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■■/. ■'

THE

STETHOSCOPE,

VIRGINIA MEDICAL GAZETTE

MONTHLY JOURNAL

JtlcMcitu ani tl)£ Collateral Sriences.

EDITED BY

P. CLAIBORNE GOOCH, A. M., M. D.

ONE OF THE SECRETARIES OF THE AMERICAN MEDICAL ASSOCIATION, AND SECRETARY

OF THE MEDICAL SOCIETY OF VIRGINIA— FELLOW OF THE PATHOLOGICAL

SOCIETY OF MONTREAL AND OF THE PARISIAN MEDICAL

SOCIETY, ETC.

'Medicine is enriched "by facts only." — Bboussais.

VOL, I.

RICHMOND :

PRINTED BY RITCHIES & DUNNAVANT.

1851.

ft

52

THIS VOLUME CONTAINS ORIGINAL PAPERS FROM THE FOLLOWING

CONTRIBUTORS:

L. B. Anderson, M. D.

G. W. Ashby, M. D.

James Bolton, M. D.

John J. Boswell, M. D.

W. S. Bowyer, M. D.

D. W. Brodnax, M. D.

J. N. Broocks, M. D.

Wm. M. Broocks, M. D.

Wm. Browne, M. D., Pres't Med.

Society Fredericksburg.
P. H. Cabell, M. D.
Robt. G. Cabell, M. D.
J. H. Claiborne, M. D.
G. Lane Corbin, M. D.
J. B. Davies, M. D.
F. H. Deane, M. D.
Thos. Dunn, M. D.
J. R. Elsome, M. D.
D. S. Evans, M. D.
W. B. Evans, M. D.
J. M. Gait, M. D., Phys, and Supt.

Eastern Lunatic Asylum.
T. J. Garden, M. D.
S. C. Gholson, M. D.
P. C. Gooch, M. D.
P. H. Grigg, M. D.
W. D. Haskins, M. D.
R. W. Haxall, M. D.
M. H. Houston, M. D.
R. E. Jennings, M. D.
R. G. Jennings, M. D.

C. P. Johnson, M. D., Prof. Anat.
and Phys. Hamp. Sid. Med. Col.

W. F. Jones, M. D.

L. S. Joynes, M. D.

Joseph Laidley, Pharmaceutist.

Zachary Lewis, M. D.

Harvey Lindsly, M. D.

J. P. Little, M. D.

R. L. Madison, M. D.

J. C. Marcks, M. D.

O. F. Manson, M. D.

D. T. Martin, M. D.

W. D. Meriwether, M. D.

A. T. B. Merritt, M. D.

J. P. Mettauer, M. D., Prof. Med.

Sfc. Rand. Macon Med. College.
C. R. Palmore, M. D.
J. F. Peebles, M. D.
Thomas Pollard, M. D.
M. P. Scott, M. D.
Albert Snead, M. D.
J. Snyder, M. D.
P. C. Spencer, M. D.
J. J. Thweatt, M. D.
J. W. H. Trugien, M. D.
A. B. Tucker, M. D.
T. J. Young, M. D.
J. Wistar Walke, M. D.
G. A. Wilson. M. D.

TH£

AND

Ho. 1.

RICHMOND, JANUARY 1851.

[Vol. I.

INTRODUCTION.

In embarking upon the arduous and responsible task of establishing and editing
a monthly medical journal in Virginia, we deem it due to those upon whose pa-
tronage and support we are dependent, to set forth our views and intentions at
some length. The establishment of a medical press in Virginia has been a long-
cherished desire of the whole profession. In 18-16, in convention assembled, the
report of a committee urging the establishment of a journal was unanimously
adopted ; but, from various causes, no one hitherto has volunteered to risk the la-
bor and expense of the undertaking. In doing so ourselves, we naturally felt some
doubts and misgivings as to the success of our enterprise. These, however, have
been totally dispelled by the flattering and earnest assurances of assistance — (with-
out which we feel incompetent to the task) — which we have already received from
many of our zealous professional brethren, in every direction. It is proper to say,
that our determination to assume the important post which we occupy dates no fur-
ther back than the past month. In the short space of 30 days all the arrangements
were to be made to put into operation a monthly publication. Arrangements
with publishers — securing original matter and contributors, the making known our
intention and obtaining subscribers — all to be done at once — were embarrassments
which cannot be readily appreciated by the uninitiated. These disadvantages be-
ing met, we found another source of perplexity, viz: the selection of a name ;
and it being a matter of considerable moment, gave much concern. To choose
one which would please everybody we knew was impossible, and to select one
which would give satisfaction to the greatest number presented no little difficulty.
We accordingly communed with many professional friends, of the best judgment
and taste, both far and near, for aid ; and, after the most mature consultation about
a matter of so little real importance, the Stethoscope was selected. As some
have already criticised the election, it may be well to allege some reasons in its
favor. There are so many "Journals," "Gazettes," "Recorders," "Examiners,"
and other similar titles already in circulation, that none of those seemed eligible.
The aptness of a name after some important professional instrument, had been at-
tested by the "Lancet," " Scalpel," &c. The " Stethoscope," then, Avas deem-
ed particularly adapted, as the name of a work not devoted to any particular de-
partment, but to medicine generally. It is an instrument used in each of the prac-
tical divisions of our art, and is a valuable means for obtaining information —

Z INTRODUCTION.

such, may we hope, will be our Stethoscope. Its devotion to auscultation will he
no more exclusive than is that of the "London Lancet" to venesection, or the
" Scalpel" to dissections. So much for the name — it being satisfactory to us, we
hope that it will not be the source of any sort of prejudice with others.

The objects of this journal scarcely need to be explained. We desire our pages
to be the medium for drawing more closely the bonds of professional union, and
for encouraging that esprit du corps among our brethren, which is so essential to
their well being. We will labor in the advancement of medical science and its
literature in Virginia and the South generally ; to aid in drawing into active use-
fulness the great fund of information and talent which is now dormant; to collect
and diffuse all the facts which medical science is rapidly developing, both in our
own country and abroad; to suppress empiricism and charlatanry, both legitimate
and illegitimate ; and to favor the protection and fostering of the science of me-
dicine, by sound and effectual enactments of legislature, and to lend our mite in the
" elevation of the science from the position of a trade to that of a noble profes-
sion."

Much is to be done for the interests of medical men, now not only neglected
entirely by law, but most shamefully oppressed. In the reform and the movement
in favor of medicine, which it is hoped will soon be effected, we wish " to let the
professional voice be heard on professional questions," and through an organ
which will afford every facility for that interchange of investigation, experience
and opinion among those engaged in active practice, which is so valuable in a
progressive science — and which is as abundant and valuable in our own as in an}'
other country. All agree that it is high time for the South to be building up itself
and advancing its own institutions — its own medical schools and literature. To
these ends will our energies be directed. We will be governed by those rules and
principles laid down by the " American Medical Association," and oppose every
innovation upon them. Having no party to favor — no sinister purposes to ad-
vance, we will pursue steadily the course here laid down ; and though it may oc-
casionally be our duty to take positions, and strive to establish them, in opposition
to some of our brethren, we will ever be actuated by high and pure motives — will
act promptly and decisively, according to the best lights before us — and in the
discharge of the delicate duties incident to the editorial chair, to the best of our
feeble ability, we hope to retain the friendship of all, and merit the enmity of none.

Being desirous of making our work interesting in all the branches, we invite
practical communications upon the subjects of chemistry, pharmacy, botany, and
every subject of medical interest, as well as of medicine and surgery. And, finally,
as the work must surely die without support, we solicit the patronage of the pro-
fession by their liberal subscription.

HAXALL ON UTERINE HAEMORRHAGE.

A few Remarks on the subject of Uterine Hemorrhage, limited to cases of
Placenta Previa and those which occur subsequent to the completion of
Labor.

BY ROBT. W. HAXALL, M. D.

Not intending to enter into an examination of the several modes by
which it was attempted to explain the occurrence of flooding at the
time of labor, I will merely remark, that it was clearly understood
at an early period that the placenta might in some way or other be-
come attached near to, or over the mouth of, the womb in such manner
as to give rise to haemorrhage during its dilatation. Suffice it to say, that
the first complete description of this kind of haemorrhage was furnished
by R aederer in his Elementa artis Obstetricia, published about eighty
3rears ago.

Hemorrhage occurring in a case of placenta praevia, has been very
properly denominated unavoidable; and it is so, because, to use the
words of Prof. Naegele, " the very action which nature uses to bring
the child into the world, is that by which she oftentimes destroys both
it and its mother." In this sense it is clearly distinguishable from ac-
cidental haemorrhage, which may happen at any period of gestation, and
against which we have to contend in the common and ordinary forms
of abortion.

The causes of placenta praevia are not, it must be admitted, fully
understood. The most generally received opinion, I believe, is, that
the semi-fluid condition of the decidua at this very early period of preg-
nancy, does not always present a force sufficient to retain the ovum in
the superior portion of the uterus. Hence it is that it has been supposed
to glide down between the deciduous membrane and the uterine pari-
etes, until finally arrested at the os internum. The manner of its ar-
restation is seen to be different in different cases ; and we may sa,y,
that in proportion to its direct implantation over the os internum, is the
danger to be estimated by which both mother and child are threatened.

As just intimated, this central implantation may exist; at other times
a portion only of placenta is observed to overhang the dilating os
tincae ; and fortunate for the patient is it, when this complication exists
in no greater degree.

The eruption of haemorrhage, in cases of placenta praevia, is confined
to the latter months of gestation ; it is never perhaps noticed earlier
than the sixth month ; much more frequently is it entirely unobserved
until a month or six weeks before the period of accouchement, and this-
is the case, for reasons which must suggest themselves to the minds of
all.

The appearance of haermorrhage is sudden and unexpected — -unex-
pected because the woman cannot recal to mind any act of impru-
dence by which it might have been induced. It is more abundant
than accidental haemorrhage ; and particularly is' it so, the nearer the
patient has approached the period of parturition. Should1 she have
two or three months, yet to go before reaching thfeterm, the flooding
will not be so profuse ; but the probability is that a return of it will be

4 HAXALL ON UTERINE HEMORRHAGE.

experienced every twelve or fifteen days. There is also a very con-
siderable difference in one respect, between accidental and unavoid-
able haemorrhage ; in the latter, the eruption of blood shews itself during
the 'presence of pain, for very obvious reasons, and diminishes when
this subsides ; while in the former the reverse of this is found to be the
case.

When the symptoms which I have here detailed exist, there is
much reason to dread the existence of placenta praevia. A resort to
the touch however will very frequently impart sufficient information to
dispel our doubts ; not always however with entire accuracy, because
the os tincae is at this stage of gestation so high up in the hollow of the
sacrum as to render the touch somewhat obscure. It may, to be sure,
be reached if the whole hand is introduced, and I would not hesitate
thus to act, if I could not otherwise gain the desired information. By
whatever method we may reach the os uteri, it will be found to be
more bulky and much softer than in ordinary gestation, for the reason
that its vessels are enlarged and distended, as are those of any other
portion of the organ where the placenta may happen to be attached.
When the finger penetrates the cervix, if there be a partial implanta-
tion of the placenta, it will be felt overlapping one side, while upon
the other we may recognize the distended membranes, and in all pro-
bability be enabled to distinguish the presenting portion of the foetus.
If the implantation be central, the finger comes in contact with a soft,
spongy body, which is found to be attached throughout the whole cir-
cumference of the os internum.

This diversity in the mode of the placental implantation will clear-
ly explain to us the characters which belong to haemorrhage connected
with this complication. It is unquestionably true that the most alarm-
ing and profuse gushings of blood take place when the after-birth is
centrally attached ; for every pain but serves to separate more and more
the connection which exists between it and the womb. Under these
circumstances, awful and appalling in the extreme, are we sometimes
called upon to act ; and our action can admit of no delay ; for if the
case be left to nature, the unhappy patient is sure to find a bloody
grave ; — and how are we to act ? The ingenuity of the profession has
devised several means, to which the intelligent accoucheur will imme-
diately resort, according to the varying circumstances of the case —
means which sometimes succeed, but which, it must be confessed, are
too often inadequate to the end.

Where the placenta is but partially attached, the haemorrhage will
not be so profuse, and the danger is consequently less. Should the
uterine pains be sufficiently active, and the placenta overlap a small
portion only of the os uteri, the case may demand but little interfer-
ence ; for the bag of waters will more or less protrude through the
gradually dilating os, and thus serve as a compress by which the flood-
ing will be measurably commanded. If the presenting placenta cover
a large portion of the os tincae, the tampon ma}7- in such a case be used
with advantage, in order to afford time for its dilatation. Should the
flooding however prostrate too much the powers of the patient, the
finger may be passed through the unobstructed portion of the os tincae

HAXALL ON UTERINE HEMORRHAGE. 5

and the membranes ruptured. By this process we gain the advantage
of causing the uterus to contract with more energy, and perhaps the
greater one of bringing down the head immediately upon the mouth
of the womb ; by which manoeuvre it is made to act the part of a com-
press, and thus becomes instrumental in arresting the further flow of
blood. As the pains cause the head to advance, the less becomes the
danger ; and so soon as the delivery of the foetus takes place, in the
generality of instances the placenta follows without delay. It is
scarcely necessary to add, that the patient may require pretty active
stimulation should the loss of blood have been considerable, as well
as the use of ergot, should the pains not be sufficiently energetic.

Should haemorrhage supervene at any early period, whether the pla-
centa be partially or centrally implanted, we ought to make no forcible
effort to enter the os tinea?. All our endeavors should tend to mode-
rate the flooding, and conduct the patient to the latest period of ges-
tation. A contrary course would ensure the death of the child in all
human probability ; nor would it redound to the well-being of the woman.

The remedy adapted to this condition of things, in the first place,
is bleeding if the patient is feverish, with a quick and active pulse, as
frequently happens ; the bowels should be emptied by an enema or
laxative, and cold applications assiduously applied ; and should the
uterine pains become at all expulsive or harrassing, they may be
calmed by opiates and anodyne injections. The administration of lead
and opium will also prove beneficial. At this period of gestation these
measures will often be effectual without the aid of the tampon; indeed
the tampon is objectionable at this stage, because its presence might
become a source of irritation to the uterus, and thereby increase the
activity of the expulsive efforts.

Let us now proceed to consider the case in which the placenta is
centrally attached ; and I need not remark, that here the most alarm-
ing difficulties are presented. At every recurrence of pain the hae-
morrhage is increased necessarily, and without the most prompt and
well-directed action the patient inevitably succumbs.

The main object to be attained is to rid the womb of its contents
with as much despatch as may be consistent with the safety of the
woman; and how shall this be done ? The method uniformly adopted
heretofore, was to turn the child and deliver by the feet. But ano-
ther measure has been recently practised, to which I shall frequently
call the attention of the reader.

The os tincae however may not be sufficiently dilated to admit of
the introduction of the hand, and all are agreed that no forcible entry
should be attempted. To introduce the hand it must either be dilated
or dilatable ; in which latter case a very moderate effort will be
sufficient to accomplish our purpose. But suppose that neither con-
dition exists ; every returning pain increases the haemorrhage, and if it
be not checked the most disastrous results are to be feared. Under
these circumstances it is that the tampon is capable of exercising the
most beneficial and saving influence ; until the os tineas is sufficiently
dilated to admit the hand, we must plug the vagina as speedily as pos-
sible. By this method the flooding is greatly checked, if not entire-

6 HAXALL ON UTERINE HAEMORRHAGE.

ly arrested ; and during the subsequent dilatation of the os tinea?, which
is not at all impeded by the presence of the plug, the haemorrhage is
held in check. And here permit me to say a word or two as to the
manner in which the vagina should be plugged. One or even two
large sponges will not be sufficient for the purpose; the vagina should
be completely filled and distended ; and to accomplish this in the
most effectual manner, several small pieces of sponge not larger than
half the fist should be successively introduced. After accomplishing
this, a bandage moderately tight should encircle the body, and the T
bandage finally applied. I have had the fullest evidence of the utilit}7-
of such a plan. Under its action the os tineas will continue to dilate
or become dilatable ; and when this desirable end is attained, we shall
have obtained the only practicable condition in which turning can be
readily accomplished.

How is this to be effected ? Are we forcibly to thrust the hand
through the centre of the placental mass, search for the feet, and then
proceed to deliver ? By no means ; and without reciting the various
arguments against such a procedure, allow me to dismiss this part of
the subject by quoting the language of the late Dr. Dewees : " This,"
he says, "should never be done; especially as it is impossible to
assign one single good reason for the practice, and there are several
very strong ones against it."

But how are we to proceed ? So soon as the hand can be introduced,
it should be passed between the os tincae and the placenta, by in-
sinuating the fingers carefully, one after the other, if no portion of it be
detached ; if any part of its circumference, however, shall have been
separated, it is at that point through which the hand will be more
easily made to penetrate. When it shall have gained admission, the
haemorrhage will at once materially diminish, if it be not entirely sub-
dued, just because the arm will most effectually perform the office of a
well-adjusted plug. We should now proceed in our search for the
feet, endeavoring to retain the membranes entire until this part of the
process shall have been accomplished. When we have succeeded in
grasping one or both, they are gently to be brought down ; and if the
patient be not in the extreme of prostration, we may begin to congratu-
late ourselves upon the favorable termination of the case. Like the
arm, when introduced, so does the body of the child, as it advances,
play the part of a most effectual plug. So soon as the child is deli-
vered, the tonic contraction of the womb succeeds as in ordinary
cases, and the placenta, the great cause of all the mischief, is speedily
thrown into the vagina.

In looking over the history of obstetrical medicine, we shall find
many cases recorded where the delivery of the placenta preceded the
birth of the child ; these were necessarily cases of placenta prasvia.
In many of these both mother and child have fallen victims ; the child,
I may remark, invariably did — but in some few, the life of the parent
was preserved. These facts have been known to the profession for
years, but it is only within a comparatively recent period that they
have been scrutinized with a scientific eye, and made available in a
practical point of view.

HAXALL OX UTERINE HEMORRHAGE. 7

In those cases in which the life of the mother has been preserved,
the somewhat astonishing fact was observed that the haemorrhage had
very much diminished, and in some instances entirely ceased, so soon
as the placenta was expelled. Dr. Collins relates a case in which the
placenta had been delivered eighteen hours before the birth of the
child, and the mother did well.

Reasoning upon these ascertained facts, the idea occurred to two
eminent members of the profession, Dr. Simpsonof Edinburgh and Dr.
Radford of Manchester in England, (and who, by the by, disputed
the point of priority,) that a separation and abduction of the placenta,
in cases particularly where this was centrally attached, would be the
speediest means of bringing about a cessation of the haemorrhage.
This plan has frequently been adopted of late years by both, and, they
tell us, with a success which fully equals their expectations. Success-
ful cases are also recorded by other practitioners who have adopted
their views.

Are the arguments sufficiently strong in support of this plan of pro-
ceeding? This is a question which every man must decide for him-
self, upon a careful review of the whole ground ; for it is certainly
true that reasons may be adduced both for and against the validity of
such a procedure. In Scotland and in England, where the gentlemen
referred to severally reside, the profession appear to have taken sides,
and many of the back numbers of the Lancet particularly, are crowded
with communications on the subject. I shall not attempt to relate
all that has been said on the one side and the other ; the reference I
have given as to the sources of information, will be sufficient for those
who feel any curiosity about the matter — I shall merely revert to this
plan of Drs. Simpson and Radford, as one of the modes now adopted
in the treatment of placenta praevia.

The great object to be attained by the prior delivery of the placen-
ta, is the arrestation of the haemorrhage. To this conclusion no theo-
retical reasoning would perhaps have led us. The occurrence of the
fact itself was absolutely necessary to induce a positive belief in its
existence. We are told by many who have adopted the practice that
it is true, and I for one am willing to trust their authority, having no
personal experience in the matter. The fact being established, it is
not perha.ps very difficult to find a satisfactory explanation.

When a separation of the placenta takes place, the flooding must
proceed from the large uterine vessels, the mouths of which are thus
exposed ; and as the womb cannot take on its tonic contraction so long
as its contents are unexpelled, the haemorrhage will necessarily conti-
nue. If, however, the membranes be ruptured and the waters evacuat-
ed, and in addition to this the placenta be extracted, uterine contrac-
tion will supervene to a degree sufficient to check materially, if not
wholly to arrest the flow of blood. With this end accomplished, al-
though the life of the child is almost inevitably sacrificed, turning need
not be resorted to unless there may chance to be a faulty presentation
of the foetus.

Such then is the plan of Drs. Simpson and Radford, which, although
it destroys, as I have just observed, the life of the child in a very large

8 HAXALL ON UTERINE HEMORRHAGE.

majority of instances, yet has the advantage of very frequently saving
that of the mother. By a comparison of the two modes of practice,
can we only arrive at positive conclusions with respect to the value of.
each. If we adopt the generally received plan of proceeding, the life
of the infant is sometimes, though not very often, saved, while that of
the mother is too frequently sacrificed. By the method newly recom-
mended, and which I have here endeavored to detail, a large per cent-
age in the saving of maternal life is found to result; and if the rule,
universally I believe adopted by the profession, that the life of the
mother is of more value than that of the child, is still to hold good, the
weight of argument would seem to incline to the practice of the prior
removal of the placenta.

The manner of effecting this, we are told, is simple enough. When
the os uteri is sufficiently dilated, the finger is to be passed between
the uterine walls and the adherent placenta, and by gliding it around its
whole circumference, the connection is thus severed. When this part
of the process is finished, with the hand above the placenta, it is gent-
ly pushed down into the vagina, from whence it may easily be removed.

I shall now say a few words in relation to those cases of haemorr-
hage which supervene subsequent to parturition. This is a condition
also of very great danger to the woman, and it has fallen to my lot
to witness several severe cases of this variety of haemorrhage. I have
seen the patient delivered without one disagreeable symptom manifest-
ing itself, and when all bid fair speedily and safely to terminate.
Soon, I have seen her complain of a sensation of sinking or faintness ;
her lips become blanched, her ears ringing with disagreeable sounds,
and her vision darkened and obscured. Her pulse hurries on with
a fearful rapidity and with diminished force, until by and by it is no
longer to be felt; a clammy moisture bedews the surface; the respira-
tion is deep, prolonged or gasping; vomiting frequently ensues — and
muttering delirium,, with wild and senseless tossing of the arms, but
add still gloomier features to the horrors of the scene. When we turn
our attention to the condition of the uterus, we shall find that it has
failed to return to that state of tonic contraction which it ought to
have assumed, and that haemorrhage to a greater or less amount, has
been the result.

Inertia of the womb, if the placenta shall not have been detached
in whole or in part, will not be productive of haemorrhage, because the
large uterine and placental vessels still remain unexposed ; and I have
seen this condition of things continue for hours. When, however, the
placenta shall be wholly or partially separated, the interposition of art
cannot be long delayed ; every effort must at once be put into requisition
for the purpose of producing contraction of the womb ; for until this shall
have been attained, it is idle to expect a cessation of the haemorrhage ;
it is the only condition upon which we can rest the security of the
patient; and fortunately for her, several available means are at the
command of the accoucheur. Active friction should without dela}'' be
made over the region of the uterus, and ergot promptly and largely
administered. Cold applications may also be resorted to ; and if these
remedies fail to produce contraction of the womb, and consequent ex-

HAXALL ON UTERINE HEMORRHAGE. iJ

pulsion of the secunclines, the hand should without hesitation be intro-
duced, and the placenta removed. When this end is accomplished,
the uterus almost always returns to its state of contraction.

But there is another and more serious complication than the one to
which reference has just been given ; it is, the continuation of haemorr-
hage after the extraction of the placenta. In this case the flooding
may exist under two very different circumstances ; it is either appa-
rent, deluging the patient's bed with blood, or it. may be concealed ; in
which latter event it is retained within the womb.

In the case where the blood is retained, all the rational signs of
haemorrhage, if I may so speak, and which have been named above,
may take place ; and when we come to examine the condition of the
womb we shall find it largely distended, reaching in some cases even
above the unbilicus. The obstruction to the exit of blood is produced
either by a contraction of the os tincae or by the presence of a pretty
firm clot. So soon as this is removed, or the contraction of the os
overcome, the blood pours out with a fearful rush. Contraction of the
uterus very generally succeeds to this; and while perhaps we may be
congratulating ourselves with the hope that it will remain permanent,
the lapse of a few moments will convince us that we have again to
contend with the same disagreeable symptoms. This alternate con-
traction and dilatation of the uterus, I have witnessed in one case as
many as three times ; and it is not difficult to believe that under such
circumstances the patient is often brought to the brink of the grave.

The first thing to be done, when haemorrhage supervenes, whether
apparent or concealed, is to proceed diligently with frictions over the
region of the womb. If this should not cause it to contract, the appli-
cation of cold may be resorted to, and the plan recommended by Dr.
Gooch will often be found very available. Cold water should be poured
from a pitcher or teapot elevated some foot or more above the body
of the patient. Injections of cold water into the womb have also been
advised, but having succeeded by other means, I have never employed
them. Velpeau's plan of placing a mustard plaster between the sca-
pulae, the action of which he candidly confesses he does not under-
stand, but as to the efficacy of which he speaks with much certainty,
may also be tried ; nor should the administration of ergot be omitted.
The application of the child to the breast should not be disregarded,
for the sympathy existing between the mammae and the uterus will
not unfrequently ensure its contraction. Failing in all these measures,
the practitioner should boldly but cautiously pass his hand within the
uterus, and having turned out all the clots, with the other hand placed
upon the abdomen, and thus embracing as it were this organ between
the two, he should institute such an amount of irritation as to produce
its contraction. While this is taking place he will find his hand gra-
dually pushed from its position within the womb, until it finally reaches
the vagina. A bandage reaching from pubes to sternum should be ap-
plied, taking care to place a thick and firm compress immediately over
the womb.

In the case now under consideration, the tampon is not only useless
but even objectionable; for it would be the means of converting an

10 THWEATT ON DIARRHCEA AND DYSENTERY.

open into a concealed haemorrhage. In conclusion, I will merely re-
mark, that active stimulants are frequently demanded during the pro-
gress of the treatment; and when the haemorrhage has ceased and the
s}Tstem re-acted, a bland and nutritious diet will become necessan7.

On the use of the Nitrate of Silver in certain forms of Dysentery in Adults
and Diarrhoea in Children, with cases and remarJcs.

BY J. J. THWEATT, M. D., PETERSBURG, VA.

My object in this paper is to call the especial attention of the profes-
sion to the therapeutic action of the nitrate of silver in certain patho-
logical conditions of the intestinal mucous membrane. The experi-
ments that have been made with this medicine on the continent of Eu-
rope, conclusively shew that its action on the mucous membranes
generally is of a particular or specific character. The attention of
many able pathologists has been directed to the object of ascertaining
the precise morbid states, to the removal of which it should be ad-
ministered. Upon this point, there is much diversity of opinion ; with
some, the existence of the inflammatory element is no contra-indicaiion
to its use ; while others maintain, that, when inflammation is present, it
should be withheld or used with extreme caution. My experience
with this agent, which has been pretty extensive, convinces me, that
in diseases of the mucous membranes, where the inflammatory action
seems high, the employment of the nitrate of silver is attended with
prejudicial effects ; and I am moreover convinced, after an attentive-
perusal of the authors who have written upon the subject, that much
of this contrariety of sentiment is to be attributed to the confounding
of the terms of irritation and inflammation. In my opinion there is a
marked distinction between the two pathological conditions, and that
this distinction should be kept prominently in view b}r the practitioner
who contemplates employing the nitrate of silver. In the one state he
will find its action eminently curative, in the other highly injurious. In
the one state the nitrate of silver acts like a charm, removing everv
symptom — in the other, it acts like a poison, aggravating all of the
symptoms ; in the one it is a placebo — in the other it is an active irri-
tant.

With these general remarks upon the pathological action of the ni-
trate of silver, we will proceed to its application in dysentery and di-
arrhoea of marked forms.

During the summer months, and particularly after heavy rains, d}rs-
entery in some form prevails to considerable extent in the suburbs of
our towns and the surrounding counties. In the years 1846-7-9, 1 was
called to attend many cases of this disease ; one form, from its fre-
quency and obstinacy, attracted particularly my attention. The follow-
ing phenomena characterized it : The person would be seized, after an
exposure to the heat of the sun, with an intense desire to have an eva-
cuation, accompanied with a disagreeable itching about the anal region ;
on going to stool and passing a small quantity of mucus, he would ex-
perience relief; this however was but momentary, for in about half an

THWEATT ON DIARRHCEA AND DYSENTERY. 11

hour, he would be again seized with the same symptoms. The con-
stitution at first is but slightly affected. There is no fever — pulse
calm — skin in a perspirable condition — no thirst — no headache — the
upper portion of the digestive organs remaining in their normal condi-
tion— no anorexia — no nausea — no enlargement of liver or spleen — no
tenderness on pressure ; the patients complaining of nothing but great
tenesmus, itching and soreness around the anus. The quantity of the
discharge rarely exceeded half an ounce — often no more than a drachm
was evacuated at a time. The discharge consisted entirely of mucous,
tinged more or less with blood. The above symptoms would continue,
with very little diminution or aggravation, for some four or five days,
when a new train of phenomena would make its appearance. The
patient complained of great debility, want of sleep and appetite —
the mind became irritable and fretful, pulse more excitable, especially
as night approached ; in some cases anemia came on — still there was
no pain in the bowels except in the lower portion of the rectum, about
an inch or two inches from the anus. The pain in this part was in
some cases excruciating, particularly on examination with the fingers :
the soreness around the anus was a great annoyance — the evacuations
would remain the same, only increased in frequency. I have seen the
patient go to stool twenty to thirty times during a day, and the dis-
charges all put together would not amount to/our ounces. When first
called to treat this affection, I employed the usual remedies, calomel
and opium, gentle laxatives, anodyne injections and fomentations,
leeches to the perineum — in some cases mercury was carried as far as
ptyalism, in conjunction with flying blisters over the abdomen. The
result of this treatment was unsatisfactory ; a mitigation of the symp-
toms would follow, and sometimes the disease appeared entirely sub-
dued, but in a short time all the symptoms would return ; for instance,
the calomel would frequently bring copious bilious passages, and after
the lapse of five or six hours, the same inclination to go to stool, fol-
loweel by the same discharge, would ensue. The anodyne injections
and fomentations would produce their grateful and soothing effects,
but in a few hours their pleasing results would disappear; no benefit
was derived in any case from the application of leeches.

The treatment proving so unsatisfactory, and the seat of the disease
being evidently limited to the lower portion of the rectum, I came to
the conclusion to direct my treatment to that point, and abandon all
internal remedies except the mildest laxatives. The high encomiums
which had been bestowed upon the nitrate of silver by continental
writers, induced me to try its effects in this disease. I commenced by
throwing up the rectum every three or four hours, two ounces of a so-
lution containing five grains of the nitrate of silver to an ounce of dis-
tilled water, adding a few drops of the tincture of opium. The first
case in which I employed this treatment yielded in a few days. The
treatment was fully carried out in all of the subsequent cases, and with
the most beneficial results ; in a few cases the dose was increased to
ten grains, but generally five grains to the ounce was of sufficient
strength. I have selected the following case to illustrate the treatment :

August, 1848, Mr. C, aged 25, of a strong constitution, general

12 THWEATT ON DIARRHCEA AND DYSENTERY.

health good, after exposure to the heat of the sun, was seized about
six o'clock in the afternoon with a great inclination to go to stool, ac-
companied with itching about the anus — on going to stool, he would
evacuate a small quantity of mucus mixed with blood, which afforded
relief; the inclination gradually increased, so that from six o'clock in
the afternoon to nine in the morning he had been to stool twenty or
thirty times. At nine o'clock I found him in the following condition :
complaining of no pain, none was felt on pressure, skin moist, pulse
slow and moderately full, tongue broad, moist, with a whitish coating,
no derangement of the cerebal or digestive organs. On examination
of the rectum by the introduction of the finger, he complained of pain,
extending about two inches up the intestine ; the parts around the anus
were swollen and acutely sensible to the touch. On inspection of the
evacuations passed during the night, they were found to consist of
mucous, slightly tinged with blood. Had two discharges while pre-
sent, of the same kind, about a drachm at each evacuation, complains
of itching around the anus — says the desire to have an evacuation re-
turns every fifteen minutes ; prescribed the following enema :

&

Argenti. Nitrat. gr xxx
Pul. Gum Arab. 3 j
Tinct. Opii. gtts xij

Aq. Distill. 1 vj

M
Fiat enema.

Two ounces to be thrown up the rectum every three hours — barley
water for diet and drink — cold applications to the anus. Saw him
again in six hours — had only three discharges — taken two injections ;
says he feels much better — the inclination to go to stool diminished —
ordered him a dose of oil with ten drops of the tinct. of opium. After
the operation of the castor oil, to give an enema, and repeat it every
three hours if necessary ; continue the cold applications ; same diet.
Saw him again at 9 o'clock in the morning. Had slept well ; the oil
had opei'ated twice, bringing faecal discharges ; used one injection ; had
only one mucous and bloody passage. The tenesmus had almost disap-
peared. Says he feels entirely relieved. Ordered an enema ; chicken
water. Saw him in the afternoon. Had no evacuations — doing well
in every particular. Left directions to use an enema, if the disease
should return. Saw him again on the third day of his attack ; found
him entirely relieved of every symptom of the disease, except sore-
ness around the anus ; directed cold applications to be continued, and
ceased my attendance, the cure being perfect.

Remarks. — We could cite many similar cases, but this one is suffi-
cient to shew the nature of the disease, and its proper treatment.
The question now occurs, "What is the pathology of this affection ? Is
it an inflammation ? We must reply in the negative. There was no
symptoms which usually attend the inflammatory action; and the treat-
ment, which generally subdues inflammation, was nugatory and some-
times aggravated the symptoms. The disease appeared to consist in

THWEATT ON DIARRHOEA AND DYSENTERY, 13

an irritation of the follicles of the mucous membrane of the rectum,
attended with an undue secretory action. The action of the nitrate of
silver in the case cited was that of a sedative ; it subdued the irrita-
tion, arrested the undue secretion, and restored the parts to their nor-
mal condition.

Diarrhcea.— The nitrate of silver has been lauded by many emi-
nent physicians as a remedy in this disease ; but I think they have
failed to point out clearly the cases in which it is most applicable. It
is admitted, that diarrhcea is dependent on a variety of causes for its
production- — its anatomical lesions are various and diversified in their
character; its therapeutics must consequently be of a diversified cha-
racter. In our climate a peculiar form of this disease is to be met
with during the summer months ; it makes its appearance without pre-
monition. The attention of parents or nurse is first excited by the
frequent and sometimes copious evacuations — the physician is sent for
— he finds no heat of skin, or head, or mouth, or abdomen ; no sick
, stomach or vomiting — pulse calm and quiet — tongue clean and moist ?
the child is apparently in excellent health- — its appetite is good — his
sleep undisturbed, except by the passages. This state of things is
however of short duration. The constitution becomes affected ; the
child gets weaker and weaker — loses flesh- — instead of pursuing its
usual gambols, is disposed to lie down — it becomes fretful — the exter-
nal features undergo a marked change — the countenance is pale — skin
corrugated and of low temperature — the pulse small and quick — ■
tongue contracted, but still free from fur — appetite fails — the secretions
from the bowels become more and more frequent, and if not soon ar-
rested, death ensues. In the dissections which we have made of this
form of diarrhoea, nothing was discovered but a slight congestion of
the mucous membrane of the small intestines ; no traces of inflamma-
tory action were detected. The character of the evacuations is various,
both with regard to quantity and quality ; in some they are natural,
only more abundant and frequent, and less consistent ; in others they
are small, mixed with mucous and of strong bilious appearance — in
some green, in others dark or whitish. We have found no remedy so
beneficial in this form of the disease as the nitrate of silver, as the
following cases will shew :

June 8th, 184S. W., set. 19 months, has been subject to the bowel
complaint for two weeks — 'much debilitated from the disease — coun-
tenance pale — skin cool — tongue natural — pulse slightly irritable — ap-
petite bad — no pain on pressure — no cerebral derangement, but is very
restless and peevish. The discharges from the bowels were of a deep
yellow color — no mucous or blood could be discovered. Prescribed a
warm bath and a teaspoonful of the following mixture every four hours ;

Argent. Nitrat. gr ij
Aq. Gummi. 1 iij
Tinct. Opii. gtts xij

M
Fiat mist.

14 THWEATT ON DIARRHCEA AND DYSENTERY".

June 7. Has had three operations from the bowels of more con-
sistency, color more natural — appetite improved — had rested well —
continued the mixture.

June 8. Had only one evacuation in twelve hours — that one of a
healthy appearance. Looks better, had taken heartily of nourishment :
suspended the mixture.

June 9. Had no return of the diarrhoea, condition improved in
every respect. The child recovered without further medical aid.

June 18. Edward, infant, aet. 9 months, had diarrhoea for four or
five days. Had taken calomel, Dover's powders, oil and chalk mixture.
The effects of these medicines had been only temporary. The dis-
charges would cease for a day and then return. When I saw the child
it was free from fever, lively and playful, gums not swollen, having
five or six passages during the day. They were green and slightly mixed
with mucous. The abdominal perietes soft and flexible. No pain or
sensibility on pressure. Tongue natural — no vomiting ; ordered the
following mixture :

Argenti. Nitrat. gr j

Pulv. Gum. Arab. 3 j

Tinct. Opii. gtts vj

Aq. Distill. 1 iij

Fiat mist. Teaspoonful every three hours.

Saw the child in the afternoon. Had taken three teaspoonsful of
the mixture. No passage after the first dose of the mixture. No fever ;
had been sleeping. Ordered a tepid bath at bed time and a teaspoon-
ful of the mixture and one early in the morning.

June 19. No passage through the night — had slept well — was
playful and entirely free from fever. Ordered a dose of oil and a tea-
spoonful of the mixture after the operation of the oil, to be repeated
every four hours if necessary.

June 20. Had rested well during the nioht. No fever. One health v
operation from the oil. Suspended the medicine, with directions to
resume it if the disease returned. Saw the child on the 23rd. Had
taken only one teaspoonful of the mixture. The passages were healthy.
Stopped all medicine. The child enjoyed excellent health.

Remarks. — The action of the nitrate in these cases was prompt and
efficient. It soothed the irritation of the mucous membrane ; gave
tone to the general system — and acted as a sedative and tonic astrin-
gent. The doses were small, from iV to aV of a grain. It has been
recommended in larger doses. I will add that no doubt larger doses
would be borne with safety.

lindsly's cases of mumps. 15

Tivo Cases of Mumps, with Metastasis to the Brain, both terminating fatally .
— By Harvey Lindsly, M. D., late Professor of Pathology and Prac-
tice of Medicine in the Columbian College, honorary member of the Rhode
Island Medical Society, the New Jersey Historical Society, <8fc.

Cases of mumps with determination to the brain are so exceedingly
rare that I do not recollect to have seen or read of more than three
besides those referred to at the head of this article. Most of our popu-
lar writers on the practice of medicine, though men of extensive ex-
perience, have evidently never seen a case, while they still speak of it
as of occasional occurrence. This is the fact with Good, Eberle, Wood,
Dewees, Mcintosh, Watson, Tweedie, &c. ; and indeed the only author
that now occurs to me, who speaks of this complication as having come
under his own observation, is Dr. Dickson of Charleston, in his able
and interesting work published a few years since.

In January 1849, a son of Gen. W., who at the time was a student
of medicine and attending the lectures of the medical school in this
city, was attacked with the mumps, and after a few days' illness died,
as I was informed, from metastasis of the disease to the brain. I can-
not give the particulars of this case, as the patient was not under
my professional care. On the 1st day of February following, about a
week after the death of this young man, I was requested to see his
brother, (setat. 20,) a student of Princeton college, who was at home
on a short visit to his friends. I found him laboring under a well de-
veloped attack of mumps of the left side, the gland considerably swol-
len and with some fever, though on the whole suffering but slightly,
and feeling, as he remarked, very comfortable. The disease seemed
to be taking its usual course, and if it had not been for the recent
death in the family, would have excited little interest or observation.
As it was, however, his friends felt some anxiety, and I was induced to
attend the case more carefully than I should have thought necessary
under ordinary circumstances. As precautionary measures, I directed
pretty active purgatives, followed by diaphoretics, hot pediluvia, warm
flannel to the swollen gland, &c, and watched very closely for any in-
dications of disease of the brain. I could detect nothing of the sort
however, and until the fifth day everything seemed to promise a fa-
vorable termination. I examined my patient carefully twice a day,
with reference to the condition of the testicles as well as the brain —
but there was no apparent disturbance of the functions of the one, and
no enlargement of the other. He was cheerful, slept naturally, and
felt confident of a speedy recovery. Upon examining him, however,
on the morning of the fifth day, my apprehensions were excited by
finding that he was laboring under -priapism. I dreaded this symptom
the more, as the disease seemed now to be taking the same turn that
proved fatal in his brother's case. He was immediately ordered to be
leeched freely at the base of the brain — a blister was applied to the
nape of the neck, purgatives given and an active general antiphlogistic
treatment adopted. At the same time additional professional advice
was obtained. During the whole of this day, however, the priapism
was the only indication we could detect of diseased brain.

16 PEEBLES ON THOMPSONIANISM.

On the next morning we were informed that he had been laboring
under delirium the greater part of the night — had been restless and
suffered much. These symptoms continued to increase in violence,
convulsions came on, and in a few hours death closed the scene on the
sixth day of the disease and the second after the appearance of the
priapism.

A careful examination of the brain was made thirty hours after
death, when decided marks of inflammation and congestion were found
in the cerebellum, but none in the cerebrum.

Washington, Nov. 29th, 1850.

The Rise and Progress of Thomj)sonia?iism.

BY J. F. PEEBLES, M. D.

This is an indigenous production. Perhaps, on that account, we
ought to approach it in a friendly spirit. Ours has been said to be
*' the greatest people in creation." The writer is the last person in the
world to underrate the national supremacy : but candor is an indis-
pensable attribute of the historian. This compels us, in the very out-
set, to declare that this, which is the most prominent specimen of our
native medical delusions, proves that the attempts of our people in
that line have, as yet, been awkward, bungling and extremely unre-
fined. The right materials seem not to exist with us yet for excellence
in these matters. How coarse and crude appears this torturing prac-
tice of medicine, when compared with the refined idealisms of home-
opathy and mesmerism ; even before the less elegant system of hydro-
pathy, it sinks into insignificance — it has no protot37pe in the old world.
It embodies a spirit which has no existence there, that of our restless,
dauntless, active, western backwoodsmen, who even judge of their
"physic" by the amount of labor it is capable of performing. It
sprung from the necessities of this part of our population, and it em-
bodies that which comports with the characteristics of their minds. —
The man who is ripe for a belief in Thompsonianism would turn up
his nose at homeopathy. The true nationality of its production is
elucidated by its course ; it tends westward with the pioneers, leaving
the east, where men, living upon their wealth and retired from business,
have the time to be invalids, for the prevalence of the more luxurious
and aristocratic systems of homeopathy and its kindred spirits.

Samuel Thompson, its founder, was born in the year 1769, in the
town of Alstead, New Hampshire. His parents were among the first
who settled in that region, then a wilderness ; they were poor, and
supported themselves by the labor of their hands. The young Sa-
muel, therefore, became early acquainted with manual labor ; and he
tells us himself, in more than one place, that he had no fondness for
it. Whatever genius he might have possessed, was certainly not soon
discovered by his hard-working father, who, despite his aversion to it,
and a lameness which much incapacitated him, kept his son steadily
employed on the farm. This parental sternness, as has been often the
case, was the making of the boy. It fixed his aversion to labor so in-

PEEBLES ON THOMPSONIANISM. 17

delibly, that he early began to turn about that he might devise some
means of living without it. An opportunity was not long in present-
ing itself. Being totally unprovided with physieians, the necessities
of the rude settlers, scattered through that wild country, often led them
to seek medical aid from any source it was profFered. In this way a
sort of rude practice sprung up in the hands of old women and others,
whose medicaments were gathered from the fields. Young Thomp-
son was not slow to discover the necessities of the community, and
with an eye always toward an escape from the drudgery of labor, he
early joined these drug-gathering parties, and eagerly turned his atten-
tion to the simple practice of the neighborhood. The expedient was
a successful one ; his knowledge of the rude medicaments in common
use became so perfect, that when only 8 years old he was dubbed
" Doctor " by his neighbors, and was often called on to decide upon the
properties of medicinal plants.

His acquirements, and the general belief in his great medical pro-
mise, finally overcame the sternness of his father, and he tells us, that
provided his services could have been spared from the farm, and had
his education, which as yet consisted of only one month's schooling,
been sufficient, he would, in his 16th year, have been sent to learn
medicine under a certain root doctor of Westmoreland. This step,
had it been carried out, might have been unfortunate for his subsequent
celebrity as a doctor ; and if so, it would certainly have been fortunate
for many a poor victim to his crude and remorseless system of practice.
We have no idea of the medical knowledge of the root doctor in
question, but we hold that, were he possessed of any experience in dis-
ease, or any information about remedies, it would have been sufficient
to have enabled him speedily to instil that in his pupil's mind, which
would have thoroughly disgusted him with the career he was about
entering upon. Our meaning can best be illustrated by a veritable in-
cident. We once heard of a groom, who fancied he had a natural turn
for surgery. After performing with the rudest implements, many mi-
nor operations, a woman was finally brought him with a cancerous
breast, which the most distinguished surgeons had declined amputat-
ing, because the disease had extended itself to the glands of the axilla
in such a manner, as to render the operation, not only useless, but
immediately dangerous. It was a mere trifle to our groom. He re-
moved it in a jiffy. It is true, the axillary artery was wounded and
the haemorrhage was terrific ; yet, nothing daunted, he coolly seized the
wounded vessels with a pair of ordinary pinchers well heated, and
miracuously stopped the bleeding. The wound healed kindly, and the
woman was soon sent home as well.

The result of this feat was the formation of a purse, by some be-
nevolent persons, who, determining that such natural abilities should
not be lost to the world, had resolved to afford the operator a regular
medical education. Before his term was half out at the university,
however, he returned home and quietly resumed his stable duties. —
When asked for an explanation of this conduct, his reply was, that he
bad become so shocked at his former foolhardiness, by what he had
learned of medicine, that he was deterred from its further prosecution-
2

18 PEEBLES ON THOMPSONIANTSM.

That he then knew the danger of the knife, and henceforward, those
who chose it might become surgeons; but as for himself, he never
meant again to remove even a wart from the human body. Denied
even the small chance of having the conceit taken out of him, which
the root doctor might have afforded, our hero, we find, was left to pur-
sue his labors on the farm and his medical studies at the same time.
Without learning, without books, without a guide or example, it ap-
pears, of any kind, this rude child of genius boldly knocked at the door
of nature's great storehouse of knowledge, and he fancied that it was
opened unto him. His history is a curious and not uninstructive ex-
ample of the study of medicine denovo, without reference to what was
hitherto known respecting it, occurring in our own times.

A contrast of his method with that of the most primitive medical
enquirers of which we have any account, certainly proves an advance
in the human mind, which is exceedingly interesting. Instead of ap-
pealing to the gods or to the heavenly bodies ; instead of selecting
remedies as was done b}r the earliest medical enquirers, according to
a fancy, dictated by the shape, color, brillancy of substances, Thomp-
son very philosophically, certainly, appealed directly to nature. He
tasted and tried for himself; he experimented on his playmates and
fellow-laborers with any thing that came in his way. We approve of
this method of enquiry, and when we have said that, we have said all
we can say in the praise of our hero.

The great storehouse of nature had been too sedulously and tho-
roughly examined by men qualified for the work by the learning of
ages, to leave any thing to be culled by so crude and ignorant an ob-
server as Thompson. Yet, for all this, we can sjmipatbise with his
belief in the originality of many of his discoveries. How was he, for
instance, to know that the lobelia had been long known and used by
physicians, when he was altogether unlettered had never seen a me-
dical work, and had no acquaintance, with any man having any preten-
sions to medical knowledge. The maintenance of this belief, when
he was told better, is exactly what might have been expected of one
so ignorant and uncultivated in every thing necessary to an enlighten-
ed and civil man. Though utterly useless to science, the labors of
Thompson brought him rich results in the way of conceit and self-
sufficiency.

He soon began to look upon himself as a favored emissary of Heaven,
sent to snatch his fellow-creatures from the clutches of the murderous
faculty. Taking his own statements as authority, the man seems to
have had but slight grounds for such a belief. The views which he
took of disease would disgrace an enlightened New Zealander. We mar-
vel how even he could have held such doctrines. It appears to us that the
very powers of thought required to frame a theory at all of disease, ought
to have ensured him against such manifest absurdities. He looked upon
the human body as a great pot, to be boiled or refrigerated at pleasure.
Disease he held to be something, endowed with a sort of life, which could
only be killed out of the body by his " courses." To destroy this mis-
chievous stranger was the end of his medication. He puked, steamed
and stimulated ; that not answering, he puked, steamed and stimulated

PEEBLES ON THOMPSONIANISM. 19

again and again. His method of practice was exceedingly simple ;
it was as plain as the building up and the putting out of a fire. He
made no allowances for the vital properties of the body, but acted on
it as though it were but inorganic matter. Heat, every one knows, vo-
latilizes water : taking the hint, Thompson cured dropsy through an
evaporation of the effusion, by raising the internal and external heat
of the body. Such crudities fail to excite even our derision, and we
turn from the further consideration of his mere theories with feelings
of pit3r, blended with amazement, that such notions could have ever
found advocates among a civilized people. Having fixed upon his
" courses," to be employed alike in the treatment of all diseases, he
set out on his great mission. It is due to the man to state that he
prosecuted his plans with admirable energy. Indeed it is difficult to
recognize the possession of so much perseverance associated in the same
individual with so little intelligence. One would have supposed, at
least, that the latter would gradually have been supplied, to some
extent, by the exercise of the former quality. Not so with Dr.
Thompson — he was too wise to learn; and he gained nothing by the
contact with the world. His ignorance and self-sufficiencv encrusted

O J

him too securely to admit of the penetration of a single ray of know-
ledge. He rivalled Paracelsus in the importance in which he held him-
self: the professor of the much longed for philosopher's stone could
not have been more arrogant. The brass of the man was inconceiv-
able. Not content to preach his doctrines into the ears of the unenlight-
ened in medicine, he bearded the lion in his very den. He -tells us
that he called to have a conversation on medicine with Dr. Rush, and
speaks of an interview with the elegant and accomplished Prof. Bar-
ton of Philadelphia.

The smiles of physicians at his blunders he construed into envy of
his success, and he seemed to be in perpetual trouble lest some one
would seize and appropriate his discoveries. He carried the war into
the enemy's country, and probably owed much of his popularity among
the unenlightened to his attacks upon the faculty. It was lis that ori-
ginated the prejudice against mineral medicines, still deeply rooted
among the ignorant, and set the popular current in favor of vegetable
or botanic remedies. Such was the character of Dr. Thompson. We
dismiss its consideration with the assertion, that so much ignorance,
self-conceit and daring energy were probably never before associated
together in the same individual.

After many }rears spent in journeying about from place to place,
healing the sick, the results of his medical investigations and dicove-
ries, Dr. Thompson, to protect himself, as he says in his narrative
from being robbed of all merit and emolument, ultimately embodied
in a book, which he sold under the protection of a patent. His first
patent, it appears from his narrative, was obtained in 1813. The early
introduction of the system was attended with many annoyances. Dr.
Thompson fairly suffered martyrdom for his strong faith in his discove-
ries. We read in his book constantly of severe trials, arising chiefly
from the ingratitude of his patients, the persecutions of the faculty,
the faithlessness of his agents, and the general wickedness of mankind,

20 PEEBLES ON THOMPSONIANISM.

from the judges on the bench, who sat on his causes, down to the old
women who had acted as nurses to his patients. His whole life, as he
has most touchingly given it, is a satire on humanity: an instructive
commentary on the injustice of the world ; marked, however, by the
pleasing contrast afforded by his own meek endurance of evil, and
steady adherence to the interests of his fellow-men. The Doctor seems
to have encountered a perfect shoal of swindlers ; to have submitted
his bantling to the world in most evil limes ; hence, he got but slight
gains for all his troubles — received but little remuneration for his bene-
fits to mankind.

His agents ran off, however, with immense sums obtained from the
sale of rights, which, first to last, must have yielded a vast deal of
money. The new doctrine gradually spread from New Hampshire
into other states. Next to that giving it birth, Ohio, from the first, ap-
pears to have afforded it the warmest reception. It was disseminated
with the greatest zeal. The manner of its circulation was like that of
a patented machine. Agents, armed with set phrases against the use of
mineral poisons, and in favor of vegetable remedies, peddled the books
through the country, and sold the right to their use in practice at twenty
dollars per right. It steadily spread on, until it pervaded the whole
country, including the Canadas. Every neighborhood was invaded,
and in every neighborhood one or more individuals were to be met
with, possessed of the requisite turn of mind necessary to constitute a
Thompsonian doctor. An observer might soon have learnt to point
out the individual in any given place likely to adopt the new calling.
The varieties of the species are great, }7et admitting of classification.
Your embryo Thompsonian doctor is considered in his neighborhood a
smart man for his chance, although }Tet he has never been good for much.
He is constantly astonishing his neighbors by his versatile mind.
He is much wanting in veneration ; hence, old and established usages
of every sort are frowned at by him. There is nothing which he be-
lieves he cannot do; hence he is ever ready to attempt aiyvthing that
comes to hand. He has no particular trade or business, yet he follows
any that he fancies. Ten to one if he is not set up in some intricate
trade, as watch-making, which he has never learnt. If not so, he as-
pires higher. He may deal a little in law7 — generally he is only a
preacher — in every thing he is essentially by nature a quack and pre-
tender.

These are the men who readily take up this practice of medicine,
making their neighborhoods ring awhile with their exploits, causing
the old women to gape and wonder at the canker ejected, by the emetic
weed, from stomachs hitherto held innocent of such abominations.

These are the men who deer}7 the faculty, who shudder at mineral
remedies, and who see health alone in the vegetable kingdom. One
such was asked in our presence of what was calomel made? Of cop-
per and brass, was his confident reply, doubtlessty deriving the opinion
from a fancied analogy between that ''awful" poison and the vene-
mous look of the rust of these metals.

It took time — but, as we have said, the new practice has pervaded
the whole country. We suppose fifty years must have elapsed from

PEEBLES ON THOMPSONIANISM. 21

its first promulgation before it became so generally diffused. Not only in
its results, but in the manner of its invasion, does its progress resemble
that of the cholera. It comes, and after a time departs; its residence
in all places is temporary, and its return only at long intervals. After
sweeping through a neighborhood, it will depart ; years after, when the
memory of its freaks has become dimmed in the recollection of" the
survivors, it will suddenly re-appear and vehemently assert its claims
to popular favor. Although partly, it is not altogether in this way that
it has been kept alive. Samuel Thompson, it seems to us, was honest
in his belief about this practice. This is demonstrated by the artless
manner he unfolded his doctrines. It is evident he meant them to rest
exclusively on their own merits. He believed them himself, and he
expected them to carry conviction to others. This was a frail reliance ;
the creed had within itself the elements of its own speedy destruction.
We affirm that, had its original spirit been maintained, had not its con-
trol passed in a measure out of his hands, the system would have
died with its founder. Long before his death, Thompson complained
bitterly of the innovations of his disciples. These, more artful and
long-sighted than himself, watched the popular mind. Money-making
was their object; hence, to keep the delusion triumphant, they steadily
propped it wherever it appeared to be giving way.

In this way only has it been kept from sinking. In late years but
few, if any, of the true breed are to be met with. Thompsonianism, as
Samuel Thompson taught it, has long been dead ; but out of its ashes
there has arisen recently a more dangerous, because more imposing
and disingenuous sect. We have now the Eclectics. These pre-
tend to combine the excellencies, without the obnoxious parts of both
systems of medicine, the "regular" and the Thompsonian. This has
led to a new swarm of specious quacks, which overspread the land.

Cincinnati is their head-quarters ; from thence they emerge like lo-
custs, to desolate the country. In many places they are now in the
full tide of their prosperity. But they cannot last long; this medical
monsoon will soon vanish ; then Thompsonianism will be forever dead.
The system is completely worn out;' there is not enough of it left to
hitch on another saving appendage. One word about the practical ope-
ration of this system of medicine, and we are done with it. We have
before alluded to the theories which guided Thompson in the applica-
tion of his remedies. They are too absurd and ridiculous to be again
referred to ; yet we candidly state that there was more in his proce-
dures than he had the mind to appreciate. We mean that he was una-
ble to perceive wherein his remedies were in certain cases salutary ;
too ignorant to tell in what manner they might sometimes cut short an
attack of disease. Need anything more be said to prove the utter
recklessness and danger of this system of quackery? His remedies
were powerful ; the;y produced the most violent and perturbating effects.
In this way, in cases suitable, but limited in their number, their revo-
lutionary tendencies might induce, although in a bungling and exceed-
ingly uncertain manner, salutary changes. Applied without discrimi-
nation, as it was in every disease, it could but lead constantly to
the most criminal consequences. The people are slow to condemn

22 JONES' OPERATION FOR LOSS OF UNDER-LIP.

their petted systems ; yet Samuel Thompson, for all that, was several
times brought to the bar of justice to answer the charge of murder, too
palpably committed to escape the observation of the bystanders. Un-
like some other delusions, all his blunders and crude experiments upon
his patients have added nothing to the stock of medical knowledge.
He had but glimpses of very few and unimportant therapeutical truths,
such as the influence of sweating as a curative means, which truths
have been long unfolded in the most satisfactory manner, and are
known to the merest tyro in medicine. He could do nothing, with all
his bungling and torturing procedures, which medical men do not
hourly do by safer, simpler and less disgusting means. He developed
no principle in medical practice which had not been known for ages,
whilst his therapeutical additions, which were new, were utterly value-
less. The whole delusion was but an unmitigated evil. In addition
to its direct evil tendencies, it has indirectly been the cause of much
mischief. Its spirit, and the manner of its introduction, tended to make
the people rebel against medical authority. It diffused a contempt of
study and learning, and excited a prejudice in the popular mind against
physicians as a privileged class, who held unjustly a monopoly, which
they used to oppress the people. The vaunted success of its heroes
favored the idea, that any one with twenty dollars in his pocket could
be a better doctor than the most scientific and learned physician. It
fostered and maintained all the existing popular errors about drugs,
and even originated many that were new. We repeat, therefore, that
the whole delusion, from the first to the last, has been an unmitigated
evil, and one not at all likely to reflect credit upon the intelligence of
our people.

Deformity of the Mouth, caused by the use of Mercury, with loss of the
greater portion of the Under-Lip, relieved by a Surgical Operation.

BY WALTER F. JONES, M. D., OF PETERSBURG, VA.

During the year 1845, 1 was requested to examine the case of a little
boy from the county of Gloucester, Va., aged 14 years, who, it seems,
had contracted a bilious remittent fever some six or seven years pre-
viously, during the treatment of which, mercury had been employed
by the attending physician, which resulted in the recovery of the pa-
tient, followed by severe ptyalism and sloughing away of the under-
lip. The patient exhibited the following appearance : The youth's ge-
neral health seemed pretty good, but the deformity above referrred to
consisted of the entire loss of the under-lip, save a very small teat-
like remnant on the left side. The whole under surface, where the lip
formerly adhered, from long-continued pressure, had become almost
entirely cartilaginous, and was united firmly to the anterior portion of
the inferior maxillary bone ; the tongue, with the sub-lingual glands,
was much diseased and enlarged; also the sub-maxillary on one side.
The patient could not articulate without the aid of a bandage, which
served to prevent the tongue's protruding and the copious discharge

JONES OPERATION FOR LOSS OF UNDER-LIP.

23

of saliva. This bandage had been worn for several years, and from
its continued pressure, served still more to paralyze the muscles upon
which it acted. His voice was reduced to an indistinct guttural
sound. Food could only be taken over the bandage, and had to be
forced back by the finger to the posterior dorsum of the tongue, the
latter having partially lost the power of aiding in the art of deglutition.
All the teeth in the lower jaw had been destroyed as far back as the
second molar. A
the subjoined.

drawing from a cast of the original is exhibited in

After the necessary preparatory treatment in the presence of Drs.
Peebles and Spencer of our city, I commenced the following operation:
It became necessary in the first place to remove the cartilaginous adhe-
sion which had formed and which has been described above. An in-
cision from left to right was made with the scalpel, including the rem-
nant of the lip to the left down to the periosteum. The bone itself
was found sound and healthy, judging from the condition of the latter
membrane, although the alveolar processes had been absorbed. After
removing that portion which seemed devoid of all vitality, the dissec-
tion was continued entirely around the chin and clown to the perios-
teum, and the operation for hare-lip was performed, all the substance
gained from under the chin being previously pushed up. In order to
prevent adhesion from taking place to the gum, a small portion of zinc,
of proper form, suggested by the shape of the decayed alveola?, and
to supply their deficiency, was applied and worn during the whole
treatment. Of course there was little or no haemorrhage, as only small
branches of the facial artery were divided, which required only a small

24 JONES' OPERATION FOR LOSS OF UNDER-LIP.

twitch of the forceps to arrest the slight flow of blood. The bandage
for fractured lower-jaw was then applied, which served to keep the
substance under the chin in its desired position. After the operation
the patient was comparatively comfortable, and only required an ano-
dyne for the night, which was spent quietly. Nourishment was ad-
ministered by means of a glass tube through an aperture afforded by
the loss of an upper tooth. After the fourth da}* the bandage was re-
moved, and the adhesion was already formed, needing only the appli-
cation of a narrow strip of adhesive plaster between the sutures, and
one below the second suture. The bandage was re-applied. It was ne-
cessary to remove it every third or fourth day and adjust the zinc plate,
if necessary. Our little patient continued well until about the fourth
week, previously to which the adhesion had entirely formed, to all ap-
pearances, and the needles had been removed. When about the com-
mencement of the fifth week we observed a small dark spot which
appeared immediately under the upper suture. In a few days a fever
came on, and we began to fear sloughing ; but with close watching,
nutritious diet mild tonics, and perfect rest, with an occasional ano-
dyne, we began to see our little patient improve ; although the dark spot
above alluded to continued to increase, leaving a narrow band between
the upper extremities of the lip, and was not arrested until about the
eighth week, notwithstanding the above general treatment and the oc-
casional cautious application of lunar caustic. I may here add that
the bandage was worn for several months, which afforded considerable
comfort to the patient. Even at this stage he could speak quite dis-
tinctly, and eat with comparative ease. The enlarged glands were
greatly improved, and the tongue itself could be protruded with little
or no inconvenience. The patient was allowed fresh air and nutritious
diet ; and the opening on the lip was protected by a small portion of
court plaster. After the expiration of six months from the first ope-
ration his health had been entirely restored, and about the eigth month
the second operation for hare-lip, employing only one suture, was per-
formed, which in less than ten days had healed completely. It be-
came necessary to apply a few false teeth upon a well formed artificial
plate, corresponding with the deficient alveolae, which gave the lip its
former natural appearance. In a few weeks he returned home entirely
relieved from this distressing deformity. Drawing No. 2 will give a
tolerably good idea of his appearance after the second operation..

BROWNE S ADDRESS.

25

[ We regret to send out such a caricature of the face as the second cut gives, but
the lateness of the receipt of the cuts rendered it impossible to have a new one
made. We hope an idea, at least, of the cure of the deformity will be given by-
it and the description in the context. Editor.]

An Address delivered before the Medical Society of Fredericksburg.

BY WM. BROWNE, M. D., (PRESIDENT OF THE SOCIETY.)

I congratulate you, gentlemen, upon having at last completed the
organization of the "Medical Society of Fredericksburg and the ad-
joining Counties." I hope in all our proceedings we shall be guided
by a spirit of conciliation and forbearance, which alone can render our
intercourse agreeable and our action beneficial to ourselves and useful
to the profession. We shall be frequently called on to exercise this
forbearance in our remarks and criticisms on the reports of cases and
professional essays which may be read before the society. But the
characters of our members, happily, area satisfactory guaranty, that,
in all our discussions, they will exercise a due regard for the feelings
of each other, and render this caution superfluous.

On this occasion, it being our first meeting under our present organi-
zation, I think it proper to submit a few remarks on one only of the
numerous errors which have, for many years, been gradually extend-
ing, and which, in this our day, prevail so generally. The error to

26 browne's address.

which I allude is, the strong propensity to catch at and adopt novelties,
both in theory and in practice, without allowing sufficient time to test
their claims to confidence, by reason and experience.

For the past half century, and especially during the last twenty
years, revolution and progress have been stamped on every depart-
ment and occupation of life. Even in the fixed sciences, the novel
application of old and well-established principles has produced re-
sults truly marvellous' and astounding. The general introduction of
steam as a locomotive power has brought the inhabitants of our widely-
extended country almost within the bounds of social intercourse, and
by means of electricity we carry on friendly and business conversations,
if such intercourse can properly be so called, with individuals thou-
sands of miles from us. Schemes are also in progress, and will, in all
likelihood, be ultimately accomplished, to bring the whole of Europe
within conversational distance of us ; and it may be that some of the
present generation may live to interchange greetings with their friends
in England, France, Holland, German}^ and probably even in Rus-
sia, in the space of a few short hours.

Mutation and progress are also stamped on our profession, and it re-
quires vigilant care and close application to study to keep pace with
their rapid strides. Our profession, however, is not a fixed science, and
there are but few principles belonging to it that can be considered as
determined. Progress and change here, then, must be carefully
watched, that they lead us not into error. Our profession deals with
the lives of our fellow- men, and our errors lead to death. Let us be
careful, therefore, to avoid being led astray by the specious represen-
tations and unsound deductions of over-sanguine members of our pro-
fession, which too often come from men of high professional reputation,
and which are scattered throughout the world in medical periodicals.
There is a strong tendency in the present day, in all classes of societyr, to
catch at novelty, and to build up ingenious theories and s}7stems, on the
foundation of a few isolated facts, and these by no means satisfactorily
substantiated, but, in truth, too often assumed. Our profession is by no
means exempt from this prevailing bias. From this source has arisen
homeopathy, frydropathy, Thompsonianism and other kindred medical
fictions, which have obtained many proselytes, even from the ranks of
the profession, and which are yet extensively engaged in the work of
death, not only abroad, but throughout our own country ; and not onl}
has it given rise to systems professing to be based on pathological data,
but it has resuscitated from the ruins of Iry-gone superstitions, the
miracles of monkish charms and relics, Prince Hohenlohe's prayers,
Mesmer's hallucinations, and many others equally repugnant to reason
and to sound sense. At a more recent date the semblance of deadi
has been paraded on the stage, and ether and chloroform, the agents
in this counterfeit representation of the extinction of vitality, have been
hailed as among the choicest gifts from Heaven, which were, if not to
deprive disease of its mortality, at least to procure exemption from all
physical suffering, and to wreath in smiles the countenance of the most
timid and delicate during the painful throes of parturition, and, what
have heretofore been considered the agonies of the gravest surgical

browne's address. 27

operations, the very sight of which would cause the stoutest heart to
tremble. That many have passed through this seeming death, with
apparent impunity, we have abundant evidence, and I trust reliable, to
shew ; that many, or indeed any, have been saved from real death,
we have yet to learn. Sufficient time has not yet elapsed to enable us
to learn whether dormant predispositions may not, in many instances,
have been excited into life and vigor, which might have remained in-
active for many years, if not for life, by the direct application of these
potent agents to organs so important to life as the lungs. The evidence
which has heretofore come to us has been, mostly, from the side of
anaesthesia; an occasional lamentation, however, reaches us from the
opposite quarter ; and late developments on the other side of the At-
lantic are well calculated to excite alarm. The victims of this humane
effort to mitigate suffering, have of late sadly increased, and the Lon-
don Medical Gazette of the 7th of September 1S49, in a review of
some treatises on anaesthesia in child-birth, closes with the following
language, conveying a most solemn warning to all who use these agents
to relieve the sufferings of labor :

" The trial has been made ; the claims of chloroform and ether, as
employed in midwifery, have been tested. The result has been, that
the little advantage gained by the many, and the great detriment sus-
tained by the few, fully confirm the statements made by Mr. Gream
and others, as to the dangers attending the use of these agents — at the
same time justifying and strengthening the voice of alarm; so that it
is now almost as rare an occurrence to meet with an obstetric practi-
tioner in London, who would venture to chloroformise a patient in la-
bor, as it was common, a few months ago, to meet with those who
were daily making trial of this new charm for the relief of suffering.
After the perusal of Mr. G ream's pamphlet, now before us, we feel
that they in whose hands the experiment has not resulted in sincere,
but unavailing regrets, have much cause to be thankful."

We have yet much to learn in relation to these important agents,
before a correct opinion can be formed, either of the benefits or inju-
ries which are likely to result from their use ; but the eagerness with
which they were seized on, the extent to which their use has been
carried, and the re-action which is already, to some extent, taking place,
in regard to their introduction to general use, from the increased num-
ber of fatal results, clearly point out the propriety of great caution in
adopting novelties, and the necessity of carefully testing them before
we give credence to the merits which their authors claim for them.

The number of specifics introduced into practice of late years, b}*-
medical men of distinguished stations — the facility with which they
have been adopted, and the rapidity with which they have passed out
of notice, have their origin in the same source; and it is mortifying to
see the members of a profession, who claim pre-eminence on account
of liberal education and careful mental culture, so often led into this
prevailing error, when they have been so often misled and disap-
pointed. But a few years since a gentleman who occupied a. high rank
in the profession, and who was physician to one of the most extensive
hospitals in London, proclaimed, as the results of his own personal

28 beowne's address.

experience, that bi-carbonate of iron, in one or two drachm doses,
amounted to a specific, almost, in tic doloroux. The same gentleman,
about the same period, or perhaps a few years before, trumpeted fbtth
kreosole as an infallible remedy in diabetes — one of the most fatal ma-
ladies it has ever been my misfortune to treat. We all know with
what avidity these remedies were adopted by many physicians in this
country, particularly the first, as fortunately there occur more of those
diseases in which iron was to prove specific, and how many feeble
and delicate stomachs were crammed to overflowing with this earthy
drug, luckily comparatively inert; and what has become of the anti-
cipations so fondly cherished, that weapons were supplied to our hands,
to disarm of their suffering and mortality, two at least of the enemies
of our health, our comfort and our life? They have vanished into thin
air, with the thousands which have preceded them; and, what is to be
deplored, on account of distinguished talents, though sadly misapplied,
their originator, still in search of some universal panacea, has wrecked
his fame and reputation on the shoals of " Nickel and Mesmerism,"
and has become an exhibitor of the wonders of animal magnetism to
the gaping nobles of England's metropolis in this the 1 9th century! How
can we be surprised that individuals, uninstructed in our profession,
and totally ignorant of our physical organization and of the functions
and relative importance of the various and complicated organs of the
human body, should seize with avidity on any of the nostrums, which
in countless thousands are spread before them in newspapers, pam-
phlets and almanacs, promising relief to "all the ills that flesh is heir
to," and in too many instances recommended to public confidence by
certificates from ministers of the Gospel, who "know not what they
do" — and which, for the sake of suffering humanity, is deeply to be
regretted — when members of the profession have so often been led to
adopt medical prescriptions and plans of treatment in cases seriously
involving life, on representations devoid of the necessary foundation to
inspire judicious confidence? " Fashion in physic," has long been a
reproach to the profession, from which, I regret to say, it is by no
means exempt even at this day. How long it will remain so, must de-
pend on the intelligence, the independence and honesty of its members.
Nothing has a stronger tendency to increase and perpetuate such
evils, as the introduction into the profession of young men of naturally
sprightly talents, but of limited education, of little reading, and, of
course, of defective judgment. Incapable of comprehending the che-
mical changes which may take place from the introduction of incon-
gruous materials into their prescriptions — unacquainted with the exten-
sive and complex sympathies which exist between the various organs
of the body, and the influence which remedies applied to one part,
exercise through this medium on parts far removed from it, it is not to
be wondered at that they should readily adopt remedies and modes
of practice introduced to public notice by specious representations of
their efficacy, and sustained by certificates of men of standing and
reputation, but more ignorant of such matters even than themselves,
and recommend and prescribe them with a confidence well calculated
to beget a corresponding confidence in those to whom they are thus

JOHNSON S CASE OF TETANUS. 29

recommended. Among such persons we often find individuals pos-
sessed of considerable astuteness, who know well the necessity, and
practice it too with no little success, of supplying, by address and a
confident manner, the defects of education and the want of knowledge.
It is to be lamented too, that the public is more gullible on medical
subjects than on any others, and too often invites the deceptions that
are practised on it.

The formation of the " National Medical Association," with its va-
rious ramifications extending throughout our country, by procuring a
freer and fuller interchange of views, and bringing medical theories
and facts to the test of close and strict examination and professional
criticism, promises to do much towards ridding our profession of many
of the evils and errors which encumber it. Its recommendations also
to our public schools to raise the standard of medical education, which
I am glad to see, has been favorably responded to by some of our
leading institutions, will bring to its aid a most important adjunct in
sustaining and forwarding the cause of humanity.

I have thus briefly alluded to this tendency to delusion in our pro-
fession as a caution to all of us, against yielding a too ready credence
to new systems, new theories and novel facts, and to the adoption of
new remedies, more especially if in undue quantities they act as poi-
sons, without a strict and critical examination of the foundation upon
which their claims to confidence rest.

It is also highly important to avoid the opposite error, skepticism,
which is equally, if not in a higher degree, injurious to the character
and usefulness of our profession. In our search for what is true and
useful, it would be well if both extremes could be avoided.

Proceedings of the Medical Society of Virginia — November Meeting 1850.

The society was called to order by Dr. R. W. Haxall, (president,) a large
number of members and several visitors being present. After the disposal of some
matters of business, there were presented letters of application for membership
from several gentlemen, who were duly nominated. The subject of discussion for
the evening, " Tetanus," was then called up by Dr. Carter P. Johnson, who
said :

In presenting the report of the following case to the society, I would
remark, that tetanus, as well as other spasmodic diseases, assumes a
higher degree of interest at this time, in consequence of the investi-
gations at present in progress in regard to the functions of the nervous
system.

All writers agree in assigning the spinal marrow as the seat of
tetanus ; or rather, in ascribing !o that portion of the nervous centres
the emanation of the influence which is directly concerned in pro-
ducing the spasmodic muscular aclion. The solution, therefore, of
the iiutliology of this disease, must depend upon the proper compre-
hension of the physiology of the spinal marrow.

Besides the mere office of conducting impressions and influences to

30 Johnson's case of tetanus.

and from the brain, the spinal marrow possesses the power of appre-
ciating impressions conveyed to its grey matter, and of generating in-
fluences which are conveyed from it by its exodic nerves, as was first
proved by Procharca, and afterwards elaborately demonstrated by
Marshall Hall.

When in its normal state, an impression conveyed to the spinal
marrow by an exodic nerve, causes an influence to be generated which
is reflected back merely through the corresponding exodic nerve, pro-
ducing a motion in the muscle to which that nerve is distributed ; but
if the natural excitability of the spinal marrow be exalted, the same
impression conveyed to it will be responded to by a considerable por-
tion of the organ, and will be reflected back by a large number of
exodic nerves, producing a corresponding muscular contraction. Now
if, when the excitability of the spinal marrow is thus exalted, }-ou
have, at some peripheral portion of the body, a permanent source of
irritation, such as a wound (particularly if in a state of high inflamma-
tion) would afford, you will have, through the exodic nerve proceeding
from this point, a constant series of impressions conveyed to the spinal
marrow, and consequently a constant series of reflex influences con-
veyed through the exodic nerves to the peripheral muscles, producing
a constant state of spasm — or, in other words, tetanus.

Such I conceive to be the pathology of this disease, in whatever
form it may present itself. Writers divide it into traumatic and idio-
pathic ; but I am inclined to think, that if we could analyse strictly
every case of idiopathic tetanus, so called, we should find its patho-
logy to correspond with that of the traumatic variety, both being re-
solved by the principles which I have just endeavored to explain. In
every case of tetanus, I believe that you will, find an exalted condition
of the function of the spinal marrow and a local point of irritation, be that
point in the spinal marrow itself, or, as it most usually is, at some peri-
pheral portion of the body.

These views are borne out by the case I am about to report. It
would ordinarily be laid down as a case of idiopathic tetanus ; but
that there was in this case a local point of irritation, I think is highly
probable from its history, and that that point was the uterus, which
had but the week before been the seat of a process well calculated to
produce serious inflammatory action, I can scarcely doubt ; and if so,
in what respect would this case differ from a case of ordinary trauma-
tic tetanus.

On Sunday, September 15th, I was called, in consultation with Dr.

Wm. A. Patteson, to see Mrs. , of whose case I obtained from

Dr. Haxall, the attending physician, the following histoiy :

Mrs. is about 27 years of age ; has been married nine years,

and has borne four children. Her general health has been very good.

On Tuesda}T, 3d September, being about six weeks advanced in
pregnancy, she experienced some pain in the loins, which was soon
followed by haemorrhage. The occurrence of these symptoms she at-
tributed to fright. During the day, Dr. Haxall saw her, but was not
permitted to make an examination. Ordered acetate lead and opium,
external application of cold — strict rest.

Johnson's case of tetanus. 31

Wednesday j 4. Haemorrhage continuing, an examination was in-
sisted on, which disclosed the placenta presenting itself at os tineas,
which was slightly dilated. Tampon was applied, strict rest enjoined,
and all other remedies discontinued. No haemorrhage occurred after
the application of the tampon.

Thursday, 5. Tampon being removed, a portion of the placenta
came away. No additional haemorrhage. Tampon re-applied.

Friday, 6. Remainder of the foetal mass came away to-day, unac-
companied by any haemorrhage. Tampon was discontinued. At this
time her pulse wras good, her appetite good, and she made no complaint.

Saturday, 7. Found her sitting up in bed sewing. Enjoined entire
rest.

Sunday and Monday she remained in bed, but appeared quite well.

On Tuesday, 10th, Dr. Haxall left home, and Dr. Patteson saw her ;
she was then sitting up and appeared quite well. On that day, after
the doctor's visit, she engaged in a romp with one of her friends, and
afterwards sat by an open window for some time. On that night
(or the next?) she also sat by an open window, watching a fire that
was in progress in the immediate neighborhood.

On Wednesday, 11th, she experienced some slight stiffness of the
jaws, which continued with a slight increase up to Saturday, when
her husband consulted Dr. Patteson. On Sunday, Dr. Patteson saw
her about 3 o'clock, when he ordered her calomel and Dover's powders,
aa grs. x. At 7 o'clock on Sunday evening, I visited her with Dr. P.

When I saw her, the case presented the following symptoms : The
patient lay on her back with the head drawn slightly backwards and
resting on the occiput ; the muscles of the back of the neck were in a
state of tension, though not excessive; the jaws were closed .quite
firmly, the patient not being able to open them more than ^ inch ; the
masseter muscle was firmly contracted, and its fibres could be felt
hard and resisting as when the teeth are strongly closed by a volun-
tary effort. There was considerable difficulty in swallowing, every
attempt to do so being accompanied with pain and an increase in the
tension of the muscles. She complained of severe pain just below
the sternum, passing through to the right shoulder, doubtless caused
by spasmodic action of the diaphragm. Her pulse was soft, com-
pressive and more frequent than usual, probably 95. Her skin was
relaxed and covered with slight perspiration, and she was suffering
somewhat from nausea, caused probably by the Dover's powder wrhich
had been administered.

She was directed to take Hoffman's anodyne 3j, black drop gtts
xx., every three hours, and to inhale sulphuric ether, which Dr. Patte-
son had already exhibited, through the night, "pro re nata;" and in
the morning to take a tablespoonful of castor oil.

September 16th, 9 o'clock, A. M. Pins taken two doses of the ano-
dyne and repeatedly inhaled the ether. During the morning has dozed
a good deal. Did not take the oil until a few minutes before our visit.
Her condition very similar to that of last night ; complains very much
of the spasm of the diaphragm. Directed to continue the use of
ether, to take a teaspoonful of oil in three hours; and if the bowels

32 Johnson's case of tetanus.

were not then opened, to have a stimulating enema. Dr. Patteson
visited her at 3 o'clock, and finding that only the lower bowels had
been evacuated, directed Croton oil, gtt ij, in mucilage, to be repeated
in two hoars if it did not operate.

At 6 o'clock, P. M., we visited her together, and found that the
bowels had just been fully evacuated, the passage not being very
offensive, and presenting a healthy and natural appearance. She was
more quiet, complained less of the diaphragmatic pain, and seemed
to swallow with more ease. During our visit, a tendency to tetanic
spasm coming on, it was speedily controlled by the exhibition of the
ether, under the influence of which she became composed and relaxed.
With the view of favoring the purgative action of the oil, she was
directed simply to continue the use of the ether, and only to resort to
the anodyne in case of excessive purgation or great tetanic action.

September 17. We were summoned about 7 o'clock this morning
to see the patient, a tendency to syncope having occurred upon raising
her in bed. We found her with a very pallid countenance, increased
tension of the elevator muscles of the lower jaw, and increased tend-
ency to spasm of the muscles of the back of the neck ; the pulse more
feeble, though not indicating great prostration. She had passed a tolera-
bly quiet night, inhaling the ether frequently, and being always relieved
by it. She had had two more evacuations of the bowels. She com-
plained more of the diaphragmatic pain than last night. She was direct-
ed assafcetida 3 ij., opium grs. xvi., water 1 iv., an ounce of which to be
thrown into the rectum every two hours ; also a blister to be applied
over the spine three inches wide, from the nape of the neck to the
dorsal region. Beef tea ordered for nourishment, and occasionally
a little toddy. We saw her again at 3 o'clock ; two clysters had been
administered, the blister applied and some of the beef tea taken.
She had continued to use the ether. There was an abatement in the
spasm of the muscles, and she had been much more quiet and com-
posed. At 6 o'clock, P. M. — Still farther improvement ; she can sepa-
rate the jaws sufficiently to admit the index finger; complains of no
pain; pulse more full, and countenance less pallid and more natural.
During the day the parts over the affected muscles were constantly
anointed with an ointment of aconite. Directed to dress the blister
with stramonium leaves, and to continue the above remedies "pro re
nata. "

September 18. Passed a comfortable night ; rigidity of muscles
about the same as last night ; complains of no pain ; pulse a little ex-
cited and skin a little warmer than natural. Directed to use ether
less freely ; to take beef tea and the assafcetida enema if necessary.
At 3 o'clock had not taken the enema. Ordered her a cathartic ene-
ma, which was given, and followed by free evacuation of the bowels.
At 6 o'clock, P. M., found her very restless ; the spasms increased;
constant tendency to throw the head backwards and some slight ten-
dency to opisthotonos ; complains again of diaphragmatic pains. Ordered
25 droits of black drop in a teaspoonful of Hoffman's anodyne, immedi-
ately to be followed by the anti-spasmodic enema; these to be admi-
nistered through the night "p-o re nata; " the ether to be used freely.

TRANSACTIONS OF MEDICAL SOCIETY OF VIRGINIA. 33

We left her about half an hour after the administration of the first
dose of the anodyne, sleeping quietly.

September 19. Passed rather an uncomfortable night, sleeping but
little. Took three doses of black drop and Hoffman's anodyne and
several enemata. The spasms are persistent to-day ; condition very
much as last night. Directed her to take 50 drops of black drop
every two hours, to use the enemata, and to drink milk toddy and
julep. At 2 o'clock she was more calm, and had passed a more quiet
morning. Ordered her croton oil, two drops every two hours, until
the bowels were evacuated, and a solution of extract Indian hemp
in 1 gr. doses every two hours. At 6 o'clock, found her more feeble,
her respiration much more difficult and wheezing. Her voice was al-
tered, indicating an evident contraction of the "rima gloltidis." Her
pulse was feeble and countenance pallid.

From this time she continued to grow worse, the respiration be-
coming more and more laborious, until about 10£ o'clock, when she
expired, apparently from asphyxia.

In reply to questions asked by several members, Dr. J. stated that
the ether was administered constantly and sometimes until complete
anaesthesia was produced. It was taken with much avidity, and greatly
relieved the agony of the patient, but did not relax the spasms.

Dr. Snead entirely concurred in the opinion which had been ex-
pressed by Dr. J., and believed there was no such thing as idiopathic
tetanus ; that there must always be irritation, if not a wound, found in
some part of the body, from which the impressions giving rise to teta-
nus emanated. • In this case he thought it was unfortunate that the
womb was not examined.

Dr. Johnson replied, that it was determined in consultation that
no good could result from such an examination, and it was therefore
not made. He did not, however, defend the opinion.

Dr. Gibson believed, notwithstanding the opinion wThich had been
expressed by other gentlemen, that there was such a thing as idiopathic
tetanus, and proceeded to draw the distinction between the two forms,
calling those traumatic which could be traced to a wound as the ex-
citing cause, and all others idiopathic. The case under consideration
he thought was traumatic, the womb being the seat of the injury.

Dr. Cunningham remarked, that it had been his lot to see thirteen
cases of this formidable disease, and that he also believed in the ex-
istence of pure idiopathic tetanus. In two of his cases there was no
wound whatever. The first was a very formidable one, attended with
as violent symptoms as any case of traumatic tetanus. It occurred
in a child, and was produced, he believed, by worms. The other oc-
curred in the person of a laborer in a rolling mill, who slept in a cold
place after being heated and fatigued. He suffered violently with te-
tanus three or four weeks. In this case he used the most active pur-
gation, with calomel, croton and castor oils. The patient recovered.

Dr. Johnson said he had been misunderstood. If the absence of
a wound was sufficient to establish idiopathic tetanus, then he be-
lieved in it, and these were cases ; but, according to the position he had
3

34 TRANSACTIONS OF MEDICAL SOCIETY OF VIRGINIA.

taken, mere irritation of any part transmitted to the spinal marrow, and
finding it with an exalted excitability, might produce tetanus. In Dr.
Cunningham's cases, intestinal worms produced the irritation in the
one, and the effect of cold in the other.

Dr. Cunning-ham replied to an enquiry, that both of the cases were
attended with opisthotonos. He then said, that although the pathologi-
cal difference, based upon their exciting cause, was not clearly defined,
a practical difference between the two forms seemed important, inso-
much as idiopathic (or the chronic tetanus of writers) was less danger-
ous than the traumatic or acute.

Dr. Brockenbrough remarked, that in 1842 the county of West-
moreland was visited by a great many northeasters, and he de-
tailed two or three cases of this disease produced by them, which
terminated fatally. He regarded them as cases of idiopathic tetanus.

Dr. Scott preferred to read what he had to say on this subject,
whereupon he proceeded to read a paper, which will be found on file.
In it he commented upon the views of several authors — Wood and
Watson among them — and thought them rather vague, teaching but
little whereon we could build any rational treatment. He preferred
to adopt the conclusions of Marshall Hall, as they were based upon
experiments which he thought satisfactorily proved this to be a disease
of the excito-motory system. The terms centric and eccentric he thought
much better to express the different forms of the disease, as they were
much more definite than idiopathic and traumatic. He referred to
Trousseaus' account of the effects of strychnine, and said that he be-
lieved in tetanus the same organs were not only affected, but they
were in the same condition as when under the influence of strychnine.
He attributed the occurrence of sleep in the disease, to an exhaustion
of the superabundant nervous excitability. Patients sleep because
spasm has relaxed, not that sleep relaxes spasm. During rest, time is
given for accumulating a new supply of excitability, and spasms again
follow. As to the treatment, Dr. S. had nothing to say, having seen
only two cases : they were treated with assafoetida and opium, and, he
supposed, calomel — both patients died.

Dr. Gooch said he would respond to the call made by the able re-
porter this evening, on members, to detail their experience. He had
seen a good many cases in this country and in Europe, but was sorry
he had not made better notes of them. He had seen cases which he
considered idiopathic, according to the accustomed signification of that
term, being attended with no traceable injury, inflammation or irrita-
tion. He preferred the terms centric and eccentric, and thought it pro-
bable there was no centric tetanus : the so-called cases were epileptoid
disease. He referred to Dr. Johnson's case, and said he should have
deemed an uterine examination necessary. In regard to the tobacco
enemeta, he should not have used them, as Dr. Johnson had said, be-
cause the tendency of the case was downward, and the patient very
feeble — moreover the bowels were opened well. He considered to-
bacco in nine cases in ten an invaluable agent. It is directly a ner-
vous sedative, and indirectly so, by proving an efficient laxative, ridding
the bowels of their irritating load. It was freely used in British prac-

TRANSACTIONS OP MEDICAL SOCIETY OF VIRGINIA. 35

tice. Etherization is a great boon to the poor tetanic. But this was
only an adjuvant means. He considered the treatment in the case be-
fore us, like it most generally is — not curative, but merely •palliative. We
should be searching now for some remedy, and no longer relying upon
soothing and palliating the most severe symptoms. In this case he
thought it exceedingly probable that quinine, in full doses and often
repeated, might have saved the patient. We agree that it is a sedative,
besides being a fine tonic. In addition to this theory we have evidence
in its favor. The case reported to the society last year, by Dr. T. S.
G arnett of Westmoreland, has two bearings on this discussion : Firstly,
it was one of terrible character, with no traceable cause, (an idiopathic
case,) resisting the whole list of remedies most energetically applied ;
and, secondly, it yielded to a treatment with quinine and alcohol,
adopted when the case was of forlorn hope.

Dr. Scott asked how quinine could be both a sedative and a tonic ;
and if it was, he did not see the object in giving it for this double
effect.

Dr. Gooch said, that if the sedative was the principle of cure, (and
he believed it was,) he should think quinine a powerful and use-
ful drug; and if the spasms could be broken in upon, he should assur-
edly use a tonic , and should rather use this anti-periodic, in hopes that
it would prevent the recurrence of them. He would answer the other
part of the query, by asking another : How is the cold douche both a
sedative and a tonic in mania potu?

Dr. Haskins said he believed the correct pathology had been
stated ; that tetanus was a disease affecting especially that portion of
the nervous system concerned in the performance of the reflex func-
tions, and consisted in a morbid increase or exaltation of its excita-
bility. This no one had denied. Now, assuming this to be the cor-
rect pathology, he did not believe the mode of treatment adopted by
ourselves, and recommended by the highest authorities, was the true
or philosophical one. The remedies used in the case reported, ether,
opium, alcohol in some form, and a few other nervous stimulants, make
up our list. What principle, he asked, would indicate the propriety
of stimulating a nervous system already in a state of hyper-excite-
ment? This plan of treatment may be defended, perhaps, upon a
principle alluded to by Dr. Gooch. He has said quinine was a
stimulant in small doses, and a sedative in large ones ; and we all
agree with him. In this admission, however, I do not conceive that
any objection to the use of such articles is removed. This phenome-
non is in accordance with a well known law of the animal economy, ■
" that undue action is followed by subsequent depression." They
cause an expenditure and exhaustion of the super-excitabilit}^ and
temporary sedation is produced. This whole class of medicines are,
nevertheless, nervous stimulants, though, secondarily, they may be seda-
tives. If these remedies operated principally upon that portion of
the nervous system involved in the disease, I confess that my diffi-
culty would be in a measure removed. But opium, alcohol, &c. act
first upon the brain. Ether illustrates it well. Labor throes, respi-
ration, &c. go on uninterruptedly, while the patient is in a state of

36 TRANSACTIONS OF MEDICAL SOCIETY OF VIRGINIA.

anaesthesia. There is a complete depression of the sensorium at the
same time. It then seems to me that all we gain by the use of such
articles is the production of insensibility to the pain of the spasms.
If, however, it be a correct principle of treatment when we wish to
produce sedation in any organ, to do so by stimulating it until we
have exhausted its excitabilit}T, would it not be much more plausible
to use in this disease strychnine, which we know to act directly upon
the excito-motory system ? Would not large doses of strychnine pro-
duce the opposite effect of small ones? — the desirable effect. Dr.
H. appealed to Dr. Gibson, as a lecturer upon surgery, and one
whose province it had been to investigate especially this disease, for
his opinion as to the existence of centric tetanus, discarding the old
and indefinite terms, traumatic and idiopathic.

Dr. Gibson was not prepared to say that there were cases of more
centric tetanus than those arising from effusion, pressure on spinal
marrow, &c. He differed with Dr. H, and did see great good
arising from the use of opium. Patients die of exhaustion, or of
asphyxia ; and, as opium gave rest, he thought it very valuable. He
highly approved the treatment of the case, notwithstanding the stric-
tures of Dr. H,

Dr. Johnson said he believed Dr. Haskins' theory and explana-
tion of the different effects by different sized doses to be correct. But
why not suppose that these remedies act on the spinal marrow di-
rectly, as well as on the brain? Is it probable that we only reach
this system with them, going round by way of the brain ? We re-
lieve colic by venesection and opium. Is it not by direct action on
the spine, which furnishes the nervous influence giving rise to the con-
tractions ?

Dr. Cunningham said we do not act upon the principles of mo-
dern pathology : as a London doctor remarked, " It would ruin the
practice of physic." In reply to Dr. Haskins, he would ask, why
give stimulants through the brain in hysteria or delirium tremens,
where we know the nervous system to be in a state of hyper-exalta-
tion. We act with the means which we possess, because we know
their effects, not because we know how they act.

Dr. Haskins replied, that if his strictures upon the treatment of
tetanus had been thought to apply to the case under consideration, he
had been misunderstood. So far from disapproving the treatment
practised by Dr. Johnson, it was what he should have felt himself
bound to have done under similar circumstances. But we were here
now in the medical society, and should discuss philosophically the
principles of treatment indicated by pathology, regardless of the ab-
surdities into which we may be led. Dr. Cunningham has referred
to the success of nervous stimulants in the treatment of hysteria and
mania potu as an argument why they should be used in tetanus. Now,
as regards the former of these diseases, though involving principally
the same nervous system, we know its form to be entirely different
from tetanus, and rarely ever proving fatal — indeed ceasing of itself
after a short time, whether medicines have been administered or not.
Is it then fair to conclude, that in all cases where medicines have been

TRANSACTIONS OF MEDICAL SOCIETY OF VIRGINIA. 37

administered, that they have arrested the paroxysm ? As to mania
potu it does not generally depend upon excitement of the nervous
system, but on the contrary, is due to the absence of an accustomed
stimulus. We can therefore readily see why it should be relieved by
stimulation. But the Doctor apprehends that our modern pathology
" will ruin the practice of physic." Now he himself has stated that
he never saw a case of traumatic tetanus recover under the present
practice ; and this is but the concurrent testimony of all the members
of the society, as well as all authors who have written upon the dis-
ease. It has also been shewn this evening, from statistical tables,
prepared by Curling, that of 128 cases, (including every variety of the
disease,) only 56 have recovered. I for one, sir, do not feel that we
shall sustain any great loss, even though our modern pathology does
ruin such practice as this.

Dr. Maupin made some remarks upon the general principles of the
disease and of sympathy, and said we must fix our disease and its
laws by reasoning, and then by experience build a system of treat-
ment.

Dr. Snead said he wished to be understood as one of those who
believe idiopathic tetanus had not been established.

Dr. Bolton had seen two cases recently. One supervened on an
abscess and erysipelas of arm, and was fatal. He used chloroform
in it, and with marked advantage.

Dr. Parker remarked that one of the cases referred to by Dr.
Bolton was his — traumatic and fatal. He should always use chlo-
roform, having seen its great benefit. He had seen an infant aged
13 days, die with congenital tetanus.

Dr. Terrill, of Hanover, had used tobacco enemata until com-
pelled to desist, together with the usual recorded treatment, in a case
of traumatic tetanus, but his patient died.

The subject was then informally laid over.

Dr. Bolton exhibited a flannel bag of unbroken flies, which he
said was given him by a patient from the country, and had been used
for 17 years to blister. She said, by moistening one side with warm
vinegar and applying to the surface, it would draw in an hour. An
additional advantage which this acetate of cantharidin possessed,
was, that it was not so apt to produce strangury.

December Meeting.

After the election of several members and the transaction of some
business, Dr. Merritt read an elaborate essay on "congestive fever."
As the author of this paper has had great experience in this, one of
the most serious diseases of the South, and as we think his views of
its pathology and the correct treatment are good, we will publish the
main points in our next Number.

38 COLLODION IN ERYSIPELAS.

Collodion — Its Use after Leeching and in Erysipelas.

Like most other American inventions, whether of great or of little
importance, this article has been claimed by our trans-atlantic friends.
A paragraph passed around the American papers stating that this
liquid adhesive plaisterhad been invented by a French chemist — pro-
bably a Mons. Alexandre. This is not so ; and, though of no great mo-
ment, yet " to render unto Caesar that which is Caesar's," is but just
and proper, and I take pleasure in stating that it was first made in
Paris by a young American from Boston — I believe, a Mr. Maynard.
Charriere, the great instrument maker in Paris, applied it, the day
after it was first made, to my hand to cover the wound made by Mr.
Alexandre's artificial leech which we were trying — Mons. Charriere
applied it, saying that it was a neat preparation made and given to
him for trial by our countryman, Mr. Maynard.

It is an exceedingly useful substance, and has been applied to all
sorts of uses in the arts and sciences.

A short time since I had occasion to apply a dozen leeches to an
infant of only a few months' age. I was called an hour or two after
the operation to stop the bleeding, (which had been twice arrested by
cold cloths and pressures, but only for a time.) Other means failing,
I poured thick collodion over the bites, previously pressing the surface
with a dry towel, and in a few minutes I left my little patient perfectly
secure from any recurrence of haemorrhage. We know that children
have bled to death from leech bites, and they are sources of no ordi-
nary trouble frequently. This preparation is a convenient, comfortable
and certain application, and should be always at hand. It is better to
apply a thick collodion, so that it may be dried and adherent before
any blood can accumulate under it. It seems to be a temporary
styptic, and the bleeding is arrested long enough for it to dry, when it
is prevented. It usually peels off in from two to five days, and is a
source of no inconvenience whatever.

It is reported in the " Lancet" to have been used, with great suc-
cess, by Mr. Luke, of the London hospital, in the treatment of ery-
sipelas. He says, "it would appear that collodion fulfils two import-
ant indications ; it protects the inflamed surface from the contact of
the air, and it contributes, by the pressure it effects, in driving the
blood from the distended capillaries." G — .

We believe that the treatment recommended below for scarlet fever
has not had as fair a trial as the high standing of its author would de-
mand for it. Though Dr. Lindsly's letter is not very recent, we deem
the subject one of much practical interest, and give it in full.— Ed.
To the Editor of the Boston Medical Journal.

Washington, April 11, 1850.

Sir : As everything relating to the treatment of scarlet fever, a
disease almost as fatal and destructive as cholera itself, is of great in-

INUNCTION IN SCARLET FEVER. 39

terest to the profession and the public, I desire to call the attention of
your readers to the mode of treatment recommended by Dr. Schnee-
mann, physician to the king of Hanover, as contained in a recent num-
ber of the London Lancet. The plan proposed by Dr. S. has not re-
ceived the attention from the medical profession in this country or in
England, so far as my knowledge extends, that its importance de-
mands. My experience with it is now considerable, and I think I can
safely recommend it as a very valuable addition to our means of con-
ducting this dreaded disease to a satisfactory termination. It is phi-
losophical and rational in theory — simple and efficient in practice.

Its modus operandi will be seen at a glance, and will commend itself
to every discriminating physician ; for every one, I think, will admit
that the chief weight of this disease falls upon the skin ; and of
course whatever tends to restore the deranged functions of this im-
portant part of the body will contribute most materially to alleviate
all the symptoms. The employment of this remedy of course will not
prevent the use of such other means as experience sanctions, and each
particular case calls for, as laxatives, febrifuges, application to the
throat, internal and external, &c.

I hope a fair trial will be given to this mode of treatment by the
profession, and the results made known through the journals, that its
true value may be definitely ascertained. I subjoin the most impor-
tant directions given by Dr. Schneemann, in a somewhat abbreviated
form.

HARVEY LINDSLY, M. D.

Treatment of Scarlet Fever ly Inunction.- — From the first day of the
illness, and as soon as we are certain of its nature, the patient must
be rubbed morning and evening over ihe whole body with a piece of
bacon, in such a manner that, with the exception of the head, a co-
vering of fat is everywhere applied. In order to make this rubbing
in somewhat easier, it is best to take a piece of bacon the size of the
hand, choosing a part still armed with the rind, that we may have a
firm grasp. On the soft side of this piece slits are to be made, in or-
der to allow the oozing out of the fat. The rubbing must be tho-
roughly performed, and not too quickly, in order that the skin may be
regularly saturated with the fat. The beneficial results of this appli-
cation are soon obvious. With a rapidity bordering on magic, all,
even the most painful symptoms of the disease are allayed ; quiet,
sleep, good humor, appetite return, and there remains only the im-
patience to quit the sick room.

The advantages of the treatment indicated may be summed up as
follows :

1. The improbability, we might almost say the impossibility, of the
patient getting cold while the skin is thus covered with fat, a point in
no disease more important than here.

2. The dry brittleness of the skin and the tormenting itching are by
it not only materially alleviated, but generally entirely removed.

40 SPECULUM IN UTERINE DISEASES.

Every practitioner knows how often the itching and burning of the
skin in scarlet fever are unendurable to children, keeping them con-
stantly in distressing movements, and robbing them of sleep. Hence
children are generally well satisfied with this process, and often ask
for its repetition long before the time is come.

3. The influence on the physiological functions of the skin is still
more important. Daring the coming on of scarlet fever the skin be-
comes diseased, in consequence of which it loses its vital power.
During this illness, and until a new covering is again prepared for the
surface, the functions of the skin are very imperfectly performed, or
during the desquamation probably not at all. In order to explain the
extent and importance of the imperceptible functions of the skin in a
merely mechanical view of the matter, the reader is referred to the
accurate experiments of Seguin, which fix the quantity of matter
thrown off from the outer skin at eleven grains per minute in a grown
person, therefore more than two pounds per day. What efforts must
it cost the organism to lead so large a quantity into other paths, in
order to throw it off, when the skin is incapable of doing so !

4. With this disappearance of the desquamation disappear all those
bad symptoms which attend on it. In order to give a striking proof
of the importance and bad influence which the interrupted functions
of the skin produce on the healthy activity of relative, even if dis-
tant, organs, we may cite the fact that death is always the result where
more than one-half of the skin has been destroyed by fire or boiling
liquid. A similar destruction of the skin ensues in scarlet fever, with
this difference — it takes place gradually, and thereby the organism is
better enabled, by employing all the activity of the body, to find aid
against the mischief which must result from the cessation of the func-
tions of the skin.

The Speculum in Uterine Diseases.

At one of the meetings of the Royal Medical and Chirurgical Soci-
ety of London, the distinguished obstetrician, Dr. Robert Lee, read a
paper on the use of the speculum in the treatment of uterine diseases.
Quite a bitter warfare has since been going on between the friends
and opponents of the instrument, among whom are many of the most
eminent English physicians. It seems very strange that such diversi-
ty of opinion and observation should exist as to the real condition of
the membrane about the os and cervix uteri. Some insist that there
is never any ulceration, abrasion, &c, unless of specific character,
and Dr. Ash well is one of these. That author has said " that the
use of the speculum has almost become a professional dishonor, and
that the necessity of employing it as frequently as it is now employed
by respectable practitioners, would compel him to retire from the
practice of diseases of women." In commenting upon the views of

SPECULUM IN UTERINE DISEASES. 41

Dr. Ashwell, and his " unguarded expression," Dr. Tilt, a gentleman
who has lately put out a work on " the diseases of menstruation" which
will elevate him to the highest rank as an author, very tersely remarks:

"I can easily understand that a noble nature should aspire after a
better world, where there may be no distinction of sexes, and where
no obstetric physician will be required to meddle with delicate organs.
But as long as there are bond fide women in this sublunary sphere,
those organs which constitute them women must be assisted in their
functions and ministered to in their diseases, and unless the medical
attendant is himself indelicate minded, there is, as Dr. Locock tersely
remarked, no more indelicacy in doing so than in curing a sore throat
by cauterizing the tonsils."

The reader is referred to the Lancet for the very interesting debate
and communications on the subject, but as we think the following let-
ter as applicable here as in England, if not much more so, we give it.

" To the Editor of The Lancet.

" Sir — If you will allow me space, I would offer a few remarks
on the use of the so much abused speculum uteri. I have for some
time adopted it in my practice, and have found it so valuable an aid
to diagnosis and treatment, that I consider its use in uterine disease
as indispensable as is the stethoscope in affections of the chest. In
proof of this assertion, I would cite the following case, which re-
markably illustrates not only its utility, but its necessity. I was
consulted, about four months since, by a married lady, who presented
symptoms of uterine disease, and on stating this to be my decided
opinion, I was requested by her mother at once to ascertain the fact.
On examining with the finger per vaginam, the labia uteri presented
that velvety feel described by Dr. H. Bennet as indicating the exist-
ence of ulceration, and also considerable induration ; my diagnosis
was afterwards confirmed by the speculum. I lost sight of this pa-
tient until very recently, when she again requested my attendance. I
found her with all her symptoms much aggravated. She told me
that she had been under the care of one of the obstetric physicians
who are now taking so prominent a position in the present anti-
speculum crusade, and who had been occasionally attending her
during the last seventeen years. This gentleman had always de-
clared that she was laboring under stricture of the rectum, for which
he had been diligently drugging her during that long period. In this
opinion he was strengthened by another eminent obstetric physician
of the same school, who occasionally saw the patient. On becoming
worse she again sought my advice, but I declined any interference
unless I was permitted to make a thorough investigation of her case.
To this she willingly consented. I first passed my finger easily into
the rectum, through which it was declared " a crow-quill could not
enter." I felt a hard, projecting tumor, completely filling the hollow
of the sacrum. This I discovered, on examination per vaginam, to

42 EXCHANGES.

be the retroverted fundus uteri, much enlarged, and excessively
tender to the touch. The labia uteri presented unmistakable granular
ulcerations, with induration extending up the walls of the cervix.
Now, I would ask, am I to believe the evidence of my senses, or am
I to take the opinion of men who would not for the world use that
dangerous instrument called Simpson's uterine sound, and w7ho are of
too pure a school of medical ethics to make a vaginal examination ?
I would ask the profession, in sober earnestness, are we to accept the
dicta of such men, as to the use of instruments which many of us
have proved to be of incalculable value, and which have been intro-
duced to us by men certainly of as high professional standing as any
who oppose their employment. Of what value are the opinions of
those who either declare that they have never derived any information
whatever from the use of the speculum, or who altogether ignore
the use of instruments in uterine diagnosis ?

" Whilst I am upon the subject, in conclusion, I would hint to Dr.
Marshall Hall, that should his opinions become known to the wives
and daughters of England, they would repudiate his championship of
their morals, and would throw back upon him with indignant scorn
the sentiments he has dared to attribute to them.

" Requesting you will favor me by giving insertion to this letter in
your forthcoming journal,

"I remain, sir, your obedient servant,

"W. Moon."

OUR EXCHANGES.

Our thanks are due to the editors of the following works, who have
been good enough to commence exchanging in prospectu. We wel-
come them to our table, and hope that our acquaintance will be mu-
tually agreeable.

The New York Register of Medicine and Pharmacy, a neat semi-
monthly of 16 pages, edited by Dr. C. D. Griswold. We have re-
ceived the six numbers issued, and are much pleased with it. The
December (15th) Number, after noticing our prospectus, goes on to say :

" It is often remarked that we have already too many medical jour-
nals, more than can be supported, &c.,and we have no doubt but that
the same kind of objections have been urged against each new publica-
tion, since the first one was established in this country. Franklin was
advised not to set up a second newspaper in Philadelphia, on the
ground that it could never be sustainecl, as Philadelphia had already
attained its full growth ; and so it is, that there are always prudent
ones, who advise against any undertaking for which they may be called
upon to subscribe. We may have too many journals, but we have not
enough good ones, nor are xhey sufficiently well patronized. Let every

EXCHANGES. 43

man double his subscription list for one year, and after that time it will
cost him but little if any more than he now pays — such is the influ-
ence of patronage upon the press. With a proper spirit of indepen-
dence, the medical journals of this country might do much to relieve
the profession from its worst evils ; but as it now is, the doctors are
handled more like sick babies, and their defects covered up writh the
scrupulous care that a foolish mother would screen the errors of her
spoiled boy. The truth is, our journals, or many of them, are con-
servative to a degree which impairs not only their own interest, but
lessens the good they might do the profession. We do not like to see
the many suffer from the errors or vices of the few, and it is not right
that it should be so. A journal that has no character or principle or
opinions independent of the communications upon its pages, is not
worth having. As with the stethoscope we ascertain the condition
of internal structions, whether they are healthy or unhealthy, so
through our Virginia cotemporary, may we have revealed to us the
true condition of the heart of the profession."

The Southern Medical and Surgical Journal, a good monthly, 64
pages, edited by Dr. J. P. Garvin, Augusta, Georgia. We perceive
by the December Number that this work will in future be conducted
by Professor L. A. Dugas, of the medical college of Georgia. This
gentleman is the successor in the chair of surgery to Dr. Paul F.
Eve, who was last year appointed to Dr. Gross' vacant chair in the
university of Louisville. We see by an advertisement that " Dr.
Eve will resume the practice of his profession in the city of Augusta
by 10th March 1851. We suppose, then, that Dr. E. will resign his
new professorship and go back to the field of his old labors. He is
the chairman of the committee on surgerv of the American medical
association, and asks that communications may be forwarded to him
to Louisville or Augusta either.

Though " the editor, publisher and printers were all suffering from
break-bone fever" they got out a very good number. It opens with
the conclusion of a very interesting paper " On the present state of
Medicine," by Dr. C. Todd Quintard, of Roswell, Georgia. Its peri-
scope is well made up.

The Boston Medical and Surgical Journal, a weekly of sixteen pages,
and a number of advertisements. Its editor, Dr. J. V. C. Smith, is
writing letters, interesting enough to the general reader, from the
East. His last is from Alexandria, and is principally devoted to the
harem, the city, and other things not medical. We see by this paper
that there are negro medical students in the Harvard university ! and a
white woman. The students remonstrated, but to no purpose. This
paper publishes the marriages of the Massachusetts doctors, and we

44 VIRGINIA MEDICAL SCHOOLS.

are pleased to see that our old friend Prof. Jeffries Wyman, late of
the Richmond medical college, has " taken unto himself a wife."

The New York Medical Gazette and Journal of Health, weekly,
edited by Dr. D. Meredith Reese : a medical newspaper, worth to New
Yorkers its subscription. It tries to conciliate the Southern medical
students to the Northern colleges.

The Northern Lancet and Gazette of Legal Medicine, edited by Dr.
F. J. D'Avignon and Dr. Horace Nelson, of Plattsburg, New York :
a double column octavo, very indistinctly printed, and not much of a
" Northern Light?'' in medico-legal science. We adopt, however, his
notice of

The American Journal of Medical Science. Dr. Isaac Hays, Phila-
delphia. " This excellent journal needs no recommendation of ours
in inducing the profession to extend their patronage to a publication
which may be considered as truly American."

The Philadelphia Journal of Pharmacy, another national work of
great value, most particularly to all apothecaries and country prac-
titioners, who are necessarily both prescriber and compounder. To
this work we shall look to keep us posted in the new preparations.

The London Lancet, which is so expeditiously re-printed in an un-
abridged form by Messrs. Stringer & Townsend of New York, is fur-
nished us by Messrs. Morris Sf Brother. This work we would not be
without, and its circulation is so general we need not say a word in
its praise.

dSP" Other works receiving this Number will please exchange.
Authors and publishers sending works for review, will please do so
through the Richmond booksellers, or, post paid, by mail.

VIRGINIA MEDICAL SCHOOLS.

It is a source of pride and congratulation among Virginians to see
the present flourishing condition of our colleges, and to know that they
are rapidly assuming that position which their merit demands, and
which it is the duty of every Virginian to aid them in attaining. The
stigma upon the state, that it cannot educate its own sons, is being
rapidly wiped away ; and the time is close at hand when we will no
longer be going to the North to seek fountains of wisdom and learn-
ing. The present session of our medical schools proves that a proper
feeling of state pride is being awakened, and we feel quite confident

MEDICAL SOCIETIES- 45

that in a few years our state will occupy the position in medicine with
the South that Philadelphia once did with the whole Union. The
climate of any city further South than Richmond is too warm for an-
atomical pursuits, and evidence is abundant that Southern medical
students are not going further North. So we are warranted in the be-
lief that this state is soon to become the seat of the great medical
school of the South. We know that the older members of the pro-
fession were all educated in Philadelphia, and that they have that
love and veneration for their alma mater which is so natural. But we
believe that they are also duly impressed with the importance of
throwing off that vassalage which bound us to the North, and which
circumstances no longer render necessary. The progress of medicine
has been so rapid, and the means of communicating it has become so
much facilitated, that there is no longer that centralization of Ameri-
can medicine necessary as was the case when our country was young
and its population sparse and scattered.

The Medical college of Richmond has a much larger class than ever
before, and the proportion of second course students is very great.
The faculty are lengthening their course, and steadily raising their
standard of graduation.

The medical class of the University of Virginia is unprecedentedly in-
creased, and far greater in proportion than any of the academic de-
partments. This speaks well for professional education in Virginia,
as the university is universally granted to be the most thorough drilling
or preparatory course in our country.

The Winchester medical college has a very respectable class, and we
learn the professors are advancing its interests with a zeal and in a
manner worthy of the praise of the profession.

The medical department of Randolph Macon college is also on the in-
crease, and we believe preparations are being made there to extend
the course.

From want of accurate information, we defer stating the numbers,,
&c. of our schools, but we will do so in a future number.

MEDICAL SOCIETIES.

We give in the present Number an abstract from the very interest-
ing debate in the Medical Society of Virginia at its November meet-
ing. This body holds regular meetings, on the third Tuesday of
every month, in the hall of the Richmond library association, corner

46 PURIFICATION OF CHLOROFORM.

of Main and 11th streets. Its annual meeting is in May. Its officers
for the present year are : President, Dr. Ro. W. Haxall ; vice-presi-
dents, F. Marx and James Beale ; secretary, P. CI. Gooch ; corres-
ponding secretary, Carter P. Johnson ; treasurer, James Bolton ; li-
brarian, W. J. Clark. The society is in a very flourishing condition,
and has a large number of members throughout the state. In a future
Number we will give a full account of its organization and history.
We learn that societies exist in Petersburg, Norfolk, Fredericksburg,
at the University of Virginia, Wheeling, Loudoun, and in Greenbrier
county. There are others, doubtless, in the state, and some of them
are prospering. We would be glad if the secretaries of these bodies
would furnish us with their proceedings for publication. It is said,
"that the medical press is the nurse of medical talent;" so, we con-
ceive, are medical societies.

If the profession would be more careful not to use articles which
are not pure, less complaint would be heard of remedies of all sorts
which produce good or bad effects according to their preparation. If
chloroform were always as good as it should be, we believe many of
the bad consequences attributed to it would never have been heard of.

For the benefit of our readers who do not take the American Jour-
nal of Pharmacy, we publish the following article of Dr. Gregory, to-
gether with the editor's remarks :

Notes on the Purification and Properties of Chloroform, read before the
Iloyal Society of Edinburgh, by William Gregory, M. I)., Professor of
Chemistry in the University of Edinburgh.

1. Chloroform has been prepared both from alcohol and wood-
spirit. The latter has been used for the sake of cheapness ; but as it
is a mixture of several liquids, all of which do not yield chloroform,
it gives an impure product, in a proportion which varies much, but is
always below that obtained from alcohol. There is therefore not only
no advantage, but the contrary, in using wood-spirit, which is not,
after all, much cheaper than alcohol.

2. But the chloroform from these two liquids, when fully purified, is
quite identical in all its properties. Its smell, density, boiling-point,
and action in the system, are in both cases exactly the same. That
from alcohol is no doubt more easily purified than the other, but it also
contains certain volatile oily impurities, which must be removed be-
fore it can be safely used. The peculiar oils which adhere to both
kinds of chloroform are not identical, or at least, not all identical, but
they are of analogous constitution and properties.

PURIFICATION OP CHLOROFORM. 47

3. Soubeiran and Mialhe have examined these oils. They contain
chlorine, have a disagreeable smell, and when inspired or smelt cause
distressing headache and sickness. In the case of wood-spirit, some
of its own impurities distil over unchanged, and are also found in the
chloroform.

4. It is well known that many persons, after the use of chloroform,
have suffered from headache, nausea, and even vomiting, as I have
more than once seen. Headache and nausea I have myself often ex-
perienced, when I have tried different specimens of chloroform, with-
out taking so much as to produce the full effect.

5. Perfectly pure chloroform does not, so far as I have seen or ex-
perienced, produce these disagreeable effects. It is therefore highly
probable that when they occur, as they do with some individuals, from
the use of chloroform of more than the average goodness of quality,
they depend on the presence of a trace of these poisonous oils.

6. All good manufacturers of chloroform purify it by the action of
oil of vitriol, which destroys the oils, while at the same time a part of
the acid is reduced to sulphurous acid. The chloroform, to remove
this, is then distilled with lime or carbonate of baryta, and is tolerably
pure if the process be well conducted.

7. But it is not quite pure, and contains a trace, more or less dis-
tinct, of the oils. I have found this to be the case with all the best
chloroform made here up to 1849 ; and I have several times seen
headache and sickness from the use of such chloroform, which was
the best anywhere made. I must add, however, that the quantity of
oils in the chloroform of the best Edinburgh manufacturers, although
variable within certain limits, was always so small, that that product
was fit for use, and only caused headache, &c. in a few peculiarly
sensitive persons.

8. It was desirable to have a test for these impurities, as well as an
easy and effectual mode of removing the last traces of them, especially
as many sorts of chloroform not made here were far inferior in quality
to that prepared in Edinburgh. One very delicate test is, that of oil
of vitriol, which should be quite colorless, pure, and of the full den-
sity of 1.840 at least, as it may be obtained by Mr. Kemp's process,
lately read to the Royal society ; when agitated with the chloroform,
it becomes yellow or brown, from its action on the oils, which it chars
and destroys. Any change of color is easily seen by contrast with
the colorless chloroform which floats above. Pure chloroform gives no
color to the acid. It is essential that the oil of vitriol be colorless and
also of full density ; for if colored, it is not easy to see a slight change
on its color ; and if below the proper density, that is too weak, it is
not much colored by a chloroform which will render dark brown the
acid of proper strength.

9. Another test, still more delicate, I find to be the smell of the oils.
When chloroform is poured on the hand or on a handkerchief, it ra-
pidly evaporates ; but the oils, being less volatile, are left behind ; and
their smell, previously covered by that of the chloroform, is easily re-
cognised. Until very lately no chloroform was sold, or indeed known,
which would, stand this test, or even the former.

48 * PURIFICATION OP CHLOROFORM.

10. Up to 1849, the best commercial chloroform had a specific gra-
vity of 1.4S0, which was- considered a guaranty of its purity ; but it
had been obtained by chemists of specific gravity 1.494, and even
1.497. I have found that chloroform of 1.480, when once more acted
on by oil of vitriol, which destroys the oils and becomes brown, may be
obtained after removing the sulphurous acid, of specific gravity 1.500 at
60°. This I take to be the specific gravity of pure chloroform. Our
best makers have lately, much to their credit, pushed the purification
so far as to furnish chloroform even of this highest density, and also in
other respects such as it ought to be.

11. There are still, however, many makers in other places whose
chloroform is not so pure ; and I shall now describe the method
which, with Mr. Kemp, I have employed for purifying, perfectly and
easily, any commercial chloroform, except one remarkable specimen —
a process which will enable any medical man to purify it for himself
with the greatest facility.

12. The chloroform, having been tested as above, and found more
or less impure, is to be agitated with the oil of vitriol, (half its volume
will be sufficient,) and allowed to remain in contact with the acid, of
course in a clean, dry and stoppered bottle, and with occasional agita-
tion till the acid no longer becomes darker in color. As long as the
action is incomplete there will be seen, after rest, at the line of con-
tact, a darker ring. When this no longer appears the chloroform
may be drawn off, and for greater security once more acted upon by
a quarter of its volume of the acid, which should now remain color-
less. It is now to be once more drawn off, and, in a dry stoppered
bottle, mixed with a little powdered peroxide of manganese, with
which it is gently agitated, and left in contact until the odor of sul-
phurous acid is entirely destroyed and the chloroform has acquired a
mild, agreeable, fruity smell. It has then only to be poured off into
a proper phial. It will now leave no disagreeable smell when evapo-
rated on the hand. [If the commercial chloroform, after having been

frequently well shaken and left for some time in contact with the acid, has
given to it only a moderate tinge of color, it is probable that it may
be completely purified by the first process. To ascertain this, test a
fresh portion in a tube with fresh acid, shaking well, and allowing it
to stand for some time. If it do not color the acid at all, then the
whole chloroform has only to be finally purified by the oxide of man-
ganese. If the acid become colored in the test tube it will be as well
to act on the whole chloroform a second time with fresh acid till it
stands the test. Mr. Kemp has observed, in repeating this process
for me, the very curious fact, that as soon as the action is complete
and the oily impurities are destroyed, but not sooner, the chloroform
tested with the acid in a tube exhibits a strongly convex surface
downwards, where it rests on the pure acid, or what is the same thing,
the acid becomes concave at its upper surface. The smallest trace
of impurity, not sufficient to affect the density of the chloroform, we
have found to render the line of junction horizontal. It is probable
that this may become a valuable test of the perfect purity of chloro-
form ; but we shall not say more on this subject until we have

PURIFICATION OF CHLOROFORM. 49

thoroughly examined it.] This process requires no apparatus be-
yond a few stoppered bottles, and a pipette, if we wish to draw cfFthe
whole chloroform without loss, although nearly the whole may be
simply poured off. The use of the oxide of manganese is due to Mr.
Kemp, and on the large scale the chloroform may be filtered through
a cylinder full of it. In this final purification of commercial chloro-
form no distillation is necessary. Indeed, no rectification is required
at all if it be well washed with water before using the acid.

13. It may be considered as certain that the use of chloroform
thus purified will very rarely, if ever, cause the disagreeable effects
above noticed.* As to more serious bad results from the use of
chloroform, so often spoken of elsewhere, it is enough to state that a
large proportion of the cases must be attributed to the use of a liquid
so impure as hardly to deserve the name of chloroform at all.

Postscript. — Since writing the above, my attention has been called
to a paper by Dr. Wilson, on the specific gravity of chloroform, which
he was not able to obtain higher than 1.49S. I have therefore to add,
that every specimen, whether of specific gravity 1.480, 1.490, or
1.497, which I purified as above, acquired the same density of 1.500,
as ascertained by the use of a very delicate and accurate bead, (made
by Lovi,) which sank at 60.°5 and rose at 59.°5 ; and also by three
successive weighings with a very delicate balance. It will also be
seen, that three commercial specimens had this density; I could de-
tect no foreign matter in my chloroform ; and besides, every foreign
matter that is likely to occur lowers the density. 1 have no doubt that
Dr. Wilson's specimens would have colored the acid and left a smell
on the hand.

I may add, for the maker, that after distilling the materials which
yield chloroform, no distillation or rectification is needed. He has
only to wash the heavy fluid with water till its volume no longer di-
minishes, and then to use the oil of vitriol as above, finishing with the
oxide of manganese. Distillation with the acid is of no use, because
no proper contact can take place, the chloroform distilling from the
surface as it would from mercury. In testing by oil of vitriol, it is

* Dr. Simpson informs me, that the purest chloroform he has used not unfrequently
causes vomiting. On further enquiries, I find that this occurs when it is administered after
a full meal. This can easily be avoided, and must not be confounded with the headache,
nausea and vomiting alluded to in sections 4 and 5; which symptoms are persistent, and
occurred in my experiments alwnys with an empty stomach, the experiments being made
an hour or two before dinner. Mr. Carmichael, assistant to Dr. Simpson, has mentioned
to me some facts which conlirm the view I have taken. At one period, for more than a
week, Dr. Simpson and Mr. Carmichael were kept in a state of continual anxiety by the
occurrence, in all the puerperal cases in which chloroform was used, of very unpleasant
symptoms, particularly of frequent pulse and other febrile symptoms, lasting for some days.
At last, after much annoyance from this cause, it occurred to Dr. Simpson that he was
using one particular specimen of chloroform above the average in quality. As soon as
this idea occurred he threw away all that remained, and returned to that which he had
generally used. The unpleasant symptoms no longer appeared. [I regret much that I
had not an opportunity of examining that specimen, but I may add that the maker, not an
Edinburgh one, now produces chloroform of much better quality, though not yet absolutely
pure.] But the striking fact is this, that Dr. Simpson and Mr. Carmichael state, that
during the period above alluded to, when that one kind of chloroform alone was used by
them, their handkerchiefs became quite offensive from the smell left on them, which even
adhered to them after washing. There can, I think, be no doubt that here the oily impu-
rities alluded to in sections 4 and 5 were present in notable quantity.

4

50 PURIFICATION OF CHLOROFORM.

best to use some ounces of chloroform, and to shake it in a phial, be-
cause in a test-tube, the color produced, if not strong, may be over-
looked.

While I acquit the makers of chloroform, who have sold an impure
drug, of all desire or intention to adulterate it, I feel it my duty to
point out that the system which permits any one to set up as a manu-
facturer of this or any other potent remedy, without let or hindrance,
without any test of his qualifications, without, in short, enforcing a
knowledge of chemistry and pharmacy as an essential condition, is a
radically bad one ; and that our law, in relation to druggists and apo-
thecaries, requires reformation. In fact, the evils naturally resulting
from it are only neutralized, and that but in part, by the good feeling
and principle of the leading manufacturers.

To illustrate this, I may remark, that some of the makers of chlo-
roform must have been very ignorant, even of what was known and
published concerning its properties; for, among the specimens I ex-
amined, are several of specific gravity below 1.4S0, which was long
ago given as the standard, even so low as 1.347.

That this neglect proceeded more from ignorance than from inten-
tion, is, I think, plain, from the fact, that a specimen labelled "Pure
Chloroform" actually contained only a trace, about one-thirtieth, of
that substance. I did not ascertain its specific gravit}", which must
have been far lower than 1.200 or 1.100 — nay, possibly, under 1.000,
because its impurity was so obvious in every other respect, and the
quantity I had was too small ; but, on examining it further, I am
convinced that its origin was this : — The maker, after distilli^s: the
materials, obtained, of course, two liquids, a lighter and a heavier.
He evidently did not know that the latter was the chloroform, and
therefore threw it away, and preserved the lighter — a mixture of
pyroxilic spirit — of its natural impurities, of the deleterious chlorina-
ted oils, and a trace of chlorofoim. At least, such are its characters ;
and it exactly resembles what would be obtained in the way sup-
posed. But what a fearful degree of ignorance (without any evil
intention) is here exhibited. And yet this maker was free to produce
and sell pure chloroform, which was actually almost pure from chloro-
form, and loaded with deleterious agents.

[A few weeks since, having occasion for some chloroform, we ob-
tained a pound from a manufacturing establishment in this city. On
opening the bottle, the odor of the chloroform was contaminated with
that of chlorine, and the stopper had on it a greenish yellow discolor-
ation. On returning it to the chemist, with the information of its
impurity, we received the following note :

"Dear Sir — We have your favor of this morning, in regard to
chlorine found in chlorofoim, and for the same are much obliged, as
it gives us some ground other than our own opinion for declining to
make the article by the late improved process with sulphuric acid.
We soon discovered that this change was likely to go on, but some
of our customers wanting an article of this kind, (i. c. made bv
this process) particularly, we were induced to adopt the improve-
ment."

NITRIC ACID IN ASTHMA. 51

This chloroform bleached moist litmus paper rapidly, first redden-
ing it. The acidity is due to hydrochloric acid, generated from the
chlorine and moisture adhering to the chloroform operated on by
light. Mr. Abraham, in a paper on this subject, has arrived at
similar conclusions. — Editor.]

Cases of Asthma successfully treated by Nitric Acid.

BY T. S. HOPKINS, M. D., OF BETHEL, GLYNN COUNTY, GEORGIA.

The following five cases of asthma, cured by the use of nitric acid,
have occurred in my practice since the summer of 1847. It is not
my desire to attempt any explanation as to the modus operandi of this
remedy in the above disease. Its beneficial effects were accidentally
discovered, and, after a fair trial in five consecutive cases, with the
most entire success, I am induced to bring it to the notice of the pro-
fession, trusting that in other hands than my own it may prove a po-
tent agent for the relief of a disease which so often resists the best-di-
rected treatment. Several of these cases were from twenty-five to
thirtv-five miles distant from my office. Most of them were not seen
by me from the time of my first visit and prescription until a cure had
been effected. I describe them as I found them at the time of my
visit, and from the history given by parents and masters, which I think
can be depended upon.

Case I. — Emma, negro girl, aged five j^ears, belonging to Mr. T. G.,
had been asthmatic almost from birth. Nightly paroxysms of dyspnoea,
cough, &c, were represented as most distressing. During the day,
she would be up and about the yard with the other children. At the
time that I saw her, her respiration was somewhat embarrassed, with
slight elevation of the shoulders during inspiration, and a very distinct
mucous rale. Her appetite was impaired, and her countenance
cheerless.

I ordered nitric acid, three drops, to be increased to five, three
times daily, in a wineglassful of sugared water. A month elapsed
before I again saw this patient, at which time every symptom of dis-
ease had disappeared. I prescribed for her in December 1847, and
up to date no symptom of asthma has returned.

Case II. — I was called in November 1848, to see W. S., aged
about six years, son of a planter of Glynn county. I was informed
that this boy had been a subject of asthma for four or five years ; that
no expense had been spared in seeking for relief in his case ; and that all
the efforts of the best physicians in the neighborhood in which he had
resided, had been in vain. When I saw him, he had cough, slight
dyspnoea, with mucous rale distinctly audible at the distance of se-
veral feet. By walking up and down the steps of the house, once or
twice, the difficulty of breathing and cough Would be much increased.
He was very lively and cheerful, with a good appetite, and had had
no fever for months. His father informed me that, upon the least ex-
posure during the day, he would be attacked at night with the most

52 MANGE.

fearful symptoms. Wheezing, panting, incessant cough, distressing
dyspnoea, with impending suffocation, were the inevitable conse-
quences (at night) of exposure during the day.

I ordered nitric acid, five drops, three times daily, in a wineglass
of sugared water, with a strict avoidance of exposure.

In a fortnight, he had been so much relieved that his parents
imagined him cured, and discontinued the acid. In a few days he re-
lapsed, and I was again sent for. I ordered the acid to be continued,
as before, and in one month from the time of my first visit he was cured.

Up to date there has been no return of disease.

This boy's father died of phthisis pulmonalis. Several of his mo-
ther's family have died of the same disease ; and all of his brothers
and sisters, without an exception, have in early childhood been suf-
ferers from enlargement of tonsils and ulcerated sore throat. He is
now the picture of health.

Case III. — A mulatto girl, belonging to Mr. W. D. T., aged four
years. This was a case of congenital asthma.

The symptoms in this and the following case (aged about four years)
were so similar to those of Case I. that I shall not describe them.

The treatment was nitric acid, three drops three times daily in a
wineglass of sugared water.

This case resisted the treatment rather longer than the other cases,
but was cured in about six weeks.

In Case IV., the immediate effects of the acid were perceived in a
few days ; and in eight or ten days she was cured.

Case V. — I never saw. It was a negro girl belonging to Mr. C. of
Camden county. She was seven years of age. Her master applied
to me for a prescription, afrer giving some of the most prominent
symptoms, which convinced me that the case was asthma, as he de-
clared it to be.

I prescribed five drops of nitric acid three times daily.

I heard nothing more of this case for several months after I had
prescribed, when I was informed by her master that she was well.

A sufficient time has elapsed, in all these cases, to convince me that
they have been radically cured.

Should you deem the above remarks and cases worthy a place in
your valuable journal, you will please to insert them. It is at least
something new in the treatment of asthma. — Amer. Jour. Med. Science.

The " Mange" communicated to three Persons by a Pig.

REPORTED By H. R. CASEY, M. D., OF COLUMBIA COUNTY, GEORGIA.

^ I will give you the particulars of a conversation held a few days
since with a gentleman of this county, and if the deduction I have
drawn from the facts as reported is correct, we have presented to us
(so far at least as my observation extends) a new disease of the cuta-
neous system — one hitherto undescribed by dermatologists.

MANGE. 53

Mr. S. asked me " if I had ever known a man to have the mange ?"
To which I gave a negative reply : having always understood that it
was a disease peculiar to the quadruped. He then asked me "if I
thought it possible for a man to catch it from a hog?" I replied, that
there are a great many things regarded as impossible, which are not
found to be so when subjected to the test — and that this might be one
of the cases. He then proceeded to give me the following particulars :

He states that about the 1st of May last, having a pig badly dis-
eased with the mange, and being desirous to cure him, he had some
soap and water got and went to work on him with his hands — and
that after giving him a good washing, he stripped him almost of his
entire external with his nails. That he was entirely well at this time ;
but that in about three hours thereafter, he felt an itching on his hands
and wrists, and an eruption which commenced spreading upwards ;
that about the same time his ankles began to itch him and the eruption
there made its appearance, which also spread upwards and met the
eruption from above at the half-way house — the umbilicus ; that it
reached its height in about two weeks ; that the eruption was charac-
terized by great heat and intolerable itching, composed of small vesi-
cles, which, though not confluent, stood close together over his entire
tegumentary tissue. Thus was he at the time of his commencement
with the ablution — a sound and healthy man — but in a very short time
thereafter, he was transformed into a Lazarus. He thought he had
contracted his disease from the pig, and went to work to cure himself,
using first the soap and water. This not benefitting him, he was bled
and took salts. This failing, he tried pot-liquor — then the grease from
fried bacon — then a solution of blue-stone. He does not think that
any of the means used had any control whatever over the disease, but
that it seemed to pursue its course, knowing no conqueror, until it
finally wore itself out in about five weeks.

Now, from the above narrative, I can but infer that the disease in
question was one identical with the mange, and that it was communi-
cated from the quadruped to the man. And I am further strengthened
in this view of the case, from the fact — that a female and the negro
boy who held the pig while being subjected to treatment, became in
like manner affected. The view I have taken of this case, I know to
be in direct conflict with the long-established dogmas of the veterinary
school, but I think I am sustained in my position from the facts of the
case — and " facts are stubborn things." By reference to the " History
of the Horse," I find the following language. The author, in speaking
of the contagiousness of the mange, goes on to say — " If the same
brush or curry-comb be used on all the horses, the propagation of
mange is assured ; and horses feeding in the same pasture with mangy
ones, rarely escape, from the propensity they have to nibble one
another. Mange in cattle has been propagated to the horse — and
from the horse to cattle — but there is no authenticated instance of the
same disease being communicated from the dog to the horse. There
is as much difference in the character and eruption of mange in the
horse and dog, as between either of them and the itch in the human
subject ; and the itch has never been communicated to the quadruped,
nor the mange of the quadruped to the human being."

54 REMEDY FOR QUACKERY.

My only reply to the above quotation, is the presentation of the
case related ; and if I am not sustained in my corollary from the facts
of the case, this article will go for nothing. I pretend to no familiarity
with cutaneous diseases; but "if I were called, upon to classify the
mange, I should locate it in the group dermatoses scabienses of Wilson,
not only from the pathology, but also from the therapeia of the dis-
ease ; for I find sulphur the anchor of safety to the veterinary surgeon.
Nor do I think there is anything very strange in all this ; and the only
reason why we have never before had the mange communicated to
man arises simply, I think, from the fact, that in all probability more
caution has hitherto been experienced than was in the case before us.
We have examples of other diseases occurring in the human subject,
the result of propagation from the lower order of animals. In the
Revue Medicale of July 1845, we have detailed a case of an officer
who took the glanders and farcy from a horse, and in which experi-
ments were made by M. Andouard, to test the contagiousness of the
human fluid introduced into other animals — the results of which ex-
periments went to prove that the disease was not only communicable
to man from the horse, but that the disease was again transmissible
from the human subject to the quadruped. In the Southern Medical
and Surgical Journal, November 1847, we have a case of glanders
in the human subject, derived from the horse, reported as occurring in
your own city. Other -diseases might be mentioned occurring in
the great paragon of animals, communicated from the lower order ;
but I have already spun out this article to a greater length than was
designed at its commencement, and will conclude by merely advising
those persons who may have to treat the mange in stock to touch it
lightly, and never make a curry-comb of their hands ; to which in-
junction I know my friend F. will say, Amen.

[South. Med. and Surg. Journal.

Remedy for Quackery.

