility, Sympathy, Organic Func-
tions, Remedial Action, Mind, Mental Emotions, Will.
"Si queer is monumentum, circumspice" It may appear
superfluous, however, to have made these specific references
in an article connected with the work itself; but it is done to
encourage those readers who might not otherwise be inclined
to ascertain the facts.

But the writer is more interested with the European claim-
ants, of whom he has felt that he has much more reason to
complain.

" Omnc animi vitium tanto conspectus in se
Crimen habet, quanto major, qui peccat, habetur." — Juvenal.

That the author's physiological and medical writings were
generally known in Europe many years before the period at

504 Paine On the Rights of Authors Xov.

which "Dr. Campbell bases his claim" (1850), is evident
irom the distinguished honors to which they had led in that
country before that period — that from the Medical Society of
Prussia as early as 1842 — that from the Medical Society of
Leipsic in 1843 ; and the " Medical and Physiological Commen-
taries " (of 1840) were published simultaneously in London
and Xew York ; and as to the United States, the Commentaries
were early distributed throughout the land, and his Institutes
of Medicine more than a year, also, before Dr. A.'s lectures
were delivered ; and the Author's lectures at the University,
which form the groundwork of his Institutes, had been listened
to annually by medical students irom all quarters of the
Union siuce the year 1841. In 1848 the Author applied the
doctrine of reflex nervous action to a physiological demon-
stration of the substantiative existence of the soul and instinc-
tive principle, which was then published in pamphlet form,
and in 1849 the work was extended and assumed the shape
of a book, and is now incorporated, in its essential parts, in
these Institutes.

Nor is this all ; for the whole of this doctrine of reflex
nervous action, aud of the operation of the nervous power as
an alterative, an excitant of the secretions and of vascular
action (both direct and reflex), a depressant and sedative
(accordiug to the nature of exciting causes), and the great
immediate cause of diseases and their cure — variously modi-
fying organic actions — was set forth extensively and circum-
stantially in an " Essay on the modus operandi of remeddss "
in 1842, of which the Author distributed, at that time, a large
number of copies in London, and addressed four thousand
copies to physicians throughout the United States. The
Author not only sent a copy of the work to Dr. Hall, but
dedicated it to him (along with Prof. J. Muller and Dr. A.
P. W. Philip), in connection with an "Essay on the Philoso-
phy of Vitality;" and he may add that he controverted, in
the former essay, doctrines of Dr. Hall (in "Memoir on Dis-
eases and Derangements of the Nervous System, 1841 ") which
were in direct opposition to those which are now in question

1857. Paine On the Rights of Authors. 505

(also, p. 296-297, § 476 1-2 h). These Essays were subse-
quently bound up in the third volume of the "Medical and
Physiological Commentaries" where the former may be
readily consulted. But Dr. Philip had fully deduced from
his experiments the sedative as well as exciting influence of
the nervous system upon vascular action before Dr. Hall's
experiments were made (§ 492).

As to M. Bernard, his experiments bearing upon the con-
nection of the nerves with the functions of secretion, however
much they may have been varied and multiplied, were antic-
ipated long before by those of A. "W. P. Philip, which are
quoted extensively in these Institutes (p. 290-321), and towards
which Dr. Hall had no friendly disposition (p. 306-308, and
where the writer has controverted his views). The merit of
originality which belongs to the present writer, in relation to
these experiments, consists in their extensive application in
illustrating the functions of the nervous power as a vital
agent, profoundly interested not only as an " excito-secretory "
power, and a modifying cause of all secreted products, nutri-
tion, etc., when diverted from their natural standard, but in
deducing from them a universal agency of the reflex action
of the nervous system, though " the double nervous arc," in
the production and cure of disease, and by which he labored
to explode the chemical and physical doctrines as early as
1840. But, that the writer may not be misapprehended, he
will say that he endeavored to established the fact that secre-
tion in animals, as in plants, is conducted by powers implanted
in every part, but that it is constantly influenced physiologi-
cally, pathologically, and therapeutically, by reflex action of
the nervous system.

The writer is very sensible that unaccountable coincidences
often present themselves in the development of new thoughts,
and in the discovery of hidden things, especially where endu-
ring reputation may be won. "Ubi md. Hi apes" — " Uno
tiene la fama, y otro carda la lanaP But the reader, with
these Institutes before him, will quickly find that much

that is claimed by Dr. Hall, and all that he has granted
vol. in, NO ix. — 34.

506 Allen's Practical Suggestions. Nov,

to Dr. Campbell, in the foregoing quotation, and, therefore,,
all that Dr. Allen appropriates to himself,* abounds in this
volume, and, in fact, constitutes the life and soul (" zoe kai
psuche") of the work, as it does, also, of the "Commentaries"
and of the Essay on the "Modus Operandi of Remedies;" nor
can the reader fail of the conclusion that, were Dr. Hall's
" adjudication," and Dr. Allen's after-thought, founded in any
justice, and were not the claimants themselves the obnoxious
parties, the present writer would have been long ago convic-
ted by them and by others of arrogant assurance and the
grossest plagiarisms. Nevertheless, the Author is most happy
to find that his solitary position is becoming relieved, and that
a practical direction has been given to his labors by others
which cannot fail of carrying forward the great doctrines at
which he has toiled, and against manifold obstacles, during
his professional life.
New York, Sept. 185T.

Article III. — Practical Suggestions, No. 1 V. By J. Adams
Allen, A. M., M. D., &c.

Alcohol, Delirium Tremens, c&c. — Much interest has been
excited, of late, by disclosures which have been made with
reference to adulteration of the various preparations of
alcohol. An array of drugs of formidable potency has been
drawn up before our startled vision, fearful in nomenclature
as the labels upon the beautiful little bottles of sugar-plums
wherewithal our Homoeopathic cousins have wrought won-
drous works, never equalled since the days of the renowned
knight, De La Mancha.

All this is very well, provided the public mind is thereby
influenced to discountenance and discontinue the use of the
vehicle of these poisonous dilutions. One thing has been
gained, at least — the tippling public are now willing to admit

* "Unus utrique

Error; sed variia illudit partibus." — Horace.

1857. Allen'6 Practical Suggestions. 507

that all the dire evils, portrayed bo eloquently by advocates of
tee-totalism, do result from imbibing adulterated brandy, rum,
whisky et id genu# omne ; but will not allow that they result
from pure liquors. All are ready to sing,

Nunc est libendum !

over " warranted-free-from-adulteration " alcoholic potations.
Whether it is worth wThile to risk the loss of this advance, by
insisting, as we believe, that the real poison is the alcohol
itself, and not merely the infinitesimal dilution of poisonons
flavoring ingredients, — moral causists may determine. In a
scientific point of view, I beg leave to recall the minds of the
profession to the common-sense dictum, that the effect of all
the various alcoholic liquors is due to the alcohol, and in
very insignificant proportion, if at all, to the alleged poison-
ous adulterations.

Of all the analyses which have been made, I have seen
none which show the presence of foreign noxious matters, in
such an amount as to bear comparison, for a moment, with
the active effect of the alcohol. Take, for instance, strych-
nia, which, perhaps, has made the most noise in connection,
especially with " Old Bourbon." A manufacturer informs
me that this drug is put into the yeast " to strengthen it " —
in other words, to favor the more full conversion of the
saccharine matter of the grain to alcohol. It is not strange,
that the slops, containing this yeast, should kill the hogs and
cattle which are fed upon them, or kill the fishes in the rivers
into which they are emptied. But, assuredly, chemical
analysis will show that scarcely a vestige of the drug passes
through the deadly " worm of the still."

Strychnia and arsenious acid, fusel oil and prussic acid,
kreosote and oil of vitriol, sound most diabolically as con-
nected with " fire-water;" but it is well to recollect that
these are the merest shadows in the drink. The great
dragon, whose poisonous breath blasts the physical and
mental constitution of the unfortunate inebriate, is the

ALCOHOL.

508 Allen's Practical Suggestions. Nov.

The physiological and pathological actions of this substance
are, fortunately, well known to the profession, and need not
here be rehearsed. That it belongs to the class of nutrient
substances, is clear enough, notwithstanding noisy declama-
tion to the contrary. Physiolgically, it is calorifacient, and,
furthermore, convertible to the fatty matter of adipose and
nervous tissue.

Taken into the system, under certain circumstances, it will
favor the enriching of the blood with red corpuscles, as here*
tofore explained when speaking of the uses of fat. Thus, it
both becomes invigorating and promotes a healthy corpu-
lence. This effect is too well known to require argument
or further proofs. Under other conditions, however, the
opposite effect will be produced — emaciation of adipose and
nervous tissues will ensue, and

"The life of all the blood be touched corruptibly."

In one case, it proves sanative — in the other, poisonous.

Popular notions of the radical difference between poisons,
medicines and nutrients, have had too much influence on the
professional mind. An untimely beefsteak may cause an
untimely death — a laudable dose of arsenic may prove deci-
dedlv wholesome. Whilst admitting the occasional nutritive

i o

and even salutiferous qualities of alcoholic compounds, it is
exceedingly important to bear in mind their ready noxious
powers.

The aboriginal name, "fire-water," is exceedingly well-
chosen and instructive. For, as the system of man requires
a certain amount of heat for its healthy action and continu-
ance, so does the actual cautery at once " reduce it to first
principles.*' And thus, while the elements of alcohol may
prove useful under appropriate circumstances, it should no
more be used in the summer-time of health, than should
elemental fire. Careful observation upon this point inclines
me to the opinion that when the alcoholic beverage manifests
a cerebral stimulant impression, in the slightest perceptible
degree, its nutrient and salutiferous effects have been passed,

1857. Allen's Practical Suggestions. 509.

and it must be ranked among medicines or poisons. Every
medical practitioner must have noticed that, in small doses,
it is readily digested, but that the blood is speedily sur-
charged, and all subsequent excitation results in depression.
Largely diluted, or thoroughly commingled with the food,
considerable quantities may be administered with no appre-
ciable local or general, nervous Or cerebral disturbance. In
concentrated form, it speedily generates each of these.

The practical inference is, that, when, from therapeutic
considerations, it is deemed necessary to administer this most
potent drug, it should be given in small doses, either largely
diluted or thoroughly mixed with food. Moreover, the dose
should ever be iixed just below the point of cerebral excita-
tion.

The direct tendency of alcohol is to produce inflammation
of the organs to which it is applied — prominently the stomach
and liver. Ordinarily, from the mode of use, this assumes
the chronic form, and the secondary effect is impaired nutri-
tion— involving, as we might expect, particularly the blood,
adipose and nervous tissues.

Delirium Tremens is the typical result. Nothing is more
fallacious than the claim that this disease is the result of
withdrawing a habitual stimulus — for the majority, thus
affected, come under our notice with breaths reeking with
the fumes of alcohol. It more clearly resembles the delirum
of inanition, than that from any other cause. The sensation
of hunger appears to be mainly due to the required susten-
ance of animal heat. Alcoholic drinks control this sensation
to a great extent. The primary stimulating impression, it is
true, often augments the desire for food, but the secondary
effect is to lessen it. Or, again, the beverage begets local
disease and prevents digestion. Thus, in each of these wTays,
actual starvation of the organs is involved. The mode in
which the stimulant is taken determines very accurately the
resulting effect. Taken in a very dilute form, as in ale, beer
and light wines, or commingled with the elements of food,
it will never be^et delirium tremens.

510 Allen's Practical Suggestions. Nov.

The true Yankee and the mercurial Irishman are more
subject to the disease, by far, than the Englishman or the
Continental European. It is a national characteristic of John
Bull to grow mellow after filling his stomach with M the
roast beef of old England.'' Beer and wine fill up the meas-
ure of continental felicity; but the Yankee, almost invariably,
pours down his undiluted Cognac or Bourbon in hasty gulps,
to pacify the demands of an appetite he has not time to sat-
isfy; and the Irishman drowns his recollections of the
far-away Green Isle, and his present absence of culinary
comforts, with repeated draughts of domestic "mountain
dew."

The practical inference is simply this : that, even though
we may not dissuade our unfortunate patient from his cups,
we may so regulate even his excesses, that he will be little
liable to this, his great horror. Tell him to cultivate the
acquaintance of the cook before that of the bar-tender.
Dilute (and here infinitesimally. all the better) the stimulant,
so that lesion and disorder will not occur.

If the appetite fails, then is the time to see the physician,
who must anticipate the paroxysm as he would an ague.
The rules of treatment are simply those of dyspepsia, or of
acute or chronic disease of the digestive organs.

Mercurial and other alteratives, counter-irritants, and even
venesection, may be required. Mark, that the great point
is to restore digestion and appetite — and, in nine cases out of
ten, eliminating agents are the thing. Calomel, blue mass
and aloes, among the cathartics, and and acetat. potassse
among the diuretics, are, perhaps, the best. Then follow
with simple tonics, like cold infusion of cort. prun. Virgin, or
quassia and camomile — or, perhaps, the old mixture of
augustura and sem. juniperi, mineral tonics, iodide of iron,
bismuth, <fcc, of course may be useful at times. Above all,
don't think, when the patient is about again after a parox-
ysm, that he is well, any more than he would be in the inter-
mission of ague.

The treatment of the paroxysm, of course, must vary

1857. Allen's Practical Suggestions. 511.

according to both commemorative and present symptoms.
Sleep is indicated, but as a sign of remission, not as an evi-
dence of cure. A sufficient degree of elimination and nutri-
tion must be secured. Depuration may take place without
assistance, and so may nutrition of the nervous apparatus, as
every physiologist can explain. It is all-important to dis-
criminate when and how much to interfere.

The threatened paroxysm may often be avoided by the use
of simple anti-irritants and laxatives. Thus the nervous
excitement will frequently succumb to a simple pill like this:
R. Ext. hyoscy. (opt.) gm. assafoet., aa gr. ij.; sapon. venet.,
gr. j. M. Repeated every hour or two p. r. n., and then
fifteen grains of blue mass at bed-time, followed by the senna
draught in the morning. Or the quieting agent may be of a
more stimulating character, as liq. anod. Hoffm., morph.
acet. and mist, camph.; or, again, a mixture of laudanum,
comp. spts. aether, tinct. assafoet. and c. spts. lavender; or
tinct. camph. ; or of chloric ether in comp. tinct. of carda-
moms. But none of these things should be relied upon,
except for sustaining the system till depuration takes place.
When the grave paroxysm has already come on, it may often
be relieved speedily by a full dose of calomel and Dover's
powder — say gr. xij. of the latter to gr. xv. of the former.
This is all the stomach will ordinarily bear. Larger doses of
opium are rarely well borne, and other preparations of this
drug scarcely have so pleasant an influence. Emetics, in
the writer's experience, are too apt to get up an irritable
stomach, a complication more to be dreaded than any other.
The profound sedative influence of tart, antim. and similar
agents, if it can be secured without emesis, however, favors
much the absorption of alterative medicines and the func-
tional action of the excretives. When this latter fails, as is
manifested by the dry tongue and skin, by the cessation of
healthy discharge from ulcers, if present, or the dry and
angry appearance of accidental abrasions, the prognosis is
exceedingly grave. Secretion must be re-established, or the
patient will die, Neither alcohol nor opium wTill do it,

512. Allen's Practical Suggestion*. Nov.

homoeopathy will fail, and assimilative " expectancy " like-
wise. Support is imperative, and calomel a duty. Concen-
trated beef tea inside, and an epispastic outside the stomach,
are good remedies. The constant inclination to vomit will
not infrequently be relieved by minute doses of prussic acid
in syrup, morph. acet., or syr. creosote and morphine.
Neither here nor elsewhere, has the writer any confidence in
the effervescing draught for this purpose.

Some cases will occur in which nothing will control the
difficulty but raw spirits in large doses. And this is the only
instance where this is good practice. Forcing sleep by it,
is simply analogous to " breaking up " pneumonia with a red
pepper or brandy sweat. You may do it, but if not, cavete !
Opium — ditto ; chloroform — ditto ; alii — ditto. It is a trite
medical truth, that many diseases are critically resolved in
sleep, and this is the case here very frequently. But the
paroxysm will return more speedily and be more diffimdt of
control unless sleep has been solicited, not compelled.

The homely Scotch iEsculapius remarked, " There are twa
things, Sir Astley, to be aver kepit in min' ; to keep faith in
Gode, for hereafter, and to keep the booels open, which '11 do
for here" But after all, something more is necessary. The
delirium may be prolonged from actual inanition. Starvation
is to be guarded against, as well as proper medication pro-
vided for. Practitioners complain of ditficulty in inducing
patients to take nutriment, but the writer is inclined to
believe this less difficult than ordinarily supposed. The
patient can be readily persuaded by a good nurse, or physi-
cian of moderate shrewdness. Fall in with the current of his
ideas and have tact enough to direct them. Take medicine
with him, drink with him, eat with him, and pretend to sleep
with him. This may fail for some time, but by proper tactics
will before long succeed. The writer has scarcely ever failed
in this management. Oyster soup, rich animal jellies and
broths, and essence of beef, are preferable. Or egg-nogg, or
wine sangaree. Feed the patient with something nutritious,
and keep up secretion — the whole in a nutshell. And when

1857. Van Tuyl's Case of Lithotomy. 513

lie sleeps, don't let him sleep finally. The pulse is to be
watched and the strength supported hy nutriment, dilute
spirits, wines, &c. Prevent any recurring paroxysm by the
regimen and treatment heretofore spoken of.

Once more, I wish to recall the attention of the profession
to the dictum, that all the therapeutic uses of alcohol, whick
are desirable, may be obtained without any sensible cerebro-
stimulant influence--that direful influence which deranges
the whole mechanism of mental and physical action ; which
reduces the will to a mere servitor of the automatic nervous
apparatus. The apologist for the use of these beverages,
always seeks the exhilarant influence — delirium tremens
grown enchanting by the distance, which, alas, is too surely
traversed by many.

The trembling fingers and aching head of the morning,
after an evening excess, are but the initiatory scenes of the
typical result of persistent indulgence in ardent spirits " war-
ranted-free-from-all-adulteration !" Truly, we may say of
such liquor :

ISfon est vitiosum, sed vitium !

Kalamazoo, October, 1857.

Article IV. Remarks on « Case of Lithotomy, Head before
the St. Joseph Medical Society, at its October meeting, 1857-
By D. 13. Van Tdyl.

On the 7th of April, J 856, 1 operated on Mr. J . L. for uri-
nary calculi, a majority of the members of this Society
being present. But I have deferred making any remarks on
the case, in order to be enabled, by the lapse of time, to esti-
mate more fully the value of the operation to the patient
For I had good reasons for believing, at the time, that the
disease might soon return, and render a second, and perhaps
repeated operation necessary.

The case of Mr. L. is one which, in its history, illustrates
most forcibly the great importance of correct diagnosis; and
seems to remind us, that, without this invaluable guide, th«

514 Van Tuyl's Case of Lithotomy. Not.

most skillful physician must necessarily fail in medication ;
while, with it, one of ordinary acquirements may, and proba-
bly will, meet with fair success.

For more than a quarter of a century it has been known
and demonstrated that excessive and long continued exercise
of any particular set of m,uscles will cause inflammation of
the bony tissue to which such muscles have their attachments;
and that such inflammation of bone may result in hypertro-
phy, caries, or necrosis, with a train of concomitant ills, such
as human flesh is seldom heir to.

I believe this theory was first promulgated by Prof. Syine,
of Edinburgh, and he has reported a number of cases in its
corroboration.

But the common error with our profession has been, and
continues to be, the mistaking of such cases for rheumatism.
A person subjects himself, for a time, to fatiguing exercise^
and soon after experiences a difficulty in the use of a certain
muscle, or set of muscles, his case is pronounced rheumatism,
and he is treated accordingly. If he happen to fall into
the hands of a physician who regards rheumatism as an in-
flammatory affection, and is bled, blistered, and put upon a
general course of antiphlogistic treatment, he will be bene-
fitted, perhaps cured. But if his physician happens to be one
of that class who look upon rheumatism as a disease sui gene-
ris, and for which he has a never-failing specific, such a
physician may expend the full force of his remedy on the pa-
tient, and then abandon the case with his faith in his specific?
strengthened by the consoling maxim that exceptions prove
the rule. But I will proceed with the case under considera-
tion.

A few weeks since I requested Mr. L. to furnish me with a
brief history of his case, to the the time when he placed him-
self under my care. This he did in writing, as follows :

" In the fall of 1835 I was twenty years of age, and in per-
fect health. I ran a distance of five miles ; became very much
heated ; took a violent cold, and was laid up with rheumatism
in my right hip for six weeks, and then did not fully recover

1857. Van Tuyl's Case of Lithotomy. 515

from it. Soon after this, it began to hurt me to pass my
urine, and I was swelled at times across the lower part of my
abdomen, and was troubled almost constantly, more or less,
with rheumatism. In the fall of 1838, 1 walked twenty miles
in one day — very slippery, bad walking — three miles of the
distance over cakes of ice. That brought on a violent fit of
sickness, which laid me up for six months. A sore broke out
on either side of my abdomen, low down ; one ran for three
years, the other thirteen years. In the year 1851, before the
last sore healed up, I took two pieces of bone out of it. In
the spring of 1848 J had a violent attack of rheumatism in my
left hip and thigh; and a bunch half the size of a hen's egg came
on the inside of my left thigh, about four inches down from
my body. It remained there till the spring of 1849, when it
began to swell and be badly inflamed ; and on the 28th of
June I opened it. It ran freely, and the next fall I took two
pieces of bone out of it. In the spring of 1850 I was confined
to my bed, and was very sick for one year. I was under the
care of a physician the whole time. No one thought I could
recover. In the fall of 1850 the physician took a large piece
of bone out of the same opening in my thigh, and in the spring
of 1851 I took out another piece.

" From the time the doctor removed the large piece of bone,
the urine began to pass out by that opening. It would some-
times pass by the opening; sometimes by the natural way;
and sometimes by both ways at once. And this continued so
till after I was operated on in the spring of 185(3.

" During all this time, it felt to me as though there was a
chestnut burr inside of me, pricking and tearing me every
time I moved, or anything bore against me."

Here wre have a few of the mere points of a case, the de-
tails of which would fill a volume.

At the time Mr. L. came under my care, his case was truly
distressing, and for several weeks before the operation, life
had become a burthen to him. He seldom rested more than
an hour at a time, and that only when he was under the in-
fluence of opiates.

516 Van Tuyl's Case of Lithotomy. Nov.

Here we have the case of a man, who, from his own account,
has suffered with the worst forms of rheumatism for more than
twenty years. But, in reality, it is not probable that he has
ever been affected with that disease in the slightest degree.

Mr. L. is a man of five feet and six inches in height, with
an average weight Of only one hundred and twenty-eight
pounds; but he is a man of great muscular strength. When
he was twenty years of age, he supposed he was the strongest
man, of his weight, in New England. His muscular power,
therefore, was eqeal to the task of running five miles, or per-
haps a much greater distance. ' But the bones which were
required to sustain the shock of the repeated contractions of
those muscles which are most powerfully exercised in running,
were not equal to their part of the performance. The parts
to which those muscles were attached became inflamed to a
degree which gave the disease the appearance of rheumatism ;
and what the result would have been had he not exposed
himself to the excessive fatigue of that twenty mile walk, can
only be conjectured. But that additional irritation hastened
the work of destruction. The inflammation, which had been
of a sub-acute character, at once became active and violent,
and exfoliation of the anterior processes of both ossa illii, also
a part of the tuberosity and ramus of the left ischium, and a
part of the descending ramus of the left pubic bone, was the
result.

The sores on the lower part of the abdomen, as we learn,
continued to discharge, one three, the other thirteen years ;
but as soon as the last piece of bone was extruded, the ulcer
healed. The cicatrices from those sores, extend in a cresentic
shape, from the anterior superior spinous process of one illium
to that of the other. Had the real cause of these abscesses
been suspected, all his sufferings, in those parts, might have
been terminated at any time, simply by enlarging tho>e sin-
uses, and removing the exfoliations.

But when Nature, alter a most protracted, painful, and un-
assisted labor, had brought forth a whole litter of those
sequestra, one still remained, and that in a position which

1857. Van Tuyl's Case of Lithotomy. 517

bid defiance to her best directed efforts for its removal. This
was on the internal and posterior part of the descending ramus of
the left pubic bone. The exfoliations which had escaped through
the opening in the thigh, had doubtless come from the imme-
diate neighborhood of this remaining one, a little lower down.
But when this piece had ulcerated through the parts which
covered it, it found itself, as it were, looking into the neck of
the bladder; and had it become fully detached, would have
fallen into that viscus. But remaining in situ, and being
constantly in contact with the urine, it became a nucleus, or
surface, upon which was deposited the numerous small calculi
and fragments which were removed during the operation. The
position of the bone was such, that in passing a catheter (an
operation which Mr. L. had performed upon himself fre-
quently for many years), the point of the instrument glided,
lengthwise along the bone, and whenever the deposit had
become so great as to prove an obstruction to the free passage
of the catheter, the instrument would detach the deposit,
which would fall into the bladder, and there become a nucleus
for still further deposit. This accounts for the great number
and variety, in size and shape, of the calculi ; some that had
recently been detached, being still perfect casts of that part
of the bone upon which they had been deposited ; while oth-
ers, which had served for years as nuclei, had attained to
considerable size.

There were about twenty of those pieces, from the size of a
pea to that of a filbert, besides a great number of smaller frag-
ments, and a small spoonful of sandy matter.

I frankly admit that I had not suspected the existence of
this sequestrum, and when, during the operation, the instru-
ments came in contact with it, I supposed it to be an impacted
calculus ; and continued in that opinion till I succeeded in
reaching one end of it with the end of my linger. I then dis-
covered its true character, and by the help of a director, and
the application of considerable force, it was detached, and
then extracted with the forceps. It was of an irregular shape,

518 Haughton On Tubercular Phthisis. Nov.

one and a half inches in length, and one and a half inches in
its greatest circumference.

As it required so much force to dislodge this piece, 1 was
apprehensive that there was still a bony surface within reach
of the urine, upon which farther deposites might be made.
Hence my fears of a return of the disease.

I had attributed the persistence of the disease to urinary
calculi and fistula, and had given Mr. L. my opinion upon
that point ; and farther, that my only hope for a radical cure,
was that in the operation the incision might cross the fistulous
canal at a point so near its origin as to cause its obliteration.
This appears to have been the result, as the urine did not pass
by the fistula only about ten days after the operation.

No untoward symptom occurred either during, or after the

operation. The patient was walking about the streets in less
than three weeks, and for more than a year past has been en-
gaged in his ordinary business, traveling, &c, in perfect
health.

South Bend, (Ind.) Oct., 1857.

Art. Vr. Tubercular Phthisis — the Result of Imperfect Cell
Action. By R. E. Haughton, M. D.

I now offer the views which I have formed after a careful
study and analysis of many cases of tubercular phthisis,
under the following title : The primary, pathological condit-
ions of the system,, which finally terminate in scrofula and
tuberculosis.

These forms of disease are prevalent to a great and alarm-
ing extent in our country, and among our people, and the
effort to obtain the primary and exact pathological conditions,
and upon such a basis to erect a standard of treatment which
will be successful in arresting their progress, and effecting a
cure of those maladies, will be regarded as a benefaction to
the race. Not that 1 hope to have done so, but offer my
mite, to be cast into the great field of pathological inquiry*

1857. Haugiiton On Tubercular Phthisis. 519

and to be rejected as error, or gathered up as important truth.
The first stage of phthisis is commonly said to be that in which
the physical signs indicate a morbid deposit in the lung. But
we must go back, in our investigations, to an earlier period^
where there are undeniable evidences, and this long before the
most experienced observer can detect the sounds which indi"
dicate an increasing solidity of structure in the lungs. There
is, prior to this, a peculiar, antecedent state of the general
system, which acts as a causative agent or condition, origina-
ting the altered and pathological state of the blood, and which
not only acts as a predisposing cause of tubercular deposits,
but elaborates and prepares the material, ere it enters and
becomes part and parcel of the blood, from which tubercle is
to be formed, and deposited in the lung. And here, let me
say, that to this part of the subject, I ask careful attention,
and careful and future study. When we go back to the in-
vestigation of the primary conditions of the system, we shall
find, not only the real and pathological causes of these forms
of disease, but also a hopeful period of treatment, the very
period in which we may arrest the most fatal of all the dis-
eases which afiiict fallen humanity. It has always been my
belief, that if we wait till a half organized, cacoplastic deposit
takes place in the lung, before we are called to treat it, we
shall do as we always have done, most signally fail, we are
beginning at the wrong time, and place, and casting about us
for a remedy, when organic changes of structure have
doomed the patient to premature death. These forms of dis-
ease are of two kinds, hereditary and acquired, or, in other
words, accidental. I hold that in those different conditions,
we have a law of cell growth or cell development, which is
peculiar to the patient alone, whether the disease be acquired,
or whether it be hereditary. The law of cell growth is very
different in the the two, though at last tuberculosis is the re-
sult. There is a faulty cell development, established in the
system, and this exists in the imperfect and incomplete elab-
oration of the chyle and lymph corpuscles, because the cell
membrane fails to exert its transforming power upon the nu-

520 Haughton On Tubercular Phthisis. Nov.

trient material furnished in these fluids, hence the vital oper-
ations are imperfect, and the next result is imperfect elabora-
tion of the blood cells, and hence imperfect blood. And in
the blood, as in all other fluids, its own cell development is
peculiar to itself; hence, if the materials of nutrition are im-
perfectly transformed, we have imperfect blood, faulty in all
its elements, and unfit to build up and sustain the vital ac-
tions, which are so fully dependent upon healthy elements
therein contained. The blood undergoes changes of its own,
a process of growth, a process of development, peculiar to
itself, and in addition to receiving new material from the food,
it gathers up the debris of the tissues, as the elements of their
waste and disintegration. The new materials which are sup-
plied to the blood in the chyle and lymph cells, are immature
products, and if their elaboration be faulty, the blood, though
passing through a course of growth and development, cannot
change their pre-existing condition, and hence, though this
Mood development is in process, it cannot perfect that rich,
Kghly developed material, which is demanded by all the tis-
sues of the body, then we have waste and decay, because
healthy elements are deficient. The oxygen of the air cannot
replace these elements, and therefore we get an impaired vital
energy, impaired nervous power, and we discover failure in
the conditions of health, and yet there is no consumption, no
tubercles, up to this period. But in the forms of disease
called hereditary, there is inherited from the parent, or pa-
rents, that peculiar cell growth, which has. in the case of the
parents, or grand parents, become a law of the economy, and
will sooner or later produce its pathological result, viz: tuber-
culosis. TVe do not mean here that scrofulous, or tubercu-
lous material, is to pass from parent to child, nor that the
child is born with tubercle, already within its body, but the
law of cell growth descends to the child, and this law stamps
upon the blood making power this inherent law which pro-
duces tubercle, and this law exists in the charter of life, which
descends to the child, as much as the form and features of the
child take their similitude from those of the parents. The ob-

1857. Haugiiton On Tubercular Phtkffis. 521

jector would say here, that if this be true, a child descended
from such parents is hound to hare the disease developed at
some period of life, because feature or form is an invariable
law. N ot so, but where the law exists, unless counteracted
by all the means for promoting health, it will, eventually, be
developed. In other .words, the exciting causes operating
upon such a tc will much more readily develop the

forms of disease under consideration. The exciting causes
here alluded to, will be attended to more in detail hereafter.
In the accidental or acquired forms of disease, there exists,
without doubt, a primary derangement in the digestive sys-
tem, and this may grow out; of extraneous circumstances;
but the primary trouble docs not exist in the lungs, but in the
system of nutrition, and may have its origin in impure air,
low, damp places of abode, in the abuse of the stomach by
indulgence in eating, inducing dyspepsia, and all its train of
evils ; and all this teaches a means more efficient in cure than
all the vaunted specifics which have ever been used as cura-
tive agents, viz : a return to exercise in the fresh air, which
invigorates the whole economy, repairs the injuries of the di-
gestive organs, and then a proper use of nutritious, healthy
elements of food. But, says the objector again, not all of
those v ho labor under derangement of the* digestive organs,
get d; uent of tubercles, and the results of such a deposit.

Because here is the time for the correction of these, the pri-
mary evils of which, tuberculosis and scrofula, are the results.
Dyspepsia if not cured, and continuing through several years,
will develop disease in the lungs, as sure as blood is manu-
factured out of the materials of nutrition, the food which we
eat. Also, in those cai heredil I int, the same cam

may act as predisposing influences, and cell development be-
ing regulated by the same lav/, be engrafted, as it were, upon
the inheritance of life, thus becomes much more cor tainh and
readily active, and the morbid deposit is as i a product

of this cell development as that the patient sprung from a
parent stock, which has exhibited either the scrofulous or tu-
berculous cachexia. An objector may say, but the morbid
VOL. in, NO ix. — 35.

522 Hafghton On Tubercular Phthisis. Nov.

deposit does not take place in all cases, nor is the diathesis
present in many such cases; one generation to which this
charter of life, this law of cell development has descended,
escapes the dreadful fatality. But look again ; the next gen-
eration, or, at farthest, the third or fourth generation, exhibits
the surest evidence of inheritance, and these types of disease
are presented to the observer, leaving no doubt as to the
original taint ; and the law or type of development is as surely
an organic law as any of the economy, though not always so
evident as some others. Summing up, then, we say that the
scrofulous, or tuberculous diathesis, has its primary existence
in the faulty forms of cell development, which give rise to
diseased blood, and this disease of the blood mass is one affect-
ing its growth and development, and this becomes a part of
the organic law, in the transmission from parent to child,
hence the hereditary succession is as perpetual as the family
likeness, except the law of descent and transmission be in-
vaded by an influence stronger than the tendency, and this
may be done by intermingling of the races in the marriage
relation. In this way, not more than two generations would
be cursed by the hereditary descent of those forms of disease.
Of course, attention to all the laws which regulate and pro-
mote health, come to be part of the great influence which
•effects a change so desirable. But what is tubercle ? A de-
posit from the blood. This does not answer the question,
and it is not easy to answer it, as shown by the views
of many eminent pathologists, who have expressed very
different opinions in regard to its character. It has physi-
cal and chemical characters, and chemical analysis gives
us an approximate character or knowledge of it, though
not definitely settled, because, chemically, its character
changes, according to age, condition, and period of dis-
ease. And here let us inquire, what is scrofula ? Scrofula is
a name given to a form of disease which manifests itself in
enlargement of the glands in various parts of the body, which
finally soften, suppurate, dischaging • scrofulous pus. This
condition of health is preceded by a peculiar condition of the

1857. Haughton On Tubercular Phthisis. 523

system, manifested by a pale or waxy color of the skin, blue
eyes, light hair, and a delicate physical confirmation, and all
this the result of that peculiar law of cell development, and
hereditary transmission, before alluded to. These glands
which take on this process of softening and suppuration, are
the seat of tubercular deposit, and the same process of soften-
ing, suppuration, and discharge, takes place as goes on in the
lung when the seat of the same kind of deposit. Hence the
difference is more in name than fact, and only differs in the
locality of the morbid process. But while this is the case,
and the glandular system is going through these changes, de-
posits of tubercle take place, or have taken place, in the lung,
and may take place in any organ in the body. But this is
not necessarily so, the lungs may escape this deposit, so that
respiration is carried on with greater perfection than can be
done when impaired by foreign deposit, hence, by judicious
management, tubercular disease of the glandular system is
not necessarily so fatal a trouble as that of the lungs, but the
same general law of constitutional taint and disease, belong
as much to one as the other. Tubercle is not confined to man
alone, but all animals subject to confinement, and deprived
of pure air and wholesome food, will exhibit evidence of tu-
bercular deposits in various organs. If this be true, which is
confirmed by the experience and observation of all investiga-
tors, it furnishes us with a singular fact, and one of much
value in the hygienic treatment of those forms of disease, and
teaches us to look more to their prevention than their cure,
after having been fully developed. I have stated that con-
sumption and scrofula were induced, primarily, by imperfect
cell growth, which elaborates the nutrient materia] which is
furnished and emptied into the blood, hence the blood is
changed, tor how is a stream to be purer than Ltssource?
This is, in fact, the most important idea in the investigation
of this subject — the great centra] idea upon which is based
the whole knowledge of these diseases. In other words, the
organs in which the disposition to primary deposit almost ex-
clusively prevails, are those which, With equal certainly, may

524 Haugutox On Tuh'reular Phthisis. Nov.

be called, the blood making organs, or those which give rise
to blood development, and through this, we arrive at a proper
estimate and true interpretation of such diseases. The pre-
paration of food begins in the mouth, and is continued in the
stomach, and owing to the quality and quantity which is im-
posed upon this organ digestion fails, the gastric juice is not
brought into contact with the food, and frequently a changed
condition of this fluid takes place, and the food issues from
the stomach in a crude, half digested state, to be intermingled
with the biliary and pancreatic secretions, which cannot per-
fect the process begun in the stomach, hence we have an im-
perfect material, upon which the lacteals and absorbents are
to work, and as the process of absorption is done through the
agency of cells, if the nutrient material has not been converted
into a homogenous mass, by the admixture of all the fluids
necessary for this purpose, the process of absorption is inter-
fered with, and a material is offered to the circulation defi-
cient in elements for healthy blood. And this ju-ocess con-
tinues, from time to time, till disease of the blood mass, and
consequent disease in other important organs, supervenes.
Mental emotions, depressing influences, as grief, fear, the high
excitement of passion, the restless ambition which pervades
the human family, and many other influences come in to
accelerate the troubles here begun.

But now we come to take another step in the progress of
our investigations into the pathology of those troubles. The
blood is sent to the lungs loaded with these impurities, which
result from imperfect elaboration. For what purpose ? For
creation ; to be brought into contact with the oxygen of the
atmosphere ; to be purified for the purposes of health in the
general system. But what do we find ? The blood which is
sent to the lungs is venous blood, containing, in a healthy
condition of the system, the waste products of the tissues, and
now comes an increased amount of labor for the lungs, in the
increased products of imperfect cell development, viz: imper-
fect chyle, lymph, and blood. There is also a fixed and defi-
nite chemical relation between the elements of the blood and

1857. IIaugiiton On Tubercular Phthisic. 525

the oxygen of the air, and only a certain amount of oxygen
can displace so much of the impurities of the blood ; hence a
failure is the result in the important function of respiration,
which, added to the one described in the imperfect elaboration
of the primary fluids, increases the difficulty, and these im-
purities again pass the round of the circulation. One of the
elements contained id the blood is carbon, as an element of
the oxygenation of the tissues.* This takes the place of the
oxygen, which should pass the round of the systemic circula-
tion, hence we have imperfect aeration of the blood, and
next a failure of all the vital processes, more or less complete.
Here we may recur to another mode by which the blood
mass becomes impoverished, and we begin at the point where
the half elaborated chyle conies into contact with the lacteals
or absorbents. The process of absorption by the lymph
glands, is carried on by cells, and it is the law of the economy
that those cells possess the power of selection, and only such
material as has become prep are d for this process, through the
agency of these cells, will be appropriated, and this being in
diminished quantity, blood is not manufactured, and therefore
nutrition is at fault in the tissues; emaciation occurs, and
through this process a defective tonicity of all the structures
occurs, and there is a general malaise, paleness of the counten-
ance, coldness of the extremities, the result of defective circu-
lation ; and finally a morbid condition of the organs thus en-
gaged in the great process of blood manufacture takes place;
even the blood membrane, which, in health, exerts a most
powerful influence upon the cha of the Mood, from these

conditions soon exerts a morbid influence, and a mass of dis-
eased blood circulates, to carry disease and death into the
very citadel of life. Here we have more rapid wasting, or
emaciation, which is so marked a system of consumption.
This imperfectly vitalized blood, thus circulating through all
the organs, deposits elements in the glandular structures which
is soon seen in what is known as the scrofulous cachexia.

* How is carbon, in the blood, an element of the oxygenation of tissues? — Ed.

526 Haughton On Tubercular Phthisis, Nov

Defective aeration of the blood then comes in to perpetuate
the trouble already begun, and is one of the conditions, not
first, as some (modem writers) have it, not singly and alone,
as is taught by the same writers, but one of the conditions,
and only perpetuating a difficulty which began in the cells,
which prepare the pabulum of life, and which this process
of aeration cannot remove.

Taking the chain of morbid events thus occuring, we can
erect a pathology and treatment which is more preventive
than curative, and which is indicated to us in the causes thus
brought to view.

The doctrine of the inflammatory nature of tubercles is now
taught and believed by many, but it will not bear the test of
post mortem inspections, especially of those who have died of
other diseases, while tubercles were present, revealing the
fact that the pulmonary structure was perfectly healthy and
free from inflammation contiguous to these deposits. Pro-
fessor Gross, in his able work on Pathological Anatomy, treat-
ing of tubercle, says : "In a former edition of this work, I ex-
pressed the opinion, that tubercles are always of inflammatory
origin, and a more extended investigation of the subject has
only tended to confirm this conclusion." We have no doubt
but that tubercle may be the result of inflammatory diseases,
which have enfeebled the body, impaired the vital elements
of the fluids of the body ; but this will not account for all the
cases which occur, without other previous disease, in any or-
gan so far as observed ; yet it is developed, and so insidiously,
that the patient is hardly aware of disease, before he is a con-
firmed consumptive. Prof. Carpenter, in his late edition of
Physiology, says, " That persons who are of a scrofulous, or
strumous constitution, have an imperfectly elaborated fibrin,
while the blood contains an unusually large number of color-
less corpuscles, while the red corpuscles are in unusually
small proportion." " We can understand," says the same
writer, " that such a deficiency in plasticity arises from de-
fect in the nutrive processes, and thereby is made worse ;
hence this tendency to cacoplastic deposits," (without injlam-

1857. Hattghton On Tuhercular Phthisis. 527

mation). This is my own view of the nature of this deposit,
admitting the influence of inflammation in increasing the
tendency to rapid deposits, after the cachexia once exists.
My view is strengthened and supported, as regards cell trans-
formation, or cell growth, as well as imperfectly elaborated
fluids, in chyle, lymph, and blood, from this view, taken from
Carpenter : " The most frequent of all the degenerations of
lymph," he says, " being, when the lymph is placed in any
unfavorable condition from the first, for its development, and
the result is, a plastic, or cacoplastic material, which again,
after finding its way into the blood, is secreted and deposited
by cell growth in the structure of the lungs, and we have an
irritation as the result of such deposit ; and finally inflamma-
tion is set up, locally, around these deposits. Softening takes
place easily, the result being unorganised products, pus, and
an aplastic material, contained in the crude tubercle, as it
came from the blood, or from the admixture of blood and
lymph, very imperfectly elaborated.

Further evidence of the doctrine taught in this paper, is
this: The material, unorganized as it is, which is provided
for the healthy nutrition of all the different structures of the
body, is converted, under the controlling influence of vital
action, into living cells ; and all the chemical and physical
forces, by the operation of cell force, are converted into vital
powers. But Carpenter says, again : " It is inherent, in the
very nature of the living organism, that this instrumentality
should exist but a limited time. The changes," he continues,
involved in the process of organization, have the effect of
rendering the organic structure less and less instrumental in
determining this metamorphosis of force ; and thus a time
arrives, when the capacity of development is exhausted, and
these forces, no longer turned to account in vital activity,
begin to exert a destroying, disintegrating power. Hence,
then, in the process of cell-growth, these chemical forces are
known to exert their influence ; and, if the cell-force is not
active enough to resist the forces so operating, we have
imperfect nutrition and imperfect fluids, as the result of this

528 Halghton On Tubercular Phthisis. Nov

cell-force ; and we need have no doubt as to the origin of the
diseases, which grow out of such conditions. The cell-force,
which is operating, may be perverted — nay, is so — by such
influences, and this perversion ends in the deposit, in many
cases, of these unorganized, cacoplastic deposits, which are
frequently found in many of the tissues of the body.

rJLneu we come clearly to an investigation of the laws of
Cytogenesis, an investigation of the laws of cell-growth, cell-
life and cell-force ; and Ave shall be able physiologically to
show, that this manifestation of force becomes so defective,
through various agencies brought to bear upon it, that disease
is the result. By the aid of the microscope, all tissues are
reducible to three forms, of which cells are the most impor-
tant. The whole fabric of organized bodies is built up of
cells, and, moreover, we know that by cells and their deriva-
tives all the vital actions in the economy are performed.
Each kind of tissue in the body, as formed by cell-growth
and cells, differ in their character as the necessity of the vital
act demands, when the correlating forces are healthy and
originate in healthy conditions. Eur we find that transform-
ing influences may be exerted upon the cell or its contents,
and, when this takes place, the original intentions of the cell
forces engaged are so changed, that, instead of building up
new tissue, or supplying the material for such tissue, morbid
conditions result, and morbid material may be deposited.

Garpenter says, again, " that cells cannot be formed, unless
the pabulum be supplied which they require, not only for the
generation of the cell wall, but also for the filling up their
interior with its characteristic contents." We find, also, that
cells have a converting power upon their contents, changing
them so that new material is the result. If this condition be
true, and can exist in a physiological state, by parity of rea-
soning, the same condition obtains in a pathological condition,
and cells, by the transforming power which they possess over
the material which they contain, may deposit foreign
growths and originate new forms of diseased action. Hence,
it is not unlikely to suppose that tubercle is the result of cell

1857. Haughton On Tubercular Phthisic. 529

action and deposit — not of itself possessing vitality or organ-
ization, but a result of changed cell-force.

Thus, in the nutrient material which is furnished to the
lacteals and absorbents of the alimentary canal, there is con-
tained the future blood and tissues for the body, if so be no
diseased action is set up ; and it must be elaborated, vitalized,
by the operation of cell force — and these cells are the organs
of building up and tearing down this most noble machinery,
the handiwork of God.

There are various influences and agencies which exert a
deleterious influence upon the living body— these forces not
being kept at bay by the operation of the vital powers, but
manifesting themselves either in the modification of its vital
operations, or in the destruction of living tissue, either
directly or indirectly, by the deposit of some heteroclite
material, which becomes the source of irritation to surround-
ing healthy tissue ; and thus the body is impaired, and a
continuance of the process produces death. The living body
has not the power to resist the operation of chemical and
physical agencies, but is completely under their control,
— these agencies being modified, however, in the living
organism, by the continual play of the vital actions — thus
being very different from the same influences, in a body
where the play of vital actions had ceased and Death had
claimed the victory. Again, while this is the case, there are
certain other agencies which modify and pervert the ordin-
ary healthful play of the vital actions, without destroying
them, and thus give rise to morbid actions.

Therefore, in proportion to the degree of vital energy
which cells possess, in turning some agencies to their own
account and resisting others, will be the sum total of their
power in carrying on the healthy actions of life; and, as a
consecmencc, when resistance to ^uc}i influences is impossi-
ble, waste, decay and disintegration are the results. Then
the laws of cell life, development and growth are but the
phenomena of normal life, and of disease; and the law of
remedial influence ifl but an example of the truth of th v

530 Haughton On Tubercular Phthisis. Nov.

laws. But, as we have found that the pabulum of life, the
material of cell-growth, cannot be appropriated unless prop-
erly prepared, we see the great failure in the processes of
nutrition depends, first and principally, upon the manner in
which digestion is performed, and, secondly, upon the failure of
the cells of lymph glands to appropriate such material. Hence
a general failure of all the principal vital actions ; because, if
nutrition is impaired or stopped, the chemical affinities and
vital actions begin to exert their transforming power, and
there is no resistance to the morbid process which goes on.

This has a corresponding evidence in the result which
takes place when nutrition is again carried on and the diges-
tive powers resume their proper office. These changes have
taken place in tuberculosis, and, by exposure to fresh air, the
use of good, wholesome diet and plenty of exercise, the
whole condition of the system has been changed — and this,
through the influence of certain chemical and physical
changes. For instance, the exposure of the patient to fresh
air brings oxygen into the lungs, to transform the blood ; the
food becomes palatable by exercise, and thereby gives the
power for its digestion — and hence its appropriation.

But those other agencies, before alluded to, which the
vital powers can not long resist, are : confinement in close,
unventilated rooms ; little or no exercise ; breathing over
and over again the noxious emanations which take place
from the skin and lungs — thus poisoning the blood, impair-
ing digestion and enfeebling the body to such a condition,
that it is easy to find tubercles, as the result of such a miser-
able disobedience of the great laws of life and health. And
the sufferers are often those upon whom Fortune has lavished
her bounties and surrounded with wealth and luxury ; and,
through the misguided love and sympathy of friends, a cool
breath of air is not allowed to fan the hectic cheek, and that
air, which nature so much requires, is shut out — and thus the
patient is hurried to that " bourne from which no traveller
returns."

There is further evidence of the positions here assumed, in

1857. Todd's Clinical Lectures: 531

«^— — »— — ^ ^ — —

the action of the liver and the tendency to deposits of fatty-
matter in that organ. The principal element in tubercle, as
derived from analysis, is albumen ; and the office of the liver
is a double one — not only a depuratory organ, but an assimi-
lative one. The assimilation of the albumen, with which the
blood conies loaded from the alimentary canal, seems to be
an important office of the liver. Well, then the conclusion
at which we arrive is this : That the liver exerts a most
happy influence in the vital changes of the elements which
go to make up the blood when the system is healthy. But
when disease of the system takes place, and impairment of
the processes of nutrition ensues, there is an arrest or change
of this healthy action, and the materials, instead of being
converted into the tissues of the body, are converted, in the
liver, into fatty matter, and there deposited.

(To be Continued.)

giblio graphical Ikort,

Clinical Lectures on Certain Diseases of the Urinary Organs, and mi Dropsict.
By Robert Bently Todd, M. D. F. R. 8., Physician to King's College Hospital.
Philadelphia: Blanchard & Lea. 1857.

Next to Anatomical and Physiological. Clinical Instruction is, con-
fessedly, most essential to the practitioner of the healing art. Whilst
the former affords him a sure foundation, the latter furnishes him
with the most reliable and enduring materials, with which to erect a
magnificent superstructure of good works and of undying fame.

We regard, therefore, every intelligible effort to enlarge the sphere
of clinical teaching, and to give it prominence in public estimation, as
deserving the highest commendation. Thus considered, the work,
whose title stands at the head of this article, merits something be-
yond a casual or common-place notice. The high position occupied
by the author, too, both as a practitioner, as a teacher, and as a pop-
ular writer, present's a further reason why the Clinical Lectures
should receive more than a brief and imperfect examination, by all
who would fully understand the subjects they are designed to eluci-

532 Bibliographical Record. Not.

date. No reader, we think, who has toiled up the rugged ascent of
professional experience, and acquired merited position with no other
lights than those which have shown upon him from the ordinary
teachings of the lecture room, from the perusal of the systematic
works commonly found in the Doctor's library, and from his own
limited experience, will fail to appreciate the purpose, set forth in the
following quotation from the author's preface :

" In these, as in former lectures, my aim has been, to teach by ex-
ample, to inculcate cardinal points of diagnosis, treatment and pa-
thology, by observations, made at the bed side, and by illustrations,
drawn from suitable cases."

Nor will the notions held and enforced, in reference to the most
profitable mode of conducting clinical instruction, be less satisfactory
to him. who has duly considered the s

The necessity of " intelligent and industrious Clinical Clerks j' of
system and order in the mode of procedure in hospitals, reference
being made to the most advantageous hour of the day, and the pro-
priety of abridging the length of the ordinary systematic lectures ;
also, of appointing special clinical teachers, of rotation in appoint-
ment and division of labor. — all these have received particular atten-
tion from the author. He urges, also, upon those who are " responsible
for, and interested in. the advan jf medical education, v the

imperative necessity. " that in every school, hospital attendance and
clinical study be made the nucleus of the teaching of all other subjects,
in preference to the existing system, which, in effect, makes it subordi-
nate to the rest.'1'

All who are thus responsible and interested, will cheerfully approve
the suggestion that, in every schoool, " the examinations instituted for
medical diplomas and degrees." should be " conducted in a maimer
adapted to test positive knowledge, rat tan to encourage flippant

expertness in answering questions," in order that the u grinding pro-
cess" may be avoided, •"and a more healthy and zealous pursuit of
scientific and practical knowledge, for its own sake " may be made to
take its place.

The volume consists of sixteen lectures, all devoted to the consid-
eration of subjects of great practical importance. In the first two,
f hematuria, in its various forms, and results, is treated of and illus-
trated both pathologically and therapeutically, by well selected and
instructive cases.

1857. Todd's Clinical Lcctv, 533

The third and fourth consider those forma of Renal Disease, in
which albuminuria, and serous effusions, constituting the varieties of
dropsy, are prominent symptoms or results. The seven, which fol-
low in numerical order, contain an amplification, more in detail, of
the symptoms, pathology, diagnosis, doctrines and therapia of drop-
sies, in their different locations, the states of the economy, in which
it occurs, and may be anticipated, as, likewise the condition of, and
influence upon, organs and functions, collaterally implicated, as the
lungs, the liver, respiration, etc., in connection with, or resulting from,
lesion of the renal apparatus. Id these, too, the principles enuncia-
ted, the indications of treatment, and the means resorted to for the
fulfillment of such indications, as well as their effects and the ulti-
mate results to I ., are exemplifi I a succinct statement of
appropriate •

The concluding five lectures are chiefly ted to Gout, its

symptoms, its various manifestations, and the inl xereises

in modifying the character of renal diseas

We cheerfully award to the author, grer. and no common

courage in selecting and grappliug with sueli prominent, complex and
often difficult maladies, or results of maladies, as liaeaturia, dropsies
and gout, as the themes of clinical instruction.

Says another : ;i The object of clinical teaching is to impart to the
student, facility in dealing with the problems of disease which are
ever rising before him. It is, therefore, a great advantage to him to
have large and striking phenomena, so opened out and explained to
him, in all their possible causes and relations, that whenever and
wherever he meets them, they may have to him, all the significance
that really belongs to them."

Now, it is but too common for the mind to grasp, imperfectly and
superficially, the subjects that present themselves for considera-
tion ; hence the necessity of having them often brought for .
and delineated, that they may be fully comprehend

Thus it is that drawings, models, and maps, enable the beholder to
acquire more accurate and comprehensive views of natural objects,
scenery, and works of art, than can possibly be acquired from oral or
written description. Hence, also, the value of philosophical experi-
ments as illustrative of scientific doctrines and principles, and the no
less illustrative significance of cases of disease presented to the
observation of the learner; of the mode of conducting examinations

534 Bibliographical Record. Hoy

of the sick, in order to elicit essential facts, as the basis of intelligent
deductions, and of post mortem investigations. Nor is the concise
relation of striking cases of disease wanting in interest or destitute
of value, as sources of instruction.

Thus it is, too, that he whose mind is thoroughly imbued with the
great truths of physiology and theprapeutics, and, moreover, who
has studied disease in obedience to the dictates of philosophical de-
duction— in other words, who has treasured facts in reference there-
to— has it in his power to exhibit,not only the minor and comparatively
unimportant, but the more weighty and complicated questions of pro-
fessional research, to the vision of the reader or hearer, with a
freshness and copiousness of illustration that enables him to perceive
in them more than he had perceived before — that dissipate obscurity
and banish doubt. It is under these circumstances and in the fulness
of the love of philosophy and truth, that Dr. Todd has drawn upon
his large resources, both of observation and experiment, and collated
the numerous facts and deductions, which constitute the work now
under notice.

In the lectures on hematuria, the reader will find an explicit rela-
tion of most, if not all, that is essential to be known in reference to
its varied forms, locations, causes, symptoms, complications, diagno-
sis, prophylaxis, and treatment.

In regard to causes, however, we may say we find at least one
statement which does not accord with our own observations, and
which, we are inclined to believe, will be found to be in controvertion
of the experience of other competent observers. The author remarks,
u by far the most common cause of bloody urine, is the disturbance
of a calculus, formed and lodged in the kidneys."