In the October number of the New Hampshire Journal of Medicine
is an article by Dr. Garland on a proposed "Remedy for Quackery."
It is decidedly our opinion, that if the measure were adopted which
is recommended by the writer of the article in question, the profession
might be most emphatically placed in the same category with the
class of whom they complain. Oftentimes, no doubt, when the minds
of our patients are diseased, the exhibition of a placebo is attended
with better effect than that of remedies more potent ; yet to make a
general practice of giving pleasant or inerl preparations in form of
medicines, because the patient wishes it, and would otherwise obtain
that kind of remedies from the vaunting quack, would not speak well
for the purity of medical science. If we wish people to free them-
selves from the abominable habit of continually taking something in
the shape of medicine, and particularly from those whose only claim
to medical skill is their own boasting, we should endeavor to enlighten
our patients, by explaining to them the laws which govern life, and

DOCTORING BY THE YEAR. 55

so much of pathology as would intimidate them from using remedies
intended to cure a multiplicity of diseases. " A little learning" is not
always " a dangerous thing." It was said of Frere Jacques, the
natural cutter for stone in the bladder, that when the anatomy of the
parts was taught him, he saw at once the danger to which his patients
had been exposed, and was deterred from performing lithotomy ever
afterwards. He had not the moral, courage to attempt an operation
when fully informed of the danger to the life of his patient, though
previously he had done so with the utmost sang-froid and with average
success, exciting the astonishment and admiration of the crowned
heads and many of the surgeons of Europe. In our own day are
some who ranked, until a certain period, as the very best in diagnosis
and prognosis ; but when the great continental pathologist gave a key,
whereby functional and organic disturbance could easily and readily
be detected by physical explorations, they were in a great measure
despoiled of their old tact in detecting disease. The latter illustration
may be considered irrelevant to the subject under discussion ; yet it
has a bearing upon it. We contend, that if our patients are taught a
certain amount of knowledge respecting themselves, they will be less
likely to attempt to cure their own diseases, or place the least con-
fidence in the boastful quack or his medicines. If we know the prin-
ciples and practices of quackery to be fallacious and mercenary,
would it be the part of wisdom in us to place ourselves on a level
with quacks, by practising their schemes to get patients and make
them take our medicines? There is a way to abate the evil com-
plained of; the profession themselves are in a great measure to blame
for its existence. When they possess the proper qualifications and
take the right means to combat the hydra monster, their cause for com-
plaint will be very much lessened. — Boston Med. fy Surg. Journal.

Doctoring by the Year.

Some years since, it was my lot to reside, for a time, in a remote
and frontier region of our country, and among a French population of
some thousand of inhabitants, remarkable for their simplicity and
primitive manners, and exceedingly ignorant upon almost all subjects,
and especially so upon medical matters. Indeed there had never been
a physician located among them previously to my arrival. About a year
before I came into the country, it had been visited by a quack, who
called himself Dr. L — y, and who contrived to obtain for himself a
considerable practice, and for a short time quite a reputation. From
all I could learn of him he was in the habit of using but two remedies,
tartar emetic and blisters. It was said that he had obtained the anti-
mony and cantharides from the wreck of a vessel on the coast — these
two articles being almost the only ones saved from it. Be that as it
may, he soon obtained practice with them, and was employed by se-
veral families to attend them by the year. A simple-minded French-
man, in moderate circumstances, from whom I obtained the following

56 BATHING.

account, told me that he thought he would also try the doctor for a
year, and accordingly made a bargain with him to that effect. At the
expiration of that time the doctor called for his money, which our
friend Jose tendered him according to agreement, but at the same time
remarked, that it was rather hard to be obliged to pay it, as neither
himself or family had been sick. As, however, he felt very reluctant
to pay out his money without receiving some benefit from it, he told
the doctor he thought his system was in want of medicine; and on
enquiry of the doctor as to his symptoms, he told him, that " somehow
or other, he couldn't eat as much as usual, felt unusually sleepy at
times," and requested the doctor to feel his pulse, look at his tongue,
&c. The doctor, after examining into the case, prescribed for him
about twenty powders of tartar emetic, four grains each, and told him
to begin next morning with the powders, taking thern at intervals of a
few minutes ; but that as it was necessary to take away all his bile,
he must assist the vomiting by large draughts of warm water, so as to
scour all out and make a clean house of it. Jose therefore went to
work the next day, by heating two huge brass kettles of water — said
kettles being generally used for scalding hogs. The water being
ready, he then set to work in earnest with the powders, taking them
in rapid succession. They soon produced severe vomiting. Jose
drinking, at the same time, enormous quantities of warm water, till he
had used up nearly all in the kettles. By this time, he was so pros-
trated with almost incessant vomiting, that his friends became alarmed,
and sent for the doctor. He instantly applied a blister, of vast size,
covering almost the whole of the abdomen. On calling to see him
next day, he found Jose propped up in bed, and looking quite pale
and interesting. Under the blistered cuticle, was an immense collec-
tion of serum, laying like a great bag on his belly. He asked Jose if
he was not now convinced that he had got rid of his bile, and got. the
worth of his money, or if he wanted some more medicine? "Ah,
mon dieu," says Jose, holding up his hands, " I want no more dam
medicine, nevare. I am perfectly satisfied! " — Exchange paper.

BATHING.

A writer in the Boston Medical and Surgical Journal utters the
opinion that "once a week is often enough to bathe the whole body
for the purpose of luxury or cleanliness. Beyond this we consider
bathing as injurious. Flannel worn next to the skin at all seasons is
proper, and infinitely more healthful than all the daily baths now so
fashionable. " The argument by which this opinion is supported is
as follows :

" The oil which is secreted by the sebaceous glands of the skin serves
the purpose of lubricating its surface. Now, if this secretion is con-

TRANSACTIONS OF AMERICAN MEDICAL ASSOCIATION. 57

stantly removed as fast as exuded, its destined object is thereby de-
feated. The excretory ducts of the perspiratory glands themselves
require this unctuous matter of the skin to keep them in action. If
very frequent bathing of the body is practised, it must be obvious that
this matter cannot be long present to perform its office. As to the as-
similations of functions of the skin and lungs, it will be apparent that
when the skin acts imperfectly, or ceases to act at all, the lungs have
an extra amount of duty to perform ; and it is generally in just such
cases that engorgement of them takes place, constituting inflammation
or pneumonia."

Transactions of the American Medical Association — Vols. I. and II.

The October number of the British and Foreign Medico- Chirurgical
Review devotes eleven pages to these two volumes, and, as might have
been expected, handles them in rather a cool manner. The following
is the commencement of the review :

" These 'Transactions' are the chronicles of the proceedings of the
first two annual meetings of the American medical association, form-
ing two goodly volumes, the contents of which have little resemblance
to those bearing a similar title in this country. It is true, the advance-
ment of medical science is the ultimate object of publication in both
cases ; but the efforts of our trans-atlantic brethren to this end are as
yet but in a comparatively early stage of development. In a country
in which medical education, practice and literature are in so inferior
a condition as they at present hold in the United States, the earliest
efforts of the lovers of science must necessarily be employed in exam-
ining the cause of, and devising the remedies for, so lamentable a state
of things. This work the association has undertaken with courage
and ability ; and a large portion of the present volumes is taken up
with an account of the results of their enquiries, and a detail of their
suggestions. Already the National medical convention, which organ-
ized the present medical association, had published a code of medical
ethics, which met with much approbation both in America and Europe,
and formed a fitting preliminary to more extended operations. The
association is composed of delegates of medical societies, colleges,
hospitals, lunatic asylums, and other institutions from all parts of the
Union, and holds its meetings at different cities in succession, after the
manner of the British association for the advancement of science.
The two meetings which have taken place at Baltimore and Boston
were attended by several hundreds, comprising a great number of pro-
fessional names of eminence. The two volumes now before us, con-
taining an account of their proceedings, are chiefly filled with reports
given in by the respective committees upon the present condition and
future prospects of the profession, and upon the progress of medical
science. Some of these are well deserving of notice."

58 STATE INSTITUTIONS.

Then the "report of the committee on medical education" is no-
ticed, and the defects of our whole system of teaching and licensing
are very justly exposed. The opinion of the committee, "that most
of our physicians are fully equal, and in many respects far superior,
to the general practitioners of England," is flatly denied.

A long notice of the " report on medical literature," then follows.
The envy of our ability to diffuse all sorts of literature, and make re-
publications of foreign works, at a much cheaper rate than the English
can, is palpable ; and the reviewer, of course, congratulates himself
upon the petitioning of Congress to pass an international copyright
act, by our association.

After noticing and extracting from several of the practical reports
of the committees, the review closes thus :

" In concluding our notice of these volumes, although approving of
the general tone and spirit (save as to the exceptions we have men-
tioned) which have prevailed among those engaged in assembling the
materials, we must be allowed to observe, that, if the medical associ-
ation is ambitious of assuming a position among the various scientific
bodies that issue their memoirs and transactions in Europe, a very
different class of literary productions must be looked for at their
hands. They must not content themselves with merely recapitulating
in reports and retrospects what has already been published — a work
that might be accomplished by a far less massive organization — but
must themselves largely contribute to the general stock the results of
experience and the fruits of meditation."

LUNATIC ASYLUMS OF VIRGINIA.

By the executive reports from these institutions, it appears that " they
have never exhibited a more gratifying aspect to the friends of hu-
manity than at present." The reports of the physicians contain many
interesting tables of physiological and other facts, but our room will
only allow us to make the following extracts :

" The number of patients who have been inmates of the Eastern
Lunatic Asylum since the 30th of September 1849, is two hundred and
thirty-four. Of these, one hundred and forty-five were males and
eighty-nine females.

" The number of patients on the 1st of October 1849, was one hun-
dred and eighty-one, viz : one hundred and seven males and seventy-
four females.

" Since the 30th of September 1849, fifty-three have been received ;
thirty-eight of these wTere males and fifteen females.

" The number of discharges is eighteen, viz : eleven males and seven
females. One male patient eloped.

STATE INSTITUTIONS. 59

" The number of deaths is twenty-two, eighteen males and four fe-
males.

" The number of patients nt present is one hundred and ninety-
three, viz : one hundred and fifteen males and seventy-eight females."

Civil Condition of Patients in the Asylum from January 1st, 1847, to

October 1st, 1850.

Single,
Married,
Widows,
Widowers,

Ages of Patients in the Asylum September 30, 1850.

Below 20 years,
From 20 to 30 years,

30 to 40 " ■

40 to 50 " -

50 to 60 " -

60 to 70 " -

70 to 80 " -

Males.

Females.

Total.

121

50

-

Ill

59

64

-

123

0

16

-

16

9

0

-

9

Males.

Females.

Total.

2

3

5

28

6

34

26

16

42

28

32

60

17

16

33

14

3

17

0

2

2

115

78

193

WESTERN ASYLUM AT STAUNTON, VA.

Within the year just closed, there have been accommodated in the
asylum three hundred and forty-eight patients, of whom two hundred
and one were males and one hundred and forty-seven females. Of
these, two hundred and sixteen occupied apartments here at the com-
mencement of the year, viz : One hundred and twenty-one males and
ninety-five females. One hundred and thirty-two were admitted du-
ring the year, of whom eighty were males and fifty-two females.

Within the same period there were discharged, - 73

Of these, had recovered, 45

" " were much improved, - 4

" " " improved, - 2

" " " unimproved, - 2

" " eloped, - 1

" " died, 19

— 73

60

STATE INSTITUTIONS.

Tabic shewing the Civil Condition of Patients who have been in the Asylum

during the ijear.

Married,

Single,

Widows,

Widowers,

Unascertained,

Males.

Females.

Total

63

58

121

123

72

195

0

16

16

7

0

7

8

1

9

201

147

348

PENITENTIARY OF VIRGINIA.

It appears by the annual report of the surgeon of this institution,
that during the twelve months, ending October 1st, 1850, there have
been treated 515 cases of 71 diseases, injuries, &c. — of these, 110 were
of diarrhoea, 54 biliary derangement, etc.

Of these cases 22 were fatal — 9 consumption — 6 scrofula — 4 bowel
complaints — 2 typhoid fever and dropsy — 1 tetanus.

Death has made sad ravages with the medical profession in Cali-
fornia. During a fortnight, the following physicians were swept off
by cholera : Drs. Cobb, Whitlock, Noble, Mason, Yearly, Robert Mc-
Namer, Green, Stansbury, Holmes, Metcalf, H. P. Hess, G. W. Held,
and Barnes. — Newspaper.

CORRESPONDENTS. 61

TO CORRESPONDENTS.

Articles intended for publication should be received by the 10th of
the month, at least, and must only be written on one side of the page. As
printers are unacquainted with the technical language of medical men,
it is very desirable that the manuscript should be clear, written out
fully in a legible hand, and proper names ought to be in square letters.

Correspondents will always send their names to the editor ; when
it is desirable they will be kept strictly confidential. Any disposition
will be made of manuscripts desired by the author.

The short time in which we had to establish this journal rendered
a circular necessary. In sending out these circulars, the postage of
many of them was not paid, and for fear that it may have given um-
brage to others — as we know it has to two — the editor feels it due to
himself to explain why the postage of all was not paid. In the first
place, he was embarking in an enterprise of great interest to every
member of the profession, and one in which he only could be the
loser. The pittance on each circular could not be felt by any physi-
cian, but the postage on them all would have amounted to $ 100.
This, though a most useless and heavy expense, would have been in-
curred, had there been a certainty that his directions were correct.
But of the list of some 2000 or 3000 names which we obtained, there
were only a very small number with the post offices attached ; many
of the names were of persons not belonging to the profession, of dead
men, or those who had removed ; generally only the county was put
down. Whenever it could be done, the budgets for the counties were
sent by private hands, or given to a countryman for direction, and
they found their way into the mail. Two only of the 2000 have not
been deemed worthy of their postage ; and — particularly when the
above reasons are taken into consideration — we hope there are no
others who can blame us for not having paid postage on letters which
we were not sure would ever get farther than to a county C. H. post
office. Should there be, however, we will anxiously wait an oppor-
tunity of repaying them the half-dime grievance, with full and liberal
interest.

— ^

T, MIC

AN

NI>, YA.

Pima® ram.

In the department of MEDICAL LITERATURE, they devote
particular attention in keeping up a full supply of the Standard Works,
as well as the late publications, and offer them for sale as low as they
can be had in any regular establishment in the United States.

They furnish all the Medical Periodicals.

13*° English, French and German Books imported to order, with
care and despatch.

(LATE DRINKER & MORRIS,)

I

Wholesale Booksellers, Stationers, Publishers, and Dealers in
Piano Fortes, Mirsio, Mnsical Merchandise, Fancy G-oods,

See, 8to.

97 MAIN STREET, RICHMOND, VA., _

Arc constantly supplied with the most important publications in
every department of literature, the arts and sciences.

Orders from private individuals, schools, colleges, academics, semi-
naries of learning, or other public institutions for Boolcs, Stationery,
Piano Fortes, &fc, &fc, will be furnished on the most favorable terms,
and with the greatest despatch. Foreign books imported to order.

ole agents for the sale of Worcester?
uperioritv beg to sub-

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mit to a discriminating public the following testimonial

Improvement in- Pianos. — New York is fully entitled to the credit of ha%ing effected the
greatest real improvements in the construction of that noblest of all instruments, the Piano.
Some others may have added to the sweetness of certain parts of their instruments at the
cost of the power arsd brilliancy of the whole; while others again have lavished money
upon the fantistic decorations of the frames; but to our fellow-citizen Worcester, whose
Pianos have latterly made way so rapidly into jrablic favor, belongs the merit oi' increasing
at the same time the power, quality and endurance of tone, aiid without a corresponding
exaggeration of price. — New York Mirror

THE

AND

VIRGINIA MEDICAL GAZETTE.

No. 2.

RICHMOND, FEBRUARY 1851.

[VoLL

An Abstract of an Essay on Congestive Fever.

BY A. T. B. MERRITT, M. D., OF RICHMOND.
[Read before the Medical Society of Virginia, December 1850.]

After a medico-topographical outline of some sections of our coun-
try, and some general pathological remarks —

Dr. Merritt proceeded to say, that the most malignant and un-
manageable forms of " congestive fever," improperly so called, which
had fallen under his notice and treatment, had been presented to him
in Eastern Virginia, during several years, in great abundance and as
an epidemic. As a general rule, it is true the tendency of all diseases
is to run their course more rapidly in more Southern climates, and
therefore no time can safely be lost in administering our remedies;
but I have seen at times equal rapidity in their progress in our sec-
tion of the Union. At the South, our remedial agencies seem to be
followed by as prompt relief as in Virginia, and perhaps recoveries
are more rapid, and as entire and satisfactory.

I will not detain you by dwelling on the different phases of mias-
matic or bilious fever ; or distinguish very critically between its inter-
mittent, remittent, or congestive varieties; or speak at length of its
malignant, yellow or icteroid form, or its too common typhoid degene-
ration, nearly always arising from neglect or maltreatment. I will
make no distinction as to the simple or excitive, the inflammatory and
congestive varieties of each of these specified fevers, or their degrees
of violence, but proceed to describe the congestive fever, very incor-
rectly so termed, as I have often seen it prevailing extensively for
years together, and attacking large numbers of all ages and condi-
tions, and following frequently distinctly marked cases of each of
these forms of fever.

I have often used the term "congestive," as applied to this fever,
which, in different parts of our country, is called by a great variety
of names — as cold fever, cold plague, cold chill, congestive chill, con-
gestive fever, pernicious fever, typhus fever, typhoid fever, and many

62 MERRITT ON CONGESTIVE FEVER.

other names, or rather misnomers. Most of these synonyms seem to
me to be singularly inappropriate, founded on no sound pathological
views, and to be in fact medico-philological solecisms. Is not the
very term congestive fever, as thus applied, an absurdity? Conges-
tion is a symptom of morbid action, confined to no class of diseases,
and takes place at the close of many, perhaps nearly all, diseases
affecting our general system. I have no strong repugnance to using
the expression, congestive state of bilious or any other fever, to desig-
nate the presence of extensive congestion in such fever. In our fever,
as well as in cholera, it is true, there seems to be a great tendency to
congestion ; and whenever it does occur in either, it is indeed " con-
gestion in earnest." I have often been struck with the close analogy
which seems to exist in very bad cases of each of these diseases,
presenting many morbid phenomena, nearly allied, I have no doubt,
in their nature, as well as in appearances. Some subtile atmospheric
degeneration, however produced — some diffusive, penetrating mala-
rial poison, however generated and composed, acting on our constitu-
tion generally, seems to spend its chief force on the vital and natural
organs, leaving less implicated the animal functions. We may there-
fore safely conclude that the nervous system and its dependencies, in
both of these diseases, feel the chief force or impetus of the morbific
causes, and the other systems of our organism becoming involved,
are at last overwhelmed in one common ruin, with symptoms, if not
identical, at least closely allied and nearly analagous to each other.

But I have expressed the opinion, that congestion is only a symp-
tom of disease, and not the disease itself — and very often not an essen-
tial part or condition in which the other symptoms have their origin,
and from which the greatest danger is to be apprehended. The oppo-
site opinion has led to many views that are unsound in pathology and
unsafe in practice. That temporising treatment of any disease, which
looks to the relief of symptoms, must in the main be quite unsatisfac-
tory to the enlightened physician, and lead to great want of success
at the bedside. The leading secret of successful practice is an unfear-
ing and sturdy grapple with the disease itself, and as little remedial
application merely to its signs, or its symptoms, as is consistent with
the quiet and comfort of suffering humanity. We may rest assured,
that in medicine, as in every thing else, the old and long-established
maxim — " sublata causa, tollitur effectus" as soon as we remove the
cause, the effect and symptoms will cease, is true ; and that in medi-
cine especially it is a maxim of inestimable value, and ought to be a
cardinal rule with every sound and enlightened physician.

I do not believe that congestion in this fever is the chief or princi-
pal source of danger. I suppose it will be conceded on all hands,
that it is a venous congestion, and this we constantly meet with in
many other diseases, with no fatal results. We see it in syncope, in
concussion of the brain, in severe surgical operations and violent in-
juries, and in every accident and disease inflicting a severe and decided
shock on the nervous system ; yet in all these cases it is not the con-
gestion, but the great prostration of nervous power, we fear. We
rarely find on autopsical examination in fatal cases, congestion enough

MERRITT ON CONGESTIVE FEVER. 63

in any organ to account for fatal results, either in such cases, or in the
disease under consideration.

I cannot attribute to inflammation and its consequences much of the
danger and fatality of our disease. I do not for one moment believe
that we would observe in purely inflammatory diseases such marked
and distinct periodicity, and such obvious and decided intermissions
and remissions. I cannot suppose that a degree of inflammatory ac-
tion, sufficiently high to lead to a fatal termination, can be so far over-
come and extinguished as to be nearly imperceptible to our senses, and
the feelings of the sufferers themselves for hours, and then be re-es-
tablished and rage for a short time, and disappear again of itself. I
cannot believe that inflammation can be thus formed and become dor-
mant, and then be rekindled for days, and finally removed by a dose
of medicine, and a few grains of quinine. The very supposition is
almost monstrous, and post mortem examinations in most cases display
little or no inflammation. If these views be at all correct, they are the
mere attendants of the disease in some cases, and not the sources of
danger and death — the mere casual appendages, and not the disease
itself.

I believe our disease is primarily and essentially seated in the ner-
vous system ; but here it cannot remain long to any extent, without ne-
cessarily extending itself, and diffusing its deleterious influences to
other systems, and different organs, to the fluids as well as the solids.
But to the nervous system we must look for the source of symptoms
and danger. On it the malarial poison makes its first impression, and
produces a prostration of the nervous power to a greater or less de-
gree. The nervous power being diminished or prostrated by this
morbid impression, we must look in the first place for its effects on
the organic functions, and we soon find them involved in many abnor-
mal and irregular actions. The nervous fluid or power being supplied
in smaller and lessened quantity or force, we perceive a want of ac-
tion in the capillaries and extreme blood vessels, and coldness on the
surface. The extreme blood vessels seem to collapse, because they
circulate now little blood, and do not receive their due proportion of
nervous influence, which is necessary to this as well as every other
part of our organism, for the easy and normal performance of its func-
tions. The blood enters these extreme arteries on the surface, now
in an enfeebled condition, with great difficulty, and circulates through
them with a slow and obstructed progress. Hence we observe
much shrinking, contraction and paleness on the surface ; and when
the blood which passes on reaches the veins, it is there congested
or stagnates, and produces the lividness, and finally, in extreme cases
of this disease and cholera, the cyanotic appearance so frequently ob-
served. The want of due innervation at length becoming extreme,
these vessels allow the watery or serous parts of the bloodto escape
from them, and we have copious and profuse sweats ; and in cholera,
from a similar and perhaps identical condition of the capillaries on the
intestinal surface, the serous and other discharges, which we observe
in that disease. The great coldness on the surface and in the breath
arises from a deficient decarbonization and calorification of the blood

64 MERRITT ON CONGESTIVE FEVER.

in the lungs, occasioned by the great general and local irregularity
of the circulation.

The " function of respiration also suffers from the same deficiency
of nervous influence ;" and the circulation of the blood through the
pulmonary arteries, being languid and slow, or impeded, the necessary
changes for its purification do not take place. We therefore have very
often great anxiety and oppression in the chest, difficulty of breathing,
and deep and frequent sighing. The sickness of stomach and the inces-
sant vomiting and purging must be attributed to the same causes, and
we may have these symptoms prevailing to an almost insufferable ex-
tent. The distressing sensations experienced in syncope from loss of
blood, and in a semi-paralyzed limb, are to be ascribed to a similar
want of local innervation. Serous discharges from the bowels may
be compared to profuse sweatings from the surface, being evidently
analogous in their origin and nature. I will only notice, in addition to
these symptoms in this place, the intense thirst and great internal heat
of which the sick complain so much and so loudly. It is known to all
physicians, that great and most distressing thirst prevails in every dis-
ease, and in every condition of disease, where the blood vessels in their
capillary extremities are pretty well emptied of their blood, whether
this emptiness be brought on by direct loss of blood, or the usual
course of this or other diseases. The very frequent sensation of in-
ternal and the more rare sensation of external heat, are only examples
of deranged sensibility arising from the irregular and anomalous ac-
tions of the nervous system from imperfect and deficient innervation.

The heart, pulmonary and systemic capillaries, thus suffering from
a deficiency of nervous supply, arising from the prostration, in a
greater or less degree, of the whole nervous system, we have, of course,
accumulations or congestions of blood in the veins and great internal
organs, and especially those connected with the portal circulation.

This state, modification or species of miasmatic fever often presents
itself under the intermittent, remittent, and less frequently, the conti-
nued variety. But in such cases as appear to be continued in the com-
mencement, the patients surviving, and the disease being partially or
wholly unchecked for two or three days, an intermittent or remittent
garb is generally assumed, and we have quotidian, but oftener tertian
or double tertian paroxysms, the alternate paroxysms being alike, and
occurring frequently at different hours of the day, and with varying
relative severity. It presents very different and proteiform pheno-
mena, depending in a great degree on the direction of its chief attack.
I have already said the organic functions were in many cases espe-
cially affected, but in not a few subjects the animal seem to be chiefly
implicated. In the former, we trace the leading evidences of disease
in the organs of digestion, respiration, secretion and circulation ; and
in the latter, the brain and muscular system are the prominent suf-
ferers. We also find different symptoms more obvious and promi-
nent, as this or that organ has the chief impetus of the morbific cause
directed against it.

The attack is usually preceded by feelings of languor and indispo-
sition, giddiness or headache, and pain in the back, but at times it is

MERRITT ON CONGESTIVE FEVER. 65

very sudden, and gives little warning of its approach. It may occur
at any time of the day, or in the night ; and it may present its severer
characters at once, or differ in little or no respect from ordinary mias-
matic fevers for days, if, indeed, it is at all different. In particular
years, I have seen nearly every case of fever, when neglected or mis-
managed, shew a most decided tendency to run rapidly into the form
of fever now under discussion ; and I verily believe I have seen more
cases of it at times, brought on in this way, than by the force of the
morbific causes.

A chilly fit or paroxysm, differing in no sensible character from an
ordinary intermittent or remittent, often ushers in this disease. The
pains in the head, back and limbs ; the frequency, irregularity, and
often the weakness of the pulse ; flushes of heat and cold, alternating
with slight outbreaks of perspiration ; copious discharges of limpid
urine ; slight nausea, and a dull, constricted, inelastic and harsh feel-
ing of the surface, continue sometimes for hours, when they are fol-
lowed by a re-action or fever more or less complete. This re-action
is, however, often short in its duration, and followed by considerable
relief from these symptoms. This respite lasts generally till the next
day, or the disease may assume the tertian form, when these paroxys-
mic symptoms re-appear, and are more severe, and followed by more
dangerous phenomena; or these phenomena may be postponed till
the disease has continued for several days. In many cases, the re-
action is never complete, unless aided by medicine, but the conserva-
tive powers of nature continue their efforts, as if tbey desired a full
development of open fever. The symptoms, when this imperfect re-
action and ataxic state are removed, and the disease fully formed, dis-
playing in the organic functions its principal power, may now be suc-
cinctly detailed. They of course do not all present themselves at the
same time, or in one and the same case, but are generally to be ob-
served during its progress more or less in every attack.

The pulse, though sometimes strong, frequent, laboring and irregu-
lar, is generally quite small, quick, feeble, frequent and irregular, and
not unfrequently fluttering, thread-like and intermitting. The number
of pulsations in a minute vary from 110 to 160, or even more, and of
course incalculable, though I have seen the pulse very weak, feeble
and fluttering, and not frequent in a few cases. In a few cases it is
not to be felt at all at the wrists, while the heart and carotid arteries
beat rather violently. During the partial intermission or remission,
the number of pulsations is lessened, and the volume and force of
the arteries increased; but unless we now resort to prompt remedies,
in order to avert the next paroxysm, the pulse each time becomes
more frequent, feeble and irregular, until it entirely disappears.

The stomach is often extremely irritable, and throws up everything
which is swallowed, very soon after it reaches its cavity. This is a
most distressing symptom; and the vomiting being often very violent,
with much retching, is accompanied by great tenderness and some-
times pain in the epigastric region. The matter thrown up is some-
times bilious, but oftener what has been swallowed, or a mucous or
muco-serous fluid, occasionally tinged with blood. The bowels are

66 MERRITT ON CONGESTIVE FEVER.

generally, but by no means always, confined, and when moved,
their contents appear unhealthy and offensive, but are sometimes wa-
tery and tinged with blood, fetid, and resemble the water in which
fresh meat has been washed. The respiration is very much altered,
and accompanied by continued sighing in many cases. It is often
" hurried, irregular and panting," and the patient complains of much
" difficulty in getting his breath," and requires constant fanning, and
desires every moment the accession of fresh air. Towards the close
of the disease, the number of inspirations is generally greatly in-
creased, but I have seen it in a few cases much diminished. The
tongue is sometimes nearly natural in appearance, but it very seldom
remains so long. At other times it is pale, cold, and covered with a
whitish coat, which frequently becomes much thicker and darker, and
brown, or brownish in the middle or over its whole dorsum. The
mouth soon becomes full of a thick, tenacious secretion, and the teeth
covered over with a dark sordes. The tongue and mouth, however,
often become very dry, and sometimes quite red and glazed, many
papillae appearing on the surface of the former in the last stage of the
disease. The skin presents in many cases a most marked aspect.
The hands, feet and face are pale ; the features sharp and shrunk,
strongly expressive of uneasiness and alarm, which the patient does
not appear really to feel. The eyes are bright, and sometimes very
clear and brilliant, but after a while seem to sink in their sockets.
Their membranes are sometimes slightly inflamed, secrete a thin fluid,
and at last throw off a thick purulent matter, rather copiously. I
have, in two cases, seen the whole eye altered in color, and the hu-
mors very opaque and milk-like in their appearance, accompanied by
total blindness, and a dead and shrunken appearance of the balls for
several days. I feared at the time one of these patients, a little boy,
would never recover his sight ; but his eyes, at once so discolored and
collapsed, were at length fully restored. The general surface is cold
and shrivelled, and after the sweating has continued for hours, the
hands, feet and legs are like these parts in patients dying of cholera,
or the hands and arms of a washer-woman. The patient, in this cold
state, often complains of great and most distressing internal heat, and
will bear no bed clothes. The thirst is a most striking symptom, and
often very oppressive. The patient is continually crying out for water,
and can never be satisfied, and whatever he swallows is returned very
soon, even the little water from a melted pellet of ice. I have often
been told by such sufferers, that they would swallow water, even if
convinced it would kill them, so great and uncontrollable is the desire
for it.

The secretions from the liver and kidneys are either very small, or
suspended, and the same may be said of the secretions of the stomach
and bowels in many cases. The hiccough is sometimes very distress-
ing, and I have seen the patient nearly convulsed by it, the bed vio-
lently shaken, and heard it at a distance of 200 yards. Along with
these symptoms we have many others, the most prominent of which
are, great restlessness and constant jactitation, an inability to lie in the
same posture a moment, continual change of position, a moving from

MERRITT ON CONGESTIVE FEVER. 67

bed to bed, or from room to room, a perfect unconsciousness of danger;
and when asked how he feels, the patient will often tell you " he is
very well," and laugh at you when you tell him he is ill and must take
medicine. The sick will at times walk about their rooms after they
have lost their pulse, retaining in a great degree their muscular
powers. The mind is often clear and unclouded nearly the whole
course of the disease. While the skin is generally cold, there is often
warmth about the forehead, breast, stomach and heart, and in some
cases I have observed spasms in the thighs and legs. Deafness and
haemorrhages are not uncommon, and general convulsions have occa-
sionally occurred.

When the disease directs its chief force to the animal functions we
have a different set of phenomena. Perhaps a slight chill is succeeded
by drowsiness, the patient becoming in a short time comatose, and
then stupid, so that he cannot be roused. The breathing is slow and
stertorous ; the pulse is usually full and accelerated in some degree,
but sometimes very slow. In children this form of the disease is often
accompanied by convulsions, and I have often, in adults, seen the co-
matose symptoms disappear in the remission and return with the pa-
roxysm for several days. I might here add other symptoms, and trace
those enumerated more fully, but perhaps I have said enough on this
part of the subject.

I will now hasten to the treatment of this disease which I have found
most successful. I can, perhaps, accomplish this object more clearly
and satisfactorily, by giving a few cases, and their management, than
in any other way, and conclude by some general remarks. Unfortu-
nately for our profession, and more unfortunately for our patients, the
ordinary treatment of febrile diseases is too often a temporising alle-
viation of symptoms, or a remedial address to the phenomena, and
not to the disease itself. Let us recur to the treatment, for instance,
of a well defined case of bilious fever, with distinct and well marked
tertian paroxysms, as it is frequently seen, and we find decided heat
on the surface, activity of the pulse, torpor in the secretory organs,
and the usual febrile symptoms after a chill. We perhaps bleed,
and give a mercurial cathartic, which brings off bilious discharges
with much relief. The next exacerbation approaches, is rather
milder, and a similar course is pursued, and attended by similar re-
sults. After several chills and fevers, the sulphate of quinine, or some
tonic, is used, and the patient recovers, but is weak, emaciated, pale
and anaemic in appearance, and we are told we were obliged to half
kill our patient in order to cure him. This I have long considered
one of the opprobria of medical science. But we have a more violent
case, and after pursuing the above or some analogous practice for
several days, it is true the fever is subdued, but too often the patient
has departed with it. We look too much therapeutically to the
symptoms, and use many other remedies in such cases, but our views
of pathology are too confined, and our remedial applications quite
too restricted. In the remission we have the most suitable time to
combat the disease, and by such management we lose the first and
most valuable moments, and our patients too often by such mis-

68 MERRITT ON CONGESTIVE FEVER.

management become typhoid or die. Let us, therefore, examine
well into the pathology of disease, analyse its ravages on all the dif-
ferent systems of our organism, address our remedies to the disease
itself, and thus protect and save our patients, and adjust all the
balances of the different organs.

Sept. 27th, 1832. I was called to see Mr. T. A., a wealthy and
intelligent gentleman, of good constitution, and about thirty years of
age. He had been sick about six days, and had taken several cathar-
tics and other remedies. His face was pale and sharpened, his coun-
tenance anxious, his extremities cold, and his whole surface covered
with a copious perspiration. The pulse was weak, small and irregu-
lar, and about 135 in the minute, with great sickness at the stomach
and frequent vomiting of a muco-serous fluid. The headache, dis-
tressing at first, had disappeared ; delirium last night ; tongue covered
with a thickish white coat ; mouth and fauces dry ; thirst insatiable ;
great restlessness ; sighing and jactitation ; hurried respiration ; no
sleep for several nights ; shrivelled* and corrugated skin on the ex-
tremities ; heat on the forehead and epigastric region, and a deficient
secretion of urine, were some of the other symptoms. The pur-
gatives had produced debilitating, watery evacuations, with little or
no bile, and he had been in this state of collapse some fifteen hours.
This case I consider a very fair specimen of very numerous cases
that occurred, which were generally followed by fatal results in two
or three days, unless promptly treated and relieved. The indications
of cure were here, according to my views, an alteration of the secre-
tions of the stomach, bowels, liver and kidneys, a determination to
the surface, and a protection against the next paroxysm. To accom-
plish these ends I gave him cal. 12 grains, opium l£ grain, and Dov.
pow. 3 grains ; applied a large blister plaster, six by eight inches,
over the stomach, and ordered the free use of the sulphate of quinine
in four hours. I desired the action of the medicine and plaster to
begin to bring the system under their influence before the use of the
quinine was commenced. In a few hours he was composed, the
sweating nearly arrested, the thirst, sickness of the stomach, and
other distressing symptoms gone, and he, to use his own expression,
" never felt so much relief in so short a time." The quinine was
given in large quantity or doses, and sinapisms, with some warm
stimulating drink, administered before the time of the next paroxysm,
the next day, wholly averted it. He recovered at once, without one
untoward appearance, and has enjoyed fine health ever since this
attack. Some weeks since, in a conversation with me, he alluded to
this attack of disease, and spoke of his relief as almost immediate
and most surprising.

Sept. 2, 1826. I saw in consultation Col. , a strong, healthy

and athletic man, about 32 years of age. He was very much in the
same situation as the preceding patient ; had been sick seven days,
and the perspiration had continued some time longer. I recommended
an immediate resort to the above course of treatment and decided sti-
mulation. The delirium being considerable and having lasted for
some time, fears were entertained of the use of opium and stimula-

MERRITT ON CONGESTIVE FEVER. 69

tion. I urged the absolute necessity of bold measures to fortify the
patient against the next paroxysm, under which I was sure he would
irretrievably sink, if it approached before he was under the influence
of this or some similar course. T could not prevail on him to use my
remedies, and left. He used blisters, sinapisms and very mild tonics ;
and on the night of the 7th of September, I was called again to see this
gentleman, and found him unprotected for the approaching paroxysm
at 10 o'clock on the 8th, and now there was no time to accomplish his
safety by these remedies. The paroxysm anticipated, and the patient
never rallied, but died soon, presenting the wrinkled and blue appear-
ance and copious perspiration of those who die of cholera. I have
always thought that the same treatment, applied perseveringly and
faithfully, would have been attended with the results of the first case.
I am much strengthened in my opinion, by my general experience,
that nearly all similar cases treated as I have suggested, recovered,
and almost all of those which were not, resulted fatally.

Oct. 27, 1826. I was called as consulting physician to see Mr. ,

a wealthy and most intelligent gentleman, about 26 years of age. He
was very cold, with a weak, small, fluttering, and at times nearly
imperceptible pulse, 147 or 148 in the minute. There was great cold-
ness on the surface, with slight and unequal perspirations, confined
mostly to the forehead ; great restlessness and jactitation and thirst,
hurried and sighing respiration, the tongue slightly furred and dry, the
stomach extremely irritable, and rejecting everything, and much
anxiety of countenance, and bright and brilliant eyes. He had been
treated for several days by purgatives and the usual remedies. The
purgatives had not brought away much bilious matter, but thin, wa-
tery and debilitating discharges. There was slight delirium, and he
had been in his present condition twenty-four hours. The purgative
plan had been continued to the time I saw him, and only two hours
before he had taken a full dose of calomel. He was now using the
close-stool every fifteen or twenty minutes, and all that passed from
him was a small quantity of thick secretions very much resembling
indigo mud, not exceeding a half teaspoonful at a time — and often no-
thing but flatus.

I suggested an entire change of treatment, and immediate resort to
opiates, with extensive blisterings, sinapisms, and free and continued
stimulation, and then tonics and alteratives. I remarked, that without
improvement, life could last only 24 or 36 hours ; that the plan of
treatment now in trial had been urged sufficiently, and had made no
salutary impression whatever on the disease, and would be fatal to a
certainty if pursued any farther ; and that the only hope of success
arose from the opposite plan of treatment, suggested by me. After
a long argument and animated discussion it was agreed, that I
might try my treatment till morning, if I would stay all night with the
patient. I immediately gave an opiate alone, as he had already taken
a full dose of calomel, applied a very large blister and sinapisms, and
commenced on moderate doses of quinine, — for I had not yet learned
the value of large doses, — and the free use of old rum, three pints of
which were given in 15 hours. In a few hours, he became more quiet ;
10

70 MERRITT ON CONGESTIVE FEVER.

had for three or four days no more motions from his bowels, and his
pulse by morning was increased in volume, and reduced to 138 or
140 in the minute. This course of treatment was now continued,
and he gradually improved, the paroxysms being each rather slighter
than the preceding, and in four or five days, having thrown in, as I
could see a safe opportunity, small doses of calomel or blue mass,
with the opium and quinine, dark colored and satisfactory secretions
were taking place in the bowels and liver, and warmth was restored
to his surface. The improvement was now steady and uninterrupted,
and no further difficulty occurred in this most awful case of " conges-
tive fever." Similar cases were presented almost every day ; and I
will here remark, that although within my practice and observation in
the earlier part of this sickly season, such cases were too often fatal,
I found, on instituting the above specified treatment, little difficulty in
controlling their violence or depriving them of their danger. Here
permit me also to remark, that in many cases like the preceding, so
prostrated were the powers of the system, and so low the action in
the capillary vessels, that purgatives the most powerful, and even the
most drastic combinations, repeated over and over, would produce no
cathartic operations. However we may classify and arrange medi-
cines, as cathartics, emetics or sudorifics, ample and abundant expe-
rience proves most clearly, that they act as such only in certain condi-
tions of the animal economy ; and we often find, especially in this con-
gestive state of the system, and its cognate conditions, that these
medicines will not act in accordance with this arrangement and classi-
fication. The vital energies are so low, and the action of the capillary-
vessels of the skin, and secretory surface of the stomach, and intesti-
nal canal, and the glandular apparatus of the liver, and other abdomi-
nal viscera so prostrated by the malarial poison, that these remedies
lose their usual and appropriate force. Many articles of the materia
medica, in large and repeated doses, and in powerful combinations,
fail wholly to produce their usual effects in this abnormal condition ;
blisters and sinapisms are unnoticed by the sick, mercurials cease to
salivate, emetics compose the stomach, and purgatives are followed by
no action from the bowels. These things were very common within
my notice. But when this state of disarray and disaster did occur, it
could be very easily removed generally by a change of remedial
strategy. The opium and mercurials, the sulphate of quinine and
stimulants, the sinapisms and blisters, combined and used cotemporaneously
and per sever ingly , as I have recommended, nearly always, even in very
bad cases, would rouse up and increase the nervous energy, sheath and
shield the nervous system from further morbific action, determine to the
surface, and alter and restore all the secretions ; and in most cases a
thick and consistent, and frequently a dark and tar-like and copious
secretion from the bowels, a sure harbinger of safety and recovery,
would ensue in 18 or 36 hours. I did not rely on these remedies se-
parately, for they would thus surely fail very often. The opium and
mercurials, and other remedies, will bring on temporary relief and
warmth, and improve the action on the surface, but without the blis-
ters and sinapisms we had no guaranty of their remaining. The blisters,

MERRITT ON CONGESTIVE FEVER. 71

sinapisms and diffusible stimulants would produce warmth and tran-
sient reaction ; but without the opium, calomel and quinine, we had no
surety that innervation would become regular and normal, the secre-
tions be restored, and all these changes and this improvement remain.
I am aware much is gained by any of these remedies separately, but
to fail in applying the others is to encounter danger, and often death,
most unnecessarily and reprehensibly .

Sept. 18th, 1832. I was called to attend Mr. B. M., about 10
o'clock at night, a strong, healthy and muscular man, who had been
nine days under the management of a Thompsonian. He was in a
state of collapse, and had rested none for nine days and nights. His
sweating, thirst and restlessness were extreme. He was lying with
his head and shoulders about the middle of his bed, and his buttocks
and lower extremities in chairs, with a servant fanning him. His
breathing was hurried, sighing and short, his surface and extremities
cold, tongue brownish and dry, his skin seemed corrugated and close-
ly stuck to the bones at the wrists. He was so restless, that he would
move from his bed to the floor, and roll over it, and was talking, call-
ing and groaning all night. He had been under the influence of
Thompsonian remedies nine days, and had a chill or exacerbation
daily. I gave him at once a full dose of opium, mild chloride of mer-
cury, and Dover's powder, and ordered him to be placed in bed, and
everything to be kept quiet, so that he should by no means be dis-
turbed under the first influence of the opium. I also applied a very
large blister to his epigastrium, and ordered large doses of quinine at
4 or 5 o'clock, and sooner if he should be awake. He rested so well,
that his wife informed me she approached his bed three times very
quietly during the night, and placed her ear to his mouth, to see if he
was breathing. He was so very still, she feared he was dead. The
quinine prevented any more chills ; but on the evening of the 19th
he had a considerable reaction. I moved his bowels with an enema,
the stool being large, dark and thick. At bed-time I repeated the ano-
dyne mercurial, and ordered the quinine freely next morning. The
reaction was now decided, and rather high, and I repeated the opium
and calomel and Dover's powder for two nights, and continued to
give the sulph. of quinine to destroy all the remains of periodicity.
His convalescence was now rapid, and his recovery complete.

In August 1829, Mr. M. was thrown from his sulky, and had both
bones of his leg broken. I was his physician, but being on a visit to
Southampton court, or at least out of my range of practice, Dr. B.
was called to see him. He set his leg and bled him, and used freely
cold water to his limb, and administered saline cathartics, and ma-
naged his case for two or three weeks. He was in a paludal district,
with a highly miasmatic atmosphere, and was attacked with the au-
tumnal fever. Finding his case becoming very critical, he was moved
to his own residence, and I was called to see him on the 5th of Sep-
tember. He was cool, and his pulse weak, frequent and fretful, his
alvine evacuations thin and watery, and his condition verging rapidly
to congestion and collapse. I proposed at once to give quinine and
my usual remedies. No objection was made by Dr. B., and I left

72 MERRITT ON CONGESTIVE FEVER.

the patient, fully persuaded all things would soon be right. On my
next visit I found, instead of the course suggested, which I supposed
would have been faithfully pursued, some drastic compound purga-
tive pills had been given every two hours, and that the patient was
in the worst possible state of congestion. His surface was cold, his
stomach irritable and rejecting everything, his pulse very small, weak
and fluttering, and from 155 to 160 in the minute, his voice altered,
his countenance haggard and anxious, his delirium constant, his rest-
lessness and jactitation extreme, his broken leg very cold, and the
bones entirely ununited. No medicines whatever had been given to
protect him against the next chill or paroxysm, which was to approach
in 16 or 18 hours, and in which, I was sure he would die, unless it
was greatly mitigated or prevented. I forthwith commenced admi-
nistering stimulants and tonics, blisters and sinapisms ; and gave be-
fore the time of the next chill, 44 grains of quinine, five of opium,
and old rum "ad libitum;" and using at the time of the approach of
the chill, some other and decided diffusible stimulation, I succeeded
in a measure in averting it. I now called in to my aid my friend
Dr. B., one of the most skilful and enlightened physicians it is my
happiness to know, and we continuing this treatment for several days,
our patient recovered without an untoward symptom afterwards.
The medicines brought on dark-colored and feculent discharges, the
disease gradually disappeared, the bones of his leg re-united, and
this gentleman now enjoys fine health.

In those cases where the cerebral functions are disturbed, and the
disease spends its principal force on the brain and animal functions,
the same or a similar treatment, except when meningeal or cerebral
inflammation is obvious, is followed by its usual success. The blis-
ters, sinapisms, and other applications to the surface, and mercurials,
with a more moderate and guarded use of opium, seem to be indi-
cated ; and this course, thus modified, I have used with much success.
I would not, however, be understood as precluding the use, in differ-
ent circumstances, of many other remedies, when they are seemingly
indicated. Many of these remedies, to be found in all our treatises
on fevers, are useful adjuvants, and were often profitably employed.
But not designing to write a labored essay, and only wishing to call
attention to the leading remedies, which for many years I have found
to succeed so well in our fevers, I will not particularize them. I will,
however, here remark, that as long as the disease continued, and un-
til the secretions were resumed, I generally gave the opium, Dover's
powder and calomel once or oftener in the twenty-four hours.
Whenever I could choose the hour of administration, and this was
most generally the case, I preferred to give this dose at bed-time, for
many and obvious reasons. I thereby derived full benefit from the
medicine, and in most cases ensured to the sufferer a night of com-
parative comfort and repose, thus robbing the sick chamber of most
of its horrors. The patient would generally in the morning be quite
refreshed, and the medicines of the preceding night prepare the sys-
tem for the free use of the sulphate of quinine, and other tonic reme-
dies.

MERRITT ON CONGESTIVE FEVER. 73

In regard to the administration of the sulphate of quinine, I was not
scrupulous, caring very little as to the mode or the quantity given, so
I could bring the system under its fall influence in due season. In
most cases, from sixteen to twenty grains would prevent a recurrence
of the chill, if the patients had been prepared for their administration
by the previous use of the medicines to which I have alluded, and
which I have so strongly recommended. I have often given much
larger quantities in large doses, and always desire to produce a degree
of cinchonism, and have the nervous system well under its influence,
some hours before the time of approach for the chill. By pursuing
this course, my experience assures me we can nearly always in two
or three days, even in the most refractory and unmanageable cases,
avert the quotidian and tertian paroxysms, divest them of their dan-
ger, and thus secure the lives of our patients. We have been told,
that in this class of diseases the sulphate of quinine should be our
" first, last, and only remedy." This I consider very unwise advice.
It is probably the most important remedy ; but, unaccompanied by
other adjuvant agencies, I have seen it fail too often to subscribe to
this doctrine. The curative powers of quinine seem to be confined
mostly to its action on the nervous system ; and it must be plain to
the enlightened physician that we have in our disease other indica-
tions to fulfil, and that we cannot safely disregard the secretoiy sys-
tem. Indeed, we must view the whole ground before us, and have
an eye, in our treatment of this disease, to every system and organ,
and guard against all dangers and lesions. I am willing to concede
to quinine all- the importance it so justly merits, and in attacking the
citadel of disease, assign it the most honorable position on the right
wing. But here, to be successful, we must use the whole battery of
medicine. We cannot rely on the right wing alone, but must call to
our aid the centre and the left wing. To pursue any other course,
would be as unwise in us, as it would be in a commander to make an
important attack with his right wing alone, and leave his centre and
left wing unemployed, to be defeated and destroyed in detail.

This practice I have followed with a success highly gratifying to
my feelings, and satisfactory to me in all respects, since the autumn
of 1825. I then became perfectly aware, from witnessing the great
want of success in the treatment of many cases of collapse which I
then met with, and which were very common, that much more was
necessary than the usual routine practice pursued by physicians, and
laid down in our books. I looked closely at the disease, as I encoun-
tered it at the bedside, and scanned and analysed the action of all the
remedies used — observed the "juvantia and Icedentia" with fear and
trembling, and step by step adopted it, and I have to-day more confi-
dence in it than I have in any treatment applied to any other disease.
It curtails the duration of our fevers fully one-half; it greatly alleviates,
and almost takes away the sufferings of our patients. It allays the
distressing thirst ; composes the irritability of the stomach, often most
distressing, and which, I now disregard, or look upon as a mere chi-
mera ; it produces a moisture on the surface, and secretions from all
the torpid organs, and it quiets the sufferer's fears. It renders many

74 MERRITT ON CONGESTIVE FEVER.

violent cases mild at once, subdues those that are dangerous, and robs
them of their danger, and averts disaster and death from those cases
in which we see it approaching, if we can judge from comparison
with other cases under the usual treatment, and which we daily wit-
ness in the medical world. It is a rare thing for the sick not to sleep
quietly and refreshingly, and with comfort to themselves, and soon re-
cover from their attacks with very little waste of solids, fluids and
strength ; and for many years I have had no cases pf typhoid fever in
my practice, when I have treated cases in their earlier stages. This
is bold ground to assume ; but, sustained by truth, I know it to be im-
pregnable, and invite the severest tests at the bedside. When com-
pared with other treatment, I fear no defeat there, and will with great
pleasure submit it practicalhj to the most critical examination. Desi-
rous to discharge faithfully and conscientiously every professional duty,
and to use every honest effort to alleviate and lessen human suffering,
and having a firm and abiding belief that this practice, when fairly
tested, must supersede the present practice laid down in our books,
and more or less pursued by the profession, I would be pleased to in-
stitute a full and fair comparison of success as tested at the bedside.
I perhaps ought to remark, that within the last ten or fifteen years, an
analogous practice has been adopted by some of the most skilful sur-
geons in the British army and navy with most distinguished success,
according to their reports. These, with some of our own Southern
physicians, I consider the best authority in our day in the treatment
of diseases in southern latitudes, and especially the disease under our
consideration.

I believe that congestion is generally the result of neglected and
badly managed cases of our autumnal fevers. I have very rarely
met with this congestive state of fever, without being able to trace
it most legitimately and certainly to one or the other of these causes.
I have often foretold its advent from an improper dose of medicine.
and seen my predictions realized; and so confident am I of the
truth of this opinion, that I never fear its approach in cases which are
well treated or managed, as I shall in the sequel of these remarks re-
commend. I do not believe I have seen one case of decided congestion
in a properly managed case of any of our forms of bilious fever for ten
years — nor have I witnessed within the same period the common and
more dreaded typhoid degeneration of these fevers in such cases. I
therefore am forced to conclude that the latter as well as congestion
arises from the same causes, and ought never to be met with when
physicians have been called to the management of cases in their early
stages ; and it is a well-merited reflection on our skill, if they do then
occur.

Entertaining this view of the nature and causes of " congestion " in
our fevers, improperly called " congestive fever ■," and having no doubt
that it is based alone on the neglect or maltreatment of our intermit-
tent, remittent and continued bilious fever, I will now proceed to
make some remarks on the treatment of these forms of our annual
autumnal visitant, which I think will nearly always guard and pro-
tect our patients from both congestion and the typhoid condition.

MERRITT ON CONGESTIVE FEVER. 75

These remarks and this treatment are so closely allied to our subject,
and so inseparable from it, that we cannot omit them in this connec-
tion, for I consider them as identified, as cause and effect, with it. The
causes and pathology of intermittent and remittent fevers are now
so well understood, that any remarks from me on these points may
be deemed unnecessary, especially as I do not pretend to be able to
cast any new light on them. I will also pass by the symptoms of the
usual forms of bilious fever, and also their distinctive characters.
These are too well known to the profession to need even a more par-
ticular passing notice. In all these forms of our fevers I have often
seen the most distinct and marked cases of congestion arise under the
circumstances to which I have alluded, and against which I am
anxious to throw all guards and protection.

When called to prescribe for a patient in the cold stage or chill of
any of our forms of fever, if it threatens to be obstinate, it has been
the practice of some few of my professional friends, as well as my-
self, for many years, to give without delay from one to two grains of
opium, with ten grains of calomel, or its equivalent of blue mass. If
the sufferings of the patient should be severe, and the chilly sensations
protracted unreasonably, we have no hesitation at all in repeating the
anodyne. It is seldom, however, that a second dose is found neces-
sary, for prompt and decided relief is almost certain from the first
dose, and that with a success attainable by no other means, however
skilfully employed, with which I am acquainted. The chill is most
obviously shortened, and the subsequent fever moderated to an extent
highly gratifying to the patient, and its duration very much curtailed.
When irritability of the stomach exists, I have no knowledge of any
therapeutic agent that is calculated so surely to compose it, especially
if aided by a sinapism ; and if pain, cramps or looseness of the bowels
be present, it seems to be so manifestly indicated, that no one could
hesitate in employing it. In short, there are few or no symptoms,
except such as point to the graver affections of the brain, which at-
tend the cold stage, that would deter me from its use, so great and
salutary and controlling have I found its effects in this stage of the
disease. I have rarely found it necessary to resort to any other
means ; but to most of the remedies usually employed in the cold
stage I have no objection as adjuvants. But to rely on them alone,
in severe cases, threatening at every step alarming collapse, appears
to me the worst species of folly. I have, however, encountered a few
cases where I was obliged to administer very freely sulphate of
quinine and diffusible alcoholic stimulants, and resort to blisters to
ensure the safety of my patients, even in the cold stage.

When I have not been called to prescribe, till the cold stage has
been passed and the hot supervened, with a view to shorten the hot
stage, relieve the febrile s}^mptoms, give ease and comfort, and pre-
pare my patient for subsequent treatment and the use of quinine and
tonics, I forthwith administer the combination of the anodyne and
mercurial, to which I generally add two or three grains of Dover's
powder, feeling always well assured the happiest results will follow.
The first and speedy effects of this dose are, to bring on a relaxation

76 MERRITT ON CONGESTIVE FEVER.

of the skin and remove the thirst, and establish a gentle perspiration
or^ the surface, when the fever subsides in about half the time it
would have done, if reliance had been placed on the abstraction of
blood, cold drinks, and the usual remedies in such cases. We have
very high medical authority for the use of opium in the hot stage of
fever, and I am decidedly of the opinion its efficacy is greatly en-
hanced by this combination. But even supposing, instead of being
recommended, it was condemned by the profession generally, I would
still cling to it, relying upon my own experience and that of my
friends, and sustained, as I think, by the authority of reason and pa-
thology, and as I know, by the most flattering success in practice.

I am aware that many cases occur in which we may call to our aid
many other remedies with advantage. Our treatises on fever abound
with recommendations of such remedies, and many of them are under
some circumstances quite useful; but as my object is not to write an essay
on fevers generally, but to bear my testimony to a particular kind of
practice in our autumnal fevers, which I have found very successful,
I will not undertake to descant on their virtues, or point out objections
to their use. This practice does not at all interfere with the employ-
ment of blisters, and in fact many other remedies that may be judged
to be proper. But if it is adopted promptly ancbpursued judiciously,
there is nothing more certain than that they will be much less fre-
quently demanded than in similar cases differently treated. The ne-
cessity for bleeding will ver}T rarely exist, active purging will never be
required, and the patient will find himself upon recovery possessed of
more strength, and in better condition every way, than by any other plan
I have ever seen pursued. He will have passed through the period of
his confinement, shortened at least one-half, perhaps more ; and instead
of having suffered the horrors usually attendant on such cases, he will
have spent the time of his disease, if not with comfort, at least with a
degree of composure and rest, entirely unknown to those whose misfor-
tune it has been to be subjected to the routine of practice usually
followed.

The thorough evacuation of the bowels by some cathartic medicines,
previously to the administration of quinine, I think by no means neces-
sary. The use of sulphate of magnesia and other saline purgatives
for this purpose, I deem, from much observation, highly injurious, and
often imminently hazardous. From long experience, I am quite satisfied
that no purgatives, having such high authority for their use, have
fewer recommendations, and that they have been productive of more
congestions than all the other articles of this class in the materia
medica. In most cases there is no need for any such evacuations ;
the mercurial itself will generally produce sufficient action from the
bowels; but if it should require aid, I would greatly prefer an occa-
sional enema, or a dose of castor oil. Before any action from the
bowels, our medicine, given either in the cold stage or in the fever,
having controlled the activity of the circulation, tranquilized the sys-
tem, softened the skin, and brought on a secretory action in the
stomach and alimentary canal, we may safely, and with great advan-
tage, begin on the sulphate of quinine and other tonics.

MERRITT ON CONGESTIVE FEVER. 77

If there be a distinct intermission or remission between the pa-
roxysms, it is known to every member of our profession, that this is
the most favorable time to administer quinine, the only remedy on
which we can safely rely to arrest the disease, and none now hesitate
to use it. But should no intermission, or apyrexial state take place,
doubts exist in the minds of many physicians as to the propriety of
exhibiting it. In urgent cases, I never fail to recommend it. The
calomel and opium seem to prepare the patient admirably for its use,
and we cannot wait with safety for marked intermissions in many
cases. In deciding on the propriety of administering quinine in such
cases, I am inclined to believe many are deterred from its use by
fears of the existence of internal lesions. I am, however, very far
from concurring in the opinion that their existence contra-indicates
the free use of this tonic; and when we reflect that every paroxysm
adds to the extent, and increases the danger, of congestion, I must
conclude that it is far better at once to arrest the chills than to allow
them to continue. Indeed, I think we may well doubt whether any
amount of visceral lesion necessarily forbids the use of quinine, acting
as I suppose it does, chiefly on the nervous system.

It is not to be questioned, that under the old plan of treatment, the
best time, as a general rule, for giving the quinine is during the inter-
mission. Not because the powers of the medicine are greater at one
time than another, or that they are impaired during the paroxysm,
but on account of the difficulty of giving a patient in that state any
kind of medicine, the stomach being generally irritable and unable
to bear it. But with the soothing practice we follow, it is very rare
to meet with that obstacle to its use, and hence we seldom hesitate
to recommend it, if it is at all desirable to administer it at that time.
Experience has taught that it can be given at any period ; and to those
who have been in the habit of witnessing its operation, it will appear
astonishing with what certainty and promptness its febrifuge proper-
ties are in most cases manifested.

The form in which it is given is a matter of very little importance.
In solution it acts rather more promptly than in any other way ; but
being extremely bitter and unpleasant to many in solution, I prefer
the form of pills. These are also retained more certainly by the sto-
mach, and with them I often combine an opiate or mercurial, and,
frequently both, as the indications of the case may seem to require*.
In most cases 12 or 15 grains in the 24 hours will answer remarks
ably well ; but sometimes, in urgent cases, exciting serious apprehen-
sions, two or three times that quantity is administered without hesi-
tation.

In many milder cases, where the paroxysm is short and the symp-
toms not distressing, I prefer waiting until bed-time to administer
the anodyne-mercurial. By this plan, a night of quietude and re-
freshment is ensured to our patients, and they are in the morning in a
favorable state for the tonics ; and even in graver and more severe
cases, when, with safety, we can wait for a few hours, I much prefer
giving this medicine at night.
11

78 MERRITT ON CONGESTIVE FEVER.

If any functional derangement or disorder of the chylopoietic vis-
cera should remain after the paroxysms of these diseases have been
arrested, which requires attention, a few doses of blue mass, and pro-
per address to the bowels for a short time, will contribute materially
to the permanency of the cure. The remittent and other forms of
bilious fever I regard as essentially the same, and requiring to be
treated upon the same principles. They are produced by the same
causes ; and as they differ only in grade of violence and the duration
of paroxysms, it requires only a slight modification of the practice in
intermittents to treat successfully the other forms of this disease.

The chief indications in the management of bilious fever being to
moderate the febrile action in the arterial system, and to obviate gas-
trointestinal irritation, and restore the healthy functions of the liver
and alimentary tube, I conceive I meet them all by the combination
of the opiate and the mercurial recommended in the treatment of in-
termittent fever. My practice is to commence with its use, and con-
tinue it as long as I may deem it necessary ; and I give it at any
period in the progress of the case, if either of the indications enume-
rated above still exists.

What others aim to effect by the lancet, I think may be accom-
plished by an opiate, and more besides. It certainly moderates arterial
action to every desirable extent, in most cases ; and in addition to that,
it soothes the whole system, relieves pain, allays thirst, tranquilizes
the stomach, produces perspiration, and very materially aids the mer-
cury in exciting all its desirable effects.

It has been objected to the action of opium in this complaint, that
it has a tendency to constipate the bowels. But this effect is entirely
removed by its combination with calomel ; and in this combination, I
consider it the safest, most soothing and certain cathartic I have ever
administered. I have often seen it succeed in moving the bowels,
and taking away dark discharges, when all other measures had failed.
In most cases treated with this mediciue, no other cathartic is ever
required ; and when it does need aid, I have generally found an occa-
sional enema or a gentle dose of oil amply sufficient to accomplish
our wishes.

Emetics, cathartics, nitrous powders, and many other remedies, I
consider very perturbating and irritating, and their use as irrational
and highly injurious. In a disease where there exists such a tendency
to gastro-intestinal irritation, as is met with in bilious fever, I cannot
conceive what benefit can result from their use ; and it is obvious to
my mind from what I have seen, that in most cases they are sadly
mischievous. I have never yet found any advantage resulting from
the administration of violent and irritating cathartics in this form of
fever ; but they seldom fail, according to my observation, to induce a
state of irritation in the mucous membranes of the bowels, from which
a train of distressing and dangerous consequences arise, in the ad-
vanced stages of the disease, which are often more serious and diffi-
cult to manage than the original disease. Among the most common
consequences of this irrational and imprudent practice, is the produc-
tion, in the mucous membranes of the intestinal canal, of a high state

MERRITT ON CONGESTIVE FEVER. 79

of irritation, or sub-acute inflammation, causing the disease to lose its
original character, and assume a low typhoid form, much more dan-
gerous and annoying than the original attack. By this practice I
have seen much mischief and disaster produced, and I have no hesi-
tation in declaring my solemn conviction that nearly all of our typhoid
fevers are thus brought into existence.

I am sure I need not, at this late day, enter into a defence of the
use of calomel, at least in combination with other medicines, in the
treatment of bilious fever. In combination with opium its virtues are
greatly increased, and it is at the same time so thoroughly guarded,
as to lose all its irritating and unpleasant effects, resulting frequently
from its use alone.

While I deem the use of calomel or blue mass absolutely necessary
in the treatment of bilious fevers, I will here remark, that I always
combine it with opium or some other medicine ; and I must here en-
ter my protest against the extravagant use of it recommended by
some medical authorities of high standing. Instead of 10 or 20 grains
every few hours, until the gums are touched, I seldom give more than
that quantity in the twenty-four hours. I frequently derive no satis-
faction when the specific effects of the medicine are produced, but
continue to give it as long as the liver is inactive or engorged.

Blisters in this disease are a most important auxiliary in our treat-
ment. They are not so often accompanied by strangury or distress
as in other cases not treated with the opium. They excite a fine and
healthy action on the surface and the internal mucous membranes,
and sustain the natural temperature of the skin. In many cases I
consider them absolutely essential, and have it in my power to em-
ploy them much earlier than is done under other treatment, owing
perhaps to opium and calomel preparing the patient for their advan-
tageous use.

The propriety of employing tonics in this disease is a point I con-
sider no longer questionable. Our practice has been to prescribe the
quinine promptly and freely, as soon as we discover the liver has re-
sumed its regular action ; and if that is tardy in being brought about,
and there is any material prostration of the general powers of the
system, we combine with it the mercurial preparation, which may be
employed to restore the healthy functions of that organ.

To the early and free use of quinine is attributable, in my opinion,
much of the success attending the practice we recommend in the
treatment of our fevers. The patient is prepared, by the early use of
opium and calomel, for tonics, which arrest and remove the dis-
ease long before serious organic lesions generally ensue. With qui-
nine we can nearly always shorten the duration of the attack at once,
if there be a distinct remission ; and in cases where there is no ob-
vious remission, much benefit results from its use; and we are most
generally gratified by the occurrence of remissions, following closely
on its exhibition. In cases of great violence, when a paroxysm has
occurred, from which the patient has been saved only by the most
strenuous exertions, and we have great reason to fear that a similar
one will prove fatal, we cannot wai,t> but must have recourse to the

80 MERRITT ON CONGESTIVE FEVER.

free and full use of quinine during the remission, however short and
imperfect it may be. The quantity given must always be sufficient
to bring the system under its influence before the time of the next
paroxysm ; and to attain that effect, we must sometimes administer it
without stint or measure.

[Dr. Merritt read a long and most interesting letter from his friend,
Dr. O. A. Browne of Hicks' Ford, Virginia, one of the most enlight-
ened and skilful physicians of our country. Dr. B. has long resided
in the same district of country with Dr. M., and been engaged in a
most extensive and successful practice. He coincides with Dr. M.
in his views of the pathology and treatment of our disease, and the
other forms of bilious fever also, and most strikingly confirms the
great comparative success of this practice, and its vastly superior ad-
vantages over the usual routine practice of the present da}\ This
letter is replete with sound and philosophical views of the pathology
and practice in the diseases under consideration, and much of his
letter has been freely incorporated both in substance and in his own
language in our abstract. This letter was addressed to Dr. Merritt,
and we will conclude with a few more extracts from it : ]

"I might, if I had time, give numerous cases which I have wit-
nessed, both in my own practice and that of others, that would go
very far to establish the superiority of our practice in the treatment of
the autumnal diseases of this neighborhood, over that which is still
followed by some. But as 1 have not, I must be content with the
expression of my opinion, that the superiority does exist in a very
marked degree, and that the practice must prevail in all places where
it can have a full and fair trial. Having practised long and exten-
sively upon both plans, I have had ample opportunities, from my
own experience, of making the comparison ; and the conclusion at
which I have arrived, is sanctioned by all of my friends who have
adopted it, not one having abandoned it, who has given it a sufficient
trial.

"Under the old practice, I think myself within bounds when I say,
that not less than eight or ten days are usually necessaiy to cure a case
of bilious fever. You, I am sure, will be willing to verify my assertion,
that it is by no means common for us to have a case on hand more than half
of that time. That fact of itself ought to be sufficient to cause the
preference to be given to the new plan. But it has the additional
recommendation of greater certainty of cure, as I think can be esta-
blished by the testimony of all who, like myself, have the opportunity
of witnessing the operation of both systems.

" Besides the advantages already pointed out, there are others of
much importance that ought to claim the consideration of every phy-
sician. In the first place, it eminently commends itself by its simplicity.
By it the patient usually escapes much of the pain and suffering which
usually attend such cases when differently treated, and is often con-
ducted through all the stages of the disease, with a degree of comfort
which deprives the sick bed of most of its horrors. He is for the most
part relieved from pai?i, has often refreshing sleep, and when he gets up
finds himself possessed of a degree of strength tlwt it is impossible he
could have retained under the evacuating treatment commonly pursued.

METTAUER ON SCARLET FEVER. 81

"Not the least of its advantages is, that by it the patient is almost
completely insured against congestion, when the practice is adopted early,
and judiciously carried out. You and I both recollect, when conges-
tive fever was common in this region, and thai a patient was con-
sidered as having his death warrant signed when it was announced
that he had it. Now, we know, it is of very unfrequent occurrence,
and that it is extremely rare to see a case at all. All that I have seen
for several years past, were the result of improper practice in inter-
mittent and remittent fevers, or of the grossest neglect."

I might add some other advantages, if it were at all necessary, of
this practice, and among them the comparative freedom from anxiety
and mental disquietude on the part of the physician himself, and the
very rare circumstance of his being disturbed by calls at night. But
I hope the above enumerated catalogue will be enough to call the
attention of the profession to it, and induce them to give it a full and
fair and impartial trial. It is all its friends claim for it, entertaining
no doubt of its final success and adoption by those who will give it an
impartial test; and with these observations it is commended to the
candid consideration of the profession. If it realizes the expectations
of its advocates, and the superior advantages so fearlessly set forth in
its behalf, it will prove one of the greatest boons in modern times to
suffering humanity, and relieve us from an opprobrium, too often cast
upon us, that practical medicine has made but little improvement
since the days of Sydenham.

For the Stethoscope.

Practical Observations on Scarlet Fever.

By John P. Mettauer, M. D., L. L. D., Professor of the Principles
and Practice of Medicine and Surgery in the Medical Department of
Randolph Macon College of Virginia, January 11th, 1851.

The characteristic symptoms of scarlatina are generally so well
known to practitioners of ri iedicine, that it will be needless to repeat them
in a paper like the present, designed to be practical. Three principal
varieties of the disease are generally admitted by the profession ; that
is, scarlatina simplex, scarlatina a.nginosa, and scarlatina maligna. It
belongs to the major exanthemata, is inflammatory in its commence-
ment, but rapidly tends, like typhoid fever and erysipelas, to depres-
sion ; and is chiefly a disease of childhood.

Scarlatina simplex is generally distinguished by the mildness of the
attending symptoms, more especially by the mildness of the affection
of the throat, if that symptom should attend at all. The fever and
rash are the chief symptoms of this variety to which attention is usu-
ally directed, but in a good many instances the fauces are also more or
less reddened or inflamed, and sore in some cases, but seldom to a se-
rious extent.

Scarlatina anginosa is characterized chiefly by the violence of the

82 METTAUER ON SCARLET FEVER.

throat affection, though it too is attended with a rash. The earhr
commencement of this variety is generally attended with stiffness of
the jaws, soreness of the throat, and more or less pain and difficulty
in swallowing. The eruption does not appear as early as in the sim-
ple form, being delayed to the third or fourth, instead of the second
day, at which time it usually appears in the simple variety. The rash
too is less abundant and diffused in this form, and may even be con-
fined to a particular part, as the hand or arm, or distributed in distinct
spots, very sparsely diffused over the trunk, separated by the inter-
vening skin of its natural color. In some instances, however, it makes
its appearance generally over the whole surface, displaying the uni-
form and scarlet redness of the simple variety. Now and then, after
partially appearing, the eruption recedes and returns after a longer or
shorter interval: and these alternations may be repeated several times.
The fever of this variety is generally more intense than in the simple,
and is often attended with delirium or coma. The pulse is usually
greatly accelerated beyond its normal condition, and the skin is ex-
ceedingly hot. The inflammation and swelling of the throat are some-
times frightfully intense, not only causing great pain, but actually im-
peding deglutition and respiration.

Scarlatina Maligna. — It is not unusual in this variety for complete
prostration to mark the commencement of the attack, and even for
death to take place at once, without the slightest reaction. In these
examples sudden and extensive disorganization of the cerebral func-
tions may be induced by the cause of the disease operating upon a
constitution naturally unsound, or rendered so by bad habits. Cases
sometimes are to be met with, when scarlet fever prevails extensively,
in which comatose symptoms, faintness, anxiety, a feeble, small, fre-
quent and irregular pulse ; cool or hot skin unequally manifested ;
slow, impeded respiration, or irregular and accelerated ; pale or livid
face ; great muscular debility, and now and then complete coma
occur. In such examples there will be feeble efforts at reaction, and
the febrile heat, if developed, will be transitory and partial ; or if the
rash appear, it will assume a violet hue, and only shew itself in spots
or small patches, and generally the powers of the system seem to
give way, and death closes the scene on the third day from the
attack. Sometimes reaction comes on, and a low fever follows, at-
tended with delirium, stupor, a feeble pulse, a livid, purplish or dark
red eruption ; petechia? ; haemorrhage ; involuntary discharges from
the bowels and bladder, and frequently death takes place in a few
days. But when the cause operates less violently, and the constitu-
tion is more vigorous, the attack comes on with symptoms of the
anginose variety. The affection of the throat is distinguished by a
deeper redness, inclining to purple, and the symptoms are decidedly
typhoidal or malignant as the disease advances, distinguished by in-
creasing feebleness of pulse, unequal warmth of the body, a fading
and re-appearing rash of a livid or purplish hue, &c. These symp-
toms, although menacing in the highest degree, are not always the
harbingers of a fatal result. It is by no means uncommon for reco-
veries to take place in this form of the disease, after the case has as-

METTAUER ON SCARLET FEVER. 83

sumed the most fearfully unpromising conditions, both of the local
and general affections.

Anomalous scarlatina is occasionally to be met with during the
prevalence of the ordinary varieties of the disease, and sometimes,
too, it occurs as the prevailing form, but is liable to appear endemi-
cally, and is often confined to a particular family. It is the disease
without the rash, and its seat is the fauces, attended with more or
less general fever, however. This variety pursues the course of ordi-
nary scarlatina as respects the throat affection, and is distinguished
by symptoms of every grade of intensity.

Scarlatina is unquestionably an inflammatory disease, and the skin,
as well as the mucous and serous surfaces, seem to be its principal
seats. Professor C. D. Meigs considers it to be an inflammatory af-
fection, and refers its seat to the membrana vase/rum communis, or the
endangium of Mr. Burdah. He bestows the epithet of ' en&angitis upon
the inflammation, and ingeniously argues in support of his theory.
The opinion of Professor Meigs on this subject, or any other connected
with medicine, is entitled to the highest respect. Scarlet fever, in
some respects, is assimilated to typhoid fever, in nature, both being
inflammatory, but the inflammation consisting of mixed characters ;
and these two diseases are to be met with of nearly every grade of
mixed inflammatory irritation, and their tendency is to early depres-
sion of the energies, and to assume adynamic characters. In scarla-
tina the inflammation passes rapidly through its acute stage, and by
reason of its rapid tendency to depression, if an active treatment of
enfeebling nature is to be employed, it must be adopted in the very
commencement of the early stage. In many cases of scarlatina, as
well as of typhoid fever, our most successful mode of treating them
is by the early and decisive employment of the lancet and other en-
feebling remedies. We, by such treatment, superinduce direct de-
bility, and substitute it for indirect, or what I term ataxic debility, and
thus disarm these diseases of their most menacing and dangerous ten-
tencies.

As a general thing, scarlet fever occurs but once with the same
person, though it must be conceded that many departures from this
course have occurred. It has seemed to me that second attacks
have chiefly taken place with individuals who were affected with the
disease partially : that is, who either had the rash without the af-
fection of the throat, or the throat affection without the rash, in both
cases indicating that the disease was imperfectly formed.

Treatment. — In the mild form, scarlatina, in a vast number of in-
stances, requires very little, if any, medical treatment. There is
always fever, and in the onset of the disease it is generally intense,
and attended with more or less disturbance of the secretory exercises.
To maintain these balanced, as far as is consistent with a diseased
state of the system, with the earliest appearance of the rash, I have
found an emetic, consisting of calomel and ipecacuanha, to meet the
indications most perfectly, especially if the tongue is coated. Five or
ten grains of ipecacuanha, and three or five of calomel, if the subject
be a child, or larger doses if an adult, I have employed in hundreds

84 METTAUER ON SCARLET FEVER.

of cases of the simple and mild form of the disease, with signal benefit.
Subsequent to the operation of the emetic, if the calomel fails to purge,
or acts imperfectly, a moderate portion of oil should be given, taking
care, however, to allow some three or four hours to intervene between
the termination of the emetic commotion and the administration of the
cathartic. After the bowels have been opened, it will only be neces-
sary to maintain their solubility by the gentlest means. To this end
I have employed indiscriminately, a solution of the bitartrate of potash
and sulphate of magnesia, and the acetate of potash, administered two
or three times during the 24 hours, and just in doses to act moderately
upon the bowels. A mixture formed of 3 ij. of the sulph. magnesia,
3 j. of bitart. potass., and 1 ij. of water, administered in tablespoon-
ful doses, will be found both grateful and beneficial in these cases with
children. With adults, of course, larger doses will be required. Be-
sides the cathartic action, it also produces febrifuge, or rather refrige-
rent effects. The acetate of potash operates very nearly in like man-
ner ; and when the crystalized article is employed, which should be
preferred, from two to five grains in watery solution may be adminis-
tered at a dose. It is all-important that the temperature should be
rendered as agreeable as possible. If the heat is excessive, exposing
the surface of the body to the air, or sponging it with water and vine-
gar until it moderates, will afford relief to the patient's sufferings, as
well as ameliorate that most distressing symptom. The patient must
be allowed to use cold or cool drinks, and cool slippery elm tea will
generally answer best.. A restricted diet is all-important ; everything
exciting must be carefully inhibited. Confinement in bed will be ne-
cessary, even in the mildest cases, until complete desquamation has
taken place. Should the throat be much affected, as will sometimes
be the case, it will be proper to apply gargles or other topical reme-
dies to it. As a gargle, nothing answers better than a strong solution
of the borate of soda. Sage tea, with the nitrate of potash ; solutions
of the sulphate of magnesia, or soda ; the chloride of soda ; vinegar
and water; dulcified spirits of nitre and water, and the nitrate of sil-
ver, either in strong solution, or the solid nitrate may also be used as
topical remedies. Generally, however, they will not be required, by
reason of the mildness of the anginose affection.

Bleeding, when the simple variety puts on more violent characters,
and the febrile symptoms run high, especially if the patient's constitu-
tion is very good, will be proper and allowable in many cases. With
-children from five to eight or ten years of age, bleeding would prove
highly beneficial, particularly if there should be strong cephalic ten-
dencies. Even with younger subjects, blood-letting might be employed
with safety and advantage. With these it would be safest to abstract
the blood by leeching, and the temples or other convenient parts near
the head should be selected for the operation. The bleeding, no mat-
ter how effected, must be used in the very onset of the fever, and to
the extent of impressing the action of the heart and arteries decidedly.
One decisive bleeding will be far more beneficial and safe in the early
beginning of the disease, than a repetition of it after the fever has
somewhat advanced. Frequently it will reduce the fever at once to

METTAUER ON SCARLET FEVER. 85

the proper degree for bringing out, and for sustaining the rash in its
ordinary development and self-limiting tendencies. The direct de-
bility it induces weakens but does not exhaust the vital energies, and
guards the constitution in a great degree from indirect, or as I have
denominated it, ataxic debility, which is always dangerous, and far
more difficult to correct than pure debility. If one bleeding does not
control the pulse, a second, or even a third repetition must be em-
ployed.

Refrigerants will, in some cases, be found of great benefit in this
variety also, used after bleeding. Now and then their employment
will supersede the necessity of using the lancet, particularly in those
cases characterized by great exaltation of the animal temperature.
In such examples the fever is kept up or aggravated by the undue
temperature; and when reduced by refrigerating, both through the skin
and stomach, both the violence of the fever and the patient's sufferings
are mitigated at the same time. In the employment of this valuable
and grateful remedy, it will be proper that its depressing agency shall
not be urged to the extent of interfering with the eruptive tendencies.
Gently sponging the heated regions of the body, from time to time,
and allowing cold drinks or pounded ice, merely to moderate the un-
due animal temperature, will enable us to meet the indication with
certainty and without danger.

Cathartics will generally be required in this variety. In some cases
they may even supersede the use of the lancet or refrigerants. Early
in the disease it will be proper to purge decisively ; and the cathartic
I have generally preferred and employed, is the mercurio-saline ; that
is, to administer the requisite dose of calomel with a minute portion
of ipecacuanha, and to follow it up in four, six or eight hours with a
dose of sulphate of magnesia, acidulated with the bi tartrate of pot-
ash. In some cases, I have employed the infusion of senna with be-
nefit when the bowels were torpid. I have also, at different times,
had recourse to oil and the syrup of rhubarb. The last named article
is particularly suited to the cases attended with diarrhoea. Purging
must invariably act impressively ; and if the first dose fails to procure
consistent as well as copious evacuations, the cathartic should be re-
peated in six or eight hours.

Diaphoretics will be demanded early after sufficient purging has
been premised ; and for children nothing answers better, according
to our experience, than minute doses of ipecacuanha and the nitrate*
or bicarbonate of potash, administered in watery mixture, or in the
form of powder or pill. From the third to half a grain of ipecacu-
anha, and one, two or three of the nitrate or bicarbonate of potash
may be administered at a dose once in three or four hours, and will
often be followed, after a few doses, by relaxation of the skin and
diaphoresis. This diaphoretic is particularly suited to children in
catarrhal affections, more especially in the bronchitic forms. Certain
aromatic teas may also be employed beneficially as diaphoretics, after
the force of the pulse is greatly subdued, and when there is a ten-
dency to recession of the animal temperature from the surface ; such
as the teas of balm, sage, elder flowers, saffron, boneset, dittany, &c.
12

86 METTAUER ON SCARLET FEVER.

Employed moderately warm, the exciting qualities of these ptisans
render them active and decidedly diaphoretic in many instances. In
some cases the warm teas of slippery elm, flaxseed and althea will
be found of great benefit, both as diaphoretics and demulcent diure-
tics, when the urinary secretion is greatly defective, or when the se-
cretions generally possess undue acrimony.

Revellents will be required in some cases when the disease introverts
upon the internal organs. Should the lungs, pleura, stomach, intes-
tines, bladder, uterus or brain be seriously menaced, after venesection
and other enfeebling remedies had been employed, it would be proper
to have recourse at once to these valuable measures. In most cases
involving the pectoral organs, revulsion, by dry cupping or sinapisms,
is to be preferred as the first trial of the agency. If, however, the
symptoms are very acute, and the pulse active and strong, humid
cupping must be employed. The pectoral spine should always be
counter-irritated also in these cases, as an important influence is of-
ten exerted upon thoracic diseases through it if effectually performed.
If the local affection is connected with an enfeebled constitution, or if
a state of debilit}^ exist, resulting chiefly from the duration of the
primary affection, it would be best to use vesicants. The propriety
of employing revellents to the throat, in the anginose affection, has
been questioned. Vesicants, as a general rule, should not be em-
ployed, as they greatly augment the patient's suffering, and frequently
irritate the faucial affection. Rubefaciants that act moderate^ should
be preferred, such as the ammoniated, camphorated, and terebinthi-
nated liniments. In most cases, the oil of turpentine with sweet oil
will answer best, mixed in nearly equal proportions. These reme-
dies applied four or five times during the 24 hours, less or more fre-
quently, will excite and keep up the proper counter-irritation in the
skin, without incommoding the patient or aggravating the anginose
affection.

As topical remedies, the gargles and other applications already sug-
gested will be of service, and must be employed. In this variety, if
there is intense heat of the fauces, it would be advisable to use cold
water gargles, or pounded ice to the throat, governed by the cautions
laid down in reference to the employment of refrigerants generally.
Should sloughs form in the throat the parts must be touched occa-
sionally with spirits of turpentine, or the ammoniaret of copper in
solution, prepared by dissolving sulphate of copper in diluted water of
ammonia. These applications are far better than the nitrate of silver;
they promptly change the disorganizing action into granulating and
reparative. The ammoniaret of copper is best suited to those cases
of some continuance, but I have often used it beneficially in the com-
mencement of the sloughing process : it is to be applied with a soft
mop previously saturated with the solution, simply pressed on the
slough once daily. Very soon the slough will be cast off", exposing a
healthy looking granulating surface, which of course is to be managed
as a common healthy ulcer.

The drinks and nourishment to be as suggested in the simple form.
Great care will be required during desquamation, and for some time

METTAUER ON SCARLET FEVER. 87

after, in regulating the bowels, diet and exercise. Early exposure to
wet, cool, or. variable atmosphere must be inhibited, even after con-
valescence has considerably advanced.

In the anginose variety, the general treatment suggested in the
simple will be applicable. Early and decisive bleeding will be re-
quired in a majority of instances, both generally and locally employed.
If the anginose affection is violent, it would not be safe to rely on
general bleeding, but the region of the affected part must be leeched
freely. In some very threatening cases I have resorted to scarifica-
tions, and have never regretted their employment. The free discharge
of blood they cause, speedily reduces the swelling and heat of the
fauces, and the incisions take an ordinary traumatic inflammation,
which tends to change the original disorganizing inflammation into one
of a more favorable description.

Early after bleeding it will be proper to employ emetics, and the
compound already suggested will meet the indication fully, if its
strength is somewhat augmented. In most cases the emetic should
be repeated every tenth or twelfth hour, until the anginose symptoms
ameliorate. A single dose will frequently arrest the anginose affec-
tion, and impart to the constitutional symptoms an improved con-
dition likewise. More frequently, however, it will be necessary to
employ several emetics before a favorable impression is made on the
disease.

Cathartics will be demanded early in the treatment, and if the ca-
lomel, administered with the emetic dose, fails to purge in four or five
hours after it is taken, a dose of oil, or salts and magnesia, should be
given. The aromatic infusion of" senna and salts" is also admirably
suited to this variety as a cathartic ; and when the bowels are in a
diarrhceal condition, rhubarb in substance, in combination with blue
mass, and a small portion of ipecacuanha, will be found to meet the
indications fully. It is not proper to purge actively y but the secre-
tories should be ameliorated, and for this end those agents that im-
press the mucous membrane of the enteritic cavity, decidedly, but
moderately, should be preferred. Such agents procure copious and
consistent evacuations ; and the articles already mentioned will be
found generally to act in that manner. A soluble state of the bowels
should be maintained throughout the whole course of the disease,
and for this purpose nothing succeeds better than the simple syrup of
rhubarb, administered once or twice daily, in moderate doses.

Refrigerants can be safely and beneficially used, but only when the
animal temperature is unduly exalted ; and the modes already sug-
gested, as well as the rules for their employment, are equally appli-
cable in this variety. In the early stage there will be little danger in
the employment of refrigeration, as the energies are not likely to be
suddenly or unduly depressed by its operation. In the advanced
periods, however, sudden depression might follow, if the remedy
should be too profoundly or improperly used, and dangerous con-
sequences result. Very light sponging of the surface with vinegar
and water, or spirit and water, with cool drinks or pounded ice,
merely to moderate the undue animal temperature, but not to depress
it suddenly, is all that should be attempted.

88 METTAUER ON SCARLET FEVER.

Diaphoretics will be demanded as soon as the force of the pulse has
been subdued, and the means already suggested may be employed.
The ipecacuanha and nitrate or bicarbonate of potash will be found
an admirable diaphoretic in this variety, and should be preferred,
according to my experience, to all other agents of this class, in the
earlier periods of the disease. After it is commenced, the remedy
should be continuously employed until its proper effects are produced.
In the subacute stage stimulating sudorifics will often be required ;
and a combination of gum camphor with the ipecacuanha, in suitable
doses, or the spiritus mindereri, or the dulcified spirit nitre alone, or
united with ipecacuanha, or tartar emetic, or warm stimulating teas,
such as I have already pointed out, may be employed. In some cases
Dover's powder might be beneficially resorted to with adults, when
there is great restlessness at night ; but with children it can be seldom
used with safety.

Revellents will sometimes be demanded to combat certain coincident
local affections, as was remarked of the treatment of the more intense
forms of the simple variety. In these affections the suggestions
already made must suffice. When the animal temperature, however,
is unequally diffused, it will be necessary to employ revellents, with the
design of restoring it to those regions in which it is defective, as well
as to equalize the circulation of the blood. With these intentions
friction, rubefaction by mustard seed, heat artifically applied, ammo-
nia, capsicum, spirit of turpentine and vericants may be employed as
they seem indicated.

The topical treatment of this variety differs little from that considered
in the preceding. It will be proper to emplo}r the same remedies, but
in many cases they must be used more energetically. As soon as a
slaugh forms in the fauces it must be separated by the decisive use of
the solution of the ammoniaret of copper, applied as already advised ;
and after it is cast off, it will only be necessary to use mild gargles
formed of gentle astringents and demulcents. Should the slough re-
appear, or the ulcer, left by the one cast off, assume unhealthy appear-
ances, the ammoniaret must be again applied, or some other of the
local contra-irritants already pointed out as useful in such cases, ac-
cording to the condition of the ulcer.

Stimulants and tonics will be demanded in the depressing stage,
should there be marked debility, and a tendency to dangerous in-
crease of it — a condition frequently to be met with when the case is
protracted and the anginose affection violent. As stimulants, nothing
answers better than mint julep or milk toddy, administered in quan-
tities and formed of a strength to suit the particular case and the age
of the patient. The object should be merely to re-excite and main-
tain the action moderately exalted whenever collapse threatens.
Tonics will be demanded, if stimulants fail to maintain the action
induced by them sustaining and equable ; and as far as my expe-
rience enables me to decide, the infusions of chamomile flowers and
wild cherry bark are to be preferred with children. These infusions
may be converted into syrup by the addition of sugar, which form
renders them less offensive to children, and of course more easilv

METTAUER ON SCARLET FEVER. 89

taken. Even with adults they may be used beneficially, though with
them the infusion of bark, columbo and gentian answer best. Tonics,
however, are hazardous remedies in this disease, and should not be
employed hastily or rashly.

In the dropsy of this variety, as well as that of simple and malig-
nant scarlatina, a combination of tonics, cathartics and diuretics has
generally succeeded best in my hands; and the form I employ is that
contained by the annexed formula :

PL Fol. Senn. 3 iss.

Flor. Anthene. Nob. 3 ss.
Fol. Digital. Dup. 3 iss.
Sem. Anis. 3 j.

Sulph. Magnes. lj.

Aq. Bullient. 1 xij.

Infuse in a close vessel for half an hour, then strain. Dose from
£3 ij. to f>1 j. twice or three times daily.

A tablespoonful, more or less, according to the age or strength of
the patient, administered three or four times during the day, so as to
act moderately on the bowels and kidneys, will very speedily remove
the dropsical affection. In a vast number of cases I have employed
this remedy, and have never been disappointed in its effects. If it
purges too freely at first, no injury will result ; and after the remedy
is employed a while, it will only act moderately, rather as an ape-
rient : its diuretic operation is generally decided. The infusion must be
continued for a week after the subsidence of all tumefaction ; and the
bowels after it to be kept soluble.

In the malignant variety it will seldom be safe to bleed, by reason of
the rapid tendency of the disease to depression, unless the case com-
mence as scarlatina simplex or scarlatina anginosa. Our chief reli-
ance must be on emetics, cathartics, refrigerants, diaphoretics, stimu-
lants, tonics, revellents and contra-irritants. In the commencement
of the attack it will in every case be proper to vomit freely ; and the
emetic already suggested in the anginosa variety, will be found to meet
the indications. In some cases it might be proper to augment the
dose, or the emetic would not act by reason of the insensible state of
the stomach. The turpeth mineral was suggested by the late Profes-
sor Benjamin Smith Barton of the University of Pennsylvania as an
emetic in this variety of the disease when there was gastric insensi-
bility ; and within the last twenty years the same article was vaunted
through Virginia as a specific though secret remedy in every variety
of scarlatina ; and in an advertisement through the newspapers, a Vir-
ginia physician and a graduate referred the suffering public to a dis-
tinguished apothecary in Philadelphia for a supply of his secret re-
medy— a complete humbug. The vomiting should be effective, or little
benefit will follow from it ; and it ma}r be repeated several times af-
ter intervals of eight or ten hours.

Cathartics will be demanded early in the disease ; and if the calo-
mel of the emetic compound should not purge in four or five hours, it
will be proper to administer a suitable dose of oil, the bitter aromatic

90 ASYLUMS FOR THE INSANE.

infusion of senna, or a commanding dose of the syrup or powder of
rhubarb, with one or two grains of aloes. In all respects purging in
this variety must be governed by the same indications, and directed
to the same objects requiring them in the preceding. The same may
be remarked of refrigerants, diaphoretics, stimulants, tonics, revellents
and contra-irritants.

The toxical treatment will be the same as was advised in the angi-
nose variety, only that it must be more energetically employed. It
will be important from time to time to remove the obstructing mucous
from the nostrils, to allow patients to breathe through those passages,
and not through the mouth. This may be done by carefully absorb-
ing it with elongated pieces of soft sponge, or small rolls of bibulous
cloth introduced carefully into the nostrils from time to time. The fauces,
too, must be cleansed of their tenacious and adhering mucus, by gently
wiping it away with a soft mop formed of old linen or sponge. The
onion poultice I have often used to the exterior of the throat with
much benefit. Blisters should seldom if ever be drawn over the ex-
terior of the throat, or indeed elsewhere, in this variety, as they are
prone to take on disorganizing inflammation. The room must be ren-
dered comfortable, both as to temperature and ventilation. A heated
room, with a highly rarefied state of the atmosphere, would certainly
increase the patient's restlessness, as well as the unpromising charac-
ters of the disease, by withholding from the lungs the proper supply
of oxygen, so necessary in a disease constantly tending to disorganize
the vital energies that are chiefly maintained by its vitalizing influ-
ences.

During the convalescing stage it will be proper to guard carefully
against exposure and excesses of every kind. The bowels must be
carefully attended to. Constipation should not be allowed to take
place. In most cases of this variety of the disease, recoveries take
place slowly, and on that account the utmost attention should be given
to the convalescing stage. Generally the body should be protected
against the atmospheric transitions of temperature by the use of flannel.

Inunction in scarlet fever, as practised by Dr. Schneemann of Hano-
ver, I have never employed ; but from the report of Dr. S. and Dr.
Harvey Lindsly of Washington city, I am disposed to think favora-
bly of it, and hope it will be fairly tried in the United States. It may
do good, but cannot do hurt.

On Asylums for the Insane.

Asylums for the insane are charities, which, like other establish-
ments for somewhat analogous purposes, are the concomitants or
effects of the increasing civilization characterizing the last three cen-
turies. It is true that the earliest may be traced to a date far into the
past ; but, like the primordial attempts at inventions, which often long
precede success, these few institutions for the purpose were but slight
evidence of a tendency in that direction. The original idea upon
which such institutions are based, apart from charitable motives, is the

ASYLUMS FOR THE INSANE. 91

circumstance, that the necessity to protect the public from the fury of
the maniac makes his confinement in many instances absolutely re-
quisite. But again, taking this idea in another sense, one more appro-
priate to the philanthropic considerations of the present day, it is found
that, so far as the insane person himself is concerned, in general his
own safety is better guarded than it could be elsewhere. It is true that
in asylums occasional examples of suicide and other sad occurrences
are almost necessary facts. But this does not contravene the general
rule — it does but confirm it. For, on looking over the yearly file of
almost any newspaper, the number of suicides palpably due to insane
impulse, of which we may there read an account, is out of all propor-
tion to similar statistics of any institution for the mentally afflicted.
But again, what has led to the establishment of lunatic asylums to so
large an extent in modern times, is, in the first place, that far more
patients are here cured than is the case with equal numbers treated
in private ; and secondly, to the great mass of those bereft of a sound
mind, such abodes, although attended by separation from relatives and
home, yet prove far more conducive to their comfort and happiness,
than would enure to them if this severance did not take place. It is
these last two considerations that make it the imperative duty of all
countries fitly to provide for their insane. And especially does this
idea apply to the pauper insane ; for, could we conceive a more ca-
lamitous condition for an individual, than to be in circumstances re-
quiring the most earnest daily exertion to " make both ends meet,"
whilst a near and dear relative may require rigorous restraint at home
for the want of friends to watch him. We rejoice that the common-
wealth of Virginia has come up to her duty in this respect; under the
present noble laws as to the particular here considered, no inhabitant
of her extensive confines, whether bond or free, whether white or
black, whether rich or poor, is refused the aid which an asylum can
bestow. In comparing the situation of the insane without and within
an asylum, we have on the one hand, in the first place, the most care-
fully devised means for the moral and medical treatment of insanity,
whilst on the other, there is either a total want of these, or they are
applied inefficiently and partially. And secondly, in the one situation,
the comfort of the patient is better attended to, and he is subject to a
less strict management than in the other. All the important hygienic
regulations as to ventilation, modes of heating, suitable food and
clothing, and attention generally to what were entitled by the ancient
physicians res non nalurales, now obtain from every superintendent of
a lunatic asylum the greatest and most zealous study. Measures
savouring of coercion are also reduced as far as possible to a mini-
mum ; and the use of chains and such like means are wholly relin-
quished, whilst they are still but too often employed in private.

We have before us a number of works on insanity, in which the
subject discussed above is referred to, and the same remark holds
good as to an extensive collection of the reports of institutions for the
insane. There are also reports from committees in various states of
the Union, appointed to search out the condition of the insane
amongst the population at large in those communities ; and moreover,

92 ASYLUMS FOR THE INSANE.

Miss Dix, the eminent philanthropist, has published a number of
pamphlets, detailing her experience throughout a large portion of the
Union. By these productions this excellent lady has caused asylums
to be erected where little interest in that regard had previously
existed, and has also given increased impetus to exertions towards
the same end, where this noble cause had been sustained by other
individuals. In her memorial to congress, presented on the 27th of
June, 1848, she arrives at the general conclusion, that the wretched
condition of a multitude of the insane not placed in asylums does not
differ in the several members of the American confederacy ; and of
nearly ten thousand idiots, epileptics and insane persons whom she
had sought out and seen, there have, she says, been hundreds, nay,
rather thousands, bound with galling chains, bowed beneath fetters
and heavy iron balls, attached to drag-chains, lacerated with ropes,
scourged with rods and terrified beneath storms of profane execrations
and cruel blows. It would be false policy to blame too much those
having charge of these unfortunates for a state of things so lament-
able ; it seems almost inherent in the want of proper means which
usually attends the management of the insane in private. And we
thus perceive also, from the statement of Miss Dix, that there is little
difference in one section of America from another. It may be re-
marked, however, that she thus alludes to our commonwealth : " The
laws of Virginia forbid a protracted detention of the insane in the
county prisons at this period. Formerly, I have traced the most
cruel sufferings in the confined apartments, uncleansed and unventi-
lated, and the still more neglected dungeons into which the insane
have been cast." The desirable change here referred to was brought
about, first, by representations and statements made in the report of
the Eastern asylum for the }Tear 1843, and, secondly, by the wise
liberality of the legislature in making suitable provisions for the insane
in Virginia. The congressional document of Miss Dix just men-
tioned contains pretty much a complete resume of her charitable labors
in the various states of the Union which she had traversed, up to
1848, on the same estimable errand. It may not be uninteresting to
those having the welfare of the insane at heart, to detail the remarks
of other enquirers pursuing analogous researches. Dr. de Vitre,
formerly physician to the Lancaster county asylum in England, and
at present one of the commissioners in lunacy of that county, gives a
number of striking facts in an able pamphlet on the subject under
consideration. Amongst other instances, he relates that of a poor
man whose wife became insane. He at first tried to do the best he
could for her at home. But as her case progressed, fresh difficulties
beset him on every side, and when all his little earnings were ex-
hausted and he could no longer remain at home in charge of his wife,
being compelled to labor for his daily bread, he adopted the extraor-
dinary expedient of enclosing her in a large packing case, with a
small aperture cut in the lid, through which she could breathe and
see, but not large enough to permit her head to pass through. Thus
did this poor creature remain a long time, literally screwed up in a
wooden case, and was only at last liberated by the humane inter-

ASYLUMS FOR THE INSANE. 93

position of two medical gentlemen, through whose instrumentality she
was removed to a public asylum, and whose disinterestedness was
rewarded by the ultimate recovery of their patient. Another child
of misfortune, a male sufferer, was usually chained or confined in a
railed-off corner of a barn or other out-house, without clothing of any
description, and his only bed consisted of a little straw. In the same
locality, says he, there was a lunatic of limited income, residing with
his own brother, who ;has been chained for years in a cellar on a bed
of straw, who is never allowed to leave his dungeon, and who has
not been shaven for upwards of seven years.

A third example was an insane son. At first he was chained by
his father ; but by and bye a communication was made from the house
into a hay -loft, all access with the stable below being first cut off, and
into this loft the maniac was thrust. He had no clothes given him, no
light to cheer him, no stream of air to refresh him, no water to wash
himself with, and only a little straw for a bed. Previously to the
erection of the hospital at Worcester, Massachusetts, the commissioners
appointed for that purpose reported a case in which the patient had
been twenty-eight years in prison ; for seven years he had not felt the
influence of fire, and many nights he had not lain down for fear of
freezing. He had not been shaved for twenty-eight years. Another
individual in the same stale is mentioned, of seventy years of age,
who had been chained for twenty-five years, and had his chain taken
off but once in that time. From investigations made by a committee
of the legislature of Connecticut, they report that there were probably
more than seventy lunatics in the state in close confinement by chains
and cells. A similar committee some years since made a detailed re-
port to the legislature of Pennsylvania. In one of the counties they re-
ceived information that the accommodation for the insane in the poor-
house consisted of a single room, in which the furious and violent
were confined, males and females, in the same department, separated
only by the length and restraint of their chains. In another county
the apartments were damp, confined, ill ventilated, and several lives
had been actually lost from the improper construction of the cells for
the insane. When permitted to take exercise and recreation in the
open air, these unfortunates were loaded with hobbles and chains,
and exposed in summer to the hot sun, without the shade of a single
shady tree. In another prison, two lunatics, a man and woman,
each over seventy years of age, occupied the same apartment of an
upper story. The female was lying upon a heap of straw under a
broken window, through which a severe snow-storm was beating upon
her. The man had been in that room twenty-one years. A woman
was found in the cellar of a prison, in an apartment six feet by eight,
and the only place for admission of air by day or night, was six inches
by four ; and here she had lived seventeen years, or more than half a
generation. In a poor-house in Delaware, a visitor reports that there
were twenty insane persons ; each of them in a dark, illy-ventilated
room, and each chained to a ring in the centre of the apartment. But
it is needless to multiply further these painful accounts. Doubtless
every state in the Union, unprovided with asylums, would furnish
13

#•*•

94 ASYLUMS FOR THE INSANE.

scenes but too exactly corresponding with the above, and also of but
too frequent occurrence.

After such details as the above have been substantiated, as they
must ever be by suitable enquiries, the duty of the citizens of all civi-
lized communities is direct and unmistakeable. If this great amount
of misery is to be alleviated or removed, it can only be through the
intervention of asylums properly constructed and governed. And if
in the establishment of these asylums we would recede as far as pos-
sible from the management of poor-houses and prisons, the main fea-
tures of improvement will consist in appropriate architectural arrange-
ments and a judicious organization. In connection with the former
topic we would speak but as to a single point, and that is, the build-
ings for the insane should be fire-proof. If this precaution should be
adopted in an edifice of any kind whatever, it would seem demanded
in a lunatic asylum. For it must be ever remembered that we have
here a number of patients locked up, thus differing from ordinary in-
dividuals ; secondly, the windows of these institutions are so guarded
as to prevent all escape through them ; and thirdly, the character of
insanity is often such as entirely to prevent co-operative efforts on
the part of the poor lunatic, or indeed may even induce him to resist
efforts made for his safety. Hence it is that Dr. Conolly well remarks,
in his valuable treatise on the "Construction and Government of Lu-
natic Asylums :" " The savings to be effected by omitting the simple
precaution of having all parts of the building fire-proof, is not to be put
in competition with this horrible danger." We are glad to observe that
in a magnificent structure lately erected near London, and capable of
containing a thousand lunatics, one of the provisions is, that the whole
establishment is completely fire-proof.

Respecting the organization of an asylum, it appears worthy of re-
mark, in the first place, that an increased number of those officials or
attendants in the constant and direct management of the inmates, and
watching over them night and day, is still needed in all asylums.
The insane are left too much under the general management of the
establishment, whilst various particular cases may require, for their
most successful treatment, the exclusive action of one sane mind for
days and weeks uninterruptedly. Sometimes also a patient is closely
confined, who is inclined to violence, or suicide, or elopement, because
there is not an attendant to devote himself exclusively to the preven-
tion of these occurrences. Secondly, in arranging the organization of
an asylum, due caution should be used, lest this power should be en-
trusted to any but those capable of suggesting a suitable plan, from
their knowledge and experience concerning such matters. No crude
or inapplicable theories should be permitted to prevail here, or evil re-
sults will inevitably ensue.

These two points — an increase in the number of those in charge of
the insane, and providing fire-proof buildings — necessarily involve a
greater expenditure than has heretofore been usually appropriated to
the construction and management of lunatic asylums. It remains for
the sovereign people on the one hand, and the benevolent on the other,
to determine whether any alteration in these respects shall be made
by the contribution on their part of the necessary funds. j. m. g.

QUININE IN THE FEBRILE PAROXYSM. 95

On the Exhibition of Quinine in the Febrile Paroxysm.

BY OTIS F. MANSON, M. D., OF GRANVILLE CO., N. C.

The introduction of quinine as a remedy in the treatment of remit-
ting fever, given in the remission, was perhaps coeval with its discovery
as one of the constituents of cinchona, the bark itself having been
used in that stage of the disease by Lind, Senac, Clark, Balfour and
others, anterior to its disintegration ; but it was perhaps riot more
than twenty- five years ago that this salt was administered in the ex-
acerbation, and at this time the practice is almost exclusively con-
fined, in our own country, to the extreme Southern and Western
states.

A number of my professional friends in Virginia and North Caro-
lina having adopted this plan of treatment, at my suggestion, I have
felt it my duty, in compliance with their solicitations, to place within
their reach all of the knowledge I possessed on the subject, drawn
from my own experience and many others ; and I therefore embrace
the opportunity to do so, offered by your flattering invitation to con-
tribute to the pages of your journal.

Remitting fever has for many years assumed a congestive charac-
ter, in the vast majority of instances being attended with the periodi-
cal recurrence of a stage of congestion, commonly termed chill; this
stage being characterized by a diminution of temperature, varying
from a slight coldness at the tips of the nose, fingers and toes, to a
fearful frigidity of the whole extremities, and in some few instances a
death-like coldness of the whole surface of the body ; these latter
cases being termed, par excellence, " congestive fever."

Although in many instances this stage is not manifested after the
initial chill, by any discernible reduction of temperature in any part
of the body for several days, yet it sooner or later becomes apparent
to the touch of the attendant, although unfelt by the patient, who, in-
stead of experiencing any sensation of cold, is oppressed with intense
heat and unquenchable thirst; indeed, we have often discovered the
presence of this stage by the increased urgency of his thirst and de-
sire for removal of the clothing.

At the same time that this coldness of the extreme parts is per-
ceived, the rest of the body is of high febrile heat; the pulse quick, fre-
quent and small, the breathing laborious, deep sighing, oppression at
the praBCordia, pain in the head, loins and limbs, anxiety, nausea and
vomiting.

After a lapse of time, varying according to the violence of the at-
tack, but averaging about an hour, this stage terminates in the ex-
acerbation, the heat becomes now diffused over the whole surface,
the pulse becomes diminished in frequency, and increased in fulness
and force, the pains and thirst still continuing, occasionally, though
not commonly attended with delirium and other indications of cere-
bral disturbance ; pain on pressure of any of the abdominal regions
not generally present in the first exacerbation, but more apparent as
the disease advances, especially in the epigastric region. This stage,
after a lapse of 24 or 4S hours, according to the type of the disease,

96 QUININE IN THE FEBRILE PAROXYSM.

is succeeded by a recurrence of the stage of congestion ; the tongue
now becomes sensibly altered, but so variable in appearance that no
particular description will apply to it. Evidences of organic irritation
in the great cavities, particularly of the stomach, bowels and liver,
now become more apparent, and the abdomen becomes tense, tender,
and in some cases meteoric. From the fifth to the fifteenth day, the
disease terminates, without aid, in 1st, intermittent fever; 2d, fever of
a more continued character ; 3d, death.

I have deemed it necessary to give this brief description of this
disease as it usually appears in my field of observation, in order that
the following remarks may be fully understood, as the object of this
article is chiefly to display the effects of quinine in this disease.

Given in free and full doses of from twenty to thirty grains in the
exacerbation, quinine reduces the pulse in frequency, fulness and
force ; it removes local determination to the head, chest and abdomen,
thereby relieving pain, restlessness, nausea, vomiting and diarrhoea,
producing generally a copious, warm diaphoresis, and, in short, to
expel fever and

" all its dire attendant train,"

safely, surely and expeditiously, in a period of time varying from
four to ten hours from its administration.

But along with the employment of quinine the following means are
resorted to :

Called to a patient in the exacerbation, venesection is practised in
every case where the pulse will justify it, but it is rarely that this is
called for. In fact, the general experience of myself and confreres
is adverse to the use of the lancet in this affection ; the pulse, though
often full, and apparently tense, is generally compressible. Local
bleeding by cups and leeches will usually be sufficient, and if there
is tenderness on abdominal pressure, or other symptoms of visceral
implication, these should be freely applied. Should symptoms of
cerebral irritation be present, a copious flow of blood will be obtained
by cups to the mastoidal regions.

This is to be immediately followed by a cathartic dose of calomel,
say twenty grains, and in three hours thereafter by twenty grains of
quinine, diffused in a wineglassfull of cold water, and if the febrile
excitement is intense, thirty grains may be given, but twenty grains
will in almost every instance be sufficient for the first dose. Four
hours are now suffered to elapse, during which the local bleeding is
continued, if required. In this time, in a vast majority of instances,
the fever will be considerably reduced, when the quinine should be
repeated in doses of six to ten grains every four hours, until thirty -five
or forty grains are taken. If in four hours after the first dose has
been taken the fever has not sensibly declined, the large dose (twenty
grains) may be repeated ; but in many hundred cases the first dose
has seldom failed in that time to produce an evident declension of the
fever, rendering the after employment of the medicine, in doses of
six to ten grains, amply sufficient to effect a complete solution of the
disease, the great aim being to throw into the system at least thirty-
five or forty grains before the period for the recurrence of the next
paroxysm.

QUININE IN THE FEBRILE PAROXYSM. 97

In cases attended with obstinate vomiting the stomach should be
previously calmed by the administration of forty or fifty drops of
laudanum, and if this should be rejected the laudanum may be given
by the rectum in double that quantity. But if the gastric irritability
should not yield to the anodyne, after local depletion also has been
employed as before advised, (and in some cases the stomach will not
bear the presence of any medicine long enough to induce its effects,)
the quinine must be given by the rectum. One drachm of quinine
should be suspended in four ounces of mucilage of gum arabic or thin
starch, and given at once as an enema ; to be repeated at the same in-
tervals as per orum, and in thrice the quantity above recommended.

If, however, the stomach will bear the quinine for an hour, the
nausea and vomiting will in almost every instance cease.

In some few instances, although the foregoing treatment has been
adopted, a slight exacerbation may be perceived towards the next
evening ; but this will generally be of brief duration, and will be fol-
lowed by a complete intermission, when the quinine may be given in
doses of ten grains every morning for three or four days.

Although I have described the effect of large doses of quinine in
this disease, it will be perceived that I have not proposed to give any
name to the group of sequences induced by its action, for the reason
that no single term yet designated will denote its peculiar properties ;
but the term " sedative," approximates more nearly to its proper
designation than any other, and has generally been adopted by the
advocates of its employment.

I could fill the pages of your journal with extracts from the writings
of distinguished physicians of our own country to corroborate what I
have stated, but, instead of doing so, must refer the skeptic to our
Southern and Western journals.

To those who have observed the action of this remedy in the dif-
ferent modes and various conditions of the system in which it is ad-
ministered, the inference is irresistible, that its effects are solely de-
pendent upon its salutary action on the nervous system. This effect
is so often immediate, arresting the disease at once, before it could be
absorbed in the blood, or resolve inflammation, that we are compelled to
regard its action as purely nervous. Now if it be contended that this
fever is merely symptomatic of gastro-enteric lesion, none will surely
argue with Broussais that quinine arrests the febrile movement by its
local application to the inflamed surface ; that it has any power to
effect this, has never been demonstrated, and is opposed to the expe-
rience of all. Or if it be contended with Liebig, that in fever some
of the elements of the brain az~e removed which are supplied by the
alkaloids of bark, &c, we may reply, that prior to this restoration of
the lost elements of the cerebral substance, the agents have to be sub-
jected to the functions of absorption and nutrition, both so imperfectly
conducted amid febrile excitement, and for the performance of which
a far greater period of time is necessary, even in health, than is am-
ply sufficient for the sanatory action of quinine. These conflicting,
but ingenious theories of two great minds, only serve to make the
" darkness visible" that surrounds the essential nature of disease and
its remedies.

98 QUININE IN THE FEBRILE PAROXYSM.

The effect of quinine upon the pulse is one of the most remarkable
of its powers in this disease. I have reduced the pulse from 140 and
150 pulsations in a minute to its normal standard in six hours. In-
deed I have in several cases desisted from its continuance, for fear
that its sedative effect might be carried too far. The organic lesions,
therefore, so often developed in the course of this fever, so far from
contra-indicating its use, are certainly relieved by it, or their cure ac-
celerated. Where blood-letting, both general and local, assisted by the
other usual antiphlogistic measures, have failed in arresting cerebral
inflammation, quinine in a few hours completely arrested the pro-
gress of the disease, reducing the pulse, calming delirium, promoting
free diaphoresis, and inducing sleep, from which the patient would
awake to speedy convalescence, quinine would seem to effect this by
allaying the morbid excitement of the nervous system, upon which
this increased action of the heart and arteries is dependent, and from
the continued excitement of which the organic lesions developed would
seem to arise.

It will need but a short experience with this article to convince the
careful observer that it possesses the power of allaying nervous irrita-
tion, spasm' and pain. Neuralgia, whether intermittent or continued,
will almost invariably yield to its sedative and anodyne properties.

Those to whom the facts and views herein set forth are entirely no-
vel, may here enquire, " If there is no danger in administering quinine
during febrile and inflammatory excitement?" Confining my reply to
this disease, I unhesitatingly answer, " That there is no danger when
given in full and free doses, in the manner which I have indicated !"
They may also enquire, " Have all authors on therapeutics committed
an error in classing quinine amongst the excitants, in fact, as the 6rst
and most valuable of tonics ?" To which I reply, that all of the
standard authorities on this subject I believe to be perfectly correct ;
but their knowledge of quinine is confined to its tonic, stimulant and
antiperiodic character, as it assuredly is in small, repeated doses, but
given in large doses it produces the effects I have described ; and
therefore not only admissible, but indispensable where small doses
would not only be improper but pernicious. I speak from great expe-
rience with this article. I have given 60 ounces in one fall, (1846,)
and I here declare my belief that armed with this agent, remitting
fever, if attacked early, is as certainly and completely under its con-
trol as ague. I have given it in the chill, the height of the paroxysm
and its decline, complicated with indisputable evidences of lesion of
the cerebral and abdominal organs, without any injurious effect in any
case ; and to sum up in few words, the sulphate of quinine in full
doses allays pain, irregular nervous action and restlessness, diminishes
the pulse in frequency, fullness and force, removes local determination
and equalizes the circulation, by allaying that morbid excitement of
the nervous system upon which remitting fever depends, and conse-
quently relieves the local lesions arising from this exalted action of the
circulation.

" Heec certamina tanta
Pulveris exigni factu compresa quiescunt."

HASKINS' CASE OF DOUBTFUL SEX. 99

Report of a Case of Doubtful Sex,

BY WM. D. HASKINS, M. D., OF RICHMOND CITY.
[Communicated to the Medical Society of Va.]

In September 1850 I examined by request a slave belonging to a
gentleman in Mecklenburg county, Virginia, who had been reported
as "A curious case of Hermaphrodism," by Dr. S. H. Harris, in a com-
munication made to the 27th Number of the American Journal of Medi-
cal Sciences.

In the lower orders of organized bodies hermaphrodism is common ;
indeed, in vegetables it is so prevalent as to have led some to suppose
it to be an attribute of the order; and the more nearly the other class
of beings approach the vegetable, the more common is this combina-
tion of sex. But it is now admitted by nearly all those who have
investigated the subject, that no such phenomenon ever existed in the
human species as a perfect hermaphrodite, although there are numerous
instances of preternatural structure which give the appearance of a
double sex. This slave I found to be an instance of this kind ; and,
as the report of Dr. Harris was calculated to produce a different im-
pression, I have thought it of sufficient importance to justify a re-de-
scription.

I must say, injustice to my friend Dr. Harris, that the examination
which I was enabled to make was much more satisfactory than the
one from which he made the report. His having been made at a time
when he did not expect it, he was unprepared with instruments to
assist him, and had also to contend with the reluctance which is usually
manifested by such persons to have their real situation known. In
this instance, nothing but the authority of a master whom he (adopt-
ing the masculine pronoun when referring to the case) greatly feared
could induce him to submit to an examination.

Anticipating this difficulty, I approached him in a different manner
from that resorted to by Dr. H. 1 met him alone, as it were acci-
dentally, and told him that his situation had been described to me,
and I doubted not, from what I had heard of it, that he could be re-
lieved, and if he would confide in me I would promise to observe the
strictest secrecy. By this means I succeeded in inspiring him with
confidence, and arousing a hope that his difficulty could be removed,
whereupon he became communicative, and readily submitted to an
examination.

There is nothing very peculiar in his appearance that would arrest
attention, until you are told that there is some doubt as to his sex,
when it at once occurs to you that his appearance is that of a woman
dressed in man's apparel. This conviction is forced upon your
mind by observing his stature to be low, frame delicate, hips broad,
lower extremities bent or inclined inwards at the knee joints, making
him knock-kneed, gait shuffling, instead of the firm, strong, elastic step of
manhood, face perfectly smooth, exhibiting no trace of beard, although
he is now 21 years old. Opening his bosom I found the mammas,

100 HASKINS' CASE OF DOUBTFUL SEX.

although not exhibiting the plumpness of virginity, as well developed
as you ordinarily see them. Upon exposing the genital organs, how-
ever, there is presented a very curious condition of things. The
mons veneris is prominent and well developed, being covered with hair
as in the female, and immediately over the symphisis pubis is situated
an organ which resembles almost exactly a dwarfish penis. It is
about an inch long and half an inch in diameter, is terminated by a
tubercle corresponding in shape and appearance with the glans jjenis.
There also appears at first sight to be the orifice of an urethral canal,
properly located in the glans, but upon closer examination it proves
to be the terminus of a fissure situated on the inferior surface of the
organ, formed by the approximation of the edges of what appears to
be the nymphae, which had adhered to, and were stretched over it,
so as partly to contribute to the formation of a preputial covering.

The prepuce, I may say here also, consisted of that portion of the
labia majora which was separated by the root of the organ, as well
as the lower portion of the mons veneris. Drawing back this organ
upon the mons veneris, I introduced a silver probe along the fissure
before alluded to, to the distance of about an inch below its root,
where the fissure terminated by the apparent union of its lips, form-
ing a cicatrix, which resembled somewhat the raphe of a scrotum.
This raphe extended to what should have been the position of the
posterior commissure of the vulva in the female. Directing my at-
tention again to the point where the fissure terminated, I endeavored
to find, with a probe, the orifice of the urethra, which I supposed
existed at or near this place ; in this I was not mistaken. I then took
a, female catheter, and introduced it into the bladder, and there es-
caped through it about a teacupful of urine. Withdrawing the ca-
theter and inserting it again, at a point a few lines below the orifice of
the urethra, I gave it a direction downwards, instead of that of the
urethral canal, and found no difficult}7 in inserting it its whole length
into a cavity where its point could be freely moved in any direction.
Taking it out, the lower portion was filled with a dark-colored fluid
resembling blood, and I doubt not, was the menstrual fluid which had
there accumulated.

The lower portion of the labia externa presented a rugose, flabby
appearance, and with the raphe or cicatrix dividing them, resembled
very much a scrotum deprived of testicles. This condition of the
labiae was doubtless produced by the collection behind them of the
fluids escaping from the womb, causing them to act temporarily as
the outer walls of a sac containing fluid, the pressure of which varied
with the positions of the body. There was evidently a considerable
quantity of this fluid in the vagina at this time, as was indicated
by the height to which the catheter was filled when withdrawn.
I learned from the individual himself that its escape from the vagina
was irregular and depended upon the attitude of the body, the only-
outlet being the small orifice just beneath the urethral opening through
which the instrument was introduced. There were, however, regular
periodical returns of all those symptoms which accompany menstrua-
tion, and so marked were they as to have attracted the attention of

BROOCKS' PENITENTIARY CASES. 101

the elder female servants in the family. I also learned from him that
his penis (as he supposed it to be) was subject to erections, and that
he had desires for the female sex, but had been deterred from attempt-
ing connexion by an apprehension that his deformity would be dis-
covered. As regards the former of these statements, it is not at all
inconsistent with our knowledge of the structure of the clitoris ; for
all anatomists have described it as consisting of erectile tissues like
those of the penis, and subject to similar orgasms. The latter I think
has been satisfactorily accounted for by Dr. Harris, who supposed it
to be the results of education : " He having been taught from child-
hood up to look upon himself as a male, now, in imitation of others,
deports himself as such to the other sex."

Thus it appears that this " curious case of hermaphrodism," has
been deprived of all its mystery, and proved to be nothing more than
a case of occlusion of the vagina, accompanied with hypertrophy of
the clitoris.

An operation was proposed ; but when I informed him that it would
entirely change his assumed sex, and make him a woman, he opposed
it with so much earnestness that it was not insisted upon.

Cases Treated in the Armory and Penitentiary Hospitals,
With Remarks.

BY JOHN N. BROOCKS, M. D., SURGEON TO THESE INSTITUTIONS.

Case I. — Osteosarcoma.

M. Beasly, a mulatto and convict in the Virginia penitentiary, has
been in the prison 5£ years, was sentenced for 12 years, and was ad-
mitted into the hospital the 27th of October 1846, aged 42 — his health
was good and his habits intemperate previous to his conviction. He
said his mother had a cancer on her breast when he was ten
years of age, which was excised, and there was no return of it. One
of his brothers had a white-swelling on his foot at the age of 12 years,
and lost several bones and recovered. He recollected to have fallen
down a precipice when intoxicated, some 12 years since, and striking
his head against a large stone, from which he received a considerable
shock, and was for a time in a state of insensibility. He has for the
last three years had frequently slight pain in his jaw, so slight how-
ever, as not to give him any uneasiness until last March, when it be-
came more violent and assumed a more serious character; sometimes
acute and lancinating, and at other times dull and aching, and at no
time free from pain. His gums became spongy and insensible to the
touch, and often bled copiously. There was no marked change in
his condition until June following, when he had a tooth extracted from
the affected jaw. Its root was decayed. This gave him no relief.
The gums continued to swell and to bleed. His face commenced
swelling in September, and the tumor became hard and unyielding to
pressure. The remedies administered had no influence on the pro-
gress of the disease ; and in consultation with Drs. Cunningham and
14

102 BROOCKS' PENITENTIARY CASES.

Deane, it was decided that no benefit could be afforded by an opera-
tion, and that, it would be cruel to perform one. The remedies used
were principally the different preparations of iodine and opium inter-
nally, and soothing and emollient applications to the tumor. The
disease, in its uninterrupted progress, involved the whole of the right
superior maxillary bone, and extending to the eye, destroying it and
shooting up a fungus from its orbit. The tumor attained to the size
of a man's fist — it was irregular and lobulated. He died the 3d of
December.

Autopsy the next day in the presence of Dr. Cunningham and my-
self, by Professor J. Wyman, who was so kind as to make it for me.
" The disease was found to be a malignant tumor of the upper jaw,
involving principally the antrum extending to the orbit of the eye, de-
stroying the floor, the outer walls and part of the roof. The malar
bone had entirely disappeared, also the alveolar portion of the maxil-
lary bone behind the bicuspid teeth, and the palatine process nearly to
the median line. The interior of the tumor was disorganized and in
a gangrenous condition."

Remarks. — The prognosis in this disease is always unfavorable.
When once developed, we have no reliable means of arresting its
progress ; our treatment, therefore, is necessarily palliative. — limited
to such remedies as are best calculated to alla}r irritation and to soothe
the pains of the suffering patient. Should an operation be resorted
to, in most cases the disease will return and seize upon some more
vital organ and hasten the dissolution of the patient. We are as yet
almost entirely ignorant of the causes of this most malignant affection.
It has been attributed to syphilis, to rheumatism, to hereditary taint,
to cancer, to local injury, and in many cases no cause can be assigned
for its production. It may attack any of the tissues of the body, but
it begins usually in the periosteum and the cancellated texture of a
bone, and its distinctive and pathognomic characters will be modified
by the part affected and the constitutional tendencies of the subject.
The antrum, the alveolar depressions of the jaws, the palatine bones
forming a part of the roof of the mouth, the floor and the sides of the
nostrils and the floor of the orbit, have been found to be most fre-
quently the seat of this disease. All ages and both sexes are liable
to this disease, but it occurs more frequently from infancy to forty
years of age.

Case II. — Scirrhns of the Stomach.

W , of the public guard of Virginia, and formerly in the United

States' service, age 55, constitution had been greatly impaired by
exposure and by previous intemperance, was admitted into the
armory hospital the 13th of November 1848. He had torpid liver
and catarrhal symptoms, with pain of right side. I ordered cups to
be applied to his side, and ten grains of calomel and rhubarb to be
given him. 14th, tartar mixture; 15th, alterative doses of calomel
and ipecacuanha every four hours ; 16th, had pain of stomach — cups
to epigastrium and flaxseed tea for drink. 17th, blister to stomach,

BROOCKS' PENITENTIARY CASES. 103

powder at night. 19tb, stopped treatment. Dec. 10th, pain of side
returned. Cups were applied to his side, and five grains of calomel
and fifteen of rhubarb were given. 11th, blister to stomach and three
grains of calomel at night. Anodyne and alterative doses of calomel
were directed to be given pro re nata, until the 18th, when he com-
plained of a burning sensation in the stomach. Gave him lime-water
and milk. This was continued until the 31st, when he thought he
was able to go to duty, and was discharged on that day. From the
persistence of this sensation in the stomach I now suspected that or-
ganic changes were in progress, and that scirrhous degeneration was
going on in the stomach. I gave him this opinion, and suggested to
him the propriety of being discharged from the guard, and of obtain-
ing some employment on a country farm, as better calculated to ren-
der his condition more comfortable and to prolong his life. Being
entirely dependent on his pay in the guard, and hoping that he would
soon be better, he was unwilling to follow my advice, and preferred
to remain longer in the company.

January 22nd, 1849. He returned to the hospital with increased
burning of the stomach. Ordered cups to the stomach, and lime-
water and milk. The lime-water and milk produced a very soothing
effect, and was continued until the 30th, when I discovered a pulsating
tumor in the epigastrium and in the region of the cardiac orifice of
the stomach. I directed him to keep perfectly still, and to continue
the lime-water and milk. On the 31st I made a careful stethoscopic
examination, and found that it was not an aneurism. As the distin-
guishing characters of this disease were not observed, it was my opi-
nion that it must be some indurated body lying over the artery, and
received its pulsation from the artery beneath ; and from the history
of the case and the location of the tumor, I supposed that it was scir-
rbus of the cardia. The soothing and anodyne treatment was directed
to be pursued, and five drops of a solution of iodo-hydrargyrate of
potassium to be given three times a day in water. In a few days the
tumor began to change its seat and gradually to move to the right
side, until it reached the region of the pyloric orifice of the stomach,
and it remained there. Regarding it to be a very interesting case, I
invited several of my medical friends to see it with me at different pe-
riods of the disease, and at different stages of its transition. Drs. Mi-
nor, Nelson, Gibson and Haxall saw it ; the former, when it was loca-
ted in the epigastric region and pulsating; the latter, when in the py-
loric region without pulsation. Dr. Gibson saw it when about mid-
way between these points. The iodine and anodyne treatment was
continued, with an occasional enema and other auxiliary remedies, du-
ring its progress, as they seemed to be required. He died on the 16th
of April. After eating, he suffered great pain for some months before
his death; and a short time before he died, he vomited and passed a
large quantity of a dark, offensive, glutinous mass which adhered
firmly to the vessels, and was of a coffee-ground color. On the next
day, the 17th, I made the autopsy in the presence of Drs. Haxall and
Minor. The stomach was found to be greatly enlarged and distended
with a fluid of a gruelly consistence and color — its coats very much at-

104 BROOCKS' PENITENTIARY CASES.

tenuated, and its mucous one softened and disorganized, and could be
readily detached with the handle of a scalpel. The pyloric orifice
was scirrhous to the extent of an inch or more, and it would admit the
end of the little finger if slight force was used. The other organs
were not carefully examined, they, however, on a superficial view, had
a normal appearance.

Remarks. — How long this disease had existed, I have no means of
deciding. He had been infirm and in delicate health for some years,
complaining mostly of dyspepsia, biliary derangement and costive-
ness, but was enabled to attend to his military duties. The most
remarkable feature in this case, and one for the solution of which I
can offer no satisfactory explanation, was the change in the seat of the
tumor. He was extremely emaciated and almost ex-sanguine, and
his death was evidently caused by starvation, his stomach not being in
a condition to digest and assimulate food sufficient to sustain life.

Case III. — Lumbar Abscess.

of the public guard of Virginia, age about 45, constitution

delicate ; had been intemperate ; was admitted into the armory hos-
pital the 1st February 1850, with pain and slight swelling of his left
foot ; both pain and swelling soon disappeared by the application of
poultices and the use of salts. On the 15th, he had the ordinary
symptoms of catarrh, for which I prescribed tartar mixture and cups
to his temples for pain of his head. 14th, gave him 10 grs. calomel
and rhubarb ; 16th, tartar mixture ; 17th, salts ; 18th, had pain of
loins, directed cups and gave dose of salts ; 24th, pain of loins con-
tinuing and extending to hip, and down the thigh and in the left groin,
with some swelling in the groin ; the pain was increased by extending
the limb ; gave 30 drops wine of colchicum three times a day ; 26th,
Dr. Haxall saw him for me, (I was out of town ;) hip bath and 10
grs. Dover's powder were ordered; 27th, retention of urine. Cathe-
ter introduced ; colchicum, 25 drops to be given in a tablespoonful of
hyd. potash mixture morning, noon and night. March 1st, I saw him,
he complained more of his back, directed blister to loins and 10 drops
of a solution of iodine and hyd. potash three times daily; 3d, had con-
siderable fever and violent pain in his hip and thigh, his suffering was
very great, especially at night — ordered cups to hip and 10 grs.
calomel and 6 Dover's powder, and the part to be covered with a
warm poultice ; 4th, 5th and 6th, lime-water and milk for sickness of
stomach, and introduction of the catheter for retention of urine on the
4th. March 7th, colchicum ; 9th, iodine solution and 6 grs. of Do-
ver's powder at night ; 10th, retention of urine, introduction of the
catheter, and salts in the morning and Dover's powder at night. Re-
tention of urine again occurred and required the introduction of the
catheter. In every instance in which laudanum or Dover's powder
was administered, this effect followed ; 11th, some ardor urinae, gave
juniper berry tea ; 12th, cups to hip; 14th, hip bath morning and
evening and colchicum ; 16th, blister to hip, and colchicum ; ISth, 5
grs. hyd. potash three times a day, and 40 drops of laudanum, with

BROOCKS' PENITENTIARY CASES. 105

the same effect on the function of the bladder. I had again to intro-
duce the catheter — hyd. potash was continued until the 22d, gave 10
grs. calomel and rhubarb, and directed vol. liniment to be applied to
the hip and thigh ; 23d, vol. liniment and colchicum. April 1st, had
diarrhoea, directed acetate of lead and opium in pill every two hours,
until it should be arrested ; 22d, abscess pointed in the loins over the
crest of the ilium, and fluctuation was very perceptible. I made a
free opening with a lancet — a large quantity of pus escaped and the
pain was greatly diminished ; 23d, matter had continued to flow very
profusely, and the patient a good deal debilitated, with some sensation
of chilliness — gave infusion of bark and spirits mindereri. From this
time his condition required a supporting system of treatment, and a
more generous and nourishing diet was ordered. To permit the mat-
ter to escape freely, and to prevent its being at any time confined, I
was very careful to keep the orifice free and open. For months large
quantities of matter, sometimes mixed with blood, were discharged —
hectic fever came on, and he became very feeble and greatly ema-
ciated ; poultices were kept constantly applied to the loins. July
10th, I ordered quinine and porter freely. About the middle of Sep-
tember the discharges of matter ceased — the wound healed, and his
improvement was rapid — he was discharged from hospital treatment
the 18th of October, and is now, (January 14th, 1851,) perfectly well
and attending regularly to his duties as a soldier of the guard.

Remarks. — This was a case of very great suffering until the pointing
of the tumor and the liberation of the matter by the lancet; indeed,
medicine seemed to have had little or no influence in alleviating his suf-
ferings. The pain appeared to continue unabated, regardless of the
remedies used — opium, apparently, had an effect which I never wit-
nessed in any other case, that of taking from the patient the control
over the function of his bladder. As this occurred so frequently, and
invariably after its exhibition, and at no other time during his long ill-
ness, and as no obstacle was ever found to the introduction of the ca-
theter, I am constrained to believe that the retention was induced by
the opium acting in some way upon the nervous system.

This is, fortunately, a very rare disease in America, for according
to high authority, "very few patients recover from this disease under
any circumstances, and those that escape remain puny and debilita-
ted." Up to 1S27, Dr. Physic never saw but one case in this coun-
try " unconnected with disease of the spine."

Case IV. — Traumatic Tetanus.

John C. Bryant, aged 31, had been in the prison more than 3
years, of previous imperfect health and intemperate habits. He was
sentenced for 15 years — whilst drawing water from the well in the
yard, he had vertigo and fell, and was caught in the massive wheel
attached to its machinery, and received a compound fracture of the
right fore-arm, (both bones broken,) and several wounds of the face
and scalp, on the 17th of September last, and was brought to the
hospital — the wounds were dressed and proper splints were applied

106 BROOCKS' PENITENTIARY CASES.

to the limb. He appeared to be doing well up to the 28th, when I
observed some swelling of the arm, blisters on the hand, and a slight
bluish color. I took off the splints and bandages, and found that the
bones had not united, and that a large quantity of matter had formed
within the two days past — since which time I had made an examina-
tion. This rendered farther effort to save the limb unsafe, and it was
thought advisable to resort to immediate amputation as the only means
of preserving his life. 1 requested Dr. Marx to assist me in the ope-
ration. After examining the case, he concurred with me in its pro-
priety and necessity, and in the morning of that day, assisted by him,
I amputated the limb some 3 or 4 inches below the shoulder joint.

He bore the operation well, and under the use of brandy his sj^stem
reacted perfectly. After the dressings were applied he suffered scarcely
any pain, and enjoyed some sleep. It was very warm weather, and
several of the windows of the hospital were up, and a light coverlet
placed over him. A decided change took place in the night — it turned
suddenly cold, and before the change was observed he was chilled.

29th. — When I saw him, his jaws were firmly locked, so much so
as to resist considerable force to open them — his pulse was soft, rather
weak, and more frequent than usual, and his surface was covered with
slight perspiration, and he complained of pain in the region of the
sternum. I caused him to inhale ether, and in a short time he could
open his mouth partially — cups were applied to the spine, and a flax-
seed poultice to the stump — 3 i. tincture opii. was directed to be given
every 2 hours until drowsiness or sleep was produced, and if he
should be unable to swallow, 3 ij of tincture opii. was to be given by
enema every 2 hours, and to keep him under the influence of ether by
its occasional inhalation, and 20 grs. of calomel were given. Sleep
was produced : and whilst he was sleeping the muscles were relaxed,
and his mouth remained wide open ; but the instant he awoke the
spasms returned, and would snap the jaws violently together, and they
would remain firmly clinched until he again fell to sleep. 6 o'clock,
P. M., the spasms increased in violence, and the muscles concerned in
respiration so powerfully contracted as to threaten suffocation. I
directed a blister 3 inches wide to be applied to his spine its whole
length, and a cathartic and an enema during the night, unless his
bowels were moved. Finally, the spasms of the respiratory muscles
became so great as to arrest this function, and he died at 9 o'clock,
P. M., with the symptoms of strangulation.

Remarks. — The pathology of tetanus is very obscure, as is the case
with the diseases of the nervous S}^stem generally. Most writers,
however, I believe, regard the spinal cord and the afferent nerves to
be most affected, and the brain not to be involved. In the cases
which have come under my observation, there was no evidence of
disease of this organ. Pathologists agree in the opinion, that the spinal
cord is either irritated, inflamed or congested. The treatment of this
disease has been very unsatisfactory in its results. We occasionally
see reported in the periodicals of the day cases cured by different
modes of treatment, but all such cases followed very slight injuries,
from which the system had sustained but little shock, and the conse-

bolton's case of ovariotomy. 107

quent irritation not great or of long continuance. I have never seen
any case reported as cured, where the primary injury was great and
the system received a considerable shock ; and hence the universal
testimony of the army surgeons is, that all cases are fatal in their ex-
perience. They meet with cases occurring after gun-shot wounds, and
other serious injuries. Before we can hope to contend successfully
with the diseases of the nervous system, we shall have to learn more
of the laws which control its movements; and as interesting investi-
gations are now in progress, we do not despair that some gifted mem-
berof our profession may not yet be enabled to elucidate its forces
and to indicate the means with which its diseases may be made more
obedient to treatment. I do not regard opium as a curative agent in
the treatment of this disease, but as acting beneficially, by allaying
irritation, moderating the spasms, and preserving the vital powers un
til cups, blisters, purgatives and other remedies can act upon the spi-
nal cord. I advise ether for the same purpose, and I believe it to be
more efficient than opium.

N. B. With the exception of the treatment, of which I took notes
at the time, the above cases have been reported from memory.

January 1851.

A Case of Ovarian and Peritoneal Dropsy.

Paracentesis during period of eight months and a half— Attempted ex-
tirpation— Failure — Death on 23d day — Autopsy. By James Bol-
ton, M. D.

June 25, 1849. N. G., aged 39 — living in concubinage, never
pregnant. Saw her in consultation with Dr. C. B. Gibson. She had
previously been under the care of Dr. John Cullen, and had taken,
by his advice, large quantities of iodide of potassium, iodide of iron
and sarsaparilla, besides applying active counter-irritation to abdomen.

Present condition. — General debility ; disturbance of respiration and
digestion; great enlargement of abdomen, with regular contour in
both upright and horizontal positions ; distinct fluctuation. Careful
manipulation proved existence of tumors in both iliac, and pubic
regions ; percussion exhibited some symptoms of peritoneal, and
some of ovarian dropsy.

Treatment. — Tapping below umbilicus ; — 9 quarts of greenish, te-
nacious serum drawn off.

Effects. — Very great relief; tapping borne very well ; iliac and pu-
bic tumors very distinct.

July 13. — Uterine examination per vaginam — os and cervix uteri
healthy and normal, pelvic cavity rilled with tumors. She menstruated
a few days previously, and has done so regularly.

August 9. — Second tapping, with results similar to those of first;
general health much improved.

September 25th. — Third tapping.

October 28th. — Fourth tapping.

108 bolton's case of ovariotomy.

November 2d. — Left tumor much enlarged ; tapping in left iliac
region ; — nearly two quarts of semi-purulent fluid, probably from
ovarian cyst, drawn off.

Nov. 30th. — Fifth tapping below umbilicus.

Dec. 1st. — Sixth tapping, about an inch above umbilicus, drew off
nearly a quart of fluid similar to that from iliac region.

Dec. 25th. — Seventh tapping, below umbilicus.

1850, Feb. 3d. — Eighth tapping, below umbilicus, also above umbili-
cus, and in left iliac region ; at all three places in immediate succession.

March 4th. — Ninth tapping, below umbilicus, and immediately after
in left iliac region; fluid from latter having at first a reddish, limpid
appearance, but afterwards its usual color and consistence. Patient
not relieved as usually ; complains of distressing pains in right lumbar
and hypochondriac regions, which are filled by a firm tumor ; obscure
fluctuation ; two deep punctures with grooved needle did not reveal
existence of fluid. Patient decidedly cachectic ; has been falling into
this condition daring the past month.

March 10th. — At the urgent request of patient and friends, Dr.
Gibson attempted extirpation of tumors, assisted by myself, Drs. C.
P. Johnson and A. E. Peticolas. Ancesthesia produced in 10 minutes
by about 3 ij. chloroform, and effects very favorable — sustained about
25 minutes by an additional 3 i. chloroform.

Operation. — Incision in course of linea alba, commencing 2 J inches
above umbilicus, passing on right of it nearly to symphysis pubium ;
considerable thickness of adipose tissue, peritoneum much engorged
and thickened ; on opening this membrane a large quantity of fluid
gushed out; intestines extremely flaccid, tumors occupying both iliac
regions, pubic, both lumbar and extending into hypochondriac ; ex-
tensive adhesions to walls of abdomen and intestines ; pelvis filled
with tumors; cauliflower excrescence on apex of right tumor. Opera-
tion abandoned ; wound closed with interrupted sutures and adhesive
plaister ; strip of linen soaked in collodion laid over all, and well sealed
at edges with collodion to exclude air. Nausea produced by chloro-
form continued during the day : pulse feeble — ?-- Gum camphor,
gr. ij., and morph. sulphat. gr. J, pro re nata.

11th. — Passed night pretty well; nausea, prostration of strength;
no tenderness of abdomen ; riced barley water. — B- Emplast. sinapi,
ad. epigast.

12th and 13th. — No material change.

14th. — Much improvement ; wound closing ; large, ill-looking fun-
gus protruding just above umbilicus ; fistulous opening above it, from
which fluid of ascites drains.

23d. — Continued in much the same condition until to-day ; dis-
charge more fetid with cadaverous order.

April 3d. — Symptoms gradually worse ; loss of strength ; tumid
abdomen, without tenderness on pressure.

Died 24th day from operation.

Sectio cadaveris. — Large quantity of fluid gushed from peritoneal
cavity ; ovarian tumors filling pelvis and most of abdomen ; all these
contained fluid varying from a watery consistence to that of cream,
and from a light greenish tint to a yellowish color ; their surfaces pre-

EDITORIALS. 109

sented in some places the appearance of granulations or cauliflower
excrescences, and in others, of cerebrifbrm matter. The uterus was
healthy, and not enlarged.

Remarks. — That the operation of ovariotomy may be performed
with safety, any one who will take the trouble to consult the reports,
particularly of the last few years, may soon satisfy himself. That it
is extremely hazardous, is admitted. The question then arises, is it
justifiable ? I answer unhesitatingly, as in all other like cases, an ex-
tremely hazardous operation is justifiable for the purpose of curing a fatal
disease. Acting simply upon the doctrine of probabilities, the patient
has a right to demand that course which gives the best chance for his
life, and the physician is bound to recommend it. This principle is
admitted continually in the various capital operations. The writer
has known an instance of recovery after amputation for dry gangrene,
which was extending. The operation had been declined by several
surgeons, who abandoned the patient to his miserable fate.

In the present instance the opinion was very properly unfavorable
to the success of the operation. The tumors were known to be nu-
merous and extensive, and there was reason to believe that adhesions
existed. The patient had been gradually declining during the pre-
vious month. She was believed to have reached that point in the
course of her disease when she must inevitably sink in a short time,
unless she could be rescued by an operation. If the attempt were
delayed any longer, she would soon be beyond the reach of art. At
this critical period the whole case was fairly laid before the patient
and friends, and their decision was adopted. Although the case ter-
minated fatally, I believe that decision was correct.

J. B.

lIDfflTOIEMJLf

The Stethoscope.

It is a pleasant duty to acknowledge the debt of gratitude which
we owe to the public press generally throughout Virginia, for their flat-
tering notices of our first issue, and their commendations of our en-
terprise. We would be pleased to exchange with many who send
us their paper, but we must be denied the pleasure of doing so, be-
cause the wise governors of the land have not deemed the periodical
literature of sufficient importance even to allow us the poor privilege
of exchanging, even with one another, free of postage. Newspapers
noticing us will be thankfully received.

The Stethoscope has met with a reception among the physicians
of the state, which, in cordial welcome, far exceeded our expec-
tations. It would be very agreeable, if time permitted, to answer the
15

110 EDITORIALS.

many letters we receive daily from our brethren, cheering us on in
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mation of those who may have waited to subscribe, to see if we would
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work is permanently established, and they may now safely forward
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We would here call attention to a necessary rule — that subscrip-
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of back numbers is exhausted ; and the sooner we are furnished with
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It is proper to say, that it was deemed more advisable to throw the
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This we hope no one will complain of, as we are entitled to a fly leaf
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medical journal in the United States ; and a cotemporary has noticed
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Our size and cheapness render two things necessary. First, a large
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interesting cases, in letter form, if preferred. Original articles will
be preferred to selections, even though they occupy a very large pro-
portion of each number.

The second necessary is, a large subscription list. The size and
price render a full list necessary to pay expenses ; and it must be very
large to be the source of any profit, after bestowing the time and labor
upon it requisite to edit a monthly journal.

Our original matter has so completely filled up the present number,
that it is necessary to defer many selections as well as other things of
importance. Readers, doubtless, will find no objection to this ; we
ourselves hope that it may be frequently the case.

EDITORIALS. Ill

The article of Dr. Merritt on congestive fever, from its length, has
excluded much other matter from our present issue. It may be
deemed prolix by many of our readers, but as the subject of which
it treats is one of great practical importance and is a disease of the
South, we have departed from a rule we have adopted, not to give up
so much space to one subject. We commend the article to a careful
perusal, as it comes from a gentleman who has enjoyed great expe-
rience in a region of country where congestive fever is a prevailing
disease.

Our Exchanges.

In addition to the list announced in our January No., we are in re-
ceipt of the following medical journals. There are others which we
would like to have on our list, but which have not been sent to us —
among these is the American Journal, &c.

The Charleston Medical Journal and Review, bi-monthly, handsomely
published, and containing much good matter, which we have not room
to notice.

The New Jersey Medical Reporter and Transactions of the N. J. Medi-
cal Society, edited by Dr. Joseph Parish, Burlington. Our thanks
for its notice of us are due.

American Journal of Insanity, published quarterly by the N. Y. State
Lunatic Asylum. The three last numbers received.

The Medical Examiner. — This popular monthly is now entering on
its seventh volume, and we believe its popularity is increasing daily.

The New Orleans Medical and Surgical Journal, bi-monthly, edited
by Dr. A. Hester. Its first article is 30 pages long, being a portion
of an article on congestive fever, by S. Ames, M. D., of Montgomery,
Alabama. It contains much other valuable matter.

The Philadelphia Lancet, (first two numbers) — a quarto of six page*
of matter, semi-monthly, edited by Dr. Thomas Dunn English.

We thank the authors for several introductory addresses, among
which is one from Dr. Horace Green, Prest. N. Y. Medical College
and Prof. Prac. Med. This address abounds in high-toned sentiment,
and merited the honor it received of being published by the class.

We have received a paper on " The Curability of Consumption, con-
sidered in reference to a new method of ascertaining the disease of
the lungs," &c, from the author, Dr. M. Mattson, fellow of the Mas-
sachusetts medical society. This new method is to ascertain the vital

112 EDITORIALS.

capacity of individuals, or the amount of air which they can inspire,
by means of an instrument called the spirometer. This paper was
published in the Boston Medical Journal, and is one which will doubt-
less elicit some examination into the subject wherever it is read. We
think the author underrates auscultation and overrates the new method.

Our reception by the medical press generally has been very flatter-
ing ; and, considering that we are somewhat of a greenhorn as yet, we
have been fortunate in not drawing down more raps over the knuckles
than we have. The Boston Medical Journal complains and justly, that
we " cut down his number of pages one-fifth," &c. We make the
amende honorable with pleasure. That sheet has twenty pages, and of
good matter too. As to the " withholding the modifying circumstances
respecting the colored students," &c, it is unimportant. The me-
dical faculty of the Harvard University now announce that in future
colored men will be excluded from their classes. The marriages of
other doctors than those of Massachusetts are published in the Jour-
nal. We stand corrected, and as a bachelor, it is a matter of
some interest to us. The plan is a good one ; for it informs many of
the advance in life made by their old classmates, though distant and
almost forgotten.

The New York Medical Gazette thinks hard of our saying that Vir-
ginia is destined to become the seat of medical learning for the South, &c.
Now, in the same number, we find the following most sanguine pre-
diction and in italics : " In ten years, the seat of medical learning in Ame-
rica, since the establishment of the Republic, claimed by Philadelphia, will
be transferred to the great metropolis." Still we think we have as much
right to hope and expect to say why Virginia will be the medical cen-
tre for the South, as our friend has to prophecy that New York will be
the great centre of medicine in America. As for the medical colleges
further South, we wish them the greatest possible success. And if
they exert themselves, we believe that in a twelvemonth the editor of
the Gazette will not congratulate himself " that there are now several
hundred Southern students at the North, and a large proportion of
them from Virginia."

Tilden & Co.'s Extracts.

We have received ten samples of different extracts, prepared by
Messrs. Tilden & Co. of New Lebanon, N. Y. They are beautifully
put up in half pound bottles, each cased in a box, and hermetically

EDITORIALS. 113

sealed. We thank the manufacturers for the present, but a proper
examination of them will tax our time just now more than can be
afforded. However, they shall be duly examined and reported on as
early as possible ; and, like all such things, will be dealt with accord-
ing to their merits. Suffice it to say for the present, that they come
highly recommended from many good sources, and purport to be pre-
pared in a different manner and a more scientific one than that usually
adopted. They are prepared in vacuo, at a very low temperature,
thus the active principle of the vegetable is retained in an unimpaired
and concentrated form. We have examined the extract of conium
before us. It is refined, and deprived by a peculiar process of its
coloring matter, of chlorophylle and albumen, which are liable to de-
compose and prevent its keeping well in humid climates.

Messrs. Tilden & Co. are spoken of on all sides as being thoroughly
competent and prepared to produce articles in every way equal to
those which are now imported ; and if they will carry out their " in-
tention of supplying the profession with such preparations as can be
entirely relied on," these extracts will be very generally used through-
out the country, both because they will be cheap and convenient.

Messrs. Purcell, Ladd & Co. are Tilden's agents for Richmond.

The Medical Society of Virginia — Act of Incorporation.

We would call the attention of every physician in Virginia to the
subjoined charter and constitution, and the important by-laws of the
Medical society. It will be seen that the whole profession can and
should be enrolled, and that a county and state organization, which
would benefit individually every member of it, can be most easily ef-
fected by the establishment of branch associations. Our want of
space renders it necessary to defer a fuller notice of it, but meanwhile
we hope to see a continuance of the rapid increase of its members,
from every county, which has been steadily going on, and in another
year we confidently expect that it will number a thousand members.
Then the reform and regeneration now so necessary will be easily
effected.

" An Act incorporating the Medical Society of Virginia.

" Whereas it has been represented to the general assembly that sun-
dry citizens hereinafter named, have for several years associated them-
selves as a society, with a view to the advancement of medical know-
ledge throughout the state of Virginia ; and that the accomplishment

114 MEDICAL SOCIETY OF VIRGINIA.

thereof would be greatly facilitated, and their labors rendered more
extensively useful, if they were vested with some of the attributes of
a corporate body :

" Be it therefore enacted by the general assembly, That William Foushee,
Senior, George Cabell, George Watson, James Henderson, John Hays,
Micajah Clark, Thomas Nelson, William A. Patteson, James Blair,
William H. Hening, James Warrall, John Adams, Lewis W. Cham-
berlayne, Robert H. Cabell, R. A. Carrington, John Dove, Branch T.
Archer, William Tazewell, Nathaniel Nelson, Edward H. Carmichael,
R. L. Bohannan, Philip Augustus Klipstine, William R. McCaw, as
well as all others who may hereafter be admitted to membership with
them, be a body corporate and politic by the name of the " Medical
Society of Virginia;" that they shall be capable of suing and of being
sued in any of the courts of this commonwealth ; that they shall have
perpetual succession, and be authorized to use a common seal.

" Be it further enacted, That it shall be lawful for the Medical society
thus constituted to enact all such by-laws as they may deem neces-
sary and proper for attaining the objects of their institution, and not
contrary to the constitution or laws of the United States or of the com-
monwealth of Virginia.

" Be it further enacted, That it shall be lawful for said society to re-
quire of persons admitted to membership therein, such admission fees,
and annual contributions, as a legal quorum thereof may from time to
time enact ; and if any member shall refuse or fail to pay such admis-
sion fee or annual contribution, that the same shall be recoverable
by the society, on motion with ten days' notice, before either of the
superior or inferior courts of law held in the city of Richmond, or in any
county, city or corporation whereof the member so refusing or failing
to pay shall be an inhabitant.

" Be it further enacted, That it shall be lawful for the said society to
hold, under any title recognized by the laws of Virginia, such buildings
as may be required for their immediate personal accommodation as a
society, for lecturing rooms, for a dissecting room, and such other
apartments as may be manifestly necessary or convenient for the pro-
motion of medical knowledge.

" Be it further enacted, That it shall be lawful for the said society to
hold, under any title recognized by the laws of Virginia, whether
coming to them by purchase, donation or otherwise, so much real pro-
perty, exclusively of that mentioned in the fourth section of this act,
whereof the clear income, on an average of ten years, shall not exceed
two thousand dollars per annum.

" Be it further enacted, That this act shall be at all times subject to
be altered, amended or repealed, as the legislature of Virginia shall
deem necessary and proper.

" This act. shall be in force from the passing thereof."

The above is a true copy of an act passed by the legislature of
Virginia, the 2d January 1824.
(Signed,)

WM. MUNFORD, Clh H. of D.

MEDICAL SOCIETY OF VIRGINIA. 115

Constitution of the Medical Society of Virginia.

The objects contemplated by the Medical Society of Virginia,
are — the collection, diffusion, interchange, preservation and general
advancement of medical knowledge throughout the state.

Its constitution embraces the qualifications, election and duties of
its members, the election or appointment and duties of its officers and
committees, and provides for its own amendment, whenever the ne-
cessity and propriety of amending it shall be sufficiently obvious.
The following are its provisions :

ARTICLE I.

Of Admission to Membership.

Sec. 1. Eveiy candidate for membership must make application to
the society by a written document, bearing his own signature. Such
application is to be presented and seconded by members having a
competent knowledge of the applicant, and can only be received at a
stated meeting. Tne application shall lie over for one month, at least,
for the consideration of the members, after which the candidate shall
be ballotted for, and the approving votes of three-fourths of the mem-
bers present shall be necessary to his admission.

Sec. 2. In every city, town or county of the state, associate medi-
cal societies may be formed, the members of which may become mem-
bers of this society, upon the payment of the requisite initiation fee,
provided their qualifications be such as are required in the following
section.

Sec. 3. But previously to a candidate being ballotted for, his qualifi-
cations shall be duly ascertained, and shall be as follows :

(a) The candidate shall have received, from some public school,
society, college or university, legally authorized, a degree of
bachelor or doctor of medicine or surgery, or diploma or
other certificate, evidencing his capacity to practise medicine
or surgery.

(b) When such degree, certificate or diploma has not been ob-
tained, the candidate shall furnish satisfactory evidence of
having regularly attended, in some public school of medicine,
lectures on anatomy, surgery, the theory and practice of me-
dicine, materia medica and chemistry ; and of having passed
in such academical attendance two full courses, and after-
wards maintained a respectable standing as a practitioner
for five years.

(c) Or that he shall have attended one course of lectures in the
before mentioned branches of medical science, and shall have
afterwards practised with credit for eight years, submitted to
a satisfactory examination before the society, presented a
medical essay, and publicly defended it.

Sec. 4. The person nominating a member shall be deemed respon-
sible for all charges occurring against his nominee, for twelve months
next ensuing the period of his election.

116 MEDICAL SOCIETY OF VIRGINIA.

ARTICLE II.

Of Honorary Members.

Sec. 1. Honorary membership shall only be conferred on distin-
guished medical characters residing beyond the limits of the common-
wealth of Virginia, on presidents of the society who shall have dis-
charged their official duties with fidelity and attention, and on mem-
bers of five years standing, who shall have rendered eminent services
to the society.

Sec. 2. The election of honorary members can only be made at
the annual meetings of the society, and not more than four shall be
elected in any one year.

Sec. 3. The election of honorary members shall be by ballot, and
the concurring votes of four-fifths of all the members present shall be
necessary to an election.

Sec. 4. Honorary members shall be exempted from the payment of
all pecuniary contributions to the society.

ARTICLE III.

Of the Duties of the Members.

Sec. 1. All the members of this society (honorary members ex-
cepted) shall, at the time of their admission, pay to the society a fee of
one dollar, and shall also pay once a year, (to fall due on the 1st day
of January, each year,) such contribution as the by-laws may from
time to time prescribe.

Sec. 2. A copy of any communication, after being read to the so-
ciety, shall be delivered to the librarian.

ARTICLE IV.

Of Resignation of Membership.

Any member wishing to withdraw from this society, shall be per-
mitted to do so, on his written resignation, or the written request of
the secretary of the associate society to which he belongs, after he
shall have presented the treasurer's receipt for all moneys due.

article v.

Of Certificates of Membership.

Every member shall be entitled to a certificate of his membership
after he shall have complied with the requisitions of the 3d article.
The form of such certificate to be prescribed by the by-laws.

MEDICAL SOCIETY OF VIRGINIA. 117

ARTICLE VI.

Of Forfeiture of Membership, or other Censure.

Sec. 1. Any member who shall be guilty of gross misconduct,
either as a member or citizen, or shall be palpably negligent of his
duty, either as a member or officer, shall be liable to expulsion, or
such other censure as the society may approve.

Sec. 2. But no judgment of expulsion, suspension, or other censure,
shall be passed against a member, till after at least one month's no-
tice and a fair trial. And no member shall be expelled unless by the
votes of three-fourths of the members present. And should such
member come forward within the six months succeeding his expul-
sion, and offer a sufficient explanation, he may be reinstated without
expense, provided three-fourths of the members present agree thereto.

ARTICLE VIL

Of the Meetings of the Society.

Sec. 1. The society shall be convened in the city of Richmond on
the third Tuesday of every month.

Sec. 2. Five ordinary members shall constitute a quorum for the
transaction of all business to which the society is competent.

Sec. 3. Special or intermediate meetings may be held by resolution
of the society at its stated meetings, and at such other times as the
president shall appoint, at the request of any three members.

Sec. 4. The stated meeting in May shall be considered the annual
meeting.

ARTICLE VIII.

Of the Election of Officers and Committees.

Sec. 1. The officers of this society shall consist of a president, a
senior and a junior vice-president, a recording and a corresponding
secretary, a treasurer, a librarian, and a committee of publication, of
three members ; all of whom shall be chosen by ballot at each annual
meeting, and shall continue in office for twelve months, or until an-
other election ; and the election shall have precedence of all other
business at that meeting, after reading annual reports.

Sec. 2. In conducting the annual election, should more than two
members be ballotted for any office, the member having the smallest
number of votes on the second or any subsequent ballot, shall not be
voted for in such ballots as may follow.

Sec. 3. In all cases of election, a majority of the suffrages of the
members present shall be necessary to constitute an election,

ARTICLE IX.

Of the Duties of Officers and Committees.

Sec. 1. It shall be the duty of the president to preside at all meetings
of the society, to preserve order, and regulate the debates according
16

118 MEDICAL SOCIETY OF VIRGINIA.

to the most approved rules of parliamentary proceeding : Provided,
Any member shall have the right of appealing to the society from the
president's decision on any question of order. The president shall
appoint all special committees, unless otherwise ordered, except the
committee of publication.

Sec. 2. In the absence of the president, the vice-presidents, according
to seniority, shall perform all the duties appertaining to the chair ; but
if neither be present, the society shall elect a member to act as presi-
dent for that meeting.

Sec. 3. The recording secretary shall keep a correct list of all the
members of the society, arranged in the order of their admission. He
shall keep accurate minutes of all the proceedings of the society, in-
cluding the names of members present, and from time to time tran-
scribe them into the record book in a fair and legible hand.

Such papers of the society as are not necessarily recorded, he shall
preserve in distinct and regular files, holding them always accessible •
for the inspection of the members.

Whenever any special committee is appointed, the recording secre-
tary shall furnish the chairman with a copy of the minute of appoint-
ment, as well as any documents that may be essentially connected
with the duties of the committee, or the chairman may require of him.

Sec. 4. The corresponding secretary shall notify all members and offi-
cers of their election ; he shall write and answer letters in behalf of
the society; and, in general, manage their distant correspondence, as
particular exigencies or the resolutions of the society may require.

He shall read to the society all communications and answers which
he may have received or made during each preceding recess, and then
deliver them to the recording secretary or the librarian, according to
their several characters.

Sec. 5. The treasurer shall receive all moneys arising from the ad-
mission and contribution of members, and shall pay the same agree-
ably to the orders of the society, certified by the member presiding.

He shall keep regular accounts with the society, and between the
society and the members thereof; and immediately preceding each
annual election, or oftener if required by the society, shall render de-
tailed statements of the business of his department, and shall deliver
up to his successor the books, papers, money, or other property of the
society remaining in his hands.

For the faithful performance of his duties, the treasurer, before en-
tering thereon, shall execute bond to the president and vice-presidents
for double the amount with which they, or any two of them, shall
judge he may probably become entrusted during his continuance in
office.

^ Sec. 6. The librarian shall have under his custody, and it shall be
his duty to take special care of, all the books, essays, and whatever
may constitute any part of the literary or scientific stock of the
society.

The books he shall give out for the perusal of the members under
such regulations as the by-laws may direct ; but no manuscript shall
be carried out of the library without a special order from the society,
except by the members of the committee of publication.

MEDICAL SOCIETY OF VIRGINIA. 119

Sec. 7. It shall be the duty of the committee of publication to select
from the essays of the members, and other communications made to
the society, such as they may think worthy of being published.

They shall, whenever they deem it expedient, report to the society
that they have selected a sufficient number for publication ; and when
the society deem it proper, the committee shall publish their selection
under the title of the " Transactions of the Medical Society of Virginia."

After the publication of each number or volume of the Transactions,
the committee shall return to the librarian all papers belonging to the
society.

ARTICLE X.

Of Amending the Constitution.

Every proposition for amending this constitution shall, on being se-
conded, be handed up in writing to the chair. It shall then be audi-
bly read by the recording secretary, after which the society shall de-
cide whether it pass to a second reading. If they resolve in the affir-
mative, it shall be placed on file to be read at the next regular meet-
ing, when the question shall be taken on its third reading, and if so
determined, the proposition shall again be read and finally decided at
the third meeting ; but shall not even then be adopted, unless with the
concurrence of three-fourths of the members present.

By-Laws of the Medical Society of Virginia.

Section 1. Two days previous to each stated meeting, the record-
ing secretary shall give notice thereof in writing to each member re-
siding in Richmond and Manchester, and six weeks previous to the
annual meeting, he shall give notice thereof through the public prints.

Sec. 6. When members resident in the country present communi-
cations to the society, they shall be allowed precedence of members
in town in the reading thereof, though junior in the time of admission
to membership; and all voluntary contributors of communications shall
be entitled to the same privilege.

Sec. 10. The annual contribution of each member residing in Rich-
mond or Manchester shall be fixed annually.

Sec. 11. The associate societies of each city, town or county, shall,
at the annual meeting of the society, report to the secretary the num-
ber and names of their members, and any other matter they may
deem of importance to the interests of the society.

Sec. 12. Each member of the society shall have the privilege of
inviting medical gentlemen and students of medicine to attend the
mee lings of the society.

120 MEDICAL SOCIETY OF VIRGINIA.

Proceedings of the January (21st) Meeting.

A very large number of members and visitors were in attendance.
After the usual business, several gentlemen were balloted for and
elected members of the society.

Dr. F. H. Deane then operjedthe subject of the evening, by making
some remarks on " the use of calomel in the treatment of scarlet fever."

Dr. Bolton here interrupted the discussion by stating that he
wished to exhibit to the society a chemical experiment for testing the
purity of cod-liver oil.* If not performed at this time it must be
omitted altogether. The attention of Messrs. Adie & Gray of this
city had been called by the president of the society to an article by
Levick, in the American Journal of Medical Sciences for the present
month. It is stated by this writer, on the authority of one who has
been extensively engaged in the preparation and sale of cod-liver oil
during thirty years, that the best method of testing the oil, is as fol-
lows : " Take a small vial half full of the oil, add say one-eighth part
of nitric acid, shake it well together ; if it turns a handsome orange
color and remains so for thirty minutes or more, it is a test for pure
oil ; but if it turns quite dark it may be suspected that other oils are
mixed with it."

An animated and interesting discussion then ensued, in which there
were many participants, and which lasted until a late hour. It should
be reported if space permitted, and will most probably be given in
our next.

Typhoid fever was then made the subject for the February meeting.

A committee of three was then appointed to report a memorial to
the city council for the establishment of a Dispensary.

A resolution appointing a committee to report the experience of the
profession in the city, in regard to ancesthesia in medical, surgical and
obstetric practice, was adopted. Drs. James Bolton, C. Bell Gibson,
John A. Cunningham and W. W. Parker wTere appointed said com-
mittee. (We are requested to ask that gentlemen in this city and else-
where, having communications to make on the subject, will please do
so as early as possible to Dr. Bolton, chairman of the committee.)

The president was empowered by resolution to appoint the number
of delegates to wThich the society is entitled to represent it in the Ame-
rican Medical Association, which is to assemble in Charleston, South
Carolina, in May next — and that he himself be included. These de-
legates will be announced in due time.

* Samples from several different manufacturers were placed in a conspicuous position, and
the test was applied. The result was, that but one responded to it. This was procured
from a person in Philadelphia by the name of Shaw, who is the agent of a house, whose
name was not learned. Some of the clear oil poured from the top of a bottle of Rushton,
Clark & Co's. turned brown. On shaking up the same bottle the next day and testing
again, a nearly black color was produced. Simes & Baker's turned to a salmon color.

Errata in January Number. — Page 5, 13th line from bottom, last word, read
"presently,"' for frequently.
Page 30, 7th line from top, read "esodic," instead of exodic.

MEDICAL INTELLIGENCE. 121

To the Medical Profession. — The undersigned, chairman of the stand-
ing committee on practical medicine, appointed by the American
Medical Association, May 1850, respectfully solicits the co-operation
of members of the medical profession in furnishing materials for the
annual report in May 1851. The duty of this committee, as de-
fined by the constitution of the association, is to "prepare an annual
report on the more important improvements effected in this country in
the management of individual diseases; and on the progress of epi-
demics ; referring, as occasion requires, to medical topography and
to the character of prevailing diseases in special localities, or in the
United States generally, during the term of their service." In order
to fulfil the objects thus expressed, the requisite data must be supplied
by medical practitioners in different sections of the Union. This is
more particularly true with reference to the "progress of epidemics"
and "the character of prevailing diseases in special localities." Com-
munications, therefore, are particularly desired from persons residing
in places in which epidemics have prevailed, or in which prevailing
diseases have been marked by special characters during the present
year. Epidemic cholera and dysentery are known to have prevailed
more or less in different parts of the country during the past summer.
Facts bearing upon the features peculiar to the present season, the
production, diffusion, mortality, treatment, &c, of these diseases, will
be acceptable. It is requested that communications upon these or any
of the subjects coming under the cognizance of the committee, be
transmitted to the undersigned by the 1st of March 1851.

All contributions with which the committee may be favored will
receive due attention and acknowledgment.

AUSTIN FLINT.

Buffalo, N. Y., Nov. 1850.

Surgical Report for the American Medical Association. — The com-
mittee is invited to meet in the Charleston hotel, South Carolina, the
evening of the first Tuesday in May next. All professional brethren
who have surgical facts connected with the improvement of this branch
of the profession during the year, will please address them to the
chairman of the committee by the 1st of April, at Augusta, Georgia.
As all cannot be reached by a circular, it is hoped no one will wait
for a more direct application than this general invitation.

PAUL F. EVE, M. D.,

Prof, of Surgery in the Louisville University, and Chairman of the
Committee on Surgery of the Am. Med. Association.

Louisville, Ky., Dec. 1850.

American Medical Association. — The committee of arrangements re-
quest all societies and other institutions authorized to send delegates,
to forward a correct list of those selected to attend the next annual
meeting, to the secretary, Dr. H. W. De Saussure, at Charleston, S. C,
on or before the 1st day of April.

In consequence of the resignation of Dr. Stille, one of the secretaries,
from ill health, all communications intended for the next meeting of the

122 ADVERTISEMENTS.

association must be addressed to the remaining secretary, Dr. H. W.
De Saussure, Charleston, S. C.

The fourth annual meeting of the American Medical Association
will be held at Charleston, S. C, on the 2d Tuesday of May next.

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Orders from private individuals, schools, colleges, academies, semi-
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ADVERTISEMENTS. 123

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THE

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No. 3,

RICHMOND, MARCH 1851.

[Vol. L

Abstract of an Essay on Typhoid Fever.

BY JOHN P. LITTLE, M. D., OF RICHMOND CITY.
[Read before the Medical Society of Virginia February 18, 1851.]

I will not speak of typhoid fever in the present paper as occurring
in Europe, or as it is found in some parts of our own country, but will
confine myself to the disease as I have met with it in practice, or ac-
quired knowledge of it by conversation and correspondence. It is
known to have existed in some parts of Virginia (in the Valley about
Staunton for instance) for fifty years past; in most parts of our state,
however, it is of recent origin. In the Valley it is the fever of the
couniry, never occurring epidemically, generally mild in character and
tedious in duration, requiring the expectant treatment, and when fatal,
generally so from cerebral complications. Dr. Waddell of Staunton is
my authority for this statement. In Loudoun and Fauquier it has existed
some twenty years, having crossed the Ridge in 1830, and has been
spreading over those counties from that mountain range ever since in
an easterly course. It did not there prevail epidemically until the
summer of 1849. It made its appearance in Danville and the region
around, about the year 1845, and the next year epidemic typhoid fever
shewed itself in Nelson, Albemarle and Madison. In 1847 and '48 it
gradually overspread those counties, and extended into and over the
adjoining ones of Culpeper, Orange, &c, and in 1S49 prevailed as
an epidemic in Fauquier and other counties neighboring. The dis-
ease has evidently pursued a northeasterly course, and has rather
spread during the summer season, as if it was borne on the south or
southwestern winds that prevail during that season. It was preceded
during the years 1845 and '46, over a large part of these counties, by
abundant remittent and intermittent fever. Regions of the upper
country, never invaded by those fevers, afforded during the summer of
those years no other affections, and in many parts of what were sup-
posed the non-miasmatic regions scarcely a family escaped the visita-
tion of one form or other of these diseases. Many of these cases
17

122 LITTLE ON TYPHOID FEVER.

were of so debilitating a character, of so long continuance and liability
to relapse, that they deserved the name of typhoidal cases. This epi-
demic of a remittent and intermittent class of fevers, with tendency to
a typhoidal character, served as a fit introductory to the more formi-
dable disease.

Great mortality accompanied the first invasion of this epidemic form
of Typhoid fever, especially in the counties of Albemarle and Madi-
son. Whole families were prostrated, both white and black, and in
some households, where forty or fifty were under the disease, more
than half died. An active treatment from mistaken opinion of the
disease, the influence of fear, and the frequent neglect of the sick,
owing to the large number affected, leaving often a very few who were
well to attend a large number of sick, were causes of this result.
In the majority of cases treated in Madison county, from one-third to
one-sixth died before the alarm subsided under a more judicious plan
of treatment. The question of contagion was often raised, and cer-
tainly there appeared some ground for the belief, as the disease espe-
cially invaded those who attended the sick, and was more apt to oc-
cur among the night-watchers. So much for the history of the dis-
ease.

The term typhoid fever has been so constantly applied to every form
of depression in fever, and the typhoid state is so often spoken of,
that it is difficult to get a clear idea of the term. Whether drawn
from the Greek word, which means debility, or from the Egyptian
word, which means the devil, it is alike applicable to the appearance
of the patient, and the provoking and often fatal character of the
disease. I consider it a true dothinenterite, the primary s}Tmptom
and essence of the disease consisting in a peculiar inflammation of the
mucus membrane (with the glands lying in it) of the small intestine,
this inflammation extending often into the large intestine ; and these
glands thus inflamed tending to take an ulcerative action. Accompany-
ing this we have general irritation of the system, shewing itself in
fever, &c, and the local irritation producing diarrhoea, and in some
cases haemorrhage early or late occurring. Other organs of the body
often become affected during the progress of the disease, and death
frequently results from these complications. Its cause is unknown ;
and the duration of the disease, if the patient die not, is generally
from four to eight weeks.

In considering the pathology of this affection, we must consider the
position of the disease and the disorders likely to arise from such an
affection so situated. It is then a disease affecting a sheet of mucus
membrane, which, if spread out, would cover a space of 1440 square
inches for the small intestine, and 500 more for the large intestine,
equal to about ten square feet. The whole of this is not equally
affected, yet the function of the whole is either destined or impaired,
and parts of it so much affected as to ulcerate. This membrane too
is the organ through which the chyle, formed from the food, is carried
into the general system, and by its action the body is nourished. It
lies too in and near the extensive ganglionic system of nerves, which,
besides anastomosing with the cerebral and spinal systems, supply the

LITTLE ON TYPHOID FEVER. 123

viscera of the abdomen in their several functions, send their ramifica-
tions to the heart and lungs, and accompany with their ganglions and
fibrilae the minutest arterial branches. It is a membrane also which
has for its base and substance an extensive plexus of veins, through
which all the blood in the body rapidly passes, and by whose diseased
state the character of the vital fluid must be essentially changed. In
these modes then the disease is dangerous ; from the direct action of
the inflammation, from the impaired nutrition, from the change in the
blood, and from the extensive and varied nervous sympathies. Ulce-
ration in such an organ is dangerous in itself, and more dangerous
from the fact that the system may be re-inoculated from this source.

Symptoms. — In all cases the approach of the disease was gradual ;
there was general uneasiness felt, and headach was complained of,
with furred tongue, a quickened pulse, disturbed sleep, chilliness and
tendency to diarrhoea. With some, the disease went no farther. I
have known patients with all these symptoms to continue on their feet
and attend to business. I had the disease in this form myself and still
attended my cases.

These symptoms continue and increase in severity ; a chill comes
on often ; the patient is compelled to lie down from weakness ; fever,
with heat of skin and a pulse varying from SO to 140, according to the
severity of the case, appears ; discharges of a yellowish color and
watery consistence, or turbid and dark brown, or black like tar and
very offensive, take place with more or less frequency, according to
the severity of the disease. Occasionally discharges of blood take
place, mingled with the matters evacuated ; epistaxis occurred in al-
most every case, and may be indeed considered almost a symptom of
the disease ; these haemorrhages occurred generally as early as the
second week. The appearance of the tongue varied ; in the most
rapidly fatal cases there was scarcely any abnormal appearance ; ge-
nerally it is coated with a white tenacious fur, becoming yellow and
black, and the tongue itself became dry as the disease advanced ; its
substance also is fissured, and sordes collects on the lips and teeth.
The gurgling sound, heard on pressing over the right iliac region, was
in no case absent after the diarrhoea had set in ; and tympanites often
occurred in the latter stages of the disease. Abdominal pain was
often complained of in the early part of the disease, more especially
if purgatives had been used improperly. Affections of the nervous
system began early and continued ; they were shewn in the headach,
debility, chilliness and muscular tremor, as seen in protruding the
tongue and in moving the body. The headach soon ceasing, either
from epistaxis or from other cause, the patient generally lies painless,
answering that he feels quite well ; the vacant look, the deafness and
other disturbance of the senses occurring early in the case, restless
slumber and unconsciousness of having slept at all, wandering of in-
tellect on waking from sleep, and muttering delirium when awake — all
indicate the decided impairment of the nervous system. To these,
in grave coses, are added, dimness of vision and a tendency to sub-
sultus tendinum. During the progress of the case, emaciation steadily
advances, and in exact proportion to the severity of the case. In the

124 LITTLE ON TYPHOID FEVER.

latter stages, sometimes sudden hasmorrhage from the bowels came
on, or violent pain and acute peritoneal inflammation carried off the
already worn out patient. In the one case, a vessel had been eaten
into by ulceration ; and in the other, perforation of the intestine had
occurred from the same cause. Again — sometimes the cervical glands
would become inflamed and swollen largely, apparently inoculated
by the depraved condition of the blood and the presence of ulceration
in the abdomen. I never knew this to occur until I felt satisfied, from
the condition of the patient and the duration of the disease, that the
glands of Peyer were in an ulcerated condition. This class of cases
generally died ; the patients not being able, in so late a period of the
disease, to bear up under the new inflammation, or death being assisted
by strangulation induced by the swelling. Hysterical symptoms I
have always looked upon with alarm, and esteemed them indications
of new danger in an already impaired and excited condition of the
nervous system. Especially is this the case, if they occur at the men-
strual period. In fact, as the disease lasts for a longer time than in-
tervenes between two menstrual periods, the occurrence of this dis-
charge and the consequent disturbance of system should be looked for
with some degree of dread. The amount discharged itself cannot
well be lost by a very feeble patient — it is often profuse ; and when
with this much excitement and consequent languor ensues, or if hyste-
ria make its appearance, a mild case of disease may become severe,
and a severe case become fatal. I regard the menstrual flow as an
alarming s}'mptom in the latter stages of typhoid fever.

Of prognosis in this disease much need not be said. Some cases
seemed marked out for death ; these died early in spite of every
effort. In some the disease was severe from its complications, and
these differed in different parts of the country and in different seasons
of the year. In the winter the head was chiefly affected, and pneu-
monia was the most frequent fatal complication during other seasons.
This came on insidiously, and could not be detected without careful
examination of the chest. The aged, the feeble and the very young
were less able to stand the length of the disease, and often sunk under
the necessary confinement of it, instead of its violence.

Our opinion in a case of typhoid fever may be regulated by ob-
serving the character and abundance of the diarrhoea, the frequency
of the pulse and the progress of the emaciation ; if these go on
rapidly there is danger, and vice versa.

Treatment. — The first thing to be done in treating this disease is, to
render the patient comfortable in the bed on which he is to lie so
long, and then to get him a good nurse.

In no disease has the " nimia cura mcdend'C caused more harm and
produced more deaths than in this one. Good nursing, without a
physician, will be twice as valuable as the most skilful physician
with bad nurses.

The indications for treatment are, to guard the important organs
and to husband the powers of nature until the patient gets well.
Many patients die of starvation in this disease. It is forgotten that
no man can lie in a sick bed for four or five weeks, with a disease of

LITTLE ON TYPHOID FEVER. 125

the organ of nutrition itself, and not require sufficient food. The irri-
tation of S}Tstem natural to the disease is increased by the want of
food, and the patient wastes for lack of nutriment. Light and whole-
some food should be given as regularly, and more frequently because
in smaller quantities, as in health. Mild laxatives, if used early in
the case, render the progress of the disease milder. They must be
used early, however; the mildest enema is alone needed during the
course of the disease. Rest, in the horizontal position, is itself a valu-
able remedy, and warm fomentations to the abdomen have a salutary
effect and add to the comfort of the patient. Venesection, although
advised by some writers, and by some physicians with whom I have
conversed, has never been required in any case that I have seen ;
nor is it recommended b}^ those on whose judgment I rely. I have
never known it to be used in this epidemic form of the disease, even
when apparently required, without being followed by death. Local
bleeding over the abdomen by cups and leeches, followed by decided
counter-irritation, was indicated, and had good effect, if early applied,
in checking the diarrhoea and mitigating the severity of the case. In
some cases it could not be borne ; the patient could not afford to lose
blood in any manner. Then, dry cupping, and stimulant applications
well rubbed in, or a large mustard plaster over the whole abdomen,
would serve. My custom was, during the severity of the case, to
have dry cups applied daily, (teaching the nurse to use large tum-
blers,) then to rub in spirits of turpentine. This last was often com-
bined with diluted nitric acid and opium. It acted as a counter-irritant,
and part of it also was probably absorbed and possessed some astrin-
gent effect on the diarrhoea. Dr. Wood's suggestion as to the use of
turpentine in some cases was found useful ; from trial, we believe
that it can be used as a valuable adjunct to treatment from the be-
ginning. Contrary to the opinion advanced by Bartlett, and sustained
by many authorities, blisters were found very useful in very many
cases. They were not used very early — not until there was some
abatement of fever ; before this they added to the excitement of the
patient. Yet, when this blistering point was reached, their use was
decidedly beneficial, and they could be used repeatedly over different
parts of the abdomen. Diuretics should be used, and the patient
often directed to pass his urine, otherwise he will forget it, and the
accumulation produce injury. Demulcent drinks, as infusion of
slippery elm, with sp. nitre dulc, were used ; ice to the head, in
cases of pain or extreme heat, and small pellets held in the mouth to
quench thirst, were adjuvants to treatment, and made more comfort-
able the patient. Astringents were of little service ; they were tried,
of all kinds, and in the severer cases nit. argent, or acet. plumb, did
not restrain the diarrhoea. Kino, either alone or combined with
opium, was decidedly the most useful of them all, and could be used
from the bemnnino; of the case.

One of the chief indications in treatment is to give your patient a
good night's rest; and to do this give him sufficient opium. This
remedy is well borne, in typhoid fever, in large doses, while the small
ones produce excitement and delirium. It is necessary that the pa-

126 LITTLE ON TYPHOID FEVER.

tient sleep ; and to do this give him from a quarter of a grain of
acet. morph. to a grain, or equivalent quantity of opium. He must
sleep ; and I have given it in the delirium, and in spite of the excite-
ment, in large quantities, with the effect of quieting excitement and of
saving life. Practitioners are too much afraid of the use of large
opiates in fever ; they use it with caution where it should be pushed
boldly.

Our most important remedies, however, were mercury and quinine;
they were the right and left hands of practice in this disease. Calo-
mel, or rather blue mass, with Dover's powder and kino, if much di-
arrhoea existed, was given in the severer cases, usually in these pro-
portions and thrice a day. 3--. blue mass iij grains, Dover's powder
vi or viij, and kino v to xx grs. This was kept up for some time ;
leaving out the Dover's powder if much excitement prevailed. As
soon as this excitement was found to be abating, quinine was used,
and increased in quantity as the patient was found to bear its use.
On this practice we were much disposed to rely; mercury as an al-
terative, quinine as a tonic, and opium sufficient to compel sleep.

In swelling of the cervical glands a blister early applied was found
most serviceable in preventing the swelling from increasing; and sti-
mulant applications, with support to the general system during the
progress of the affection, were demanded.

In one case only did any good result from treatment when subsul-
tus tendinum had set in ; it came on suddenly in a patient much pros-
trated, and an enema of soup with half an ounce of brandy and 20
grs. of camphor was administered every half hour until the patient
rallied and the affection ceased. This patient lived for several days ;
began to mend, and died suddenly under a large haemorrhage from
the bowels.

For hysterical symptoms the assafoetida enema was most serviceable.
With regard to the haemorrhages that occur, I regard two of them as
salutary. I allude to the epistaxis, which commonly occurs and relieves
the head very much, and to that haemorrhage from the bowels which
occurs early in the disease in some cases, and which appears to make
the case milder. This appears to come, as the epistaxis does, from the
congested state of the mucous membrane, and is an effort of nature to
relieve itself; it comes from the surface, and differs from the haemor-
rhage so often fatal in the latter stages of the disease. The one is
purer and brighter blood, from a vessel opened by ulceration ; the
other comes from the surface of the membrane, and is mixed more or
less with fecal matter. I am inclined to think that it occurs more
often than is imagined, and being mixed up with the discharges, is
unnoticed by the attendants. In some cases, from the beginning al-
most, a gently stimulant plan of treatment must be pursued, in addi-
tion to the use of the quinine ; and during the latter stage of the dis-
ease, while the system is depressed by its duration, and the powers
of life are scarcely able to support the ulcerative process, stimulants
of a decided character must be used according to the patient's strength
or weakness. The chief advantage of the use of mercury appears to
be in preventing complications from occurring; patients rarely be-

LITTLE ON TYPHOID FEVER. 127

come affected by it, as it seems to pass off in the discharges. In many-
cases where I saw the gums slightly touched, there were none of the
frequent complications, and the patient made a more rapid recovery.
All the physicians who treated this form of the disease agree in the use
of mercury as an alterative, and quinine as a tonic. It seems to have
arisen with different men in different parts of the country ; they were
forced into it by the nature of the disease and the insufficiency of
other treatment ; and it therefore possesses strong claims to our belief,
as the concurrent testimony of many observing physicians.

I am disposed to believe that there is antagonism between this dis-
ease and the usual bilious remittent fever of the summer. They do
not exist in the same place during the same season ; one displaces the
other; and even in the typhoidal cases of bilious fever, in which the
diseases appear mingled, the second epidemic or invasion of fever is
more likely to be typhoid than bilious fever. The one surrendering
its sceptre of terror to a rival still more terrible and dangerous. The
one is a disease of the upper country, the other of the lower, and they
mark the peculiar character of their respective districts. I would
thus account for the singular fact, often observed in the upper country,
that those who come there to escape bilious fevers are liable to se-
verer forms of fever than those of the district they left, or of that to
which they have come. They bring the seeds of one disease with
them, and engraft on it the influences of another. No class of fevers
are more difficult to treat than this one ; they require care, combina-
tion of treatment, and last for a long time, exhausting the patient by
the violence of the disease, and wearing him out by its length. The
typhoid seems destined to supplant our other forms of fever ; as in
the last year or twro it has entered the lower country of Virginia, and
is there imparting its character to the diseases. As, however, it has
always shewn itself in a milder form, after having prevailed epidemi-
cally and with violence, it is probable that, when it becomes the pre-
vailing fever of our part of the state, its violence will be so far abated
that a mild expectant course of treatment will be all that is necessary
in its cure.

With regard to prophylaxis, I have observed that in large gangs of
negroes, where saccharine substances, molasses especially, were used
as food, the disease did not prevail. I saw one case, in a cluster of
negro houses, where over sixty slaves lived and slept ; in a house too
where some dozen of them made their abode ; the disease did not
spread, although it spread through that neighborhood. Again, I knew
the disease to exist in severe forms in establishments around this one,
without invading it ; there was no difference in the food served out,
save of the kind mentioned. On making inquiry, I learn that on se-
veral plantations in the upper counties on James river, a similar fact
has been observed.

I do not assert that molasses as food is a prophylactic in this dis-
ease ; I give the fact, observed and corroborated, for what it is worth.
One other suggestion has struck me in writing ; as typhoid fever is a
disease of nutrition, and as emaciation goes on rapidly in it, would it
not be of service to the p:itient to use cod liver oil largely, as diet in
this tedious and wasting disease?

128 DEANE ON SCARLET FEVER.

I have thus put together, in as compact a manner as possible, some
memoranda of typhoid fever, preferring conciseness to completeness
of description, and thus leaving the subject open for discussion by
the society.

Remarks of Dr. F. 3EL Deane on Scarlatina and Measles,

In presenting the subject for discussion at the January Meeting of the

Medical Society.

Dr. Deane said he intended to make only a few remarks, and he
would endeavor to avoid all allusion to such features in both diseases,
in relation to which there existed unanimity of opinion among medical
men — to discuss such points would be to occupy the attention of the
society most unproritably. He would not argue the point of the con-
tagiousness of these diseases, but would merely express the belief
that both of them are contagious — scarlet fever less so than measles.
In relation to the pathology of scarlet fever, he thought the theory
which most nearly approximated probability, was the one which as-
cribed it to some morbific cause in the air, most probably an animal
poison taken into the blood, poisoning it, and that soon the nervous
system became involved, and this disorder of the nervous S3Tstem was
soon followed by that condition of things usually termed congestion —
this, at any rate, appeared to be the case, if we selected the more ma-
lignant forms in forming our opinions. However, it was his wish to
avoid the pathology of the subject as far as possible. His object was
to arrive at something useful in the way of treatment — he wished to
contrast his own experience in the management of these diseases with
that of others who were present — not that he was satisfied with his
treatment, but still it was the best with which he was acquainted. He
should select certain modifications or complications occurring fre-
quently in both diseases, and which placed the patient in circum-
stances of the greatest peril, and which involved points of treatment
of the greatest difficulty and embarrassment. But before considering
these complications he wished to premise, for fear of being classed
with those who were charged with active interference in the treatment
of these diseases, that oftener than otherwise he suffered both of them
to pass through their different stages without administering a single
remedial agent. It was certainty true that the simplest form of scar-
let fever did not require any thing deserving the name of treatment,
and the same thing was true as regards the second form in many in-
stances, and it was even to a great extent true in the malignant form.
The greatest discretion was necessary in his opinion before we ven-
tured even to administer the simplest aperient or any other agent.
Oftentimes a fearful struggle was seen to exist between the disease
and the resources of nature, and under such circumstances one could
not be too cautious how he interfered. And notwithstanding all this,
he feared there were some so much influenced by the fact that both
diseases run a prescribed course, as to induce them to push their views

DEANE ON SCARLET FEVER. 129

of expectancy rather too far. He wished to be unders'ood as being
one of those who would not be deterred in endeavoring to relieve a
perilous condition of things, because his patient had scarlet fever or
measles, by all the resources known to the healing art. He admitted
that his treatment would be somewhat modified. What he objected
to was, the ultraism which said, you should not bleed, or you should
not stimulate.

After these preliminary remarks, he proceeded to the consideration
of the complications in these diseases, to which allusion had been
made.

We are often summoned to a child fifteen or twenty months old,
and find him with a quick, feeble pulse, cool surface, pallid face, with
frequent vomiting and diarrhoea. The whole appearance of the child
indicates more constitutional disturbance than cholera morbus, occa-
sioned by ordinary causes, would produce. If you are told the child
has been guilty of no imprudence in diet, and if the season of the year
is unfriendly to the appearance of bowel affections, and especially if
scarlet fever is prevailing, you may naturally conclude your patient is
suffering from it. Such a condition of things I regard as being replete
with danger — the vomiting and purging will become more and more
frequent, the passages will soon be colorless, and unless this condition
is relieved, your patient soon has a convulsion, and probably dies in a
few hours. Now, I regard this condition as one of congestion ; the
indication is to develop reaction, and in this way relieve the over-
powered nervous system and the suffering viscera. I would seek to
accomplish this by the warm bath, the frequent application of sina-
pisms, the use of warm foot-baths, with mustard and salt in them. If
the system was greatly depressed, I would use ammonia or camphor,
and at the same time I should not hesitate to use calomel every hour
or two in one or two grain doses, until the vomiting and purging di-
minished in frequency, or else the passages improved in appearance;
and generally ten or twelve grains will accomplish this. I have often
seen this treatment fail, to be sure; I do not think, however, I ever
knew it to produce mischief. Often, by arresting the vomiting and
purging, I have seen reaction take place and patients recover that
otherwise would have perished.

2dly. We are often called to a patient and find he has vomiting and
purging, and we discover some appearance of eruption, and there re-
mains considerable heat of skin; but every time the patient vomits or
has an evacuation from the bowels the eruption greatly diminishes or
else disappears altogether. This state of things is often seen in both
scarlet fever and measles. Unless you can develop the eruption
more fully and increase the temperature of the skin, these cases will
soon become as unfavorable as the one we have just instanced, and
the termination will be as unfortunate. I would endeavor to relieve
it by the means I have already pointed out, modified, it is true, by the
circumstance that the danger is less intense, therefore not requiring the
same energy of treatment. Again, we may find the patient with pun-
gent heat of skin in scarlet fever, with a high degree of arterial excite-
ment, with cerebral disturbance enough to make you fear great

130 DEANE ON SCARLET FEVER.

hazard from this quarter, besides the patient to some extent has vomit-
ing and purging, and whilst the evacuations from the bowels are not
watery, they yet appear vitiated, and are wanting in bile. At this
time there may scarcely be any evidence of an eruption, This is a
case where you may soon expect death to ensue from injury to the
brain. I would treat such a case by the cautious withdrawal of blood
either generally or topically. I would not bleed the patient from any
hope of cutting short the disease, but merely to protect a vital organ
to enable the disease to pass through its stages ; and with a view of
relieving this congestion of the brain, I would use calomel until I dis-
covered biliary secretion in the passages. I do not wish to be under-
stood as recommending such practice as this unless the symptoms and
the whole appearance of the patient produced an impression on my
mind that the greatest danger to life was to be apprehended. Under
such circumstances I expect no aid from nature — I have seen it fail
too frequently to commend the practice to use.

The complications which 1 have alluded to occur, as I have already
said, anterior to the time of the full development of the eruption. I
will now mention one or two, often seen at or after the period of des-
quamation. At this period, the febrile symptoms, after either having
greatly diminished or disappeared altogether for a day or two, recur
perhaps with increased intensity. The tongue, from having been
clean and red, becomes indicative of less gastritis, and perhaps is
thickly coated. The external glands of the neck became greatly en-
larged, the tonsils are also greatly swoln, and the ulceration of the
throat appears worse. A calomel purge under these circumstances,
I think, often mitigates this congested and inflammatory state of things
about the throat, and simplifies the subsequent treatment. If the state
of the circulation seems to justify it, bleeding generally or topically
ought to be practised, merely with a view of moderating the symptoms.

It frequently happens ten or fifteen days after a child has recovered
from an attack of scarlet fever, symptoms of dropsy manifest them-
selves. The child appears bloodless ; the tongue looks bloodless ; it
presents no evidence of the acute gastritis which existed during the
eruptive period and the one of desquamation. A tendency to consti-
pation is seen in the place of the diarrhoea of the early stages. These
dropsical appearances may be accompanied with or without fever. I
have observed at this time that no purgative seems to distress the pa-
tient or to be followed by hypercatharsis, whereas at an early period
of the disease a small dose of oil would have produced the greatest dis-
tress. In the commencement of these dropsical appearances I am in
the habit of prescribing calomel freely, followed by some aperient.
The condition of the patient appears to be one of torpidity, and I have
found it serviceable for the first three or four days to purge actively
with calomel — if relief is not obtained, I am sure at least of some
mitigation in the symptoms, and afterwards rely upon diuretics or to-
nics, according to the indications.

In regard to measles, we often find the same condition of s}^stem
antecedent to the eruption as that which exists in scarlatina, and I
would endeavor to overcome it by the same means.

SCOTT ON SCARLET FEVER. 131

With some, I believe, there exists a great prejudice to the lancet
during the period of incubation. I think it often happens that the
tardiness with which the eruption makes its appearance, is owing to
the intense excitement — the severe congestion of the mucous tissue or
the active pneumonia, (for I have often seen pneumonia in measles
before the appearance of the eruption,) and under these circum-
stances I would bleed freely, feeling it was the best means of bring-
ing out the eruption and of lessening the consequences of a severe
bronchitis or a pneumonia. It frequently happens in this disease, as
in scarlet fever, for the first few days during the time of desquama-
tion all cause for anxiety about the sufferer is at an end. But in a
day or two you find your little patient with fever and with a slight
dry cough. He lies all the time with his eyes closed as if asleep.
The slightest movement in bed occasions the cough, or he coughs if
he speaks. The pulse is frequent and the skin is hot. This is often-
times the beginning of an obstinate and dangerous bronchitis. Of
course I do not mean to exclude blistering, bleeding, or any other re-
source known to the healing art, yet I have never seen any practice
so beneficial as calomel, given from time to time, enough to keep the
liver acting. I have seen tartarised antimony used in the most de-
cided manner from day to day and week to week. I have seen a
child pale and nauseated for hours, and yet, even when the remedy
was used for days together, I have never seen it produce the slightest
fluidity in the cough.

Dr. D. said, in the latter part of the debate, that he had purposely
avoided pathological and theoretical discussion in the remarks which
he had submitted. He would remind his friends who had introduced
the views of the text-books, that such high authorities as Andral and
others differed widely as to the constitution of the blood in scarlatina.
He did not believe in any of the abstract theories on the subject, one
being about as good as another. When pathology is more perfect we
may deduce from it proper treatment; that now is impossible.

Dr. M. P. Scott then read the following paper on scarlatina — the
calomel treatment :

One would think, from listening to the reports of the wonderful
cures performed by calomel, that we had at last found the elixir of
of life. What No. G is for the Thompsonian, calomel is for the Alo-
pathist.

It would be curious to trace its history since its introduction into
the materia inedica. There is scarcely a disease which human flesh
is heir to, for which it has not been given and extolled as a spe-
cific ; even in the present advanced stage of medical science it is
sometimes given to fulfil the most opposite indications. No matter
what the disease or its stage, calomel is the resort, and if we do not
know what is the matter, " still calomel."

Of all therapeutical agents its action is the most varied, and one
might think, by a little stretch of the imagination, that it changed its
modus operandi, according to the disease to be combatted or its stage.

Calomel is an antiphlogistic — -calomel is a sedative at one time- — ■

132 SCOTT ON SCARLET FEVER.

at another, it is a stimulant. Now it acts upon the nevous extremi-
ties— then again upon the ganglionic system. At one time it increases
the secretions of the liver — at another diminishes them ; some think
it a liver regulator and rectifier of the secretions of the whole system ;
calomel is an alterative, calomel acts by sympathy.

It is given in pneumonia for one reason; in typhoid fever, where an
opposite condition of system exists, it is also employed — as a remedy
for cholera it is highly extolled, given in small and repeated doses
and in enormous quantities, its advocates differing as to its effects, ac-
cording to the views they entertain of the pathology of that disease.
Some give it to increase the secretions, to produce black, tarry dis-
charges, which to them are the harbingers of returning health ; others
to relax the spasm of the gall duct; others to effect, they know not what,
but say experience bears them out in the propriety of its use.

Calomel is a useful and powerful remedy, and because it is, I
would be guarded in its use — it is capable of fulfilling a great many
indications, but it is given. I contend, too indiscriminately. There is
none which has been so abused and which has produced such disas-
trous effects — in many cases leaving the patient scarred, disfigured,
and sometimes maimed for life. The last case that I have noticed is
reported in the " Stethoscope," where an operation was performed to
remedy the ravages that calomel had made upon some unfortunate
who had been doubtless cured by a course of mercuiy.

I wish now to say a few words concerning its employment in scar-
latina ; but before doing so it will be necessary to go a little into the
pathology of that disease, and also to advert to some of the known ef-
fects of mercury, and then conclude if such practice is founded upon
sound pathological views. If it is not, we should discard it ; for when
we throw aside the principles of physiology and the facts drawn from
pathological investigations, we leave ourselves a position but little
above that of the Thompsonian or Homeopathist, and should no longer
practise the science of medicine, but view it as an art to be studied, by
observing the effects of certain medicines upon certain symptoms, and
giving those medicines when we think we have again met with simi-
lar symptoms.

It is with some diffidence that I undertake to give my views of the
pathology of this disease, deduced from what I have read and ob-
served. I hope, therefore, all due allowance will be made if I do not
make irryself clearly understood — I may in any event console nryself
by the reflection, that I will not have been the only person who has at-
tempted and failed in giving a clear idea of the pathology of scarlet
fever.

If you will take the trouble of examining what has been written
upon this subject, you will be surprised to find how few there are who
have succeeded in giving anything like a clear account of the causes
which produce and the effects which follow scarlatina. Some will tell
you that this is an inflammatory disease, and adduce the state of the
skin and fauces as evidence of it — they will tell you that the brain is
implicated, and ascribe the cerebral symptoms to a congested or in-
flamed condition of that organ.

SCOTT ON SCARLET FEVER. 133

Some authors, and among them one who in his prime had few su-
periors, (Dr. Chapman,) consider this disease as produced by a con-
tagious matter which is swallowed with the saliva ; its first action is
upon the mucous membrane of the prima? viae, and nature relieves
herself by a metastasis to the skin, the general system being deranged
by sympathy. This is only the Broussais doctrine, which located all
diseases primarily in the stomach or intestines. It is a mere assertion,
an hypothesis supported by no facts ; for he has to resort for an ex-
planation to the sympathetic action supposed to exist between the
jyrimce via, the skin and fauces. The explanation is worth nothing —
sympathy being a very convenient word to cloak our ignorance, and
should be discarded from the medical vocabulaiy. It is impossible to
reason with any one, if, when there is a difficulty to explain, he is al-
lowed to resort to an explanation by sympathy. I cannot subscribe
to this view. Nor can I agree with those who look upon this as an in-
flammatory disease. The fact of there being an ulcerated throat is
not enough to establish this view. We might with the same propriety
say that typhoid fever was an inflammatory disease, because the glands
of Peyer and Brunner were always ulcerated. The eruption is more
an evidence of vitiated blood than of inflammation. But how account
for the cerebral symptoms ? Certainly the existence of delirium is not
enough to prove that there is inflammation of either the brain or its
membranes. If, however, such was its condition it would not be dif-
ficult to prove it, as post mortem examinations would shew traces of
its existence.

Graves of Dublin has reported a few cases, where the symptoms
were such as to lead him to the conclusion that he had to deal with
inflammation of the brain, and he treated them accordingly. His pa-
tients died, and upon making the autopsies there was not a trace of
inflammation or even congestion.

One such fact is worth a volume of theory drawn merely from the
S3^mptoms ; it leads us to look for some other cause to account for
these symptoms.

If we could agree as to what constitutes inflammation, it would be
easier to solve the question whether scarlet fever is or is not an in-
flammatory disease. A great deal has been written in explanation,
and a great many symptoms which accompany inflammation usually,
laid down, but these symptoms may also occur when it does not exist,
so that they cannot be looked at as pathognomonic.

Andral, aware of this, investigated the subject more profoundly, and
searched for some change, wrhich always occurred. After examining
the blood of more than a hundred patients, he was led to the conclu-
sion that in all inflammatory diseases there was an excess of fibrine.
Subsequent observation has confirmed him in this opinion. Whether
an excess of fibrine is the cause of the inflammation or its product, he
was not able to establish ; the co-existence of the two he demonstrated.

"An excess of fibrine in the blood is the pathognomic sign of in-
flammation." Should we not then expect, if scarlet fever is inflam-
matory in its character, to find an excess of fibrine in the blood of the
patient? But what is the fact? According to Trousseau and others,

134 SCOTT ON SCARLET FEVER.

the blood is less plastic— more fluid than in a normal state. There is
also a diminution of red globules ; the blood is altered, but does not
present the change which we have seen always to take place in in-
flammation. I might stop here, and, if my premises are true, say,
that I have established my point, as there is not only not an increase
of the fibrine of the blood, but actually a diminution. But, again — if
scarlet fever is an inflammatory disease, ought we not to expect that
the antiphlogistic treatment would be the most successful? But the
reverse is the case, as may be seen by examining the statistical tables
of Williams, who gives the results of several modes of treatment —
the mortality being much greater under the antiphlogistic. What
does Watson sav? " Sometimes it becomes necessarv to bleed, but
do it with the finger upon the pulse." But I do not think the anti-
phlogistic treatment properly deduced from the symptoms as usually
presented. The pulse is frequent, small, and sometimes irregular ;
not indirectly, by oppression of the vital forces, but directly, and
under the influence of an agent which acts upon the blood, altering it
so that it no longer subserves properly the purposes of nutrition, ren-
dering it unfit for supplying the different organs with those constituents
which are necessaiy for the proper performance of their functions.

This cause I think to be some deleterious agent — some poison
existing in the atmosphere, which is taken into the system through
the lungs. Its effects are first felt by the blood. Here is the primary
seat of the disease, the cause a poison.

This view is supported by the alterations observable in the blood,
acting secondarily upon the nervous system, producing all those de-
pressing effects which are seen in scarlet fever. The state of the
pulse is that which characterizes the action of most morbid poisons.

Another symptom is a malignant sore throat, with a tendency to be-
come gangrenous ; another, an eruption upon the skin, through which
the poison is probably eliminated and propagated ; if eliminated, of
course from the blood. If once we admit that the primary cause is
some poison, it seems to me that we should look to its effects upon the
blood ; for is it reasonable to suppose that any poison should be taken
into the system through the blood, without its affecting this fluid in a
deleterious manner — and would not this be felt in turn by the whole
system? Cannot the cerebral symptoms be thus accounted for? Is
not healthy blood necessary for the proper performance of the func-
tions of the brain — for the maintenance of sufficient nervous energ}'- ?
' And would not a vitiated blood cause a general derangement of all
the functions of the animal economy — and is not this general func-
tional derangement seen in scarlet fever?

Why the throat and skin are selected to spend its virulence upon,
we are no more able to explain, than why one medicine acts upon the
kidneys and another upon the liver— or why one poison will prove
fatal by its action upon the nervous system, and another upon the
blood.

Now, bearing in mind the symptoms, viz : the feeble, frequent pulse,
the ulcerated throat, with a tendency to become gangrenous, and more
especially the altered condition of the blood, the depression of the

SCOTT ON SCARLET FEVEK. 135

nervous system and general debility which exists, I do not think anti-
phlogistic remedies called for — bleeding would increase the evil— nor
do I think mercury indicated.

Let us see what are some of the effects of mercury when its consti-
tutional action is produced — and first, upon the blood. It diminishes
its plasticity, renders it more fluid, and lessens the amount of fibrine
and red globules. Now certainly there is no condition of the blood of a
scarlatina patient demanding an agent acting thus upon this fluid — on
the contrary, it would appear that there was an indication for an agent
which would produce an opposite effect. Mercury would tend to in-
crease the general debility which already exists — it is a depressing re-
medy. It increases the secretion of the liver, but is not a liver regu-
lator— but this gland is not especially implicated in scarlatina. If
mercury is pushed too far, it acts as a veritable poison — the alterations of
the blood become more manifest, the face is bloated, the legs swoln —
general anasarca may be produced. Its effects upon the nervous
system now shew themselves : there will be extreme debility, ner-
vous tremor, the brain becomes involved, and according to Trousseau,
presenting symptoms somewhat resembling mania a jpotu, &c. Now,
what indication have we for mercury ? Not to combat inflammation ;
for, if the view I have taken be correct, it is not an inflammatory
disease. There is general debility and a tendency to assume a ty-
phoid state. Would not mercury increase these symptoms — does the
feeble, frequent and irregular pulse call for calomel? Cases of scar-
latina might be cited — complicated with something else, which might de-
mand the moderate use of the lancet and of calomel, just as in typhus
fever we may have to combat an affection of the lungs by bleeding or
tartar emetic ; but no one will on this account recommend such a course
in genuine typhus fever.

It may be said, that, taking the view that a poison of some kind is
the cause of the disease, the indication would be, either to neutralize
it by some antidote, or, failing in that, to assist the efforts of nature in
eliminating it. The means which she employs operate through the
various emunctories, particularly the skin. Now is not here an indi-
cation for calomel? Does not it act upon many of the emunctories,
increasing their activity? Indeed it acts upon the skin itself. True
enough ; but we lose sight of the other effects of mercury, and to do a
little good, would do much harm. I may further answer, that we
have other means of arriving at the same end, and by a safer route.
We have the class of diaphoretics for the skin, diuretics for the kid-
neys, &c. ; and it seems to me that in this channel our remedies
should be directed, merely aiding the efforts of nature. By what we
call the " heroic practice," we exhaust her resources without affording
relief from the enemy which is preying upon her vitals ; and when at
last, seeing the inutility of our efforts, we cease, and leave her to her
own exertions, she has no longer strength to rally from the double
attack of the disease and the doctor.

I wish to say a few words of a mode of treatment suggested by
Dr. Schneeman, physician to the king of Hanover. He proposes to
cure scarlatina by greasing the skin with fat bacon. His treatment is

136 SCOTT ON SCARLET FEVER.

based upon the opinion, that the skin performs probably the most im-
portant office in the human system ; that it throws off a large quan-
tity* of matter which, if retained, would disturb the functions of the
other organs, by giving to them a task for which they are unfitted ;
that the affection of the throat is due to this cause, and is cured or
prevented from occurring by a resort to fat bacon, and so with all the
other parts or organs implicated. Scarlatina is then, according to his
view, essentially a disease of the skin. We are not told what causes
this disease of the skin. I should like to go more than skin deep,
when probably we might find, that what in the first place gave origin
to the eruption would account for some of the other symptoms. He
compares the eruption to a scald. Now there is very little analogy,
if we may judge by the results produced. In a scald, the entire skin
is suddenly destroyed, and consequently its functions are immediately
suspended. In scarlet fever, there is not a total destruction of the
skin, nor is the whole of the skin diseased, neither are its functions
altogether suspended ; for new skin forms as desquamation proceeds.
If there is such an analogy, we ought to expect to behold some of
the symptoms of scarlet fever as a consequence of a burn.

As he has referred to a scald as an analogous case, I would sug-
gest other skin diseases as presenting a condition more similar to
scarlatina than a scald : for example, measles. If this remarkable
relation exists between the skin and throat, a disease of the former
causing an affection of the latter, we might reasonably expect to meet
with the sore throat as a consequence of an attack of measles. But
no; he will tell you, I suppose, that here there is some peculiarity
which causes the mucous membrane of the bronchial tubes to be af-
fected. But we meet with other diseases of the skin which derange
its functions more than either scarlatina or measles : as pemphigus,
where the entire cuticle is gradually destroyed, the patient presenting
a miserable condition. This disease is always fatal, and if Dr.
Schneeman's views are corrective might expect to behold these s}rm-
pathies and unknown relations existing in all their force. But have
we any of the symptoms of scarlet fever? Do we see the sore
throat ? Have we cerebral complications ? No, none of these ; but
the patient lingers out a miserable existence, dying by inches ; and
upon post mortem examination there is only one internal organ found
diseased, viz. : the liver, which is always found fatty. With more
propriety I might contend for some direct relation between the skin
and liver. There are also other skin diseases, as urticaria, eruthema,
psoriasis, &c, which derange the functions of the skin, yet in none of
these are seen symptoms resembling scarlatina.

Again : if the views of the doctor are correct, why do we see the
symptoms which he would make dependent upon the eruption occur
in a more malignant form when there is no eruption ? Why are we told
by those experienced in this disease that the fading of the eruption is
a bad sign; and indeed some will tell you to use all your efforts to
bring out the eruption fully? There is another circumstance which is
against this idea, namely, that the mildest cases of scarlatina are
always attended with the eruption. Sydenham tells us that it is only

BOLTON ON CATARACT. 137

dangerous through the officiousness of the doctor, yet he describes
this as an eruptive fever.

In one part of his article on this mode of treatment, the doctor says,
so beneficial is its influence upon the organs attacked by the malady,
particularly those of the throat, that the normal condition is in every
case and in every part speedily restored. In another portion he
speaks of the cerebral complications at the commencement of scarla-
tina, which are to be met by bleeding, which he goes on to say is the
sheet anchor ; he also uses mustard plasters to the shins. Now it ap-
pears to me that there is some inconsistenc}r ; first, he views the erup-
tion as the cause of all the attendant evils which are remedied by the
" fat bacon," and a few pages on says that our sheet anchor, when the
brain is implicated, is bleeding. It seems to me, if his first view is
correct, his remedies to meet the cerebral affection are wrong — he
ought still to use his "fat bacon," which is to remove the eruption,
which is the cause of the complications ; or does he view the cere-
bral complications as unconnected with the main disease — as some-
thing superadded and to be treated apart; as an inflammation of the
brain, not proceeding from the cause which in the first place produced
the disease ? Such an opinion cannot be sustained.

It does seem to me that the doctor takes a very superficial view of
the pathology of scarlet fever, and I have no idea that his fat bacon
treatment will work the wonders he ascribes to it. I have heard of a
few cases which have been treated in this manner, with the effect of
allaying the itching, for which it is doubtless very good. Another re-
commendation is its extreme cheapness, placing this remedy within
the reach of every Christian. Alas! for the poor Jews. Watson recom-
mends it as a coating for the protection of the tender skin during des-
quamation, which I am inclined to think is the best use it can be put
to in the treatment of scarlet fever.

Dr. Brooks presented a table of the post mortem appearances,
according to the different pathologists. A very interesting debate was
carried on until half past 11 o'clock. Drs. Bolton, Minor, Little, G.
A. Wilson, Snead, Haskins, Parker, Rives, Gooch, and C. P. John-
son took part. We regret that it is impracticable to give their re-
marks.

The following paper was then presented and laid on the table :

The Catoptric Test for Cataract.

BY JAMES BOLTON, M. D.

The diagnosis of cataract is often extremely puzzling. In amauro-
sis, an opacity is often observed behind the pupil, which resembles an
opaque crystalline lens.

When we consider the extreme value of the affected organ, and the

totally diverse methods of treatment applicable to the two diseases

thus liable to be confounded, we are prepared to place a high estimate

upon any means which may enable us to form an accurate diagnosis.

18

BOLTON ON CATARACT.

If the opacity be produced by inflammation of the vitreous humor
and retina, the puncture and laceration of these tissues, required by
the operation for cataract, would probably increase the existing inflam-
mation, and render the case hopeless.

When the anterior surface of the lens is opaque, owing to loss of
transparency of the anterior surface of its capsule, or of its substance,
or of both combined, the diagnosis is comparatively eas}^

There are three principal points which distinguish the opacity from
an affection of the vitreous humor. 1st. Its position. It appears
nearly in contact with the iris at its pupillary margin. 2d. Its form
being convex. 3d. It does not disappear on taking an oblique view
of it. Opacity of the vitreous humor is more deeply seated ; its form
is concave ; and it can be seen only by a direct front view.

When the posterior surface of the lenticular capsule has lost its
transparency, the opacity corresponds, both in form and position, with
opacity of ihe vitreous humor ; and the resemblance will be still more
perplexing if the cataract be in the nascent state.

In such cases, the highly philosophical, delicate and accurate test of
Sanson, called also the Catoptric Test, is of inestimable value.

The following is a description of it :

If a clear flame of a candle be held before a healthy e}^, there will
be seen upon the surface of the cornea, a bright, well-defined image
of the flame, erect, and very much diminished in size. On looking
deeply into the eye, through the pupil, there will be seen a faint, bluish
image, with an outline not well defined, erect, and larger than the first.
Between these two may be seen a third image, bright like the first,
very clearly defined, much smaller than the other two, and inverted.
There are then two erect images, and an inverted one between them.
On moving the candle across the eye, the erect images will be ob-
served to follow it, while the inverted one moves in the opposite di-
rection. The outer one traverses the entire cornea, and the other two
pass no farther than the margin of the pupil.

These phenomena are explained by the fact, that when a ray of
light penetrates a healthy eye, it encounters three reflecting surfaces :
first, the convex cornea ; second, the convex anterior portion of the
lenticular capsule ; third, the concave posterior portion of the same
membrane. The two first and second reflect upright images ; the
third, being a concave mirror, reflects an inverted one, which falls be-
tween the other two, in consequence of that being the position of its
focus.

These images furnish us with very important indications.

Obliteration of all three images indicates opacit3T of the cornea,
without giving any information as to the condition of the interior struc-
tures of the eye. Obliteration of the inverted image only, indicates
opacity of the posterior surface of the lens, with transparenc}^ of its
anterior surface, and of the cornea. Obliteration of the posterior erect
image indicates opacity of the anterior surface of the lens, and must
necessarily be accompanied by obliteration of the inverted one.

The most important of these images is the inverted one. If that
can be made out distinctly, there is no cataract ; for the posterior sur-

Johnson's medullary sarcoma. 139

face of the lens must be clear, in order To reflect the rays of light,
and the body and anterior surface of the lens must be clear, in order
to transmit these rays.

In amaurosis, therefore, all three images are visible ; in cataract,
when fully formed, only one, the corneal image, can be seen.

But this method of diagnosis is available for the detection of not
only matured cataract, but such is its mathematical precision, thai the
least departure from a healthy condition of these reflecting surfaces
is invariably indicated by a corresponding departure from the normal
appearance of the images which they present. It not only detects
the existence of cataract, but indicates its state of progression from
incipiency to maturity.

In the whole range of medical science, 1 know of no method of de-
tecting disease more beautifully illustrative of physical science, and
none which may be relied on with more implicit confidence.

The following case, although unfortunate in its termination, exem-
plifies these remarks in an interesting manner :

J. F., bookbinder, about 50 years of age, intemperate, has been
blind in the left eye for several }7ears, during which it has been sub-
ject to attacks of inflammation.

There is sufficient vision to distinguish night from day. Behind
the pupil, and very deeply situated, is an opacity of a brownish muddy
color. Its form is indistinct. The sight of the other eye is defective,
but all the images are visible.

Diagnosis. — Opacity of the posterior part of the capsule of the right
eye, with probably some degree of amaurosis, which already exists
in the left eye.

Operation. — Anaesthesia was produced by chloroform. An incision
was made in the superior margin of the cornea, through which the
lens was extracted. On the posterior surface of the capsule was an
opacity, darker at its centre and shaded off to an undefined edge.
The diagnosis was therefore accurately confirmed. The patient was
confined to bed, cold water was applied locally, and a strictly antiphlo-
gistic regimen enforced. On the fourth day the patient accidentally
used the eye for a moment, and distinctly saw some small object. In
a day or two more the eye was suddenly attacked by violent inflam-
mation and pain, which were relieved by active antiphlogistic mea-
sures, but the eye became hopelessly amaurotic.

Case of Medullary Sarcoma of the Right Breast.

Reported by Carter P. Johnson, M. D., Professor of Anatomy and
Physiology in the Medical Department of Hampden Sydney College.

Mrs. J was admitted into the infirmary of the medical college

on the 1st of May 1849. She is about 45 years of age — says that her
general health is good, though her complexion is cachectic.

The disease originally made its appearance in June 1847, and was
removed in December of that year by Dr. Spencer of Petersburg, the

140 Johnson's medullary sarcoma.

wound healing well. It made its re-appearance in June 1848, since
when it has increased with great rapidity, especially within the last
three months. At the present time, May 1849, the tumor extends
from an inch above the clavicle to the eighth rib, and from the margin
of the axilla to the edge of the sternum. It measures 2 feet in cir-
cumference at its base, 14 inches in its vertical, and 11 inches in its
transverse diameter. Its appearance is nodulated^ and the integu-
ments at some points are inflamed ; at these points softening appears
to have taken place, but no ulceration.

Having been fully apprised of the danger of the operation and of
the probability of the return of the disease, the patient still insisted on
the removal of the tumor. Accordingly, on May 3d, the patient having
been placed fully under the influence of ether, I commenced the ope-
ration, assisted by Drs. Gibson, Conway and Peticolas, by a long cir-
cular incision, beginning at the inner side of the axilla, and passing in
succession around the upper, inner and lower portions of the circum-
ference of the tumor. I then rapidly commenced the dissection from
within outwards. The enlarged vessels feeding this immense mass
sprung in rapid succession as the knife passed through them, but were
well controlled by the gentlemen assisting me. The tumor was found
to embrace the pectoral muscle throughout its entire thickness, and to
rest immediately upon the ribs and intercostals. Having carefully
separated these deep-seated attachments, the operation was completed
by dividing the integuments attached to the external portion of its cir-
cumference. Five or six vessels were then ligated.

The tumor was found to weigh 4£ pounds ; on microscopic exami-
nation, it exhibited caudate cells of various forms and sizes.

The patient lost a good deal of blood during the operation, and was
excessively prostrated, rallying only partially after the lapse of an
hour, under the free administration of stimulants.

The wound was dressed with lint spread with simple cerate, and 75
drops of laudanum with 2 ounces of brandy administered. Reaction
was slow, and her condition during the evening was critical.

May 4th. Has rallied somewhat ; wound dressed as before ; beef
tea ordered as her diet.

May 7th. Has continued to improve slowly under the above treat-
ment; wound beginning to suppurate freely.

May 8th. Suppuration very free and offensive ; ordered simple water
dressing, covered with oil silk, twice a day — wound to be washed at
each dressing with solution of chloride of lime.

May 9th. Suppuration much diminished ; but little fetor about the
wound ; pulse feeble and appearance very cachectic. Ordered precip.
carb. iron 5 grs. three times a day, and a tablespoonful of milk toddy
every two hours.

May 12th. Wound looking more healthy; suppuration slight ; gene-
ral condition somewhat improved ; increased carb. iron to 10 grs. 3
times a day, and continued the milk toddy.

May 14th. Toddy discontinued ; wound beginning to fill up ; gene-
ral condition improving.

May 19th. Improvement since last report very decided ; the wound

Johnson's medullary sarcoma. 141

is filling up from the bottom ; suppuration is very slight ; there is no
appearance of granulations, but the surface is smooth, though florid ;
the process of modelling is evidently going on, gradually filling up and
contracting the wound. Increased carb. iron to 15 grs. three times a
day.

May 24th. Wound continues to fill up rapidly, and its whole ap-
pearance is improving, with the exception of a spot on the cartilage of
the third rib, which was touched with the knife during the operation,
and now shews some tendency to ulceration. Ordered a pint of por-
ter in addition to the iron.

May 25th. Complains of a sense of fullness and pain about the
lower portion of the abdomen. Relieved by an enema and the appli-
cation of hot cloths over the abdomen. Carbonate of iron disconti-
nued and substituted by sulphate iron, grs. 12, water oz. 6 ; teaspoon-
full three times a day.

June 5th. Wound filling up and beginning to cicatrize from the
edges ; the cartilage of the third rib has become completely denuded,
and ulceration taken place along its upper and lower edges and inner
surface, a probe passing easily under it ; the cartilage and sternal por-
tion of the rib was to-day removed to the extent of 2 inches. A por-
tion of the cartilage of the fourth rib, which was exposed during the
operation, but not touched, shews also a tendency to ulceration.

June 8th. Suppuration from the cavity left by the removed costal
cartilage very abundant ; the cavity filling up by granulation ; the 4th
costal cartilage becoming extremely denuded, and ulceration com-
mencing at its upper and lower edges. Patient still occasionally com-
plains of pain and sense of weight in abdomen. Her appetite is fail-
ing and the stomach becoming irritable. Ordered her to stop the sul-
phate iron and to continue the porter.

June 12th. Cartilage of the 4th rib having, by the extension of the
ulceration, become separated from the subjacent tissues, was removed
by a chain-saw to the extent of l£ inches. Suppuration from the two
cavities left by the removed cartilages continues very abundant ; sto-
mach becoming more irritable ; occasional restlessness. Brandy and
water substituted for the porter, with an anodyne at night, as occasion
may require.

June 26th. Since the last date, the irritability of the stomach has con-
tinued almost incessantly, causing patient to reject all food and almost
every medicine attempted to be introduced to remedy this condition ;
she has been gradually growing more feeble, and for the last few days
has been occasionally irrational. Since the 20th inst. the second rib
and its cartilage, which were not exposed during the operation, have
shewn a disposition to ulcerate. The general appearance of the wound
has, within the last few days, become unfavorable, the healing process
having ceased, and the hitherto florid appearance superseded by a pale
and flabby condition ; she died this morning at 12 o'clock.

Post mortem. — Thorax — The left side was found healthy ; on the
right side, the lung was healthy ; there was general adhesion between
the costal and pulmonary pleura ; and, extending from the 2d to the
5th ribs, just under the points at which the ulceration of the cartilages

142 DAVIES ON AMENORRHEA.

and the ribs had occurred, a strong coat of lymph was found on the
outer surface of the costal pleura, covered externally by several la}*ers
of granulation. The pericardium and heart were normal. Abdo-
men— Stomach healthy, with the exception of some softening of the
mucous membrane about the pylorus ; intestines blanched, but other-
wise healthy; liver pale ; spleen, kidneys and bladder healthy; uterus
presented several tumors ; two small encepholoid masses occupying
the fundus on either side of the cavitv, each about half the size of a
hen egg ; developed apparently in the peritoneal coat of the uterus,
on its posterior surface, and connected with that organ by small pedi-
cles, were three tumors, each about the size of a partridge egg, nodu-
lated upon their surfaces, and presenting at several points in their inte-
rior depositions of osseous matter.

In reflecting upon the foregoing case, the following points have sug-
gested themselves to my mind : 1st. The history of this case affords
another illustration of the very unfavorable issue of operations upon
malignant diseases, although the general health of the patient may be
good, and the whole of the local affection may be removed. 2d. It
illustrates the great superiority of water-dressing in wounds where a
large surface is exposed, preventing, as it does, the formation of pus-
globules, and favoring the modelling process of McCartney, thus saving
the patient from an immense drain upon the nutrient elements. 3d. I
have never been able satisfactorilv to explain the cause of the denuda-
tion of the 3d and 4th ribs, neither of which were touched during the
operation, and of the ulceration of the muscular tissue attached to
them, while the other portions of the wound were rapidly healing, and
the general condition of the patient improving. 4th. This case illus-
trates very beautifully the protective power of nature in guarding the
cavity of the thorax from the effects of the ulceration going on in the
intercostal spaces ; and 5th. It illustrates the frequent co-existence of
malignant disease in the breast and the uterus, the probability of
which should always be taken into consideration in deciding upon the
propriety of the operation.

Remarks on Amenorrhosa, with Cases.

BY JOHN B. DAVIES, M. D., OF CABIN POINT, SURRY COUNTY.

Derangement of the uterine functions have so often been the subject
of comment, and the theme of such crude suggestions from novices in
the profession, that I feel some delicacy in exhibiting my experience to
the public in the form of an essay, for fear of being considered pre-
sumptuous, or having the triteness of the subject charged upon me ;
but when I know what I state to be facts, untinctured with any vision-
ary or theoretical speculations, and tending to lessen the suffering of
the females of our land, by oivinsf extensive diffusion to all knowledge

111 ' 'J o , .o "J

calculated to ameliorate a most painful and dangerous disease, I am
prompted by higher, and, I trust, nobler motives than the mere aspira-
tion of the empty bubble applause, and feel impelled by duty and be-
nevolence to offer my mite in the accomplishment of so desirable an

DAVIES ON AMENORRHEA. 143

object. It is unnecessary here to detail the symptoms, as all are con-
versant with them, and I shall only mention such as occurred in the
following cases :

Case I. — In 1S-39 I was called to Miss R. of Chesterfield, aged 24,
who had not menstruated in seven years. Pain in the head and back,
leucorrhcea, chlorotic appearance, some fever, bowels costive, tongue
white, numbness down the thighs, tumultuous action of the carotids,
fulness of the abdomen, palpitation of the heart, a periodical monthly
discharge from the uterus of a greenish fetid character, producing
excoriations about the vulva, some dysury and globus hystericus. I
ordered the following: One pill at bed time, one next morning before
breakfast, and one at 12 o'clock, unless the two first operated. Then
omit a night and day, and resume, continuing this course until the liver
disgorged itself of its morbid secretion, and healthy action was evi-
denced by yellowish discharges:

ft Mit. hyd. chlo. 3 j.

Socot. aloes 3 j.

Sapo. castil. grs. v.

Tart, antim. grs. ij. — Mix — make x pills.

If it happened, as it does sometimes, to be insufficient to produce
the necessar}' evacuation, follow the third pill in four hours with a
dose of oil and turpentine. Use red oak bark and alum, alternated
with chamomile and flax-seed tea, as tonic astringent and lubricant va-
ginal injections. This is a bold, but highly excusable robbery of the
hymen, enriching her untainted honor with the choicest blessing, health,
before which this bubble in the ocean of pleasure sinks into insignifi-
cance. It is only in cases of fetid uterine discharge that I resort to
vaginal injections in the unmarried, or when the leucorrhcea is severe
and obstinate. So soon as the digestive functions assumed healthy
action — which, en passant, I take occasion to say are always deranged
in these cases, and too much overlooked — I ordered a teaspoonful of
the following mixture three times a day:

ft Vin. tinct. sanguinariae canadensis, § ij.

Tinct. Valerianae, 3 j.

" dyttae, 3 v.

Syrupi. simp. 3* vij.

M

Keeping the bowels regular with the pills as before directed. Here
we fill three indications, the first a tonic and emmenagogue; the 2d,
calming nervous excitability, and the 3d, relieving the leucorrhcea*
One remarkable feature in this mode of treatment is, that preparations
of iron, as in ordinary anemic conditions of the system, are scarcely
ever necessary — all obstruction being removed, all the functions come
into action, and healthy blood is generated from the newly established
and improved laboratory. I may be too sanguine, too much imbued
with the spirit of enthusiasm, but in all candor and truth, I believe this
treatment as much a specific in amenorrhcea as quinine in intermittent
fever. I have never known it to fail — I have given the prescription to
many of my medical friends, and I do not believe one has been disap-
pointed.

144 SURGICAL CLINIQUE.

For this preparation, the mixture, T am indebted to my friend and
former partner in the practice, Dr. Francis J. Mettauer of Petersburg;
a practitioner whose enlightened views and distinguished medical
skill are properly appreciated where known, but one whose unobtru-
sive diffidence and innate modesty have obscured the lustre of his
medical talents.

Case II. — A negro, belonging to Mr. Sublett of Powhatan, had la-
bored under that disease for three years, complained of nearly every
symptom except the periodical monthly discharge. The same treat-
ment with the same success.

I could mention mnny more, but it is unnecessary, as the same
treatment was pursued.

Surgical Clinique of Richmond Medical College.

Service of Dr. Gibson — February 8, 1851.

REPORTED BY ALFRED B. TUCKER, RESIDENT STUDENT.

Dr. Gibson exhibited to the class this morning a negro boy 13
years old, with enlargement of the right side of the lower jaw. The
boy's master, Mr. Baylor of Essex, states that this side of the bone
has always been larger than the other, even from birth, but that it be-
gan to produce deformity about two years since, and had increased
considerably within the last six months. The patient's condition at
present is as follows : On opening the mouth, there is seen an irregu-
lar tumor, extending from the first molar tooth to the angle of the jaw,
and apparently including the roof of the coronoid process. This tumor
is very dense, and is apparently composed of bone alone, without any
admixture of fleshy fibres or of cartilage. There are no teeth attached
to it, and the only interruption to its surface is a rugged opening,
through which a probe may be passed an inch in depth. This open-
ing may be some two or three lines in diameter, and is on the inner
edge of the tumor. The external aspect of the tumor, as observed,
covered by integument, is irregularly elongated, and presents the
same dense feel when handled. The tumor is free from pain, and
has alwa}rs been so, even when rudely examined. The boy's consti-
tution has been in no way involved by this affection. There are no
general symptoms — but he is entitled by hereditary predisposition to
the strumous diathesis, and manifests it by certain characteristics.

Dr. Gibson remarked, that the diagnosis he should be disposed to
make in this case was, that of spina ventosa or cellular exostosis — a
disease non-malignant in character, and injurious chiefly by its dispo-
sition to increased enlargement, whereby the functions of mastication
and deglutition are impaired, and from the pressure of which impor-
tant parts, as the larynx and oesophagus, may ultimately suffer.

Dr. Gibson said that he thought the indication in the treatment of
this case was to remove the diseased bone, not because of actual in-
convenience at this period, but because, judging of its future advance

SURGICAL CLINIQUE. 145

by its progress in the last six months — it was much to be feared that
its removal would become necessary at no distant period, and he con-
sidered that every month's delay must add to the difficulties and dan-
gers of the operation. Accordingly, he should proceed to remove the
disease by disarticulating the condyle of the jaw of the right side, and
by section of the bone near the symphisis. The boy was laid upon
the table and caused to inhale chloroform from a sponge held in a little
piece of cotton cloth, and after some four or five minutes became un-
conscious. The first incision was made, beginning over the condyle,
and extending down in a straight line to the base of the jaw- — here
another incision was commenced, extending along the base of the jaw
until it reached a point corresponding with the corner of the mouth —
a third incision was then made from the end of the second, directly
upwards to the lip, stopping at the margin of the lip, and thus leaving
it intact. The facial branch of the carotid artery was necessarily di-
vided in the second incision, and its haemorrhage was controlled by
the pressure of Dr. Johnson's finger. The flap thus formed by the
three incisions was dissected up, and the tumor brought clearly into
view. The second bicuspid tooth was now extracted, and the soft
tissues being incised from the bone at this spot, it was cut through,
partly with the straight saw and partly by means of powerful bone
pliers. The bone being separated, was now held in the left hand, and
the surgeon began the work of separating the attachments to it within
the mouth. This was concluded with but little haemorrhage. The
bone being depressed forcibly, and as a lever, the coronoid process
was separated from its muscular connections, and finally the condyle
was removed from its capsular attachments, and the whole mass
brought away. Some delay was occasioned at this stage of the ope-
ration, perhaps in consequence of the enlarged and expanded condi-
tion of the coronoid process, which had been altogether changed in
form by the extension of the disease into it. The patient also mani-
fested considerable though momentary pain, when the inferior dental
branch of the 5th pair of nerves was cut across. After securing the
facial artery by ligature, the edges of the flap were accurately ad-
justed by means of the interrupted suture and the isinglass adhesive
plaster. A piece of lint soaked in cold water was applied over the
wound, and covered with oil silk, and the patient was removed from
the operating room.

Examination of the diseased bone verified the diagnosis expressed .

February 11th.

Dr. Gibson announced to the class that he intended to-day to per-
form the operation of extirpation of a diseased testis, in the case of a
man who had been in the infirmary during the last five or six weeks.
This man, it seems, contracted gonorrhoea whilst at work in a factory
in Manchester, about a year ago, and had orchitis supervening upon it
in May last. The inflammation of the testis resulted in suppuration
of the gland, and when he entered our institution he had gonorrhoea!
discharge, and purulent secretion from two sinuses which led into the

146 SURGICAL CLINIQUE.

testis. He was placed upon appropriate treatment, and in a short
time the urethral discharge ceased, but no amendment was observable
in the condition of the testis ; on the contrary the sinuses increased in
depth and communicated with each other, whilst the general health
began to be impaired; loss of appetite, evening exacerbations of fevers
and night sweats, all marking the general effect of the local malady.
Under these circumstances, Dr. Gibson said that he deemed it expe-
dient to perform the operation of removing the diseased testis, believ-
ing as he did, that the arrest of the dangerous constitutional symptoms
referred to would be favored thereby. He remarked that the opinion
had often been expressed that the operation of castration was too fre-
quently performed unnecessarily, and that many very distinguished
surgeons limited its employment to cases of malignant disease occur-
ring in the organ ; but that whilst he was willing to believe it had
been often needlessly performed, he could not subscribe to the limita-
tion of it to malignant disease. Indeed, he remarked, he conceived
the case before us to be one which not only admitted of, but loudly
demanded the operation, as the life of the patient, threatened as it
now is by hectic, might perhaps be saved by means of extirpation of
the testis, whilst in cases of disease undoubtedly malignant there is
too much reason to fear that no operation whatever might prove
availing.

Dr. Gibson stated that the ordinary mode of performing castration
was this : The patient being placed on his back near the edge of a
narrow table, with his feet supported by chairs — the surgeon sits or
stands between his thighs, and grasping the scrotum (which, with the
pubes, has been previously shaved,) with his left hand, makes an in-
cision through the tunics of the testes, commencing at the external
abdominal ring, and ending at the bottom of the scrotum. This in-
cision exposes the gland — the cord is now detached from its connec-
tions, and being held by an assistant, is cut across, and the testis is af-
terwards dissected out from its attachments.

Dr. Gibson stated that he had never yet performed the operation
of removing a diseased testis, but that on this occasion he should not
pursue the plan usually recommended, because he had seen in the
" Abeille Medicale" of 15th April 1850, an account of a suggestion
of M. Jobert, as to a new mode of performing the operation, which he
thought superior to any other. He stated that one of the inconve-
niences of the ordinary operation is the leaving of a deep cavity in
which the fluids accumulate, and very much interfere with immedi-
ate union. M. Jobert's suggestion is to make a sort of bi-valve flap,
exposing the testicle by a semi-circular incision, with the convexity
downwards. The scalpel is entered at the margin of the external
ring and carried from above downwards, along the external and ante-
rior portion of the tumor, as far as its base, where it takes a turn to
the inner side and remounts towards the ring, without, however, be-
ing carried quite to it. The lips of the wound open almost of them-
selves, and it is only necessary to carry the scalpel, first under the
anterior and afterwards under the posterior flap, in order to isolate
the testis. The cord is now divided, and its arteries tied. There

MEDICAL CLINIQUE. 147

thus remains a sort of shell, of which the two valves are perfectly
adapted to each other, and are consequently in a condition the most
favorable for immediate re-union, which is not in this, as it is in the
ordinary operation, interfered with by the stagnation of the fluids.

Dr. Gibson having thus explained the operation of Jobert, pro-
ceeded to place the patient under the influence of chloroform, which
was accomplished in about 12 minutes — after which he extirpated the
testis in the manner referred to.

The only haemorrhage that occurred, and this was exceedingly
slight, was from a small cutaneous artery — not requiring the ligature.
The arteries of the cord were tied, not because they poured out blood,
but for fear of subsequent bleeding. The interrupted suture and the
isinglass plaster were employed in bringing the valve flaps into ac-
curate adaptation, and the cold water dressing then applied by means
of the T bandage, and the patient removed from the amphitheatre.

Medical Clinique.

Report of Two Cases of Paralysis, occurring in the Infirmary of the
Medical Department of Hampden Sydney College — Service of Prof
Tucker. Communicated by Samuel C. Gholson, Resident Student.

Case I. — George, a negro boy, aged ten years, property of Dr.
Pollard, entered the infirmary of the Hampden Sydney medical
college on the 21st day of December 1850. He, upon examination
by Professor Tucker, was found to be afflicted with paraplegia. The
loss of motion in the lower half of the body was complete, but the
anaesthesia was only partial. Of his previous history we know no-
thing, except what was obtained from the boy himself, and that, of
course, was indefinite. He worked in a tobacco factory ; had never
received any injury from fall or otherwise. The paralysis super-
vened gradually, its first approach being only manifested by insta-
bility of the lower extremities, attended with irregularity of motion.
He had been visited several times by an able practitioner of this
city, the paraplegia having existed two months previous to his ad-
mission in the infirmary. It seems, from the note that accompanied
him, that his recovery was despaired of, his condition hopeless, and
that he had been sent here, as a dernier ressort, by the agent of his
master. We may add here, that the boy was supposed to be in-
fected with entozoa. He never voided worms, by stool or otherwise,
during his stay here.

Prof. Tucker stated, that hemiplegia was the usual form of paralysis
observed in cerebral apoplexy, softening, &c. ; whereas, in spinal hae-
morrhage, or in softening of the spinal marrow, &c, though hemiplegia
may exist, it is commonly temporary, the paralysis assuming, after a
longer or shorter time, the form of paraplegia, or paralysis of motion
and loss of sensation in all that part of the body supplied with nerves
emanating from a point below the seat of spinal disease. In this
case, taking into consideration that the intellectual faculties of the

14S MEDICAL CLINIQUE.

boy were unimpaired, that the power of motion and sensation in the
upper extremities was perfect, he deemed it admissible to infer that
the lesion existed in the medulla spinalis only. This lesion he sup-
posed to be ramoUlssement or softening of the spinal cord, but stated
at the same time, that in diseases of such long standing, and whose
seat was so inaccessible as those of the cerebro-spinal axis, it was
impossible to make a certain diagnosis, the more especially when
but little was known in reference to the previous history of the patient.
That the diagnosis could only be verified with absolute certainty, by
an actual examination of the parts implicated, and this, he thought,
from present appearances, we would have an opportunity of doing in
the course of a few weeks.

Presuming that the usual routine of remedies had been already em-
ployed, after ablutions to remove the filth that had accumulated upon
the person of the patient by want of a proper regard to cleanliness, a
purgative dose of calomel and jalap was administered to evacuate the
alimentary canal of any vitiated secretions or other irritants that might
exist in it. This was followed by the exhibition of strychnia, in doses
of iV of a grain three times a day, increased by xV every second day.
Stimulating frictions were also exercised upon the lower extremities
and over the vertebral column. The administration of strychnia, as
above laid down, was continued for a week, when marked convulsive
movements of the muscles of the legs occurred — its use was then in-
termitted, and its effects rapidly disappeared. During all this time,
the patient remained utterly helpless, passing his fasces and urine in
the bed, all the power of the sphincters being lost. The strychnine
was resumed in doses of -^j of a grain three times a day, and con-
tinued until rigid contractions of the paralyzed limbs supervened, at-
tended with spasmodic movements of the muscles of the extremities,
particularly when irritated by being touched. The patient mean while
emaciated rapidly ; ulcerations of the nates were produced by con-
tinued pressure. There was perfect anorexia. The palliative treat-
ment was resorted to, and occasional hypnotics exhibited for the pur-
pose of procuring the necessary rest. Milk toddy was given to sup-
port the flagging energies of the patient. The strychnia was never re-
newed, but its effect continued until the death of the patient, which
took place on the 7th of February.

Post mortem. — The vertebral canal was laid open from the middle
of the dorsal region to the extremity or apex of the sacrum, but no
lesion presented itself to which the grave symptoms that attended this
case could be justly referred. There was considerable congestion in
the plexus of veins about the vertebral canal, but there is room to con-
jecture whether this would produce the paraphlegia. It is to be re-
gretted that the whole medulla was not examined — a neglect which
renders the case much less interesting and instructive than it would
otherwise have been.

Case II. — Werter, a negro man, aged 45 years, entered the in-
firmary of the medical department of Hampden S}^dney college on the
22d of January 1851. The following symptoms were presented in

MEDICAL CLINIQUE. 14$

his case: — Paralysis of the left side and entire loss of sensation,
features drawn towards the right side in consequence of paralysis
of muscles of the left j tongue, when protruded, turned towards the
unaffected side. His sight seemed to be somewhat impaired, his
hearing was perfect. He appeared drowsy and as if verging upon
coma, though he could be readily aroused from his lethargy ; breath-
ing somewhat labored, pulse full and slow, but not incompressible.
The radial artery of the right side presented evidences of ossification.
Previous history only gained from the patient. He stated that he was
a workman on a canal freight boat, had suffered from repeated
attacks of vertigo, and in the present instance fell suddenly whilst en-
gaged in his work. This occurred three days before his admission into
the infirmary. He used ardent spirits ; in person he was corpulent ;
neck short and very stout. He had not been treated, as w7e could
learn, before he came into the infirmary, and had never suffered from
an attack of a similar nature to this one before.

Professor Tucker saw him on the 22d ; said that he supposed him
to be laboring under an attack of apoplexy or its consequences, pro-
bably softening of the cerebral substance, from irritation and inflam-
mation produced by the clot. ; that the disease existed in the right
hemisphere. Explained why he thought so, stating that the fibres of
the anterior pyramids of the medulla-oblongata decussated' — hence the
paralysis of the left side. Professor Tucker also remarked, that in all
probability there existed ossification of some of the arteries of the brain.

Treatment. — Cupping at back of the neck, mustard pediluvia, as
hot as the patient could well bear, sinapisms to the ankles, thighs and
breast. 23rd January. — Small doses of calomel and ipecac. ; that is,
calomelanos, grs. ij ; pulv. ipecacuanha, gr. i, every 4 hours. Jan.
24th. — Calomel and ipecac, continued — blister over the right hypo-
chondrium — size about 5 by 10 inches: during all this time the pa-
tient passed his faeces and urinated involuntarily. 25ih January. —
Cal. et ipecac, continued — purging considerable ; gum opii gr. -J ad-
ministered— 'Cupped over the nuchas again. 26th. — Salivated — mer-
cury discontinued- — he was purged freely. 27th.- — Blister at back of
the neck. Diet of the patient mild, unirritating and fluid. The act
of mastication and deglutition performed, with difficulty even pre-
vious to salivation. 28th. — Condition unimproved, complained of
want of sleep. Sulph. morphias gr. £, exhibited at night — obtained
some sleep from it. Seemed better on 29th, though still approxima-
ting a comatose condition — mouth continued sore — no ulceration took
place — patient asked for apple- water. He continued pretty much in
the same condition, passing his fasces and urine involuntarily, breath-
ing somewhat stertorously, between sleeping and waking, until the 8th
of February, when he died about 3 o'clock, P. M. It is perhaps
worth while to state, that after a few days the tongue was protruded
naturally — that is, without any forced inclination to the right side.
For several days previous to death the patient was annoyed with in-
cessant hiccoughs — to relieve which, bismuthi subnit. grs. ij et ex-
tract hyosciami g. i was exhibited every 3 hours.

The post mortem examination was conducted by Professor D. H.

150 EDITORIAL.

Tucker and Professor C. P. Johnson. It was very interesting — parti-
cularly so, for the reason that the lesions found fully explain the
symptoms that existed during life. The pia mater presented a beau-
tiful array of vessels, though obscured here and there by patches of
coagulable lymph, having underneath a jelly-like substance. In the
sub-arachnoid space a considerable amount of serum was effused.
The amount, including a small quantity of blood, which was mingled
with it, measured four ounces, and when treated with nitric acid, a
large quantity of albumen was precipitated. The arachnoid membrane
was opaque and thickened. Its consistence was considerably in-
creased. The structure of the left hemisphere of the cerebrum was
comparatively healthy, whilst that of the right side was softened,
pulpiform, and even puruloid in character. Before the substance of
the brain was incised, the existence of a large depression over the seat
of the ramollissement enabled us readily to distinguish the diseased
from the healthy hemisphere. There was not much unnatural effu-
sion into the ventricles. Some of the arteries at the base of the brain,
chiefly the posterior, communicating a portion of the circle of Willis,
were partly ossified. There was no evidence of the cerebral soften-
ing having been produced by the presence of a clot of blood. In
this case, though there was evidently very serious lesion of the brain,
it was impossible, in consequence of a want of knowledge of the pre-
vious history of the patient, of the mode of invasion, and of the pro-
gress of the disease, to diagnosticate the precise character of the or-
ganic lesion of the brain.

IBITOIIMJLS,, &@,

State Organization.

It would be needless for us here to enter into a lengthy article on
the importance and value of an organization of the profession of the
whole state. We should like to publish extracts from various letters
on that subject, received from subscribers in every part of the coun-
try, but space will not permit it in the present Number. The interests
of the physicians call loudly for an organization of some sort, and its
necessity is palpable. Many different plans may be suggested and
schemes concocted, but they will all be attended with some trouble
and labor ; they will all fail, unless there is an united action and a
good hearty co-operation on the part of all its friends, regardless of
minor details.

It has been suggested by several correspondents and others, that the
Medical society of Virginia is an institution of the state at large, and
not intended to be a local affair for the city of Richmond. It holds a
valuable charter, (we published this in our last,) under which every

EDITORIAL. 152

physician in the state may be enrolled, and which is amply sufficient
to cover an organization of a body which could effect all the practical
reform, &c. which may be achieved in any other way. Then it is
plain that the simplest and most effective mode of organizing the pro-
fession now, is to take advantage of that strong charter, and make the
respectable physicians of the state members of the society. Let it
hold annual meetings, as the American medical association does, and
let the county and city societies be branches, to regulate their local
matters — -while those of general interest would be the business of the
general state society. Other states have acted, and without having
any such advantageous medium to operate through. We are fully
aware that there are some who are unwilling to give up the charter
now held by the Richmond city society to the state at large and re-
solve it into a branch body, with a local organization, but we are as
well aware that there are some who are unwilling to do anything to-
wards the accomplishment of the object, or towards anything further
than to make and collect fees. We trust that these do-nothing gentle-
men will turn out to be in the minority, Let the profession elsewhere
in the state insist on their rights and enjoy the privilege of making
their state organization under an authoritative act of assembly, al-
ready passed, but now in the hands of the Richmond city physicians*

We hope that Virginia will be fully represented at the next meeting
of the National Medical Association, and as that body meets about the
1st of May, there is no time to be lost in making up the delegations to
represent the schools, societies, and the profession at large. It is too
much the custom in Virginia to appoint large delegations to all con-
ventions. The effect of this is, that few, if any, ever deem it their
duty to go, and the appointment passes off as an empty honor. We
therefore hope, in the appointment of delegates to go to Charleston on
the part of our schools and societies, that men who will go will be ap-
pointed, and not those who simply desire to be recorded on the roll.
We would be glad to receive correct lists and to announce them in
our next Number.

It may be well to state that, according to the rules of the association;
societies are allowed one delegate to every ten members.

A good delegation from Virginia will induce the convention of 1852
to assemble here.

152 EDITORIAL.

" A Treatise on Strabismus, with a description of new instruments designed
to improve the operation for its cure, &fc, illustrated by cases. By
James Bolton, A. M., M. D., Memb. Med. Soc. Va., 36 pp. P. D.
Bernard, Richmond.''''

We have received this little treatise from the author, and take plea-
sure in recommending it to the profession, as a simple but perfect de-
scription of this deformity, with the manner of procedure for its cure.
With it and the simple instruments described, the merest tyro may
operate with safety and success. The remarks on the cuuses, advan-
tages of the operation, and the complications, are short but to the
point. It is entirely a Richmond production — the writing, printing,
engraving and binding — and does credit to the artists.

41 Report of a case read before the Med. Soc. East Tennessee, in which the
diagnosis was disease of the Tcidney. By Frank. A. Ramsey, M. D.,
Cor. Sec," fyc.

We have received this little brochure, " published by order of the
societ}'," and perused it. It is a sort of treatise on the diagnosis of
kidney disease, with a case followed up. The paper is an instructive
one, but the author is rather indefinite in some points. After announc-
ing the death of the patient, the author says : " It is true, no post
mortem examination was made ; but with all the lights which are given
us by the developments made from post mortem examination of the
reported cases, we cannot ascribe our patient's symptoms to any other
source than the kidneys." An examination should have been in-
sisted on.

We have received the Introductory Address of Dr. M. M. Pallen,
Professor of Obstetrics, &c. in the St. Louis University, delivered to
the class of 1S50-'51. Of course, this lecture abounds in good senti-
ment and is prettily written ; but we take this occasion to remark,
that throughout our whole country pathological anatomy is too much
neglected. A proper estimate is not instilled into the 37oung doctors
of the great value of making close and accurate post mortems when-
ever an opportunity is afforded. Let us do this, and in a few 3Tears
we will not have to look to Europe for all of our pathological facts.
Of course we differ widely with Professor Pallen, where he sa3*s :
" The undue importance attached to post mortem examinations (a
valuable aid I admit) is another serious error — it leads to the neglect
of correct observation during life," &c. Now, the learned professor
may be very right in much that he says here, but it is at least a ques-
tion of doubtful policy to underrate post mortems to a class of stu-
dents, a majority of whom may never be prone to make them. They

EDITORIAL. 153

ought rather to be encouraged to do it, and every means ought to be
adopted to do away with the prejudice in the popular mind against
them.

Medical Progress, alias Fanaticism.

We have received, under the frank of a M. C, a little pamphlet
entitled " An Appeal to the Medical Society of Rhode Island,

IN BEHALF OF WOMAN TO BE RESTORED TO HER NATURAL RIGHT AS

' MIDWIFE,' and elevated by education to be the physician of her
own sex"—! ! ! " NO COPY-RIGHT," " printed for the author—
1850." Endorsed on the last outside page, is " Read and Lend," in
big black letters.

At the end is the following insinuating appeal :

" Respected Reader,

"In order to promulgate the principles of the ' mighty
truth,' I am induced to publish gratuitously the above letter, which is
offered for }Tour candid consideration and attention, and with the
prayer that it will awaken you to a sense of moral duty to accomplish
its sole object of pure benevolence. By reprinting or publishing,
(by subscription or otherwise,) and freely distributing these sentiments
throughout our country, you will aid the cause of morality and virtue,
and may God, in His infinite goodness, reward you for your labor, is
the prayer of The Author."

This filthy and obscene effusion, from some whining, hypocritical fa-
natic, has been very extensively circulated, we believe, throughout the
whole United States, and is put into the hands of women and of he
grannies. Its doctrine may work its way like priestcraft, particularly
as its language is that of ranting fanaticism and popular piety. It be-
gins, " With a deep sense of my duty to God, and my obligations to
society ; with a trusting faith that an overruling Providence will
rightly direct my efforts in the cause of humanity," (! ! !) "I wish to
address you upon a subject of vital interest, and one on which you
will soon be called upon to decide, by the overwhelming force of pub-
lic opinion, viz: Women's Rights, in this matter," &c. !!!

There are some novel facts which we learn for the first time in this
grand document. One or two of the newest are these :

" while every nation on the continent of Europe educate and

employ women only in obstetrics. In our Southern states, the negro
woman, with no other than the intuitive education of nature, always
19

154 EDITORIAL.

performs this office for her white mistress with far greater safety than
is possible for man.

" The medical college at Geneva has done itself honor in conferring
a diploma on Miss Blackwell. Mrs. Fowler and Mrs. Gleason,
with degrees of M. D., are professors in the Eclectic medical college
of Rochester, N. Y.; a female medical college has just been chartered
by the state of Pennsylvania, at Philadelphia ; female students are ad-
mitted to equal privileges in the medical colleges at Memphis and Cin-
cinnati, and are about to be admited at the medical institution at Wor-
cester, Massachusetts."

This small potato should not have received even a notice at our
hands, but for the fact of its general circulation, and our opinion that
it is calculated to make as great an impression in some communities
and produce as bad an effect, as a respectable practitioner could era-
dicate in years. "Vive la bagatelle!"

The following journals have been added to our exchange list since
the last Number :

The Northwestern Medical and Surgical Journal, 64 pages, bi-
monthly, published at Chicago and Indianapolis, and edited by
John Evans, M. D., Professor of Obstetrics, etc. in Rush Medical
College, and Edwin G. Meek, A. M., M. D.

The American Journal of Medical Sciences, with the Medical News
and Library for January and February.

The Western Medico- Chirurgical Journal, a small monthly, published
at Keokuk, Iowa, and edited by Drs. J. F. Sanford and Samuel
G. Armor, Professors in the Iowa University, No. V., Vol. 1, Janu-
ary 1851.

The Western Lancet and Hospital Reporter, Cincinnati. Edited by
Professors L. M. Lawson and Mendenhall.

The New York Journal of Medicine, edited by Dr. S. S. Purple,
an excellent bi-monthly.

The Medical Examiner for February has not yet been received.

The Ohio Medical and Surgical Journal for January is received.
We notice it contains the valedictory of its late editor, Dr. S. Plan-
bury Smith, who has been called to take charge of the Ohio Lunatic
Asylum. Dr. Richard S. Howard, who succeeds Dr. Smith in the
chair of surgery in the Starling Medical College, has taken charge of
the Journal, and promises in his introductory " to use every exertion
to make it a good journal, and to discontinue it when it is reduced to
a mere echo or reprint." From this introductory, we observe that the
profession in Ohio numbers about four thousand.

EDITORIAL. 155

The Buffalo Medical Journal and Monthly Review, edited by Dr.
Austin Flint; February Number.

The Southern Literary Messenger, of our own city, for February, is
on our table. It sustains well the high character which it bears, and
is certainly one of the best literary magazines published anywhere.
Its only fault with Virginians is, that it does not come from abroad.
We thank its able editor for his notice of us. We hope that our sub-
scribers will increase sufficiently to support our work at its present
cheap rate, though our experienced friend Thompson says we have
started on too large a scale.

To Correspondents.

Communications have been received from Dr. John P. Mettauer,
J. M. Gait, Richard H. Parker, J. L. Dorset and others, but they
came too late for the present Number.

B.'s article will appear in our next. We shall not only be pleased
to hear from him frequently, but beg that he will at least give us his
name.

Dr. S. is informed that our pages are not the proper medium for
personal wrangles between physicians. According to his statements
great injustice has been done him, to be sure, but the medical society
of his district is the proper place for adjusting the grievances com-
plained of, and we advise the doctor, (who is no doubt a gentleman
of the highest tone,) to appeal to his fellows. If there is no society in
the county, then form one at the next court.

Medical Society of Virginia.

The last meeting (Feb. 18th) was a very full one, and we were
glad to see that there were many country members and visiters pre-
sent, though at the same time the State agricultural society was in
session, and there were several other occurrences in the city calcu-
lated to draw off members. A large number of letters of applica-
tion for membership were read and laid on the table — they were
mostly from physicians in the country.

The subject of typhoid fever was then debated at great length, the
pathology of the disease being the principal topic of each member's
remarks.

156 EDITORIAL.

The whole, or such part as may be ready, of the report of the
committee on anaesthesia was made the subject of discussion for the
next meeting, (March 18th.) An interesting debate may be expected.

Dr. Bolton presented a portion of the stomach of a mare, having
its mucous surface thickly studded with larvae of the bott-fly (cetrus
equi.) The animal died of colic during the winter of 1849-50, having
been previously in fine health. She was thorough-bred, and about 9
years old.

The report of a committee to prepare a memorial to the cit}*- coun-
cil for the establishment of a city dispensary was read and adopted,
and the committee instructed to present it to the council.

The hour being late, the society then adjourned.

It may not be known to many of our readers, that every post in
France, almost from that of nurse in a hospital ward up to the highest
scientific honor, (member of the Academie des Sciences,) is filled by
public competition or concours. This system we believe will be uni-
versally adopted, unless the world takes on a retrograde action ; and
as an illustration of the admirable working of the system, we clip the

following

From the London Medical Examiner.

The Concours.

A description of the late contest for the chair of operative surgery
in the faculty of Paris, will explain the matter more fully. We ex-
tract the particulars from the " Gazette des Hopitaux" and " L'Union
Medicale." The judges were, Cruveilhier, Andral, Denonvilliers, Du-
bois, Gerdy, Langier, Moreau, Roux, Velpeau, Begin, Jobert, Gi-
melle, Baffos and Huguier. The candidates, Lenoir, Nelaton, Richet,
Gosselin, Sanson, Robert, Maissonneuve, Jarjavay, Chassaignac and
Malgaigne. Several questions are put into the urn, and the candidate
has to answer that which falls to his lot. This examination consisted
of five proofs. 1. A written dissertation, (drawn by lot,) the subject
the same for all the candidates. 2. A lecture, after three hours pre-
paration. 3. A second lecture, after twenty-four hours preparation.
4. One or more operations on the dead body. 5. A thesis, upon
which each candidate is examined by his competitors. The relative
value of the different modes of union, after surgical operations, formed
the subject of the first trial. The remaining questions were as fol-
low : On the different methods of arresting haemorrhage after opera-
tions ; subcutaneous sections ; the use of the trephine ; operations
applicable to the treatment of erectile tumors; on amputation and ex-
tirpation of tumors in general ; on amputation of the limbs ; opera-
tions for non-united fractures ; operations for varicose veins ; of arti-
cular resections in general ; operations on the iris ; operations for

SELECTIONS. 157

aneurism of the carotids ; on strangulated femoral hernia; on punc-
ture of the bladder; operation for the restoration of the eyelids.
Three operations on the dead body were performed by each of the
candidates.

The numbers were, first "tour," Malgaigne 8, Robert 4, Nelaton 2,
Lenoir 1, Jarjavay 1. Second "tour," Malgaigne 8, Robert 4, Nela-
ton 3. The election of Malgaigne must be hailed by all with satis-
faction. This mode of decision cannot invariably insure a just selec-
tion, but an incompetent candidate can never succeed.

Results of Fifteen Operations for Lithotomy.

BY P. C. SPENCER, M. D., OF PETERSBURG, VIRGINIA.

In the following operations, performed within the last fifteen years,
in Petersburg, Va., the instrument used was the lithotome cache, or
the bilateral improved instrument of Baron Dupuytren.

Case I. — A free boy, four years of age, was operated on in Sep-
tember 1833. Drs. Theophilus F. Gilliam and Birchett were present.
From some unknown cause he died in the course of the night. His
parents refusing positively to allow any kind of examination to be
made, and as the loss of blood was very inconsiderable, and nothing
unusual occurred in the operation, we were totally at a loss how to
account for his death, unless it was from a nervous shock given to the
system. The calculus extracted was about the size of a pigeon's egg.

Case II. — Mr. Edward Ragsdale, of Virginia, aged seventeen years,
was operated on October 1st, 1835. Drs. L. White, of Petersburg, and
Morrison, of Brunswick county, assisted in this operation. We found
a very large calculus encysted a little behind and laterally to the pros-
tate gland, and so completely imbedded as to require considerable
force to separate it from the wall of the bladder.

This operation was performed about fifty miles out of town, and I
was unable to see the patient as often as I wished. For a few days
after the operation the case appeared as though it would do well.
Later, however, he fell back, and steadily declined, and died on the
fourteenth day. This result was not altogether unexpected, and was
attributed to the great delay on the part of the patient in assenting to
the operation, his weak condition, and the severity of the cystic irrita-
tion, which had so long existed ; for he would only submit to the knife
in the last extremity.

Case III. — A slave, aged thirty-five years, operated on in May
1837. After the result of the two previous cases, I invariably placed
the patient under preparatory treatment, varying the treatment accord-
ing to the circumstances, and witnessed the happiest results. In this
operation I was assisted by Dr. L. White and several students of
medicine. We removed a very large calculus. The patient passed
his urine naturally on the eighth day, had no fever of consequence,
was walking about on the twentieth day, and in the course of a month
returned home cured.

158 SELECTIONS.

Case IV. — A slave, aged eighteen years, was operated on May
16th, 1837. In this operation I was assisted by Dr. L. White. We
removed a very large number of calculi, which we found this bladder
contained, many of which were so fragile that they were broken to
pieces in attempting to bring them away. This patient, much to my
astonishment, but more to my pleasure, passed his urine naturally on
the fifteenth day, had no fever of consequence, but little after treat-
ment, and returned home about the fortieth day cured.

Case V. — J. L. Long, of Virginia, aged seven years, was operated
on November 21st, 1838. I was assisted in this operation by Drs. L.
White, Cox, Michie, and several students of medicine. We removed
a calculus of medium size. On the fifth day he passed his urine natu-
rally. His recovery was rapid, and he returned home on the twenty-
fifth day cured.

Case VI. — Ripley Maggett, of Virginia, aged nine years, was ope-
rated on in May 1S39. Drs. Robinson, White and Jones assisted in
this operation. I made an opening into the rectum, and found it ex-
ceedingly difficult to effect a union of the parts. The only remedy
resorted to was the solid stick of lunar caustic, introduced into the
rectum on the finger of the left hand ; an operation which I found ne-
cessary to be exactly repeated every thirty-six hours, for if I waited
forty hours, his evacuations would pass through the cut, sometimes
fasces and urine commingled. The after treatment was more pro-
tracted than in any previous case. He returned home in about forty
days, but with occasionally some moisture of the parts. He finally
recovered, and his health has been perfectly restored.

Case VII. — Slave Ambrose, aged five years, was operated on
June 1st, 1840. Drs. White, Michie and Jones assisted in this ope-
ration. We removed a calculus of more than ordinary size. He
passed his urine naturally on the tenth day, and on the thirtieth re-
turned home cured. Nothing unusual occurred in the case.

Case VIII. — James Wells, of Virginia, aged four years, was ope-
rated on in September 1844. In this operation I was assisted by Drs.
White, Jones and Couch. He passed his urine naturally on the
eighth day, was walking about on the fifteenth, and returned home
cured on the thirtieth day.

Case IX. — Mr. H. Hardy, of North Carolina, aged eighteen years,
was operated on November 21st, 1844. The necessary preparatory
treatment was administered by Drs. Johnson and Cross, of the neigh-
borhood, when I visited him, attended by my friend Dr. J. F. Peebles,
who assisted, in conjunction with the two gentlemen above named, in
the operation. We removed an uncommonly large calculus. Although
the operation was performed with our usual caution, and in the same
manner as heretofore, yet the pudic artery was unfortunately wounded.
It is perhaps worthy of remark that this accident did not at once mani-
fest itself. It was only after the patient had been cleansed and re-
placed in bed that haemorrhage came on. After, in quick succession,
he had discharged several coagula of blood of the full size and shape
of the bladder, which he voided, impelled by a desire to urinate, symp-
toms of sinking to such an alarming extent came on that it became
necessary to replace him once more on the table, with the view of

SELECTIONS. 159

arresting the haemorrhage. Whilst preparing a tent for this purpose,
Dr. C. Cross inserted his finger into the wound, and feeling the jet of
blood impinging against it, suddenly made pressure on the spot. The
manoeuvre was eminently successful. It was soon found that he had
the bleeding entirely under control. Other measures were at once
abandoned for this simple yet direct procedure. With unflagging
zeal, altogether above all praise, Dr. C, despite the discomfort of his
position, steadily maintained the pressure on the wounded vessel for
five or six hours, when, gradually withdrawing his hand, we found
that all bleeding had ceased. A sponge was then introduced on a
canula, which was saturated with a solution of creosote, and allowed
to remain until suppuration took place.

The weak state of the patient, combined with much cystic irritation,
which continued for some time, rendered his condition extremely pre-
carious for several weeks. Under appropriate local and general treat-
ment, however, he gradually gained and finally was perfectly re-
established in health.

Case X. — Mr, J. R. Lunsford, of Virginia, aged twenty-seven years,
was operated on January 17th, 1845. Drs. White, Jones, Couch and
Strachan aided in this operation. We removed two calculi, one of
more than ordinary size, lying just in front of the prostate gland, the
other in the bladder. Finding two, either over the common size, I
examined very minutely with the finger and the instruments, but found
no other. I then proceeded to wash out the bladder with warm water
and Castile soap, and replaced him in bed. He rallied at once, and
was restored to complete health in an unusually short time. He
passed his urine naturally on the tenth day, and returned home on the
twenty-fifth day.

Case XL — Master Rufus Stallings, of North Carolina, aged four
years, was operated on May 18th, 1847. I was assisted in this ope-
ration by Drs. J. F. Peebles, White, and Thweatt. The calculus was
removed, and he commenced passing his urine naturally the next
morning. On the third day he passed all his urine per urethra, and
returned to the interior of North Carolina on the nineteenth day from
the operation, in fine health and condition.

Case XII. — Cornelius, a slave, four years of age, was operated on
May 31st, 1848. Drs. Peebles, White, Withers, and Thweatt as-
sisted in this operation. The calculus was removed, and he com-
menced passing his urine naturally on the fifth day, recovered his
health rapidly, and returned home on the twenty-fifth day well.

Case XIII. — Master Louis Blitz, of Virginia, aged seven years,
was operated on March 25th, 1849. I was aided in this operation by
Drs. White, Michie, Couch and Hinton. We removed rather a small
calculus. The health of this patient was extremely low, and his re-
covery gradual until the tenth day, when he commenced passing his
urine naturally; from that time he recovered rapidly, and- returned
home on the thirtieth day from the operation in good health.

Case XIV. — William, a slave from Williamsburg, Virginia, aged
four years, was operated on April 29th, 1S49. In this operation I
was assisted by Drs. Peebles, Michie, Withers, Couch and Durkin.
We removed an uncommonly large calculus from the bladder, mea-

160 SELECTIONS.

suring one and a half inch in length, and large in proportion. The
little boy had suffered from birth, and had become so much emaciated
and relaxed as to render the operation most difficult. After the first
cut of the scalpel, such immense relaxation and prostration of the lin-
ing membrane of the rectum took place, that I was compelled to lay
the bistoury down frequently to replace the protruded membrane be-
fore I could complete the necessary section to get in the groove of the
staff. In the progress of the operation, I unavoidably cut into the
rectum, as I apprehended. Having committed the same error in the
sixth case, or operation on R. Maggett, I at first feared much trouble,
but suggested to my friend Dr. Peebles the propriety of locking up the
bowels, with some preparation of opium, and permit the small open-
ing in the rectum to heal as speedily as possible. To our astonish-
ment and gratification, in a few days the part had healed and become
firm, and on the fourth day he passed his urine naturally. Recovery
in this case was as speedy as in any I had ever known. On the
twenty-second day from the operation he returned to his home in Wil-
liamsburg, full of life and health.

The above mode of treatment I have since ascertained, first sug-
gested, 1 believe, by M. Chomel, of Paris, is now generally employed
in cases of intestinal perforation occurring in typhoid fever. It is cer-
tainly applicable to all cases of wounded intestines, and I perceive that
Dr. Gerhard also recommends it in pneumothorax.

Case XV. — Mr. A. Wells, of Virginia, aged twenty-eight jTears,
was operated on September 23d, 1849. I was assisted in this opera-
tion by Drs. Couch, Peebles, Hinton and Rives. We removed a cal-
culus weighing five hundred and sixty-three grains. The enormous
size of the stone considered, it was with no little surprise and pleasure
that we found him passing his urine naturally on the eleventh day.
His general health improved rapidly, and the only after treatment pur-
sued was the infusion of buchu through the day and a good and nour-
ishing diet. It may be proper to remark here, that the external inci-
sion did not heal as rapidly as we anticipated. The healing process
was very gradual, and it was not until the caustic had been several
times applied that we could get the part to heal completely.

Recapitulation of the Fifteen Cases.

1st case died in the course of 12 hours.

2d do. " " " " 14 days.

3d do. urinated naturally on the 8th day.

4th do. " " " 15th day.

5th do. " " " 5th day.

7th do. " " " 10th day.

8th do. " " " 8th day.

10th do. " " " 10th day.

11th do. " " " 3d day.

12th do. '• " " 5th day.

13th do. " « " 10th day.

14th do. " " "4th day.

15th do. " " " 11th day.

SELECTIONS. 101

In the 6th and 14th cases the rectum was cut. In the 9th case the
pudic artery was divided.

Of the 15 cases, 9 were whites, all males; 3 boys, 4 nearly grown,
and 2 over 21 years of age. The number of blacks 6, 4 boys and 2
men. — American Journal of Medical Sciences.

[Case XVI. — The boy Austin, a slave, aged 17 years, having la-
bored for years under a painful affection of the bladder and urethra
penis, as was supposed by some of the profession, was, on the 26th
February 1850, ordered to this place, to have an examination made.
It was supposed, from the general history of the case, that a calculus
of ordinary size was contained in the bladder. The introduction of
the sound shewed this to be true — and after the necessary preparatory
treatment, the operation was performed, March 3d, 1850, Drs. Peebles,
White and Cox being present. We removed a calculus weighing 630
grains. I think it extremely probable that more than one opening was
made into the rectum, owing to the ungovernable character of the sub-
ject, the difficulty of managing him being greater than in any former
case. On the third day, I found the urine passing off with the faecal
evacuations — and to remedy it, gave the opiates a fair trial. They
were ineffectual. In this case sloughing of the celular tissue was very
extensive. After the use of the opiates the stick caustic was resorted
to — it being applied every 36 hours, was also ineffectual. Recovery
being slow, it seemed important that the improvement of his general
health should be looked to. To accomplish this, a more generous diet,
in combination with quinine and camphor, moderate exercise, and
longer intervals for sleep and quiet, were recommended. These acted
like a charm. On the 22d May he returned home, and very soon en-
joyed complete health.

He has not been heard from since November last ; he was then
well and growing rapidly ; he no doubt continues well, or he would
have been heard from, as he lives only a few miles out. — p. c. s.]

Attending Families by the Year. — The plan of attending
families by the year is dictated by a trading, mercenary spirit, un-
worthy of members of a dignified profession. It has too much the
air of pelf about it, and should at once be abandoned. It may suit
the dealer in matches, the butcher or the iceman, but is clearly out of
place among physicians. We are glad to hear that, notwithstanding
the efforts of some members to have it recognised by the Medical
society, that respectable body unhesitatingly condemned it. — St.
Louis Probe.

[We cordially concur in the sentiment here expressed. In Rich-
mond (and throughout the state, we believe,) the practice has long
since been scorned down. If there are any exceptions, the low
tradesmen in the profession who practise it are beyond the pale of
respectability, or conceal their names even from the public. — Ed.~\

162 SELECTIONS.

Case of Communication letween the Stomach and External Surface of
the Abdomen. — In the last number of the Edinburgh Monthly Journal
of Medical Science, is a paper by Dr. William Robertson, one of the
editors, upon the case of a woman who has a communication between
the stomach and external surface of the abdomen. The great simila-
rity between this patient and Dr. Beaumont's, Alexis St. Martin, who
was the subject of many experiments in this country, some years since,
has induced the Medico-Chirurgical society of Edinburgh to make si-
milar observations and experiments upon her, so far as may seem
compatible with her welfare. The committee to whom is entrusted
the examination, consists of Drs. Christison, Bennett, Maclagan and
Robertson, with Messrs. Syme and Goodsir. We have no doubt that
this committee, which consists of gentlemen eminent in medical litera-
ture and science, will make many interesting observations in the phy-
siology of digestion, which the modern researches on that subject
would seem to render very desirable. This opening into the stomach
is attributed by Dr. Robertson to a chronic ulcer in its cavity, which
occasioned, " whether by perforation or otherwise, extension of inflam-
mation to a limited portion of its external surface, and consequent ad-
hesion to the abdominal parietes — that thereafter an abscess formed
external to the stomach, and discharged its contents into the viscus —
that the contents of the stomach, acting upon the walls of the abscess,
ultimately caused the ulceration of the integuments." — Boston Med.
and Surg. Journ.

Vaginal Speculum. — Mr. Haslam of Harvard Place, Boston, is
the inventor and manufacturer of an improved vaginal speculum. It
is made of glass, and silvered on the outside ; the silvering being co-
vered over by gutta percha, makes it, of course, perfectly safe. The
inside of the tube is a perfect mirror, and will reflect the light better
than a metallic one ; besides, there cannot be any danger of corrosion,
either by the secretions or the substances used in medication. This
speculum has been used by many of our best physicians for a year or
two past, and has given the greatest satisfaction. Since the first ones
were manufactured, the proprietor has made improvements upon them,
in form, size and covering, but can still afford them at prices extremely
moderate. — Boston Med. and Surg. Journ.

[We know this excellent speculum of old, as Dr. Simpson's of Edin-
burgh.— Ed.~\

In the 39th No. of the American Journal of Medical Sciences, Prof.
Bigelow of Boston has made a complete record of the history of one
of the most unparalleled cases in the annals of surgery. It is the case
of recovery after the passage of an iron crowbar through the skull,
carrying away with it much of the substance of the brain.

This case occurred in the practice of Dr. Harlow of Vermont, in

SELECTIONS. 163

September 1848, and full details of it and the present healthy condi-
tion of the patient are given in the journal above referred to, where
the curious or skeptical may satisfy themselves of the authenticity of
the report, and of all the circumstances. As portions of the brain to
which are allotted different functions, passions, &c, were entirely de-
stroyed, phrenology would teach that these functions would be entirely
annihilated. This, however, was not the case, for " the man was still
able to walk off, and talked with composure and equanimity of the
hole in his head," and has never been, up to this time, other than a
rational man, save for a short period at an interval of about a fortnight
after the accident.

A New Propei'ty of Chloroform. — Academy of Sciences, Paris, Nov.
11, 1850. — M. Augend of Constantinople, transmitted a memoir, in
which he pointed out a property that places a very distinct line of de-
marcation between chloroform and ether ; this is, its power of disin-
fecting organic matters. M. Augend related the following experi-
ment :

Take three wide-mouthed flasks, the first containing a few drops of
ether, the second a few drops of chloroform, the third left empty. If
in each of these a piece of beef be placed, and the flasks be closed
and left undisturbed in the summer season, the following circum-
stances wTill be observed : The meat, which was of a reddish brown
color in its natural state, changed instantly to a vermilion-red in the
mixture of chloroform and air, while in the ether vapor no change oc-
curred. At the end of a week the difference was greater still ; the
meat in the flask containing atmospheric air was but little changed in
its aspect ; that in chloroform had acquired the appearance of boiled
meat. On opening the flasks it was found that the meat, both in the
atmospheric air and in the ether vapor, was putrefied, and emitted a
most offensive odor ; while that in the mixture of chloroform and air
had the sweetish taste and odor of chloroform.