In the course of our experience, we have met many cases of baema-
turia. Some we could trace directly to irritation, congestion, or
active hyperemia of the kidney, and induced by various causes ;
some to the influence of suppressed habitual discharges, as hae-
morrhois, or interrupted catemenial flow, the kidney, or the
the urinary vescicle being the source, as the predominant pre-dispo-
sition ; some succeeding the retiring of chronic cutaneous eruptions ;
some as the sequel of, and accompanying the prostration, consequent
upon long continued fever ; and not a few, originating in the bladder,
from passive congestion, or active hyperemia- of its mucous lining,
but never a ease, that we could carry back to the formation and lodge-

1857. Todd's Clinical Lectures. 535

ment, and "disturbance of a calculus in the kidney;'''' nor a single case
that did not readily yield to treatment, adapted to the condition of
the constitution under which it arose. This may come from local
influences, whether of climate, pursuit, general mode of life, moral
influences, by whatever cause induced, food, drink, etc.

In the course of a continued practice in the same locality during a
period of thirty-two years, and among a large population — mechanics
and tradesmen, as well as agriculturalists — no more than two cases
of urinary calculus occurred. Of these, one was in a lad about
twelve years old ; the other, in a foreigner about fifty. Both were
cut, and recovered most satisfactorily.

A reference to statistics will be found, we apprehend, to confirm,
the results of our observations. Thus : " In one hundred post mor-
tem examinations, where the history of the symptoms during life,
was obtained, hasmaturia is noticed as having occurred in five only.
In one of these, it was from purpura; in a second, from diffuse cel-
lular inflammation ; in a third, from morbus Brightii (enlarged kid-
ney), in a fourth, from cardiac and renal disease ; and in the fifth,
from scrofulous, renal disease. In not one in the hundred, was
there renal calculus."

If, then, calculus can be shown to be a comparatively rare abnor-
mity, and particularly in certain localities, the inference will obviously
accord with our position, in reference to the matter in question ; for,
although we have no statistics within our reach, showing the com-
parative frequency of hematuria, we have no question, since the dis-
ease may arise from many and various causes and conditions, as
shown by the author himself; but every practitioner who has seen
much practice, has seen examples of this disease, in the proportion, at
least, of twenty to one, of calculus.

Admitting the former, then, to be thus, in excess of frequency
over the latter, how can it be that, as a rule, applicable to all coun-
tries and localities, " by far the most common cause of bloody urine
is the disturbance of a calculus, formed and lodged in the kidney V
Again, may it not be true that what obtains in one locality may be
wanting in the attribute of truth in another, and, therofore, unsafe, as
the basis of a doctrine, proposed to be general in its application I

Let us now advert, briefly, to records, showing the relative fre-
quence of calculus in different localities, and thus endeavor to show
that what the author puts forth as a rule, without qualification, must

536 Bibliographical Record. Fov.

to say the least, have been hastily uttered, or, if true, it is so only
in regard to certain countries, or even to certain sections of the same
country.

Take. England, for example. And here, while we find that " calcu-
lus disorders " are somewhat frequent, we learn that remarkable
differences characterize different sections. Thus, while Dr. Prout,
calculates that one in fifty thousand five hundred of the entire popu •
lation dies of calculus annually, in England and Wales, he shows that
the greatest mortality is in Manchester, the proportion being, on the
average, about one in thirteen thousand two hundred, annually. In
York, Durham and Wales, the mortality ranks next in degree, aver-
aging about one in thirty-one thousand. The mortality is above the
average, also, in Stafford, Lancashire, the west riding of Yorkshire,
Leeds, London, and Liverpool, while it falls considerably below, in
the districts now to be mentioned, and in the following order : Nor-
folk and Suffolk, where the average range of mortality varies but
little from one i;. sixty-four thousand five hundred, nearly five times
less than in Manchester. In Cheshire, Dorset, Oxford, &c> — Essex,
Devon, Cornwall and Sommerset, the average mortality . annually,
is but one in two hundred and seven thousand, something more than
fifteen times less than in Manchester. This is a most profitable field
of research, and nothing could afford us greater pleasure than to trace
the parallel throughout the range of literature that belongs to the
subject, but our limits forbid. We can only allude to a few particu-
lars. It will be found that differences, not less remarkable, exist
throughout the different countries of Europe, than "are shown to be-
long to the respective sections of England and -Wales. Thus, in
Ireland, calculus, as we learn from Dr. Yellowly, is a rare disease.
In Scotland, France, and Holland, it is greatly more common, whilst
in the principal localities of Prussia, in Spain, the Sardinian States,
and in the Ionian Islands, and particularly in those districts in which
the Rhenish variety of wine is manufactured, " the malady is infre-
quent."

Again, in Denmark and Russia, it is of common occurrence, while
the inhabitants of Saxony, Norway and Sweeden suffer but little
from it. An examination of the statistics of the Austrian dominions,
in reference to the point now being considered, shows that, in ten
years — from 1820 to 1830, — in a population of something more than

1857. Todd's Clinical Lectures. 537

nineteen and a half millions, no more than one thousand four hun-
dred and forty -nine cases of calculus occurred.

If we extend our search to what is taught by the history of our
own country and the British dominions on the American Continent,
in reference to the point in discussion, we shall find that while calcu-
lus, as regards the whole population, may be considered an infre-
quent malady, there are no inconsiderale differences, in various sec-
tions. Now, we deduce from the foregoing facts, that, unless ha3ma-
turia is of vastly less frequent occurrence than our observations in-
dicate, from the comparative infrequency of calculus, the position of
our author cannot be strictly true, as regards the inhabitants of Eng-
land and Wales ; that, in reference to certain sections, as Chester,
Dorset, Oxford, Essex, Devon, Cornwall, and Sommerset, it must
diverge widely from truth ; that, save in certain localities, it can
scarcely be said to approximate the truth ; and therefore that it can-
not be relied upon as a law of general application, and as a guide in
diagnosis. That it may be true, or a near approximation to truth,
in certain districts, and particularly in Manchester and in the creat
metropolitan city, in which the distinguished practitioner and author
has gathered his experience and won his laurels, seems not improba-
ble ; for we find that London, though our statistics are silent as to
the proportional frequency of its occurrence, is, nevertheless, one of
the localities in which the mortality from calculus is above the aver-
age. As regards the speeies, — the civilized portion especially, — it is
nothing short of a fallacy, whose effect must be to lead the inexpe-
rienced astray. On the whole, we conclude Dr. Todd must have
intended to put forth only what is true in certain limited districts, or
that he hurried to his conclusion, without having given the subject
the full and earnest investigation, by which he is characterized.

At page 83 we find the following : " The nausea and vomiting
were also probably caused by an irritated state of the gastric mucous
membrane, arising from the diseased blood. It is, indeed, to this
poisotied state of the blood, resulting from the formation or reten-
tion in it, of substances which would have found a ready exit through
the kidneys, had they been in a sufficiently healthy state, that most
of the symptoms from which this patient suffered, were due. In this
respect, all forms of diseased kidney are much alike ; all tend to pro-
duce similar secondary phenomena, whether large or small, the dis-
eased organ fails to excrete the normal elements of the urine. ;m«l
vol. in, no ix. — 36.

538 Bibliographical Record. Nov.

these, or certain of them, accumulating in the blood, affect all the
tissues and organs, more or less, and at length exert their baneful
influence on the nervous system, disturbing its functions in the most
serious manner." In the course of the volume, numerous references
will be found to the, now getting to be popular doctrine of the exist-
ence of " disease," or " poison in the blood," and of the cogency of
such diseased condition, or poison, as a cause of disease ; and particu-
larly of the urinary organs, by giving rise to irritation and congestion,
if not to inflammation, in their efforts to eliminate it — the poison —
from the circulating mass.

Refraining, for the present, from the discussion of questions, both
physiological and therapeutical, involved in the above quotation, and
the doctrines inculcated, we observe it is incumbent on the advocates
of such principles and doctrines, and in an especial manner upon the
learned author, to inform us in what this alleged " diseased condition "
consists, what are the characteristics, as well as the modus operandi
of the toxical materials, so frequently, and with such a show of learn-
ing, announced, and what their antidotes. A reader, who happens
to be a little fogyishly inclined, might not inappropriately inquire,
why not return to the most out and out humoralism at once, and re-
establish the supremacy of acrimony, atribilia and lentor 1

The former had conferred upon it, the power of irritating, corroding
and dissolving the substances of the body, not endowed with it as an
essential quality; hence acid and alkaline acrimonies. The author says,
" And these, or certain of them, accumulating in the blood, affect all
the tissues and organs more or less, and, at length, exert their bane-
ful influence on the nervous system, disturbing its functions in the
most serious manner." It may be asked, where is the real difference 1
Verily, it seems like taxing the credulity of the intelligent men of
the nineteenth century overmuch; — but we forbear. Within the
past few years, the condition of the urinary secretion, which exhibits
the existence of albumen, its value in diagnosis, the therapeutical con-
clusions to which it gives rise, as well as the pathological conditions,
whence it originates, has called forth much learned investigation,
and the hybrid term, Albuminaria occupies a large space in the pe-
riodical literature of the professional world, and finds a prominent
place in the systematic productions of the age. The lectures devoted
to the consideration of hydropic effusions contain an intelligent, and,
in most particulars, a satisfactory resume, of the accepted doctrines,

1857. Spirit of the Medical Press. 539

connected with the subject. One thing, however, surprises us not a
little ; it is that we find no allusion to the originator of the doctrine,
now so absorbing, Cotunnius, to Darwin, who entertained it, nor
to Blackall, who amplified and elaborated it into a treatise, illus-
trated by numerous cases and gave it to the world in the early part
of the present century. In the portion of the volume which treats of
Gout, the reader will find a satisfactory summary of what pertains to
the subject, not only in its individual aspects, but in its complica-
tions. All things considered, we regard the performance as credita-
ble to the author, as a highly useful contribution to practical medi-
cine, and cheerfully recommend it to our professional brethren.
For sale at the house of Raymond & Selleck, in this city. K.

ipirtt 0f \\t fktol |tess.

On the use of Aconite as a Therapeutic Agent. — I wish to give the
readers of this Journal my experience with the use of aconite as a remedy
especially as I find, in conversation with my medical friends, that very
many of them do not avail themselves of an agent, that, with me, has
proved very efficient and satisfactory.

The aconitum napellus (monkshood — wolfsbane) is represented by wri*
ters, with great uniformity, to rank among our most active poisons ; thus
in the article on aconite, in Wharton & Stille's Medical Jurisprudence : —
" The leaves and root of the aconitum napellus contain one of the most
extraordinary and speedy poisons known ; and fatal mistakes are recorded
from small portions of the leaves or root having been eaten by mistake.
Writers also describe the root, seeds, and leaves of the plant as possessing
" a hot, acrid taste, giving rise to a burning sensation in the fauces, numb-
ness and tingling in the limbs, swelling and pain in the abdomen, vomiting
and purging, accompanied by giddiness, delirium, dimness of sight, and
other symptoms indicative of cerebral affection ;" and even when simply
applied to the cutaneous surface, it is said to produce at first a feeling of
heat, which is followed by prickling or tingling sensations, with numb-
ness.

Although I have directed the use of aconite with comparative frequency
I have not in any case observed such strongly marked manifestations of its
therapeutic effect as those which are thus attributed to it ; and I am satis,
fied that, administered medicinally, these are exaggerated descriptions of
its effects.

540 Medical Independent. Nov.

Another quality attributed to aconite is, that while consciousness may
be in no degree impaired, both general and special sensibility will be
greatly diminished. Thus, Pereira relates, that under the influence of a
full dose, a dog would wag his tail when noticed by his master, and en-
deavor to follow him around the room, though quite insensible to pinching,
or the pricking of a needle.

With such very positive effects upon the nervous system, we should
naturally expect this remedy would find a prominent place in the treat-
ment of a large class of neuralgic affections, and diseases of a kindred
character. It is, however, somewhat singular, that Baron Storck, who
first brought aconite into special notice as a remedy, about one hundred
years since, more particularly recommended it in scrofula, dropsy,
phthisis, and cancer ; and having enjoyed a brief but of course fictitious
reputation, for the cure of these formidable diseases, it passed for a time
almost entirely out of notice again.

I have found good results from the use of aconite, in almost the entire
range of neuralgic affections, and in those obscure complications of rheu-
matism and neuralgia in which there is freedom from local or constitu-
tional trouble, independent of the nervous derangement ; but more
particularly in such cases as are usually styled pure neuralgia, I have fre-
quently had results almost as prompt and satisfactory as were recently at-
tributed to valerianate of ammonia.

Something more than a year ago, a lady called upon me for advice, for a
severe neuralgia of the face and head. From the history of the case, I
supposed it to be a result of previous attacks of miasmatic disease, and ac-
cordingly prescribed quinine, which relieved her temporarily, but every
few weeks she would have a relapse, and for several days at a time suffer
excruciatingly. In addition to the quinine, quite a variety of customary
treatment was resorted to, until in November I directed the following pre-
scription, after she had suffered a week, and had tried without avail all the
remedies that hitherto had given temporary relief:

R. — Tinct. Aconite, JRoot, dr. i.,
Tinct. Cimicifuga, oz. ij.

Sig. — To take a teaspoon full every four hours.

My patient took three doses, when she was promptly and entirely re-
lieved ; and what is better, she has scarcely felt a neuralgic twinge since,
now about ten months.

In another case, a friend had for a long time suffered a peculiar form of
neuralgia, or neuralgic rheumatism in the arm, which seemed to yield to
no remedy, even temporarily. I suggested the aconite. The result was
equally prompt with that of the case I have just given. I might multiply
these satisfactory examples to considerable extent.

The formula given above is the one I most frequently use in administer-

1857. Spirit of the Medical Press. 541

ing tlje aconite to adults. It will be observed that, given in that way,
each dose would be equivalent to about four drops of the tincture (except
that tinct. aconite gives something. more than sixty drops to the drachm);
and in that dose I have never seen any effects sufficiently marked or vio-
lent to occasion alarm. It will also be observed that the tinct. of the root
is directed. The U. S. Dispensatory recognises two officinal tinctures : of
the leaves and of the root. I prefer the tinct. of the root, as of greater
efficiency, and more reliable as to uniformity of effect. The tinct. cimici-
fuga is intended chiefly as a vehicle, but selected with the view to its con-
tributing to the special effect of the aconite.

I have not tried the aconite in acute rheumatism, but in the chronic
rheumatic pains, particularly such as aged people complain of, I have seen
very excellent effects. Neither have I used it much locally, though with
many, even those who do not use it internally, it is a favorite topical appli-
cation.

There is a form of neuralgia, associated with uterine derangement, which
I have frequently met with, coming up sometimes in connection with the
catamenial period, or immediately subsequent to it, in which there is pain
through the hips, sacrum, and uterine region. Sometimes I have seen this
group of symptoms succeed abortion. I remember a case of this kind,
where the local distress I have just alluded to remained very troublesome
for several weeks, while much of the time there was almost uninterrupted
sleeplessness, despite the free use of opiates. The tinct. aconite root, given
through the afternoon and evening, relieved the neuralgic pain, and se-
cured a sweet and refreshing sleep through the night.

I have no explanation to give of the manner in which aconite acts the-
rapeutically. I offer the suggestion, however, that its action is directly
upon the nervous tissue itself. If this be correct, we should find in some
sort a key to the irregular action of remedies in neuralgic affections, and
some explanation of the fact, that a remedy gives prompt relief in one
group of neuralgic cases, while it is apparently void of all effect in a group
apparently similar.

These suggestions as to the use of aconite are not given as by any means
original, but simply as confirmatory of old known, but not practically
known truths. The query is naturally suggested, are there not many
other active agents sleeping on our shelves, which, if called into service,
would materially contribute to the comfort of our patients, and to our own
self-satisfaction. Will not, for example, some patient investigator demon-
strate that the gungha, or cannabis indica, is a valuable agent, administered
medicinally, for something more admirable than the unearthly intoxica-
tion which is its peculiar manifestation. — Medical Ooseiter.

542 Medical Independent. Nov.

(Bttaml anb Ptstfllanjj.

VERITAS ET JU5TITIA, SI5E TIMORE.

Professional Honor ; — Not that reflected honor which our pro-
fession has been so free to lavish, even upon the unworthy, but that
which has given character and perpetuity to Medical Science. In
this we find the text for a few observations.

The practitioner of Medicine, who has acquired the confidence of
community, sustains a relation to society which can not be secured
by any other accomplishment. He is not only entrusted with the
life of his fellows, but obtains a passport which freely admits him to
the inermost apartments of home, where he is even permitted to hold
the secrets and share the sympathies of the heart. What bond of
security has he given for these chartered rights and priveliges ? His
honor, endorsed by the profession as a whole, and this ought to be
sufficient. But, alas ! poor human nature too often finds in our pro-
fession melancholy examples of its infirmaties. Neither great ac-
quirements, the vows of religion, nor honorable position, always
afford undoubted assurance against the violation and forfeiture of the
sacred trust. Even carnal lust has invaded the sanctity of home,
under the guise of professional honor, prostituting the highest pre-
rogative to the gratification of sensual desire. If we may judge
from numerous individual instances, there seems to be a prevalent
disposition to lay aside moral character, to ignore the code of Medical
Ethics, to advertise medical talent and acquirement, to loan profession-
al honor for the ends of justice, and even to become a party to crime
for a paltry consideration. The editor of the American Medical
Monthly tells us in the September number, that '; there would have
been no difficulty in obtaining the services of a Doctor, who, for a
a thousand dollars or less, would have done all that Dr. Uhl was
asked to do."

However reluctantly we may admit the truth of this remark, it is
indeed a humiliating commentary upon the honor of our profession.

What has aroused the attention of the Medical public to the sub-
ject of " criminal aboi tion," urging it upon the attention of State
Medical Societies, calling forth fervent and lengthy editorials from
the Medical Press ? What is it, but the facility and readiness with
which medical men have permitted themselves to be pursuaded from

1857. Editorial and Miscellany. 543

the legitimate path of Professional duty and Professional honor ?
Jt ^has even been said that our Statutes, which were designed to
recognize and punish this infamous crime, have been rendered null
and void by the apparent sanction of respectable Medical men.

Is it not time, then, for even the respectable members of the pro-
fession, to consider whether they are not entertaining loose opinions
upon this subject, whether their influence towards the suppression of
the evil is not at least negative. Popular opinion upon the subject
of infanticide at the present time more fitly belongs to an age of bar-
barism.

The destruction of foetal life before the time of quickening, seems
not to be regarded as a criminal offence, either in the sight of God
or Man. Hence the enormous sale of nostrums that u must not be
taken in the early months of pregnancy.'1'' Hence, too, the numerous
applications and entreaties which every physician has, to violate
physiological, civil and moral law, by the sacrifice of embrionic life.
These ought to be startling truths, and sufficient to prompt every
respectable member of our profession to consider the obligation
which he owes to community and his own honor, and to labor with
zeal to correct this morbid public sentiment.

The character of the Medical profession, in every community, is
just what Medical men choose to make it. If they are true to its
highest interests, and worthy of its mission, they will ever preserve
its honor. \l.

"Medical Education" — Not u the American system of medical educa-
tion," as made up to suit the body corporate of the Jefferson Medical Col-
lege of Philadelphia, but the system of education adopted for the training
of students of medicine by the authorities of the State of Michigan, the
working of which is intrusted to the faculty of medicine in the State Uni-
versity.

We know of no school in our country whose plan of instruction is more
completely adapted to fulfill the designs of its creation than that prescribed
for the medical department of the University. Having an active faculty, a
six months lecture term, and a course of analytical chemistry, and a course
of clinical instruction interposed between the close of one lecture term and
the commencement of another, to which the more advanced students are
admitted, it seems to us more nearly to meet the wants of students than
any other we are acquainted with in the United States.

If the design could be executed faithfully, there would be but few other
things to be added, to make the institution as perfect as the popular form
of our political organization will admit of. But this is not the case. Of
the fidelity of the faculty in the main, we are ready to give our testimony.
It gives us no pleasure to speak of the exceptions. But being cognizant of

o±± Medical Independent. Nov.

the evil, we think our duty requires us to point it out, so that it may be
talked of and sanctioned, or else suppressed, in compliance with an intelli-
gent judgment. "We allude, especially, to the non-residence of a part of
the medical faculty during the lecture term at Ann Arbor.

On this subject we have heard complaints. In what way this habit or
custom produces evil, we do not propose to speak at this time. "We de-
signed only on the present occasion to speak of the fact, not wishing to
excite prejudice against individuals by any comments of our own, as to the
manner in which the wrong doing is made manifest. — Peninsular Jour, of

We copy the above article entire, for the purpose of giving what-
ever object the writer may have had in view, the advantage of the
additional circulation of the Independent ; and we should not further
notice it. but that it contains an insinuation, which is simply, both
cowardly and false.

As we are the only member of the Medical Faculty, who is not
either a resident of. or who does not pass the winter in Ann Arbor.
" the exceptions." of which the writer speaks, so greatly at the ex-
pense of his " pleasure." (?) refer, manifestly, to us. The writer in-
sinuates that we are guilty of infidelity to the University, because of
our non-residence. ,; during the lecture term at Ann Arbor." jWe
do not propose to enter upon a defence, further than to state, that
we have never failed, except in one instance, and that in consequence
of dangerous and prolonged illness, to give our full quota of instruct-
ion (four lectures per week throughout the term), or to fully per-
form all the duties pertaining to our office. The time, too, devoted
to our duties has been in conformity with Faculty action. If this be
infidelity, then are we the ;% exception" to " fidelity " which the Penin-
sular Journal so manfully insinuates.'

Our object is rather to discuss some of the disadvantages arising
from the country location of medical schools. Were not the remo-
val of the medical department to the city of Detroit eminently prac-
ticable, and would not the prosperity of that department be vastly
enhanced thereby, and that, too, without detriment to the University
as a whole, we would not dwell upon this subject. But as we re-
marked last month, our dearest aspirations are entwined with its
interest and prosperity : we were identified with the inception of the
medical department, and it constitutes our first professional love.
No one has labored more earnestly in its behalf than we. During
the first three years of its existence, we discharged the duties of both
the surgical and anatomical professorships, and we have ever given

1857. Editorial and Miscellany. 545

to the work, the best of our poor abilities. We shall therefore, per-
haps, be acquitted of overweening egotism, if we claim for our views,
respectful consideration.

Country medical schools can never take high rank among medical
institutions. Past experience shows not only this, but the more un-
welcome fact, that they cannot survive to a vigorous, prolonged ex-
istence. Fairfield, Woodstock, Dartmouth, Geneva, Willoughby, and
Laporte, are all dead ; and yet the Faculties of these schools contained
men, who have since been among the brighest ornaments of successful,
because more fortunately located institutions. Castleton, Pittsfield,
and Burlington, the Faculties of which, all contain able men, are
barely able to keep up an organization. Prosperous, they are not,
and from the misfortune of location, can never be. The principal reason
for the languishing and dying condition of these schools, consists in the
absence of clinical advantages, a subject which has been already
largely discussed in the pages of this journal. We do not, therefore,
dwell upon it now, but would call attention to another difficulty per-
taining to country locations, which is suggested by the article above
quoted.

The professorships of Practical Medicine, Surgery, Obstetrics and
Materia Medica, all imperatively require for their incumbents, practi-
cal men, i. e., men engaged in the daily practice of their profession.
Such men only, are qualified to teach these practical branches. A
single country location does not afford practice sufficient for so many
men ; hence in all country schools, only a portion of the Faculty
reside in the locality of the institution ; and the balance are permit-
ted to hurry through their course in eight weeks, to the great detri-
ment of the class, in order to return to the field of their labors.

The University of Michigan prescribes a six months course of in-
struction, and a continuance of each course throughout the term. To
facilitate the working of this plan, our colleagues have " sanctioned"
(is not the Pen insular satisfied with this sanction?) our delivering
two lectures per day, on two days in the week, thus making out our
weekly aggregate ; and we have, by returning home by cars in the
evening, and performing most arduous labor, been enabled fully to
discharge the duties of our professorship, and at the same time, to
attend to our practice in Detroit.

Ann Arbor cannot furnish practice for all the practical men which
it is necessary to combine in the faculty of a medical college. It con-

54:6 Medical Independent. Kov.

tains about four thousand inhabitants. Does the Peninsirfar Jour-
nal believe that it affords a sufficiently ample field of practice for the
Professor of Surgery in an important medical college % The Univer-
sity of Michigan pays its medical professors one thousand dollars
each for a course of lectures. Does the Peninsular Journal believe
that such a sum will induce any man capable of filling the chair of
surgery, to reside six months of the year away from his practice?
We do not judge so poorly of its sagacity ; and we earnestly invite
the attention of the Boards of Regents to the question which the
Peninsular Journal has opened. G.

COREESPOXDEXCE.

Ann Arbor, Oct. 9th, 1857.

Prof. Gunn, Detroit : — 1 have just read an editorial in the
Peninsular Journal of Medicine, the object of which appears to be
to drive you into a six months residence, in each year, at Ann
Arbor.

Two, if not three, out of the galaxy of editors of that Journal, are
anxious candidates for the honors and emoluments of surgical prac-
tice in Detroit.

Will this account for the milk in that cocoanut ?

MEDICUS.

New York, Sept. 17th, 1857.
Editors Medical Independent: —

At a clinique delivered last Thursday, by Dr. Carnochan, a
woman of middle age was presented, in whom had occurred a spon-
taneous oase-of vesico-vaginal fistula, under the following peculiar
circumstances : — It appears that the fistula resulted from violence
during a delivery, which was effected on ship-board, two years pre-
viously. On applying to the Emigrant's Hospital (of which Dr. C.
is Surgeon in Chief), it was discovered that, in addition to the
existence of a vesico-vaginal fistula, the case was complicated with
a strictured condition of the vagina, and the presence of one or more
calculi posterior to the stricture, — thus demanding a double opera-
tion. At that time, however, owing to the debilitated and cachectic

1857. Editorial and Miscellany. 547

state of her system, an operation of any kind was deemed inexpe-
dient ; and she was accordingly recommended a tonic course of
treatment, aided by a generous diet. After an interval of a few
months, her general health had so far improved as to justify an
operative attempt to remedy the local disease. On suggesting its
expediency to the ^patient, "she informed the Doctor that the urine
had lately been ^passing per viam naturalem. It was conjectured
that the calculus, or a portion of it, had become impacted in the
fistula ; but, to the Doctor's surprise, on liberating the stricture, by
means of a crucial incision, and removing the calculi (a feat accom-
plished with difficulty, owing to their size and their having pushed
the upper portion of the posterior wall of the vagina downwards and
backwards, forming, as _it were, a ail de sac), he discovered that a
spontaneous occlusion of the pathological opening had been effected.
ft was suggested, in explanation of the phenomena, that the calculi
(of rough exterior) had vivified the margin of the fistula, after the
manner of a caustic, so that granulations were evolved, whose succes-
sive growth had obliterated the fissure (closed the fistula?). The
woman appeared in excellent health, and profoundly grateful.

At the same ciinique, a male child, cct 5, was presented, with
ambiguous symptoms of coxalgic disease. Dr. C. remarked, that
the importance of the joint, its proximity to the trunk, and the fre-
quency with which it becomes diseased, invested such cases with
peculiar interest, while, at the same time, the difficulty sometimes
experienced in establishing a diagnosis, rendered it important to
obtain, from any and every source, knowledge, whether of a positive
or negative character, which would throw light upon the matter.
He then adverted to the subject of congential dislocation (" luxation
original "of the French), remarking that even Sir A stley Cooper,
with his immense means of research, denied the existence of such a
pathological condition. The French and Italian surgeons, however,
had amply refuted this position; and he exhibited a preparation of
the pelvis of a woman (whom he had the felicity of dissecting some
ten years since), in confirmation of the fact that original luxation
could occur; for die woman referred to had been lame from birth.
The acetabula were both obliterated, the capita femorom much di-
minished in size, the capsular ligaments remaining entire. No other
malformation or distortion, of any of the component parts of the
pelvis, was discernable. The flexed positon of the thighs upon the

548 Medical Independent. Nov.

abdomen of the fetus in utero, favored retraction of the psoi and
iliaci muscles, while dislocation was further endangered by the
shallowness of the acetabulum at that period.

A case of chronic eczema, extending from the knee of an old man
down to the toes, accompanied by a decidedly varicose condition of
the veins above the knee, well illustrated the truth of a remark
made by Dr. C, that the true causus morb'i was defective (impaired)
nutrition — the balance of the circulation being disturbed by the
morbid condition of the veins above ; that the disease occurred
chiefly in the lower extremities, and in persons whose vocation
involved long-continued standing — and hence, that if. in this case, a
radical cure were contemplated, ligation ©f the saphena vein would
be necessary.* Taking this view of the pathology of such cases, we
should not be surprised to find them obstinately chronic — yielding
to the horizontal decubitus and other adjuvant treatment in hospital,
but soon relapsing when the patient resumed his occupation.

A. G. MERRETT. M. D.

A Small Matter, but an Important one. — Editors Medical
Independent : — Gentlemen — Permit me to call the attention of your
readers to a matter trifling in itself, but, under certain circumstances,
great in its results — and these circumstances are in suits for alleged
mal-practice . I allude to a natural difference in the length of the
legs, as proved by accurate measurement from a given point on the
patella to the internal rnelleolar process. I have long been
acquainted with this fact, though I have no recollection of seeing it
mentioned by any one. My attention was first called to it in my
own person. I have no fault to find with my physique, although it
is slight ; but there is a difference of nearly one quarter of an inch
in the length of the legs. 1 have satisfied myself by the examina-
tion of several friends, and proved it beyond doubt in two cases of
fracture above the knee. When the measurement has been carried
down to the heel, the difference, in some cases, has been found still
greater, from the unequal development of the cushion formed of the
integuments and adipose and fibrous tissues on the inferior surface of
the os calcis.

* Your readers will be gratified by referring to a case of Elephantiasis Arabum of the right
Inferior extremity, succassfully treated, by ligature of the femoral artery, by J. W. Carnochan,
M. D., in the New York Journal of Medicine, September, 1852.

1857. Editorial and Miscellany. 549

The application of this knowledge was well exemplified a few days
since. I had been summoned to Essex County, in this State, as
witness in a suit for mal-practice. Although expected to be the
Plaintiff's man — my attendance being secured by a subpoena and
fifty cents a day ! — my feelings were enlisted for the Defendant, a
most worthy and capable professional brother. I urged the presence
of all the medical witnesses at the time the thigh was examined.
One person, very officious, and imported from Vermont for the
Plaintiff, constituted himself the factotum, and went busily to work,
measuring his own way, till he had made out the amount of short-
ening three inches. I now directed how to proceed — the leg was
laid on the carpet, the body being placed in as straight a position as
possible ; a tape line carried from the anterior superior spinous pro-
cess of the ilium to the internal melleolus, gave a shortening of but
two inches and a half. As the fracture was one of the femur, at the
union of the middle with lower thirds, no shortening could reasona-
bly be expected to exist elsewhere than above the knee ; but what
was the surprise of the measurer, and the pleasure of the doctor's
friends, when I told him to measure from the patella to the internal
melleolar process 1 It was done, and the result gave a shortening
of more than half an inch of the leg of the injured extremity. Here
was something very unexpected ; the main stay of the prosecution
was knocked asunder, and the boy only stood upon a leg a little less
than two inches, instead of one they had noised about as being
three inches and more shorter. The above amount of shortening
should have been expected in a bad case of oblique fracture, in a
very unmanageable patient, and where it was expected to prove that
the dressings had been tampered with. Of this, however, I have
nothing to say, as the trial was postponed till next March. Should
I be in attendance on the trial, I will forward you a few notes and
its results.

In all cases, I would advise your readers not to forget measuring
every portion of the extremity ; the leg, if it be a broken thigh,
and the thigh, if the leg is the fractured part, — and they will find a
handsome balance to the account of the defendant.

I remain, Gentlemen,

Very respectfully yours,
Horace Nelson.

PUttsburgh, N. K, Sept. 22dy 1857.

550 Medical Independent. Nov.

A Healthy Location. — A medical friend, in the northern part of
the State, writes as follows :

" I reside here in the capacity of a farmer ; and there is not sick-
ness enough here, among upwards of eight hundred people, to enable
a physician to earn his giving — obstetrical cases^ being almost the
only ones. I have Jnot seen a single case of fever, of any kind,
within three years ; and but three or four cases of pleuritis, and one
of inflammation of the brain — and yet~I am obliged to attend to all
the medical calls, there being no other practitioner here."

S. H. D., Ypsilanti, sends the following " Scarlet Ointment," for

glandular swellings : —

R. Lard, six ounces.

Iodine, one drachm.

Calomel, twenty-five grains.

Triturate the calomel and iodine with a small quantity of the lard
until well incorporated ; then add the lard, and mix. Effect, rube-
facient and alterative. — American Druggist's Circular.

How a Doctor Looks (to his Patients) : —

Three faces wears the Doctor ; when first sought,

An Angel's — and a God's the cure half wrought ;

But when, that cure complete, he seeks his fee,

The Devil looks less terrible than he ! Ibid.

Eratta — For October No., page 459, nineteenth line from top,
instead of Magnesium, (better waters,) read Magnesia prevails, (bit-
ter waters.)

In twenty-first line, read, likewise in most cases, a metallic sul-
phide, &c.

In twelfth line from botton, instead of Magnesia, etc., read Man-
ganese, etc.

Page 460, sixth line from top, for Sulphate of Sodium, read Sul-
phide of Sodium. Sixteenth line from bottom, instead offerro cyan-
ide of potassium, read ferri-cyanide, etc.

Page 461, thirteenth line from top, instead of Magnesia, read
Magnesian. Sixteenth line from top, instead of white precipitate in
any free acid, read white precipitate insoluble in any free acid.

Page 463, eighteenth line from top, insert if after colon, and read
if therefore, etc.

THE

Medical Independent,

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EDITED BY

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MEDICAL INDEPENDENT:

A MONTHLY

Review of Medicine and Surgery.

VOL. 3. DETROIT, DECEMBER, 1857. NO. 10.

Original €mmmmtm$.

Article I. Mechanism of Nervous Action. — Reply to Prof.
Paine. By J. Adams Allen, A. M., M. D., Formerly
Professor of Therap., Mat. Med. and Juris, in the Indiana
Medical College ; and late Professor of Physiology and
Pathology, and acting Prof, of Mat, Med. in the Univer-
sity of Michigan.

" Be not deceived, readers, by men that would overawe vour ears with big- names
and huge tomes that contradict and repeal one another," because they can cram
a margin with citations. Do but winnow their chaff from their wheat, ye shall
see their great heap shrink and wax thin past belief."— Apology for Smectymnuus.

Had Prof. Paine been content to have published his article
on the " Rights of Authors " only as an Appendix to the
new edition of the " Institutes of Medicine," where it would
have been read but by those who had previously fathomed
his own ideas upon this subject of nervous agency and me-
chanism, I would not trespass upon the pages of the Inde-
pendent in animadverting upon it. Put it appears, now
{Independent, Nov., 1857), in a position where a replv is
necessary, even though the reply have the effect, undoubt-
edly intended, of advertising gratis the ponderous volume to
which it alludes.

Although the irate Professor seems to think that no
authors have rights, except those who have written massive
VOL. Ill, no. x. — 37.

552 Allen On the Mechanism of Nervous Action. Dec.

volumes, I shall endeavor, in this article, as heretofore, to
condense my ideas into a brief space, even though, to impress
upon the attention without "vain repetitions," it may happen
that italics and capitals are legitimately employed.

By the kindness of a friend in Detroit, who volunteered a
thorough search, I have been permitted, since the announce-
ment of Prof. Paine's article, to read, for the first time, the
" Institutes of Medicine," with a steadfast endeavor to find
the new doctrines therein. Since the appearance of his
article, I have gone over it again, under the guidance of his
own references, — and nowhere is there the remotest approach,
nowhere the vaguest approximation to the real pith and mar-
row of the new principles under consideration ; but, on the
contrary, principles are therein taught, as diverse from these
as darkness from daylight.

It may happen, that some men have been unduly ambi-
tious of urging recognition of their priority of discovery ; that
some men have been anticipated in independent discovery ;
that some have worked out problems in nature, which others
have tried in vain to solve, and yet have themselves been
unconscious of their high significance. But it is rare that he
who has spent his life in establishing certain peculiar views
— whose written works are libraries in themselves, encyclo-
pedic in their vastness, — in his ambitious aspirations, should
so far overreach himself, as to seize upon ideas utterly
repugnant and destructive to the fabric of his life-time's
creation, and endeavor to avoid their influence, by urging
them as part and parcel of his own thought.

" Sophistry," says an eminent logician, "like a poison, is at
once detected and nauseated, when presented to us in a con-
centrated form ; but a fallacy which, when stated barely in a
few sentences, would not deceive a child, may deceive half the
world, if diluted in a quarto volume." The reason of this is
evident — a single false assumption will vitiate the conclusion,
however many correct statements may be made in connection
■with it. We shall see that this single false assumption vitiates
the " Institutes," as an authority, from title-page to Finis.

1857. Allen On the Mechanism of Nervous Action. 553

Again, we premise another thought, from the high logical
authority just quoted : — " The fallacy of References is partic-
ularly common in popular theological works. It is, of course
a circumstance which adds great weight to any assertion, that
it shall seem to be supported by many passages of Scripture :
now when a writer can find few or none of these, that dis-
tinctly and decidedly favor his opinion, he may at least find
many which may be conceived capable of being so under-
stood, or which, in some way or other, remotely relate to the
subject; but, if these texts were inserted at length, it would
be perceived how little they bear on the question. The usual
artifice, therefore, is to give merely references to them —
trusting that nineteen out of twenty readers will never take
the trouble of turning to the passages, but, taking it for
granted that they afford, each, some degree of confirmation
to what is maintained, will be overawed by seeing every
assertion supported, as they suppose, by iiye or six Scripture
texts." * The Appendix shows that Prof. Paine has a clear
idea of the power and mode of using the " Fallacy of Refer-
ences " — as I propose to make manifest to the dullest com-
prehension before I shall have done with this article.

But this is not the only fallacy which Dr. P. has recourse
to in the Appendix. Archbishop Whately evidently had the
Appendix in his mind, when he wrote that to the " Fallacy
of References " the Ignoratio elenchi is frequently conjoined.
Assummg the parallelism of two cases, from their being in
some respects alike, keeping out of sight that they differ in
essential points, the result is, what Dr. P. arrives at in the
Appendix, emphatically an " irrelevant conclusion."

There is a startling coincidence in the fact, that these
claims of Prof. Paine were not announced until the death of
Marshall Hall, who had fully conceded the claim of Dr.
Campbell, and in effect, therefore, of the present writer. By
Prof. Paine's own testimony, Marshall Hall was familiar with
his works.

• Whately's Logic, B. iii, § 10.

554 Allen On the Mechanism of Newous Action. Dec.

The graceful dignity with which Dr. Hall yielded preced-
ence to Dr. Campbell, puts at rest forever the insinuation
that he could arrogantly refuse priority to Prof. Paine, if that
were his due. We have, then, in effect, Marshall Hall's
testimony that Prof. Paine's work — dedicated and even sent
to him by the author — contained none of these ideas. The
conclusion is inevitably forced upon the mind, that the New
York Professor would never have promulgated his " after-
thought," had not the great London physiologist been cut
down by death. Does he hope to extinguish the present
writer more easily, by launching those big volumes at his
head?

"We will look into this matter a little — and, though wanting
-the prestige (" major nomen ") which surrounds the book-
writer of New York, and his elevated position in a metropol-
itan college, we shall not fear justice from an intelligent,
thinking and clear-sighted profession. The little modicum of
reputation which belongs to the present writer, is as much
prized by him, as though it equalled that of the author of the
"Institutes of Medicine," <fcc, &c; but, beyond this, and
infinitely more important, is it that the clear deductions in
the present exposition of the mechanism of nervous action
should not be confounded with the crude dogmata of the
"Institutes," — dogmata which, at one blow, would strike
down everything in the advance of chemical and physical
science, which can possibly throw new light upon the causes
and phenomena of health, disease and therapeutics.

Nor is this a groundless imputation — for what says Dr.

Paine ? First, then :

"The Institutes of Medicine are natural inductions of prin-
ciples and laws from the healthy and morbid phenomena of
living beings. They relate to Physiology, Pathology and
Therapeutics, and to nothing else. All other systems, there-
fore, must be spurious." — Institutes, § 2, a.

"The immediate objects of Physiology are a critical analy-
sis of the vital conditions and results of organic beings, as
manifested in different organs, and in their relations to each
other."— Ibid, § 2, b.

1857. Allen On the Mechanism of Nervous Action. 555

" Chemistry has been a perfect incubus upon medicine /
and the time is not far distant when it will nave proved, by
its own showing, its want of relation to our subject, if it have
not done so already." — Ibid, § 5. (The italics are Prof.
Paine's.)

" It is clear that while the laboratory is the proper place
for the study of the inorganic kingdom, we must go to the
organic being itself to learn the nature of the powers and
laws by which it is governed." — lb. § 6.

" When we consider the constant deceptions of the micros-
cope, especially in all explorations of soft substances, and the
absolute uselessness of any knowledge it may convey as to the
recesses of organization, it may be reasonably expected that
the time is not far distant when all this lumber will be
excluded from practical works on physiology, and turned, at
least, into a channel by itself." — lb. § 131.

Quotations might be extended ad infinitum, or as nearly
to it as this almost endless work extends, but it is unneces-
sary. Its author claims, as an especial merit, that he utterly
rejects all physical and chemical science, as having any
possible relation to physiology. He investigates phenomena
only, and attributes them, in gross, to forces and properties,
in every instance utterly distinct from any in physics and
chemistry. This is what "is impressed upon these Institutes"
and all the author's works and lectures — this is their cardinal
and only distinction.

Minute structure is so entirely disregarded, that, from the
beginning to the end of this work {par evcellence — the
"Institutes of Medicine!"), there is not an allusion to the
vesicle as distinct from the fibre or tube of neurine — there is
not an allusion to the vesicular structure of gland, or surface
or muscle. Ab uno, disce omnes — those who have read my
articles on this subject, or listened to my lectures, will see
that this is at the very heart and essence of the doctrine.

The relation of the cell (whether of neurine, gland, secret-
ing surface, or muscle) to the fluids and to the nerve conduc-
tor, is the very Hamlet of the play — and yet the New York
Professor brings it upon the stage as his original, with the
Hamlet out !

556 Allen On the Mechanism of Nervous Action. Dec.

So thoroughly does he despise the very principia of physi-
ological science, that, in this November, Anno Domini 1857,
he still clings to the exploded docrine of the instruments of
secretion being the " extreme vessels," " with open orifices !"
(op. citat. § 407 b et seq.) This theory of their structure and
mechanism will explain a point which he slurs over by igno-
ratio elenchi in the Appendix, but which I shall notice in its
place.

The generalization, which Dr. Paine now would ante-date,
is as follows, viz : — " What I do claim, is the great general-
ization that the excitor influence is followed by a reflex
change, in which the effect is not a motion, but a modifica-
tion OF VASCULAR AND NUTRIENT ACTION. That this effect takes

place by means of the double nervous arc." Upon which
Prof. P. remarks, that "the whole of this doctrine is im-
pressed upon" divers of his volumes, and has been pro-
mulged in all his lectures since 1841.

If so, he has been remarkably unhappy in the use of
language — for no such idea is expressed, in the Institutes at
least, but distinct and emphatic disclaimers of the same.

What I mean, by a " modification of vascular and nutrient
action," is fully explained in the same article, in close con-
nection (vide Independent for September, p. 384), viz :

" The molecular or integral composition or decomposition,
at the distal extremity of the reflex nerve, is the real element
— the motion, secretion or change of vascular or nutrient
action, production or abatement of inflammation, or other
change of the organ supplied by the nerve (reflex), being
altogether secondary or incidental."

Mark well — the whole effect depends upon the molecular
or integral composition or decomposition ! And yet Prof.
Paine, the Anti-chemist, the Anti-microscopist, the Anti-
physicist, always has taught and held these doctrines!
"TellitnotinGath!"

I was writing for thinking men — not for " Appendix "-
making literary -chiffoniers. But what does Dr. Paine say in
his book, to which this strange assertion is an "Appendix?"

" The properties of life are the fundamental cause of all

1857. Allen On the Mechanism of Nervous Action. 557

healthy and morbid phenomena. They are liable to be more
or less diverted from their natural state by a variety of
causes, and these .new conditions constitute the most essential
part of disease. This instability of the properties of life is
at the foundation of all disease, and even of therapeutics." —
Institutes, § 177.

" In their highest development, the properties of the vital
principle are six ; namely, irritability, mobility, vital affinity,
vivif cation, sensibility and the nervous power. They are
called vital properties, vital powers and vital forces, but
are clearly attributes of a common principle." — Ibid, § 183

" Since the perpetuity of organic matter depends upon the"
vital principle, it is manifest that both were brought into
being without the agency of each other."

" The vital properties cannot be generated by matter, since
upon them the existence of organization depends ; nor is
there a single phenomenon that indicates their presence in
inorganic substances ; nor can they be produced by the forces
of physics, since they are perfectly incapable of restoring the
structure, or even its elementary composition, after the
organized matter is decomposed." — lb., § 170, a.

" By nutrition, through the operation of these vital proper-
ties, and according to specific plans, instituted by the Creator
and to be forever perpetuated by the substituted energy [ ! ! ]
of the vital principle, all those forms of organic beings, which
pass, by almost insensible gradations, from the mushroom up
to the gigantic tree, and from the microscopic animalculse to
the majesty of man, are maintained, in all their exact peculi-
arities, in all their analogies to each other, in all their vital
and moral attributes.

" Such, and far more, is the wonderful power, — a power
substituted for the Creator Himself — which directs capillary
circulation, and governs the process of nutrition in the devel-
opment of the embryo, in the maturity of the being, and in
the perpetuation of the species."

"Briefly, then, the whole essential philosophy of organic
life — all that is important, or useful, or dignified, in medicine
— is directly relative to the vital constitution and the vital
actions of the formative and secretory vessels. Here is the
labyrinth of life, here of disease, here the ultimate aim of
medical philosophy ." — lb., § 411 (Dr. P.'s italics).

These propositions the " Institutes " claims to establish by

legitimate "induction," and a large number of phenomena

of health, disease and therapeutics, are brought forward in

558 Allen On the Mechanism of Nervous Action. Dec.

evidence of their truth. Observing the multitude of pheno-
mena, explicable on the hypothesis of a vital principle
" substituted for the Creator," he claims the operation of that
vital principle in " reflex action" as a scientific generaliza-
tion. But, to the careful student, it is unnecessary to observe
that this is anything but the inductive system, and is, in fact,
but gigantic dogmatism, upon the basis of a loose and painful
collection of instances, without philosophical distinction of
the essential relations of the phenomena. In my generaliza-
tion, these essential relations are distinctly and unequivocally
pointed out.

Commenting upon Liebig's celebrated dictum that " every
motion, every manifestation of force, is the result of the
transformation of the structure or of its substance " (id est,
" molecular or integral composition or decomposition "), the
author of the " Institutes " — who now claims that "the whole
of the foregoing doctrine is impressed upon the Medical and
Physiological Commentaries, and upon half the pages of
these Institutes, and has always been taught in the author's
lectures, since 1841," — says :

" But I will merely present, in relief, from Liebig's revolu-
tionary work, a doctrine of the chemical school, from which,
if I mistake not the ambition of intellectual beings, the very
impulse of nature will turn the most indifferent with a
loathing aversion." — Ibid, § 349, d.

Could Dogberry himself have surpassed this? And yet
this author ventures to thrust in the foul and calumnious
insinuation that I have evinced a " partiality for the author's
writings, or for his lectures!" ^

The real objects of Marshall Hall's generalizations were
quoted in the November number of this journal. To these,
Dr. Campbell claims to add the discovery^ of a^systemjjof
nerves exciting secretion by reflex action — " the excito-secre-
tory system." My own claim was somewhat different from
either. Recognizing the full claims of Hall, as to the dis-
covery of the phenomena of excito-motory action, I was
equally willing to attribute to Dr. Campbell independent

1857. Allen On the Mechanism of Nervous Action. 559

though subsequent discovery of the phenomena of excito-
secretory action ; but, carrying the investigation beyond
either^ of the gentlemen named, I reduced the two noticeably
and remarkably diverse effects to a uniform law, pointing out
the essential relations which caused them to be merged in
one mechanism, then seen to extend to, and include, all the
phenomena of nervous relation.

I will, tor the benefit of those whose respect for the age
and position of the author of the " Rights of Authors " may
still lead them to entertain a lingering doubt upon the matter,
re-word the sense of my proposition, which that writer
" gambols from."

The local change by the counter-irritant, or whatever
physical or chemical cause, is conducted by the nerve fibre
to the vesicular nerve centre, there inducing molecular or
integral composition or decomposition, which, again, affects
the organ supplied by a reflex nerve from that part, there
producing other molecular or integral changes, the effect of
which changes varies according to the structure and con-
dition of the organ reached.

Thus, the effect produced may either be motory, secreto?yf
sensitory, perception or intellection ; or there may be produc-
tion or abatement of inflammation, or other change of con-
dition— the effect being altogether secondary or incidental.

"Secondary or incidental" to what? To the molecular or
integral changes of structure — composition or decomposition,
— a doctrine which our medical Salmasius of the "Institutes"
can only look upon with " loathing aversion !"

But secondary or incidental to what, according to the
"Institutes?" To the "sensibility" and " nervous power" —
" vital properties," " attributes of the vital principle or vital
force." By reflex nervous action " these Institutes " under-
stand only the operation of " nervous power and sensibility "
— precisely as the alchemists of antiquity recognized in the
mixture of an acid and carbonate the " property of efferves-
cing."

It is a little surprising that this author does not look after

5€0 Allen On the Mechanism of Nervous Action. Dec.

the "Rights of Authors" of the Paracelsian era; and, when
the moderns talk about the theory of atoms and the law of
definite proportions in combinations, that he does not insist
that " the whole of these doctrines is impressed upon " the
works of the alchemists.

The office of the nerve fibre, according to the new doc-
trines, is simple conduction, by which the condition of one
extremity, chemically and physically, is brought to influence
the condition, chemically and physically, of the other extre-
mity. Stripped of all incomprehensible "properties," it
falls into the same category with the wire of a battery.

But here the " Institutes " triumphantly asks : "How can
the impression be reflected definitely upon a particular
part?" Briefly, because it is anatomically connected with
that part.

We need to call upon no Ariel, or other tricksy spirit, to
" put a girdle round the earth in forty minutes," when we
can telegraph in the twinkling of an eye : we need invoke no
familiar demon, to be "substituted for the Creator" here.

Now, what is the explanation of the action of a blister upon
the chest, as given by Dr. Paine? Vide § 201, d, Institutes,
— where it is assumed that the impressions made upon the
vital property, " sympathetic sensibility," are transmitted to
the brain, spinal cord or ganglionic centre, and there give
rise to the development and transmission of the "nervous
power " through motor nerves, thus inducing motions. ( Vide
also § 227, for same idea.) But, in § 223, he qualifies this
by saying that the "nervous power" does not generate mo-
tion, either in animal or organic life — " It only influences the
organic property, mobility, upon which all motion depends,
through the medium of irritability." (Two more Richmonds
in the field !)

Properties again — all properties.

"However complex and destitute of analogies, in the world
of mere physics, this phenomenon may be, I have no doubt
that the solution [ ! ] which I have offered will be received
by every philosophical mind which may attentively consider

1857. Allen On the Mechanism of Nervous Action. 561

the nervous power, in its connections with the motor nerves
and the experiments of Wilson Philip." — Ibid, § 233.

But § 224 informs us definitely : —

" The phenomena of contiguous sympathy, as when inflam-
mation of the liver, the lungs, &c, is relieved by blisters
over the region of the affected organs, can hardly be traced
throguh the mechanism of the cerebro-spinal system, though
they may perhaps through the medium of the ganglionic
nerve " !

Take, with this, sections 11, 12 and 13 of § 516, d, where
the phenomena of the ganglionic nerve are discussed, and
again and again considered as motor, with no glimpse of any
further reflex action, exeept in so far as dependent upon
motion — and, throughout the whole section, wherein the
ganglionic is all along considered in this light only — and we
can no longer wonder that this same author urges, in page
after page of argument, that the heart has a power of active
dilatation, and wondrous suction " properties."

Again, § 222, b, where motion, produced by the " nervous

power," is held to embrace all the phenomena of sympathy

induced by morbific and remedial agents, and hence, of

course, of the blister.

" The nerves of the ganglionic system have only an invol-
untary motor influence upon the parts to which they are
distributed."— § 470.

But, in § 475, he qualifies this by saying that the nerves
are not the causes of motion, as that is the immediate result
of the action of the organic properties mobility or contractil-
ity— the motor influence of the nervous power acts upon
the properties. "The term excito-motory is far preferable
to motor ; and sensitive it would be difficult to improve."
Still, the production of motion is the foremost idea, and the
reader can only get a glimpse of the mechanism he defends,
by recollecting that he believes all nutrition and all secretion
to be accomplished through the medium of " extreme vessels
with open orifices," which are the subjects of mobility. This
is the meaning, if he have, in fact, any clear idea at all.*

• Thia ia distinctly suggested in Paine's essay on " The 8oul and Instinct."

562 Allen On th-e Meihanism of Nervous Action. Dec.

Now, then, we are clear of the § §, and can take an observ-
ation. The cantharides, according to the Paine theory, is
not absorbed to produce its effect, either locally or remotely,
but acts on the " sympathetic sensibility" calls up the " ner-
vous power" thereby arousing " mobility " by acting on the
"irritability" of the finally-influenced organ. This is the
Paine-ful conclusion.

If the bladder becomes affected by the cantharides, it is by
a " modification of the nervous power," whereby it "actually
acquires the virtues of an inflammatory agent," and (I am not
writing a satire, but quoting), neglecting all other organs,
affects the " sensibility and irritability " of the bladder !

And this is called the " Institutes of Medicine," — which is
to put down humoralism, explode organic chemistry, and
utterly overthrow the doctrine of the operation of remedies
by absorption !

" The cantharides" says Dr. P., " supply an apt illustra-
tion of the whoU philosophy of our subject"

Now, then, I appeal to every sensible mind whether that
philosophy is any kin to that which my article of September
contains, and from which that " paper philosopher," quotes ?
There are some to whom I shall appeal in vain, but who, like
old Polonius, will still insist that the cloud is "very like a
whale !" But candid men must say, that between the mod-
ernized theory of Stahl and Yan Helmont, of the author of
the Institutes, and the simple statement of the laws of action
of the nervous mechanism or apparatus, of the present writer,
the distinction is clearly vital.

In my view, the epispastic, or other counter-irritant, acts
locally, by slow absorption, and production of molecular
changes in the fluids — and, of course, in the solids (by cell
action, partly or wholly,) — or by direct physical and chem-
ical changes, with resultant compositions and decompositions.
Then follow nervous conduction, central change and reflex
action, in the manner previously indicated. If the canthar-
ides affect the bladder, it is by absorption of the active prin-
ciple of the fly, precisely as though the application had been
made to the stomach.

1857. Allen On the Mechanism of Nervrus Action. 563

There is nothing in the new doctrines which contravenes,
in the remotest degree, the operation of remedies by absorp-
tion— there is nothing in them which contradicts the enlight-
ened humoralism of the day. The assertion of the New York
Professor, and his idle assumption, that, by their exposition,
his " solitary position is becoming relieved," simply indicate
that he either does not or will not understand their import.

We implicitly recognize the operation of medicines by
absorption ; and the view is no more inconsistent with these
doctrines, than the fact, by his own theory, wThich he dwells
upon, that the " organic properties " are independent of the
" nervous power," is opposed to the occasional influence of
that power, in accordance with the exigencies of animal life,
in modifying those properties.

The absorbed medicine reaches the profoundest recesses of
the organic frame — the locally absorbed medicine influences
distant parts in the manner we have set forth. These two
modes of operation are nothing more than we might expect,
from the meeting of organs endowed both with organic and
animal characteristics. In both cases, the result harmonizes
beautifully with the splendid generalization of Liebig, to
which we have already reverted, and illustrates, in the most
striking manner, the natural tendency of great truths to blend
in unison. Principia prima are the footsteps of Nature
treading in different paths.