M. Augend has ascertained that Tooth of chloroform completely
prevents the putrefaction of fresh meat. The most apparent action
of the chloroform is the rapidity with which it traverses the thickest
tissues, and causes an immediate contraction of their parenchyma,
with consequent exudation of the fluids of the structure experimented
upon. The author further dwelt upon the value, in a medico-legal
point of view, that chloroform thus possesses in arresting putrefaction.

[_Med. Gaz.

Medical College Circulars. — Does not the honor of the j)rofession
call for a reform in relation to the spirit and tone of these circulars?
Read the following from one of the fraternity — the editor of the West-
ern Lancet : " We wish to call the attention of our friends, the pro-
fessors of medical colleges, and also the editors of medical journals,
to the style of commendation which has for the last few years crept
into the circulars of our medical schools. It is not necessary to al~

164 SELECTIONS.

lude to the origin of this practice, or to designate one college more
than another, for all are more or less implicated in it. It appears to
us that the style of these documents might be much improved, and
made to conform more to professional propriety than they do at pre-
sent, with advantage. We see no reason why a body of men, col-
lectively, ought to say that about themselves, that would be impro-
per for any one to say about himself as an individual. Professional
etiquette and propriety prohibit puffing and laudatory notices of one's
self'l Ought it not to be equally binding on an association of medical
men ? We have thrown out these few thoughts without intending to
cast censure, but for reflection ; if we are wrong, we do not object to
being set right." We may, in a future number, say something on the
character and tendency of these annual productions. — [N. Y. Jour,
of Med.

Cod-Liver Oil in Phthisis. — M. Duclos thus sums up the results of
his experience with this substance : 1. The presence of fever is what
we must chiefly attend to, relying more on this remedy when it is
absent and less when it is present. 2. The remed}^ frequently arrests
the progress of the disease when only in the first stage. 3. It rarely
arrests it when in the second stage, although it may retard it. 4. The
third stage is not favorably influenced by the oil. 5. The oil should
be administered for a considerable time, and, if a good effect results,
it should be suspended awhile, to be' again resumed. Thus, it may
be given for two months and then suspended for a fortnight, resumed
for a month and re-suspended for a fortnight again, so as gradually to
reduce the length of the intervals during which it is given. 6. The
clear, slightly smelling, nearly tasteless oil, is less efficacious than the
brown, thick, strong oil. — Brit, fy For. Med.-Chirurg. Rev., Oct. 1850,
from Bulletin de Therapeutique, xxxviii.

On the best manner of administering Iodine — Use of Iodide of

Starch.

BY DR. QUESNEVILLE.

The interesting memoir lately published by M. Chatin should at-
tract the attention of medical men to the important part that iodine
plays in medicine. According to M. Chatin, in fact, iodine is to be
found in nearly all soft waters ; it exists in plants, in terrestrial ani-
mals, in fermented liquors, wine, cider, perry, in milk and in eggs. It
forms a part of arable earth, and its presence, in a word, is almost
universal in all the aliments used by man.

When iodine is absent from the waters of certain springs and of cer-
tain countries, it is remarked in these countries that the inhabitants are
more unhealthy and have a peculiar predisposition to scrofula and
goitre. The water from wells, always so unwholesome, does not con-
tain nearly as much iodine as soft water, and the water proceeding

SELECTIONS. 165

from the liquefaction of snow is totally without it. These observa-
tions, supported by between five and six hundred analyses, are most
important, and should be taken into serious consideration by medical
practitioners.

Reflecting on all these facts, we asked ourselves under what form
iodine could be administered in medicine ; we then remembered that
many years ago we recommended the use of soluble iodide of starch
to some scrofulous patients, and that the cure had been remarkably
prompt.

Combined with a body like starch, so easily assimilated with the
other digestive principles, iodine is liberated immediately on its arri-
val in the stomach, and thus disengaged from its combination.

It then acts as iodine would act were it administered in the pure
state and not combined with alkalis or metals which cause the loss of
a portion of its virtue.

M. Huette proposes the use of hydriodic ether, which he advises to
be inhaled by the patients. This means is without doubt most inge-
nious, and may render great services in certain exceptional cases.

Whilst trying to reproduce soluble iodide of starch, we remarked
that sugar heated for some time with the iodide of starch, precipitated
as a paste, combined with it perfectly, and that the syrup which is ob-
tained from it was of a very deep blue color and perfectly transpa-
rent ; this, then, will enable us to prepare a syrup with the iodide of
starch.

Wishing to know in what proportions this syrup of iodide of starch
can be prepared, we have made it ourselves, and have obtained the
proportions of 12 grammes of iodide of starch to 1 kilogramme of sy-
rup, which represents, according to the composition of iodide of starch,
5 grammes of iodine to each kilogramme, or £ per cent. When it is
wished to give iodine in small doses, to order it for children for exam-
ple, to susceptible systems, or to stomachs already irritated, nothing
can be better than the soluble iodide of starch. It thus replaces suc-
cessfully the cod-liver and skate-liver oils. In giving large doses of
iodine, as the syrup, if taken in too great quantity, becomes disagree-
able, it can be replaced by powder of iodide of starch, which can be
given like rhubarb, made into pills or simply mixed in water. These
powders contain, combined with an excess of starch, 10 per cent, of
iodine ; they are perfectly washed in boiling alcohol in order to deprive
them of all excess of iodine which would be dangerous.

Iodide of starch can be taken in very strong doses without irritating
the stomach or intestines ; it acts much more readily than the other
compounds of iodine, and should be preferred to them in most cases,

[Revue Seientifique.

Re-Vaccination in Prussia. — Re-vaccination is systematically
practised in Prussia. No child is admitted into a school without
proof of vaccination, and every recruit is vaccinated on admission
into the army. In the year 1848, 28,859 soldiers were vaccinated ;
of these, the vaccine disease was regular in 16,882 ; in 4,404 indi-
viduals it was irregularly developed, and in 7,573 it did not take any
effect. — London Medical Gazette.

166 SELECTIONS.

Poisoning with Hemlock.

BY DR. BOUCHARDAT.

Cases of poisoning with hemlock are rare. I have lately had occa-
sion to observe an instance at the Hotel-Dieu. A young woman had,
in a moment of desperation, as she said afterwards, swallowed a strong
dose of the juice of hemlock, which she had herself prepared, being
aware of the poisonous qualities of this plant.

When brought to the hospital, she was unconscious. The only guide
I could obtain was this — " This woman has knowingly poisoned her-
self with a plant, which she gathered in the neighborhood of Meudon."

The eyelids were firmly closed ; force was necessary to open them ;
it was then clearly perceived that the pupils were dilated ; respira-
tion, though weak, was performed in a satisfactory manner ; ,the pulse
was small and 82. The skin, although not icy, was cold ; some slight
spasmodic movements were to be remarked in the superior members
as well as in the muscles of the face.

I thought that an hysterical attack complicated the effects of the
poison. I suspected stramonium, or other poisonous solanum, digita-
lis or hemlock. In this dubious state, it was certain that the best
course would be to cause vomiting, and then, by examining the mat-
ters expelled from the stomach, to ascertain the nature of the poison
which had been taken. Fearing a decomposition of the emetic, I pre-
scribed a mixture of 1£ gramme of ipecacuanha in powder, and 15
centigrammes of tartar emetic, in three doses, to be administered at
thrice with five minutes interval.

The emetic draught acted thoroughly, the patient vomiting several
quarts ; the liquid thrown up was slightly green ; but after these vo-
mitings she seemed to be going on so well, that I thought it better to
wait before prescribing anything further. The improvement was so
rapid, that by the evening she was nearly well; and the next day she
felt no farther inconvenience from it. — Repertoire de Pharmacie, Au-
gust 1850.

On the danger of tying up the Lower Jaw immediately after

supposed death.

BY C. J. B. ALDIS, M. D.,

Fellow of the Royal College of Physicians, and Lecturer on Medicine at the Hunterian

School.

Various well known practices are resorted to by the public imme-
diately after the supposed death of their relatives or friends, such as
placing shillings on the eyelids, a plate containing salt on the abdo-
men, touching the body, closing the nostrils, and tying up the lower
jaw. Some of these peculiarities are harmless enough ; but the two
latter may be the means of destroying life, either wilfully or through
ignorance.

C — — , an infant, aged two months, was brought to me at the Lon-

SELECTIONS. 167

don dispensary, on a Friday, a short time since, by its mother. It
became atrophied soon after birth, and continued in that state for two
months. The mother having taken away the child, returned with it in
a few minutes, told me that it was dead, and asked for a certificate. I
examined the neck, and found the lower jaw tied up so tightly, as to
prevent its being moved. I immediately set the jaw free, and asked
why she had fastened it up so quickly. She replied that a woman at
the dispensary seeing the jaw fall, and thinking the child was dead, had
done it up. I declined giving a certificate then, but kept the mother
in conversation for a minute or two, in order to see if any change took
place in the countenance of the child, when the right eyelid began to
move, and soon after the infant was restored to its usual state, and
did not die until the following Monday.

It is very probable that the child would have been destroyed on the
Friday had I left the dispensary before the mother's return ; and it
is also probable that in another case, with more stamina in the consti-
tution, life might have been preserved for a longer period. It is true
that air would gain access to the lungs through the nostrils, though
the mouth be firmly closed, but not sufficient to keep a very weakly
child long alive, especially when we consider the pressure frequently
made against the larynx on binding up the lower jaw, and the effort
required to fill the lungs with sufficient air merely through the nostrils.
Is it not, then, obvious that the public should wait until a medical man
has seen the body, or at least for a few hours after death, without pre-
cipitately tying the lower jaw, and incurring the risk of committing
murder ? — Lancet.

Complete Ahsence of the Anus and Rectum. — M. Forget lately pub-
lished in U Union Medicate the case of a child which thirty-six hours
after birth had not passed any meconium. In place of the anal
orifice, there was an elastic piece of skin which did not yield a
sense of fluctuation. M. Forget, though he suspected an absence of
the rectum, thrust a small trocar into the pouch, but brought away a
few drops of blood only ; he continued to search for the rectum with
a straight bistoury, but found no such gut, though his knife was fairly
in the pelvis. M. Forget proposed to the parents an artificial anus in
the iliac fossa, but this was obstinately refused, and the child sent to
nurse into the country, where it died, amidst homble suffering, without
having passed any motions.

On a post mortem examination the descending colon was found to
end in a blind pouch opposite the lumbo-sacral articulation, and from
this bag a fibrous cord, representing the rectum, was proceeding
through the pelvis to the septum across the anus, holding the same re-
lations to the surrounding parts as the rectum would have done. M.
Forget mentions four cases, where both rectum and anus were want-
ing; they are respectively related by Ruysch, Binninger and Jamie-
son. The author infers from this case that surgeons should search
for the rectum with much caution, when called upon to remedy an
anal malformation. — Lancet.

168 SELECTIONS.

[A case somewhat similar to the preceding has been related to us by
Dr. Boaz, we believe, of Albemarle county, Va. As well as we re-
member the description, the rectum was only a small tube resembling
an ureter, and terminating in the vagina of the infant. The child died,
and we believe a dissection was made. Will Dr. B. be good enough
to write out a description of it? — Ed.]

On Phospkenic Phenomena. — M. Serres (of Alais) lately addressed
a paper to the Academy of Sciences of Paris, in which he endeavors
to shew that the luminous impressions excited in and around the eye
by pressure in the neighborhood of the organ, and called phosphen,
might be rendered useful in ophthalmology, as a diagnostic sign, in
those diseases of the eye where it is of importance to ascertain the
state of the retina, and the degree of paralysis which it has suffered.
After more than one thousand trials, the author has found that the lu-
minous circle has always been produced when the pressure has been
applied on the nasal side of the eye ; and when, after several days
trial, no annular light is thereby excited within the eye, it may confi-
dently be concluded that the retina is paralyzed, and that any opera-
tions performed on the cornea, the iris, or the lens, would have no
good results.

Observations on the Emmenagogue Properties of Polygala

Senega.

BY CASPAR MORRIS, M. D., OF PHILADELPHIA.

Among the articles contributed to the materia medica by our own
country, not one is more important than the polygala senega. How-
ever little its virtues may be esteemed abroad, there are few American
physicians who do not recognize its importance in the treatment of
certain stages of croup and bronchitis. My present object, however,
is not to celebrate its praises in affections in which its value is so
generally appreciated, but to draw attention to its effects in a class of
cases which often baffle the efforts of the physician and cause no little
anxiety to the patient — to properties which, though recognized be-
fore, have been overlooked or forgotten. It is now more than twenty
years since my attention was first directed to the emmenagogue pro-
perties of this root. I cannot recall the source from whence the
knowledge of its virtues was derived, but am disposed to ascribe it to
the teaching of Professor Chapman, as I find on reference to his work
on therapeutics, that he speaks of them in very strong terms of com-
mendation, and gives the credit of first drawing the attention of the
profession to them to the late Dr. Joseph Hartshorn. At the period
to which I refer, I was induced to direct the employment of the senega
for an unmarried lady, of about thirty years of age, suffering from sup-

SELECTION?. 169

pression of the menstrual discharge of several months duration, com-
bined with a catarrhal affection. So prompt was the restoration of
the uterine discharge, that I considered it a mere coincidence, and re-
marked it as one of those cases of facts which may be misapplied so
as to teach error instead of truth. Since then I have had ample op-
portunity to verify its claims to the credit of the result.

The tendency of its influence to the sexual and urinary organs has
often since arrested my attention, in cases of children to whom I have
given it for croup, in which I have found difficult micturition follow
its use, sometimes to a degree quite inconvenient. Pereira mentions
among its physiological effects, "increased secretion of urine and feel-
ing of heat in the urinary passages," and adds, "it appears to excite
moderately the vascular system, to promote the secretions (at least
those of the kidneys and skin, uterus and bronchial membrane) and to
exert a specific influence over the nervous system ;" he mentions the
fact that "it has been used as an emmenagogue in amenorrhosa." In
the Dispensatory of Wood and Bache there is a mere casual allusion
to its having been recommended in amenorrhcea ; while Dr. Eberle
refuses credence to the assertion that it possesses any emmenagogue
properties. The strong testimony of Dr. Chapman deserves to be
disseminated anew, as it may be overlooked among the many modern
works on materia medica and pharmacy. I shall therefore furnish it
for the benefit of your readers.

He introduces it first on the list of emmenagogues in the following
terms: —

" To Dr. Hartshorn of this city, we owe the credit of having dis-
covered the properties of this article as an emmenagogue. Conversing
with him some years ago on the difficulty of managing certain forms
of amenorrhcea by the common treatment, he told me that he thought
he had used it with advantage in these cases. Confiding in the accu-
racy of his observations, I determined to lose no time in making trial
of the medicine. This I have done since, both in my public and pri-
vate practice, to a considerable extent, and with sufficient success to
warrant me in recommending it as one of the .most active, certain, and
valuable of the emmenagogues. It may be used either in powder or
decoction, though I prefer the latter mode. My rule in the adminis-
tration of the medicine, is, to direct about four ounces of the decoction,
more or less, during the day, according to the circumstances of the
case. But at the same time when menstrual effort is expected to be
made, and till the discharge is actually induced, I increase the dose
as far as the stomach will allow, having given sometimes as much as
two ounces every hour. In the interval of the menstrual periods, I
lay aside the medicine for a week or two, as without these intermis-
sions, if it does not lose its power, it becomes disgusting to the patient."

Dr. Chapman directs the decoction to be made by putting one
ounce of the bruised root in a pint of boiling water, in a covered ves-
sel, and reducing it one-third by slowly simmering; and recommends
that its nauseating tendency should be averted by the addition of an
aromatic bitter. I have not found my patients able to bear so large
doses as those indicated by Dr. C, and have been wont to add liquor-
20

170 SELECTIONS.

ice root, which disguises the peculiar taste of the senega, and continue
the process until it is reduced to one-half. A tablespoonful three times
daily of this strength, is generally tolerated without difficult}''. My
habit is, when I can determine the period at which the natural ten-
dency to the discharge will occur, to give the medicine in these doses
for a fortnight before ; and then, as Dr. C. advises, I have suspended
it until the same period is again approaching. The causes of interrup-
tion to the menstrual discharge, being various, it is of course impossible
to find any remedy which will meet every case. Where it depends on
debility, or accompanies an anemic state of the system, other remedies
than senega are more appropriate, or should be conjoined with it.
Iron, aloes and myrrh, in combination, form an excellent remedy in
such cases. The senega is appropriate to those cases where the sup-
pression has been caused by improper exposure, and to those very
frequent instances in which there is but little disturbance of the gene-
ral health.

Every practitioner in our large cities must have had his attention
arrested by the numerous calls for advice on account of obstruction,
on the part of newly arrived immigrants ; who complain of headach,
and miserable general feelings, with swelling of their lower extremities.
To what cause we are to ascribe the interruption of the natural func-
tions under such circumstances, it is difficult to say. The same result
has been noticed in the cases of young women coming from the
country to Paris. It is not, therefore, due to any impression made
by the sea atmosphere, but, very probably, is caused in both cases by
a less nutritious diet than has been customary and the confinement in a
vitiated atmosphere.

In those cases in which hemorrhoids, or an irritable condition of the
lower bowrels, prohibit the resort to the formulae into which aloes so
generally enter, the senega may be resorted to with benefit, and also,
when there is a diseased state of the ovaries or uterus itself. I have
not tried it in cases of dysmenorrhoea, with scanty secretion, but be-
lieve it will be found a very admirable remedy for these cases, which
are so distressing to the habitual sufferer, and vexatious to the physi-
cian. I shall certainly take an early opportunity to test its powers,
combined with some of the narcotic extracts. Hellebore and hyoscy-
amus have been the agents on which I have heretofore relied, with a
good degree of satisfaction ; and the senega appears to me to partake
of the same character as the hellebore, without that tendency to purge,
which is often displayed by the hellebore when given in full doses. I
am aware that some of our best teachers are disposed to dei:ry the
existence of a class of remedies having a specific tendency to promote
the menstrual flow, and rely on general treatment for the restoration
of this function when suspended. This is, perhaps, a natural reaction
from the disposition to rely on specific remedies in all cases. Either
extreme is unsound. We may not disregard the state of the general
health, but must adapt our specific means to meet special indications.
I know of no reason to doubt the tendency of certain remedies to pro-
duce an action on the uterus in its unimpregnated state which would
not lie with equal force against the action of calomel on the liver and
salivary glands, or ergot on the same organ at the time of parturition.

SELECTIONS. 171

Mesmerism.

There are certain things on which there must always be difference
of opinion, because they do not come within the range of true science.
Some persons, for instance, believe in ghosts, haunted houses, and all
such phenomena ; but it by no means follows that they are therefore
to be quarrelled with, for we hold that one man's opinion is as good
as another's, until proved to be erroneous. Were mesmerism confined
to non-professional persons, it would not engage our attention, or be
more worthy our notice as promoters of science, than the belief in
ghost stories ; and it is only because a few deluded medical men and
others have striven to make it appear a valuable department of medi-
cal knowledge, that we ever take up the matter at all. Neither is it
with any fear of mesmerism proving so popular as to call for a profes-
sorship in any of our universities : our sole object is, to remove the dis-
grace which has necessarily been brought upon our high and noble
profession by the manner in which some ardent imaginations have
thrust it forward as an important branch of the healing art.

Admitting that all the marvellous stories of its promoters were true,
admitting that it were even possible to raise the dead by its means,
how could its most zealous acfvocates prove the adequacy of the
means to the result ? What room for science in the matter at all?
There could certainly be the miracle staring them in the face, but
there would be no scientific elucidation of the matter. Let not our
readers suppose we believe such things. We are taking the mesmer-
ists on their highest ground. During the many years the public ear
has been abused with it, they have not given any pathological or
physiological proofs. Were any one of our brethren to say of chlo-
roform, or ether, that the effects which followed were owing to spiritual
agency, we should at once tell him he had not made himself acquainted
with the science he professed ; for it is easy to prove that the conse-
quences produced by chloroform are dependent upon the physical ac-
tion of chloroform itself. Mesmerism admits of no such proofs. But
if men honestly come forward and say that there is something in it
which they cannot explain, they are welcome to their belief in it, as
freely as to their belief in any other nursery tale. But we reiterate
our protest against mixing up the subject with the medical art, and
we will never rest until it has been exterminated from a profession
which ought to be devoting itself to higher and nobler aims.

As we have before stated, we are not finding fault with any man for
his peculiar notions ; but among other things on which we have set
our hearts, is the crushing of quackery in each and all its detestable
forms: and quackery is not confined to advertising specifics for incu-
rable maladies. Legerdemain, under the disguise of the words animal
magnetism, is the vilest quackery of all. If, as some of our corres-
pondents affirm, the power exercised be spiritual, then, for heaven's
sake ! let us leave it for those whose peculiar province it is to deal
with such. If, on the other hand, it can be proved to depend upon a
magnetic fluid, we shall be happy to give the subject our best con-

172 SELECTIONS.

sideration. Our only surprise is, that this wonderful fluid is not to be
had long before this, at the patent medicine venders, in little bottles
Is. l%d. each, for we are persuaded this is all that is needed to crown
the delusion. Again : if its advocates only pretend to state that cer-
tain results follow certain manipulations, they state nothing more than
has been affirmed from time immemorial ; but what in the name of
common sense has this to do with animal magnetism, or how does it
prove that there is such an extraordinary fluid in any animal ? We
wish our readers distinctly to understand that we are not attacking
individuals in their private capacities ; we are composing a compara-
tively small number of medical men, in their character as members
of a body politic, upon which they have brought dishonor. We, as
private individuals, may have many opinions peculiarly our own, not
only on the subject of mesmerism, but on insanity, catalepsy, &c, all
of which might be strongly expressed were our journal a miscella-
neous one; but to devote its columns to such purposes would be to
render ourselves guilty of the very thing we condemn. As journalists
we treat of facts and reasonings in science and literature ; all without
the range of these we consider quackery, and mesmerism pre-emi-
nently so. — London Institute.

Medical Organization.

We were struck, on reading the recent address of the king of Prus-
sia to the Prussian chambers, with the circumstance that the policy
and organization of the medical profession was referred to as one of
the great questions of national welfare to be discussed by the two
chambers of representatives. The king's words were — " the draught
of a law regulating the practice of medicine will shortly be laid be-
fore you."

Without question, this is taking a right view of the national impor-
tance of medical affairs. But when shall we hear any reference to
such vulgar matters as physic and surgery from the lips of our sove-
reign, on meeting her two houses of parliament ? When will the
lords and commons of England be recommended to take the state of
medical legislation in this country into their serious deliberation ? We
would commend these questions, and the considerations to which they
give rise, to the reflections of those in authority. In Prussia, at a time
of unparalleled warlike agitation, questions of medical government are
still thought worthy of even royal notice. And it is not the Prussian
medical code which is affected by any of the monstrous wrongs and
inconsistencies which are rife in our own professional regulations.

We do not hesitate to declare that the present laws relating to medi-
cine in this country are a national disgrace. England has now been
blessed with thirty-five years of uninterrupted peace, yet the medical
profession, essentially a profession which might be expected to flourish
in such an epoch, is at the present time in a state of injudicious anar-
chy. Practically speaking, all the laws relating to medicine are sus-
pended. Thousands of mercenary and uneducated pretenders live

SELECTIONS. 173

by preying upon the health of the community. Murder by the quack
is the only kind of murder tolerated and excused by the forms and
principles of our courts of law, as now reduced to practice. Great
Britain in 1850, is the only civilized country under the sun in which
the government at once takes a revenue from quack medicines, and
permits the most ignorant knave to prostitute medicine for purposes of
gain, and with murderous results, without let or hindrance, [save some
of the United States — Ed.'] Such a state of things would be a dis-
grace to a semi-barbarous country. The millions ruled by the knout
are protected from such a state of things. The rights of life and
health are the only rights not protected in this country. Let any pre-
tender attempt to enter a pulpit, and he would be removed by the po-
lice without much ceremony. Let any man appear in our courts of
law as a solicitor or barrister without a just qualification, and he goes
straight to prison as a reward for the intrusion. But any fool or vaga-
bond may take the place of the regular practitioner at the bedside of
the dying, and administer the most hazardous medicines in perfect
ignorance, and with perfect impunity. The false maxim of our laws,
as at present interpreted, is, that he is no more a criminal than a
Chambers or a Brodie when death ensues. Conscience and property
are abundantly protected ; life, human life, is the only thing not worth
caring for, in its grosser violations, by the state !

Against cholera, which has visited us twice in this century, the
whole kingdom was in agitation ; but against quackery, a greater de-
stroyer, and always with us, government have palsied limbs and
tongues, and the laws are really dead. Immense preparations are
made, and very properly to prevent disease, but none to defend its
victim from the ignorant and empiric. Sewers may not emit their
odors, nor chimneys their smoke, on account of the public health, but
Coffinites, Morrisonians, and all the genus of quacks, may pursue their
pestilent steps unmolested and unpunished.

How long are these things to continue? Surely some virtuous
minister will arise, who will not think the concerns of the health of
our population, and the defence of the sick, unworthy of his care.
Something more than a civil reception of deputations, and smooth an-
swers to addresses, are necessary before this great question can be
settled. Its adjustment would make the fame of any minister, and en-
title him to the gratitude of this and succeeding generations. It can-
not be said that the profession of medicine is unworthy of such a
boon, as the restriction of medical practice to properly qualified per-
sons would prove. The calls upon us in the public service, and in
the vast machinery of charitable ministration of the profession to the
sick, should alone entitle us to such reform of the laws relating to
medicine. More than this, the rights of the lives of the sick poor to
legal defence demand it. Glad indeed shall we be if, at the next
meeting of the British parliament, our sovereign should echo the
words of the king of Prussia, and tell her assembled lords and com-
mons, " the draught of a law regulating the practice of medicine will
shortly be laid before you." — LanccL

174 SELECTIONS.

Missouri State Society.

A medical convention has recently been held at St. Louis, which
was largely attended, and the business of which was conducted in the
right spirit. It resulted in the formation of a state society, the elec-
tion of officers, appointment of permanent committees on various
topics. We observe that, on motion, all the members of the schools
were excused from the committee on medical education. Whether
this was prompted by the innate modesty of the excused, or signifi-
cantly done by the excusers does not appear.

We observe that by the law of Missouri, " every person or co-part-
nership of persons in the state, who shall follow the practice of medi-
cine for a livelihood, in whole or in part, is declared a physician."

The repeal of this enactment will forthwith be sought, on the
ground that " such interference of the legislature, in pronouncing upon
the qualifications of physicians is uncalled for, and unjust to the medi-
cal profession who are supposed to be the best judges of its own fel-
lows and of their abilities." There is cause to apprehend, however,
that no success will attend the effort ; for in these degenerate days,
legislators are wont to go for the " largest liberty," and run into latitu-
dinarianism in their horror of monopolies. Their law is no worse
than ours in New York. — N. Y. Med. Gazette.

A Portion of a Gall-bladder discharged externally. — Miss T , aged

forty-eight, has had a very severe cough and purulent expectoration,
attended with signs of a cavity in the left lung, and other symptoms
of phthisis, for more than twenty years. About eight years ago she
had an attack of vomiting and diarrhoea, with faintness, when a tumor
was discovered on the right side of the abdomen, but apparently un-
connected with the liver. As it increased in size, the tumor passed
more into the centre of the abdomen, leaving a marked sulcus between
it and the edge of the liver. For twelve months it had descended
toward the right iliac region, where it pointed, and burst in April last,
a little lower than the edge of the transversalis muscle, and midway
between the spine of the ilium and the pubes. The discharge at first
was very offensive, consisting of pus, followed in a few days by num-
bers of hydatids, of various sizes, from that of a pea to that of a tur-
key's egg, and some very minute ones, in clusters, with pedicles like
a bunch of grapes, and striated externally. In about five weeks the
hydatids were all expelled, and the pus became healthy and less offen-
sive. The opening continued to discharge till the 11th of August,
when she had another bilious attack, and the discharge ceased ; the
abdomen became tense and tender over the right side ; occasional ri-
gors took place ; and on the 15th the orifice re-opened, discharging
pure bile. This continued to flow, to the amount of about a pint a
day, till the 24th, when a slough came away, which, on examination,
proved to be a portion of the gall-bladder, having small calcareous
plates imbedded in it, similar to some that had passed occasionally

SELECTIONS. 175

from the wound. The bile has continued to pass in greater or less
quantity, almost uninterruptedly, to the present time. There is now
about a drachm passed in twenty-four hours. The patient's health
has varied considerably, as she is sometimes able to go about the
house, and again has been reduced so low as to not be able to sit up
in bed without support. — -Lancet.

A Piece of Bone and Teeth, which were dissected from between two layers
of Membrane forming the walls of an Ovarian Cyst, taken from a Girl

after Death. — Fliza F , aged twenty-two, single, was admitted at

the Stoke Newington Dispensary, under Dr. Duesbury, August 9th,
1850, with dropsical swellings, distending so uniformly the abdominal
parietes, that it was difficult to diagnose whether it was ovarian dis-
ease or ascites. She complained of weakness and inconvenience from
the weight and size of the body. She stated that she had been ailing
for three years and upwards, during which period she had suffered
much from pain in the left side of the abdomen, but had not perceived
her body enlarging more than two years ; that it had increased much
more rapidly of late. She attended at the dispensary, and slightly
improved in health under tonics and diuretics, until a fortnight previous
to her death, when she was attacked with peritonitis, and died on the
7th October. Mr. Price attended her for a considerable period for
what he considered to be an ovarian tumor ; and four months previous
to her being admitted a patient at the dispensary, (in consequence of
the lady with whom she lived as servant having suspicions of her be-
ing pregnant,) he sent her to Dr. Lee, who pronounced the uterus to
be unimpregnated, and confirmed the previous diagnosis as to the ex-
istence of an ovarian tumor. On opening the abdomen, the left ova-
rium was found to have been converted into a cyst, occupying the
greater portion of that cavity, the viscera of which were pressing in
every direction. A few recently deposited threads of lymph extended
from its anterior surface to the peritonaeum, lining the abdominal pa-
rietes; otherwise it was perfectly detached, except by its peduncle,
which was not larger than the little finger, and consisted merely of the
obliterated Fallopian tube, enlarged vessels and peritonaeum. The
cyst, together with the uterus and appendages were removed ; and on
opening the cyst, from three to four gallons of a cream-colored fluid
escaped, suspended in which were numerous flakes of fatty matter;
it also contained a conglomerate mass as large as the fcetal head at six
months, consisting of hair, (from four to five inches long,) and this
fatty substance matted together, besides many smaller pieces of the
same substance. The cyst was divided by tranverse bands, and also
into pouches or smaller cysts, opening into the common cavity ; ad-
hering to the walls in places were considerable quantities of the fatty
matter, and attached hair, similar to that in the mass ; and between
two layers of the membrane, forming the walls of the cyst on the left,
side, was the specimen produced. The teeth are in every respect per-
fect, with their fangs inserted into the processes of the bone, resem-

176 SELECTIONS.

bling the alveolar processes of the jaws. The right ovarium was
rather larger than usual, congested, and contained several small cysts,
the size of a pea, filled with fatty matter. The uterus presented the
appearance in all respects of that of a virgin, and healthy, with the
exception of slight congestion, which might be merely post-mortem.
Dr. Baillie mentions similar fatty matter, hair, bone, and the rudi-
ments of teeth, (but without fangs,) having been found in ovarian tu-
mors, and under circumstances leaving little doubt that they had been
formed independently of impregnation. One case occurred in his own
practice. In another, published in the Philosophical Transactions, this
change was found in the ovarium of a child, whose age did not exceed
twelve or thirteen years, with the hymen perfect, the uterus not in-
creased in bulk, as is usual at puberty, together with the other signs
of puberty wanting. From the fact of the uterus being totally devoid
of all those changes that follow impregnation, whether the foetus be
developed within its cavity, or, as in extra-uterine fcetation, within the
ovarian or Fallopian tube, from the respectability of the girl's parents,
together with the good character she herself had borne, and her anxi-
ous desire that her body should be opened, for the satisfaction of her
friends, in consequence of the suspicion her appearance had excited,
Mr. Denny was induced to believe that in this case there had been no
impregnation. The consideration of this case suggests whether an
ovum which the stimulus of the catamenial period caused to burst
from the Graafian vesicles, and which was prevented from passing off
with the menstrual discharge by the impermeability of the Fallopian
tube, might not become adherent to the lining membrane of the ovary
or Fallopian tube, and thus obtain nourishment, setting in action a
power which may be inherent in it, of developing the structures of
the body, but in an incoherent manner, without the power to regulate
the formation, or to produce a circulating s}7stem or nervous centre,
necessary to the perfect development and independent life of the
foetus ; the latter power may emanate from the male, exerting an in-
fluence in some way analogous to the electric influence exerted in
crystallization, of attracting and arranging the particles, so as to give
a definite form, and thus to characterize the individuality of a salt. —
The statistical information furnished by the record of these cases, es-
pecially with evidence of existing virginity, may, by affording data
for physiologists, enable them at some future period to throw light
upon the functions of the ovary, and upon the elements supplied to-
wards the formation, and the power exercised over the development
of the foetus by the sexes individually, and may also prove of practi-
cal importance in removing the odium which a supposition of the ne-
cessity of impregnation in such cases as the above might cast upon
the fair fame of the patient. — lb.

Etiology of Tuberculization. — A Mons. Wanner has written an essay
attributing the production of tubercle to the presence of lime in the
soil of the district in which the patients reside. He brings some curi-
ous facts to bear in favor of his theory.

SELECTIONS. 177

ITEMS.

The distinguished professor of obstetrics in the University of Edin-
burg, Dr. John Y. Simpson, has been lately elected president of the
Royal College of Physicians. — The St. Louis " Probe" has died of
angemia. — Dr. James M. Austin, late of Virginia, has been appointed
professor of materia medica and therapeutics in the medical depart-
ment of Georgetown College. — Queen Victoria is a fellow of several
of the British learned societies ! — The American Dental society have
repealed their law prohibiting its members from using any other foil
than pure gold for plugging teeth. — Royer Collard, prof, of hygiene,
&c, lately died in Paris, age 47. — The British government is about
to erect a bronze statue on a monument to Jenner. — Suits against
doctors and apothecaries for mal-practice are reported in almost every
newspaper. — The number of matriculates at the University of Virgi-
nia for the present session is 381, of which 271 are from Virginia.
The class of medicine numbers 93, that of physiology and surgery 96,
anatomy 97, and chemistry 180. — Dr. Rush was, perhaps, one of the
most untiring students that ever lived. Two young physicians were
conversing in his presence once, and one of them said — " When I fi-
nished my studies" " When you finished your studies !" said the

doctor abruptly ; " why you must be a happy man to have finished so
young. I do not expect to finish mine while I live."

t3^° At the request of many subscribers in the country, we publish
below the Fee-bill of the Richmond profession. Like all other things,
every item of it cannot meet with unanimous approval, but, as a whole,
it has as few defects probably as any other which we have examined.
He who cannot be regulated by this one, will not be bound by any
instrument of the kind.

TARIFF OF FEES

Adopted by the Medical Profession for Richmond City.

Medical.

1. For each visit in the city during the day, $ 1

2. Do. do. when detained, for each hour after

the first, - - - - 3

3. For single visits and advice in a case in which no

further visits are required, - - 2 to 10

$3T This is not intended to apply to those cases
in which the physician is considered the regu-
lar medical attendant.

178

TARIFF OF FEES.

4. Each clay visit at an hour appointed by patient or

his friends, -

5. Prescription or advice anywhere,

6. Visit in the city between 10 o'clock P. M. and

sunrise, -

7. Visit without the corporation, but not more than

half a mile, -
S. Visit beyond that distance $2; for every mile

thereafter to ten miles, -
9. Visit to the country after 10 o'clock P. M., with

above mentioned mileage,

10. Ordinary consultations, -

11. Consultations during prescribed hours of night,

visits included, -

12. Detention with patients all night,

13. Do. at patient's house lor days, per diem, -

14. In cases of several patients at same house, charge

visit to one, and prescription or advice to each
other, at -

15. For written advice or opinion,

16. For oral opinion of health or disease,

17. For stethoscopic examination,

18. Opinion involving a question of law,

19. Post mortem examination in cases of legal investi-

gation, -

20. Post mortem made at request of family or friends,

2 to

5

1

5

1

1

5

5

10

10 to

20

20 to

100

1

5 to

20

2 to

10

5 to

20

10 to

50

25 to

50

5 to

15

Obstetrical.

21. Attendance on simple natural cases of labor, and

attention for eight days after delivery, provided
no serious ailment occurs to mother or infant,
(in which case visits are to be charged,)

22. Attendance on complicated, protracted or instru-

mental labors, including visits for eight days,

23. Attendance on cases of abortion, exclusive of

visits and other services,

24. Delivery of placenta, -

20

30

to 100

10

10

to 20

Surgical.

25. For bleeding, exclusive of visit or advice,

26. For bleeding in jugular vein or arteriotomy,

27. Cupping, - - -

28. Introduction of seton or forming issue,

29. For pumping stomach,

30. Dressing recent wounds,

31. Each subsequent dressing,

32. Opening abscess or exploring tumor,

1

2

to

5

2

to

5

5

5

to

20

5

1

1

to

5

TARIFF OF FEES.

179

33. Vaccination of one white person $ 3; of two at

same time $ 5; for each one thereafter in same
family at same time, -._■•-

34. Vaccination of single slave $2; each one there-

after, &c. as above,

35. Re-vaccination, white or black,

36. Extracting teeth, each, -

37. Lancing gums, -

38. Plugging posterior nares, -

39. Application of truss, -

40. Reduction of prolapsus ani,

41. Examination per vaginam or per anum,

42. Introduction of pessary, -

43. Introduction of speculum vaginae, first time $5,

each subsequent time, -

44. Introduction of bougie to explore urethra,

45. Cauterization of urethra, -

46. Operation of sounding the bladder,

47. Introduction of catheter into bladder first time,

48. " " each subsequent time,

49. Treating stricture of urethra,

50. Treating syphilis, -

51. Treating gonorrhoea, -

52. Operation for phymosis or paraphymosis,

53. Palliative operation for hydrocele,

54. Radical cure of " - -

55. Operation for hypospadias or irregular opening of

the urethra, -

56. Operation for fistula in ano, or in perineo,

57. " for haemorrhoids,

58. " for imperforate anus or vagina,

59. Reduction of hernia by taxis,

60. Operation for strangulated hernia,

61. " for recto-vaginal, or vesico-vaginal fistula,

62. Stone in the bladder, -

63. Extraction of calculus from urethra,

64. Puncture of bladder, -

65. Paracentesis abdominis $10, each subsequent

time, -

66. Paracentesis thoracis, -

67. Caesarian section, -

68. Extirpation of uvula, -

69. " of tonsils,

70. " of mamma, -

71. " of diseased ovary,

72. " of testicle,

73. " of tumors, -

74. " of polypus uteri,

75. " of " nasi,

76. " of eye,

1

1

1

1

to

5

5

5

to

15

5

to

40

5

to

15

5

to

10

2

to

5

5

to

50

10

to

50

5

to

50

5

1

20

to

150

20

to

200

15

to

50

5

to

20

5

to

10

20

to

50

15

to

50

20

to

150

20

to

100

10

to

100

5

to

50

50

to

200

50

to

200

50

to

500

10

to

20

20

to

50

5

20

to

50

100

to

500

5

to

15

10

to

50

20

to

100

50

to

250

50

to

100

10

to

200

20

to

100

10

to

50

100

180 TARIFF OF FEES.

77. Operation for cataract, - - - 50 to 200

78. " for artificial pupil, - - 50 to 200

79. Other operations on the eye and its appendages, 5 to 50

80. Amputation of superior or inferior extremities, in-

cluding dressing and attendance, - 40 to ]00

81. Amputation of the finger, thumb or toe, &c, - 10 to 30

82. " of penis, - - 20 to 50

83. Evulsion of nail on finger or toe, - - 5 to 30

84. Application of trephine, - - 50 to 100

85. Exsection of diseased bone, - 20 to 100

86. Removal of upper or lower jaw or portions, - 15 to 200

87. Exsection of diseased joints, - - 10 to 100

88. Operation for artificial joints, - 20 to 100

89. Reduction of luxations of greater joints, - 20 to 100

90. " of " of lesser joints, - 10 to 20

91. " fracture and first dressing, - 5 to 30

92. Treating fractures, including dressing and attend-

ance, - - - - 20 to 100

93. Treating fractures of cranium, with or without tre-

panning, - - - 10 to 150

94. Operation for aneurism, - - 20 to 180

95. " for harelip, - - - 20 to 50

96. " for ranula, - - 5

97. Division of fraenum of tongue or penis, - 2 to 5

98. Operation for club foot, - - - 20 to 100

99. Operation of myotomy or tenotomy, - - 10 to 100

100. Plastic operations, - - - 10 to 100

101. Extracting foreign bodies from pharynx or oeso-

phagus, - - - 5 to 50

102. Laryngotomy or trachecotomy, - - 20 to 50

The above fee bill, founded on a just consideration of the important
services which physicians are called upon to perform, is intended to
enable the practitioners of Richmond to exhibit uniformity in their
rates of charging, and it is expected that every member of the profes-
sion will, in good faith, conform to it in his charges, whenever the pe-
cuniary circumstances of the patient are not such as clearly to forbid it.

It is considered obligatory upon physicians to collect their bills at
least once a year, whenever this can be done without serious incon-
venience to the patient.

We will not attend either individuals or a collection of persons by
the year, at any stipulated price or under any circumstances.

In case any one should transgress these rules, he shall be considered
beyond the pale of the profession, and all consultations withheld. We
will refuse to hold medical communion with those who may them-
selves consult with such persons knowingly.

Richmond, May 1850.

THE

AND

No. 4.]

RICHMOND, APRIL 1851.

[Vol. L

Report of the Committee of the Medical Society of Virginia,

On the Utility and Safety of Anesthetic Agents.
[ Read at the March Meeting. ]

The committee, appointed by the Medical Society of Virginia to
enquire into the experience of the medical profession of the city of
Richmond, in regard to the utility and safety of anaesthetic agents,
respectfully report :

That we have entered upon our duties deeply sensible of the re-
sponsibility which devolves upon us. We have undertaken to collect
the facts fully, to analyze them carefully, to classify them correctly,
and to interpret their meaning faithfully, uninfluenced by a prejudiced
hostility to, or an enthusiastic admiration of, the agents in question.
We believe that we have performed these duties honestly, and we
present herewith the data on which this report is based, viz : the se-
parate reports of the physicians of this city who have used anaesthetic
agents in their own practice, and who have witnessed their use abroad.
In addition to this source of information, we have, in accordance with
the spirit of the resolution under which we were appointed, collected
materials from those gentlemen who confine their practice to a branch
of minor surgery, viz : the dentists of our city. They have politely
and promptly responded to our application.

We believe that this report, if adopted by the society, will have
considerable influence upon the mind of the medical profession of the
state and of the community at large. All are interested in its accu-
racy ; for there is no one who may not at some time have occasion to
decide upon the propriety of inducing anaesthesia in his own person.

It is not surprising that one who witnesses the anaesthetic state for
the first time should feel considerable apprehension about the ultimate
result. To see a strong man reduced in a few minutes to a state of
utter helplessness, the most powerful intellect annihilated, the acutest
senses abolished, and every evidence of life become extinct, except
the breathing and the pulse, and even these rendered slower and
weaker, is well calculated to alarm the inexperienced. It resembles

182

TRANSACTIONS OF THE MEDICAL SOCIETY OF VIRGINIA.

too nearly the condition of one suffering under fatal disease or injury
of the brain, to be viewed for the first time with indifference. He
may well ask, is it not rash presumption to lead a human being so
close to the portals of death ? What, if we should loose the bond of
life, and we should witness those dark portals inclosing him in their
awful embrace forever !

But we would reply to such an one — Have you never tapped one
of the heart's tubes, and drained the vital current until even a more
alarming condition was produced ? Have you never seen from this
cause the countenance blanched, and the eye become vacant, and the
limbs tremble, and the stoutest man reel and fall senseless as a corpse,
the heart become still, and the chest cease to heave, and not a breath
or motion occur to give evidence that life is not extinct? Alarming as
is the appearance of syncope produced by blood-letting, we do not
hesitate to induce this state, not only in the treatment of those dis-
eases whose fatal course requires them to be promptly and boldly ar-
rested, but even when a dislocated limb is to be replaced, or an in-
flamed eye is to be relieved. This latter condition has ceased to alarm
us, because we have become familiar with it. The former is one with
which a large number of the medical profession have had no experi-
ence whatever, and still more regard with a feeling of undefined dread.

Every contribution to the fund of knowledge on this subject is
therefore a valuable acquisition to the science of medicine, and pro-
motes its noble practical design of alleviating human suffering.

We have been furnished with the results of observations on thirteen
hundred and eighty -four cases of anassthesia, occurring in the practice of
physicians and dentists in our city. Nearly all the parties concerned
being residents, we have the best opportunity of judging of the accu-
racy of these reports. The following table exhibits the principal facts
which could be readily arranged in a tabular form, and the remainder
will be stated in a more full and detailed manner :

Agents Used.

IB

o.S

Physicians' Reports.
Chloroform,
Ether,

Ether and chlo-
roform,

Dentists' Reports.
Chloroform,

Ether,

Total,

gtt5-|iv
"ss. — ?i

gtt. 10—

?iss.
?ss.-?iv

291 1

99 I

loj

215

149

400

428
556

984
400

1384

674

889

674

823

15 months to
80 years.

4 to 50 years,

Less than 1

minute to an

hour.

10 seconds to
1 hour.

1 minute to seve-
• ral hours.

30 sec. to J hour.

REPORT ON ETHER AND CHLOROFORM. 183

Besides these cases, we have been informed of several others which
have not been reported.

The following observations require to be presented in a more de-
tailed manner.

Time required to induce ancesthesia. — Variations were produced by
several causes, viz : Age, sex, idiosyncrasy, and design with which
the agent was administered.

Age. — Children were much more susceptible than adults. For ex-
ample, a child four years old was brought into a profound state of
anaesthesia in less than one minute, while the average time required
to induce a similar condition in adults was about eight minutes.

Old and infirm persons yielded more readily than the middle-aged
and the robust.

Sex. — As a general rule, females were more susceptible than males :
the difference, however, was not very striking.

Physical condition. — Intemperate persons offered the greatest re-
sistance. A case of this kind is reported to have required an hour to
produce anaesthesia. In one instance, it was administered to a patient
habituated to the use of opium, for the purpose of relieving severe
attacks of neuralgia. In this case, inhalation was continued an hour
before complete anaesthesia was produced ; but it should be borne in
mind that the patient was then suffering from a severe attack of the
disease.

Design of administration. — When this was simply the extraction of
a tooth, a sufficient state of insensibility was generally produced in
from 2 to 5 minutes ; when a more profound state was required, the
time averaged about 8 minutes, and it was not unfrequently extended
to 15 or 20 minutes.

Mode of administration. — If a large quantity were poured upon a
handkerchief or other inhaler, and applied close to the face, the effect
was more sudden.

Duration of ancesthesia. — This has varied, from causes similar to
those which affected the readiness with which patients were brought
under the influence of the agent, and the period during which this in-
fluence was maintained. If the inhalation were continued a short time,
and consequently a small amount of the agent used, the effects were
evanescent. If it were prolonged, with the use of a larger amount,
they were more persistent. If the design was the extraction of a
tooth, for instance, the patient frequently recovered so rapidly as
scarcely to afford time for -the operation to be completed, and the
shock of the operation appeared to assist in thoroughly arousing the
patient.

Frequently, a prolonged state of anaesthesia was desired for cases
of midwifery or surgical operations. In these cases, it was usually ne-
cessary to repeat the inhalation several times, whenever the patient
appeared to be returning to a state of consciousness. In this mode
anaesthesia was maintained several times for more than an hour, and
in one instance between two and three hours.

Young children, who yielded in half a minute or a minute, continued
in a state of anaesthesia about five minutes.

184 TRANSACTIONS OF THE MEDICAL SOCIETY OF VIRGINIA.

Adults, who required about 10 or 15 minutes, were thoroughly
roused in from 10 to 20 minutes.

To these definite causes, we may add some obscure idiosyncrasy, by
which the time was greatly shortened or prolonged. This, however,
forms no greater objection to their use, than to that of other active re-
medies, whose effects we are obliged continually to watch cautiously
on this account.

In a few cases, the effort to produce anaesthesia was so tedious, that
it was abandoned as impracticable. This occurred more frequently
in the use of ether than in that of chloroform. When the latter agent
failed, it was usually in cases of intemperate persons, or else the ope-
rator had not sufficient confidence to proceed with boldness. Proba-
bly to the latter cause all, or nearly all, cases of failure are to be
attributed.

Quantity administered. — This also was varied by causes similar to
those already named, and the agent employed. About 30 drops of
chloroform were administered in about a minute, and one drachm in
about 5 minutes. This would make an average of about one drop to
two seconds, counting 120 drops to the drachm. Of course, the mode
of inhalation and the temperature would greatly affect this estimate.

If it were simply necessary to induce anaesthesia, the average
quantity was about a drachm. In several instances, as much as one
ounce was administered. In others, one ounce and a half. One case
occurred in the practice of one of our most accurate physicians, in
which from 3£ to 4 ounces were required to produce anaesthesia.

Ether. — A much larger quantity of this agent than of chloroform
was required. The average quantity was from Iss. to Ij. As large
a quantity as 5iv. was administered, and in one instance three gills
were used in three days.

Effects during administration. — At the commencement, there was
usually considerable increase of the force and frequency of the pulse.
Often the respiration was impeded, and the patient had to be urged
to make full inspirations. Sometimes there was coughing and a sense
of suffocation, especially if the administration were carried on too ra-
pidly, or there were an insufficient supply of air. In about a minute,
the patient complained of noises in the head, as of a multitude of
wheels or hammers in motion. In two or three minutes, the face be-
came slightly flushed, and the veins of the temple became turgid.
Occasionally, at this period, the patient was very talkative, or burst
into immoderate fits of laughter or crying. He usually answered
when spoken to, and obeyed directions. Occasionally, spasm of the
limbs occurred, which soon passed off as the anaesthesia became more
profound. Sometimes there was considerable resistance, the patient
struggling violently to make his escape, and refusing to take any more
inhalations ; but he was usually soon subdued by the persevering ap-
plications of the anaesthetic vapor. The pulse fell considerably ; the
respiration became slower ; the muscles were perfectly relaxed, and
all the functions, save those of mere organic life, were suspended.
The subject was in a state of mere vegetable existence. The senses
no longer gave intimation to the spiritual being within, of what was

REPORT ON ETHER AND CHLOROFORM. 1S5

occurring to its material tenement or around it. Its nervous tentacula,
so exquisitely sensitive to impressions from the external world, were
utterly paralyzed. It was as if dead, and its own body was the sar-
cophagus which encased it.

A few instances occurred, however, in which prolonged administra-
tion failed to deprive the nerves of all irritability. Although there
was a state of perfect composure, and a very depressed state of the
pulse — so much so that it was deemed imprudent to push the impres-
sion further — yet, whenever any attempt was made to operate, the pa-
tient became restless, and sometimes complained of pain. But even
in these cases, when the patient was fully roused, he had either no re-
collection, or a very faint one, of anything which transpired during
this imperfect state of anaesthesia.

If we take a physiological view of these various grades of insensi-
bility, we may arrange them under the following heads :

1st. Incomplete anaesthesia, in which the nerves of ordinary sensa-
tion and motion are obtunded, while those of reflex action and the
sympathetic retain their functions. The other senses are preserved :
the mental powers are confused.

2d. Complete anaesthesia, in which the cerebo-spinal system, ex-
cept the medulla oblongata, is paralyzed. The sympathetic continues
to retain its functions.

We now proceed to consider these effects more in detail.

The pulse is usually much excited at first, running in one instance, in
which it was carefully noted, from ninety up to one hundred and fifty
in the space of two or three minutes, and after the same interval sink-
ing to ninety again. One of the most reliable signs of complete anaes-
thesia was, sinking of the pulse in regard to force and frequency.
Sometimes it was very small and weak.

The eye was soon closed, and on raising the lid before the anaesthe-
sia was complete, the pupil was observed to be enlarged. This was
owing to its being protected from light by the lids ; for when the light
was admitted the pupil immediately contracted. In this state, the pu-
pil was rolled up under the upper lid ; but when the second state was
induced, the eye was fixed with its axis directed forward. The pu-
pils were contracted, and perfectly insensible. The lids no longer
closed spasmodically when opened. There was usually some conges-
tion of the conjunctiva.

The hearing was remarkably retained in the first state, the patient
often answering questions and obeying requests, of which he had no
recollection afterwards.

Stomach and bowels. — Nausea and vomiting usually occurred if the
stomach were full, but as soon as it was emptied anaesthesia was
readily induced. In one instance, inhalation was frequently repeated
during two or three hours, and it always produced distressing nausea
and vomiting, just as anaesthesia was about to become complete. The
best remedy was crushed ice taken into the stomach.

The sphincters of the bowels have been observed, though rarely, to
become relaxed. In one case, that of a boy, the bowels were evacu-
ated involuntarily. In the case of an old man of 80, there was an es-

186 TRANSACTIONS OF THE MEDICAL SOCIETY OF VIRGINIA.

cape of flatus. It was not unusual to hear the rumbling of flatus
without its escaping.

Bladder. — In two instances it discharged its contents involuntarily.
The first case was that of a child incompletely anaesthetized by ether.
The second was that of an old drunkard, who required an hour's in-
halation to produce complete anaesthesia.

Respiratory organs. — If the vapor were suddenly applied close to
the mouth and nose, it was apt to produce coughing and a sense of
suffocation, which were immediately relieved by removing the source
of irritation, and gradually approximating it again. The patient was
apt to restrain the action of the respiratory muscles, and required to
be urged to take full inspirations. When complete anaesthesia com-
menced, the respiration frequently became quite full and strong ; after-
wards it was chiefly abdominal.

Stertorous respiration was occasionally observed when anaesthesia
became profound. This was alarming to the inexperienced, but was
never followed by injurious consequences. It was one of the most
certain signs of complete anaesthesia.

Blowing respiration was once observed in the case of a feeble old
man, anaesthetized by ether.

Muscular system. — In the first state there were, not infrequently, ir-
regular spasmodic contractions ; sometimes strong convulsions : as
the second stage ensued, these ceased, and the muscles became per-
fectly relaxed.

Uterus. — When anaesthesia was profound, the contractions of the
uterus were impeded during delivery at the full term. In case of
abortion, they were entirely suspended. When anaesthesia was mode-
rate, they were as vigorous as usual.

The salivary glands and mucous lining of the mouth and fauces were
occasionally considerably excited, causing the patient to spit fre-
quently.

Skin. — When inhalation was prolonged, the cutaneous surface was
not infrequently bathed in a copious perspiration.

If the wetted sponge or handkerchief were allowed to touch the
face, it produced a burning sensation and an erythematous blush.
This effect was quite painful, if it came in contact with the vermillion
border of the lips.

Comparative effects on children and adults. — Children were much more
rapidly anaesthetized, and by a much smaller quantity than adults
were. In other respects the effects were similar. Except in one in-
stance, where an over dose of chloroform was accidentally adminis-
tered, and another in which involuntary discharge of urine occurred
during a partial administration of ether, the unpleasant effects ob-
served in adults were not observed in children.

Comparative effects on males and females. — The latter were gene-
rally more susceptible than the former. To this rule there was one
exception, in the case of a negro woman, who, on two different occa-
sions, required from 3£ ounces to 4 ounces of chloroform. Hysteric
convulsions were peculiar to females.

Subsequent effects and their treatment. — A condition similar to the

REPORT ON ETHER AND CHLOROFORM. 187

first state of angesthesia succeeded to the second or profound condi-
tion, the functions being gradually restored. In other words, the
effects passed off in the inverted order of their occurrence. In very-
many cases, the patient awaked as from a pleasant dream, delighted
with the agreeable sensations he had experienced.

Nervous system. — Drowsiness was the most common consequence,
especially when the inhalation had been prolonged. The best prac-
tice was to allow the patient to yield to this feeling and sleep off the
effects. If it were desirable to dispel it, this was best effected by
dashing cold water in the face, a draught of cool air, and moving
about. It was remarkable, that sensibility to pain was not recovered
immediately with consciousness. In one instance, the patient con-
versed about the operation which had just been completed, occasion-
ally looking at the part, during the space of ten minutes before he be-
gan to complain of pain. This accords with our remarks on the order
of the subsidence of the effects.

Hysteric convulsions occasionally occurred in young females. Some-
times there was high nervous excitement, with excessive talkativeness,
lasting from an hour or two to twenty-four or thirfcy-rsix hours. Quiet-
ness, sponging the face with cold water, and ice to the head were suf-
ficient treatment. Sleep was produced, from which the patient awaked
quite calm.

Headach was sometimes complained of for a short time : in a few
instances, it lasted for a day or two.

Chilliness and coldness of the extremities. This was a rare conse-
quence, and was relieved by warm, stimulating drinks and warmth to
the surface.

Eye. — Blindness was complained of in the case of a female for more
than an hour, while the hearing was as acute as ususal. This was
speedily relieved by a warm, stimulating drink.

The conjunctiva occasionally remained in a congested condition for
an hour or longer.

Muscular system. — General debility and an unsteady gait in walk-
ing, as of one under the effects of intoxication, often occurred, lasting
from a few minutes to half an hour or longer, usually dependent upon
the length of time that inhalation was continued.

Digestive organs. — Nausea and vomiting having commenced during
inhalation, sometimes continued afterwards ; and were relieved by
swallowing crushed ice, or by an external sinapism.

In the case of a child, copious evacuation of the bowels occurred
in twenty minutes after recovery.

In compiling this report on the effects of anassthetic agents, we have
felt greatly the want of accurate and minute records of cases. About
twenty have been furnished, of which the observations were carefully
made and noted immediately in a case-book kept for the purpose. One
of these, we deem sufficiently interesting to be reported in full, as the
operator and subject were both physicians experienced in the use of
anaesthetic agents.

Dr. P., about 25 years age — in good health, of rather spare form,
excitable and cheerful — desired me to administer chloroform and ex-

188 TRANSACTIONS OF THE MEDICAL SOCIETY OF VIRGINIA.

tract two teeth, in order that he might have personal experience in re-
gard to a new agent, which he occasionally administered to others. I
determined to avoid profound anaesthesia.

Quantity used. — Chloroform 3jj. on the sponge and oiled silk inhaler.

Effects. — Incomplete anaesthesia in five minutes, marked by occa-
sional laughter and incoherent expressions. Entire insensibility to pain
in ten minutes. The muscles of the lower jaw were completely re-
laxed. One tooth was then extracted without resistance, although he
appeared somewhat conscious of the operation. Decided signs of re-
turning consciousness occurring, I remarked, " I had better give you
some more to extract the other tooth." To which he replied, " Go on
without it ; I don't think you will hurt me." He opened his mouth at
my request, and I immediately extracted the other tooth, when he com-
plained of slight pain. In ten minutes he recovered ; stated he was
insensible, or nearly so, to the pain, and exclaimed several times,
" What a wonderful discovery ! " " Is it not a glorious discovery? "

During the whole period he answered questions, though rather in-
coherently.

The following is a description of his sensations, written by himself:

Wishing to have two large molar teeth extracted, and also desirous
of relieving myself, to some extent, from responsibility in administer-
ing it to others, Dr. B. was kind enough to put me under the influ-
ence of this wonderful agent. The following are my recollections of
its effects upon myself. While inhaling the chloroform, I endeavored
to resign myself fully to its influence, determining at the same time
calmly to observe its sensible effects. The first impression was that
of most decided exhilaration. I found myself laughing, at what, I
knew not; then commenced the buzzing or ringing in the ears, follow-
ing which was an illusion of countless stars, with a diameter of about
half an inch, and of bright colors, (blue and red, I think,) each revolv-
ing on its own axis with great velocity. Up to this time I could
hear any question asked me, but was rather indifferent to other sounds
about the room. My mind seemed engaged with the bright illusions
above mentioned, and now and then occupied in a sort of abstract
contemplation, hard to describe. From this state, (how long it con-
tinued I cannot say, but it seemed only a short time,) I found that I
began to revolve slowly myself, (not on my own axis, however,) and
in a few moments joined in the common whirl. It seemed to me that
I was on the end of some great lever, which revolved with inconceiv-
able velocity — not producing any fear, however, but seemingly a sen-
sible giddiness. From this condition I lapsed, in a few moments I
suppose, into complete insensibilit}r. The feeling was very similar
to that I have felt while fainting. It was at this time, I presume, that
the first tooth was extracted. In a few minutes, I became somewhat
conscious, and recollect Dr. B.'s putting his hand into my mouth, at
the same time remarking he would give me a "little more." I think
I told him to pull out the other without giving me more — that I would
not feel it. He complied with my request, and I distinctly recollect
his putting the forceps upon the tooth, and was conscious of some pain,
but knew scarcely from whence it proceeded. I seemed to make
some resistance.

REPORT ON ETHER AND CHLOROFORM. 189

For about a half hour after recovery, had some pain in the frontal
region, and noticed slight congestion of the conjunctiva. The most
remarkable effect of this agent upon myself, was the current it seemed
to give to my thoughts for about two weeks afterwards. In this I am
not mistaken. I frequently found myself making exclamation, spon-
taneously it seemed, such as I discovered myself using when recover-
ing from the effects of the chloroform.

I was not aware of any unpleasant consequence from the use of
this agent — no depression of body or mind.

The next case is one of such extraordinary character, that we would
not feel justified in reporting it, if we had not satisfied ourselves of
the accuracy of the facts. They were reported by a son of the indi-
vidual, and were confirmed by the statements of several respectable
apothecaries, together with the personal observations of two members
of the committee.

J., about sixty years of age, blacksmith, of fine athletic form, had
enjoyed such uninterrupted good health, that he had not been known
to lose a day's work during twenty years. It was his habit to work
every day, Sundays included, until a late hour of the night. Every
Saturday night he stopped work earlier than usual, and indulged
himself in a frolic. About three years since, his mind became sud-
denly disordered while he was at work in his shop. He was totally
incapable of applying himself to his usual employment, and imagined
that he had been poisoned. He returned home and went to bed,
from which he has never risen since, except for a short period.

While under medical treatment for this hypochondriacal condition,
it was suggested to him to use ether, which had then been just intro-
duced, for the purpose of producing anaesthesia. A few trials were
not satisfactory to him, and when chloroform was introduced, he
soon substituted it for ether. Since then, he has continued to use it
to an enormous extent. He has often inhaled a pint in twenty-four
hours. On one occasion, his son left in his room a pound, which he
had just purchased. On returning home six hours after, he found the
bottle empty. On enquiry, his father assured him that he had inhaled
the whole of it, and entreated him for more. Fearing that it would
prove fatal, he refused to procure a further supply, until after an in-
terval of about twelve hours, when his father's entreaties became so
importunate that he yielded, and during the remaining six hours, the
old man inhaled ten ounces more, amounting in all to 26 oz. in 24
hours. Probably, however, much of this wasted.

One apothecary of the highest character testifies, that he has sup-
plied him with more than two hundred pounds, and that he has not
sold him any for a considerable time. His son declares, that his fa-
ther's use of chloroform has consumed the greater part of the earn-
ings of himself and brother, in one of the largest and most profitable
shops in the city. He supposes they have expended at least twenty-
five hundred dollars in this way during the last three years. Lately,
they have succeeded in reducing the amount used, to four ounces in
three days.

22

190 TRANSACTIONS OF THE MEDICAL SOCIETY OF VIRGINIA.

It is remarkable, that during the period that he has been using chlo-
roform, he has entirely abandoned the use of ardent spirits.

About the middle of last February, two members of the committee
visited the patient, in company with his son. He was found occupy-
ing an attic room, lying upon a pallet on the floor, in compliance with
his own wishes. His appearance was that of a hearty, fleshy man,
of about sixty years of age. His pulse, respiration, in fact all his
functions, we ascertained were perfectly healthy. His appetite and
digestion were remarkably good. During this inordinate use of chlo-
roform, he has fattened probably thirty pounds, his weight being now
about one hundred and eighty pounds.

He has never been unpleasantly affected in any way, either during
anaethesia or afterwards, except once, when, having become insensi-
ble, his head fell upon the inhaler. Then, a more profound state than
usual, marked by stertorous respiration, was produced, but it wTas of
short duration.

We remained in the room about half an hour, conversing with him
most of the time, and were several times interrupted by his urgent
entreaties for more chloroform, although he had just emerged from the
anaesthetic state. His remarks were chiefly on the subject of his hav-
ing been poisoned, which is evidently his principal illusion. He ima-
gines himself unable to walk, and refuses even to be dressed.

At length his desires were indulged ; and an ounce vial, half full of
chloroform, was brought to him. He eagerly grasped it ; and having
drawn the bed-clothes over his face, sufficiently to cover his mouth
and nose, he placed the vial to his lips, and took strong, deep inhala-
tions for ten or fifteen minutes. A slight quivering passed over his
frame, he rolled upon one side, and lay in a state of profound sleep.
We then left him to his strange infatuation.

This case proves conclusively, that the intemperate use of chloroform
is attended with far less danger than is the same use of alcohol or
opium. It is a remarkable fact, that in this case it has not been ne-
cessary to increase the dose, which would have been required, had
any known stimulant or narcotic been used, instead of chloroform.

Three cases have been reported, in which fatal or permanently inju-
rious consequences have been suspected; but in all of these, there were
other palpable causes quite sufficient of themselves to have produced
the results. That the anaesthetic agent used, even co-operated with
these causes, has not been satisfactorily shewn ; and without this evi-
dence we cannot admit a conclusion opposed by all the other evidence
which we possess.*

We now proceed to state the various occasions on which anaesthesia
was used with advantage. Had our queries been more definite on this
head, we might have been furnished with more interesting matter than
we are now enabled to report.

Surgical operations. — The cry of distress is always attractive, even
among brutes, which rush instinctively to the scene of suffering, re-

* The details of these cases were reported in full to the society, so far as the facts could
be obtained. Two of them we do not feel at liberty to publish. The other was simply a
case of fatal result, after a prolonged capital operation.

REPORT ON ETHER AND CHLOROFORM. 191

gardless of danger. Among human beings, the desire of alleviating
pain is one of the strongest natural impulses. Especially are our
feelings enlisted, when we ourselves occasion that pain, though for
some beneficial end. A timid, inexperienced surgeon, of sensitive
feelings, is liable from this cause to lose his presence of mind in the
midst of an operation, and thus risk the life of the patient. In such
a case we can hardly over-estimate the value of an agent, by which
we can reduce the human frame, for any desirable period, to a state
of mere vegetable existence.

Often, the patient, terrified by the thought of enduring the physical
suffering of a surgical operation, has dangerously procrastinated, or
even sacrificed life itself. How wonderful the relief to his agitated
feelings, instead of being directed to string up his nerves to their
highest pitch of endurance, to be requested simply to compose himself
to sleep, with the assurance that he shall awake, to be informed of
the completion of the long-dreaded application of the knife.

In one instance of extreme debility, from diffuse inflammation of the
cellular, tissue of the arm affecting the elbow joint, it was deemed im-
portant to amputate. It was feared the patient could not withstand
the shock of the operation, and yet it was believed she would sink
from the exhausting effects of the disease. Chloroform was adminis-
tered, the amputation was performed, and the patient recovered.

Statistical tables of capital operations have shewn a fearful amount
of mortality. In many of these instances the catastrophe has been
attributed, no doubt properly, to that state of innervation, called the
shock to the system. Anaesthesia has almost annihilated this source
of danger. While the reports of this city are not sufficiently definite
on this point to enable us to state actual results, we would refer the
society to tables published by Professor Simpson, which prove an ex-
traordinary diminution of mortality, after capital operations, in the
principal hospitals of Great Britain and Europe, since the introduction
of anaesthetic agents.

Eye. — It has been objected, that in anaesthesia the ball is rolled up,
and is in an unfavorable position for most operations on this organ.
This is fully contradicted by observations in this city : several opera-
tions in ophthalmic surgery having been performed upon anaesthetic
patients, and in every instance the axis of the eye was observed to be
directed forward. For the extraction of foreign bodies embedded in
the cornea, as pieces of steel occurring among stone-masons, the po-
sition of the eye and its quietude, are the most favorable that can be
desired.

In extraction of the lens for the cure of cataract, the only inconve-
nience which occurs, is, that the ball is not sufficiently steadied by its
muscles, and requires counter-support against the thrust of the knife.

Occasionally, in surgical operations, anaesthesia was not sufficiently
profound, nor well sustained, and then, considerable embarrassment
was experienced, in consequence of the restlessness of the patient.

Fractures. — For the purpose of setting a fracture, when much pain
was experienced, and there was much resistance from muscular con-
traction, anaesthesia enabled the surgeon to effect his object with great
facility.

192 TRANSACTIONS OF THE MEDICAL SOCIETY OF VIRGINIA.

Dislocations. — We possess no means by which the muscular relaxa-
tion necessary for reduction can be effected with so little loss of vital
force, as by anaesthesia. Blood-letting and the other usual means are
followed by much more prolonged debility ; nor can we possibly in-
duce so perfect a state of relaxation in any other way ; for, however
great the debility of the patient may be, if he be conscious of pain, he
will make some involuntary resistance, and often this is very consider-
able. In anaesthesia, the muscles continued perfectly relaxed during
the efforts of reduction ; and the dislocated limb was replaced with
more facility than it could have been upon a lifeless body.

Tetanus. — We have tried, in vain, the most powerful agents of the
materia medica, to subdue the frightful parox}Tsms of convulsion,
which constitute the most obvious feature of this dreadful disease.
Anaesthesia abolishes all this agony. One who witnesses such a
scene of intense suffering, and hears the entreaties of the patient for
this means of relief, and then observes the perfect composure which
follows its use, is prepared to render an acknowledgment of devout
gratitude to the Giver of so great a blessing. The reports we have
received do not furnish any instance, in which this formidable disease
has been cured by anaesthetic agents. So far, they have produced a
temporary alleviation of suffering, and have aided the use of other
means. In one case in which traumatic tetanus was feared, the alarm-
ing symptoms were subdued by ether as often as they appeared du-
ring three days, when they finally subsided.

Stricture of the urethra., with retention of urine. — One instance of this
kind is reported, in which the attempt to pass the catheter produced
intense pain, with a discharge of blood. Free bleeding and the warm
hip bath were resorted to in vain. Anaesthesia was then induced,
with the effect of giving prompt and entire relief, without the use of
the catheter.

Obstruction of the oesophagus in its lower part. Anaesthesia was used
successfully for the purpose of passing the probang into the sto-
mach.

Mania d potu. — In this disease, in which a nicely-adjusted combi-
nation of stimulants and sedative narcotics has proved most effica-
cious, anaesthesia succeeded in giving relief, when the usual means
had failed. In the cases reported, there was " flushing of the face
and spasm of the extensor muscles of the whole body ; the breathing
was hurried, and occasionally entirely suspended. This state lasted
only a few seconds, and was relieved by throwing cold water upon
the face. The patients then fell into a sleep, which lasted from ten to
thirty minutes, and awoke quite refreshed."

. Epilepsy. — Anaesthesia has greatly mitigated the violence and short-
ened the duration of the attacks of this formidable disease.

Hysteria. — In violent paroxysms of this disease, accompanied by
delirium, convulsions, screams and violent resistance of control, with
a full pulse, the patient was composed by a cautious administration of
chloroform. While she was in this condition, free venesection was
practised, followed by a large dose of morphine, and cold applica-
tion to the head. The paroxysms soon began to recur, and they were

REPORT ON ETHER AND CHLOROFORM. 193

again promptly subdued by chloroform. The inhalation was repeated
at intervals, so as to keep up a state of anaesthesia, until narcotism
commenced, when its use was dispensed with.

In one of these cases, two pounds of blood were taken during
anaesthesia.

It should be particularly observed, that the act of deglutition was
performed during anaesthesia.

Convulsions from other causes have been relieved by a mode of
practice similar to that last mentioned.

Cramps of Asiatic cholera. — This dreadful symptom of a most ma-
lignant disease has been entirely relieved by anaesthesia. In two
cases, the one complicated with r^sterical symptoms, and the other
in a state of collapse, chloroform was used as occasion required, with
the happiest effects, and. both patients recovered. In the last case,
the system, nearly exhausted by the principal symptom of the dis-
ease, seemed in danger of complete exhaustion of the vital powers by
the fatigue and pain of the violent muscular contractions. Tranquil
sleep was produced by chloroform, and an opportunity given to the
system to recruit its worn-out energies.

Neuralgia. — Severe attacks of this disease have been entirely re-
lieved by chloroform ; no case of permanent cure has been reported.

Burns. — Anaesthesia relieved a patient from the intolerable suffering
produced by this injury, and enabled the surgeon to apply suitable
dressings with facility.

Asthma. — No agent of the materia medica gave such prompt relief in
this distressing affection as chloroform. It was premised by venesec-
tion when this was indicated. In one case, continued gentle inhala-
tion gave entire relief, without the use of any other means. It was
used several times, with the happiest effect, in the case of a feeble
person of seventy years old.

Abortion. — In one case of strongly threatened abortion, venesection
and opium were used, followed by chloroform, with the best results.
During about a fortnight, opium and chloroform were used as occasion
required, and the patient, who had aborted at the same period the
year before, was carried on to her full term. The child was perfectly
healthy. In many of these cases, the cause of irritation is extraneous
to the uterus, and by controlling this irritation, we ward off its reflex
action on that organ. Besides this, a profound state of anaesthesia
does, to some extent, control the uterus itself during labor at the full
period ; much more, then, would it be likely to do so, when the uterus
is unprepared for normal spontaneous contraction.

Labor. — On the use of anaesthesia under this head, we have not
been furnished with much material for communication, only about
nine cases having been reported to us. In these, the results were
very favorable. In two, there was retention of the placenta, but, in
the other cases, it was expelled so readily, as to prove the complica-
tion to have been purely accidental.

The uterine contractions appeared to be temporarily suspended,
when the anaesthesia was very profound ; but they soon returned in
full force, as the patient emerged from this condition. When the pains

194 TRANSACTIONS OF THE MEDICAL SOCIETY OF VIRGINIA.

occurred rapidly, and with little force, the intervals were lengthened,
and the pains became stronger under the influence of chloroform.

It was remarkable, that during a moderate state of anaesthesia, the
patient unconsciously made the usual efforts auxiliary to the uterine
contractions.

In two or three instances anaesthesia was induced towards the close
of labor, in others when the os uteri was ascertained to be fully dilated,
and was then maintained during the remainder of the process. There
was one particularly beneficial effect observed, viz : a remarkable de-
gree of relaxation of the soft parts at the outlet of the pelvis. The
peringeum yielded with such facility, that the last stage of parturition
was accomplished almost without obstruction.

In one instance of protracted labor, chloroform was used to enable
the patient to obtain repose, which she greatly needed, after which
ergot was administered, and when vigorous contractions were pro-
duced, chloroform was again resorted to with the happiest effect.

In several instances, the child was delivered and dressed without
the least knowledge on the part of the mother of what had occurred ;
indeed, in two instances the mothers positively denied the children to
be their own when first presented to them. The children were as
vigorous as usual.

From the effects observed on the occasions reported, we feel autho-
rized to recommend these agents on other occasions when their effects
are evidently indicated, viz: severe colic, with or without invagina-
tion of the intestines, taxis for strangulated hernia, surgical diagnosis
of injuries, instrumental labor, manoeuvres in case of malposition of
the foetus, puerperal convulsions, &c.

Comparison between Chloroform and Ether. — The details
under this head are rather meagre.

Comparative strength. — About thirty drops of chloroform have fre-
quently produced a transient state of anaesthesia sufficient for the ex-
traction of a tooth, but no case is reported, in which less than £ oz.
of ether was used for the same purpose. Now one drachm of chloro-
form contains 120 drops. To produce this transient effect, therefore,
one part of chloroform was equivalent to about sixteen parts of ether.
In order to produce more profound and prolonged anaesthesia, one
part of chloroform was equivalent to about six parts of ether.

Comparative effects. — The taste and odor of chloroform was much
more agreeable than those of ether.

Respiratory o?-gans. — Ether was much more irritating to the air pas-
sages during the first inhalations. For this and the previous reason,
patients made greater resistance to its administration.

Nervous system. — Ether was much more stimulating than chloroform.
It sometimes produced a high state of delirium, with a disposition to
do violence to others. Chloroform occasionally produced excitement,
with a disposition to resist control.

Ancesthesia was more persistent when induced by chloroform. This
point, however, was not fully established.

Comparative efficiency. — Ether failed more frequently than chloro-
form. Its prolonged administration failed in two instances to pro-

REPORT ON ETHER AND CHLOROFORM. 195

duce complete anaesthesia in children. In one of these, chloroform
was used on the following day with prompt and complete success.

Modes of administration. — Those usually adopted were with an in-
haler, a cambric handkerchief, a cupped sponge, a sponge wrapped
in a handkerchief or napkin, and a sponge attached to the middle of
a piece of oiled silk. The neatest form of an inhaler which we have
examined is that called Rushton's. It is composed of a flat glass bot-
tle capable of holding about a half pint, having a mouth-piece of suf-
ficient size to cover the lips. At the bottom is an opening for the ad-
mission of air. A sponge is introduced through the neck, which is
contracted, so that the sponge must be compressed to pass through
it. The sponge remains in place very well, and is kept from contact
with the face. A fresh supply of the agent may be dropped in with-
out removing it from the patient.

The objections to this instrument are : 1st. The nostrils are not inclu-
ded in the inhaler. The patient may, therefore, close his mouth, and
breathe through his nose, thus avoiding the act of inhalation entirely.
One of the committee was obliged to lay it aside, owing to this cause,
the only time he tried it. 2nd. Although it is more portable than
some other forms, it is inconvenient to carry, and cannot always be at
hand. 3rd. Its brittleness.

The sponge answers very well, but it is not always at hand. The
cambric handkerchief may nearly always be procured, and may be used
advantageously in every case. It should be placed in the hand and
folded in a cup shape, in the bottom of which the agent should be
poured.

By enclosing a sponge, we have a better reservoir for the agent than
we have with the handkerchief alone.

The next plan we believe to possess some advantages over every
other, and we therefore describe it more minutely.

A sponge, large enough to hold about a half ounce of chloroform, is
loosely stitched to the middle of a piece of oiled silk about six inches
square. The silk lies loosely over the face and under the eyes, and
allows the air to enter under the lower edge, which must be raised, if
it fit too closely about the chin. When it is not in use, the oiled silk
is to be wrapped about the sponge, to prevent evaporation, and it is
then ready to be re-applied. Its advantages are, 1st. The eyes of the
patient are protected from the vapor, which is apt to irritate them.
2d. The operator is protected. The other usual modes leave him ex-
posed to considerable annoyance from the vapor. 3d. It can be
readily prepared, and is cheap and portable. 4th. It economizes the
agent used.

One of the committee, who has used it frequently, has added a tri-
angular piece of leather larger than the nose. This is stitched to the
oiled silk, and to it the sponge is attached. The leather, when laid
over the nose, keeps the sponge from touching the nostrils or lips.
The evaporation is slower from this instrument than from the hand-
kerchief, consequently the effects are produced more slowly, and for
this reason more advantageously.

This method was originally published, in the Buffalo Medical

196 TRANSACTIONS OF THE MEDICAL SOCIETY OF VIRGINIA.

Journal and Review, by Dr. Geo. M. Burwell. He used it in mid-
wifery cases, with a sponge holding a drachm.

For the purpose of noting as accurately as possible the amount
used, one of the committee is in the habit of keeping the chloroform
for immediate use, in a flat, graduated one ounce vial, which we would
recommend for general use. It is satisfactory to the operator to know
the amount used, for reasons similar to those which cause him to keep
himself informed of the amount of any other medicine, which he may
administer. It enables him to produce the desired effect with more
accuracy, and to give the same quantity to the same person.

Rules to be observed in the Administration of Anesthetic Agents.

1st. Examine the quality of the article used. Ether should be care-
fully prepared for the express purpose of inhalation. Chloroform
should be procured only from some factory of established reputation.

2d. Examine the condition of the "patient. We consider the follow-
ing conditions as contra-indicating the use of anaesthesia : Organic dis-
ease of the heart, by which its strength is greatly impaired ; for instance,
softening and dilatation. We would fear, that in such a case, a greatly
enfeebled organ might cease to act under the influence of a powerful
sedative. Disease of the lungs, producing considerable loss of sub-
stance or extensive tubercular deposit, by which the supply of oxygen
to the system is greatly diminished. In these cases we would fear,
that the patient might be asphyxiated by lessening suddenly the sup-
ply of air, already insufficient for the healthy performance of the vi-
tal functions. A tendency to apoplexy. In such a case we would ad-
vise either that these agents should be abstained from altogether, or
that their use be premised by blood-letting. The congestion of the
vessels of the head, together with the sensations experienced just be-
fore anaesthesia occurs, indicate some degree of cerebral congestion,
which, superadded to that already existing, might be followed by
dangerous consequences.

• 3d. Place the patient in either the recumbent or reclining posture.
The vapors of ether and chloroform being heavier than atmospheric
air, in this position they gravitate towards the mouth and nostrils,
and thus a smaller quantity is necessary to produce the effect. When
the patient becomes perfectly relaxed, an upright position cannet be
maintained without support, and if the operator have no assistants
the patient may fall from his seat.

4th. Avoid, if possible, administering these agents when the sto-
mach is full, for they will then almost inevitably cause profuse vomit-
ing, with protracted nausea. This will greatly delay anaesthesia, and
seriously embarrass the operator. Strong efforts at vomiting increase
the existing cerebral congestion, and often produce severe headache.
The patient should be directed to avoid his usual meal preceding the
inhalation, or the operator should select his time when the stomach
will be empty.

5th. Attend to the admission of air during inhalation. This we be-
lieve to be the most important precaution requiring our attention. If

REPORT ON ETHER AND CHLOROFORM. 197

the vapor be inhaled in a very concentrated state, it will produce
coughing and a sense of suffocation ; the act of respiration will be
temporarily suspended, and the patient will run the risk of being as-
phyxiated.

6th. Secure complete anaesthesia before commencing a surgical ope-
ration, and maintain this condition, by repeating the inhalation as often
as may be necessary during its performance. For this purpose, as in
the employment of other remedies, pay more attention to the effect pro-
duced than to the quantity used. Inattention to this rule may cause
the patient to be in a worse condition than if anaesthesia had not been
attempted. If this state be incomplete, he is deprived of self-control,
and left under the full influence of the reflex system of nerves, when
he will be more restless than in a state of perfect consciousness.

Chemical composition of ether and chloroform. — In order to the com-
pleteness of this report, we subjoin the following remarks : These
agents belong to two series of bodies, distinguished by hypothetical
radicals, each of which is a hydro-carbon. The radical of ether,
called ethyl, consists of four equivalents of carbon, and five equiva-
lents of hydrogen, represented by the formula C4 Hs.

The radical of chloroform, called formyl, consists of two equiva-
lents of carbon and one equivalent of hydrogen, represented by the
formula C 2 H.

Ether consists of one equivalent of oxygen combined with ethyl,
and may be termed oxide of ethyl.

Chloroform consists of three equivalents of chlorine combined with
formyl, and may be termed perchloride of formyl.

The chemical formula of ether is C4 Hs O.

" " chloroform is C2 H CI 3.

The specific gravity of ether is 0.720

" " '.■■«■■* chloroform is - 1.48

It is reported to have been obtained as high as 1.5

Ether is a highly inflammable substance. Chloroform is not inflam-
mable. We should be cautious, therefore, when administering ether,
not to bring a lighted candle near the patient, lest the vapor should
take fire. This risk does not occur when chloroform is used.

We learn that the only "preparation of chloroform in use in this city
is obtained from the factory of Messrs. Powers & Weightman of Phi-
ladelphia, whose high character is a guaranty of its purity. The
quality must, therefore, have been generally uniform. This fact is of
importance, as it enables us to ascertain with more certainty the
causes producing the variety of effects noticed. On one occasion, a
strong chlorine odor was observed, and on examination, it was found
that the patient had sent a vial which was not clean. No doubt the
impurity had caused a decomposition.

From the facts which we have presented, we deduce the following
propositions :

1st. Of nearly fourteen hundred instances reported, in which anaes-
thesia has been produced, not one has occurred in which either a fatal
or permanently injurious consequence has been proved to have re-
sulted.

23

198 TRANSACTIONS OF THE MEDICAL SOCIETY OF VIRGINIA.

Note. — This proposition is the more remarkable, when it is recol-
lected, that the period embraced in this report extends over the entire
history of the use Of anaesthetic agents in this city since their introduc-
tion ; that their early use was necessarily to a great extent empiri-
cal ; and that a large proportion of cases occurred in the practice
of those who were not physicians, and of whom we may say, with-
out disrespect or disparagement of their professional skill, that
they were less competent than physicians to discriminate between
those who were and those who were not suitable subjects for the ad-
ministration of anaesthetic agents, or to judge of the physiological
effects produced. We believe that such a proposition could not be
maintained in regard to any other of the most powerful agents of the
materia medica.

2d. That on every occasion on which it is desirable to use anaesthe-
tic agents, we may do so with confidence, observing proper precau-
tions.

3d. That chloroform is preferable to ether, and is equally safe. We
would compare its advantages to those of the alkaloids, quinine, mor-
phine, &c, over the bulky and often nauseous substances from which
they are derived.

4th. That in surgical operations the patient is not only saved the
cruel agony which has hitherto been inseparable from many of them,
but is in a more favorable condition for their successful performance.

5th. That the process of natural labor is facilitated by anaesthesia.

6th. That in some cases of a purely medical character, these agents
furnish a most valuable resource to the physician.

7th. Finally, when we consider the extensive application of these
agents, the diminution of suffering and the preservation of life which
they have effected, and the relief from embarrassment to the operating
surgeon which they afford, together with their safety, they deservedly
rank among the most valuable resources of the healing art, and their
discovery marks an important era in the history of medical science.

All which is respectfully submitted.

JAMES BOLTON, M. D.
C. BELL GIBSON, M. D.
JOHN A. CUNNINGHAM, M. D.
WILLIAM W. PARKER, M. D.

Erratum. — In the table on page 182, read, instead of the numbers under the correspond-
ing columns:

Physicians' report, ...

Dentists' report, ...

729 655

Males.

Females

237

1(33

492

492

THE VAPORS. 199

For the Stethoscope.
The Vapors.

There are few persons so fortunate, or so happily constituted, as
not to be liable at times to feelings of depression, bordering on melan-
choly. For. as has been remarked, those who seem most buoyant in
public, are often in other moments the most prone to despond. All,
however, should endeavor, as far as possible, to attain a cheerful
frame of mind. It is somewhat difficult to determine the exact point
which separates the mere state of ordinary low spirits in the sane,
from the morbid condition of mind and pain to which, from the most
ancient times, the epithet melancholy has been applied in a technical
sense. The very closeness of this connection, indeed, is such as should
induce a habitual struggle against yielding to any emotions of the
kind. Perhaps, apart from delusions which do not necessarily ac-
company insanity, at least in a marked form, two of the most charac-
teristic symptoms, separating it from ordinary depression, and con-
stituting melancholy considered as mental derangement, are the pre-
sence of nervousness, and a long continuance of the feeling involved,
with naught in the nature of an adequate external cause for such a
psychological phenomenon. However different the two conditions
may be, a proneness to the one should be carefully avoided as cer-
tainly apt to lead to the other. So doubtless too. in a measure, the
means employed to dissipate the mild or precursory symptoms of
melancholia and hypochondriasis, if habitually adopted, would serve
to neutralize the action of low spirits.

Philosophical considerations present themselves to almost every
one, in demonstration of the groundlessness of feeling too deeply the
ills, whether fancied or real, of this mortal life. But alas for us !
The path of history is strewed with the wrecks of altars raised to
principles fondly deemed everlasting, but which now serve only as
subjects of curiosity, or materials to construct other theories as fleeting
and transitory as they. Still we may allude to a few considerations
that almost by their very triteness fail in exciting a practical atten-
tion on the part of individuals, and which yet, it seems likely, should
have the effect, when duly digested, of diminishing the intensity of a
painful inquietude. Thus, take many of those who are victims to
lowness of spirits, and let them compare their situation with that of
a multitude of persons, both now in existence, and also of those long
buried beneath the lapse of centuries, and they cannot but perceive
that their lot is endowed with far more of the elements of comfort,
than occurs to a vast number of their fellow-creatures, whose portion
nevertheless has not been unhappiness. Again, if there be real mis-
fortune to cause feelings of despondenc}^, do we not all see how fleet-
ing are alike both earthly sorrows and earthly joys. Of course too, in
the deepest night of affliction, religion points aloft to the solemn stars,
shining above all the storms and clouds of this world, and beaming
on radiantly and undimmed forever. So too, the providence of God,
as seen in all things, should be soothing to the grief- worn — that eter-

200 THE VAPORS.

nal substratum to the universe, of whose existence they are fully con-
scious who have faith,

" And hear at times a sentinel,

That moves about from place to place,
And whispers to the vast of space,
Among the worlds, that all is well."

[In Memoriam.

Although reflections like the above, as it is with arguments against
the delusions of the insane, usually fail in producing any consider-
able effect, the depressed in spirit would do well to bear them in re-
membrance. Such conclusions may be looked upon as the judgment
of the thoughtful in the long line of ages, the experience of the
thinkers in all time. But each epoch has its own separate experience,
and the unusual degree of investigation into the symptoms of insanity,
at this date, has elaborated opinions of importance in this regard.
Two of these, which we deem plain inferences from facts concerning
insanity, traced by physicians of lunatic asylums and other observers
of the disease in point on a large scale, seem worthy of mention.

We estimate a habit of self-control as very essential to a peaceful
and healthy state of mind in this world. We are satisfied that a num-
ber of insane persons owe their malady to a want of self-government.
The inculcation of this in childhood, to the mind so docile and pliant
at that period of life, is especially necessary — as the twig is bent the
tree will grow. And if an early vigor is imparted to the youthful
mind, by teaching moderation, by a constant endeavor to produce a
balance of power in the various mental attributes, then may the
storms of life spend their fury in vain upon an individual who is so
fortified against them. In Virginia we are accustomed to look upon
Washington as the most exalted character that is found on the pages
of history : and amongst the qualities constituting the greatness of
this illustrious man, no peculiarity is more striking than the complete
mastery which he held over all his feelings and emotions, and the ge-
neral equilibrium which reigned in all his faculties. If the hopes and
associations be fixed on any object in life, whether it be wealth or am-
bition, or love, and this darling end be placed apparently beyond the
reach, the ill-balanced mind is apt to fall precipitately into the dark
abyss of insanity. Moreover, the mere habitual yielding to gloomy
thoughts and feelings at last causes these to be persistent, when, if
resolutely striven against, they would have been only temporary ; for
it is the nature of every mental trait to be increased in strength by
exercise. Even, indeed, when a sufferer becomes actually insane, we
often witness the internal conflict which he undergoes in resisting the
sway of delusions and morbid feelings. It is in truth far more ad-
vantageous in managing the insane, to encourage them to use all their
efforts in this line of action, than to contend against their false ideas
by a logical discussion. Analogous exertions are both feasible and
proper on the part of the sane; and it is just as requisite for those
prone to them, to refrain from giving way to the predominance of som-
bre ideas and feelings, if they would avoid the great calamity of an
unsound mind, as it is for the victims of intemperance or the other

THE VAPORS. 201

appetites to refrain from such excesses, if they seek to avoid a similar
fate.

In the treatment of mental alienation, as novv-a-days everywhere
pursued, one of the leading measures consists in bodily and mental
employment. The particulars into which these two heads may be
divided are boundless in number, and have been frequently discussed,
sometimes with direct reference to their comparative value and utility.
The great principle involved is, however, throughout the same — being
to keep the mind so occupied that the morbid feelings and delusions
are effaced through inaction. In lowness of spirits, this identical
course is to be pursued. Doubtless for such individuals some avoca-
tion or employment, naturally congenial to them, will prove most suit-
able ; but let them be occupied in some mode, whatsoever it may be.
If, perhaps, a man were to seek that condition of things which was
calculated to render him most happy, it would be found in a conti-
nuous, though not too laborious occupation, in some pursuit in which he
took great interest. But even if there be a disinclination to all sorts
of occupation, and even to amusements, and although the individual
may be wealthy, still it would be the best remedy for a causeless de-
pression of spirits, steadily to pursue a fixed object requiring action
and thought, in order to attain the end proposed in that relation. . Aber-
nethy's counsel to a nervous and dyspeptic lady, was: "Dismiss
your servants, madam, and make your own beds." And Burton's
wondrous volume, the "Anatomy of Melancholy," concludes with a
da capo of advice to the following effect : " Only take this for a corol-
lary and conclusion, as thou tenderest thine own welfare in this, and all
other melancholy, thy good health of body and mind, observe this
short precept, give not way to solitariness and idleness — ' be not soli-
taty, be not idle.' " In certain cases of mental disturbance, in which
there is an unaccountable nervous distress and agony of mind, Dr.
Bell, an accomplished superintendent of the insane, observes, that
" the restraints, discipline, and interdiction from friends of an asylum,
or of a sea-voyage, are pretty sure to effect a recovery."

Not unfrequently we find low spirits distinctly connected with im-
pairment of the physical health. In this event medical means will
sometimes have a good effect; so on the other hand the mind, even
when strictly speaking undiseased, may prey upon the body. We
believe, indeed, that these circumstances, though acknowledged in the
main, are yet frequently overlooked in details, and occasionally to the
disadvantage of the individual concerned. In a trip to a watering-place
the mind is pleasantly engaged ; various cares are laid aside ; there is
nothing vexatious to disturb the psychical tranquillity ; the change of
scene, and the many new objects prevent an indulgence in gloomy
reflections, by their pre-occupation of the mind, and this, reacting on
the body, causes it also to recover from its ailments. We are inclined
to think that, per se, a pleasant sensation is of service to both the men-
tal and physical economy conjointly. Indeed, perhaps, effects in
themselves pernicious to a certain degree, from the use of certain
articles of diet, are counterbalanced by the pleasant sensations felt in
the system generally. Thus an individual comes to his home at the

202 THE VAPORS.

evening hour, wearied with a day of toil, and perhaps harassed with
mental uneasiness. Refreshing to him under these trials is the influ-
ence of tea or coffee ; any evil effect on the nerves is thus, perhaps,
compensated for by the soothing power over mind and body, and
their mutual reaction for the good of the whole animal frame. This
idea may also apply measureably to tobacco ; but it will not answer
to extend the theory too far. For the continuous effects of these
agents on the nervous system, if they are used for a long time to
excess, must prove highly deleterious. And we may here remark,
that nothing can be more erroneous, than for those affected with low
spirits to resort to nervines for the purpose of relieving their despon-
dency. Apart from the permanent ill consequences in the end, there
is always a scate of depression immediately following the preceding
exhilaration. This remark applies to every nervine, for all the ex-
hilarating substances employed by man are but letters of the same
alphabet, whether they are entitled stimulants or sedatives. There is
no intrinsic or essential difference in this aspect ; for example,
between tea, coffee, alcohol, opium, hachish, chloroform and tobacco.
He who becomes an abject slave to any one of these, realizes the an-
cient legend of Faust's compact with the demon, to resign his hopes of
everlasting bliss, for temporary pleasures of an exciting character.
If there be any circumstances justifying the use of such agents in these
cases, it is the employment of those nervines so calculated to act, in
order to procure sleep. But even here great caution is requisite lest
that become a habit, which in the first instance was so pleasant in
itself, and that besides relieving pain perhaps, procured rest and all
its attendant refreshment, in place of a previous general malaise.

Most diseases are brought on b3r improper indulgence during health,
or want of due carefulness against the invasion of a malady. Per-
sons when in health, finding that they can neglect hygienic rules for a
long period without evident detriment, are led to imagine that their
experience runs contra to supposed facts deduced from them. But
oftentimes they are but sowing the seeds of disorders which ultimately
burst forth in an aggravated form. They who would property enjoy
life, should strictly attend to these pi-inciples, unless, indeed, they pre-
fer the error of passing " a short life and a merry one." Those sub-
ject to low spirits of course come within the general category. There
are, however, a few precautions, which seem to demand particular
care on their part, and to which, moreover, the attention of their
friends should be directed when their habitual tristesse seems on the
verge of terminating in actual insanity.

Dr. Brigham observes, that "notwithstanding strong hereditary pre-
disposition, ill-health, loss of kindred or property, insanity rarely re-
sults unless the exciting causes are, such as to occasion loss of sleep.
A mother loses her only child, the merchant his fortune — the politician,
the scholar, the enthusiast, may have their minds powerfully excited
and disturbed — yet if they sleep well, they will not become insane."
In order to secure this blessing, active exercise is the chief resource,
should it be feasible. Early rising and retiring are also advantage-
ous ; and the individual should avoid excitement at night, and the in-

THE VAPORS. 203

fluence of perplexing thoughts. He should endeavor to turn his mind,
on retiring to bed, from any present idea creative of anxiety, by fixing
his thoughts on scenes in the past, or the consideration of other per-
sons rather than himself, or on expected events in the future, which
are attended with hope. " Building castles in the air" may also be
resorted to, and counting a large number is an old plan in this regard.
The educated have also a resource here in directing the attention to
matters which they have read, or in endeavoring to recollect snatches
of poetr}', or in testing their remembrance of historical and scientific
truths. In some cases where the rest is broken, rising from bed and
washing the face and hands in cold, or bathing the feet in warm water;
or the use of perfumes will be of service. As a last resort, and un-
der peculiar circumstances, the cautious employment of nervines may
be adopted. Dr. Macnish, in his work on the " Philosophy of Sleep,"
says, the body should be brought to a medium temperature before re-
tiring, and that, as a general rule, a person who eats nothing for two
or three hours before going to rest, will sleep better than he who does ;
and he approves of the habit of the Chinese, of brushing their teeth
before lying down.

Another precaution to which the nervous and melancholy would do
well to attend, is, being careful as to the condition of the alimentary
canal ; for keeping the bowels open, as holds good with respect to
other processes of nature, diet and exercise are preferable to medi-
cines. Especially if there be a dyspeptic tendency, it will be often
found beneficial to substitute the Graham biscuit for all other kinds of
bread. In some cases of low spirits, a mild laxative might doubtless
be used occasionally with advantage. In melancholy derangement,
purgatives have been employed from the most ancient times — less now
perhaps than formerly. Pliny asserts that the black hellebore was
first discovered at an early period, by Melampodius, and that through
its action he cured the daughters of the king of Arcadia; and in an-
cient times those laboring under mental derangement were sent to
Anticyra to be purged, this plant growing very abundantly on that
island.

With regard to bathing, Dr. Winslow makes the following remarks:
" The state of the mind is closely dependent on the condition of the
cutaneous secretion. I should recommend those who are subject to
mental depression — hypochondriasis, the vapors, ennui, or by what-
ever designation it may be termed — to try the effect of systematic
bathing. I feel assured that, in many instances, violent attacks of in-
sanity may be warded off by the use of the warm or cold bath. In
cases of cerebral irritation, evidently the result of a tendency to vas-
cular excitement, bathing the head regularly every morning with cold
water, or vinegar and water, will be followed by great benefit to the
health of the body as well as the mind."

J. M. G.

204 METTAUER ON PUERPERAL FEVER.

A case of Puerperal Fever successfully treated — with
Observations.

BY JNO. P. METTAUER, M. D., L. L. D., OF VA.

The case of puerperal fever about to be reported through this pa-
per, occurred with an exceedingly delicate female servant, aetat. 25
years, who had borne children very rapidly, having had five, includ-
ing the one born immediately before this attack. Her previous labors
were not distinguished by anything very remarkable, and the recove-
ries from them were generally as speedy as could have been expected
with one naturally delicate, and who was rendered more so by fre-
quent pregnancies and childbirtbs. The pregnancy immediately pre-
ceding this attack of childbed fever, in its early periods, was similar
to the former ones. In the latter months of it, however, and particu-
larly the last two, the woman suffered more or less from fever, espe-
cially of evenings, restlessness, thirst, loss of appetite, irritable bow-
els, debility, abdominal tenderness, especially near the close of ges-
tation, and the most hopeless despondency.

When labor set in, the woman was a mere living skeleton — the
most emaciated person conceivable, to be struggling with the throes
of childbirth. The labor continued about 16 hours, and was not more
distressing than her former ones, with the exception of the soreness
of the soft wall of the abdomen, which each uterine contraction, to-
wards the close of labor, rendered very distressing. When the mem-
branes gave way, and the liquor amnii dashed over the midwife's
hands, the temperature of it was so high as to impart the sensation of
a " scalding heat," as the midwife expressed herself, and actually
greatly alarmed her. The woman, too, complained of the unusual heat
of the waters. The midwife informed me also, that when she passed
her hand into the cervix, for the purpose of dislodging the placenta, its
surface was exceedingly hot, more so than in any case in which she
had ever officiated before, and her experience had been considerable.
This condition of the liquor amnii, as represented by the midwife,
was not new to me, as I had met with it in some seven or eight cases ;
and I have now and then found the reverse to be its condition, as
well as of the uterine surface, which I have found so cold as to impart
a decided and exceedingly unpleasant sensation of coldness even
during the heat of summer. The case in question occurred in Sep-
tember, and during very warm weather, so that the midwife could
hardly have been deceived by reason of her hands being cool at the
time the waters were discharged upon them. These remarkable de-
partures of the temperature of the liquor amnii and uterine surface
from their ordinary conditions, I have always esteemed indications of
danger, and a strong liability to puerperal lever ; in several instances
they have been succeeded by that terrible disease before I adopted my
prophylactic treatment of childbed fever — a paper on which subject
I contributed to the January Number of the " Charleston Medical
Journal and Review for 1851," an exceedingly well conducted and
valuable journal.

METTAUER ON PUERPERAL FEVER. 205

On the fourth day after delivery, nearly 100 hours from the time of
its completion, I saw this woman for the first time after the attack of
puerperal peritonitis commenced. I learned from the family, that a
chill ushered in the disease, which occurred about 13 hours after de-
livery, and was soon succeeded by violent febrile reaction, pain of
the inferior portion of the abdomen, thirst, nausea, and some tumefac-
tion of the abdomen. I was informed by the midwife, that the abdo-
men did not subside, as is usual after delivery, but remained full and
rather puffy. Very soon after febrile reaction set in, the abdomen
became more tender under pressure during efforts to turn the body or
to cough ; and the after-pains, which the case was supposed to be for
nearly three days, greatly augmented the sufferings of the woman, as
well as the peritonitis. I could not procure from the family, nor from
the suffering woman, who was too ill when I arrived to give me a
satisfactory account of the case, after the pains greatly augmented in
violence. I learned that the lochial discharge ceased about 20 hours
after delivery ; that the pain was constantly confined to the region of
the uterus and inferior part of the abdomen ; that urination was at-
tended with difficulty early after delivery, and for the last day before
I saw the woman, was impracticable ; that the bowels had never been
properly evacuated, and were still constipated ; and that the abdomen
had been swollen to its present enormous size for more than forty hours.
I found the whole abdomen greatly tumefied, painful and exceedingly
tender under the slightest pressure. Even the bed-clothes resting
upon it, or the least change of posture, caused intense suffering. The
pulse was greatly, nay, fearfully accelerated, exceeding in frequency
160 beats in a minute, was concentrated, tense and resisting; the
respirations were hurried, exceeding 45 in a minute ; and the breath-
ing was laborious, attended with frequent sighing, and chiefly thoracic ;
the skin was hot and dry; there was incessant and most tormenting
thirst ; the eye was unsteady, and expressive of the greatest suffering ;
the position of the body was constantly dorsal, with the legs flexed
on the thighs and drawn up ; the tongue was moist, but covered with
a whitish fur; the bowels were constipated, yet there was a frequent
desire and repeated ineffectual efforts made to evacuate them ; there
was retention of urine ; intense internal heat was constantly com-
plained of; the lochial discharge had disappeared in a very great
degree, and in its place a sanious, dark, offensive discharge appeared ;
the breasts were flabby and pendulous, and without the slightest ap-
pearance of a disposition to secrete milk; the vagina was hot and
dry ; there was almost a constant disposition to eructate, which caused
the woman much distress in fruitless efforts to expel air from the sto-
mach ; there was almost incessant moaning as well as great restless-
ness ; the mind at times was wandering, bordering on delirium ; the
most perfect disregard and want of concern for the infant was con-
stantly manifested by the woman ; there was a fixed aversion for food ;
and for three days and nearly four nights the eyes had not been closed
in sleep a moment.

The treatment adopted in this highly interesting and threatening case
was antiphlogistic, decisively and vigorously carried out in practice,
24

206 METTAUER ON PUERPERAL FEVER.

regarding the disease, as I have always done, inflammatory in the
highest degree, especially in its early stage. My first aim was to en-
feeble the organs of the active circulation so decidedly as to arrest the
inflammatory process at once, and to protect the inflamed peritoneum,
uterus, &c, against disorganization. To accomplish these ends, I first
employed blood-letting from the arm, previously placing the woman in
a semi-recumbent posture, and detracting the blood through a large,
free orifice, until fainting was induced. In this manner sixty ounces
were drawn at the first bleeding, before fainting could be produced.
The effect, however, was decisive — a complete syncope came on, which
continued fully two minutes after the woman was placed completely
horizontal. Indeed, consciousness did not fully return for ten minutes,
and from the commencement of the swoon, a copious and general
sweat made its appearance, that continued more than three hours.
The condition of the pulse was remarkably changed by the bleeding ;
its frequency was suddenly reduced from 160 to 120 pulsations in a
minute, and was softer, more expanded and regular in its heat. The
respiration and abdominal pain were also greatly ameliorated. Twen-
ty-three respirations instead of forty -five were now only to be enu-
merated in a minute. The countenance was less anxious, and the
woman expressed herself as greatly relieved in all respects. With-
out a moment's delay, an emetico-cathartic was administered, which,
to save time, had been previously prepared, consisting of half an
ounce of senna, one drachm of jalap, two ounces of Epsom's purging
salts, one drachm of aniseseed, infused in a half a pint of boiling
water for a few moments, and then gently boiled until the quan-
tity of the menstruum was reduced to a gill. To the strained fluid,
while pretty warm, three grains of tartar emetic were added, and
the preparation thus formed was administered at one dose. The
woman was now slightly turned on the right side, so as to cause
the gastric contents to gravitate to the pyloric extremity of the sto-
mach, both to prevent the rejection of the medicine, should early
emesiatake place, and to quicken the passage of it into the duodenum,
and its operation as a cathartic. The change of position of the wo-
man's body was effected without much difficulty, and with very little
pain, and it was maintained until vomiting commenced, which took
place nearly three-quarters of an hour after the dose of medicine was
administered. As soon as the purgative had been given, and the
position of the body properly arranged, fomentations were emplo}red
over the entire abdomen. These were used as hot as they could be
borne, and were repeated every fifteen minutes. In the mean time an
active enema of strong salt water was prepared, consisting of three
heaping table spoonsful of the chloride to the pint of hot water, which
was injected into the rectum, of the proper temperature, immediately
after the commotion from the first vomiting subsided. The enema
was retained, contrary to expectation, nearly twenty minutes, and
pretty soon after its action commenced the vomiting was renewed,
the two remedies acting simultaneously, producing artificial cholera
morbus ; and this state of cathartico-emetic action commencing with
the operation of the enema, continued during the action of the purga-

METTAUER ON PUERPERAL FEVER. 207

tive, which commenced its operation in an hour after the administra-
tion of the enema. I have never witnessed, in the whole course of
my professional life, such copious products by vomiting and purging,
as were yielded by those agencies in this case. The quantity ejected
from the stomach was so enormously large as actually to astound me,
and yet very little in the way of food or drinks had been taken into it
from the commencement of the attack, as I was assured by the family
and nurse. The same was the effect with the alvine discharges ; they
were copious beyond anything I have ever seen in like cases. The
evacuations from the bowels consisted of large quantities of faeces, in-
termixed with crude, undigested alimentary substances, and sero-
mucous matter. Four evacuations from the bowels were procured by
the enema and internal cathartic, and two of them were very copious,
while two were free, but not unduly so, and feculent. Vomiting dis-
charged considerable quantities of bile mixed with flakes of mucus,
and an extremely dense, tough, and ropy semi-fluid of a mucous cha-
racter.

It could be perceived at the close of vomito-cathartic commotion,
that the tumidness as well as the tenderness of the abdomen had
considerably subsided. The woman was now able to turn in bed,
and otherwise change the position of her body with less difficult}'- and
suffering, and she certainly complained less of pain, and stated that
she felt less of it. The fomentations were laid aside after the third
alvine evacuation, and the whole abdomen freely rubbed with pure or
mixed spirits of turpentine made a little warm, and then covered with
a blistering plaster securely confined with a suitable bandage. At this
period the sweating had considerably abated, but the skin was still
moist, though unequally so; and whenever quite dry was manifestly
unduly warm. The pulse, too, was becoming more active and strong,
and the woman complained of some return of abdominal pain, and
was more restless. The orifice was again opened — though, I confess,
with fearful misgivings, by reason of the alarming syncope from the
previous bleeding — first elevating the woman's head and trunk, as
far as could be done without causing pain, to enable me to avail my-
self of the horizontal posture suddenly, should fainting again follow
bleeding. I now detracted twenty-three ounces more of blood
promptly, which produced faintness, but not complete syncope ; and
as soon as the woman was placed horizontal, the sweating was re-
newed. This bleeding reduced the force, as well as the frequency, of
the pulse most decisively ; and in half an hour after it, the woman fell
into a quiet, sound slumber, which continued until she was aroused by
the drawing of the blister, supposed by the nurse to have been of
three hours duration. The drink chiefly used was cool " pine-tops
tea," and the woman was urged to take it freely, which she willingly
did. Pounded ice and iced water were also allowed, and freely used
as gastric refrigerants, as long as the internal sensation of distressing
heat and the thirst continued. The introduction of ice into the sto-
mach, coarsely pounded, effectually and most gratefully relieved that
distressing symptom, internal heat. I also applied ice to the os uteri
and cervix, as well as to the dry and hot vagina, by introducing pieces,

208 METTAUER ON PUERPERAL FEVER.

quite up to the os tincse, of proper size and form to fill the vagina, as
long as undue heat of those parts continued. This last was a most
grateful and efficient remedy, and co-operated beneficially with gas-
tric refrigeration.

As soon as the woman was fully awake, I administered twenty
grains of calomel, with one-fourth of a grain of tartar emetic, mixed
in dry brown sugar, washed carefully from the mouth with pine-tops
tea, and swallowed ; and had her placed partly on the right side and
back, for the reasons already stated. In two hours after the calomel was
taken, an active enema of strong saltwater was administered, which,
being retained some five or six minutes, procured a slight feculent dis-
charge from the bowels ; and it excited considerable irritation about
the rectum, that caused the woman to complain greatly, for some ten
or fifteen minutes, of tenesmus and straining. As soon as the rectal
irritation subsided, the blister was examined, and found to be well
drawn in every part of its extensive surface. It was indeed an ex-
tensive as well as perfect blister : fully sixteen ounces of serosity
were discharged from the blisters, as they were opened. A dressing
of soft cabbage leaves was applied to the blistered surface, which, in
a majority of instances, should be preferred as the first dressing, by
reason of its softness and lightness.

The dressing of the blister, for the first time, took place about the
tenth or eleventh hour after my arrival, and the one hundred and tenth
of the disease, and in all respects the case had very greatly amelio-
rated. Very soon after the dressing of the blister was completed, the
woman fell into a soft, quiet sleep, which continued three hours, and
would have been still farther prolonged but for the operation of the
calomel. The bowels acted freely, and the evacuation was of good
consistency, as well as of the proper color of feculence, emitting like-
wise the true feculent odor. With the purging from the calomel, the
tumefaction of the abdomen began to subside, and its diminution was
so rapid as to be almost perceptible. Several times while observing
the tumefaction, during a dejection, I imagined that I could actually
perceive it to diminish and subside, and yet there was no expulsion of
flatulence from the bowels. All pain and tenderness of the abdomen
very soon disappeared after the operation of the calomel, and the wo-
man expressed herself as entirely relieved. The pulse now was re-
duced to 90 beats in a minute, and was soft and expanded. The skin
became moist and of the proper temperature. The respirations were
reduced to twenty, and of easy performance. From this period there
was progressive amelioration in the symptoms to complete recovery,
without the slightest interruption. The blister suppurated freely three
or four days. There was no necessity for diaphoretics. To prevent
constipation, a moderate dose of aloes, rhubarb and jalap, in the form
of a pill, was given nightly, which completely answered the purpose.
The appetite returned by the twentieth hour after I saw the woman
the first time, and by the fortieth was very keen. There was a slight
return of the lochial discharge very soon after the calomel ceased
operating, which was about 15 hours from my first visit, and it in-
creased in quantity until the discharge was quite free for one so feeble.

spencer's occlusion of the vagina. 209

On the third day from my first visit, or the fifty-eighth hour after the
first bleeding, there was some fulness of the breasts, and a few drops
of milk could be pressed out from them. From this time I discon-
tinued my visits, requesting, however, that I should be sent for imme-
diately, if any thing threatening occurred, or if the convalescence
did not proceed regularly ; and I learned some weeks afterwards, that
the woman had recovered without any accident, and was quite well
except somewhat feeble.

Remarks. — The chief importance of the case reported, somewhat
in lengthy detail, is connected with the very free employment of san-
guineous depletion at so late a period of the disease in its medica-
tion ; and perhaps in no other disease but puerperal fever would
such apparent ultra, bold or rash treatment have been -justifiable. It
was too evident that the case must speedily end in fatal disorganiza-
tion of the uterus, peritoneum, and such other organs as might be im-
plicated in the inflammatory process, unless its course could be
promptly arrested ; and I had in many other cases employed a like
treatment successfully, though never in a single instance under cir-
cumstances as unpromising. I think it questionable if bleeding alone
would have arrested the progress of the inflammation, although its
effects upon the pulse, pain, &c, were decisive. The powerful im-
pression made upon the gastro-enteritic mucous surface, so soon after
the heart and arteries had been profoundly impressed by the enfee-
bling operation of bleeding, and on a surface naturally antagonizing
the serous, the principal seat of inflammation, was well calculated to
produce revulsion from the serous surface, and while secretion was in
some degree restored, and the circulation equalizing itself, as mani-
fested by the change in the character of the pulse and the perspiring
state of the skin. Prompt and decisive bleeding, speedily followed
by an active emetico-cathartic, have in numerous instances arrested the
course of this fearful and cruel disease in my hands; and I can con-
fidently recommend the treatment to my brethren of the country, and
especially to those practising in healthy situations. My experience
leads me to the conclusion, that puerperal fever is always an inflam-
matory affection ; that its tendency is rapidly to disorganize the organs
in which it occurs ; that it is not a contagious or communicable dis-
ease, and that it can be most successfully combatted by the early
adoption and rigid and energetic enforcement of antiphlogistic medi-
cation.

Prince Edward C. H., February 1851.

Occlusion of the Vagina — Successful Operation — followed by
Conception and Delivery.

BY P. C. SPENCER, M. D., OF PETERSBURG, VA.

Mrs. ***, aged 25, -fleshy, Lymphatic temperament, apparently in
good health, came under my treatment in April 1846. She sought
relief for an extremely distressing state of the genital organs, which
had existed seven years. Upon examination I found complete occlu-

210 spencer's occlusion of the vagina.

sion of the vagina. When the labia majora, which were perfect, were
separated, a firm cicatrix was exposed, which involved and oblite-
rated the labia minora, and occupied the place of the natural vagina.
This cicatrix was firm and unyielding, and seriously deformed the
parts by the contraction it had produced. In its centre was an orifice
with firm edges, feeling, when the finger was placed on it, like the
bore in the tube of a key. A probe could be passed a couple of
inches along the orifice when an obstruction presented itself. No com-
munication to the uterus existed, and this lady had not menstruated
since the accident which led to the deformity. The obstruction of the
vaginal canal, notwithstanding this duct, was complete, and that ob-
struction appeared to consist of a firm, white cicatrix.

The origin of the mischief could be traced to parturition. From
her statement it appeared that she married early — gave birth to an
unusually large infant in her 17th year. Her labor was tedious and
difficult, and, unfortunately, immediately was followed by alarming
illness, which served, by diverting the minds of the attendants, to pre-
vent that attention to the state of the genitals, which their tender and
lacerated condition required. Sloughing was the result, and accom-
panying her recovery was the gradual approximation of the vaginal
walls, by adhesive inflammation, ultimately terminating in that condi-
tion which we have described. In a short time after her recovery the
bloom of health faded from her cheek, she became sallow, and com-
plained of great debility. Besides the disease, to be relieved of a de-
formity so distressing, the patient was prompted to seek aid from the
fear that the long-retained menses might ultimately prove destructive
to her health. It appeared that at regular intervals she had every
symptom of menstruation, without any external discharge.

The case presented some rather novel aspects, and it was evident
that a peculiar treatment was required. The vaginal walls were too
much distorted, and too much hardness existed in the cicatrix to per-
mit of the hope that dilation, by tents, &c. could be effectual. Such
a method, to say the least, would have been extremely tedious, if suc-
cessful, for only a small sized bougie could be introduced in the ori-
fice, and that only for a short distance. The whole mischief seemed
to result from the cicatrix, which by its contractions had served to
draw the anterior and posterior surfaces of the vagina together, so
that the rectum and urethra were nearly approximated, whilst laterally
the canal seemed greatly widened. This state of things forced the
external labia apart and exhibited the cicatrix, the smooth surface of
which resembled the palm of one's hand. Under the circumstances
it was determined, with the patient's full consent, to excise the cica-
trix. For this purpose, after evacuating the rectum and bladder, the
patient was placed on a table in the position for lithotomy, and with
the aid of my friend Dr. J. F. Peebles, by whom I was assisted in
this novel proceeding, we proceeded as follows : An eliptical inci-
sion was commenced, just below the urethra and carried around the
cicatrix, very much in the course and position of the internal labia,
which, as we have said, had been obliterated or merged into the cica-
trix, terminating at the commissura below. A corresponding incision

A CASE OF IRRITABLE UTERUS. 211

having been made on the opposite side, the intervening mass was
then carefully dissected out, inclining upwards and rather in front.
The mass removed consisted of the hard cicatrix, and was two inches
wide and two inches and a half deep. This proceeding completed the
operation. We found that by it we had obtained a canal in the direc-
tion of the womb, nearly three inches deep, at the bottom of which
the orifice above spoken of could be felt and easily dilated by the
finger. This circumstance, together with the altered character of the
imperforation still existing, led to the adoption of simple dilatation for
its further removal. For ihis purpose, after cleansing the wound and
arresting the bleeding, which was very slight, a sponge tent smeared
with wax, of suitable size and length, was introduced and kept in situ
by appropriate bandages. The patient was kept on her back and
the dressing daily employed, each time using the finger as a bougie,
to overcome the bands still existing. Some short time after the ope-
ration, we requested her to inform us of any symptoms indicating a
return of the catemania : she readily complied, and we ordered an ap-
propriate emmenagogue course with the happiest effects ; for at the
very next return of her period, much to her gratification, the men-
strual flow took place. Gradually a natural mucous surface was
formed along the new canal, and in four months from the time of the
operation all treatment was abandoned. Our patient was a widow at
the time of the operation. She chose to marry, however, a few
months after getting out of our hands, and within the course of a year
afterwards gave birth prematurely to an infant. Since that time, she
having left the state, we have lost sight of her.

For the Stethoscope.

A case of irritable Uterus of four years standing, successfully

treated.

Mrs. D. of N. J., about 35 years of age, mother of four children,
the youngest five years of age, requested my advice relative to her
case — stated she had been a great sufferer for four years ; had been
treated by several physicians, who had, by the usual treatment and
short confinement to bed, given her temporary relief. No sooner out
of bed than a return of the usual distressing symptoms — often find-
ing relief by elevating the hips unusually high. There was a con-
stant inclination to make water, which she could only do by sitting
flat on the bed or cushion over a flat pan. Her sufferings were fre-
quently so great, from sitting up or walking, that she was compelled to
use large opiates. Menstruation regular, but painful ; constipated
bowels or distended bladder alike produced distress. On examina-
tion I found the uterus low ; the os tineas a little enlarged, of a carti-
laginous feeling; neck but little enlarged, and excessively painful
when touched, find portions of the vagina were likewise very sensi-
tive. Slight febrile paroxysm in the evening, headach and the pecu-
liar feeling of a hair about the tongue. I readily came to the conclu-
sion that it was one of the peculiar cases so accurately described by

212 LOOSENESS OF MODERN MEDICAL WRITING.

Dewees. I made known to her my opinion, and the treatment she must
submit to, as the only hope of relief. To this she readily consented,
remarking, " Death would be preferable to a life of sufFerino-." The
course of treatment, as recommended by Dr. Dewees, was steadily
pursued for seven months ; a rigid diet, cupping over the pubic re-
gion, leeching the vagina, occasionally a poultice or blister, mild and
soothing injections, and finally a small pessary, and she was enabled
to move about the house with much less inconvenience than she had
done for four preceding years. It has been some months since I saw
her, but I learn she is doing well.

R. H. P.
Portsmouth, Va.

For the Stethoscope.
The Looseness of Modern Medical Writing.

There is, at the present day, great looseness in much of our medi-
cal writing, especially in this country, which is by no means credit-
able to the profession, and ought to be corrected. Even in the use of
some of our common terms, there is an indefiniteness, which renders
the sense obscure, and impairs the value of much which would other-
wise be useful.

I was particularly struck with this, in reading some portions of the
report of the committee on practical medicine, made at the last meet-
ing of the American Medical Association ; and in no part more forcibly
than in the general conclusion at which the committee arrived, on the
subject of the contagious or non-contagious nature of cholera, in the
following words : That " cholera is portable, but not contagious ; that
it is dependent for its accidental power, rather upon density of popu-
lation and personal uncleanliness, than upon any other causes. An
atmosphere highly charged with emanations from living bodies seems to
be the chief stimulant to the choleric influence. Next to this, the most
powerful auxiliaries seem to be habits, passions, and food of a depres-
sing character; whilst the influences of ever}^ kind, which usually de-
termine the blood to the intestinal surface, give to the diseased- agency
its most dangerous direction."

In most of this paragraph there is an obscurity and vagueness of
language, which makes it difficult if not impossible to comprehend
the meaning of the writer. He speaks of the "cholera" being port-
able— shewing that he considers it a something capable of being
transported to a distance, either, I suppose, in the bodies or clothing
of individuals, or in the atmospere within or about vehicles, which
go from an infected into an uninfected town or district. He then
speaks of " emanations from living bodies,'''' as the " chief stimulant of the
choleric influence." This is clearly an admission that these emana-
tions contain the genuine cholera poison, how or* from whatever
source it may be generated. But what is meant by an atmosphere
charged with this poison, in other words, the poison itself, stimulating
the choleric influence ? What is this peculiar influence ? Is it intended

LOOSENESS OF MODERN MEDICAL WRITING. 213

to imply that there is some principle, apart from the cholera poison,
generated or already existing in locations where cholera breaks out,
influencing living bodies and bringing them into a condition of suscepti-
bility to the action of the poison ; or, that the influence spoken of is
the susceptibility itself, generated by some occult cause in bodies sub-
jected to its influence ? Or does the writer mean that the language is
to be taken literally, and there really exists some undefined material
or essence, which he designates as " choleric influence," and which,
being stimulated into activity by " emanations from living bodies," be-
comes the agent in producing the disease ? That the writer had some
definite conception of the meaning he intended to convey by this lan-
guage— sanctioned, as it is, by the committee — cannot, or ought not, I
suppose, be doubted, but he surely ought to have taken more pains to
convey it in a plain and intelligible form to his readers.

Towards the close of the paragraph, the writer speaks of the " dis-
eased agency" receiving its most dangerous direction from the " various
influences which determine the blood to the intestinal surface ;" in-
cluding also, doubtless, the stomach. Now, as far as I know or ever
heard, this surface is the part to which the disease is in all cases di-
rected, whether in its milder or more dangerous form. The language,
however, is smooth and pretty ; and, I suspect, the writer jeoparded
the sense to the desire to finish off a rotund and flowing sentence.

In pointing out the cause or causes of disease, it is not uncommon
of late to find the remote or predisposing spoken of as the exciting
cause, and the exciting as the proximate. Thus the poison of small-
pox is said to be the exciting cause of that disease — marsh miasma
of bilious fever, and the presence of a foetus in utero is made the
proximate cause of puerperal convulsions, &c. This practice is alto-
gether inexcusable, when so little attention is necessary to correct it.

It may not be out of place to give a short explanation of the seve-
ral links in the chain of causes, engaged in preparing for or bringing
on disease, adopted in the early ages of the profession, and not since
improved on. They are, the remote or predisposing, the exciting and
the proximate. The last might be dispensed with, as it is defined to
be the " morbus ipse," and therefore cannot be a cause of itself, but it
has been retained by common consent, and is well understood. The
office of the remote or predisposing cause is to bring the whole or
some part of the system, slowly or rapidly, according to its intensity
or the resistance it meets with, into a condition which the old writers
called disposition to take on diseased action. The exciting cause then
being applied to the part or parts so disposed, the morbus ipse is lighted
up, and the three links in the chain thus become complete.

B.

[The justness of the criticism of B. will be readily conceded by
every reader of our medical periodicals. A little more attention on
the part of reporters of cases, would make their papers much more
valuable. We frequently see communications in the journals, which
are nothing more than announcements that the reporter had treated
them. If the diagnosis, progress, treatment or termination of a
25

214 MEDICAL DUTIES AND OBSERVATIONS.

case is interesting or novel, then the practitioner in whose hands it
occurred owes it to the profession to report it — but the report is not
worth the room which it occupies, unless the reader can learn from it
the points of interest. Writers should study to give briefly, though con-
cisely, all the circumstances which could possibly be instructive or in-
teresting to a reader. How often, after reading the history of a dis-
ease, do we have our curiosity excited on many points of absolute im-
portance, but which the writer entirely forgot to notice. These re-
marks are called forth by the fact that we have received several re-
ports which are valueless, and cannot be published on account of the
meagreness of the details, and the absence of facts essential to their
interest. Elegance of composition we consider of secondary moment,
but accuracy of observation and clearness of description are absolutely
necessary in matters of science. — Ed. Steth.]

Medical Duties and Observations.

Mr. Editor — The possibility of my offering a few suggestions of
practical utility to my professional brethren, and particularly the
junior members of the profession, induces me to send you a few lines
for the pages of your valuable journal.

We would then first direct attention to the consideration of the
physician's duty on his first visit to a patient. Before instituting any
plan of treatment, he should direct his enquiries to the " history of the
case" — the sex, age and previous condition of the patient, his or her
location and occupation, the degree of nervous impressibility, and
susceptibility of the system to the action of medicine, the duration
and particular stage of the disease at the time he is called, the con-
stitution and strength of the patient, the probability of any modifying
influences, giving to the disease a peculiar character, whether epide-
mic, endemic, or other agencies that may possibly have exerted a
morbific impression upon the animal economy.

In the next place he should not forget that, as a general rule, the
safest, most philosophic and successful course to pursue, in the ad-
ministration of remedial agents, is to treat the disease upon general
and scientific principles, practising, according to indications, the vary-
ing condition of the patient, and the mildness or malignity of the ma-
lady ; that the sanative or curative properties, or rather influences, if
medicinal agents are not positive, but entirely relative, and that to effect
a cure they must be administered with direct reference to the peculiar
circumstances of the case. Hence they may exert a salutary or dele-
terious agency, according to the degree of enlightened judgment exer-
cised in their employment ; and I would offer the following as a medi-
cal maxim, that the indiscriminate employment of remedial agents is
the dictate of neither science, philosophy, reason nor humanity, and
that only the intelligent, the discriminating and well-educated mind is
qualified for the assumption of the responsible duties that devolve
upon the practitioner of the " ars divina," or healing art. From the
above observations, the deliberate expressions of (I think) enlightened

RUSHTON AND CLARK'S COD LIVER OIL. 215

conviction, the deduction may be very logically made as to the light
in which I regard every species of empiricism 'end quackery in medi-
cine, which is generally suggested and practised in perfect accordance
with the promptings which " the love of money" excites, patronized
and sustained by the ignorance and blind credulity of the people.
In reporting any case for the edification of the profession, the writer
should not call any medical authority to his assistance in order to
M make up" the diagnosis of a disease occurring in his section of
country, but should describe the phenomena as he observes them, and
not conclude that, under the modifying circumstances of other locali-
ties, it may not present diversified phenomena, indicating a correspon-
ding modification of the remediate treatment. In procuring a collec-
tion of facts as the preliminary step to the construction of any medi-
cal theory, the following rules should be strictly and constantly ob-
served :

1. That all the facts be clearly ascertained, introducing none but
those derived from rigid experience and close observation, and receiv-
ing only such as are well authenticated by the testimony of observers
fully competent to judge of their accuracy. 2. That a fair, full and
comprehensive view be taken of all the facts connected with the sub-
ject, modifying or disguising none so as to make them bear upon a
particular theory. 3. That we omit nothing that is essential, and in-
clude nothing that is irrelevant or incidental, being careful, at the same
time, of the post hoc and propter hoc. 4. And lastly, that we do not
admit as facts assertions which are not facts, but mere opinions or gra-
tuitous assumptions. Many minds are in the habit of drawing sweep-
ing or general conclusions from one or two facts. The statements of
such should be received with a great deal of caution, for they are not
reliable authors,' being liable to self-deception. In conclusion, I would
remark, that an intelligent, free agent should never yield a cowardly
subscription to the ipse dixits of any writer, nor float passively in the
current of popular opinion. The bold, original, independent mind
bursts asunder the restraints of usage and the bonds of fashion, and,
like the soaring eagle, proudly mounts above the dogmas and clouds
of ignorance and prejudice that enshroud the dependent parasitic
mind. In medicine we should have no hobbies, no predilections, no
obstinate partialities for this or that remedy exclusively, and inde-
pendently of all modifying circumstances and contra-indications.

J. L. D.

Oalc Grove, Va., February 20th, 1851.

Rushton's Cod Liver Oil.

Mr. Editor — It seems that in a preceding number of your journal,
you gave the results of some experiments made before the Medical
society, testing the purity of the different kinds of cod liver oil which
are offered for sale in this city — the test used was nitric acid. The
result was calculated to cast suspicion upon the purity of that manu-
factured by Rushton* Clark & Co. These gentlemen have asked at

216 RUSHTON AND CLARK's COD LIVER OIL.

your hands a fair trial, and at your request I have submitted their oil
to the test used before the Medical society. The oil was furnished by
their agents, Messrs. Purcell, Ladd & Co., and was said to be ge-
nuine.

1st. When one part of strong nitric acid was added to five parts of
the oil, that portion in contact with the acid assumed a bright red co-
lor. Upon being shaken, the whole became of a dark red or brown
color. The mixture was then set aside, when, after the lapse of half
an hour or more, it assumed gradually a brighter red, and finally re-
mained of a deep orange color. This I repeated several times, the oil
in every case finally assuming the last named color.

2d. When nitric acid was added to whale oil, or a mixture of whale
and cod liver oils, the bright red color, as observed in the experiment
with the unmixed cod oil, appeared, but when shaken assumed a black
color which it retained.

3d. When nitric acid was added to pure lard oil, and the two sha-
ken well, and allowed to stand several hours, the whole assumed a
dark clouded appearance. When the acid was added to a mixture of
cod liver and lard oils, the resulting color was a much darker red
than when the unmixed cod liver oil was used.

4th. When nitric acid was added to olive oil, it became of a light
greenish color, and finally, losing the greenish tint, becoming slightly
clouded dark.

When the acid was added to a mixture of this oil and cod liver oil,
the ultimate color was deeper than when the unmixed cod oil was
used, intermediate between that produced upon the pure cod liver oil
and that upon a mixture of lard and cod liver oils.

You may draw your own conclusions, Mr. Editor, as to the purity
of the cod liver oil furnished. There certainly was a marked differ-
ence in the color produced by the action of nitric acid upon the cod
oil and upon a mixture of this with any of the oils used. The light
orange or salmon* color, spoken of by some as a resulting color, did
not make its appearance. I have not tested any other oil than that of
Rushton, Clark & Co.

The question now arises as to the value of nitric acid as a test : It
certainly is, in my opinion, (assuming the oil I used as pure,) a test by
which any adulteration with whale or lard oils to any extent may be
readily detected ; the difference in the color produced by its action
upon the olive and cod oil mixed, and upon the pure cod oil, is not so
well marked as to be readily detected by an inexperienced person,
without having a sample of the pure oil with which to compare it.

It seems to me that, by ascertaining the specific gravity of the pure
oil, any admixture of other oils might readily be detected, as its
specific weight would vary according to the adulteration ; by the nitric
acid test we might detect some, and by the specific gravity test others.
— It may be said that the specific gravity of the genuine oil itself
varies according to the skill of the manufacturer in purifying it. To
this I answer, that unless some standard of purity shall be adopted,
it will be impossible to prevent its adulteration.

M. P. SCOTT.

EDITORIAL AND MISCELLANEOUS. 217

CORRECTION.

In my article on the catoptric test, (see March No.,) I observe a strange confusion oc-
curring in the report of the case, p. 139. It should read thus:

"J. F has been blind in the right eye, &c."

After the description of the opacity of the right eye, read :

"The two erect images can be seen distinctly following the motions of the candle. The
inverted image is entirely obliterated."

On page 138, line 14 from bottom, instead of " the two first and second," read " the
first and second."

I omitted to mention that the enlargement of the pupil by belladonna or stramonium
greatly facilitates the observation of the images. Dissolve a little of the extract of one of
these substances, say about the size of one-fourth of a split pea in half a teaspoonful of wa-
ter— put a few drops in the eye about half an hour or an hour before examination. When
the pupil is enlarged, take the patient in a dark room and hold the clear flame of a candle
a few inches before the eye. Move the candle from side to side very slowly, and look be-
yond the image usually seen depicted on the cornea, and with a little patient watchfulness
you will discover the other two images. If you will hold up the fore finger and middle fin-
ger of your left hand before your own face, and pass the little finger of your right hand be-
tween them with its point downwards; then move the two fingers of your left hand in one
direction and the little finger of the other in the opposite direction, you will have a very
good representation of the relative sizes, positions and motions of the three images in a
healthy eye.

The editor of the Stethoscope will please make the above corrections and additions, and
oblige

Yours very truly,

J. BOLTON.

3EJDOTOMAJL 111 MHTCEILILAirHOOTo

We had intended in the present Number to follow up the few ob-
servations made in our last, on the very important subject of state
organization. Since then, however, the subject has been taken up in
the Medical Society. All seem to be of one opinion as to the impor-
tance of doing something towards advancing the interests of medi-
cal men, but the plan which will best carry out the high objects in
view has not been yet sufficiently matured for any action to be taken
on it. The whole subject is in the hands of a committee, at the head
of which is an able and energetic gentleman, and we forbear to enter
into the subject until it reports. We have no doubt but that the com-
mittee will digest and report a scheme which will prove satisfactory
to all who take any interest in their profession, and which will be
successfully carried out by the physicians in the state. We know
enough already of their abilities and their feeling of state pride, to
be well convinced that they have every requisite to place medicine in
Virginia in as proud a position as the Virginia bar has so long enjoyed.

We call the attention of medical students to the advertisement of
the summer course of lectures at the Medical college in this city. We
are not sure but that it is the most instructive course which, students
attend, for there is ample time to read on and study the subject mat-

218 EDITORIAL AND MISCELLANEOUS.

ter of each lecture before another comes on. The smaller size of
the class renders quizzing and conversational instruction more fre-
quent and useful, as well as the bed-side of the patient less crowded —
and lastly, those allurements to society and the gaiety incident to the
winter season in our city do not exist, and the student is more in-
clined to prepare himself for the winter course and an easy gradua-
tion.

Exchanges.

Our table is covered with the Medical Periodicals of the month.
In addition to those already announced, we have received the follow-
ing, in exchange :

The British and Foreign Medico- Chirurgical Review. This sterling
quarterly is re-published by Messrs. Wood, 261 Pearl street, New
York, at $ 3 per annum.

The Dublin Medical Press, up to March 6th. This is an excellent
weekly, and may be styled the Irish Lancet. It notices us and copies
an article.

The New Hampshire Medical Journal, Concord, N. H., edited by Dr.
Ed. H. Parker. The February No. gives Dr. Mattson a rub for his
" arrant quackery," in circulating among the professional, secular and
religious public, his pamphlet on "The Curability of Consumption."
Dr. M. has been handled rather roughly by several others.

The St. Louis Medical and Surgical Journal, a capital bi-monthly,
edited by an able corps of gentlemen, viz : Drs. Linton, Moore,
McPheeters and Johnson. The Number for January and February,
opens with a strong review of the opinions of the London doctors,
who have been preaching a crusade against the speculum vaginae,
from the pen of Prof. Pallen, formerly of this city, but now profes-
sor of obstetrics in the St. Louis University.