It was very well worth the while of Prof. Paine to illus-
trate the " Rights of Authors " by directly misquoting the
author whom he reprehends in his " Appendix." Not con-
tent with merely garbling to suit his own peculiar wishes,
and basely insinuating atrocious charges to meet his own
ambitious views, he bodily changes the wording of a quoted
sentence, so as to pervert its entire meaning. After repro-
ducing my induction from the action of counter-irritants, he
makes the reading as follows,

viz : " The oral elaboration of
this principle was suggested

Correct Reading.

" In the oral elaboration of

by an idea (?) which does not, this principle was suggested

564 Allen On the Mechanism of Nervous Action. Dec.

an idea which does not even
now," &c.

even now, appear to have oc-
curred to either M. Hall or
Dr. Campbell, viz :" &c.

By turning to the September number of the Independent,
p. 384, the effect of the misquotation will be apparent to any-
one who reflects upon the matter a moment. Correctly read,
it means that the " oral elaboration " was in explanation of
the generalization — it included the idea suggested as original,
and determined the sense in which the generalization was to
be understood.

Dr, Paine's reading makes the simple statement of the
idea, which he inserts ivithout my explanation (in the very
next sentence), to be the groundwork of my generalization.
The detached sentence in italics, without the explanatory
sentence, especially after his misquotation, looks as though it
might mean something a little like what is written in the
" Institutes, § 893, e, pp. 646 and 647, to which he refers.
"With the explanatory sentence, it is utterly unlike in inter-
pretation and effect.

Precisely as in the case before given, I make the reflex
effect secondary or incidental — which is also intimated in
" § 893, e," where the effect is attributed to " a modification
of the nervous power in great conformity with the nature of
the causes by which it is brought into operation," nevertheless
"under the influence of its own nature?' — " Vide § 228 #."

And this is the nearest approach to my language (and the
language is nearer than the idea) in the whole paragraph,
which the metropolitan book-maker so triumphantly flaunts
as containing " nearly the foregoing language of Dr. Allen !"

I need not repeat what I have already stated, as to my
explanation of the terms " secondary or incidental," in the
connection in which I have used them. Suffice it to say, that
neither in word nor idea does " § 893, e, pp. 646 and 7," or
any other paragraph or page of " these Institutes," touch or
approximate even the expression he detaches with his critical
scalpel from my article.

I am at a loss to explain such serene indifference to naked

1857. Allen On the Mechanism of Nervous Action. 565

veracity of statement, upon the part of this " Appendix "-
maker of literary and professional calumny.

There was a Paine who startled all New England with a
tale of pistol-shooting and robbery, of which he claimed to be
the victim — the police, I remember, ascertained pretty conclu-
sively that he had neither been robbed nor shot at. There
was a Paine who illuminated the world with gas manufac-
tured from pure water — and he created a sensation, even in
Europe.

In this "Appendix " on " Eights of Authors," we have the
history of such another robbery, and in "these Institutes" we
have equal light.

It appears that this author cares most for the injuries he
has received at European hands, although he devotes nearly
the whole of the " Appendix " to myself.

He who cannot see any difference between the exact, care-
ful and beautiful experimentation of Bernard, and the rough,
gross, not to say loose and questionable, essays of Wilson
Philip — who attributes to Prochaska the establishment of the
theory of reflex nervous action, and barely admits that to this
" Marshall Hall and others have made some contributions !" — •
(§ 463, &,) ought to rest content with laurels gathered from the
eastern hemisphere, when their mental powers were more
appreciative. But this writer even prefers the experiments
of Philip to those of Bernard !

Does this simple statement need any addition, to show that
he is utterly oblivious to the real facts at issue ?

As to the use of the terms "depressor" and "alterative,"
in connection with this subject — and which Prof. Paine
proves, by a shower of § §, that he has used throughout his
works — the present writer has never claimed them as orig"
inal, but, on the contrary, says expressly, in the very article
commented on and inveighed against : " Pathologists and
therapeutists have been obliged to recognize something more
than the mere increase or diminution of action." Are we to
understand Prof. Paine as claiming that idea as original in
" these Institutes ?" The veriest tyro knows that the terms

566 Allen On the Mechanism of Nervous Action. Dec.

have been employed years upon years, even before 1840 or
the era of the " Commentaries." But the application of them
by us, respectively, is as diverse and antipodal as the doc-
trines we individually espouse.

A few points more, and I have done with the " Institutes."
Throughout the work, he objects to the application of
physical and chemical principles to explain the phenomena
of life. The idea is very broadly intimated, that all that man
can ever do, in this study, has been done in the author's
works and lectures.

An abstract, immaterial force "substituted for the Cre-
ator" (§ 411), "analogous to the soul" (§ 175, b\ but, like
light, possessed of distinct attributes, controls and governs
the animal frame in all its operations and derangements (ac-
cording to the perfected system of laws laid down in the
Institutes, and not elsewhere, as the work is copyrighted).

All other views are " materialistic," and of " infidel tend-
ency."

" Certain external impressions, of a mechanical or chemical
nature, and divers organic matters, vegetable and animal
poisons, are able to annihilate this power , and thus cause
the death of the living bodies on which they operate." — §
167, d. (The capitals and italics are Dr. Paine's.)

This power, this iorce it is, which the " Institutes " de-
mands us to receive as the ultimate principle, to which all
physical and chemical principles must succumb, or else be
branded as materialists !

A power which — " substituted for the Creator " (by Dr.
Paine), " analogous to the soul," — is capable of being des-
troyed by material agencies — a force which can be annihil-
ated !' This is the entertainment to which the " Institutes "
invite us.

But we remain content to believe, wTith all sound philoso-
phy, that " no force is, or can be, lost or annihilated."

We are content to believe that the subtle force of the im-
mortal soul comes in to influence the changes of the material
organism, through its own channel, the vesicles of the brain,
as the immortal force of light comes in at the retina.

1857. Allen On ths Mechanism of Nervous Action. 567

We are content to labor, in our humble way, to wrest more
and more of the modes of operation of the organic and ani-
mal apparatus from the sway of the occult creative demon,
"capable of annihilation," — to be comprehended under those
powerful forces of the natural world which are eternal in their
operative effect.

We are content to continue in this field of effort, notwith-
standing the sneers of superficial reviewers, and the over-
weening insolence of shallow and obtuse delvers among the
ooze and slime of antiquity.

Meanwhile, we may admit the terms " vital property,"
" vital action," (fee, to indicate discoveries yet to be made,
and not to set them up as pillars of Hercules, beyond which
there shall be no more inquisitive search.

Not only have we failed to find anything of the new doc-
trines, now in controversy, in the Institutes ; but we have
failed to find a single advance upon the hypotheses of Stahl
and Yan Helmont. Prof. P. himself explains Stahl's meaning
to be, in effect identical with his own belief (§ 167, e,). If
these doctrines are comprehended in the Institutes, then have
they boen involved in the oldest recorded hypothesis: if
these doctrines are "impressed upon" the Institutes, and
from thence we have derived them, then are we entitled to
more credit than though we had photographed them from
the mere chaos of nature and experiment, — for the latter task
were infinitely less difficult. Our vital principle, in such
case, must surely have been " substituted for the Creator."

So sensible is Dr. Paine of his own views being but an
elaboration of those of antiquity, that he devotes a consider-
able portion of his work to an argument to prove the literal
truth of Solomon's statement, that "There is nothing new
under the sun !"— § 376 3-4, a.

There is another point of view in which the " Institutes "
makes the pedantic quotation from Juvenal (from the Dic-
tionary of Quotations ?) rebound, with ten-fold potency, upon
the author of the " Appendix." It is, the fundamental admis-
sion of what the Ilahnemanidce "would purchase with a great

568 Allen On ike Mtch/amitm of Nervous Action. Dec.

price :" viz : that the operation of all medicines is dynamical
— that they do not produce their effect by direct material
changes in the tissues, but by operating, in virtue of their
own peculiar nature, directly upon the " vital principle," —
the " creative intelligence n of Stahl — the immaterial entitv
of divers attributes, ••substituted for the Creator," '•analo-
gous to the soul n and *• capable of annihilation," of the
amiable author of the " Rights of Authors." Hahnemannism
is the logical sequence of the vitalism of Paine imaginings.
17 : § 5 5 and ^ v7 .

*•/- is lite to truth." Bays this medical instructor in a nie-
tropolitan college of high rank, " (Jiatjustil .

thai theph nologisi th} that his hypo-

thetical views may he di

if tl } health] . J\

L hie hi his

n pathology .and thera% tict tl nd-fold

\ *. ilth

and to life^ tha

phy With * °f

IphiU : with tht other i

at all " — § 878).

TThat more is l rhan t: dum, this

" lame and impotent concli monstrate the sheer

incompatibility of the teachings of the Institutes with those
which have commanded our attend ad to which the

author of that lucid work now lays claim \

We are about to leave this subject. It may appear to
some readers that we have been unnecessary re upon the

author of the •' Appendix." But. in our view, the case was
one which demanded the exp: of sentiments of indig-

nation, in terms much harsher than are employed in this
article.

Beyond the _. — violations of professional courtesy, and
even ordinary literary honesty, there is assumed by this
M Appendix "-maker a tone of arrogance and offensive as-
sumption which not even his years or position can excuse.
The utterly atrocious and wanton insinuation of direct or
indirect plagiarism, I have shown to be as baseless as the
fabric of a vision.

1857. Stearns On Weights and Measure*. 569

Pretending to care more for European neglect to do him
homage, he nevertheless levels almost the entire Appendix at
myself.

" But as some muskets so contrive it.
As oft to miss the mark they drive at,
And, though well aim'd at duck or plover,
Bear wide and kick their owners over ;
So fares our Paine, whose reasoning toil
Does thus upon himself recoil."

The covert sneer and labored sarcasm of the " Appendix*'
have exploded in his own fortress —

"The engineer is hoist with his own petar."

I leave him to the " solitary " enjoyment of his own murky
vitalism, to coin new calumnies for other appendixes, and
venture his " afterthoughts'' upon the tide of medical pro-
gress, at his leisure.

Kalamazoo, JVov., 1857.

Article II. Reform in Weights and Measures. By Fred-
erick Stearns, Pharmaceutist.

" In order to secure the greatest amount of convenience and utility in calcula-
tions connected with commerce, it is self-evident that the scale of notation,

the SCALE OF MONEY, and THAT OF WEIGHT AND MEASURE, SHOULD BE BASED UPON
ONE COMMON PRINCIPLE. OUR MONEY SCALE, like the SCALE OF NOTATION, 18

already on the decimal plan, and the last-named is so firmly established
throughout the civilized world as to be unalterable; and all thnt remains for us
is to make the scales of weight and measure harmonize with it,"*

The necessity for a reform in our present standards of
weight and measure — a reform based upon the adoption of
the decimal system — is admitted by every one whose business
transactions compel them to employ those now in use. More
particularly is it felt by the compounder and prescriber of
medicine, and especially by the pharmaceutist ; for he buys
and sells by one standard of weight) compounds and dis-
penses by another, purchases liquids by standards perhaps
legal only in the place of purchase, sell> them by that one
which is legal in his own State, while he dispenses them as
medicine by yet another one.

* Report of M. Leflerte to the New York Chamber of Commerce.

570 Stearns On Weights and Measures. Dec.

The initiatory steps towards this reform have been taken
by various scientific societies and commercial associations, in
appointing committees to consider upon the best means of
securing a decimal arrangement, applied to the scale of
weight and measure, and to endeavor to find one practicable
in its adaptability to the wants of commerce, and available in
the ease with which it may be made to supersede the present
standards, by not involving too wide a departure from present
well-known quantities.

From several several reports which I have read, it appears
that a plan proposed by Mr. J. F. Felton, of New York, is
recommended — one which is the result of 17 years labor in
this hitherto unfruitful field, and to which, in its general
principles, I give my unqualified admiration. But as the
adoption of any new system is worthy of previous careful
consideration, and it is incumbent upon all who feel inter-
ested in the subject to give their views, if differing from
those offered the public, the writer is led to submit the
following remarks in regard to the unit proposed in the plan
alluded to.

Mr. Felton proposes, in his plan, not to disturb the most
important commercial weight now employed — the avoirdu-
pois pound of 7000 grains, — but to adopt it as the unit in his
new system, and to create the scale by decimal divisions and
multiples of this weight, using in the scale names now em-
ployed for nearly similar weights.

The three orders of weight — Troy, Apothecaries (the pound
in each being 5760 grains), and Avoirdupois (the pound
being 7000 grains) — he supersedes by the establishment of
one, the scale as follows :

EQUIVALENT IN PRESENT STANDARDS.

1 grain

<= 1-1 0 of 1 grain.

10 grains

1 scruple

«== 7 grains.

10 scruples

«=

1 dram

= 11-6 drachms Apoth.

10 drams

—

1 ounce

j 1 ounce 3 dr. 2 sc. Apoth.
( 1 ounce 262.5 gr. Avoir.

10 ounces

1 pound

= 1 pound Avoirdupois.

10 pounds

1 stone

«== 6-7 of 1 stone.

10 stones

1 hundred

weight

less than cwt. by 12 lbs.

10 hundred

weight

•=*

1 ton

" ton by 1240 lbs.

1857. Stearns On Weights and Measures. 571

In the above scale, it will be'seen that the pound (commer-
cial) alone remains unchanged — the grain being reduced to
the ten-thousandth part of the pound, or seven-tenths of the
present grain.

Now, I differ from Mr. Felton in regard to the practicabil-
ity of adopting the Avoirdupois pound as a unit, and propose,
in place of it, the grain now employed ; because, while I
admit that the Avoirdupois pound may be the most impor-
tant weight of our standards in ordinary commercial transac-
tions, yet I believe, if the present arrangement is to be
disturbed at all, and one be adopted similar to Mr. Felton's,
that the standard grain, the present unit, should be the unit
in the new system —

First — Because it is alike in all the systems we employ,
while the Avoirdupois pound is the pound of no other scale
used in this country.

Second — I believe the grain to be the most important of
the divisions of weight which we employ, on account of its
use in estimating the power and effect of remedies — it being
a guide in prescribing and dispensing; — and upon it, and
other attenuated weights, are constructed all our medical
formulae.

Third — I consider that, by employing the grain for the
unit, the reduction of the old systems to the new one is much
easier, being easily made without the aid of written figures,
— in fact, by a method which Mr. Felton has pointed out,
reduction is almost done away with — which method does not
apply to his scale with equal facility.

Here is the scale, with the standard grain for a unit :

KQCIYALRNT IN STANDARD WEIGHTS.

1 grain *= 1 grain,

10 grains = 1 scruple = \ scruple (Apoth.),

10 scruples = 1 dram *= If drachms (Ap.), 1 dr. 2 sc

1A A , ( 2 ounces 2 scru. Apoth.

10 drams «= 1 ounce —= \ „ loc K ..

( 2 ounces 125 grs. Avoird.

in ummm , , ( 1 lb. 8 oz. 6 dr. 2 sc.Apoth.

10 ounces T 1 pound ~ j ! 3-7 pound Avoird,

10 pounds «= 1 stone «=• 1 stone 2 6-7 lbs. Avoird.

10 stones «= 1 hundred weight excels cwt. by 30 6-7 lbs.

10 hundred weight — 1 ton less than ton by 81 1 3-7 lb».

572 Stearns On Weights and Measures. Dec.

In the above scale, the pound contains 10,000 standard
grains, instead of 10,000 grains of the value of only seven-
tenths of the present standard — which I am led to believe
just as practicable for commercial purposes, and much more
available for ours. Reference to the following table shows
the relation between the different scales :

SCALE OF EQUIVALENT IS EQUIVALENT IN

STANDARD WEIGHTS. POUND-UNIT SCALE. GRAIN-UNIT SCALE.

1 grain = 1.3 grains = 1 grain

1 scruple, Apoth.. = 2.6 scruples =■ 2 scruples.

1 drachm, Apoth., = 7.8 scruples = 6 scruples, or .6 of one dram.

1 ounce, Apoth., = 6 dr. 2.4 scrup. = 4 dr. 8 scrap., or 4.8 dr.

1 ounce, Avoir., = 5 dr. 68.75 grains = 4 dr. 37.5 gr.

1 pound, Avoir., = 1 pound = 5 oz. 7.6 dr.

1 pound, Apoth., =■ 7 ounces 4.88 dr. = 7 ounces, or .7 lb.

1 stone =1.4 stones = 9 lbs. 8 oz., or .98 stone.

1 cwt. (112 lbs. Av.) = 1.1ft hundred weights = 7 stones 8.4 lbs., or .784 cwt.

1 ton (2240 lbs. Av.) = 2.240 tons = 1 ton 5sto's 68 lbs, or 1.568 tons.

It will be seen that the reduction of the attenuations of the
standard weight into the grain-unit scale is unattended with
the inconvenient fractions which accompany that of the
pound-unit scale.

Moreover, if any quantity of Avoirdupois, Troy or Apoth-
ecaries'' weight be reduced to grains, the figures which express
that number of grains shotv the number of any denomination
of the grain-unit standard contained in that quantity. Thus,
37 pounds, 11 ounces, 7 drachms, 2 scruples and 14 grains
(Apoth.) is equivatent to 218,874 grains, either of the Troy,
Apothecaries, Avoirdupois or grain-unit standard. JSow,
this can be read, by the decimal arrangement of the grain-
unit scale, — 2 stones, 1 pound, 8 ounces, 8 drams, 7.4 scru-
ples ; or 21 pounds, 8 ounces, 8 drams, 7.4 scruples ; or 218
ounces, 8 drams, 7.4 scruples ; or 2,188 drams, 7.4 scruples ;
or 21,887.4 scruples.

In order to reduce, as above, the standards now employed
to the pound-unit scale, when the numbers indicate a quantity
of a division less than the pound Avoirdupois, that quantity
must first be reduced to grains, and then be converted into
grains of the pound-unit scale, by adding to each 3-10 of a
standard grain.

1857. Stearns On Weights and Measures. 573

It is evident that, in employing a decimal arrangement of
the scale, the reduction of a quantity of one division to that
of another becomes a nullity, when it is remembered that the
figures used to express any quantity show the number of any
denomination contained in that quantity ■, as shown by the
example given above.

Having shown why it appears to me that Mr. Felton has
overlooked the imporance of the standard grain, in pharmacy
and medicine, in his desire not to disturb the current of com-
mercial transactions, and considered the advantages afforded
by the grain-unit decimal scale, — let us look at the system of
Measure of Capacity, in his plan.

He takes one-eighth of the New York dry bushel for the
unit of measure — this contains ten pounds, Avoirdupois, of
distilled water at 60° F. This unit he terms a gallon — cor-
responding with the " stone " of the pound-unit scale of
weight. The divisions and names in the scale are as follows :

10 grains equal 1 scruple.

10 scruples " 1 dram.

10 drams " 1 gill.

10 gills " 1 pint.

10 pints " 1 gallon.

10 gallons " 1 anker.

10 ankers " 1 tun.

— thus making the pound-unit scale to equal, in distilled
water at 60° F.,—

1 grain equals 1 grain.

1 scruple " 1 scruple.

1 dram " 1 dram.

1 ounce " 1 gill.

1 pound " 1 pint.

1 stone " 1 gallon.

1 hundred weight " 1 anker.

1 ton " 1 tun.

Now, to establish a similar uniformity between the stand-
ard of measure and the grain-unit system, it requires that we
should have a minim measure, corresponding, in distilled
water at 60° F., with the weight of the grain, and that this
minim be the unit for measure — the scale and names as
follows :

574 Sxearns On Weights and Measures. Deo.

IN WKIOHT.

IN MKASURR.

1 standard

grain

1 grain

«=*

1 minim.

10 standard

grains

1 scruple

1 fluid scruple.

100

1 dram

1 fluid dram.

1,000

1 ounce

1 fluid ounce.

10,000

1 pound

**>

1 pint

100,000

((

1 stone

1 gallon.

1,000,000

1 hundred

weight =

1 anker.

10,000,000

—

1 ton

=•=

1 tun.

It is an advantage to have the number of divisions in the
scale of measure correspond with the number of those in the
scale of weight, and that the corresponding divisions of both
should weigh alike in water, from the fact that most liquids
in common use — milk, wine, oil, etc., — are of nearly the same
specific gravity as water at its ordinary temperature — near
enough for commercial purposes, — while expensive liquids, of
varying specific gravity, and powerful liquid medicines should
be bought and sold by measure only. It will be noticed that,
in the last table, the minim is preserved in the scale of meas-
ure and made a fraction over .5 of a grain heavier than the
standard minim (Apoth.), while, in the previous one, the
drop or minim is discarded. I deem the minim an important
item in the scale of measure ; and, when made to correspond
with the grain in weight, quite as appropriate to adopt for a
unit of measure as the eighth part of the New York dry
bushel — which bushel is not a standard in many other States.

The following table shows the relative value of Apotheca-
ries' and minim-unit standard measures, in distilled water at
60° F. :—

1 minim = .9493 of 1 minim.

1 fluid drachm = .569 of 1 fluid dram, — about 5.7 scruples.

1 fluid ounce = .455 of 1 fluid ounce, or 4 dr. 5.5 scruples.

1 pint = .7291 of 1 pint, or 7 fluid oz. 2 fluid dr. 9.1 scr.

1 gallon = .58328 of 1 gall., or 5 p'ts 8 fl. oz. 3 dr. 2.8 scr.

— and, by comparing the following table of Apothecaries'
measure —

1 minim = .9493 grains.

60 minims = 1 fluid drachm ■== 56.9 "

8 fluid drachms = 1 fluid ounce (480 m.) == 455.6 "

16 fluid ounces = 1 pint (7680 m.) . = 7291.1 "

8 pints = 1 gallon (61,440 m.) = 58328.8 "

— with that given, with the liquid grains for a unit, the con-

1857. Gunn's Selection from Surgical Notes. 575

trast shows the glaring ununiformity of the latter and the
simplicity of the other.

Now let us see the beautiful uniformity of correspondence
between the systems of decimal weight and measure, and our
present currency — taking for example an article, liquid or
solid, valued at one dollar per ounce :

1 grain, or 1 minim costs 1 mill.

1 scruple, or 1 fluid scruple, " 1 cent.

1 dram, or 1 fluid dram, " 1 dime.

1 ounce, or 1 fluid ounce, " 1 dollar.

1 pound, or 1 pint, " 1 eagle.

1 stone, or 1 gallon, " 10 eagles.

1 hundred weight, or 1 anker, " 100 eagles.

1 ton, or 1 tun, " 1000 eagles.

I would, in conclusion, refer those interested in this much-
needed reform to the sources which have led to the foregoing
remarks — the report of M. Lefferts to the New York Cham-
ber of Commerce, and that of Dr. Guthrie to the American
Pharmaceutical Association. These contain — together with
matter not appropriate for comment in a paper of this kind —
interesting historical information, and many unanswerable
arguments in favor of the early introduction of the decimal
arrangement into our scales of weight and measure.

Article III. Selection from Surgical Notes. — Exsection of
the Head of the Humerus. By Moses Gunn, M. D., Prof,
of Surgery in the University of Michigan.

In the August number of the Western Lancet, Prof. Black-
man reports an operation of exsection of the humural head,
made by him, in the Commercial Hospital, in June last, —
prefacing which, he remarks as follows :

" Notwithstanding the numerous instances which have
since occurred on the Continent of Europe and in Great
Britain, according to Prof. Smith, of the University of Penn-
sylvania, this operation has not often been performed by
surgeons in the United States. In his System of Operative
Surgery, bearing date of 1855, vol. II., p. 383, he remarks
that the only cases he has found reported were, one by Dr.
Hunt, of Washington, D. C, and another of a partial charac-

576 Gunx's Selection from Surgical Notes. Dec.

ter by Dr. Pinkney, of the U. S. Xavy. My distinguished
friend, Dr. Chas. Tripler, U. S. A., has given me the details
of one in which he successfully operated ; but besides these,
I am not able to refer to any in the practice of American
surgeons.

Had Prof. Blackmail turned back to the April number, for
the current year, of the Medical Independent^ he would have
found two cases of this operation, reported by myself, — one,
made in the winter of 1850-51, the other, in Dec, 1854. In
both of these cases, the wound healed very rapidly, the pa-
tients being discharged at the end of the second week. Each
retained very tolerable use of the arm, and illustrated the
beauties of conservative surgery.

I am now able to report an additional operation of exsec-
tion of this bone, which I made on the 5th inst. "W. "W. AY.,
aged 29 years, was suffering from a carious condition of the
bead of the humurus, of some months standing. From the
proximity of the joint, it was feared that the disease had ex-
tended into it that cavity. The operation was, however, in
its first stages, only exploratory. An incision was carried,
from over the accromion, downwards, dividing longitudin-
ally, the deltoid muscle, which was raised from the bone,
thus exposing the diseased surface, an examination of which,
betrayed extensive communication with the joint. The in-
cision was now extended, the capsular ligament divided, the
bead of the bone dislocated, and its surgical neck sawn
through. Only one vessel required ligature. The wound
was closed by seven sutures, and tepid water dressings
were applied. But little febrile reaction supervened. The
sutures were removed on the fourth and sixth davs, when
perfect union had taken place, except at a point correspond-
ing with the fistulous opening. A generous diet, with ale or
porter, supported the patient after the first three or four days
from the operation. At the present date — three weeks sub-
sequent to the operation — the wound is entirely closed,
except at the original fistulous opening, which is nearly filled
up. The discharge is but trivial, and the patient is attending
to his business.

1857. Schetterly On the Pulse. 577

It will be noticed that in this case, as in one of the two
previously reported, a single straight incision only was used.
This form of incision is abundantly ample, and far prefer-
able to the nap or angular form, as it exposes less surface,
and leaves less work for nature to accomplish in the healing
process.

87 Shelby St., Oct. 26th, 1857.

Article IV. Chapters from an Unpublished Monograph.
By II. E. Schetterly, M. D.

Pulsation an Effect of Discharges of Electricity on the
Sympathetic Nerves. — Most physiologists have supposed that
the pulsation of the arteries is owing to their dilatation,
caused by each contraction of the left ventricle of the heart.
Some attribute it to an alternate dilatation and contraction
of the arteries themselves ; and Bichat and Weitbrecht, to
the locomotion of the arteries. All these suppositions are
effectually refuted by Bichat himself, who cut out a piece of
the carotid artery of an animal, and substituted an inert tube
for it, when, lo ! the same kind of pulsations were felt in the
tube as in the artery. To the tube he adapted a bag of
gummed taffeta, so as to simulate an anurismal tumor, and
the pulsations were evidenced in the bag.

Doctors Young and Parry think the pulsations are pro-
duced by the sudden rush of the blood forward in the
arteries, without distension — the existence of which they
deny ; and others, again, suppose the impulse of the heart's
contractions to be transmitted through the blood as through
a solid body. If either of these suppositions were true, the
pulse should be always synchronous with the contractions of
the left ventricle, and there could be no pulse except in the
arteries ; but there are numerous cases on record that contra-
vene these essential conditions. In a young man recovering
from typhus fever, Dr. Parry found the contractions of the
heart and the pulsations in the left arm, to be ninety; while,
in the right arm, they were one hundred and eighty per

578 Schetterly On the Pulse. Dec.

minute. The patient said he could at any time cause this
difference in the pulse of his two arms, by violent exercise.
In other cases the pulsations in the arteries are only half as
numerous as the contractions in the left ventricle ; and, in
some cases, the pulse is altogether wanting in one or more
arteries, in which there is no obstruction and the blood con-
tinues circulating as usual.

Drs. Jadelot and others attribute the pulse solely to the
resistance made by the blood to the fingers, or to whatever
diminishes the diameter of the artery along which the blood
is moving with increased celerity when the left ventricle
contracts. But this supposition is also refuted by facts.
Some persons — and the writer among the rest — sometimes,
and some of them always, experience a violent, uncomfort-
able pulsation in the toes of one or both feet, when brought
naked near, without touching, some good conductor of elec-
tricity. Even the varnished and polished board of the
bedstead produces this sensation to such a degree as to
waken a friend from sleep.

Besides the facts already stated, there are many others that
invalidate all the theories hitherto advanced to account for
pulsation. That the pulse does not depend on the action of
the heart, is proved by the fact that, when two ligatures are
put round an artery at some distance from each other, and a
puncture is made between the ligatures, the blood still flows
with a jet, as it does in arteries generally. Dr. Dunglison
states a case of pericarditis, in which " the pulse exhibited a
decided intermission every few beats — yet the heart beat its
due number of times, the intermission of the pulse at the
wrist consisting in the omission of one of the beats of the
heart." Dr. Storer details a case of paralysis, in which there
was an entire absence of pulsation in both limbs on the left
side, during five days before death occurred ; and yet there
is good reason to believe that the circulation continued unin-
terrupted during the whole of this time, for the limbs contin-
ued recovering from the paralysis till the day of death.
Prof. Jackson states the case of the mother of a physician, of

1857. Schetterly On the Pulse. 579

Philadelphia, whose pulse disappeared in every part of her
body, during an attack of acute rheumatism, and could never
be again observed during her life — yet she was active, both
in body and mind, and possessed unusual health ; but died at
last of inflammation of the intestines — no pulse existing.
Analogous cases of the cessation of the beating of the heart
are recorded in the Gazette, Nov. 21, 1836; and by Parry on
the pulse.

It is very manifest that, if the sensation of the pulsation of
the arteries were produced by the action of the heart, or of
the blood-vessels themselves, or by the motion of the blood,
or by all of them combined, such cases as those just stated
could not take place while the blood continued circulating ;
and there can be no question that, in the case recorded by
Prof. Jackson, the blood did continue to circulate vigorously
during life ; for, without this being the case, neither health
could be enjoyed nor inflammation take place. When the
above facts are all allowed their proper weight, the conclu-
sion becomes irresistable, that the physico-mechanical causes
assigned by physiologists are not the primary causes of the
pulse, since all pulsation may cease while they are all in full
operation in the living system ; and to regard these as excep-
tional cases, and try to explain them away by a multiplicity
of suppositions to suit each case, as physiologists are in the
habit of doing, is mere prevarication — is explaining the
ignotus jper ignotum.

The pulse, then, in every possible case, is caused by dis-
charges of electricity from the heart and arteries on the
sympathetic nerves to their ganglia — being previously pressed
out of the blood, which it entered through the walls of the
pulmonary air-tubes, by the contractions of the left ventricle
of the heart ; — and from these ganglia it is gradually dis-
charged, along the same nerves, to all the organs of the body,
both voluntary and involuntary, in proportion as they become
negative to the ganglia, during the performance of their
functions. Hence the reason why the sympathetic nerves
are connected with all the others and with the spinal marrow*

580 ScHETTERLY 0)1 the Pulse. DEC.

and thus distributed to every part of the body. This also
accounts for the general periodicity of the pulse, and for all
the anomalies in the phenomena of pulsation on record, even
for the cessation of pulsation in the heart itself; for it is not
supposable for a moment that the heart ceases entirely to
contract when its sensible beats become imperceptible. It is,
indeed, doubtful whether the alternate contractions and dil-
latations are the cause of the sensation of the pulse, even in
the heart itself. The only abnormal change necessary to the
cessation of the pulse is such a one as will produce a constant,
instead of an interrupted or periodical, discharge of electricity
along the sympathetic nerves ; and that this is the alteration
existing in such anomalous abnormal cases, appears from the
fact that autopsy does not reveal any perceptible lesion any-
where in these cases, — the alteration in the nervous matter
itself, where only it must exist, being too minute for percep-
tion, and is the last looked to for an explanation.

If any additional evidence were needed to prove that dis-
charges of electricity are the primary cause of pulsations,
that evidence is abundantly supplied by the fact that, in cer-
tain conditions of the system, strong pulsations are felt, and
sometimes, even, are perceptible to the naked eye, not only
where ordinarily no pulse exists, but where no arteries are
near sufficiently large to pulsate. Almost every person is at
times sensible of strong pulsations in the ends of his fingers ;
and mental emotions, which can operate upon the circulation
only through the medium of the nervous system, not only
occasionally excite very strong pulsations in every part of the
body, but sometimes depress the pulse to such a degree as to
cause fainting. Every physician must have observed, in his
anemic patients, the pulse becoming almost imperceptible
when they fell into a doze or quiet sleep ; but, anon, when
they were startled from it by a trifling noise, it bounded at
once with such a force as would almost seem to burst the ar-
teries. So ignorant are some practitioners of the nature of
the pulse, that the writer has known them to bleed such pa-
tients day after day, and thus kill them outright.

1857. Sciietterly On the Pulse. 581

There are on record many cases of abnormal pulsation in
the region of the stomach and of other organs, — in some so
violent as to be distinctly seen externally, at a distance of
twelve or fifteen feet. In some cases, this pulsation in epigas-
tis is caused by pregnancy, lasting only during the first three
or four months ; while, in other cases, pregnancy suspends or
even cures this disease. But, in the majority of cases, there
is no obvious or discoverable cause ; and on dissection, after
death mostly caused by other diseases, no perceptible morbid
change is found anywhere. Sometimes these abnormal puis*
ations are synchronous with those of the arteries or beats of
the heart, at others not ; and they often amount to a mere
fluttering of the prsecordia Pulsations in cpigastrio are,
therefore, attributed, by the most eminent physiologists, to
nervous irritation ; while, in the same connection, they at-
tribute pulsation in the heart and arteries to the action of
these organs themselves — as if, indeed, under the same cir-
cumstances, the same effect could be produced by entirely
different causes, in the same person, and simultaneously. It
sometimes seems as if physiologists did not consider them-
selves obligated to regard the laws of philosophical reasoning
in the least. The same cause often produces different effects
under varying circumstances; but, under similar circumstan-
ces, never. Nor can the same effect be produced by different
primary causes, under any circumstances whatever.

Dr. Morgagni has recorded a case of the most violent pul-
sations in epigastrio he ever saw, accompanied by " large and
vibrating" pulsations, in every principal artery in the body;
but, after death, no vestige of disease could be found any-
where, by the most careful dissection. As the absence of
pulsation may be produced by a continued discharge of
electricity — so the pulsations may be produced where they
do not normally exist, by the constant discharge of electricity,
on the functional nerves, being changed into the interrupted
or periodical ; — or the discharge on the nerves accompanying
the arteries of the organ, in which the pulsations are felt and
sometimes seen, may be intensified.

582 Schetterly On the Pulse. Dec.

Dr. Knox made "many hundred experiments" on the
pulse, and found that the statement of Dr. Cullen, that there
are two diurnal accelerations — one about noon, and the other
in the afternoon, — independent of excitement by food, etc.,
which has been copied by subsequent writers, applies only
to febrile abnormal states of the system. Notwithstanding
the use of a moderate quantity of ardent spirits, taken at noon
and in the evening. Dr. Knox found the pulse always higher
in the morning, after a light breakfast consisting of coffee,
bread and eggs, than in the evening, after supper consisting
of similar articles and spirits, instead of coffee, — the beats
averaging about eight more per minute in the morning than
evening. He found'the pulse not only quicker, but also more
excitable, by the same quantity of food, or drink, or exercise,
in the morning," than at any other time of the day or night.
Dr. Thomson verified these experiments ; and they agree that
animal food is much more stimulating to the pulse than veg-
etable, and ardent spirits still more so. It is only by persons
subsisting on the same, or similar, diet that such experiments
can be made ; and Dr. Knox seems to have been uncommonly
regular in this respect. His dinner always consisted princi-
pally of animrl food, with a small quantity of vegetables and
spirits or porter ; and, notwithstanding the difference between
his breakfast and dinner, the pulse, after the latter, averaged
onlv two beats higher than after the former. To determine
the difference between the effects of his food at breakfast and
at dinner, he changed his fare at the latter to that at the for-
mer, and found that then his pulse was from eight to thirteen
beats less after dinner than after breakfast. In diseases at-
tended with fever, and particularly in hectic fever, he found
the case reversed, — the pulse being more frequent in the
evening than in the morning ; and, when it became the re-
verse of this, he prognosticated recovery from the disease, and
was rarely disappointed.

Now, If it be true, as before stated, that electricity ig
accumulated in the nervous centres during sleep, when the
expenditure is at its minimum, — the cause of this diminution

1857. Bibliographical Record. 583

of the pulse as the day advances, is explained by the suppos-
ition that, during active waking hours, more is necessarily
expended than received into the system by respiration, not-
withstanding the increase of breathing during active exercise
and labor ; and hence the reason of the necessity of sleep, and
generally, of rest after great exertion and fatigue, is obvious,
— fatigue being nothing else than the exhaustion of electricity
previously stored up in the nervous centres.

BibliagopMcal *%mi\.

On Diseases of the Skin. By Erasmus Wilson, F. R. S. Fourth American,
from the fourth and enlarged London Edition. Philadelphia : Blan chard & Lea.

The diseases of the skin — constituting a class of maladies im-
mensely diversified, and yet, in numerous examples, so nearly
running into each other as to render it difficult for the most learned
dermatologists to determine the precise location they ought to have
assigned them in dermal nosology, — will be conceded by all to be
among the most perplexing ailments that science contemplates, or
with which the prescriber has to contend.

The past history of medicine indicates how extensively they have
occupied the thoughts of physicians ; and the numerous works ex-
tant, exclusively devoted to their consideration, clearly show how
much consequence has been attached to them. Dr. Wilson's treatise
has been in the hands of the profession quite a number of years,
undergoing improvements and receiving additions, from time to
time, until, in this fourth edition, it has acquired a copiousness, and
a richness in detail and in practical illustration, which entitle it to
be considered as one of the most, if not the most, desirable works
on the group of diseases of which it treats.

One thing cannot fail, we think, to excite the wonder of the indus-
trious and thoughtful cultivator of our science. It is, that, although
the various departments of the healing art are prosecuted, on this
side of the Atlantic, with an eagerness which characterizes our young
and vigorous institutions, nevertheless the branch to which the vol -
vol. in, no. x. — 39.

5S4 Bibliographical Record. Dec.

ume before us is devoted, can scarcely be said to have engaged the
attention of the writers of our country. This is the more singular,
since our savans have never evinced the least hesitancy in grappling
with the great and more complex matters of pathology and thera-
peutics, as exemplified in surgery, midwifery and general practice.
On the contrary, we may point with pride to the many ennobling
achievements, both of our predecessors and cotemporaries, in these
several fields of profsssional culture.

As far as recollection serves us, we may observe that — save a
small work by Dr. Worcester, of Ohio, and republications, by Dr.
Bulkley (of New York), of a foreign work on cutaneous diseases,
with occasional articles in the journals, appropriated to a single form
of skin disease, or to a variety, as to ichthyosis and to the variolus
forms, — American authors and the American press have been silent
on the subject. It may be hoped, however, that ere long Dermology
may awaken in the minds of medical men, in our great centres of
professional investigation, that attention which it truly deserves ;
and that, therefore, the hiatus now manifestly existing may be hon-
orably filled.

Certainly, when the diversity of our climate, .the unprecedently
rapid increase of our population, both native and foreign, and our
unbounded intercourse with all the countries and peoples of the
world, are considered, it will be perceived there can be no deficiency
of material.

In the first chapter, the reader will find himself greeted with an
exceedingly well-written and able resume' of the anatomy and physi-
ology of the skin.

In the section appropriated to the physiology of the dermal tissue,
the author remarks (page 64) : " By means of its absorbing power,
the skin is enabled to act as a respiratory organ. The importance
of this function, in man. is not sufficiently estimated ;. but, in the
lower animals, it is universally acknowledged. The process of ab-
sorption, in the skin, is effected by an active endosmosis, which is
more and more controlled by vital influence, as it reaches the strata
of the epidermis most nearly in contact with the derma. This func-
tion of the skin is calculated to enact an important part in the health
of the individual, in relation to the purity or impurity of the atmos-
phere in which he moves."

He again remarks: "When the body is immersed in water, of a

1857. Diseases of the Skin. 585

temperature say of 82° of Fahrenheit, and a few degrees below, and
allowed to remain in it some time, it increases in weight by absorp-
tion of the fluid." After enumerating the experiments of certain
distinguished physiologists, in proof of the above important truth,
and their results, he states the converse in the following terms : —
"Opposite results to these — namely, loss of weight by transpiration
— take place whenever the temperature of the bath nearly approaches
or exceeds that of the body." He still further observes : " These
experiments have another imporant bearing on the physiology of the
skin, since they prove that the temperature of a bath which conduces-
to absorption has the effect of a sedative on the system, and dimfn-
ishes the rapidity of the pulse ; while the converse, acting as an
excitant of exhalations, increases the frequency of the heart's pulsa-
tions. Thus, it will be perceived how essential, to the intelligent
practice of medicine, is a thorough knowledge of physiology, and to
what important deductions, both pathological and therapeutical, it
gives rise.

The classification of cutaneous diseases, on a basis at once rational
and natural — viz : the character of their respective causes, — has been
an object of first consequence with the author ; and it is believed his
will accord more nearly with established physiological principles,
than any that has preceded it.

Passing over the main body of the work without comment, which
the space .allotted to us will not allow, we come to the last chapter,
which is appropriated to certain selected formula: — which, as we are
told by the author, in the preface, he has " found of value in the
treatment of diseases of the skin." To these, it will be observed,
" frequent reference is made in the pages of the work." From a
hasty examination of their constituents, we are inclined to regard
them as peculiarly applicable to the more chronic forms of eruptive
diseases. Those which are designed for internal use, having arsenic
entering into their composition — either as base or as one of the prin-
cipal ingredients, — cannot fail to be singularly efficacious, when
judiciously prescribed.

In our judgment, the publishers have erred greatly, in not binding
the plates, so frequently referred to by the author, with the text
\\ e do not undertake to say that such an arrangement would be at
remunerative to themselves; but we offer it, as our unqualified
opinion, that it would be vastly more advantageous to the profession

586 Bibliographical Record. Dec.

for whose benefit, especially, the work was doubtless composed.
Thus considered, we will not question but that arrangement, which
would render the book most acceptable, and therefore most anxiously
sought for by the practitioners of the country, would be most profit-
able to the publishers.

It were but to reiterate a truism, admitted by all, to say that
mere verbal description affords exceedingly inadequate impressions
of objects, natural or artificial, which have not been presented to, and
recognized, bv one or more of the senses. Nor is it less a truism,
that, so far as the diagnosis — and, to some extent, the treatment of
the great mass of cutaneous diseases — is concerned, most of the
works devoted to their consideration, and not illustrated by plates.
are next to useless to such practitioners as have not had it in then-
power to avail themselves of clinical advantages. We submit, then,
to the publishers of such works, in future, the propriety of inter-
spersing, in their appropriate places, such plates and drawings as the
authors may have deemed essential to the clear understanding of the
text : or, if they must adhere to the plan of publishing them sepa-
rately, of sending them forward to the retail dealers in association with
the works they are designed to illustrate. We venture to suggest,
too, that the proprietors, respectively, of the Periodical Medical Press
would in no sense be annoyed by the receipt of a copy of the plates,
in company with the book they are expected to notice or review.
Notwithstanding this, to us. obvious error, the reader will find much
in the treatise to commend — much that will confirm impressions
already existing in his mind, and possibly correct others, which may
have been quite too hastily adopted.

The style, throughout, is bold, vigorous and manly, and the
mechanical execution satisfactory. It gives us great pleasure to
recommend it to the favorable consideration of the profession.

For sale by Raymond & Selleck, in this citj. K.

1. Transactions of the Twelfth Annual Meeting of (he Ohio State Medical Society, held
in the City of Sandusky, June 1857.

2. Transactions of the New Hampshire Medical Society (Sixty -seventh Anniversary)
held at Concord, June 2d and 3d, 1357.

The first of the above named publications, is a volume of 226
pages, containing the records of the Society, the address of the
President, and the reports of the several Committees. The Society

1857. Transactions of the Ohio Medical Society. 587

was in session four days, and transacted a verj considerable amount
of business.

Dr. Hays, surgeon to the late Dr. Kane's Arctic Expedition, was.
present, and elected to an honorary membership. In response to an
invitation, Dr. H. made a few remarks, medically, relevant to the
Arctic regions.

He said that the influences of climate upon the animal economy
were marked, and th diseases peculiar. He had never seen a case of
tubercular disease among the natives, and this is doubtless due to the
great consumption of fatty food. If he had a consumptive patient,
he would send him to Greenland, if possible, and put him upon train
oil diet, with a dog sledge and a bear huut for exercise. He had
heard of but one case of hemorrhage from the lungs, through his
friend D. Kane, Jr.

The crew of the Advance suffered much from scurvy, but the Es-
quimaux are rarely afflcted with it. The prevalence of this disease
he attributed to the combined influences of salt food, darkness and
cold. The darkness seemed to have a bleaching effect, and tended to
diminish the coloring matter of the blood. The brick-dusty appear-
ance of the blood, mentioned by Dr. Kane in his narrative, expressed
it very clearly. In the treatment of this fearful disease, he derived
much benefit from the use of raw potato, which he dressed for his
patients as a salad ; but its effect was lost as the severe cold weather
of mid-winter set in, overpowering the vital forces. Strong, carbon-
aceous food was then requisite, and potato was good only as an
adjunct. His specific was then walrus meat, or, still better, the liver
of the same animal. But the term specific he would only use here
as applicable to the meat in its raw state. It seemed then to have a
power which was lost in the operation of cooking. Like cooked
fruits and vegetables, it lost its freshness. He gave it at first to
his patients dressed like the potato as a salad. They aflerwprd be-
came partial to it, and, overcoming their repugnance to raw flesh, and
hard frozen, they really often preferred it thus.

It is in this condition the natives mostly take their food, and from
them the Doctor received the idea to which, he believed, the ship's
company owed its salvation. They had no vegetable food, and a
strictly animal diet, in that region, seemed to furnish all the requisites
of perfect health.

He would relate a case falling under his notice. An Esquimaux

588 Bibliographical Reord. Dec.

had his leg frozed above his knee, stiff, colorless, and to all appear-
ance, lifeless. He was placed in a snow house at a temperature of
20 deg. below zero. The parts were bathed with ice cold water for
about two hours, then enveloped in furs for three or four hours.
Then frictions were used, first with the feathery side of a bird skin,
then with snow, alternately wrapping the limb in furs and rubbing it,
for nearly twenty -four hours. It was then carefully wrapped up, and
the temperature of the snow house elevated, by lamps, above zero.
On the third day the patient was taken to his house, (where they
have often a temperature of TO or 80 deg.) and in seventy hours he
was walking about with only a slight frost bite on one of his toes.

This treatment the Doctor thought highly philosophical, and he
profited greatly by it in his own practice with frost-bitten limbs.
The point being to keep away all external heat, and allow the vital
powers of the system to do their work. By exposing a frozen part
to a warm temperature, the skin becomes thawed out, and dies, be-
fore the circulation can work itself through the underlying frozen
tissue.

The address of the retiring President, Peter Allen, M. D., contains
an interesting account of the profession in the early days of Ohio,
and the peculiar nature of the labors of the pioneer physicians of the
now great and prosperous State which reposes between Lake Erie
and the Ohio river.

Somewhat kindred in spirit, to the address, is the report on obstet-
rics, by J. G. F. Holson, M. D. It contains a chapter devoted to
the early history of midwifery, which carries the reader through the
successive stages of advancing art, from the rude accouchment pf the
dusky savage, to the appliances and luxuries which surround her pale
sister of the present day.

The balance of the reports are creditable productions, and indicate
zeal and industry on the part of the several committees.

The transactions of the New Hampshire Society are interesting,
from the fact that the last meeting was on the sixty-seventh anniver-
sary of its organization, an age truly venerable in Medical Societies
of this country. They constitute a pamphlet of one hundred and
four pages, containing the usual addresses and reports. It is gratify-
ing to see such evidences of professional industry and ability, as are
exhibited in these transactions. G.

1857. Spirit of the Medical Press. 589

Manual of Physiology. By William Sinhouse Kirkes, M. D., Fellow of the
Royal College of Physicians ; Assistant Physician to, and Lecturer on Botany
and Vegetable Physiology at, St. Bartholomew's Hospital. A new and revised
American, from the last London edition. Philadelphia: Blanchard & Lea, 1857.

The favorable reputation of this book renders anything more than
a mere notice of a new edition, unnecessary. It is, what it claims to
be, a manual of Physiology, exceedingly convenient for the student's
use. We cannot hut commend the modesty which characterizes the
appearance of the American reprint. The author's name is not
overshadowed by that of the American editor.

For sale by Raymond & Selleck.

pint 0f % glebttal |tm

Clinical Instruction in Medicine. — Free access to hospitals, both
general and special, is of inestimable advantage to medical students, and
particularly to those of an advanced grade. They ought to become familiar
with the physiognomy of disease, so that, when thrown upon their own
resources, and obliged to diagnosticate for themselves, without prepara-
tion, they may not be wholly like wanderers in a strange land, nor feel
like a person at the junction of several roads, not knowing which to take.

But if it be true that a great deal may be gleaned by the careful student,
even while only "walking1' the wards of hospitals, the latter may be of
infinite value to him. The truth of this assertion is plain to all who have
enjoyed the benefits of attendance upon some of the cliniques of the
European medical institutions. And it is not only to follow the visiting
physicians and surgeons, to hear what they say, see what they do, and
note the effects upon the patients, which can be said to constitute the
clinical study of disease. The opportunities afforded to students in certain
foreign establishments, of exercising their powers of diagnosis upon
patients, and rendering their account to the critical questioner in charge,
are the genuine tests of knowledge, and the surest means of acquiring
sound medical information. With these privileges, the young physician
returns to his home with a feeling of strength and confidence, such as
those cannot have who are launched into practice fresh from a three yean1
course of mere lectures and office study. The latter are at once quite "at
sea," and make such blunders as the "W* madieatrix naturw." will have
hard work to remedy. We trust, however, that even a neophyte would
not so egregiously stumble, as did, to our knowledge, a popular honueo-

590 Medical Independent. Dec.

pathist, who gravely pronounced a patient to be laboring under mild
typhoid fever, when he had serious congestion of one lung, and not a whit
of any intestinal disorder.

"We were led to the consideration of the advantages of true clinical
instruction in medicine and surgery, by listening to the admirable lecture,
introductory to the course for this year, under the auspices of the Medical
Faculty of Harvard College, and which was delivered on Wednesday, the
4th inst, at the Medical College in Grove Street.

Professor Shattuck was eminently successful in entertaining and in-
structing his audience, in which we noticed clergymen and other gentle-
men not uto the manor born,'' who heard many wholesome truths worth
remembering. We trust that the production may be given to the public,
for, unlike many introductory and valedictory addresses, it seemed to us
very worthy of a typographical dress. There are many sayings in it so
necessary to be known, by the laity as well as the profession and students
of medicine, that we should esteem its wide circulation a real benefit.

The lecturer gave a "bird's-eye view" of the clinical advantages to be
obtained in France and Italy particularly, with allusions to the schools of
England. The system adopted at Florence is an admirable one ; and the
action of the government most creditable. By its liberality and strict
surveillance, a body of wholly reliable practitioners is constantly secured
to the community ; and thus, more than in any other way, is quackery
discouraged, and, in fact, repressed.

Dr. Shattuck did not, if we rightly remember, refer to the German schools.
We have been much interested, of late, by the perusal of letters from some
of our younger medical men, who have spent most of the time allotted by
them to study abroad, in the German institutions. Conversations with
some of them, since their return, confirm us in the very favorable opinion
we had formed of the advantages to be secured by the faithful student
under such incentives and with such facilities.

The question will occur, in conclusion, why cannot more be made of our
own hospital advantages ? If we cannot boast the colossal establishments
of the older countries, we certainly have enough material, and plenty of
opportunity might be afforded, for a most efficient and valuable course of
clinical teaching. And why cannot the system of foreign instruction
which has also of late obtained in some of our sister cities, be set on foot
here. Nothing would attract students more quickly, nothing could fit
them more thoroughly for the duties of their responsible profession. It
seems to us a duty which the profession owe to those about to enter it, to
do this We say the profession — we mean especially those who are
teachers and hospital medical officers — but we think that the profession,
as a body, should call for this plan to be thoroughly put into execution
Practitioners and patients would alike reap the benefits which result from

1857. Spirt of the Medical Press. 591

such a course of instruction ; the former in having well-educated brethren,
and securing, at first, a great diminution of quacks, and finally, it may be
hoped, their extermination ; the latter, in being sure of always having
sound practitioners, versed in the practical as well as the theoretical
knowledge of their art.

The subject should command the earnest attention of the profession
everywhere ; and we trust the time is not far distant when we shall boast
a well-organized, fully-attended, and widely-reaching system of clinical
instruction in medicine and surgery. — Boston Med. and Surg. Journal.

Reproduction of Bones and Joints, after their Removal in cases of
Whitlow. By H. H. Toland, M. D., of San Francisco, California.— Par-
onychia or Whitlow: its Consequences and Treatment. — Although this
is an exceedingly painful disease, and frequently destroys the parts
affected, it has received but little attention from the profession, because it
rarely endangers life. There are four varieties of Whitlow :

1st. That seated between the epidermis and cutis vera.

2d. That situated in the sub-cutaneous cellular tissue.

3d. That occupying the sheaths of the tendons.

4th. That seated between the periosteum and bone.

Every phlegmonous inflammation of the fingers and toes belongs to one
of the forms of paronychia above specified. Every variety of this disease
is excessively painful. The first three are speedily removed by a free
incision ; but the fourth is a much more serious affection. Even when
treated early and properly, it frequently causes a destruction of the bone,
in consequence of a separation of its periosteum ; pus forms between that
membrane and the bone ; the former is detached, and the latter loses its
vitality, and if not removed will be destroyed.

As the bone is formed by the periosteum, if the latter be not removed,
and the soft parts are kept extended, the bones as well as the joints are
reproduced, and the part restored to its former usefulness. It has long
been known that bone will be re-produced, provided the periosteum re-
mains, and we only claim to have made the discovery that the joints are
also, by proper management, restored, even under the most unfavorable
circumstances. Whether they are as perfect as the original, possessing
cartilages, ligaments, and synovial fluid, we are unable to say ; but we
know that they possess motion, and sufficient strength to perform the
function of the most perfect joints.

James Clarke, a porter, now of Columbia, Tuolumne county, consulted
us respecting the propriety of having the middle finger of the right hand
amputated. He had been treated by a good surgeon, who thought its
removal necessary.

592 Medical Independent. Dec.

As only the third, and half of the second phalanx were diseased, and
believing they would be re-produced, we advised their removal, so that
even if there was no motion in the first joint, the finger would still be
useful. An incision was made from the first joint, extending laterally,
under the nail, to the same point on the opposite side. The soft parts were
detached from the denuded bone, and the second phalanx divided with
bone forceps about a quarter of an inch from the second joint. The
wound was closed by the interrupted suture, and the soft parts retained
in a proper position, by the application of splints and a bandage.

In four weeks, to my astonishment, the hones icere not only restored,
but also a perfect joint wo* formed. The finger is now as strong, and the
motion of the newly-formed joint as perfect as the original. Being a
porter, he injudiciously used the finger before the bones were perfectly
solidified, and a slight lateral curvature was produced ; but in every other
respect the finger is as perfect and useful as before the occurrence of the
accident.

McGowen, now employed at Newland's stables, on Kearney-street, was
advised, in January, 1857, by his physician, to have the forefinger of the
right hand amputated at the second joint, and he came to our office for the
purpose of complying with his instructions. Instead of amputating the
finger, the phalanges were removed, and the wound dressed as in the for-
mer case. In a few days, although requested to visit the office until
cured, he renewed his occupation, and we lost sight of him entirely. On
the 10th of June his finger was examined, and we found the second joint
perfect and the entire phalanx restored. The last phalanx, in consequence
of the soft parts being allowed to contract, is short, although a joint exists,
and the finger is as strong and useful as before the operation.

Shannon, a cooper, living at No. 6 Jackson street, had a whitlow of the
first forefinger, involving only the last phalanx, which was removed at the
joint by a lateral incision. He resumed his business in a few days after
the operation, and the finger was not examined for several months. The
newly -formed bone is shorter than the original one, although the motion
of the joint is perfect, and the finger in every respect as servicable as
before.

Other cases might be given, if these were not considered sufficient, to
establish the point in question.