The Ohio Medical and Surgical Journal for March has been received.
Its spirited editor, Dr. R. L. Howard, announces his intention of
leaving the United States immediately, on a visit to the schools and
hospitals of the old world. We envy his happy lot, and hope that he
will enjoy a prosperous voyage.

We can but feel elated and nattered by the high stand and charac-
ter given by the medical press of the Union to our work. The large
amount of matter which it contains, and the low price at which it is

EDITORIAL AND MISCELLANEOUS.

219

published, have been remarked by all our confreres; and the highest
compliment that could be paid to the contributors of the Stethoscope,
is the fact of so many of their articles having been copied. For the
very general and undeserved compliments from the secular press, we
are much obliged. The subscription list is rapidly increasing, and
the circulation is extending well in other states. Some allowances
must be made for our faults, as the enterprise is yet in its infancy, and
the editorial department cannot command the entire attention of the
editor.

Close of the Session of the Richmond Medical College.

The ceremonies of commencement of the medical department of
Hampden Sidney college took place on Friday, 14th inst., in the pre-
sence of a numerous and brilliant assembly. After the opening prayer
by the Rev. Mr. Woodbridge, Prof. Maupin announced the following
gentlemen as having passed an examination, rendering them worthy
of the doctorate, and the degrees were conferred by the Rev. W.
Green, president of the college :

Homer L. Anthony,
George M. Bowen,
Wm. Burke,
Patrick H. Cabell,
Daniel S. Evans,
Samuel C. Gholson,
Meriwether Lewis,
John G. Lumpkin,
John K. Marable,
Wm. McGwigan,
David McQueen,
Thomas B. Miller,
Samuel Nicholson,
Robert F. Page,
Albert C. Pleasants,
Wm. A. L. Potts,
P. K. Reamey,
Quintus A. Snead,
Wm. O. Snelling,
John D. Stuart,

Pittsylvania,

Culpeper,

Richmond,

Richmond,

Campbell,

Richmond,

Essex,

Hanover,

Halifax,

Isle of Wight,

Richmond,

Summerville, Tenn.

Sussex,

King & Queen,

Richmond,

Pennsylvania,

Henry,

Goochland,

Chesterfield,

Patrick,

Adol's B. Sutherland, Richmond,
Robert P. Toney, Franklin, N. C,

Alfred B. Tucker,
Jos. C. Vaiden,
John B. Walthall,

Winchester,
James City,
Southampton,

Thos. J. Wooldridge, Chesterfield,

Honorary Degree — Edward D. Kernan,

Puerperal Fever,
Inflammation.
Diseases of the Chest.
Fracture.
Variola.

Puerperal Fever.
Fever.
Hernia.
Electricity.
The Pulse.
Neuralgia.
Hysteria.
Hernia.
Rheumatism.
The Heart.
Bronchitis.
Dislocations.
Intermittent Fever.
Remittent Fever.
Haemorrhage.
Adult Circulation.
Pleuritis.
Hernia.
Pleuritis.
Pneumonia.
Pneumonia.
Russell county, Virginia.

220 EDITORIAL AND MISCELLANEOUS.

It was then stated that the number of candidates for the gold me-
dal was five — each one handing in an essay of considerable merit.
Two of these, one signed Faustus and the other Stethoscope, evinced
such equal claims for reward, that it was found difficult to judge be-
tween them. The decision, however, was in favor of Faustus, whose
real name proved to be Thomas B. Miller of Summerville, Tenn. Dr.
Green presented the medal, and addressed the successful candidate
in appropriate and moving terms. The proceedings were closed by
a beautiful valedictory on the part of the faculty, delivered by Dr. C.
P. Johnson.

At night the graduates, together with the faculty and many profes-
sional gentlemen, partook of a sumptuous entertainment at the hospi-
table mansion of Professor Maupin.

SOCIETY OF ALUMNI.

The annual meeting of the Society of alumni of the medical de-
partment of Hampden Sydney college, was held in the chemical hall
of the college, on Thursday evening, March 13th. The president,
Dr. C. P. Johnson, in the chair.

The graduates of the present year were then severally elected
members of the society. After which Dr. A. E. Peticolas delivered
the regular annual address, which was chaste, well written, and did
high credit to the orator. A vote of thanks was returned to Dr. Peti-
colas.

The society then adjourned over to the afternoon of the ensuing
day, when most instructive and creditable essays were read by Drs.
J. W. Walke of Chesterfield, and George B. Dillard of Spotsylvania,
to whom the society tendered a unanimous vote of thanks.

The election of officers resulted as follows : Dr. P. C. Gooch of
Richmond, President — Dr. J. W. Walke of Chesterfield, 1st Vice-
President — Dr. E. Powell of Goochland, 2d Vice-President — Dr. W.
E. Wilson of Richmond, Corresponding Secretary — Dr. A. E. Peti-
colas of Richmond, Recording Secretary — Dr. Wm. T. Taylor of
Henrico, Treasurer.

Dr. Isaac T. Forbes of Fluvanna received the appointment to de-
liver the address, and Drs. W. T. Taylor and Carthon Archer of
Henrico, to read essays at the next annual meeting.

The following gentlemen were chosen by the president to represent
the society in the American Medical Association of 1851, which as-
sembles in Charleston, S. C, on the first Tuesday in May : Dr. C. P.
Johnson, Dr. A. E. Peticolas, Dr. J. W. Walke, Dr. W. T. Tavlor,
Dr. L. B. Anderson, Dr. J. T. Forbes, Dr. S. C. Gholson, Dr. J. G.
Lumpkin, Dr. Wm. Burke.

To these was added, by a vote of the society, the president, Dr. P.
Claiborne Gooch.

On motion, Resolved, That hereafter all persons admitted as mem-
bers of this society shall be required to pay an initiation fee of one
dollar.

A. E. PETICOLAS, Secretary.

EDITORIAL AND MISCELLANEOUS. 221

Medical Society of Virginia.

The meeting on March 18th was very well attended by members
and visiters. A number of gentlemen were elected to membership
and some twenty nominations made.

The report on anaesthesia was then read and made the subject of
discussion for the next meeting, April 15th.

Several resolutions were adopted, among which are the following :

" That the delegation to the American Medical Association be in-
structed to tender an invitation to that body, in the name of the Medi-
cal Society of Virginia, to hold its next annual meeting in Richmond.

".That the president be invited to deliver an address to the society
at its annual meeting in May next.

" That a committee of three be appointed to enquire into and re-
port on the expediency of building a hall for the use of the society."

The new form of the diploma was read and approved, and the
committee discharged.

After the transaction of some other business of local importance,
the president announced the names of the delegates to the American
Medical Association, and the secretary was directed to prepare their
credentials and forward them to Charleston, where delegates will find
them on their arrival.

The following list of delegates to the American Medical Association
has been furnished us. It is expected that all will attend, but an al-
ternate who is present will take the seat of any absent delegate :

From the Medical Society of Virginia,
Dr. Landon Rives,

Dr. Rob't W. Haxall, (president,)*
Wm. A. Patteson,
Beverley R. Welford,
G. Lane Corbin,
P. CI. Gooch,
M. P. Scott,

Walter F. Jones,
Jno. Prosser Tabb,
H. C. Worsham,
James Beale,
George F. Terrill.

ALTERNATES.

Dr. J. Spottswood Welford,
C. S. Mills,
Jno. N. Broocks,
F. W. Roddy,
Wm. D. Meriwether,
W. W. Parker,

Dr. A. T. B. Merritt,
G. G. Minor,
Jno. R. Walke,
L. B. Anderson,
Tho's E. Cox,
J. J. Thweatt.

* Appointed by the society.
26

222 METTAUER ON THE PROPHYLAXIS OF PUERPERAL FEVER.

From the Medical Department of Hampden Sydney College.

Professors L. W. Chamberlayne and D. H. Tucker; Alternate,
C. P. Johnson.

Medical Department of Randolph Macon College.
Professor Jno. P. Mettauer.

[Other constituent bodies will please forward a list of their delegates
for announcement in the May No.]

SyWe are requested by the editors of the Charleston Medical
Journal and Review, to correct an error which crept into their January
Number. It stated that the American Medical Association meets on
the second instead of the first Tuesday in May.

Notice to Correspondents.

Communications have been received from the following gentlemen,
but too late for the present Number :

Drs. T. J. Garden, L. S. Joynes, T. J. Young, D. T. Martin, R. E.
Jennings, Wm. M. Broocks.

f^p3 Articles intended for publication must be written on only one side
of the paper, and should be received by the 10th of the month to se-
cure a place in the next number.

The Prophylactic Treatment of Puerperal Fever.

By John P. Mettauer, M. D., L. L. D., Professor of the Principles
and Practice of Medicine and Surgery in the Medical Department of
Randolph Macon College of Virginia.

The practical views communicated through this paper, have been
entertained by the writer now more than twenty years, and the lapse
of time since their adoption, has fully confirmed their utility, if not
their correctness. Puerperal fever has ever been a disease profoundly
interesting to him, but circumstances early transpired to render it
painfully so; and he owns that it was a heavy domestic bereavement,
that gave the first impulse to the reflections which lead him to adopt
the mode of treating this cruel disease, about to be presented through
this paper. In his early intercourse with puerperal fever, he had to
deplore occasionally the inefficiency of the established modes of
treating it. In some cases, although early and actively treated, after
the disease had formed, it pursued its course obstinately to a fatal ter-
mination, defying medical interposition, seeming only determined to
sever the tenderest ties of the dearest of human associations.

It will not be necessary to premise a history of puerperal fever, as
introductory to the practical remarks about to be presented. Nor

METTAUER ON THE PROPHYLAXIS OF PUERPERAL FEVER. 223

need I state anything farther in relation to the nature of the disease,
than that I regard it as inflammatory, although it varies much in the
intensity of the phlogosis with which it is attended in different cases.
The numerous post mortem examinations in fatal examples of the
disease, conclusively establish the inflammatory nature of it, even if
the symptoms during life fail to do so. Upon this point a majority of
the profession are united in opinion ; and I will add, that the method
of treating puerperal fever, about to be described, and pursued by me
for more than twenty years, was deduced from my unshaken belief of
its inflammatory nature. It would be easy to shew that pregnancy
and parturition, are succeeded by conditions of the organs implicated
chiefly in those processes, and which are the usual seats of the local
affection of the disease, which predispose to inflammation in other or-
gans. A state of inaction and debility, with more or less suspension,
or perversion of the functional exercises of the organs concerned in
pregnancy and parturition, succeeds delivery in every case, in greater
or less degrees of intensity. Contusions, overstrains, or over-disten-
sion from any cause ; surgical operations, undue irritation, or excita-
tion of an organ, or from suspension of vital action for a time, as
from the operation of inordinate pressure, or low temperature upon a
part, all induce a like condition ; and this state, it is reasonable to
suppose, predisposes to the inflammations generally following the ope-
ration of such causes ; and it is well attested that they do result, in
a very large majority of instances. After pregnancy and parturition,
the uterus, and its appendages, the peritoneum, and the abdominal or-
gans generally, are left in a state of inaction, debility, and, to a cer-
tain extent, are actually collapsed. While in this condition, the func-
tional exercises of the implicated organs are more or less disturbed,
perverted, or perhaps suspended ; and it is this state, which, if pro-
foundly impressed upon the organs, or too long continued, that pre-
disposes to puerperal inflammation or fever. Other causes may co-
operate, in some cases, with that post-parturient collapse of the organs,
such as contagion, or a predisposition to some other disease, espe-
cially typhoid, typhus, and eruptive fevers, erysipelas, rheumatism,
catarrhal fever, and some others, in the causation of puerperal fever.
But the debility and inaction of the organs concerned in pregnancy, and
consequent perverted secretion, seem to be the intimate predisposing
pathological conditions of the disease ; while the others are to be re-
garded, as adventitious or incidental, differing essentially, too, from
those occasional causes that often induce the disease, as inciting or
producing agents. In some instances, puerperal fever has come on
without the known operation of an exciting cause. In those cases it
is probable that the predisposing condition was so profoundly im-
pressed upon the organs, as to act also as an exciting cause, nay, to
constitute the initial stage of the disease. A majority of cases, how-
ever, result from exposure to variable temperature, or from catarrhal
irritation or colds. Any disturbing cause, capable of inducing fever
or diminishing general secretion, may, and often does operate as an
exciting cause of the disease when there is pre-existing predisposition
to it. It is not unusual for the too early use of solid food of stimula-

224 METTAUER ON THE PROPHYLAXIS OF PUERPERAL FEVER.

ting qualities, alcoholic incitants, conversation, or premature undue
exercise of the body or mind, to cause puerperal fever; and in such
cases, there doubtless must have been pre-existing predisposition to
the disease. The region of country from which the facts supporting
the views presented through this paper are drawn, has not afforded a
solitary case of puerperal fever that could be traced to contagion as
its cause ; nor is it believed that such a cause ever does induce the
disease in this section of country ; and yet numerous cases have oc-
curred, in which the disease was marked by the characteristic symp-
toms during life, and the usual anatomical appearances after death.
Contagion, nevertheless, may, and doubtless is, to be regarded as a
cause of puerperal fever under fit circumstances, such as may arise
in cities or other situations favorable to the generation of idio-miasm,
and its propagation from individual to individual in the causation of
the disease in question.

In considering the prophylactic treatment of puerperal fever, it will
be proper to examine it under the following heads, that is :

I. Purging in a few hours after delivery. — This will be demanded
when parturition has been protracted and attended with great suffer-
ing, or when the latter period of pregnancy has been distinguished
by those symptoms which indicate a morbidly impressible state of
the uterus and its appendages, as well as of the contiguous organs
that are usually involved in the processes of pregnancy and parturi-
tion. In some cases the last month, or the closing period of it, of
utero-gestation, is attended with undue restlessness ; uneasiness, or
tenderness of the abdominal wall; a feverish disposition, with or
without thirst ; a furred tongue ; impaired appetite ; frequently sick
stomach and vomiting ; constipation or diarrhoea ; sleeplessness ; oc-
casionally delirium ; and some other symptoms, indicating an unu-
sual degree of irritation. Occasionally, too, these examples of labor
are attended with a preternaturally warm or cool state of the liquor
amnii, discoverable as that fluid escapes from the ruptured membranes,
and a correspondingly warm or cool condition of the uterine surface.
The pains and suffering of parturition in such cases are generally
more intense and distressing, and the woman experiences less of the
customary sanguineous discharge than in ordinary labors, as well as
more exhaustion after delivery has taken place. In a case thus cir-
cumstanced, it would be necessary to purge in three or four hours
after delivery, nay, sometimes sooner, especially if there is more ab-
dominal tumidness than usual; and the cathartic I have most fre-
quently employed, is that supplied by the annexed formula :

fy. Aloes Socot., - - - gr. vii.

Scam. Alep., - - - gr. v.

Calomel, __■_'"_ gr. viii.

Ipecacuanha, - - - gr. i.

Water S. Q.
Make the mass into four or five pills for a dose.

This compound may be administered in the form of pill or powder.
The earlier purging is effected in these examples the better. In

METTAUER ON THE PROPHYLAXIS OF PUERPERAL FEVER. 225

some instances I have exhibited the cathartic before the delivery of
the secundines, when symptoms of threatening character existed ;
and, in all such cases, the action of the cathartic should be quickened
by the employment of purgative injections, repeated after intervals of
an hour, until the bowels are impressively purged, commencing with
the enema in two hours after the administration of the purgative dose,
and to enjoin it upon the woman to lie chiefly on the right side, until
the medicine passes from the stomach. The cathartic above advised,
has uniformly met the indications in the cases in which I have em-
ployed it ; and has, as constantly, operated without distress of any
kind to the patient, while its action has been impressive and secer-
nent. It seldom fails to procure copious, consistent, and feculent dis-
charges from the bowels ; and rarely ever operates too freely. Other
cathartic substances, of like qualities, might be employed in these
cases, and with equal benefit ; but, the compound here presented,
having so constantly met the indications, I have not been willing to
modify, or substitute it, by the employment of other means in the ex-
amples now under consideration. If the first dose fails to procure
full and feculent discharges, the remedy must be repeated in eight or
ten hours. In these cases, the treatment should be continued until
every threatening symptom disappears ; and, in a majority of in-
stances, a single dose or two will accomplish it. The bowels must
be kept soluble during convalescence, by the use of any mild aperi-
ent. Magnesia taken at bed-time, in teaspoonful doses, has often
maintained the bowels easy. In some cases, I have employed a pill
composed of aloes, jalap, and colocynth in powder, just in doses to
act moderately, and with the best results.

As an auxiliary means of treating these examples, it will be useful,
if the skin is dry, to use grain doses of ipecacuanha, once or twice of
a night made into pill, until that state is corrected. It will also be
safe to employ some diuretic, and the infusion of " pine-tops," I have
uniformly preferred, if the stomach did not loathe or reject it. Taken
cool, the tea is not unpleasant ; nay, with many it is grateful, being
acid, and not very strongly terebinthinate in taste, and it is decidedly
diuretic in its action with the economy. Restrictions on diet will of
course be necessary, as well as on the deportment of the woman
generally, while a morbid impressibility, or liability of the system to
inflammation exists. In a vast number of cases, marked too, in
many instances, by symptoms of the most menacing character, the
simple treatment here briefly pointed out, has been employed by me
with unvarying success. In not a solitary instance, in which I
adopted it, has puerperal fever resulted ; and there is not a doubt
that most, if not all of the cases, would have eventuated in that ter-
rible disease had it not been employed. If it would render this paper
more useful to my brethren, I could append numerous cases to it,
with the details of their treatment ; but such an appendage would
only lengthen, without adding to its value. In confirmation of the
value of the treatment here advocated, as far as a solitary case can do
so, as well as of the efficiency of the purgative, I will state that a
highly intelligent physician of a flourishing town of Virginia, employed

226 METTATJER ON THE PROPHYLAXIS OF PUERPERAL FEVER.

it in an extremely threatening case, some years since, at my sugges-
tion— being at the time myself on a visit to him, and with complete
success. The lady, who was intelligent, and of a highly cultivated
mind, as well as her intelligent husband, who was a well-educated
physician, as also the attending physician already referred to, were
equally struck with the effects of the cathartic, both as to its curative
efficiency, and pleasant and painless operation upon the bowels.

II. Purging more remotely after delivery. — When the signs indica-
tive of predisposition to puerperal fever are less urgent or threatening,
and when the labor has not been distinguished by grave abnormal
concomitants, purging may be deferred some ten or twelve hours
after delivery, or until the succeeding morning ; and then the cathartic
already suggested will be found to meet the indications as perfectly
as in the preceding description of cases. Occasionally I have em-
ployed a cathartic pill, composed of aloes, jalap, and colocynth in
powder, according to the annexed formula, and with the best results :

ft. Aloes Socot., " ~\

Jalap, Rad. Pulv. a. a., ) ° *

Colocynth, Pulv., gr. in.

Water S. Q.
Make into three or four pills. From one to three to be taken at a
time.

This compound, however, is better suited as an aperient, unless
taken in doses of three or four pills, which then might nauseate, or
produce higher cathartic effects; it is very well adapted to the sequel
of the examples we are considering, after sufficient purgation with the
first described pill, merely to maintain the bowels soluble, or to excite
them in some moderate degree, from time to time. When labor has
been somewhat protracted, and more painful than usual; and, espe-
cially, if considerable haemorrhage has followed the expulsion of the
secundines, it would not be safe to depend on this pill. In such cases,
the first described pill should be preferred, and its action must be
hastened by the use of enemata, as was advised in the first descrip-
tion of cases, and by position of the body on the right side for an hour
or two after the medicine is taken. The presence of undue abdomi-
nal tenderness, will also indicate the necessity of employing the first
described pills ; and the remedy must be repeated daily until the case
ameliorates. The bowels should be maintained soluble; and if the
pills of this second formula are too irritating to the stomach or bowels,
as will sometimes be the case, the annexed formula may be employed:

ft. Aloes Socot., - - - - gr. ii.

Jalap, Pulvo., - - - - gr. hi.

Rhei. Pulv., - - - - gr. iv.

Ipecacuanha, - - - - gr. i.
Water S. Q.
Make two or three for one dose.

These pills operate mildly, and produce both aperient and diapho-
retic effects. These should be taken at ordinary bed-time, and if not

METTAUER ON THE PROPHYLAXIS OF PUERPERAL FEVER. 227

active enough, an enema may be employed the succeeding morning.
As was advised under the first head, should the skin be dry, it will
be necessary to employ grain doses of ipecacuanha nightly, and com-
bined with the bi-carbonate of potash and rhubarb, according to the
annexed formula :

ft. Ipecacuanha, - - - - gr. v.

Bi-carb. Potass., - gr. x.

Rhub. Pulv., - - - - gr. xii.

Water S. Q.
Make five pills — one the dose.

One of these pills may be taken at 9 o'clock, and again at 12 during
the night; if it is deemed very important to act upon the skin gene-
rally, a single pill, at ordinary bed-time, and at 10 in the forenoon,
will meet the indications.

When the lochial discharge is defective, or suspended, besides ca-
thartics, it will be necessary to have recourse to a terebinthinate lini-
ment, over the hypogastrium and loins, formed according to the an-
nexed formula :

ft. Spirit Terebinth. Ten., - - 3 j.

Adep. Suil., - - - - 1 vj.

Mix and keep in a wide mouth jar.

This liniment may be freely applied twice daily, until the lochial
discharge re-appears, both with the cases under this head, as well as
the first. Usually, purgation restores general secretion promptly, and
the lochial discharge now re-appears after that change takes place,
without resorting to the turpentine. Care should be taken not to put
the child to the breast for some hours after the application of the tur-
pentine, or it may be rendered sick by the action of the terebinthinate
upon its economy, through the milk of the mother — convulsions may
even follow. The diet should always be restricted, and every thing
carefully guarded against that tends to induce fever or inflammation
after delivery.

III. Purging in all cases after delivery. — This has been my custom
for many years, believing that women are more or less predisposed to
puerperal peritonitis and fever, in every case after parturition. In
twelve hours after delivery, I invariably order a cathartic, mild or
otherwise, no matter how favorably situated the case may be ; and I
believe that many cases, nay, I might with propriety say all, have
been benefitted by the practice more or less. I think it very probable
that attacks of puerperal fever have been warded ofF by it, when a
predisposition to the disease was not suspected. Certainly the prac-
tice greatly ameliorates the condition of the breasts during the setting
in, and early periods of lactation. It also guards patients against cer-
tain cutaneous and other irritations, frequently consequent upon par-
turition. I have little doubt that it has prevented phlegmatia dolens
in many instances ; and I am led to this conclusion, from the fact,
that no cases of this painful disease have occurred in my practice
since it was adopted. Patients, however, are often unwilling to sub-

228 SELECTIONS.

mit to it after delivery, when, as they express it, they " feel so well."
And, in some cases, females entertain such a horror for medicine, that
they will incur the danger of an attack of puerperal fever, rather than
consent to take a cathartic, when they do not feel really sick.

It must not be supposed from the preceding remarks, that I have
not met with cases of puerperal fever since the prophylactic treat-
ment I have advocated in this paper was adopted by me. On the
contrary, I have treated many cases in the various stages of the dis-
ease ; and I would state, country practitioners are peculiarly liable to
meet with it somewhat advanced, by reason of the uncertainty of the
true nature of the symptoms which mark the early periods of its pro-
gress, and the consequent delay in calling in medical aid. But I have
never met with an instance of it following labors managed by myself,
since the adoption of the prophylactic treatment I am advocating,
with females who submitted to such treatment. Puerperal fever is a
formidable disease, has brought grief and sorrow into many a happy
family, by reason of its intractable nature and rapid tendency to end
fatally ; and any innovation upon the plans of treating it, now gene-
rally adopted by the profession, would be justifiable ; and should the
plan I have proposed possess no other merit, it will at least shew that
I have not regarded this cruel disease with indifference, and that I
have made an effort, though feeble, to disarm it of its difficulties as
well as its dangers.

In conclusion, I would earnestly call upon my brethren as medical
men, and as the friends of suffering females in the trying hour of
childbirth, to give the prophylactic treament of puerperal fever,
briefly described in this paper, a trial ; and if it shall prove as success-
ful in their hands as it has uniformly done in my own, I shall feel more
than repaid for the time and trouble it has cost me in the preparation
of this paper. — Charleston Med. and Surg. Journal.

Tumor of the Neck of extraordinary size, successfully removed.

BY P. C. SPENCER, M. D., OF PETERSBURG, VA.

Thomas Wilkinson, a native of the neighboring county of Sussex,
37 years of age, placed himself under my care for the surgical treatment
of an enormous tumor of the neck.

The history of the case, collected from accounts given by himself
and friends, was as follows :

The tumor had been in existence thirty years. It was described as
being located, when first observed, at the angle of the lower jaw, and
beneath the lobe of the left ear. Its presence and growth being
wholly unattended by pain or annoyance of any kind, it does not
seem to have created anxiety or to have attracted much notice during
the period of his youth. This apathy, however, was not of long du-
ration. Before he reached his twentieth year, its great size, and the
deformity and annoyance it occasioned, led him earnestly to desire
relief.

It was then sixteen or eighteen years before the time of his applica-
tion to me that he, for the first time, sought surgical advice and assist-

SELECTIONS. 229

ance. The tumor was at that time represented as being double the
size of a large orange, and firmly embedded beneath the angle of the lower
jaw.

He was immediately placed under treatment necessary to prepare
him for its excision by a distinguished and very bold surgeon of this
place, since deceased.

When the day fixed for it arrived, however, he was, much to his
disappointment and chagrin, dismissed without the operation, the sur-
geon urging as a reason for the postponement, that he had not been
able to prepare himself with some necessary preliminary. Wilkinson
was desired to return home, with the assurance, that so soon as this
could be accomplished, he should be sent for. This promise was ne-
ver fulfilled. Whatever may have led to the postponement on the
part of the surgeon, the impression was created on the mind of the
patient and his friends, that the operation required was deemed one of
a nature too hazardous to be attempted with any prospect of success.
This impression was subsequently confirmed as the case wore on,
since the many medical men, who, from time to time, obtained a sight
of the disease, as the man's business called him from place to place,
were almost unanimously of opinion, that the safe removal of the tu-
mor was beyond the reach of art. With this conviction, the man pa-
tiently resigned himself to his fate, awaiting the issue.

But the disease did not remain idle. Mass after mass of degene-
rate structure continued to shoot out from every side ; reaching down-
wards it touched the shoulder, the whole breadth of which it proceeded
to occupy, and then on both breast and back, it ultimately fell in large
folds. Finally, its great weight, acting upon a frame already worn
down and emaciated by the ceaseless irritation of its presence, pre-
cluded all employment, allowing him to remain in an erect posture
for a short period only, and that at long intervals. In addition to all
this, decay ultimately set up in the morbid mass. Patches of ulcera-
tion appeared on its periphery, resulting apparently from imperfect
nutrition, caused either by pressure or lesion upon its nutritive vessels.
Abscesses formed in its interior, tunnelling it with large sinuses, which
constantly discharged offensive matter, and hectic fever supervened.

Feeling that he could live but a short time as he was, and being
convinced that the excision of the tumor afforded him the only chance
for his life, the patient had arrived in town with the determination to
have the operation attempted.

After a minute and tedious examination of his case, with several
professional friends to assist me, we found it almost impossible to
come at anything like a positive opinion as it regarded the safety or
practicability of an operation. This ambiguity and embarrassment
arose from the exceeding difficulty of ascertaining correctly the parts
involved in the attachment of the tumor, and in defining the nature of
the operation required for its removal.

Firmly attached by a strong and almost unyielding band to the
whole side of the neck, its sides shelving over all around, below, be-
hind, and before, anything like a satisfactory examination was wholly
precluded, since there was but a narrow space for the hand to pass
27

230 SELECTIONS.

under to effect the exploration. Nor was this all : admitting that a
free examination of the attachments of the tumor could have been
made, its immobility on its stem, and the extent of these attachments
were so great that nothing positive could have been ascertained of the
parts involved likely to be wounded in an operation. Nothing is
easier than to prove this by a glance at the bounds of its attaching
surface. Extending from an inch above and behind the lobe of the
left ear, these ran posteriorly on a line with the sterno-cleido mastoid
muscle, (which it covered with the great vessels of the neck,) down
to within an inch of the clavicle. In front, its connection ran from
the ear over the cheek to a point midway below the chin, where it
passed again downward in a line with the trachea to the top of the
sternum. The whole formed a triangular connection or band, firm and
almost immovable, at least six inches through its longest line.

It was a prominent question in the enquiry, as to whether there would
be danger or probability of wounding either one of the great vessels
of the neck. This result, under ordinary circumstances, would not
have been feared by the surgeon ; but, in the present case, the acci-
dent could but be fatal, for the very plain reason, that the courses of
these vessels in their entire extent were so completely covered by the
diseased mass, which was so unyielding and immovable as to pre-
clude entirely the possibility of securing them by ligature or other
means, did it occur.

After being made fully sensible of these difficulties, the patient still
persisted in his determination, and the operation was therefore under-
taken as a dernier ressort.

It was necessary to place him on a more generous diet than he had
lately allowed himself, in order to ensure him sufficient strength for
trial. Some eight or ten days sufficed for this result, and on the 9th
of January, 1844, the operation was performed. A narrow table
was provided, in a room tolerably well lighted, on which the patient
was placed, lying on his right side, with his head elevated. Whilst
in this position, in the presence, and with the assistance of Drs. Pee-
bles, Jones and W. Michie, all of Petersburg, I proceeded to ope-
rate.

My first design was to raise the tumor from behind, by cutting it
away from the whole line of its posterior attachments, freeing it there-
by from the great vessels of the neck as early as possible. For this
purpose an incision was commenced about two inches below the ear,
and carried on and down to the tumor, to within half an inch of the
clavicle. The skin was carefully, but with great difficulty, (so closely
was it agglutinated to the diseased mass,) dissected off to the neck.
When this was completed, I cautiously proceeded to divide the ad-
hering bands which had been exposed by the incision. The sterno-
cleido mastoid muscle, attenuated to a mere filament, had been partly
brought into view, and being closely affiliated to the diseased mass,
was divided across, above the point where it is decussated by the
omo-hyoideus.

When, by these means, its lower part had been freed, so that the
tumor could be raised, the carotid artery was plainly seen beating in

SELECTIONS. 231

front of the line of the original incision, but now about an inch back-
wards from its still adhering surface.

The tumor was next held, raised, and borne slightly forward, when
the dissection was carried on without danger of wounding the vessels.
The very strong and firmly adhering bands which connected the ex-
crescence with the mastoid process of the temporal bone, with the
tuberosity of the occiput, and with the transverse processes of the
upper cervical vertebrae, were next severed in the order in which they
presented themselves.

Up to this time no vessel of any importance had been wounded ;
the haemorrhage had been slight, the only embarrassment to the opera-
tion arising from the unpleasant strangulation resulting from the pres-
sure of the tumor on the trachea, as the patient lay, through the una-
voidable manipulations on it, already described. Starting under the
ear, at the origin of the first, another incision was next extended
through the skin down to the tumor, across the cheek to the chin, and
then carried downwards on a line with the trachea, finally terminating
in the first j ust above the clavicle.

Much time was next required in removing the adhering skin from
the surface of the tumor, which was carefully done through the whole
line of the incision, that it might serve as a covering to the wound,
and many considerable vessels were wounded, two of which, one of
them near the angle of the inferior mixiliary bone, the other beneath
the symphysis, requiring the prompt application of the ligature.
When this tedious and exceedingly painful dissection was completed,
the exhaustion of the patient was so great that I was forced to sus-
pend my dissection about the throat, in order that he might be allowed
to breathe with the necessary freedom. But all its adhering bands
had been severed, and the tumor could be raised ; and, so soon as
the patient recovered from this partial syncope, its final excision was
readily completed.

Though overcome and greatly exhausted, the patient was found to
be in quite a favorable condition ; his pulse was good, and he had not
suffered so much from haemorrhage as had been expected, the principal
loss being, in fact, venous blood. A reasonable time having elapsed,
and there being still little or no decrease of this oozing from the di-
vided veins, a weak solution of creosote was applied to the wound.
It had the desired effect almost immediately, and I proceeded to the
dressing. The flaps of the skin, which had been left, covered the
wound very well, considering that the nature of the case, leaving no
choice in the matter, had obliged us to dissect without regard to this
object, and having carefully brought them together, they were secured,
and the wound closed by straps of adhesive plaster. The dressings
were completed, and the patient placed in bed in forty minutes from
the time the operation commenced. No accident occurred, and the
night succeeding the operation was spent quietly and comfortably.
On the second day there was a slight rise of fever, which was at once
successfully combated by a mild purgative.

It is considered entirely unnecessary to detail further the progress
of the case, for after this time no constitutional symptom arose, and
its management became entirely a local affair.

232 SELECTIONS.

The improvement of the general health proceeded pari passu with
the healing of the wound, which, under the simplest treatment, was
gradual yet progressive. On the 23d of January he left his bed en-
tirely, and, late in February, he returned home in good health, and so
altered in appearance that his nearest neighbors did not at once recog-
nize him.

He has been seen within a few weeks by the writer, and he re-
ported that the improvement of his general health had steadily pro-
gressed since his return home.

The tumor weighed within a fraction of twelve pounds. It evidently
belonged to the class of non-malignant tumors. A further estimate of
its true nature cannot be made, since, preferring to preserve it as a
specimen, no dissection was made into its structure. — American Journal
of Med. Science for 1845.

[We copy the above case because it was an operation of very great
importance, and done without " going to Philadelphia." It has been
insinuated that Dr. Spencer has concealed the fact of the ultimate fatal
result of this operation. It is not so, for the subject of it may be seen
in the Petersburg market-place weekly. — Ed.]

The Claim of Physicians to compensation for services ren-
dered in Medico-Legal Examinations.

It seems scarcely credible, that in the state of South Carolina, which
is noted for the liberality of her acts and for her enlightened policy,
the physician is expected, nay, required, to make post mortem examina-
tions when summoned by the coroner, without receiving the slightest
compensation for his services. This is so flagrant an act of injustice,
so grievous a wrong, done the profession, as to demand their serious
consideration, and incite them to strenuous exertions to effect a recog-
nition of their rights. When it is remembered that the medical man
expends hundreds, perhaps thousands of dollars, that he toils year af-
ter year, for the acquisition of the most complex, and, consequently, the
most difficult of sciences, it is reasonable that his knowledge should re-
receive its reward, when practically applied for the public as well as
the private weal. When invited by the coroner to make the examina-
tion of a body, in case of suspected poisoning, murder, etc., he has al-
ways willingly rendered his services to the state regardless of the in-
convenience to which he may be exposed. Is it not just that he should
receive a quid pro quo? The lawyer who conducts the case on the
part of the state receives a compensation, and why should not the
physician, who is perhaps mainly instrumental in establishing the guilt
or innocence of the accused ? It would be superfluous for us to do
more than merely advert to the cases on record, in which medical tes-
timony has been all-important to the conviction of the individual sus-
pected of having perpetrated the crime. We need only instance the
dreadful tragedy, recently enacted by one of our own profession, to
convince any one of the great weight attached to the testimony of the
scientific physician.

SELECTIONS. 233

We are not sufficiently acquainted with the laws of the several
states of our confederacy, to know whether physicians in the majority
of cases are paid for these examinations or not. It is only lately that
Georgia has rendered this act of justice to her physicians. By a law
passed at the last session of the legislature of that state, as we learn
from the July Number of the Southern Medical and Surgical Journal,
the physician is allowed, for each post mortem examination, when
death has resulted from external violence, where no dissection is re-
quired, the sum of ten dollars ; for the same, where dissection is ne-
cessary, and where no interment of the body has been made, twenty
dollars ; for the same, after one or more days' interment, thirty dollars;
for the same, when any chemical analysis is required, the sum of fifty
dollars, and the expense of such analysis. In reference to this matter,
the above journal remarks :

" We are pleased that this tardy act of justice to the medical pro-
fession has been done ; but, at the same time, we are constrained to
say that the compensation for post mortem examinations, where chemi-
cal analysis is required, is entirely inadequate. In almost every case
of this kind, the entire responsibility is thrown upon the physician.
Upon the correctness of his analysis, the reputation and life of the ac-
cused depend. His opinion alone determines the question whether or
not a crime has been committed. To place a man under such a
weight of responsibility, and then to offer to compensate him for fifty
dollars, shews a very low appreciation of the profession, or a very ex-
travagant estimate of the value of money."

Now, although we cannot comprehend how a physician's responsi-
bility is lessened, or his conscience relieved of remorse, by pecuniary
reward in the event of the execution of an innocent person convicted
upon his testimony, as the result of his examination, still we coincide
with the editor that the fee allowed should be proportionate to the
amount of labor and of knowledge required of him ; that fifty dollars,
for instance, for a chemical analysis, is wholly disproportionate to the
expensive process that it involves.

The statute of the state of New York, we are told by the Northern
Lancet, directs the coroner to summon a physician to attend profes-
sionally at an inquest, but does not provide for his remuneration. A
numerously signed petition to that effect was presented to the legisla-
ture, during the session of 1842— '3, but its remonstrances were utterly
disregarded. Inasmuch, therefore, as the state has not complied with
the demands of the profession, the physicians when summoned by the
coroner, although obliged to attend, do not generally touch the body,
as he cannot force them to do it.

In Great Britain the fees are awarded to the physician in a scale
according to the services performed. In France likewise, and, we
presume, upon the continent generally, physicians are remunerated.

And shall this state be one of the last to comply with the just de-
mands of the profession ? It has happened that, time after time, bills
for post mortem examinations, made at the instance of coroners, have
been presented to our legislature, and have, so far as we knowT, inva-
riably been rejected. Why is this ? What incentive is held out to

234 SELECTIONS.

the physician to qualify himself for such arduous and responsible du-
ties ? Were it not that he was actuated by a conscientious discharge
of his duties as a citizen, and that he dreaded the loss of reputation, he
might often be utterly indifferent to the examination made, and to the
evidence subsequently delivered by him.

But we contend that the physician should not only be liberally re-
munerated for his examination, but that he should be adequately com-
pensated for the evidence subsequently delivered in court. With the
physician, as with other business men, time is money, and as he is re-
quired to spend hours, perhaps, as is not unfrequently the case in ci-
ties, days in attendance on the court, waiting his turn to be interro-
gated, it is but right that he should be fully paid. Add to this, the
annoyance to which he is occasionally subjected by unscrupulous
lawyers, and he certainly has sufficient cause for complaint. In or-
der to shew to what great inconvenience physicians are subjected by
being required in these cases to attend court, we have the statement
of Dr. James Webster, professor of anatomy in Geneva college, New
York, in his introductory address to the class of 1849-'50, to the ef-
fect that on one occasion, physicians were summoned from New York
city, Albany, Utica, Auburn, Geneva, and himself from Rochester, to
give evidence in a case that was to be tried in Cayuga county. He
was not onl}r subjected to great loss of time, but also to the expendi-
ture of nearly one hundred dollars for examinations, travelling ex-
penses, etc., not a dollar of which was refunded him. This is one
instance, among many, which he adduces to shew the injustice in the
legislature in not awarding to physicians remuneration for the services
rendered the state.

There is one consideration above all others that should prompt the
state to recognize the just demands of the profession in this respect,
and that is, their voluntary and gratuitous assumption of the guardian-
ship of the public health. When consulted on questions of public hy-
giene, the physician, actuated by the noblest impulses of the human
heart, viz : a desire to ameliorate the condition of his species — readily
and cheerfully imparts all the information he possesses that may tend
to the accomplishment of that object. Nay, he is most frequently
foremost in devising means for the improvement of the body politic ;
whereas, were he to obey the dictates of interest, he would rather en-
deavor to promote disease than prevent it.

We shall not, for the present, pursue this subject further, our object
being merely to direct thereto the attention of our readers, and through
them, that of the members of the legislature.

It is our intention to move at the next meeting of the South Caro-
lina medical association, for the appointment of a standing committee,
to be called the committee on the interest of the profession, whose
duty it shall be to take cognizance of all matters relating to the good
of the profession. — Charleston Medical Journal.

The population of Virginia, according to the recent census, numbers
1,428,000, of which 1755 are physicians — giving a ratio of one phy-
sician to every 813 inhabitants.

SELECTIONS. 235

Quackery Amongst Regular and Irregular Practitioners.

The columns of the Lancet have for some time furnished valuable
information respecting the adulterations of food and drink ; we rejoice
to find that the adulteration of our profession by the intrusion of quacks
amongst us is destined to similar treatment, as appears from the fol-
lowing :

Dr. Johnson instituted a striking comparison between the social po-
sition of the lawyer and the physician. Few, he says, know the de-
fects of the physician they employ, and no man is acquainted with the
excellence of him he refuses to consult. But the lawyer is obliged to
produce himself in public, and give evident proofs of his claim to the
reputation he enjoys. Like many other sayings of the great moralist,
there is more speciousness than fact in these distinctions. The annals
of the bar contain as many and as conspicuous examples of shallow,
undeserved success, and of neglected worth, as the history of any
other occupation, while we feel confident that the medical profession
generally, through all its branches, assumes, and maintains as high a
standard of intellectual capacity, profound learning, and high moral
worth, as either of the two other learned faculties. Some of the great
medical celebrities of London do, however, rest on very shadowy
foundations. We have always, as our readers well know, constantly
wielded the power of this journal to baffle and destroy the advertising
quacks, whose avowed occupation it is to deceive and swindle, but
we are bound to say the race of semi-quacks within the pale of the
profession are hardly less noxious or more derogatory. It is our duty,
occasional^, to devote our attention to the latter, for the sake of those
whose integrity forbids them to follow any but the straight and labo-
rious way, and who are too often left behind in the race by more un-
scrupulous competitors. These regular irregulars consist mostly of
two classes ; of men who, starting with honorable ambition, and try-
ing the pains-taking road without a speedy success, sink into money-
making business, and so make their profession a trade ; and of others
who had neither a tincture of shame, a sense of dignity, or a regard
for truth from the beginning. Of the first class we would speak with
tenderness, when they keep themselves in the shade, and content
themselves with the great object of their pursuit — wealth. The other
class it becomes the correctional police of the press to deal with se-
verely, and we propose to pass some of the parties who belong to it
under the lash of criticism. It is they who are ever ready to seize
every novelty, every real or fancied improvement in practice, and push
it to the verge of quackery, so that the public cannot really see where
the profession ends and where quackery begins. Such men are more
dangerous and more mischievous to the profession than the avowed
irregulars. We shall take an early opportunity of applying these
general remarks to particular instances, though every medical man
must, in his own sphere, be able to make an abundance of such ap-
plications.— Lancet.

We are glad to find that this praiseworthy effort to arrest the pro-

236 SELECTIONS.

gress of quackery amongst regular practitioners is to be directed
against notorious offenders principally. It is no easy matter to define
where quackery begins in the medical ranks, and therefore no easy
matter to restrict the application of the term to its proper objects ; but
there is no difficulty in dealing with him " who has had neither a tinc-
ture of shame, a sense of dignity, nor a regard for truth from the be-
ginning." The barefaced, impudent, professed charlatan, who openly
avows his contempt for all restraints which interfere with his proceed-
ings, can be easily culled from the flock, for the brand which distin-
guishes him has been applied with his own hand. The base arts of
fawning, fulsome adulation, which, without a blush, he employs to in-
gratiate himself with every class of society, from scum to dregs, serve
as so much pitch and tar to warn all honest men to avoid coming in
contact with him ; while the practices necessary for the successful
conduct of his trade approach so nearly to tangible criminality that
cautious men stand aloof. Nothing, however, of this kind takes place
until the finger of scorn is pointed. As long as he suits the taste of
" the public," makes himself useful to confederates, and does the
work of his employers without scruple, so long does he retain his po-
sition ; but the moment his true character comes to be exposed, then
does he find his level, and hence the value of the interference here
proposed to be undertaken. That it is the duty of a journalist to hold
up to public scorn the evil-doers of our profession, there can be no
doubt. He is the guardian, and the only guardian of our body against
the contamination which such entail. He it is who must remind us
of the truth of the homely saying, that "one scabby sheep corrupts
the whole flock," for without his admonition it will be forgotten.
Neither " the public" nor " the profession" care to be very inquisitive
as to the moral qualities of the man who answers a purpose ; they are
not fastidious ; and with them men seldom lose caste because they
act without scruple, provided they succeed. People should, however,
be taught, and especially people of our profession, that such laxity is
not a universal failing amongst us ; they should know that, some at
least, shun a black sheep, however many may bear him company, be-
cause of his value as a companion, or as a necessary aid in the pur-
suit of their objects. — Dublin Medical Press.

A New Remedy for Short-Sightedness.

BY A. TURNBULL, M. D.

Addressing the editor of The Lancet, Dr. Turnbull says — I beg to
call your attention to a newly-discovered remedy in cases of short-
sightedness, which I have applied with very considerable success.

A few months ago, I observed that persons who are short-sighted,
when looking at objects at a distance, partially close their eyelids, for
the purpose of overcoming the difficulty they find in discerning them.
This action is instinctive; it is a natural effort to adjust the eye to an
increased sphere of vision. It is well known that short-sightedness

SELECTIONS. 237

depends not only on convexity of the cornea, but also on convexity of
the lens ; and having no hope of being able to effect any alteration in
the structure of the lens, my attention was directed to the iris, which
I found to be, in such persons, generally much dilated. It then occur-
red to me that contraction of the iris has the effect of apparently
lengthening the convexity of the cornea, which approaches a circum-
scribed plane, that permits the rays of light to enter only in a straight
line. The effect of this is obvious. The length of vision hereby ne-
cessarily becomes increased, and distant objects are brought within its
range. It therefore struck me, that if we could discover any sub-
stance which could be so applied as to contract the iris, one cause of
the defect of short-sightedness would be remedied. The result, I am
happy to say, has been most satisfactory. In the first instance, I ap-
plied the extract of ginger, which was rubbed for five or ten minutes
over the whole forehead, with the view of acting upon the branches
of the fifth pair of nerves. Afterwards, I substituted a concentrated
tincture of ginger, of the strength of one part of ginger to two parts
of spirit of wine, decolorized by animal charcoal. The success of
this application was remarkable. In many cases it had the effect of
doubling the length of the vision. In some persons I found the iris
was not much dilated, but very torpid. In these cases I applied the
concentrated tincture of pepper, made of the same strength, and in
the same manner as the tincture of ginger. This I used until I ob-
served that the iris had obtained a greater power of contraction and
dilatation, after which I had again recourse to the tincture of ginger.

This plan of treatment has been attended with the most signal suc-
cess, and persons who were extremely short-sighted have very soon
been enabled to lay permanently aside their concave glasses. The
best method, I may observe, of testing the improvement of the sight
during this treatment, is not by taking a printed book, and holding it
near, and then at a greater distance from the eyes ; this range of vi-
sion is much too limited. It is better to fix. the attention of the pa-
tient upon a distant object, such as the brass key-hole of a door, and
by stepping some paces backwards, so as to place himself at a greater
distance from it, he will soon discover the progress he is making.

So important a discovery as this will, I hope, be fairly tested by the
members of our profession, who may rely on the success of the treat-
ment I have recommended, if it be only judiciously and carefully car-
ried out. It is possible that the advantage derived from the tincture,
as above described, may be ascribed to the alkaloid principle of piperin
which is held in solution in the tincture of pepper. — The Chemist.

Success in the Medical Profession.

The following extract is from Professor Ware's introductory lecture
to the class in the Massachusetts Medical College, as published in the
Boston Medical and Surgical Journal. Parallels to the characters here
so graphically hit off, are to be found in every community :

" One man who succeeds is a boaster. He is a living advertise-
ment of his own recommendations. His talk is of great cures, of
28

238 SELECTIONS.

which he tells long and marvellous stories ; of the distinguished and
well-known families whose attendant he is ; of the great distance
from which patients come to seek his advice. He loses no opportu-
nity of impressing on mankind his great skill and his extensive re-
putation. There is another who develops his self-complacency in a
different manner. He is lofty and oracular. His style of discourse
is that of a superior; he cherishes something of the old mystery in
which the profession used to delight. He talks obscurely ; he en-
trenches himself behind technicalities, is magnificent upon trifles ; he
even deals out his pills with an air of majesty. There is still another
who is irritable and arbitrary ; who is a tyrant in the sick room ; who
resents every little disobedience as a personal insult, and regards the
natural expressions of doubt and anxiety as so many reflections on
his professional character. As his opposite, there is one who is all
gentleness ; who always assents — never finds anything or anybody in
the wrong ; who courts the patient, the friends and the nurse — and
has a flattering word for each ; who is all things to all ; who is a syco-
phant and almost a hypocrite — whose countenance is the index to his
character :

' Eternal smiles his emptiness betray,

As shallow streams run dimpling all the way.'

Then there is, on the one hand, the man of invincible taciturnity, in
whom silence is taken by some as the sign of wisdom ; and on the
other, the man of invincible loquacity, whose never-ending stream of
words flows on as innocent and as empty of meaning as the babbling
of a summer brook.

" In this picture there is perhaps a little exaggeration of what wTe
meet in actual life ; 3ret men exhibiting these various peculiarities do
oftentimes succeed. Their currency, however, is usually with a
limited class ; those who like one, naturally dislike his opposite. But
there are some physicians whose mode of intercourse with the sick
recommends them equally to all, independently of any mere reliance
on their medical skill." — St. Louis Med. and Surg. Journal.

Cod Liver Oil in Phthisis Pulmonalis.

Dr. Levick, resident physician in the Pennsylvania hospital, pub-
lishes in the January No. of Amer. Jour. Med. Sciences, fourteen
cases of pulmonary disease in that institution, in which cod liver oil
was used. The following are his conclusions respecting its effects.

[Med. and Sur. Jour.

" If I mistake not, it is highly important that the real value of this
remedy should be soon determined. Exaggerated impressions of its
worth have no doubt been made, to be followed by their necessary
disappointments. All the results promised by some writers from it,
have certainly not followed its use in the hospital, nor in a large
number of cases in private practice, which, through the kindness of
his medical friends, the writer has had an opportunity of closely
watching. On the other hand, we can positively say, that most of

SELECTIONS. 239

our patients, while using the oil, have increased in flesh, in weight,
and in strength ; that with most of them there has been a diminu-
tion of cough and of expectoration ; that with some of them, hectic
and rigors have entirely disappeared ; and that there have been some
so benefitted as to be able to resume their former occupations. We
can also understand that it may so strengthen the patient as to enable
him to make use of those hygienic means which are so efficacious ;
that it may thus, perhaps, indirectly cure consumption. Again, in
phthisis, as the local affection is but a part of the disease, if the gene-
ral health continue to improve, we may hope that the diathesis will
be, in the course of time, thoroughly changed, and thus, perhaps,
cod liver oil may cure consumption. But these suppositions are
merely such ; the assertion of its good, but limited effects, are posi-
tive. The first may happen, the last have happened.

" An objection has recently been made to the use of cod liver oil, that
it produces pulmonary congestion and haemorrhage. This is a plausi-
ble suggestion ; we have not found it to exist in practice. The only
instance in which an attack of bleeding could be positively traced to
the use of the oil, was that of a patient admitted for haemoptysis,
who, after having been in the house for several weeks, with great
improvement of his haemorrhagic symptoms, was placed on the use
of the oil from some suspicious physical signs. Nausea and emesis
were produced by the oil, and a haemorrhage followed the act of vo-
miting. This may suggest a caution under similar circumstances.

" It will be seen that in no instance did any decided benefit arise
from the oil until it had been used at least four weeks ; it is equally
important to observe, that to be of any permanent benefit, its use
must be persisted in for a long time, even after the most striking
symptoms of disease have in a great measure disappeared ; a fact,
of which we have always endeavored to impress the importance on
our patients at the time of their dismissal from the hospital.

" Although then, in conclusion, our experience has not been quite
so gratifying as has that of some others, yet the writer is fully pre-
pared to say, that he believes cod liver oil to be by far the best remedy
for phthisis pulmonalis of which we have at this time any knowledge ;
and that to neglect its use in cases of this disease, unless there be a
strong contra-indication. is, under existing circumstances, both injudi-
cious and culpable."

Of the candidates examined for admission into the naval service as
assistant surgeons, the following from Virginia have been found quali-
fied, viz :

Frederick Horner, Jr., Warrenton.

James B. Whiting, Norfolk.

Randolph Harrison, Cartersville.

John C. Coleman, Halifax courthouse.

J. Page Hopkins, Winchester.

240 COMMUNICATION.

The Medical Society of Clarke County, Virginia,

Met, by appointment, on the 24th March 1851 — Present, Drs.
Little, Randolph, Harrison, Nelson, Kownslar, Barton, Neill and
Haynes. The society was called to order by the vice-president, Dr.
Kownslar, and the minutes of the preceding meeting were read.

The committee appointed at a previous meeting to draft a constitu-
tion and by-laws for the society, reported through their chairman,
Dr. Haynes, which report was received and unanimously adopted.

On motion of Dr. Randolph, the society agreed to exempt certain
members from all expenses, otherwise required by the by-laws.

The society then elected the following officers for the ensuing year,
viz :

Dr. Randolph Kownslar, President.

Dr. J. F. Fauntleroy, Vice-president.

Dr. S. S. Neill, Recording Secretary and Treasurer.

Dr. H. T. Barton, Corresponding Secretary and Librarian.

Dr. Haynes, }

Dr. Randolph, > Publishing Committee.

Dr. Harrison, )

On motion, a committee of three (Drs. Randolph, Harrison and
Kownslar,) was appointed to prepare a code of ethics for the society
by its next meeting.

The society then appointed Dr. J. F. Fauntleroy as its delegate to
the National medical association, to meet in Charleston, South Caro-
lina, on the first Tuesday in May next, and Dr. Kownslar alternate.

The committee for the purpose then announced typhoid fever as
the subject for the next discussion, and appointed Dr. Barton to write
an essay on Placenta Prcevia, to be read at the next meeting.

On motion, the books presented to the society by Dr. Nelson were
received, and the thanks of the society returned.

On motion, it was ordered that the proceedings of this meeting be
sent to the " Stethoscope" for publication.

J. A. HAYNES,

Chairman of Committee on Publication.

Hygienic Virtues of Mustaches. — Our contemporary, the Union Medi-
cate, announces the discovery, by the National and Military Gazette of
London, (a journal with which we are unacquainted,) of certain hy-
gienic virtues in mustaches. These consist in the hygrometric and
thermometric properties possessed by the human hairs — so that, when
growing below the nostrils, they absorb the moisture, and prevent
cold air from entering the respiratory passages. Statistics prove their
value, as they prove everything else. In the regiments that wear
mustaches, pulmonary affections, colds, &c, are unknown ; whilst in
the regiments in which the men shave, catarrhs, pneumonias, coughs,
&c, are common ! — Edin. Monthly Journal.

THE

AND

No. 5.

RICHMOND, MAY 1851.

[Vol. L

Remarks on the Pathology and Therapeutics of Colica Biliosa,

or Bilious Colic.

BY J. J. THWEATT, M. D., PETERSBURG, VA.

The frequency and formidable character of bilious colic invest it
with peculiar interest to the Southern practitioners of medicine.
Notwithstanding the intense investigation which has been made rela-
tive to its pathology and treatment, it must be conceded that much
obscurity still rests upon these important points. The influence of the
schools of Hamilton and Rush on the practice of medicine in this
country, has been the cause of grave errors. No branch of the science
of medicine has suffered more from this influence than pathology ; and,
we will add, that in no disease has the fallacy of the principles of
those schools been more conspicuously shewn, than in the treatment
of bilious colic. The light which has been shed upon the nature of
diseases of the intestinal canal by the so-called anatomico-pathological
school of medicine, enables us in a manner to throw off the shackles
of those high authorities ; and, instead of a vain and unprofitable
searching after the remote and proximate causes of morbid action, to
study, "scalpel a la main" the effects of disease in tissues, organs and
systems of organs. It is by this method alone that our science can
ever reach certainty. According to the etymology of bilious colic,
the phenomena which characterize the affection depend upon a
vitiated secretion of the liver, (acrid bile,) which, passing into the
intestinal canal, produces spasmodic action, vomiting, &c. In almost
all the systematic works on the practice of medicine, and by medical
men of the highest professional eminence, the opinion is pertinaciously
maintained, that the essential features of bilious colic are connected
with a depraved condition of the biliary secretion and spasmodic
action of the muscular tissue, which enters into the composition of
the intestinal tube, the liver being in an engorged condition; hence all
of the symptoms of the disease depend on an engorgement of the liver,
defective and depraved secretion, and muscular irritability. We are
utterly opposed to this opinion of the nature of this disease; we
believe that it has been the source of great mischief, and should be
29

242 THWEATT ON BILIOUS COLIC.

discarded by medical men. With respect to the pathology of bilious
colic, we are prepared to maintain the following propositions : 1st.
That bilious colic is eminently an inflammatory disease. 2nd. That all
of its more prominent features arise from an inflammation of the mucous
membrane of the pyloric region of the stomach and superior portion
of the intestinal tube, especially the duodenal portion, accompanied
with spinal irritation. The force of the remote or proximate causes
of the disease is spent upon this portion of the intestinal mucous
membrane, exciting inflammatory action. According to this pathological
view, the symptoms of the disease are susceptible of easy explana-.
tion. No difficulty is experienced on the part of the practitioner to
locate them, and apply the proper remedies.

In the more violent forms of this disease, the patient is seized with
violent pain in the epigastric region, accompanied with intense heat,
nausea, vomiting, and obstinate constipation, the irritability of the
stomach being sometimes so great that nothing liquid can be retained
for the shortest time, incessant vomiting, not of acrid, bilious matter,
as is generally stated by authors, but of thin, acid mucous, secreted
from the gastric mucous membrane. Vomiting of bile in this disease
is far from being so common as is thought by many writers. The
stomach is irritable, which constitutes one of the most annoying s}'mp-
toms to the patient, the circulating system soon becomes involved,
and you have a full, strong, bounding pulse, redness of the face with
constant flushings, accompanied with more or less headach ; the ner-
vous system soon manifests derangement, extreme jactitation, cries of
alarm follow, the patient often complains of pain in the back, and,
■on examination of the spine, tenderness along the dorsal vertebras is
produced by pressure, (the abdominal muscles are spasmodically con-
tracted, especially the rectus.) The above description appertains
to the severe cases of bilious colic ; but there is another class of
cases of this disease of quite a different character — the patient com-
plains of a dull pain in the region of the stomach, extending along the
posterior border of the liver ; there is no appetite, tongue thickly
coated, slight jaundice, pulse slow but strong, slight pain on pres-
sure, constant nausea but no vomiting, or great irritability of the sto-
mach, constipation not so obstinate as in the more violent cases ; but
what is peculiar to this form of the disease is, that no relief is af-
forded by the evacuations from the bowels ; these evacuations shew
the want of proper bilious secretion, being of a brown or whitish
character, sometimes slightly tinged with bile. The character of the
constitutions of persons affected with this form of bilious colic is leu-
cophlegmatic ; it is frequently to be met with in those localities
where intermittent and remittent fevers prevail, and in seasons sub-
sequent to long droughts. The more prominent phenomena of bilious
colic are admitted by many authors to be the result of inflammatory
action; but it is contended that they are the effects of previous biliaiy
derangement, of acrid bilious secretion. The post hoc propter hoc ar-
gument has been, sa}rs a recent writer, the bane of the science of
medicine from time immemorial. We find the power of this false
mode of reasoning fully exemplified in the minds of s\~stematic wri-
ters on bilious colic.

THWEATT ON BILIOUS COLIC. 243

The symptoms exhibited in a case of bilious colic are the result of
inflammation confined as we have stated to the mucous membrane of
the pyloric region of the stomach and superior portion of the digestive
tube ; and we are strongly inclined to the opinion that the mucous
membrane of the duodenum is the first to be attacked. We wish to
direct particular attention to this point : the symptoms which mark
inflammation of this portion of the intestinal mucous membrane, as
given by the most distinguished pathological observers on the Conti-
nent of Europe, corresponds exactly with those of bilious colic in a
large majority of cases. M. Piorry, in his Traite de Medicine Pra-
tique, says that duodenitis is characterized by a dull, circumscribed
pain extending from the lower border of the liver to the pit of the
stomach. On percussion mattity is detected in this region — the pain is
also exasperated on pressure.

We do not intend to confine the pathology of bilious colic exclu-
sively to the duodenum, for we are well aware that the pathology of
this portion of the digestive apparatus is yet to be made ; our opinion
is that the disease, in a large number of cases, commences here. Here
is the veritable point de depart of the malady, the inflammatory action
extends itself to the biliary ducts, the bile ceases to flow in the intes-
tinal canal, or if it does, in small quantities. From the same cause fol-
lows the accumulation of bile in the lobules and cells of the liver,
engorgment and inflammation of that viscus, and arrest of secretion.
Jaundice is almost an invariable symptom in bilious colic. In truth,
from our short observation, we have never seen a violent or mild case
of this disease without some appearance of jaundice. Now, is not this
symptom satisfactorily explained by the pathological condition of
the duodenum? M. Broussais was the first to draw the attention of
medical men to this cause of jaundice. M. Andral has published
some valuable papers in the Archives de Medicine in corroboration of
this view. The acrid and stimulating quality of the bile, upon which
so much stress is laid, becomes so from accumulation and confine
ment; and if deficient secretion occurs, it arises from engorgement or
accumulation of bile in the lobules or cells of the liver, the latter
being the proper secreting organs of that viscus. If the symptoms
are not sufficient to prove that bilious colic is an inflammatory disease,
we can confidently appeal to the condition of the blood, and the au-
topsic phenomena, as furnishing incontestable proofs of the fact. In
all of the cases of bilious colic which have come under our observa-
tion, whether in strong, robust, or weak and debilitated constitutions,
the examination of the blood shewed an excess of fibrine ; and this
is regarded by the highest authority in our science as indicative of
inflammatory action. What are the results of dissection? The mu-
cous membrane of the stomach and superior portion of the alimen-
tary canal is found in these conditions, viz : deeply congested, or
softened or ulcerated ; the liver, in a large number of instances, is
engorged, enlarged, and sometimes presents the hob-nailed appear-
ance— a true sign of intense phlogosis. A case occurred recently in
the practice of one of our medical friends, which proved fatal, and on
a post mortem examination, the mucous membrane of the stomach

244 THWEATT ON BILIOUS COLIC.

was not only softened, but there was ulceration in different parts of
the same membrane of the small intestines, which were contracted,
and in some parts so much so, as not to permit the passage of a com-
mon bougie — the liver was engorged and augmented in volume.

We have stated that symptoms of spinal irritation were often pre-
sent in this disease. This is a point which has been entirely over-
looked by authors ; our attention has been particularly drawn to it,
from the fact that in the first case of bilious colic which fell under our
observation, spinal irritation was well manifest, the pain in the back
was intense, and caused incessant complaint from the patient ; there
was evident tenderness on pressure, the constipation in this case was
very obstinate, cramps and contraction of the abdominal muscles and
inferior extremities very annoying to the patient. From more extended
observation we are convinced that spinal irritation enters as an impor-
tant element in the pathology of bilious colic.

Treatment. — There is no disease in which more remedies have been
recommended and tried than in bilious colic ; the catalogue of emet-
ics, cathartics and narcotics have literally been exhausted in the vain
endeavor to find one that would answer the indications — which are,
according to the old notions of the nature of disease, to evacuate the
alimentary canal, and restore the biliary secretion. Under this hepa-
tic delusion, calomel, oil and turpentine, croton oil, tobacco injections,
et id omne genus, have been used with a lavish hand ; under this
perturbatory plan, of treatment, which we regret to say is the one still
adopted by many physicians, the inflammation, the main cause of the
symptoms, is increased instead of diminished ; and thus many cases
which were mild in the commencement become obstinate and intract-
able. To those who are not laboring under this hepatic delirium with
regard to the true nature of bilious colic, the indications of treatment
are plain and simple. Regarding the disease as essential^ inflamma-
tory, the first remedy to be used is blood-letting. We do not hesi-
tate to affirm that in no disease, without exception, is the lancet more
demanded, and in none is the use of it followed by more gratifying
results. To reap the full benefit from this remedy, it should be used
to the extent of making a decided impression on the constitution : the
patient should be made to sit up in bed, a large orifice made, and the
blood permitted to flow until syncope, sickness of stomach or palor
of the countenance indicate that a sufficient quantity has been taken.
The effect of bleeding in this disease is sometimes magical : we have
seen cases where the irritability of the stomach, vomiting, pain, mus-
cular contraction — all yielded to free bleeding. One of the most emi-
nent practitioners of our city related to us the history of a case of bilious
colic of frightful severity, in which the constipation gave way under
bleeding. We have often seen cases yield, after free bleeding, to
mild laxatives. Many authors admit the value of blood-letting, but
they say it should be confined to the incipient or early stages of the
disease, and that it is inadmissible after the lapse of a certain num-
ber of hours or days. This idea of bringing the use of remedies to a
rigid mathematical limit, is a pernicious one, and if carried out, is
calculated to produce the most pernicious results. The lancet should

THWEATT ON BILIOUS COLIC. 245

be employed in all stages of the disease when there are manifest
symptoms of inflammation, or, to use stronger language, in all cases
where the constitution of the patient will admit of its legitimate use.
We have not the hardihood to say, that purgatives and emetics will
not cure the disease ; for morbid action will yield under the most op-
posite treatment; but we do say, that the practitioner who relies on
these remedies will be disappointed : he therefore should not be sur-
prised if his repeated efforts prove abortive and his patient dies. Let
a post mortem examination be made in a case of bilious colic that has
been treated by purgation, and we venture the assertion, that the
most prejudiced opponent of the lancet will admit its indispensable
necessity. In persons of strong and vigorous constitutions the bleed-
ing may be repealed with benefit. . We have found, however, that
after free blood-letting, the local abstraction of blood bv leeches and
cups, repeated three or four times, according to circumstances, will
remove all inflammatory symptoms. In old persons and those of a
leucophlegmatic habit, and especially those who have been subject to
the multiplied forms of dyspepsia, the local abstraction of blood is
our chief reliance ; under these circumstances leeches in the epigas-
tric and right hypochondriac region will produce most beneficial effects.
Topical depletion therefore is a valuable adjunct in the treatment of
bilious colic, and should not be neglected.

Emetics. — This class of remedies were and are still much lauded
by the advocates of the old pathology of bilious colic. To administer
an emetic was the first step in the treatment of the disease ; but, ac-
cording to the view we have taken of the nature of the disease, eme-
tics are rarely indicated — cases are rarely met with in which matters
capable of offending the intestinal mucous membrane are not thrown
off long before medical aid is solicited. The great difficulty to sur-
mount here, is to allay vomiting ; emetics would only tend to increase
it, and likewise increase the inflammation. In old dyspeptic persons,
after a free indulgence of the appetite, a mild form of this affection is
induced; in such cases we have found a gentle emetic to act benefi-
cially ; it is only in cases such as described that we ever prescribe
emetics.

Calomel and, Opium. — After depletory measures, a large dose of
calomel and opium, say from 10 to 15 grains of the former to 1 or 2
of the latter, followed in four or five hours by a dose of oil or any
other mild laxative, will act in the happiest manner. It is a common
practice in our day to resort to large and repeated doses of calomel,
regardless of pathological indications. This medicine is looked upon
as magnum bonvm dei, which is to answer all purposes, fulfil every in-
dication, cure every disease. Calomel is a valuable remedial agent,
but it should be given at a proper time and in a proper manner. The
full therapeutic benefit of this remedy cannot be obtained as long as
high inflammatory action exists in the system ; it may calm irritation,
it may prevent the results of inflammation, it may, it does remove
the results of the inflammatory process, but that it possesses the
power of controlling high inflammatory action, we deny. How often
does it happen that this medicine is administered dose after dose in

246 THWEATT ON BILIOUS COLIC.

inflammatory diseases without producing any effect but active purga-
tion or constitutional irritation. Apply the antiphlogistic means, and
the calomel will shew its proper operation immediately. The worst
cases of salivation are brought about by this means. To obtain then
the full benefit of this remedy, it should be taken after the more in-
flammatory symptoms have been subdued by general or local deple-
tions. At this period a dose of calomel, repeated in four or six hours,
will relieve the engorgement of the liver and portal circulation, and
assist measurabl}r to allay the general irritation of the constitution.
Combined with opium, its curative powers are increased ; opium acts
not only in soothing irritation, but as a relaxative to the constricted
muscular coat of the intestines. We may remark, en passant, that
opium exerts a puissant influence over inflammation of the mucous
membranes. In very obstinate cases of bilious colic, calomel may
be carried so far as gentle ptyalism — intense salivation is a result to
be deprecated in all cases.

Tartar Emetic. — The high laudation which has been bestowed upon
this article of the materia medica, as an antiphlogistic, by the patholo-
gists of the Continent of Europe, and particularly those distinguished
authorities, Andral, Louis, Chomel and Bouillaud, has induced many
practitioners to resort to its powers in the disease under consideration.
Close observation has convinced us that however beneficial tartar
emetic may be in inflammatory diseases on the Continent of Europe,
in our climate it should be used with a cautious and sparing hand. In
uncomplicated inflammation of parenchimatous structure, it is trul}7" a
heroic remedy, but when the mucous membrane becomes involved in
the inflammatory process, its action is pernicious. That the violent
symptoms of bilious colic may be controlled by its action, we are
not disposed to call in question, but care should be taken, that in con-
trolling these symptoms you do not bring about, if not gastro enteri-
tis, a slow form of sub-inflammation, with its concomitants, softening
and ulceration of the intestinal mucous membrane. In our opinion,
tartar emetic should be discarded from the list of remedies in bilious
colic.

Blisters. — Blisters during the early stage of the disease are wholly
inadmissible, and we must confess we are not ver}r partial to these
agents at any period of the disease. Our experience of blisters in bi-
lious colic will not permit their recommendation ; the}'' are always
very objectionable to the patient, and almost always, when used, in-
crease the irritation of the system. When the disease has been pro-
perly treated, there is rarely any necessity for blistering. However, in
some cases, when there are indications of a slow sub-inflammatory ac-
tion going on in the mucous membrane, they may be resorted to with
some benefit. Upon the whole, their curative agency is very limited
in this affection.

Adjuvants. — In giving the above appellation to the agents we shall
introduce, we do not intend to convey the idea that we think lightly of
their effects; on the contrary, we hold them in high estimation, and
regard them as playing a very important part in the cure of the dis-
ease. Among the most important articles of the list of adjuvants are

THE PANCREATIC JUICE IN DIGESTION. 247

castor oil, rhubarb and magnesia, and especially a combination of sul-
phate of magnesia, sulph. of postash, bicarb, of soda, a small quan-
tity of the tinct. of opium, syrup of orange peel in some aromatic
menstruum. This makes a pleasant mixture— it acts gently on the bow-
els, correcting, at the same time, any acidity that may be present in
the pritjtKB vice. Enemas are useful ; in order to render them more ef-
fectual, oil and turpentine may be added ; sometimes active purga-
tives are required, as a decoction of aloes, &c. When the patient
complains of flatulence, we have found the assafcetida enema to act
like a charm. Great thirst and irritability being very troublesome
symptoms, no remedy is more effectual in removing them than ice ;
the patient should be allowed to eat plentifully of ice well beat up.
It often is the case that patients are permitted to take large draughts
of water. This practice produces no benefit, and is highly injurious.
The application of flannels, wrung out of hot water, milk and bread
poultices, particularly hop poultices, to the abdomen, is not to be de-
spised. We have derived more advantage from the hop poultice than
any other. It is peculiarly soothing, from its anodyne properties, to re-
lieve the pain in the back, which is very annoying, after topical deple-
tion by cups to the painful region. The application of the chloroform
liniment to the spine will answer a valuable purpose. We have often
used the chloroform with admirable effect. The veretria ointment
sometimes acts well, but it does not merit the encomium which has
been bestowed upon it as a nervine. When the heat of the stomach
is very great, accompanied with intense irritability, we have found
nothing so grateful to the patient as the application of ice to the epi-
gastric region. It should be pounded and put into a bag, and allowed
to remain on as long as it proves grateful and pleasant to the patient,
and should be removed immediately on the least complaint of chilli-
ness. It is almost superfluous to add, that the diet should be anti-
phlogistic. In no disease is a properly regulated diet of more import-
ance than in bilious colic.

The Pancreatic Juice in Digestion.

Mr. Editor : I send you an article upon the importance of the pan-
creatic juice in digestion. It was suggested upon looking over notes
which 1 took whilst attending a course of lectures upon physiology,
delivered by C. Bernard of Paris, during the year 1848. I am not
aware that the views here given have been hitherto published in this
country. Carpenter, in the last edition of his work, alludes to its
property of digesting fatty matter, but does not take into considera-
tion its other properties. I take some interest in this subject, as I had
the pleasure of witnessing the experiments of M. Bernard, which sa-
tisfied me of the truth of his views.

Yours, &c,

M. P. SCOTT.

248 THE PANCREATIC JUICE IN DIGESTION.

Bernard was the first to discover the true functions of the pancreas,
which, if his conclusions are sound, is one of the most important or-
gans concerned in the process of digestion. By his patient investiga-
tions and philosophical deductions, he has cleared up one of the
mysteries of ptrysiology, concerning which all has been heretofore
mere speculation. It is true that his conclusions have been deduced
from experiments made upon the lower orders of animals; but by
shewing the identity of the different fluids concerned in digestion in
all of the lower orders, he was justified in coming to the conclusion,
by analogical reasoning, that the same phenomena exhibited by them
were also performed in the human system. He has proved thus the
importance of searching for truths in medical science, by experiment-
ing upon animals, and upon the facts thus gained, establishing the
physiological laws which regulate the human system. Upon a just
and accurate knowledge of these laws, it is only possible to establish
a sound system of practice, without which all must be uncertainty or
empiricism.

The old practice, of first concocting a theory and afterwards search-
ing for facts to sustain the preconceived opinion, has been discarded —
the order is reversed. The inductive system of reasoning obtains now
in this science as in all others, and all theoretical notions that are not
founded upon facts are cast aside — we obtain our facts, and upon
them establish our theories. This may be a slow method ; but it is the
only sure one. It must be confessed, however unpalatable it may
be, that we are far behind our brethren on the other side of the At-
lantic in our researches in physiology and pathology. We are satis-
fied with folding our arms and quietly waiting for all improvements
in our science which may be sent to us. These we receive and swal-
low with avidity, or speculate vaguely upon, or reject if they do not
agree with the theories taught when we attended lectures. None think
the experiments upon which they have been founded worthy to be
repeated, or of making experiments to test the truth of those theories
created in the imaginations of the speculative class of physiologists.
But. we have an offset, and flatter ourselves that if the French excel
us in the science of physiology and are the best pathologists, we are
the best practitioners. A vain illusion — for what kind of practice must
that be that is not founded upon facts drawn from physiology and
pathology, upon a proper knowledge of the functions of the different
systems and organs of the human being, and the changes which are
produced by disease. In the same vein and in the same manner the
swarm of quacks and charlatans who overspread the land boast that
they excel us. They point to the results of their systems — laugh at phy-
siological facts, and care not to know whether a human being has a
liver, so that he is possessed of a stomach or sac to receive their drugs
and nostrums. They go ahead. The French are the most cautious
practitioners, for the same reason which induced Frere Jacques to give
up the operation for stone in the bladder after the anatomy of the
parts was taught him. He never knew before the imminent risk his
patients ran of losing their lives if a blunder was committed. We
are more heroic, bolder practitioners — not better.

THE PANCREATIC JUICE IN DIGESTION. 249

The process of digestion has alwa}7s been one of the most inter-
esting subjects in physiology — no part of the science has perhaps so
much engaged the attention of the profession in all ages, and there is
none about which there has been so much speculation, nor indeed at
the present time has it ceased to engage the attention of scientific
men — the field for speculation and experiment is still open. Certain
facts have however been established, by which ancient as well as more
modern theories have been overthrown.

The opinions of some of the older writers, that the stomach was
the only organ for digestion, and that the liver and pancreas, like
the kidneys,* were merely secernants, destined to separate certain
noxious principles from the blood, has been long since exploded.
More modern authors have adopted the theory of chemical solution
put forth by Spallanzanne. These suppose that all kinds of food are
reduced by the action of the gastric juice to one uniform, homogene-
ous semifluid ; that all kinds of aliment produce the same nutrient
principles which, submitted to the action of the gastric juice, becomes
chyme, and that this chyme is changed by the action of the bile and
pancreatic juice into chyle, which is now ready for absorption by the
lacteals. This last is the opinion of Beaumont, deduced from his ex-
periments upon a patient having a fistulous opening in the stomach.
This opinion has been proved by modern experimenters to be errone-
ous, as also the opinion that chyle was formed by the action of the
bile and pancreatic juice upon chyme — thus overthrowing the asser-
tion formerly made that the chyle contains the essence of all kinds of
nutriment.

Almande was enabled to establish that all alimentary matters were
not digested in the stomach — his observations were made upon a
patient having an intestinal fistula, through which he was enabled to
see certain kinds of food pass, and to extract those which had not
been affected during their passage through the stomach. Subsequent
experimenters have established this. Thus the glucose class of aliment
is not acted upon by the gastric juice; this fluid does indeed act upon
cane sugar, changing it into grape sugar, but here its action ceases,
but upon amidon it has no effect. How this class of substances was
ultimately disposed of has been a subject of much speculation and
experiment. Some have supposed that the saliva was the digestive
agent, that by its action the nutritive materials were separated ; others,
that the stomach was the organ for this purpose, and that ulti-
mately they were changed into oleaginous compounds and formed
part of the constituents of chyle.

It would appear now that the stomach digests the azotized class of
food, or rather that the first stage of the digestion of that class is per-
formed in that organ, and that their digestion is completed in the du-
odenum by the operation of the bile and pancreatic fluid. The agen-
cy of the pancreatic juice in digestion has been until recently con-
founded with the bile, and many of its effects attributed to that secre-
tion. Thus, when it was ascertained that fats and oils were not di-

* This was the opinion of Blondlow.

250 THE PANCREATIC JUICE IN DIGESTION.

gested by the agency of the gastric juice, it was supposed by Muller
and Brodie that the digestion of these matters was performed by the
bile; it was not until the experiments of Bernard that its true func-
tions were discovered. Physiologists for the most part have held the
opinion that the pancreas was merely a salivary gland — some few
thought that its office was to supply albumen to the system when
there was a deficiency of this principle in the blood. They supposed
that the pancreatic juice contained albumen, as it was seen to coagu-
late when heat was applied, or a strong acid added. Both of these
opinions have been proven to be erroneous, but that the office of this
secretion is to digest certain alimentary substances which are not
acted upon by any other digestive fluid ; and also by its union with
the bile to complete the digestion of the azotized class which have
been first submitted to the gastric juice.

The pancreatic juice is a colorless, slightly viscid fluid, con-
stantly alkaline in its reaction ; it is coagulated by heat. Its ten-
dency to putrefaction is very great, and, for this reason, should
be always experimented with very soon after being taken from the
duct. After being kept for a short time, it ceases to act upon alimen-
tary substances submitted ; its appearance alters, it loses its consist-
ency, and will not coagulate when heated. The quantity of the
secretion is influenced by the condition of the organ, as is also
its quality; thus, when the pancreas is irritated or slightly in-
flamed, there is a much larger flow ; but it will not act as that
secreted during a normal condition of the gland ; if, however, the in-
flammatory action is great, the secretion will be entirely arrested ; it
is similar in this respect to the stomach.

Those who considered the pancreas as a salivary gland, founded
their opinion upon the similarity of the pancreatic juice'to saliva. The
action of each upon amidon was supposed to be the same, and referred
to as evidence of the identity of the two secretions. Had they been
more careful in making their observations, they would have seen that
there was some slight difference in the action of the two secretions upon
this substance. For example, saliva changes amidon first into dex-
trine, and subsequently into sugar of second class or grape sugar,
and, finally, into lactic acid, whereas the pancreatic juice only
changes it into grape sugar. This difference of itself should have
raised some doubt as to the identity of the two. Magendie, in speak-
ing of the action of saliva, says : " If by an opening into the parotid
duct, we remove the fluid of the parotid gland before it reaches the
mouth and place it in contact with starch, no conversion into sugar
takes place. It is the same also with the saliva drawn from the
maxillary ducts in the dog. There is, then, something peculiar in the
buccal saliva dependent upon all its constituent principles. " Here
then, is a wide difference between the salivary glands and the pan-
creas ; for the pancreatic fluid of itself effects the transformation.

The first class of substances which are acted upon by the pancre-
atic fluid to which I shall refer, is the amylaceous, or that class, which
is capable of undergoing transformation into grape sugar. That the
saliva does not, under ordinary circumstances, effect this change

THE PANCREATIC JUICE IN DIGESTION. 251

can be easily established ; indeed, that the action of saliva is me-
chanical and not chemical, and that its place could be supplied with
pure water, is now, I believe, the received opinion. These substances
undergo no change in the stomach, as may be seen by giving amidon
to a dog, and afterwards extracting the contents of the stomach,
through a fistulous opening, and testing them. This will also be seen
to be the case, if it is digested out of the body with pure gastric
juice. If this substance be followed, it will be seen that it disap-
pears in the duodenum. Now, the only secretions which are poured
into the duodenum, are the bile and the pancreatic juice, and to' one
of these must the disappearance of the starch be due. That it is not
owing to any action of the bile, may be proved by digesting it with
pure bile when no transformation takes place; and, we might now
reason, that it must be the pancreatic fluid which digests it, that
being the only remaining digestive agent ; but, a more conclusive
proof is, that if the duct leading from the pancreas be tied, and the
contents of the duodenum of an animal previously fed upon starch
be examined, it will be seen that no change has been made upon it ;
and, lastly, if starch is digested with pure pancreatic juice, a trans-
formation into grape sugar will result. That it is now fit for absorp-
tion is most probable ; as if a solution containing grape sugar be in-
jected into a vein, no trace of it can be discovered, either in the blood
or in any one of the secretions, thus shewing that it has been assimi-
lated, so that it is reasonable to infer that this class of substances do
not undergo any further change, as now they are ready for assimila-
tion.

Of its agency in the digestion of fatty matter. It was, for a long
time, the received opinion, that the bile was the agent designed for
the digestion of fatty matter. This opinion was founded upon expe-
riments made by Muller, and it was not until his experiments were
repeated by Bernard, that it was found to be fallacious ; for, if pure
bile be added to oil free from acidity, no emulsion will be formed ;
and, if the mixture be allowed to remain a short time, there will be a
complete separation, the oil floating as pure and unchanged as it was
before it was mixed with the bile. If, now, a small quantity of pan-
creatic juice be added, an emulsion will be formed immediately, simi-
lar in appearance to chyle. From this it might be inferred that the
bile, experimented upon by Muller was not pure, or that the oil was
rancid ; for bile has a peculiar action upon rancid oils, forming with
them a kind of soap. Here may have been a source of error; most
probably, however, that distinguished physiologist obtained the bile
from the biliary duct after it had been joined by a pancreatic duct.
In the dog there are two ducts leading from the pancreas, one joining
the ductus choledocus, the other entering the duodenum an inch lower;
so that the error was natural enough if the bile was taken from the
biliary duct after being joined by the pancreatic duct, giving as the
result all the phenomena justly ascribable to the pancreatic juice. In
order that the experiment should succeed, it is necessary that the
pancreaclic juice should be perfectly fresh, and the oil free from
acidity. When the experiment is performed out of the body, the

252 THE PANCREATIC JUICE IN DIGESTION.

emulsion will have an acid reaction. This is not the case in the in-
testine, for it does not lose its alkalinity. This difference is probably
due to the oxygen of the air, there being a decomposition of the oil
into glycerine and oleic acid, the latter being free gives to the emul-
sion an acid reaction.

The gastric juice has no effect whatever upon the oils as any
one may convince himself by obtaining pure gastric juice from the
stomach of a dog, and subjecting the oil to an artificial digestion at
the common temperature of the body. It will be seen that the oil will
remain unchanged.

Thus it has been shown that neither the gastric juice nor the bile,
when experimented with out of the bod}', has any power in digesting
the oils, but that the pancreatic fluid forms with them an emulsion
similar in appearauce to chyle ; but, it may be argued that, although
such are the results of the experiments as performed, that in the in-
testine the action of these fluids may be different, or that the secre-
tions from the intestine may alter in some way their operation. The
following experiment is, I think, conclusive:

If a rabbit be fed upon oil, and its abdomen opened during full di-
gestion, no trace of the oil will be found, but the lacteals will be seen
loaded with chyle.

Now, take another rabbit, ligature the pancreatic duct, and feed it
in like manner upon oil ; after a sufficient time has elapsed, open the
abdomen as before, when the oil will be found unaltered in the intes-
tine, nor will there be seen an}'- appearance of chyle in the lacteals

From these facts two conclusions may be justly drawn ; first, that the
oils and fatty matters are solely digested by the pancreatic juice ; and
secondly, that chyle is not the essence of all kinds of 'alimentary mat-
ter, but is formed by the action of this fluid upon fatty matter; for we
have seen that none of the other secretions act upon oil ; that that of
the pancreas forms an emulsion with it similar in appearance to chyle ;
and lastly, that no chyle is formed if the duct of the pancreas has
been previously tied.

The pancreas then is the chylopoietic gland.

The pancreatic fluid changes sugar of milk into sugar of grape ;
there being this difference between the two, that the former will not
undergo fermentation when yeast is added to a solution containing it.

The active principle of the pancreatic juice, to which the changes
induced upon the various substances submitted to its action is due, is
an organic matter which can be isolated ; for a solution containing this
organic matter will effect the same changes as the pure fluid itself; it
has been named clujloyoiene, from its property of forming chyle ; it
may be precipitated by alcohol, and afterwards dissolved by water.
There is also another peculiar principle, which has never been isolated,
which will be alluded to further on.

Pancreatic juice aids also in completing the digestion of the azo-
tized class of alimentary substances which have been subjected to the
action of the gastric juice and bile. This class of alimentary matter,
after being introduced into the stomach, is dissolved by the gastric
juice, and forms a new compound, the lactate of fibrine. When this

THE PANCREATIC JUICE IN DIGESTION. 253

compound is introduced into the duodenum, a further change takes-
place when it is mixed with the bile. According to Platncr, there is
a general play of chemical affinities, double decomposition takes place,
and two new compounds are formed — lactate of soda and a cho-
leate of fibrine ; the latter is insoluble, and must undergo a further
change before it is fit for absorption and assimilation. This is effected
by the intestinal juice, which is the result of the union of the pan-
creatic and hepatic secretions ; there being two peculiar principles in
the former, one chylopoiene, which can be isolated, the other, mingling
with the bile, forms a third liquid, (intestinal juice,) which completes
the digestion of the azotized substances.

All kinds of food are reduced under the action of the different fluids
concerned in digestion to three classes, viz :

1st Class, Albuminose.

2d Class, Glucose.

3d Class, Fatty matter.

The albuminose class is absorbed by the veins and are poured
into the general circulation and assimilated. The glucose is ab-
sorbed by the veins which empty into the vena porta, and traverse
the tissue of the liver. The third class, or fatty matters, having
been dissolved by the pancreatic fluid, are absorbed by the lac-
teals, and constitute the chyle, which probably undergoes a further
change in traversing the mesenteric ganglions ; it is constantly al-
kaline. Besides the element already mentioned, chyle contains
lymph held in suspension, which has been erroneously supposed
by some to be vegetable chyle. It is owing to the presence of lymph
that chyle coagulates. After passing through the mesenteric glands, it
assumes a rosy hue, which is owing, according to some physiologists,
to the admixture of blood. Teedeman attributed this color to the
lymphatics of the spleen.

These discoveries are, I think, calculated to shed light upon certain
forms of indigestion, whose seat has heretofore been placed in the
stomach ; and we may be induced to search elsewhere for those de-
rangements of the functions of digestion placed under the omnium ga-
therum head of dyspepsia. A better plan of treatment may be adopted
— a more appropriate diet, one which may leave the suffering organ
in a greater state of repose ; thus, there have been cases of dyspepsia
reported, which have been cured by confining the patient to a diet of
fat bacon, which was supposed by most persons to be peculiarly indi-
gestible ; here was a mystery which was explained by saying that,
what was one man's food was another's poison. Would it not have
been more philosophical to say that such a diet did not tax the sto-
mach ; that organ being left in a state of repose, nature was enabled
to repair the injury induced by the imprudence of the patient; the
pancreas in the mean time furnishing the digestive agent? Again:
when the stomach is the seat of any chronic disease, do we not re-
commend a farinaceous diet, because experience has taught us that
these articles of food are of easier digestion? I think that now a better
reason can be given, when we know that the stomach is not called
upon to aid in digesting them, but that this process is carried on in
the duodenum.

254 CLAIBORNE ON ARSENICAL TESTS.

We find also in certain forms of dyspepesia, that solid food is the
most appropriate diet ; now, bearing in mind the functions of the sto-
mach, whose office it is to digest the azotized class of aliments, should
we not be led to ascribe the dyspepsia to a derangement of some
other organ concerned in digestion ; for assuredly, if the stomach was
the seat of disease, it would be somewhat paradoxical if it digested
well that class of food for which all agree it is principally designed,
and that class in the digestion of which it is only remotely or not at
all concerned should be rejected. Would it not be more reasonable to
refer the seat of disease to those organs whose especial office it is to
digest the amylaceous class of substances, and that therefore, this kind
of food was rejected, and that the stomach being free from disease,
digested as usual the nitrogenized matter, for which it is peculiarly
fitted ?

Arsenical Testing.

BY JOHN HERBERT CLAIBORNE, M. D., PETERSBURG, VA.

The color and tastelessness of arsenic, the readiness with which
It may be obtained, and, above all, its uncompromising and impla-
cable enmity to life, mark it as an agent peculiarly fitted 1o meet all
occasions upon which it is desired insidiously and criminally to
bring about death. In the annals of crime and turpitude, its deeds
are recorded as many, sure and murderous ; while to the wavering
mind of the unhappy suicidist, it has appeared as kindly as Cato's
sword— his bane and antidote. From these features it is invested
with especial interest to the jurist and physician, as upon them may
devolve the task of relieving the wretched being writhing in the
agony of its cruel torture, or of dragging to deserved punishment the
dastardly fiend who faithlessly places it to his neighbor's lips. Its
modes of test and detection are oftenest committed to the physician ;
and to qualify himself for the weighty responsibilities of this impor-
tant office is befitting his most active care. In a late case, reported in
the Philadelphia Medical Examiner for March 1851, a slight inaccu-
rac}'', or a want of minuter research upon the part of the medical tes-
timony, has delivered from the condign reward of his deeds, a
wretch whom the clearest circumstantial evidence had convicted of
murder, and returned to society a villain and an assassin. In view
of this case, and in recently experimenting in arsenical tests, and
reviewing some of those proposed and commended by the most emi-
nent toxicologists, we have determined to publish the very accurate
and conclusive methods devised for the detection of the poison — less,
indeed, with the hope of presenting any newT or original experiment,
than with the desire of awakening the minds of the profession in Vir-
ginia to a subject which, though so important, has, in very many
cases, we believe, laid long unnoticed.

The form in which this substance is usually administered, crimi-
nally as well as medicinally, is in that of the oxide of the metal ar-

CLAIBORNE ON ARSENICAL TESTS. 255

senic, termed arsenions acid, commonly called by the uninitiated rats-
bane— sometimes fly powder, and occasionally, very improperly,
cobalt. It is a transparent, vitreous mass when first sublimed ,• but,
as seen in the shops, is a white powder, tasteless, inodorous, except
when heated, assuming then the smell of garlic, and very sparingly
soluble in cold water.

If in a case of suspected poisoning a portion of stuff of this cha-
racter be found, under suspicious and unexplained circumstances,
make a solution by throwing some of it into pure, (better distilled)
hot water, and if it be arsenic, the following tests will easily prove it :

Ammonio-nitrate of silver, prepared by making a strong solution
of nitrate of silver, and carefully dropping into it aqua ammonia, till
the precipitate falling is nearly re-dissolved, will throw down from
the suspected solution, if arsenic be present in it, a yellow precipitate,
arsenite of silver. An excess of ammonia will instantly re-dissolve
this and give a clear solution ; hence the care necessary in preparing
the ammonio-nitrate.

Ammonio-sulphate of copper, prepared similarly and with like
care, will throw down from another portion of the suspected solution,
if arsenic be present, a green precipitate, arsenite of copper — a com-
mon pigment known as Scheele's green.

Hydro-sulphuric acid gas, bubbled through a third portion, will, if
arsenic be present, throw down a yellow precipitate, orpiment — ses-
quisulphuret of arsenic. If the supposed arsenic have been dis-
solved in pure water, the evidence of these tests may be deemed con-
clusive.

But it is in very many instances impossible to obtain so pure a solu-
tion of the suspected substance. We are often considered fortunate to
obtain it even in the form of discharges from the stomach and bowels;
and when mixed there, with a variety of organic material — vegetable
and animal. The presence of these matters will variously interfere with,
change the color of, or prevent the precipitates that should be thrown
down by the two former tests, while the presence of any free alkali
will prevent the formation of the yellow precipitate by the hydro-
sulphuric acid. The organic matters, before experimenting, must be
gotten rid of, and the following process of doing this is simple and
effectual : Boil the suspected matter for an hour in distilled water,
then filter, and set the liquid aside to cool. This will, to a great
extent, remove all organic material. If it should not, the addition of
a small portion of acetic acid will give a ftocculent precipitate, and
the mixture must be still further purified by adding to it a strong so-
lution of the oxide of zinc in potassa. The oxide will unite with and
carry down all of the remaining organic matter, and the potassa will
remain in solution in the form of an arsenite. Now filter — neutralise
a part of the liquid by the addition of an alkali or acid, as the test
paper shall indicate necessary — and proceed to test with the ammonio-
nitrate of silver and copper, as in the last case. The ammonio-sul-
phate of copper will throw down a green precipitate., if arsenic be
present in the proportion of one to five thousand parts of the liquid —
the ammonio-nitrate of silver, a yellow precipitate, if arsenic be pre-

256 CLAIBORNE ON ARSENICAL TESTS.

sent in proportion of one to four hundred thousand parts of the liquid.
Take a third portion of the suspected fluid and bubble through it
hydro-sulphuric acid gas — having first, however, acidulated this por-
tion, as the expected precipitate, the sulphuret of arsenic is highly
soluble in any free alkali. If arsenic be present to the two hundred
thousandth degree, a yellow precipitate will fall. But the sulphurets of
antimony, tin, cadmium and selenium are also yellow, and if either
of these metals be present in solution will likewise be precipitated.
Hence it becomes necessary to examine this precipitate more mi-
nutely. Obtain it by filtering — -carefully dry, and place it down to
the bottom of a clean glass tube hermetically sealed at one end —
throw down upon it twice its weight of powdered charcoal and car-
bonate of soda — -wipe the glass out carefully down to the mixture by
a piece of cotton on the end of a wire, and heat the closed end in the
flame of a spirit lamp. The carbon will abstract the oxygen from
the minerals, arsenic and soda, and carbonic acid will escape — the
sulphuret of sodium will be formed and metallic arsenic be sublimed,
depositing a dark ring upon the tube where it is condensed a short
way above the materials heated. But antimony treated in a similar
manner will also give a dark metallic ring — and how shall this be
known from arsenic ? Cut off the tube below the ring, incline it and
heat the lower end so that a current of atmospheric air may pass
through it. The metallic arsenic will be oxidised, arsenious acid will
be formed and seen depositing in white crystals above the ring. This
may be taken, washed out into a tumbler of distilled water, and
easily tested as a pure solution of arsenic. This experiment may be
condsidered conclusive.

But it sometimes happens that none of the ejectments from the
stomach or bowels can be obtained. In the absence of suspicion,
these are usually thrown away, and when the question comes up for
medico-legal investigation, the body of the deceased is all that re-
mains, or even this may have been buried for weeks or months. If,
however, the stomach or bowels can be procured, the presence of
arsenic, may even now be detected, if it exist, only requiring minuter
investigation for its detection than in the former cases.

Let the procured matter be weighed, whatever it be — perhaps a
part of the stomach — add to it one-sixth of its weight of sulphuric
acid, and digest for a day or two. The organic matter will be trans-
formed by the action of the acid into carbonic acid and water, and a
char will remain as a sediment. Now add to this one-sixth of its
weight of nitric acid and the char will be consumed and a clear solu-
tion be left. The fluid is now ready for the test ; and to determine whe-
ther arsenic be present, we will resort in this case to the plan de-
vised by Marsh, upon the principles of the powerful affinity of hydro-
gen for arsenic. He has constructed an instrument especially for the
purpose, but it is not always readily obtained, and the experiment
can be as well conducted without it. The only object is to cause hy-
drogen gas to be generated within the suspected liquid, and the most
convenient manner in which this can be done will prove the test.
Let us place the liquid to be tested in an ordinal glass retort — add

CLAIBORNE ON ARSENICAL TESTS. 257

to it a little sulphuric acid and throw in some pieces of zinc — hydro-
gen gas will be immediately generated by the action of the acid on
the metal, and in its nascent state will seize upon the slightest portion
of arsenic present. The gas which then escapes will be arsenieu-
retted hydrogen. Permit this to escape until there shall cease to be
any admixture of atmospheric air, to avoid the accident of explosion,
which would necessarily ensue upon firing the mixed gases, and
then apply a taper. Hold over the burning gas a cold, polished
surface, as of a piece of porcelain or glass, and the sublimed arsenic
will be condensed in a dark, metallic spot ; or we may cause the gas
to pass through a small glass tube, and without firing it, heat the tube
through which it passes. Hydrogen will be driven off and a black,
metallic ring, arsenic, be deposited. This process will detect the
presence of arsenic to the five hundred thousandth degree. It will
reveal the existence of one hundredth of a grain in a pound of sto-
mach. (Prof. R. E. Rogers.) This experiment might be considered
as perfected at this stage of the process — but for the fact that hydro-
gen will form with both antimony and mercury compounds, which,
burning, will each give the characteristic dark ring. And may not the
unfortunate victim of crime possibly have taken calomel or tartar
emetic in his last illness, and thus introduced mercury and antimony
into his system as well as arsenic ? And would not this possibility
materially affect the legal consequences of the medical testimony, if
not. the truth of the case?

In a criminal case tried some years since in New York city, a me-
dical man, summoned as a witness, swore, upon the strength of this
experiment of Marsh's, that he could tell the shadow of a shade of
arsenic without doubt or deception ; and pointed to the black, metallic
ring to sustain him. But a shrewd lawyer, in minute research, prompted
by a lawyer's characteristic regard for justice and love of the whole
truth, discovered that mercury similarly treated with hydrogen as ar-
senic would give a similar dark ring ; and therefore our medical friend
proved too swift a witness. The experiment, however, may be made
perfect. If heat be applied to the metallic spot or the metallic ring,
and it be arsenic, it will be volatilized and disappear, because the
point of volatilization in arsenic is below its point of fusion. On the
contrary, if the metal be mercury or antimony, it will melt and run
into globules. Or the tube may be cut off, containing the ring, in-
clined and heated so as to cause a current of air to pass over the ring,
when, if it be arsenic, white crystaline arsenious acid will be formed,
which may then be tested by being thrown into solution and acted on
by ammonio-nitrate of silver, ammonio-sulphate of copper, and sul-
phuretted hydrogen. Or it may be thrown into a test tube with flux
and be re-sublimed, which will cap the climax of perfective experi-
ment. Great care is necessary, however, in the choice of the mate-
rials to be used in experimenting. The common sulphuric acid of
commerce, and more especially the zinc, sometimes contain arsenic
in sufficiently great proportion to respond to these delicate tests ; and
hence, if not known to be perfectly pure, they both should be tested be-
fore being used in an experiment where life or death may be concerned.
30

258 CLAIBORNE ON ARSENICAL TESTS.

The glass of the tubes, in which the suspected materials may be
placed previous to being treated with black flux, may also readily de-
ceive the experimenter by giving, when heated in the spirit lamps, a
ring of metallic lead, the oxide of which they contain. These might
also be tested. The French manufacture tubes of pure leadless glass,
(silicate of soda,) especially for the purpose of being used in this deli-
cate testing, and these, if procurable, are greatly to be preferred. Lais-
saigne proposes the following plan of separating the arsenic from the
hydrogen, when the arsenieurreted hydrogen gas has been obtained.
Pass the gas through a solution of the nitrate of the oxide of silver, the
hydrogen will seize upon the oxygen of the oxide, metallic silver will
be precipitated, and nitric and arsenious acids will be left in solution.
Add a little muriatic acid to precipitate any silver that may be in ex-
cess— filter and evaporate the solution. Arsenious will have become
arsenic acid by absorption of oxygen from the nitric, but it will be
left on the filter, and may then be treated with the usual tests.

Dr. Christison commends a plan devised by Professor Reinsch.
He throws into the suspected fluids muriatic acid and copper. If
arsenious acid be present, it will give up its oxygen to the copper ;
the muriate of the oxide of copper will be formed, and the arsenic will
appear in a steel grey deposit upon this. As antimony, bismuth, tin
and zinc, if present, might also give a deposit upon the copper similar
to arsenic, and only differing a little in color, it is necessary that this
should be sublimed from the copper, and the usual tests exhibited.

The ease and accuracy with which these experiments may be con-
ducted, afford to the physician and jurist an efficient and gratifying
means of basing their decisions upon the truth ; while the certaint}r
which must attend their results ensures to the accused the benefit of
that justice which the law metes out.

In a case in which life and death are concerned, probably no
strength or clearness of circumstantial evidence should render unne-
cessary the eliciting of the metallic ring; and if one link be wanting
in the chain, or the slightest doubt of the guilt of the prisoner pervade
the mind of the jury, the evidence of the minutest chemical investiga-
tion should be required.

It may not be amiss to state in conclusion, that the antidote of ar-
senic, the hydrated sesquioxide of iron, which is not always readily ob-
tained, may be crudely prepared in a few minutes by adding a satu-
rated solution of carbonate of soda to the muriated tincture of iron,
(Rogers,) until effervescence ceases. The mixture, containing nothing
but the muriate of soda or common salt in solution, and the hydrated
sesquioxide of iron in sediment, may be administered by the wine-
glassful. It is harmless in itself, and if arsenic be in the stomach or
bowels, will form with this the insoluble and inert arsenite of iron,
and consequently prevent its further pernicious action. This may
then be caused to be ejected by cathartics and emetics ; and the in-
flammatory or other symptoms of the previous action of the poison
be treated on general principles.

GARDEN ON TURPETH MINERAL IN SCARLATINA. 259

On Turpeth Mineral in Scarlatina.

BY T. J. GARDEN, OF WYLLIESBURG, CHARLOTTE, VA.

I noticed in the February No. of the Stethoscope, that Professor Met-
tauer of Randolph Macon, in his paper on scarlatina, has made an
apt and appropriate allusion to a vaunted specific, " Turpeth mineral,"
used within the last 20 years as a secret remedy by a physician and
graduate of Virginia, in this formidable disease. As it has always
been our aim to find out the truth, and to make it known, we deem it
a fit and suitable occasion to re-publish, in a respectable medical
journal, some interrogatories published by us in the Enquirer about
the time referred to by the professor, with a view, if possible, to elicit
the whole truth in relation to this mooted subject. A reply now,
through the columns of a medical journal, will enable the professional
public to decide upon its merits. Should that verdict be in its
favor, the disease will at once find a local habitation and a name,
and be shorn of its terrors everywhere. A reply was promised us at
that time through the columns of the Philadelphia Journal, (Hays',)
but it has not as yet, to our disappointment and regret, seen the
light. One thing is certain, there is truth in it, or the unprofessional
public, by a strange delusion, were at one time made to believe a lie.
Here follow the interrogatories :

1st. Dr. *****, near Finneywood, Charlotte, is likewise solicited
to give his views of the modus operandi of his remedy as they
present themselves to his mind, and to point out its superiority over
other modes of treatment, as it is apprehended the mode he has
adopted for giving publicity to it, will limit rather than enlarge the
sphere of its usefulness ?

2d. Whether the peculiar article employed b}' him produces, in ad-
dition to its more obvious operative effect, any specific impression
upon, and change of condition in the diseased structure, whereby
such a counteracting and resolved power is exerted over the disease
as to supersede in its subsequent stages, in all cases, a resort to other
efficient modes of medication?

3d. Does he not believe he has had, in the general, a mild disease
to treat, (for there are grades of it from the mildest to the most ma-
lignant, the former of which the physician need not tamper with, and
the latter he most assuredly cannot cure,) and that his remedy has been
resorted to in a very large proportion of mild cases ; and, is it not fair
to infer, that it has obtained the credit of the cure very often in cases
which were so very mild as would have resulted favorably if left to
nature ?

4th. Is he prepared to maintain, from multiplied observations and
very considerable experience, from many trials, and from the obser-
vations of many under the direction of other physicians, by careful
comparative observation of this with other methods at the same time
and place, and in the same epidemic, and much more a thorough
trial of this with others by the same practitioner, that his method is
superior to all others ?

260 GARDEN ON TURPETH MINERAL IN SCARLATINA.

5th. While it is admitted to be an undoubted fact that the fatal
cases will unquestionably be found to be less numerous in this, as in
all acute diseases, under some plans of treatment than under others,
should the advocates of this exclusive method not beware of doing
such injustice to themselves as to make any pretensions to its curing
all cases, or that it is to be " relied upon with as much certainty as
mercury in syphilis ;" for is it not equally certain that a certain pro-
portion of all acute diseases, under ordinary circumstances, will al-
ways be found incurable ; and that, too, under any and every method
of management?

6th. Whether by his mode of treatment the patient is relieved from
the dangers of a terrible factitious disease, and is in no danger of be-
ing subjected to subsequent exhaustion or excessive morbid irritabi-
lity, and the necessity of struggling both against exhaustion and a
violent factitious malady, oftentimes the worse disease of the two ?

If an affirmative answer can be given to this last interrogatory,
and clearly sustained, herein, I imagine, will be found to reside the
virtues of the doctor's specific in scarlet fever ; for, although the dis-
ease may be inflammatory, I maintain that this state or condition is
not always the same, and that tartar emetic and the lancet are not al-
ways the safest and surest means of subduing it. Evidences to this
fact are not wanting from numerous sources, and may be obtained
from almost daily observation. I consider the lancet in this disease
as a " sword put into the hands of a fool, " an agent of destruction
and devastation, rather than an auxiliary in the treatment. I design
to condemn its abuse, not its use. No argument with me, however,
" like matter of fact, " is in a science which does not rest upon ab-
stract reasoning alone, than which nothing has contributed more to
retard its progress, or lead its votaries so wide from the truth.

The foregoing enquiries are submitted in the true spirit of science.
Truth, humanity itself, and the honor of the profession demand they
should be met in the same spirit.

The interest we feel in this matter, too, has suffered no abatement
from the fact that another physician and graduate of Virginia, who, to
our face, at one time, was clamorous in his denunciations of the doc-
tor and his specific, was afterwards seen writing and publishing his
praises of its virtues and powers in this very disease in a Western
journal ; so that his opinions, when seen in private and exhibited in
public, appeared in opposite shades of light and color. If my me-
mory serves me right, that writer stated he had seen it used success-
fully in one hundred cases, without witnessing a solitary fatal result.
Wonderful success ! He stated that the specific action of the mineral
on the system was speedily developed, and in this way he accounted
for its success. Turpeth mineral is a violent emetic, and if not skil-
fully wielded, would inflict direct injury. We all know how credulous
persons are who are the victims of disease in regard to secret nostrums,
and that a man of intelligence, who will scruple to confide his health
to the care of such physicians, as should be the just objects of his
confidence, will venture to take, through an unaccountable infatua-
tion, the most dangerous medicine, upon the credit of an imposing ad-

GARDEN ON TURPETH MINERAL IN SCARLATINA. 261

vertisement. In charity we are willing to award to the author of this
pretended specific a tact in the use of it which few can claim. This
is true of most remedies, and applies to all physicians — not that the
individual is a man of superior skill either, but has a greater tact in
the use of some particular remedy, and is thereby enabled to produce
effects which none other can. For the information of such as may
feel inclined to give this remedy further trial and more extended ob-
servation, we will just state that the mode of using it, as taught and
practised at that day, is simple enough. The mineral is blended with
a few grains of ipecacuanha and simply rubbed upon the tongue until
the tongue is lightly coated. The patient, if a child, is made to suck a bit
of sugar, which washes down the mineral and ipecacuanha. Vomit-
ing speedily ensues. If an adult, the mineral and ipecacuanha are
blended in relative proportions with a little hot water in a spoon. If
its action prove too violent, either by emesis or catharsis, it is checked
by a little laudanum or paregoric. The balance of the treatment con-
sisted in diluent drinks, and teaspoonful doses of castor oil to keep the
bowels free, with an occasional sinapism to the epigastrium. Seven-
teen years ago, when scarlet fever was endemic in our vicinity, a
great deal was said on the subject of the success of this remedy. This
perhaps was all cabaling. We do not assert that it was so, but per-
haps it was so — we were in the habit ourselves of making compara-
tive observations with other modes of treatment. In one family, the
only fatal case was treated with the mercurial emetic. In this case,
the child was vomited in half an hour after the disease developed it-
self. It was a family of rank and fortune, and as we were required
to spend a great part of the day, and five successive nights with the
family, no time was lost in its administration. I recollect at that time
we were inclined to attribute the secret of the success of this remedy
more to the non-jierturbatmg treatment afterwards, than to any specific
action of the agent employed. It was a form of scarlatina in which
more was done by not doing, than by doing at least in a large propor-
tion of the cases.

Until physicians are more successful and less divided on the mode
of treating this disease, further facts and observations from any quar-
ter will need neither preface nor apology ; for it is only by a faithful
narration of its pathological anatomy, and the effects produced on it
by remedial agents, whenever it has been epidemic in the same and in
different places, that its treatment can ever be correctly ascertained.
Some may think the general stock of information already possessed
on this subject sufficient. Experience has long since proved that the
same remedies produce very different effects in the same disease, at
different times and in different epidemics. Stimulants, emetics, ca-
thartics, mildness and harshness, are only relative terms. We have
seen tartar emetic purge and calomel puke, and stimulants impart no
strength; and within the last thirty years we have seen small doses
of castor oil operate as a hydrogogue cathartic, and kill the patient.
In the same state of the system we have seen spts. terebinth., the mild-
est of all purgatives.

262 young on placenta previa.

A few Observations on Placenta Frsevia.

BY THOS. J. YOUNG, M. D., OF PRINCE GEORGE COUNTY, VA.

It is not my intention, in considering this subject, to enter into a de-
tailed or very elaborate account of the causes, symptoms, and vari-
ous methods of treating this most appalling condition : (for all these
I find to have been sufficiently, and very ably animadverted on in the
January Number of the Stethoscope.) It is my purpose only to offer
a few concise and common-place remarks, in condemnation of a plan
of treatment now in vogue with some, and which I find discussed at
some length in the article above referred to, viz : with the tampon.
Not that I wish to detract anything from the merits of the tampon as
a remedy in treating uterine haemorrhages generally : nay, for within
itself, when judiciously and timely applied, we have a blessing for the
mother, when all other means have failed to afford her relief. But
as the mother is not the only one to whose welfare the physician in
the practice of his obstetrical vocation is called upon to look, it be-
hooves him to discriminate nicely the cases for its application, lest it
prove in his hands a curse, in lieu of a blessing. Would any accou-
cheur think of introducing a tampon into the vagina, so long as a
hope of saving both parent and offspring existed, or until the sacri-
fice of the child was called for to warrant the security of the mother?
Surely not. Then, if he thinks not of this, why should he advise its
introduction in placenta praevia when the os uteri is neither dilated or
dilatable ? Does he expect by this means to plug the orifices of the
bleeding vessels, and thus remedy the evil? If this he could do, by
bringing the tampon into immediate contact with the gaping vessels
from which the blood is issuing, it would be indeed a happy resort ;
but when we take into consideration the relative position of the
vagina and uterus, and the undilalable state of the os uteri, we see at
once the utter impossibility of such contact, and are led to the con-
clusion that the tampon, by confining the blood, and damming it back
upon the uterus, converts the previously open, into a concealed haemor-
rhage, and thus enhances the danger tenfold. The blood will con-
tinue to flow with every renewed contraction of the womb, and hav-
ing no outlet through which it can pass, will necessarily collect in the
remaining portion of the cervix uteri, and between the superfices of
the womb and placenta, dissecting the latter body entirely from its
seat on the matrix — and in this manner effectually shutting off the
natural supply of oxygen from the foetus, the result of which is evi-
dent to the merest tyro in medicine. This is the first objection to its
use that should present itself to the mind of every discriminating
accoucheur, and is within itself of sufficient magnitude to deter him,
and stay his hand whilst yet it is not too late.

A second objection to its use, is this : The capacity of the womb,
from the fifth month of utero-gestation until the completion of term, is
such that it is capable of containing blood enough to endanger the life
of the female, notwithstanding the vagina may be securely tamponed.

walke's case of hydrocephalus. 263

There is yet a third objection, although of less importance than the
two preceding, yet it is of sufficient weight to demand our attention.
It is this fact, (which has long been familiar to the profession at large,)
that the presence of a coagulum of blood in the vagina and uterus so
depresses the nervous system of the parturient female, that she will
die of exhaustion, (if not relieved by breaking up and turning out the
clot,) long before the loss of blood is sufficient to produce such a de-
plorable catastrophe. Let me add, in conclusion, that I renounce the
practice as hazardous in the extreme ; and I consider it a duty incum-
bent on my professional brethren to view it in all its bearings before
putting it to the test. Let them consider well the dangers of convert-
ing this open into a concealed haemorrhage, which I have endeavored
to show is : first, The certain loss of the child by asphyxia ; second-
ly, the capacity of the womb being such as to make it a questionable
remedy ; and thirdly, the extreme nervous depression caused by the
presence of a coagulum of blood in the uterine cavity. Let them,
instead of experimenting rashly with their patients, look calmly and re-
flectingly to the exigencies of the case, and model their treatment ac-
cordingly. I much wish that time would permit me to lengthen out
this essay, and discuss at some length a different and a much safer
plan of treatment; but as I have neither the time nor the inclination to
be prolix, I will draw my remarks to a close, hoping at some future
time to be enabled to do the subject more justice.

Hydrocephalus.

March 1851.
Dear Doctor : As I prefer this mode of communicating a case I re-
cently met with, I send you the report of a case of hydrocephalus
supervening upon the sudden disappearance of an eruption of integu-
ments of the cranium, with profuse serous discharge — a fatal termi-
nation. W. W. B., infant child, aged five or six months, was troubled
from very early infancy with a spontaneous scaly eruption of the
species pityriasis capitis of Willan. This eruption, as I learn from
the parents of the child, first presented itself in an isolated form, but
soon began to spread uniformly over the head, until the entire scalp
was involved. Unlike scurfiness, as described by authors, there was
always more or less redness, indicating an inflamed condition of the
parts, only to the extent, however, of maintaining, as I supposed, a
natural process which nature had adopted, whereby the system might
be freed of some vitiation by a serous discharge, which was quite
profuse up to within ten clays of the child's death. This state of
things continuing, and seeming to bid defiance to the many little sooth-
ing applications made by an anxious mother, induced the parents to
consult me in regard to the propriety of " drying it up," (to use their
own expression,) which I positively admonished them against, having
been informed that the child enjoyed uninterrupted general health,
and perceiving, as I supposed, a hydrocephalic diathesis. Unfortu-
nately for the child, the mother, (as they usually do,) considering the

264 walke's case of hydrocephalus.

personal appearance of primary importance, and not appreciating the
principles upon which rny advice was founded, employed poultices of
various kinds, with a view of relieving the inflamed scalp and thereby
relieve the child of the excessive itching with which it was troubled.
After the application of some three or four poultices, there was an
apparent amendment in the local affection, which continued rapidly
to disappear, until there was not a trace of lesion to be seen of the
former eruption.

About this juncture the parents discovered the child somewhat in-
disposed, which, continuing for several days, induced them to send for
me. Feeling more than an ordinary interest in this little child, I was
quite surprised, and at the same time uneasy, at finding the head en-
tirely relieved of what I conceived, from the first, to be an issue set
up by nature for the purpose of relieving the system of some vitia-
tion, or as the ancients supposed, "peccant humors." Though there
were no physical symptoms prognosticating the existence of effusion
when I first saw the child, still, when I was informed that the child,
naturally lively, had been disposed to be drowsy and fretful for seve-
ral days, I had my fears excited in relation to what might be the ulti-
mate issue of the case. I must confess, that had I not known the cir-
cumstances under which the symptoms, drowsiness, fretfulness, &c.
were ushered in, I would not, at so early a stage of the effusion, have
pronounced it emphatically hydrocephalus. My suspicions were only
aroused, knowing that an issue discharging a vast quantity of sero-jm-
rulent matter had been repelled, during the existence of which the
child enjoyed perfectly good health. These facts, linked with the
symptoms, drowsiness, a fretful disposition, &c, warranted me, as I
thought, in suspecting more or less effusion about the brain.

After prescribing such remedies as I thought the symptoms indi-
cated, I left the child to see it the next day. On my next visit I was
very much disposed to believe the child better, finding the s}7mptoms
not so threatning, and, as I thought, a general improvement in every
way. The next morning, however, I was summoned, at an early
hour, with the melancholy tidings that the child was worse, and on
my arrival found all the symptoms greatly aggravated. The case
now evidently presented symptoms which I could not mistake for
any other than those of incipient hydrocephalus. These alarming
symptoms gradually increased day after day, with dilated pupils —
the eyes remaining nearly all the time open and intently gazing, with-
out expression, at some stationary object. In a short time spasms super-
vened, at irregular intervals, lasting from a few minutes to an hour and
a half, the little creature apparently suffering the greatest agony, evinced
by loud and unnatural shrieks, distortion of the frame, &c. This state
of things continued for forty-eight hours, more or less, when the child
expired. It would be proper to state that the pulse throughout the
attack presented no peculiarity — there being very little excitement,
and it was generally soft and yielding, contra-indicating the presence
of inflammation.

Remarks. — This is a very interesting case, in a pathological point of
view, and tends to elucidate somewhat the difficulties, acknowledged

WALKE S CASE OF HYDROCEPHALUS. 265

by authors to exist, in discriminating between hydrocephalus as a
disease, or merely a symptom of disease. There is great contrariety
of opinion with authors in regard to this disease — some believing it
to be unlike the other hydropic diseases dependant upon the develop-
ment of a peculiar diathesis, but rather the result, of some pre-existing
inflammation or irritation — thus making it merely a symptom of in-
flammation or irritation of the brain, or its meninges. Bell and Stokes
say, " The old idea of this affection was, that it was a species of dropsy,
depending on the relaxed state of the cerebral vessels, and hence the
term hydrocephalus. Modern pathology has shewn that the occur-
rence of serous effusion is a mere accidental circumstance, as it is pre-
sent in one case of arachnitis and absent in another. When it does
occur, however, it is the result of inflammatory disease, and it is to the
prevention and cure of this that the practitioner must direct his atten-
tion." This I conceive to be very bold language in the face of the
strongest evidence in support of hydrocephalus, sometimes originating
in its own peculiar way, and in direct opposition to the experience of
many authors enjoying equal celebrity.

Dickson confesses his embarrassment in defining the disease patho-
logically, but dissents from the doctrine preached by the authors
quoted above. He adduces good authority, and also relates many
cases as occurring in his own practice, supporting the doctrine. of me-
tastasis of serous effusion.

Wood says — " It is possible that the same condition of the blood
and of the extreme vessels, which sometimes induces dropsy in the
cellular tissue and the serous cavities, may operate in the brain so as
to occasion hydrocephalus, especially when, from a want of union be-
tween the bones of the cranium, little resistance is offered to the ac-
cumulation."

Underwood also speaks of scirrhus tumors, a watery state of the
blood and debility as sometimes occasioning the disease in question.
I might adduce (were it not for taking up too much room in your valu-
able journal) many more authors to substantiate the opinions main-
tained by those already mentioned. The authority last quoted, as
corroborative evidence with my own experience, (however limited,)
forces me to support the latter doctrine, and to believe that hydroce-
phalus may exist independent of previous inflammation.

That cases of hydrocephalus do sometimes occur as the sequelae of
arachnitis I readily admit, but to suppose that, every case of dropsy
of the brain is necessarily dependent on a pre-existing inflammation of
the tissues of the brain is, to me, preposterous. Dr. Rush, in speaking
of dropsy of the brain being sometimes occasioned by the exanthe-
ma, says, " I have seen one case of dropsy of the brain, in which it
was obviously the effects of debility induced upon the system by the
measles." There is such a thing, we know, as congenital dropsy
of the brain, evinced by an unnaturally large head, together with
fluctuation on percussion ; and this state of things has existed for
months and years, and the child ultimately recovered without the
slightestest appearance of inflammation of the brain or its mem-
branes, or even functional derangement of this important organ,

266 walke's case of hydrocephalus.

which latter phenomenon, we know, is an almost invariable attendant
upon inflammation or irritation of the brain. I have seen a case in
which the head was swelled to an incredible size, and, as I was in-
formed, had gradually increased in size from birth, to the extent of
rendering the child (now three' or four years old,) unable to elevate
the head erect on the vertebral column — the head, obeying the laws
of gravity, would fall in any and every direction, the child seeming
to have no control whatever over it ; and, notwithstanding, so far
from phrenitis or arachnitis accompanying these extraordinary phe-
nomena, the child enjoyed perfect health ; its appetite was uniformly
good, and, what was astounding, was noted for its sprightliness of
mind. As my purpose is of a twofold character — first, to adduce
the case described above to substantiate the doctrine that dropsy of
the brain does sometimes occur, independent of antecedent inflam-
mation of the brain or its meninges — and secondly, to remonstrate
against an endeavor to repel eruptions of a similar character, know-
ing it to be the practice with some to use various unguents, with a
view of affording speedy relief — after having briefly noticed the rea-
sons that induce me to yield to the theory of metastatic influences,
producing the disease in many instances, I propose noticing some
principles that should ever direct us when we are called on to pre-
scribe in a case similar to the one reported — indeed, in treating any
spontaneous issue set up by nature in her sovereignty, for wise pur-
poses, though not appreciated by us. When we reflect on the many
ways nature has to accomplish her ends, when her fair fabric is as-
sailed, and the success usually attendant upon her efforts, when un-
fettered and displayed in her own favorite way — I say, we should
pause and survey the ground well before we adopt any measure, even
adjuvant to her own means, much less those at war with every prin-
ciple, and inconsistent with the very nature of the case. Let us take
a few cases for example, illustrative of the wonderful feats of nature.
How frequently, after spending anxious days and nights, in a case of
fever, after all our means have been fruitlessly exhausted, and the
monster, disease, as it were, seems to reign " monarch of all he sur-
veyed," a floodgate, somewhere or other, is opened, and the pent up
and vitiated secretions, which were working disorganization and
death, are permitted freely to escape, and the "vis mcdicatrix naturae"
to collect its scattered forces. Hence the critical sweats ; critical
haemorrhage; critical diarrhoea; the copious expectoration, and uri-
nary discharge, which we hail with so much pleasure — to stop or sus-
pend which, would almost certainly ensure the death of the indi-
vidual.

Might we not apply the same reasoning to other morbid conditions
of system besides fevers, and reasonably conclude that, for every ab-
normal state of the economy, there is some process by which nature
endeavors to administer relief? I should say we might. The same
might be said of eruptions almost of every description. There is
some internal disorder which they are intended to modify or cor-
rect— hence the fatality attendant upon the exanthematous diseases,
because of a too frequent interference with, and blocking up, the way

Johnson's case of resection of femur. 267

marked out by nature for her own footsteps. Modern writers are
more negligent, I think, than the ancient, in impressing the importance
of duly considering the designs of nature in establishing issues and
critical discharges of every description. That physician who con-
forms more nearly, in the treatment of disease, to the modes usually
practised by nature, will have his efforts more frequently crowned
with success, and deserves more richly the encomiums which
should be heaped upon the medical man of science. No one, I ima-
gine, after reading the history of this case, would question that the
sudden disappearance of the eruption, and the serous discharge con-
sequent thereon, was the " causa proximo" of the effusion upon the
brain, which resulted in the death of the child. Nothing, we know,
is more common than for us, in indeavoring to remove a disease safely
located, to transplant it to some vital organ. In such a case, the
primary disease either assumes its original type, or puts on an en-
tirely new garb. Remedies are sometimes prescribed in the eruptive
diseases of the integuments of the scalp and face, peculiar to children,
with no view to their specific action in relieving or repelling the erup-
tion ; but such remedies, while they do not thus act, may occasionally
combat successfully the excitement or irritation upon which such erup-
tions or discharges depend. I do not, therefore, always see the ne-
cessity of interfering with such diseases, (beyond cleanliness,) when
we see the child enjoying good general health. We should also bear
in mind, that these diseases are most frequently met with in children
of robust and vigorous constitutions, and generally in a few weeks,
or months, at least in due time, the affection disappears, leaving the
child in the enjoyment of permanent health.

With the hope, dear sir, that you may have your most sanguine
expectations realized in the laudable enterprise you are engaged in,
and that the profession, particularly in the South, may feel it their du-
ty as well as privilege, to contribute to the efforts of the first indi-
vidual (that we know of) who attempts to edit a medical journal in
this state, I subscribe myself,

Most respectfully, yours,

J. WISTAR WALKE,
Clover Hill Coal Mines, Chesterfield County, Va*

Dr. P. Cl. Gooch, Editor of the Stethoscope.

Case of Re-section of the Ununited Ends of a Fractured

Femur.

BY CARTER P. JOHNSON, M. D.,

Professor Anatomy and Physiology Medical Department Hampden Sydney

College.

The subject of this operation was brought before the class in the
operating room of the medical college, on Saturday, November 30th»
and the following statement made in reference to the case:

26S Johnson's case of resection of femur.

P. F., an Irishman, about 19 years of age, of robust frane, in sound
and vigorous health, was brought into the wards of the infirmary on
the 20th August, having just suffered fracture of the right thigh by
the falling of a derrick connected with the gas-works then in process
of erection in this city. Upon examination, the fracture was found to
be very oblique from behind, forwards and from above, downwards,
in the upper third of the bone ; the leg was consequent!}' much short-
ened. ' As there was much swelling and pain about the seat of the
injury, the limb was temporarily placed in a fracture-box and cold ap-
plications made until the third day after the accident, when, the
swelling having sufficiently subsided, the fragments were adjusted and
the limb placed in Smith's fracture apparatus. Shortfy after the ap-
plication of the apparatus, an important part of it broke, rendering it
necessary to remove it altogether. The limb was then carefully ad-
justed in Physic's modification of Desault's apparatus, which effectu-
ally maintained the fractured fragments in apposition. During the
night, the patient finding the extending bandage pressing uncomfort-
ably upon the foot, removed it, and at the next visit the parts were
found in precisely the same condition as before the application of the
instrument. The apparatus was again carefully adjusted, great care
being taken to protect the heel and instep from undue pressure. At
night the patient again removed the bandages, and though continually
warned of the consequences of his folly, continued to remove them
for fourteen or fifteen days after their first application. Ultimately, by
the use of Barton's handkerchief, in lieu of the ordinary bandage, the
apparatus'was applied in such a way as to give him no pain. We have
reason to believe, however, that by the aid of a fellow patient in the
ward, who had observed the simple mode of applying the handker-
chief, he continued to loosen the extending band every night, escaping
detection by having it tightened again in the morning before the wards
were visited by the dresser.

At the expiration of eight weeks after the application of the appa-
ratus, it was removed, and no evidence of union appeared. The leg
was immediately retracted about two inches and a half, and the bro-
ken segments of the thigh could be freely moved upon each other.
There was no crepitus, shewing that the ends of the bone were co-
vered, and that a false joint had been formed. There can be no doubt
that this most unfavorable termination of the treatment of this frac-
ture was caused bv the continual motion between the fractured ends
of the bone whenever the bandages were removed by the patient
during the period when callus was being thrown out, and when it was
most important that perfect immobility of the parts should be pre-
served.

Such having been the result, the question occurs, whether the pa-
tient should be subjected to any further treatment. If permitted to
remain as he is, his limb will not only be entirely useless, but a posi-
tive inconvenience to him. He is unwilling to submit to amputation,
nor do we advise it. With the hope of producing union between the
ends of fractured bones thus ununited, several modes have been pro-
posed, viz: long continued rest, accompanied by pressure, friction of

JOHNSON S CASE OF RESECTION OF FEMUR.

the ends of the bone and the seton. None of these remedies, I appre-
hend, are applicable, except in cases of transverse fracture, or where
the obliquity is comparatively slight; and in the case now under con-
sideration, where the ends of the bone so overlap as to be separated
from each other at least three inches, could be of no avail. The only
other remedy proposed worthy of consideration at this time, is that of
resection of the ends of the bone and the co-aptation of the transverse
surfaces thus exposed. This, where the bone involved is the femur,
becomes a difficult and a hazardous operation. Do the statistics in
reference to this operation justify its performance? Out of 150 cases
of ununited fracture collected by Dr. Norris, the operation of resection
was performed in 38. Of these, 24 were cured, 1 amended, 7 failed,
and 6 died. Twelve of these cases were in the femur, of which 7
were cured, 2 failed and 3 died. Now, when it is recollected that one
of the most common causes of non-union of fracture is some consti-
tutional affection, such as syphilis or scrofula, which would operate as
powerfully in preventing the success of the operation as in producing
the non-union, it is fair to presume that some of the failures in the
above-mentioned cases were attributable to that cause. Applying
these statistics to the case before us, where there is not only no con-
stitutional affection, but the individual is in strong and vigorous health,
and at an age when the nutritive functions are fully and perfectly de-
veloped, they would seem to justify and even to indicate the opera-
tion. It is regarded, however, as a most serious and hazardous ope-
ration, and has only been determined, upon at the request of the pa-
tient, and after the whole of its danger has been fully explained to
him.

After these remarks to the class, and after explaining the successive
steps proposed to be taken in the operation about to be performed, the
patient was put fully under the influence of chloroform, and kept so
by applications repeated whenever he appeared to be emerging from
the anaesthetic state, during the whole operation.*

The operation was then commenced by an incision extending from
a point opposite the trochanter major to a point opposite the outer sur-
face of the external condyle. This incision extended down to the
fascia lata, which was then divided continuously with the first inci-
sion. In order now to reach the lower end of the upper fragment of
the fractured bone, which was drawn forwards and outwards, the
vastus externus muscle was separated from its attachments to the rec-
tus femoris and held back by an assistant. With some little difficulty
the extremity sought for was found, a chain saw passed around it
about an inch from its termination, the section readily made, and the
fragment separated from its ligamentous attachments and removed.

The next step in the proceeding, viz : the section of the upper ex-
tremity of the lower fragment, proved very difficult in consequence of
the great retraction of this portion of the fractured bone. This lower

* This was one of the cases referred to by the Committee on Anaesthetic Agents, in their
report published in the last No. of the Stethoscope, as having probably proved fatal in con-
sequence of the use of chloroform. The sequel will shew, however, that there is no good
ground for attributing the result to any other agency than the shock of a violent operation.

270 Johnson's case of resection of femur.

fragment was found drawn up to the lower portion of the genital re-
gion, and carried by the adducter muscles very considerably inwards,
rendering its access by an external incision very difficult. Finding it
impossible to reach the upper portion of this fragment through the
separation already made between the vastus and the rectus, the vastus
was then separated from its posterior attachments and turned forwards.
After a very tedious dissection, in which the handle of the scalpel and
the fingers were used very much to the exclusion of any cutting in-
strument, in order to avoid the risk of dangerous haemorrhage, which
was imminent, the extremity of the bone was at length reached, and
with considerable difficult}', owing to its very great depth, the chain
saw passed around it. This portion of the operation was much faci-
litated by carrying the foot across the opposite instep, so as to force
the fragment sought for nearer to the external surface of the thigh.
The chain saw, bound down both in front and behind by the thick
muscles and the strong fascia of the thigh, was worked with difficulty,
and before the section was accomplished, broke. A good metacarpal
saw which was at hand, however, made a very good substitute, and
with it the section was finished. The separated fragment, about an
inch and a half in length, was then easily removed. The two oppo-
site ends of the bone, thus rendered transverse, could then be brought
accurately into contact, producing a shortening of the limb of about
two inches and a half. The next step in the operation consisted in
boring, with a small bit and brace, a hole in each of the ends of the
bone thus approximated, through which a very strong silk ligature was
passed by means of an eye-probe, and firmly tied. The holes were
bored obliquely, commencing each about half an inch from the sawn
extremity, and passing the one upwards and the other downwards,
and terminating in the medullary canal. The ends of the ligature
were brought out of the wound. The edges of the wound were then
brought together, the limb lightly bandaged, a long splint applied
along the whole posterior surface of the limb, and the patient put to
bed with the leg resting upon a slightly inclined plane.

During the operation a good deal of blood was lost, a large portion
of which was venous, and after its completion the patient, who had
then recovered from the effect of the anassthetic agent, was very pallid
and excessively prostrated. Brandy and water was freely adminis-
tered and warm clothing applied. Reaction took place very slowly;
about four hours after the operation the pulse began to rise and the
skin to regain its warmth. The stimulants were then used more
moderately. The reaction, however, was never complete, and only
lasted a few hours. During the night the pulse again began to flag
and the patient became more restless. Stimulants, both external and
internal, were again resorted to, and used very freely, but with no
effect. The system seemed to have lost its power of responding to
any agent, and in spite of the most active stimulating treatment, the
patient continued gradually to sink until about six o'clock the next
evening, just thirty hours after the operation, when he expired.

In this case I think there can be no doubt that the patient died from
the shock or concussion produced by the great extent of the operation

JOYNES' CASE OF OBSTRUCTION OF THE BOWELS. 271

and by the violence necessarily done to the tissues during its per-
formance ; and it is interesting as shewing that chloroform will not
always, whatever it may do sometimes, prevent the occurrence of
this shock after capital operations. Here chloroform was exhibited
very freely, so much so as to induce the suspicion that it may have
had some agency in producing the fatal result. That it did really
have no such agency, would appear from the fact that the anaesthetic
effect had entirely passed off before the patient left the operating room,
and he had entirely recovered his consciousness. The symptoms,
too, which preceded death, were all those with which we are familiar
as characterizing the state of shock or concussion, not those of as-
phyxia or of coma.

This case is further interesting as pointing out to the young or inex-
perienced surgeon some of the difficulties in resection of the femur,
which are not generally alluded to in the books, in which, apparently
with the view to entice to operative surgery, oftentimes difficulties are
concealed, with which the surgeon only becomes acquainted in the
person of his first patient.

Mechanical Obstruction of the Intestinal Canal, produced by

Worms.

BY L. S. JOYNES, M. D., ACCOMACK C. H., VA.

The following example of an unusual effect of worms in the ali-
mentary canal, has appeared to me worthy of being recorded, both
for its intrinsic interest and on account of its bearing on an unsettled
question in pathology, which merits the attention of practical men.

• No little difference of opinion has long prevailed among medical
authors and practitioners, with regard to the degree of importance to
be assigned to the presence of entozoa as a cause of disease. While
one party has attributed to their local and sympathetic irritation an
almost endless catalogue of disorders, another has maintained that
except in rare cases, they are quite harmless : indeed, some have gone
so far as to ascribe to them a positively beneficial agency, as scaven-
gers of the alimentary canal. Some apology may be be found for this
under-estimate of the pathological consequence of worms, in the ac-
tual infrequency of any serious effects which can be unequivocally as-
cribed to their presence, and in the absurd abuse of vermifuges, aris-
ing from the manifest exaggeration of the opinions entertained on this
subject by the public and a portion of the profession. It is, indeed,
somewhat astonishing, considering what we hear and read of the ra-
vages of these intruders on the human organism, how long a physi-
cian may practice, and successfully too, in cases popularly attributed
to worms, without feeling once called upon to prescribe a dose of an-
thelmintic medicine. But a case will now and then occur, in which
some abdominal disorder, or some nervous derangement, is so plainly
dependant on the presence of worms, that scepticism is compelled to
give way, and pink-root, wormseed and turpentine are appealed to, of
necessity.

272 JOYNES' CASE OF OBSTRUCTION OF THE BOWELS.

Among the local effects ascribed to these parasites, some authors al-
lude, in terms of doubt, to the possibility of their occasioning, by
their agglomeration, mechanical obstruction of the intestines. Dr.
Joy, of Dublin, in his very copious and learned article on the subject,
in the Cyclopedia of Practical Medicine, remarks on this question :
" Whether they have ever, from their numbers being very great,
caused obstruction, and consequent inflammation and gangrene, is
doubtful." And he quotes Rudolphi as expressing the opinion, that
" They can never produce absolute obstruction, as there will alwa}~s be
room for the passage of chyle and faeces. Their agglomeration, oc-
casionally detected in the human intestines along with iieus, as in a
case mentioned by Rahn, is probably the effect, and not the cause, of
the obstruction."

Grisolle, in his Pathologie Interne, after alluding to the possibility of
a mass of worms causing the incarceration, and perhaps the strangu-
lation of a hernia, goes on to say, "It has been in like manner pre-
tended that these masses of lumbrici might interrupt the course of
the fecal matters in a free portion of intestine, and produce all the
symptoms of ileus; but this has not yet been demonstrated by any
authentic fact. We may, however, conceive the possibility7 of such a
thing. Thus, in a case reported by M. Bretonneau, a mass of worms
as large as the fist distended the intestine," &c. Though Grisolle
does not so state in express terms, I infer from the context that this
convoluted mass of worms was only discovered after death.