Cullens, who lives on Stevenson-street, between First and Second
streets, had suffered for three months before he became my patient, from
a whitlow, involving the whole of the right thumb. Free incisions had
been made, without affording relief. The thumb was enormously enlarged,
the first and second phalanges were denuded, and the flexor tendon near
the extremity destroyed. Notwithstanding its excessively diseased con-
dition, we determined to remove the bones, believing they would be re-

1857. Spirit of the Medical Press. 593

produced, although we were confident that the thumb would not be as
perfect as if he had received proper attention at an earlier period.

An incision was made upon the upper side of the thumb near the loca-
tion of the extensor tendon, and carried upwards under the nail, and both
phalanges removed. This operation was performed about the first of
April, and in six weeks the soft parts Were healthy, and the bones and
joints re-produced. Although he has but little control over the last phal-
anx, in consequence of the destruction of the tendon, the thumb is nearly
as long as its fellow of the opposite hand. It presents a natural appear-
ance, and is improving daily, both in strength and motion.

A gentleman, living near Redwood city, had suffered for several weeks
from a similar disease, and was operated upon on the loth of April, 1857.
In his case a lateral incision was made, and both phalanges of the right
thumb were excised. This case was progressing much more favorably
than that of Cullens, when he left the city, two weeks after the operation.
He has not been heard from since, although no doubt is entertained of the
entire restoration of both bones and articulations.

In 1853 a carpenter was admitted into the State Marine Hospital with a
compound commuted fracture of the great toe. After remaining two
months, and finding that union had not taken place, and that the bones
were diseased, instead of amputating the toe, we removed the bones, and
in a short time they were restored, although we were not aware of the re-
production of the articulations.

Blaisdell, who then lived near Oakland, had the great toe of the left
foot injured by a large piece of timber. When examined, we found the
second phalanx diseased, although the foot was healthy. In December,
1856, an incision was made upon the internal side, and extended from the
articulation with the metatarsal bone to the extremity under the nail.
Both phalanges were removed, and the wound closed by the interrupted
suture. In four weeks from the time the operation was performed, the
bones were re-produced, and the patient could wear a boot without incon-
venience. The articulations appear to be perfect, although the last phal-
anx was not diseased and was removed with the periosteum. This can
only be accounted for by supposing that the periosteum detached from
the second phalanx produced a sufficient quantity of osseous matter for
the restoration of both. Mr. Blaisdell is now employed on Bird Island,
and suffers no inconvenience from the injury.

In removing diseased bones from either the fingers or toes, lateral incis-
ions should be made to avoid the tendons ; and the soft parts, until bony
matter is deposited, should be supported by pasteboard splints, applied so
loosely as not to produce pain. If they be found inconvenient, the other
fingers or toes may serve as splints. Before the bones are fully developed,
the member should be flexed occasionally, although that precaution was

594: Medical Independent. Dec.

not taken in some of the most satisfactory cases given above. In Cullens'
case, in consequence of the destruction of the tendon, an effort was made
to produce anchylosis of the first joint, by the application of splints, but
without success.

Many operations of a similar character have been performed in the
United States Marine Hospital, but not being able to furnish the resultsr
they have been omitted. Most of the cases cited can be examined by the
incredulous, and the above statements verified. The result of these exper-
iments is not only interesting but extremely useful. Useful, because by
the loss of a thumb a laboring man may be deprived of the means of pur-
suing the only occupation with which he is acquainted, and by which
alone he can support himself and family. By the loss of a great toe, the
strength of the foot is impaired, the gait rendered unsteady, and locomotion
fatiguing. Interesting, because it establishes the efficiency of the restora-
tive powers of the human system more fully and unquestionably than
anything that has heretofore been observed ; and when assisted and di-
rected by those who, from greater skill and experience, are more com-
petent than ourselves to act efficiently, results more brilliant than we can
now imagine may be realized.

Supra-Renal Capsules. — M. Brown Sequard has recently addressed the
Academy of Sciences, of Paris, from Philadelphia, a note in response to a
communication of If. Philipeaux on the above organs.

M. Brown*Sequard has undertaken a new series of experiments to dem-
onstrate that death is the immediate effect of ablation of the supra-renal
capsules.

The following are the results of fifteen coneys submitted to extensive
violence to the peritoneum and divers other organs. Three survived from
two to eight days, seven from twenty-four to forty-eight hours, three died
at the end of seventeen, nineteen and twenty hours, while one lived
eighteen days, and another as long as three weeks. Of ten coneys from
which the kidneys had been extirpated, five survived from twenty-four to
sixty hours, and one sixteen hours only. Of ten ten coneys despoiled of
the supra-renal capsules, not one lived so long as those of the preceding
experiments which died soonest. Six died between the seventh and tenth
hours, and the other four between the tenth and fourteenth hours from the
operations.

The mean duration of life in the above experiments may be stated thus:

1st, In the coneys with the wounded peritoneum, liver, kidneys, etc.,
about three days, or more exactly, seventy-two hours.

2d. Those from which the kidneys alone had been extracted, about one
day and a half, or thirty-five hours.

3d. Those despoiled of the capsules but nine and a half hours.

The difference, then, is very great, and with a knowledge of these facts

1857. Spirit of the Medical Press. 595

is it possible not to admit that the extraction of the supra-renal capsules
was not the special cause of death in these last experiments. It is proper
to observe that those despoiled of the capsules died too soon to have been
killed by peritonitis. Moreover the ablation of the capsules was followed
by symptoms which were not manifested in the animals submitted to the
injuries of the peritoneum, liver kidneys, etc. These phenomena show
that the supra-renal capsules have a great influence on the blood, and the
nerves of these little organs exercise a singular influence on certain points
of the nervous centres. * * * * * The influence of the nerves of
the capsules is clearly demonstrated in some cases after the extirpation or
puncture of one of these organs. In such cases sometimes the animal is
seized with vertigo, and some minutes before death roll, or rather revolve
around the longitudinal axis of their body as they do when the middle
peduncle of the cerebellunTis punctured.

I conclude from facts observed concerning the supra-renal capsules,
1st, That if these organs are not essential to life, they are at least of very
great importance ; 2d, That their function are at least of equal importance
to that of the kidneys, because when it fails, death supervenes more
quickly than after ablation of the kidneys.

If these conclusions are correct, 'the fact as stated by M. Philipeaux,
that life may continue after the extirpation of the two supra-renal capsules,
depends probably for existence upon the consideration that there are other
organs that can supplementarily discharge their function. There may be
organs, then — as in the case of some of the glandular organs — whose action
is capable of compensating to the system for the loss of the supra-renal
capsules.

The congested condition of the thymus and thyroid bodies observed in
animals dying after the extirpation of the capsules renders the supposition
highly probable they may supplementarily discharge the functions of the
supra-renal capsules in the absence of those little organs. — Gaz. Des. Hos.,
and Nashville Journal of Medicine.

Medical Responsibility. — Judge Minot, of Pennsylvania, lays down the
following rules as applicable to medical practitioners : 1. The medical man
engages that he possesses a reasonable degree of skill, such as is ordinarily
possessed by the profession generally. 2. He engages to exercise that
skill with reasonable care and diligence. 3. He engages to exercise his
best judgment, but is not responsible for a mistake of judgment. Beyond
this the defendant is not responsible. The patient must himself be res-
ponsible for all else : if he desire the highest degree of skill and care, he
must secure it himself. 4. It is a rule of law that a medical practitioner
never insures the result. Judge Sargent, in a recent case occurring in
Strafford County, N. H., thus charges the jury : "The law requires of a
man who offers his services in any profession, three things: That reasona-

596 Medical Independent. Dec.

ble degree of learning, skill, and experience, ordinarily possessed by others
of his profession ; reasonable care in the treatment of the case committed
to him ; and the exercise of his best judgment in cases of doubt. Judge
Story defines ordinary diligence and care to be that degree of care which
men generally employ in their own concerns. All engage for the exercise
of ordinary care in a profession. A physician does not engage to warrant
and effect a perfect cure. The rule is, that where both parties are bene-
fitted by a contract, they should use such skill and diligence as men of
common prudence employ ; not such as belong to very prudent or skillful
persons. Few cases of surgery are alike, and judgment is required in the
treatment of them. The law does not require freedom from errors of judg-
ment. The employer has to exercise judgment, too, in the selection of the
professional man ; and, in cases of reasonable doubt, none are held res-
ponsible for errors of judgment, nor for mistakes committed with ordinary
care and skill. Now, diseases are rendered different by influences of char-
acter and habit, and by constitutional and natural causes. When the jury
are satisfied of reasonable skill and care, that is sufficient. To show the
want of skill and negligence, it is never enough to show that the physician
has not treated in that mode or used those measures, which in the opinion
of other medical men the case required. This alone is not evidence of
want of skill and care. The plaintiff must go farther, and show that the
defendant had not the requiste qualifications, or did not use them. — Ameri-
can Druggists' Circular and Chemical Gaz.

Bromide of Potassium in Epilepsy. — By Sir Charles Locock. — Some
years ago he chanced to see a paragraph in the British and Foreign Medi-
cal Review, giving an account of some experiments that a German had
been making with bromide of potassium. He found that by taking ten
grain dosesHhree times a day about a fortnight he became impotent, but
upon leaving off the medicine his powers returned ; he tried a similar
experiment with others, and a similar result was produced. He accord-
ingly thought he would try bromine of potassium in many hysterical cases
that he met with unconnected with epilepsy, in which there was a great
deal of sexual excitement and disturbance, attended with various distress-
ing symptoms difficult to manage ; and he found that from five to ten
grains given three times a day had the effect of calming the excitement to
a very great degree. About fourteen months ago he was applied to by the
parents of a lady who had had hysterical epilepsy for nine years, and had
tried. all the remedies that could be thought of by various medical men
(himself among the number) without effect. She began to take the bro-
mide of potassium last March twelve month, having just passed one of her
menstrual per5otis, in which she had two attacks. She took ten grains

1857. Spirit of the Medical Press. 597

three times a day for three months ; then the same doses for a fortnight
previous to each menstrual period ; and for the last three or four months
she had taken them for only a week before menstruation. The result had
been that she had not had another attack during the whole of the period.
He had tried the remedy in fourteen or fifteen cases, and it had only failed
in one, and in that one the patient had fits not only at the^times of men-
struation, but also in the intervals. — Med. Times and Gazette.

Surgery. — Excision of the Head of the Femur in the Hip-Joint Disease.
— Dr. Kinloch, (Charleston Med. Jour.) reports a case of the excision of
the head of the femur in morbus coxarius, which terminated fatally. The
patient was 20 years of age, and had suffered from symptoms of hip-joint
disease about two years. On exposing the joint, the disease was found to
be very extensive, with a perforation of the acetabulum. A portion of the
rim was removed with the head of the femur. The patient did not rally
well, and sunk in about thirty hours.

Mr. Erichsen, in a recent clinical lecture, (London Lancet) discussed
minutely, the pathology of hip-joint disease, and pointed out the class of
cases in which excision is justifiable. He divided coxalgia into three vari-
eties, ath r it i<\ femoral, and acetabular. The first is characterized by the
symptoms of acute articular inflammation. The joint becomes hot and
swollen, is exquisitely sensitive, the pain being more severe than in other
forms of arthritis. This variety occurs in young adults, and usually ter-
minates in anchylosis without suppuration. Excision in these cases is not
necessary. The acetabular form differs widely from this. In it the pri-
mary seat of disease is in the'pelvic bones, the joint being involved second-
arily. It occurs in adults, always goes on to suppuration, never to anchy-
losis, and is generally fatal. It commences with abscess in the illica fossa,
or at some point within the pelvis ; there is at first little or no pain, with
no change in the length of the limb — excision is here impracticable. The
third, or femoral form, is where the head of the bone is primarily affected
by caries, often of a tuberculous character. It occurs in strumous children,
is subacute for a time, and is attended with the early formation of abscess
it is in these cases that excision may be undertaken. The details of a case
of excision are given, in a patient, set. 7 1-2 years, which promised good
results.

Extirpation of the Supra-Renal Capsules, Spleen ana\ Typhoid Gland^
from living Animals — M. Philipeaux addressed a note to the Academy of
Sciences, in which he says that he has succeeded, not only in removing
the supra-renal capsules, but also the spleen and thyroid body in two
white rats (.Mus Rattus), aged one month. By an operation of the kind
described in my first note, I have removed first the right supra-renal cap-

598 Medical Independent. Dec.

sule, and in ten minutes afterwards the left. These animals in about one
month were completely recovered, when I proceeded to remove the spleen

through a small opening in the side of the abdomen, after which 'the
wound was closed by a single suture. It was but a short time until they
had again completely recovered, and I was successful in removing from
the same animals, the thyroid gland, through a longitudinal section in the
anterior part of the neck, on a level with the tracheal artery. At this
time these animals, aged three months, are in excellent health, notwith-
standing they have been despoiled of their supra-renal capsules for sixty"
seven, the spleen for twenty-six, and the thyroid body seven days. I take
this opportunity of informing the Academy, also, that I possess one male
rat, living in fine condition, which has been for four months deprived of
his supra-renal capsules, and a female for forty -three days, without any
modification of their functions that can be perceived. The female has
been impregnated, borne eight young ones, and is raising them. — Ibid.

Resection of the Elbow-Joint, by a single Long Inciseon. — The London
journals notice an important modification of the operation of resection of
the elbow-joint, practiced recently by Paget, Fergusson, and Erichsen, viz :
a single straight incision, instead of the H or I incision, so generally prac-
ticed. This improvement is attributed to Langenbeck, and these surgeons
were led to adopt it upon the representations of one of the German Sur-
geons pupils. It is contended in favor of this modification, that the lateral
separation of the soft parts, thus afforded, gives ample space for the opera-
ration, while it leaves the bones much better covered, and the wound a
much smaller one than would otherwisebe the case. The " single long
incision," is not, however, a recent improvement, as it was originally sug-
gested and practiced by Park, in 1781. It is the method of excision of
the elbow-joint, practioed by Drs. Buck, Post, and Van Buren, of this city.

Spmpathetic Inflammation of the Eyeball. — Mr. Walton remarks (Brit-
ish Med. Jour.), that the horse doctor is in advance of the accomplished
opthalmologist in their knowledge of some diseases of the eye. It has
been a practice among farriers, in certain ophthalmic diseases of the horse,
to destroy the eye by suppuration, knowing well that the other eye, which
is in great peril, could be saved by this means. Mr. Wardrop, taking ad-
vantage of this hint many years since, practiced evacuating the humor of
the affected eye, and thereby relieved the sound organ from the dangers of
a sympathetic inflammation.

Treatment of Primary Syphilis by Preparations of Iron. — Ricord sug-
gested the employment of potassio-lactate of iron in phagenic chancre, and

1857. Spirit of the Medical Press. 599

Mr. Acton recommends it very highly. Mr. Behrend (Lancet), believing
in the essential identity of the virus of every form of chancre, and attrib-
ting the apparent differences to special circumstances was led to employ
this preparation of iron in the treatment of the common chancre. He
reports the details of a number of cases thus treated, with the most satis*
factory results. His method of administering the iron, is to make a
mixture of one ounce to six, of which two tea-spoonfuls are to be taken
three times a day. The local applications are simple.

On the use of Iodide of Potassium in the Treatment of Leucorrhoza by
Injections. — The wise man said, " There is nothing new under the sun,"
and the saying applied to the practice of Medicine in the present age, can
admit of no refutation, and indeed of but little opposition.

Most of the remedies or curative agents lately brought into notice, more
especially those which are published to the world as new discoveries, may
be proved to have been used in very remote periods ; and many too, have
been well known among the teachers of medicine, in the very infancy of
the art. The present age, perhaps, more than any other, has been charac-
terized by the successful diligence and zeal which it has displayed in re-
searches. The efforts made in the various arts and sciences, have been
often rewarded by great and important discoveries, and none of the
branches of knowledge can boast of more successful improvements than
those which have been connected wilh medical inquiries. While conces-
sion to the truth of this opinion must be very generally acknowledged, it
will also be allowed, the assiduity and ardor of pursuit after novelties, es-
pecially in the healing art, has been almost every where so exclusively
directed to recent or modern innovations in practical as well as theoretical
principles, that much very important though ancient medical skill, com-
municated by the writings of an early age, has been disregarded, or ignor-
antly confounded with pretended new discoveries; the new medical author
or practitioner claiming the merit and honor, of first introducing as a bene-
ficial novelty, some plan or method well known to his predecessors, and
recorded in works yet extant, and of easy attainment. It is certain that
many important articles of the materia medica, apparently of opposite
tendency to one another, are judiciously used in morbid affections. To
account satisfactory for this fact, theory alone will not suffice, but expe-
rience will, in such instances, guide the physician's conduct, without
regard to any theory ; and the beneficial result of the use of seemingly
opposite medicines, will often do away the extravagant respect so uniform-
ly shown to theoretical reasoning in the practice of young physicians.

But my present object being to awaken the attention of my medical
brethren to an article which I deem of greater importance and efficacy*
VOL. Ill, NO. X. — 40.

600 Medical Independent. Dec.

and possessed of more valuable properties than are now generally ascribed
to it. This remedy is the iodide of potassium.

I will now give the history of three cases which came under my care :
although they may be imperfect in many particulars, yet I hope they are
of sufficient minuteness and correctness to occupy the sphere they are
intended for, in the mind's eye of the reader.

In the spring of 1856, Jane, a negress of Mr. E. S. Miller, cet. 30 years,
of a leucophlegmatic temperament, came under my treatment. Two years
ago she was attacked with dysmenorrhoea, followed soon after by prolap-
sus uteri, with a leucorrhceal discharge. When she came under my care
the leucorrhceal discharge was of more than an ordinary quantity usually
met with in such cases. When the discharge came in contact with the
external parts, it produced excoriation. Previous to the appearance of the
catamenia, the uterus would sink low into the pelvis, frequently making
its exit beyond the labia externia. The catamenia was of the usual char-
acter and quantity for the first two or three days ; then it would change
its form in regard to quantity, and assume that of menorrhagia, never
yielding but to the action of remedies. Such is a general history of the
above case when it came under my care.

My first object being to relieve the dysmenorrhoea and prolapsus of the
uterus, which I accomplished after " so long a time," but with no diminu-
tion of the leucorrhceal discharge. I followed the usual course of treat-
ment for its relief, but with no avail. Relying solely on an alterative
course of treatment for its cure, my mind naturally led to the use of the
iodide of potassium. I reasoned with myself thus : If the iodide of potas-
sium is such an efficient alterative when taken by the mouth and addressed
to the constitution generally, would its action not be more potent, if
brought within direct contact with the diseased parts ? Acting upon these
premises, I commenced the use of the iodide potassium by injections per
vaginam ; and, much to my surprise (though of an agreeable character),
the discharge made a speedy surrender. It has not not made its re-ap-
pearance, now nearly a year since.

1857. Mrs. S., mt. about 21 years, of a sanguine temperament ; has
suffered much since her last confinement (six months ago) with leucor-
rhcea, of an ordinary character. Ordered a solution of iodide potassium
by injections three or four times a day. The discharge was soon relieved.
Mrs. C, mt., about 28 years ; leucophlegmatic temperament. Confined
about seven weeks since with her fourth child. Suffered much after her
accouchment with ovaritis. Leucorrhceal discharge somewhat profuse,
and of a thin, white appearance. Ordered iodide potassium by injections.
Discharge checked on the fourth or fifth day.

The quantity of iodide potassium used was as follows : dr. iss to a half
pint of aqua purge. — New Orleans Med. and Surg. Journal.

1857. Editorial and Miscellany. 601

(BYxtaxml anlr pisnllang.

Medical Education — The Duties of the University of Michi-
gan in Reference Thereto. — In previous numbers of the Independ-
ent, we have discussed the general subject of Medical Education, and
its bearings upon the Medical Department of the State University.
We propose, now, to allude to the moral obligation resting upon the
University in reference to educational advance, in consideration of
the advantages afforded by its endowment.

In previous articles, we have held, what is now the general senti-
ment of the profession, that certain improvements in the course of
medical training were imperatively called for by the wants of the
medical student. These improvements are briefly as follow : —
Increased period of pupilage ; prolonged lecture terms ; a highe
standard of acquirement; and hospital instruction to be made a
requirement for graduation. Schools depending for their support
upon ticket fees, naturally mark out such a course of requirements
as will attract the largest number of students ; and such schools will
consequently be slow to adopt all of the above-enumerated improve-
ments. Possessed, as all the best schools are, in a greater or less
degree, of hospital advantages, they will give prominence to these
privileges, and fail to incur the risk of diminished classes, consequent
upon the more rigorous demands of increased time and acquirement.
To this class of schools, useful and meritorious as they are, we shall,
so long as they compete for numbers, look in vain for the pioneer in
thorough reform. Where, then, is the school that will wreath for
itself a crown of professional glory, by instituting all the require-
ments consistent with the enlightened and humanitary demands of
the times 1 Wherever that school is, we would rather be connected
with it, than with any other school in the United States, whatever
may be its present prestige.

Virginia has two medical schools ; one, the Medical Department
of the University of Virginia, luxuriates in a country location at
Charlottesville, where it has long operated as a mere feeder to the
Philadelphia schools; the other, the Medical College of Virginia,
is located at Richmond, where hospital advantages are available.
The Medical Department of the University cannot, in its country

602 Medical Independent. Dec.

location, afford to its students a practical medical education ; and we
can readily see why it operates as a tributary to Philadelphia, rather
than to a rival school in Richmond. The Virginia Medical Journal
is laboring to effect a union of the two, by transferring the Medical
Department of the University to Richmond, and blending it with the
Virginia Medical College, thus concentrating effort, with the inten-
tion of elevating the standard of acquirement, and making the degree
of the consolidated school " the first medical honor in America."
God speed the laudable enterprise ; but we fear that, even with the
consolidation in Richmond, competition with Philadelphia, for num-
bers, will paralyze effort to materially lengthen the term of study or
elevate the standard of acquirement. So, too, with all schools whose
organization is such as to make the amount of income dependent
upon the number of students.

The Uuiversity of Michigan is fortunately situated in this respect,
in reference to the needed reform ; and she has consequently a duty
to perform, from which she cannot shrink without loss of credit.
Entirely independent of patronage, she can make her own terms with
those who seek benefits at her hands. Nor is this her mere privilege.
It is an absolute duty resting upon her, in consideration of the
great importance of the work, her ability to perform it, and the
source from which her endowment was derived. Originating in the
munificence of the General Government, and wisely cared for by
State authority, that endowment enabled the Legislature of Michigan,
as early as 1836, to anticipate its benefits and organize a University,
in all the departments of which education was to he free and open to
all. Free education thus being secured by organic law, a matricula-
tion fee of only ten dollars entitles the matriculant to the benefits of
perpetual scholarship. Enabled by this endowment to offer such
advantages, the University of Michigan should enter the field of com-
petition, not a mere bidder for numbers, but with an earnest endeav-
or to attain the greatest degree of excellence — to furnish the greatest
and most perfect advantages, and to demand the highest grade of
scholarship from those on whom she bestows her honors. The spe-
cific duties devolving upon her, in the management of her medical
department, are : —

First — To require a four years' course of study.

Second — To establish a nine-months lecture term.

Third — To make an attendance of one year upon hospital instruc-
tion one of the requirements for graduation.

1857. Editorial and Miscellany. 603

The adoption of these measures of reform, with the transfer of the
Medical Department to this city, where hospital advantages could be
furnished, would place it in advance of all other schools in the
United States ; while, unless such transfer is made, and hospital
means of illustration are rendered available, it must remain content
to rank, like the medical school of the University of Virginia, only
secondary in importance, and as a mere feeder to more perfect insti-
tutions. Such a position, for its medical school, the profession of
Michigan is not prepared to be content with. It is not content that
the great advantages afforded by the University endowment should
be productive of anything less than a first rank institution. It is not
content that a reform, the necessity of which it — in common with the
whole profession, throughout the Union, — recognizes, should remain
unaccomplished, when ample means for successful accomplishment
are at hand. The Medical Profession, at home and in other States,
look, at this time, to the University of Michigan for a gigantic step
in educational advance.

The expenses of the Medical Department will be no greater in
Detroit than in Ann Arbor ; while, in Detroit, it can be placed in
the highest rank — in Ann Arbor, never. Located in Detroit, where
it could offer every advantage to the student, with the ability to dic-
tate terms of graduation, without fear of diminished classes, it would
clearly be within the power of the University to institute all the
desired reforms, and, in so doing, to serve the causes of science and
humanity. Let her not, then, neglect what should be considered her

HIGH PREROGATIVE and SOLEMN DUTY. G.

Anecdote of Dr. Radcliffe. — Radcliffe, one of the most eccen-
tric and witty men of his time, lived, at one time, in Bow-street,
Covent Garden. Between his garden and that of Sir Godfrey Knel-
ler, the king's painter, a door had been made, to allow the Dr. the
pleasure of visiting the rich collection of exotic plants contained in
the latter garden. Radcliffe's servants became depredators ; Sir
Godfrey remonstrated ; and, the grievance continuing, Sir Godfrey
sent his compliments to Dr. Radcliffe, accompanied by a threat to
lock the door. The wit answered that Sir Godfrey might " do with
the door as he pleased, so he did but refrain from painting it."
" Did my good friend Dr. Radcliffe say so ?" cried Sir Godfrey. —

604: Medical Independent. Dec.

" Go back, present my service, and say that I can take anything from
him, but his physic.'''' This anecdote has been immortalized in verse:

" Quoth Kneller, ' I'll certainly stop up that door,
If I ever find it unlocked any more.'
'Your threats,' replied Radcliffe, 'disturb not my ease,
And so you don't paint it, e'en do what you please.' "

The Preparations of Garnier, Lamoreux & Co. — These truly
elegant medicines answer, most fully, a want which we have long
felt. To so large a proportion of patients are the odor and taste of
most medicines highly offensive, that it not infrequently prevents
a full obedience to orders. Nor is this the only evil experienced
by the physician — he has seen former patients seeking after strange
gods, actuated by no other motive. Pharmacy, to remedy this evil,
has made a rapid advance ; but in no other instance has it accom-
plished so much, as in the one under consideration. Cleanly, odor-
less, and giving to the tongue only the taste of sugar, these pills and
granules are readily swallowed, even by the most fastidous ; while
the easily-soluble nature of the covering exposes the medicine, almost
immediately, to the action of the stomach. They have become to us
almost a necessity, in making many prescriptions.

Treatment of Scarlatina. — A contributor to the Nashville Jour-
nal of Medicine has adopted the following treatment in scarlatina,
and has found it highly successful :

" Commencing with mercurial purgation, followed, as soon as an
action was produced, with sedative doses of quinine. Giving it — no
matter how quick the pulse — and repeating it again and again, until
its peculiar effects ensued ; after which there was always an amelior-
ation of the disease. Neither did I neglect the throat — using poul-
tices externally, with some one of the numerous gargles, the simplest
and best of which was an infusion of kino, or, if not this, nitras
argent! directly applied to the inside of the throat. Sometimes
combined with the quinine small doses of ipecac, when the stomach
was not irritable ; but to the quinine alone I looked for the great
good, and I can say, of a truth, it seldom failed me."

1857. Editorial and Miscellany. 605

Mr. Stearns' Circular. — Mr. Frederick Stearns was appointed
by the American Pharmaceutical Association, at its last meeting, a
committee to report " upon the abundance, commercial value and
medical importance of the medicinal plants of Michigan ;" anu he has
addressed a circular of inquiry to the different members of the pro-
fession throughout the State. We trust that physicians receiving
his circular will make a prompt reply, conveying such information
on the subject as they may possess.

Cicuta Maculata. — Dr. J. C. Norton, of Homer, Minnesota, in a
report upon the botany of Winona County, says of the cicuta : — " In
small doses, it is, according to my experience, a sure cure for nervous
and sick headache.''''

CORRESPONDENCE.

Vermont, Nov., 1857.

" A Small Matter, but an Important One " — If True. — Surely
this is an age of wonderful discoveries. Man has hitherto been limp-
ing through the world upon unequal legs, utterly unconscious of the
" fact," ignorantly supposing himself to be " in form and moving ex-
press and admirable." But the truth, unwelcome though it may be,
has at last been discovered. There is " a natural difference in the
length of the legs." (See Med. Independent, Nov., 1857, p. 548).

Dr. Nelson's article would leave the impression that this difference
is quite common. At least he and his " several friends " are

*« * * " curtailed of this fine proportion,
Cheated in figure by dissembling nature."

Of course I do not design to deny his " fact," as only negative evi-
dence can be brought. Besides, " it is never a pleasant duty to call in
question the accuracy of another's statements as to what he has him-
self alone seen and experienced."

But, for " the application of this knowledge " correctly, attention
must be paid to the method of measuring. False measures, like false
weights, may deceive. It is easy to apply the tape-line, but it is not
as easy to place the body in such a position that the line shall show
the truth. The usual method of measuring the person being in the

606 Medical Independent. Dec.

dorsal-horizontal posture, is manifestly the true way. But certain
precautions are of importance. The body and limbs must be in the
same straight line. By extending a line from the top of the sternum
over the symphisis pubis, and continuing it on beyond the feet, the
legs may be brought accurately into line. Without this aid to the
eye, a deviation, which will make considerable difference in the meas-
urements, may pass unnoticed. The pelvis should now be adjusted
so that the line joining the spines of the ilia shall be exactly at right
angles to the former line. If one leg has been for a long time wholly
diseased, some support will be required under the buttock of that
side, to supply the deficiency caused by the wasting of the muscles.
Being now satisfied that the position is perfect, the point, from and
to which the measurements are to be made, demand attention. The
anterior superior spine of the ileum, and the inner maleolus are com-
monly selected. These are fixed points, well defined and easily found,
and hence admirably adapted to the purpose. The patella is mova-
ble, and presents no prominent points, hence very little reliance can
be placed upon measurements to or from it. The condyles of the
femur and head of the tibia are large, rounded, and furnish no distinct
point from which to measure.

In the case alluded to by Dr. Nelson, I did measure in the above
manner, using all the precautions described. He did not measure in
this way. As he has entirely forgotten to tell his method of proce-
dure, I may be allowed to describe it, that the profession may know
the different modes, adopting whichever seems the most accurate and
reliable. He placed the boy in the upright position, with his back to
the wall, and endeavored to obtain the difference in the length of the
legs by measuring the thickness of books placed under the heel of
the shortened leg ; when lo ! it required only two and a half inches?
instead of three inches, to make the boy appear to stand perpen-
dicularly.

Now listen, ye lawyers, and learn a lesson in logic. The Plaintiff
has overstated the amount of deformity, therefore his " mainstay is
knocked asunder." There is now little necessity of investigating those
minor points of original treatment, and after care and management
of the broken bone.

That the boy had a bad leg, be the shortening two or three inches*
is indisputable ; whether from the surgeon's fault or from his own,

607 Editorial and Miscellany. 1857.

or from that of his attendants, or from neither, I certainly do not feel
competent to decide, not having heard the evidence upon either side.
The Defendant, a surgeon of good standing and character, has had
my sympathies from the commencement of this suit, which, I suspect,
adds another to the list of malicious prosecutions, instigated by ene-
mies, and carried forward by one anxious to avoid the payment of a
large bill.

Let me remind Col. Nelson that when a man publicly proclaims
his own wonderful powers and superiority, whether exhibited in
drilling the militia of a country regiment, or in matters of science,
however amusing or riduculous he may make himself appear, it is his
owrn affair. But when he becomes so intent upon blowing the trum-
pet of glorification that he tramples unceremoniously upon the by-
standers, and certainly when he intentionally endeavors to knock
down another, that he may elevate himself upon the fallen body, to
make his notes reverberate more widely, he must not expect impu-
nity. " One Person."

Ann Arbor, Nov. 15th, 1857.
Editors Medical Independent : —

Allow me, through your journal, to make a few observations on
the advantages and disadvantages pertaining to the course of instruc-
tion in the Medical Department of our State University.

With regard to the advantages, I can truly say, that there is no
better plan of instruction, in any medical school in the Union, for
the Junior student, than the one adopted by it. It has a six-months
lecture-term, with but four lectures per diem. — thus giving the stu-
dent ample time for the study of the various branches, and acquiring
a thorough knowledge of the principles and theory of the science.

Its course of Analytical Chemistry — an admirable and unsurpassed
arrangement, giving the student the opportunity of manipulating and
experimenting in chemistry, — constitutes the only true way of ac-
quiring a complete knowledge of the science.

The disadvantages are full as great to the Senior, as the advan-
tages are to the Junior student. Clearly, the lack of clinical instruc-
tion is the great disadvantage the institution now labors under. The
senior student, before starting out upon the noble calling of his pro-
fession, requires clinical instruction, to enable him to manipulate

608 Medical Independent. Dec.

with the knife in the varied operations of surgery, and prescribe with
confidence and skill at the bed of the sick ; for there are ever small
links of connection between symptoms — indescribable relations,
which fix the practiced eye and decide the experienced judgment, —
an idea of which even the most accurate writer or speaker fails to
convey to the student.

Clinical instruction is as essential for the completion of a medical
education, as practical work is to the young mechanic, in enabling
him to undertake work upon his own responsibility.

Medical schools located in large cities possess this advantage of
clinical instruction, which accounts for the resorting of numerous
physicians, graduates of country schools, to them, to complete their
education ; and also of those senior students from smaller schools,
who go for the same reason. It is said by some, that the only ad-
vantages afforded by large cities, are for surgical clinics. Not so,
where hospitals are regulated for the instruction of students, as they
should be, and with a lecture term sufficiently long to give the stu-
dent time for observation. They then afford the greatest advantages
in all practical departments.

Large cities, too, furnish patients for medical clinics, held at the
college, where such cases present themselves, as would naturally
resort to the offices of physicians, in the absence of the college
clinic. The clinic thus becomes at once a source of relief to the city
physicians, and a real charity to the patient, — for its advantages are
sought by those unable to remunerate.

I see that a clinical course, connected with the University, has been
delivered in Detroit, between the lecture terms of the Medical De-
partment ; but, so far as I can learn, it amounted to but little. A
few only availed themselves of it, and they were poorly satisfied.
The place for clinical instruction should be located where the college
is, and such instruction should be imparted during college terms, so
that a greater number of students may avail themselves of its bene-
fits. No doubt many would attend during the intervals of the lec-
ture term, if conducted as it should be.

The system of medical instruction, adopted by the Jefferson Med-
ical College, seems to have met with some objection from a certain
fogy clique, in your city, as not being in accordance with its high
aspirations in medical education ; but, in my opinion, there are few
schools which possess greater advantages for the senior student than

1857. Editwial and Miscellany. 609

it. The only alteration to better it, would be a longer lecture term,
and fewer lectures per day.

Having attended our own institution, and also those in large cities,
I have seen that the advantages of the latter, for the senior student,
far surpass those that can possibly be afforded in any country school.
I feel it a duty to the profession of our own State, to express my
views, and endeavor, with them, to make our own institution second
to none in the Union. Surely, it is endowed with advantages, such
as none others are. Requiring scarcely any pecuniary means on the
part of the student, to avail himself of a thorough medical education,
it would undoubtedly be the model school, could it have the benefit of
clinical teaching, in the absence of which we find the only reason that
keeps it in the background of medical instruction. W. L.

Owosso, Mich., Nov. 13th, 1857.
Editors Medical Independent :

I have noticed with pleasure in several numbers of your excellent
journal, remarks upon Clinical Instruction, with suggestions recom-
mending the removal of the Medical Department of the University
of Michigan to Detroit, where the same can be made available.

That the interests of the medical class, and the wants of the pro-
fession of Michigan, imperatively call for this change, no one can for
a moment question. Being a graduate of the Medical Department,
I have ever entertained for the University that peculiar filial regard
that all cherish for their Alma Mater ; and while I would deprecate
any measure that had not for its aim the glory and prosperity of the
University, I, on the contrary, hail with joy a plan which, if carried
into operation, must place its College of Medicine and Surgery in
the foremost rank of American Medical Schools.

It may be argued by some that arrangements have already been
made, and carried into operation, for clinical teaching ; but it must
require but little reflection for the most obtuse mind to appreciate
the impracticability of the present plan.

A clinique situated forty miles from the school to which it pur.
ports to belong, can be one only in name ; and any one who has the
hardihood to contend that the present arrangement meets the wants
of the profession, is, in our humble opinion, much better skilled in
sophistry than in logic.

610 Medical Independent. Dec.

Now, in order for the student to avail himself of the clinical course,
he must spend the summer in Detroit, after his winter course in Ann
Arbor, when, in our judgment, it would be far more to his interests
to take the two courses in connection, to say nothing of increased
expenses, and being pent up in a city at a season of the year most
irksome for a residence in a large town ; and when, too, he needs
rest from his previously protracted labors.

And if the present arrangement offers no additional inducements
to the students, will the friends of the measure tell us in what way
it is going to advance the interests of the department, and how it will
add to the glory of the institution ?

The inducement is certainly not in the clinique at Detroit, because
the student may attend the lectures at Ann Arbor, and then avail
himself of the advantages of more extensive hospitals, to be found in
our larger cities, without incurring any greater expense than under
the present arrangement.

But remove the Medical Department to Detroit, where the two
courses may be taken in connection with a clinical course of six, in-
stead of two months, and where medicine, surgery, and obstetrics, each
receive the requisite attention, then we shall have a rational system
of clinical instruction, one in reality — not in name only ; a system
that will offer, not only strong inducements to the student, but to
those members of the profession who, from time to time, wish to
avail themselves of the advantages of lecture and clinical teaching.

That schools not furnishing this important element of medical edu-
cation, are soon to be numbered among the things that were, is evi-
dent from the manner in which they have fallen oft in the last few
years.

It is urged by some, that to remove the Medical Department from
Ann Arbor, will mar the University system. Now, if to remove a
branch of the University that has not the remotest connection with
the other departments, save through the President and Board of Re-
gents, is going to disturb the harmony of the system, as a whole, will
they tell us what the result will be to divide the branch itself, leaving
a wing in Ann Arbor, and locating the other in Detroit ? Such ar-
guments defeat their own object, and require but the sober second
thought to be repudiated. E. L.

611 Editorial and Miscellany. 1857.

Stockbridge, Nov. 16, 1857.
Editors Independent : —

An editorial in your November number, with " Professional
Honor " for its text, together with several other articles of a similar
nature, which have come to my notice of late, have induced me to
pen the following from my own observation :

During the short time I have practiced medicine, the number of
applications I have received from various individuals, in almost all
grades of society — from the highly-respected wife and mother, as
well as the degraded unmarried unfortunate, — to " help one out of a
scrape " — " give nature a start " — " do something for me," &c, has
been so great, that I have queried whether my unfortunate experience
in this direction has not been an unusual one.

To all attempts to convince these applicants of the danger to life
and injury to health, as well as the immorality and criminality of
such proceedings, the unvarying reply has been — " / dorCt care : I
will do it!n or "If you won't do it, I will!"

Now, it is not to be presumed that these individuals are entirely
regardless of their own lives, and indifferent to morality. The truth
is, they look upon abortion (especially in the earlier months) as
widely distinct from infanticide. They have been educated to this,
as well as to the belief that physicians are in the possession of some
drug which, seldom or never endangering life or health, will always
produce miscarriage.

At the present time, they have but to look to public opinion for
such authority ; which, in its turn, was created by the energetic per-
severance of the charlatan, both through the instrumentality of his
private practice and the public prints ; and negatively sanctioned by
the silence of the regular profession.

With such opinions as these, coupled with the gaudy and alluring
temptations of modern society, what wonder that frail mortals should
desire to enjoy the pleasures of venery, and shun the responsibility
of maternity ? Hence the enormity of fearful consequences! Set
public opinion aright, by the relation of intelligible (and consequently
convincing) facts, and you strike a blow in the right direction.

A few brief remarks, relative to a particular case, may not be
unacceptable. On the third day of November, 1856, I was called to
the bedside of Mrs. K., a strong, well-proportioned lady, of appar
ently about thirty years of age, and mother of two children. The

612 Medical Independent. Dec.

husband informed me that two or three days previously she had
miscarried (at about the third month), and had "had a bad diarrhoea
ever since ;" also that from the first she had, with great difficulty,
merely been able to articulate monosyllables. I found her bathed in
perspiration, with a largely-distended and tympanitic abdomen, and
pulse about 150. She strongly denied having taken any drugs, re-
sorted to any mechanical means, or sustained any accidental injury.
About thirty hours afterward she expired.

In the course of a few weeks, a neighboring woman, who was also
enciente, acknowledged (very confidentially) that she and Mrs. K.
had for some time been drugging themselves unsuccessfully, and that
Mrs. K., becoming desperate, had swallowed, at one time, nearly
f. oz. ss. Olei Sabina?. Whether this be true or not, the probabilities
are that she took a sufficiently concentrated potion, of some kind, to
partially disorganize the vocal organs, produce abortion, peritonitis,
and death.

November 16/A, 1857. G. E. C.

Wyandotte, Nov. 17th, 1857.
Editors of Medical Independent :

Will you please give the following notice an insertion in your
December and January numbers.

MEETING OF THE MICHIGAN STATE MEDICAL SOCIETY.

In accordance with the Resolution passed at the last meeting of
the above Society, the next Annual Meeting will be held on the 3d

Wednesday (20th) of January next, in the city of Detroit, at

at 10 a. m.

Members of Committees please take notice and prepare themselves
accordingly. E. P. Christian, Sec'y.

THE

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MEDICAL INDEPENDENT:

A MONTHLY

Review of Medicine and Surgery.

VOL. 3. DETROIT, JANUARY, 1858. NO. 11.

Article I. Tubercular Phthisis the Result of Imperfect

Cell Action. By R. E. Hatjghton, M. D.

(continued.)

The fact, which has so often been proved by analysis, and
by so many chemists, that the deposit called tubercle is prin-
cipally composed of albumen; that, also, the principal agent
of the blood, chyle, and lymph, is albumen ; and that the
albuminous materials of nutrition are converted into fat by
the liver ; — has led me to regard tubercle as the result of
certain changes in the vital actions, by which albumen is
imperfectly vitalized, and deposited, as tubercle, in the
lungs ; and, in the liver, converted, by a pathological state of
that organ, into fat, and there deposited — producing what is
called fatty degeneration of the liver, which is a common
attendant upon well-marked tubercular consumption.

The action of the liver, as well as its abnormal condition,
is understood by reference to this general law of the economy
— " That two organs, the office of which is partly the same,
or entirely so, sympathise with each other ; and if one is im-
paired, or becomes so by diseased conditions, the other takes
on increased labor, to compensate, in some measure, for the
failure which has thus taken place.

The lungs, by reason of deposits going on in their struc-

VOL. III., NO. xi. — 41.

614 Haughton On Tubercular Phthisis. Jan.

ture, do not receive the necessary amount of oxygen — hence
less carbon is disposed of, and the liver must dispose of more ;
and the albuminous elements of the blood and of the food,
which are principally composed of carbon, are converted into
fat, — hence the fatty liver. So, also, is this true of the action
of the skin, which, in health, is an extensive emunctory,
eliminating various elements, among which is carbon, an ele-
ment of destruction, by reason of its retention in the system.

Every person is aware of the sensitive condition of the
skin, in reference to cold. This condition is the result of the
failure of calorification. The fatty matters, instead of being
used for the purposes of respiration, to generate animal heat,
are deposited in the liver ; and here, then, we have failure of
the lungs, the first mode of removing carbon ; next, the skin,
which is destined to eliminate more carbon than even the
lungs ; and, thirdly, the liver fails to eliminate carbon, but
works it up and deposits it, as fat, — the whole process, from
its inception to its close, a morbid one ; — and, therefore, the
carbon of the food, and tissues, and blood, failing to be elim-
inated, and the liver not being able to consume it all in fat,
the balance is a foreign body, to all intents and purposes, and
no organ can eliminate it. Hence, it is deposited in the
various organs (as tubercle) ; and it holds a definite relation
to such organs, in point of priority of deposit, as the organs
are more or less active as its eliminators. The coldness and
chilliness, of which consumptives so much complain, in this
climate, is here explained and understood ; and we have no
means of changing this condition of things, while the chain
of morbid events is unbroken.

Carpenter says, in reference to the conversion of albumin-
ous or protein compounds into fat, that " it must always be
considered, or regarded, as a pathological change ; and its
spontaneous occurrence must be admitted as valid evidence
that the fat, which is generated in the liver, may be formed
out of the products of the disintegration of the albuminous
tissues, or by the metamorphosis of the albuminous portions
of the blood and of the food."

1858.Haughton On Tubercular Phthisis. 615

The organic materials, necessary for the genesis of tissue,
are both albuminous and fatty ; and these are eminently
producible from the elements of food, by the action of
the digestive organs. The fatty elements of nutrition are
important in their relation to the diseases of which we are
writing ; and this importance is shown in more ways than at
first supposed. For instance, saccharine and oleaginous food
is converted into fatty matters, and, in healthy play of the
vital forces, is used to support combustion, — the balance
being deposited, as adipose tissue, throughout the body.
Let, however, the vital actions be changed, and the elements
of nutrition diverted from their legitimate channels, and the
fatty tissues are taken up and burned in the process of respir-
ation, and a progressive emaciation takes place; the liver
converts albumen into fat, which is deposited in its own
structure ; and the system fails to produce a proper tempera-
ture, by reason of a failure in the proper relation of the
elements which support combustion, — one of which is the
carbon of the fatty matters, which ought to be supplied in
the blood. The temperature of the body is below par, and
there is nothing now to support combustion and thereby gen-
erate the heat necessary for the enjoyment of health ; and
this failure in calorification is but another step in the progress
of this tuberculous disease, which acts both backward and
forward, — backward by increasing the deficiency in all the
vital actions before described, and forward by producing
congestions and, finally, local inflammations, which hasten
the disease to its fatal termination.

Among the causes in the production of phthisis, deficient
oxygenation stands prominent ; but it is not the great first
cause, as has been taught, and is now being taught, by some
modern writers. It is a cause growing out of other causes
and other circumstances. In an array of causes, I have
dwelt upon the primary conditions, pathologically, and have
remarked that hereditary influence, indigestion, impure air,
want of exercise, emotions of the mind, depressing conditions
of life, low, damp places of abode, a want of attention to

616 Haughton On Tubercular Phthisis. Jan.

cleanliness, both of person and dress, are among the causes
which impair the nutritive functions, in such a way that di-
sease results. Contracted chests, from errors in dress ; imper-
fect breathing, as one of its results, — even in a pure atmos-
phere— will be as dangerous to health as if the elements of
the air were deficient ; and thus failure in the oxygenation of
the blood would take place, not from want of air, but from
want of the use of it. In other words, the chest being con-
tracted, imperfect expansion would result, and want of
oxygenation.

But this is not the primary process. It exists in extraneous
circumstances, and causes which affect, mehanically, the or-
gans of respiration. Deficient aeration of blood is not, then, a
primary failure, in this disease, but an important one, and it
should not be overlooked, but remedied. " Want of oxygen-
ation converts albumen into fibrin," says Dr. Gardiner, in de-
tailing his experiments. If this be so, it is evident that it is a
process directly detrimental to the system — as fibrin is an ele-
ment of decay, as held by some authorities, — an element of the
inflammatory act in the economy ; hence is one of decay — and
requires elimination. Also, it is the conversion of an element
of nutrition into one of waste, and thereby the amount of this
conversion has a direct bearing upon the healthy nutrition of
the body. Emaciation is the result of such a process, and
this we see so fully displayed in the condition of the lungs,
called tuberculosis.

The changes, then, wrought daring respiration, are won-
derful ; and, according to Dr. Southworth Smith, when mind
and body are in a tranquil state, the amount of air inhaled at
a single inspiration is about a pint. If we count eighteen
respirations per minute, that many pints of air are received
in the same time ; which, in an hour, would amount to 1,080
pints. This, then, we take as a standard for health ; and this
amount of air is necessary to purify and aerate the blood, the
liquid essence of food, the future solids of our own bodies, so
that all the functions of life may be carried on, and thus
render existence pleasurable and happy. Until acted upon

1858. Haughton On Tubercular Phthisis. 617

thus, the blood, to all intents and purposes, is dead, — yea,
more, it is a poisonous stream, carrying, on its red currents,
death to all portions of the body — totally incapable of repair-
ing structures which are worn and decaying, but assisting in
the disintegration, waste and decay, which then rapidly take
place. Vitality is on the wane, and the pestiferous poison,
which is slowly insinuating itself into the inmost recesses of
the human system, though brought to the lungs to be con-
sumed and expelled, is retained, and again passes on its
course round the systemic circle, with increasing influence
for evil ; and thus the individual who may be the unhappy
sufferer is worn out by influences not then controllable, till
death closes the scene. What is this poison ? Carbonic acid.
To breathe in an atmosphere of this kind is death, as rapid as
it is certain. Imperfect respiration increases the amount of
carbonic acid, which goes on increasing till an arrest of all
the vital processes takes place.

But when the lungs are unimpeded in their action, and a
pure atmosphere is furnished, — which is the case the universe
over, except where man's operations contravene the laws of
God, — then the conditions are present for the greatest enjoy-
ment of health. It is the oxygen of the air which kindles the
fires of our being. It is this element which is, within us, the
principle of vital action, working out the great destiny of
humanity. It is this element, which, in the early morn of
human existence, rushes into the lungs, its proper recipients,
and, by its influence upon the blood, wakes to life the inert,
slumbering brain, which, by this power, sends forth its influ-
ence to regulate the whole vital machinery. Oxygen, then,
is the force, or agent, which animates and reanimates the
material universe of God. There is no power, save in oxygen
and oxygenation, which can produce the manifestations of
nervous power; and there is no power, save this, which can
prepare the blood for all its proper uses in the human econ-
omy.

Then we come to another proposition, which may be start-
ling, as well as new, to some : The motive power of the

618 Hafghton On Tubercular Phthisis. Jan.

blood is in the oxygen contained in the lungs; and, unless this
play of affinities between the oxygen of the air and the
elements of the blood existed, no respiration, no arterializa-
tion, no circulation of the blood, no generation of (brain or
nerve) power could occur ; and, consequently, the vital pro-
cesses, which follow as regularly and successively as the links
of a chain, would not take place. The reader will pardon
this digression, to consider the importance of perfect respira-
tion in all the vital processes. We see clearly, that whatever
impairs the lungs, or deteriorates the atmosphere, reacts upon
health ; and, if such conditions exist long, permanently-im-
paired health and life are the results. Here "we see the
adaptation of the prescription, Live in the open air, to such a
condition of health, where digestion and respiration are the
important functions interfered with ; for how is it possible
any human being can enjoy health, when food is not digested
or breathing not half performed ? The wonder would be, if
such disease had not occurred to afflict fallen humanity.

But we have looked at the causes of, and progress of,
tubercular disease — let us see if such causes have no remedy.
We hear it often remarked, " There is no cure for consump-
tion : let the patient's course to the tomb be made as smooth
as possible " — and the patient, as well as friends, settles down
upon this view, and makes no effort, either of mind or body ;
and a deadly despondency of mind seizes hold of him, which,
with the confinement and listlessness, is enough to originate
disease. Let the reverse take place in the actions of those
who are diseased. Exercise in the open air, ride, walk, hunt,
fish, travel, sail on the waters of our beautiful lakes, enjoy
society, invigorate mind as well as body ; and the nervous
power improves, digestion improves, of course, respiration
improves, and the curative actions are in full play. I have
said, and I repeat it, medicines, without these influences,
never did cure a case of consumption, and never will. But
such influences have cured all those who have been cured —
of whom not a few are known to the profession. The opin-
ions of those eminent physicians, Dr. Physic and Dr. Norcum,

1858. Haughton On Tubercular Phthisis. 619

are to the point. Dr. Norcum gives a history of his own
case, which was cured, in a letter to his preceptor, Dr.
Physic. Says he, "If I were asked what remedy rescued
me, I would say, ' It was a life of hardy exercise and of unre-
mitting toil, activity and exposure.' "

This is the experience of the writer of this paper. After
having been reduced by night-sweats, cough and purulent
expectoration, till I had to be assisted to mount my horse or
get into my buggy, yet I continued exercise in the open air,
expanding my lungs freely every day, with frictions of the
whole surface. I am cured, and have been able for all the
fatigues and exposures of my profession for four years.
Drugs never impaired my stomach, but the means thus
described were used diligently. I increased the capacity of
my chest, by expansion, 150 cubic inches of air, by measure-
ment of a pulmometer, in one year; and this increased
capacity for air arterialized the blood, improved digestion,
along with exercise ; and now there is not a man enjoys
exercise, and sleep and food, as I do, — or who enjoys, from
month to month, more uninterrupted freedom from all that
afflicts humanity, in the way of disease. This is my experi-
ence with this disease, in a few words ; and it corresponds
with Dr. Xorcum's and all those who have an experience in
its cure.

Do not let me be understood as waging a warfare upon
medication in this disease ; but I do say, most explicitly, that
the pathological conditions in this disease are not removable
by medicines introduced into the stomach. The reasons are
plain, and have been given. Most medicines impair the
tone and condition ol the stomach, whereby the trouble is
increased. As I have shown, this organ is always impaired
— why make that impairment worse ? If we had a due sup-
ply of healthy nervous power, superintending the vital pro-
cesses, we might gain more from medication. But we have
not — hence some other means must be resorted to to bring up
the tone of the nervous system, and through it all the vital
actions of the economy.

620 Haughton On Tubercular Phthisis. Jan.

The acts of secretion are under the control of the (excito-
secretory) system of nerves ; and these acts of secretion are
all at fault, as has been shown in another part of this paper.
Why is secretion at fault ? — Because the law of cell develop-
ment is an hereditary one ; or, in other words, the law of
hereditary consumption is transmitted from parent to child,
and the impairment of the nervous system progresses, pari
passu, with the development of the disease.

It will be proper, in the investigation of this subject, to
examine some of the modes of medication, and the remedies
used, as recommended by some of our eminent medical men
of the present day. Among these are the use of intoxicating
drinks ; the use of cod-liver oil (jecaris aselli) ; the use of
iodine preparations ; emetics ; venesection ; nitrate of silver ;
injections into the lungs, by the introduction of an instrument
beyond or below the rima glottidis; and, lastly, the treat-
ment by inhalation. These are among the most prominent
and later methods of treatment of disease of the lungs —
which we will notice briefly. Here let the reader bear in
mind, that Nature's indications are presented to us in a
demand for more nervous power, better digestion, more
oxygen ; and these methods of medication do not furnish the
remedy thus demanded and required.

We propose to consider the effects of any stimulant, in the
shape of an intoxicating drink, as given for a remedial agent
in tuberculous affections of the lungs. The points of interest
will be, the effect of such a remedy upon the stomach, upon
the nervous system, upon, the circulation, and upon the func-
tion of nutrition. Upon this last function, its most important
bearing will be found, as we have asserted, in the fact that
this disease is one of nutrition. Hence, if alcohol, in any of
its forms, permanently benefits nutrition, then is the remedy
a good one. Knot, then it is injurious.

But let us return a little, to examine the effect of such a
stimulant upon the stomach. In the condition of the stomach
under consideration, it has failed to digest food. The effect
of a stimulant is to increase its power for the time being.

1858. Hattghton On Tubercular Phthisis. 521

Suppose it does — the absence of such stimulant, after this
temporary excitement, produces greater depression. Alco-
hol stimulates the coats of the stomach, and there is vascular
fulness of the vessels, redness of the mucous coat, and all the
evidences of irritation. Depression follows this condition.

But the effect does not stop with the stomach. The ner-
vous system feels its force and increased power under the
stimulus, and afterwards the depression — which thus reacts
upon the stomach and the whole chain of vital actions. This
stimulation and depression soon impairs the wronted vital
energy; and, sooner or later, the digestive power is worse
than when begun, and only responds to the stimulus in much
increased quantities. This soon ends in excess, and brings
all the evils of excess upon the system. In this influence,
there is an exhaustive power, not only upon the stomach, but
upon the vital energies. Under the use of such a stimulant,
the stomach is comparable to a race-horse, goaded by the
whip and spur of the rider to momentary or temporary labor
beyond the accustomed power, — and the result is, the horse
conies out of the race exhausted, trembling in every fiber and
muscle, from over-taxation ; and, the next time, will require
more goading and spurring to accomplish the very same
labor. There is then a loss to the vital energy, and the stim-
ulant becomes, in its remote effects, a depressing agent, —
permanently so, where the vital energies of the system have
been impaired, so that this stimulation is not responded to
and sustained for the future benefit of these forms of disease.

But we have another objection to the use of alcohol, in any
form, as a stimulant to digestion. It goes into the stomach
with the food, and dilutes it, — which is opposed to one of the
well-known laws of digestion, which is, that the food requires
no other diluent than the salivary and gastric fluids, and
when it takes place, the digestive process is arrested, because
the fluids of the stomach are so diluted that they do not act
upon the food in their accustomed manner. Moreover, it
(the stimulant) is not assimilated, but is absorbed directly into
the blood, diluting and impairing it in such a way, that the

622 Schetterly On Calorification. Jan.

blood is not fit for the building up of healthy tissue, or the
proper nutrition of all the component parts of the organism.
Again, alcohol acts as a poison to the animal economy ; and
the habitual use of any poison, either in health or disease,
evidently contravenes nature's laws, and, of course, produces
pathological conditions of its own. Alcohol cannot be assim-
ilated, but, wherever found, presents all its peculiar charac-
teristics of smell and taste ; and, when fire is applied, burning
with its peculiar blue, lambent flame. It never acts upon the
alimentary products, so as to render them more nutritious or
more easily assimilated, but exerts its own peculiar, specific
action, independent of all other influences. (Its effects upon
the nervous system, &c, will be the beginning of the next
paper, — continued by a consideration of the other agencies
before mentioned.)

P. S. In the preceding portion of this paper, on page 525,
November number, 7th line from the top, — for carbon, read
carbonic acid. R. E. H.

{To be Continued.}

Article II. Chapters from an Uupublished Monograph.
By H. R. Schetterly, M. D.

Calorification an Effect of the Combustion of Carbon and
Hydrogen by Electricity. — Various theories have been in-
vented to account for the production of animal heat ; but all
of them have been disproved and abandoned, except two and
their ramifications. One of these attributes the evolution of
heat in the living system to the combustion in it of carbon
and hydrogen, and is advocated by Liebig and others. The
other attributes it to nervous action, and is advocated by
Chopat, Broclie and others. Both are based upon experiments
on living animals ; and each party tries to refute the theory
of the other, by urging objections against its hypothetical
and consequently weak points. It will be found that truth
lies between them.

1858. Schetterly On Calorification. 623

The temperature of the human body, and that of all warm-
blooded animals, generally, is essentially the same in the
torrid and in the frigid zones; but — as the body may be
regarded in the light of a heated vessel, which cools with
the greater rapidity the colder the surrounding medium, —
the fuel necessary to maintain its heat must vary in different
climates. In the animal body, the fuel must be supplied in
the food ; and, with a proper supply of oxygen to combine
with the fuel, — with carbon, forming carbonic acid ; and with
hydrogen, forming water, — and an agent (electricity) to kin-
dle this combustible matter, we obtain the heat from the
combustion. According to Liebig, the combination of carbon
and hydrogen with oxygen must generate as much heat as if
these two gases were burned in the open air ; and that this
combustion is amply sufficient to maintain the human and
animal body constantly at the same temperature, he shows by
calculation, thus : — An ounce of carbon, burned, according
to the experiments of Despretz, evolves fourteen thousand
and sixty-seven degrees of heat ; and thirteen and nine-tenths
ounces — which, according to Liebig's numerous experiments,
is the average quantity contained in the food eaten by a man
in twenty-four hours — will therefore evolve one hundred and
ninety-five thousand five hundred and thirty-one degrees of
heat. This heat would suffice to boil sixty-seven and nine-
tenths pounds of water, of the temperature of ninety-eight
and three-tenths degrees — being the average of the human
body, — into vapor. Supposing, now, the quantity of water
vaporized through the skin, in twenty-four hours, to be three
pounds, there will remain, after deducting the amount of heat
required to maintain the body at its uniform temperature,
one hundred and thirty-seven degrees of heat for radiation,
and to warm the air expired and the excrementitious matter,
— a quantity amply sufficient, especially since the hydrogen,
which evolves a much greater amount of heat in proportion
to its quantity than carbon, has been omitted in this calcula-
tion. If the quantity of carbon and hydrogen supplied as
food be insufficient to maintain the body at its uniform tem-

624 Schetterly On Calorification. Jan.

perature, the fat previously accumulated in it is liquified and
again absorbed by the blood-vessels, to supply the combust-
ible matter necessary to maintain the vital functions of the
organism ; and, when this is all consumed, the muscles,
membranes, and even the brain, are gradually appropriated
to the same purposes. Hence the time required to starve an
animal to death depends on its fatness, on the state of its
activity, on the temperature of the air, and on the supply of
water.

The facts urged in favor of the theory of combustion are
principally as follows : If an animal be entirely deprived of
food, it gradually cools down, at first slowly, and then more
rapidly, to about seventy-nine degrees, when it dies, at the
same temperature of its body at which it would die from ex-
cessive cold if it were supplied with its natural quality and
quantity of food. It is evident that, during the cold season
of the year, and in cold climates, more heat is radiated from
the body than in warm seasons and climates ; and, to pre-
serve the natural temperature, that is essential to health and
life, the quantity of heat radiated must be made up in the
quality and quantity of food, or the radiation must be dimin-
ished by confining the heat generated in the system with
clothing, — or by both these means combined. Accordingly,
during the cold season, in temperate climates, the appetite
craves a kind of food richer in carbon and hydrogen — such
as the fat of animals, sugar, etc., — than it craves during the
warm season; and navigators and travelers relate astonishing
tales of the quantity of fat — such as the blubber of the whale
the seal, the sea-horse, and of other animals, — eaten by the
Esquimaux, Samoyedes and Siberians. "A fat calf, weighing
two hundred pounds," says a northern writer, " would serve
five or six good Yacuti for a single meal." A Samoyede has
been known to eat sixteen pounds of flesh and a dozen tallow
candles, at once ; and a Yacuti devoured twenty pounds of
rich rice gravy, with three pounds of melted butter, and
whiskey to match, at a single meal, though he had break-
fasted before. The animals of prey, in the Arctic regions,

1858. Schetterly On Calorification. 625

far exceed those of the torrid zone in voraciousness ; and both
men and animals are soon frozen to death when in a starving
condition, as Napoleon's retreat from Russia testifies. In
those inhospitable regions, too, the animal temperature is
four or five degrees higher than in temperate regions ; and
animals, abundantly supplied with food, are much fatter
there than here.

From these and other facts, it is very manifest that the
materials from which animal heat is produced (i. e., electric-
ity set free) are supplied by food, and must be conveyed into
the blood as constituents of the chyle. By many experiments,
Liebig and others ascertained that the quantity of oxygen in-
spired with the air, by a healthy man, in twenty-four hours,
amounts to thirty-two and a half ounces ; and Liebig asserts
that none of this remains in the system, the whole of it being
expired again, in combination with carbon and hydrogen, in
the form of carbonic acid and water, either through the lungs
or the skin. The quantity of carbon contained in the food,
per diem, is thirteen and nine-tenths ounces ; and if any of it
is not oxydized, it is excreted by the liver with the bile.

Now, since the oxygen contained in the inspired air enters
into the blood contained in the arteries ; and since the
veins return the blood, laden with carbonic acid, to the lungs,
to be expired, it is evident that the oxygen must have been
combined, in the arteries, with the carbon contained in the
blood, and must tliuu have formed the carbonic acid, — for
there is no other possible source from which it could be
derived. But oxygen and carbon, and oxygen and hydrogen,
can combine only by the process of combustion ; and hence
it is obvious that combustion takes place in the arteries, and
thus produces animal heat.

The objections to this theory are : That the Bengal tiger
and Cape hyena require, in proportion to their size, quite as
much food as the Arctic carnivora; and that the vultures of
Hindostan and Persia exceed, perhaps, all other animals in
gluttony. The voraciousness of the shark, too, even within
the tropics, is proverbial. "The people who ride over the

626 Schetterly On Calorification. Jan.

pampas of South America," says Dr. Graves, " at the rate of
a hundred miles a day, exposed to the burning sun, subsist
entirely on boiled beef and water, without a particle of veg-
etable food of any kind ; and yet they attain to an extraor-
dinary condition and capability of enduring violent and long-
continued exertion."

From these facts, it has been hastily concluded that, since
the climates inhabited by these animals and people are in the
temperate and even in the torrid zones, the voraciousness ol
the arctic carnivora, and of the northern nations generally,
does not furnish any valid evidence in favor of Liebig's theory
of combustion ; because the former seem to consume as much
animal food as the latter, while the radiation of heat by these
must be vastly greater than by those.

To dispose of this objection rationally, it must be considered
that, in the arctic regions, nature provides against an irreg-
ular and casual supply of food, by loading every animal — the
fox, the polar bear, the whale, the seal, the sea-horse — in fact
every animal and fish — with a superabundance of fat. In the
warm climates of the temperate and torrid zones, on the con-
trary, almost every animal and fish is lean, nearly destitute
of fat. Now, as are the conditions of the animals with regard
to fat, so is the food of those animals that subsist on them —
extremely fat in hyperborean regions, and comparatively
very lean in the sunny climes of the South. But fat, of all
kinds, contains from seventy-five to eighty per cent of carbon,
about twelve per cent, of hydrogen, and from ten to twelve
per cent, of oxygen, without any nitrogen, which is essential
to the development of the muscular system. On the other
hand, muscular flesh contains only fifty-three per-cent of car-
bon, seven of hydrogen, twenty-four of oxygen, and fifteen or
sixteen of nitrogen. Now, it appears, from the comparative
composition of animal food in the North with that of the
South, that the northern carnivora and nations, who, for want
of vegetables, eat nothing but animal food, consume far more
combustible matter — carbon and hydrogen, — in the same
quantity of aliment, than those of the South ; and Liebig's

1858. Scjietterly On Calorification. 627

theory, of combustion being the source of animal heat, is
therefore vindicated.

The other theory, which ascribes the production of animal
heat to the action of the nerves, rests on the following exper-
iments : When an animal is decapitated, or when the spinal
marrow, or the brain, or both, are destroyed, the action of the
heart may still be kept np by artificially inflating the lungs
with atmospheric air. In such cases, the blood is still appar-
ently changed from venous to arterial ; but the generation of
animal heat is suspended. Chopat divided the crura cerebra
in living animals, anterior to the origin of the pneumogastric
nerves. Respiration consequently continued, without inflat-
ing the lungs artificially; the circulation went on, and arterial
blood circulated in the arteries ; but, in twelve hours, the
temperature of the animal sank from its natural height (one
hundred and four) down to seventy-five degrees, when it
died. He then divided the pneumogastric nerves in a dog,
and kept up artificial respiration; and, within sixty hours,
the temperature of the dog sank to sixty-eight degrees, when
he died. He next divided the spinal marrow, below the
occiput, in another animal, and kept up artificial respiration ;
but the animal's temperature fell, gradually, to seventy-nine
degrees, in ten hours, when it died. In his subsequent expe-
riments, Chopat found that, when the spinal marrow was
successively divided between each of the twelve dorsal verte-
brae, in so many different animals, the depression of their
respective temperatures occurred less and less rapidly, the
lower he made the intervertebral section, and, at the lowest,
was imperceptible. In all these cases, the animals evidently
died from refrigeration. Hence he concluded that the spinal
marrow does not act directly in producing calorification, but
that the trisplanclmic nerve must be the organ of this func-
tion.

To satisfy himself that this is the case, he divided this
nerve, in living animals, where it joins the semilunar gan-
glion, and the animal gradually lost its heat, and died in ten
hours, in the same condition as if the spinal marrow had been

628 Schetterly On Calorification. Jan.

divided beneath the occiput. To satisfy himself on this
point, he tied the aorta where it passes through the dia-
phragm— preventing asphyxia by inflating the lungs, — and
the animal, losing its heat much more rapidly, died in five
hours.

These experiments prove that both the circulation of the
blood and innervation are indispensible to the evolution of
animal heat ; and that respiration is also essential to it,
requires no proof, for, without this, every man and animal
would die before it had time to lose its temperature. — The
reason of all this will appear presently. — But, to assure him-
self that the animals on which he experimented died solely
in consequence of refrigeration, he killed others by protracted
immersion in cold water, without drowning them ; and found
that the lowest temperature to which warm-blooded animals
could be reduced, and life preserved, was seventy-nine de-
grees ; while the lowest temperature, compatible with the
continuance of human life, seems to be about eighty-three
degrees. But, in the state of hybernation, the temperature
of warm-blooded animals has been found as low as thirty
degrees ; and, in this respect, they seem to be on a par with
cold-blooded animals.

Doctors Brande, Thomson, Paris, and others, consider the
facts adduced by Chopat completely subversive of the theory
that attributes calorification to the combustion of carbon and
hydrogen in the system ; and substantiative of the theory
which attributes it to the nervous system. But they do not
explain the manner in which the nerves generate heat, nor
do they assign the source whence they derive the materials,
by the transformation of which they evolve heat ; and their
tacit assumption that the nerves can create heat, without
producing a change upon something, — secrete it underived,
as some assume, — is repugnant to all nature's operations and
to every principle of correct philosophical reasoning; for
created beings cannot create anything — there is but one
Creator, — and nothing can come from nothing. Nor can
they adduce even a shadow of proof that the nerves generate

1858. Schetterly On Calorification. 629

heat by operating, directly, upon any materials received into
the system as food ; for they do not operate directly, but
mediately, upon such articles. Again, they cannot point out
any source from which the carbonic acid and aqueous vapor,
so constantly and copiously expired from the lungs and skin,
are derived, unless they admit that a process of oxydation of
carbon and hydrogen is continually going on in some part of
the living system, — and that this process of oxydation is
identical with combustion cannot be denied ; nor can it be
maintained that heat can be generated in the living system
without combustion, or that combustion can be maintained
anywhere without a corresponding evolution of heat. So
that, even if it could be proved that the nerves supply the
rest of the body with heat, they could be regarded only as
conductors; but for this no one contends. Dr. Dunglison
has justly and very properly remarked, that the production ot
heat cannot be localized ; for, as the living system is a very
bad conductor of heat, the organ evolving it must be much
hotter than any other, and would consequently be consumed
in a short time ; and this objection he urges against Chossat's
supposition that the trisplanchnic nerves are generators of
heat. Neither can the advocates of the nervous origin of
animal heat explain why both men and animals require so
much more carbonized and hydrogenized food, during the
cold season and in cold climates, than in warm ; nor why
animals soon die, of refrigeration, when fed with food that
contains all the elements necessary to develop or nourish the
organs and muscles, but only a small proportion of carbcii
and hydrogen, — their organs being loaded with fat, — as was
proved by the French Gelatine Committee. Until these facts
are rationally explained away, the theory of combustion, as
the immediate source of animal heat, stands firm upon an
invulnerable basis.

However learned a man may be, if he sets out to defend a
preconceived but erroneous hypothesis, he either comes in
collision with stubborn and irreconcilable facts, or contradicts
himself. The latter seems to be the case with Liebig. In

VOL. III., NO. xi. — 42.

630 Schetterly On Calorification. Jan.

one place, he asserts that none of the oxygen inspired remains
in the system, all being given out again in combination with
carbon and hydrogen, in the forms of carbonic acid and
water ; in another place, he asserts that the combustion, and
evolution of heat, take place in the lungs ; and, in a third
place, he says the blood corpuscles are carriers of oxygen to
the tissues. All these statements are contained in his Animal
Chemistry — the pages cannot be recalled to memory. Now,
it is obvious that, if the oxygen combines with carbon and
hydrogen in the lungs, and is all given out in these combina-
tions, there remains none to be carried to the tissues by the
corpuscles of the blood. But, besides, this supposition (for
Liebig adduces nothing to prove it), that the combustion
takes place in the lungs, is obnoxious to Dunglison's objection
to its localization in any particular organ, that that organ
would be prematurely consumed.

The oxydation (*. e., the combustion) of carbon and hydro-
gen takes place in the arteries, — not in any particular ones
only, but in the whole arterial system, — commencing in the
pulmonary capillaries, which receive the oxygen and elec-
tricity, and extending through all the arterial systemic
branches and capillaries, — not excepting, even, those distrib-
uted, for nutrition, to the lungs. To substantiate this propo-
sition, let facts speak : —

First — The carbon and hydrogen are received from the
thoracic duct into the left subclavian vein, and are thence
conveyed, through the right auricle and ventricle of the
heart, into the pulmonary capillaries ; and, in the air-tubes of
the lungs, also, the oxygen and electricity are separated from
the air of the atmosphere, and enter the same pulmonary
capillaries. It is here, then, that all the materials of combus-
tion are first brought in relation with each other ; and com-
mon sense will inform every one that here they must begin
to act on each other, in the blood which contains them all.
But the blood itself is in continual motion — the whole of it
passing through the lungs every minute or two, while some
experiments go to prove that it is once in about eighteen or

1858. Schetterly On Calorification. 631

twenty seconds. The combustible materials, then, are ignited
in the systemic part of the pulmonary capillaries, and the
current of the blood carries them, in this condition, through
the left auricle and ventricle of the heart, to every part of
the living system, in this ignious condition, — the motion of
the blood and the combustion going on simultaneously.
Hence the reason why, in the normal state of the entire
organism, every part is warmed in proportion to the amount
of blood passing through it, is manifest.

Second — Dr. J. Davy made many experiments on the tem-
perature of the blood, and found that arterial blood is from
one to one and a half degrees warmer than venous ; Magen-
die found it nearly two degrees warmer ; and Lecanu states
this difference to be two degrees. This fact proves that the
combustion takes place in the arteries ; and that it also con-
tinues in the capillaries, at least in local inflammations, is
proved by the fact that those parts, in which abnormal action
exists, often become considerably heated. Dr. Thomson
found that a small inflamed spot, in his right groin, gave out,
in the course of four days, a quantity of heat sufficient to heat
seven wine pints of water from forty to two hundred and
twelve degrees ; and Dr. Earl ascertained that a superficial
inflammation on the fore-arm, caused by a wounded nerve,
raised the thermometer nearly three degrees higher, when
applied to the arm, than when placed imder the tongue. It
has been already stated, on authority of Sir E. Home, that
the nerves regulate the quantity of blood circulating in any
particular part of the body or organ. Consequently, when
irritation exists anywhere, the nerves conduct a larger quan-
tity of electricity to the irritated spot, than in its normal
state. This electricity attracts an increased quantity of blood
to it, augments combustion, and consequently produces a
greater evolution of heat; and, when the inflammation is
confined to the skin, these phenomena must necessarily be
confined to the capillaries.

Third — All articles of food are composed of carbon, oxy-
gen and nitrogen, with the addition of the minerals found in

632 Schetteklt On Calorification. Jan.

the ashes after incineration, and a little phosphorus and sul-
phur. M. Magnus found in the blood three gaseous element-
ary substances — i. <?., carbonic acid, oxygen and nitrogen,
— the hydrogen having disappeared (combined with oxygen
and formed water). The two last of these gases — since, in
the process of chyniification and chylification, all food is
decomposed into its elements — seem to have been set free
from the food, while the oxygen, inspired into the lungs, is
combined with the carbon, also set free from the food, and
formed into carbonic acid. Xow, since carbonic acid is con-
tinually expelled from the blood, and expired, it is not likely
that it would enter into the arteries, if it were formed in the
lungs ; for simultaneous absorption and exhalation, of the
same substance, are incompatible, since the former depends
upon electric attraction, and the latter upon repulsion ; and,
besides, according to the very precise statement of Matte acci,
Dr. Magnus found one-sixth more carbonic acid in venous
than in arterial blood. This proves that carbonic acid is
formed in the arteries and systemic capillaries ; for, in these,
it must continually increase, or its quantity could not be
larger in the veins than in the arteries. At the same time,
a quantity is exhaled by the skin — and, if so, then the com-
bustion, and evolution of animal heat, must also take place
in the arteries, because, where the carbonic acid is formed,
there also must the formative process, the combustion, be
going on. But that combustion takes place in the vessels
conveying arterial blood, is proved by the fact that, when all
the arteries conveying blood to any part of the body are tied
or divided, animal heat is no longer developed in it, though
the nerves remain uninjured.

But, according to Thomsons Chemistry, the artificial
oxydation of carbon requires a temperature of eight hundred
degrees, and the artificial oxydation of hydrogen, by heat, a
temperature of one thousand degrees. He says, — "If pure
oxygen and hydrogen gas be mixed together, they remain
unaltered ; but, if a lighted taper be brought in contact with
them, or an electric spark be made to pass through them,

1858. Schetterly On Calorification. 633

they burn with astonishing rapidity, and produce a violent
explosion." The temperature of arterial blood varies in
different persons and animals, and also, in different climates,
in the same animal, — being highest in the coldest climates.
In the feathered tribes, it is between one hundred and four
and one hundred and eleven degrees; in human beings, from
one hundred to one hundred and four degrees ; and in the
rest of the mammalia, from one hundred to one hundred and
four degrees, in temperate climates ; but, in the Arctic
regions, Captains Lyon, Pallas and Parry found it to be from
one hundred and four to one hundred and seven degrees.
Now, when the temperature of the human and animal body
is compared with the artificial heat at which carbon and
hydrogen ignite, it is perfectly obvious that these combust-
ibles can, in no case, encounter such a temperature as to
ignite them, in the living system. But every chemist is
acquainted with the fact, that, when combustibles are re-
duced to an impalpable powder, they may be ignited, even
by artificial heat, at a much lower temperature than when
they are in mass, — though in no case can carbon and hydro-
gen, or either, be enkindled at the temperature of arterial
blood, without the aid of electricity. The reader will now
please to recollect the experiment of Professor Faraday, that
when, at the common temperature of the atmosphere, a small
bar of platinum is partly immersed in a mixture of oxygen
and hydrogen, which constitute the elements of water, parts
of these elements combine chemically, evolving heat in pro-
portion to the intensity of the chemical action, and form the
same weight of water, as that of the gases which disappear.
Now, considering the peculiar relation of platina to electric-
ity, there should be no doubt that, in this experiment, these
two gases are combined by the agency of electricity, at the
common temperature of the atmosphere; for Faraday states,
no less than four times, that electricity and chemical affinity
are the same power, — but, in this case, they combine slowly,
not by explosion, as in Thomson's experiment. If any one
feels inclined to dispute that electricity is the cause of this

634 Schetterly On Calorification. Jan.

combination, let him assign another adequate canse for the
production of heat by it.

Here, then, are the reasons why respiration, the circula-
tion, and innervation, are all indispensible to calorification : —
Without respiration, there could be no electricity in the blood
to ignite the carbon and hydrogen, and no oxygen to com-
bine with the carbon and hydrogen to form carbonic acid
and water, preparatory to their being expelled from the sys-
tem. Without the circulation, the carbonic acid and water
could not be conveyed to the lungs to be expired, nor could
a fresh supply of electricity and oxygen be inspired, to main-
tain the combustion, — which must consequently stop when
the circulation is arrested. And, lastly, without innervation,
the lungs could not be maintained, by the pneumogastric
and sympathetic nerves, in a condition fit for respiration;
the electricity could not be conducted away from the arteries
to the ganglia, and the arteries would consequently become
equally positive with the blood, by induction, and would no
longer attract the blood — which would, therefore, stop circu-
lating.

Now for the proof: — All living beings, vegetable as well
as animal, have the power of generating heat to some extent.
Dr. Hunter found the temperature of trees always several
degrees higher than that of the atmosphere, when the tem-
perature of the air was below fifty-six degrees; and Lamarck,
Hubert and St. Vincent observed the same in plants during
their blossoming. All physiologists agree that the tempera-
ture of cold-blooded animals and reptiles, is, to a certain
extent, dependent upon that of the medium in which they
live, and may be depressed much lower than that of warm-
blooded beings, without destroying life. Fish and insects
may even be frozen hard, and afterwards brought to life by
thawing. But men, and all the animals that have ganglia
on their nerves, as stated by Sir Everard Home, are alone
capable of maintaining a uniform temperature at all seasons,
and in all climates to which they are otherwise adapted,
provided, only, they are plentifully supplied with their accus-

1858. Schetterlt On Calorification. 635

tomed carbonized and hydrogenized food. Here, again, is
exhibited, in the most striking manner, the great law of
adaptation. Why should beings that have ganglia alone be
able to preserve their temperature uniform, if it be not
because they have a store of electricity deposited in these
ganglia, to be called into action as exigency requires, instead
of depending momentarily upon that inspired ? But, as if to
display His infinite wisdom, the Creator also made animals
specially adapted to continue their existence, either with or
without a constant supply of food, in warm or in cold cli-
mates. These are the hybernating animals — the marmot,
the hedgehog, the viper or snake, etc. Jenner found the
temperature of a hedgehog to be ninety-seven degrees in
summer, when it was active ; but only thirty degrees in win-
ter, when it was torpid.

There yet remain a great number of facts, going to prove
that animal heat is produced by combustion, and that elec-
tricity is the primary cause of this combustion, a few only of
which can be here added. Animals whose temperature is
the highest, bear privation of food the least, showing that
the supply of food must be proportional to the temperature.
Animals whose eyes are closed at birth, are subject to the
changes of the temperature of the surrounding air, like cold-
blooded animals ; but, so soon as their eyes open, they ac-
quire the uniform temperature of their parents. This seems
to indicate that electricity enters through the eyes, as well as
through the lungs. Dr. dime found the temperature of a
man, plunged into water at forty-four degrees, to be reduced
from ninety-eight to eighty-seven degrees, in a minute and a
half; while, in other cases, it fell even to eighty-three de-
grees. !N ow, the attraction of water for heat is so slow, that
it may boil over a mass of ice ; but its attraction and capacity
for electricity has been shown to be very great. It is, there-
fore, probable that, in these cases, the temperature was
reduced by the abstraction of electricity, the action of which,
only, can produce heat. Dr. Currie had himself bled; and,
during the operation, the mercury in the thermometer, held

636 Schetterly On Calorification. Jan

in his hand, fell ten degrees ; and, when he fainted, it sub-
sided eight degrees lower still. Dr. Edwards' experiments
show that, during summer, less oxygen is consumed and less
carbonic acid expired,] than in winter, and that the radia-
tion of heat is proportionally diminished, — which proves that
the evolution of heat depends upon the formation of carbonic
acid (i. e., upon combustion of carbon). Dr. "W". Philip found
that, if an electric current be passed through fresh-drawn
arterial blood, its temperature rises three or four degrees, it
assumes the character of venous blood, and partly coagulates;
and Drs. Gordon and Fourcroy found that, if a thermometer
was moved about in blood during the process of coagulation,
the mercury rose six degrees in twenty minutes ; and, in
blood drawn during an attack of inflammatory fever, it rose
twelve degrees. The former of these experiments shows that
the combustion of carbon is continued by the electric current ;
and the latter, that electricity is thrown off during coagula-
tion, particularly in inflammatory diseases, when the blood is
surcharged with it, producing heat — which is always the case
when electricity is set free in fluids. Lavosier and La Place
placed animals in the calorimeter ; and, by comparing the ice
which they melted with the carbonic acid they expired, found
that the amount of heat which they radiated was the same as
if the carbonic acid had been formed by artificial combus-
tion. Hence the only difference between calorification in the
living system, and artificial combustion, is, that the former
process is slower than the latter, and less intense. The ex-
periments of Lagallois and Edwards show that there is a cer-
tain direct ratio between respiration and calorification. This
seems to be contradicted by the lolling of animals in hot
weather ; but it should be remembered that, the slower the
respiration, the more effectually the air is deprived of its
oxygen and electricity. Hence the slow and deep respira-
tions, during sound sleep, supply the system with a far
greater quantity of these active agents of combustion, than
the rapid breathing, in hot weather and during severe mus-
cular exertion ; and animals loll, not to get more oxygen, as

1858. Schetterly On Calorification. 637

physiologists suppose, but to cool their lungs and blood, by
bringing more air in contact with them to carry off the heat,
without retaining it long enough for the oxygen and electric-
ity to enter their arteries. Hence, also, the pathological
cases adduced by Drs. Brodie, Graves and Stokes, in which
the temperature of the body rose to an extraordinary height,
while the number of respirations was greatly diminished, are
not exceptional, as Dr. Dunglison regards them, but confirm-
atory of the theory of combustion. Nature knows nothing of
exceptions to her laws ; but always produces the same effects,
under the same circumstances, and by the same agents ; and
any theory, that is full of exceptions and inexplicable cases, is
sure to be wrong.

Some may, however, still urge that, in all the experiments
of Chossat on the nerves, the blood seemed to be changed
from venous to arterial, becoming scarlet in the lungs, and
some carbonic acid continued to be expired, and oxygen sep-
arated from the air inspired, as usual, though the combustion
of carbon evidently ceased. But Brodie's and Chossat's ex-
periments are too indefinite to overthrow the theory of com-
bustion, supported as it is by so many facts that cannot be
refuted nor explained without admitting its truth. They did
not ascertain whether the oxygen inspired was all combined
with carbon during their experiments, as it is in normal res-
piration, or only a part, or none of it; nor whether the
carbonic acid expired and oxygen inspired were proportional,
and continued so during their experiments. They assume
that the combustion continued during their experiments, and
that the temperature fell and the animals died from cold not-
withstanding ; and, from this assumption, they infer that the
theory of combustion is not true. But this inference is by no
means adequately supported by the facts they furnish. All
they ascertained was, " that the blood appeared to undergo
its ordinary changes," which they inferred solely from the
fact that the blood circulating in the arteries had the color of
arterial blood, and that " oxygen is absorbed and carbonic
acid exhaled at usual." But appearances are often deceptive;

638 Schetterly On Calorification. Jan.

and, in experiments so important, we have a right to demand
something more definite than conclusions drawn from ocular
appearances. We are not, however, destitute of explanatory-
facts going to show that their conclusion, that " the theory of
combustion is completely subverted," is not warranted by
their facts. Prof. Matteucci's experiments show that, when
a clot of coagulated venous blood is cut into pieces, and the
fresh surface exposed to oxygen, or even to atmospheric air
(and in no place could it be more effectually exposed to the
latter, than in the air-tubes of the lungs), its arterial color is
renewed, without combustion. Their first fact, then, yields
no support to their conclusion at all. Again, if an electric
current be passed through fresh-drawn blood, containing free
carbon, the combustion may be prolonged, as shown by Dr.
Philip's experiment; and if it contain free electricity and
carbon, the combustion of the carbon may be renewed by
exposure to oxygen, as proved by Drs. Rogers' and Davy's
experiments ; and Sir A. Cooper's and Dr. Reid's experiments
prove that, when the pneumogastric nerves are divided, the
animal consumes less and less oxygen, and expires a progres-
sively diminishing quantity of carbonic acid, in proportion as
the difficulty of respiration increases, though it inspires more,
instead of less air, than in normal breathing. Now, from all
these experiments, it appears that the blood is so far subject
to the influence of physical causes, that oxygen and electric-
ity produce some changes upon it, even when it is withdrawn
from its proper vessels, similar to those it undergoes in them.
And — since all the branches of the sympathetic system of
nerves are most intimately connected with each other, and
also with the crura cerebri, with the medulla oblongata, and
with the spinal marrow, and are so copiously distributed to
the arteries, in which combustion and calorification take
place, — it is not at all strange that a serious injury, done to
any part of it, should produce a like serious effect upon every
part. When respiration is seriously affected, carbonic acid
accumulates in the blood, as shown by Dupuytren's experi-
ments ; and, since the inspiration of atmospheric air keeps

1858. Schetterly On Calorification. 639

the lungs positive to the blood and carbonic acid, which are
alike positive, the carbonic acid is still endosmosed into the
air-tubes, so long as the blood contains it, and respiration,
either natural or artificial, continues. Consequently, there
will still be an exchange of oxygen and carbonic acid, to
some extent, by the mere physical diffusion of these gases,
— sufficient to authorize Drs. Chossat and Brodie to say,
" that oxygen is absorbed and carbonic acid exhaled as
usual," judging, as they did, merely from appearances, —
though the combustion of carbon, which produces carbonic
acid, may have nearly or entirely ceased. Hence, it appears
that Brodie's and Chossat's second fact also fails to substanti-
ate their conclusion, that their experiments entirely subvert
the theory of calorification by combustion.

The attentive reader is now prepared to take another view
of the nervous system. There are, as it were, two nervous
systems, — one having its connections partly with the crura
cerebri, partly with the medulla oblongata, and partly with
the spinal marrow. This is entirely under the control of the
mind, and, in its normal state, obeys the will whenever
called upon, so far as motion is concerned. At the same
time its fibrillar serve as millions of the most vigilant senti-
nels, giving instant telegraphic intelligence to their comman-
der (the mind) of danger or glad tidings approaching, from
without or within ; receiving his behests, and executing his
commands with a readiness, precision, facility and celerity
that an omniscient Creator only could plan and institute.
This may be termed the systematic system of nerves. The
other system acts entirely independent of the mind, the will
having no control of it whatever, though it may be seriously
affected through the medium of mental passions and emo-
tions, which, acting independent of the will, withdraw elec-
tricity from it. This system has its immediate connection
with a series of ganglia, situated principally in or under the
great cavities of the body, one of which alone — the semilu-
nar, according to Flouren's experiments — responds to arti-
ficial stimulation. This has been termed the " Sympathetic

640 Schetterlt On Calorification. Jan.

or Organic system of Nerves," because, through its influence
all the involuntary functions are performed. These two sys-
tems of nerves are everywhere connected with each other,
generally forming ganglia at the points of intercommunica-
tion : and, from what has been already repeatedly stated,
it appears that the systematic system is entirely dependent
upon the sympathetic, as the source of its powers. This
collects electricity from the arteries, into which it entered
through the air-tubes of the lungs, after it has been set
free from the blood by the contractite pressure (systole) of
the heart, and delivers it to that system, whenever the latter
becomes negative to the former in consequence of expendi-
ture.

Hence it appears that the nervous system, including all its
parts, has a particular series of primary functions to perform :
First, that of collecting the agent (electricity) of motor and
chemical power from atmospheric air, and of distributing this
agent to the various organs of the body, which perform sec-
ondary functions immediately inservient to the maintainance
of life, nutrition and growth. Second, That of supplying this
agent of motive power to the organs that perform voluntary
functions, i. e., to the brain for mental action ; to the muscles
for voluntary motion ; and to the organs destined for the
propagation of the species. The nerves — being merely col-
lectors, distributors and propagators of power, or of its agent
— electricity — are not adapted to produce any change upon
any material received into the system, from extrinsic sources;
and this is the best evidence that they produce none, even
upon the electricity they receive primarily from the air ; and
that they do not, is positivily proven by the fact that the
electricity thrown off by electric fishes is the same as that
generated by the electrical machine and by the voltaic bat-
tery, in all respects, and yet it is certain that it is generated,
or at least collected, by their nervous system. And, besides,
there are also many cases on record of living persons having
become so much surcharged with electricity as to give off
sparks, involuntarily, and to receive an electric shock, when-

1858. Hitchcock On Gun-shot Wounds. 641

ever they approached a good conductor. All of these facts
prove that the living system produces no change, whatever,
upon electricity itself. But, the idea of adaption, has appar-
ently never entered the mind of Physiologists, at least they
never allude to it.

Article III. Gun-Shot Wound — Axillary Artery severed
— Excessive Hemorrhage — Gangrene of Arm — Recovery.
By Homer O. Hitchcock, M. D., late House Physician to
Bellevue Hospital, New York City.

On the evening of the 19th of last August I was summoned
to meet Drs. Borroughs and Babcock, of Galesburg, in con-
sultation over Edward Clemence, a young man of twenty-
five, who had that day suffered a severe wound from a rifle
ball. I learned that he had been out gunning with his friend.
In crossing a stream Clemence reached his right arm out for
his rifle, which was handed him by his fellow, and, taking it
by the barrel, jerked it suddenly away. The hammer caught
in the clothing of his friend, or in the grass, and the rifle was
discharged, wounding the right arm at its upper part. Blood
flowed very freely smdper saltum. Clemence walked about
a rod and fell down from faintness. His friend ran some
eighty rods for men, who carried him to a house ; blood flow-
ing profusely all the while. His arm was now bound up so
that external hemorrhage was mostly checked, and he was
carried to his home, a distance of five miles, and immediately
attended by Drs. Borroughs and Babcock. The accident
happened about noon ; he reached home about six o'clock.
I saw him about nine o'clock.

I found he had not yet rallied from the shock of the acci-
dent— surface very pale, and covered with a cold prespi ra-
tion— pulse very rapid and weak in the left arm, and no pulse
at all perceptible in the right — temperature of right arm
much below that of the left — no sensation at all below the in-
sertion of the deltaid muscle — very little hemorrhage from

64:2 Hitchcock On Gun-shot Wounds. Jan.

the wound — but the upper part of the arm and the shoulder
throughout its whole contour was excessively swolen.

The ball had entered about the middle of the anterior
boundary of the axilla by a small aparture. Its course was
upward, inward, and backward. Glancing under and around
the humerus, it seemed to have struck the head of that bone,
and by it to have been directed to the back of the scapula,
whose spine bent its course downward so that it lodged just
over the lower angle of the scapula.

I introduced my finger into the aparture made by the ball,
and found large clots of blood, easily broken down ; but no
pulsating artery could be felt, and very little hemorrhage
followed its withdrawal.

There was no hesitation for a diagnosis — but what was to
be done ? Would not hemorrhage, and fatal hemorrhage,
come on when full reaction had taken place ? Several oper-
ations, and the probable chances they would give the patient,
were considered — amputation at the shoulder joint — ligation
of the subclavian — ligation of the axillary artery at its bleed-
ing end — and lastly the operation of letting him alone ; — and
be it said, that a young surgeon, thirsting for the fame of a
subclavian successfully tied — or a successful shoulder joint
operation — in spite, moreover, of the outward pressure
of friends, who wanted "to have something done,'' decided
upon the " letting alone " process.

Ordered — perfect rest and the most careful watching — a
little beef tea, and cold water dressings to the shoulder as re-
action comes on — if hemorrhage occurs compress the artery
over first rib.

Afternoon of 20th. — Reaction has fully taken place — pa-
tient has passed a much more comfortable night than any
had expected. Surface warm and much less pale than yes-
terday— pulse in left arm one hundred, and of considerable
force and volume — no pulse in right arm— but the tempera-
ture of this arm is normal — no more sensation than last even-
ing— during the night slight hemorrhage once, but soon
checked. Ordered same treatment continued.

1858. Hitchcock On Gun-shot Wounds. 643

On the 24th of August I visited him, having been tele-
graphed that his arm was mortifying. Since my last visit
the patient has taken, by the order of Dr. Borroughs, mor-
phine, p. r. n., and small doses of antim. et Potas. Tart, and
also Potassse Netratis, to control action of heart and arteries
— diet spare, and water dressings to arm and shoulder until
signs of gangrene— bowels moved by enemata.

I found the patient at this visit with a rapid and rather
weak pulse — tongue coated — surface clammy — right arm
enormously swolen, and of dark purple hue — about the
wound, and for several inches below, the cuticle was raised
in blebs, and there were other too sensible signs that gan-
grene had already commenced.

I laid the arm freely open, both before and behind, by in-
cisions of several inches, relieving at once the tension, and
allowing a free escape to the sainous pus and serum. I also
cut down upon and removed the ball.

Ordered — that the whole arm and shoulder be covered
with poultices of yeast and charcoal, frequently changed —
diet, beef tea, beef essence — brandy — quinine, p. r. n.

On the 26th I found him much better — gangene had ceased
to advance — wounds made on the 24th were freely discharg-
ing— pulse slower and fuller — appetite good, and improving.
Ordered treatment continued.

From this time I did not see the patient until he came to
my office on the 16th of November. His improvement, I
am informed by Dr. Borroughs, was steady from my last
visit, and he was discharged on the 12th of September. No
notes were taken of the case after my last visit. I desire
here to speak in praise of the watchful attention and good
management of my friend Dr. Borroughs, in this case.

On the 16th of November, I learned the following facts : —
When Mr. C. was discharged from the Doctor's care, he
could move the fore-arm very little, if at all — could extend
the arm upon the shoulder, perhaps five to ten decrees.
There was very imperfect sensation below the insertion of
the deltoid muscle. To-day sensation is nearly normal — so

64A Lewitt's Cases. Jan.

that he can plainly feel a fly walk upon his arm nearly to his
wrist. There is considerable sensation along the palmar side
of the thumb — but very little along its dorsal surface. Sen-
sation also considerable along both dorsal and palmar surfa-
ces of fingers, except the little finger and the external half of
ring finger.

He tells me that most of the time the injured arm is
warmer than the other, but is chilled much quicker. To-day
the patient having ridden in an open wagon from Galesburg
to my office, the injured arm is much chilled — the fore-arm
and hand look quite purple. Pulse, however, is distinct,
though weak, in both radial and ulnar arteries.

Motion is slowly returning. He can now extend the arm
upon the shoulder to nearly sixty degrees. The fore-arm
naturally rests at a right-angle with the arm, but he can
move his hand through an arc of more than forty-five de-
grees. There is, as yet, no motion whatever of his hand upon
the wrist, nor of his fingers upon the hand.
Moral. — " Learn to labor and to wait."

Kalamazoo, Dec. 10th, 1857.

Article IV. Tioo Cases. By *Wm. Lewitt, M. D.

Case I. — Puncture of the Bladder through the Rectrum. —
The patient was a man something over sixty years of age.
He had occasionally been troubled with a retention of urine,
but not to any great degree until this attack, which was
brought on by riding on horseback.

He called upon a medical man to relieve him, by the in-
troduction of a catheter, who, — having but one, and that a
very poor one, "broken near the eye — to facilitate the introduc-
tion, cut the end off transversely, and tried to introduce it in
this condition. Failing in that, he cut it off obliquely,
thrust it into the bladder, {hard practice /) and relieved him
for the time, lacerating the urethra its whole length terribly.

The next day a physician was called upon to relieve him,

1858. Lewitt's Cases. 645

but finding himself foiled in the attempt, called in a neigh-
boring physician in consultation, who also failed.

I was then called in consultation with the two; and it be-
ing then over fifty hours since any urine was evacuated, the
patient was becoming comatose. The bladder was very full,
extending nearly as high as the scrobiculus cordis. Upon
attempting the introduction of the catheter, I found consid-
erable spasmodic stricture at several points along the ure-
thra, which was overcome by putting the patient under the
influence of chloroform. I found, however, a complete oc-
clusion of the prostatic portion of the urethra, preventing the
introduction of any kind of catheter into the bladder.

Shreds of the mucous membrane of the urethra, from the
laceration caused by the miserable instrument used by the
first attendant, came away in the eye of my catheter.

By an examination per rectum, I found the prostate very
much enlarged and inflamed, principally, I have no doubt,
from the same cause as the laceration.

The only alternative then, was puncture of the bladder,
which I resorted to, through the rectum. As the prostate
was much enlarged, I introduced the finger into the rectum,
and drew down the gland as much as possible to avoid
wounding it. I then introduced a long curved trocar and
canula, punctured the bladder, and evacuated the urine, to
the immediate relief to the distended viscus. The canula
was left in the rectum twenty-four hours, and retained there
by a T bandage.

The patient was then treated to subdue the inflammation
of the urethra and prostate, with infusion of bnchu and uva
ursi. lie rapidly improved under this treatment, and in a
few days was able to pass the urine per viam natnralem, and
soon able to go about his business.

Case II. — Hydatids of the Uterus, ,r',fjt suppression of
Urine, followed by profuse U trine Hemorrhage. — Mrs. F.,
aged forty-eight years, called upon me to relieve her of occa-
sional attacks of vomiting and constipation, for which I suc-

VOL. III., NO. xi. — 43.

64:6 Lewitt's Cases. Jan.

cessfully prescribed equal parts of tinct. Bhei and tinct. Gen-
tian. About a week afterwards I was called npon to visit
her, and found her laboring under almost complete suppres-
sion of urine, not voiding more than two or three ounces in
the twenty-four hours, and this very thick, dark colored, and
offensive. The catamenia had been regular up to three
months before this time. She had given birth to a child
about two years previous. Upon examining the abdomen,
I found it somewhat enlarged, and had the impression that
the enlargement was owing to pregnancy, but thought it
might possibly be the bladder distended with urine. On in-
troducing the catheter no urine made its escape, which fact
fully convinced me the enlargement was uterine. I pre-
scribed some mild diuretics, but without any effect upon the
secretion.

About two weeks afterwards I was sent for^in great haste
in the night. I found her much prostrated, with small, fre-
quent pulse ; she had suffered from considerable uterine pain
and profuse hemorrhage during the fore part of the night,
but both had quite subsided before I arrived ; the abdomen
had increased in size very much since I first saw her, and
was as large as it would be at seven months utero gestation ;
the suppression of urine still continued.

On making an examination per vagiam, I found the os
uteri firm and rigid, not admitting the point of the index fin-
ger, and feeling like a cartilaginous ring. I gave her small
doses of morphine and acet. plumbi, after which she remain-
ed quite comfortable, without hemorrhage or pain, until three
o'clock in the afternoon, when profuse hemorrhage returned,
without the slightest uterine effort, the os still remaining
quite rigid. I made cold applications, ice in the vagina, gave
ergot, and several other haemostatics, but all without effect.
I then passed a flexible metalic catheter into the uterus, for
the purpose of rupturing the membranes, but to my great
surprise, it met with no resistance after passing the os uteri.
I could feel the end of it directly through the abdominal
walls. On withdrawing the catheter I discovered a few

1858. Bibliographical Record. 647

transparent visicles in the eye of it, and in a few minutes
afterwards about half a wine glass full of them were expelled,
which at once convinced me the nature of the case.

I called in counsel ; but all efforts to suppress the hemor-
rhage were in vain ; no more hydatids were expelled, and
she died about seven o'clock that evening. No autopsy was
allowed.

There is a curious physiological and pathological question
here, concerning the suppression of urine and rapid growth
of the hydatids. The kidneys, no doubt, performed a part
of their functions, in separating the more solid excrementi-
tious matter from the blood, while the aqueous portion in
place of being elminated by the kidneys, was appropriated
for the rapid growth of the hydatids. I have no doubt that
the uterus was filled with them. In no other way can I ac-
count for the great suppression of the fluid portion of the
urine, and rapid increase of the vesicles or hydatids,

jibtopjjmal ^mx^

Transactions of the American Medical Association at its Tenth Annual Meeting,
held at Nashville, May, 1857.

We received the transactions, at date, too late even for a brief
notice in our December issue ; and the multiplicity of our engage-
ments renders it impossible to do more than barely notice it at this
time. Some of its reports and essays, shall, however, receive more
extended attention hereafter. We have heard not a few invidious
comparisons of the present with previous volumes ; and we have not
unfrequently heard the question asked : What has the Association
accomplished ! Has it fulfilled the purposes for which it was origi-
nated 1

We very much doubt, whether any very definite purposes were
ever conceived in reference to its organization. It is true that re-
form in Medical Education was a somewhat conspicuous subject ;

648 Bibliographical Record. Jan.

but like many other subjects which would naturally be affected by the
Association, it has never had definite action. Committees have re-
ported, reports have been published — and medical schools have gone
on apparently uninfluenced by either the report or its wide publica-
tion. But this want of influence has been merely apparent. At no
previous time in the history of Medicine in this country, has there been
so much thought, conversation, and writing, on the subject of Med-
ical Education, as during the last two years ; and whoever will take
the pains, can trace this result to reports and debates in the Asso-
ciation. The seed has been sown, and we confidently look for an
abundant harvest.

But the great good which the National Association is accomplish-
ing, consists in bringing together the Profession from widely differ-
ent sections, breaking down prejudices, and forming ties, which,
increasing in number and strength from year to year, will gradually
bind the profession together, and give a force to its legislation, which
at present is comparatively unfelt and unacknowledged, but which,
nevertheless, is exerting a wide spread influence. This feature un-
derlies and gives vitality to every other consideration. Let then,
the social character which has ever attended its meetings be pre-
served ; and while we neglect not the "weightier matters of the law,"
let us take care to knit closely and extensively social ties. We
have unbounded faith in the Association ; but we look for general
influences, rather than special results. The latter must follow ; and
its connection with the former will not always be seen. G.

Proceedings of the American Pharmaceutical Association, at the Sixth Annua}
Meeting, held in Philadelphia, September, 185?.

We are pleased to see such marked evidence of vitality, as is ex-
hibited in the volume whose title we have recorded above. Truly,
practitioners of medicine are much indebted to a body of men, who
will give their whole energies to the improvement of pharmacy ;
and whosoever will take the trouble to compare the present state of
the science, with its condition twenty years agone, will acknowledge
this indebtedness with a hearty good will

The proceedings comprise a volume of one hundred and seventy-
eight pages, in which we find many truly able reports and communi-
cations. Among them, we notice a paper, " Upon improvements in

1858. Spirit of the Medical Press. 649

methods of rendering medicinal preparations pleasing to the eye and
to the taste, and agreeable to use," by Frederick Stearns, of this city.
This paper was deemed of sufficient interest, by the Executive Com-
mittee, "to warrant its being more generally circulated than the
voluminous character of the Proceedings " would allow ; and an
additional edition was ordered struck off, for more general circula-
tion. We notice, also, another paper by Mr. Stearns, on the " Pro-
duction of Leeches in Michigan," which will be found entire in the
" Spirit of the Medical Press " of this number of the Independent.

To the report " On the Sale of Poisons," is appended " An Appeal
to Druggists and Pharmaceutists in the United States in regard to
the sale of Poisons," which, if generally heeded by dispensers of
medicines, would tend greatly to curtail both intentional and acci-
dental poisoning.

The reprint on " Unofficinal Formulae " will be interesting to that
class of physicians who are continually seeking new prescriptions,
and whose faith in curative remedies has never been shaken by ob-
servation of nature's operations.

The Association has laid out much work for another year ; and
we look forward to its future reports with greatly interested expect-
ation. G.

spirit 0f \\t fPrintl *§xm.

Removal of a Foreign Body from Beneath the Heart. By E. S. Cooper,
M. D., of San Francisco. — The operation I am about to describe has been
the subject of such a variety of comments, and so differently represented
by the public prints, as well as by parties who were not present, and con-
sequently knew nothing of its real merits, that in giving a true description
of the case it appears due to myself to mention this fact, and also to refer
to those present at the operation, for confirmation of my report. No one
who knew anything of Beal's condition at the time, hesitated to say that
he must die without an operation. He expected to die under the knife,
and gave directions about his burial before the operation began. His
friends expected him to die, and were assured that such would probably
be the case ; but all wished him to embrace the only remaining chance of
prolonging life ; and guided by a brave spirit, he most cheerfully took all
risks, and fortune rewarded his courage.

650 Medical Independent. Jan.

It has been known from immemorial time that wounds penetrating the
cavity of the chest are not necessarily fatal. This knowledge suggested
operations upon the thorax in the very infancy of surgery. Accordingly
we find that exsection of the ribs was practised by Galen in his native vil-
lage, Pergamus, Asia Minor, while he was still a very young man, as early
as the first half of the second century, and by numberless other surgeons
up to our own time. (Mercure de France, April 1758. Suif excised two
ribs of a man named Botaque, in such a manner as to be able to introduce
the fist into the chest. (Velpeau's Operative Surgery.) Even the native
Fiji Islanders frequently cut through the intercostal spaces by means of a
splinter of shell, and extract barbed arrows from the inside of the chest
(Williams' Tonga Islands.)

The operation of Richerand, where a most extensive section was made,
is well known. Since 1818, the ribs have twice been exsected successfully,
by Cittadini, by Percy, for caries of two ribs, resulting from gun-shot
wounds, by M. Blandin, at Beaujon, by Roux, at la Charite, and by Mott,
of New York.

But the case of Richerand is the only one that bears any resemblance to
the one I am about to report. In Richerand's case " it became necessary
to remove the middle portion of four ribs, to the extent of several inches.
The pleura, which was greatly thickened, had also to be removed, so that
the pulsations of the heart were exposed naked to the sight." This opera-
tion was for cancer, and the patient died at the expiration of a few months,
from regeneration of the disease. ( Velpeau loc. cit.)

"Wounds of the heart itself are well known not to be necessarily fatal.
Dissections have revealed cicatrices on the heart, when the subject had
died from an entirely different cause, long after the wound had been re-
ceived. Cases might be cited with names and dates if they were not well
known to the learned.

But the demand for surgical interference in cases of foreign bodies in
the chest, depends upon the violence of the attendant symptoms, and upon
the nature of the foreign body itself. Lead, for instance, will generally
become encysted and cause comparatively little inconvenience after it once
stops, while a small bit of iron will produce suppuration and is liable to
keep changing its location, and may therefore produce violent symptoms
after months or even years.

Case. — Mr. B. T. Beal, ozt. twenty-five, of Springfield, Tuolumne Coun-
ty, California, with some other young men, in a frolicsome mood, resolved
to burst an old gun, and accordingly loaded it with eighteen inches of
powder, to which they connected a slow match and then endeavored to
seek security by flight. Unfortunately a brisk wind blew up the powder
with great rapidity and the gun exploded before they had retreated far.
A slug of iron had been driven into the gun as a temporary breech pin,

1858. Spirit of the Medical Press. 651

which bursting out in the explosion struck Mr. Beal in the left side below
the armpit, fracturing the sixth rib, entering the chest and lodging, as
was afterwards found, beneath the heart, upon the vertebral column, just
to the right of the descending aorta, where it had evidently remained from
the period of the injury, January 26th, 1857, until it was removed, April
9th, seventy-four days after. In a state of extreme prostration he was
brought to the city, having had frequent discharges of several ounces of
purulent matter at a time from the chest through the original wound.
The left lung had lost its function, probably less on account of the violence
done the lung at the time, than from the subsequent accumulation of pus
in the chest, though he had bloody expectoration for a few days. He came
to my Infirmary, on Mission Street, 8th of April, and during the night
following had alarming symptoms of suffocation, so much so that I enter-
tained most serious apprehensions that he would not live till morning. So
urgent had his symptoms become, that after his arrival he was constantly
in absolute danger of dying from suffocation, so that no time was to be
lost, even for him to obtain rest from the fatigues of his journey. Under
the greatest disadvantages, therefore, the operation had to be performed ;
otherwise he must be abandoned to his fate, which a surgeon feels but
little inclined to do, in case of such a brave patient, who is willing to en-
dure any operation, however painful or hazardous, to save life.

Operation. — The patient being placed on the right side, an incision
through the soft parts three inches long was made ; commencing opposite
the seventh true rib and following the track of the original wound, was
carried over the fifth and sixth ribs, which were drawn close to each
other by contractions, consequent upon the injury. The sixth true rib
was found fractured and slightly carious. A transverse incision three
inches long, was now made, beginning at the centre of the first when the
soft parts were reflected so as to expose the ribs. Torsion was applied to
one intercostal and two or three small arteries which bled rather freely.
The wound was now fully absterged, after which an effort was made to
find the breech-pin by using the probe. This failing, the incisions were
lengthened and the ribs further exposed. A portion of the sixth rib,
which was carious, was now removed, and was followed by the discharge
of about ten ounces of venous blood, contained in a cyst which was broken
by the removal of the portion of the rib. A most extensive but careful
examination with the probe was now made, in order to detect, if possible,
the foreign body, yet to no purpose ; but air having already been admitted
into the chest, I unhesitatingly removed portions of the fifth and seventh
ribs, together with such an additional piece of the sixth as was necessary
to make ample room to afford every facility for the further prosecution of
the search. Some very firm adventitious attachments were now broken
up with the fingers, which gave exit to an immense amount of purulent

652 Medical Independent. Jan,

matter — two quarts at least — which had been entirely disconnected with
the fluid first discharged from the chest. The pleura had several large
holes through it, and was thickened to four or six times its natural state
in some parts. The pulsations of the heart in the pericardium could be
distinctly seen through these holes. Brandy was now administered to the
patient, who appeared to be rapidly sinking. The left lung was found
completely collapsed after the discharge of purulent matter. By giving
brandy freely, the patient soon began to revive, when the search for the
foreign body was resumed. At this time the fingers could be placed upon
different parts of the heart and feel its pulsations distinct^, but could ob-
tain no clue to the location of the foreign body. The patient now appeared
almost completely exhausted. Brandy was given freely. Chloroform was
not administered at first, owing to the expected collapse of the left lung
on the admission of air into the chest, but a considerable reaction taking
place, a limited quantity was now used and the manipulations continued.
A sound was introduced and the theoracic cavity explored for at least
three-quarters of an hour before anything like a metallic touch could be
recognized, and then it was so indistinct as to leave the matter doubtful.