These two are the only authors out of a dozen or so that I have
consulted, that make any distinct allusion to the point under conside-
ration.

The following case, which occurred under my observation very
recently, although it does not offer an example of a complete and in-
superable obstruction of the intestinal tube, yet goes far to justify the
admission made by the author last cited, as to the possibility of such
an occurrence.

On the 6th of March last, Mr. J. B. brought to my office a little
negro boy, aged about seven years, who appeared to be suffering se-
verely from pains, similar to those of colic, for which, I was informed,
no relief could be procured. Mr. B. stated, that about a week be-
fore, the boy, previously in his usual health, had complained of colicky
pains of the same character, but less severe, which were relieved by
the aromatic stimulants commonly resorted to in such cases in do-
mestic practice, and a dose of castor oil. No return of pain or other
sy^mptom of disease occurred until the day before that on which he
was brought to my office. Then the colic returned with increased
severity, and experienced no alleviation from a repetition of the reme-
dies prescribed in the first instance. Although castor oil and an ene-
ma were administered, it was found impossible to move the bowels.
The boy had called the attention of those around him to a " hard
lump" in the lower part of his abdomen, which appeared to be the
starting point and centre of the pains which he suffered. I was far-
ther informed that he had vomited after taking some medicine, and
had thus rejected two lumbricoid worms.

JOYNES' CASE OF OBSTRUCTION OF THE BOWELS. 273

On examining the patient, I found him with a calm pulse, a coated
tongue, and complaining only of pain in the abdomen, which recurred
in frequent paroxysms of considerable severity, and was evidently
of the nature of colic. The abdomen was very tumid and tense,
but free from tenderness, except immediately in the region of the tu-
mor, where the sensibility to pressure was very decided. This tumor,
which was evident enough to the touch, felt at first very much like
the edge of some solid growth springing from one of the viscera, or
from the posterior wall of the abdomen ; but it was soon perceived
to be moveable, and free from attachment to any more deeply seated
solid mass. It was elongated and cylindroid in shape, and extended
from near the left side of the brim of the lesser pelvis below, obliquely
upwards and to the right, and terminated at a point an inch or two to
the right of the umbilicus, and on a level with it. It was not quite
straight in its direction, but presented one or more slight curves. Its
total length I should estimate, (having made no measurement at the
time,) at six or seven inches. Its thickness below was apparently
about one inch ; at the upper part it gradually diminished in size, and
at its termination in this direction, was not more than half an inch
thick. At some points of its surface, little irregularities could be felt
through the thin abdominal wall ; one of these, more distinct than the
rest, imparted to the finger just such a sensation as might be produced
by contact with the round, slender body of a worm. This circum-
stance, taken in connection with the other characters of the tumor, and
the fact that the boy had vomited up two worms the day before, left
little doubt that this tumor, the cause of the constipation and colic,
was in reality a convoluted mass of lumbrici, occupying a part of the
small intestine. I should add, that the patient stated to me that the
tumor had changed its position somewhat since he first discovered it.

My prescription was in accordance with the view just expressed.
I gave the boy immediately a dose of calomel and jalap, of each 5
grains, with 5 drops of oil of chenopodium, and directed that he
should take 2 ounces of an infusion of spigelia and senna, with the
addition of sulphate of magnesia every two hours, until the bowels
should be thoroughly evacuated. The operation of the medicine was
also to be promoted by the use of enemata, largely impregnated with
salt.

Notwithstanding the employment of these means, no action of the
bowels was produced until the next morning; (the first dose of the
medicine was given at noon.) The greater part of the infusion was
vomited. When at length the bowels gave way, forty-six large lum-
brici were discharged, all convoluted (according to the account given
me) in one mass. The pains were at once relieved, and the tumor
and the abdominal tension had disappeared.

Here it will be seen, that although the intestinal obstruction was
not insuperable, it was apparently complete, so long as it continued ;
and it would not have required a much greater degree of obstruction
to give rise to all the symptoms of ileus. I apprehend that so distinct
a tumor of this character is rarely met with.

Q1

274 martin's case of worms.

A large number of 'Worms discharged from the Bowels of a

Child

REPORTED BY D. T. MARTIN, M. D., PULASKI COUNTY, VA.

February 20, 1851, 1 was called at 7 o'clock, A. M., to visit a child,
five years old, the daughter of J. W. H., in the town of Newbern,
Pulaski county, Virginia. According to the account given by her pa-
rents, she had been a little unwell for two or three days ; but on the
day previous to my visit, she was suddenly taken with pain in the ab-
domen and vomiting. As her habit was known to be costive, her pa-
rents gave an enema of castor oil and warm water, as well as oil by
the mouth. They also applied fomentations to the abdomen, and gave
a large quantity of laudanum, (according to their statement about 3ij.
in twenty hours,) without relief. At the time she was examined by
me, I found her laboring under the symptoms of colic, pain in the re-
gion of the stomach and bowels, the muscles of the abdomen drawn
up into ridges or knots, with some tenderness upon pressure about
the umbilicus, constant inclination to lean forward and lie upon the
face, tossing to and fro, retching and vomiting every few minutes,
throwing up a frothy mucus, mixed with a little bile ; the tongue
coated with a yellowish fur ; there was also some fever, the pulse be-
ing full and frequent, though compressible.

I gave her calomel grs. iv., Dover's powders grs. ij., to be followed
in four hours by castor oil, and applied sinapisms and fomentations to
the abdomen. The oil was taken, but afterwards thrown up from the
stomach.

I again visited her at 2 o'clock, P. M., and gave calomel grs. ij.,
Dover's powder grs. i., after which she slept about four hours ; at
which time she was aroused for the purpose of giving an enema com-
posed of warm water, castor oil and spirits of turpentine. She now
complained of a choaking, whereupon about ten drops of spirits of
turpentine were given by the mouth. Some time elapsed, and she had
a small passage, in which were 5 or 6 lumbricoides ; after the lapse
of an hour she had a second passage, in which were 4 or 5 worms of
the same kind. She then slept about two hours, when she awoke and
had the third passage, which brought 114 worms, (lumbricoides,)
making in all 120. I understood from her father to-day, (February
25th,) that she had another passage on the evening of the 21st inst.,
in which were 16 worms of the same kind, making in all 140.

The novelty of this case does not consist so much in the symptoms
or treatment as in the number of worms discharged.

BROOCKS' CASE OF DOUBTFUL SEX. 275

Report of a Case of Doubtful Sex.

BY WM. M. BROOCKS, MILTON, NORTH CAROLINA.

It is so exceedingly rare to meet with a lusus natura of this kind in
the United States, that it might be thought almost culpable if it were
not reported. It is doubtful whether any of the primitive races of
any nation ever present such anomalies. It is only among high bred
classes of men and animals that such cases are to be found. Na-
ture here seems to hesitate as to the sex she will choose to cast off
from her generative matrix.

Martha, the subject of this report, is a slave, the property of a gen-
tleman of Pittsylvania county, Va. She is not a pure African, but a
brown mulatto, about 24 years old ; she has the rounded limbs of the
female, weighs 145 pounds, and of Dutch build from shoulders to pel-
vis. She has suffered from neuralgia of her foot, and fever; has been
married some three or four years, and has never menstruated. It was,
therefore, naturally supposed that her sufferings were caused by
amenorrhcea. When she was before me for examination in April 1850,
my attention was first called to the flatness of her broad chest, and
entire absence of her breasts, and as she had never had her catamenia,
I inferred that her genital organization was defective ; and upon ex-
amination very carefully made, both by the sight and the touch, I
found this to be the fact. The pectoral muscles were as devoid of the
mammary glands above them, as those of a male of the same age ;
the nipple was of the ordinary male size ; face full, oval and mascu-
line. The genitals presented the most extraordinary appearance.
The mons veneris was covered with the usual growth of hair of pu-
berty— descending from the upper part of the external labia, was a
small black apron, about three inches long, like the African prepuce,
which at first sight, as it tapered to a small point forward and down-
wards, resembled the pendulous penis. On lifting it up, it was not
round or solid, but extensible, and like a cut open prepuce. Near its
junction to the labia, and just within, could be seen and felt a large
clitoris nearly two inches long, and feeling like the spongy corpora
cavernosa of the penis, and having the cellular membrane only over
its structure.

On passing through the nymphas, the finger came in contact with
the upper portion of the vagina, on which the distended bladder
rested, and no further ingress to the finger forward was permit-
ted. In the centre of the axis of the pelvis, the finger was intro-
duced, and then carried to the left side, and in this direction it was
arrested.

On the right side, the finger passed some three inches towards the
left iliac fossa to a cul de sac, near the bottom of which a small
spongy tuber like a testis gland was felt, having no scrotal covering.
I then searched higher up for the uterus, and all around the sac
as far as it could be reached — I could find none, neither os tineas,
body or fundus. She said she had never had pains in her loins, &c,
which usually precede the incipient menstrual effort at puberty. She

276 A CASE OF MONSTROSITY.

had little or no desire for copulation, . and did not enjoy it, and it
sometimes gave her pain.

I regard this case highly interesting, physiologically, and as well
entitled to be classed with those of hermaphrodism as any which I
have seen reported — the absence of mammae and uterus assimilating
her to the male, and the well developed external labia and nymphae
to the female.

A Case of Monstrosity.

Church Hill, March 15th, 1851.

Dear Sir, — A singular case of monstrosity came within my obser-
vation some years ago, an account of which may be interesting to the
readers of the Stethoscope. Mrs. B., aged 20, was delivered by a
midwife of her first child in the summer of 1849, two years after her
marriage. On account of the peculiar appearance of the infant, I was
invited to see it.

The child was a boy of the ordinary size, and regular in form and
appearance, with the exception about to be stated. On the front of
its abdomen, somewhat to the right side, and exterior to its parietes,
was a mass of considerable size enveloped in a transparent serous
membrane, and connected with the child by a single cord attached to
its umbilicus. This mass was found to contain most of the abdomi-
nal organs : the liver, spleen, stomach and small intestines, being dis-
tinctly observed, all natural, and in an ordinary state of development.
The ccecum and colon not being in the mass, must have been within
the abdomen. The connecting cord comprised the oesophagus part of
the small intestines, and all the vessels supplying the liver, spleen,
stomach and small intestines ; all of which passed through the umbi-
licus of the foetus to reach their respective destinations. This foetus
was reported to have lived half an hour. Its parents enjoyed ordi-
nary health, though the mother had suffered several attacks of St. Vi-
tus' dance or chorea.

Very respectfully,

R. E. JENNINGS, M. D.

A Case of Casuistry. — We observe that several persons in the
land profess to have remedies for hydrophobia, the recipes for which
they refuse to divulge. If a man pretends to have such a thing and
has it not, he is a swindler. If he really has it, and keeps it secret,
giving it only for money, and letting hundreds die for want of it, how
many degrees is he in moral character above a murderer? And the
same questions apply, with more or less force, to all who claim to
have cures for diseases, the nature of which specifics the}' conceal.
Enlightened and honorable medical men make it a point of duty to
publish such discoveries as they make, for the advantage of their
kind ; and we cannot wonder at the contempt with which they look
upon all advertised nostrums, the components of which are secret.

EDITORIAL. 277

MBITOMIAIL Hi MH§(D3iIL]LAM^©ra>

State Organization.

We call the especial attention of every legitimate practitioner of
medicine in Virginia, to the paper published in our present Number,
which emanates from the Medical society. This paper sets forth the
policy of the society, so far as its own organization is concerned, and
offers a sufficient guaranty to the physicians of the country, that the
city members do not desire to retain the power in their own hands.
The objection which has hitherto been so frequently raised to becom-
ing a member, viz : that " one is unwilling to put himself in the
hands of a local society, a bare quorum of which is competent, at any
of its monthly meetings, to impose obligations on and legislate for all
its members," is now entirely removed.

The policy set forth in the paper is that which has been long asked
for by country members, and very many others who desired to be-
come members ; and now nothing remains but for individuals to take
the necessary steps to be enrolled, and at no very distant day the
constitution will be so altered as to adapt it to a general state insti-
tution, holding annual meetings.

This we anticipate will be done before another annual meeting, or
before the assembly of a general convention of the doctors in the
state.

It was gratifying to observe the unanimity with which all the
speakers, in a long and warm discussion on the subject in the society,
urged the importance of some effectual scheme of organization.
There were many differences in regard to the most effectual method
and as to minor details, but the most lively interest and an unmis-
takable determination to accomplish the great end was evinced on
all sides. We now call upon the profession of the state, individually,
to exert themselves in the cause — to agitate the subject of their own
welfare among one another, and to rally around an institution through
which the greatest good may be achieved.

Would that our feeble pen could do justice to this subject — that we
could arouse our brethren to a proper sense of the merits of this
question — and that we could inspire that enthusiasm among the me-
dical men of this commonwealth which would so soon tell to their in-
terests and elevate their position.

The most lukewarm or self-contented physician in the state needs

278 EDITORIAL.

not be told of the present position of his profession, nor is it neces-
sary to impress the importance of medical reform on the minds of any*
The repeal of the law laying a tax on the profession of medicine, with-
out protecting or even recognising it, the enactment of laws for the
suppression of quackery, and the promotion of science, a registration
act, a licentiate board, a proper coroner's system, and other measures
of this character, are objects worthy of a strong effort for their accom-
plishment; and, while individual effort, which has been and is still
being exerted, must prove futile in matters which are not of a popular
nature, their accomplishment is a work of no great difficulty, by united
and well concerted action.

In this age of progress and change, all the reforms which directly
affect the popular mass " go ahead by steam ;" but movements which
are not taken hold of by the demagogue politicians originate with in-
dividuals, who, by combination and united effort, achieve many of the
great works which mark the history of the age. Then we call again
upon the physicians of this proud old state to rally around the society,
and build it up until it attains that numerical strength which will give
it the ability to execute those powers already granted to it by act of
assembly. Place it, and yourselves through it, in a position which
will command the respect of the profession at home and abroad, and
which will make the public look to it as the authority on matters of
the " science of life." Were not the few men who labored to establish
the "Royal Society of London and Edinburgh," the "Academy of
Sciences of Paris," and the other great and powerful learned bodies
of the old world, told that their schemes were visionary and impos-
sible of accomplishment? What has the combined effort and talent of
the few originators of these works now achieved ? The history of the
world and the condition of man will forever answer. Then why have
we not every reason to expect the dawn of a brighter day. The race
of Virginians is not degenerate, the atmosphere is not incompatible
with the highest scientific achievements, and the necessity of going
beyond our borders for books, education, literature, even the simplest
authority in physic, no longer exists. We hold that the medical pro-
fession in Virginia is as able and talented as that of any other country;
why then can it not take that stand in position at home, and fame
abroad, to which its worth entitles it? Let it form into a powerful
association, and by a league of talent and exertion, achieve a triumph
over oppressive legislation and the features of republican government,
which are averse to the promotion of scientific pursuits. There is

EDITORIAL. 279

already an association of one hundred and fifty of the most respectable
members of the profession formed. The body contains much talent
and learning, and we believe the requisite amount of energy also, to
effect ultimately the objects set forth in its charter and constitution.
But, as we have said, to extend its usefulness and make it the impor-
tant and authoritative institution needed, it must be built up by the
whole profession of the state; and to advance this end speedily, we
have feebly thrown together these ideas for the consideration of our
subscribers and readers who are not members.

A Registration Act.

Our readers will be pleased to see that a movement has at last been
made in Virginia to obtain the passage of an act requiring the regis-
tration of births, deaths and marriages. It may seem a little strange,
that the memorial on the subject is to be sent to the constitutional con-
vention instead of the legislature ; but as the latter body is generally
so occupied with " mud-pike schemes" and " never has time" to at-
tend to any other interests but those in which each member or his
constituents are immediately interested, it has been deemed import-
ant to ask the convention to engraft in the constitution a requisition of
the legislature to obtain correct data on this point, both for the use of
the country and their own guidance.

We regard such a law as of the utmost importance to the political
economist, the lawyer, the physician, and indeed to the public at large.
Correct data as to the increase of native and immigrant population,
statistics of mortality, and the security afforded to the rights of pro-
perty by a proper registration of marriages, are objects of great mo-
ment, more or less directly important to every citizen. Speaking of
the same subject, the editor of the Buffalo Medical Journal says :
" Medical practitioners, if they are disposed, can do much to further
the passage of such a law, in the first place, by informing themselves
of the advantages to be secured by it, and, in the second, by taking
pains to enlighten those who are directly or indirectly instrumental in
the making of laws." Hoping that the memorial to be sent to the
convention will set forth the value of a general registration requisition,
and that it will prove effectual in obtaining its passage, we defer fur-
ther remarks on the subject until we see that paper. We may take
up the subject again, in connection with our present most defective
coroners' system.

280 EDITORIAL.

Rushton, Clark & Co.'s Cod Liver Oil.

We are requested by the gentleman who made some rough tests
with nitric acid, before the Medical society, on this oil, to say that it
was not his intention to bring it into discredit or to cast any imputations
on its genuineness, nor was he responsible for the accuracy of the test.
Lest an undue importance should be attached to the experiments
made on it with nitric acid, we feel it our duty to say that little or no
value can be attached to the test, and all that the experiments prove
is, that different samples of the same oil (be it Rushton's or that of
others,) will not give exactly the same reaction. We learn from reliable
sources, that the oil of Messrs. Rushton, Clark & Co. is made at the fishe-
ries, and that no expense or trouble is spared to make and preserve it
pure and unadulterated. Great wonders were to be worked with cod
liver oil after its introduction ; but now, that it has so often failed to
cure consumption, the wish has fathered the thought of attributing its
failure to the impurity of the article. This is a natural consequence
of the too high estimate of an overrated medicine ; and as we have
never had the furor which was so general in its favor, it may be right
to say that our opinion of the oil of Messrs. Rushton, Clark & Co. is
unaltered — the bottles which we have used and examined, all seem
to have been perfectly pure, and we doubt not, as good as that of any
other establishment. Certainly the nitric acid test recorded in our
February Number, was not sufficient to cast the slightest reflection on
it. We have said this much as an act of sheer justice, and nothing
more.

Exchanges.

Our regular exchanges have been received.

The March No. of the Northwestern Medical and Surgical Journal,
published at Chicago and Indianapolis, contains the valedictory of Dr.
Edwin G. Meek, one of its editors. Dr. M., it is said, contemplates
establishing a journal in California. We wish him entire success.

We have received No. 1 of the Northwestern Medical Intelligencer,
which is a supplement to the above, and is intended "to furnish in-
teresting medical intelligence as it transpires in the interim of the re-
gular bi-monthly issues of the N. W. Journal."

The Northern Lancet and Gazette of Legal Medicine, published at
Plattsburg, N. Y., which has been coming to us in a very poor form,

EDITORIAL. 281

obscurely printed with worn out type and set up by young appren-
tices, comes in a new and much improved dress, pretty well printed
and neatly covered. It is the only journal of medical jurisprudence
published in America, and should be liberally patronized. The way
to make it what it ought to be, is to increase its circulation and re-
sources, and we doubt not but that it will grow to be a national work
of medico-legal medicine, now so much needed in the United States.
Terms only $1 per annum.

The Quarterly Review of the Methodist Episcojml Church South, edited
by D. S. Doggett, D. D., for April, is rich in good reading. The arti-
cle on " Education," by Rev. Charles Collins of Emory and Henry
college, is an able, clear and well-written appeal, and though wTe are
opposed to sectarian schools and colleges, we recommend its perusal
to the general reader. This work is handsomely gotten up, and does
credit to the printers, Messrs. Colin & Nowlan of this city.

The Southern Literary Messenger for April sustains its high character,
and we are glad to learn that its editor has made most valuable ac-
cessions to his list of contributors as well as patrons by his late South-
ern tour.

We have received " The eighth Annual Report of the managers of the
New York state lunatic asylum" at Utica. From this interesting docu-
ment we extract the following : " It will be seen that the whole num-
ber of patients under treatment during the year was 816 ; of whom
171 were discharged recovered, 8 much improved, 49 improved, 108
unimproved, and 51 died — leaving 429 remaining in the asylum at the
end of the year."

We observe in the Journal of Insanity a notice of the " Opal," a
monthly newspaper, entirely original, and edited by the patients in
the asylum. The purchase of a library is contemplated by the profits
of the publication. This is said to be the first effort of the character,
but we are quite certain that it is not the first paper edited by mad-
men.

Proceedings of the Medical Association of the State of Alabama, begun
and held in the city of Mobile, December 10 to 14, 1850, with an
appendix.

This is a handsome half bound volume, containing 156 pages. Be-
sides the proceedings, constitution and by-laws, and roll of members

282 EDITORIAL.

of the association, it contains the annual address of Dr. A. Lopez,
the able and indefatigable president, and a beautiful valedictory ad-
dress by Dr. Charles E. Lavender. Nearly 100 pages of this volume
are filled with reports of diseases prevailing in certain sections, medi-
cal topography, botany and other papers of interest and value. We
were surprised to see a volume so large and so respectable coming
from a body yet in its infancy, and not more numerous than the Me-
dical society of our state. The explanation is simple ; in Alabama
there is a spirit and an energy among the profession which has not as
yet been aroused in Virginia. We sincerely trust that in another }rear
our Alabama friends will not be ahead of us.

The Physician' 's Prescription BooJc. — We have received from the pub-
lishers, Messrs. Lindsay & Blackiston, a copy of the first American
from the tenth London edition of this invaluable little work. We take
great pleasure in recommending it to both old and young practitioners
and apothecaries. The list of terms, phrases, contractions and abbre-
viations used in prescriptions, the synonymes and translations of the
Latin phrases used in pharmacy, and the chapter on nomenclature
are all so accurately and compactly arranged in a very small compass
that reference may be made to it in a moment. To apothecaries,
students and young practitioners it is invaluable, and not unfrequently
of great use to the most accomplished prescriber.

GF° The Editor of the Stethoscope will be absent from the city,
in attendance on the American Medical Association at Charleston,
S. C, from the 1st to about the 15th of May. During his absence
Mr. Win. W. D unnavant will attend to any business connected with
the journal. Mr. D unnavant can be found at the publishing office,
corner of Bank and 10th streets.

Medical Society of Virginia.

April Meeting.

After the consumption of much time in ballotting for new mem-
bers, and reading letters of application, the subject for the evening
came up for discussion. Some exceptions were taken to the language
used by the committee in that part of their report relating to the
physiology of anaesthesia. After a short defence by the chairman, a
motion prevailed adjourning the discussion over for a week.

MEDICAL SOCIETY OF VIRGINIA. 283

A resolution was passed appointing a committee of three, on the
part of the society, to act in conjunction with a committee of the
Medical College and any other body, for the purpose of memorializ-
ing the state convention on the subject of a general system of regis-
tration of births, deaths and marriages.

After the transaction of other business of local importance, the so-
ciety adjourned over for a week. The number of members and visit-
ers was so great that the propriety of procuring a larger hall for the
future was spoken of.

Called Meeting — April 19.

Pursuant to notice given, and in accordance with a resolution
adopted in February, requiring this subject to be acted on at called
meetings, the society met to receive the report of the committee on
state organization. From the full attendance on the occasion, we re-
mark the lively interest taken in the subject.

A report and two series of resolutions were presented by the com-
mittee.

A substitute was offered on the part of the minority of the com-
mittee.

Two resolutions, recommending the formation of local societies, and
a mother association, with delegations from them, were offered in lieu of
the two reports.

After a long and animated discussion the above substitutes were
rejected, and the following paper was offered and adopted, by a very de-
cided vote, as a substitute for the committee's report. It was ordered
to be printed in the Stethoscope, and the society adjourned.

"The Medical Society of Virginia, observing with great satisfaction
the success which has attended united effort for the promotion and ad-
vancement of the science of medicine in other states of our Union, have
taken the subject under consideration, with a view of devising some
plan by which a general organization of the profession throughout Vir-
ginia could be effected.

" After a careful- examination of a number of plans which have been
suggested, we are of the opinion that the one which was reported by
a committee appointed by the state convention assembled at Rich-
mond in 1S46, to take into consideration the same subject, and which
the Medical society, by resolution of the same body, was appointed
a committee to carry into effect, is the plan which is most practica-
ble, and, when once effected, will be most permanent, and thereby
contribute more to the advancement of our profession than any other
which has been proposed. It is, in a few words, this : That the medi-
cal men throughout the state, whose qualifications are such as enti-
tle them to membership, be urged to enrol themselves members of
the " State Medical Society," a body organized under an act of in-
corporation, passed in 1824, and now in operation. That when a
sufficient number from different portions of the state shall have been
thus enrolled, to constitute it a fair representative of the medical pro-
fession of the state, it shall assemble once a year to transact such

284 MEDICAL SOCIETY OF VIRGINIA.

business, and engage in such exercises as will be promotive of the
general good of the profession. We regret to say that this, like
many other great plans of improvement which have been commenced
in our state, has not realized the expectations of its originators — not
from any defect in the plan, however, but from a variety of causes,
not the least prominent of which has been the want of that zeal
and perseverance with which they should have been prosecuted to
ensure success. We hail the interest which has been recently mani-
fested by prominent men in different parts of the state, as well as by
members of our society, as an indication that a better day is dawning.
" There are existing other causes which have operated to prevent
the success of this plan, and to which we deem it of importance to
refer. They are feelings of prejudice which have grown out of
the position which the physicians of Richmond have occupied in
this society. While these appear strange to us, who are familiar
with the history of this society, and understand the position which
we occupy in it, we confess that they might naturally enough have
arisen in the minds of those unacquainted with the circumstances
which forced us to take this position. We feel assured that a short
explanation upon this point will be all that is necessary to remove
these feelings. In 1824, a number of medical men, principally resid-
ing in Richmond, conceived the idea of organizing the physicians of
the state upon this plan. They applied to the legislature and obtained
a charter, which gave them the privilege in general terms of doing any
thing which they might deem necessary for the promotion of medical
knowledge, provided it did not conflict with the constitution or laws of
the United States, or the commonwealth of Virginia. They did not suc-
ceed, however, in this organization. It was regarded as a novel propo-
sition, and one the practicability of which had not been demonstrated
in this portion of our country — that such a thing was indeed premature
for our state of society. Its advocates, seeing that they could not at that
time carry out their original design, and that as there were enough mem-
bers of it in Richmond alone to retain the charter, provided they held
meetings as a medical society, determined to convert it temporarily
into a local society, and instead of meeting annually, to meet once a
month, retaining, however, the original name, " State Medical Society
of Virginia," hoping that at some time the original design might be
revived under more favorable auspices, and carried into effect. We
would hope that that time is not far distant — and we do hereby
pledge ourselves that, when it does arrive, we will cheerfully yield to
the physicians throughout the state any local right which we may
have derived by this temporaiy possession of it. The physicians of
Richmond, to keep in existence the interesting local society which
has sprung up under this organization, will resolve themselves into a
local society proper, and meet under a new name, retaining, however,
if it is their pleasure to do so, the constitution and by-laws by which
we are now governed. We deem it inexpedient, at this time, to
carry into effect this separation, inasmuch as our society, as now
organized, is the most efficient committee that could be appointed to
carry into effect this general organization ; for, according to our con-

SELECTIONS. 285

stitution, we have now the power to elect members to this state me-
dical society at each one of our monthly meetings, a facility which
the experience of a few meetings, held since this question of organi-
zation has been revived, has shewn to be a very important one. We
lose this facility by immediate separation, for those members could
only be elected at annual meetings. We therefore propose to retain
the position which we now occupy, until this organization shall have
been so far effected, as to place beyond doubt its ultimate success :
we will then withdraw ourselves, and occupy the same position rela-
tively to the state society as other local societies elsewhere, the
only connection with it being the privileges of membership. We
feel assured, from the success of efforts recently made, that, if
all the members of our society and the profession generally
will give a cordial support to this plan, that we shall, in less than
twelve months, have succeeded in organizing a body, consisting of a
number sufficiently large, and endowed w7ith ample power, to effect
those reforms which are necessary for the protection of the rights, and
the maintenance of the honor and respectibility of our profession."

SSP1 The twenty-seventh annual meeting of " The Medical So-
ciety of Virginia" will be held in the hall of the Richmond library
association, corner of Main and 11th streets, on Tuesday evening,
May 20th. The chair will be taken at 7£ o'clock, P. M.

P. CLAIBORNE GOOCH, Sec.

The Nature of Evidence, and the Requisites for the Credibi-
lity of Testimony.

BY ASA D. LORD, M. D., COLUMBUS, OHIO.

All the knowledge we possess, or are capable of acquiring, may be
referred to one of the three following heads : First, those primary
truths given us by reason, the various operations of our own minds
as revealed by consciousness, and the thoughts and opinions formed by
the combined action of the several faculties of the mind in the pro-
cess of reflection ; second, the information acquired through the me-
dium of the senses in the processes of observation, experiment, or in-
vestigation ; third, that which is derived from the testimony of others
as the result of their experience, observation, or research. Hence, it
is proper to name the exercise of the senses, the operations of our
own minds, and the evidence of testimony, as the sources of know-
ledge.

To the last source we are indebted for the greater portion of the
information we possess, and for nearly all that which we value most
highly. In history, geography, and astronomy, in chemistry, and
nearly all the branches of natural science, we must depend, mainly,
upon the testimon}' of others for our information. Few have the op-
portunity to travel, and view for themselves the localities described
by the geographer and the historian, the instruments for seeing the

286 SELECTIONS.

wonders revealed by the telescope and the microscope ; and few have
either the time or the conveniences for performing the experiments
which substantiate the great truths on which the whole superstructure
of many of these sciences rests.

From these considerations, it is obvious that some acquaintance
with the nature and laws of testimony is important to every indivi-
dual; but perhaps no class of persons, except those connected with
the bench or the bar, are more frequently placed where such an ac-
quaintance is of the utmost importance, than those engaged in the
practice of medicine. Not only is the pl^sician often called to the
stand under circumstances of the deepest interest to all concerned,
and when the nature of his testimony is to decide questions of the
highest importance, and the manner in which it is given may do
much for the credit or reproach of his profession — but the new and
conflicting views and theories in regard to the nature and causes of
disease and the mode of treatment, which are constantly claiming
his attention, demand, on his part, a familiar acquaintance with the
laws of belief, and the ability to apply them to the fects and argu-
ments by which these theories and opinions are sustained, with clear-
ness of perception and correct judgment, if he would not be a mere
empyric in his practice, and receive his opinions and theories ready-
made, from those whose lead he prefers to follow.

Nature of Testimony.

The office of testimony is to give to us the same information we
should obtain by the use of our own powers of observation and in-
vestigation, in regard to facts and phenomena, which have not come
under our notice ; it is employed to establish the existence or validity
of facts, not to sustain opinions or theories. Opinions must be sub-
stantiated by arguments: the validity of arguments must be tested
by the rules of logic. Theories must be sustained by facts. In or-
der that a theory may be regarded as the law by which the facts for
which it professes to account are governed, it must be consistent with
all the facts and phenomena pertaining to that subject. The exist-
ence of one single, well-attested fact at variance with a theory, is
sufficient to destroy our confidence in it altogether: not only must it
be thus accordant with the facts, but it, or an identical one, must be
absolutely demanded by them. Thus, the theory of gravitation is
not only consistent with all the facts for which it professes to ac-
count, but it, or a similar theory, is imperatively demanded by them ;
hence, this is without hesitation denominated the law of universal
gravitation ; but the same is not true of either of the two theories
which have been proposed in regard to the nature of light. Har-
vey's theory of the circulation is also exactly in point ; it was de-
manded by the facts known, or easily ascertained, in regard to the
structure of the heart, the arterial and the venous systems, the pul-
monic and the systemic circulation: the same is true of the modern
theory of the nervous system, the facts demand the existence of the
distinct classes, denominated nerves of sensation, of voluntaiy mo-
tion, and of organic life.

SELECTIONS. 287

The existence, or the validity of facts which have not come un-
der our own observation, must be established by testimony. Al-
leged facts may be of two kinds, impossible or possible ; no amount
of evidence can justify us in believing an impossible thing : only the
latter, therefore, can be substantiated by testimony. We may be
called to believe strange things, those which are marvellous, and,
with our present knowledge, unaccountable ; but they must, at least?
be possible, they must not involve any palpable contradiction, or
manifest absurdity. We are accustomed to speak of impossibilities
of two kinds, physical and moral: in the former are included things
which are contrary to the known laws of the natural world ; as, that
a body should exist in two places at the same time ; that a circle
and a square, or a cube and a globe, should be the same thing : by
moral impossibility is meant, a very high degree of improbability.
The term 'physical impossibility, or the phrase physically impossible, is
also employed for describing mathematical and other absurdities ; as,
that two and three should equal seven ; that an idiot should demon-
strate an intricate problem ; while the statement that one who had
been an idiot up to the age of twenty, had from that time manifested
the possession of an intellect of the highest order, would be so im-
probable as to be considered a moral impossibility. Possible facts may
be classified, first, as probable or improbable, when they do or do not
accord with our experience, or the results of our observation : second,
as credible or incredible, when they do or do not correspond with the
known powers of the agent to which they are ascribed, with the laws
in accordance with which they are supposed to occur, or by which
the producing causes are governed.

To classify accurately, with reference to these distinctions, the
statements made in the reports of remarkable cases or wonderful
cures, and the certificates of the inventors of specifics, and the ven-
ders of nostrums, and the graver assertions of those who are sup-
posed to have a claim to credence, is often a work requiring no little
care, and no small degree of critical acumen ; for, while an indis-
criminating credulousness is indicative of a weak mind, incapable of
thinking or judging for itself, a tendency to indiscriminate skepticism
is equally characteristic of a bigoted mind, which reasons incor-
rectly if at all, or upon imperfect data, or from unsound premises,
and makes its own preconceived opinions the test of all new theo-
ries, and its limited observation the standard of probability, by which
all alleged facts are to be tried. This is the disposition which,
when told that ficts do not accord with his favorite theory, leads the
holder to exclaim impatiently, "So much the worse for the facts
then ;" or like the King of Siam, who, when told by a Dutch travel-
ler that in Holland, water sometimes became so solid that an elephant
might walk on it, replied, "I have believed many extraordinary
things which you have told me, because I supposed you a man of
veracity ; but now I know that you lie." With a cultivated mind
and the ability to discriminate clearly, we can readily see how the
king just named, or any other person who had ever seen the metals
liquefied by the application of heat, and again become solid when it

^88 SELECTIONS.

was abstracted, might have regarded the traveller's statement, not
only as possible, but as credible, and even highly probable, without
reference to the credibility of the traveller. In the same manner, we
can easily conceive how Archimedes, or any other similarly intelligent
philosopher of his time, might have given credence to a description
of the feats of a steam engine, or any other piece of modern machi-
nery, while his ignorant countrymen would have regarded it as en-
tirely fabulous.

In order to prove the existence of facts or the occurrence of events
of which we have not personally taken cognizance, it is desirable that
they should be substantiated by the concurrent testimony of two or
more individuals; but cases frequently occur, in which, from the cir-
cumstances, this is impossible, and our opinions must be formed from
the testimony of a single witness. In such cases, it is necessary that
the witness possess most or all the characteristics needed to render
his testimony valid ; and hence the importance, to every person, of a
knowledge of these characteristics.

'Ov

Requisites in a Single Witness.

The most important requisites for the credibility of testimony from
a single individual, are the following :

1. Unexceptionable moral character; or, at least, a character for
veracity unimpeached and unimpeachable : the importance of this is
too obvious and too well understood to need comment.

2. That he be disinterested in the present case ; that he have no
private or personal ends to accomplish.

3. That he possess a capacity for understanding the facts in regard
to which he testifies : the savage would be but poorly qualified
to give information in the processes required in the mechanic arts ;
the man unacquainted with human anatomy, physiology, and patho-
logy, would be equally incompetent to testify to the facts revealed by
a post-mortem examination.

4. He must have had full opportunity to observe, for himself, the
facts to which he testifies : this will, of course, exclude every thing
like "hearsay," or second-hand testimony.

5. There must be satisfactory evidence that adequate attention
was given to the facts at the time of their occurrence, and that the
memory of the witness does not deceive him. This is a requisite of
the utmost importance ; the testimony of many a witness is invalida-
ted, and his character for veracity rendered questionable, by the ma-
nifest want of attention to the facts, and the confused remembrance
of them indicated in his statements.

6. His testimony must be given in plain, unequivocal terms.
Nothing is more directly calculated to discredit the testimony, or
bring suspicion upon the character of the witness, than the use of
ambiguous expressions ; and it adds no weight to testimony, to have
it expressed in technical language, when common and perfectly intel-
ligible terms may be employed with equal accuracy and propriety.

7. There must be consistency in his statements, and between them

SELECTIONS. 289

and his conduct. Had Columbus manifested any unwillingness to re-
turn to this continent, or had he even seemed indifferent to the under-
taking of another voyage in this direction, who would have believed
his statements in regard to the discoveries he had made ?

Corroborating Circumstances.

Aside from these characteristics of the witness himself, there are
often circumstances entirely unconnected with his character, his ca-
pacity; or his conduct, which have an important bearing upon the
credibility of his testimony ; among those which tend to confirm his
statements are the following :

1. The entire absence of all motives to misrepresent the facts, or
to give false testimony, and especially the presence of strong motives
of an opposite character ; under such circumstances, we often feel
impelled to receive testimony without reference to the moral charac-
ter of the witness.

2. That the witness be aware that he is open to conviction if his
testimony is false.

3. When the facts stated, though unknown before, accord with
others of a similar nature, already known.

4. When, though without parallel or analogy in our experience or
observation, they accord with the known powers of the cause alleged
to have produced them.

5. When the facts stated develope laws not previously discovered,
or reveal properties or powers in the alleged causes, or the exist-
ence of relations, before known ; here, the farther removed from ex-
perience, the greater the probability of the truth of the facts : be-
cause, if not true, they would have been unknown to the witness.
One of the earliest Greek historians mentions that a ship's crew pro-
fessed to have sailed from the Red Sea, around the southern extremity
of Africa, and returned by way of the Straits of Gibraltar; but adds,
" We know they do not tell the truth, because they affirm that, during a
great part of their voyage, the sun appeared north of them at noon !"

6. The entire absence of all conflicting or contradictory testimony,
and the knowledge of facts which cannot be accounted for, except
by supposing the statements true.

Testimony from two or more Witnesses.

When two or more witnesses appear to testify to the same facts, it
is important,

1. That each possess all the requisites previously named.

2. That they concur in their statements in all essential particulars.
The following circumstances tend to increase our confidence in

concurrent testimony thus given.

1. When one witness mentions facts or particulars omitted by others.

2. When coincidences occur in regard to which the nature of the
case and their circumstances, or relations to each other, preclude the
idea of collusion.

3. When statements apparently contradictor}7', are reconciled by a
more full acquaintance with the subject.

32

290 SELECTIONS.

4. When the characters of the witnesses, and their relations to the
subject of investigation, are materially different, and hence their tes-
timony, if influenced at all by personal feelings, would vary.

5. To these may be added, in regard to recorded testimony of
every kind, one of the strongest corroborating circumstances is, the
general assent to its truth of all those to whom the statements were
originally made, and during whose life-time they wTere recorded.

It will be obvious, without remark, that the views here presented
may be applied in every department of investigation or research. To
those already familiar with the subject, it is unnecessary to say that
the writer claims very little on the score of originality : his object has
been to arrange, in a form as condensed as possible, and convenient
for reference, an outline of the subject, for the benefit of those who
may not have time for consulting the voluminous legal treatises upon
evidence, and who may wash to be able to form for themselves opi-
nions which they can defend, as wrell as state and illustrate, in regard
to every subject to which their attention is directed.

Preliminary Examinations of Students in Medicine.

The successful study of the medical profession requires a combina-
tion of mental powers and acquirements, which can only result from
a sound and judicious course of training, commencing in early youth,
and continued throughout the career of the practitioner. No sensible
man believes that his medical education is completed because he has
passed his examination, and is launched into the duties of professional
life ; he feels that he still is, and ever must be, a student, so great is
the field of observation which he is ever compelled to explore, so va-
rious and so complicated are the diseases w7hich he is called upon to
treat, so heterogeneous are the theories and the modes of practice
which he is called upon successively to examine, to adopt, or to reject,
and so numerous and important are the discoveries in every branch of
the healing art which teem in this prolific age of intellectual progress.
But to steer his course advantageously towards the haven of truth,
and to escape the shoals and quicksands which impede and obstruct
his onward career, he must possess a mind richly endowed with phi-
losophical truths, habituated to systematic discipline, ready to wel-
come what is valuable, prepared to abandon what is worthless. To
induce this exalted tone amongst the members of the medical profes-
sion, there is not a more powerful incentive or auxiliary than a com-
prehensive system of preliminary education. The mind which is
once imbued with correct principles of thinking and acting will not
easily abandon the habits of early life, which, on the contrary, will
grow stronger and stronger as age advances :

" duo semel est cuibuta recens servabit odorem
Testa diu."

Impressed with the value and necessity of an efficient preliminary
education in forming the character of the medical practitioner, it has
long been the practice at some of the examining boards to require the

SELECTIONS. 291

candidate to produce evidence of a knowledge of classics and mathe-
matics, not because such an acquisition is absolutely indispensable to
the study of medicine as an art, but because the possession of such
information of these branches of education necessarily involves, on
the part of the student, a certain amount of that information which is
essential to make him a scholar and a gentleman. Our own views
upon this subject are very latitudinarian. We have no deep-rooted
prejudices in favor of Latin and Greek as the only portals to the tem-
ple of knowledge, and should be quite willing to see their places sup-
plied by the modern languages, such as German or French ; but it is
obviously necessary that the majority of the world should agree upon
certain elementary branches of instruction to be employed in the edu-
cation of youth ; and so far as the learned professions are concerned,
the classical languages have hitherto held the primary place. Again,
in the discipline of the mind, the mathematics, which include the sci-
ences of number and of measurement, are unquestionably of immense
importance; but a correct knowledge of logic, or the art of reasoning,
is equally valuable, and might very well be substituted.

There can be no question as to the relative facility with which the
sciences strictly belonging to medicine may be learned and apprecia-
ted by the well-informed as compared with the ill-informed student:
The former readily grasps the facts and reasonings presented to his
notice, arranges them under their proper heads, and stores them up
for future use; the latter finds himself continually in a labyrinth of
perplexity, and is not only unable to follow out any train of reasoning,
but is even ignorant of the meaning of the technical terms which are
employed by his teachers.

But it has been a common error to demand the evidence of an ac-
quaintance with general literature or science at the close of the pe-
riod of medical pupilage, instead of requiring it, as in our opinion
ought to be the case, at the commencement : and hence the student
has too often been compelled to combine the elementary studies of
grammar and syntax with the proper pursuits which belong especially
to his medical curriculum. We conceive that every student should
be required to give evidence of possessing a good general education
before he enters upon his medical studies, and then the system of grinding
Latin grammar into the heads of men who ought to be employed in
the hospital and the dissecting room, would be entirely unnecessary.

The system adopted at the University of London, of requiring that
all students, for whatever profession they may be destined, should
pass the matriculation examination, is one that deserves the highest
commendation; and we should rejoice to see the day when every
medical student would cheerfully present himself at this preliminary
tribunal before entering upon his anatomical and medical courses. If
the College of Surgeons of England were to require at least some pre-
liminary knowledge from those who seek its diploma, they would
neither lower their own dignity nor degrade their members in public
estimation; and if the demand on the part of the College for a smat-
tering of Latin, or German, or mathematics, from those to whom the
lives of the community are to be entrusted, should perchance exclude
some few persons from the membership, the result would not be par-

292 SELECTIONS.

ticulaiiy disadvantageous either to the public or the profession. The
society of apothecaries have for several years required a knowledge
of Latin, at least, from their licentiates ; and we could wish that they
would so far modify their present plans as to allow students to come
up for examination in classics at a very early period of their hospital
studies, or before they have commenced them, by which means a
double good would be effected ; the student would be better able to
comprehend the instructions of his medical teachers, and he would be
enabled to pursue his after studies without being compelled to mingle
them with elementary pursuits, which, however useful and important
to a schoolboy, are out of place in a medical school. The prelimi-
nary knowledge is as important to the medical practitioner as a scaf-
folding is in construction of a house ; but it is just as absurd to teach
medicine first and Latin afterwards, as it would be to try to build a
house first, and afterwards to erect the scaffolding. — Lancet.

Sick Headach cured by full Inspirations. — When a medication is
based upon the experiments made upon himself by an honorable pro-
fessional brother, it is far better, in reporting it, to give his own
words. We will then simply publish the communication of M. Ta-
vignot upon the new therapeutic agent in the cure of this painful, if
not dangerous disease.

" It was in the following manner that I discovered the efficacy of
this new and apparently strange method for the cure of this affection.
In October last I was attacked with pain and weight in the head, ano-
rexia, a physical and moral prostration, &c. Experience taught me
that I had to remain in this state for twenty-four hours. I concluded
that this peculiar state of the nervous centres might depend upon a
stagnation of blood in the venous sinuses of the dura-mater, as M.
Auzias Turenne supposes, or upon an imperfect aeration of this
fluid. I immediately commenced respiring freely and fully during
several minutes. I perceived a sensible relief, which induced me to
continue, and in a short time I was cured. I got up and undertook
my usual occupations, as I felt but a slight pain in my temples, which
vanished in a quarter of an hour. This result was doubly agreeable
to me, as it furnished me with a new and practical remecfy. In ten
persons, upon whom it has been tried, one half have found instanta-
neous relief, and in the others there has been an amelioration, or a
complete failure. However, upon interrogating with care those who
were not relieved, I am convinced that they did not have genuine sick
headach: they had a neuralgic pain of the head, but it was not ac-
companied with that profound prostration and melancholy that I have
mentioned as characteristic of the disease. It seems to me to be use-
less to search for the modus operandi of full and profound inspirations
in the cure of sick headach. It is evident that by this means the
venous circulation is accelerated, and the chemico-physiological act of
hematosis is hastened. Then the explanation of the success of this
new method is in one or the other of these conditions, or perhaps in
both. — South Med. fy Surg. Jour.— from TJ Observation.

SELECTIONS. 293

[From a Letter from the Editor of the Boston Medical and Surgical Journal.]

On Medicine and Surgery in Egypt.

As mentioned in some preceding letters, a variety of medical adven-
turers hover in and about Cairo and Alexandria, because, in some
cases, there seems to be not another place to rest the soles of their feet.
Like Noah's dove, they go abroad from their homes in Europe, in the
strength of hope, the profession being multiplied there beyond the de-
mands of the people. They thus sometimes fly almost to the ends of
the earth — and it will be admitted Egypt is about the terminus ; but,
unlike Noah's dove, if they fail of success, they cannot conveniently
return to the ark from whence they went out. Some of them succeed
admirably, provided they obtain the patronage of the merchants
among their own countrymen here, for they have the wherewithal to
increase the store of a physician. The security which Mahomet Ali
gave to the lives and property of foreign merchants, induced multi-
tudes of them to settle in this granary of the old word. English phy-
sicians are the best paid ; and the Italians, worthless as some of them
are, the next. Arabs, even sheiks, the heads of villages, mechanics,
shopkeepers, and others, possessing means, are miserable paymasters
to the physicians ; still they are always wanting advice and surgical
assistance. "Only cure," is a common remark, " and the best cow
in the herd, my courser," &c, are promised to be forthcoming ; but
they never come. Those who have most reputation in their view —
those who make the blind see, by pricking their eyes, and stop the
growth of scrotal enlargements — a complaint that is quite prevalent —
have no security of payment for their services till a certain sum in
current piastres is laid upon the table. What is thus obtained is all
that ever will be paid them, and consequently the course is quite jus-
tifiable. It strikes me that an accomplished dental surgeon would
find his account in settling at Alexandria. If any dentists are there
now, they can have no extended reputation, or I should have heard of
them. It would be quite impossible to realize such prices, however,
as they obtain in the United States.

Apothecaries seem to have good picking, particularly in Alexandria,
where they have possession of one side of a street. Perhaps, like
spiders in a bottle, they live on each other — for it is not by putting up
prescriptions for Arab customers that they thrive. By combining su-
gar plums, tooth-washes, fancy soaps, and such kinds of showy nick-
nacks as have gradually crept into drug-shops all over Christendom as
well as here, the paras are probably gathered quite rapidly.

French medical works are most in vogue: how much they are
studied, is another matter. As for keeping up with the improvements
and discoveries of the day, no one appears to think of it. Consequently
a copy of any medical journal is a rarity. Possibly one may be taken
by some of the English physicians ; yet 1 have not seen one in any
office in Egypt, to my recollection. Nor does any one appear ambi-
tious to record or publish the results of his observations on the diseases
of the country.

294 SELECTIONS.

A few days before sailing from Boston, in April 1850, a letter was
received from my much-esteemed friend, Dr. Musse}7, of Cincinnati,
urging me to investigate that horrible disease, leprosy, and while at
Athens, ascertain respecting the prevalence of acute rheumatism there
during the last 2500 years — and lastly, to enquire concerning the ex-
istence of intermittent fever, of five days' interval between the parox-
ysms, for the same long period. I have not been unmindful of the re-
quest. When I reach Damascus, the first will be looked after ; and in
Greece, whoever has a twinge must expect to be mulled over pretty
thoroughly, on the doctor's account. Some of the old aches that were
engendered in myself by years of exposure in an open boat during my
connection with the external health department of Boston, give occa-
sional intimation of their whereabouts between the shoulder and the
elbow of the left arm, even in the bland climate of Egypt. This is
the more extraordinary, as during the warm weather in New England
there was a complete exemption from rheumatic troubles. As an in-
dication of the temperature here during the whole of January, it may
be mentioned that the musquitoes are so pestiferously annoying, that
the bed must be secured by a muslin net, or the sleeper would find
himself sucked as dry in the morning as one of the baked monks of
St. Bernard.

I cannot deny myself the pleasure of adverting to Dr. Mussey's
widely-promulgated anathemas against the use of tobacco — the ha-
bitual use of which is as much objected to by myself as by that staunch
apostle of temperance in eating, drinking and smoking. But with all his
zeal, his philanthropy, his bold arguments and cogent reasoning on this
subject, in Egypt he would find stumbling-blocks in the way of his con-
clusions, that would be worse to manage than a hogshead of the best
Kentucky in the market. Men, from childhood, smoke incessantly in
Egypt. They smoke everywhere and under all circumstances. There
is no cessation — not an hour when a cloud of curling smoke is not as-
cending. It is the first and prominent civility to hand a pipe — and
smoke you must, or suffer under the imputation of being no gentleman ;
and were that good man of Cincinnati sitting where this sentence is
written, he would himself smoke, like every one else here. People live
long enough, in all conscience, notwithstanding this everlasting smok-
ing ; for they outlive their usefulness — outlive everything but animal
wants — live, some of them, till everybody wishes they were dead ! I
have not been an inattentive observer of the smoking mania in Ger-
many, and other parts of continental Europe ; on the contrary, a strict
inquiry into the moral and constitutional effects of the habit, very ju-
diciously called a vice, was instituted as I travelled from kingdom to
kingdom where it prevailed ; and I have arrived at the gratifying con-
clusion that if persons wish to smoke, they maj'", and I shall not waste
my breath in warring against the habit.

Another kind of smoking is practised in Egypt, and probably in
Syria, unknown to us in America, viz., that of Indian hemp. Cigars
are charged with it, and there are apartments where individuals may
go and draw in, through a long pipe-stem, a kind of smoke that exalts
a dirty, barefooted rascal into an imaginary prince. In a few minutes

SELECTIONS. 295

he sees the gates of a Mahomedan paradise, gazes wildly towards the
sky, and laughs till all consciousness passes. away, and he falls into a
lethargy of considerable duration. I suspect it is hemp, and not opium
as generally supposed, with which cigars are drugged, and made the
instruments in the hands of designing men, in London and other great
cities on the Continent, for the perpetration of many dreadful crimes.

I have collected many curious and novel facts, illustrative of the die-
tetic regimen and social habits of Arabs, Jews, Nubians, Abyssinians
(slaves and freemen) with whom I have had as much acquaintance as
is desirable, in their own countries : but how or when they are to be
used, is uncertain. A knowledge of them would sadly unhinge some
excellent theories of our regenerators of society. Were they to
attempt the introduction of some of their hobbies into these countries,
they would be laughed at as fools ; and after the blush of mortifica-
tion at the absurdity of their moonshine propositions had subsided,
they would laugh themselves at their own stupidity and narrow-minded
conceptions of the elements of humanity.

On the way to Beyroot, Feb. 4, 1851.

Payment for Medical Services.

The following extract should convince all men who attempt to
meet competition by low charges, how utterly futile such a method
proves :

Remuneration of Medical Attendants in France.

M. Amedee Latour, editor of U Union Medicate, has lately pub-
lished a very instructive article on the above subject. From this con-
tribution we find that the majority of medical men, especially in the
country, are lamentably paid, the principal cause of this sad state of
things being the unfortunate practice of underselling one another.
There are surgeons in the country who will pay a visit for five pence,
and even two pence half-penny ; attend a midwifery case for twenty
pence or half-a-crown ; set a limb for ten pence, &c. &c. In Paris
the evil is likewise very great, it being well known that some unscru-
pulous characters offer their services underhand at a lower rate than
the usual attendant has fixed, that rate being indeed low enough, as
it ranges from twenty pence to half-a-crown a visit, even in Paris.
At Toulouse a club was formed some time ago, composed of a thou-
sand individuals, who offered a surgeon one thousand francs (<£40) a
year to attend all the members. He, being a beginner, accepted
these miserable terms; seeing which, a professional brother went
and offered his services for half the sum. But the latter was soon
outwitted, as a third sprang up and offered to do the work for .£10 a
year! M. Latour throws out the idea that a minimum should be
fixed and agreed upon in each locality ; but we fear that he did not
consider human frailty sufficiently when he thought of that expe-
dient.— [Lancet.

296 SELECTIONS.

We are of opinion that whatever price a practitioner sets on his
services, to that price he should invariably adhere. The physician or
surgeon who requires a sovereign as a fee may perhaps venture to ac-
cept a half sovereign from persons of limited means ; na}r, in some
cases, he should do so ; but the practitioner who values his services
at five shillings or half-a-crown should never accept a farthing less
than his customary charge. Far better to treat parsimonious persons
as paupers than allow them to go forth boasting of their success in
pursuit of cheap doctoring. Such people can be easily taught that
they must conform to a rule of trade, they being generally them-
selves traders, and if they cannot be taught, the sooner they are got
rid of the better. — [Dub. Med. Press.

Dr. Robert Lee and Dr. Simpson.

To the Editor of the Lancet.

Sir — At a late meeting of the London Medico-Chirurgical Society,
it was stated to the society by Dr. Lee, that at the dissection of a
case in which ovariotomy had been performed by Mr. Lizars, some
twenty-five years before, I considered the tumor ovarian, until the two
ovaries were shewn me at the dissection. The following letter to Dr.
Lee will shew how very far he was from stating what was true, when
he made such a statement :

Edinburgh, 52 Queen street, Feb. 3, 1851.

Dear Sir — At the last or one of the last meetings of the Medico-
Chirurgical Society, you adduced a private letter sent to you b}r Mr.
John Lizars of Edinburgh, stating in relation to one of his published
cases of ovariotomy, that " Dr. Simpson, on inspecting it, pronounced
it to be ovarian, but in looking to the ovaria, they were both found
healthy."

Mr. Lizars was not present at the dissection ; and the statement
which you thus gave to the Medico-Chirurgical Society was altogether
incorrect.

Dr. Myrtle had charge of the patient and of the dissection; and I
enclose to you a letter from that gentleman, stating that I was the first
to point out at the dissection that the two ovaries were unaffected.
The tumor was, as you are aware, a fibrous tumor, arising from the
fundus of the uterus.

Let me merely add, that I have long given up the idea that ovarian
tumors (such as this was supposed to be a quarter of a century ago,
when Mr. Lizars operated) ever remain stationary for any long term
of years. Fibrous tumors, however, of the uterus, often enough re-
main latent, and without increase for a great length of time. And this
simple distinction led me, a priori, to doubt whether the tumor m
question could possibly be ovarian.

I write this, in order that you may, at the next meeting of the Me-
dico-Chirurgical Society, set the society right on a point which you

SELECTIONS. 297

thus thought fit to lay before them. I scarcely could have fancied it
worthy of being mentioned to such a society, whether I was right or
not right at the dissection and diagnosis of a case. But as you con-
sidered it worthy of the observation of the society that I was in error
in regard to the case, you will, I doubt not, now equally consider it
worthy of their observation, that it was you who were inadvertently in
error in making the statement.

Yours, &c.
To Dr. Lee.

J. Y. SIMPSON.

Dr. Lee having refused to correct in any way the mis-statement
which he made, I hope the fellows of the Medico-Chirurgical Society
will pardon me taking the present as the readiest means of correcting
the erroneous statement publicly made to them by one of their own
body.

Again, at the last meeting of the Medico-Chirurgical society, (as
reported in your journal,) it would appear that Dr. Lee thought fit to
misrepresent to the society another case in which I was concerned,
and published an account of. Dr. Lee stated to the society, that in a
case of mollities ossium, I intended to perform the Caesarian section,
" when the sacrum was straight above, so that its promontory did not
probably encroach upon the brim ;" hence attempting to lead the fel-
lows to the untrue inference that the pelvis was not contracted to such
an extreme degree as to require such an operation. But he delibe-
rately suppresses the two facts ; first, that the outlet was so greatly
contracted, that it was under an inch in its transverse diameter, and
about two inches in its conjugate ; and secondly, that the dead and
putrid child was so diffluent and decomposed, that it was passed
readily after its birth, through an artificial aperture one-eighth of an
inch in width, and two and three-eighths of an inch in length.

Perhaps most of your readers may think it unnecessary to point out
these two instances of misrepresentation on Dr. Lee's part ; the one
consisting in a suggestio falsi, which he refuses to recal, and the other
presenting an equally marked instance of the swpprcssio vert. But I
trust they will excuse my alluding to them in your pages, as 1 have
no other way of refuting publicly the ridiculous and disengenuous
charges which they contain. They afford, also, I fear, only two com-
mon instances of the type of misrepresentation in which Dr. Lee in-
discreetly indulges himself in those painful fits of furor obsfetricans
against all his professional brethren, under which he, from time to
time, so unhappily suffers. Is it right for the Medico-Chirurgical so-
ciety to abet these morbid attacks in Dr. Lee? Is it kind to Dr. Lee
himself to encourage him in their open and public manifestation?

Yours, &c,

J. Y. SIMPSON.

Edinburgh, Feb. 1851.

298 SELECTIONS.

Sale of the Chemical Apparatus belonging to the late Prof. Webster. —
The various appliances of the late Prof. Webster's laboratory were
sold at auction last week, by Mr. Leonard, Tremont Row. The most
notable article in the collection was a Magnet once owned by the dis-
tinguished French chemist, Lavoisier, who, it is well known, was be-
headed during the great French Revolution. After various fortunes
it came into the possession of Prof. Webster, by whom it was highly
prized. It seems to have been owned by men who have met with a
most unfortunate end. It was purchased by Mr. Francis Alger of
South Boston, for the trifling sum of $ 5 25. Its rare history gives it
a value entirely beyond any intrinsic virtue. At the auction of Prof.
Webster's library, previous to the above, his name was erased from
all the books except one, and which book is now in the possession of a
well known literary gentleman of this city, who has one of the largest
collections of autographs of any person in the country. This book
contains the professor's signature, written in a bold and dashing man-
ner. It escaped the detection of the family, by one of the leaves ad-
hering to the cover. — Boston Meol. and Surg. Jour.

Enlargement of the Aponeurotic Orifice of the internal Saphena Vein
in cases of Varicosed Veins of the Legs. — We condense from the Bul-
letin Gen. de Therap. the following particulars in relation to this ope-
ration, which was performed a few years ago by M. Herapath, of
Bristol, but a full report of which was not made. M. Malgaigne has
recently performed the same operation, and reports the case as fol-
lows :

J. D., aged 26, was admitted into the hospital in July 1850. The
internal saphena vein of the left side was varicosed, and a varicocele
also existed upon the same side. Both these affections commenced
at the age of seventeen, and had increased to such an extent as to
prevent the patient from pursuing his occupation. The internal sa-
phena was varicosed from the internal malleolus to the point at which
this vein passes through the aponeurotic orifice into the femoral vein.
There were several tumors along the course of the vein, formed by its
tortuosities.

The varicocele was quite large, the testicle a little atrophied, and
in the engorged epididymis was a tumor the size of a small nut. The
operation was performed on the 21st of July. The patient being
placed upon his back, the leg flexed and turned a little outwards, an
incision was made over the saphena orifice and parallel with the
course of the vein. The parts were carefully dissected until the
fibrous band of the orifice could be distinctly felt. A grooved director
was passed beneath the fibrous band of the ring, and an incision
made upwards through the band. Considerable inflammation and a
rupture of the vein ensued. The wound, however, was cicatrized the
twentieth day. The patient left the hospital seven weeks after the
operation, very much relieved, though not entirely cured. The tu-
mors along the course of the vein had very much diminished and the
varicocele entirely disappeared. — Southern Med. and Surg. Journal.

SELECTIONS. 299

Of the Retained Testicle Extruded by Accident.

BY DR. J. M. ARMSTRONG, BERLIN, OHIO.

In the autumn of 1S42, I was called to see a gentleman who, the
messenger informed me, was laboring under hernia. When I ar-
rived, I found what I supposed to be, a case of inguinal hernia ; but
upon further examination, I discovered that it was of a peculiar form
and density. When upon still further examination, I discovered that
one of his testicles had been retained from infancy, and that the sup-
posed hernia was this testicle, which had passed through the inguinal
ring. Upon a more particular investigation, and by comparing the
supposed hernial tumor with the testicle in the scrotum, I found that
they were exactly similar, and came to the conclusion, that the sup-
posed hernia was in fact the retained testicle, that had been forced
out of its abnornal resting place, by the effort the patient had made
in attempting to raise a beef that he had slaughtered. I replaced it,
or reduced it with little difficulty, after which, upon the introduction
of my index finger, into the ring, which was large, I could feel the
testicle pressing against the internal ring.

This case, to me, was rather singular, never having read or heard
of a case of the kind. Therefore I kept my eye on the patient for
some time, and learned from him lately, that it never had escaped since,
nor had an}Tthing like hernia appeared. But he stated to me, that
whenever he attempts to lift heavy loads, he can feel the nut, as he
calls it, pressed against the ring.

Now, had this been a case of simple hernia, it would most proba-
bly have returned again, for his occupation being that of a butcher,
and being called upon to lift frequently, and the ring being large, her-
nia would undoubtedly have taken place. The retained testicle ap-
pears to act as a plug, in or against the ring, and prevents the escape
of any of the abdominal contents. — Ohio Med. and Surg. Jour.

Coroners.

As the jurisdiction of these officers is almost entirely in matters
strictly medical, it seems desirable that they should be physicians.
There is but one case in which the coroner is called upon to perform
duties of any other nature, and medical men are as competent as
others to the performance of this. We do not, then, see why it is not
wiser to appoint to these sometimes responsible posts men who, from
their professional knowledge, are qualified to select the fittest men to
make the necessary examinations of the body ; to direct properly a
medico-legal investigation ; and to instruct the jury upon the compara-
tive importance and bearing of different medical facts. As it is, these
officers must either depend upon some entirely irresponsible friend at
their elbow, or be at the mercy of any witness whose ignorance or in-
terest should lead him away from the truth. At present, none of

300 SELECTIONS.

these officers in our state are from the medical ranks. We would
suggest that if they should be made elective by the people, the physi-
cians of different districts should present the fittest man among them
as their candidate. Still farther, we believe it is time that the profes-
sion asserted their right to certain positions. When commissions are
appointed for the examination of medical matters, whether it be as to
the treatment of the insane, the sanitary condition of paupers or prison-
ers, or the healthfulness of localities, physicians have a claim upon
the appointing power, which courtesy, if nothing else, demands should
be considered, and which, in justice to themselves, they are bound to
urge. It is from neglect of this duty to themselves that they are so
often compelled to take a second place, when in justice the first be-
longs to them. — New Hump. Journal of Med.

ITEMS.

McFadden, the Philadelphia druggist, convicted of manslaughter in
causing the death of a young woman by dispensing morphine through
mistake, has been sentenced to three months' imprisonment in the
penitentiary. There have been several cases of this sort reported in
the journals of late, and they will continue until the laws are amended
on this subject. The managers of the Savannah hospital have pre-
sented a splendid piece of plate to Dr. Rd. D. Arnold, in testimony of

their appreciation of his labors during a period of 15 years. The

celebrated obstetrician, Francis C. Naegele, lately died at Heidelberg,

in the 72d year of his age. A cotemporary says that another pair

of Siamese ? twins has been born in Pennsylvania ! ! The statistics

of the American medical schools published thus far, shew, for the
past sessions, 3800 students, and they have graduated 1280 new
doctors ! We learn that a medical journal is about to be esta-
blished in Washington city, D. C. Dr. Andrew Smith has been ap-
pointed to succeed Sir James McGrigor, as the head of the medical

department of the British army. The concours for the chair of

surgery of the faculty of medicine of Paris was still going on, by the
last accounts. It is said M. Robert or Professor Buisson of Montpe-

lier, will get it. The head surgeon of a French lunatic asylum has

been condemned to 15 days' imprisonment for "causing the death of
a patient by laudanum in a lavement." He was condemned upon
the evidence of two veterinary surgeons, which was counter to the evi-
dence of five of the most celebrated physicians ! ! The celebrated

Boston surgeon, Dr. Warren, has been sojourning for several days in
Richmond, on his way to the American medical association at
Charleston. It is to be regretted that the Doctor's health is feeble,
though he still retains that vigor of intellect which has rendered him
pre-eminent in his profession.

THE

AND

VIRGINIA MEDICAL GAZETTE.

No. 6.]

RICHMOND, JUNE 1851.

[Vol. I.

Remarks on Scarlet Fever.

BY M. H. HOUSTON, M. D., OF WHEELING, VA.
[Read before the Ohio County Medical Society.]

The number of deaths caused by scarlet fever every season in
most parts of the world, indicates it as a disease occupying the very
front rank, in point of practical importance. In the United States it
figures so largely in the annual bills of mortality, that if an aggregate
estimate of all the deaths it causes, within a period of twenty years,
were made and compared with the mortality caused by the epidemic
which now makes the world to quake with fear, the latter disease
would become, if not insignificant, at least of secondary importance.
Whilst epidemic cholera, in its warfare upon the human family, car-
ries off its thousands at a single charge, maintained only for a short
time, scarlet fever consigns to the tomb its tens of thousands by an
untiring and perpetual siege. The one does its work quickly, and
sinks exhausted by the effort, whilst the other works more slowly, and
acknowledging no respite, is almost an entire stranger to fatigue. A
disease which commits such frightful ravages can scarcely claim too
much of our attention.

The great mortality of scarlatina results from two prominent causes,
and whether the greater portion of it be due to the one or to the other,
it would be very difficult if not impossible to determine. The one
is, the necessary and inevitable fatality which results from the viru-
lence of the disease, as it occurs in some individuals under certain
circumstances — the other, the result of unsettled and empirical modes
of practice, arising from the want of a proper understanding of its
true pathology. To remedy the first may be considered an impossi-
bility, whilst to correct the latter may fairly be considered within the
range of professional observation and research.

The object of the following remarks will be to establish some pa-
thological facts of a general nature, which may serve as a foundation
on which to, build a more uniform and rational system of practice.
That no general principles have been laid down and established
sufficient to guide us in the treatment of the disease under the various
33

302 HOUSTON ON SCARLET FEVER.

modifications which it presents, must be evident to any one who will
examine the productions of all those who have written on the subject.
As far as my reading has extended, the systematic winters on scarlet
fever have indulged in a few vague and general remarks on the dif-
ferent varieties of the disease, together with some directions, equally
vague and unsatisfactory, as to the treatment proper for these varie-
ties, whilst those who have made it the subject of special attention
through the pages of our periodical literature, have, without any excep-
tion, had in view the enforcement of some specific modes of treat-
ment, which in their own hands, have proved more than ordinarily
successful. In no one of them is there to be found any prominent
pathological consideration, or any broad general principle which may
serve as a beacon to guide us in adapting our remedial means to all
the different phases of the disease. Without some such controlling
principle of practice it is impossible for us to treat such a disease as
scarlet fever with the greatest possible success ; whilst with it, we
may at least save ourselves from the imputation of having treated a
disease more for its name than for any substantial indications which
it presents.

Scarlet fever is the result of a specific poison. Is this a proposi-
tion which admits of any doubt ? To my mind it is clearly proved
by the fact, that when an individual susceptible to its action is ex-
posed to the influence of the poison, he has produced within him a
train of morbid action, resulting in the development of certain ap-
pearances to be found in no other disease, and without which it can-
not be pronounced scarlatina. In other words, the development of
the poison in the system produces an eruption on different parts of
the body, presenting certain uniform, essential characteristics, and
without such evidence of the existence of a specific poison as is fur-
nished by this peculiar eruption, scarlet fever cannot be pronounced to
exist. It may be said, however, that we have cases of scarlatina
without any eruption on the skin, and that, too, in its very worst
form. This is true; but in all such cases, the eruption will be found
on the mucous membranes generally, and its non-appearance on the
skin is owing to causes to which more particular allusion will be
made hereafter. In no case do we fail to detect some appearances of
the peculiar eruption on certain portions of the mucous membranes.
Added to this, is the evidence furnished by our olfactories. The
odour of the poison of scarlet fever is just as distinct, and in many
instances quite as strong as that of the smallpox poison.

It is no evidence against the existence of this specific poison to say
that we know nothing of its essential properties. The same may be
said with equal truth of all other animal poisons, and indeed, of all
matter whatever, and yet, like other varieties of matter, we may
know it by its properties ; and to the observation and investigation
of these properties, our attention may be very profitably directed.

The first ascertained property of the poison of scarlatina to be
noticed is, that however introduced into the living system, it repro-
duces itself whenever there exists that condition of the circulating
fluids which favors its reproduction. In this respect, it is analogous

HOUSTON ON SCARLET FEVER. 303

to the poison of smallpox, syphilis and other animal poisons, whose
reproduction is brought about by inoculation. This is proved by the
fact, that when an individual enjoying the susceptibility to scarlet
fever is exposed to its contagion, a longer or shorter period elapses
before its development is made manifest. This is the period of in-
cubation of the poison. That such a period does exist, must be
evident to any one who has observed the order of succession in which
the disease occurs in large families of children. A single one is gene-
rally seized in the first instance, and the symptoms do not display
themselves in the remainder until six or eight days have elapsed,
when they all fall sick about the same time. It does sometimes hap-
pen that only a portion are taken sick at the end of the period men-
tioned, whilst the attack is postponed in others until the end of another
eight or ten days. This can be accounted for only on the supposition
that the last of the family contracted the contagion, not from the first,
but from those secondarily affected. The same thing sometimes hap-
pen in smallpox. It does not militate against this view of the repro-
ductive property of the scarlet fever poison, to admit that the disease
does not always have its origin from direct contact with those affected.
The poison does certainly exist in the atmosphere, in such quantities,
at certain periods, as to impart an epidemic character to the disease.
But does this prove that it does not possess the power of reproduction
when introduced into the living system? Certainly not ; for if it did, it
wrould equally prove the non-reproductive properties of the smallpox
poison — a property which no one seems to doubt its possessing. A poi-
son purely atmospheric in its origin may possess this property of re-
production as certainly as one purely animal.

The time during which this reproduction of the poison takes place
in the human system, and the extent to which it is carried, are influ-
enced by a variety of circumstances and conditions, all of which have
their effect in modifying the symptoms and in increasing or diminish-
ing the violence of the disease. It is modified by the quantity of the
poison at first introduced into the system. With like conditions of the
circulating fluids and other corresponding circumstances, the greater
the amount of poison introduced, the more rapid will be the comple-
tion of the reproductive process. We hence find that, other things
being equal, those are most violently affected who contract the disease
from breathing an atmosphere in which the poison has been accumu-
lated and concentrated by numbers of the sick being crowded to-
gether in ill-ventilated apartments. At least, such is the result of my
own observation. Unless very special attention be paid to cleanliness
and ventilation, the last cases occurring in large families are usually
the worst.

The condition of the blood itself exercises a modifying control
over the reproductive process, supposing equal quantities of the poi-
son to be introduced into systems unequally predisposed. It is well
known that some persons manifest no susceptibility to the disease,
however much they may be exposed to its contagion. This, however,
is the exception to a general rule ; for it is equally well known, that a
very large majority of all the human family are born with a suscepti-

304 HOUSTON ON SCARLET FEVER.

bility to this disease, which susceptibility, once developed, is rarely
reproduced. Some individuals, subjected to the same general influ-
ences, and exposed to the same sources of contagion, under the same
circumstances, will have the disease severely, others more mildly,
whilst a very few will not suffer at all. This can only be explained
upon the supposition that we are born with, or acquire during the
early period of lactation, some peculiar principle of the blood, upon
which this special poison is dependent for its reproduction. What
this peculiar principle may be, it remains for future investigation to
determine. It is sufficient for the present to know that it must exist —
that in the reproduction of this poison it is destroyed — that it is very
rarely regenerated, and that when so regenerated, it renews the sus-
ceptibility to the disease.

The extent to which the reproduction of the scarlet fever poison
will be carried in any individual, must of necessity be mainly de-
pendent on the amount of this principle which exists in the blood at
the time of exposure to the contagion. This principle is the pabu-
lum upon which the poison feeds. The destruction or consumption
of this pabulum furnishes the limit to the quantum of the poison, and
as a general rule the limit is always reached.

The time occupied in the consumption of this pabulum varies un-
der varying circumstances of temperature and individual constitution.
We find the period during which scarlet fever develops itself vary-
ing at different seasons of the year. During the spring months, the
poison reproduces itself rapidly, and the disease runs its course more
speedily than during the steady, cold weather of winter. Whether
this be owing to the effect which an increase or decrease of tempera-
ture has upon the reproductive process itself, or whether it be owing
to the different conditions of the system found to prevail during these
seasons, or whether to both of these causes combined, it is not our
purpose to enquire. We know that the same disease assumes differ-
ent types in the same individual, when occurring at different sea-
sons of the year, and scarlet fever furnishes no exception to the gene-
ral rule. Activity characterises the diseases of spring, whilst sloth is
equally characteristic of those of dead winter, and we moderate the
activity of the one by diminishing the heat, whilst we increase it in
the other by an increase of warmth. The effect which difference of
temperature has in modifying the disease, and the practical indica-
tions furnished by these modifications, will be alluded to more particu-
larly hereafter.

From what has been said, it will readily be inferred that the ten-
dency to a fatal result in scarlet fever may arise from several distinct
circumstances, although the primary and efficient cause be always
the same. The quantity of the poison at first introduced into the
system may be large, and the condition for its propagation so bounti-
fully supplied in the blood, that such an amount of poison will be
generated as will necessarily prove destructive to life, under any cir-
cumstances. These are the cases, fortunately of not very frequent
occurrence, in which the patient dies as though he had been knocked
on the head with a hammer. No remedies have any effect in arrest-

HOUSTON On SCARLET FEVER. 305

ing the fatal result. Death is the necessary and inevitable conse-
quence of a cause which we can neither avert or counteract.

But death may result, even although the amount of poison in the
system does not necessarily constitute a fatal dose — it may destroy
life by the mere rapidity with which it is reproduced. We all know
how the system will gradually accommodate itself to the action of
morbid impressions of any kind, until it will at last bear, with com-
parative impunity a dose, which, if given at first, would have speedily
proved destructive. A confirmed drunkard will swallow as much alco-
hol at a single draught, with the effect only of rendering him comfort-
able, as would kill outright one of the sons of temperance. So with the
poison of scarlatina. It may be reproduced so rapidly that the vital
organs cannot accommodate themselves to its action, and death will
result from the suddenness of the blow.

Again, death may result from the slow and long protracted repro-
duction of the poison, by which the vital organs are exposed to its
continuous action so long, that their natural sensibility is exhausted
and their functions hopelessly perverted. If the wine-bibber con-
tinues his potations, he as certainly dies in the end as though he had
taken a fatal dose of the poison in the beginning, and the same is true
with regard to the action of the animal poisons.

Death may also result from an unequal distribution of the poison,
even when the whole amount in the system is not sufficient necessa-
rily to produce such a result. An undue proportion being determined
to the brain, for example, whilst other organs are in alike proportion
relieved, will as certainly cause death, unless such determination be
removed, as though all of the organs were oppressed with a fatal
dose of the poison. The same remark will equally apply to all the
other vital organs.

In the last place, death may result from causes which interfere with
those processes instituted by nature to throw off the effete poison
after its reproduction has been completed and its active properties
destroyed. These constitute the so called sequelae of the disease.
Their true pathology, and the general principles which should guide
us in their treatment, demand a separate and more extended con-
sideration than the limits of this paper will admit.

Bearing in mind the foregoing general propositions, which we con-
ceive the phenomena of the disease warrant us in affirming, we have
a clue to its varieties, as recognized by authors, and to the few broad
principles which should govern us in its treatment. When the quan-
tity of the poison introduced into the system is small, the pabulum
for its reproduction in the blood limited, and the poison when repro-
duced equally distributed through the system, we have presented to
us the most simple variety of scarlet fever. When the quantity of
the poison originally introduced is large, the pabulum for its repro-
duction very abundant, and circumstances of all kinds existing to
favor the reproduction,- we have presented to us the most malignant
species of the disease — one of those cases in which the patient goes
down to the grave suddenly and surely, in spite of the best directed
efforts of the most skilful physician. When the poison is not repro-

306 HOUSTON ON SCARLET FEVER.

duced to an excessive degree, but is unequally distributed, we have
the several other varieties, as the anginose, the congestive, &c. Now
it must be evident, that between the two extremes, we may have every
variety of grade, and that the simple may be converted, by various
circumstances, into the more malignant and fatal varieties, whilst
some, that in the beginning have a fatal tendency, may, by judicious
management, be converted into the milder forms. Thus, the amount
of poison which in one individual, under the same circumstances,
will, when equally distributed through the system, be productive of
no very serious inconvenience, may, in another, when the larger por-
tion of it is determined to a vital organ, prove very speedily fatal.
These local determinations may be caused by constitutional pre-
disposition, by varieties of temperature and different seasons of the
year; or lastly, by the use of medicines injudiciously administered.
In one individual, undue predominance of cerebral development will
give rise to the comatose variety ; in another the scrofulous diathesis
will lead to obstinate glandular enlargements, whilst special local af-
fections of various kinds will result from special local predispositions.
In the spring of the year, anginose affections are apt to prevail, and
then we have an excess of the poison about the throat, giving rise to
anginose variety. In the winter, when other diseases assume a low
form, we find the reproductive process carried on slowly, giving rise
to the typhoid variety, in the manner before explained, and so on of all
the other varieties. The local determinations caused by the use, or
rather by the abuse of medicines, will vary, as a matter of course,
according to the medicine used. They constitute a very large por-
tion of that numerous class of cases which prove fatal in spite of the
most powerful medicines the doctor could prescribe.

From the foregoing considerations we may deduce the following,
as leading objects to be kept in view in the treatment of scarlet
fever.

First. To regulate, as far as may be practicable and desirable,
the time during which the reproduction of the poison is carried on.

Second. To secure by all the means at our command, the distribu-
tion of the poison among the different organs in proportion to their
ability to sustain themselves under its action, and

Third. To promote the rapid and complete elimination of the poi-
son from the system, after the process of reproduction is complete
and the activity of the poison expended.

Any theory of disease, in order to be true, must be sufficient to ac-
count for all the phenomena which present themselves under every
variety of circumstances. It has been stated before, that different
writers on scarlet fever have extolled different and very opposite
modes of treatment, and they all adduce cases to prove the success
of their practice. The history of these cases cannot for a moment
be doubted, nor is it necessary for the support of our views that they
should be proved to be untrue, since they are all satisfactorily ac-
counted for on the general principles already laid down. The error
consists in recommending an exclusive plan of treatment for scarlet
fever in general, which is alone applicable to distinct, and perhaps

HOUSTON ON SCARLET FEVER. 307

very rare modifications of the disease. We find one writer recom-
mending the application of cold, ice water as a specific, another the
use of an increased amount of heat; one advises blood-letting, whilst
another uses stimulants — one says, give large doses of calomel, with
active cathartics, whilst another recommends the avoidance of mer-
curials, and the cautious use of the most gentle laxatives — and they
all adduce numerous examples of the success of their treatment.
Now, it is unreasonable to suppose that any one of these exclusive
methods of treatment would prove successful in those cases in which
a directly opposite mode of treatment has been attended with fortu-
nate results. We accordingly find, that when the remedies advised
and extolled by one practitioner have been used by others under dif-
ferent circumstances, the results have proved so destructive as to
lead to their speedy abandonment. How, then, are we to account
for the different results of treatment, in the same disease, upon the
general principles of pathology already laid down? Are they suf-
ficient to explain all these varying phenomena ? We most unhesita-
ingly answer in the affirmative.

Take, for example, those cases in which the free application of cold
to the head and surface generally, was attended with the most salu-
tary effects, and we constantly find the symptoms to have been all
such as indicated an unusually rapid reproduction of the poison, with
or without local determination to the head. Within a few hours after
the first onset of disease, there were high fever, burning hot skin, and
a sudden and copious eruption over the whole surface. These are
the very circumstances, which, according to the general principles al-
ready explained, would indicate the propriety and necessity of a re-
duction of temperature. The poison has generated loo rapidly, and
the very suddenness of the impression was such as to cause death,
unless something had been done to moderate and prolong it. The
vital organs, taken by surprise, would have yielded to an impression,
which, with the advantage of a timely warning, they proved them-
selves able to withstand. In this respect, the reproduction of the
poison may be aptly compared to the ordinary process of fermenta-
tion. The poison is the. leaven, the blood the pabulum, and the dif-
ferent organs of the body the vessels which contain it. If you stir
the materials together and place them in a warm situation, the pro-
cess of fermentation or reproduction will prove so rapid as to break
the vessels, unless free exit be given to the product. If the leaven,
however, be not mixed with every part of the pabulum, and if the
whole be placed in a cool situation, the process will take place slowly
and without endangering the destruction of the containing vessels.
In an analogous manner cold acts in retarding the reproduction of the
poison of scarlatina, and it matters not, as far as the general princi-
ple is concerned, whether it act by its depressing effects upon the
nervous system, or whether upon the ordinary philosophical principle
of a reduction of temperature. In all of the cases which I have ex-
amined, the effect of the cold has been to protract the period dur-
ing which the eruption made its appearance.

The same illustration will apply to those cases in which warmth

308 HOUSTON ON SCARLET FEVER.

has been found to benefit the patient, and in which too slow a repro-
duction of the poison has tended to subject the organism to an impres-
sion of the poison too long to prove consistent with a resumption of
healthy function.

The next general principle is one which applies with equal force
to every variety of the disease. It is to secure as far as possible a
distribution of the poison among the different organs of the body, just
in proportion to their ability to sustain themselves without fatal injury,
under morbid impressions of all kinds. This is the one grand princi-
ple, an observance of which can alone lead to the most successful
treatment of the whole family of eruptive diseases. Were we able
in any given case to determine beforehand, that an amount of poison
would be generated, which, when thus distributed, would be sufficient
to cause death, we might, with a clear conscience, resign our patient
to his fate, without inflicting on him the additional discomfort of nau-
seous medication. As it is impossible, however, to determine, a priori,
what amount of poison will be generated in any particular case, it
becomes our duty to watch closely the development of the disease,
and when we find fatal oppression of the vital organs impending, to
use such means as are calculated to solicit from the more delicate, and
determine to the less important organs. This can only be done by
soothing the one at the same time that we irritate the other. We
cannot cut short or cure the disease — all we can hope to do is, to
conduct it to a safe termination ; and to administer medicine of any
kind without some special, definite object in view, having reference to
the general principle above laid down, would be as rash as to throw
a firebrand into a magazine of gunpowder. We should play the
owl and watch, but never strike until compelled by necessity.

It has been said before, that the varieties of scarlet fever are due
to certain local determinations of the poison. Although the general
principle which guides us be still the same, yet the treatment of these
varieties must be modified according to the particular determination.
The same general principle will in fact lead to directly opposite and
apparently inconsistent modes of treatment. The judicious practi-
tioner must feel compelled to blow hot and cold upon disease bearing
the same name whenever he finds it clothed in garments of unequal
warmth.

It may be said by the advocates of mere matter of fact narration,
that all this is hypothesis, and therefore worthless. That it is, to a
certain extent, hypothetical, I am free to admit, and yet if it leads to
sound practical results, a quietus should be put to all such objections.
The principles of our science are not subjects of mathematical de-
monstration. To discard hypothesis entirely, would be to put an end
to all reasoning upon medical subjects. When an hypothesis is as-
sumed, and facts are presented to its support, harm must unquestion-
ably be done, but when it is deduced from the facts, and proves suffi-
cient to account for them all, and when it forms the basis of correct
and determinate modes of treatment, it certainly can make but little
difference whether it be true or false. Its adoption, under such cir-
cumstances, can do no harm, and may do a great deal of good.

HOUSTON ON SCARLET FEVER. 309

It might, perhaps, be sufficient for me to enumerate these general
principles of treatment, and leave it to each individual to select his
own means to fulfil particular indications ; but as there are some spe-
cial points of practice to which I desire to direct particular attention,
I shall apply them as concisely as possible to some of the varieties
of the disease usually recognised by systematic writers.

And first, of the mild or simple form of scarlet fever. In this variety
of the disease, the poison generated is not excessive in quantity, and
it is fairly distributed among the different organs. The best authors
concur in saying, that the proper treatment consists in letting the dis-
ease take its own course, without any, or if any, with very little medi-
cation. They neglect, however, to impress upon the mind of the
reader the important fact, that active medication of any kind will
prove decidedly injurious, and that by improper interference, the
mild may be converted into a very troublesome, not to say malignant
and fatal form of the disease. This becomes the more necessary,
since many persons are apt to think that the same remedies which
cure a violent form of disease, will, a fortiori, and with much greater
certainty, cure a milder form. They forget, or entirely lose sight of
the principle, that in this disease medicines act by relieving one local
determination at the expense of producing another, and that in the
use of active agents of any kind, it always becomes a mere choice be-
tween two evils. Hence, in any given case, when no local determi-
nations exist, active remedies produce them, and thus convert a
simple and mild form of disease into one complicated and malig-
nant. It is to the importance of avoiding all rash interference in cases
of this kind that I wish to direct particular attention. It may be
thought by some, that under such circumstances, no sane man would
ever dream of adopting any active treatment ; but in this they are
mistaken. The very name of scarlet fever strikes terror into the
minds of patient as well as practitioner, and it requires some expe-
rience, as well as some firmness of purpose, to stand with folded arms,
in the presence of a disease known to be attended with such danger,
and that, too, when all around are disposed to think that so powerful
an enemy can only be successfully combatted by very powerful wea-
pons.

The truth of this remark, as well as the evils resulting from such
rash interference, will be best illustrated by referring to a few cases,
selected from persons not treated by any member of this association.
A girl aged twelve or thirteen years, of good constitution and robust
general health, was taken with the ordinary symptoms of scarlet fe-
ver some time in the spring of 1836. On the second or third day of
the fever, the eruption began to make its appearance on the surface,
and a physician was sent for, who pronounced it scarlet fever, and at
once commenced his " scarlet fever treatment." At this time the pa-
tient complained of no extraordinary discomfort. There was some
soreness of the throat, with moderate thirst and heat of surface, but
no hcadach — no pain in any part of the body, and nothing that I
could discover from the most careful enquiry demanding any active
interference. The patient, however, was bled in the morning, and
34

310 HOUSTON ON SCARLET FEVER.

took some closes of cremor tartar and jalap, at intervals during the
day. The eruption was sufficiently copious on every part of the skin,
and of a florid, healthy color. The medicine operated moderately on
the bowels, and the case seemed to progress favorably in every re-
spect until the evening, when the patient was again bled, and the
purgative repeated. In two hours after the bleeding, the medicine
operated copiously, the eruption left the skin, the face became pale,
violent convulsions set in, and the child died at two o'clock in the
morning. I saw it a short time before death, and obtained the above
history from the attending physician and from the child's father.
Now, in this case death was certainly due, in the end, to the action
of the poison on the brain and nervous system ; but why did it act
so powerfully on these organs ? To what cause was the death to be
legitimately attributed ? To my mind there is no doubt but that it
was caused by the uncalled-for and injudicious use of remedies. The
direct effect of venesection is to impair the strength of the vital powers,
and to render the nervous s)'stem, particularly, more impressible by
morbid agents. The force of the heart and arteries being reduced
by the loss of blood, and by copious serous evacuations, they failed
to circulate the blood in the extreme vessels ; hence an accumulation
of the poison in the vital organs, by the same cause which rendered
them less able to sustain themselves under its impression. Convul-
sions and death were the consequences which might have been antici-
pated from such a course of treatment under such circumstances.
Three other cases occurred in the same family, admitted to have
been of equal severity in the commencement, and yet they all re-
covered without the employment of any active treatment whatever,
and without the occurrence of a single unfavorable symptom.

It may be asserted with safety, that in the simple form of scarlet
fever at least blood-letting is never required, and that it cannot be
practised without great danger. In many other diseases, even where
not clearly indicated, it may be practised without any very serious
injury, but here it is capable of producing the most deadly effects.
When the poison is already equally distributed, it can have no effect
in maintaining that equal distribution, but it may be the means of in-
ducing fatal accumulations in vital organs.

Are purgatives proper in this form of the disease, and if so, what
kind ought to be used, and under what circumstances are they indi-
cated ? As a general rule, the impression of the poison on the mu-
cous membrane of the stomach and bowels is such as to exalt their
sensibility, or rather to induce such a state of irritability as leads to
vomiting or purging, or both together. Under such circumstances,
cathartics of any kind would not be proper, but more especially would
irritating cathartics be contra-indicated. Their effect would be to in-
crease the evil which they were intended to remedy, and yet how
often do we find them used under precisely such circumstances?
Their effect must be to determine still more of the poison to the
bowels, and thus induce a state of the mucous membrane, which days
and even weeks of the most careful management will, in many cases,
scarcely prove adequate to remove.

HOUSTON ON SCARLET FEVER. 311

Upon the general principle already laid down, the proper treatment
of such cases consists in soothing the stomach and bowels by the use
of mild opiates, with the free use of mucilaginous drinks, and in de-
termining to the surface, by gentle diaphoretics, the tepid or warm
bath, and stimulating embrocations to those portions of the skin on
which the eruption is least abundant. The poison is thus drawn off
from the more important and directed to the less vital organs.

The circumstances under which purgatives are demanded in this
form of the disease are, when there are costiveness of the bowels,
with little or no redness of the tongue, indications of undue determi-
nation to the head, and such determination of the poison to the skin
itself as may endanger life ; for it must be borne in mind, that an
amount of the* poison may be determined to the skin sufficient to de-
stroy life independent of its direct action on other organs. A very
memorable example of this kind occurred to me in the spring of
1837. A lady, the head of a large family, was seized with scarlet
fever, which prevailed epidemically at the time. The eruption came
out more copiously than I ever saw it in any case either before or
since. The evidences of the poison in other parts of the system
were much less than usual. The tongue retained its natural color ;
there was no soreness of the throat, the stomach and bowels were un-
affected, and nothing remarkable presented itself except the intense
scarlet rash on every portion of the surface. Desquamation com-
menced at the usual period, and continued during several days to
such an extent, that when the patient walked across the floor, as she
was able to do at this time, her track was as though a bran bag had
been shaken over the carpet. The functions of the skin were en-
tirely suspended during so long a period that congestion of the inter-
nal organs supervened as a consequence, and death took place at the
end of eight or ten days. The patient obstinately refused all. medi-
cines during the whole course of her disease. A burn covering the
whole surface could scarcely have proved more certainly fatal.
Nothing but the free application of cold to the surface during the stage
of eruption, with active purgation, could have afforded her any chance
of relief, and to these she would not submit.

Under all circumstances the action of purgatives should be very care-
fully watched, and their use discontinued whenever we find the tongue
becoming red and dry, and the operations frequent, watery and irri-
tating.

When they do become necessary, what kind of cathartics ought to
be used in the simple form of scarlet fever? This will of course de-
pend upon the particular indication which they are intended to fulfil.
We have before remarked, that as a general rule they are not required
at all ; but when they are indicated by a simple costive state of the
bowels, without local determinations to important organs,, the mildest
and least irritating should be selected and given in such doses as
merely to open the howels. It is surprising how small a dose of the
mildest purgative will sometimes operate more powerfully than we
either anticipate or desire. We have known a single teaspoonful of
castor oil to produce hypercatharsis in an adult patient when given

312 HOUSTON ON SCARLET FEVER.

during the stage of the active reproduction of the poison, and the
same may be said of other cathartics. Small doses of oil, a Seidlitz
powder, or small portions of Epsom salts will, in general, answer the
purpose very well. Calcined magnesia, from its insolubility and its
consequent irritating effects on the mucous membranes, is for the most
part an unsafe purgative.

Are the different preparations of mercury, when used either as al-
teratives or purgatives, proper during the active stages of scarlet fever ?
This is a very important question. And as all writers recommend
without much qualification, and nearly all practitioners use mercu-
rials to a greater or less extent in the early stages of the disease, I
shall offer no apology for attempting to expose what I believe to be
an improper practice.

Viewed merely as a purgative, calomel, in addition to the irritating
effects common to it with other cathartics, has the additional effect of
exciting the liver and other secreting organs opening into the alimen-
tary canal into increased activity, by which acrid secretions are
brought into immediate contact with mucous membranes already in
a state of morbid excitability. They are thus subjected to the mor-
bid impression, not only of an increased amount of the poison itself,
thus invited through the blood-vessels, but likewise to the injurious
impression of a host of vitiated secretions. Under their combined
action the tongue becomes dry, red and disposed to ulceration, whilst the
operations become thin, frequent and acrid, as the excoriations about
the rectum will generally testify. If persevered in, these symptoms
are all aggravated, the skin becomes dry, the pulse becomes full and
frequent, sordes collect about the mouth, and in the end the patient
dies, either from haemorrhage, or at a later period, from ulceration of
the mucous membrane of the stomach and bowels. This is no pic-
ture of the imagination. I have witnessed such cases, and I could
attribute the result to no other cause than the blind and persevering
use of mercurial cathartics.

But what are the effects of mercurials when used as alteratives as
well as cathartics ? You may combine them with opiates and thus
prevent their free action on the bowels, but at the same time they are
not without their injurious effects on the mucous membranes, whilst
the}' are producing other effects not less troublesome and oftentimes
fatal. It is known to all that mercury is rapidly taken up by the ab-
sorbents, and that in this way its constitutional effects are produced.
When thus absorbed it may act beneficially in one of two wa}7s,
either by destroying some poison with which it meets in the blood,
thus becoming its antidote, as in syphilis ; or by substituting its own for
some other morbid action not necessarily persistent in the system, as
in inflammation. Now, experience has taught us that it is not an an-
tidote to the poison of scarlet fever, and therefore it cannot prove use-
ful in this respect ; neither can it substitute its own for the action of
the other poison, since the latter continues to exert its influence as long
as the reproductive process continues. Hence by its introduction into
its circulation, the organism is subjected to two poisonous impressions
instead of one.

HOUSTON ON SCARLET FEVER. 313

But mercury is known to have a predilection for some particular
organs, and in stimulating these it necessarily carries with it a larger
amount of the scarlet fever poison : hence an excess in the glandu-
lar system generally, but more especially in the lymphatic glands. It
is this abuse of mercury in scarlet fever which in many instances
gives rise to those glandular enlargements, inflammations and ulcer-
ations which we so often meet with among the number of its sequelae.
The predilection which mercury has for the salivary glands and the
organs about the throat is well known, and hence the extensive ulce-
ration and sloughing of the tonsils met with in the anginose variety
of the disease, when its salts have been used even in moderation.
It will be borne in mind that I am now speaking of the use of mer-
curials at any time during the stage of reproduction of the poison ;
their use during the latter stages of the disease involves considera-
tions of a nature altogether different. The following narration may
serve in some measure to illustrate the truth of these remarks.

Some ten or twelve years ago scarlet fever prevailed as an epi-
demic in Burlington, a village at that time containing not more than
one or two hundred inhabitants. Whilst on a visit to a patient in the
neighborhood, I was met by a gentleman of the place, who told me
that some eighteen or twenty cases had occurred, and that out of the
whole number not a single one had recovered. From more particu-
lar enquiry, made as well at the time as subsequently of other indi-
viduals, I ascertained that it was the anginose variety of the disease
which prevailed, and that all the cases were treated actively during
the early stages with emetics, calomel and stimulating gargles, and
particularly that calomel in large or small doses, or both, had
never been omitted. I also learned that the patients had died with
mortification of the throat, and evidences of much disease in the ali-
mentary canal — that the eruption, although sufficiently florid and co-
pious at first, would not stay out, and that all the strong medicines the
doctors could give seemed to have no effect on the disease. He also
told me that his own children, four in number, were then taking the
disease, and that he had determined not to send for any physician,
but to consult me and be governed by my advice. The only thing
he had given them was onion juice. Taking advantage of his preju-
dice in its favor, I advised him to give them no other medicine ; but
if the throat became very sore, with much accumulation of viscid
mucous, to give it in such quantities as to vomit gently, and then omit
it entirely. I also advised him to let them have no cold drinks, and
to use tepid slippery elm or flax seed tea for a gargle. On the de-
cline of the disease he was recommended to use the warm bath daily,
and if the bowels were costive and the kidneys at all inactive, to give
a teaspoonful of Epsom salts, with a few grs. of nitr. potass, every
morning for several days. With these directions he left me, with a
promise to call again if anything unfavorable should occur. Four
weeks afterwards he informed me that every member of his family
had recovered under this simple treatment, without a single unfavor-
able symptom.

From these facts it is certainly not unreasonable to draw the con-

314 HOUSTON ON SCARLET FEVER.

elusion, that in some of the fatal cases, at least, death did not result
from the whole amount of the poison in the system being too great to
prove compatible with life, but from the fact that so great an excess
of it was determined to the throat and alimentary canal by the reme-
dies used as to destroy their vitality. They were cases of the simple,
converted into the malignant anginose variety.

As a general rule, then, it may be asserted that the preparations of
mercury are not only not demanded, but that their use is apt to prove
highly injurious in the simple forms of scarlet fever. This danger is
increased or diminished just in proportion as the whole amount of
poison in the system is greater or less in any particular case.

Without discussing further the effects of particular remedies or the
influence of other specific modes of treatment, it may be stated in
general terms, that the proper mode of treating the simple form of the
disease under the general rule laid down, consists in watching closely
the progress of events and in not interfering in any way, unless local
determinations are impending ; and where these do occur, they are to
be corrected by soothing applications on the one hand, and derivatives
on the other. A comfortable temperature — warm lemonade or warm
slippery elm tea, acidulated with lime juice, for drink — an occasional
teaspoonful of castor oil when the bowels are costive, a mild, unirrita-
ting diet, and the daily use of the warm bath on the decline of the dis-
ease, are generally all that becomes necessary.

Local determination to the throat, constituting the anginose variety,
demands some special notice. It is manifest that this may be either
mild or malignant, in proportion to the relative amount of the poison
directed to the throat as well as in proportion to the whole amount in
the system. Whilst the first class of cases may generally be consi-
dered manageable, the latter are often necessarily fatal. We may
procure a more equable distribution of the poison, but we cannot con-
trol the whole amount in the system. The same general principle of
treatment, however, will apply to both.

Whatever may be their modus operandi, emetics certainly have the
effect of lessening the determination of blood to the throat. Unless
its use is specially contra-indicated, a mild emetic will, therefore, ge-
nerally be proper in the commencement of the disease. Should the
bowels be costive, it may be followed by a small dose of castor oil.
Magnesia, on account of its rough action on the mucous membranes,
should be avoided. The stomach and bowels should then be left in
quietude. In the mean time the integument of the throat and upper
part of the chest should be rubbed with a stimulating liniment and
kept moderately warm. The liniment should also be applied to the
whole surface of the body, but particularly to those parts where there
is the least appearance of eruption. No cold drink should be allowed
to the patient. If cold could be constant^ applied to the throat in
the form of cold drinks or small lumps of ice, it might prove useful;
but as it is generally used, reaction takes place in the intervals and
the inflammation is increased. When the tonsils are much enlarged
and the general tumefaction great, local depletion by scarifactions will
become proper; but, if possible, it is best to avoid them, as they are

HOUSTON ON SCARLET FEVER. 315

liable to be followed by troublesome ulcerations. All stimulating and
irritating gargles should be studiously avoided. The mildest are the
best, and I know of none better than the slippery elm or flaxseed tea,
acidulated, when there is much mucosity, with lime juice or vinegar.
The local practice should consist in soothing the throat, whilst the
skin and other organs, in which there is a less amount of the poison,
are being constantly and uniformly stimulated.

The limits of this paper, already transcended, will not allow me to
allude to much less to dwell on the different points of practice that
are of great importance in the management of this disease in all its
varieties. On the form with cerebral determination, however, I feel
constrained to make a single remark, as it calls for a class of reme-
dies which prove injurious in most of the other forms. In the malig-
nant variety, with determination to the head, the danger is always
imminent, and death must result unless the nervous system be spee-
dily relieved. We are then compelled to choose the least, it may be,
of two great evils. We must relieve the head at the risk of destroy-
ing the functions of other organs, not so immediately required in sus-
taining life. Calomel in large doses, from its known power to relieve
congestion of the brain, as well as from its effects on other organs,
must be resorted to at once. Large doses are preferable to small,
because the sedative effect is more prompt and decided, and because,
from its action as a cathartic, it is less liable to be absorbed and thus
produce its injurious constitutional effects. Ten grains, repeated at
intervals of six hours, each close to be followed by a dose of castor
oil, is the plan which, in my hands, has proved the most successful.
At the same time, cold should be applied to the head, whilst the pa-
tient is put in a warm bath ; and this should be succeeded by fre-
quent stimulating pediluvias and turpentine embrocations to every part
of the surface. Even here it is necessary to keep a close watch lest
we attract more of the poison to the stomach and bowels than they
are able to bear. As soon, therefore, as we find the tongue becoming
redder, and indications of a free and more permanent eruption on the
skin, with corresponding evidences of relief to the brain, our active
measures should be relaxed, and our attention directed to palliating
the effects of our remedies. At the best, if the head be relieved, we
will have a long and troublesome course of soothing treatment to pur-
sue before the stomach and bowels will resume their healthy tone.

This is the form of scarlet fever in which blood-letting has been
practised and so highly recommended. In all cases of the disease,
the state of the pulse, as an indication of fever, is strangely dispropor-
tioned to the other symptoms; and although I do not deny its utility,
yet, I must confess, with the frequent, feeble pulse that I have alwaj^s
met with in this form of the disease, I have never thought it safe to
venture on the use of the lancet. The only stage of the disease in
which I have resorted to blood-letting, is after the process of repro-
duction is complete, and nature fails in her effort to throw off the
effete poison. To accomplish this, inflammatory action is lit up, and
unless controlled by suitable remedies, it terminates either in local in-
flammation or general drops}'. Under these circumstances the lancet,

316 HOUSTON ON SCARLET FEVER.

and calomel in small and frequently repeated doses, become the an-
chors of our hope, and I know of no disease in which the effects of
our remedies prove more generally satisfactory.

The typhoid variety, or the winter form of scarlet fever, requires a
long course of close watching, with very little medication. We must
look out for local determinations, and as far as possible counteract
them when they occur. Of course we must carefully avoid all sources
of irritation, and be on our guard for a much longer period than in the
other varieties of the disease.

There is one simple point of practical importance common to this,
with every other variety of the disease, to which I must merely allude;
it is the state of the kidneys. If we can succeed in keeping up a
free action of these organs, our patients will generally get well. It
is more particularly important that their functions should be main-
tained during the decline of the disease, as it is through them and the
skin that the poison must for the most part be eliminated. For this
purpose, the warm bath and an occasional dose of spts. nitr. dulc.
will generally prove useful after the third or fourth day of the eruption.

Passing over the whole of the sequelae, which involve topics quite
as numerous and of equal importance with the disease itself, I shall
close with a single suggestion on the subject of prophylaxis.

We have stated in the commencement of our remarks, that scarlet
fever depends for its development on the existence in the blood of
some peculiar principle not yet ascertained, on which the poison pro-
bably depends for it sreproduction, and that this principle, when once
destroyed, is never, or but very rarely reproduced. The first step,
then, towards a true prophylaxis, supposing it to exist, should be to
ascertain what this principle is, and the next, to find some substance
which, when introduced into the circulation, will have the effect of
destroying it. It happens very singularly* that belladonna, the only
article which enjoys the reputation of being a specific prophylactic, is
extensively used by some brewers to modify the process of fermenta-
tion. May it not combine with and destroy that peculiar principle in the
blood on which the poison of scarlet fever depends for its reproduc-
tion?

If some competent person having charge of a scarlet fever hospital
were to institute a series of experiments on the blood previous to the
occurrence of the disease and subsequent to complete recovery, might
it not be possible to detect this principle? With the accuracy of mo-
dern chemistry in conducting minute analyses such a result might be
fairly anticipated. Once discovered, it would prove an easy task to
ascertain its antidote, and in this age of wonders it may yet happen
that some of us will live to see the day when as thorough and as cer-
tain a protection will be afforded, not only against scarlet fever but
against all other eruptive fevers, as we now enjoy against smallpox
by the practice of vaccination.

Note. — Since writing the above I have had an opportunity of wit-
nessing the effects of the anti-Hebraic treatment introduced and so
highly recommended by Dr. Schneeman.

Three children labored under the typhoid anginose variety of the

GARDEN ON CIMICIFUGA IN PHTHISIS AND CHOREA. 317

disease. The inunction with bacon rinds had been sedulously em-
ployed from the commencement of the disease. One child was dying,
and the other bid fair to follow in its footsteps. Strong turpentine
liniment was substituted for the grease, and they slowly recovered.
My impression is, that if the friction be used, the lard may be omit-
ted without disadvantage.

Observations on the Remedial Powers of the Cimicifuga Ra-
cemosa in the Treatment of Incipient Phthisis and Chorea.

BY DR. THOS. J. GARDEN OP WYLLIESBURG, CHARLOTTE CO., VA.

I promised on a former occasion a detailed report of some cases of
incipient phthisis successfully treated with cimicifuga. Before doing
so, however, it may be well to disseminate anew some observations
relative to this article, published by me in the Medical Recorder as
far back as the j^ear 1823. This paper is, I find, in the hands of a
very limited number of physicians of the present day, and a consider-
able time elapses always before a discovery or any important informa-
tion on a novel subject finds it way into the text books of the schools ;
for, according to my experience, the man who subscribes to and reads
a well and ably conducted medical periodical, is invariably in ad-
vance, on many practical points, of the literature of the schools and
text books some ten or twelve years.

The cimicifuga has now advanced to the first rank among the indi-
genous articles of the dispensatory ; and although it has been before
the public for near thirty years, and numerous tests of its powers and
virtues in various forms of disease have been made by accurate ob-
servers and faithful reporters, as well as numerous references to my
paper in 1823, and since in Dungleson's new remedies, subsequent
numbers of the Recorder and Journal, Gregory's and Wood's Prac-
tice, still I fine some physicians and graduates in medicine are as
ignorant of all that has been written and published upon the subject
as those without the profession ; indeed I may say more so. All this
must be the offspring of neglect, or something else, in not subscribing
to periodicals. To my view they constitute a common centre or point
whence our most valuable practical knowledge is radiated and re-
flected.

Up to the time of my first publication in the October Number of the
Medical Recorder in 1823, page 609, the only account of this plant
was to be found in Barton's collection of the indigenous articles of the
United States, classed under the head of astringents. The popular
name is rich weed, by which it is readily recognized by a number of
planters, farmers and old women of our country, but as it may now
be procured from any well regulated apothecary shop, neatly put up
in a good state of preservation, any further description is superfluous.
For the information of the curious, its botanical characters can be seen
by consulting the Florida Cestrica of Doctor Darlington. As I enter-
tain the same views I did thirty years ago relative to its therapeutic
action and effects upon the human system, I have transcribed the
35

318 GARDEN ON CIMICIFUGA IN PHTHISIS AND CHOREA.

language used by me in the publication referred to : " Like the digi-
talis, it disorders the sensorium, and operates in a powerful manner
upon the secreting and absorbent systems. When exhibited in a full
dose it prostrates in a distressing degree, producing nausea, vertigo,
pains of the extremities, anxiety, dilatation of the pupil, quick, small
pulse, with universal restlessness and uneasiness. These effects are
immediate and transitory. Its ultimate and remote operation is the
converse of the above. It is this which gives it the supremacy over
all other medicines of the same class. The digitalis induces a re-
duction of arterial action at too great an expense of the general pow-
ers of the system to be applicable to those cases wherein this medi-
cine seems to be so admirably calculated to be productive of benefit.
It is a paradox in medicine, and in whatever way it may be expe-
rienced it certainly possesses the power in an eminent degree of lessen-
ing arterial action, and at the same time imparting tone and energy to
the general system. This, like many other phenomena relating to the
science of medicine, will for some time to come be clouded in doubt
and obscurity."

In a publication by Charles C. Hildreth, M. D., of Zanesville,
Ohio, on the same subject, in the October Number of the American
Journal 1842, in a few remarks on the general character of the ci-
micifuga, he uses the following language, shewing a coincidence of
opinion, when it is manifest, too, he had never seen my first publica-
tion, as at the onset he confesses his ignorance as " to whom we are
indebted for the original introduction to the notice of the profession
of the black snake root in phthisis."

" That it has narcotic properties, somewhat similar to those of col-
chicum, veratrum album or digitalis, we cannot for a moment doubt,
after observing its influence on the brain, stomach, vascular and ner-
vous systems. Thus a large dose of the strong decoction or tincture
will produce vertigo and impaired vision, nausea and vomiting, re-
duce the action of the heart and arteries, and induce perspiration."

My principal object in making the above quotation from Dr. Hil-
dreth's paper is, that the medicinal qualities of the cohosh may be
more accurately defined, for while some ascribe to it narcotic pro-
perties, others consider it a slight tonic. As before stated, it combines
in its action both a narcotic and tonic property, and while the former
prostrates so powerfully, it is by no means a dangerous narcotic. I
once knew a confirmed drunkard, who was in the habit of begging for
the tinctures in the shop, take two ounces of the strong tincture at a
dose. It prostrated him completely, and he lay in the street until he
was taken to his lodgings. He complained of slight headach next
day, but his appetite was ravenous. Whiskey is a very good antidote
to an over dose.

Tonics, as Dr. Paris has justly remarked, are but relative in their
operation. Debility in general is the result of organic or functional
disease, and therefore not demanding the use of tonics for its remo-
val. Strychnia in minute doses will display tonic powers, by stimu-
lating the spinal or excito-motory system of nerves. The action of
the cohosh on the nervous system is very obvious in chorea, of which
I shall give some further illustration in the sequel.

GARDEN ON CIMICIFUGA IN PHTHISIS AND CHOREA. 319

My first experiments with the cohosh in phthisis were made in 1819,
upon the bare testimony of vulgar report, on my own person. At that
time it was confidently expected by my friends, as well as a number
of distinguished physicians, some of whom had examined me criti-
cally, that I could survive but a few weeks at best. As the physical
signs from auscultation and percussion were imperfectly understood
at that time, it is probable the real nature of my own case was over-
looked, and that instead of tubercles, softened down and excavated, it
was what would now be diagnosed vesicular bronchitis. Be this as it
may, I was promptly and permanently restored, mainly by the use of
this article, to the enjoyment of comfortable health, and have per-
formed the labors and encountered the exposures incident to a lucra-
tive practice for thirty years since, after all other resources had failed
to give even temporary relief from suffering. Suffice it to say, I had
all the symptoms of phthisis of the most rapidly exhausting charac-
ter. In a letter addressed to me by Professor Dudley of the Tran-
sylvania University, Kentucky, in reply to one which informed him of
my recovery, he uses the following emphatic language : "Your reco-
very is a signal triumph over disease."

In the case of J. F., reported in my paper in 1823, no doubt was
entertained by myself or Dr. James May, formerly of Christiansville,
now of Petersburg, as to its being a case of tubercular softening, the
whole family, several brothers and sisters having died of phthisis,
about the age of puberty. Under the use of the tincture of cimici-
fuga, the form used by me at that time, in the space of between two
and three weeks this man was restored from a state of perfect debi-
lity and helplessness in bed so as to be able to walk about the yards
and garden and take exercise in a carriage. Here the action of tu-
bercle was evidently suspended, as the individual lived two years af-
terwards, free from cough, and died finally of scrofula of his bowels,
having rode as deputy sheriff part of this time.

The more readily to make ourselves understood, two cases will be
reported as having occurred within the last two or three years, but as
I do not profess to be familiar with auscultation, the cases may be
wanting in precision, and I shall of course not be able to give a satis-
factory account of the pathological state of the lungs of my patients,
and on this account, to some my communication may lose much of
the interest that might otherwise be imparted to it.

Case. 1. — This lady, Mrs. B., setat. 35, when first seen by us, had
that train of constitutional symptoms induced bv the presence of tu-
bercle or induration in the upper lobes, which even the common ob-
server will justly pronounce consumption. She had for some years
previously resided in a section of country proverbial for its fruitfulness
in the production of bilious remittent and intermittent fevers, and had
herself been the victim of repeated attacks. Her constitution had
sustained a considerable shock from the conjoint action of disease
and some of the effects incidental to remedies. At this time her con-
finement to bed had been of about two weeks duration. Her pulse
was rapid, skin hot, tongue foul, respiration embarrassed, cough trou-
blesome and expectoration copious, of a muco-purulent fluid. As

320 GARDEN ON CIMICIFUGA IN PHTHISIS AND CHOREA.

pneumonia bliosa was endemic in the neighborhood at the time, for
the want of something better at hand, I left her some powders con-
taining fractional portions of cal. t. emet. nitre and ipecacuanha, to be
used pro ra nata. Finding no amendment under this treatment, I di-
rected free pustulation over the diseased lobes with t. emet., and I pre-
pared for her a strong decoction of cohosh from the root, with a com-
bination of 6 grs. of tartar emetic and 1 gr. of acetate morphia to
the pint of the decoction. Of this combination she was directed to
take one tablespoonful every hour through the day, and as much of
the decoction in a separate state as the stomach would bear without
vomiting. With a view to regulate the biliary secretion, which was
defective, I gave her 6 grs. of blue mass as an alterative cathartic
every other night, and to quiet cough and diminish expectoration, a
powder containing 5 grs. of acetat. plumbi. and 3 grs. pulv. Doveri
every night. This plan, with some slight modification, was pursued for
the space of about 10 days, when her amendment was apparent to
all. The pustulation was directed to be continued, and as all the dis-
tressing and urgent symptoms in her case had vanished, she was di-
rected to take, which I prepared for her, 8 drops of the sol. of iodine
and hydriod. potass., three times a day in a strong decoction of cohosh,
until her natural respiration was restored, appetite and strength had
returned and cough relieved. The sol. of iodine and hydriod. potass.
was prepared with 10 grs. of the former and 20 grs. of the latter to
the ounce of water. In a short time this lady, under the above treat-
ment, was restored to her usual health, which continues permanent.
This case occurred in the latter part of the winter 1S49, now two
years since.

I must acknowledge my indebtedness to Dr. Hildreth for this par-
ticular mode of using the cimicifuga, since I deem it preferable to the
tincture, the mode formerly used by me. It more readily throws off
febrile heat and allays irritation.

Case 2d. — This case occurred in the spring of 1850, just 12 months
ago — a colored man, gel at. between 30 and 40, wheelwright by trade,
of scrofulous family, and addicted to the intemperate use of intoxi-
cating drinks. The physical signs in this case, when seen by me
some three or four weeks after his confinement, caused me to diagnose
a disorganizing process of the lungs, which would speedily result fa-
tally. His pulse was steadily at 130 to 140 per minute ; on sitting
up in bed, soft and compressible ; skin hot ; cough troublesome ;
breathing difficult and hurried ; copious night sweats, &c, throwing
up profusely mucous and muco-purulent expectoration. Viewing
the case as almost absolutely fatal, I unhesitatingly prognosticated
speedy dissolution. The cohosh occurred to me as the only remedy
deserving a trial, or that promised even to palliate the symptoms in
his case, and was resorted to more with a view to render his situation
comparatively comfortable than any well-grounded expectation of a
cure. Pustulation, with tartar emet. over the entire chest, was directed,
but especially over the left lobe of the lungs, as there was consider-
able dulness on percussion under the left clavicle. The poisonous ef-
fects of the tartar were well developed in three or four days, causing

GARDEN ON CIMICIFUGA IN PHTHISIS AND CHOREA. 321

a slough that extended from axilla to axilla, and yielding a most co-
pious and salutary discharge. He was directed to take every hour
through the day one tablespoonful of a strong decoction of cohosh,
combined, as in the former case, with six grains of tartar and one
grain of morphine to the pint, and as much of the decoction in a sepa-
rate state in the intervals as his stomach would bear, and when the
secretion into the bronchial tubes was excessive, to increase the dose
until vomiting was produced. Blue mass in six grain doses was given
every other night, and the lead and Dover's powder every night. The
same general plan of treatment was pursued in this case as in the
last. At the expiration of ten days the pulse had come down to near
the natural standard, the cough much better and the febrile symptoms
nearly disappeared. His recovery was rapid and uninterrupted.

The iodine and cimicifuga in decoction were continued as long as
his breathing was hurried on slight exertion. He is now (March 27th
1851) perfectly free from pulmonary disease and in robust health.

The pages of the American Journal bear ample testimony to the
power of this remedy in various forms of cough in the Western and
Northern states ; and that whenever it has been wielded by a skilful
hand — one who knew when and how to to control and modify its ac-
tion by combination or other circumstances — I find it has always been
used with good effects. Like all other remedies, this may be the pro-
per one, yet it may fail for want of tact, not skill, in its administra-
tion.

The powers of this remedy do not end here, but are displayed
more happily and promptly in chorea than in incipient phthisis. This
wide range may alarm the incredulity of some, but well authenticated
facts are worth all the reasonings of the theorist and the visions of
scholastic philosophy. I know the power of habit and the prejudices
of an early education, and the tenacity with which early imbibed opi-
nions, however untenable, cling to the mind and effectually preclude
the most palpable evidence.

I once treated a case of chorea successfully by means of this re-
medy alone, in a little boy nine years old, after the usual and most
approved remedies had been previously perseveringly and diligently
used for some weeks without the least effect. It was given in form of
powder in teaspoonful doses morning and evening in a little molasses.
Its effects were prompt and decisive. Its administration in this form
of disease had not been thought of by me until my attention had been
awakened by a publication in the Medical Journal, No. XVIII. Feb'ry
1S32, page 310, by Dr. Jesse Young of Chester county, Pennsylvania.
He, like m}7sclf, was induced to use it upon vulgar report. Some old
woman put him in possession of the remedy. In the sequel, in a note
by the editor, he states he had been informed by Dr. Physic nearly
ten years previous, that he had known that plant, given in doses of ten
grains every two hours, prove successful in the treatment of chorea in
several instances. In this disease the cimicifuga no doubt cures by
an immediate and direct impression upon the nervous system.

Eight or ten years ago, meeting with Dr. Wooton of Pleasant Grove,
Lunenburg, quite an intelligent and sprightly physician, he informed

322 snead's case of mumps.

me he had at that time a patient with chorea, a very interesting little
girl about nine or ten years old ; that the girl bad been under his care
about two months, and he had failed to afford her any relief. I sug-
gested to the doctor the use of the cohosh in her case, and upon his
consenting, and expressing a strong desire to give it a trial, I requested
he would write me the result, as I was collecting some statistics for
publication upon that subject. Three weeks afterwards I received a
letter from Dr. Wooton, informing me of his patient's entire recovery,
the fifth powder having arrested the entire catenation of morbid ac-
tion, and up to that time there had been no return of her disease.

In June 1849 I was requested to visit a patient with chorea, then
under the care of Dr. Giles Harris, a popular practitioner of this
county. It occurred in a girl about 12 or 13 years old, and proved
to be a very intense and aggravated form of the affection. This case
had been treated by purgatives and ol. terebinth., under the impression
that verminous irritation had occasioned the disease. The cohosh in
teaspoonful doses was now used for a short time, which entirely changed
the character of the disease, causing it to take on periodical action,
occurring about the same hour of the day, and shifting its seat from
the muscles of the extremities to the chest and respiratory organs, im-
parting to the breathing a peculiar convulsive and distressing moan or
whine. A few more doses of the powder obliterated all traces of the
affection.

When subjected to analysis the cimicifuga is found to contain gum,
starch, sugar, resin, wax, fatty matter, tannin and gallic acid, a black
coloring matter, a green coloring matter, lignin and salts of potassa,
lime, magnesia and iron. From a remedy so constituted, what should
we justly expect but great activity and extended influence?

Wylliesburg, Charlotte, March 1S51.

Metastasis of Mumps to the Brain and Uterus.

SUCCESSFULLY TREATED BY A. SNEAD, M. D., RICHMOND.
[Read before the Medical Society of Virginia, April 1851.]

Believing that the following case may, in some of its features, inte-
rest the society as it has my own mind, I hope to be excused for de-
taining it, by reading a short account of the case :

On Monday, 31st March, being on a visit to Mrs. T., I was re-
quested to see her servant Mary Ann. I found her to be a remark-
ably tall, athletic woman, aged twenty-six years. On enquiry I re-
ceived the following statement : On the Monday preceding she had
been attacked with mumps in the right parotid. She had not however
been so much indisposed thereby as to prevent her from attending to
her duties, that of nurse to Mrs. T.'s child. On Friday night, last
she experienced the first indications of the disease making its appear-
ance in the left parotid. On Saturday and Sunday she felt more in-
disposed, and on Sunday evening her head commenced to pain her,
and had been so distressing as to prevent her from sleeping the greater
part of the night. She had taken last night some aperient pills, by
which her bowels had been three times moved, but without affording

snead's case of mumps. 323

her any relief. She had vomited several times during the night and
this morning ; had taken but little food on yesterday. At this time
headach is distressing, and there is much intolerance of light ; head
hot and temporal arteries throbbing ; pulse increased in frequency and
force ; extremities cool but not cold. Her bowels having been freely
moved, I ordered a hot mustard bath for her feet and legs, hoping by
this means to relieve her of her sufferings ; but if not relieved, and es-
pecially if she should grow worse, I directed I should be immediately
informed of it.

At 2 o'clock, P. M., I received an urgent message to visit her, and
on arriving I found her verging on delirium. Her head was intensely
hot and temporal arteries beating violently ; the extremities had
warmed up, and pulse at rest, fuller and stronger. Head aching vio-
lently, and great intolerance of light — had vomited. I observed in a
vessel a small quantity of blood, and enquired of her if her nose had
been bleeding — she replied in the negative. I then on enquiry ascer-
tained she was menstruating, and learned it had set in on the previous
evening. I asked if it was her regular time — she said no — but that it
was at least ten days too soon. She stated that heretofore she had
always been very regular, and that at such times she has suffered no
pain, but that now there was very smart pain in the region of the
womb, and that the discharge was greater than it was accustomed to
be. On pressure being made on the hypogastrium she manifested
considerable tenderness. I ordered her to be cupped without delay,
and that 20 1 of blood should be taken from behind the ears.

5 P. M. The cups had been promptly applied, and at least 20 1
of blood had been taken. She had been greatly relieved by the loss
of blood. Heat of head and surface lessened, and headach greatly
mitigated. There has been no vomiting since she was cupped. On
moving the head it becomes very painful — intolerance of light lessened.
I prescribed calomel, 12 grains to be given at once, and after three
hours to be purged off by salts and senna tea ; this to be repeated
until the bowels had been actively moved. Sinapisms to be applied
to the parotids.

April 1st, 9 A. M. Took calomel and senna tea as directed. The
bowels have been three time actively moved. She rested better last
night, having enjoyed some refreshing sleep — expresses herself as
being much more comfortable. She says her head is easy if kept
quiet, but pains if it is moved — intolerance of light much diminished —
pulse 80 and rather tense. Surface pleasant — very little heat of
head — intolerance of light diminished — tenderness of hypogastrium
less — catamenia continues. Directed a small blister to be raised over
each parotid, and a draught of salts and senna tea to be taken at
noon.

6 P. M. The surface over each parotid is well vesicated. Head
entirely relieved — no pain on motion, neither does there remain any
intolerance of light. She thinks the blistering has done much good.
Pulse soft and less feverish than in the morning ; has had two alvine
evacuations. Blisters to be kept dressed with poultices. No medi-
cine.

324 manson's case.

2nd, 10 A. M. The patient has passed a comfortable night ; slept
well ; has neither headach nor pain on motion, and there remains no
intolerance of light. No fever — bowels have been twice moved. She
expresses herself as being very much better.

4th. Since the 2d the case has continued to progress favorably,
and visits were discontinued. I, however, incidentally saw her on the
6th, in her mistress's room, and on enquiring how she was, she said,
" Well, except the numbness down her right arm and leg." Of this
she had never before complained to me, but said she had felt it all the
time I had been attending her. She left for the country the next day,
so I do not know how long the numbness continued.

The chief points of interest in this case are the state of the head
and uterus. Was this a case of metastasis or mumps to the brain ?
and was the condition of the womb a mere coincidence, or was there
a connection between its state and the diseased parotids ?

I conclude it was metastasis of mumps to the brain, from the fact
that there appeared no other exciting cause for so violent a set of ce-
rebral symptoms ; and the train of symptoms were such as I should
expect to meet with in cases of metastasis. I further conclude so
from the fact that the disease yielded to a course of treatment appro-
priate to such a state of things. The blistering of the parotids ap-
peared to produce a good and permanent effect, as after it had been
done, there remained neither uncomfortableness of head nor intoler-
ance of light.

In answer to the second enqui^, I conclude that there is no reason
why the genitals of the female may not become involved in this dis-
ease as well as those of the male. In the two cases reported by Dr.
Lindsly, in the Stethoscope, priapism was present in both, and in the
latter case it was the first symptom that excited alarm for his patient.
It is true that, ordinarily, the testes in the male and the mammae in
the female are the organs to which translations take place in mumps.
But why is this so? Can any one explain it? In this case let it be
remembered, that the period for the catamenial flow had not arrived
by at least ten days. Why should it now set in, accompanied by
much pain in the uterus and very marked tenderness on pressure be-
ing made on the hypogastrium, and this, too, in one in whom its flow
had always been unattended by pain, and recurring only at the regu-
lar times ? The mammas were not at all affected. How shall we ac-
count for the benumbed feeling of the right side ? Was it that the
left side of the brain had suffered during the attack a greater amount
of injury than the right? The left parotid was the last attacked.

A Case of Retention of Urine from Paralysis — Puncture of
the Bladder above the Pubes — Recovery.

BY OTIS F. MANSON, M. D., OF GRANVILLE COUNTY, N. C

Although we readily concur with Mr. Liston, when he exclaims in
characteristic language, that " there is no disease in which the patient
is more liable to be bungled out of his life than in retention of urine,"
and that the instances are rare in which puncture of the bladder is

manson's case of puncture of the bladder. 325

demanded, yet cases must present themselves to the most skilful, in
which the bladder cannot be reached by its natural outlet, and in which
paracentesis is the only alternative. Perfectly satisfied I am, from
the convictions of my own mind, and from the concurrence of high
surgical authority to whom the case has been minutely and accurately
reported, that the operation in the instance I am about to relate was
the only practicable means, under the circumstances, to rescue the patient
from death. Alexander, a mulatto, aged 30, belonging to Major W.
M. Sneed of this county, was injured by the falling of a heavy piece
of timber upon him, which threw him prostrate on the ground, its
whole weight resting for some moments upon the lateral regions of
the abdomen. The accident occurring on the 25th of February last,
paralysis of the inferior extremities of the bladder, and consequent re-
tention of urine immediately ensued.

On the evening of the 26th, Dr. William F. Henderson was called
to see him. He found him suffering from great distension of the blad-
der; no urine having passed since the reception of the injur}r. Pro-
longed and persevering efforts were made by the doctor to introduce
the catheter, but without success. On the morning of Thursday, the
27th, 1 was called in consultation, and found the patient in great
agony from the distension ; the bladder was enormously enlarged, pro-
jecting prominently over the pubes, its superior fundus extending above
the umbilicus. Called in at this late moment, it is needless to enume-
rate the difficulties I experienced in reaching the bladder : they will
present themselves at once to the surgeon. It is only necessary to
state that no means were left untried, no efforts spared to relieve the
threatened organ, but without success. The patient's condition at
this time was truly alarming; the distension, already beyond the
bounds I had ever conceived the bladder capable of attaining, seemed
rapidly increasing; violent paroxysms of rending pain, attended with
a " sense of bursting," as the patient expressed himself, warned us
that unless soon relieved, the case would be beyond the reach of art.
The abdomen, seemingly stretched to the utmost by the turgid organ
beneath, was hot and tender on pressure, to which being added the
helpless condition of the patient from paraplegia, rendered his situa-
tion distressing in the extreme.

Puncture of the bladder being the only resort left to us, the patient
was made aware of his imminent danger, and informed that the ope-
ration presented the only mode of escape from death ; to the perform-
ance of which he immediately consented.

Operation. — The patient being placed on his back with his thighs
semi-flexed, an incision was commenced with a scalpel about an inch
above the pubes, and brought down to the symphisis, exposing the
linea alba. The incision was continued by several sweeps of the knife,
but diminished in length as I advanced, until the bladder was reached.
The wound, therefore, presented a conical opening ; the small, exposed
point of the bladder forming its apex ; the bladder was now touched
with the point of a lancet, and a female catheter introduced with slight
force and gentle rotary motion into the opening. An enormous quan-
tity of foetid, bloody urine was discharged, followed by the most de-
36

326 manson's case of puncture of the bladder.

lightful relief to the patient. The catheter was secured by two soft
cords passing under the thighs, attached behind to a waistband, and
another passing upwards fastened to it before, to the extremity of the
catheter a gum elastic tube was attached, leading to a cup by which
the patient was kept entirely dry, the tube being left constantly open.

The alimentary canal having been fully evacuated previous to the
operation, the patient was placed on his right side with the abdomen
inclined downwards, and perfect rest enjoined in that position, the pa-
tient soon fell asleep for the first time since the reception of the injury,
and awoke comparatively comfortable.

February 28. Condition improved ; has slept well ; pulse 90 ; very
slight heat of skin ; some appetite ; feels no pain, no abdominal ten-
derness or tension ; urine passes freely and copiously through the
tube ; can move his legs slightly. Ordered ol. ricini ; rigid diet ; mu-
cilaginous drinks.

March 3. Still improving ; complete apyrexia ; pulse 60 ; wound
healed closely around the tube ; paraplegia almost entirely relieved.
Attempted to pass the catheter per urethram, but considerable urethri-
tis still existing, desisted after very slight efforts.

March 5. Some slight tenderness about the pubic region, and a con-
siderable quantity of viscid, tenacious mucous, tinged with blood, occa-
sionally blocking up the tube ; these symptoms of cystitis completely
disappeared under the use of bals. copaiba.

The catheter was withdrawn from the wound and a cork fitted
around its middle to prevent its passing too deeply, as it constantly
had a tendency to do.

March 14. Urine passes to-day per vias naturalcs for the first time
since the accident, the stream small, twisted and forked.

March 18. Urine passes freely per urethram, a cork introduced into
the end of the catheter.

March 22. Patient passes his urine altogether per urethram.

March 29. Urine now discharged as freely and regularly as in health.
Catheter withdrawn from the supra-pubic passage, which was touched
to the depth of half an inch with a pencil of lunar caustic.

March 30. Strange to relate, but fortunately, not a drop of urine
has passed through the wound since the tube was withdrawn ; wound
almost entirely closed ; retouched with nit. silver.

April 1. Artificial passage entirely closed. Discharged.

Remarks. — So far as I can learn this operation has been usually fol-
lowed by fatal consequences. Success in this case is probably refer-
able to the following circumstances :

lstly. The greatly distended bladder in mounting high up in the
abdomen, carried the reflection of the peritonaeum upward before it,
which only invests the superior and posterior surfaces of the organ,
in consequence of which displacement, that important membrane was
not wounded in making the supra-pubic opening.

2dly. The form of the wound was highly favorable to the exit of
any urine which might pass outside of the tube, and thereby prevented
infiltration. There was still less danger of wounding the peritonaeum,
owing to the slight extent of the incision as the bladder was approached.

palmore's obstetric case. 327

3dly. The mode of opening the bladder, by making a small clean
incision, instead of the ragged, bruised wound inflicted by a trocar,
which is generally used.

4lhly. The admirable conduct of the patient, who bore his suffer-
ings with great fortitude, and conformed in every respect to advice,
&c, particularly as regards rest, position and diet.

I beg leave, in conclusion, to offer my thanks to Prof. Chs. Bell Gib-
son for his kindness in having had made for me, under his immediate
su pervision, the Prostate Catheter of Mr. Liston, for the case, and for
his kind and judicious advice in relation to the after-treatment.

Report of an Obstetrical Case.

BY C. R. PALMORE, M. D.

Mr. Editor — Supposing the recital of the following case, which
occurred in my practice whilst connected with the " Obstetric Insti-
tute" in Philadelphia, will be acceptable to you, and interesting if not
instructive to the readers of your valuable magazine, I have taken the
liberty to transmit a condensed report of it from my case-book for
publication. It involves a question in obstetricy, which has always
puzzled the young physician not a little, and which I hope this case
will at least serve to direct the attention of practical physicians to
the elucidation of the mystery with which teachers and books have
surrounded it.

Case. — April 10, 1850. Mrs. M. G. was seized with labor pains
this morning. The labor proceeded very well, (the vertex presenting
in the first position,) till the head emerged from the vulva. At this
time the child took several deep inspirations and cried lustily. I
immediately perceived, however, the umbilical cord around its neck,
and on more minute observation discovered it drawn thrice very
closely. The pains were now very severe, of the expulsive kind,
which caused the funis to become tighter at every effort. I endeavored
to pull the cord down and pass it over the head, but soon found the
attempt useless from its extreme tenseness. I next attempted to dis-
engage and suffer it to pass over the shoulders as they descended.
This was also of no avail ; for I could scarcely insert one ringer be-
tween the cord and neck, so closely was it fastened. My next duty I
conceived was to suffer it to remain, or in other words trust to the vis
medicatrix natures,. This negative plan was as nugatory as the others
had been unfortunate. The child, which before had cried, now
ceased. Its face became first dusky, then black, exhibiting plainly the
compression of the jugular veins and the consequent stagnation of
blood in the brain. Here then was no time to be lost.

The only alternative at my command was to sever the funis. But
here, (I should not call it a demon,) authority arose before me. Dewees,
Ramsbotham, Meigs, Hodge, whose opinions we all recognize, passed
in rapid review. I remembered only one similar case, that mentioned
in Dr. Meig's Treatise on Obstetrics, page 295. That this was a
similar case, I had no doubt. I resolved therefore to cut the cord,
which having been done, the child, released from its halter, soon re-

328 palmore's obstetric case.

vived ; its face gradually assumed its natural hue ; its breathing again
commenced, and the mother's heart was illumed afresh by its re-
awakened cry. A few bearing down pains soon sufficed to drive the
child from the vulva. I now tied the cord. Nothing unusual occurred
in the after treatment.

Remarks. — It will be noticed that I pursued the usual course of
treatment laid down in the books, and found this routine practice to-
tally unavailing. Since the occurrence of the above case, I have ex-
amined the subject pretty closely : have maturely considered the sa-
lient points of the practice, and have come to the conclusion, that the
treatment usually recommended is at least irrational, if not radically
defective, and that it will not answer in practice.

Upon a superficial examination, I know some may say that the suc-
cess of the above case was post hoc, and not propter hoc. But if such
persons would examine attentively the details given, they could not,
in my opinion, refrain from being convinced that it was propter hoc.

What are the dangers that are so particularly inculcated by teach-
ers? There is only one, and to my mind this scarcely deserves the
name of danger. I refer to the supposed probability of the child's
dying from loss of blood. I say supposed, because I cannot conceive
why this can take place, as the child's body presses the cord against
the vulva, effectually serving the purpose of a ligature. And this ac-
tually occurred in the case I have just narrated. The loss of blood
was scarcely appreciable. This is the most prominent, if not the only
objection, that can be urged against the treatment.

The advantages are numerous, and, in my opinion, insuperable. It
saves the child from impending death, and it empties the placenta of
its retained blood ; thus allowing it to be more easily detached by the
efforts of the uterus, or, if necessary, by the hand. Moreover, if the
cord were suffered to remain around the neck, and the child to de-
scend, the cord might be torn from the placenta, by the roots, or else it
might draw the fundus of the uterus after it, and thus cause inversio
Uteri.

Those who have had this latter affection to deal with, will easily
appreciate any plan recommended for its partial prevention.

Stony Point Mills, Cumberland county, Va., April 23, 1851.

Powers' and Weightman's Chloroform.