The space immediately above the diaphragm was considered the region
in which the metal was most likely to be found ; since the immense
amount of suppuration which had taken place, it was thought might have
dislodged, and gravitation carried it down to the bottom of the chest. The
metal not being found here there was no longer any probable opinion to
be formed as to its whereabouts, and to describe the difficulties of the
search that followed would be difficult if not impossible. No one can
have any just conception of the degree of patience required to do what
was done, save the one who did it. This is not spoken boastingly, but is
simply the truth. It is sufficient to say that a general exploration of that
side of the chest was made, and then it was taken by sections, occasion-
ally passing through holes in the pleura, which latter appeared to have
scarcely no normal relations to the surrounding structures, touching by
lines the entire surface of the parts, and at last the sound appeared to en-
counter something of a metalic nature, beneath the heart, but the pulsa-
tions of that organ were so strong against the instrument as to render it
difficult to settle the matter definitely. At last, however, it became evi-
dent that the location of the iron was found, and I endeavored to move it
out of its position with the point of the sound, in order to get it into a
place more eligible for extraction by the forceps. I failed in this, and in
maneuvering, the instrument finally lost the track by which the sound had
first passed back of the heart to the metal, and it was during my efforts to
recover this, and which was accomplished with the more difficulty owing
to some membranes falling in the way, that I discovered the sound had in
the first instance reached the metal by passing between the descending

1858. Spirit of the Medical Press. 653

aorta and the apex of the heart. The metal being again found, the sound
was steadily and strongly held in contact with it until a pair of long litho-
tomy forceps was thereby conducted to the spot and the breech-pin seized
and extracted, which, however, was the work of several minutes, owing to
the great difficuly in grasping it even after the forceps was made to touch
it The forceps, however, being heavier, the motion of the heart was not
so embarrassing to its manipulations as it had been to that of the sound,
but owing to its size it could not follow the sound and be expanded suffi-
ciently to seize the metal without lifting the apex of the heart considera-
bly out of its natural position. After the metal was extracted, the patient
was turned on the wounded side, and a tent placed on the track of the
original sinus, after which the wound was dressed and the sufferer per-
mitted to rest in bed with his body still inclined towards the injured side.

April 10 — Greatly prostrate : slight pain in the left breast ; no motion
of that lung ; gave morphine.

April 11th — Same as yesterday.

April 12th — Slight cough ; gave enema and light nourishment.

April 13th — Evacuations from bowels ; slight discharge from the wound,
being the first since the operation.

April 14th — Improving ; considerable appetite.

do do

April 19th — Considerable cough.

April 20th — Severe cough to-day, and pain in the right side, as also in
that of the wound, though not so great as in the other.

Skin dry ; no expectoration ; urine scanty, and highly colored. These
symptoms were very alarming, the more so from the fact of their implica-
ting the hitherto sound lung.

The pneumonic symptoms continued without abatement for several
days, and finally subsided, but left the patient greatly prostrate. On the
26th purulent expectoration began and continued to increase for about a
week, when nearly a pint was discharged in the space of twenty-four
hours, and during this time but little escaped from the wound. After
this period, for nearly two weeks, the discharge was greater or less
from the wound, in proportion to the amount of purulent matter expec-
torated, and vice versa. The matter from both places being of the same
quality, and occasionally tinged with blood.

At the end of two weeks from the time the communication between
the trachea and the original suppurating surface appeared to have been
established, the purulent expectoration began gradually to subside, and
the patient's condition slowly to improve until the end of seven weeks

April 15th

April 16th

April 17th

Apirl 18th

654: Medical Independent. Jan.

after the operation, when he left the city. There was no perceptible
motion of the left lung at this time. He was considerably fatigued by
his journey from the city to the country, and appeared worse for sev-
eral days in consequence, but eventually began to improve rapidly, and
continued to do so until three weeks since, at which time, as is well
known, he visited this city, and was so improved as not to be recog-
nized by medical men present at the operation, who had seen him every
day for some weeks after.

Aug. 1 — Present condition — The external wound has entirely cicatri-
zed. No cough nor pain in the left side — good appetite and all the func-
tions of the system well performed.

The left breast is somewhat sunken, but the upper lobe of that lung has
recovered to a great degree its former action.

The operation was performed in presence of the following medical men,
some of whom assisted : —

Dr. I. Rowell, Censor of San Francisco Medical Society.
M Wm. Carman, Secretary San Francisco Medical Society.
14 B. A. Sheldon, Vice President San Francisco Medical Society.
11 L. Grover, Member San Franisco Medical Society.
* J. M. Williamson, Censor of State Medical Society.
•' Wm. Fifer, Member State Medical Society.

11 R. Beverly Cole, Pres. S. F. County Medico Chirurgical Association*
44 P. J. Reilly, Secretary
44 L. Hubbard, Ex-Pres.
44 Wm. Hewer, Censor
44 J. W. Tewksbury, do
44 F. P. Wierzbicki, do
44 J. Lee Webster, do
44 J. P. Macaulay, late Surgeon San Francisco City Hospital.
44 B. F Hardy, late of Honolulu, S. I.
44 J. S. Calef, Member San Francisco Medical Society, and others.

Remarks. — The carious condition of the sixth rib was probably a fortu-
nate circumstance in this case, since it favored the formation and continu-
ation of a sinuous opening, through which purulent matter was discharged
from time to time, prior to the operation, and which limited, to some
extent, the immense accumulation that, as it was, had nearly terminated
the patient's life previous to that period.

His subsequent astonishing recovery is attributed to his great cheerful-
ness, good constitution, and to the effects of our unparalleled climate, in
which it appears nearly impossible for a patient to die with almost any
ordinary degree of injury, provided a reasonable share of attention is after-
wards given him. San Francisco has the advantage of every other city on

1858. Spirit of the Medical Press. 655

the globe, in regard to climate, for surgical operations, since, if owing to
any peculiarity of the case, our coast breezes are not equally well adapted
to all the stages of convalescence after an operation, it is an easy matter
to obtain almost any desirable change by half a day's easy travel, which I
think can be said of no other city.

In Mr. Beal's case, while nothing could have been better than our cool,
bracing atmosphere, for the first few weeks after the operation, still, having
recovered from the immediate effects of that, the subsequent lung symp-
toms were much better controlled by a removal to the Santa Clara Valley,
thirty miles distant, than they could possibly have been by medicine, con-
joined with the greatest care that could have been bestowed upon him in
this city. — Transactions San Francisco Med. Chi. Association.

The Production of Leeches in Michigan. — The great cost of imported
leeches, and their liability to accident and disease, have proved a serious
drawback to their general use in this country, more especially in interior
towns and cities, where the delay incident to the transportation is another
objection to the purchase and sale of them by the pharmaceutist.

I believe that large dealers in leeches in the country confine themselves
solely to the importation of those of foreign collection, and that our indig-
enous varieties, some of them valuable, are entirely neglected.

I desire to call the attention of the Association to the fact, one proved
by an experience of twenty years, that by means and appliances so simple
as to commend them to pharmaceutists in every part of the Union, we
may insure to ourselves an abundant and cheap supply of these invaluable
animals.

The foreign varieties of leeches can be easily naturalized, and the sup-
plies of those indigenous varieties found valuable, can be indefinitely
increased.

The idea of growing leeches in the State of Michigan was first carried
out by a member of the medical profession, who moved there from New
York city some twenty years ago, while that portion of his adopted State
was yet a wilderness. Feeling the want of leeches, which he had freely
used in his eastern practice, he was led to experiment with those found
in the neighboring marshes, with indifferent results. He finally procured,
in New York, a lot of Spanish leeches, and, building a tank for them, had
the satisfaction of seeing them thrive admirably, and to this day has pro-
duced them in large quantities, sufficient to supply the practitioners of his
portion of the State. The " Hirudo decora," a leech found abundantly in
some parts of Pennsylvania, was in this way introduced, and is now large-
ly used in some counties of the State.

The " aquaria " required consists of a wooden tank eight feet long, six

656 Medical Independent. Jan.

feet wide and four feet deep ; this is set into the ground near a running
stream of water, a portion of which is conducted into and through the
tank, its entrance and exit being made through wire cloth to prevent the
escape of leeches. The bottom of the tank, to the depth of eighteen
inches, is covered with cobble stones, in order to afford a refuge for the
leeches. The water exit is placed about ten inches below the top edge of
the tank, which edge has a rim of boards, projecting inward, all the way
round nailed to it. This is all the apparatus required, and they need but
very little attention. A few frogs thrown in once a week will supply five
thousand of them with food sufficient. In winter they become torpid,
and so remain till spring.

They produce their eggs during the months of June and July, and the
leech is matured in about two years. Their age, when subject to ordinary
care, is about fifteen years.

When applied they bite readily, and draw about two drachms of blood,
the flow of which, however, is to be excited in the usual ways.

Those parts to which leeches are to be applied should be well cleansed
from smell or perspiration, and they are best used by putting the requisite
number into a suitable sized cupping glass partly filled with water, and
applying the edges of the cup closely to the part to be leeched ; after they
have taken hold, the cup may then be gently removed.

The naturalized leech is hardy, rather small (from one and a half to two
inches long), and very active ; those produced from the variety brought
from Pennsylvania (a specimen of which is herewith submitted) are of a
velvety olive green color upon the dorsal surface, with three longitud:nal
rows of spots ; the centre one orange colored, the others black ; the belly
is of a rusty orange spotted with black.

The grey leech of Michigan, the best of those indigenous to the State, is
of a uniform grey color, extremely thin or flat, peculiar in its motions, is
with difficulty induced to draw, though its bite is unaccompanied with
any pain ; the eggs of the leech, instead of being left to themselves, as in
the case of the other leeches, are attached to the belly, as are the young
leeches for some time after their development.

The low price at which these leeches can be produced renders their aid
available to the poorest ; and while by cheapening them, they are, by in-
creased demand, rendered a greater source of pecuniary profit, they will
cost the producer nothing but a little time and patience. — Transactions
Am. Pharmaceutical Association.

New Views on the Physiology of the Large Intestine. By M. F. Colby,
M. A., If. D., etc., Stanstead, C. E. — It is now more than eighteen months
since I discovered the error in the received physiology of the function of

1858. Spirit of the Medical Press. 657

the large intestine, particularly in that part of it called descending colon,
sigmoid flexure and rectum. Every day's observation since has confirmed
me in the correctness of my views. Although I have not been able to
engage in general practice, I have had numerous opportunities of testing
them as to their bearing on pathology. The knowledge of the true
function of the descending bowel does away with all the uncertainty
complained of by medical men as to the effect of cathartics, and more
particularly of enemas, in many cases. A discussion took place in the
Westminster Medical Society in 1833, which is reported in the London
Lancet. The discussion developed one fact, that there was a conscious-
ness among all present that there was something not satisfactory in the
received physiology ; which led off the question to the anatomists present,
whether there was anything in the anatomical structure of the descending
bowel which could operate as a valve ?

I can demonstrate the received physiology of the function of the de-
scending bowel to be untenable, and that it implies the charge that the
Creator has left a defect in the organization of a particular part, which
renders it inadequate to the performance of the function assigned it. My
new physiological doctrine recognizes two distinct apparatuses, each pos-
sessing peculiar and distinct functions over and above what is recognized
by the old system. These functions were supposed to pertain to that
apparatus called the large intestine, and heretofore assigned to the func-
tion of organic life, assisted by the voluntary co-operation of the abdomin-
al muscles.

As to the purport of my new physiological doctrine, I quote from lec-
tures which I am preparing illustrative of the subject, the following re-
capitulation : —

1st. I assume that the organic function of the colon ceases at its left
transverse extremity.

2d. That the portion called descending colon and sigmoid flexure has a
separate and independent function.

3d. That this portion of the bowels is anatomically inadaquate to the
performance of the function heretofore assigned it.

4th. That this portion constitutes the link between the animal and the
organic life. That it is possessed of both animal sensibility and contract-
ility to such an extent as to entitle its functions to be considered those of
animal life.

5th. That although it is to a certain extent subject to the will, and can
be brought into action at any moment by it, yet it has an independent in-
stinctive life which gives it an influence and a power which neither its or-
ganic or animal life could give it.

Gth. I assume the name of curator as proper to express its functions ;
and as it is a dualite acting under its instinctive life, at times in a separate

658 Medical Independent. Jan.

capacity, I give the name of curator superior to that portion above the
superior spinous process of the ileum, and which for the time is devoted to
the functions of organic life ; and curator inferior to the portion below
usually called sigmoid flexure — this for the time being devoted to the
functions of animal life.

7th. That the curator, when acting as a unit, occupies the post of ob-
servation between the two lives. That it takes cognizance of the time
when the digestion and the nutritive absorption is completed in the small
intestine ; that it then opens the ileocolic valve, and at the same time by
a suctive and expansive action it takes the faecal matter from the trans-
verse colon and conveys it to the rectum, which it aids the levator ani
muscles to raise, and by a divergent action of its two longitudinal muscles
it opens to receive the same. The curator by its instinctive power, recog-
nizes the fitness of the rectum to receive and expel the faecal matter sim-
ultaneous to the opening of the ileo-colic valve ; it also at the same time
brings into action the abdominal muscles, by which the contents of the
small intestine are pressed forward to supply the place of the refuse mat-
ter removed from the colon. Its office is therefore not only prehensible
in taking the faecal matter from the tranverse colon and conveying it to
the rectum, but it exercises the conservative function of keeping the ileo-
colic valve closed till such a time as the absorption of all nutritive matter
from the contents of the small intestine renders its closure no longer nec-
essary.

8th. That the rectum is part of an aparatus which I call rectal, and
which is wholly under the domain of the will ; that it exercises the func-
tion of defaecation, and aids in that of urination and parturition. In its
anatomical structure it is analogous to that of the upper part of the diges-
tive tube, with the difference of the reversion of the sphincters. It con-
sists of the strongest muscular portion of the bowel ; the rectum, with its
muscles ; the two sphincter, the levator ani, the coccygei, etc. The same
looseness of the cellular tissue, which connects the muscular coat of the
oesophagus, is found between these coats of the rectum.

9th. That the power of the will extends over that part of the digestive
tube which extends from the mouth to within two or three inches of the
cardiac orifice of the stomach ; so also the power of the will extends from
the external sphincter ani to within two or three inches of the left trans-
verse extremity of the colon.

10th. That the rectum in that abnormal state which results from
phlogosis of its muscular coat, has its contractility exalted so as to cause
it to act antagonistically to the curator. This is the most frequent cause
of constipation and its consequence. When th's contractility becomes
spasmodic this resistance leaves the curator to th e mechanical forces —
hence results accumulations and detention of its weakened side walls. It

1858. Spirit Of the Medical Press. 659

is this abnormal state of the most sensitive part of the digestive tube which
fills hospitals with lunatics. It is also in this state that the curator, by its
instinctive life, acts as a dualite by a peculiar transposition which gives it
a great power in overcoming the resistance of the rectum.

11th. The ileo-colic valve may have its functions suspended by local
disease, as well as by peritoneal inflammation ; but the most frequent
cause is the suspension of the function of the curator, which may arise
from antagonism from the abnormal state of the rectum, or from a phlo-
gosed state of its own mucous membrane. A sudden closure of the valve
would cause tympanitis, ileus or strangulated hernia. A weakened or too
active state of the valve would result in emaciation from the premature
passing of the nutritive matter. — Montreal Med. Chron. — South. Jour.

Interesting Case of Transfusion. — This operation, says an English
paper, has been successfully performed by Mr. Wheatcroft, surgeon, of
Cannock, on the person of a woman named Wood, residing there. Imme-
diately after her accouchment, fearful hemorrhage set in, draining the
woman of blood. She felt herself dying, and summoned her husband to
her bedside, bid him " good-bye," and earnestly requested him to take
care of the children when she was no more. She then became pulseless
and gasping, occasional breathing being the only indication of life. A
vein was opened in her arm, and one in the arm of her husband, and as
the blood flowed from the latter it was transmitted by suitable apparatus
into the veins of the wife. After seventeen ounces had been thus injected,
the pulse became perceptible, the colorless lips reddened, the glassy eye
brightened, and she thankfully said, " I am better." The case has pro-
gressed very favorably, and the woman is recovering. Death was here
robbed of his victim. We quote the above from the Western Lancet
The success in the case of Mrs. Wood should lead to renewal of this inter-
esting and valuable method of keeping alive the vital spark.

A Substitute for Transfusion. — Some years ago, our colleague, Dr.
Linton, suggested the propriety of applying bandages to the lower ex-
tremities in case of extreme hemorrhage. By this means the blood from
the extremities is forced into the large vessels of the trunk, and may thus
be made to supply the life-giving fluid to the vital parts until other rem-
edies can be brought to bear. A successful case was reported at the time,
in which this plan was resorted to, but the suggestion was never acted on
that, we have heard of, save in one instance, in which it was resorted to
by ourselves with marked benefit. It is manifest that by this means sev-
eral ounces of blood may be economized. W<i we led to these remarks
by the foregoing case of transfaAiOZL — St. Louis Medical and Surgical
Journal.

660 Medical Independent. Jan.

Use of Chloroform in Retention of Urine. — An intemperate cabman,
aged fifty-two, was admitted into a medical ward at Guy's a few days ago
on account of chest symptoms. It appeared that he had had gonorrhoea
twelve years before, and had ever since had more or less difficulty in pass-
ing his water. After having been in the hospital nearly three weeks, he
was seized with retention of urine. The dresser and house surgeon made
patient and repeated attempts to pass a catheter, but without success.
There was little doubt that the stricture was a permanent one, which had
been closed by inflammation. In February the retention had become
complete for two days ; the symptoms were becoming very urgent, and
Mr. Cooper Forster was accordingly called to see him. Opium had been
most freely given. Having failed in persevering attempts to introduce a
No. 2 catheter, Mr. Forster determined to administer chloroform, and, if
needful, to puncture the bladder by the rectum. "When completely in-
sinsible, another trial was made with a No. 3, which now passed most
readily. "We cite this case as important, because it proves beyond dis-
pute the influence of the anaesthetic state in relaxing an otherwise imper-
meable stricture. An opiate treatment had been fairly tried before, and
had failed, and the catheter had also been found useless in the hands of
several well practiced surgeons. The plan of administering chloroform in
cases of obstinate stricture and retention, is one in wide use, both in hos-
pital and private practice ; but as it is not yet in such general favor as it
deserves to be, we have thought that so pointed an example of its advan-
tages might be worth bringing before our readers. — Med. Times and Gaz.

Post-mortem Examination of the late Dr. Marshall Hall. — A stricture
of the oesophagus was found opposite the eighth ring of the trachea. The
tube was but moderately thickened, but the membrane >was folded in so
as to form a valve, almost closing the passage. There was ulceration and
congestion of the oesophagus above, and the pharynx to the extent of
nearly three inches. — St. Louis Medical and Surgical Journal.

Treatment of Sore KippUs. — A friend, says the Boston Medical and
Surgical Journal, whose judgment and experience entitle his opinion to
much consideration, assures us that equal parts (by weight,) of glycerine
and tannin is the best application for sore nipples which he has used. It
is also an excellent remedy for chaps and excoriations of other parts.
The tannin dissolves readily in the glycerine. We hope this formula
will be as widely known as the celebrated tincture of benzoin cure, which
has, we believe, been quoted in every medical journal in this country. —
St. Louis Medical and Surgical Journal.

1858. Spirit of the Medical Press. 661

Yellow Jessamine. (Gelseminum Semper vir ens.) — UA planter of Missis-
sippi, while laboring under a severe attack of bilious fever, which had not
yielded to the remedies used, sent a servant into his garden to procure a
root, and prepare an infusion of it for him to drink. The servant, by mis-
take, collected the root of the Yellow Jessamine, made an infusion of it,
and gave it to his master to drink. Soon after. swallowing some of it, the
planter lost his muscular power, so as to be unable to move a limb or
to raise his eyelids ; while he could hear and feel, and exercise his usual
faculties as in health. His friends became much alarmed at his great pros-
tration ; but after some hours he recovered his muscular powers, and was
highly pleased* to find himself free from fever. He soon learned from his
servant what plant it was from which he obtained the roots ; and trying
its effects upon the people of his own plantation, and those of his neigh-
bors, he ascertained that he had a valuable remedy for fevers. Thus was
a new remedy introduced to the world by pure accident."

In fever it is extensively used by the Thompsonians, and is the active
ingredient in several quack medicines, as the "Electrical Febrifuge,"
"Speed's Fever Tonic," "Mississippi River Tonic," etc.; by many physi-
cians experienced in its use, it is considered little inferior to quinine.

While various virtues are ascribed to it by many, all are agreed upon
its sedative and narcotic properties. As a sedative, it is deemed superior
to either digitalis or veratrum veride, and although not so powerful as the
latter, it is yet more safe and manageable, and often times more applicable
from the fact that it neither causes nausea, nor acts on the bowels. It
acts chiefly upon the sensory ganglia, spinal chord, and voluntary muscles,
leaving entirely unaffected the intellectual faculties. It reduces the circu-
lation and frequency of the respirations, promotes perspiration and the
secretions generally, and while it relaxes wonderfully all the muscles, it
relieves by its action on the nerves of the general system all sense of pain.
" Under its influence restlessness is soon succeeded by calm repose, and
the excited, frequent pulse, tempers down to tranquility. These favorable
impressions must be secured however, by a frequent repetition of the dose,
as its effects are not very durable, wearing off in two or three hours."
From a full dose, intoxication, langour, dizziness, double vision, and ina-
bility to raise the eyelids, result ; from an overdose, complete muscular
prostration and death.

Dr. J. A. Mayes to whom these extracts are due, says, " I esteem it a
most valuable adjuvant to other treatment, in all cases where high arterial
action exists, in which it is desirable to lessen the frequency of the pulse,
and to calm excitement, and where, as in the case of injuries, it is desira-
ble to lessen the irritability of the nervous system ; also in that trouble-
some hysterical exaltation of the nervous sensibilities, so often met with
in enervated females, its value cannot be too highly estimated. In short
VOL. III., no. xi. — 44.

662 Medical Independent. Jan.

it is a specific for no particular disease, but an admirable adjuvant in the
treatment of nearly all, bringing about in the system a state of repose fa-
vorable for obtaining the full action of other and more radical treatment."

The root contains a dangerous resinoid principle, readily soluble in
strong alcohol, but not in dilute liquor or water, while the sedative prop-
erties are fully so.

Dr. Mayes recommends the following formula : " Four ounces of the
fresh root, chipped small, to one pint of dilute alcohol ; macerate for four-
teen days." The dose of this tincture for adults is lrom twenty to fifty
drops, repeated as often as required.

Dr. J. Douglas regards it as almost a specific in gonorrhoea. He has
found it a most uniform, speedy and permanent cure in all and numerous
cases which he has treated. He gives a tablespoonful, night and morning,
of a tincture made by placing a handful of the root in a bottle of whisky ;
after a few doses its narcotizing effects are strongly marked, and the bene-
ficial results immediate.

The whole of this plant, flowers and root, possess the same medicinal
virtues. — Charleston Med. Jour. S. C.

Cholera. — This fell disease has once more made its appearance in
England ; and there can be no doubt, if it be true to its antecedents, that
it will visit the shores of America during the course of the approaching
summer. Should it do so, it will again find us unprepared, and the
usual mortality and panic will be the result. Six months previous to the
outbreak of the cholera of 1854, we warned the authorities of its approach,
and urgently advised the adoption of measures calculated to arrest its
progress and disarm it, in a measure, of its power. Our warnings, how-
ever, were unheeded, and a mourning community were insulted by the
solemn mockery enacted by short-sighted and incapable officials, in the
great activity displayed to check the progress of an epidemic which had
gathered its victims, expended its power, and was already rapidly on the
decline.

During the week ending Saturday, October 17th, there were registered
in London four deaths from cholera and choleraic diarrhoea ; whilst in the
West Ham district, there occurred seven deaths from the same diseases.
During the week ending October 24th, six deaths from cholera and chol-
eraic diarrhoea were registered. It is to be hoped that these cases are
merely sporadic, for not a year passes without a few deaths from cholera
occurring in London Some of those recorded, however, appear to bear an
epidemic character. — Medical Chronicle.

1858. Spirit of the Medical Press. 663

Good Effects of Guaiacum in Cynanche Tonsillaris. — Dr. Brinton has
been treating several cases of cynanche tonsillaris, at the Royal Free Hos-
pital, on what he informs us has been his usual plan for many years — a
plan so simple and so efficacious as to deserve mention. He regards the
tonsils as an offshoot of the intestinal canal, and considers that not only is
constipation, in most cases, an element of the malady, but that, on the
above view, the inflamed structures are best relieved by free purging, and
perpetual gargling and fomentations with hot water. For the first of
these indications he relies chiefly on powdered guaiacum, which he gives
in large (one scruple to one drachm) doses, every four hours ; often in
combination with opium, aloes, and jalap, and suspended in mucilage.
He finds that, if commenced tolerably early, this treatment generally
averts all abscess, and even later, rapidly removes the malady, while it
allows of a rapid recovery, very unlike the long convalescence which often
follows bleeding, blisters, and tartar emetic. — Lancet.

Cold Applications in Pneumonia and Pleurisy. — Prof. Niemeyer, in
his contributions to clinical medicine, expresses his opinion, based upon
numerous observations, that in pneumonia and pleurisy cold applications
(around the chest and back) are not only unaccompanied by danger, but
as efficient here as in inflammation of external organs. They produce
great relief, and the patients, even children, ask for their renewal when
they have become warm. Dr. N. saw, under this treatment, the exudation
cease earlier, the fever extinguished sooner ; — and the patients often re*
turned to their work on the seventh or eighth day, while he never observed
metastases or the consequence of cold from his treatment. In the latter
stages of these diseases, Dr. N. gives preparations of iron with great suc-
cess, on the theory adopted by distinguished pathologists, that the blood-
corpuscles are materially diminished in these diseases. — N. Y. Medical
Report.

Successful Ovaritomy. — Dr. H. N. Bennett, of Ct., reports (Am. Jour.
Med. Sci.) a case of successful ovariotomy in a patient, a>t. 24 years, un-
married. The tumor was a multilocular cyst, seventeen inches in circum-
ference ; her recovery was rapid and complete.

Successful Removal of loth Ovaries. — A case is reported in which both
ovaries were successfully removed by Dr. Potter, of Geneva, N. Y. The
patient, at. 25 years, married, had suffered two years from a tumor of the
right ovary. The left ovary was also diseased, but not greatly enlarged.
— Am. Jour. Med,. Sci.

664: Medical Independent. Jan.

(BYxUxml anb Utisnllojr,

VERITAS ET JUSTIT1A, SINE TIMORE.

Report from St. Mary's Hospital. — We find in the Peninsular
for December, a sketch of the origin, and a statement of the present
condition, of St. Mary's Hospital. Never having seen an official re-
port of this institution, during the whole twelve years of its existence,
we took up the paper with the hopeful assurance of gratifying our
desire to know some facts, concerning which the tax-payers of our
city, as well as the " hand of charity," ought to have known long ere
this.

The editors first inform us, in their preface, that " the paper was
written for submission to a superior ecclesiastical authority ;" but, in
their closing paragraph, they style it an " unpretending narrative'''' of
the efforts by which St. Mary's Hospital has become " an established
institution of the city" and express the hope that our fellow-citizens
will carefully examine the paper, " from which they will learn how
much relief from sickness and want may be traced to their own
munificence."

Now, this very question, " hoio much relief" has been afforded by
our fellow-citizens, is of all others, the most interesting and impor-
tant, just at the present time. The project of erecting an " Aims-
House," which would supply all the demands of a city hospital, is
now before our municipal authorities, and agitating the minds of our
citizens. Policy would seem to have dictated that the officials of
this already-established institution of our city should present all the
facts that have reference to the economy, or appeal to the liberality,
of our municipal interests. Indeed, a proper regard for the " munif-
icence of our citizens " would call for a full annual report, setting
forth all the facts, financial and executive. Then we should know
whether the institution is worthy of the liberality which has been
bestowed, and whether, all things considered, it might not be made
to answer all the present demands of a City Hospital.

The report tells us that the institution, as it stands, has cost about
$26,000, to which the citizens of Detroit have contributed the sum
of $10,000. But it has failed to inform the public, from whom so
much of material aid has been received, just " how much " in the

1858. Editorial and Miscellany. 665

aggregate, or even to give us the facts by which we may know how
much is paid annually, by our city and county, for the support of
the poor. All that we find upon this point is, that the institution
receives from the city and county, for each patient, $2.50 per week,
and from those who pay for themselves, from $2.00 to $5.00 per
week. The report gives us the number of patients treated annually,
male and female ; their nativity and religious faith ; the number of
deaths, and those that have been discharged as cured, improved or
incurable. All well enough so far as it goes.

To the medical man, however, the report is of no interest or value.
It presents no data worthy of being added to our statistical tables,
nor a single practical deduction in support of. the principles of medi-
cal science.

The editors of the Peninsular have taken the liberty to append to
the report a schedule of operations, with the name of the operator !
The editors are alone responsible for this extremity of the " narra-
tive ; and we have no doubt their readers would be glad to learn
what it was intended to show ?

It seems, from this exhibit, that seventy operations, great and
small, have been "done" in that institution, up to June 30th, 1857,
during a period of about 12 years, — making an average of a little
over five operations per year. Is this fact offered as an advertisement
of the clinical department of the University, as it now stands? If so,
the advantages could not be better illustrated.

Prominent among the numerous minor operations reported in the
schedule stands : " Operation for Paracentisis Abdominis " ! ! This
must have been intrinsically a surgical disease; and as the results of
the three operations for this new malady are not given, it is but fair
to suppose that it was deemed advisable, on due reflection, to spare
the blow to surgical science, which had proved so fatal to the unfor-
tunate poor.

But why should the editors offer this as a complete report, and
yet leave out of the list the name of Dr. E. M. Clark, who, as they
well know, has performed, in that institution, a goodly number of
important operations'? What is the standard of merit which has
been adopted in the selections of surgical operators in St. Mary's
Hospital, as shown by this attempt to manufacture surgical fame?
Is it servility rather than competency ? If so, the schedule indicates
justice in one instance at least, and serves to illustrate the proscrip-

666 Medical Independent. Jan.

tive policy which has ever been adopted by the medical administrator
of that institution.

The Peninsular has modestly informed us how the present incum-
bent received his appointment as Surgeon and Physician in Chief of
St. Mary's Hospital. We give it in the language, and with the ital-
ics of the report, as follows :

" * * But the eye of the all seeing God watched over
the interests of the house of His suffering members, and the hand of
His Providence led forth Professor Zina Pitcher, to whom He, in
His infinite wisdom, saw fit to confide the temporal welfare of His
flock."

This ought to be considered as ironical ; for, if we contrast the
medical supervision of this institution with that of any of the numer-
ous hospitals of our country, we should be compelled to regard this
so-called manifestation of the Hand of Providence as an afflictive
dispensation.

The number of patients treated in this house, since it was founded,
in 1845, amounts in the aggregate to 5,900, or an average of nearly
500 a year. For the last three years, commencing with 1854, the
yearly number of patients treated has been as follows : In 1854,
1170; in 1855,908; in 1856, 790, — making a yearly average of
965. Now, if there is any one man on earth capable of doing full
justice to this number of patients, and at the same time attend to a
long-established private practice, then we admit that it would require
the Hand of Providence to point him out. We are not surprised
that the report shows, in its rate of mortality, one death in every nine
patients.

St. Mary's Hospital, although the result of private enterprise, is
in fact a public institution. The citizens of Detroit have contributed
liberally to its establishment and support. It " has become an es-
tablished institution of the city." As citizens, then, we have a right
to expect that it will be so conducted as to accomplish in the best
manner the great purposes for which such institutions are designed.
The medical profession, too, have a right to expect that all its advan-
tages will be cultivated and improved, and made to contribute to the
advancement of medical science, by recording anomalies which occur
in the phenomena of disease — the results of treatment and studious
observation. This can only be done by a division of labor.

We are informed by the report that Dr. Pitcher " has been aided
from time to time," by three or four other physicians ; but, so far

1858. Editorial and Miscellany. 667

as we can learn, there has never been that order and systematic
arrangement in the medical administration, which has long been so
successfully adopted in other institutions of the kind, and which is
indispensable, both as regards the claims of medical science, and the
most successful treatment of the patient. One man has had the care
of from twenty-five to one hundred patients daily. Now, why not,
instead of this, appoint a Medical Staff, as in other institutions of the
kind, and assign a ward or section to one physician, the same to
another, and so on — appointing as many physicians as necessary to
do the work easily and well. Then require each physician, at the
end of Irs quarter, or term of office, to present a full report of the
number of patients treated, together with their diseases, and what-
ever he may have observed in the effects of remedies, or considered
valuable for statistical purposes. There are physicians enough in
our city who would be glad to give their services gratuitously, for
the advantages of observation and study which such an opportunity
would afford. We should then have something better than a inert
apology for a report — something that would be a credit to our citj
rather than a self-adjusting advertisement, owned and engineered by
an editorial quartette.

The report has paid a well-merited compliment to our worthy
Director of the Poor, L. B. Willard, Esq.; and also to the officers
of the Michigan Central and Detroit & Milwaukee Railroads.

In conclusion, we can only express the hope that the officials of St.
Mary's Hospital will yet be free to act by what we confidently
believe would be the dictates of their best judgment, and adopt ar
organization and system of management which will bring into requis-
ition the best medical talent of our city, and most subserve the great
purposes which such an institution is designed to accomplish. When
this is done, St. Mary's hospital will be worthy of the self-sacrificing
devotion of the Sisters of Charity. R.

Jenner's Test for Genuineness of Vaccination. — The celebra-
ted Charles Fox, once said to the discoverer of vaccination : " Pray,
Dr. Jenner, tell me of this cow-pox that we have heard so much
about ; — what is it like ? " " Why, it is exactly like the section of a
pearl on a rose leafy

Physicians would do well to remember this evidence of a pure and
successful vaccination.

668 Medical Independent. Jan.

[Apologetic. — We crave the indulgence of our readers for devoting
so much space, in the present number, to an article so largely per-
sonal in its bearings and interest. It will be seen, however, that we
are acting in self-defense. We were charged, by insinuation, with
infidelity to the University — a charge well calculated to injure us in
the estimation of the Regents and Profession, and which, in the Nov.
number, we briefly repelled. A reiteration of the charge renders the
following article a necessity.]

The Senior Editor of the Peninsular Journal. — Our readers
will remember that, in the November issue of the Independent, we
quoted, entire, an article from the Peninsular Journal, containing an
insinuation, which, in our reply, we termed cowardly, and proved,
by a statement of facts, to be false. The authorship of the article
not being indicated, we dealt only with the insinuation, and, in
accordance with our usual habit, applied the right names to the right
things. We now regret to see that our venerable friend, the senior
editor of the Peninsular Journal, in a reply to our article, over his
initials, Z. P., fathers the article and the insinuation which we so
justly designated ; for it is impossible for us to see that the author-
ship alters, in any degree, the character of the insinuation. He takes
to himself qualities of " cowardice and mendacity," which we applied
to the insinuation, and says :

" The movement of our blood is not accelerated by the application
of such epithets to ourselves, because we know that they are not
bestowed by gentlemen upon their equals."

Is the senior editor aware that the application of this principle,
judging him by the words of his own mouth, will convict him of not
being a gentleman 1 If not, let us refer him to the July number of
his Journal for 1856, where, in an unprovoked and undignified attack
upon the then senior editor of the Independerit, he speaks as follows
of the latter gentleman, and a specimen previously described by him :

" * * * * there is wood reason for doubting whether
such another specimen can be found, out of that country where men-
dacity is not regarded as one of the attributes of the subject."

Verily, we advise our venerable friend to scrutinize his own record

more closely, when coining tests for gentility ! The senior editor

further says :

"When the Peninsular came into the hands of its present conduc-
tors, it claimed to be the organ of the Medical Profession of the

1858. Editorial and Miscellany. 669

State [ ? ], and promised, as such, to take note of the errors of ad-
ministration, that might creep into the Medical Department. * *
If, in fulfillment of this promise, the Professor of Surgery should
fancy himself singled out, it may prove to be only another case of
the fly upon the coach-wheel."

Judging from previous exhibitions, we confess ourself not a little
surprised at the candor of this last allusion ; for the only possible
application which it admits, is one which would liken the senior
editor of the Peninsular, in his former and present criticisms upon
the administration of the Medical Faculty, to the sapient fly, criti-
cising the construction of the vehicle, upon the wheel of which it had
chanced to alight, and of which it could see about as much as the
senior editor, and Emeritus Professor, does, of the practical working
of the Medical Department.

But let us see how this valiant watchman upon the towers of our
medical Zion has performed his self-imposed duty. At the time he
donned his armor, the present arrangement of the surgical course —
which, be it remembered, continues through the whole term — had
been in operation for two years. The session following, another
" error " was suffered to " creep in," by the adoption of a plan by
which the anatomical course was cut short, " indefinitely," at the
latter portion, and the course on Materia Medica at the commence-
ment of the term — the Professor of Materia Medica being a co-edi-
tor of the Peninsular Journal. Yet notwithstanding these " errors
creep in," not a note of alarm is sounded by this vigilant and faithful
sentinel, until two years after, when " Faculty arrangement " has
required the extension of the time-curtailed courses through the term,
and we have incurred his displeasure by an independent and fearless
advocacy of measures which we regard as conducive to the good of
the University and the Profession. But what is the chief note in his
alarm ? Hear it :

* * * "want of diurnal regularity in the delivery of
lectures, * * by which certain subjects were crowded out of place,
to the prejudice of students who thus found the symmetry of the
course of instruction violated."

Now, when it is remembered that we lecture twice daily on two
days of the week, instead of once daily on four days, it will be seen
how very far " subjects are crowded out of place," and how much the
symmetry of the course is violated ! One-half of our lectures occur
on the same days that they would if "diurnal regularity prevailed —
the other half are " crowded out of place" one day ! A distortion of

670 Medical Independent. Jan.

one day in a six month's course ! ! Here our friend certainly strains
at a gnat, and in the " error " ignored, as detailed below, it will be
seen that he commits the camel bodily to his deglutory apparatus ;
for another most serious and unparalled " error " has been permitted
to " creep in," which he fails entirely to notice ; and as we are also
"walking about our Zion, marking her bulwarks and telling the towers
thereof," we will indicate it. We allude to the discharge of his own
duties by proxy ; and we wish we could express the conviction that
the Clinical Professor " will hereafter give his whole energies to an
institution, from a professorial connection with which he has " not
" derived his principal " or even any " claim to personal and public
consideration." That our readers may appreciate the last remark,
we again quote :

******* that the Professor of Surgery will hereafter
give his whole energies to an institution, from a connection with
which, he has derived his principal claim to personal and public con-
sideration."

In reference to this characteristic insinuation, we would only re-
mark, that a private course of lectures, sustained for three successive
years, constituted, at the time of our election, our "claim to public
consideration," which claim the Board of Regents admitted by our
appointment ; and we certainly congratulate ourself on having earn-
ed, by public teaching, whatever claim we have to " personal and
public consideration," and that it is not based upon merely nominal
distinctions, or accidental honors.

" Some men are born great ; some achieve greatness ; and others have great-
ness thrust upon them."

We are content to labor for the achievement of whatever portion
of greatness falls to our lot, and leave the senior editor of the Penin-
sular to determine the source of his own greatness. But let us hear
him further :

" If we were not restricted both in time and space, we should
make some remarks on the neglect of the rule requiring a critical ex-
amination of the semi-monthly theses of the students, growing out
of the other abuse."

Now if the worthy senior of the Peninsular, had been as familiar
with what is going on in the Medical Department, as became one
who assumed the critic, he would never have penned the above sen-
tence ; for he would have known that during the current year, the
same method of examination of the theses of students, had prevailed
in the surgical, as in the other departments. He would have known

1858. Editorial and Miscellany. 671

too, that there had never been a time when a thoroughly critical ex-
amination of the theses had not been made. But the eyes of our
venerable friend improve with age ; and with

" Optics sharp I ween,"
He " sees what is not to be seen."

In his former article, he says :

" In what way this habit or custom produces evil, we do not pro-
pose to speak at this time."

Again in his last ebullition, as above quoted, " time andg space "
" restrict ' ' him from saying all that he has to say. Now we beg the
senior to come out openly and manfully, and say distinctly, all that
he has to say, and not to fire insinuations from behind a tree.

In conclusion, we again respectfully submit to the Board of Re-
gents, the question of alleged Faculty mal-administration, which so
seriously exercises the senior editor of the Peninsular Journal ; and
we take occasion to reiterate the sentiments advanced in former ar-
ticles, viz. :

First — That in country medical schools, a portion only of the Fa-
culty can man tain a residence in the locality of the institution.

Second — That in the Medical Department of the University of
Michigan, the course of lectures of each of the non-resident profes-
sors is much more perfect than that of the same class of professors
in any other school.

Third — That in a country location, a medical school cannot attain
a high grade of usefulness ; for in such a location, it is impossible to
furnish to the student a practical education.

Fourth — That the history of country medical schools indicates the
fact that they cannot sustain a vigorous, prolonged existence ; and
also, that nearly all of this class of schools in the United States, have
died from inanition.

Fifth — That the Medical Department of the University of Mich-
igan, while located in Ann Arbor, must remain content with a secon-
dary rank.

Sixth — That by a removal to Detroit, where a practical course
could be instituted, the time of study could be extended, the lecture
term prolonged, the standard of graduation elevated, and enabled by
its munificent endowment, to insist upon compliance with all its re-
quisitions, it could be placed in advance of all other schools in the
United States.

672 Medical Independent. Jan.

Seventh — That the removal is eminently practicable, and demand-
ed alike by the wants of the student, and the enlightened sentiment
of the Profession.

Eighth — That in consideration of her ability to accomplish this
great work of reform, the University of Michigan should regard it as
her high prerogative and solemn duty. G.

B. 'Frank Palmer and his Artificial Limbs. — An invention
which serves the purpose of alleviating the suffering and adding to
the comforts of the afflicted, entitles its author to the thanks of the
human race, and should constitute letters patent to the title of Public
Benefactor. Such is the invention of B. Frank Palmer. Deprived
of one of his legs at the early age of eleven, we find him struggling
manfully along life's pathway for education and livelihood. One
effort of this struggle was the purchase of one of the then celebrated
Anglesey legs. This limb did not satisfy him ; and, true to his
manhood, he directed his own inventive genius to the work of pro-
ducing a better. Armed with a cooper's shave and a jack-knife, with
no practical knowledge of mechanics, he set to work upon a section
of a willow tree, to fashion the first specimen of what has now be«
come the most perfect artificial limb ever made. Completing and
mounting this specimen, at the age of twenty-two, he started for the
National Fair at Washington, in May, 1846, when he made the ac-
quaintance of, and received encouragement from, distinguished men.
In 1851, Mr. Palmer visited London, to compete with the inventors
of the old world at the great exhibition. Victory and Palmer's leg
went in company, and have never, since then, broken the association.

Mr. Palmer has just completed an improvement in the self-acting
arm and hand, thus adding another large figure to the debt of grati-
tude which the world owes him. Truly, we regard the inventive
genius exhibited in his works alike honorable to the possessor and
beneficial to the world. Limbs may be obtained directly of Mr. P.,
by visiting him at 1320 Chestnut St., Philadelphia, or they may be
ordered through Messrs. Higby and Stearns, 162 Jefferson Avenue,
Detroit.

The State Medical Society. — When we compare the feeble ex-
istence of the Michigan State Medical Society, with the sturdy vitali-

1858. Editorial and Miscellany. 673

ty which characterizes the Medical Organizations of neighboring
states, we confess to a feeling of deep and overpowering mortification.
But when we remember that during the four years of its existence,
its meetings have all been held at Ann Arbor, we are not surprised
that it has failed entirely to secure the energies and affections of the
Profession of the State ; and now that a new order of things has been
instituted, in reference to the places of meeting, we are led to cherish
the hope that a period of renewed vitality and vastly increased use-
fulness is at hand.

By an amendment of the Constitution, effected at the last annual
meeting, the Society will hereafter hold Biennial Sessions on the
third Wednesday of January, at Lansing, during the regular sessions
of the Legislature ; and on alternate years, its meetings will occur
at such time and place, as may be determined by the Society, at the
meetings not held at Lansing. The object of this arrangement is two-
fold ; first to secure a recognition from the Legislature, similar to
that which is enjoyed by the N. Y. State Society ; and second, to
distribute the alternate meetings among the principal towns, and
thus augment the general interest felt in the Society, by the Profes-
sion in widely remote sections of the State.

It will be seen that the coming meeting, on the 20th inst., is im-
portant in respect to the place of meeting two years hence, for ac-
cording to the Constitution as amended, this point must be deter-
mined at this time. We trust to see a goodly number of delegates
and volunteers at the ensuing meeting. We appeal to the Profes-
sion ; " come up and help us." Let not the Peninsular State beany

longer a reproach in the family of State Medical Societies.

A Model Prescription. — Abernethy frequently compressed a
vast deal of meaning into a very short prescription. He was once
consulted by a lady about a nervous disorder, the multitudinous and
fanciful symptoms of which, she proceeded to give in detail. Natu-
rally impatient of long stories, he interrupted her, by holding out
his hand tor his fee ; a one-pound note and a shilling, constituting
the usual fee, (a guinea) were placed in it; the shilling he immediate-
ly returned to his patient with this advice : " There Ma'am J go and
buy a skipping rope ; thai is all you want.''' We commend the pres-
cription to the Flora McFlimaey'a of our day and generation,

674 Medical Independent. Jan.

Removal of the Medical Department. — We cannot refrain from
making the following extract from a private letter, as it so clearly
expresses the general sentiment of the profession on the subject of
medical education in Michigan. We should be glad to hear from the
writer often, and are anxious to add his name to our list of collabora-
tors.

" Your articles in the Independent, I have read with satisfaction,
and the arguments therein advanced, cannot but commend themselves
to an unprejudiced well-wisher of our Medical Department.

It is not within the range of probability, that Ann Arbor will ever
be of the requisite size to warrant the residence of the necessary tal-
ent to fill the chairs of that Department, and it can hardly be expect-
ed that such men will absent themselves for six months in each year
from their fields of practice, for the present inadequate remuneration.
It seems to me, there can be no man in the practice of medicine, who
is not heartily in favor of giving to the student the best advantages,
for they are sufficiently imperfect to prepare for the onerous and res-
ponsible duties of a physician. That Ann Arbor can never afford
such advantages, ought to be sufficient to warrant the removal, if it
be practicable.

As it is, we can never hope that the school will be more than a
preparatory institution, answering very well the purpose of rudi-
mentary instruction, but sadly deficient in all the means for its prac-
tical application.

Many other reasons must be suggested to any candid considera-
tion of the subject, so obvious indeed, as to render it superfluous to
particularize. I am fully satisfied that this can only be a question of
time."

Wyandotte, Nov. 17th, 1857.
Editors of Medical Independent :

Will you please give the following notice an insertion in your
December and January numbers.

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In accordance with the Resolution passed at the last meeting of
the above Society, the next Annual Meeting will be held on the 3d

Wednesday (20th) of January next, in the city of Detroit, at

at 10 a. m.

Members of Committees please take notice and prepare themselves
accordingly. E. P. Christian, Setfy.

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MEDICAL INDEPENDENT:

A MONTHLY

Review of Medicine and Surgery.

VOL. 3. DETROIT, FEBRUARY, 1858. NO. 12.

Article I. — Phenomena Connected with Fermentation, and
some Experiments upon its Causes. By Henry Erni, Pro-
fessor of Chemistry and Pharmacy in the University of
Vermont.

Fermentation we call, in common life, that process by
which liquids containing sugar are decomposed into alcoholic
products, such as wine, beer, whisky, etc. ; but, chemically
speaking, we ought to extend the definition still farther, for
other organic compounds besides sugar undergo decompos-
ition under similar circumstances.

In fermentation, we have to distinguish, first, the ferment,
a nitrogenous substance which acts decomposingly upon a
second complex body containing no nitrogen.

As the so-called alcoholic fermentation, in all of its rela-
tions, has been much better studied than any of the others,
we shall treat, here, almost exclusively of the former.

If the expressed juice of grapes, or other vegetables, con-
taining sugar and, at the same time, some albuminous matter,
as it always does, is exposed to the air at a temperature of
from 10° to 15°, we perceive, after a while, an evolution of
carbonic acid gas (which, when accumulating in cellars
where fermenting liquors are stored, often gives rise to acci-
VOL. III., no. xii. — 45.

676 Erni On Fermentation. Feb.

dents, but is easily removed by caustic lime). The mass
comes now to be in constant motion. Particles of tbe fer-
ment (yeast), loading themselves with the liberated gas-
bubbles, become specifically lighter, and, rising to the
surface, discharge the gas and then sink again. This process
continues until all the sugar is decomposed, in the place of
which we now find alcohol. When the amount of sugar
greatly predominates, as in southern wines, the yeast loses
its power before all the sugar is decomposed: hence such
wines are sweet.

On the same principle depends the brewing of beer, the
manufacture of whiskey, etc. Here, the starch found in bar-
ley, corn, and potatoes, is, by the action of malt (containing
diastase), first converted into sugar, which latter is decom-
posed by the addition of yeast.

If we bring a drop of any fermenting liquor under the
microscope, we will find it to contain a large number of veg-
etable cells, eliptical in form, and varying in size from 0.005
to 0.01 millimeter in diameter. In the Lyman grape raised
in Yermont, I found the cells rarelv to exceed 0.002 m. m.
These cells multiply by budding — i. e., by shooting forth
branches from one or several parts of the cell surface, which
branches, after a certain growth and development, separate
from the parent cell.

Hoticherlick thus observed one cell to pass thrice, in twen-
ty-four hours, through six different generations. As from the
first moment, when tracing fermentation, we observe this
fungus to be present, some chemists attribute this decomposi-
tion to its vital activity, whilst others, like Liebig, consider
the cause of this phenomenon to lie in the power of the fer-
ment itself, in a state of decomposition (that is, in chem-
ical action), to produce a similar metamorphosis in com-
pounds placed in contact with it. Thus, this savant thinks it
probable that miasmata should act as ferments on the blood,
and explains the action of sausages, poison, &c. Brendecke
published a variety of experiments, which seemed to show
that porous substances, such as straw, feathers, alum, pulver-

1858. Erni On Fermentation. 677

ized charcoal, potato starch, flowers of sulphur, scraps of
paper, and even small particles of metals (tin), can produce
fermentation when brought into a solution of grape sugar, to
which some tartrate of ammonia had been added. Should
this be so, it appears probable that yeast, though made up of
vegetable cells (a fact formerly denied by some chemists),
might, like the substances enumerated, excite fermentation,
not by its vital power, but simply by its looseness of porosity.

In repeating some of Brendecke's experiments, I employed
grape sugar, extracted from honey by means of alcohol and
purified by boiling with charcoal, and cane sugar, prepared
from white refined sugar several times re-crystalized from
solution in hot water. In the following experiments, one
part of sugar and eight parts of water were usually employed.

First Experiment. — Common straw was treated with cold
potash-ley, to dissolve any albuminous substance united there-
with. After twenty-four hours, the straw was washed with
water, and the last traces of the potash removed by dilute
hydrochloric acid, and the straw again cleansed under a
stream of water.*

Second Experiment. — The straw, cleansed as above stated,
produced no fermentation in solutions of either grape or cane
sugar.

Third Experiment. — Additions of cream of tartar, or tar-
trate of ammonia, to the last solution, had no observable
effect.

Fourth Experiment. — Finely-pulverized quartz, added to
the solutions of cane and grape sugar, caused no fermentation
during four weeks, although some mould was formed, which
fructified and yielded spores. Such was also the case, not
only in this, but also in some of the previous experiment-.

Fifth Experiment. — In a solution of cane sugar was placed
some common, uncleaned straw, in order to see if it excited
fermentation ; and, if so, to ascertain if it might not be owing
to the development of fungi. After twelve days, fermenta-
tion commenced, and, at the same time, a microscopical

* Most of these experiment! were published by themselves, in the proceeding! of the Amer-
ican Association for the Advancement of Science, in 1851.

678 Erni On Fermentation. Feb'

examination of the liquid revealed the presence of vegetable
cells, indented with upper yeast.

Sixth Experiment. — The same experiment, performed with
grape sugar, produced the same result. Fermentation, how-
ever, commenced a few days earlier.

Other experiments were now made upon yeast (obtained
from a brewery). Rousseau had previously made known
that fermentation could be induced by yeast, even in the
presence of vegetable or mineral poisons, if rendered acid
when mixed with the solution of sugar. The following trials,
made by me, did not confirm these statements :

First. — Upper yeast, brought into solution of sugar cane,
acidified with tartaric acid and poisoned with arsenious acid,
produced no fermentation. The same mixture, without the
addition of arsenious acid, fermented after two days. The
liquor, which was strongly acid, turned sweet, and fermenta-
tion commenced.

Second. — The same trial was made with liquid acidulated
with acetic acid, and no fermentation took place. The same
mixture, without the arsenious acid, produced fermentation.

Third. — The above two experiments were repeated, using
oil of turpentine as a poison instead of arsenious acid, and the
same negative results obtained.

Fourth. — Yeast, added to cane or grape sugar solution,
acidified with tartaric or acetic acid, and poisoned with a few
drops of kreasote, excited no fermentation whatever.

Fifth. — Mixtures of cane and grape sugar with yeast, acid-
ified with cream of tartar, and poisoned with considerable
quantities of arsenious acid, yielded fermentation. Perhaps,
in this case, the arsenious acid formed a chemical compound
with the cream of tartar, as such a salt was proved to exist by
Mitcherlich.

Sixth. — The same experiments repeated, with this differ-
ence, that, in the place of arsenious acid, kreosote and oil of
turpentine were employed, showed no fermentation.

When the poisoned liquids were examined under the mi-
croscope, it could be plainly observed whether the poison

1858. Ekni On Fermentation. 679

had taken effect, the albuminous layer (Mohl's primordial
utricle), lying closely within the cell-membrane, appeared to
have undergone a change, similar to that produced when
yeast was boiled.

It has also been asserted, that the boiling of yeast perma-
nently destroys its power as a ferment.

Seventh. — Brewer's yeast, much diluted with water, was
boiled in a glass vessel. A glance at such cells under the
microscope revealed that their vitality had been destroyed.
Instead of being eliptical in shape, as at first, many were
pear-shaped, looking darker ; the muclaginous lining (primor-
dial utricle) was partly removed from the cell-membrane
(coagulated). Yet boiled yeast brought into sugar solutions,
on repeated trials, caused fermentation. A microscopical
examination of the liquid, at this period, showed that new
cells had been formed.

The experiment of Ludersdorff (Pharm. Ceui. JBlatt^ 1846,
575 ; Pogg, Annal, LXVII, 408), who stated that yeast, the
organization of which was destroyed by grinding, induced no
fermentation, was repeated ; but, on trial (grinding yeast on
a smooth glass plate), I was convinced of the impossibility of
thus annihilating the cellular structure, a fact readily ac-
counted for, if we reflect that the largest cells do not exceed
1.01 m. m. in diameter.

Intending to test the statement that washed yeast loses
considerable of its power as a ferment, I experimented fur-
ther as follows :

Ninth. — Brewer's yeast was for some time digested with
pure water on a filter. No difference could be observed
wdien such yeast was mixed with sugar solution.

Tenth. — The filtrate passing through the filtering paper,
poured into a sugar solution, excited no fermentation in the
course of several weeks, although other filamentous fungi
flourished and lived luxuriantly in the liquid.

Mitscherlich proved by experiment {Pogg Ann at, 55 ; 224)
that the yeast-cells must be brought in actual contact with
the solution of sugar in order to cause fermentation. Re-

680 Erot On Fermentation. Feb.

peating his experiment, I took a common lamp-chimney, and
closing one side with a double layer of filtering-paper, the
tube was now vertically suspended in a solution of sugar,
and some yeast, diluted with water, put into it. The solution
of sugar, entering the tube through the bibulous paper, com-
menced soon to ferment, whilst the liquid outside remained
unchanged during an entire week. Helmholtz also found
that the action of fermenting grape juice is not communi-
cated to another portion of the same juice, which, put into a
vessel closed with a bladder, was immersed in the fermenting
liquid.

Some other experiments upon different kinds of fermenta-
tions were now made. In the acetic viscus, butyric and lactic
fermentations, apparently different kinds of fungi developed
themselves, and were traced, in each kind, as soon as decom-
position commenced. Blondeau has, to strengthen the idea
that different kinds of fermentation were due to different fun-
gi, lately come forward with new proofs, as he believes ; and
assigns to each species its proper botanical name. In regard
to the origin of these yeast cells, we have to contend with the
same conjectures and diversity of opinions, as when account-
ing for the sudden appearance of millions of infusoria in
stagnant water, or in explaining the origin of intestinal
worms.

Guy Lussac believes himself to have proved by experiment
that grape-juice, expressed in an atmosphere of lrydrogen or
carbonic acid, remains unchanged for months ; but, by
allowing access to only a few bubbles of air or oxygen gas,
fermentation takes place, even on the total exclusion of these
gases afterwards.

Schwann favors the idea that the germs of the yeast-fungi
are diffused in the air and water (like the eggs of infusoria,
which have actually been traced in the air, water, mist, and
even snow), and that these develop themselves when brought
into favorable circumstances. He establishes the experi-
mental proof, that when air is first passed through an ignited
tube before coming in contact with solutions of sugar,

1858. Erni On Fermentation. 681

containing besides some nitrogenous substance, no fermenta-
tion is excited. The same negative result is witnessed when
the air is conducted through an apparatus filled with concen-
trated sulphuric acid, or a strong solution of caustic potash.
The germs being thus destroyed by heat or chemical agen-
cies, no yeast-fungi are formed. From this fact, Appert's
method for preserving different kinds of food may find its ex-
planation. Milk, meat and vegetables are put into tin cans ;
these are put into boiling water and immediately hermetically
sealed.

Liebig's explanation is, that the trace of oxygen in the air
that may still be present with the food, is at once taken up
by some parts of it, without giving rise to the fermentation
of ferment at this high temperature ; whilst Schwann believes
that, by the destructive influence of the heat on the germs of
fungi and infusoria, the food is preserved.

Though the old theory of spontaneous generation, even
when limited to some of the lowest orders of vegetable and
animal life, loses daily more ground, and the " omne vivum
ex ovo" has become the axiom with the naturalist; still, there
yet remain many unsettled points in connection with this
matter, which require further investigation. Thus, if we take
it for granted that, according to Guy Lussac's experiment, a
few bubbles of oxygen gas, obtained from chlorate of potassa
at a high temperature, induce fermentation (when admitted
to grape-juice surrounded by an atmosphere of carbonic acid),
it must be admitted, that in this case, any vegetable germs
must have been excluded, and still fermentation took place ;
and, if so, were there no yeast-cells present I

The effect of antiseptics, arresting fermentations (as, also,
putrefactions and eremacausis), may be differently explained,
according as we favor Liebig's or Schwann's theory. The
former assumes that corrosive sublimate, arsenic, Kreasote,
&c, uniting with the ferment, prevent the decomposition in
the ferment, and in consequence that of other organic bodies
in contact with them. Schwann believes that these substan-
ces, acting as poisons, destroy the life of the previously-

682 Schetterly On Sensation. Feb.

described organisms, and that hence the metamorphosis of
vegetable bodies is arrested by them.

We must acknowledge that, notwithstanding all of the vol-
uminous writings on fermentation, but little is known of its
original cause, and no one of the theories advanced is compe-
tent to the full explanation of all the facts.

Article II. . — Chapters from an Unpublished Monograph.
By H. R. Schetterly, M. D.

Sensation an Effect of Electrical Action. — The electrical
theory of life is not entirely new. Dr. Priestley first pro-
posed it in 1774. Since then, Professor Faraday, Mell,
Dumas and Prevost have advocated it ; and Dr. "W. Philip
asserts, in his Experimental Inquiry into the laws of the
Vital Functions, and in the Philosophical Transactions, that
the identity of Galvanic Electricity, and the Nervous Fluid,
is established by his experiments. In his Physiology, Dr.
Dunglison says : " Physiologists of the present day, we think,
accord with the electrical hypothesis. The late Dr. Young,
so celebrated for his knowledge in numerous departments of
science, adopted it prior to the interesting experiments of Dr.
Philip ; and Mr. Abernethy, whilst he strongly opposed the
doctrines of Materialism, goes so far as to consider some sub-
tile fluid not merely as the agent of nervous transmission, but
as forming the essence of life itself." But, notwithstanding
this array of the most eminent talent in its favor, no physiol-
ogist has yet set himself to work to investigate the subject
scientifically, so far as is known, though the materials required
for such an investigation have been on hand, scattered, in a
fragmentary condition, through many volumes, for some
twenty years. But Dr. Bostock remarks, in his Physiology,
that " before the electrical hypothesis can be considered
proved, two points must be demonstrated : first, that every
function of the nervous system may be performed by the
substitution of electricity for the action of the nerves ; second,
that all the nerves admit of this substitution."

1858. Schetterly On Sensation. 683

Now, the attentive reader will have observed that not only
this has been accomplished in the preceding articles, with
regard to all the most important functions, and could easily
be done with regard to the rest ; but that, in addition to this,
the adaptation of the nervous system expressly to the action
of electricity, has also been clearly demonstrated ; and every
other objection to the electrical theory has been reconciled
with it. To enumerate: — 1. It has been shown that the
principal objection — namely, that no electric current can be
discovered in any nerve, during the most intense action of
its corresponding muscle, — constitutes an essential condition
of the nerves to the action of electricity through them. 2. It
has been proved, by TV. Philip's experiments, that both
digestion and respiration may be kept up by electricity, after
the nerves on which these functions depend bave been di-
vided, and their normal action destroyed. 3. By Prof. Ure's
experiments, it has been shown that muscular contraction,
respiration, the most decided, and the most striking expres-
sion of the passions and emotions of the mind, may be
renewed after death by hanging. 4. By M. Donne's experi-
ments on living animals, it appears that the acid skin and the
alkaline mucous membrane of the intestines or mouth form a
voltaic battery, the effect of which is decidedly appreciable
by the galvanometer ; and that still stronger electric currents
exist between the acid stomach and the alkaline liver. 5. By
the experiments of Fodera, it is proved that absorption and
exhalation are also under the control of, and may be greatly
accelerated by, the action of electricity artificially applied to
the living organism.

It has been already stated, on the authority of Dessaignes,
that electricity may be pressed out of all substances. If, for
instance, pressure be made on the eyeball, behind the cornea,
so as to affect the retina, concentric luminous circles will be
seen opposite the part on which the pressure is applied ; and,
if the pressure be continued twenty or thirty seconds, a broad,
undefined light, which increases every moment in intensity,
rises immediately before the eye. If the eyelids be then

684 Schetterly On Sensation. Feb.

opened in the presence of light, and the experiment repeated,
a dense cloud appears before the eye, which becomes per-
fectly blind in a few seconds; but when the pressure is
removed the cloud rolls away in a few seconds, and sight is
restored. Hence, it appears that the electricity pressed out
of the humors of the eye produces the phenomena of light
and, when dissipated, leaves the eye blind ; but when the
pressure is removed, the nerves supply the electricity anew.
That this effect results from electrical action, is proved by the
fact that, if a piece of zinc be placed under the upper lip and
a piece of copper above the eye, the same appearances are
produced without pressure. In this latter experiment, physi-
ologists attribute the production of the light to electrical
action, but, in the former, to mechanical pressure. But there
should be no doubt that the immediate cause of the lumin-
osity is the setting free of electricity in both cases. Anato-
mists generally agree that the iris of the eye is a muscular
structure ; yet, unlike other muscles, no mechanical irritation
can excite it to contract. But the direct application of solar
light and electricity produce contractions of it immediately.
This indicates that light and electricity are the same agent,
and substantiates the conclusion, alreadv drawn from the fact
that animals born with their eyes shut are destitute of calori-
fication, that electricity enters the organism through the eyes,
as well as through the lungs — aiding in the process of calori-
fication, and exciting vision at the same time ; — for it has
been proved that both light and heat are the effects of elec-
trical action. By analogous experiments on the living system,
with electrically-related metals, it may also be proved that
the senses of taste, smell and hearing are dependent on elec-
trical action for their excitation ; and every one knows that
the sense of feeling is very acutely excited by the passage of
an electric current through any members of the body. From
these facts it follows that electrical action is the primary
cause of sensation in general ; for it is unphilosophical, being
contrary to the simplicity of nature's uniform laws, to attrib-
ute the same effect to more than one primary cause, operating

1858. Schetteelt On Sensation, 685

on the same substance and under the same circumstances ;
and to conjure up a multitude of primary causes, exciting
each other to action, as physiologists are in the habit of
doing, is an absurdity, and an effectual bar to all progress in
science.

According to Dr. Hitter's experiments, as cited by Prof.
Ure, the electricity of the positive pole augments, while the
negative diminishes, the actions of life. Tumefaction of parts
is produced by the former — depression, by the latter. The
pulse of the hand, held a few minutes in contact witli the
positive pole, is strengthened ; that of the hand in contact
with the negative is enfeebled. The former is accompanied
with a sensation of warmth ; the latter, with a feeling of
coldness. Objects appear, to a positively-electrified eye,
larger, brighter, and red ; while, to one negatively electrified,
they seem smaller, less distinct, and bluish, — colors indicating
opposite extremities of the prismatic spectrum. The acid
and alkaline tastes, when the tongue is acted on in succession
by the two poles, are well known, and have been ingeniously
applied by Sir IT. Davy, in his Bakerian Lectures. The
smell of oxymuriatic acid, and of ammonia, Dr. Ritter says,
are opposite odors, excited by the two opposite poles ; as a
full body of sound, and a sharp tone, are the corresponding
effects on the ears, when the olfactory and auditory nerves
are acted on by the two poles. These annunciations may not
be so strange as, on first thought, they may appear, when it
is recollected that the positive is the discharging pole, and
consequently imparts electricity ; while the negative is the
receiving pole, and therefore abstracts electricity.

In the article on magnetism, it is proved that polarity is an
effect of electrical action, and that like magnetic poles repel
each other, and therefore recede, while unlike poles attract,
and consequently approach each other and adhere. When,
therefore, particles of any substance collect together and ad-
here, arranging themselves in determinate order, and form
bodies, it is manifest that those particles are polarized by the

686 Schetterly On Sensation. Feb.

agency of electricity, for this is the only known cause of
polarity. Now, the latest microscopic observations on the
blood, made by Drs. Young, E. Home, Hodgkin, Dumas,
Prevost and others, show that the blood-corpuscles are flat-
tened disks, consisting of a red vesicle, which gives color to
the blood, and a central colorless nucleus. Mell, Dumas and
Prevost observed that, during the process of coagulation, the
vesicles burst, and the central nuclei are attracted together,
and arrange themselves into fibres, which form a network
that entangles some of the serum and colored vesicles of the
blood. These being washed away, the network is found to
be pure fibrin. Dr. Hodgkin observed the process by which
this network is formed, which is as follows : After the blood
has been drawn from its vessels, he first observed a consider-
able agitation among the corpuscles ; but, as this subsided,
they applied themselves to each other by their flat sides,
forming fibres that were sometimes of considerable length,
which often, again, combined among themselves, forming a
network. The jmilosophic reader need not be informed that
it is utterly impossible to account for these phenomena on
any other principle, than that of electrical action ; and this
not only explains them completely, but gives us, also, a dis-
tant view of the manner in which organization itself is
effected.

At present, Physiology consists of a mere heap of observed
and experimental facts, and vague conjectures of causation ;
and yet it must necessarily constitute the basis of scientific
medical practice. Who can wonder that, under such circum-
stances, the practice of medicine remains a mere system of
empiricism, wThen neither the cause of life, nor of disease, is
understood, and when certain remedies are prescribed in
certain cases, because somebody says he has found them use-
ful in similar cases ! Every impression must necessarily be
made primarily upon the nervous system, for this alone is
susceptible of being impressed. It is, indeed, very probable
that the famed miasma, which has never been detected,

1858. Schetterly On Sensation. 687

nor its nature or even existence demonstrated, consists in
nothing else than electrical changes, first in the atmosphere,
and then, through this medium, in the nervous tissue of the
living organism. In the Asiatic Cholera, for instance, almost
all the fluids of the system are poured into the intestinal
canal, carrying off the electricity from the nervous centres,
and thus preventing the development of animal heat. It is
manifest that, in this disease, nothing but a change in the
distribution of electricity among the fluids and solids is
necessary to produce the effects witnessed in this disease ;
for, under Endosmose and jExosmose, it has been shown that
positively-electrified fluids pass, through an animal mem-
brane, into negative with great rapidity. That this disease is
caused by such an electrical change in the system, is proved
by the fact that severe spasms of the muscles always attend
it, as they do when the electric circuit, in experiments on
animals, is either closed or opened, as shown by Matteucci.
Accordingly, the so-called exclusively nervous diseases, are
entirely under the control of artificial electricity, when prop-
erly administered. By transmitting an electric current from
the nape of the neck to the pit of the stomach, Dr. Wilson
Philip gave decided relief in every one of twenty-two cases
of asthma. From the peculiar relation of water to elec-
tricity, so often noticed, it is not strange that it should be
exceedingly useful in many diseases ; and this relation can
alone account for the prevalence of what are called mias-
matic diseases in marshy regions and districts where a vast
quantity of organized electricity is set free by the decompos-
ition of vegetable matter ; or where the free electricity of the
atmosphere is absorbed by stagnant water. Miasma is a
mere creature of the imagination, whose existence has been
inferred solely from the existence of diseases supposed to be
produced by it.

688 Clark's Case. Feb.

Article HI. — Successful Operation for Vesico- Vaginal Fis-
tula. By E. M. Clark, M. D.

Mrs. has been afflicted, during the past two years,

with a vesico- vaginal fistula, caused by an ulcerative process
excited by, and giving exit to, a phosphatic calculus. On
examination, the fistula was found to be situated about mid-
way between the cervix uteri and the neck of the bladder
— of circular form, and nearly three-fourths of an inch in
diameter. Urine dribbled from itconstantly, rendering the
patient in every sense wretched.

The external parts were extensively excoriated. The uter-
us was prolapsed, and its anterior lip much enlarged and
ulcerated. The perinaeum anterior to the anus had sloughed,
leaving a cicatrice too firm to admit of much expansion.

This cicatrice, together with the prolapsed condition of the
uterus, rendered it impossible to get as fair a view of the fis-
tula as can ordinarily be obtained.

The patient having been placed on her knees on a couch,
with the head and shoulders depressed, with the assistance of
several eminent medical gentlemen of this city, I proceeded
to close the fistula.

The uterus was carried up and supported in its proper pos-
ition by a ring having a stem some ten inches in length,
which was held by an assistant. By this means, together
with the manipulations and speculum recommended by Dr.
Sims, I was enabled to reach the fistula.

I pared away the vaginal mucus membrane from the edge
of the fistula, to the extent of about three-eighths of an inch.
This is emphatically the difficult j^art of the operation. I
then introduced four sutures of fine annealed silver wire —
being careful not to allow the needles to penetrate the mucus
lining of the bladder. The wires, having been placed, were
readily so adjusted as to bring the scarified surfaces in per-
fect coaptation, and then twisted. The patient was then
placed in bed in a prone position, a Sims' catheter intro-
duced, and two grains of opium administered.

1858. Clark's Case. 689

I had provided myself with the lead bars used by Dr.
Sims, and the buttons used by Dr. Bozman, but I saw no
occasion to use either. The twisted suture is much less com-
plicated, and has, in this case at least, given a satisfactory
result.

I found it necessary to remove and cleanse the catheter
twice daily. A sufficient amount of opium was ordered to
keep the bowels quiet till the seventeenth day.

On the ninth day, I removed the sutures, when union was
found to be perfect throughout the whole extent of the scari-
fied surfaces. The patient was then directed to insert the
catheter, at intervals of from two to six hours, for a few days.

On the seventeenth day, the bowels were moved by an
enema, — she having suffered no inconvenience from this
prolonged constipation.

The principal inconvenience^ to the patient, during her
confinement after the operation, results from the constant
flow of urine upon the nates and vulva. This may be readily
obviated by a very simple apparatus — viz : a piece of flexible
gum-elastic tube, some two feet in length, attached at one
end to the catheter, and at the other to any sort of a vessel
which will serve to receive the urine. I use, for this purpose,
a transparent glass bottle, which enables me to determine
whether the urine is passing freely or not. This tube should
be so secured to the patient's thigh, as to prevent traction
upon the catheter. This may be done by adhesive plaster, or
by tape tied around the patient's thigh.

By the prone position, the fistula is more effectually pro-
tected against the injurious effects of the urine ; and, after
the first twelve hours, the patient will not object to it.

If the Sims' catheter be used when the patient lies on her
face, the anterior orifice should be extended back to the
angle. The reason will be obvious when you examine the
catheter.

This morning (Jan. 5th, 1858), twenty-6ix days since the
operation, I received the following note from my patient :

" Dr. Clark : — The water passes freely, and in as natural

690 Allen On the Mechanism of Nervous Action. Feb.

a manner as ever, — attended however, at the close, with a
slight pain, the same as when the catheter is withdrawn.
Shall I allow it to take care of itself, or shall I insert the
catheter occasionally ?"

[The operation of which the above is an example has be-
come one of the standard proceedings of surgery. The prone
position of the patient, adopted by Dr. C. in this' case, goes
very far towards insuring success, and enables the surgeon to
dispense with the bars or buttons, in the absence of which he
can examine the wound from time to time ; and, in case of
deficient or bad action, he is enabled to make such applica-
tions as may be indicated. — Ed.]

Article IV. — Mechanism of Nervous Action — Prof. Canvp-
oelVs Prize Essay, dec. By J. Adams Allen, M. D.

Facts, whether collected by observers or experimenters,
are but the field-notes, by the aid of which the reflecting
mind maps out the principles of science. Some people seem
to think that the accumulation of " field-notes " is all that
is permissible, and suppose that therein they are strictly
carrying out the principles of the Baconian philosophy.
From this vicious idea, their minds become microscopic to
that extent,

" that, with optics sharp I ween,
They see what is not to be seen,"

and cannot see what rises before them in colossal proportions.
They can see minute resemblances — they cannot see vast
diversities. They can see isolated and barren facts — they
cannot see their frequent "prerogative" nature, whereby
they demand the admission and establishment of profound
laws, which will not only include them, but an immense
number of, as yet, unexamined instances.

The motto of the work before us — " Observation becomes
experiment when used in severe processes of induction "—
indicates a truth well worth remembering in this connection.

1858. Allen On the Mechanism of Nervous Action. 691

Experimenters, who are but the hewers of wood and carriers
of water in science, having no kind of idea of the symmetrical
plan of the building, hold in small repute the labors of the
architect and'draughtsman of the edifice — him who sees, in his
mind's eye, the completed structure or the grand generaliza-
tion. But experiment, like faith, without works, is dead;
and, uncombined with observation, it is inert and unprolific.
It is observation which is the vitalizing principle ; and with-
out this you may marshal experiments in vain. It is grown
a fashion to disparage observation and magnify experiment,
as a means of arriving at truth, so that many writers fall into
error from mere imitation, with no clear idea of their own
whatever. Y> hen, therefore, we read of the "severity of the
induction " necessary to render " observations equivalent to
experiments, we ought to charitably allow that the writer
employs other persons' thoughts, to the saving of any expend-
iture of his own feeble stock of brains. He but follows the
fashion of the times, and the sin of that ignorance let ns wink
at.

Thus much for a contemporary reviewer, who evidently
has read no more of this essay than the motto.

The object proposed by Prof. Campbell to himself "is to
develop more fully a function of the nervous system, which,
though enunciated and described nearly seven years ago in
this country, is only now beginning to be recognized by the
profession in Europe. We refer to that function which has
been termed the Excito- Secretory, and which results from the
relation between the excitor or sensitive nerves of the cerebro-
spinal and the secretory branches of the ganglionic Bystenu"

The train of argument, in support of his proposition, Is re-
ducible to the following series :

1. The intimate anatomical relation of the two systems of
nerves — viz: the cerebrospinal and the secretory or gan-
glionic.

2. The peculiar distribution of the ganglionic nerves upv>n
the blood-vessels supplying secretory surfaces and glands.

3. The enlargement of the ganglionic nerve centres in pro-

VOL. III., NO. XII. 46.

692 Allen On the Mechanism of Nervous Action. Feb.

portion to the activity of the nutrient or secretory process in
the organs which they supply, even when the causes of in-
creased activity are only temporary.

4. The effect produced upon nutrition (e. g., ulceration) by
artificial or pathological section of the sympathetic, together
with experiments showing the independence of the circula-
tion, of the cerebro spinal system.

5. Observations and experiments on the fifth pair of nerves
— particularly those of Magendie.

From this resume, he adopts the generally-received opinion
of Bichat, that " to the ganglionic system alone are confided
all those important and mysterious processes which pertain to
nutrition and secretion.

From the facts set forth in the well-known paper by Dr.
Davey, on the sympathetic system {London Lancet, June,
1853), "and also from analogies to be found in the animal
kingdom and in pathological records, we find that an inde-
pendent existence can be maintained under the sole influence
of the secretory system of nerves.

Thus far there is no novelty in the views presented. He
then passes to explain the received views upon the relation
existing between sensory and motory nerves, as explained by
Dr. M. Hall, — the excito motory system.

The time has gone by when it is necessary to dilate upon
the immense stride in advance, which both pathology and
physiology have taken since that splendid induction of the
London physiologist, — the world has placed its laurel crown
upon his head, and the century points to him as immortal.
Thinking men have long since desisted from attempting to
detract an iota from his well-earned fame, to lavish upon
whatsoever predecessor, or to gratify the personal malice of
whatsoever pensioned organ of opposing professional cliques
or colleges. Even hatred itself has forgotten to stand haugh-
tily " non-committal," and has bowed before the supremacy
of his genius. Ignorance only talks of " progressive develop-
ment " and " noise," — an ignorance so gross that it sinks to a
lowerdeep than the profoundest contempt can reach.

1858. Allen On the Mechanism of Nervous Action. 693

Prof. Campbell observes :

"These same sensory nerves are not only excitors to the

motory system, but, under certain circumstances, most of
them sustain an analogous relation to the secretory nerves,
exciting them and modifying their action, diminishing, in-
creasing and altering the secretions, according to the extent
and character of the irritation applied. It will be our object,
then, to show that the sensory nerves, or, at least, some of
them, sustain to the other two portions of the nervous system
a double relation : First, excitors to the motory system,
giving rise to the excito-motory system, described by Dr.
Marshall Hall in 1837 ; and,

" Secondly, excitors to the secretory system, resulting in the
excito-s<-<-rttory system, enunciated first in this country in the
year 1850, and which second system Dr. Marshall Hall did
not appear anywhere to recognize, until the present vear,
1857."

In the establishment of this proposition, he cites various
phenomena of the animal economy as strikingly illustrative.
Thus, the correlation of the skin and kidneys, and internal
secretory surfaces, is shown not to be dependent upon the
gross hydraulic principle of " driving in of the fluids," or on
any fanciful "antagonism" or " sympathy," but to be clearly
a reflex function of the nervous system.

"But. in order to study the excito-secretory system in its
most obvious relations, it will be necessary to select some
portion of this system wherein a single excitor nerve will be
found to exercise Its influence over an extended region, be-
coming productive of a diversity of result

The fifth pair are accordingly selected, and irritations of its
brandies are traced to a great variety of results, among which
we may enumerate :

1. "Modifications in the circulation, secretion and nutrition
of the eveball. which acts are under the immediate reigm of
the ganglionic system."

'2. The same with reference re the nostrils, fauces and
pi larynx.

3. With reference to cutaneous eruptions— "tooth rashes,"

OVC.

4. AYitli reference to cavities and interspaces . ".. droj sv,

694 Allen On the Mechanism of Nervous Action. Feb.

the urinary secretion, involuntary micturition, &c, — ad-
ducing also the beautiful experiments of Bernard.

Aberrations of secretion in hysteria are also suggested as
analogously explained.

In each of these cases, Prof. Campbell points out the par-
ticular track of the excitor and reflex action, and clearly
develops a large series of otherwise inexplicable phenomena.

In a manner entirely analogous to the excito-motory system
of Hall, two classes of nerves— viz : incident and reflex — are
presumed — the incident or excitor series being the sensory
nerves of the cerebro-spinal system ; the reflex nerves being
ganglionic (secretory, gray fibre, gelatinous fibre, &c.,).

We do not understand him to mean that any portion of
the ganglionic nerve is excitor to its centres in that system.
At all events, this is not the point which he considers. The
point which is especially insisted upon is that the sensitive
cerebro-spinal nerves are the excitors of the ganglionic
nerves, precisely in the manner in which they affect the mo-
tor fibres of the cerebro-spinal system.

Xo person can arise from Dr. Campbell's transparent ex-
position of the law of operation in this case, without becoming
fully sensible that the doctrine is one of vast importance in
the euclidation of heretofore occult ju-oblems of health and
disease. The discovery of Hall, though the parent of this, in
practical effect upon our knowledge of disease, is of compar-
atively little moment. Who will claim, for an instant, that
diseases of the motory apparatus are to be compared with the
vast catalogue that involve the nutrient and secretory ?

The clearness, force, and concise brevity, with which Prof.
Campbell has presented his views, are worthy wof all praise ;
and his article, as a whole, may be taken as a model medical
essay. It affords us one of those rare instances wherein prize
essays are more than mediocre.

Whoever may have taught these doctrines, or entertained
these views, prior to the author of this essay, it is very evi-
dent that no person had previously recorded them in printer'6
ink. So far as the author himself and the medical public at

1858. Allen On the Mechanism of Nervous Action. G95

large are concerned, they are unquestionably original, as
they are most certainly seen to be, in the language of the
lamented Hall, " of vast importance."

Bichat, whose division of the nervous system into animal
and organic is adopted by Prof. Campbell, entertained some
very singular ideas with reference to their relation to each
other.

Sir Charles Bell observes: "The opinion, borrowed from
the continental writers, and more particularly Bichat, has
been entertained, that the sympathetic nerve of the human
body was the same with the nervous cord found running
down the centre of the vermes. This is paying too much
respect to a name — too little attention to nature.''

Bichat supposed that the passions and emotions had their
seat in the ganglionic centres {i. <?., of the sympathetic), and,
by this continuity of structure, could act upon the brain and
hence upon animal actions. lie recognized, from this loose
assumption, what we may term the influence of a particular
mental state, having its seat in the sympathetic, a secondary
effect upon motions.

Passion and emotion, located in the ganglionic nerve cen-
tres, excite, sympathetically (by continuity with "the nervous
cord found running down the centre of the vermes"), the
brain, the seat of perception and will; and its "reaction on
the muscles which receive it (the affection or change of form)
from the nerves, will produce in them those motions which
we observe." A mental art in the sympathetic ganglion
produces a motion elsewhere. How this could he explained
perplexed him, but he still adhered to the Location of the
passions ani emotions, and suggests:

"Perhaps the internal organs do not act upon the voluntary
muscle> by the intermediate excitement of the brain, but by
direct nervous communications ; /""r th\ y act is of no const -
auence. * * * What is most essential is the fact
itself; what is evidently in support of it is, on the one part
the affection of an internal organ by the passions ; on the
other part the determinate motion to this affection in muscles,

696 Allen On the Mechanism of Nervous Action. Feb.

over which this organ has no influence in the ordinary series
of phenomena ;" — that is, except under the influence of emo-
tion or passion.

The nearest approximation of Bichat to the views now
under consideration, then, reduce themselves to a possible
affection of the Drain and secondary effect upon the muscles;
and even this modus appeared so incomprehensible to him,
that he inclines to adopt the idea of " direct nervous commu-
nication."

Broussais, another speculatist, to explain this obscure point,
boldly assumes :

"The cords of the great sympathetic are continuous with

the cerebral nerves, and are to be considered like these latter,
as conductors of irritation. This granted, it must of necessity
follow that irritations which are developed in the viscera,
where the great sympathetic predominates, should be com-
municated to the encephalic centre.

"It is also ecpially indispensible to admit that irritations or
volitions emanating from the brain should be carried into the
ganglionic nerves, and penetrate, by means of these latter,
into the tissues in which these nerves are distributed.

"There is then reciprocity of stimulation between the
encephalic and ganglionic nerves — that is to say, they serve
as exciters of each other."

— Because confirm on* with each other!
Again, in explaining the effect ot excessive pain, in pro-
ducing involuntary agitation and delirium, he says:

"All the perceptions being, as I have proved, reflected
from the brain to the viscera, the irritation caused by an ex-
cessive pain must be transmitted to the great sympathetic."

And again :

"The great sympathetic establishes, in the interior of the
body, relations between the viscera, and regulates their par-
ticular movements. For the exercise of this function, it bor-
rows stimulation from the encephalon, and transmits some to
it at need.

"The great sympathetic receives stimulation from the
cerebral nerves, which are themselves indebted for it to
external bodies, and make use of it to bring into play the
cephalo-splanchnic and splanchnic muscles, and the coats of
the arteries."

1858. Allen On the Mechanism of Nervous Action. 697

It is thus seen that Broussais starts with the assumption
that the ganglionic nerves are continuous with the cerebral
nerves, and thus their sympathy is one of continuity of struc-
ture. The brain and perception are the only mediums of
what is now termed reflex action ; and the action itself is ex-
hausted upon the cephalo-splanchnic and splanchnic muscles,
and the coats [muscular !] of the arteries — and all these under
the vague influence of his omnipotent General Irritation.

The extracts which we have given, " and particularly the
last two, contain a very clear enunciation " of the total
diversity of the views of M. Broussais from those now before
us. They contain the ingenious speculations of an enthusias-
tic dogmatist ; and are at the present time more noticable
for the obscurity in which, for a long period, their adoption
veiled the whole subject. The bitterest enemies of Marshall
Hall never ventured to insinuate, even, that Broussais had
any claim to priority in this matter, although they did find,
in the sensational reflex phenomena quoted by Whytt and
Prochaska, enough of system to give a faint color of support
to their ceaseless calumnies upon him. They may be said to
approximate the present view, so ably set forth by Prof
Campbell, about as the " flux and reflux of fluids" of olden
time, approached the beautiful discovery of Harvey. It is
deplorable to find that the rancor of professional cliques, and
mere personal malice, can lead medical writers to seek to
confound the results of sound inductive observation and ex-
periment with the obscure gropings of a speculative fancy.

It is well to recollect that the mere statement of phenom-
ena is a far different thing from that wide generalization
which reduces them to orderly series.

When, therefore, old experimenters and writers speak of
the operation of medicines through the medium of the nerves,
it is proper to inquire what they understand by this state-
ment.

The reply of one will be, that the nerve fibre transmits the
irritation by direct continuity — as Bichat and Broussais.
Another, that it affects the vital force, under whose demon-

698 Allen On the Mechanism of Nervous Action. Feb.

iac inspiration the vital properties of distant parts are acted
upon — as Stahl and Paine. Others, receiving the excito-mo-
tory system of Hall, suppose it to call into action the muscles
and muscular coats of the arteries supplying particular parts
— as Todd and Bowman, Pereira, &c.

There cannot be found one, who, till the present discov-
eries, has ever suggested any other reflex change than
motion, except where mental action is involved ; and none
have pointed out the excitor and reflex relations of the
cerebro-spinal and ganglionic systems. Many have said, the
apple falls, but it was Newton who said 'why.

Thus, the statement of operation of medicines by sympathy,
as by Morgan and Addison, and a vast number^of other wri-
ters, was the expression of, to them, inexplicable phenomena.

Thus, the statement of irritation of the alimentary canal
and its appendages ; the occurrence of " tooth rashes," &c,
as incident to dentition, has been made from time immemo-
rial ; and has been made with as little reference — as in the
analogous case of laughing, vomiting, or other convulsive
muscular action from titillation or injury of particular points
or surfaces — to any physiological law of operation.

Pereira observes : — " The arguments in favor of the sym-
pathetic action of these agents (medicines) are few, feeble and
of doubtful validity. The experiments of Dr. Blake appear

TO ME TO HAVE GIVEN THE COUp-de-grace TO THE LATTER {i. C,

the sympathetic) hypothesis." — So much for Pereira's " ex-
planation of the excito-secretory system applied to therapeu-
tics."

But Pereira admits that sundry agencies — e. g., electricity,
heat, cold, light, mechanical irritants and corrosives — affect
remote parts through the agency of the nervous system.
" They act," says he, " on the principle of shock " (referring
to Marshall Hall's Gulstonian Lectures in 1842, — vide Perei-
ra, vol. 1, p. 162). Pereira adopted Hall's explanation of the
modus, and his only • and this involved ' nothing but motor
action. Otherwise Hall himself could base a claim to prior-
ity on the date, 1842.

1858. Allen On the Mechanism of Nervous Action. 699

Pereira himself is careful to separate the action of these
agents from that of medicines proper, and compares them
rather (with Liebig, whom he quotes,) to the action of red-hot
iron or the knife ! There is no reference by him to any phys-
iological law of action — he never dreamed of it ; — the phe-
nomena he adduced were those of death and utter overthrow
of physiological laws.

Todd and Bowman differed from Marshall Hall in dis-
carding the difference between the cerebro-spinal and true
spinal systems. The entire encephalic and spinal cords, with
their appendages, furnish but a single system of afferent and
efferent fibres, converging to a single axis of ganglia, fused
by commissural fibres and conducting vesicular neuvine.

With this exception, the modus of action was precisely
identical with that of Hall — continuity with the brain being
necessary to mental phenomena. Their view simplifies the
subject materially ; but it is well to recollect that it contains
not even the germ of the present doctrine.

Their view of the sympathetic functions is as follows :

" The sympathetic appears to exercise a three-fold office —
first, that of a sensitive nerve to the parts to which it is dis-
tributed ; secondly, that of a motor nerve for certain muscu-
lar parts ; and thirdly, that of a nerve to blood-vessels. It is
almost certain that blood-vessels enjoy in their coats a power
of contractility ; and it seems highly probable that these
nerve-fibres exercise an influence upon that contract Hit >/.
Such an influence, it is evident, would materially affect the
nutrition of parts, the blood-vessels of which are subject to it;
and, as secretion is mainly dependent on the normal nutrition
of glands, it is reasonable to suppose that that function like-
wise would be to a certain extent controlled by these nerves."

It is worthy of notice that these authors do not even allude
to any reciprocal reflex action between the cerebro-spinal and
sympathetic systems, nor dwell upon any usual reflex action
among its own sensitive and motor nerves. S<> far as this
essay is concerned, they may be thrown out of the question.

The discovery of the difference in function between the
anterior and posterior roots of the spinal nerves was first defi-
nitely made by Alexander Walker, in 1809. Sir Charles

700 Allen On the Mechanism of Nervous Action. Feb.

Bell, who lias the general credit of it, it is more than prob-
able, derived the idea from Walker. But it is quite remark-
able that Walker believed the anterior roots to be sensitive.
and the posterior motor in function — which all know to be
just the reverse of the opinion of Bell. The establishment of
the diversity in function of the anterior and posterior roots is,
however, really the gist of the discovery ; and even now it is
not certainly proven, but what Walker is right and Bell in
the wrong. There are very many striking facts in favor of
the position of the former ; but this one thing is evident —
that neither had the remotest idea of pkysica 7 reflex actions.
Sensations and motions were all they had in mind.

Sensations and mental emotions were the necessary precur-
sors of any reflex action-, according to Prochaska, Bichat,
Broussais and every known writer prior to Marshall Hall in
1836. Hall recognized physical reflex acts of motion, inde-
pendent of Bensation or mental action. When mental action
or sensation were involved, he believed there were involved
cerebro spinal fibres; otherwise, only true spinal fibres — but
motion always. The modified doctrine of Todd and Bowman,
which we have already given, is the one generally received.
It does not conflict with, but simplifies, that of Hall.

But modern physiology must recognize something else than
motion. There is a symmetry, a balance, a beautiful adjust-
ment oi' the other phenomena of the system, which equally
demands the systematic action of a superintending function.

Pathologists began to see that -i dillatations and contrac-
tions, accelerations and retardations" were not enough to
account for the remarkable phenomena of inflammation.
They saw that the processes of secretion and nutrition were
subject to modifications not Less noticable than those of the
motory apparatus. The attempt, then, was to render them
subsidiary to motor action by contraction or dillatatioii of
the blood-vessels. Or. feeling the imperfection of this mode,
they cut the gordian knot by subjecting all to the domination
of an abstract vital force, "analogous to the soul," and en-
dowed with creative energy. Strange as it may appear, a

1858. Allen On the Mechanism of Nervous Action. 701

prominent medical journal (the N". Y. Med. Gazette) inclines
to the opinion that this is the best mode of explanation — that
its great defender carries too many guns for any and all an-
tagonists! Is it not as passing strange as pitiful, that so
much darkness can prevail where light can so easily be had ?

On the whole, this is established :

The excitor branches of the cerebro-spinal axis, prove also
excitor to the nerves of the ganglionic chain, thus modi-
fying nutrition and secretion. This is demonstrated by Prof.
Campbell, so far as human observation, experiment and
reason can demonstrate any proposition.

It is a magnificent starting-point for future progression.

The writer of this article begs to add, that this is but a
branch of a wider generalization, which, since 1848, he has
believed the facts warranted, and which will be seen to
include all the phenomena of nervous relation.

He believes, with Bacon, that whereas, while myriads of a
certain class of facts can establish no law, there are certain
kinds of facts, a single one of which only being known, a
certain law is seen, which will include myriads of future dis-
coveries in the world of facts. They are commanding —
" prerogative."

Thus : All the active phenomena of life take place through
the medium of cells. Each cell is essentially independent,
save of its peculiar fluid nutriment. The assemblage of vari-
ous cells in the organism renders a variety of nutriment
necessary, and the nutrient fluids are so constituted that each
variety is provided for, and by the circulation a proper con-
dition of the nutrient fluid is maintained.

Altered nutrition of any single cell varies more or less the
general nutrient fluid; and variation of the fluid varies more
or less the actions of the single cell.

In vegetable life, the fluid or gaseous nutriment remaining
ever the same, the cells are uniform in action. So tar as the
distinction of organs of vegetable life in the animal being
holds good, so far the same equable result ensues from the
pervading nutrient fluid.-.

702 Allen On the Mechanism of Nervous Action. Feb.

But it is peculiar to animal existence that irregularities in
the nutrition of particular parts should ensue. These are
what distinguish animals from vegetables.

It is necessary that there should be a mechanism for
bringing the physical being into relation with external forces
and the high power of mind.

The facts warrant us in believing the cells of that system
to be the dynamic portion, and the fibre the conducting.

By experiment and observation, we everywhere see cells
modified with their fluid nutriment.

We everywhere see molecular or integral changes of the
fluids change the functional operation of the cells — this ele-
ment is everywhere present, whether in or out of the body.
The facts warrant us in concluding this the essential element
of cell modification.

Shall we suppose the nervous system to act upon the cells
in any other manner ? Is it philosophical to invoke a new
cause when one is already known ?

The resulting effect from nervous impulse ever depends
upon the structure reached. ISTo effort of will or art can
produce any other than the effect for which the structure
provides.

Anatomically and microscopically, the nerve-conductors
have precisely the same structure — shall we assume that they
are essentially diverse, unless this be necessary to the explan-
ation of the phenomena ?

The facts warrant us in saying that there is no more real
distinction between sensitive and motor fibres, than between
the fibres of extensor and flexor muscles — the connection is
the thing..

Changes at one extremity of the nerve fibre manifest their
influence at the other extremity, and the result is a modifica-
tion in fluid and cells. This is the whole secret of reflex
action, for the cells and fluids at the extremity secondarily
influenced stand in precisely the same relation to a tertiary
series.

It is unnecessary to suppose the change in the fluid to be

1858. Allen On the Mechanism of Nervous Action. 703

totally dissimilar to a chemical one — indeed, there are myriad
facts which show that often this is all that is effected.

It is not contrary to analogy that nervous fibre has the
power of conducting, or indicating, these delicate changes of
composition at its extremities.

Again : Motion depends upon changes in the cells of mus-
cle ; it is as much an act of nutrition as that of a gland. In
a large proportion (viz: voluntary) of the muscles this is
effected by cerebro-spinal nerves — hence, cerebro-spinal
nerves directly vary nutrition.

Sensation, likewise, depends upon changes in the cells of
the part affected, or in their nutrition, and, indeed, may
shade, by indefinable lines, into actual inflammation. In
most cases, if not all, the nerves of sensation are cerebo-
spinal. Destroy motor, or sensitive, nerves, and the parts
which they modify wither ; and thus of other changes in
them.

But even perception and intellection are varied by changed
nutrition of particular parts of the nervous centre (e. g.
inflammation, various medicines, etc.), and, without lending
a shadow of support to pseudo Phrenology, or cranioscopy,
it is evident that increased activity of mental action modifies,
and even increases the nutrition of the brain.

"We might enlarge, indefinitely, but it is unnecessary, for
our own views are already before the profession.

The ganglionic is not the only secretory nerve — all nerves
are truly "secretory" in their effect, for they all change
nutrition. All "excitor" nerves, therefore, whether their
effect be experienced through the glands, or muscles, or
encephalon, or whatever, are " excito-secretory."

It is to be hoped that there are few remaining in the pro-
fession, so shallow in understanding as to mistake these views
for materialism.

There is, it is true, in them, no acknowledgment of a
"vital force" of occult qualities — neither is there in them
the frippery of " secreted " mental action.

704: Allen On the Mechanism of Nervous Action. Feb.

Indeed, this is the only doctrine which can escape the
charge. It renders necessary a belief in the "substantive
existence of the soul." The physical changes are not ideas ;
the cell-power is not the mind-power.

The appreciative soul commands the material "master
piece of Omnipotence " to do its bidding. From the disin-
tegrating material mechanism, the mind collects the forms
of ideas.

The ignorant looker on half believes that the delicate
mechanism of the telegraph is possessed of a demoniac vital-
ity (as Prof. Paine believes the human mechanism to be
occupied by an occult familiar, " substituted for the creator
and capable of annihilation ; ") but the true physiologist,
with the true christian, sees, in its surpassing analogue, the
human body, the inimitable handiwork of the Supreme
Architect, and the thinking, willing, perceptive human spirit
which He has placed within it to command its operative
parts, and to be impressed by its ceaseless changes whilst life
shall last.

Practically, then, will two prominent results ensue from
the discussion of these laws of the nervous apparatus. There
will be a more rigid investigation^into the remote causes of
local diseases.

And, again, physicians will have enhanced confidence in
the efficacy of medicines, when they sincerely believe they
are treating material changes, and not merely the erratic
perversities of obscure vital forces and properties.

The great length to which this paper has most undesign-
edly prolonged itself must bring it to an abrupt conclusion.

We cannot forbear, in closing, to urge this whole subject
upon the careful attention of the profession, notwithstanding
the persistent and systematic attempts of sundry interested
partisans to prevent recognition and reception of the im-
mensely important advances which have been made in this
deeply interesting branch of physiology.

Kalamazoo, January, 1858.

1858. Haughton Oh Tubercular Phthisis. 705

Article V. — Tubercular Phthisis tfo Result of Imperfect
Cell Action — Continued— With a Consideration of its
Treatment, and Review of som< of tJu different modes
which hurt' been and are now recommended. By R. E.
Haughton, M. I >.

The effects of Alcohol, or any of its preparation.-, upon the
nervous system, are now to be considered, in its relations to

the treatment of tubercular disease of the lungs. We see, in
all cases, an impairment of nervous power, a loss of nervous
energy, and this takes place from the principle causes. One
is the confinement in close rooms over heated, imperfectly
ventilated, and from a knowledge that an insidious and fatal
disease is fastening itself upon vital organs, this is a depress-
ing influence, and impairs nervous powers. The second cause
is a vitiated or changed condition of the blood, and spinal
cord — the elements accessary to the generation of health, ner-
vous power, and this failure grows worse, from day to day,
as the powers of nutrition fail, because every organ is depend-
ent upon healthy nutrition for the manifestation of healthy
power. But some Alcoholic stimulus is recommended, and
. i'- sustain, a- they tell us, the nervous energy. Does it
do it \ Does it do any thing, in such a case, but injury? —
Certainly not. The stimulus goes into the stomach, reaches
the brain through the medium of absorption into the blood
vessel-, stimulates its energio for a time, poisoning its nutri-
tion at the same time. What is the result i The stimutation
passes away, and depression follows. Then the alcohol re-
quires to be eliminated, having exerted its poisonous influ-
ence upon the brain, and it, together with the elements of
waste, passes into the current of venous blood, and return
the heart, thence to the lungs, and burned Off along with the
carbon and other waste products, the result of the activity of
the organs. But the lung- are crippled, and do not carry cm
the process of respiration, hence there is an imperfect aera-
tion of the blood, and this blood poisoned by some alcoholic
stimulant, perhaps brandy, wine, ale — query— can health be

706 Haughton On Tubercular Phthisis. Feb.

regained under this process of poisoning ? Alcohol is a pro-
duct of fermentation, a rotting process, and it is introduced to
assist in curing a diseased or decaying lung, from morbid de-
posits. There is not a particle of nutrition in all that has ever
been manufactured ; and now we expect to derive no benefit
from any agent, unless it assist the nutritive processes, or can
by the agents of nutrition, be converted into fat, and thereby
arrest the blood impairment, which is so marked a feature of
this disease.

But it is said that the immediate effects of alcoholic liquors,
is to produce a deposition of fat. This is true to a certain ex-
tent, but the result of imperfect elimination of material, which
should have been consumed in the respiratry process, or
thrown off by the skin, liver or kidneys. The deteriorating
effect of alcohol, upon admixture with the blood, is deficiency
in plasticity, the red globules diminished ; and more than all
this, aeration of the blood is always impeded — the liver, skin
and kidneys become structurally deranged, from efforts at the
elimination of a poison at which the whole economy rebels,
and with one simultaneous offort endeavor to expel it from the
system.

The deposits of fat, in any case, depends upon the kind of
liquor used ; thus, ale and beer contain saccharine matter
which is either consumed in respiration, leaving the rich ma-
terials of the blood to be converted into fat, and deposited, or
is itself converted into fat. But these again, it must be recol-
lected, do not so readily stimulate as other liquors ; but if the
sugar they contain is the fat producing agent, let it be intro-
duced for that purpose, in some other agent. The deposition
of fat, as well as its production, in the system of a tubercular
patient, is a result greatly to be desired ; in fact, it is the sum
total to be desired in any treatment, because if this takes place
deposits cease to take place, and an arrest of the disease is the
result. But fat can only be produced, as a healthy product,
by and through a good condition of the nutritive functions,
and we do not believe that any stimulant, in the form of alco-
holic liquors, can improve the nutrition, only as a temporary

1858. Haugiiton On Tubercular Phthisis. 707

thing, which will, sooner or later, fail, and leave a depression
of nutrition greater than in the beginning.

To sum up in a few words — the use of alcoholic liquors, in
cases of disease of the lungs, are not warranted, and are like-
ly to be productive of injury to the various organs of the body,
ending in organic disease of the same.

We proceed now to examine the effect of Cod-Liver Oil, in
tubercular disease. The basis upon which this agent was in-
troduced, was the ease in which the system could convert it
into nutrition, and, also, that it contained a sensible portion of
iodine, which also would be beneficial as an alterative. But
I suppose that all the iodine which it contains would never ex-
ert any remedial influence ; hence the oil is continued as an
element of nutrition easily converted into fat, and thereby pro-
ducing the desired result. It must be admitted that cases
have been benefited, or apparently so, and some, perhaps,
have been cured — or at least the disease has been, for a time,
arrested. But it will be found that such cases have been of
that class which I have named — the accidental cases — and in
which there was no original failure of the power of nutrition.
It must be admitted, that where the stomach has failed entire-
ly to digest, or change even fluid injesta, as I have often
seen, it would not be likely to retain or act upon the oil, in
such a way as to be beneficial. First, the smell and taste of
the oil is intensely nauseous to many persons, and sickness of
the stomach is prostrating, impairs the balance of nervous en-
ergy, hence is likely to do more harm than good, especially
as digestion and absorption are dependent upon nervous pow-
er for proper performance. Again ; where the stomach tol-
erates the oil, it may accomplish a good purpose, otherwise it
cannot. Again ; it is well known that there is deficient or
arrested biliary secretions in these diseases, hence the oil can-
not be absorbed so well, as a proper admixture of bile with
any oleaginous portion of food, fits it for absorption. There
is no digestion of oil or fats, so to speak, but an admixture of
all the fluids of the digestive organs, which favors a minute
division of the oily particles favorable for lacteal absorption.

VOL. III., NO. XII. — 47.

708 Haughton On Tubercular Phthisis. Feb.

From observation, I am satisfied this does not take place in
those cases where failure of nutrition is the first and promi-
nent lesion ; hence, the oil fails of its desired effect. In con-
sumption, the principal agents demanded in the system, are
those of the saccharine and oleaginous group, because either
are convertible into fat ; and those of the saccharine group are
useful in the process of combustion aud generation of animal
heat, which last is an important item in the consumptive per-
son, who is always chilly, except in heated rooms, the very
place where, of all others perhaps, he ought not to be, and
which are decidedly prejudical to his present and future
progress towards health. Then, in the place of cod-liver oil>
I would use such agent, either as food or medicine, or both,
as combine these elements, viz : fat and sugar , and in none,
perhaps, do we find them more palatable, or combining them
in more perfect fitness, than in the rich cream of milk. Not
only does it combine these elements, but, also, another, which
has been shown to be of great importance, and which, in this
disease, plays an important part in the morbid process which
are known to take place. I refer to albumen. The cream
contains the oily or fat particles, the saccharine and the albu-
minous element, which ought to be introduced, and a little
experience has shown to me, that it is not likely to disappoint
us in its use. Not only so, the patient can take it, and take
it, too, with the most pleasurable feelings, and is anxious from
time to time to repeat the draught. If there is an indication
for means to improve the blood, and act as an alterative, there
is none which is so likely to do good, as the syr. iod. ferri. —
It contains an element which the blood is commonly deficient
in, viz : iron — and acts as an alterative upon the liver, by vir-
tue of the iodine it contains, and is a tonic. These are among
the chief means, and fill the indications required in any case
of hereditary consumption. If we would assist the digestive
powers of the stomach, pepsin would be the agent I would
select, as coming nearer to nature's effort, in accomplishing
the desired result. Experiments of later date have tended to
confirm Wasmann's inquiries in the following statement :

1858. Hatjghton On Tubercular Phthisis. 709

" In regard to the solvent power of pepsin for coagulated
albumen, it was observed that a liquid which contains IT
10-100 of acetate of pepsin, and 6 drops of hydrochloric acid
per ounce, possesses a very sensible solvent power, so that it
will dissolve a thin slice of coagulated albumen in the course
of six or eight hours. The same acid, with pepsin, dissolved
blood-fibrin meat and cheese, while the isolated acid dissolved
an insignificant quantity at the same temperature. These ex-
periments, by Wasmann and others, would indicate that pep-
sin was a principal agent in digestion, and that when com-
bined with hydro-chloric acid, digestion was performed out
of the body."

If, then, digestion fails, introduce the agent ; and Leibig
taught the doctrine that nature indicated to us, the element
required, and as we followed her teachings we should be faith-
ful exponents of a successful practice. But let us introduce,
pepsin in a failure of digestion, and if we find that food is more
perfectly digested, and nutrition more perfectly carried on,
we do a great work, and do what all our boasted remedies
have failed to do in such a case. We pass over the treatment
of this disease by emetics and bleeding, as relics of past days
in the history of the treatment of this disease, and pass on to
some which are more modern ; and we look at the proposition
of Prof. Green, to cure this trouble even when cavities, (vom-
ica,) exist in the structure of the lungs. Prof. Green says he
injects the solution of nitrate of silver into those cavities,
thereby cures the ulceration, and promotes the cicitrization
of the same, and there is a cure. But it is not quite so easy.
We must recollect that while one crop of tubercles are soften-
ing and forming cavities, another crop of deposits are taking-
place in other portions of the structure of the lungs, and even
if he succeeded in cicatrizing the first cavities, others are to
be produced by the same process as the first. The only safe
rule, is to change the system so the deposits do not take place ;
then what have been deposited may be rendered latent, or
softened, and that is the end of it. He cannot do it by such
means, could he introduce the remedy into these cavities, as

710 Haughton On Tubercular Phthisis. Feb.

he says. But I remark here, it cannot be done ; and even if
it could, it would be eminently dangerous to the patient.

For further remarks upon this point, I refer to the report of
the Committee appointed by the New York Academy of Me-
dicine, upon the paper of Prof. Green upon the subject of
Diseases of the Air Passages, and their treatment. I also re-
fer to a paper of my own, on the Topical Treatment of the air
passages, in the November number of the Medical Observer,
for 1856, in which I review a little that report. The report of
the Committee was divided, the majority agaist the treatment
or its feasibility. A minority report rather in favor of it. I
believe that the larynx may be reached and injected, but no
instrument has ever passed the rima-glottidis and passed
through the bronchial tubes, and injected a cavity in the
lungs. For chronic laryngitis and pharyngitis, the treatment
is feasible and effectual ; beyond that, it is neither feasible or
safe. Not only so, if the whole treatment were eminently
practicable, the disease could not be cured by it, because it
begins wrong — the constitutional difficulty is still in existence,
and the disease progresses as before.

But now we come to the plan of cure by Inhalation. This
plan of treatment is not new, by any means, but has been
spoken of and used by very ancient writers. But in our coun-
try it has been built up into a system of treatment almost in-
dependent, by men who certainly have not clearly understood
the pathology, in its inception of this disease. It is declared
to be curative. But it is not so ; it can only be palliative. —
It begins at the wrong place, and does not do that which is
most required by the vital actions, viz : improve nutrition,
and restore the blood to a healthy condition. Until this be
done, tubercular deposits will continue to take place as cer-
tainly as the sun shines, for it is governed by laws as unchan-
geable as those which cause the revolutions of the planets —
an effect as certain to take place under certain conditions, as
the cause existed. Inhalation boasts of its many and wonder-
ful cures, but they are cures on paper. This treatment is pal-
liative when the vapor inhaled is saturated with anodyne or

1858. Haughton On Tubercular™ Phthisis. 711

soothing remedies. It is only useless to follow this treatment,
as it serves to disappoint the victim of consumption more
surely, as his hopes are fictitiously elevated by reported suc-
cess. If you take a genuine case of consumption, you have
conditions which the inhalation of no remedy reaches — a con-
dition of the blood deficient in iron and sulphur ; and more
than this, this very condition of deficient red corpuscles, be-
cause of deficiency of iron, is one which, of itself, explodes
Inhalation as a system.

Now for the reason. Iron in the blood attracts and absorbs
oxygen, thus in health perfecting all those important vital
changes which preserve health ; but, when deficient in the
blood, the oxygen, though taken into the lungs, does not re-
vivify and reanimate the vital machinery, because the agent
for which it has the greatest affinity is absent, or so much de-
ficient, that it is almost powerless. How shall we build up
the blood? is the great question. We are cut off, frequently,
by the condition of the stomach, from assisting nutrition in
that way ; where shall we begin. I propose now that a treat-
ment by transfusion of blood, is rational, furnishes the mate-
rials, or elements, which are deficient in the blood, and fur-
nishes all the elements which have become deficient, particu-
larly iron. The oxygen of the air then begins to exert its
transforming power, and the vital current carries more of vi-
gor to the attenuated frame of the patient.