Having failed in my efforts to test the purity of the chloroform pre-
pared by Messrs. Powers and Weightman in time for the report of the
committee on anaesthesia, I have since ascertained its specific gravity
to be 1.47777 instead of 1.48, the chemical standard. Owing to the
high temperature of the room where the scales were kept, I am sure
this is rather under than over the true sp. gr. This extremely slight
difference, if any, is altogether inappreciable in practice. It is highly
commendable to the honor and skill of the manufacturers that they
prepare the article for commercial purposes of such very great pu-
rity. Does not this account for the fact that no injurious consequences
have been observed in Richmond in about 1400 cases?

J. BOLTON.

AMERICAN MEDICAL ASSOCIATION. 329

The American Medical Association.

The meeting of this body took place on Tuesday, May 6th, in St.
Andrew's hall, at Charleston, S. C. The president, Dr. Mussey, of
Ohio, took the chair at 11 o'clock, and called the association to order.

Dr. Frost, on behalf of the committee of arrangements, read the
list of delegates who had reported themselves ; (this list is too long to
be published here — there were some two hundred in attendance, and
they represented twenty-five states. The following gentlemen com-
posed the delegation from Virginia: Drs. B. R. Wellford, P. C.
Gooch, M. P. Scott, J. P. Tabb, H. C. Worsham, W. W. Par-
ker, Medical Society of Virginia; C. P. Johnson and D. H. Tuck-
er, Medical Department of Hampden Sydney College ; J. W. Walke
and J. G. Lumpkin, Soc. Alumni of ditto, Hugh McGuire, Winches-
ter Medical College, and F. W. Powell, Middleburg.)

The association having been organized, Dr. Thos. Y. Simons, the
chairman of the committee of the South Carolina Medical association,
in a warm and hearty address, welcomed the delegates present from
the other states to the city and state, on behalf of his associates,
which was responded to in a becoming manner by the president.

The president of the association read a letter from Dr. Stille, re-
signing his office, in consequence of the impaired state of his health.

On motion of Dr. Arnold, of Savannah, Ga., it was proposed that
the letter of Dr. Stille be placed on record, in compliment to him,
for the interest he has manifested in the association.

Dr. Arnold offered the following resolution, which was adopted :

Resolved, That a committee of one from each state represented in
the association, to be chosen by their respective delegates, be ap-
pointed to nominate suitable officers to be elected for the ensuing
year.

The association took a recess for ten minutes, to allow the delega-
tions to elect their committeemen under the above resolution.

On the re-assembling of the convention, the president reported the
following gentlemen as having been selected as the nominating com-
mittee : Drs. B. It. Wellford, of Virginia; Geo. Mendenhall, of
Ohio ; Joseph Fithian, of New Jersey ; R. D. Arnold, of Georgia ;
G. W. Miltenberger, of Maryland ; H. R. Frost, of South Caro-
lina; N. G. Pittman, of North Carolina; W. H. Anderson, of Ala-
bama ; A. H. Stephens, of New York ; Usher Parsons, of Rhode
Island; Jos. Carson, of Pennsylvania; H. Adams, of Massachusetts ;
Thos. Reyburn, of Missouri; Jas. Jones, of Louisiana; J. B.
Flint, of Kentucky; John Sloan, of Indiana; C. Boyle, of the
District of Columbia, and J. B. Lindsey, of Tennessee.

The committee having retired, the president delivered an address
of some length on matters connected with the association, and the
advancement of medical science. It was received with marked at-
tention and applause.

330 AMERICAN MEDICAL ASSOCIATION.

The nominating committee, through their chairman, then read the
subjoined names as suitable candidates for officers of the association
for the ensuing year, viz :

Dr. James Moultrie, of S. C, President.

Dr. Geo. Heyward, of Mass.,")

Dr. R. D. Arnold, of Geo., I TT. „ ••.

Dx> r> \xr c \r r rice- Presidents.

r. 13. R. Wellford, of Va., f

Dr. J. B. Flint, of Kentucky, J

Dr. H. W. Desaussure, of S. C, > 0

Dr. P. C. Gooch, of Va., \ Secretaries.

Dr. Isaac Hays, of Pa., Treasurer.

On motion of Dr. La Roche, of Pennsylvania, the report was ac-
cepted, and the gentlemen thus nominated were elected the officers
of the association for the ensuing year, and they were invited to take
their seats on the platform.

The president elect then took the chair, and in a few appropriate
remarks, returned his thanks for the honor thus conferred on him by
the association.

The secretary read a report transmitted to him from the committee
on unfinished business, appointed at the session of 1S50, which,

On motion of Mr. Arnold, was accepted and laid on the table.

On motion of Dr. Gaillard, of South Carolina, the following re-
solution offered by Dr. Drake, of Cincinnati, at the session of 1S50,
be taken up for consideration:

Resolved, That the second section of the regulations of the associa-
tion be so amended as to require that candidates for membership by
invitation, be nominated in writing by five members ; that when
elected they shall enjoy all the rights of delegates, and that all per-
manent members shall be entitled to vote.

After some discussion, on motion of Dr. A. H. Stevens, of New
York, the resolution was referred to a committee, consisting of Drs.
Drake, of Ohio, Wood, of Penn., and Wellford, of Virginia.

Dr. Stevens, of New York, offered the following resolution, which
was discussed by Drs. Storer, of Mass., and Moore, of Georgia, and
finally rejected:

Resolved, That a committee be appointed to report to the associa-
tion the business before it, and to offer such suggestions as they may
deem advisable for the due discharge of the same.

On motion, the association adjourned to meet on Wednesday morn-
ing at 10 o'clock.

Second Day.

The president called the association to order at 10 o'clock, and the
minutes of the preceding meeting were read and confirmed.

Dr. Wood asked and obtained leave to read the following report,
on amending the constitution, signed by himself and Dr. B. R. Well-
ford :

The committee to whom was referred the proposition of Dr. Drake,
for an alteration of the rules in relation to the admission and rights of
members, have the honor to report as follows :

AMERICAN MEDICAL ASSOCIATION. 331

There are two distinct branches of the proposition ; the first of
which relates to the invitation of medical men not delegates to parti-
cipate in the proceedings of the association ; the second has in view
the extension of the right of voting to permanent members.

The committee agree in the general purport of the first part of the
proposition. As it now stands, the rule admits of a too easy admis-
sion to the privileges of members, and it is susceptible of great abuse.
It might happen, in a place where the number of physicians was very
considerable, that sufficient might be introduced to control the deci-
sions of the delegates. To guard against such a result, the committee
recommend, that, in addition to the provision that none should be in-
vited by the association unless upon a previous written proposal by
five delegates, the existing rule should be so altered as not to confer
upon the invited members the privilege of voting.

In relation to the second part of the proposition, that, namely, which
gives the privilege of voting to permanent members, the committee do
not consider its adoption advisable, on the following grounds : This
association is essentially a representative body. Its opinions are sup-
posed to be those of the societies or associations by which the dele-
gates are appointed, and go forth to the world with the authority in
some degree of the medical profession generally. Now, if permanent
members were permitted to vote, they would express their own indi-
vidual opinions and support their own individual preferences; both
of which might be in direct opposition to those of the delegates, and
not fairly representative of general medical sentiment. It is easy to
conceive that combinations among permanent members might be
formed, more powerful than the properly delegated body, which might
thus be overruled in its decisions. The opinions or wishes of a com-
paratively few individuals might thus go forth to the world as those
of the profession at large, and private purposes might be answered
at the expense of the general good. This would defeat the main ob-
jects of the association, and prevent it from continuing what it may
now be considered to be, the exponent of enlightened medical senti-
ment in this country.

The committee, therefore, recommend that the question on Dr.
Drake's proposition be taken separately upon its two branches; that
the first be adopted with a modification, withholding the right of voting
from invited members ; and that the second, which confers this right
upon permanent members, be not adopted.

GEO. B. WOOD,
B. R. WELLFORD.

Charleston, (S. C.,) May 7, 1851.

Dr. Drake then read the subjoined minority report:
The undersigned, a minority of the committee to whom was re-
ferred the resolution for amending the second section of the constitu-
tion, begs leave to report, that in his opinion it is expedient, and will
be found promotive of the great objects for which the association was
formed, that " members by invitation" should not be admitted, except
under a written nomination by five members ; that when thus chosen,

332 AMERICAN MEDICAL ASSOCIATION.

they should enjoy all the rights and privileges of delegates, including
permanent membership ; and that all permanent members should be
entitled to vote. With these views the undersigned respectfully sub-
mits a revision of the resolution into the following :

Resolved, That members by invitation shall be nominated in writing,
by five members, which nomination shall be made a matter of record ;
that when elected they shall enjoy the rights and privileges of dele-
gates, and remain as permanent members of the association.

Resolved, That all permanent members shall have the right of voting.

Respectfully submitted.

DAN. DRAKE.

Dr. I. Hays moved to take up the majority report, which motion
was carried.

Dr. Arnold spoke against the article of the constitution authorizing
invited members to vote.

Dr. Wood explained his report, and urged its adoption.

Dr. Davis, of Chicago, said that there was much misunderstanding
in regard to the intention of the constitution in respect to the mem-
bers by invitation. He hoped that the constitution would be strictly
acted up to, and that members should be invited only " from sections
not otherwise represented."

Dr. Wood said his was an amendment, and not a repeal of the old
provision.

Dr. Drake responded — he had waited for arguments against his
resolution, but had heard none. He then entered into a long argu-
ment in favor of popularizing the association with the profession in the
United States, and took ground in favor of a permanent place of meet-
ing at Washington City.

Dr. W. Atlee, of Pennsylvania, said he could see no harm in giving
the privilege of voting to invited members who came from unrepre-
sented localities, but was opposed to the right of voting proposed to
be given to permanent members.

Dr. Meigs, of Philadelphia, asked whether a gentleman would be
invited to attend without any privileges, and went on to say that he
hoped the association would have five, ten or even twenty thousand
members at some future period.

Dr. Hooker, of Connecticut, begged to be allowed to offer the fol-
lowing resolution, the resolution of Dr. Drake, having been laid on
the table for the present :

Resolved, That no member be permitted to speak longer than ten
minutes at any one time in any one debate.

Dr. Philips, of New York, offered to amend the resolution by in-
serting "15," which motion was lost.

The resolution as offered by Dr. Hooker, was then adopted.

Dr. Hays moved to lay the subject on the table, and added that by
a constitutional provision it was required to lay over one year.

The motion was seconded by Dr. Tucker, of Virginia.

Dr. Dickson, of South Carolina, asked if the motion swept off the
whole resolution, and was answered affirmatively by Dr. Hays.

AMERICAN MEDICAL ASSOCIATION. 333

Dr. said if the matter was postponed now they would not

be out of difficulty, because all that is necessary to defeat it next year
would be to move to amend it, and it would have to lay over a year
again, &c.

The matter was finally laid on the table.

Dr. Wood, of Pennsylvania, called up the second part, or that por-
tion giving to permanent members the right to vote.

The majority of the committee accepted the substitute of the mi-
nority, which was read as follows, viz :

Resolved, That all permanent members shall have the right of voting.

Dr. Dickson urged the adoption of the above resolution.

Dr. Hays, of Philadelphia, remarked that the constitution had not
been studied by the gentleman who had urged the adoption of the re-
solution, and spoke in opposition to the measure.

Dr. Thompson, of Delaware, supported Dr. Hays, and hoped that
the whole matter would be laid over for a year.

Dr. Dickson observed that he had been accused of ignorance of the
constitution. He hoped to have these gentlemen always here to in-
struct him.

Dr. Bond, of Maryland, took part in the discussion.

Dr. Adams, of Massachusetts, remarked that they ought to strike
out the words "permanent delegates" from the constitution, and was
proceeding with his remarks, when the gentleman was called to order.

The question was here taken on the adoption of the resolution,
which was lost by a large majority.

Dr. I. Hays, the treasurer of the association, then read the report of
the committee of publication and also the report of the treasurer.

The subjoined resolutions, appended, were read and adopted :

1. Uesolved, That the assessment for the present year shall be $3.

2. Resolved, That those delegates who pay the assessments shall
be entitled to one copy of the transactions for the present year, and
that the payment of two dollars, in addition, shall entitle them to two
additional copies.

3. Resolved, That permanent members shall be entitled to one copy
of the transactions for the present year on the payment of two dollars,
and three copies on the payment of five dollars.

4. Resolved, That societies which have been represented in the
association shall be entitled to copies for their members on the same
terms that copies are furnished to permanent members.

5. Resolved, That permanent members, unless present at the meet-
ing as delegates, shall not be subject to any assessment.

6. Resolved, That any delegate who is in arrears for his annual
assessment shall not be considered as a permanent member.

7. Resolved, That the several committees be requested to bring to
the meeting of the association their reports, correctly and legibly
transcribed, and that they be required to hand them to the secretaries
as soon as they have been read.

All which is respectfully submitted.

ISAAC HAYS,
Philadelphia, April 20, 1851. D. FRANCIS CONDIE.

37

334 AMERICAN MEDICAL ASSOCIATION.

Dr. Drake, of Ohio, moved that the report on surgery be read
first. Adopted.

Professor Eve, chairman of the committee on surgery, then pro-
ceeded to read his report.

A motion was made by Dr. Davis to commit the same to the com-
mittee on publication ; which was adopted.

Dr. Hays moved to read Dr. Flint's report by its title — Practical
Medicine — and refer the same to the committee on publication, which
motion was adopted, and the several hundred copies printed and fur-
nished by the author were directed to be distributed among the dele-
gates present.

A motion was then made to adjourn till 5 o'clock, P. M., which
was adopted.

Afternoon Session.

The president having called the meeting to order,

Dr. Boyle, of Washington, offered a resolution that the association
in future meet in Washington city.

Dr. Gooch extended an invitation from the Medical Society of
Virginia to hold the next meeting in Richmond city, which he said
was in accordance with the instructions of the delegation, and Dr.
Carter P. Johnson, from the medical faculty of Hampden Sidney
college, presented an invitation to the same effect. Invitations were
also presented by Dr. Jones, of the University of Louisiana, to meet
at New Orleans, and Dr. J. P. Johnston, of Missouri, to meet at St.
Louis. The resolution and invitations were referred to the committee
on nominations.

The president suggested the propriety of appointing the standing
committees at an early day.

Dr. Wood remarked that there was a proposition to abolish stand-
ing committees.

Dr. Hays said he was opposed to these committees, but would not
press an alteration.

Dr. Tucker moved that the appointment of the standing commit-
tees be referred to the committee on nominations, which motion was
adopted.

Dr. Jones, of Louisiana, resigned as a member of the committee of
nominations, and Dr. Fenner, of New Orleans, was appointed in his
place.

Dr. Parsons then moved that the committee of nominations be re-
quested to resume its labors, which was adopted.

Dr. Wragg, of Charleston, moved that the report of the committee
on prize essays be read, and then that the obstetric report be brought
up. Carried.

The report on prize essays was then read, and the resolutions ap-
pended thereto were adopted.

When, on motion of Dr. Ready, of South Carolina, the whole mat-
ter was referred to the committee of publication.

Dr. Storer, of Boston, chairman of the committee on obstetrics,
read the report on that subject. He stated that he had received a

AMERICAN MEDICAL ASSOCIATION. 335

letter from Dr. Thompson, of Illinois — that he was the only member
of the committee who had aided him in any degree. He mentioned
this fact, because he had to hold himself entirely responsible for all
the inaccuracies, &c.

Dr. Phelps, of New York, moved that the report be referred to the
committee of publication.

Dr. Robertson, of South Carolina, moved that the statistics al-
luded to in the report be stricken out, as they had been taken from a
source not very reliable.

Dr. Storer seconded the motion.

Dr. Bond moved to postpone the report until morning, which was
seconded by Dr. Gilman.

A short debate here ensued ; when it was finally agreed to re-com-
mit said portion of the report, to be corrected and laid before the as-
sociation in the morning.

On motion, the association adjourned to meet on Thursday morn-
ing at 10 o'clock.

Third Day.

The president, Dr. James Moultrie, took the chair at 10 o'clock.

The minutes of the previous meeting were read, and after some
slight amendments, were confirmed.

Dr. J. M. Smith, of Massachusetts, moved that the report of the
committee on medical education be made the special order, after the
disposal of the report on the committee of obstetrics.

Dr. Gaillard, on behalf of the committee of arrangements, read a
list of delegates reported and registered since the last report.

Dr. Campbell, of Georgia, presented a model of a malformation
of the knee joint, the patella being absent.

Dr. Wood, of Pennsylvania, offered the following resolution :

Resolved, That colleges, exclusively of dentistry and pharmacy,
are not recognized by the association as among the bodies authorized
to send delegates to its meetings.

Dr. Wood, of New York, moved to amend, by dividing the resolu-
tion, so as to make the question, first, on the reception of delegates
from colleges of dentistry ; secondly, on the reception of delegates
from colleges of pharmacy.

The amendment having been accepted, the question of the recep-
tion of delegates from colleges of dentistry was debated.

Dr. Lamb moved an indefinite postponement of the resolution,
which was lost.

Dr. Yard ley, of Pennsylvania, asked and obtained leave to read
a resolution from the Philadelphia county medical society.

The discussion of the original question was then resumed.

A motion was finally marie by Dr. Hays, of Pennsylvania, that
the whole resolution of Dr. Wood, including colleges of dentistry and
pharmacy, be referred to a special committee of five members, which
resolution was adopted.

On motion of Dr. Yardley, of Pennsylvania, the resolution pre-

336 AMERICAN MEDICAL ASSOCIATION.

sented by the Philadelphia county medical society was also sent to
the same committee.

Dr. Jones, of North Carolina, offered the following resolution :

Resolved, That all the medical colleges in the United States are
hereby earnestly and respectfully requested to hold a convention,
through delegates respectively chosen by them, at least once in every six
years, to take into consideration the proper method of harmoniously
elevating the standing of medical education in the said colleges.

The order of the day was then called up, when Dr. Storer re-
ported that he had erased the statistics referred to yesterday, and that
he placed the report in the hands of the association. Dr. S. said
that there was objection to the remarks on the subject of Dr. Gil-
man's paper on the speculum relm. He asked that he be permitted
to remove the unnecessary expression of opinion in regard to that sub-
ject. He further added, that he had taken from the journals these
facts, and was not therefore responsible for the correctness of the pa-
pers, &c.

Dr. Bond, of Maryland, remarked that there were charges in these
reports which he did not individually endorse, but which go out in a
book under the sanction of the association.

On motion of Dr. Davis, the report was referred to the committee
of publication.

At this stage of the proceedings, Professor S. S. Holdeman, of Lan-
caster county, Pennsylvania, through Dr. John L. Atlee, presented
to the association an essay on Latin pronunciation, of which he is the
author ; and which, on motion of Dr. Atlee, was referred to the com-
mittee on medical literature.

On motion, the regular order was suspended for the reception of
the report of the committee of nominations, which was read and laid
on the table.

Dr. Hays then called up the resolution on page 43, vol. 2 of the
Transactions of the Association, and moved to strike out " all that re-
lates to committees," &c.

The motion was seconded by Dr. Stevens, and urged by Dr.
Drake, who announced some ten or twelve special points, which he
said ought to occupy the association, instead of being occupied with
epitomes of Rankin & Braithwaite.

Dr. Hooker, of Conn., spoke of the looseness of committees and
editors of journals.

Dr. Davis thought that they could decide on the matter at once.

Dr. Hays proposed to dispense with the standing committees. The
question was then taken on the resolution, which was adopted.

Dr. Wood, of Penn., offered the following resolution, which was
adopted :

Resolved, That a committee be appointed to take into consideration
the arrangement of a committee for future action, to report as speedily
as possible.

The chairman of the committee on medical education was about to
read the regular report on that subject, when Dr. Drake moved the
suspension of the reading till after the recess, as it was a very long
report.

AMERICAN MEDICAL ASSOCIATION. 337

On motion of Dr. Johnston, of Missouri, the report of the commit-
tee on medical literature was then taken up.

Dr. Desaussure announced that Dr. Davis would read a paper
entitled " An experimental enquiry concerning some points connected
with the process of assimilation and nutrition."

Dr. Reyburn, of Missouri, presented and read the report of the
committee on medical literature. In the course of his reading the re-
port, he gave way to a motion to adjourn, which was carried.

Afternoon Session.

The president took the chair at half past 5 o'clock.

The secretary announced the following gentlemen as having been
appointed by the president, under a resolution of this morning, concern-
ing a committee for the arrangement of business for the occupation of
the association in future : Drs. G. Wood, of Pennsylvania, J. Hays,
D. Drake, A. H. Stevens, W. Hooker, B. R. Wellford and S.
H. Dickson.

The following gentlemen were appointed a committee under a re-
solution in regard to schools of pharmacy and dental surgery, viz :
Drs. Hays, Stevens, Yardley, Storer and Jones.

Dr. Dickson moved the following preamble and resolutions, which
were seconded by Dr. Lebby, and unanimously adopted without de-
bate :

Whereas efforts are being made to repeal the law of 1847, which
confers protective ranks on the members of the medical department
of the army — Therefore,

Resolved, That the American Medical Association views with re-
gret the existence of hostility to the act of congress, approved Febru-
ary 11, 1S47, which confers legal rights and equality with other staff
departments on the medical officers of the army, and gives them a
position to which the importance and character of the profession enti-
tle them.

Resolved, That copies of these resolutions, with the resolutions of
the association passed at its last annual meeting on the same subject,
be transmitted to the secretaries of war and of the navy, through the
chiefs of the medical department of each service, and to the presiding
officers of the senate and house of representatives of the United
States.

The reading of the report of the committee of medical literature
was then concluded.

On motion, the report was received and referred to the committee
on publication.

The report of the committee on medical education was then called
for, and as the hour was late, the chairman read only so much of it
as relates to demonstrative midwifery, which had by special resolution
been referred to the committee.

On motion, the report was accepted, and referred to the committee
on publication.

Dr. Dickson then offered the following resolution, which was
adopted :

338 AMERICAN MEDICAL ASSOCIATION.

Resolved, That this association unanimously approve of the opinions
expressed in the report of the committee on medical education in re-
spect to demonstrative midwifery.

The association then adjourned to meet at 10 o'clock on Friday.

Fourth Day.

The president, Dr. James Moultrie, in the chair.

The minutes of the last meeting were read and confirmed.

The report of the committee on medical education being the special
order, Dr. Stevens, of New York, asked and obtained leave to intro-
duce the following resolutions :

Resolved, That the members of this association cannot separate
without expressing their grateful sense of the hospitalities and nume-
rous delicate attentions received from their medical brethren of South
Carolina and the citizens of Charleston.

Resolved, That a committee be formed to procure a tablet, with a
suitable inscription, commemorative of this meeting and the feeling
it has elicited, to be placed at the disposal of the Medical Association
of South Carolina.

Inscription. — " This tablet is here placed by the American Medical
Association, to commemorate their annual meeting in the city of
Charleston in May 1851, and to signalize their gratitude for the extra-
ordinary professional and social enjoyments that accompanied it."

The resolutions having been seconded were adopted ; and Dr.
Stevens further moved that Drs. Hayward, of Mass., F. A. Ramsey,
of Tenn., and himself constitute the committee.

Dr. Ramsey, of Tenn., asked and obtained leave to read a letter
from Dr. E. D. Fenner, of Louisiana, and offered the following reso-
lution on the subject, which was adopted :

Resolved, That the efforts of Dr. Fenner to place on a firm and
durable basis an annual publication, embracing medical reports from
the whole Southern portion of the Union, merit the commendation of
this association, and should receive solid support from American phy-
sicians.

Dr. Hays, of Pa., asked and obtained leave to call up for conside-
ration so much of the report of the nominating committee as relates
to the selection of the next place of meeting of the association, and
the appointment of the committee of arrangements and the committee
of publication, the other standing committees having been abolished.
The report having been read, Dr. Drake, of Ohio, made an urgent
appeal in favor of Washington city as the next place of meeting.
The question being taken on the adoption of that part of the report
of the committee, which proposed Richmond, (Va.,) it was adopted
by a large majority. The question being taken on the confirmation of
the committee of arrangements and publication, the nominations of
the committee were confirmed.

Richmond, Va., was selected as the nest place of meeting by the
association, and the following gentlemen appointed a committee of
arrangements, viz : Drs. R. W. Haxall, Chairman ; Carter P.
Johnson, James Beale, Chas. B. Gibson, S. Maupin, R. D. Has-

AMERICAN MEDICAL ASSOCIATION. 339

kins, C. S. Mills and M. P. Scott. Committee of Publication —
Drs. Hays, of Pa., G. Emerson, of Pa., D. F. Condie, of Penn., H.
W. Desaussure, of So. Ca., J. Parrish, of Penn., P. C. Gooch, of
Va., and G. W. Norris, of Penn.

Dr. Hooker, of Conn., chairman of the committee on medical edu-
cation, completed the reading of the report on that subject, and of-
fered the following resolutions :

Resolved, That the abuses which exist in the modes of medical edu-
cation pursued in this country demand the serious consideration of
the profession.

Resolved, That free discussion in relation to these causes is an im-
portant means of effecting their removal.

Resolved, That in the opinion of this association no effort to remove
these abuses can succeed, that is not based upon a reform in the pub-
lic sentiment, both of the profession and of the community.

Resolved, That this reform, so far as the profession is concerned, is
to be effected mainly through its organizations, and that it is therefore
incumbent upon every physician to do all that he can to give them
character and efficiency.

Resolved, That this association has confidence in all proper efforts
which have for their object a reform in the sentiments and practiceof
the community in relation to medicine and the medical profession.

Resolved, That the recommendations of this association at its former
meetings in regard to education, both preliminary and medical, be re-
affirmed, and that both the schools and private preceptors be still
urged so to do their duty as to secure to the community a well-edu-
cated profession.

Resolved, That in the work of medical reform, while all precipitate
movements should be avoided, we should aim at a steady advance,
from year to year, till a thorough S37stem of education be established
by the profession throughout our country.

Dr. Wood, of Pennsylvania, asked leave to suspend the order usu-
ally taken with reports. Permission being granted, he read the fol-
lowing report, wThich was adopted :

The committee to whom was referred the subject of arranging a
plan of committees for future action, in place of the standing com-
mittees abolished by the association, have the honor to report as fol-
lows :

It appears to them that the most feasible plan of accomplishing the
objects of the association is to select certain subjects which may be
considered as suitable for investigation, and to refer these subjects to
special committees, to be appointed before the close of the present
session, and to report to the next. Such a selection the committee
have accordingly made, and will offer to the consideration of the as-
sociation.

As an additional means of securing valuable contributions, they
propose, also, the appointment, of a committee, whose business it
shall be, in the interval between this and the next session, to receive
original volunteer papers, upon any subjects which their authors may
choose, to decide upon the merits of these papers ; and to present to

340 AMERICAN MEDICAL ASSOCIATION.

the association, at its next session, such of them as they may deem
worthy of receiving this direction. With a view to increase competi-
tion, they think it advisable that a prize of fifty dollars, or a gold me-
dal of that value, be awarded to each of the five papers presented to
the association, or any smaller number of them, which the committee
may consider most meritorious and the association may resolve to
publish.

In reference to the resolution presented in the report of the stand-
ing committee on medical literature, and referred to the present com-
mittee, they have only to observe that, as its ends will probably be
most effectively obtained by the adoption of the general plan which
they have already brought before the notice of the association, they
do not consider it expedient to make any further report.

As to the appointment of the special committees referred to, your
committee think that the most convenient plan will be to refer to a
special committee the nomination of a chairman for each, who shall
then select, at his convenience, two individuals to aid him, with the
restriction only, that the persons so selected shall be members of the
association.

To the same nominating committee may be referred the appoint-
ment of the general committee, whose business will be to receive and
judge whatever papers they may receive. As this general committee
must frequently compare opinions, it will be desirable that they should
reside near each other, and it is accordingly proposed that they should
be chosen from one neighborhood. If the plan be found to work well,
this locality may be changed every year, so that each section of the
Union may in its turn be charged with this duty. The committee
would suggest that the general committee should be first chosen from
members of the association, residing in Boston or its neighborhood, as
the most Northern point.

To embody these suggestions in due form, the committee offer the
following resolutions :

1. Resolved, That committees of three be appointed to investigate
and report severally on the following subjects :

1st. Causes of the tubercular diathesis.

2d. Blending and conversion of the types of fever.

3d. The mutual relations of yellow fever and bilious remittent fever.

4th. Epidemic erysipelas.

5th. Acute and chronic diseases of the uterus and its neck.

6th. Dengue.

7th. The milk sickness, so called.

8th. Endemic pi'evalence of tetanus.

9th. Diseases of parasitic origin.

10th. Physiological peculiarities and diseases of negroes.

11th. The action of water on lead pipes, and the diseases which
proceed from it.

12th. The alkaloids which may be substituted for quinia.

13th. Permanent cure of reducible hernia.

14th. Results of surgical operations for the relief of malignant dis-
eases.

15th. Statistics of operations for removal of stone in the bladder.

AMERICAN MEDICAL ASSOCIATION. 341

16th. Cold water dressings.

17th. The sanitary principles applicable to the construction d£
dwellings.

18th. The toxicological and medicinal properties of our crypto-
gamic plants. i

19th. Agency of the refrigeration produced through upward radia-r,
tion of heat as an exciting cause of disease.

20th. Epidemic diseases of New England and New York.

21st. Epidemic diseases of Pennsylvania, New Jersey, Delaware
and Maryland.

22d. Epidemic diseases of Virginia and North Carolina.

23d. Epidemic diseases of South Carolina, Georgia, Florida and
Alabama.

24th. Epidemic diseases of Mississippi, Louisiana, Texas and Arr
kansas. <

25th. Epidemic diseases of Tennessee and Kentucky.

26th. Epidemic diseases of Missouri, Illinois, Iowa and Wisconsin.

27th. Epidemic diseases of Indiana, Ohio and Michigan.

II. Resolved, That a committee of nomination be appointed, whose
duty it shall be to nominate the chairman for each of the above com-
mittees.

III. Resolved, That each of the chairmen thus nominated shall se-
lect, at his earliest convenience, the members of the association to
complete the committee. j

IV. Resolved, That a committee of five members be appointed, to
be called the committee for volunteer communications, whose duty it
shall be, in the interval between the present and the next succeeding
session, to receive papers upon any subject from any persons who may
choose to send them, to decide upon the merits of these papers, and
to select for presentation to the association, at its next session, such as
they may deem worthy of being thus presented.

V. Resolved, That the committee for volunteer communications
shall have the power to form such regulations as to the mode in which
the papers are to be presented, and as to the observing of secrecy or
otherwise, as they may think proper.

VI. Resolved, That the selection of the members of this committee
be referred to the same nominating committee, whose duty it will be
to appoint the chairman of the several special committees as above
directed, with this restriction, that the individuals composing it shall
reside in the same neighborhood. •

VII. Resolved, That a prize of fifty dollars be awarded to each of
the volunteer communications reported on favorably by the committee,
and directed by the association to be published : Provided, That the
number to which the prize is thus awarded do not exceed five ; and,
provided, also, if the number approved and directed to be published
exceed five, that in such case the prize be awarded to the five which
the committee may determine to be most meritorious.

All of which is respectfully submitted.

GEO. B. WOOD, Chairman. ;
Charleston, May 9th, 1851.
38

342 AMERICAN MEDICAL ASSOCIATION.

Dr. Hays, of Pennsylvania, gave notice, that at the next meeting of
the association he should offer an amendment to the constitution, line
4, so as to read " $10, instead of $ 3."

Dr. Atlee, of Pennsylvania, remarked on the value of the report
of the committee on medical education, and offered the following re-
solution, which was adopted :

Resolved, That it be recommended to the several state medical so-
cieties throughout the Union, to procure are-publication of the report
of the committee on medical education, for general distribution among
the profession.

Dr. Drake offered the following resolution :

Resolved, That in the opinion of the association, the students of our
schools should be required to matriculate within the first days af-

ter the opening of the sessions, and continue their attendance to the end
of the terms, taking with them evidence of the same, to be presented
with tickets of the professors when they become candidates for de-
grees.

The resolution was adopted, and Dr. Gibson moved to defer the
filling up of the blank. Some discussion arose on this point, when
the resolution was left to read, " within the first days," &c.

The report of the committee on medical science was then called
up, when a letter was read from Dr. Dowler, chairman of said com-
mittee, regretting his inability to be present, and the necessity of send-
ing it.

Dr. Fenner then read the outlines of the report, and asked per-
mission to retain the same for revision, copying, &c, which was
granted.

Dr. Mauran offered the following resolution, which was adopted :

Resolved, That the committee on publication be instructed to print
conspicuously upon the title page of the forthcoming volume of the
transactions, the following declaration, viz : " The American Medical
Association, although formally accepting and publishing the reports
of the various standing committees, holds itself wholly irresponsible
for the opinions, theories or criticisms therein contained."

Dr. Storer moved the following resolution, which was adopted :

Resolved, That the hearty thanks of this association be presented
to their late secretary, Alfred Stille, M. D., for his constant, un-
wearied and invaluable services since its first organization.

The secretary then read the report of the committee on " adulte-
rated drugs."

Dr. Gooch expressed his disapprobation of the report, on account
of its meagreness, &c

A motion was made to refer the same to the publication committee ;
which was rejected.

Dr. Gooch then moved to lay it on the table, which motion prevailed.

Dr. Gaillard, of South Carolina, chairman of the committee on hy-
giene, presented an outline of the report on that subject. Referred to
the committee of publication, with authority to append thereto a pa-
per now in preparation, on the mortuary statistics of certain cities.

Dr. Drake, of Ohio, offered the following amendments to the con-
stitution, which were read and ordered to lie over under the rule :

AMERICAN MEDICAL ASSOCIATION. 343

" All members by invitation must be nominated in writing by five
members of the association, whose names shall be recorded in the mi-
nutes. When elected, they shall enjoy all the rights and privileges of
delegates, and remain permanent members of the association.

" All permanent members shall be entitled to vote, and when they
attend a meeting of the association, their respective names shall be re-
gistered, and each shall pay the sum required from a delegate."

The secretary read a protest from the Iowa University, against the
representation of Rush medical college in this association.

Dr. Jervey moved to refer the protest to a special committee, to
report at once.

Dr. Wood moved to refer it to the committee on colleges of phar-
macy and dentistry, which was carried, Dr. Jervey having withdrawn
his motion.

Dr. Wood read the following report of the committee of nomina-
tions, which was adopted :

The committee to whom was referred the nomination of the chair-
men of the several special committees, to report at the next session,
and also of the committee for volunteer communications, report that
they have fulfilled the object of their appointment, and offer the fol-
lowing list of chairmen to the committees first referred to, viz :

1st. Dr. D. F. Condie, Philadelphia, chairman to the committee on
the causes of the tubercular diathesis.

2d. Dr. S. H. Dickson, of Charleston, S. C, on the blending and
conversion of the types of fever.

3d. Dr. James Jones, of New Orleans, on the mutual relations of
yellow and bilious remittent fever.

4th. Dr. John B. Johnston, of St. Louis, Mo., on epidemic ery-
sipelas.

5th. Dr. Charles D. Meigs, of Philadelphia, acute and chronic dis-
eases of the neck of the uterus.

6th. Dr. J. P. Jervey, of Charleston, S. C, on dengue.

7th. Dr. Daniel Drake, of Cincinnati, milk sickness — so called.

8th. Dr. Lopez, of Mobile, Ala., epidemic prevalence of tetanus.

9th. Dr. George B. Wood, of Philadelphia, on diseases of parasitic
origin.

10th. Dr. R. D. Arnold, of Savannah, Geo., on the physiological
peculiarities and diseases of negroes.

11th. Dr. Horatio Adams, of Waltham, Mass., on the action of wa-
ter on lead pipes, and the diseases which proceed from it.

12th. Dr. Jos. Carson, Philadelphia, on the alkaloids which may
be substituted lor quinia.

13th. Dr. Geo. Hayward, Boston, Mass., on the permanent cure of
reducible hernia.

14. Dr. S. D. Gross, Louisville, Kentucky, on results of surgical
operations for the relief of malignant diseases.

15. Dr. James R. Wood, New York, statistics of the operation for
the removal of stone in the bladder.

16. Dr. Charles A. Pope, St. Louis, Missouri, water, its topical uses
in surgery.

344 AMERICAN MEDICAL ASSOCIATION.

' 17. Dr. Alex. H. Stevens, New York, sanitary principles applica-
ble to the construction of dwellings.

' 18. Dr. Porcher, Charleston, S. C, toxicological and medicinal pro-
perties of our cryptogamic plants.

v 19. Dr. G. Emerson, Philadelphia, agency of the refrigeration pro-
duced through upward radiation of heat, as an exciting cause of disease.

20. Dr. Worthington Hooker, Connecticut, on the epidemics of New
England and New York.

21. Dr. John L. Atlee, of Lancaster, Penn., on the epidemics of
New Jersey, Pennsylvania, Delaware and Maryland.

22. Dr. Robert W. Haxall, Richmond, Va., on the epidemics of
Virginia and North Carolina.

■ 23. Dr. Wm. M. Boiling, Montgomery, Ala., on the epidemics of
South Carolina, Georgia, Florida and Alabama.

24. Dr. Ed. H. Barton, Louisiana, on the epidemics of Mississippi,
Louisiana, Texas and Arkansas.

25. Dr. Sutton, Georgetown, Ky., on the epidemics of Tennessee
and Kentucky.

26. Dr. Thomas Reyburn, Missouri, on the epidemics of Missouri,
Illinois, Iowa and Wisconsin.

27. Dr. George Mendenhall, Ohio, on the epidemics of Ohio, Indi-
ana and Michigan.

The following gentlemen were appointed on the committee for vo-
lunteer communications, viz : Drs. Geo. Hayward. J. B. J. Jackson,
D. H. Slorer, and Jacob Bigelow of Boston, and Dr. Usher Parsons,
Of Providence, R. I.

Signed in behalf of the committee.

GEO. B. WOOD, Chairman.

Charleston, Friday, May 9th, 1851.

The president read an invitation from the committee of reception to
a steamboat excursion on the Cooper and Ashly rivers, on Saturday.

Dr. M'Intyre, of New York, proposed that the code of ethics and
constitution of the association be recommended to be published by the
several state societies. Proposition adopted.

• Dr. Grimshaw offered the following resolution, which was laid on
the table :

Resolved, That medical colleges, in publishing statements of the
number of medical and surgical cases treated at their dispensaries,
act contrary to the spirit of the code of ethics adopted by this body.

Adjourned till 5 o'clock.

Afternoon Session.
> The association re-assembled at 5 o'clock, Dr. B. R. Wellford, of
Virginia, vice-president in the chair.

U The special order was called for, and Dr. Davis, of 111., read a pa-
per on the influence of certain diet on the functions of respiration and
calorification, &c.

The president, Dr. James Moultrie, resumed the chair.
-'. Dr. Hays moved to proceed with the consideration of unfinished
business.

MEDICAL SOCIETY OF VIRGINIA. 345

Dr. Grimshaw offered the subjoined resolution, which was adopted:

Resolved, That the thanks of the association be returned to Dr. Da-
vis for the paper just presented by him.

Dr. F. A. Ramsey, of Tenn., called up, as unfinished business, the
resolution offered yesterday by Dr. Jones, of Tenn., and not then
acted upon, to which Dr. Grimshaw offered the following amend-
ment : " And that the first convention be held before the first of May
1852." The question being taken on the resolution and the amend-
ment, they were both negatived by a large majority.

Dr. Phelps, of New York, offered the following resolutions, which
were unanimously adopted :

Resolved, That the warmest thanks of the association be tendered
to the trustees of the St. Andrew's Society, for the gratuitous use of
their very convenient and eligible hall ; and to all those other institu-
tions and reading-rooms, which have been so freely thrown open for
the inspection and use of the members.

Resolved, That the committee of arrangements receive our most
grateful acknowledgments for the very handsome, and indeed magnifi-
cent manner in which they have provided for the entertainment and
pleasure of the delegates from abroad, during their sojourn in the city
of Charleston.

Resolved, That not only the profession of medicine, but also private
munificence, and the kind attentions of the citizens generally, have
conspired in manifestations of that urbanity of manner, and that un-
wearied and kind attention, which commands not only our profound
admiration, but will be followed by the most pleasing recollections so
long as life and thought shall endure.

On motion of Dr. Stevens, the above resolutions, with those of-
fered by him at the morning session, were ordered to be published in
the city papers.

Dr. Johnston, of St. Louis, moved to adjourn sine die, which was
adopted.

The vice-president in the chair, Dr. Wellford, of Virginia, then
congratulated the association on the happy termination of its labors,
and declared it adjourned, to meet again in Richmond, Va., on the
first Tuesday in May next.

The Medical Society of Virginia.

The twenty-seventh annual meeting of the Medical Society of Vir-
ginia was held at the hall of the Richmond Library Association, on
Tuesday evening, May 20th, 1851 — Dr. Robert W. Haxall (Pre-
sident) in the chair. The attendance of members was very large,
though there were not as many from the counties as we had hoped to
see.

After reading the minutes of the preceding meeting, the President
addressed the society as follows :

Gentlemen, — Before entering on the duty before us of electing the offi-
cers of this society, Jewish, with your permission, to say a word or two.

It is known to most of you, if not to all, that I have expressed the

346 MEDICAL SOCIETY OF VIRGINIA.

wish that some other member of our body might be called upon to
preside over its deliberations for the coming year. Not only am I in-
fluenced by a desire to see the principle of " rotation in office" esta-
blished among us, but I am also swayed in some degree by a feeling
which attaches to my own personal convenience. When I accepted
the office which you did me the honor to confer upon me, I deter-
mined most faithfully and conscientiously to perform its duties as far
as I was able so to do. No considerations of social enjoyment have
I ever permitted to come in conflict with these duties ; nay, I might
go farther and say, that on more than one occasion my professional
engagements have been made to yield to those obligations which de-
manded my presence here.

In thus expressing myself, you will not, I am sure, accuse me of any
feeling akin to egotism, for I am as sensible as any of you can possi-
bly be, that the interests of this society would have been subserved
even in a far greater degree by the selection of some other individual.
If I have been punctual in my attendance, and impartially rigid in
the performance of my duty, it has arisen mainly from a sentiment
which I have ever entertained, viz : that one should never accept an
office unless he intended to bestow upon it his undivided attention. If
I have succeeded in eliciting your good will, my highest ambition has
been answered.

Although, gentlemen, I have really not had it in my power to re-
spond, as I wished to do, to a resolution unanimously adopted by the
society some two months since, yet I cannot permit the occasion to
pass away without congratulating you upon our present prosperous
condition. Nine years ago, when this society was re-organized, a most
praiseworthy spirit seemed, for a time at least, to infuse itself among
us ; our meetings were well attended, papers were regularly read,
and our discussions were conducted with considerable zeal — but it
was only for a time. If since that period our progress has not con-
stantly been onward — if some among us can remember a year or two
of comparative lukewarmness, does not the flattering prospect before
us amply repay the cares and toils through which we have passed ?

It will not be indecorous in me to assert — for the position which I
have held for the last year has prevented me from taking part in our
debates — that in my opinion they are now conducted with an ability
worthy of all commendation. The generous rivalry, not for master-
ship merely, but for the elucidation of truth, which has so often dis-
played itself in this hall, will never separate us in feeling, but will
contribute rather to rivet still closer those kindly sentiments which
now exist.

Nor are we the sole beneficiaries of a purpose so laudable — so pro-
ductive of good. Our example has become in some degree conta-
gious, and the proof of the assertion is exhibited in the fact that within
the last few months a very large accession to our numbers has taken
place. If present and immediate benefit does not accrue to those who
do not reside among us, from the discussions which take place here,
they no doubt look with much interest to the reports which are sub-
mitted to their inspection. In some measure it may be said that this

MEDICAL SOCIETY OF VIRGINIA. 347

is due to non-resident members, as a partial remuneration for the en-
couragement given in permitting us to record iheir names.

I am sure I need not submit a single remark calculated to stimu-
late the energies of our members. Endowed with as large a share of
natural ability as usually falls to the lot of a like number of indivi-
duals, there is no reason why we may not contribute our mite to the
general fund of medical improvement ; and perhaps it may be some-
what gratifying to know that more than one paper has emanated from
this society which has been noticed in terms of marked commendation.

Let us then, gentlemen, bring to our labors a zeal and an industry
which shall know no other limit than the accomplishment of the ends
we have in view. With no sinister purposes to subserve — no private
piques to disturb the smooth current of our way, let us continue to
encourage those fraternal feelings which now so happily abound.
And if it be that no brilliant discovery shall hand down the name of
any to an admiring posterity, the consciousness that we have faithfully
acquitted ourselves of the obligations which rest upon us will serve
to brighten the memory of the past, when the decrepitude of years
shall have unfitted us for the active pursuits of life.

The treasurer's report was then presented and read, and his books
laid before the society. On motion, a committee of three was ap-
pointed to examine and audit his accounts. The report exhibits a
surplus in the hands of the treasurer over and above all liabilities.

In the absence of the librarian no report was made as to the condi-
tion of the library. We are sorry to see no steps taken to build up
a scientific library commensurate with the dignity and importance of
the society. We hope that before the next annual meeting something
will be done in relation to this subject, and that the new hall in con-
templation will contain a fine library and museum.

The following gentlemen were then severally ballotted for and de-
clared duly elected officers for the ensuing year :

President, Dr. Beverly R. Wellford of Fredericksburg.

1st Vice-President, Dr. James Beale of Richmond city.

2d do. Dr. Carter P. Johnson, do. do.

Recording Secretary, Dr. P. Claiborne Gooch, do. do.

Corresponding Secretary, Dr. William D. IIaskins, do. do.

Treasurer, Dr. James Bolton, do. do.

Librarian, Dr. William J. Clark, do. do.

C Dr. Chas. S. Mills, Chairman.

Publication Committee, < Dr. Goodridge A. Wilson.
( Dr. Arthur E. Peticolas.

After ballotting for regular members, and the reading of numerous
letters of application for membership, the following gentlemen were
elected honorary members :*

Dr. James Moultrie, president of the American Medical Associa-
tion of Charleston, South Carolina.

Dr. A. H. Stevens, professor in college of physicians and surgeons,
of New York city.

* The constitution prohibits the election of but four honorary members at any annual
meeting.

348 MEDICAL SOCIETY OF VIRGINIA.

Professor Jeffries Wyman, M. D., &c. of Harvard University,
Mass.

Dr. George D. Gibb, F. R. C. S. I., &c. of Montreal, Canada.

The following resolutions were adopted :

" Resolved, That the thanks of the society are eminently due to the
president and other officers for the past year, for the able and courte-
ous manner in which they have discharged their respective duties.

" Resolved, That the president elect be and is hereby requested to
deliver an address at the next annual meeting."

Notice was given that at the June meeting a resolution would be
offered putting aside the balance now in the treasury, together with
the initiation fees hereafter received, as a separate fund to be disposed
of by the society for the general benefit, and only at its annual meet-
ings.

The following resolution was offered and laid on the table until the
next meeting :

" Resolved, That the members of this society pledge themselves not
to purchase, by prescription or otherwise, of any apothecary who is
in the habit of prescribing."

The following resolution wras adopted, and the chair was given time
to make the appointments under its provisions :

" Resolved, That the president appoint committees of five on the
subjects hereinafter mentioned, and that they be requested to draw up
written reports on these several subjects, and present them to the so-
ciety at convenience."

These appointments to hold until the next annual meeting.

1st. On the present condition of medicine and the interest of the
profession in the state of Virginia.

2nd. On medical education and literature, and the progress of pro-
fessional and popular quackery.

3rd. On hygiene and public health, and the medical topography
and statistics of Virginia.

4th. On practical medicine and pathology.

5th. On surgery.

6lh. On anatomy and physiology.

7th. On obstetrics.

8th. On materia medica and chemistry.

9th. On the indigenous botany of Virginia.

10th. On those pursuits so connected directly or indirectly with the
profession as to demand its attention, such as dentistry, dispensing
physic, manufacturing of instruments, apparatus, &c, &c."

After a lengthy discussion on some private business, the society
adjourned.

The New York Medical Gazette has the following item :
" Quite Interesting. — In the report of a surgical clinique of an am-
bitious college in Cleveland, Ohio, recently reported, the following case
is gravely published : Case 13 — A boy aged thirteen, sore thumb.
Treatment — A clean rag every day for a week."

EDITORIAL. 349

IBETOMUJyLi

Visit to Charleston — The American Medical Association.

Our late visit to Charleston will long be remembered as the most
pleasant trip of our lives. We had not been in the city long enough
to take a quiet stroll incognito, that we might allow first impressions
to be formed independent of personal circumstances, before strangers
met us as friends, and we were soon overwhelmed with those hospi-
talities for which the South Carolinians are so renowned. Though
the crowd induced by the State convention and the association was
so great that the city was filled to repletion, yet the committee of re-
ception, by its activity and energy, procured good accommodations for
all who arrived. We were more fortunate than our neighbor of the
Messenger, in procuring good quarters with friend Mixer of the
Charleston hotel, and it would be ungrateful not to say that we re-
ceived the best attention, &c.

The cordial reception by the profession, and the generous and splen-
did entertainment by the citizens of the 200 delegates from abroad,
produced a lasting impression upon all who were so fortunate as to be
present. We would like to have time and space, with the ability, to
do justice to the beauties of the city, the happy and pure state of the
profession, and the kindness of the inhabitants of Charleston, but we
are compelled to leave this duty to some confrere who will do it better.

As will be seen by the proceedings which we publish in the present
Number, the association was in session four days. Much of the time
was occupied in the reading of long reports of the several standing
committees, which were generally able and useful documents, and
which most of our readers, we hope, will read in the forthcoming vo-
lume of Transactions. The abolition of these committees, and the
substitution in their stead of others on special topics of general and
practical interest, was a popular measure ; and it is earnestly hoped
that hereafter the papers presented will be of a character calculated
to raise the value and reputation of the publications by the embodi-
ment of American physicians, both at home and abroad. The only
other feature in the proceedings of this meeting which we will notice
now, is the rejection of Dr. Drake's proposition, which, in effect, con-
templates the establishment of the association permanently in the
Smithsonian Institute at Washington city, and changing it into a great
39

350 EDITORIAL.

National Medical Society. This favorite scheme of its very distin-
guished originator seemed to meet with but little encouragement.
While many would rejoice to see a national society of medicine at-
tached to the Smithsonian Institute, they would be unwilling to give
up the present independent organization of the association, the most
beneficial influences of which are exerted by its migratory character.
This was well illustrated at Charleston, and we think it will be seen
and felt next year at Richmond. The adjournment of the association
to meet in this city next year is an honor to the state, which we sin-
cerely trust will be duly appreciated. It is now incumbent upon us
to organize speedily and perfectly, if we do not, our representation
will not be as large as the numbers and character of the profession in
Virginia would demand. Before the meeting in May next, we hope
to see the State medical society so built up in numbers and strength,
that every honorable practitioner in the state may be represented
through it ; and we would again urge upon our friends in the coun-
try to form local societies. Where five or more are in striking dis-
tance of one another, let them organize and send a delegate. We
hope, too, that the Doctors in Virginia will not be outdone, either in
their zeal or in their hospitality and cordiality of reception. The cen-
tral position of Richmond, the season, and the growing importance of
the national association, cause us to believe that there will be present
at the next meeting three or four hundred delegates. We promise
them a suitable reception.

We commend to our readers a perusal of the paper of Dr. Houston,
on the pathology of scarlatina. It is long, and the subject has already
occupied much space in our journal ; but as we have published very
conflicting views on this subject — some, indeed, to which we heartily
dissent — and without comment, we throw this paper before the pro-
fession, like the others, for what it is worth.

It may be well to take this occasion to say, that we do not hold our-
selves responsible for all the views promulgated through the pages of
the Stethoscope. It would be truly an endless task, if not an impos-
sible one, for an editor of a large medical journal to undertake to give
his opinion on every view expressed by his contributors or even in his
selections. If he could do so, he would assume the position of an
author, and his publication would degenerate into a mere series of
essays on different subjects, compiled by one man. And a journal
would be worth very little if it were made up of the opinions of any

EDITORIAL. 351

one man. That the value of a journal depends on the value of the
matter which it contains, its independence, &c, we do not deny ; but
it is the duty of an editor to throw before his readers the views of
men occupying high rank as practitioners and essayists, for their judg-
ment, whether they accord with his opinions or not. Then, we say,
we expect to continue to publish papers, as we have done, containing
doctrine which we believe is not orthodox ; but in doing so, there must
always be appended a responsible name, or we shall take the liberty
of expressing very freely our own opinions. Indeed, comment is a
right and not a privilege, which we shall always exercise when it is
deemed proper, but it would be useless if not stupid for us to express
disapprobation of all the opinions of contributors, when they do not
accord with our own. When an individual sends us a paper for pub-
lication, he desires to lay it before his brethren for their judgment and
verdict, not for ours; and it is the duty of the journalist to give an op-
portunity to all for free discussion, and not to assume to carry it on
himself. These remarks have been called out by a knowledge of the
fact that some readers have held us responsible for the soundness of
doctrines promulgated through the medium of our journal, by men of
reputation and ability, and on which we did not comment. To such
we say, once for all, that our pages are open for free discussion, and
that we should be pleased to hear from them in it.

Reviews and Bibliographical Notices.

Burke's New Work on the Mineral Springs of Virginia. —
" The Mineral Springs of Virginia : ivilh Remarks on their use, the Dis-
eases to which they are applicable, and in which they are contra-indicated,
accompanied by a Map of Routes and Distances. A New Work. By
William Burke, M. D., Richmond, Va. Published by Morris &
Brother. 1851. Pp. 348, 12mo."

This is a neat, well-executed work, fresh from the press of Messrs.
Ritchies & Dunnavant, and is wholly a Richmond production. It is
due to say that it does great credit to all concerned in its issue.

It purports to be a guide to the invalid in his pilgrimage to those

unrivalled fountains of health, the Mineral Springs of Virginia, and as

such, if it had no other merit, it is entitled to great praise and a wide

circulation. In speaking of the necessity of some guide to the use of

mineral waters, the author says:

" Whatever scepticism may have existed at a former period among medical men
as to the efficiency of mineral waters, no man, in our day, who has any claim to

352 EDITORIAL.

rank as a physician, can call their powers into question ; I shall not therefore en-
ter into any argument on that subject. Unfortunately, however, they are no less
potent for evil than good ; and it therefore becomes my duty not only to point out
the advantages that may be derived from their proper use, but also the injuries
that may result from their improper prescription. Both these duties I mean to
perform to the extent of the moderate ability I possess, without fear, favor or pre-
judice. I have no connection or interest, directly or indirectly, with any of their
proprietors, and shall, therefore, be guided in my estimate of them by my own
reflections and observations, derived from an experience of many years."
*******

41 1 have touched on this subject, because I have seen persons absolutely lose all
the chances of benefit from the waters for want of judicious advice. Distant phy-
sicians— at least many of them — know nothing of the Virginia Springs, except as
a group. Very frequently, they do not know the difference between the White
Sulphur and the Red Sulphur ; and often confound the latter with the Red Sweet.
When, therefore, a physician, thus ignorant of the distinctive characters of those
waters, undertakes to prescribe them, he is as likely to be wrong as right; and,
indeed, we see, every season, many instances of such unfortunate mistakes."
*******

•' Whether he employs a physician or not, let me say to the invalid : ' Be in slow
haste.' Survey the whole ground according to the suggestions I have laid before
you. Do not gulp down large quantities of water to expedite a cure. It would
be about as wise as the conduct of a man who eats to repletion, in order to get
the worth of his money, or as that of the old negro who swallowed down all the
physic left by his master lest it should go to waste."

The Doctor then gives " a general prescription for invalids," in
which he lays down the rules of conduct in regard to diet, exercise,
the use of the waters, &c, &c, and touches lightly upon the " point
of saturation" which so many persons neglect entirely.

Each of the springs, analyses of their waters, the principal diseases
in which they are indicated and contra-mdacsXed, their situation, mode
of approach and capacity of accommodation, together with a general
description of whatever is interesting about them, is taken up in regu-
lar order. We have not the space to give an extended notice of the
professional part of the work at present, but we find in the chapter
on " diseases of the liver," the following paragraphs, in which we
heartily concur :

"In no disease may more be expected from change of climate and habits of life
than in diseased functions of the liver, and in no region of the United States is
there a summer climate more favorable than the transmontane division of Virgi-
nia. Independent, then, of all mineral waters, much may be expected from visit-
ing this region ; but when the agency of the greatest variety of Mineral Springs
may be obtained in connection with climate, our Southern friends have induce-
ments to visit Virginia which are not presented by any other region of the Union.

"Now, to say that any one of the Sulphur Springs is a specific, in all varieties
of functional diseases of the liver, is to display great ignorance of the action of
those agents. I would desire to impress upon the reader that it is not a purgative
effect that is desirable in those cases. If it were, those waters that act most
freely upon the bowels would be the most prompt to relieve the disease, and Sa-
ratoga water would claim preference over all other waters in the United States,
in those conditions of the system ; but such is not the case. We want an agent
that will, in the first place, modify the original cause of the hepatic affection, and
produce thereon an alterative effect."

EDITORIAL. 353

In the chapter on " phthisis," Dr. B. says :

" The question may now be fairly raised, allowing the curability of consumption
under the most favorable circumstances, have cases thus marked and identified by
an unmistakeable diagnosis been relieved at the Red Rulphur ? I answer, without
hesitation, that they have.

" Since the advances in diagnosis by means of percussion and auscultation, I
have examined numerous patients for signs of tubercular deposition and lesion,
whom I met at the Red Sulphur, and several whom I sent thither; and although
I do not claim any great skill in these methods of exploring the internal organs,
I satisfied myself that there was a tuberculous condition, and 1 was nevertheless
gratified by seeing many such cases receive prompt and decided relief. I trust,
however, it will not be inferred that I am disposed to hold forth delusive hopes to
any poor invalid who may place reliance on my opinion. I seek not to deceive a
human being in this matter. I candidly acknowledge that there are annually
many persons presenting themselves at the Red Sulphur, that are not and cannot
be benefitted, and whom, if I could have seen them before they left the comforts
of home, and the kind attentions of friends, I would have advised against the
journey; — but again, I do say, that if there be hope left, it is in the water of the
Red Sulphur." ******

"The principle upon which the Red Sulphur acts is the sedative principle.
From whatever elements this principle has been imparted to it, it is manifest that
it is the great lever by which it operates."

Having previously said :

" This water being manifestly narcotic, is contra-indicated in plethora, apoplexy,
epilepsy, chorea, vertigo, and all diseases indicating too great a tendency of blood
to the brain. In the acute stages of disease, it is decidedly injurious. In the
course of my practice in the neighborhood, it was used in some cases as ordinary
drinking water, in the first stages of pleurisy and pneumonia, and in bilious fever,
but with invariable aggravation of the symptoms. After the inflammatory stage
was subdued, and in incipient convalescence, I found it exceedingly valuable in
invigorating the constitution."

The author sets out by modestly saying:

"My readers will of course understand that I do not attempt an elaborate trea-
tise on any of the subjects discussed in this work. My highest ambition is, to
throw out some hints that may serve to direct the young, inexperienced physician,
or the intelligent patient, capable in some degree of treating himself — if, indeed,
there be any one, professional or unprofessional, capable of managing his own
case, which I very much doubt, owing to that principle of self-love, and conse-
quent self-indulgence, which is inherent in man."

But this book is not a mere guide to the valetudinarian. It is writ-
ten in a smooth, happy style, agreeable and instructive to the general
reader, and is really an invaluable travelling companion to all those
who frequent the mountains of Virginia. The chapters on scenery, cli-
mate, the natural curiosities, the society at the springs, and the general re-
marks, are exceedingly interesting, whether the reader be stationary
at home, in the railroad car en route, or in the present enjoyment of the
mirth and luxury of the season at the springs. The edition must soon
become exhausted, and in the next the author promises to "embody
the results of his observations on the Eastern group of springs, which
it has been out of his power to visit." The public as well as the pro-
fession are laid under real obligations for a book of such utility, com-
ing too from one so well qualified by along experience and residence

354 EDITORIAL.

among the springs as Dr. Burke. It is proper to state that Dr. B. is
in no manner whatever connected with any of the springs, and his ob-
servations on them all are marked by a candid, fearless impartiality
worthy of all comment.

"Medical Delusions," by Worthington Hooker, M. D., author
of " Physician and Patient," of Norwich, Connecticut. New York,
Baker &f Scribner. 1851. 12mo. Pp. 105.

This excellent little book has met with a favorable reception through-
out the country. It bore off the Fiske prize, of the medical society of
Rhode Island, for 1850, and is printed in a neat form.

Its style is plain but forcible, and the work is of a popular charac-
ter, and calculated to do good wherever it finds its way. After some
general remarks, the author takes up the " causes and nature of me-
dical delusion."

The first and most potent of which is " a too ready disposition to
consider whatever follows a cause as being the result of that cause."
The humbugs of past and present times are then taken up, among
which are the following : Bishop Berkeley's tar-water panacea, which
was in great vogue from 1741 to '49, the Perkins' tractors, which origi-
nated in Connecticut in the last century, and which soon came into great
repute in England and other foreign countries. The various cures and
preventives of hydrophobia, snake stones, all-healing balms, homoepa-
thy, and such like are then considered. After shewing up the ridiculous
reasoning of that school, he says : "You observe that the infinitesimal
doses are proved to cure diseases precisely as Perkins' tractors, the
weapon ointment, and the Bishop's tar-water, were once proved to do
it. The reasoning is this : " A patient took a decillionth of a grain of
oyster shell three or four times a day ; he got well : therefore the oys-
ter shell cured him."

Cures by charms, amulets, incantations, royal-touches, &c, &c, are
shewn to be produced by mental influences.

Another cause of medical delusion is "the disposition to adopt ex-
clusive views and notions." Under this head the " one-idea men" get
a rub. Here the author might have dilated and given the calomel pana-
cea men a dose. But as he had so many such subjects to touch on, it
would have been an endless task to do justice to all.

" The disposition to run to extremes, to overstate truth," and the
very common "disposition to theorize, instead of encountering the labor
of strict observation," "fashion in diseases and remedies," both pro-
fessional and popular, " and an undue fondness for new things," are

EDITORIAL.

355

each elucidated in a manner characteristic of the author's mental keen-
ness. In conclusion, he says: "These and other sources of error
may be abandoned ; and the wide domain of medical science may,
even in our day, be secured under the rule of a -pure, exact, rational
and compehensive observation."

There are certain subjects which occupy and excite the public mind,
such as mesmerism in all its forms, the Rochester knockings, lunar influ-
ences, phrenology, and such like chimeras, and which are considered so
much akin to medical science, that medical men are held responsi-
ble for them, or are required to combat them. Now, we quite agree
with Dr. Hooker in what he says is the cure for all this sloughing
about the professional body, viz : Rid them of the errors and delu-
sions, educate them to observe and reason, and a healthy stale of public
opinion on these subjects will soon follow. Then to accomplish the
end, we want more such books as the one before us, and more such
men as Dr. Worthington Hooker.

" Wilson's Dissector," by Goddard." " The Dissector, or Prac-
tical and Surgical Anatomy, by Erasmus Wilson, with one hundred
and fifteen illustrations. Edited by Paul B. Goddard, M. D. A
new and improved edition. Philadelphia. Blanchard & Lea. 1851."

The numerous editions through which this book has passed in Eng-
land, and the high value set upon it by the denomstrators and anato-
mists, both here and there, speak highly in its favor. The new (se-
cond American) edition now before us has been carefully arranged
and modified in such a manner that the student, by following the or-
der of parts as they are laid down, will obtain the utmost advantage
which can be derived from a single subject. The number of cuts has
been increased in this edition, and they are about as good as those we
find in any dissector's guide ; but we find the usual fault, that they are
in some cases slurred, and frequently the numbers are so indistinct
that they are illegible.

" Fenner's Southern Medical Reports." — " Southern Medical
Reports, consisting of general and special reports on the medical to-
pography, meleorology, and prevalent diseases in the following states :
Louisiana, Alabama, Georgia, Mississippi, North Carolina, South Ca-
rolina, Florida, Arkansas, Tennessee and Texas. To be published
annually. Edited by E. D. Fenner, M. D., of New Orleans. Vol.
I. 1849. New Orleans. B. M. Norman. New York. S. S. & Wm.
Wood. 8vo. Pp. 472, muslin.

The volume of this work already before the public fully sustains
the high expectations raised by its prospectus. The character and
value of the matter do great credit to the reporters and to the propri-

356 SELECTIONS.

etor of the book. It is entirely what it professes to be, and the high-
est commendations have been bestowed upon it by the press and the
profession. The American medical association, both last year and
this, adopted resolutions laudatory of the project, and recommended
it to the active support of the profession. We hope that the enter-
prising and gifted editor will meet with that liberal patronage which
the value of these reports ought to command, and which will enable
him to make it still more useful and creditable to American physicians.
" It is a standard library book for every Southern practitioner" at
least, and we look forward with much pleasure to the receipt of the
forthcoming Volume II.

History of a Case of great Distortion of the Pelvis, in which Delivery was

safely accomplished by the operation of Craniotomy. By Robert Lee,

M. D., F. R. S.

On Friday, the 21st inst., at eleven, P. M., Mr. Dunn, of Norfolk
street, Strand, requested me to see a patient with him who had been
forty-eight hours in labor, and whose pelvis was distorted in a high
degree. The os uteri was imperfectly dilated, and no part of the
head had entered the brim of the pelvis. Mr. Dunn thought, and I
agreed with him, that the distance from the base of the sacrum to the
symphisis pubis could not exceed an inch and a half — in fact, that it
was nearly as distorted as the monster pelvis lately exhibited at the
Medical and Chirurgical society. It was believed that the patient
was at the full period of pregnancy ; and in proceeding to deliver
with the perforater and crotchet, I expected to encounter very great
difficulty. The head was readily opened, and the brain evacuated;
and on fixing the perforator on the inside of one of the parietal bones,
and extracting, not very forcibly for a few minutes, the bone was de-
tached from the other bones and came away. The remaining cranial
bones were speedily crushed with the crotchet, the point of which was
then carried outside the head, and fixed in one of the orbits. With
this hold, in less than half an hour the head was extracted, with the
employment of very moderate force.

The facility with which the delivery was accomplished in this case
of great distortion, arose from the circumstance that the labor was
premature, contrary to our expectation : the foetus, instead of having
reached the full period, had only reached the end of the seventh month.
Premature labor, in this case, rendered the operation of craniotomy
safe and easy.

This patient had before been twice pregnant ; the first time the
child died prematurely, and was expelled by the natural efforts, as in
the famous Cupar case. In her second pregnancy, the labor was dif-
ficult and protracted ; but in what manner the dead child was ex-
tracted we could not certainly ascertain.

The history of the preceding case illustrates in a striking manner,

SELECTIONS. 357

the truth of my statements recently made to the medical and chirur-
gical society respecting the Caesarian operation, and the importance
of the early induction of premature labor in cases of high distortion
of the pelvis. — London Lancet.

Report of a Singular Case of Apoplexy. By Ezra Harle, Surgeon,

Islington.

On Wednesday night, January 15th, I was called to a poor " wo-
man in a fit." A few minutes after she had fallen in the street, I was
on the spot, and found her dead. At the post-mortem examination we
found the following, as I apprehend, unusual appearances conjoined.
The brain was surrounded with blood, the ventricles filled, and a quan-
tity at the base — in all about four ounces. This was sufficient to ac-
count for the death; but on examining the chest, we found the left
lung unusually smaller than the right, marked with long-standing dis-
ease, and gorged with blood, sufficient of itself to account for death,
as in ordinary pulmonary apoplexy. The other viscera were healthy.

The woman being of so spare habit, and about sixty-five years of
age, causes the case to appear more unusual; so much so, that one
can agree with the words of the deputy coroner, that " we should
hardly suppose she had so much blood in her whole body." Thus
proving that persons of very spare habit may be subject to sanguine-
ous apoplexy.

In justice to the case, it must be said, that shortly before her death
she had taken a " glass of gin," on returning from her " ironing work"
in her usual health. — Ibid.

Case of Small-pox occurring a third time after Vaccination, when it
proved fatal. — After alluding to the fact that whooping-cough, measles
and scarlatina generally occur only once during the lifetime of an in-
dividual, exceptions, nevertheless, to the above rule, as well in these
complaints as in smallpox, have been recorded by authors. Three
well-marked examples of the recurrence of smallpox, met with in the
same family, are related, one of which terminated fatally. The case

especially referred to by Dr. Webster was that of H. N. N , who

had been vaccinated satisfactorily in 1827, when three months old.
Notwithstanding this circumstance, he became attacked by smallpox
in 1S33, along with an elder brother, who had been likewise vacci-
nated. Both patients recovered, and nothing more was thought of the
matter till 1838, when the two lads were again attacked by variola,
along with another — that is, a third — brother, likewise regularly vac-
cinated. However, all three got quite well in due time. Subse-
quently, Mr. H. N. N , whose case is now just mentioned, went to

India in the company's service, where he was seized, in April last,
with the usual and well-marked symptoms of smallpox, which soon
became confluent, and proved fatal at Dharwarinth, on the 13th of
that month ; this making the third time this gentleman had been at-
tacked by variola, although previously vaccinated. — lb.
40

858 SELECTIONS.

Transfusion in Uterine Hcemorrhage was interdicted in France two
years after it was first introduced by Dennis and Emerets, and at-
tempts by a provincial judge were made quite recently to interfere
with its performance, in virtue of the prohibition of 1668. Transfu-
sion has, nevertheless, been recently performed by M. Nelaton at the
Hopital St. Louis, Paris with success, though the patient died seven
days afterwards of metro-peritonitis. The case was one of placenta
prsevia, the os being too rigid to admit the hand, haemorrhage went on
more or less for seven hours, when M. Nelaton being sent for, he suc-
ceeded in turning and delivering, whilst the aorta was being com-
pressed. The vein of a strong and robust young house-surgeon was
then opened, and about eight ounces of blood transfused : the patient
was at once freed from the choking sensation she had previously ex-
perienced, and perfectly recovered up to the seventh day. — lb.

On the Action of the Golden Sulphuret of Antimony.

BY DR. BOECKER.

The investigations contained in this essay of Dr. Boecker have been
conducted with the greatest care, the author having experimented on
himself with the medicine, and having carefully examined the princi-
pal excretions before, during, and after its use. The examination of
the urine especially furnished some interesting results. During the
use of the golden sulphuret, the bowels acted regularly once a day ;
but when the author omitted to take the medicine, he remained seve-
ral days without a motion. Whenever the alvine evacuations were
increased, the quantity of urine was diminished, particularly in its
solid contents, as appears from numerous analyses which are re-
corded. An interesting circumstance is, that the quantity of urine
and of solid excreted matters increased with the dose of the medicine,
and vice versa. It is also worthy of observation, that the fixed salts in
general, as well as the salts insoluble in water, were increased by its
exhibition. On the whole, it would appear from the experiments, that
during its use a more rapid renovation takes place in all the organs
and all the tissues. Another circumstance to be observed is, the in-
crease in the quantity of sulphuric acid in the urine, which was nearly
double the ordinary amount, doubtless in consequence of the sulphur
in the preparation being converted into the acid, which subsequently
enters into the sulphates. The author also details the results obtained
from the examination of the pulmonary exhalation. During the use of
the golden sulphuret, the amount of carbonic acid was increased,
while it gradually diminished on discontinuing the medicine. The
quantity of watery vapor, on the contrary, underwent no change. As
to its action on the blood, the author found that it diminishes the
amount of the solid constituents of that fluid. Blood drawn from a
vein was at first black, but gradually became red when exposed to
the air, and this change took place more rapidly than when the sul-
phuret was not exhibited. The microscopic examination of the blood
shewed that the nucleated globules visible in normal blood disappear.

To recapitulate — golden sulphuret of antimony increases the secre-
tion of urine and the exhalation of carbonic acid; it stimulates the

SELECTIONS. OBITUARY NOTICES. 359

intestinal and cutaneous excretions as well as the secretions of the
mucous membrane ; and it thus hastens the metamorphosis of the sys-
tem, an effect which is even to be detected in the blood itself. — Archiv.
fur Physiologische Heilkunde. — The Chemist.

"Jewish Rite. — The spectacle of circumcision, performed by the
gentleman who usually officiates in this city among the Israelites, was
recently presented to the students of the New York Medical College
in lieu of the usual clinique."

Alleged Uncertainty in Medicine. — Dr. Thompson, president of the
New York State medical society, in an address at the last annual
meeting of the society, thus compares the medical with the other pro-
fessions in regard to certainty in its results :

" When compared with the other professions, its character is vin-
dicated, and it rises in our estimation, for it may be questioned whe-
ther the results of its practice are any more doubtful than those of
the law, which also has been stigmatized for its ' glorious uncertain-
ties.' In a subject like theology, which treats of man's eternal des-
tiny, concurrence of opinion might be expected. Its doctrines, how-
ever, find no more agreement among theologians and polemical wri-
ters than do the accredited principles of medical science among well-
informed and cultivated medical men. In the science of politics, in
the laws which regulate the commerce and mutual intercourse of na-
tions, in the systems and processes of agriculture, in the arrangement
of society, and its government by laws whose principles and modes
of action shall prove most successful in directing its interests and
regulating its business affairs, men differ widely in their judgments
and the greatest dissimilarity of opinions prevails. Why, then, amid
this discrepancy of judgments and difference of opinions, should me-
dicine be held up above all, conspicuous for its uncertainties, or forks
lack of settled principles?" — Boston Medical and Surgical Journal.

Obituary Record.

Prof. John B. Beck departed this life, in the city of New York, on
the 9th day of April. He was 57 years of age, and had long enjoyed
an enviable position in the medical profession. We learn from the
New York Journal of Medicine, that Prof. Beck occupied a profes-
sional chair in the college of Physicians and Surgeons for almost 25
years. Of the distinguished ability with which he filled it, the medi-
cal profession of the Union are well advised. The profession of the
city of New York especially will feel the loss of Prof. Beck, but his
death is a calamity to the country. — Western Jour, of Med. and Surg.

Dr. Beck was the author of a valuable work on medical jurispru-
dence, and a man of much scientific acquirement.

Death of Dr. Morton. — It is with the deepest regret and pain
we find ourselves called upon this morning to record the death of an
eminent citizen, one of the brightest ornaments of Philadelphia and of

360 EXCHANGES.

the country, Dr. Sam'l George Morton, who expired yesterday at
his residence in Arch street, after a brief but violent illness of only
three days. No man in the United States, in fact, not the bravest sol-
dier or the most illustrious statesman, was better known or enjoyed a
wider or more enviable reputation abroad. It is only at the hour of
his death, that many, who knew Dr. Morton well, will be conscious
that a great man has been taken away, and a light quenched which
has long shed a common lustre upon the country and the world.

[Philadelphia North American, 16th May.

Dr. Morton had a wide reputation as a man of science. On the
branches of comparative anatomy and physiology he, probably, had
no equal in this country, and he leaves behind him many monuments
of his genius and labor.

Died at Airfield, in the county of Henrico, on Tuesday, May 13th,
1851, of congestion of the liver, Richard B. Gooch, Esq., who was
long and favorably known to the public as the editor of the Southern
Planter, was a man of fine education, of handsome talents, and of
a very amiable disposition. He obtained a considerable reputation
by a series of letters written during a sojourn of several years in Eu-
rope, and originally published in the Richmond Enquirer. He was
one of the best reporters, on the old plan of giving the spirit and sub-
stance of a speaker's remarks, (an accomplishment requiring much
higher mental attributes than the present system,) we have ever known.
His death is much regretted by the fraternity, and by the community
in which he was born and resided from his birth. He was buried on
Wednesday with military honors by the artillery company, of which
he had been an officer, and was an honorary member.

[Richmond Dispatch.

Publications Received.

Skey's Operative Surgery.

Cooper on Dislocations and Fractures, and Wilson's Dissector, by
Goddard, from the publishers Blanchard & Lea, through Morris
& Brother.

Burke on the Mineral Springs of Virginia, from the author.

Pharmacopoeia of the United States, from the publishers, Lippincott,
Grambo & Co., through Nash & Woodhouse.

Hooker on Medical Delusions, from the author.

Fenner's Southern Reports, from the editor.

In addition to our regular Exchanges, we have received the fol-
lowing :

The Dublin Quarterly Journal of Medical Science, No. XXI., Feb-
ruary 1851 ; from Nash & Woodhouse ; and No. XXII., for May
1851, in exchange.

EXCHANGES. 361

British and Foreign Medico- Chirurgical Review, No. XIV., April
1851 ; from the Messrs. Wood, New York. Price $ 3 per annum.

Quarterly Summary of the College of Physicians of Philadelphia, Nos.
I. and II. Price $1 per annum ; from Messrs. Lippincott, Grambo
& Co., a cheap and valuable publication. We have not space to no-
tice it more at length at present.

A very interesting paper on " Rupture of the Urinary Bladder, with
a table of 78 cases, by Stephen Smith, Surgeon to Bellevue Hospital,
N. Y., from the author. Re-printed from the N. Y. Journal of Me-
dicine.

Report of nine cases of Vesico-vaginal Fistula, treated by operation, with
remarks on the mode of operation, Sfc. By George Hay ward, M. D.,
re-printed from the Boston Medical and Surgical Journal, from the
author. And from the same gentleman, " The statistics of the amputa-
tions of the large joints performed at the Massachusetts General Hospital,
from its establishment to January 1, 1850. General thanks are due to
the compilers of these useful tables.

We welcome to our list a new and very promising bi-monthly,
The Nashville Journal of Medicine and Surgery, edited by Professor
W. K. Bowling, of the University of Nashville. Terms $ 2 per an-
num, in advance. This journal contains 64 pages, and is well exe-
cuted. We observe that the editor says in his second number, that
he " has still room on the subscription list for a few more names." He
has grown rapidly. We have room enough on our list for a great
many more names — (and by the bye we can furnish the back num-
bers.)— Success to the work.

The New Orleans Medical and Surgical Journal for May has come.
We observe that the publisher of this journal has become involved,
and that its spirited editor is now the proprietor. We hope that Dr.
Hester will be much more successful in the management of his bu-
siness affairs, and, judging from his editorial capacity, we doubt not
that he will.

The Southern Planter for May. P. D. Bernard. $1 per annum.

Innumerable catalogues and medical college circulars and announce-
ments (or rather advertisements) have been received.

Where is the Transylvania Journal of Medicine, that we never have
received it ?

The last No. of Dr. PupWs New York Journal has not yet come to
hand.

INFIRMARY

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Improvement in Pianos. — New York is fully entitled to the credit of having effected the
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at the same time the power, quality and eudurance of tone, and without a corresponding
exaggeration of price. — New York Mirror.

ROBERT M'NAMEE,

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all kinds of

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He likewise makes to order and repairs all descriptions of Instruments. Thankful for
the liberal patronage he has already received, he trusts to be able to merit a continuance of
it, by increased business facilities, and a determination to give entire satisfaction to his
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AB-ii a mm&%

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^s^sggSBggpii^a3j»3a ftW We take this occasion to inform our friends and the public,
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THE

AND

VIRGINIA MEDICAL GAZETTE.

No. 7.1

RICHMOND, JULY 1851.

[Vol. I.

An Essay on Auscultation and Percussion.

BY P. H. CABELL, M. D.

[Published by request of the Faculty of the Medical Department of Hampden

Sydney College.]

Auscultation and percussion are physical means of diagnosis, which
were unapplied to medicine till comparatively modern times ; but to
such a degree of accuracy have they now been carried, that we are
not more certain of the existence of stone in the bladder, as revealed
by the sound, nor of diseased bone by the probe, nor of fracture by
crepitation, than of certain internal diseases which we can neither see
nor touch, by the application of these most wonderful discoveries.
Wonderful, not because of their recent discovery, but because they
remained so long undiscovered, by the many acute observers and pro-
found reasoners who, in every age, have shed lustre on the profession.
Strange, indeed, it is that this one of our five senses should have
been so long overlooked in the discrimination of diseases. The an-
cients, even in the days of Hippocrates, were familiar with a spe-
cies of auscultation, but they applied it only to the detection of large
cavities in the lung containing water, and pneumothorax with effusion.
The ear was placed in contact with the parietes of the chest, and the
patient at the same time strongly and suddenly shaken ; this caused a
splashing sound to be heard, and was called succussion : but here, on
the very threshold of this valuable discovery, they paused, and no fur-
ther improvements were made till the time of Laennec. Before its
introduction by him, those internal organs, surrounded by bony walls
and dense fascia, were "terra incognita" to physicians, who could
only extend their observations a little way into their territories, and
gain a scanty amount of knowledge by examining their outlets.

Since the time of Avenbrugger, the discoverer of percussion, and
Laennec, of auscultation, a complete revolution has been effected in
the diagnosis of diseases of the chest ; and the healthy and morbid
sounds heard in the different regions have been described with so
much accuracy that little is left for future observers in this department
41

362 CABELL ON AUSCULTATION AND PERCUSSION.

of medicine. All persons cannot be good auscultators and percus-
sorSj as all cannot discriminate accurately between slight differences
in sound ; but all should persevere, tor the perception lor nice shades
of sound can be improved in the same manner as the reasoning facul-
ties, by practice and application. There is scarcely a disease of the
body which may not have some light thrown upon its nature or ori-
gin by this means of examination ; and the negative evidence is of
almost as much value as the positive; for we may thus discriminate
between structural and functional diseases with a degree of accuracy
unattainable by any other method ; for the general symptoms of func-
tional sometimes so nearly assimilate those of organic diseases, that
we are involved in the greatest doubt, and frequently by thus pre-
scribing in the dark do irreparable injury to the patient confided to
our care. In latent diseases also it is the only means we can possibly
command for forming a correct diagnosis, as we have no general
symptoms to guide us, and have to rely exclusively upon our ear.

The error into which Laennec fell was, in depending too exclusively
on the physical signs and overlooking the general symptoms. It
seems to me, this way of trusting to any one means of diagnosis is
wrong ; the more light we have the better, and even with all we can
procure, physical and general, we are often baffled in making out a
correct diagnosis. One should be used to correct or confirm the other,
and one should never be relied on when we can get both. If they
coincide we are strengthened in our opinion as to the nature of the
disease, but if they disagree we must re-consider our diagnosis and
pronounce on the strongest side. Each organ and each part of the
body has its own peculiar sound when stricken, and when this sound
is altered, either in character or intensity, we have disease and a
change in consistency or density of those organs situated beneath.
Elastic, tense bodies, as the walls of the thorax, which are placed
over the lungs, prolong the vibrations, and give a clear, resonant sound
when stricken ; but those which are inelastic and contain fat and cellular
tissue, cut short the vibrations and give a dull or flat sound. Some per-
sons seem so loosely put together, that a morbid sound is produced ou
percussion, while the tissues beneath are perfectly healthy, or there
may be so much muscle, fat or areolar tissue superimposed as com-
pletely to obscure the healthy sounds. In these persons it is abso-
lutely necessary to employ a pleximeter, which, by firmly compress-
ing the tissues, renders them more dense and better conductors of
sound. We may thus percuss over the mammae of females, and the
thick muscles in front and behind. The variations in sound, healthy
and morbid, over the different regions will be alluded to when the
special diseases revealed by percussion are mentioned.

Auscultation is of the last importance in the physical examination
of diseased organs. By it we learn the sounds produced by these
organs in health and disease, from their motions, frictions, dilatations,
and contractions ; having once learned the healthy sounds, we have a
standard by which to measure any changes which may take place in
their motions or alterations in their structure. Auscultation and per-
cussion should never be separated from each other, but should go

CABELL ON AUSCULTATION AND PERCUSSION. 363

hand in hand to the investigation of disease, one acting as a check on
the other, and preventing the mistakes to which we are constantly
liable when only one is relied on. Indeed, percussion is only a
variety of auscultation ; for we listen to the sounds we ourselves pro-
duce by striking on the chest, and the sounds are transmitted to our
ear through the medium of the air instead of the stethoscope. The
patient to be percussed should, if strong enough, be made to sit up in
bed, or placed upon a chair in the middle of the room. If practicable
we should have the part naked, or very thinly covered, and made as
tense as possible ; this can be effected by position. During the ex-
amination the most absolute silence must be maintained in the room,
and all sounds excluded which may embarrass the physician or dis-
turb the train of his thoughts. Avenbrugger made use of direct per-
cussion, and struck the part to be examined with the ends of his
fingers, nothing being interposed. This method had many objections,
the sound being very diffused, and caused by the vibration of the
greater part of the chest, and was incapable of detecting even serious
alterations in limited spots, and caused considerable pain to a weak or
diseased patient. All these objections were obviated by the introduc-
tion of the pleximeter by Piorry, which limits the sound to the imme-
diate neighborhood of the part stricken, gives no pain, and can be
applied with as much advantage over the soft parts, as the abdomen,
fat and muscle, as over bone. It has been constructed of wood, ivory
and caoutchouc ; the last decidedly the best of the insensible plexi-
meters. But the finger of the left hand is now universally employed,
and has many advantages over the others; it is convex, and can be
applied between the ribs, and under and over the clavicle, where it
would be very difficult to place, so as to exclude the air, an ordinary
pleximeter. It is composed of both flesh and bone, and therefore
vibrates in unison with the thoracic walls, and does not alter the cha-
racter of the sound ; and lastly, it is endowed with sensibility, and
adds the tactile to the other perceptions, and can never be mislaid.

In applying the pleximeter uniform pressure should be used over
every part of the chest, and corresponding spots examined on each
side successively ; it is wrong to examine one side before going to the
other, as we thus lose in a great measure the power of comparison;
and the disease is not so much detected by the positive as the relative
sound, for the degree of resonance is very different in different per-
sons, and what is normal in one is morbid in another. Neither should
we percuss on one side while the patient inspires, and on the other
during expiration ; for the degree of sonorousness depends in a great
degree on the quantity of air in the lung. In eliciting the sound, the
fingers of the right hand must be bent almost at a right angle, and
their tips brought on the same level; then by a quick motion of the
hand the blow is given, the arm and forearm remaining rigid, and the
only motion taking place at the wrist joint; the points of the fingers
should remain only an instant on the pleximeter, and the weight of the
hand alone should be employed ; if more force is used the sound of
resonance is interfered with, and percussion loses a great deal of its
value in the discrimination of diseases.

364 CABELL ON AUSCULTATION AND PERCUSSION.

Auscultation was discovered by Laennec in 1816, from which time
he commenced a series of experiments, every trial strengthening him
in his opinion as to its value in diagnosis. Post mortems were made,
and the appearances found after death compared with the sounds
heard before, till it has been brought almost to an exact science, and
a disease can now be discriminated by an expert auscultator with a
facility and precision truly astonishing to the uninitiated. Ausculta-
tion has thus been placed on a foundation from which it can never be
shaken, however many and manifold changes may sweep over the
medical world, and Laennec's fame will remain as immovable as the
science he nurtured into existence. The method employed by this
great man was mediate auscultation, which has still some manifest
advantages over the other method. The use of the stethoscope, how-
ever, is not so easily acquired, and this may in some measure account
for the general preference for the ear. The advantages of the stetho-
scope are, it limits the sounds heard to those parts which lie under
the instrument, which it is impossible to do in immediate auscultation,
for the bones of the head (and the temporal especially, from its great
density) are good conductors of sound, and convey impressions re-
ceived from the surrounding parts to the ear with great distinctness,
and of course confuse the auscultator. In using the stethoscope it can
be applied where the ear cannot, as over the clavicle, between the
ribs, &c. It is now always employed in diagnosticating valvular dis-
eases of the heart, for we thus avoid the impulse, and hear more dis-
tinctly the pathological murmurs ; but the instrument here used is not
the ordinary stethoscope, but the flexible one of Dr. Pennock. It can
be also used without offending the modesty of females, "to whose
bosoms it is not always seemly to be putting our faces."

In using the ear we are enabled to make a very rapid examination,
and while we hear many sounds, a practised ear can attend only to
the most important, and neglect the others. The same rules apply
in auscultation as in percussion, in regard to the parts to be examined
and the order of their examination, viz : that similar spots should be
examined on each side successively, recollecting that the comparative
sounds are almost of as much value as the positive. The organs
which may be examined, and the sounds heard during health and dis-
ease, will be mentioned fully hereafter.

There has lately been invented by Drs. Cammann and Clarke, a
means of diagnosis called Auscultatory Percussion. In this method,
a solid stethoscope is used to convey to the ear the sounds produced
by percussing in its vicinity ; the sounds heard are not merely clear
or dull, as in ordinary percussion, but each organ has a sound pecu-
liar to itself. Its authors claim for it the power of locating with accu-
racy the various organs, even when overlaid by others ; but it can
never be extensively employed, as it requires the co-operation of two
persons, one to produce and the other to listen to the sound. It may
probably be used to detect the presence of fracture in a superficial
bone ; and from the thin and firm investment of the cranium, I have
little doubt it might be made a most valuable means of diagnosis in
fractures of this important part. If the ear is placed on the stetho-

CABELL ON AUSCULTATION AND PERCUSSION. 365

scope and the cranium percussed, the vibrations will be conveyed along
the bone, from particle to particle, till they reach the ear, through the
intervention of the instrument. But suppose a fracture occurs be-
tween the stethoscope and the part stricken, the vibrations on reaching
the fracture will be suddenly arrested, and the sound will reach our
ear changed in character ; and thus we may be enabled to detect this
accident, usually so difficult of detection. In mentioning the various
disorders and alterations of structure revealed by these physical signs,
I think it best to arrange them all under three heads — first, the dis-
eases and accompanying signs of the respiratory organs ; second, of
the circulatory ; and third and last, of the abdominal. Of the first
class I shall commence with the larynx, which is the most superior
of the respiratory organs, and seems to act as sentinel to the lungs,
and prevents the ingress of hurtful substances by suddenly closing its
door against them. It is placed at the commencement of the trachea,
and is the origin of vocal sounds : it is partly closed above by the vo-
cal cords, which are stretched across from front to back, leaving a
narrow slit between, which is overhung by the epiglottis cartilage,
and through which all the air in its entrance in or exit from the lungs
must necessarily pass. The larynx is lined with mucous membrane,
which is continuous with that of the mouth and bronchial tubes.
When unaffected by disease, a hollow, cavernous sound is heard on
auscultation, and the vocal resonance loud and very distinct ; but
these sounds are variously altered by disease. In acute or chronic la-
ryngitis the mucous membrane is much thickened, either by conges-
tion or inflammation, or effusion of serum in the sub-mucous areolar
tissue. When this occurs a harsh, rasping sound is heard, and when
there is much thickening of the membrane it may become whistling.
The sound is produced by the air passing rapidly through this nar-
rowed opening — a similar sound is also heard in stridulous laryngitis ;
but here, instead of inflammation and effusion, we have spasmodic
action of the little muscles which close the glottis ; it is essentially a
nervous disease, caused by irritation of the peripheral extremities of
the nerves which cause the closure by reflex action. There is not
much difficulty in discriminating between the two diseases, as in acute
laryngitis we have the character of the sound, changing from soft to
harsh, and then remaining stationary till the decline of the disease ;
while in stridulous laryngitis the whistling sound suddenly appears
and as suddenly disappears, and is almost invariably confined to chil-
dren, while the acute attacks adults. Laryngeal ulcerations, with
thickened edges and warty growths, produce a snoring or sonorous
sound. It is also said laryngitis, with exudation of false membranes
which have become partially detached and are floating loosely in the
larynx, gives rise to a tremulous, flapping sound ; but as the diagnosis
of this disease can be made out by the other signs, and auscultation
is very difficult to practise on the neck of a restless child, I imagine
it will not be much employed in the detection of this disease.

Another and the last sign I shall mention indicative of laryngeal
disease, is diminution or absence of the vesicular murmur. This state
of things may be caused by any narrowing of the glottis ; and conse-

366 CABELL ON AUSCULTATION AND PERCUSSION.

quently a diminution of the quantity of air received into the lungs.
These are all the diseases of the larynx with which I am acquainted,
whose presence can be detected by auscultation. But this organ is
liable to accident, and sometimes receives into its cavity foreign
bodies, as beans, coins, &c. These of course cause great irritation and
difficulty of breathing; they are sometimes fixed, but are most gene-
rally moveable, acting as valves in allowing the ready entrance of air,
but preventing its return. The ear applied over the larynx in an ac-
cident of this kind, can readily detect a clacking, valvular sound, and
we not only find out the presence of the body, but the exact spot for
the performance of the operation for its removal, which alone can pre-
vent the patient from dying of apnoaea.

Before speaking of the special diseases of the lungs, it will be pro-
per to mention the healthy thoracic sounds as heard on auscultation
and percussion. The lungs occupy nearly all the space within the
cavity of the chest, and are evenly applied on all sides to the ribs and
intercostal spaces ; they are exceedingly light and spongy, being com-
posed of bronchial tubes and air vessels, and are eminently calcu-
lated to give a clear, resonant sound ; this, when heard through the
thoracic walls, loses some of its clearness, and when heard through
muscle and fat, becomes decidedly dull. Now all of the anterior and
lateral parts should yield this clear, resonant sound, it being more in-
tense over the sternal ends of the clavicles ; but over the dorsal and
scapular regions, which have a thick investment of fat, muscle and
areolar tissue, it loses its resonance and becomes somewhat dull,
and inferiorly on the right side, over the region of the liver, decidedly
so. The heart causes some slight dulness on the left side, beginning
about the cartilage of the fourth rib, and extending inferiorly as far as
the sixth ; below this the sound is frequently tympanitic, owing to the
encroachment of the stomach. The heart, although a dense muscular
organ, does not cause much dulness, being overlaid almost entirely by
the vesicular structure of the lung. The sounds heard on ausculta-
tion are these : at the junction of the clavicles with the sternum and
directly over the large bronchial tubes, a blowing sound, called bron-
chial respiration, is heard ; and posteriorly between the scapulae the
same sound, but not so loud and distinct; frequently near the apex of
the lung on the right side a like sound is produced, caused by the
greater size and shortness of the right bronchus. Over no other parts
but those indicated, do we in a state of health have bronchial breath-
ing, but instead, a soft murmuring sound, (termed vesicular murmur.)
like the sighing of a gentle wind among the leaves of a forest. This
sound is more or less marked in difFerent" persons, being more distinct
in children and thin, nervous people. Some persons, with perfectly
heahhy lungs, give scarcely any vesicular murmur. Dr. Watson
thinks they have more lung than necessary, "room enough and to
spare," and consequently do not fully dilate their lungs, which dilata-
tion, by causing the air to rush in and fill the vesicles, produces the
sound.

Bronchitis is the next disease in order, the anatomical lesion of
which is thickening and congestion of the bronchial mucous mem-

CABELL ON AUSCULTATION AND PERCUSSION. 367

brane, with subsequent effusion within and around them. Each of
these changes gives rise to an abnormal sound. At first the mem-
brane is thickened and lined with a tenacious mucus, instead of the
normal secretion ; and the same quantity of air passing through these
roughened and narrowed tubes on its way to the vesicles, gives rise
to a sound called in the large tubes sonorous, and in the sm;i.ll sibilant
or whistling rhonchus. These sounds are heard in the median line
most distinctly, and diminish in intensity on either side. This state
of things does not last long before effusion results, and then the dry
sounds give place to the moist, caused by the passage of air through
the contained liquid, and heard both during expiration and inspiration,
and are called mucous and sub-mucous rales. They may also be heard at
the same time with the dry sounds, the tubes being in some parts tu-
mefied and congested, and in others filled with liquid effusions. There
are no abnormal sounds elicited on percussion, as the lungs are as
permeable to air as ever. There is another sound heard on auscul-
tation, which, though of unfrequent occurrence in bronchitis, is a con-
stant sequela of tubercular deposit, and should be mentioned in this
place. 1 allude to dilatation of one or more of the bronchia, induced
by violent coughing while the tubes are weakened by disease. The
sound heard in such a cavity is called cavernous respiration, and
when the patient speaks, the peculiar vocal resonance is termed pec-
toriloquy ; and there is sometimes increased resonance on percussion.
I have heard all of these sounds in a well-marked case of bronchitis,
and where there were no signs, physical nor rational, indicative of
phthisis. Emphysema is a dilatation of the air vesicles, which by
decadence of their sides open into each other and form sacs, which
may vary from the size of a pea to that of a pigeon's egg. These
vesicles lose their elasticity, and become thickened ; the air does
not freely pass in and dilate them, and in this way the vesicular mur-
mur is abolished. But another sound is sometimes heard, caused by
the rubbing of these dilated vesicles against the costal pleura, and is
called the friction sound. It can never be confounded with the fric-
tion sound of pleUritis, as in the latter there is more dulness on percus-
sion, while in the former the sound is preternaturally clear. Pleu-
ritis, an inflammation of the pleura, gives rise to the following sounds :
If the pain is very acute the vesicular murmur will be very feeble, or
entirely abolished ; but on the unaffected side we will have puerile
respiration. The first effect of the inflammation is to dry the mem-
brane, and the pleura being thus deprived of its natural lubricating
fluid, instead of performing its lunctions smoothly and noiselessly,
cause a dry, rubbing sound to be heard ; this dry state soon gives way
to that of increased secretion and effusion, which soon abolishes the
friction sound, by separating from contact the two sides of the pleura.
Now for the first time percussion is available, which brings out a dull,
and at the lower and posterior part of the chest where the fluid gra-
vitates, a flat sound. The liquid continuing to increase, presses on
and abolishes the air vesicles, and bronchial respiration is heard and
is accompanied by that variety of vocal resonance termed broncho-
phony. In some rare cases, instead of bronchophony, we have a pecu-

368 CABELL ON AUSCULTATION AND PERCUSSION.

liar vibrating resonance of voice called atrophony. It is supposed, in
order to produce this sound, the serum must be in a thin stratum over
the lung, moderately compressing it. If the effusion goes on increas-
ing, all these sounds are abolished, the lung being pressed airless back
against the spine ; perfect flatness on percussion is now the only-
sound heard on the diseased side ; but after the fluid has been ab-
sorbed, and the pleura roughened by lymph, allowed to come toge-
ther, the friction sound is once more heard, but is softer in its charac-
ter, the lymph having been macerated in the contained serum for so
long a time. Pneumonia is not only a very frequent disease, but is
quite an alarming and fatal one, when not recognised in its very com-
mencement and treated energetically ; and there are no means other
than the physical to impart to us this valuable knowledge. In the
very beginning of pneumonia the lung is congested, and there is ef-
fused into the vesicles and intervesicular spaces a bloody serum,
which by its presence causes great dyspnoea, preventing the entrance
of the air and the oxygenation of the blood. This serum is not only
in the vesicles, but also in the minute bronchial tubes ; and being
more viscid than the ordinary secretion, causes the sides of these
tubes or vesicles to stick together, which being suddenly separated
by the entrance of the air in inspiration, gives rise to that peculiar
crackling sound called crepitant rhonchus, which is pathognomonic of
pneumonia ; during this state of engorgement nothing can be learned
by percussion, as the lungs are still permeable to air, and will float on
water. If the disease is unsubdued, it progresses to the second
stage ; coagulable lymph is thrown out, completely filling up the ve-
sicles and minute bronchial tubes, and abolishing the crepitant rhon-
chus, in consequence of the fact that the air is unable to pass further
the bronchial tubes. Now a new set of sounds are heard in the dis-
eased lung ; whatever increases its density, augments its conducting
power, and the sound caused by the passage of air through the bron-
chial tubes, and which in health is marked by the vesicular murmur, is
conveyed with surprising distinctness to the ear of the auscultator.
This sound is called bronchial respiration, and is heard most distinctly
at the posterior and inferior part of the chest. Coinciding with this
sound we have bronchial resonance of voice — in other words, it seems
as if the patient were speaking through a tube into our ear. This
condition of the lung is called ramollisement rouge, or red hepatiza-
tion, and yields on percussion a very dull sound, its elasticity being
entirely destroyed. If the disease still advances, and the lymph, in-
stead of being absorbed, degenerates into pus, we still have the same
sounds as in the second stage, with the addition of mucous rhonchi. In
some rare cases it goes a stage further ; cavities are formed, the dis-
integrated portions along with the pus being expectorated, and the
air passing into these cavities, gives rise to h hollow, blowing sound
called cavernous respiration, and on causing the patient to speak, to
pectoriloquy. During these three stages, the sound on percussion is
dull over the diseased parts; on the opposite side of the chest respi-
ration is performed with rapidity and noise ; one lung having to do
the work of both, and seeming to complain under the double task im-

CABELL ON AUSCULTATION AND PERCUSSION. 369

posed. This kind of respiration is called puerile, being constantly
heard in children, even in health.

Auscultation and percussion have been of incalculable value in en-
abling us to detect tubercular phthisis in its earliest stages ; for it is
only in its very incipiency, so to speak, that remedial agents are at
all available in the arrest or cure of this dread disease. Prior to the
discovery of the physical means of diagnosis, we were ignorant of its
presence till hectic supervened, " and stained the cheek of that unna-
tural red which autumn paints upon the perished leaf." Before al-
luding to the signs by which its presence may now be detected, and
its progress followed towards recovery or death, it will be proper to
speak somewhat at length as to the nature of tubercular disease, and
the reason for its frequent appearance in the lungs. Tubercular mat-
ter seems to be owing to a perversion of nutrition and assimilation.
In a healthy organization the blood must be healthy, for "the blood
is the fluid body, and the body the fixed and rigid blood." Healthy
blood contains of water 780 parts, of globules 141, of albumen 70, of
fibrine 3, of extractive matter 6 ; this is the analysis of the blood of a
male. Now that of females contains the same amount of fibrine, but
is remarkably deficient in red globules ; and this may possibly account
in part for the gieater frequency of this disease in the latter: for in
phthisis the blood is much altered, containing fewer corpuscles but
more fibrine than in health ; and this fibrine is not only increased in
quantity but changed in quality; it loses its healthy plasticity, and is
prone to degenerate into unorganized masses. Fibrine being the ma-
terial of which the tissues are composed, is constantly being deposited
and removed by the capillaries and absorbents. When first effused
it is soft, and composed of fibrils and exudation corpuscles, which
soon acquire a cell wall and nucleus, and afterwards undergo further
vital changes, and assimilates itself to those structures it is designed
to nourish. But the tubercular plasma is either cacoplastic, or en-
tirely unorganizable, and when effused from the capillaries, the exu-
dation corpuscles increase in size by endosmosis, till they are too
large to be absorbed and eliminated in the usual way. The tissue
in which this aplastic substance is effused need not necessarily be in-
flamed, but its deposit is more rapid during the existence of irritation
or inflammation, and for at least two reasons — first, more blood is car-
ried to the part than during health, and wherever there is increased flow,
there is increased deposit ; second, the quantity of fibrine in the blood
is much increased by a local inflammation, the inflamed spot seeming
to be the laboratory where it is manufactured in the largest quantities.
Now if the blood is healthy, this fibrine will become organized and
constitute false membranes, granulations, &e ; but in the strumous
diathesis every effusion and deposit in the body may become aplastic,
and is then subject to chemical and not vital laws, acting as irritants
and causes for still further deposit. Phthisis is then a blood disease,
complicated with local lesions, and it is only by restoring the normal
constituents and proportions of the different elements entering into the
blood, that we can hope to arrest the disease; and it is of the last
importance that we recognise it in its very commencement, before the
42

370 CABELL ON AUSCULTATION AND PERCUSSION.

blood has been irretrievably ruined. The first auscultatory sounds
heard indicative of phthisis, are rude respiration and prolonged expira-
tion. This rudeness is not removed by full inspiration nor coughing,
which would be the case if it depended on inspissated mucus, and
seems to be caused by the deposit of tubercular matter on and within
the bronchial tubes and air vesicles ; and in the place of the smooth,
polished surfaces we have in health, there is roughness and thicken-
ing ; the air in passing over these roughened surfaces meets with re-
sistance, and in proportion to the resistance, is the rudeness of the
respiration. When the tubercle is deposited in sufficient quantities to
fill up the vesicles, bronchial respiration and bronchial resonance of voice
are heard ; and coincident with this sound there may be mucous and
sub-mucous rales, caused by irritation, and generally commencing at
the summit of the lungs, and gradually extending downwards. Slight
bronchial respiration at the apex of the lung on the right side is not
an abnormal sound, but when heard on the left should be regarded
with suspicion. Percussion under and upon the clavicle may detect
the presence of even a small quantity of tuberculous matter; for the
summit of the lung is in immediate contact with that bone, and very
slight dulness can be recognised. In those parts of the lung free from
tubercle, the respiration is hurried and puerile, the air passing with
great rapidity through the bronchial tubes. These first sounds are
very difficult to recognise, but they should in suspicious cases always
be sought after with care ; for the disease if not now arrested, will in
all human probability proceed unchecked to a fatal termination. The
lungs, of all the organs of the body, are most liable to tubercular de-
posit, and when tubercle is found elsewhere we may with certainty
predict its presence here; for this preference several reasons have
been offered, some supposing its exceeding vascularity, and others
its eliminating character to be the cause. Dr. Williams supposes
the frequent deposit at the summit to be owing to the great quan-
tity of lax areolar tissue found there, and between the meshes of
which the tubercle is easily infiltrated. There is dulness on per-
cussion generally over the clavicle, caused by the consolidation of
the lung underneath ; and although this dulness may be slight if
heard on only one side, it should be regarded with suspicion. If the
tubercular matter increases in quantity, we soon have other signs to
guide us with certainty to our diagnosis; for after a longer or shorter
time this foreign substance must soften and be expelled, not by any
power inherent in the mass itself, for it is not endowed with vitality,
but by softening of the surrounding structures, and the bands of
areolar tissue which permeate it in all directions, and between the
meshes of which it is deposited; being thus softened and macerated,
it finally makes its way into one of the bronchial tubes and is expelled.
While undergoing the softening process a crackling sound is heard on
auscultation, which, after evacuation of the matter, gives place to
cavernous respiration and cavernous resonance of voice, (pectoriloquy,)
while in the surrounding portions we have harsh and bronchial respi-
ration, owing to the consolidation and increased conducting power of
the lung, and over those parts not involved in the disease, puerile res-

CABELL ON AUSCULTATION AND PERCUSSION. 371

piralion. Over the cavity the sound on percussion is more resonant
than in health, and if it is large and near the surface, almost tympa-
nitic or amphoric. The amphoric is only a modification of cavernous
respiration, being heard in a large cavity with thick firm walls, and
containing liquid ; when a bronchial tube opens below its level, gur-
gling is produced, and in the adjoining ones mucous and sub-mucous
rales. Now recoveiy, while extremely rare under these circum-
stances, is by no means impossible ; for if we can prevent the deposit
of a fresh crop of tubercles, the sides of the cavity gradually approxi-
mate, contract adhesions and leave only a cicatrice in the spot for-
merly occupied by the tubercle, or the more fluid parts of it being
absorbed, the rest may remain a hard, chalky and innoxious mass,
causing very little inconvenience to the patient. When the cavity is
large, placed near the thoracic walls, and has thick but soft and
flaccid sides, the sound heard on percussion is very peculiar, resem-
bling very much that caused by striking the closed hands against the
knee, and called the cracked pot sound. The same sound is some-
times heard on percussing a healthy but thin person, with the lung full
of air and the mouth open. After phthisis has existed some time, the
pulmonary pleura is very apt to be perforated, and air admitted in
contact with a serous membrane, causing great disturbance. The
irritation set up by the presence of air soon induces an effusion of
serum, (pneumothorax with effusion,) and we then have at the base of
the lung perfect flatness on percussion, strongly contrasted with the
tympanitic sound above. Pneumothorax, while in the great majority
of cases caused by tubercular perforation, sometimes occurs as the
sequela of pleuritis; for on the absorption of the effused fluid the lung
sometimes does not expand to fill the void, being bound down by
adhesions, and air is secreted by the membrane in sufficient quantity
to fill up the vacuum ; beside the flat and tympanitic sounds heard on
percussion, we have on auscultation the vesicular murmur very feeble
or entirely absent. If the perforation is large, the air passes in and
out with a blowing sound, (amphoric respiration,) but if small, the sound
heard during full inspiration or coughing, is reflected many times in
the cavity, and gives rise to a peculiar ringing noise (metallic tinkling.)
Another means alluded to before as being known to the ancients (suc-
cussion) may also be tried ; but as the other physical signs are amply
sufficient to diagnose this complication of phthisis, this one is rarely
resorted to. There are other signs indicative of this disease, but as
those I have mentioned are amply sufficient to distinguish it, and as
my space is limited, I shall not allude to them further. While the
heart and circulatory system cannot be investigated with that degree
of accuracy which obtains in the lungs, we have still had much light
thrown upon their structural alterations and functional disorders by
the introduction of the stethoscope ; before its discovery nearly all the
disorders occurring about the precordial region were included under
the comprehensive title of " heart disease ;" but the particular part
affected, and the nature of the lesion remained unknown till after
death ; and even now, with all the improvements of modern times,
we are frequently embarrassed in making out a diagnosis, for the

372 CABELL ON AUSCULTATION AND PERCUSSION.

sounds heard, both normal and abnormal, are confined to a small spot
in the thorax, and frequently similar sounds are produced by dissimi-
lar diseases. It is therefore indispensable, before pronouncing on the
nature of the affection, to collect all the symptoms, ph}rsical, general
and rational ; but in this essay 1 must confine myself exclusively to
the diagnosis by the physical signs.

The heart is a hollow muscular organ, whose office is to propel the
blood through every part of the circulatory system; it must be evi-
dent, therefore, that any derangement in the action or structure of
this most important viscus will of necessity be followed by serious
disturbance. It consists of four cavities, which communicate with
each other, and the adjoining arteries and veins, through openings
protected by valves, which in their normal condition permit the blood
to pass in only one direction ; these four cavities are lined with a
serous membrane, which is reflected over the valves and is continu-
ous with the lining membrane of the vessels. It is contained in a
fibro-serous membrane, (pericardium,) which, by giving a smooth in-
vestment, facilitates its motions, but still confines it to its proper place
in the chest. The position of the heart, which is ascertained by per-
cussion, is from between the cartilages of the third and fourth ribs
above, and from the right border of the sternum to the nipple lateral-
ly ; and below it reaches to the diaphragm, on which its apex rests,
and to which the pericardium is sometimes attached. In front it is
overlaid by the anterior lobes of the left lung, and only comes in con-
tact with the ribs at one spot. Now in health, two sounds are heard
on auscultation ; first, a dull, prolonged one, which coincides with the
impulse of the heart and the pulsation of the radial artery ; then
comes a short period of repose, and after that the second sound,
which is short and quick, and is heard after the radial pulsation ; and
lastly, a long silence occurs, after which the same series is repeated.
The first sound is synchronous with the contraction of the ventricles,
the closure of the auriculo-ventricular valves and the impulse of the
heart against the ribs ; it is supposed by some that this latter is suf-
ficient to produce the sound, but this cannot be, as in pericarditis
with effusion the sound is still heard, although the heart may be re-
moved several inches from the ribs ; the second sound is produced
by the systole of the aorta and pulmonary artery and the sudden
closure of the semilunar valves. These sounds are easily recognised,
and are the only ones heard in a healthy state of function or organi-
zation. The diseases to which the heart is liable are, inflammations
of its lining and investing membranes, alterations in its valves by nar-
rowings, insufficiencies, warty growths, deposits of lymph and osseous
matter, and by hypertrophy of its muscular structure. There are
also functional disorders, unconnected with structural alterations, and
depending on faulty innervation, or changes in the composition of the
blood. In investigating the heart, the flexible stethoscope of Dr. Pen-
nock should be used for many reasons. The first disease occurring
in the precordial region, to which I shall allude, is pericarditis, which
most generally is a sequela of acute articular rheumatism ; the fibro-
serous membrane of the heart being similar to that of the joints ;

CABELL ON AUSCULTATION AND PERCUSSION. 373

the disease in its progress and termination is very much like pleuritis;
first dryness, then serum and liquor sanguinis. During the first stage,
a dry, rubbing sound sound may be heard, conjoined with a hurried
and tumultuous action of the heart; this friction sound may always
be distinguished from that of pleuritis by desiring the patient to hold
his breath — if from pleuritis it ceases, but is unaffected in pericardi-
tis. In the second stage, the natural sounds are heard very indis-
tinctly, and that of friction totally abolished, as the effusion within
the sac removes the heart from its normal position ; but the feeble
sound is caused, not so much by this as reaching the ear through the
liquid, which does not conduct sound so perfectly as a solid body.
The sounds on percussion are dulness or perfect flatness, according
to the amount of the contained liquid ; the space over which this
dulness is heard is pyramidal, the apex being above ; after absorp-
tion of the liquid, the rubbing sound may again be heard, the mem-
brane once more coming in contact ; the effused lymph is sometimes
absorbed, but more frequently becomes organized, glues the heart to
the pericardium, hampers it in its motions, and lays the foundation
for hypertrophy and other diseases. Endocarditis or inflammation of
the lining membrane is also frequently complicated with rheumatism.
The products of inflammation are effused as in the other disease, but
are immediately swept away in the torrent of the circulation ; and
frequently the only morbid alterations found after death, are redness
and thickening of the lining membrane. The lymph effused on the
valves seems to be more tenacious, and soon becomes organized, and
passes through the different transformations till it becomes ossific.
The heart in the beginning of the disease is heard to beat with great
rapidity and violence, and frequently slight dulness may be perceived
over the precordial region, as in pericarditis ; but they can be easily
distinguished, one from the other; for in the latter the sounds of the
heart are very indistinct, while in the former they are the reverse ;
but the most constant and characteristic sign is the bellows murmur,
which increases and diminishes in intensity, according to the violence
or rapidity of the heart's action. If the disease is not completely
eradicated and the effused lymph absorbed, we have a new set of
sounds produced, very different from any heard in health ; this orga-
nizable lymph is either effused upon the membrane of the valves or
beneath it, and as it passes through the different transformations,
causes a change in the character of the sounds. In practice it is ex-
ceedingly difficult to detect the particular valves affected, nor is it
practically of much importance. Dr. Williams has, however, pro-
posed a plan which appears quite promising, namely, to note in what
direction the sounds can be longest heard ; if the murmur can be
most distinctly perceived in the direction of the aorta ; the semilunar
valves are most probably affected ; the same rule holds good with re-
gard to the pulmonary artery ; if, however, the sounds are heard most
distinctly about, the centre of the heart and decrease in intensity in
all directions, the auriculo-venlricular valves are most likely diseased.
This state of valvular disease sooner or later causes hyperirophy of
the muscular structure, composing one or more of the cavities of the

374 CABELL ON AUSCULTATION AND PERCUSSION.

heart. This hypertrophy may be of three kinds ; first, without dila-
tation or contraction of the cavity: second, with contraction, and
third, and most frequent, with dilatation. Dr. Clendenning believes
hypertrophy to be caused by vital action in the heart itself, and not
by mechanical obstruction. " I would thus," he continues, " reverse,
in a great degree, the order of causation usually received, and attri-
bute much of the valvular disease to inflammation, mainly induced
by hypertrophy, (if we exclude rheumatism,) as a most potent predis-
posing cause ;" but I believe the majority of writers consider this ex-
cessive growth as the effect and not the cause of valvular diseases
and obstructions. It seems reasonable that the obstacles to be over-
come in the circulation of the blood being greater than in health, the
propelling power must necessarily be increased, and increased nutri-
tion generally keeps pace with increased function. On auscultating an
hypertrophied heart, we find the first sound duller and more pro-
longed than in health, and frequently fills up the period of repose be-
tween the two sounds ; the heart's impulse is also heard over a larger
space, but is not so suddenly and intensely produced (provided the
auricles are not hypertrophied) as in a healthy state of the organ. A
bellows murmur is also frequently heard during the first sound, for
whatever increases the propelling power or offers resistance to the
free escape of the blood, causes an abnormal sound. When the hy-
pertrophy is considerable there is dullness on percussion, but here the
apex of dulness is below, while in pericarditis it is above. The val-
vular murmurs which generally precede and accompany this disease are
caused by narrowings, insufficiencies, rigidity and ossification of the va-
rious openings from and into the heart ; these sounds are harsh, blowing,
rasping or sawing, according to the size of the orifice and the rough-
ness of its surface ; but all the sounds resulting from valvular disease
are harsh and grating in their character, which sufficiently distinguish
them from those of anemia and chlorosis, which are musical. If the
sounds heard coincide with the systole of the ventricles, and can be
traced along the course of the aorta, the semilunar valves are most
probably diseased ; if, however, the sounds are heard during the dias-
tole, the cause most probably is insufficiency, allowing the reflux of
blood and destroying the second sound. The auriculo-ventricular
valves may give rise to morbid sounds, if heard during the systole
produced by insufficiency, during the dyastole by narrowing. These
sounds may also be heard double, and are generally rasping or sawing
in their character and indicate grave disease ; there being narrowing
of one opening and insufficiency of another, or the same opening may
be both narrowed and deprived of its valves, the blood rushing in
and out at each contraction and dilatation. To diagnose correctly
these valvular diseases is by no means easy, and we should always
avail ourselves of the signs from the general system and the radial
artery, which of course I cannot allude to here.

Aneurism of the aorta occurs with sufficient frequency to make it
necessary to say a few words concerning the physical signs by which
its presence may be recognised. It occasions a dull sound on percus-
sion over those parts of the sternum naturally resonant, and on auscul-

CABELL ON AUSCULTATION AND PERCUSSION. 375

tation a rough bellows murmur, occurring synchronously with the first
sound of the heart and preceding a little the pulsation of the radial
artery. Aneurisms of other arteries, if near enough to the surface,
may be recognised in the same way. In anaemia and chlorosis the
blood is much altered from its normal standard, containing fewer red
globules and more water. This thin blood, circulating through the
vessels, is easily thrown into vibrations, and gives rise to a bellows
murmur, which may be intermittent or continuous, but is always in-
creased in intensity at each systole of the heart, and is called by the
French bruit de diable ; it is easily distinguished from the bellows mur-
mur caused by structual alteration, in being soft, musical and tremu-
lous in its character. This bellows murmur is not only heard in the
arteries, but also in the veins ; and it is this which renders the sound
continuous ; for if a stethoscope is applied over the carotid artery of
an anaemic patient, and the jugular vein compressed, the murmur will
suddenly become intermittent and synchronous with the first sound of
the heart. It has been demonstrated by M. Andral, that this bellows
murmur always exists when the proportion of the red globules fall
below 80 parts in the 1000 of blood, the normal proportion being, for
females 127, for males 141 ; and the former have a greater proclivity
to this disease than the latter, which may in part be owing to the
greater deficiency of globules in their blood. Auscultation has also
been used to diagnose cerebral diseases ; but as the sounds heard are
few in number, indicate so many and different diseases, and are by
no means pathognomonic, I shall not take up the little space I have
left by describing them.

Auscultation of the gravid uterus has been practised with great suc-
cess of late years. No other single sign of pregnancy can be relied on
with certainty. But there is no sound heard in the body similar to
the click of the foetal heart, and when it is once recognised all doubt
as to the condition of the woman is removed. It not only informs us
that the woman is pregnant, but assures us that the child is living ;
and in difficult and protracted labors, if the sound suddenly ceases,
we know the child to be dead, and feel less hesitancy and repugnance
in performing the necessary operations for the relief of the mother.
There is another sound, called the uterine bellows murmur, heard in the
gravid uterus, and is produced by the blood passing through the long,
curling arteries; it is also called a placental murmur, but M. Depaul
asserts, "that it can be heard anywhere on the uterine walls accessible
to the ear or stethoscope." It cannot, therefore, be considered a cer-
tain sign of pregnancy, as whatever enlarges the uterus gives rise to
the murmur, and in pregnancy the death of the foetus in no way alters
or abolishes the sound. The sounds of the foetal heart are two in
number, close together, yet perfectly distinct, and are said to resemble
the ticking of a watch in all save the metallic sound ; they are re-
peated from 120 to 150 times a minute, and become less frequent
during the latter months of pregnancy. They may generally be
heard after the fourth month, and M. Depaul says he has recognised
them as early as the third month. When two sets of sounds are pre-
sent we may diagnose twins. These sounds may be heard in the

376 MERIWETHER ON THE FIBRINE OF THE BLOOD.

direction of a line drawn from the umbilicus to the anterior inferior
spinous process of the ilium, and as the sound corresponds with the
left scapula of the foetus, we may not only recognise the presentation,
but the position of the child in utero.

Percussion is the only one of the physical means of diagnosis which
can be made available in investigating diseases of the abdominal
organs. The spleen, liver, bladder and intestines all have light thrown
upon their diseases by percussion. When the liver or spleen is en-
larged their dimensions may be most accurately marked out by the
pleximeter, and still better by auscultatory percussion. The intes-
tines yield a dull, flabby sound when filled with fecal matter, and a
tympanitic one when distended by gas. The bladder also, when
filled with urine, can be recognised by its circumscribed dulness, and
liquid in the peritoneal sac distinguished from ovarian dropsy, one
shifting with the motions of the patient, the other remaining fixed. In
physometra, percussion is one of the chief means of diagnosis; in this
disease, caused by an accumulation of gas in the uterus, instead of a
dull, we have almost a tympanitic sound, which is limited in extent.
In hydrometra the sound is also limited, but is perfectly flat in its cha-
racter. But on the whole the sounds heard in the abdomen do not
indicate the nature of the disease with that certainty which obtains in
the chest, and palpation is still resorted to in preference to ausculta-
tion and percussion for the purpose of diagnosis. I have thus, to the
best of my ability, alluded as briefly as possible to the principal dis-
eases whose natures are revealed, and whose progress may be fol-
lowed by means of these physical signs. I know full well I have
omitted many things which strictly belong to this subject, but have
preferred to mention only the most dangerous and frequent diseases,
and the sounds most practically useful, to over refinement and un-
pardonable length.

Observations on the Fibrine of the Blood.

BY WM. D. MERIWETHER, M. D.
[Read before the Medical Society of Virginia at its June Meeting.]

In taking a general view of the present state of pathology, we can-
not fail to be impressed by the great importance attributed to altera-
tions of the blood in the formation of many of the diseases with which
the physician is called upon to contend.

It seems to be generally admitted at the present day by the most
eminent observers, that there are certain diseases which have their
origin in'the blood, and which owe most of their manifestations to
changes in that fluid, produced by an agent, termed virus, poison or
miasm ; that others may be traced farther to the source of the blood in
the processes of digestion, where vitiated matters are formed, thence
thrown into the blood, and by it transmitted to various organs and
tissues of the body. There are also certain other diseases known as
inflammations, which at one time were supposed to have their origin

MERIWETHER ON THE FIBRINE OF THE BLOOD. 377

exclusively in the solids, and in which the altered properties of the
blood were disregarded or considered as secondary in effect and in
importance.

As an expression of the present state of opinion in relation to the
causes of inflammation, I will quote the words of a distinguished lec-
turer on this subject :*

" We may speak much equivocally of the state of the blood itself
in determining inflammations, for there can be little doubt that a very
great majority of the so-called spontaneous or constitutional, as distin-
guished from traumatic inflammations, have herein their origin."
Again : " Morbid conditions of the blood are most probably the causes
of a great majority of the so-called spontaneous local inflammations."

It may be stated that in most internal affections, whether inflam-
matory or not, we find the blood looked upon as containing their
germ or essence.

Whether the theory of blood diseases be correct or not, I think it
may be safely asserted that pathology and therapeutics have been
much improved by regarding the blood as the seat or starting point
of numerous disorders. In fevers, for example, we no longer look
upon inflammation as their cause, or even their invariable attendant,
nor are vain attempts made to locate their origin in particular organs
or tissues. Consequently, in the management of fevers, remedies are
not directed by false theoretical views to the head or to the abdomen,
but a safer and more rational treatment is addressed to the whole
system, or to complications as they may arise.

The results obtained by chemical analyses of the blood in health
and disease have contributed to the revival of humoralist doctrines, at
least by directing to the fluids the attention so long exclusively fixed
upon the solids ; and though in disease the chemists are unable to se-
parate or detect the subtile agents which effect changes in the fluids,
yet, by demonstrating what may be called their morbid anatomy, they
have greatly enlarged our knowledge of diseased products.

While entertaining these opinions in relation to blood diseases, and
allowing due importance to the results of chemical investigations, I
do not believe that the experiments are sufficiently extended or veri-
fied, to enable us to deduce practical rules for the treatment of dis-
ease.

I shall endeavor to prove that conclusions have been drawn from
the analyses of the blood, which are not warranted by the facts them-
selves, and to shew the injurious tendency of these conclusions, if
fully carried out in practical application.

It will be recollected, that at several recent meetings of the society,
the subjects of discussion being the continued and eruptive fevers,
several members expressed themselves in favor of the treatment of
those diseases, by an occasional employment of blood-letting, and by
the use of mercury, to some extent, in most cases ; others contended
that Andral had laid down a principle which should govern us in the
use of these remedies, which is, " That an excess of fibrine in the
blood is the pathognomonic sign of inflammation ;" this constituent
* Paget — Lectures on Inflammation. — Lancet 1849.

43

378 MERIWETHER ON THE FIBRINE OF THE BLOOD.

of the blood being deficient in fevers, therefore indicating a state op-
posite to that of inflammation, they argued that the remedies for in-
flammation, particularly blood-letting and mercury, are contra-indicated
in these diseases.

It follows, of course, that when the fibrine is in excess, the anti-
phlogistic treatment must be resorted to.

The subject, then, that I propose to notice briefly, is the value of
variations in the amount of fibrine in the blood as indications of treat-
ment.

As the analyses of Andral have been alone referred to in previous
debates, and as they coincide in general with those of other observers,
I shall confine my remarks also to this author.*

Andral gives as the average amount of fibrine in health, three
parts in one thousand ; three then is the figure representing the ave-
rage proportion of fibrine to the other constituents of the blood in
health. He describes two great classes of disease, the phlegmasia?
or inflammations, and the pyrexiae or fevers ; the former characterized
by an excess of fibrine, the latter by a deficiency of the same.

Let us examine some of the diseases in each of these divisions, in
order to determine the actual value of variations in the fibrine as
guides to practice.

I commence with the first — inflammations, and take as an example,

Rheumatism. — There is in this disease, according to Andral, a great
increase of fibrine, from eight to ten parts, which places it in the
highest rank of inflammatory affections.

To fulfil the indication, there should be an activity in the treatment
corresponding to the high rate of fibrine ; the antiphlogistic method
should be strictly enforced, and calomel and blood-letting, as promi-
nent agents in this plan, should be vigorously pushed ; in other words,
we have a certain disease to treat ; the blood is examined and found
to contain an excess of fibrine ; therefore, the remedies for inflamma-
tion must be employed to get rid of this state, or, as is said, to reduce
the plasticity of the blood.

This, if correct, would be a very simple and excellent method, and
would save us a great deal of trouble in diagnosis, and in discrimi-
nating between different kinds and degrees of inflammation ; but it is
well known, that neither the antiphlogistic nor any other mode of treat-
ment yet devised, will certainly arrest the progress of an acute rheu-
matism ; that a large proportion of cases will not admit of general
blood-letting, and that a profuse administration of mercury will not en-
sure a rapid or safe termination.

I do not wish to be understood as denying that the judicious em-
ployment of these remedies is not the proper course to pursue, but
the highest authorities will sustain me in saying, that it is not advisa-
ble to push them to the extent that the violence of symptoms and the
high rate of fibrine indicate.

Dr. Alison says,t " that large and repeated bleedings in the com-
mencement of rheumatism increase the tendency to metastasis."

* Andral, Essai £>' ' Himatologie Pathologique, 1843.
t Cyclopedia of Practical Medicine, vol. 2.

MERIWETHER ON THE FIBRINE OF THE BLOOD. 379

More recent observers have noticed a tendency to anaemia and con-
sequent valvular murmurs towards the close of rheumatism, even
when no bleedings had been practised.

I may also mention that repeated bleedings increase the irritability
of the heart, and may thus determine an inflammation of that organ.
But, let us suppose that, very properly, blood is drawn two or three
times, and a correct estimate made of the proportion of fibrine at each
bleeding, what is the result, only, according to Andral? That the fi-
brine has increased with the disease, independently of the amount of
blood abstracted, and also of the age, constitution, strength, weakness
or other condition of the patient.

Those who regard the increase of fibrine alone as an indication,
must, in such a case, repeat the bleedings and continue the mercury,
though the symptoms of the disease and the constitution of the patient
prohibit the treatment — thus falling into the same error that was so
frequently committed some years since, when it was customary to re-
gard the inflammatory crust as an index of the amount of inflamma-
tion, and to treat the disease accordingly. The principle is the same
in both cases, for Andral* states, "that the inflammatory crust is a
certain evidence of an excess of fibrine in the blood ;" the reason
why neither can be relied upon as indicating a necessity for blood-
letting, is, that the most copious and frequent bleedings will not pre-
vent an increase of fibrine, and consequently its appearance as the
inflammatory crust.

I think, then, we may safely conclude, that in the present state of
knowledge on this subject, we cannot trust to the high rate of fibrine
exhibited in this disease as a guide to its treatment.

In erysipelas, we have another disease characterized by a high rate
of fibrine. Andral says, (92,) that "Erysipelas, however slightly acute
or febrile it may be, advances with an increase of fibrine represented
by the figures 6, 7."

It would appear, then, that the antiphlogistic treatment is indicated
in all cases ; it must also be employed indiscriminately, if we are to
be guided by the state of the blood alone in this disease.

Now, it is generally admitted, that this disease, particularly as seen
in hospitals and large cities, does not admit of very active treatment ;
that many cases require stimulants from the commencement, and that, in
general, depletory measures should be resorted to with great caution.
We are told by South, f that in one of the large hospitals of London,
the stimulating plan is the only one employed. So far as I am in-
formed, the experience of the profession generally is opposed to an
active treatment of erysipelas ; but those who rely upon the state of
the fibrine as an indication, must employ the antiphlogistic treatment,
" however slightly acute or febrile the case may be.""

A great deal is said about the plasticity of the blood, and the action
of calomel in reducing this state when excessive. Let us examine the
value of this opinion.

Andral says, (90,) " in any inflammation of the digestive passages
sufficient to excite fever, the fibrine rises to 5, 6 and 7, but never be-

* Op. Cit., page 74. t ChelhiB, vol. 1.

380 MERIWETHER ON THE FIBRINE OF THE BLOOD.

yond ;" he also details three cases of mercurial stomatitis, uncompli-
cated by other inflammation, in which the fibrine is represented by
the figures 4, 5 and 6 — thus almost equalling the highest grade in in-
flammation of the intestinal mucous membrane. What reliance can
be placed in an excess of fibrine, as indicating the use of mercury,
when we see this remedy producing the same state of the blood that
it is expected to counteract? Andral observes, (89, 90,) "that when
mercury is administered to combat certain acute inflammations, it is
not right to admit that its antiphlogistic action depends upon this,
that it creates in the blood a disposition opposite to that which coin-
cides in this liquid with a state of inflammation."

Andral states, " that in the phlegmasia? there is excess of fibrine in
relation to the globules ;" in anaemia an actual or relative excess of
fibrine, as compared with the globules, is characteristic of the dis-
ease ; the same resemblance to inflammation is found in the appear-
ance of the blood — he " considers it incontestible that the blood in
anaemia often presents the inflammatory crust." (54.) In phthisis,
there is a constant increase of fibrine in the last stages of the disease,
(168,) and again, we find the same state of the blood in the latter
months of gestation. (104.) Thus we have four conditions of the
system, acute inflammation, anaemia, phthisis and pregnancy, all cha-
racterized by the same state of the blood — an excess of fibrine, yet
it must be admitted that they require very different modes of manage-
ment.

I will not pursue the subject farther in this branch, for it might be
shewn in any case, that an excess of fibrine affords no correct indica-
tion as to the proper time for commencing or suspending the use of
any remedy, nor as to the extent to which a remedy should be car-
ried ; and, though we may admit that this sign, taken in connection
with all the attending circumstances of a disease, is entitled to some
consideration, yet, relied upon alone, as a principle applicable to all
cases, it must lead to gross errors of treatment.

Pyrexia. — We come next to that class of diseases said to be cha-
racterized by deficiency in the amount of fibrine, the pyrexiae or fe-
vers.

There can be no doubt that the distinction between fevers and
simple inflammations is fully recognised at the present day, as is also
the difference in treatment required by each ; fevers, as a general rule,
not. admitting of very active interference, though exceptional cases
often occur in which it is entirely proper to abstract blood and to em-
ploy other active remedies. But we are told that these measures are
all contra-indicated by the state of the blood, and that the use of ca-
lomel particularly, must be avoided for the same reason, i. e., a de-
ficiency of fibrine indicates a state opposite to that of inflammation;
therefore, in fevers, an opposite mode of treatment is required.

Let us examine this subject by reference to a few well known dis-
eases ; take for example,

Typhoid Fever. — According to Andral, the fibrine in this disease
may remain in normal quantity throughout its whole course; it may
be much diminished, or it may be increased by a local inflammation.

MERIWETHER ON THE FIBRINE OF THE BLOOD. 381

The excess of fibrine is found to be always coincident with a local
inflammation ; both are only the effects of some unknown cause ;
therefore, the increase of fibrine affords no sign, gives no warning of
the approach of inflammation. Now, almost the only period in the
disease when general blood-letting can be safely practised, is in the
commencement ; if postponed for a few days, it will generally be in-
admissible. I think a great deal of the disrepute attached to this
remedy is owing to its employment too late in the disease ; in robust
subjects, typhoid fever occasionally sets in with great violence, threat-
ening some important organ — perhaps the head or the lungs, with in-
flammation ; the timely abstraction of a few ounces of blood will re-
lieve the symptoms and tend to restrict the disease to its usual dura-
tion ; but an examination of the blood in this stage of formation will
give us no information ; the disease is allowed to run on unchecked,
until at last a low form of inflammation is established in some vital
part, and at the same time an increase of fibrine is discovered in the
blood ; then, when too late, at a time when stimulants are demanded,
we must, to carry out the principles of those who rely upon the state
of the fibrine, resort to an antiphlogistic treatment. For, if it be true
that calomel and blood-letting are contra-indicated by a deficiency of
fibrine, it must be equally true that an excess of the same demands
the employment of those remedies. As to the use of calomel in this
disease, there can be no objection, for the reason already stated, given
by Andral, " that it does not create in the blood a disposition opposite
to that which coincides in this liquid with a state of inflammation ;"
or, as I understand it, it has not the power of diminishing the amount
of fibrine in the blood.

There is a certain deviation from the healthy state, which is recog-
nised in the blood by a diminution of the fibrine and an elevation of
the blood globules — a condition very often occurring in typhoid fever,
according to Andral. (61-68.) This is plethora; but no one, I sup-
pose, would treat the two diseases in the same manner. Andral at-
tempts to explain the difficulty, by asserting that typhoid fever at-
tacks so often persons who, by their age and constitution, are in a
state of plethora.

In apoplexy or cerebral haemorrhage, there is a constant diminution
of fibrine, which is not increased unless inflammation is set up around
the clot. The indication is, to treat the disease as we are recom-
mended to treat all fevers — abstain carefully from bleeding and mer-
cury, and rather administer stimulants.

I will not dwell longer upon this subject, as the same observations
will apply equally to all the diseases of this class. I think enough
has been said to shew that it cannot be asserted as a general princi-
ple, that when fibrine is deficient, blood-letting and mercury are contra-
indicated.

The following extract from the lecture of Mr. Paget, already refer-
red to, may serve to explain why variations in the amount of the fi-
brine do not afford correct indication of treatment : " The supposed
increase of fibrine is ambiguous ; it may be at once an increase of
fibrine and of the white corpuscles of the blood. These two constitu-

382 MARKS ON THE PREVENTION OF PITTING IN VARIOLA.

ents of the blood, the fibrine and the white or rudimental corpuscles,
cannot be well separated by any process yet invented ; and in all the
estimates of fibrine, whelher in health or in disease, the weight of the
white corpuscles is included. Now, in many inflammations these cor-
puscles are increased, and we have no means of clearly ascertaining
how much of an apparent increase of fibrine is really such, or how
much is due to the corpuscles entangled in the fibrine."

To sum up some of the reasons why a variation in the amount of
fibrine cannot be relied upon as a guide to treatment :

1. It gives no warning by its increase of the approach of inflam-
mation, the increase of fibrine and the inflammation being cotempo-
raneous.

2. Its increase is not affected by blood-letting, and seems to be in-
dependent of any state of depression of the system.

3. In the words of Andral, "I have not seen that, besides the ma-
lady itself, the differences of constitution, of temperament, of age, or
of sex, produce any notable modification in the elevation, greater or
less, of the figure representing the fibrine, whether the subjects at-
tacked by any acute inflammation were weak or strong, sanguine or
lymphatic, the increase of fibrine was neither more or less consider-
able."— Andral, Op. Git., p. 81.

4. A diminution of fibrine occurs in diseases otherwise totally op-
posite, as in apoplexy, plethora, typhoid and other fevers.

Observations on the Prevention of Fitting in Smallpox.

BY JULIAN C. MARKS, M. D., OF CABIN POINT, SURRY, VA.

From a profound conviction of the engaging interest and impor-
tance of our subject, as well as from a knowledge of the little atten-
tion which has, in many instances, been bestowed on it by the pro-
fession, we are led to indulge the hope that our remarks may not be
considered unnecessary or valueless. If, indeed, it be conceded, as
we think it must, that the great terror and dread in which smallpox is
still held by mankind are owing in a considerable degree to the un-
compromising warfare which in most instances it is palpably known
to wage against personal beauty, with its every seductive charm and
attraction, we may, upon such grounds alone, rest our apology for
these observations, since it is our purpose to present a laconic expo-
sition of the remedial measures best calculated to prevent complete-
ly (other things being equal) the hideous and repulsive deformity of
face so much feared.