I propose to do this, and select, as the proper subject to
furnish the blood, a young person of robust health, free from
any traces of original or acquired disease, and take blood to
to be transfused, either from an artery, or vein, which, in
a healthy person, contain all the elements of repair, for the
economy, being in its highest sense vitalized. I apprehend
that a patient, thus furnished, would soon show improvement,
that the digestive organs would show a greater activity, and
food would be relished and digested — thus, a change would
take place in the very inception and beginning of the condi-
tions of consumption. All the secretions would be better
elaborated, nervous power would improve, and we should

712 Hatjghton On Tubercular Phthisis. Feb.

get an absolute change in the conditious of health, and the
deposits in the lung would become latent, cavities would
cicatrise, cough subside, and we should have a cure of con-
sumption— the only kind of cure we get — if deposits have
been deposited in the lungs. Such a cure is permanent, and,
with care, a patient would live on till stricken down in after
years with some other disease. In no case has transfusion
been (to my knowledge) used, tried, or recommended, in
tuberculosis, though it has been successfully tried in hemorr-
hagic cases, and the result has been a saving of life. In
twenty-three cases of this kind, eighteen lives were saved.
Death occurred in five, because the operation was too long
deferred.

Dr. Polli, in Banking's Half Yearly Abstract, volume 17,
gives these cases. He says of it, "It is safe, simple, and
efficacious.' He recommends it, not only in cases of
excessive hemorrhage, but also in cases of extreme inan-
ition, where there is not time to introduce food in the
ordinary way, or strength to digest it. I have seen a few
cases of consumption where the patient evidently died in a
state of inanition, from inability of the stomach to digest,
and the absorbents to appropriate the nutrition ; whose lungs
were not so impaired but that they might have lived months
longer could they have been nourished. And we almost
always have such a condition of the system of nutrition, and
we want a remedy — nature's own remedy. We have it in
Transfusion of Blood.

M. Trosseau (Ass. Med. Jour.), June 17, 1853, prescribes
raw meat and recent blood as therapeutic agents. He speaks
of animal blood, and attributes its good effects, principally,
to the iron it contains. The Presse Medicale Beige, says that
in Belgium it is a common custom, in some diseases, to drink
bullocks blood in the morning before breakfast. Persons
suffering from Hoemoptysis to exhaustion, rally rapidly by
taking blood in the morning, before it has cooled after
slaughter. It is said that children take it readily. "We
quote these remarks to show the influence of the remedy

1858. Haughton On Tubercular Phthisis. 713

when taken internally — and there is no reason to doubt it as
a remedy in cases of consumption, scrofula, and other dis-
eases where remedies may have failed to effect a cure.

Again, that others may be. assured of the benefit of blood,
as a remedial agent, we refer to the employment of Dr.
Breslau's Extractum Carnis, in the exhaustive diseases of
children — and such great benefit has been derived from it,
that it is worthy of passing notice.

Dr. Mauthner recommends the Extractum Sanguinis bovis,
in all the exhausting diseases of children. The mode of
preparing this extract, is — fresh blood is passed through a
seive and evaporated, in a water bath, to dryness, rubbing
into a powder when cold. Ten to twenty grains given daily.
There is then strong evidence that the elements of fresh
blood, introduced into the human system, will rapidly change
the play of the vital actions; and, more than this, it is
nature's own remedy. Why? Because the blood is changed
into healthy elements, and in this way may be speedily
restored.

Let some of the institutions for the sick — some of the hos-
pitals— make a trial of medicating the consumptive. There
is as much good sense in this as in the use of 01. Jecoris
Aselli — a nauseous remedy, to say the best of it, and most
commonly rejected by the stomach, or, at least, impairing
the tone and power of the stomach already too weak. Some
of our late journals have reported a few successful cases of
transfusion in alarming hemorrhages, and, in another paper,
I might show that the condition of blood in its elements, in
exhausting hemorrhage, and, after them, also in Asnemia,
Chlorosis, etc., as no different, essentially, from the blood of
consumptives. If so, there is no reason that this mode of
treatment should not be given to the poor consumptive inva-
lid, and, perchance snatching the victim of a cruel relentless
disease from his fate, and robbing the cold grave of many
lovely, amiable, and beloved of our common humanity.

Some may say it cannot be done, and say who shall furnish
the life-giving current to the poor sufferer. Friends are

714 Medical Independent. Feb.

anxious and willing — and I have been asked to do it — and
many are ready to bare the arm and supply the life-giving
stream.

The treatment of consumption is the opprobrium of our
art, and suffering humanity demands a cure — and, let not
a man, whose heart throbs in sympathy with the afflicted,
reject any means, from prejudice, or preconceived notions,
but come to the investigation with the feelings of a philan-
thropist, and accept the truth, or reject the error. The plan
of transfusion is already known in other cases. Drs. Leach,
Blundell, Land, Hamilton, Davis, and others, may be con-
sulted in reference to transfusion. Ramsbotham, also, details
perhaps , the readiest mode, and, in this way, it is easy, safe,
and efficient.

I may remark, in conclusion, that I have a full belief in
the curability of consumption — and the testimony of the
profession is all that way. But, to render this disease emi-
nently so, we must change the treatment and meet all the
demands of nature, in her conflict with disease. Let the
profession try it and speak out.

^iibltagnpMtal Hearth

Lectures on the Diseases of Women. By Charles West, M. D, Fellow of the
Royal College of Physicians ; Examiner in Midwifery at the Royal College of
Surgeons of England; Physician Accoucheur to St. Bartholomew's Hospital;
and Physician to the Hospital for Sick Children. Part I. — Diseases of the
Uterus. Philadelphia: Blaxchard & Lea, 1857.

There is no class of diseases capable of awakening more intense
interest in the mind of the general practitioner, than that which is
commended to our notice in the volume before us.

The commanding symptoms of frequent examples of this class of
diseases, "being often most alarming, and often consisting in functional
derangement of other important organs, thus adding complexity to
urgency, the mind of the observant physician is ever on the alert to
detect latent relations and sympathies. Intense interest in this class
of diseases thus becomes a natural result of their treatment. The

1858. Bibliographical Record. 715

work under notice, then, will be received with favor. Its author
has possessed great advantages for observation and study of his spe-
ciality, and the present work he regards as but a " first installment
towards the discharge of that debt which the opportunities of a hos-
pital and the responsibilities of a teacher impose upon him. He
promises, within the next three years, " if health and strength are
spared," a second volume, devoted to " the remaining diseases of
the female system." We trust that the learned and laborious au-
thor may be spared to complete his truly meritorious work.

Commencing, in the first two, with the symptoms and modes of
examination of diseases of the female system, our author devotes the
third, fourth and fifth lectures to the function and disorders of men-
struation. Inflammation and its consequences are considered in the
sixth, seventh and eighth, while misplacements of the uterus are
treated in the next five lectures. Outgrowths and malignant diseases
are discussed in the last seven lectures of the work. We commend
the book to the consideration of all who strive to keep posted in this
interesting class of diseases.

A Dictionary of Medical Science ; containing a concise explanation of the various
subjects and terms of Anatomy, Physiology, Pathology,' Hygiene, Thera-
peutics, Pharmacology, Pharmacy, Surgery, Obstetrics, Medical Jurispru-
dence, Dentistry, etc. ; Notices of Climate and of Mineral Waters ; Formulae
for Officinal, Empirical, and Dietetic Preparations, etc. ; with Freneh and
other synonyms. By Robley Dunglisox, M. D., LL. D., Prof, etc. Revised
and very greatly enlarged. Philadelphia: Blanchard & Lea, 1857.

While veneration for man is not a prominent trait of our charac-
ter, we freely confess to a feeling of profound respect for men who
accomplish great things, who leave their record upon the page of
science. Such a man is the author of the work whose title we have
recorded above. Did his reputation rest upon no other effort, that
enviable superstructure would repose securely upon a work which
ranks with Webster's, and which is a necessity to every medical man
who has any claim to the character of a student.

In the present edition we have added about six thousand subjects
and terms, making the work the most perfect Medical Dictionary in
the English language. It is highly creditable to the publishers,
Messrs. Blanchard & Lea, and a source of gratification to the med-
ical public, that, notwithstanding the great increase in the size of the
book, the price is not enhanced. We venture, in behalf of the Pro-
fession, to thank the publishers for their enterprise and liberality.

716 Medical Independent. Feb.

Spirit 0f tjxe gfobital f m

6to Hemorrhoids, and Prolapsus of the Rectum, with their Treatment,
by the Application of Nitric-Acid. — By V. A. Brown, M. D., Surgeon to
the Enrolled Pensioners and Volunteer Battery of Artillery, London, Can-
ada West. Hemorrhoidal affections have been so frequently the theme
of surgical enquiry, they have excited so much controversy, and called
forth so many monographs from eminent members of the profession, within
the last few years, that one feels no little hesitation in approaching such
a subject. In a practical science like surgery, far more good is in general
done by directing attention to special points, enlarging the field that has
been already sown, and maturing its products, than by lending the mind
exclusively to the conception and propounding of novelty.

A novel idea, being the result of deep meditation and close reasoning,
may in point of utility, though replete with merit, if unaided by any light
antecedently shed on the subject, be without value, while the accomplish-
ment of the task just mentioned can hardly fail to be of practical benefit to
some, and perhaps suggestive to all.

This observation applies with peculiar force to the subject of the present
communication, and may be deemed a sufficient excuse for introducing one
here, which to many may seem too often touched upon.

No class of affections which comes under the cognizance of the surgeon,
is more distressing, or more productive of uneasiness and suffering, either
to male or female, than those of the rectum, particularly if they have exis-
ted for any length of time.

On this continent hemorrhoidal affections are extremely common, to be
attributed in a very great measure to the climate and our mode of life,
which to a great extent tend to cause and promote torpidity of the hepatic
secretions, and with it a general congestion of the whole portal system.
The frequency, also, of dysenteric affections often lays their foundation and
that of prolapse.

They are seldom met with in very young persons, being scarcely ever
produced till the body is completely developed in breadth as well as height,
an age between 30 and 40 being the most common period for them to
begin.

In speaking of piles, two things very distinct in their nature, treatment
and consequences, are frequently confounded with each other, namely, he-
morrhoids and hcemorrhoidal excrescences. The former are nothing but a
varicose state of the veins at the verge of the anus. The veins are branches
of the internal iliac ; they pour their blood into the superior hemorrhoidal

1858. Spirit of the Medical Press. 717

vein, which returns its blood to the vena porta. If this becomes obstruct-
ed from disease or any torpidity of the liver, it would necessarily lead to
congestion of the veins oi the rectum ; and this anatomical fact points out
to us that the remedies, to effect a cure, must be directed to the relief of
the loaded liver. In their texture they are subject to a great deal of varie-
ty. Sometimes, as stated above, they are merely dilated veins or varices
situated near the anus, or lower portion of the rectum, forming prominen-
ces covered by its mucous membrane, or the delicate skin near the anus,
and from which a bleeding takes place whenever there is a great determi-
nation of blood to the parts.

In the other still more complicated cases, viz : of hemorrhoidal excres-
cesces, their texture is more complex, many of them being characterized
by an areolar, soft, spongy structure filled with blood.

At periods when these are in a quiet state, free from irritation, and
without any particular determination of blood to them, they are small
and shrivelled ; but in the contrary circumstances they swell, become
firmer, undergo as it were a kind of erection, and blood is voided from
their surface. Hence their texture is compared by French pathologists,
to the erectile tissues. Numerous arterial branches are distributed to
them, which have often occasioned a fatal hoemorrhage when the operation
of excision is had recourse to for their removal. Hemorrhoids are divided
into internal and external, according to their situation, either above the
internal sphincter, near the verge of the anus, under the thin delicate in-
teguments with which this part is covered. But as an internal pile may
be protruded below the ext. sphincter, the best criterion is its texture, for
it is always covered by the mucous membrane of the bowel, while an ex-
ternal pile is invested by the delicate skin which surrounds the verge of
the anus.

Those internal ones which resemble varices, lie under the mucous mem-
brane, which is often found adherent to ther surface, and so thin that their
blue colour can be plainly distinguished through it.

Varicose piles chiefly make their appearance when the parts are in a
state of congestion, in the form of dark -blue elastic knobby swellings, not
attended with much pain, yielding to pressure, but returning immediately
it is discontinued. In short, internal piles, according to the most recent
authorities, are considered to be prolapsed folds of the mucous membrane,
lining the internal sphincter, extremely vascular, hypertrophied and thick-
ened by long constriction.

External piles have, when the skin is thin, the uniform bluish tint of a
vein ; while internal piles present that purplish colour which resembles the
intense congestion of strangulated mucous membrane.

The former may be snipped off, and there is no danger of hoomorrhage
after the vein has emptied itself ; the latter, if cut away, bleed continuous*

718 Medical Independent. Feb.

ly and profusely, the blood being arterial and not venous. This fact leads
us to a question of great practical interest, viz : ought internal piles ever to
be excised? A very great, variety of opinion exists upon the point. Many
eminent surgeons advocate the propriety of the excision of all kinds of he-
morrhoids, arguing that the ligature occasions excessive danger from phle-
bitis, peritonitis, pelvic abscesses ; and while the advocates of the ligature
contend that the fatal results of hemorrhage which has so often ensued
from excision, ought to render the operation unjustifiable, it may be safely
mentioned, that both operations, in the hands of the most skilful of our
profession, have repeatedly proved fatal, so much so that many have dis-
continued both, chiefly that of excision.

Within the last few years the surgical treatment of this class of affec-
tions has undergone a great improvement, by an agent which, bids fair to
supersede all other mode of interference. I allude to the application of
strong nitric-acid, which has proved eminent^ successful. Its use is great-
ly to be preferred either to excision or the ligature, as being less painful,
very certain in its results, and free from all danger. With the timid male
or female it excites no apprehension, and a second application, should it be
required, is never objected to.

Its use was first introduced into the Dublin School of Surgery by M. G.
Cusack, who has used it with uniform suceess for some years. While at-
tending his clinique in madame Steeven s Hospital, I had numerous oppor-
tunities of witnessing the success with which he used it, and since then I
have myself applied it in many cases with similar results.

Mr. Cusack was very particular in its mode of application. The best
and readiest mode is by means of a small hair-brush, made expresslfy or the
purpose ; or if not procurable, a flat piece of wood, the size of a spatula, but
a little narrower at the end, is to be wet with the strong acid, and applied
decidedly over the pile till its surface becomes a grayish white. A little
oil is then smeared over the part, in order to prevent any free acid affect-
ing the neighboring parts. The chief things to be attended to, are not to
take up too much of the acid on the stick, lest it drop on the surrounding
parts, and to apply it effectually, so as to destroy the mucous membrane
which covers the pile. When this is done, the slough caused by the acid
soon comes away, leaving a healthy granulating surface, which rapidly
heals, and by its contraction produces a curative pressure on the subjacent
distended hemorrhoidal vessels. Frequently after its application, a dysu-
ria comes on, which lasts some hours, sometimes days, and subsides spon-
taneously. There is sometimes, also, swelling, partial or general, of the
areolar tissue about the anus. The patients complain of it a little^ and
generally think that it is the hemorrhoids which come down.

To combat these symptoms, the patient should be confined to bed for a
few days, and kept strictly on low diet, and opiates should be administer-

1858. Spirit of the Medical Press. 719

ed, in order to produce constipation of the bowels. Should dysuria occur,
warm hot stupes to the anal region, with an opiate enema or suppository,
will be found to give great relief, or the hip bath ; and should there be re-
tention of urine, which is sometimes likely to occur in consequence of sym-
pathetic irritation, the catheter should be used. In a few days small por-
tions of sloughs will be seen, indicating that the mortified tumours are
thrown off. Then should any raw surface remain, a mild astringent lotion
will rapidly effect a cure.

The following cases, selected out of many which I have treated, will
show how efficacious are its effects in these troublesome affections.

Mrs. B., aged 32, mother of two children, a very delicate person, had
been subject to piles for two or three years ; they have been greatly in-
creased by pregnancy. She had tried, in vain, various astringent lotions
and ointments, with constitutional treatment. Latterly the parts had be-
come slightly inflamed, and produced such local uneasiness, that she was
willing to undergo any operation that would be likely to affect a radical
cure ; for that purpose she consulted me.

The tumours consisted of dense, elastic, knotty swellings, clustered to-
gether, of a purplish hue, hypertrophied and thickened by long constric-
tion, and situated within the internal sphincter. Every stool caused her,
she said, intense pain. It seemed a remarkably favorable case for nitric
acid. I accordingly recommended its application to her, and, promising a
certain cure, she readily consented.

The following day, having previously perfectly cleared out ber bowels,
I freely applied the acid, according to the method described above. She
suffered considerably after it for several hours. The pain, however, grad-
ually subsided, under the use of the remedies enumerated above. In five
or six days the eschars came away, bearing three or four of the tumors, but
greatly reduced in size. She experienced great relief, and promised to un-
dergo a similar operation, which I told her would be necessary in order
effectually to remove them — whenever I considered it the proper time. In
a month afterwards, I reapplied the acid ; the application being followed
by similar symptoms, but this time with a complete removal of all the re-
maining tumours. Six months have now elapsed since the last application,
and she says that she feels perfectly relieved.

In the following case, viz : one of prolapses of the rectum of more than
88 years' standing, and which, during its continuance, was painfully dis-
tressing to the subject of it, its beneficial results, although only partial, are
extremely marked.

I shall give the gentleman's own history of his suffering. In the year
1819, while serving in India, I had a very severe attack of dysentery.
Shortly afterwards the rectum became relaxed, and continued to do so until
the year 1824, when it became a confirmed case of prolapse of the rectum ;

720 Medical Independent. Feb.

from which time until I consulted Dr. Brown, in April, 1857, it has con-
tinued to trouble me, not only at the time of evacuation of the bowels, but
when I make use of any exertion, such as rowing a boat, digging, &c,
and at times when simply walking. Previously to my consulting Dr.
Brown, I had repeatedly made use of various astringent applications, from
none of which, although given the fairest trial, did I receive the slightest
benefit.

After the first application of the acid, the prolapses did not descend except
when stooling, and then but partially ; and after the second application it
ceased to do so altogether, unless the bowels were confined or too relaxed,
and then even so slightly as to require no force beyond the contraction of
the rectum to return it.

The prolapse, in this case, was of so extensive a nature that on the occa-
sions which I use the acid, I applied it in a very small quantity. So large
a portion of the mucous membrane of the rectum was included in the pro-
trusion, that I was afraid a larger application of the escharotic would
perhaps produce untoward results from inflammation and sympathetic
irritation.

I purpose applying it, if necessary, two or three times again ; when,
judging from the very great improvement and comfort which it has
afforded already, I am very sanguine of its resulting in almost a perfect
cure.

On some of the Internal and other Uses of Chloroform. — By W. R. Gore,
M.D., Surgeon of the City of Limerick Infirmary and District Military Prison.
— During the cholera epidemic of 1854, I had considerable opportunities of
administering this remedy to relieve vomiting, and as an antispasmodic
and stimulant, and amongst the vast number of cases which came under
my care in my public duty, it was a matter of great satisfaction to me to
find that it proved itself to be a remedy of great value. Nothing so readi-
ly relieved the sickness and vomiting, the feeling of oppression, or appear-
ed to maintain the strength of the sufferer, and, by arresting exhaustion,
to prolong the time for remedial measures, or protract the fatal issue, as
this remedy. I, therefore, extensively recommended its use, and had there-
by additional testimony to its value. It was generally combined with am-
monia, tinct. of cardamoms and capsicum, and also with laudanum. The
dose, frequently repeated, was from five to eight minims. Since that time
I have used it to a considerable extent in many other affections, and as, in
my public capacity, I write some fifteen thousand prescriptions annually,
a very ample opportunity has been afforded to me of testing the efficacy of
an agent, compared with which few additions have been made to the Phar-
macopoeia of as great value.

Amongst the poor, chronic cough, with dyspnoea and varied forms of

1858. Spirit of the Medical Press. 721

dyspepsia, very much prevail. In the chronic form of bronchitis, accom- .
panied by dyspnoea and constriction of the chest or epigastrium, I know
of no remedy of equal value. I scarcely recollect a case of this description
in which I have prescribed it, where it has not produced marked benefit,
and for which its repitition has not been sought for with avidity. I usual-
ly combine it with tincture of squill and camphorated tincture of opium in
an ordinary cough bottle. Ten ounces will contain dr.ii of each of the lat-
ter, and dr.iss to dr.ij of the chloroform. Few cases will occur without
experiencing some, if not great relief; many, after a little time, have got
so much better as not to require its continuance. Experience such as this
has given me much faith in this addition to the ordinary medicines in such
cases, and I therefore prescribe it freely, or rather generally.

In those derangements of digestion, accompanied by gastrodinia, grip-
ings generally, flatulence, and disturbed functions of this class, I have
found it most useful when added to the ordinary cardiac mixture. It is
certainly a valuable adjunct in allaying abdominal pains arising from ute-
rine, dyspeptic, and nervous derangement, unaccompanied by acute inflam-
mation, and very much aids the effect of remedies in chronic constipation.
I have had some few cases of ague, in which its administration, anticipato-
ry of the cold fit, was accompanied by manifest benefit. In two out of
three cases which occurred amongst the Royal Artillery in hospital, the fit
was entirely cut short, the third case was cured after the second fit. In
such cases it was combined with considerable doses of quinine, and six
drop doses of Fowler's solution of arsenic.

I have had some cases of asthma which appeared to derive benefit from
its use, the more especially by gentle inhalations during the severity of the
spasmodic breathing, the effects of which were aided by mustard plasters
to the spine.

In cases of vital prostration, I consider it one of the most valuable stim-
ulants we possess.

It is said to be useful in sea-sickness, but I know it to be valuable in al-
laying the nausea, feeling of prostration, and sickness which arise in the
stomach from hepatic affections and other derangements of the chylopoie-
tic viscera, affecting, sympathetically, that organ.

In nervous palpitations and visceral debility from exhaustion of the
splanchnic nerves, it is one of those remedies which, if once the sufferer
uses, he will seek its repetition ; so far I can speak from personal experi-
ence. Analogy suggests many forms of disease — organic or functional —
where its administration ought to afford relief, and to which, no doubt, the
discretion and ability of the profession will apply it. There are forms of
hysterical mania, spasmodic affections, delirium tremens, hydrophobia, tris-
mus, and other affections, where experience of the remedy may add to its
usefulness, and also in typhoid prostration.

722 Medical Independent. Feb.

For the relief of pain externally applied, its combination with tincture
of aconite and anodyne linament, appear its best liquid combination. Dr.ii
of chloroform, dr.iv of tincture of aconite, and dr.iiss of anodyne liniment,
constitute a useful formula.

It is not necessary to observe anything upon its use as a vapour douche
or when inhaled to produce anaesthesia, these forms of its application are
so universally known ; but I hope the instances where I have found its in-
ternal use valuable, may lead to a more extensive test of its utility. — Dub-
lin Med. Press.

On the Proximate Cause and Specific Remedy of Tuberculosis. — Ab-
stract of a paper laid before the Academy of Medicine of Paris, on the
21st of July, 1857. By John Francis Churchill, M. D. — The total num-
ber of cases of phthisis treated by me amounts to thirty-five. All were in
either the second or third stages of the complaint ; that is, they had either
softened tubercles 'or cavities in the lungs. Of these nine recovered com-
pletely, the physical signs of the disease disappearing altogether in eight
out of that number ; eleven improved corsiderably, and fourteen died ;
one still remains under treatment.

I believe that the results, of which the preceding is a summary, taken
in connection with the considerations I have set forth at length in the
paper now in the hands of your Hon. Secretary, will be found to justify
the following conclusions : —

The proximate cause, or at all events an essential condition of the tu-
bercular diathesis, is the decrease in the system of the phosphorus which
it contains in an oxygenizable state.

The specific remedy of the disease consists in the use of a preparation
of phosphorus, uniting the two conditions of being, in such a state that it
may be directly assimilated, and at the same time at the lowest possible
degree of oxydation.

The hypophosphites of soda and lime are the combinations which hith-
erto seem best to fulfill these two requisites. They may be given in doses
varying from ten grains to one drachm in the twenty-four hours. The
highest dose which I have been in the habit of giving to adults is twenty
grains.

The effect of these salts upon the tubercular diathesis is immediate, all
the general symptoms of the disease disappearing with a rapidity which is
really marvellous.

If the pathological deposit produced by the dyscrasy is of recent forma-
tion, if softening has only just set in and does not proceed too rapidly, the
tubercles are absorbed and disappear. When the deposit has existed for
a certain time, when the softening has attained a certain dpgree, it some-
times continues in spite of the treatment > and the issue of the disease

1858. Spirit Of the Medical Press. 723

then depends upon the anatomical condition of the local lesion. I have
made numerous attempts to modify the local condition of the lungs by the
inhalation of different substances, but have never obtained any satisfactory
result independent of what was to be attributed to the specific treatment.
The hypophosphites of soda and lime are certain prophylactics against
tubercular disease.

The physiological effects which I have observed to be produced by the
use of the hypophosphites of soda, lime, potash and ammonia, show these
preparations to have a two-fold action. On the one hand, they increase
the principle, whatever that may be, which constitutes nervous force ;
and on the other, they are the most powerful of haematogens, being infi-
nitely superior to all medicines of that class hitherto known. They seem
to possess in the highest degree all the therapeutical properties formerly
attributed by different observers to phosphrrus itself, without any of the
danger which attends the use of that substance, and which has caused it
to be almost forgotten as a remedial agent. The different preparations of
hypophosphorous acid will undoubtedly occupy one of the most important
places in the materia medica.

The Academy resolved that the paper b referred to a committee, con-
sisting of MM. Louis, Trousseau and Bouilland.- -Dublin Hosp. Gazette,
Aug. 15, 1857.

Inutility of Depletion in Syphilitic Iritis. — Mr. Hamilton, in a clinical
lecture (Dub. Hospt. Gaz.)} condemns depletion in the syphilitic iritis#
His practice is to give to grains of calomel, and one-fourth or one-eighth o.
opium, three times a day, till full salivation, in sub-acute cases ; and in the
acute form, the same quantity every third hour. Where there are other
symptoms, eruptions, etc., the mercurial action should be kept up for eight
or ten weeks. "When the mouth is affected the improvement begins, and
rapidly progresses,

Congenital absence of the Supra-Renal Capsules. — M. Martone addressed
a description, accompanied with a drawing of a malformation which came
under his observation, in which there was a fusion of both kidneys, they
forming but one body, with a congenital absence of the supra-renal capsules.
Ibid.

724: Medical Independent. Feb.

(SMtorial anfc Histellw

VERITAS ET JPSTITIA, SIHE TIMORB.

The Removal Question. — The Peninsular Journal (or at least
one of its editors), in the January issue, defines its position on this
all-important subject; and, as it takes decided ground against the
removal, we propose to consider, in a spirit of the utmost candor,
its several objections. We are glad that the Journal has at last
taken position on this subject, for the known opposition of its senior
editor, and the long silence of his paper, have been matters of sur-
prise to many, who are deeply interested in the welfare of the
University. We are glad, too, because, in the consideration of this
question by the Board of Regents, we are not only willing, but even
anxious, that all the objections to the proposed removal should be
duly set forth. In reference to its silence, the Journal has, it says,

" been governed by a sense of respect for the Board of Regents,
whose powers to do such an act we suppose to be restricted by the
State constitution, and whose wisdom, we believe, would restrain
them from the performance of it, if it were not illegal."

We confess that we were not aware that respect for the Hon. Board
of Regents imposed silence ; and we have too high respect for the
gentlemen composing that body, to believe that they entertain any
such view of the sentiment, or quality, under consideration. On the
contrary, we believe them to be deeply interested in the discussion
of all matters of educational interest.

With regard to the legal question alluded to, as eminent legal
opinion as the State affords, has unequivocally expressed the legality
of the removal ; and it requires no great profundity in legal lore, to
decide, that if the clinical branch of the Medical Department, already
established in Detroit, be legal, the removal of the whole of that
Department to the same locality, will involve no legal disability.

Our readers are already aware that an effort is being made to
remove the Medical Department of the University of Virginia from
its present location, to the city of Richmond. The Peninsular alludes
to this fact in the following manner :

" Quite recently an effort has been renewed, which once proved
abortive, to remove the Medical Department of the University of

1858. Editorial and Miscellany. 725

Virginia, which is situated at Charlottsville, to the city of Richmond,
for the reasons given by those in this State who wish to disturb the
status of our own University, the parties to which, however, not
being liable to the same presumption of pecuniary attaint."

The insinuation that we wish to " disturb the status of our own
University," and " that pecuniary attaint" attaches to our efforts in
behalf of removal, we dismiss as entirely unworthy of a notice in
an article dispassionately discussing a principle of educational policy.

The Medical Faculty of the University of Virginia is composed of
only three Professors, who, being in the enjoyment of a salary of
three thousand dollars each, devote their whole time to teaching,
striving to make their school pre-eminent as a preparatory institution.
Ambitious of this distinction only, they of course oppose the
removal, and one of their number advocates his views in an able
article published in a late number of the Virginia Medical and
Surgical Journal. This article, the Peninsular republishes entire,
and thus speaks of it :

11 The writer expresses, so beautifully, opinions we have long
entertained, on the subject of country medical schools, and of the
place they should occupy in a general system, that we gladly avail
ourselves of this occasion and this mode to repeat them."

It seems, then, that the Peninsular is ambitious of making the
University of Michigan, simply a preparatory school ! That this,
is the inevitable conclusion, will be seen from the following quota-
tion from the article, which the Peninsular so cheerfully and fuily
endorses :

"It is freely admitted, however, that the education of a medical
student cannot be completed at the University. An immense major-
ity of the members of the medical class attend one course of lectures
without graduating, and then matriculate for a second term in some
of the city schools. Even the few graduates never think of passing
at once into the practice of their profession, but always visit some
of the larger cities, in order to prosecute clinical studies for a greater
or less length of time."

This, then, according to the Peninsular, is to be tin1 great result
of free education in the University of Michigan! A preparatory
school!! the students of which must leave the State to seek the
means of completing a practical education! or else, a full corps of
clinical Professors must In- salaried in Detroit, at a hum' additional
expense, and the candidates for graduation be required to have the
preparatory school at Ann Arbor, and resort, for an additional

726 Medical Independent. Feb.

period, to Detroit, to complete their education. This, too, when by
transference of the whole Department, a complete, practical educa-
tion could be furnished by the same expenditure of the University
fund that is required to carry on the preparatory school at Ann
Arbor. Is this economy ? Is it wisdom 1 Is the profession — are
the people of Michigan satisfied with such a result in the State edu-
cational enterprise ? With the ability to afford a perfect education
in practical medicine, and with the resulting ability to establish such
a standard of educational acquirement as would place the Medical
Department in advance of every school in the country, are we pre-
pared to sit down and quietly content ourselves with the rank and
position of a preparatory school1? We are earnestly opposed to
such a Rip Van Winkle line of policy. The Profession moves ever
onward — let us at least move with it. We again quote :

" We propose on some immediately future occasion to showr some
of the evils which are inherent to the custom of turning " first
course" students into the wards of a hospital, as well as the fact
that the whole business of clinical instruction, in the United States,
is placed upon a false basis — that adopted by the University of
Michigan excepted — amounting, in cases that might be specified,
to an unmitigated " sham," as asserted by another writer in the Old
Dominion."

Our readers are aware that toe have never proposed the introduc-
tion of first course students to the hospital course. On the contrary,
we have urged that the last year of pupilage should be zealously
devoted to clinical medicine, surgery and obstetrics ; and that this
course should be made a requisite for graduation. With regard to
the clinical portion of the Medical Department of our University,
as at present organized, forming an exception to the general rule laid
down in the above quotation, a sense of truth compels us to say that
it is the greatest "sham" of all. A single professor teaching clin-
ical medicine, surgery, and obstetrics, in a two-months' course ! It
is in sorrow that we make the statement, and it is due to the Medi-
cal Faculty to say that the course does not meet the approval of
a majority of that body. We cast no reflection on the acting-Pro-
fessor engaged in the course. We cheerfully express the belief that
he has given his whole energies to the work in which he engaged ;
but the course, as established, is utterly inadequate. A two-months'1
course, with a single professor! And this is the exception to the
general rule — " that the whole business of clinical instruction in the

1858. Editorial and Miscellany. 727

United States is placed upon a false basis'7 ! ! Such claims for such
advantages, make us the laughing stock of medical educators. If wc
can do no better in the way of clinical instruction, pray let us not
resort to boasting to make up the deficiency.

To show how utterly inadequate is the present clinical course, we
extract from the Peninsular a statement of the requirements made
\>\ the various licensing boards of Great Britain, which was evidently
compiled by another of the editorial corps of that journal, who,
it is surmised, does not exactly coincide with his colleague in the
removal question :

" The Edinburgh University, for the degree of M. ]).. requires three
months attendance upon lectures on clinical surgery, six months upon
lectures upon clinical medicine, and twelve months attendance in the
wards of the Medical Hospital.

The University of Glasgow, for the same degree, requires twenty-
four months attendance upon a medical hospital, twenty-four months
upon lectures on clinical medicine, and the same amount of time de-
voted to attendance upon a surgical hospital, and upon lectures on
clinical surgery.

The University of Aberdeen requires six months attendance upon
lectures on clinical medicine, three months clinical surgery, tweuty-
four mouths in a medical hospital, and the same time in a surgical
hospital.

The University of St. Andrews requires six months attendance of
lectures on clinical medicine, and the same on clinical surgery, and
ty-four months attendance in a medical, and the same in a surgi-
cal hospital.

The London University requires, for its full medical degree, that
the candidate should have attended twelve months on each of the four
courses of clinical instruction, viz. : clinical medicine, clinical surgery,
medical hospital, and surgical hospital.

The Dublin University requires, f>r the lowest degree of M. I>..
nine months attendance upon clinical medicine; and for the surf
.diploma, twenty-seven months upon each of the courses, medical hos-
pital, clinical medicine, surgical hospital and clinical hospital.

The Queen's University, of Ireland, requires, for tl degree,

six ?no)iths attendance upon each of the above coun I for the

second degree, eighteen months in each of the two hospitals, and the
same length of time on clinical surgery.

The Royal College of Physicians, London, requires thirty-si*
months attendance upon lectures in clinical medicine, and the tame

length of time in a medical hospital.

The King and Queen's College of Physicians, Ireland, requires

attendance upon clinical medicine and a medical hospital, each six
months, and upon clinical surgery and a surgical hospital, each twenty-
four mouths.

728 Medical Independent. Feb.

The Royal College of Surgeons, Edinburgh, requires attendance
upon clinical medicine and clinical surgery, each six months, and the
two hospitals each twenty-one months.

The Faculty of Physicians and Surgeons, of Glasgow, requires
the same.

The Royal College of Surgeons, London, requires nine months in
clinical medicine, twenty-seven in clinical surgery, attendance of one
winter and one summer in a medical hospital, and three winters and
two summers in a surgical hospital.

The Royal College of Surgeons, Dublin, requires attendance on
each of the four courses of clinical instruction before named, twenty-
seven months.

The Apothecaries' Hall, England, requires nine months of clinical
medicine, and eighteen months in a medical hospital.

The Apothecaries' Hall, Ireland, requires eighteen months attend-
ance upon each of the four courses.

The Army Medical Board requires, of clinical medicine and clini-
cal surgery, each eight months, and attendance upon each of the
hospitals eighteen months.

The Navy Medical Board requires the same attendance of eighteen
months in each of the hospitals, and six months attendance upon each
of the courses of clinical lectures.

The East India Company Medical Service requires six months
attendance upon lectures in clinical medicine.

By this statement it will be seen that clinical instruction is regard-
ed so essential in Great Britain, that not a single institution grants
a diploma to a candidate who has not availed himself of such advan-
tages. The American Medical Association, which may be regarded
as the authorized exponent of the professional sentiment of this
country, has repeatedly urged the importance of making such
instruction necessary to graduation among us, but as yet, with very
partial success."

From the American Medical Monthly, we extract the following
statement of what was done in the way of clinical instruction in the
Bellevue Hospital, New York, during the month of November; and
when it is remembered that this is a sample of what is being done
there during the winter, it will be seen that the attractions of hospi-
tals are real, even though " placed upon a false basis."

" Drs. Clark, Metcalf, and McCready, have lectured in the medical
wards upon the various diseases there present. Dr. Barker has
visited the lyiug-in wards, lecturing there, and also at the Pathologi-
cal Hall, upon the puerperal state, commencing his course upon the
state of the mother immediately after delivery, or the conditions
peculiar to the post-partum state. Dr. Elliot's lectures were upon
operative midwifery, with illustrations with the subject, at the Patho-
logical Hall. Dr. Woods' lectures have been upon diseases of the
breast, and ' diseases of the testes.' "

1858. Editorial and Miscellany. 729

Thus it will be seen that no less than six gentlemen have been
engaged in clinical teaching in Bellevue Hospital, or, in the estimation
of some Old Dominion and Peninsular writers, enacting a " sham" !

In conclusion, we must express the belief that the demands of the
medical public, the keenly felt wants of the medical student, econ-
omy in the expenditure of the University fund, and the glory of the
University as a whole, all point to the removal of the ivkole of the
Medical Department to the locality of its clinical branch, to the end
that the latter may be fully developed without additional cost, and
free medical education in the University of Michigan, fulfil its high
and glorious destiny. G.

Close of the Volume — The Future. — With the present number
closes the Third Volume of the Medical Independent. During our
connection with the journal, as previously, the Independent has been
entirely free from the bias and restraints of organship. It has been
free to praise and advocate, and not fearful to condemn. It has
been bound up in the interests of no single set or faction of the
profession. It has been an advocate of the Medical Department of
the State University, but has hesitated not to point out its defects
and urge reform. It has offered to the Profession a large amount of
original thought and observation, and has thus been a medium of
communication between its members. Medical Science and policy ?
and the advancement of medical organizations, have been objects of
its sincere devotion. But, while it has been thus devoted, it has
endeavored to avoid that blindness which too often constitutes the
chief evidence of adherence. It has endeavored, also, to strengthen
and substantiate the good, and to point out, correct, and improve,
whatever existed of an opposite or defective nature.

In giving such a character to the Independent, its editors have
hoped to win the confidence, and command the support of a Profes-
sion which they were striving to serve, and of which they were
proud to rank themselves working members; and they have experi-
enced the satisfaction to be derived from a constantly increasing
support. We are conscious of having accomplished good ; we have
worked for the welfare and general harmony of the Profession ; and
the latter considerations have induced us, with the commencement of
another vol., to consolidate with the Peninsular Journal of Medicine,
under the name of The Peninsular and Independent Medical Journal.

730 Medical Independent. Feb.

The consolidated Journal will be brought out, and carried on, under
the editorial management of Prof. Palmer, Mr. Frederick Stearns,
and ourself. Prof. Palmer and ourself represent the old journals.
Mr. Stearns is a highly accomplished and practical pharmaceutist,
and will develop a pharmaceutical feature in the journal which will
prove of great value to that portion of our subscribers, who, from
location, are obliged to compound and dispense Iheir own medicines.
The consolidated journal will appear on the first of April, and will
endeavor to retain all the good qualities of the two, from which it
derives its existence. Its character and tone will be independent
of, and free from all bias, whether of faction or location. It will
strive to be worthy of the Profession, and will be open for the dis-
passionate and courteous discussion of all questions of medical science
and policy. Untrammelled by the cramping and spirit-crushing
influence of organship, its whole energies will be devoted to the
advancement of Medicine as a Science and a Profession. G.

Our Editorial Exit. — Two years have now elapsed since we
issued the first number of the u Medical Independent" and having
become convinced that the main object for which it was originated,
viz: the establishment of an independent and unbiassed journal, and
assured that the interests of the whole profession can be best promoted
by a consolidation with our cotemporary — the " Peninsular" which
consolidation having been accomplished, it only remains for us to offer,
in a few words, our benediction. We have no desire to review in detail
the history of the Independent up to the present time. Its position,
its objects and aims, are familiar to our readers. Its existence seem-
ed to us a necessity, and as there would be little progress in this
world without change, so another metamorphosis in medical literature
has occurred, which seems to us also a necessity.

The combination of the two, upon a liberal and comprehensive
basis, renders two medical journals, and the efforts of six editors, no
longer necessary. Hence, three of the editors of the " Peninsular "
have consented to withdraw, and entrust their interests to one of
their associates — Dr. Palmer. On the other hand, we have cheer-
fully consented to withdraw from the " Independent" and trust its
interests to our tried friend and associate — Dr. Gunn.

In the hands of these gentlemen, aided by one of our most accom-
plished collaborators — Mr. Frederick Stearns — the Profession have

1858. Editorial and Miscellany. 731

the earnest of a journal worthy of high rank in the medical litera-
ture of this country. We have ample assuarnce that it will still be
an independent journal, and embued with the spirit of progress — the
organ of no clique, faction or school.

This is all we can ask, and if such it proves to be, we have no
doubt it will receive the cordial support and co-operation of every
medical man who desires to store his memory with new and practical
truths.

Our editorial experience has contributed largely to our pleasure,
and, in many ways, we hope, not a little to our profit. Like most
other relations in life, it has presented its " lights and its shadows."
The former we shall cherish among the pleasant keepsakes of mem-
ory ; the latter will find their place among the " bye-gones."

Those who have been our friends, and have contributed so liberal-
ly to our encouragement and support, have our sincere thanks and
the assurance of a grateful remembrance.

To our readers, all, we earnestly commend the new Journal ; and
trust that a new zeal will inspire and prompt every member of the
profession, in our State, to arouse latent energies, exhume buried
talents, and labor, with united effort, for the promotion of our pro-
fessional interests and the advancement of Medical Science.

L. G. ROBINSON.

The Annual Meeting of the State Medical Society was held,
pursuant to adjournment, at Detroit, on the 20th of January, 1858.
The country was but very slightly represented. We regret that
such was the fact. Still, those present manifested an increased inter-
est in the success of the Society, and from this we anticipate a better
representation another year. We condense the proceedings from
the minutes of the Secretary.

The President, Dr. N. B. Stebbins, took the chair; Dr. E. P.
Christian, Secretary.

The minutes of the previous meeting were read and approved, after
which the election of new members was proceeded with.

Drs. E. M. Clark, E. Kane, Detroit ; E. Leach, Owosso ; C. Gil-
bert, Lyons; J. G. Bugbee, Edwardsburgh ; A. E. Leete, Romeo,
were elected members of the Society.

732 Medical Independent. Feb.

The election of officers was then made the special order of busi-
ness, to take place after the delivery of the President's address.

The Secretary read a communication from the Indiana State
Medical Association.

On motion, the communication was referred to a committee of
three, for an investigation and report. Drs. Palmer, Sager, and
Beech, were appointed such committee.

Dr. Beech offered the following resolution :

Resolved, That it is, in the sense of this Society, becoming annu-
ally more incumbent upon the officers of the Medical Department
of the University of Michigan, to investigate closely the character
of mind, and the preliminary education of candidates for membership
in the medical classes.

Dr. Christian offered, as an amendment, the following addition to

the resolution :

And, That the members of this Society, and the profession
generally, be recommended to investigate closely the character and
preliminary education of candidates for admission to their offices.

A discussion, in regard to the merits of the resolutions, occupied
the remainder of the forenoon. The Society adjourned at twelve
o'clock, without action.

Afternoon Session. — The Society was called to order and the
minutes of the morning session read and approved.

The President, Dr. Stebbins, read an Address on the subject of

" Medicine an Inductive Science, and Hippocrates the Father of

Inductive Science."

The address being concluded, Dr. Gorton offered the following

resolution :

Resolved, That the thanks of this Society be tendered to the
President for his able address; and that a copy be requested for
publication.

The resolution was adopted unanimously.

Dr. P. A. Knight was elected to membership.

On motion of Dr. Gorton, the Convention proceeded to ballot for
officers for the ensuing year. Drs. Brown and Brodie were appointed
tellers by the President.

An informal ballot was taken for President, which resulted in the
choice of J. Adams Allen. The total number of votes cast, on the
formal ballot, was twenty-seven — of which Dr. Allen received six-
teen, and Dr. Patterson, ten ; scattering, one.

1858. Editorial and Miscellany. 7$t

A ballot was then takenTor the election of a Vice President, tb*
result of which was the election^of Dr. J. A. Brown, to that offiw.
The whole number of votes cast on the formal ballot, was twenty-
three — of which Dr. Brown received fourteen, and Dr. E. M. Clark,
nine.

Dr. E. P. Christian was elected Secretary for the ensuing ye*%
by a viva voce vote.

Dr. Klein was elected Treasurer by a viva voce vote.

( )n motion of Dr. Beech, the thanks of the Society were tendered
to the retiring PresidenCfor the able and efficient manner in wiudh
he has performed his duties during the past year.

The newly elected President being absent, Dr. Brown, the Vkft
President, took the chair.

Dr. Gorton offered the following resolution :

Resolved, That a committee of three be appointed, by the cha*$,
to report, at the next annual meeting of this Society, on the proper
means to be used to legalize the procuring of subjects, under cerfettfc
restrictions, for the study of anatomy.

The resolution was adopted,"and the President appointed Drs»
Gorton, Kane, and Ashley, such committee.

The resolution of Dr. Beech, offered in the morning, was takflfc.
under consideration.

Dr. Beech desired to amend the resolution by erasing the wor<&
" the Medical Department."

Dr. Batwell offered the following resolution as a substitute :

Resolved, That this Society respectfully but earnestly recommend
to the Regents of the University the necessity of a preliminary
examination in the elementary sciences, in the cases of those studeiste
who present themselves for admission to the Medical Departnwafc
of the State University.

Dr. Brodie moved indefinite postponement.

Dr. Pitcher said that the Faculty had the authority to make tfeft
examinations, and were supposed to do their duty. ITe supported
Dr. Brodie's motion to lay on the table.

Dr. Palmer understood that the Faculty had no power to exclude
any person from the privileges of the institution.

Dr. Palmer's resolution, and Dr. Christian's amendment, wel%
adopted as separate resolutions.

The Society then adjourned until seven o'clock p. if,

*T34r Medical Independent Feb.

Evening Session. — The Society was called to order at seven
oVlock p. m., and minutes of afternoon session read and^corrected.

Eeports of committees being called for, Dr. Palmer, chairman of
committee appointed to report in regard to the circular of Indiana
State Medical Society, asking co-operation in interchange of published
transactions, reported that the committee were unable to recommend
$ny definite action until something was determined by'the Society in
regard to the publication of its transactions; that they would favor any
such interchange if the transactions were published ; they recom-
unended that the paper be received and placed onMile, for further
action.

The report was adopted.

Dr. Sager, appointed at the last meeting to report on puerperal
diseases, reported that his paper was unfinished, but would soon be
completed, and would be subject to the action of the Society.
Dr. Sager was requested to finish his paper and refer to Committee
CA Publication.

Dr. Gunn presented a paper, written by Dr. Dubois, on rheuma-
tism. It was referred to the Committee on Publication.

Dr. Sager presented a paper, written by Dr. Corbin, on diseases
$ad topography of Livingston county. Referred to the Committee
Crti Publication.

Dr. Davenport, appointed to report on the diseases and topogra-
phy of Wayne county, was unprepared to report.

Dr. Axford read an able and interesting report on the subject of
Yaccinnation, which was referred to the Committee on Publication,
and the thanks of the Society returned fur the same.

Dr. Christian presented the report of Dr. W. W. Hippo! ite, on
^Zymotic Poisons of Michigan;" which was. on .motion, referred to
the Committee on Publication.

Dr. Palmer, appointed to report on the diseases of children, read
a highly interesting paper, entitled " The great importance and
urgent duty of especially studying the diseases of children."

Dr. Beech, of Coldwater, gave a synopsis of his paper, which was
a voluntary communication on the diseases of Coldwater, Michigan.
The paper was referred to the Committee on Publication.

On motion of Dr. Beech. Coldwater was designated as the place
<of holding the next biennial meeting of the Society. •

On motion of Dr. Brodie, the Treasurer was instructed to pay

1857. Editorial and Miscellany. 73-5

the expenses of the Convention out of the funds remaining in his

hands.

Dr. Robinson offered the following resolution as an amendment fc&

Section VIII. of the Constitution :

Resolved, That the President be empowered to appoint, annually
a committee of three, whose duty it shall be to examine the creden-
tials of candidates for admission' to membership to this Society.

The resolution was adopted.

On motion of Dr. Cowan, the publication of the proceedings of
the Society, in pamphlet form, was postponed until the next meeting.

Dr. Bugbee moved that" the proceedings of the Society be pub-
lished in the two Medical Journals,pand that the money now in tfos
treasury be devoted to that purpose.

The resolution was adopted.

The President appointed Drs. Sager, Clark, and Gilbert, a pub-
lishing committee.

The following gentlemen were appointed delegates to the National
Medical Association, at] Washington : Drs. C. M. Stockwell, R.
Klein, L. Davenport, H. P. Cobb, J. C. Gorton, E. M. Clark, R
Kane, J. A. Brown, J. A. Allen,. J. H. Beech, II. Taylor, J. Paddack

On motion, the President was empowered to appoint substitutes,
upon request of a delegate.

The following physicians were appointed to report at the nexfc
meeting :

Dr. A. B. Palmer, on the diseases of children.

Dr. S. M. Axford, on vaccination.

Dr. L. Davenport, on diseases and topography of Wayne county*

Dr. W. Cowan, on health of towns in relation to sanitary meas-
ures.

Dr. M. Gunn, on ununited fractures.

Dr. E. M. Clark, on plastic operations.

Dr. E. Lauderdale, on adulterated articles of diet.

Dr. E. Kane, on modus operandi and therapeutical applications of
quinine.

Dr. P. A. Knight, on diseases and topography of Macomb county*

Dr. E. Leach, on diseases and topography of Shiawassee county*

Dr. N. B. Stebbins, on registration.

Dr. E. P. Christian, on criminal abortions.

Dr. L. G. Robinson, on new remedies.

There being no further business for transaction, the Society-
adjourned until the next annual meeting, which is to be held at Lai-
sing, on the third Wednesday of January, 1849.

Medical Independent. Feb.

Dr. E. Brown-Sequard's Journal of Human and Animal
Physiology. — It gives us great pleasure to announce the expected
appearance of the above Periodical, to be published quarterly in
Paris, under the Editorial care of so distinguished a physiologist as
M. Brown-Sequard. We are confident that it cannot but meet with
t&e general and warm support of all intelligent medical men among
^g^ We have not space to insert the whole of the prospectus before
«s* The intended periodical had its origin, the Editor tells us, in the
fiict that no similar work is at present published in France, and that
fere is a generally-felt need of some special publication which will
feeep naturalists and physicians au courant of all the principal origin-
al works of French physiologists, and give a resume of the progress
lead revolutions accomplished in every country, which change so
soestantly the features of science. M. Brown-Sequard will be
assisted by Doctors Ch. Robin, Ch. Rouget, and Tholozan, whose
personal relations with most of the physiologists of the age, in
JS&rope and America, will enable them very readily to procure all
ie&portant publications connected with human and comparative
l&ysiology.

"We are happy to announce," he says, "that we can rely upon
tfee collaboration of most French physiologists, and many distin-
guished German, English and American ones, and we believe, in
:jquence, that we can honestly promise that every number of th:s
Journal will be exceedingly rich in original memoirs.

" Authors wishing to publish their essays in this Journal will be
allowed the most unlimited freedom of scientific discussion, but the
Ij&dacteur en eh ef feels it his duty to declare beforehand that the
o&ject of the publication is the advancement of science, and personal
polemics will be absolutely and always excluded.

" This Journal will have for its object, in addition to pure Physi-

^Ogy—

" 1. Organic Chemistry, Hygiene, Toxicology, and Medical Juris-
wrudence, in their relations with Physiology.

a 2. Descriptive and Comparative Anatomy, Teratology, Normal
and Pathological Histology, in so far as they illustrate Physiologj.

"3. The application of Physiology to the Practice of Medicine,
Surgery and Obstetrics.

"It will appear quarterly, on the first of January, April, July,
sad October, respectively. Each number will contain from 160 to
SuG pages, with engraved plates and figures interspersed in the text.

"The arrangement of the matter will be as follows :

*1. Original Essays, occupying more than half of each number.

"2. Memoirs published abroad, either entire or in part.

"3. Reflective and critical analyses of works publiched in France
abroad,

1858. Editorihl and Miscellany. 737

"4. Review of the progress of Physiology in France and abroad.

"The two or three numbers will contain a detailed history of the
progress of Physiology during the years 1855 and 1856.

"The price of subscription, payable in advance, is: Paris, 18
francs ; the Departments, 20 francs ; Foreign, 25 Francs.

"Subscriptions received in Paris, by MM. J. B. Bailliere et Fils,
Rue Hautefeuille. 19. Les auteurs Francais qui voudraient avoir
leurs ouvrages annonces et analyses devont en faire deposer deux
exemplaires chez MM. J. B. Bailliere et Fils.

" Foreign authors who wish their works noticed will send a copy
— post-paid — to MM. J. B. Bailliere et Fils, or to Doctor Brown-
Sequard, Rue du Dragon, 16, Paris.

"Mr. Pennington, of Philadelphia, is the agent for the United
States/' — Charleston Med. Journal.

Dr. Radclffe had a great objection to paying his bills. A
pavior, after long and fruitless attempts to get his account settled
caught Dr. R. just getting out of his chariot, at his own door, in
Bloomsbury Square, and demanded the liquidation of his debt.
" Why, you rascal,'' said the doctor, " do you pretend to be paid for
such a piece of work ? Why, you have spoiled my pavement, and
then covered it over with earth to hide your bad work." " Doctor,''
said the pavior, " mine is not the only bad work the earth hides."
t' You dog, you," said Radcliffe, " are you a wit ? You must be
poor — come in, and you shall be paid."

Dr. R., who was attending the lady of Lord Chief Justice Holt,
with a diligence remarkable for one of his situation as a physician,
was asked, by one of his intimate friends, the cause of it. " Why,"
said the doctor, " to be sure, I have brought her through a very
obstinate disorder, though I have no particular regard for the
woman ; but, I know that her husband hates her, and, therefore, I
wish to plague him."

Contemporaneously with Radcliffe, lived a Dr. Case, a celebrated
quack, a native of Lyme Regis, in Dorsetshire. This empiric was
famous for his astrological acquirements, and was looked upon as
the successor of Lilly, whose magical utensils he possessed. He is
said to have got more for the following distich, placed over his door,
than Dryden did for all his poetry.

" Within this place
Lives Doctor Case."

738 Medical Independent. Feb

And he was doubtless well paid for composing the couplet which
he affixed to his pill boxes :

" Here's fourteen pills for thirteen pence.
Enough for any man's own conscience."

Dr. Radcliffe met this doctor at a tavern, when the following
conversation took place : " Here, brother Case, I drink to all the
fools, your patients." "Thank ye," quoth Case, "let me have all
the fools, and you are welcome to the rest." — Physic and Physicians.

" Still Harping on My Daughter." — Our venerable friend of
the Peninsular still continues to be distressed by what he styles our
infidelity to the University, arising out of a non-residence at the seat
of the institution. In the current number of his journal, he makes a
lugubrious effort to show that we are infidel, and, consequently
(wonderful logic!), that he was not the aggressor in the present con-
troversy. To the readers of both journals, this will be simply
amusing. A single point, only, in his article, requires notice ; it is
as follows :

" * * * the public and repeated declaration of the Pro-
fessor that he would 'break down the Clinical School," together with
his publication of an apochryphal history of the acts of the Clinical
Instructor, were the immediate occasions of my remarks respecting
the ' fidelity ' of the Professor to the University."

The charge that we have threatened to " break down the Clinical
School " — emanate from whatever source it may — is simply false.
We have regretted the inadequateness of the clinical course, and
have earnestly urged its extension and amplification ; but we have
never, either publicly or privately, said anything that could be con-
strued intc such a threat. If we had, a charge of infidelity would not
have been based upon a non-residence.

As to having published " an apochryphal history of the acts of the
Clinical Instructor," we have never published any history whatever,
of his acts. We appeal to the record. Such, then, is the nature of
the " immediate occasions " of the attack upon us. Surely, our ven-
erable friend is remarkably unfortunate in his insinuations and
charges. Thus far, all have been " baseless as the fabric of a vision."

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