In doing so, however, we pretend not to originality of discovery in
this department of scientific research, but content ourselves with the
hope that by discussing what has already been discovered, we may
draw more closely the attention of the profession in general to this
interesting subject.

The deformity induced by smallpox has really been so constant,
and in very many cases assumed a character so frightful that the sub-
ject of its prevention has long been invested with some interest ; hence

MARKS ON THE PREVENTION OF PITTING IN VARIOLA. 383

various remedies have at different times been brought to the notice of
the profession, claiming to have been successfully employed for this
purpose. However, three or four of them only we deem worthy of
comment.

Perhaps those most lauded, and which present the greatest amount
of testimony in their favor, are the mercurial ointment, nit. argent,
and tinct. of iodine. Their successful action in any case will depend
much upon the stage of the eruption at which they are employed, to-
gether with the severity and variety of the disease. It having been
found that their application is attended with less certainty of success
after the first or papular stage has passed, and in very severe or con-
fluent cases, and vice versa. From these data we derive the following :
1st, that these remedies should be employed at the very commence-
ment of the eruption, or as soon thereafter as circumstances may
render their application practicable ; and 2d, that a successful issue
may be more confidently looked for in mild and distinct cases than in
grave and confluent ones. The fundamental principle in every case
is to produce an abortment of the eruption by arresting its progress
early in the disease. Of the three remedies above mentioned, the
one upon which most reliance may be placed in accomplishing the
end proposed, is doubtless the mercurial ointment. Indeed the weight
of authority in its favor is very great. Professor J. K. Mitchell of
Philadelphia, than whom we have no higher authority in the United
States, says, no other remedy with which he is conversant will com-
pare with it in efficacy.

He used a plaster, formed of equal parts of the ointment and the
semivitrified oxide of lead, (litharge,) which covered the entire face ;
openings being of course left for the nose, eyes and mouth, and with
the most gratifying results. The ointment has been employed, sim-
ply thickened with powdered starch. A preparation made by incor-
porating together twenty-five parts of mercurial ointment, ten parts
of yellow wax, and six parts of black pitch, is said to be signally ef-
ficacious. It has been much relied on in France. It is recommended
that the plaster be removed after four or five days, as from longer
continuing it an unpleasant irritation might be superinduced. Con-
stitutional effects from absorption of mercury are much feared by
some, but doubtless upon insufficient grounds; for should salivation be
produced, it would rather be conducive of benefit than injury to the
patient. The happy results which this remedy furnishes are confi-
dently referred by some to a mere property of excluding the air; but
the fallacy of such a deduction may be clearly and positively shewn
by the fact that other remedies which exclude it equally well are in-
finitely less successful. May they not, as suggested by Dr. Wood,
be ascribed to the specific action of the mercury? Such would seem
at least to us the only rational corollary. We may add, in conclusion
of our remarks on this remedy, that in view of the mental distress
which is caused the patient by the great tendency of smallpox to
leave behind it unsightly pits and scars, the ready application which
may be made of the ointment, and its uncommon success in prevent-
ing them, we would scarcely deem a physician excusable who ne-
glected to give his patient the advantages of its employment.

384 METTAUER ON MERCURIAL OINTMENT.

Much difference of opinion prevails with regard to the manner in
which nitrate of silver should be employed to obtain the greatest
amount of benefit from it. Some lend the weight of their authority
in favor of the solution, which they apply to masses of the eruption,
while others, who also rank high in the profession, give a decided pre-
ference to the solid stick, which is applied to each pock (after having
first been opened) so soon as it becomes vesicular. We deem the
latter to be the more sure and effectual mode of using it. Indeed, Dr.
Wood says, when thus employed it is almost certain to arrest com-
pletely the progress of the eruption, and that in a short time desqua-
mation supervenes, leaving no pits. The eruption has been treated
not unfrequently of late with the tinct. of iodine, and in the hands of
some it has proven a remedy of no inconsiderable value. Dr. God-
dard of Philadelphia made application of it in a number of cases,
and with the effect of preventing the slightest deformity of face even
in the severest cases of the confluent variety — while with Dr. F. Sar-
gent of the same city, it had no appreciable influence on the pitting.
It should be pretty freely applied over the affected surface by means
of a camel's hair pencil.

We may mention that sulphur ointment has also been used with
some success. Professor J. K. Mitchell speaks of it in very flattering
and commendable terms. It must be applied to the face several
times a day. We have now finished the consideration of these reme-
dies with respect to the influence they exert on the eruption ; but they
are deserving attention on another account ; and here, with one or
two remarks more, we have done. Inflammation and tumefaction of
face are not the least distressing of the many and varied phenomena
which the disease presents. Over these pathological conditions they
exercise, in not a few cases, almost surprising dominion, relieving the
burning and tension which are almost insupportable, by diminishing
the inflammation and tumefaction. Hence it would seem that, apart
from all other considerations, this alone is of sufficient magnitude to
warrant their use in most cases.

Preparation of Mercurial Ointment.

BY JOHN P. METTAUER, M. D., L. L. D.,

Professor of the Principles and Practice of Medicine and Surgery in the
Medical Department of Randolph Macon College, Virginia.

The object of this paper is to present to the medical profession,
through the Stethoscope, a short and easy method for the preparation
of mercurial ointment, that will lighten the labor, facilitate the pro-
cess, cheapen the cost, and enable the practitioner to have the article
always fresh and pure.

It has always been a desideratum with physicians residing in the
country, to possess a method for the preparation of this valuable the-
rapeutical agent, that would enable them to prepare it themselves, and
without much time or labor ; but, by the established modes, they could

METTAUER ON MERCURIAL OINTMENT. 385

not expect to do so, as the various processes generally in use require
both. The very tedious method of dividing the mercury by triturating
it with lard or suet, when completed, it is true, furnished an excellent
ointment; but the time and labor required would generally induce a
practitioner to purchase, rather than attempt its preparation himself,
especially if much thronged with professional business; and frequently,
too, he would dispense with it, when necessary, rather than under-
take to prepare it himself. The employment of terebinthinates, bal-
sams, rancid tallow, and other materials possessing irritating qualities,
for the purpose of facilitating the division of the mercury, as in some
of the methods now used, although they facilitated the extinguishment
of the particles of mercury — and the process yields a sightly, fine-
looking ointment — nevertheless it could not be used long without ex-
coriating or irritating the surfaces to which applied, and was utterly
unsuited, when required to be used to tender and delicate organs, such
as the eyes, &c.

The difficulty, too, in the preparation of the ointment might tempt
to fraud, either by diluting or coloring it with black substances. A
method then, as already intimated, more expeditious and easier of
execution, for the preparation of this valuable therapeutical agent is
a desideratum ; to supply which, the annexed formula is offered to
the profession. It was communicated through the " Boston Medical
and Surgical Journal" in 1835, and published in part 51, vol. 12,
page 396 of that valuable medical periodical.

Take of mercury, f viij.

spermaceti, 1 iv.

mutton suet, ? vj.

lard. 1 x.

The mercury and spermaceti must be united by triturating them
well together in a glass or wedgewood mortar of proper size. Should
the division of the mercury be slow, which sometimes will be the
case when the spermaceti is dry, a small quantity of lard or sweet
oil may be added merely to soften the mass. The trituration must
then be continued until the globules are extinguished and the mass
made to assume a uniform, smooth, blue appearance. The suet should
next be added, and being well mixed, the lard can be united with ihe
mass ; after which the trituration is to be continued until the ointment
is formed. I have found the preparation to succeed better in dry
states of the atmosphere, whether in warm or cold weather, and the
reason is obvious.

This process requires from 25 to 35 minutes for its completion, but
more time may become necessary with an inexperienced operator.' I
have often completed the ointment in 30 minutes by my watch, and
never consumed more than 35 minutes. The ointment yielded is in
every respect suited to the most delicate or active uses demanding it
as a therapeutical agent. I have adopted the method here given for
its preparation for many years, and the resulting ointment used in an
extensive country practice has never disappointed me, when there
was a probability it would be likely to act at all as a remedy.
44

386 pollard's cases of puerperal convulsions.

The quantities here given are those which I have generally employed
in my own practice, preferring to prepare only small portions at a
time, to enable me to have the ointment comparatively fresh always.

Believing the Boston Journal does not enjoy an extensive circula-
tion in the " Old Dominion" — and I am astonished it does not, as it
is one of the best periodicals in the Union — I have been induced to
offer my formula for re-publication through the " Stethoscope ;" a me-
dical journal which I hope every physician of Virginia will support
and take, if only from state pride — but it is a journal intrinsically of
much meiit — to afford Southern physicians, especially my brethren of
Virginia, an opportunity of testing its utility.

Prince Edward C. H., May 1851.

Reports of three Cases of Puerperal Convulsions, with Remarks.

BY TH. POLLARD, M. D., RICHMOND, VA.

Case L— 1843, Sept. 10. Mrs. B., set. 35— Third labor. Convul-
sions came on in a few hours after commencement of labor. Os uteri
dilatable and pains efficient. &. vs. xxiv. Stimulating enema and cold
to the head. In an hour convulsions much abated. Labor progressed,
and in about an hour and a half more a healthy child was born. Case
progressed favorably.

Case II. — 1849, April 30. Colored woman, aet. 21 — First pregnancy.
Had been in labor 10 hours. Pains decreasing. Os uteri dilatable ;
head engaging the superior strait. After waiting an hour, and finding
the pains had nearly ceased, administered secal. conut. in two 15 grs.
doses, with an interval of 20 minutes between the doses. In about
15 or 20 minutes convulsions came on ; pains slightly increased. Vs.
xxxij. Stimulating enema and purgative. In two hours convulsions
somewhat abated. The head seemed slightly advancing. Head shaved
and blister to the nucha. Cold douche freely used on the head. After
waiting several hours more, and finding the condition of things not
improved, it was determined, in consultation with a neighboring phy-
sician, to apply the forceps. These having been inefficiently tried, I
turned the child and delivered by the feet. At this time the pains
were very feeble.

During the convulsions the woman had been insensible, and most
of the time comatose. After the delivery she seemed to rally, the
convulsions being now very slight. But the coma supervened and
she died in 18 hours afterwards.

Case III. — 1850, March 8. Colored woman, aet. 23 — First preg-
nancy. At the full term of pregnancy convulsions suddenly came on.
Saw her in about two hours in active convulsions, with very slight
labor pains. Anasarcous in lower and upper extremities, ft. Free
venesection from both arms. Stimulating enema and an active pur-
gative. Head shaved ; cold to the head and blister to the nape. Re-
medies produced very little effect ; no hope of turning. In so desperate
an emergency determined to try ergot, hoping, though scarcely believ-
ing, that the uterus might respond to its peculiar influence. No effect

pollard's cases of puerperal convulsions. 387

produced. The convulsions continued ; labor made no progress, and
death occurred in 14 hours from the attack.

Remarks. — Cases 2 and 3 were sisters — both of low stature, and
plethoric habit. Case 3, had been anasarcous for some time previous
to her attack — a condition which some author mentions as peculiarly
predisposing to eclampsia, referring to anasarca in the upper portion
of the body, which would probably indicate some remora in the venous
circulation, and thus predispose to congestion about the brain. It was
apprehended that the ergot might have had some tendency to bring
on the convulsions in case 2 ; but when it is recollected that the ac-
tion upon the womb was very small, if any at all, and that the con-
vulsions persisted (in spite of the remedies) long after the ergot could
have continued to have had any stimulant action on the brain, I think
this apprehension may be dismissed.

In case 3, the administration of the ergot may be censured, but it
was a " dernier ressort." It was evident that the woman must soon
perish unless some impression could be made on the os uteri, and un-
der similar circumstances I should again use it.

Two of the cases detailed were first pregnancies, and a large ma-
jority of convulsions occur in first labors — of 114 cases recorded by
different authors, 91 were first children.

The pathological condition in eclampsia has not been well ascer-
tained. Dr. Denman says in an examination of many women who
have died of this affection, he has never seen an instance of effusion
of blood in the brain, though the vessels were turgid. In all the
cases the heart was found remarkably, flaccid and without a: drop of
blood in auricles or ventricles. Dr. Lee records a case he examined
after death, where there was nothing to account for the symptoms,
but a little turgescence of the blood-vessels, not more than is seen in
many who have died of disease altogether unconnected with the
brain. Dr. Ramsbotham made an autopsy in four fatal cases he ob-
served. In case 1, extravasation of blood was found ;. this case was
referrible to injury of the head. In case 2, there was no positive de-
rangement detected in the brain, except turgescence of the vessels of
the pia mater. In case 3, after a minute examination of the whole
brain, no positive derangement could be detected. Ini case 4, no
breach of the vessels could be discovered — there was injection of the
vessels of the pia mater and some serum in the ventricles. Dr. Rams-
botham remarks, "the whole train of symptoms evinces considera-
ble derangement of the functions of the brain and nervous system,
yet after death, correspondent marks of organic disease within the
brain are seldom met with. I suspect that in many instances that
important organ is no otherwise implicated than through the medium
of sympathetic irritation." Dr. Lee speaks of a case examined by
M. Cruveilhier, in which not the slightest trace of congestion of the
vessels of the brain could be detected, and of another case reported
by M. Bontilleux, in which he could detect no manifest alteration
within the skull. He also quotes from Dr. Collins, who says, "I con-
ceive we are quite ignorant as yet of what tne cause may be ; nor
could I ever find any appearance on dissection to enable me to hazard

3S8 bolton's case of still-birth.

an opinion on the subject." Other cases are related by different au-
thors, who affirm that an autopsy has disclosed effusion of blood
within the cranium. These cases are, however, rare, and do not com-
pare in number with those in which there is no manifest effusion.

The prognosis in eclampsia is unfavorable. Dr. Merriman in his
practice found the fatal cases to be about one-quarter of the whole
number. Dr. Ramsbotham makes them in his observation more
than one-third. Dr. Ingleby more than one-third. Dr. Lee one-third.
Colombat puts them down at one-half.

In the treatment of this disease, blood-letting deservedly holds a
high rank. Though effusion does not occur in many of the fatal
cases, we have every reason to believe that congestion exists in many
cases. The quantity to be taken will of course depend on the plethora
of the system and the condition of the circulation. In some enfee-
bled, hysterical women, the remedy will not be borne. After general
bleeding to a sufficient amount, cups, shaving the head, blistering,
enemata and purgatives should be used. On the use of opium there
is some contrariety of opinion. After the force of the circulation has
been lessened by the means already indicated, or in women of not
originally plethoric habit, and in those of nervous temperament, I
should be disposed to try opium. It has sometimes had very good
effect, though the weight of authority seems to be against its utility.

Would not chloroform hold out some expectation of efficacy in
these cases? After the force of the pulse has been subdued by vene-
section, and in view of the want of success of the usual treatment in
mnny cases, it seems to us that the inhalation of chloroform would be
worthy of trial. It has been known to moderate and control the con-
vulsive movements in tetanus and other diseases. Why might it not
in this?

If the means indicated do not put a check to the convulsions, de-
livery should be effected as soon as possible. This condition is de-
pendent on the frequent state of the womb, and the sooner this can be
emptied of its contents the better, and we should not wait to see the
effect of the bleeding, cupping, &c. where the life of the woman is
endangered by the violence of the convulsions, and where the womb
is in a condition for delivery. Of course, in our efforts to deliver, we
must be guided by the condition of things. If the os uteri is suf-
ficiently dilated we proceed to turn. If the head is sufficiently ac-
cessible, the forceps should be used. If neither are admissible, the
former being possibly prevented by the activity of the pains or a
narrow pelvis, and the latter by the head, being too high or a narrow
pelvis, perforation should be resorted to.

A Case of Still-birth — Normal Respiration established in three
hours and forty minutes.

REPORTED BY JAMES BOLTON, M. D., OF RICHMOND CITY.

Mrs. It., 25 years old, a healthy, robust Irish woman — primapara —
married September 7, 1S50 — delivered of a twin May 15, 1851 — 249

bolton's case of still-birth. 3S9

days. Nothing remarkable about the birth of the first. Three or
four hours after, pains being feeble, gave ergot 3 j. in three doses at
intervals of 10 to 15 minutes. Vigorous, effectual pains produced in
about 40 minutes after first dose. Gave chloroform partially — supply
being soon exhausted, and several miles from Richmond. Second
child born nearly five hours after the first. Both weakly and prema-
ture.

The second made no effort to cry, nor even to breathe. Blew air
and sprinkled cold water upon the chest and face, without producing
the slightest effect. Cleansed the mouth and nose, and enclosing them
with my own lips, inflated the lungs and then pressed upon the ster-
num. Used artificial respiration in this mode about 20 minutes, with-
out the slightest effort at respiration or motion of any kind. The
heart and cord continuing to pulsate, ordered the mother to keep as
quiet as possible, in order to preserve the child's connection with her.
Placenta expelled in 20 minutes, and slight spasm of respiratory
muscles occurred. Removed child, with placenta attached, to a tub
of warm water and continued artificial respiration. During about
two hours some three or four spasmodic respirations occurred. When
these efforts were occasionally suspended, in consequence of fatigue,
the infant's face and lips changed to a bluish hue, and the heart's ac-
tion became much slower. When they were resumed t!-ie healthy
color was restored, and the heart's action increased in rapidity. The
cord was several times examined and found to continue its pulsations.

Spasmodic efforts at respiration gradually increased in frequency
until about 3 hours and 20 minutes, when they occurred at the rate of
about one per minute. In about 20 minutes more, natural respirations
were established, occasionally interrupted by one of a spasmodic cha-
racter, and pulsations of heart having been always preternaturaliy
slow, reached their natural standard. At what time the circulation of
the cord entirely ceased was not observed, but a few minutes before
respiration was established, its pulsations could not be felt beyond
about 3 inches from the umbilicus.

Functions of respiration and circulation then established in 3 hours
and 40 minutes from birth. Cord tied and severed. Child enveloped
in warm flannels and dressing deferred till next day.

The following manoeuvres practised with advantage while infant in
warm bath, and during suspension of artificial respiration : child's
breast kept covered with warm water, then suddenly elevated above
its surface and cool air blown upon it. These sudden alternations of
heat and cold had a powerful effect in producing contractions of res-
piratory muscles when irritability sufficient. This state did not exist
until about two hours after birth.

When irritability sufficiently increased, same effect produced by
drawing the fingers and thumb of one hind down the sides of the
chest, commencing at the armpits, so as to produce gentle titillation.

May 16. Seventeen hours after birth — vital functions still main-
tained— but its skin has a maculated, unhealthy hue, with cool sur-
face; refuses to nurse, and has been i'a(\ ; has discharged meconium;
died in an hour, or IS hours from birth.

390 spencer's case of enlarged liver.

Remarks. — The long continuance of pulsation in the cord shews
the importance of endeavoring to preserve the placental circulation in
order to sustain the heart's action. So long as circulation continued
there was hope of success ; for if its co-ordinate function, respiration,
were performed, independent life was certainly established through
the reciprocal action of the heart and lungs.

From the history of this case, it is evident that the infant must have
perished shortly after birth if left to itself.

Success after so long an interval should encourage the practitioner
to persevere so long as a glimmering of hope remains.

An Extraordinary Enlargement of the Liver.

REPORTED BY P. C. SPENCER, M. D., OF PETERSBURG, VIRGINIA.

Mr. , aged about 60, by birth a Scotchman, was in the habit

for many years before his last illness, of complaining frequently of
great general indisposition, with a gradual enlargement of the abdo-
men. The bowels were in a constipated state, atiended with great
uneasiness. There was occasional swelling of the feet and ankles,
with inability to get. about — a scarcity of urine, and then an increased
quantity, alternating. There was derangement of the heart, and
great difficulty of breathing. My distinguished and excellent friend,
the late Dr. T. Robinson, was his physician. From my knowledge
of Dr. R.'s high personal and professional attainments, I knew that
all had been done for his relief that could be done. In order to
lengthen out the thread of life as much as possible, we had to per-
form the operation of paracentesis abdominis, every six, eight or ten
days. Very large quantities of fluid were drawn offj loaded with
flocculae of an uncommon size, frequently dark or black, and of such
a corroding nature as to change the color of the instruments used in
the operation, and even to render some of them useless : the large-
sized catheters and canulas shared the same fate. By the influence
of Dr. R. permission was given tor a post-mortem examination.

Post-mortem examination shewed the heart and lungs more or less
diseased, and the whole of the viscera, especially the liver. Could I
have preserved the liver, I certainly should have made the attempt ;
for, without the fear of contradiction, it was the most remarkable organ
I have ever seen. It was, without exaggeration, from three to lour
times the size of the ordinary organ — -had lost its natural fhape, size
and appearance, and had acquired an enormous size, singular shape
and peculiar consistency. Shooting out in beautiful spires, splendidly
shaped and arranged, and of various lengths, it had nearly consist-
ency enough to hold them together — but mv pen fails me in the at-
tempt adequately to describe this wonderful organ ; it was truly a
phenomenon.

REGULAR IRREGULARS. 391

For the Stethoscope.
Regular Irregulars.

The phrase forming the caption of this communication occurred in
an extract from the Lancet copied into a former number of the Ste-
thoscope. It is a very expressive title of a class of medical practi-
tioners, such as Hannah More describes in the Christian Church un-
der the term Borderers. They keep themselves within the ranks of the
regulars, but at the same time border as closely as possible on those
of the irregulars. They are very careful to do nothing which would
subject them to expulsion or even to discipline, and talk very empha-
tically about the importance of a rigid adherence to the code of ethics.
Their uniform is made of the most showy, glittering materials. If,
however, their manoeuvres be watched, they will be seen edging along
very closely to the irregulars and picking off a button or so, which,
when fastened on their own regimentals, is concealed from common
observation by the general glare. At the same time that they are very
loud in their denunciations of the artifices of the irregulars, they do
not scruple to steal a little trick now and then which they may use to
advantage.

Dr. A. hates a Thompsonian, and despises a Homoeopath. He is
very strict in his outward conduct towards a brother practitioner. If
the latter, however, be a young man, he treats him with an air so com-
pounded of respect and patronage, that the patient and friends give
him great credit for his tenderness towards the ignorant and inexperienced
youth! Perhaps the latter may be green enough to receive it in the
same manner, and feel quite flattered by the condescension of one so
vastly his superior in skill and station. The distinguished savan in-
forms the patient and friends that the plrysieian has treated the case
with a remarkable degree of skill — indeed quite as much so as if the
patient hud been under his own cure! Of course they all feel quite re-
lieved by this assurance, but agree that it would be safer to trust this
superior skill and talent on the next occasion.

Dr. A. has a patient who is rather unwell, and he prescribes a little
ride and some cheerful company. A visit to a friend would be very
renovating to the nervous system. A seat is offered in Dr. A.'s car-
riage, and Mrs. B. is quite captivated by the Dr.'s urbanily and oblig-
ing disposition. How much better to employ Dr. A. than Dr. C,
who don't keep a carriage, and simply prescribes for his patients with-
out adding all these little valuable courtesies Mrs. B. rides by the
Dr.'s side to Mrs. D.'s, and there all the family come out to receive
her. The Dr. would not go in for the world, lest he should be con-
sidered as endeavoring to supplant the family doctor. However, he
is duly introduced by Mrs. B. amidst many Battering remarks, and he
rides off, congratulating himself on his scrupulous obscrvunce of profes-
sionul etiquette. Mrs. B. finds one of Mrs. D.'s children an invalid, who
has been a long time under medical treatment, and all agree that it
would be best to try Dr. As skill, and turn off the old faithful family
physician.

Mrs. E. has been ailing a good while. Her appetite is very bad.
She cannot relish anything. Dr. A. calls at 's restorative and

392 REGULAR IRREGULARS.

orders some nice little nick-nacks to be sent to Mrs. E. " What a ca-
pital doctor," exclaims Mrs. E., " so considerate and liberal ;" and she
lauds him to the skies among her acquaintance, with a voice improved
in clearness and strength by broiled patridge and fixings, &c.

Mrs. F. has disordered bowels — she really cannot keep anything
upon her stomach. While in this deplorable condition and disgusted
with life itself, a finely-dressed servant enters, bearing a tray covered
with a white napkin, and presents it, with Dr. A.'s compliments.
"What other doctor," exclaims Mrs. F., "would have been so atten-
tive?" Just at that moment Mrs. G. drops in to enquire after Mrs.
F.'s health. The feminine curiosity of both is excited to ascertain
the nature of the nicety sent by the generous and considerate doctor.
The napkin is raised, and an elegant glass is disclosed, packed in
crushed ice, and filled with some beverage sparkling as if fresh from
a fountain. A taste proves it to be iced champaigne. " What an
elegant doctor !" they both exclaim. Besides this impression, there
is another very profitable one. The popular proprietor of the resto-
rative and all his menials are made acquainted with the important
fact that Mrs. E. and Mrs. F., &c. employ Dr. A.; and besides this,
as one good turn deserves another, mine host becomes an advertiser
of Dr. A. to all his customers.

Mrs. H. employs Dr. A. to attend herself, and is quite captivated
by a round of these pretty little civilities. Her husband requires
medical attention and sends for Dr. J., and is very well satisfied with
the trealment of his case. Dr. A. is informed of the fact at his next
visit. Alarmed and envious at the effect of such competition, he ex-
claims, " Why did you not send for me?" The next time Mr. H. is
taken sick, like a dutiful spouse, he permits Mrs. H. to send for her
favorite doctor.

Now what would be the result if the whole medical profession were
to adopt this mode of purchasing practice ? He who should degrade
himself the most by playing the sycophant to his patients, and make
them the most costly presents, would render himself the most popular
physician. The patient would learn to set a low estimate upon pro-
fessional skill, and look upon all these expensive courtesies as perqui-
sites, instead of regarding the services of the physician as of far more
value than the fee which is expected in return. These are a few
small scraps of the worn-out regimentals of the irregulars with which
Dr. A. patches his own. Unfortunately for himself, however, he gra-
dually puts on so many, that at last every shred of his own flashy li-
very is replaced by that of his antagonists, like the silk stocking which
was darned with cotton so often, that it finally became a cotton stock-
ing. He then shines out in his true livery, and is expelled from the
society of those who had long suspected and now detest him.

If any one shall perceive from this sketch that he is unconsciously
pursuing such a course towards his own ruin, let him pause and reso-
lutely determine no longer to hang about the outskirts of the regular
phalanx, but take a bold, manly stand in favor of high, independent
principles.

X. Y. Z.

EDITORIAL. 393

31BJETOM2AIL 11B 3MM©HILILAiril©TOo

We comply with the request of the faculty of the medical depart-
ment of Hampden Sydney College, to publish the essay of Dr. Cabell,
with great pleasure. Dr. C. graduated with distinction in Richmond
at the close of the last session. It is the custom of the faculty to offer
a prize, of a fine gold medal, for the best essay on some selected sub-
ject, given to the graduating class towards the close of the term. Pre-
vious to opening the packet containing the real name of the success-
ful candidate for this honor, on the last commencement day, the Dean
announced to the audience that the professors had been much per-
plexed to decide between the merits of two of the papers handed in —
that though the medal would be awarded to another, it was incum-
bent on him to say, that one signed " Stethoscope" was possessed of
almost equal merit. We thought at the time that it would have been
an act of charity to the audience, who were curious to know who
"Mr. Stethoscope" was, as well as an act of justice to the gentleman
himself, to have broken the seal and announced his real name. We
are glad that it has since been done, and the author turns out to be
Dr. P. H. Cabell. Though Dr. C. was not fortunate enough to win
the prize, his able competition for it has won for him golden opinions
from his old preceptors and the profession also. Of course nothing
new could have been expected on the subject, but the paper is so well
written and embodies so much of the valuable sciences of percussion
and auscultation, that it not only merits publication, but it will pro-
bably be more acceptable to our readers than other matter which we
might give them. This thesis evinces a high talent for writing pos-
sessed by the author; a talent which is too much neglected by medi-
cal students and practitioners, but one almost indispensable to the ac-
quisition of a wide reputation. It also speaks well ibr his alma mater,
to whom may Dr. Cabell's future career do great credit. We " shall
hear from him again," as Mr. Webster is said to have remarked to his
preceptors when he left college.

Ragland Will Case.
A legal case of much interest has been going on in the superior
court in this city, before Judge Caskie and a most patient jury, for the
last month or two — known as the Ragland will case. As it has ex-
cited general interest in a medico-legal point of view, we will make a
45

394 EDITORIAL.

brief allusion to it at present, and give a detailed account of the medi-
cal testimony, if it can be obtained, in a future Number.

The testator was a planter of some wealth, living in the county of
Louisa — his property consisting principally of land and negroes. He
was a bachelor and lived aloof from his relations, and being seized
with what his physicians testify to be typhoid fever, died in nine or
ten days. Two days previous to his death he summoned to his bed-
side several friends, with whose assistance he made the will now the
subject matter of controversy. This will cuts off Ragland's relations
and emancipates his slaves, and is objected to principally, we believe,
upon the following grounds :

That the testator, laboring under typhoid fever, was incompetent to
make a will two days previous to his death.

That it was unnatural and contrary to the feelings and usages of
men of his character and position.

That the testator was influenced by improper exertions and acts on
the part of his attendants, while not in a condition, physical or men-
tal, calculated to resist such influences.

The chief points of professional interest were, the competency of the
individual to make his will, and the correctness of the diagnosis.
These, of course, were subdivided into many points by the lawyers
and medical witnesses. The attending physicians, as well as a host
of medical gentlemen of this city, were summoned to give testimony
in the case, and their testimony was so very discordant that neither
party to the suit could make much use of the evidence of their own
witnesses. We were forcibly struck with some of the Utopian theo-
ries advanced, and the general ignorance of the profession in affairs
of medical jurisprudence.

The unwarrantable license taken by the counsel in commenting,
not on the theories or opinions of the doctors, but on their charac-
ters, capacities, and even their very persons, cannot be too strongly
rebuked, and though it were permitted by the court, it should not
have been by gentlemen having a proper self-respect. However con-
flicting may be the views of medical witnesses, lawyers should be
made to remember that they give their opinions as opinions only, and
under solemn oath, "the truth to say to the best of their knowledge
and belief." Their treatment should be the more respectful on ac-
count of their being to a certain extent tongue-tied, and defenceless
after leaving the witness's stand. Our profession in Virginia are sel-
dom called before the courts in matters of medical jurisprudence, and

EDITORIAL. 395

for this reason they are less expert in protecting their reputations than
in giving keen lawyers material to make display at their own expense.
If it is possible to obtain the evidence in the case, we will attempt
to give a summary of the testimony of each of the medical witnesses
examined. The will has been sustained.

From several quarters of the state, we learn that dysentery and
enteritis have prevailed to a considerable extent during the past month.
Quite a drought with a week of cold, fall weather was experienced
about Richmond, but the reputation of the city as being one of the
most healthy in the world, has not suffered as much as the unseason-
ableness of the weather would have warranted. It is proper to say
that the report of the presence of cholera here is entirely idle, and
would scarcely need contradiction were it not possible that it may be
credited by some in the country, and they thereby prevented from vi-
siting the city. Cherry disease and other complaints of the season
have prevailed to their usual extent, but as the public (and some of
the doctors) have suffered for two years with cholera-phobia, we are ne-
ver surprised to hear these cases, when violent and attended wiih
great prostration, magnified into the real Asiatic.

The number of practitioners in Richmond city is about one hun-
dred, and as an impression is abroad that there is " a fine opening"
here, the immigration is still going on. The population of the city is
about thirty thousand — the estimate then is one physician for every
three hundred souls. Pretty good this, for a city the bills of mortality
(if any could be made) of which would compare favorably with any
city in the Union.

Useful Articles.

We call the attention of physicians to the Extracts prepared by
Messrs. Tilden & Co. (See advertising sheet.) After a considerable
trial, we feel warranted in recommending them to the profession, espe-
cially in the country, as pure and reliable. We have seen in most of
our exchanges the highest testimonials in their favor, and doubt net but
that they need only be tried to be generally used. We will take plea-
sure in furnishing samples from the lot which was sent us by Messrs.
Purcell, Ladd & Co., the agents in this city, to any of our country
friends for trial. They may be procured from the agents in bottles
containing from % 1 to 1 ft.

896 EDITORIAL.

Our thanks are due to Messrs. Purcell, Ladd & Co. also for a fine
sample of Mexican or Chia seed. They are imported from Mexico,
where they are used, we learn, with success in the treatment of the
diseases of the bowels incident to that warm climate. They are re-
commended as a substitute for bene leaves, and are very useful for
the ready preparation of a bland and very abundant mucilage — a sin-
gle teaspoonful stirred in a glass of cold water will form in a few mi-
nutes an excellent mucilage. We have used them with great satis-
faction in irritation of the bladder as well as in infantile diseases.
From their cheapness, and the facility with which they are used, they
are already in high repute in this city. They should be kept in every
family as well as by physicians.

Editor's Table.

In addition to our regular exchanges for the month, we have re-
ceived the usual number of pamphlets and catalogues. It is a joyful
reflection, that hereafter under the new law, we shall receive these
things free of postage. From the pile before us, we select the follow-
ing as demanding some notice :

The forty-fourth annual circular and catalogue of the Medical Depart-
ment, University of Maryland. This catalogue exhibits ISO matricu-
lates for the past session, of whom 72 were graduated. Appended is
a short statement of the fees, statutes, &c. of the institution, and the
rest of the pamphlet is the annual circular, which purports to be an
expose "of the views of the faculty on the subject of medical educa-
tion." This circular, like most others from faculties, abounds in good
recommendations, and "earnestly urges" many things which the pro-
fession would be glad to see required. The school from which it ema-
nates, is one of rank, possesses many advantages, and is in a pros-
perous condition.

By the catalogue of the Medical College of the State of South Carolina,
we observe that the class of the past session numbered 230 — a very
great increase upon that of previous years. Of these, sixty-five were
graduated, and all but two are marked as having received "literary
educations " or collegiate degrees. Among the requirements of the
candidates for graduation one is, "that they have studied medicine
for three years with some respectable practitioner and then attended
two full courses of lectures." By the stand which this institution has
taken, it has commanded the support of the state and thus greatly in-
creased its own prosperity.

EDITORIAL. 397

Catalogue of the Medical Department Hampden Sydney College, Richmond,
Virginia, Session 1850—51, and announcement of Session 1851-52.

The summary of this catalogue shews the number of matriculates
to have been 90. From Virginia 78, North Carolina 6, Mississippi 2,
Alabama, Maryland, Tennessee and Ohio, 1 each. The number of
graduates was 26.

The announcement of this school shews that it has been steadily on
the increase, and is now in a prosperous condition. The faculty, in
their circular, state that " this success has been achieved in the face
of many prejudices and adverse circumstances — that it was esta-
blished by private enterprise, but now the state has taken the institu-
tion under its fostering care, and by efficient pecuniary aid has placed
it on a secure foundation, the faculty stands pledged to the public,"
&c. We are glad of this ; but we take the liberty, as a public jour-
nalist, to make a remark or two in regard to the circular and the col-
lege.

It is well known that more than a year ago the legislature virtually
made a donation to the medical faculty of the college of some $30,000.
This measure was not universally popular for many reasons, but it is
needless to enter into them here, as we believe there have been no
complaints made of the act since its passage. The college is now
one of the public and endowed institutions of the state, and there is
a general feeling not of "prejudice," &c, but one of good will to-
wards it, and a desire to see it built up into a great institution, worthy
of the metropolis of the state, is generally entertained. But, for the
institution to prosper and enjoy the good will and assistance of the
profession at large, the faculty who now literally own it, must hearken
to the wishes of the profession in regard to its management. There
is no better opportunity than that now offered, for this institution to
become permanently established and to take rank in numerical
strength and character as one of the largest and principal schools
of the United States. The profession is determined to effect a radi-
cal reform in its constitution, and it seems plain to us that it is the inte-
rest of the schools to take the lead in this great movement, and not wait
to be dragged and cuffed into it. The rapid multiplicity of the doctor
manufactories throughout the land makes it necessary for those schools
which can afford to do their duty to do it at once. All the upstart
schools which are spreading heresy and humbuggery, and poisoning
the public mind and body, are the offspring of the old ones. The
regular and legitimately organized colleges will continue to sprout
these fungi and encourage their growth as long as they continue to

398 EDITORIAL.

turn out ignorant, unqualified and unprincipled prostitutes of the once
honorable and meaning title of doctor in medicine. The remedy is
plain and simple. The faculties must refuse to admit to their lectures
men who do not give entire satisfaction of their being sufficiently in-
telligent and well educated to understand them, as well as of moral
character enough not to pervert them. The standard of medical know-
ledge necessary to obtain the title of M. D. must be raised to a de-
gree infinitely above that which now enables the schools to turn them
out like the factories do spools of cotton. Then the ceremony of li-
censing practitioners of the " science of life," with the imposing and
once respected diploma, must be made one of serious and impressive
importance. Before a school should allow its graduates to receive its
diploma, they should be required to swear to protect its honor and
character, and to comply with all the requisitions, both moral and
professional, of a high and honorable pursuit. Lawyers, and persons
of much less responsibility, are required to be sworn to do their duty
in their professions before entering upon the active practice of them.
Had this been required of the doctors, what a different spectacle
would the profession of medicine now exhibit? What a different
position would the science occupy ? But to return to our subject, from
which we may seem to have irrelevantly digressed. The Richmond
school is one which we believe inculcates as high a professional tone
as any other, and we have never heard of any of our brother alumni
who have aided or encouraged in the perversion of their calling. "We
think we can speak for the mass of the medical men in Virginia and
North Carolina, and say that they are ready to do all in their power for
the promotion of the interests of the college. But the college has much
to do for itself — now, that its position is such that it can afford to take
a firm stand, we call upon it to carry out the wishes of the profession,
as expressed repeatedly in the national association and otherwise.
Let this Virginia institution take the lead in the movement of reform,
and its position will command the respect and support of the Southern
profession to such a degree that its prosperity will soon be envied by
its present rivals, and they will follow its good example.

In regard to the announcement of the coming session, we most re-
spectfully suggest to the faculty that it contains one very objectionable
character. We allude to the publication of an imposing list of sur-
gical cases and operations treated at the college infirmary during the
past year. Whilst we are fully aware of the absence of all desire
on the part of the faculty to build up their private and individual in-
terests by this method of advertising, and believe them to be gentle-

EDITORIAL. 399

men of too high a sense of honor to be guilty of the slightest violation
of ethics, still we know that the system is distasteful to a large por-
tion of the profession, and not viewed in a friendly spirit by some.
The intention of the faculty in publishing the surgery cases done at
the college is to advertise the infirmary more favorably to the public,
and to give evidence to students of the advantages held out by the
institution for clinical instruction. This we know is the sole object,
but with due deference we submit our belief that this object would
be achieved equally well by announcing the fact of a large number,
or even the number of operations dune. It is the effect of this adver-
tisement which is complained of — and the effect is very prejudicial to
private practitioners. They are not allowed by any code of medical
ethics, or public opinion, to do the same thing, and may complain of
it with great justice. Of course, the position of the occupant of a
professional chair gives an individual great advantages in private
practice ; but when, in addition, he has the privilege, denied to all
others, of publishing his cases to the world, he must necessarily in-
crease his private practice and reputation at the expense of others,
however worthy and competent, though humble, they may be. It is
the duty of medical schools to publish their cliniques whenever any-
thing worthy of notice occurs, and the Medical Journals afford every
facilit}7 to them to do so, and are the surest media for making and ex-
tending reputations both for colleges and professors. We trust that
our friends of the college will not take umbrage at the remarks which
this lusus on their part has called forth. We mean them in the best
spirit, and are prompted to make them by an earnest desire to call
the attention of the faculty to a matter which we know to be ope-
rating against them. This same thing has been done before, and by
schools of high fame, but the profession, through the press, complained
of it, and it is discontinued. We hope it may be here.

Several addresses to graduating classes have been received, among
which are those of Dr. A. Litton, professor of chemistry and phar-
macy in the St. Louis university, and Dr. C. Todd Quintard of Ros-
wel, to the graduates of the medical college of Georgia, each abound-
ing in fine sentiment and elegant conception.

400 EDITORIAL.

In addition to the Exchanges heretofore announced, we acknowledge
the following :

The Transylvania Medical Journal. The New York Scalpel for May.
The Southern and Western Masonic Miscellany, an excellent 32 page
monthly, at $2 per annum, valuable to the craft, and edited by our
very worthy companion and confrere, Albert G. Mackey, M. D., of
Charleston, S. C, a man of great literary and masonic reputation, and
a number of outside Journals. Several of these are published in Cin-
cinnati, which city we have always regarded as the hot-bed of quack-
ery. The Cincinnati Journal of Homoeopathy, and The Psyco-Medical
and Surgical Journal, are two Cincinnati productions, each edited by
sundry M. D. Professors, who are doubtless apostates, and disgraces
to some of our respectable schools where they have obtained diplo-
mas by the loose and culpable system of medical education, now so
general. But we must be cautious or our personal safety, if ever we
chance to be in Cincinnati, may not be sure, as suits for libel are the
go now.

Among the numerous pamphlets with which we are flooded, there
are some very funny ones, such as " The Rights of Women" — " The
Practice of talcing Blood in Diseases — contrary to common sense, to ge-
neral experience, to enlightened reason, aud to the manifest laws of
Divine Providence" ! ! With sundry scriptural quotations, certificates
of M. D.'s, and a serious petition to the legislature of New York to
make venesection a penal offence, attached — By Wm. Turner, M.
I). This fanaticism doubtless will soon receive the sanction and en-
couragement of many of the whining, shaved head Reverend gentle-
men, who are not slow to depart from their sphere to adopt and en-
courage all of the heresies of fools and knaves.

We will notice in our next a pamphlet which has been very gene-
rally circulated on Cures and the Therapeutics of Mineral Waters in ge-
neral, by Rev. T. Slringfellow.

II^p0 Notices of Skeifs Operative Surgery, ChurchilVs System of Mid-
wifery, The Pharmacopoeia of the United States, Wilson's Dissector and
Cooper on Dislocations and Fractures, have been crowded out of ihe
present Number, but they shall appear in our next, when we shall also
take pains to improve the department of selections in a practical point
of view.

MEDICAL SOCIETY OF VIRGINIA. 401

Omission.

We omitted to state in our report of the proceedings of the National
medical association, that the annual prize for the best essay " on phy-
siology or medical chemistry," was awarded to Dr. John C. Dalton,
Jr., of Boston. His subject was Ovology, and his treatise is spoken of
as a very brilliant production. It will appear, by special vote, in the
forthcoming volume of the " Transactions of the Association."

We observe by the Buffalo Medical Journal that the Transactions
of the New York State medical society are published as a document
of the legislature — thus placing them in the hands of every practi-
tioner, and giving them otherwise a general circulation. They make
up an octavo volume of two hundred and forty-eight pages, and em-
brace much valuable information.

Medical Society of Virginia — June Meeting.

Dr. James Beale, 1st vice-president, in the chair. Present — thirty
members and several visiters.

After the reading of the minutes, the following gentlemen were se-
verally ballotted for and admitted members of the society:

M. H. Houston, M. D., of Wheeling, Va.

John G. Skelton, M. D., of Powhatan county.

Carthon Archer, M. D., of Henrico county.

Frank Powell, M. D., of Middleburg, Va.

H. Tatum, M. D., of Chesterfield county.

A number of letters of application for membership were read, the
nominations seconded, and laid over for a month under the rule.

The subject of the evening being in order, Dr. Meriwether pn>
ceeded to read an essay " on the fibrine in the blood." (This paper
is published in the original department of the present Number.) A
few observations were made on the paper by several gentlemen-^they
regretted, however, that the exact subject of the essay had not been
made more generally known previous to the meeting, and a motion
prevailed adjourning the subject over until the July meeting.

Dr. Meriwether stated that his object in presenting the paper was
to draw out a continuation of the very interesting discussions recently
held in the society in regard to the condition of the blood in certain
diseases. He desired to hear a fuller debate on this point, and acqui-
esced in the desire to defer it until the next meeting.

The committee for auditing the accounts of the treasurer reported
that they were correct. The treasurer then presented a financial es-
timate of the liabilities and necessary expenditures for the ensuing
year. The following resolution was adopted :

Resolved, That the assessment of each resident or attending mem-
46

402 AMERICAN INSANE INSTITUTIONS.

ber for the current or fiscal year be fixed at $5 — $3 to be payable to
the Richmond library association, and $ 2 to the treasurer of the so-
ciety.

Dr. Bolton remarked that this society being now engaged in car-
rying out its original design, the organization of the profession of the
state, and non-residents of Richmond justly objecting to the applica-
tion of their contributions to purely local objects, he therefore offered
the following resolution;

Resolved, That the treasurer be directed to invest that portion of
the balance in the treasury which has been derived from initiation
fees during the past year, together with all other funds which may
hereafter accrue from the same source, to be used by the society for
the general benefit. Adopted.

In view of increasing the library, Dr. Clark offered the following
resolutions, which were adopted :

Resolved, That voluntary contributions from members of the society
to the library, with the privilege of withdrawal, be invited ; and that
in all other respects the laws now in operation in respect to the library
remain in force.

Resolved, That the corresponding secretary be instructed to sub-
scribe to the publications of the Sydenham society.

On motion of Dr. M. P. Scott, the following resolution was adopted :

Resolved, That a standing committee of five be appointed by the
chair to investigate and report on the subject of the mineral waters of
Virginia, and that Dr. Wm. Burke be its chairman.

On motion of Dr. C. S. Mills, the resolution offered by Dr. Be ale
at the last meeting, in regard to apothecaries who are in the habit of
prescribing, was deferred until the next meeting, with the understand-
ing that it shall be taken up as the first business of the evening.

Dr. Gooch said that he had been using pretty extensively Tilden Sf
Co.'s Extracts, and had found them very efficacious and valuable. He
offered to furnish small quantities to any gentleman who might desire
to use them with his indigent patients.

After the transaction of sundry other business of local and private
snature, the society adjourned.

Proceedings of the Sixth Annual Meeting of Medical Superin-
tendents of American Institutions for the Insane.

The association of medical superintendents of American institu-
tions for the insane, convened at the hall of the American philosophi-
cal society of the city of Philadelphia, on the 19th day of May 1851,
at 10 o'clock, A. M.

The following gentlemen were present:

Dr. Isaac Ray, of Butler hospital for the insane, Providence, Rhode
Island.

Dr. N. Cutter, of Pepperill (private) institution, Mass.

Dr. John S. Butler, of the Connecticut retreat for the insane, Hart-
ifcrcL

AMERICAN INSANE INSTITUTIONS. 403

Dr. N. D. Benedict, of the New York State lunatic asylum, Utica.

Dr. C. H. Nichols, of the Bloomingdale asylum, near New York.

Dr. H. A. Buttolph, of the New Jersey State lunatic asylum, Tren-
ton.

Dr. T. S. Kirkbride, of the Pennsylvania hospital for the insane,
Philadelphia.

Dr. Joshua H. Worthington, of the Friends' asylum for the insane*
Frankford, Pa.

Dr. William S. Haines, of the Philadelphia lunatic asylum, Blockley.

Dr. John Curwen, of the Pennsylvania State lunatic asylum, Har-
risburg.

Dr. John Fonerden, of the Maryland hospital, Baltimore.

Dr. S. Hanbury Smith, of the Ohio lunatic asylum, Columbus.

Dr. J. W. Parker, of the South Carolina asylum, Columbia.

Dr. R. J. Patterson, of the Indiana hospital for the insane, Indian-
apolis.

Dr. J. M. Higgins, of the Illinois hospital for the insane, Jackson-
ville.

Dr. Pliny Earle, late of Bloomingdale asylum, New York.

Dr. Smith, of the Missouri hospital for the insane, Fulton.

In the absence of the president and vice-president, the association
was called to order by the secretary, Dr. Kirkbride, and on motion of
Dr. Fonerden,

Dr. S. W. Parker, of South Carolina, was appointed chairman pro
tern.

The minutes of the preceding meeting having been read, on motion
of Dr. Fonerden, it was

Resolved, That a committee be appointed to select the names of in-
dividuals to fill any vacancies which may exist in the offices of the
association.

Drs. Fonerden, Worthington and Hanbury Smith were appointed
the committee.

A letter from Dr. W. M. Awl, of Ohio, was read, in which he ten-
tered the association his resignation of the office of president, which
was accepted, and referred to the committee to nominate officers.

On motion of Dr. Kirkbride, it was

Resolved, That the members of this association, in receiving the re-
signation of Dr. Awl, as its presiding officer, cannot allow the occa-
sion to pass without testifying their full appreciation of his efforts as
one of the original promoters of this association, and of his varied
and important services in the cause of the insane, — and their regrets
are increased by the knowledge that impaired health should have
compelled him to cease to occupy the post of active usefulness in
which he has been so long and so favorably known.

Resolved, That the secretary be instructed to furnish Dr. Awl with
a copy of these resolutions.

The committee to propose names to supply vacancies in the offices
of the association, nominated Dr. Luther V. Bell, of Massachusetts, as
president, in the place of Dr. Awl, resigned, and. Dr. Isaac Ray, of
Rhode Island, as vice-president, in the place of Dr. Bell, nominated

404 AMERICAN INSANE INSTITUTIONS.

for president, which nominations were confirmed by the association,
and these gentlemen duly appointed.

On motion of Dr. Butler, it was

Resolved, That each member be authorized to invite such indivi-
duals as he may think proper, to attend the meetings of this associa-
tion.

On motion of Dr. Kirkbride, it wa9

Resolved, That, as heretofore, a business committee, consisting of
three members, be appointed, who shall report, each morning, what
papers will be read, and what other business is likely to come before
the association during the day.

The secretary read a letter from the late president of the associa-
tion, announcing the subjects selected by him on which the members
are expected to report during the present meeting, in compliance with
the resolution adopted last year.

Invitations from the board of directors and president of Girard col-
lege for orphans, inviting the members of the association to visit that
institution, were read and accepted.

The resolution of the American philosophical society, tendering the
use of their hall for the meetings of the association, also one of the
board of managers of the Pennsylvania hospital, offering their library
for the same purpose, were read.

Lawrence Lewis, Mordecai L. Dawson and William Biddle took
seats with the association, as members of the board of managers of
the Pennsylvania hospital for the insane, also William Bettle and John
C* Allan, as managers of the Friends' asylum.

A paper prepared by Dr. Gait, of the Eastern asylum of Virginia,
on the impropriety of treating the insane and persons affected with
other disorders, in the same building, was read by Dr. Hanbury Smith,
and after discussion, on motion of Dr. Butler, was laid on the table
for future notice.

Dr. Cutter read a paper on the use of stramonium in the treatment
of insanity, which, after discussion, was laid upon the table.

Dr. Ray read a case illustrating the great ingenuity often exhibited
by the insane in accounting for their delusions.

Dr. Worthington tendered to the association an invitation to visit
and examine the Friends' asylum for the insane ; and Dr. Kirkbride,
a similar one to visit the Pennsylvania hospital for the insane, which
invitations were accepted, and referred to the business committee.

Dr. Kirkbride made a report from the business committee, which
was accepted.

On motion of Dr. Parker, adjourned to meet at the Girard college
at 4J o'clock this afternoon.

Afternoon Session.

The association met at the Girard college, agreeably to adjourn-
ment, and under the guidance of the directors and officers of that
magnificent monument of private charity, proceeded to visit its va-
rious parts, and to examine its internal arrangements, and then ad-

AMERICAN INSANE INSTITUTIONS. 405

journed to meet at the hall of the American philosophical society, at
9 o'clock to-morrow morning.

Second Day — Morning Session.

The association met agreeably to adjournment. The minutes of
yesterday's sessions were read and adopted.

Dr. Edward Jarvis, of Dorchester, (private institution,) Mass., took
his seat as a member of the association.

Dr. W. H. Stokes, of the Mount Hope asylum, near Baltimore, ap-
peared and took his seat as a member of the association.

Dr. Charles Evans, consulting physician of the Friends' asylum, also
took a seat with the association.

J. Konigmacher, as trustee of the Pennsylvania state lunatic hospi-
tal at Harrisburg, Alex'r Cummings, W. S. Hansell and T. Robinson,
Esq'rs., as guardians of the Philadelphia lunatic asylum, took seats
with the association.

The secretary, on behalf of the officers of the United States mint,
tendered an invitation to the association to visit that institution ; also
a similar one from the managers of the Pennsylvania hospital — and
from the Pennsylvania institution for the instruction of the blind —
from the Pennsylvania institution for the deaf and dumb, and from
the Philadelphia athenaeum, which were accepted and referred to the
business committee.

Dr. Kirkbride, from the business committee, made a report.

Dr. Curwen read a paper containing a manual for the use of attend-
ants in institutions for the insane, which, after discussion, was laid
upon the table.

On motion of Dr. Higgins, it was

Resolved, That a committee be appointed to examine the manual
prepared by Dr. Curwen, and be requested to report during the pre-
sent meeting of the association.

Drs. Hanbury Smith, Fonerden and Benedict were appointed the
committee.

On motion of Dr. Hanbury Smith, it was

Resolved, That a committee be appointed to draw up a constitution
and code of by-laws for the government of the association, and to aid
in the despatch of business. Drs. Hanbury Smith, Kirkbride and
Nichols were appointed the committee.

A letter from Baines Sears, Esq., secretary of the Massachusetts
board of education, relative to the preventing of insanity by means of
early education, was read and referred to a committee of three, of
which Dr. Ray is chairman, with power to select his associates.

Dr. Ray read a paper, entitled " Hints to Medical Witnesses in
Questions of Insanity," when, after discussion, on motion of Dr. Kirk-
bride, it was

Resolved, That the paper just read by Dr. Ray is of so practical
and valuable a character, that he be requested to publish it in the
American Journal of Insanity, as containing the sentiments of this as-
sociation on the subject to which it refers.

406 AMERICAN INSANE INSTITUTIONS.

Dr. Hanbury Smith, from the committee on publication, made a
report, in which was recommended the publication of a volume of
transactions, containing the history of the rise and progress of the as-
sociation, an abstract of its proceedings, and a selection from the
papers read at its annual meetings. On motion of Dr. Kirkbride,
the subject was referred back to the same committee to make a fur-
ther report at a future session.

A communication was received from a committee of the board of
guardians of the Philadelphia almshouse, inviting the association to
visit that institution, which was read, accepted, and referred to the
business committee.

The paper prepared by Dr. Gait, and laid on the table yesterday,
was called up for discussion, after which, Dr. Patterson offered the
following resolution, viz :

Resolved, That it is the duty of the community to provide and suita-
bly care for all classes of the insane, and that in order to secure their
greatest good and highest welfare, it is indispensable that institutions
for their exclusive care and treatment, having a resident medical su-
perintendent, should be provided, and that it is improper, except from
extreme necessity, as a temporary arrangement, to confine insane per-
sons in county poorhouses or other institutions, with those afflicted
with or treated for other diseases, or confined for misdemeanors;
which, on motion of Dr. Parker, was laid on the table for future con-
sideration.

Dr. Earle commenced reading an account of several institutions for
the insane on the continent of Europe, visited by him two years since,
and suspended the reading on a motion to adjourn to meet at the
Pennsylvania hospital for the insane, at 2 o'clock P. M., which was
agreed to.

Afternoon Session.

The association met agreeably to adjournment.

Dr. Chandler of the Massachusetts state lunatic hospital appeared
and took his seat as a member of the association.

Under the guidance of Dr. Kirkbride, the association proceeded
to visit and examine the Pennsylvania hospital for the insane, and then
adjourned to meet at the hall of the American philosophical society,
at 9 o'clock to-morrow morning.

Third Day. — Morning Session.

The association met agreeably to adjournment.

The minutes of yesterday's proceedings were read and adopted.

Dr. Ranney, of Blackwell's Island lunatic asylum, took his seat as
a member of the association.

Dr. Earle concluded the reading of his paper, interrupted by the
adjournment yesterday morning.

An invitation from Dr. Horner to visit the University of Pennsylva-
nia and Wistar Museum, was read, accepted and referred to the busi-
ness committee.

AMERICAN INSANE INSTITUTIONS. 407

Dr. Kirkbride, from the standing committee on the construction of
hospitals for the insane, in compliance with the resolution adopted last
year, read a report containing a " series of resolutions or propositions,
affirming the well-ascertained opinions of this body in reference to
the fundamental principles which should regulate the erection and in-
ternal arrangements of American hospitals for the insane."

I. Every hospital for the insane should be in the country, not with-
in less than two miles of a large town, and easily accessible at all
seasons.

II. No hospital for the insane, however limited its capacity, should
have less than fifty acres of land devoted to gardens and pleasure
grounds for its patients. At least one hundred acres should be pos-
sessed by every state hospital or other institution for 200 patients, to
which number these propositions apply, unless otherwise mentioned.

III. Means should be provided to raise ten thousand gallons of
water daily to reservoirs that will supply the highest parts of the
building.

IV. No hospital for the insane should be built without the plan
having been first submitted to some physician or physicians who nave
had charge of a similar establishment, or are practically acquainted
with all the details of their arrangements, and received his or their full
approbation.

V. The highest number that can with propriety be treated in one
building is two hundred and fifty, while two hundred is a preferable
maximum.

VI. All such buildings should be constructed of stone or brick, have
slate or metallic roofs, and as far as possible be made secure from ac-
cidents by fire.

VII. Every hospital, having provision for two hundred or more pa-
tients, should have in it at least eight distinct wards for each sex —
making sixteen classes in the entire establishment.

VIII. Each ward should have in it a parlor, a corridor, single lodg-
ings for patients, an associated dormitory communicating with a cham-
ber for two attendants ; a clothes-room, a bath-room, a water-closet, a
dining-room, a dumb-waiter, and a speaking-tube leading to the kitchen
or other central part of the building.

IX. No apartments should ever be provided for the confinement of
patients or as their lodging rooms that are not entirely above ground.

X. No class of rooms should ever be constructed, without some
kind of window in each communicating directly with the external at-
mosphere.

XI. No chamber for the use of a single patient should ever be less
than eight by ten feet, nor should the ceiling of any story occupied by
patients be less than twelve feet in height.

XII. The floors of patients' apartments should always be of wood.

XIII. The stairways should always be of iron, stone or other inde-
structible material, ample in size and number, and easy of ascent, to
afford convenient egress in case of accident from fire.

XIV. A large hospital should consist of a main central building
with wings.

408 AMERICAN INSANE INSTITUTIONS.

XV. The main central building should contain the offices, receiving
rooms for company, and apartments entirely private for the superin-
tending physician and his family, in case that officer resides in the
hospital building.

XVI. The wings should be so arranged, that if rooms are placed
on both sides of a corridor, the corridors should be furnished at both
ends with movable glazed sashes for the free admission of both light
and air.

XVII. The lighting should be by gas, on account of its convenience,
cleanliness, safety and economy.

XVIII. The apartments for washing clothing, &c, should be de-
tached from the hospital building.

XIX. The drainage should be under ground, and all the inlets to
the sewers should be properly secured to prevent offensive emana-
tions.

XX. All hospitals should be warmed by passing an abundance of
pure fresh air from the external atmosphere, over pipes or plates, con-
taining steam under low pressure, or hot water, the temperature of
which at the boiler does not exceed 212 degrees F., and placed in the
basement or cellar of the building to be heated.

XXI. A complete system of forced ventilation, in connection with
the heating, is indispensable to give purity to the air of a hospital for
the insane, and no expense that is required to effect this object tho-
roughly, can be deemed either misplaced or injudicious.

XXII. The boilers for generating steam for warming the building
should be in a detached structure, connected with which may be the
engine for pumping water, driving the washing apparatus, and other
machinery.

XXIII. All water closets should as far as possible be made of in-
destructible materials — be simple in their arrangement, and have a
strong downward ventilation connected with them.

XXIV. The floors of bath-rooms, water-closets, and basement sto-
ries, should as far as possible be made of materials that will not ab-
sorb moisture.

XXV. The wards for the most excited class should be constructed
with rooms on but one side of a corridor, not less than ten feet wide,
the external windows of which should be large, and having pleasant
views from them.

XXVI. Wherever practicable, the pleasure grounds of a hospital
for the insane should be surrounded by a substantial wall, so placed as
not to be unpleasantly visible from the building.

Which propositions having been duly read, and maturely consi-
dered, were adopted by the association.

On motion of Dr. Hanbury Smith, it was

Resolved, That the secretary be instructed to cause the propositions
now adopted, in reference to the construction and arrangements of
hospitals for the insane, to be published in the medical journals of
this continent, as the sentiments of this association on the subject re-
ferred to.

AMERICAN INSANE INSTITUTIONS. 409

On motion of Dr. Smith, of Missouri, it was

Resolved, That a committee be appointed in reference to the best
kinds of furniture for hospitals for the insane, to report, if possible,
during the present meeting of the association.

Drs. Buttolph, Benedict and Curwen were appointed the commit-
tee.

Dr. Fonerden offered the following resolution, viz :

Resolved, (1st.) That when a hospital for 250 patients has received
200, a new hospital ought to be erected in anticipation of the time
when the maximum number will be in possession of all the accom-
modations.

(2nd.) The second hospital ought then to be constructed, with a
view to appropriate it to one sex of patients only, and as soon as it is
ready for admission, there should be transferred to it from the first
hospital all the patients of that sex for which the new hospital has
been provided.

Dr. Benedict moved a division of the question, which was agreed
to. The first section, relative to the erection of a second hospital, was
adopted. The second section, relative to appropriating the new hos-
pital to a single sex, being under consideration, on motion of Dr. Kirk-
bride, it was

Resolved, That the whole subject be referred to a committee, to re-
port at the meeting next year.

Drs. Fonerden, Benedict and Chandler, were appointed the com-
mittee.

On motion of Dr. Patterson, the resolution offered b}f him yesterday
was taken up for consideration, and after discussion, was adopted.

On motion of Dr. Worthington, adjourned to meet at the Friends'
asylum for the insane, at 3J P. M.

Afternoon Session.

The association met at the Friends' asylum agreeably to adjourn-
ment, and having, under the guidance of Dr. Worthington, examined
the different parts of that establishment, came to order for the trans-
action of business.

Dr. Chandler read a paper on the proper number of patients for
one institution, and whether any advantages would result from a com-
plete separation of the sexes, in hospitals devoted to their treatment,
which after discussion was laid upon the table.

Adjourned to meet at the Philosophical hall, at 11 o'clock to-mor-
row morning.

Fourth Day. — Morning Session.

After having visited in a body the United States mint and the Aca-
demy of natural sciences, the association met agreeably to adjourn-
ment.

The minutes of yesterday's proceedings were read and adopted.

Dr. Nichols read a paper prepared by Dr. Williams, one of the
consulting physicians of Blackwell's Island hospital, N. Y., on typho-
mania, which after discussion was laid on the table.
47

410 AMERICAN INSANE INSTITUTIONS.

Dr. Kirkbride read a paper on the washing, laundry, bakehouse,
&c. for hospitals for the insane, which after discussion was laid upon
the table.

Dr. Jarvis read a paper on the supposed increase of insanity, which
after discussion was laid upon the table.

Dr. Kirkbride tendered his resignation of the office of secretary, to
take effect at the close of the present meeting, which was accepted.

On motion of Dr. Benedict, a committee was appointed to nomi-
nate a member to supply the vacancy occasioned by the resignation
of Dr. Kirkbride.

Drs. Benedict, Hanbury Smith and Worthington were appointed
the committee.

Dr. Chandler commenced the reading of an obituary notice of the
late Samuel B. Woodward, M. D., the first president of this associa-
tion, and prepared at the request of last meeting.

Dr. Hanbury Smith moved that a committee of finance be ap-
pointed, which was agreed to*

Drs. Hanbury Smith, Kirkbride and Butler were appointed.

The finance committee made a report, which was accepted.

Adjourned to meet at the Philadelphia hospital for the insane,
Blockley, at 4 P. M.

Afternoon Session.

After having visited the Pennsylvania hopital in the city of Phila-
delphia, the first institution provided in America for the treatment of
the insane, being founded just a century ago, the association, under
the guidance of Dr. Haines, proceeded to inspect the different parts
of the Philadelphia lunatic hospital and almshouse, Blockley.

On motion of Dr. Fonerden, it was

Resolved, That a committee of three be appointed to decide upon
the place of the next meeting of the association.

Drs. Kirkbride, Parker and Patterson were appointed the com-
mittee.

Dr. Hanbury Smith, from the committee relative to the manual for
attendants, offered the following resolution, which was adopted, viz :

Resolved, That Dr. Curwen, when printing his manual, be requested
to supply each member of the association with an interleaved copy,
and that these copies, with what remarks may be suggested during
the year, be handed to the committee before making a final report
next year.

Adjourned to meet at the Philosophical hall, at 9 o'clock to-morrow
morning.

Fifth Day. — Morning Session.

The association met agreeably to adjournment.

On motion of Dr. Nichols, it was

Resolved, That a committee be appointed to express the thanks of
this association to the various boards of managers and officers of the
different institutions visited by the association, as well as to the va-
rious other bodies to whom we are indebted for invitations and other
acts of kindness.

AMERICAN INSANE INSTITUTIONS. 411

Drs. Nichols, Hanbury Smith, and Smith of Missouri, were ap-
pointed the committee.

On motion of Dr. Worth ington, it was

Resolved, That the members of the association be requested to re-
port to the next meeting all the fatal cases of that form of disease
described by Dr. Bell in his paper read before this association in 1849,
and other cases resembling it, together with the result of their autop-
sies, especial reference being had to the condition of the thoracic, ab-
dominal and pelvic viscera, as well as to that of the brain.

Dr. Kirkbride, from the committee to select a place for the next
meeting, reported that they had agreed to recommend that when the
association adjourns, it will adjourn to meet in the city of New York
on the 3d Tuesday of May 1852, at 10 o'clock, A. M., which recom-
mendation was adopted.

On motion of Dr. Fonerden, it was

Resolved, That Dr. Ray be chairman of the committee in reference
to Mr. Sears' letter, and that he nominate his associates. 2nd. That
the secretary of this association write to the secretary of the Massa-
chusetts board of education, informing him that his letter of June 22d,
1850, to Dr. Fonerden, was read at a meeting of the association held
19th May 1851, and then referred to a committee to report at the an-
nual meeting in 1852.

Dr. Chandler finished the reading of his notice of the late Dr.
Woodward, interrupted by the adjournment yesterday, when, on mo-
tion of Dr. Kirkbride, it was

Resolved, That Dr. Chandler be requested to publish the memoir in
the American Journal of Insanity.

Dr. Buttolph offered the following resolutions, which were unani-
mously adopted, viz :

Resolved, That this association fully appreciates the benevolent mo-
tives, the self-sacrificing labors, and the untiring perseverance of Miss
D. L. Dix, in her efforts to ameliorate the condition of the insane of
our country, and that we deeply regret the failure during the last and
previous session of congress, of her application to that body for an
appropriation of a portion of the public lands, for the benefit of the
indigent insane of the several states.

Resolved, That we do now, as we have heretofore done, most cor-
dially recommend the passage of this act by congress, believing as
we do, that the measure would be alike creditable to the benevolent
character of our government and people, and useful to the unfortu-
nate recipients of the bounty.

Resolved, That Miss Dix be encouraged by our advice and sympa-
thy to continue her application in behalf of this object until her efforts
are crowned with success, and that the secretary be requested to fur-
nish her with a copy of these resolutions.

The treasurer, Dr. Kirkbride, reported : That since the last meet-
ing he had received $18, and had paid expenses of the association to
the amount of $12 59, leaving in his hands a balance of $6 73.

On motion of Dr. Fonerden, it was

Resolved, That the president of the association be requested to open

412 AMERICAN INSANE INSTITUTIONS.

the next meeting with a public address on the progress of knowledge
concerning insanity.

Dr. Nichols, in compliance with the request of the last meeting of
the association, read an obituary notice of the late Amariah Brigham,
M. D., one of its vice-presidents, when on motion of Dr. Kirkbride,
it was

Resolved, That Dr. Nichols be requested to publish the same in the
American Journal of Insanity.

Dr. Haines read a paper descriptive of the system of steam heat-
ing, connected with a forced ventilation adopted at the hospital build-
ings of the Philadelphia almshouse, which after discussion was laid
upon the table.

On motion of Dr. Hanbury Smith, the committee on a constitution
and bye-laws was continued, to report at the next meeting.

On motion of Dr. Smith of Missouri, it was

Resolved, That a committee of three be appointed to report at the
next meeting of the association, on the relative value of an upward
and downward ventilation in hospitals for the insane.

Drs. Bell, Smith of Missouri, and Haines, were appointed the com-
mittee.

Dr. Ray made a statement in reference to an act passed by the last
legislature of the state of Rhode Island, defining the legal relations of
the insane of that commonwealth.

Dr. Nichols, from the committee appointed for the purpose, re-
ported the following resolutions, which, after consideration, were una-
nimously adopted, viz :

Resolved, That the members of this association have visited and in-
spected the Pennsylvania hospital for the insane, under the care of
Dr. Kirkbride, as well as the parent institution in the city of Philadel-
phia, with great interest and satisfaction, recognising in both abundant
evidence of the well-directed benevolence to which they owe their
origin, and feeling convinced that, if not unequalled, they are at least
unexcelled.

Resolved, That upon a close inspection of the Friends' asylum for
the insane, near Frankford, under the care of Drs. Evans and Worth-
ington, the association has much pleasure in testifying to the excellent
condition in which they found that well-conducted and now venerable
institution.

Resolved, That the visit of the members of the association to the
Philadelphia hospital and lunatic asylum in Blockley, under the me-
dical care of Dr. Haines, has afforded them an opportunity of avow-
ing their conviction that this establishment occupies a. prominent posi-
tion among the great charities which are the glory of Philadelphia.
The cleanliness and comfort of its spacious apartments, the classifica-
tion, order, and freedom from restraint of its insane inmates, are
commendable ; and in all that relates to the supply of water, warmth,
ventilation and drainage, this institution is not only in advance of si-
milar pauper establishments, but even of some of our state hospitals.

Resolved, That while the association finds so much to admire and
commend in this institution, and approvingly observes the astonishing

AMERICAN INSANE INSTITUTIONS. 413

improvements effected since its last meeting in this city, six years ago,
it feels free to remind the board of guardians, of its well-known opi-
nions on the importance of providing labor, and spacious and con-
stantly and readily accessible grounds for exercise for the insane, es-
pecially as the institution possesses abundant means of accomplishing
such advisable improvements, in the extensive grounds and beautiful
gardens connected with it.

Resolved, That our thanks are especially due to the boards of ma-
nagers and guardians of all the institutions above mentioned for their
personal attentions and the kindness shewn us on the occasion of the
visit of inspection, to which reference has just been made, as well as
other times, and for other proffered privileges, of which want of time
has prevented our availing ourselves.

Resolved, That our thanks are due and afe hereby tendered to the
president and directors of the Girard college for orphans, for the libe-
ral manner in which the association was entertained during its visit to
every part of that magnificent and admirably conducted institution.

Resolved, That the association returns its warmest thanks to Dr. R.
M. Patterson, director, and Franklin Peale, Esq., chief coiner of the
United States mint, for the highly appreciated privilege afforded us
of inspecting every part of this establishment, justly renowned for the
elegance and perfection of its machinery and arrangements, and for
the admirable manner in which it is conducted.

Resolved, That the association gratefully acknowledges the liberality
and kindness which prompted the American philosophical society to
tender its hall for the meetings of the association, and the use of
which places us under special obligations to that body.

Resolved, That the thanks of the association are also due to the
managers of the Pennsylvania hospital for the offer of their beautiful
library room for the meetings of the association : to the officers of the
academy of natural sciences, for the privilege of making a very gra-
tifying visit to that valuable institution : to the officers of the Penn-
sylvania institution for the instruction of the blind, of the Pennsylva-
nia institution for the deaf and dumb, of the Philadelphia Athenaeum,
and of the University of Pennsylvania, for the courteous invitations
to visit those institutions, which want of time alone prevented our ac-
cepting.

Resolved, That the secretary be requested to furnish the daily papers
of Philadelphia with a copy of these resolutions for publication.

The committee appointed to select a secretary in the place of Dr.
Kirkbride, resigned, nominated Dr. Buttolph, who was appointed.

On motion of Dr. Hanbury Smith, it was

Resolved, That while the association reluctantly accepts the resigna-
tion of its secretary, Dr. Thomas S. Kirkbride, it feels that it is due,
not only to him but to itself, to express its full appreciation of the faith-
ful, devoted and acceptable manner in which he has discharged the
duties, often arduous and irksome, of the office which he has filled
from the first organization of the association, and for which we return
him our heart-felt thanks.

Dr. Hanbury Smith, from the committee on publication, asked that
said committee be continued ; which was agreed to.

414 SELECTIONS.

On motion of Dr. Parker, it was

Resolved, That the thanks of the association are cordially tendered
to its vice-president, Dr. I. Ray, for the able, impartial and courteous
manner in which he has performed the duties of presiding officer du-
ring the present meeting.

On motion of Dr. Benedict, it was

Resolved, That the president of the association be requested (within
two months of the adjournment of the present meeting) to assign to
each member a subject on which he shall make a written report at the
next meeting.

On motion of Dr. Nichols, it was

Resolved, That the secretary be requested to furnish a copy of the
proceedings of the association to the editor of the " American Journal
of Insanity," and to the editors of the various medical journals in the
United States and Canada, for publication in their respective journals.

After some remarks by the vice-president, Dr. Ray, on motion of
Dr. Butler,

The association adjourned to meet in the city of New York, on the
third Tuesday in May 1852, at 10 o'clock A. M.

THOMAS S. KIRKBR1DE, Secretary.

Ovarian Tumor Removed, per vias Naturales, by Catheterism
of the Fallopian Tubes.

REPORTED BY SAMUEL A. CARTWRIGHT, M. D., NEW ORLEANS.

March 10th, 1850, I sent for Dr. Warren Stone, to consult him in
regard to the propriety of extirpating a very large and hard ovarian
tumor in a patient of mine, Mrs. * * *, a small, delicately-formed
lady, of sanguine temperament and scrofulous constitution, lately from
the country. The patient herself wanted an operation performed, and
came to the city for that purpose. When I told her that it would re-
quire an incision two feet long to extirpate so large a tumor, she re-
plied, that she did not care if it were three feet, as she had rather die
than live to suffer as she did. A tormenting strangury, from the pres-
sure of the tumor on the bladder, annoyed her very much day and
night. She was about 19 years of age, had been married two years,
and was very feeble, pale and emaciated. She said that the tumor
had been growing from her earliest recollection, but it had not become
so large as to incommode her much, until after her marriage ; she had
taken iodine and its preparations for a long time ; had been twice sa-
livated, and so far from deriving any benefit, grew weaker and the tu-
mor continued to enlarge. She was also afflicted with bronchitis and
ulceration of the throat, which she attributed to salivation. The tu-
mor made her look as large as a woman in the ninth month of preg-
nancy ; it was hard and irregular to the touch, and seemed to arise
from the left ovarium ; it would incline from side to side with the po-
sition of the body ; a prolongation of the tumor had slipped down
between the bladder and uterus, and so much compressed the vagina

SELECTIONS. 415

as to be in the way of a speculum examination. As the case was
beyond the reach of medicine, the resources of surgery were invoked.
After a careful examination, Dr. Stone came to the conclusion that a
surgical operation would be too hazardous, and in all probability fatal,
in consequence of adhesion of the tumor to the bladder and conti-
guous viscera.

The patient was put on a course of proto-iodide of mercury, com-
bined with cicuta ; the tincture of iodine was applied externally, and
a tincture of pareira brava root advised for the relief of the irritation
of the bladder. This treatment was continued for seven or eight days,
the patient growing weaker and the tumor larger. The disease of the
throat became so annoying that I found it necessary to apply the ni-
trate of silver frequentty to the ulcerated and inflamed tonsils, and to
substitute tonics for the iodide of mercury and cicuta.

On the 18th of March, the patient consented to a speculum exami-
nation. The uterus was rather under the usual size ; there was no leu-
corrhceal discharge, congestion or inflammation ; the mucous surfaces
were in a state of anaemia, being pale and exsanguious. A very small
gum elastic catheter, with a wire in it, after repeated efforts, was intro-
duced into the uterine cavity. The passage of the catheter through
the coarctation, called the os internum, gave some pain, and caused a
faintish, sick sensation ; but this is nearly always the case in probing
a healthy uterus, and the operation requires some address and a pro-
per instrument, or it cannot be effected. The small catheter was with-
drawn, and a larger-sized instrument was passed with some difficulty
through the cavity of the cervix into the uterus ; it penetrated about
two inches ; on being withdrawn, a little blood, as usual, followed. I
now concluded to try catheterism of the left Fallopian tube. With
this view, the catheter, containing a wire, was flexed like the male
catheter and passed through the fusiform cavity of the neck into the
triangular cavity of the uterus itself; the wire was withdrawn about
half an inch, so as to make the point of the instrument more flexible,
and was carried forward in the direction of the ostium uterinum of the
left Fallopian tube. It entered the tube after a few trials, and after
penetrating about an inch, it seemed to enter a cavity or expansion of
the tube itself; it was pushed forward about an inch and a half more,
seeming in its passage to encounter a soft, yielding substance ; it was
then withdrawn ; a glutinous substance followed its withdrawal, which
I recognised to be a hydatid formation. The same catheter, with a
very tapering point, was dipped in a solution of nitrate of silver, a
drachm to an ounce. Several minims of the solution were drawn
into it by working the wire in the calibre of the instrument ; it was then
passed through the uterine cavity into the Fallopian tube, until it had
penetrated the tube three inches, when it was moved about in the ca-
vity of the tube, and the wire moved so as to eject the caustic solution
through the eyes of the catheter, among the hydatid cysts that the in-
strument had reached ; on withdrawing it, a semi-membranous, tena-
cious substance, with dark specks interspersed through it, not unlike
frog-spawn, presented itself at the mouth of the uterus, seeking an
exit, but too thick and glutinous to pass freely. Finding it too soft

416 SELECTIONS.

and yielding to be drawn away with the forceps, a little raw cotton
was passed around a probe, so as to entangle the viscid substance,
and by turning the probe the stringy matter was wound around it, and
pulled out of the uterus in long mucilaginous ropes. The supply
seemed to be inexhaustible. The patient being much fatigued, the
operation of drawing away the hydatids was at length suspended ;
nevertheless they continued to come away, per vias naturales, for a
week or more. In the mean time, the tumor was reduced to less than
half its former size, and grew softer and less painful. The catheterism
of the Fallopian tube, with the catheter filled with a strong solution
of nitrate of silver, was again repeated on the 3d of April, the 1st,
7th and 13th of May. At the last operation no more hydatids or viscid
fluid was brought away ; but at all the other operations, they were
not only brought away at the time, but continued to pass off for a
week or more after each catheterism.

The day after the last operation, the patient left town for the sea-
shore ; her health had begun to improve rapidly, her pains were gone,
and her abdomen was reduced to near its natural size. While absent,
her health appeared to be entirely reinstated.

Last autumn she returned to the city quite well, though some fulness
and hardness could still be felt in the hypogastric region, the effects
of the former adhesions, verifying the accuracy of the diagnosis made
by Dr. Stone, of whose skill in surgery New Orleans is justly proud.
Soon after her return she had an attack of fever, which, as is usual,
sought out the weakest part, and the ovarian region again became the
seat of painful sensation, which, with the distension from d}rspeptic
flatulence, made her apprehensive, for some months, that she was not
cured ; but her general health improved in the course of the winter,
and she was enabled to dance, waltz, and walk about town as ac-
tively as almost any other woman. Although she suffers somewhat
from painful distension in the abdominal and pelvic regions during her
menstrual periods, and is dyspeptic and flatulent at such times, yet,
when that is over, her form is quite sylph-like. Her bronchial disease
is cured, and the leucophlegmasia is giving way to the rosy hue pro-
per to her original sanguine temperament.

As this is the first case of ovarian tumor, as far as I know, which
has been treated by catheterism of the Fallopian tubes, I have thought
proper to report it. I do not consider the operation as always a diffi-
cult one ; because, when the ovaries are in a morbid state, the Fallo-
pian tubes are, in general, much more easily catheterized than in the
healthy condition. I doubt its practicability in a state of health ; pos-
sibly it might be effected during the catamenial period. The same
important practical law obtains in regard to the uterus itself, it being
generally easier to probe when in a morbid state. I have succeeded
in curing some cases of dysmenorrhea and sterility by catheterism of
the Fallopian tubes, selecting the proper time for the operation ; but
as its virtues in this respect are already known to the profession, it is
unnecessary to dwell upon the subject farther than to say, that New
Orleans can shew some as unquestionable evidences of its efficacy in
sterility as London. — New Orleans Medical and Surgical Journal.

SELECTIONS. 417

Repudiation of Homoeopathic Members by the Edinburgh
College of Physicians.

We are glad to learn from the following that "the authorities" in
Edinburgh begin to see the necessity of purging their body of the
Hahnemannic entozoa which defile their prima, via. It was high time
for them, parties as they have been by toleration to a diffusion of this
form of medical tergiversation amongst the rising generation educated
in this ancient establishment. We are not for dictating to the better
dressed mob on the choice of their medical advisers; we think that a
fool has a right to his physician, but we have a right to dictate to
colleges which by connivance place knaves on a level with honest
men. The Edinburgh College of Physicians is entitled to credit for
their movement in this direction ; but to those unacquainted with the
varieties which exist in the medical body politic, it is necessary to
state that it forms no part of the Universily ; neither, we believe, has
it any connection with it. The University appears powerless in this
as in many other matters deeply affecting the welfare and character
of the medical profession, being under the control of the town council:
a strange arrangement still adhered to notwithstanding its origin.
Surely it is high time for the Scotch to emancipate themselves from
the authority of the uncivilized barbarians who ruled them when these
charters were granted. The following is the act of the College of
Physicians :

" Resolutions unanimously adopted by the Royal College of Physicians of
Edinburgh, regarding Practitioners of Homoeopathy.

"At Edinburgh, and within the College Hall there, the 9th day of
May 1S51, an extraordinary meeting of the Ro}ral College was held,
pursuant to a resolution agreed to at the last quarterly meeting, and
of which extraordinary meeting due notice was given, the president
in the chair, the following resolutions were moved, seconded, and
unanimously agreed to:

" I. That the Royal College of Physicians of Edinburgh, did,
several years ago, publicly express its opinion of homoeopathy and
homoeopathic practitioners, by peremptorily declining to admit into
its body a candidate for its fellowship who belonged to that denomi-
nation ; and consequently that no fellow of the college can possibly be
ignorant of the light in which all those who practise homoeopathy are
regarded by the college.

" II. The college regrets that, notwithstanding this decided expres-
sion of its opinion, more than one of its fellows, after being admitted
in a different character, have endangered the reputation of the college
by becoming homoeopathic practitioners ; and the college expresses
an earnest hope th;it these fellows, seeing they have thus virtually
separated themselves from the college, will spontaneously sever their
further connection with an institution which repudiates them, and from
which they can derive, as merely nominal fellows, nothing else than
a false position and a spurious credit.
48

418 SELECTIONS.

" III. The college feels the more bound thus to express its opinion,
seeing that those fellows who have become homoeopathists, and any
other medical practitioners who follow homceopaihy, must necessarily
be aliens to the other fellows, and to the profession at large ; inas-
much as no fellow of this college, or any other physician, can, by any
possibility, without derogating from his own honour and from the
honour of the profession, meet practitioners of homoeopathy in con-
sultation, or co-operate with them in the other common duties of pro-
fessional life.

"IV. That although the college has not thought it expedient
hitherto to take any active steps tor disclaiming those fellows who
have become homoeopathic practitioners subsequently to their admis-
sion to the college, nevertheless, since it has the power of dealing
summarily with ihose who act in a manner so unbecoming the cha-
racter of a physician, it reserves its right to exercise that power when
it shall be so advised.

Signed in name, and by authority of the college.

J. Y. Simpson, President."

We add the comments of the London Lancet, in which we concur.
The homoeopathic branch of the valetudinary section of the com-
munity will, doubtless, say that this "persecution" of their infinitesi-
mal part of a medical man is mere spite ; and will babble of Harvey,
Galileo and Jenner, but when such iblk tire of their plaything, we do
not wish to find it in our cabinet :

" The College of Physicians of Edinburgh has just come to a reso-
lution condemnatory of the practice of homoeopathy, and calling upon
any of its fellows or licentiates who may look with favor on that silly
heresy, to disconnect themselves from a body instituted for the cultiva-
tion and promotion of science. It is, we believe, well understood to
be the purpose of the Northern college to proceed against all such per-
sons as may shew themselves slow to understand what honor and
truth require of them. They will be plainly^ and forcibly ejected.
Nor will those be spared who, in weak compliance with aristocratic
caprice, and in order to steal a march upon their more sturdy and
honest competitors, so far forget what is due to their education, their
position, and their duty to their patients, as to countenance and meet
in consultation the pseudo-medical tribe who, under the gabardine of
homoeopaths, wait upon the weaknesses, and stoop to the humors of
pampered and idle men and women of the upper ranks of society.
All honor to the College of Physicians of Edinburgh. We trust they
will neither waver nor pause in their manly and honest course. It is
time that the medical profession should rouse itself to vindicate both
its character and its property. Toleration has gone far enough, and
the evil but grows with impunity. We have in this metropolis, to a
still greater extent than in Edinburgh, our impostors, and we regret
to say, also our false brothers, who d:> us more injury than the quacks.
Were the homoeopaths invariably left in the difficulties into which
their, presumption and their dishonesty frequently lead them, iheir

SELECTIONS. 419

credit with the public would long ago have been destroyed. But
when physicians of hitherto good name consent to meet such men,
and thus vouch for the propriety of their proceedings, they are vastly
aided in their scandalous and nefarious trade. We regret to think
that in London, men attending members of the royal family have been
singularly guilty in this respect. We should be glad to hear that our
own College of Physicians had roused itself to the evil which is stalk-
ing abroad. The monstrous alliances now proceeding between regu-
lars and quacks, might surely deserve the exertion of collegiate
authority. The Edinburgh College will not, we trust, forget that
there are great functionaries to be corrected. What is to be done
with Dr. Henderson, the homoeopathic professor of pathology in the
University of Edinburgh, to the condign disgrace of the university,
and of every other professor, be it spoken? What sort of pathology
does this man teach? If he teach the pupils of the university the
ordinary and approved doctrines of physic, what becomes of his prac-
tice? If he teach ihem homoeopathy, what excuse have the patrons
for the toleration ? In either case, " Ou l'honneur va-t-elie se nicher."
" We are not aware what steps have yet been taken by the College
of Physicians of Edinburgh in the matter of Professor Henderson,
the homoeopathic pathologist of the great Northern university. We
trust no hesitation will be felt by the college respecting his summary
punishment. This person has too long been permitted to scandalize
the medical profession in Scotland. We have always held it mon-
strous that a man perverted from legitimate medicine should be
allowed to tamper with medical youth, in his professional character,
for a single year after his perversion. It is discreditable to the moral
feeling of the profession in Edinburgh that a man should have been
permitted to continue year after year in the opposite and incompatible
characters of homoeopathic practitioner and medical teacher in a uni-
versity for the education of students in the rules of legitimate medicine.
We know it has been said again and again, that the professorial ap-
pointment lies with the town council, and that that body alone is
capable of removing Professor Henderson from his chair of pathology.
But the profession have had no indications of discontent on the part
of the other professors at the humiliating position in wnich they have
long been placed. They might, and should, one and all have re-
signed, unless the correction of Dr. Henderson could have been
effected. How can such men as Goodsir, Christison, and Hughes
Bennett, reconcile it to their consciences that they hold their profes-
sorial offices conjointly with a homoeopath ? This is worse than
meeting homoeopathic practitioners in practice, for teaching is a higher
matter lh;in practice. For some time past the principal professors of
the University of Edinburgh have advertised themselves as editors of
the Monthly Journal of Medicine. We have not observed their criti-
cisms upon the state of the prof ssion in Edinburgh, or the anomalous
position of Professor Henderson. We have seen plenty of captious
mult-finding with respect to everything passing in London; but the
beam in the medical eye of Edinburgh has quite escaped attention.
This is hardly as it should be, atid we beg to call the notice of the

420 SELECTIONS.

gentlemen to whom we have referred, to their duties as editors and
professors. Let them bestow their pens for a while north of the
Tweed, and let us have the pleasure of congratulating them upon the
removal of the scandal which now deforms their veteran university."

[Dublin Medical Press.

Extraordinary Tapping.

Dr. T. D. Lee, of New York, reports a case of ascites, in which
he performed paracentesis abdominis 39 times, and drew off 141 gal-
lons of water! The case terminated fatally. We recollect removing
10 gallons at one tapping, in a case of encysted dropsy, and re-
peatedly afterwards 6 gallons, by which the life of the patient was
prolonged about 18 months. — [Southern Med. and Surg. Journal.

»I»i«A& §§11111 ©F OMlOx

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THE

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VIRGINIA MEDICAL GAZETTE.

No. a]

RICHMOND, AUGUST 1851.

[VoL I.

Pathological and Diagnostic Excerpts. — In which the value of
Physical Signs is enforced.

BY RO. W. HAXALL, M. D. OF RICHMOND CITY.

One of the greatest, if not the greatest difficulty in the successful
practice of medicine is the formation of a correct diagnosis ; and it
cannot be denied that cases are frequently met with which require the
most discriminating judgment for their proper elucidation. In differ-
ent diseases of the same organ, similar functional symptoms may exist
in greater or less number ; and unless we are sufficiently skilled in
the distinctive signs which belong to them, it is easy to imagine that
error may be the consequence. Hence the great value of those signs,
particularly in chest diseases, which are termed physical, because they
depend solely upon an altered or pathological condition of the organ
involved. There are other symptoms too which are clearly pathog-
nomonic, and which when detected, are of course amply sufficient to
characterize the peculiar affection under which the patient may chance
to labor.

With these few general remarks, the design of the present paper
will be easily apprehended. I shall say nothing in regard to the treat-
ment of those diseases brought under review, my object being suc-
cinctly to state their distinctive characters. It may not be amiss also
to state, that I had occasion to make this investigation some time ago.
If the opinions then expressed were true, they are true now ; and if
the subject has enough of interest to bear a second edition, it may not
perhaps be without value to some member of the profession.

I shall first speak of some of the diseases of the chest. The affec-
tions of the abdominal organs may be considered hereafter.

Pleura. — Although the general and rational signs of pleurisy may
lead us in a great many instances to recognize the true character of
the lesion, yet are there cases of pneumonic inflammation, particularly
in their inception, in which, without the aid of physical signs, we may
mistake the one for the other. All of us have encountered cases of
pneumonia, where for the first few hours there was little or no expec-
toration ; or if any, not of that peculiar kind which belongs to this
49

422 haxall's pathological excerpts.

disease, and in which the pain also was as sharp and as acute as that
of pleurisy. The face too, has been seen to be without that flush of
vivid redness, which has been given as one of the characteristics of
pulmonary inflammation ; and it must be admitted by all who have
had any experience in the two diseases, that it would be impossible to
look for a pathognomonic sign in the condition of the pulse. Varying
as this must do by so many circumstances connected with the indivi-
dual, founded upon idiosyncracy and the different susceptibilities in
the chain of sympathies, it would be vain to draw a comparison so
well founded as to serve as a sure and invariable guide.

Nor is this all : pleurisy occurs as a secondary lesion in some dis-
eases, and may really become the efficient cause of death ; and that
too under circumstances where its rational symptoms would rarely if
ever point out its existence. Besides, it is only by the physical signs
that we can distinctly trace the various changes which supervene du-
ring its progress, and mark unerringly the amount of effusion and its
gradual diminution. And it is within the experience of those who
have had the amplest opportunities for observation, that all the local
symptoms, as pain, dyspnoea, &c. may fail, while yet the physical
signs may exist in their fullest extent. Latent pneumonia too, giving
rise as it does to but feeble functional indications, yet sufficiently so
to authorize a belief in some thoracic lesion, will almost always leave
the uninitiated in physical signs in doubt and uncertainty.

As I before hinted, it is not my purpose to detail the full history of
the general and functional symptoms which belong to those diseases
to which reference will be made. Indeed, these will only be men-
tioned when it becomes necessary to state their insufficiency towards
the formation of a clear diagnosis, when compared with the greater
certainty derived from physical signs ; and as the remarks which have
just been made relative to inflammation of the pleura and the pulmo-
nary parenchyma, may induce some little doubt as to the value of the
functional signs in all cases, I will proceed to enumerate those which
from their nature can hardly leave us in error.

Were a physician called to a case of pleurisy during the first mo-
ments of its invasion, he might probably be at a loss in his diagnosis,
except he were to reason upon the principle of exclusion. The signs
of all other affections of the lungs or pleura being absent, he might
reasonably infer the existence of this. But he would not long remain
in doubt ; for it is often surprising with what rapidity effusion takes
place into the cavity of the pleura, while the inflammatory orgasm in
its highest degree may yet remain unsubdued. Laennec tells us that
he has occasionally discovered effusion within one hour after the com-
mencement of the disease, oftentimes within the space of three or four
hours, and that it is never doubtful after the second day.

As soon as the effusion does take place, there can be no further room
for doubt. The lung, crowded towards the spinal column by the pres-
sure of the fluid, permits the respiration to be heard onry along a por-
tion of its course, and that to the extent of some two or three fingers'
breadth ; above the spine of the scapula, unless the effusion be very
great, and beneath the clavicle, it may also be discovered.

haxall's pathological excerpts. 423

This absence of respiration is owing of course to the temporary ob-
literation of the air-cells and minute bronchial ramifications, in conse-
quence of the pressure exerted upon them ; and it is only because
these last are sufficiently firm and large at their root or origin to offer
the necessary resistance, that the respiration there remains audible.
The lung of the diseased side being thus deprived of its power of re-
ceiving air, the opposite lung, in order to make amends as it were for
the deficiency of its fellow, appears to undergo an increase of action,
and the respiration assumes the character denominated puerile. This,
when very loud and well marked, as it sometimes is, may lead the
inexperienced into error ; for it may be heard when the ear or the in-
strument is applied to the diseased side, the effusion not being exces-
sive, and thus impose the belief that the lung is here still permeable
to the air. The diagnosis might then be called in question ; and un-
less the difference between puerile and bronchial respiration was very
clearly understood and appreciated, it might even be imagined that
inflammation of the parenchyma existed. The dullness of sound
upon percussion would also aid such a supposition, and if cegophony
be at the same time mistaken for bronchophony, as is not unfrequently
the case, persistence in the error would be still more certain. But he
who has once heard the full, hard and noisy sound of bronchial res-
piration in pneumonia, and that too passing immediately beneath his
ear, can hardly mistake it for the loud though soft vesicular murmur
of infancy; an attentive examination in the case before us will give
the sensation too of the sound coming from a distance, which, as has
just been intimated, is not the case when the pulmonary tissue is in-
flamed. It is not pretended that this state of things is of frequent oc-
currence. On the contrary, it is very rare, the respiration being in a
large majority of instances nearly if not quite inaudible on the affected
side, except at the root of the lung.

When the thoracic cavity is unaffected by disease, the application
of the hand upon its sides during the process of respiration, and more
particularly the act of speaking, imparts to it a peculiar trembling
sensation ; and if we use percussion o%rer any of its regions, a well-
marked resonance, greater in some situations than in others, for obvious
reasons, is uniformly elicited. The mechanism of both phenomena is
easy of explanation ; the permeable parenchyma, dilating and distend-
ing itself under the influence of the introduction of the air, comes
closely into contact with the sides of the chest, and the voice reverbe-
rating throughout the recesses of the pulmonary apparatus, thus causes
the motatory and trembling feeling which is appreciated by the touch.
The same anatomical character of the lungs to which allusion has just
been made, viz. their permeability? although not rendering them hollow
organs, in the strict acceptation of the term, yet makes them enough
so to produce a clear resonance on percussion. When effusion has
resulted, a denser medium being thus substituted for the air, which no
longer finds admission into its appropriate cells in consequence of
compression of the lung, the thorax loses the resonance which belongs
to it in its natural state, and becomes dull when percussed.

Another physical sign, which is only observed while effusion is pre-

424 haxall's pathological excerpts.

sent, is cegophony ; nor is it then heard unless the effused fluid be
moderate in quantity. From this fact we are therefore always enabled
to tell if no other symptom existed, whether the effusion be excessive
or not ; if it be so, this sign, as we have remarked, will not be heard,
and should it afterwards be recognized, an affirmative and positive in-
dication of its diminution is established. In order to appreciate the
reasons upon which these remarks are founded, it will be necessary to
enter into an explanation of the production of cegophony. This sign
bears some resemblance to bronchophony, and it does so because a si-
milar condition of the lung in part is required to produce both. This
condition is its greater density. When it has become more dense
than natural, its pathological condition, it is true, is not the same, al-
though its effect upon the development of the two signs alluded to
may be alike. In the one case, (that of bronchophony,) the paren-
chyma is engorged, overloaded and impacted with blood, and the
molecular or ultimate order of the tissue is obviously deranged. In
the other, the density is merely the result of compression, and no
other change takes place in the organic structure, than a closer ap-
proximation of its parts. This dense or compact state of the lung
being established, and the result of either the one or the other cause,
prevents that diffused resonance of the voice which is noted in its
healthy condition ; and as all more solid bodies are better conductors
of sound than those less so, the voice is heard within the chest with a
distinctness proportioned to the solidity. Were there no effusion, the
increased density of the lung, or a portion of it, as the case might be,
from whatever cause it might arise, would produce pure broncho-
phony ; but while it exists, if moderate, the resonance of the voice is
so modified by the medium through which it is heard, (the effused
fluid,) that a certain trembling sensation, a sort of saccade, is distin-
guished, which imparts to the sign of cegophony its characteristic pe-
culiarity. And from this explanation, we at once see why it requires
but a moderate quantity of fluid to allow of its detection ; if it be ex-
cessive, the medium through which the resonance would have to pass
opposes an insurmountable barrier to its appreciation.

CEgophony is one of the physical signs to which we may look with
very great certainty in almost all cases of pleurisy ; and from what
has been said it may be inferred that the stage of the disease in which
it is most generally heard, is that wherein absorption of the fluid has
taken place to a considerable extent. But it occasionally happens,
though rarely, that it is heard throughout its whole continuance ; and
this is owing, as dissection has proved, to the lung being held near the
sides of the chest by adhesions which had formed in consequence of
some former attack. During the early part of the disease, cegophony
is sometimes met with before the effusion has made sufficient progress
to impede its occurrence.

Another sign, the consequence of effusion, is dilatation of the af-
fected side ; and this is frequently observed a few hours after the
fluid is secreted. The ribs appear to be elevated ; the intercostal
spaces are augmented in breadth, and in proportion to the excess of
the fluid after it has reached a certain point, is the diaphragm de-

haxall's pathological excerpts. 425

pressed ; and hence it is, that very often a deceptive appearance of
enlargement of either the spleen or liver is observed, and more par-
ticularly the latter, on account of its superior volume. It is undoubt-
edly the chronic form of the disease in which dilatation is more uni-
formly perceptible, and the phenomena to which we have alluded are
more distinctly marked. Although always commencing early, it may
not be clearly distinguishable for some little time, yet it ultimately in-
creases to such a degree as no longer to be mistaken. All the physi-
cal signs hitherto mentioned, except cegophony, are eminently deve-
loped, and this for the reason already given. The lung, in conse-
quence of protracted compression, appears to be nearly destroyed ; its
tissue is pale and exsanguineous, and its vessels and bronchial tubes
are flattened. The character of the effusion is also found to vary ; it
is often purulent, and is of a green or yellowish color. In this state
the disease is denominated empyema.

Should life continue sufficiently long and the absorption of the fluid
take place, the affected side becomes contracted in its dimensions.
This is the result of the slow and gradual manner in which adhesions
are developed ; and without entering into a minute history of the pro-
cess, it will suffice to say that they ultimately assume a fibro-cartila-
ginous structure, and thus tend to bind down and constrict the sides
of the chest. In the mean time the lung remains compressed and flac-
cid. The signs of this complication are, either a total absence of re-
spiration, or it is but slightly heard, and that near the root of the lung
or in its superior portion. The thickness of the accidental develop-
ments does not cause this indistinctness or absence of the respiratory
murmur, as the case may be, and which might readily be inferred from
a hasty examination. Dissection reveals the true cause, by exhibiting
the lung in a compressed condition, and thus inhibiting the ingress of
air into its cells ; and the same pathological feature will abundantly
account for the dullness of sound on percussion, which presents itself
as another sign.

Before effusion takes place, or even while it is yet progressing —
and I refer now to the more acute form of pleurisy — a thick, tenacious
and plastic exudation lines that portion of the 'pleura which is in a
state of inflammation. This is the first form of false membrane or
accidental tissue, as it is called ; and it is a curious circumstance in
the history of this affection, that the hitherto unaffected portion of the
pleura opposite to the diseased part speedily itself becomes inflamed ;
false membrane is here also produced, and we refer to this condition
more particularly for the purpose of explaining another physical sign
which is not very uncommon. In a state of health the serous sur-
faces of the pleura, bedewed with a thin and slightly viscous fluid,
glide easily and imperceptibly over each other; but so soon as this
false membrane is exuded, the situation of things becomes altered, and
in proportion to the degree of consistency which it assumes, by so
much is the free and easy movement of the opposite surfaces, the one
upon the other, impeded. Rough surfaces are opposed where before
they were perfectly smooth, and if the ear be applied, the sound eli-
cited by their friction is easily distinguished. This has been termed

426 haxall's pathological excerpts.

the ascending and descending friction sound ; the former being pro-
duced during inspiration, and the latter during expiration. It need
scarcely be said that this sign is only appreciable either before the ex-
istence of the secreted serosity or after it has been absorbed.

Partial or circumscribed pleurisy is an affection of not very fre-
quent occurrence, for experience has proved the fact, that in a pleura
already adherent, inflammation supervenes more rarely than where
this is not the case. Partial pleurisies are those circumscribed by
former adhesions, and seldom if ever exist under other circumstances,
except in particular cases of pleuro-pneumonia and phthisis. They
are generally found in the fissures located between the lobes — be-
tween the base of the lung and diaphragm — upon that part of the
pleura covering the posterior and inferior portions of the lung, and be-
tween it and the mediastinum. The physical signs are, absence of re-
spiration in the part affected, occasionally osgophony is manifest, and
where the situation of the diseased part will admit of percussion, a
flat or dull sound results.

Pleuro-Pneumonia is not a very frequent affection, if the term be
adopted in its fullest acceptation, viz. where the whole of the lung
and the pleura become inflamed. Where the disease exists even un-
der this form, reason and experience teach us, quite contrary perhaps
to what might be imagined at the first blush, that the patient runs less
risk of his life than where the one or the other occurred alone. I shall
not now relate all the physical signs of pneumonia and the pathological
condition upon which they depend. Enough however will be said in
order to afford a comprehensive view of the present disease ; and it
need scarcely be remarked, that the most complete combination of
general and functional symptoms could avail nothing towards estab-
lishing the true character of the lesion.

The reason why the complication of the two is less dangerous than
either the one or the other singly, is derived from the fact that the
pneumonia is lessened in degree in consequence of compression of the
lung by the effused fluid. Thus pressed upon, its vessels are not
subjected to the extensive engorgement which would otherwise hap-
pen, and inflammation of the tissue is very much moderated ; but it
is not of course prevented, and this operates in its turn upon the in-
flamed pleura. The lung swelled and engorged, although to a mode-
rate extent, as has been said, prevents an excessive effusion from the
pleuritic surface; and the facility of absorption being thus increased, a
reciprocity of good is established between the two diseases. As
might well be anticipated, a dullness of sound is observed when per-
cussion is used. For this there are two causes : First, the engorged
condition of the lung, thus preventing to a greater or less degree the
entrance of the air; and secondly, the existence of effusion. This
not being so great as in simple pleurisy, does not prevent us from ob-
serving the sounds peculiar to pneumonia; the crepitant rale, bron-
chial respiration and bronchophony are all heard ; and oegophony, in
connection with the other signs of effusion already named, leads us to
know that inflammation of the pleura is present.

haxall's pathological excerpts. 427

A much more common form of pleuro-pneumonia is produced by
the extension of the inflammation of the parenchymatous tissue to-
wards the surface, the pleura becoming consecutively implicated. If
a portion only of the lung be inflamed, the corresponding part of the
pleura is alone found to be involved at first ; but the costal surface, to
the same extent which is contiguous, soon itself takes on an inflamma-
tory action ; and here the pleurisy is partial. One is led to suspect
sometimes this state of things without resorting even to physical signs,
from the sharp and acute character of the pleuritic pain. The pneu-
monia has continued for days, and if a proper treatment has been pur-
sued, the pain, although it may have been severe at first, is very
much moderated ; and were we not aware that the pleura may be-
come consecutively diseased, we should be surprised at this fresh ac-
cession of pain when the pneumonic symptoms themselves might be
not at all aggravated.

When but a portion of the lung with its corresponding pleura is
thus affected, the latter is clothed with a layer of false membrane as
well as its contiguous and opposite surface ; and in addition, the serous
or sero-purulent secretion of pleurisy supervenes. In this condition
of things the two lesions are easily discovered by their physical signs ;
the crepitant rale of pneumonia is of course no longer heard in this
stage of the disease, but bronchial respiration and bronchophony in-
dicate its presence. We have already given the signs of pleurisy.
If the totality of the lung and pleura be inflamed, there is rarely effu-
sion by reason of the distended condition of the former, as hitherto
explained ; but both surfaces of the latter are coated throughout with
false membrane. The thoraccic resonance becomes as dull as it is
found to be in pleurisy with effusion ; but, in the case of which I now
speak, there is always bronchophony, and that so well marked as to
bear a resemblance to pectoriloquy. Did effusion exist, this would
not be the case.

A third form of pleuro-pneumonia results from the extension of the
pleuritic inflammation to the pulmonary tissue, and the physical signs
necessarily follow an inverse order to those of the last. Should the
effused fluid become suddenly great, as it occasionally does, the pro-
bability of the complication is lessened, and the reason is apparent
from what has heretofore been said. It is then, while the secretion is
yet moderate, that we are to look for the signs of this form of the
disease. To those of pleurisy is added the crepitant rale, which es-
tablishes the existence of pneumonia. It is discoverable towards the
root of the lung, under the armpit and beneath the clavicle, inas-
much as these are the points less easily pressed upon by the effusion.

The inflamed pulmonary tissue assumes a peculiar modification
from the compression which it undergoes. The inflammation is more
limited in extent than it otherwise would be, and is often confined to
a few lobes, consequent upon the diminution of the inflammatory or-
gasm ; and its resolution does not take place with the same facility as
does that of simple pneumonia. Its pathological character differs also
from that of uncomplicated pneumonia; the induration has not the
granulated appearance of hepatigation, possesses less firmness and

428 haxall's pathological excerpts.

more flaccidity, and when a portion of it is incised, no traces of the
air cells are discoverable, although the bronchial ramifications and
blood vessels are easily recognized.

Jt is unnecessary to observe that pleurisy is sometimes double ; that
is to say, the pleurae of both sides are inflamed at one and the same
time.

Hydrothorax. — Dropsy of the chest and pleurisy resemble each
other in some respects ; but they are very different diseases. The af-
fection is both symptomatic and idiopathic. The former is found to
complicate both acute and chronic diseases, such as fevers, and more
particularly disorders of the heart and liver. Its aggression is fre-
quently sudden, making its appearance but a few hours, or at most, a
few days before death, and may in many cases be considered the
proximate cause of the cessation of life. The latter owes its origin
to those causes which induce dropsy of other cavities, and is both
sthenic and asthenic in its type. More frequently perhaps it is the
last, and its victims are they whose constitutions have been injured
by too prolonged a gratification of their animal appetites.

The physical signs which attend this disease are precisely those of
pleurisy with effusion. The side is dilated, respiration is more or less
inaudible, except towards the root of the lung, and flatness of sound
on percussion and cegophony exist. The lung is crowded and pressed
against the spine, and no longer has the crepitating feel which belongs
to it in a state of health.

The most prominent functional symptom is an exceeding difficulty
of breathing. In chronic pleurisy, with a large amount of effusion
even, this symptom is never so distressing as in hydrothorax ; besides
this, it is often paroxysmal in its character. The patient starts from
his sleep as if immediate suffocation was about to terminate his life ;
the doors and windows of the apartment are opened, that he may gasp
for air, and his agony is intense. Although the employment of the
physical signs places the fact of effusion beyond a doubt, and enables
us to measure its extent, yet it is from the functional and local symp-
toms that we are to obtain the distinctive characters between this dis-
ease and chronic pleurisy. The physical signs will indeed aid us in
another point of view, for upon the functional we could not alone de-
pend, inasmuch as the most important one (difficult breathing) is fre-
quently an attendant upon other diseases ; as for instance, hypertro-
phy of the heart and aneurism of the aorta. The former teach us that
there is effusion, while to the latter we must look for the nature of that
effusion — although it must be acknowledged that with every aid, it is
in some cases almost impossible clearly to discriminate. As has been
said, the function of respiration is carried on with more difficult}'' ge-
nerally in hydrothorax, and the peculiar and pungent pain of pleurisy
is absent. Dropsy of other caviiies and of the cellular tissue of the
extremities is frequently found to exist.

That hydrothorax is often an inflammatory disease is unquestion-
able ; that it is occasionally the result of debility is equally bej'ond a
doubt ; but it would be foreign to the subject matter in hand to dis-
cuss here the general pathology of dropsy. Certain it is, that it

haxall's pathological excerpts. 429

differs, as before said, from pleurisy most essentially; for upon an ex-
amination after death, important discrepances in the anatomical cha-
racter of the two affections are revealed. In the disease of which I
am speaking, no false membranes or accidental formations are dis-
covered. The lung, it is true, is compressed as in pleurisy, by an ac-
cumulated secretion, which is almost always a limpid serosity, never
purulent, but containing occasionally flocculent albuminous particles.

Ptieumo-thomx. — There are three distinct varieties of this affection,
which some of the French authorities appear to think are of no very
uncommon occurrence ; their true pathology, however, has only within
a comparatively recent period been correctly stated. The complica-
tion is generally met with during the closing scene of life, induced by
other diseases ; and in truth one of its forms at least may be regarded
as the last link in the chain of pleuritic lesions.

Pneumo-tkorax is sometimes simple ; that is, the cavity of the pleura
contains nothing more than an accumulation of air, and no portion of
this membrane is found upon dissection to be in a state of disease.
The lung is compressed in the direction of its root, in the same man-
ner as it would be were the accumulaiion a liquid one ; and this posi-
tion of the organ gives rise to a physical sign which is observed in
pleurisy with effusion. Respiration becomes more or less inaudible
in proportion to the quantity of air contained, and is seldom heard
except, towards the spinal attachment of the lung. This, it will be
remembered, is one of the characters frequently noticed in pleurisy;
but a mistake can scarcely arise, inasmuch as in pleurisy the breath-
ing is sometimes perceptible in other parts of the chest than the one
just named, unless the effusion be excessive.

Percussion upon the thoracic parieles affords a loud, clear and hol-
low sound, and distention is observed as in liquid effusion. If the
accumulation be not considerable, the sound, although louder than na-
tural, may lead the inexperienced into some doubt as to which is
really the affected side ; for the healthy one giving out a duller reso-
nance than the other, may, from this circumstance alone, be regarded
as the seat of lesion. Besides, the distention of the side, unless so
great as to leave no possible doubt upon the mind of any, may be
thought to be quite natural, while it may be imagined that the other,
although normal, is somewhat contracted in consequence of an ancient
pleurisy. But these discordant circumstances will all be reconciled
by resorting to auscultation. It is hardly necessary to observe that
the functional symptoms are exceedingly obscure, and the reasons are
obvious. Difficulty of breathing is the most prominent, but it is not
pathognomonic, as it. belongs to other affections.

The form of the disease just mentioned is certainly not a frequent
one ; the two last now to be described are oftener to be encountered.
Pleurisy, latent or well marked, idiopathic or consecutive, forms the
primary pathological feature. A serous or sero-purulent effusion re-
sults, and the development of air supposed to proceed from the decom-
position of the secreted fluid, forms the last link in the chain of cause
and effect. The original disease is known to have existed, by its ap-
propriate physical signs which have been related. When the gas is
50

430 haxall's pathological excerpts.

evolved these are varied, and an addition of others is made to them.
The sound on percussion, which before the evolution of the gaseous
fluid was dull, becomes changed into a clear resonance, at least in the
superior portion of the thorax, and the respiration which may have
been audible to a greater or less extent, depending upon causes al-
ready explained, is no longer heard. The resonance, however, varies,
it must be acknowledged, according to circumstances ; it may even
be less on the affected side than the other, and yet the disease exist,
for the liquid effusion may be so abundant as to prevent any decided
resonance. But by resorting to auscultation, little or no difficulty will
remain in establishing a proper diagnosis.

Another mean by which we are enabled to judge of the presence of
hydro-pneumo-thorax, is that which has been denominated the hippo-
cratic succussion. In simple liquid effusion into the thoracic cavity
it is absent ; but when a gaseous body is present at the same time, it
may be distinctly noticed. In order to discover it, the patient should
be placed in a sitting posture, and while the body is quickly though
moderately shaken by apptying the hands upon the shoulders, the agi-
tation of the fluid which is thus produced is often distinctly heard by
the unassisted ear or through the stethoscope.

Metallic tinkling is also one of the physical signs in this variety of
the disease ; but it occurs more frequently in the last, which will be
presently mentioned. In order to produce it the patient must first
occupy a recumbent position. The fluid is thus made to diffuse itself
more or less over the surface of the affected side ; and if the individual
be then requested to rise, some drops of the effusion, which may have
adhered to the upper portion of the thorax, will be heard to fall into the
general mass of fluid which is now situated below. The sound pro-
duced is similar to that elicited from the sudden contact of two bits
of metal, and hence is its name derived.

The last variety of hydro-pneumo-thorax is that wherein a commu-
nication exists between the cavity of the pleura and one or more of
the bronchial ramifications, in consequence of an opening made in
that portion of the membrane which covers the lung. The air which
then finds access is of course atmospheric, and its presence alone,
independent of any prior lesion, is sufficient to excite pleurisy. This,
as in those cases of the disease idiopathically formed, results in effu-
sion.

The lesions which may induce the communications referred to also
vary ; sometimes a rupture of the pleura is produced by external vio-
lence : occasionally a gangrenous eschar interrupts its integrity, and
more frequently still the solution of continuity is the product of a
softened and suppurating tubercle. Hence the disease is often met
with during the last stage of phthisis pulmonalis ; and this in truth is
its most common form.

Besides the various physical signs which belong to this disease and
which have been enumerated, another is revealed, which appertains
solely to the form now under consideration. This is the botile-buzzing
or amphoric sound, and results from the passage of air through the
fistulous opening ; the noise is similar to that made by blowing into

haxall's pathological excerpts. 431

an empty bottle. The metallic tinkling too is of more common occur-
rence in this than in the other form of the affection, and is produced
when the patient coughs, speaks or forcibly inspires, by thus agitating
the air situated above the liquid effusion. And where it does appear,
after having established by other signs the existence of hydro-pneu mo-
thorax, it may be regarded as a pretty sure evidence of a tripple
lesion. When heard in connection with the amphoric sound, all doubt
must at once yield to the most entire certainty.

Dilatation of the Bronchia,. — The researches of modern observers
have proved not only the existence but the frequent occurrence of this
disease. Resembling, as it does in a certain stage of its progress,,
phthisis pulmonalis, it is more than probable that it may have been
mistaken for that affection ; and the error must have remained always
uncorrected during life, had not the discovery of physical signs directed
us to a certain knowledge of the lesion.

Dilatation of the bronchiae assumes various forms, and where there
is a simple enlargement without alteration in the form of the branch
or branches, it often requires the most careful and minute examina-
tions to detect its presence. Where this is the character of the altera-
tion, the dilated branch is larger than the one from which it springs,
which is never the case in the natural progression towards their ulti-
mate divisions. Sometimes the branch forms a sort of cul-de-sac, at
the bottom and sides of which may be noticed the orifices of several
smaller bronchiae, which preserve their normal diameters. la other
cases, the natural form of the tube is altered ; a single or several suc-
cessive cavities are observed in its course, and many contiguous
branches may be affected in a similar manner. The mucous mem-
brane of the diseased bronchiae seldom or never remains in tact ; it
becomes generally or unequally hypertrophied, soft, and of a red or
deep violet color. Occasionally the entire parietes is observed to be
extremely thin, and resembles in its tenuity the pellicle of an onion.
The cellular layer, external to the branch and connecting it with the
pulmonary tissue, is frequently rendered firm and dense, and around
the smaller ramifications, seems to be almost cartilaginous ; and the
intermediate parenchymatous structure is compressed, deprived of air
and flaccid, assimilating itself in appearance to that condition of the
lung which is the effect of pleuritic effusion. The minute bronchiae
are oftener dilated than those of larger calibre, because, in the latter,
expuition is more easily performed ; and in a majority of instances,
the superior lobe becomes the principal seat of the affection. Rarely
is the entire lung diseased.

The stethoscopic signs which result from this lesion are generally so
well marked, as to leave us free from all doubt. Should a case occur
wherein all or nearly all the bronchial branches are dilated, the reso-
nance elicited on percussion would be duller than natural; for there
would be pressure upon the pulmonary tissue in numerous points, and
the vesicles could not receive their due quantum of air; but this in
truth is very seldom observed, because it rarely happens that the dis-
ease is so extensive. Confined to a smaller space, the variation from
a healthy sound is scarcely appreciated ; but the respiration is bron-

432 haxall's pathological excerpts.

chial and bronchophony exists, both referrible to the pressure exerted
upon the surrounding tissue by the dilated branch, preventing the free
ingress of air into the cells, and thus causing an unnatural vocal and re-
spiratory resonance in the affected part. When the diiatation is some-
what considerable, nearly free from its secretion by recent expectora-
tion, and the surrounding portion of the lung measurably hardened,
pectoriloquy in its most perfect form is added to the signs just men-
tioned ; thus, the first intonation of the voice is heard resounding in
the cavity, and appears distinctly to pass through the instrument and
enter the ear of the observer. The mucous rale with large bubbles is
produced by the air rushing into the cavity, which, if it has become
extensive, gives to the respiration the peculiar sound which is called
cavernous; and the "same character under similar circumstances be-
longs to the cough. When there is no cavity, but simply a dilatation,
the resonance of cough, in consequence of the pressure, is confined
and limited to the diseased part; and we have that variety denomi-
nated tubular or bronchial cough. If the dilatation be situated near
the surface of the lung and the secretion be not too great in quantity,
respiration, cough and the voice give the sensation of the vciled-llow-
ing ; something like a thin veil seems to interpose and prevent the
passage of the air into the ear ; the superior or external wall of the
cavity must be thin, and free from compression and hardness. Dif-
fused bronchophony is heard when the dilatation extends to several
neighboring branches, and is not very great in any.

The functional symptoms are wholly inadequate of themselves to
establish the diagnosis. The pulse is scarcely ever disturbed, and re-
spiration is performed as usual, unless the patient uses active exer-
tion. The expectoration is at first mucous, ultimately puriform, and
occasionally it is passed up in large quantities. When there exists a
large cavity, the stethoscopic signs denoting its presence are exactly
those of a tuberculous excavation ; and how are we to distinguish ?
In the first place, if phthisis were the disease, we should almost cer-
tainly have the physical signs of tubercles in their various stages of
development in other portions of the lung, or in both lungs ; for when
excavations have formed in the superior, they (the tubercles) very
constantly exist in their crude condition to a greater or less extent in
the inferior lobes. Another important distinctive character is, that in
dilatation of the bronchia?, there is little or no emaciation; while in
phthisis, the function of hematosis is so seriously deranged, that it
sooner or later supervenes.

The cause which seems to predispose the bronchia? to become di-
lated, is the prolonged continuance of catarrh ; and as it depends too
upon the amount of expectoration, the disease is observed to succeed
with greater certainty to the chronic and mucous form of that affec-
tion. The secreted matter remaining in the bronchial branches for a
certain time, necessarily tends to expand and dilate them ; and as the
natural tone of health is diminished more and more by the persistence
of their catarrhal condition, the dilating influence of the collected
sputa increases imperceptibly from day to da}T. This influence is
continuous ; for no sooner is expuition of the contained secretion ac-
complished, than a new collection occupies its place.

BRODNAX ON MENINGITIS. 433

It is perhaps not easy to explain why pressure upon an organize 1
and vital part should produce the very opposite conditions of hyper-
trophy and tenuity; that the fact is so in the case under considera-
tion we have a right to believe, because the agent is clearly discerni-
ble, and the minutest enquiry has hitherto been unavailing in detect-
ing any other. Thus it is that an extreme thinness of a branch is
sometimes observed on the one hand, while on the other hypertrophy
with dilatation results — both in the present condition of our know-
ledge referrible to the same cause. Hypertrophy, however, occurs
from a simple increase of nutrition; and this circumstance has led M.
Andral to imagine that in the case of a dilated bronchus, it may
sometimes be viewed as the first link in the chain of causes ; an aug-
mented secretion of the affected part supervenes, and dilatation fol-
lows.

Report of a Case of Meningitis, with Remarks on the use of
Opium in Inflammation of the Brain and its Meninges.

BY D. W. BRODNAX, M. D.
[Read before the Greensborough, Alabama, Medical Society, and published by its request.]

October 2Sth, 1850, I was called to see William W , aged 10

years, at 2 o'clock P. M. He had had whooping cough for three
weeks — was taken on the preceding Friday, three days before I saw
him, with vomiting, which had been almost incessant. His father
thought it was occasioned by the irritation of a 25 cent piece of coin,
which had been accidentally swallowed some twelve months previ-
ously. So firm was this conviction, and overwhelming the despair occa-
sioned by it, that he delayed sending for me for three days ; and when
I arrived, thought it utterly useless to harass him with any remedial
attempt, as the cause could not be removed, and the result must be,
he supposed, necessarily fatal. Having been under the almost con-
stant surveillance of a doating mother, and being a very tractable and
obedient child, his parents were entirely satisfied that he had eaten
nothing lhat could have produced such a derangement of his stomach.
When 1 first saw him there was a slight remission of vomiting, appa-
rently from sheer exhaustion ; but although he complained of much
thirst, as soon as he attempted to gratify it, his stomach rebelled ; and
the simple mention of medicine was enough to occasion retching.
His face was pallid, but there was no anxiety of countenance; his
eyes were generally closed, and his features natural. His respiration
was intermittent, sometimes being quite hurried, and then quite slow*;
sometimes hissing, then sonorous, then soft and natural. His position
was frequently and abruptly changed from side to side, with quick
and sudden tossings, which made it necessary for one or two persons
to stand by to retain him in bed and to adjust the cover. His skin
was dry and moderately warm ; his pulse 100, soft and compressible ;
the pupils enlarged. There was no fulness nor tenderness on pressure
over any part of the abdominal cavity; no pain was complained of
anywhere — auscultation and percussion indicated a perfectly healthy

434 BRODNAX OS MENINGITIS.

condition of the lungs. He was perfectly conscious when spoken to,
and would answer correctly any question addressed to him, although
otherwise he seemed not to notice anything passing around him.
Having ascertained that the fever was higher, and the vomiting more
harassing about 12 o'clock each night, and finding it utterly imprac-
ticable to administer medicines by the mouth, 1 directed, §- Quinae
sulph. gr.jii, tinct. opii camph. gtt. x., mucilag. amyli 3j — M. Ft. Enf-
ma, to be administered immediately, and repeated each two hours till
12 grains quinine had been given. Whilst this was being prepared,
1 cupped him freely over the epigastrium, and followed the cups by
sinapisms, and at the same lime had cold applications applied to the
head.

October 29. — Was called inv haste to see my patient, and a messen-
ger was despatched for my friend Dr. Barnum. 7£ o'clock A. M.
The enemata had been but imperfectly retained, and had only post-
poned the rise of fever and vomiting till 2 o'clock A. M., when he
also became delirious. When I reached him these symptoms had
been somewhat mitigated by the application of cold to the head and
sinapisms to the epigastrium. I again cupped him, and applied the
cold dash ; and by the time Dr. Barnum arrived, about 10 o'clock
A. M., he was composed and free from delirium and vomiting. He,
too, after careful investigation, could discover no inflammation any-
where ; and we came to the conclusion that the symptoms were oc-
casioned by excessive nervous irritability', characteristic of his family,
attending an attack of bilious remittent fever. (I should have men-
tioned before that the matter thrown up was sometimes clear bile,
sometimes merely the fluids taken into the stomach.) fy Hydrag.
chlor. mitis gr. vi. morphiae sulph. gr. i — Ft. pil. stat. sum. To be
repeated in three hours. He retained this prescription with great
difficulty, and some moisture of skin followed its use. B- Quinae
sulph. gr. xii. morphiae sulph. gr. £ — Ft. pil. vi., quarum tres sum.
ad. h. 9, et tres ad h. 12. So great was the difficulty in getting him
to take this that it was not till 10 o'clock P. M., that the first dose
was retained ; the second dose was retained more easily, and in half
an hour after taking it he fell into a quiet slumber. At 2 o'clock A. M.
of the 30th there was considerable moisture of the forehead, chest and
arms ; his pulse was 90 and soft ; and as he was still sleeping quietly,
and had passed the time of the usual exacerbation by two hours, I
laid down on a couch in his room well satisfied with his condition.
In half an hour I was startled by a sudden and piercing scream from my
patient, and on hastening to his bedside, 1 found him completely con-
vulsed, his head thrown violently back, his limbs rigid and stiffened,
his hands clinched, his teeth firmly locked, and his eyes turned up so
that but the lower edge of the iris could be seen. After frictions with
dry mustard had been for half an hour diligently applied to the ex-
tremities, he was so far relaxed that his teeth could be prised open
with a spoon, when some toddy was administered, and from time to
time repeated till the spasm was relieved. There was now complete
unconsciousness, excessive jactitation and frequent moaning. He
would toss from side to side, and throw his hands and feet about with

BRODNAX ON MENINGITIS. 435

a force that required the strength of a man to restrain ; the pupils
were still chimed ; the skiri soft and perspirable, the pulse 100, soft
and compressible. A blister was applied to the epigastrium, one to
the nape of the neck, and £ of a grain of sulp. morphine given, in
mucilage, each half hour till one grain had been taken, without any
abatement of symptoms ; when, after an intermission of half an hour,
Dr. B. having arrived, we repeated the morphine till | of a grain
more had been taken, with but little effect save the prevention of the
convulsions. The jactitation continued incessant, but not so violent,
the pulse still remaining about 100, soft and compressible. B- Acidi
hydrocyanici gtt. vi. mucil. acaciae Ijii. solve, cuj. coch. mag. sum.g.
h. 2da, Cold dash to the head. This produced a very slight abate-
ment of symptoms, and of short duration. We then put him into a
warm mustard bath up to the hips, and on taking him out again ad-
ministered the cold dash, the effect of which was sustained by the ap-
plication to the shorn scalp of bladders filled with cold water, frequently
renewed. This produced temporary quietness, which was sufficient
to enable us to cup him on the temples, which was done to the amount
of 6 or 8 ounces.

Five o'clock P. M. Though completely unconscious, has been quiet
since last visit, till an hour ago, when he became restless, incessantly
drawing up and thrusting out his right arm and leg, with almost per-
fect regularity, which continued for several hours, the left arm and
leg seeming to be paralyzed ; pupils dilated, pulse 100, soft and com-
pressible. Cold dash to head, cups to temples, bladders of cold wa-
ter to scalp; prussic acid continued. An enema was given, which
brought away a considerable quantity of brown, fecal matter. Du-
ring that and the following day, the 31st, his condition remained the
same as at the last visit; and the treatment consisted in the unremit-
ted application of cold to the head, by means of bladders filled with
cold water, frequently renewed, when he was sufficiently quiet, and
when restless, the cold dash — prussic acid in doses of one dop each
two hours; the frequent application of cups to the temples, taking, by
means of them, from 4 to 6 ounces of blood daily — and an occasional
enema, which always brought away dejections of the character above
described.

On Friday, the 1st November, there were some symptoms of an
amendment. His eyes were observed to follow for a short time the
movements of those who attracted his attention, and in the afternoon
he partially protruded his tongue whilst looking at his mother, appa-
rently to shew her that it had been bitten in the spasm on Tuesday
night, and was quite sore. Taking that occasion to observe it, I found
it dry, and covered with a thick, brown coat. Prussic acid disconti-
nued. The intervals of consciousness were of short duration during
that day and night, and were quickly succeeded by apparent sleep,
which was not disturbed by noise. We took advantage of them to
offer him some nourishment, a spoonful of which he would swallow.
These intervals were more prolonged on Saturday, when he, for the
first lime, spoke, asking for water, which he incessantly craved for
twenty-four hours. Being much in the habit of indulging the urgent

436 BRODNAX ON MENINGITIS.

cravings of nature, I allowed him to drink ad libitum, after having
tried the condition of his stomach by smaller draughts, and was quite
pleased with the effect ; his skin becoming soft and perspirable, his
tongue moist and clean, and the whole improvement marked and ra-
pid. I also allowed him beef tea, light farinaceous preparations, and
some ripe fruit, which he very much craved. The cold applications
were gradually withdrawn ; but at 6 o'clock P. M. of Saturday, the
l d November, he again became delirious, and was relieved by two or
three cups to the temples, the cold dash, and bladders of cold water
to the head. On the 3d he was able to converse a little ; and with
occasional intervals of delirium, of short duration, produced b}' too
high a temperature of the room, or too much food, he gradualh* im-
l roved till the 6th, when I discharged him cured.

During the two first days of the treatment of this case, we were
deceived by the absence of all signs of inflammation in any of the
organs (for we quickly discovered that the stomach, though exces-
sively irritable, was not in a state of inflammation) into the diagnosis
of "excessive nervous irritability attending bilious remittent fever;"
but when we perceived that the symptoms were not relieved by treat-
ment which we deemed adequate, were our diagnosis correct, we
came to the conclusion that it must be a case of meningitis. A more
minute enquiry into the history of the case confirmed this diagnosis,
for we found that for some days before the attack, he had complained
of dizziness of the head, and his temper, having been remarkably
gentle and quiet, had become quick and irritable. The case was then
however so much protracted, and such was the condition of the pulse,
that we did not feel authorized to use the most powerful remedy for
meningitis, viz. v. s., and we had to rely on local depletion by cups
and the application of cold to the head, which having been unremitted
for three days and nights, at length subdued the inflammation. How
much of the effect is to be attributed to the prussic acid, I cannot de-
termine. It is nowhere recommended in such cases, but knowing
its prompt, and efficient powers of depressing nervous irritability, we
were induced to try it. I am disposed to attribute to it a considera-
ble share in the happy result of the case. The morphine was given
under an erroneous diagnosis ; but, although in direct contradiction
to scholastic teaching, I am not prepared to say that it would have
been a bad prescription, that it should not have been pushed farther,
had we known the true state of the case. Opium (I use the name
generically) is prohibited by the books in inflammatory diseases of the
brain and its meninges, and especially for the relief of delirium and
convulsions, generally symptomatic of such diseases. But its effect,
when given in sufficient doses, is to depress nervous energ}' ; and as
the circulation is controlled by nervous influence, it must partake of
that depression, and its activity be diminished. Such an effect would,
in any view of the cause of delirium and convulsions in meningitis,
cerebritis, &c, tend to their relief. When the inflammation is very
gieat and the circulation very active, I would not rely on opium alone
to allay the consequent nervous irritation, but. would precede it by the
lancet, which would enable the opium to act more efficiently, in smaller

BRODNAX ON MENINGITIS. 437

doses. Opium is highly recommended in inflammation of other organs
and serous membranes — the liver and pleura for example; and were
the mind left to itself to discover from analogy the treatment proper
for inflammation of the brain and its meninges, it would certainly be
directed to opium as a most efficient agent. I know, from long ex-
perience, that it acts most efficiently in allaying the nervous irritability
(which often, especially in children, amounts to convulsions) which
exists in the hot stage of remittent fever, when, according to the
books, there is a determination of blood to the head, and a condition,
which, though transient, is analogous to meningitis; and although I
regard this pathology as incorrect, yet, being that taught by the books,
it is, as far as they shew to the contrary, a case in point. Guided by
the received scholastic teaching, few physicians will venture to give
opium in the hot stage of intermittents — a condition often of great dis-
tress and suffering ; when, especially in conjunction with mercurials,
which counteract its tendency to arrest the secretions, it deprives the
malady of its terrors, and immediately relieves the sufferings of the
patients. Dr. Stokes, in his very valuable work on the Practice of
Medicine, (vide Stokes & Bell's Prac. of Med., 2d vol., p. 473, 4, 5,)
expressly prohibits the use of opium in meningitis, for two reasons,
the second of which (which I shall first notice as being more imme-
diately connected with my foregoing remarks) is, to use his own words,
" from its well known tendency to add to the existing cerebral con-
gestion." (Op. Cit. p. 475.) If he use the term " congestion" in its
usual acceptation, and mean to express that passive condition of the
brain in which its energy has been overwhelmed, and it is incapable
of transmitting the blood sent to it, it is not the condition I have been
noticing, for such a condition does not produce delirium and convul-
sions, but coma and paralysis. But as he had nowhere alluded to
such a condition of the brain, but was treating of its acute inflamma-
tion, I presume he means to express that condition in which the blood
vessels have been distended beyond their capacity by the vis-a-tergo
of an inordinately active circulation. I have endeavored to shew
how opium, in doses adequate to depress the energy of the nervous
system, in a given case, and thereby diminish the activity of the cir-
culation, would tend to relieve that condition, and will not farther no-
tice that objection. He does not himself much insist on it. His first
reason is the only one on which he particularly insists ; and if it can
be shewn to be fallacious, his opposition to the use of opium in such
cases will appear to be groundless.

He regards delirium and convulsions as relieving the brain of its
excessive nervous energy, just as diarrhoea relieves the mucous mem-
brane of the bowels of the excessive engorgement ; and asserts that
if in either case the secretion be checked by the use of opium, the
inflammatory condition will be aggravated. (Op. Cit. p. 473.) Now,
with all due deference to so high authority, I. cannot see the analogy
between the two cases ; for even if we admit with materialists, that
thought and will (for delirium is but perverted, thought, and convulsions
excessive and perverted will) are secreted by the brain, it cannot be
shewn that they can be retained in the secreting viscus in accumu-
51

438 BRODNAX ON MENINGITIS.

lating quantities ; for, if this were so, it might be very possible for a
man to think so hard as to burst his skull ; and who ever heard of
such a phenomenon ? The brain could not conceive a second thought
nor a second motion of the will, without, ipso facto, being relieved of
the first ; and as it does not require the agency of the mucous system to
be emulged from the brain, there might be no outward manifestation of
such conception ; if so, there could be no thought conceived, nor mo-
tion of the will, without its being made manifest by the blabbing of
the tongue or the responsive action of the extremities ; or else, by ac-
cumulation, producing coma or paralysis.* But the brain does not
elaborate blood into the manufacture of thought and will, as the liver
into bile, and the kidneys into urine ; for, if this were so, we could
understand the connection between mind and matter, which is not
given to man ; nor does it, consequently, when an excessive quantity
of blood within certain limits is sent to it by increased efforts, manu-
facture a greater quantity of thought and will, as we see those organs
have their proper secretions under like circumstances. The increased
flow of perverted thought, delirium, and the excessive and perverted
action of the will, convulsions, which are produced by different de-
grees of inflammation of the brain and its meninges, are produced by
the irritation of the distended blood vessels acting mechanically, just as
any other body of the size of the blood vessels would act, if it could be
introduced into the same situation. The blood is sent to the brain to
preserve its vitality and its animal organization, and in the perform-
ance of their functions, the meninges separate from it a portion of its
serum. If the quantity of blood be more than is required, and yet
not enough to distend the capillary vessels of the meninges so much
as to force through them, or extravasate so great a quantity of serum
as to overwhelm the brain by pressure, there will be delirium or con-
vulsions, according to degree ; but if the quantity extravasated be so
great as to produce a pressure beyond the point of delirium and con-
vulsions, there will be coma or paralysis. In each case the effect is
mechanical, and the different effects are the results of different degrees
of pressure.

If my position be correct, opium, by lowering the energy of the ner-
vous system, and consequently, the activity of the circulation, would
relieve the blood vessels of the brain of their distention, and would,
consequently, allay delirium and convulsions. Dr. Stokes admits that
it will have that effect; but regarding delirium and convulsions as
proper secretions of the brain, which by accumulation would increase
its engorgement, he condemns its use ; a position which I humbly
think I have shewn to be fallacious. Even admitting it to be true,

7 Memory may be adduced as antagonistic to my position, as an instance of the accumu-
lation of thought without oppression of the brain. But memory is not an accumulation of
thought, but a habit which the brain acquires of recalling a thought or train of thoughts
which had once impressed it, each thought of the train passing off as the succeeding thought
comes into view. Two thoughts cannot occupy the brain at the same time. If memory
be an accumulation of thought, and thought a secretion of the brain, so far from opposing
my position, it would be an insuperable argument in favor of it; for it would prove that
thought could be indefinitely accumulated without producing oppression of the brain, and
that, consequently, opium may be given to allay delirium without the danger of producing
coma or paralysis.

spencer's case of injury. 43$

opium, by lowering the energy of the nervous system on which secre-
tion depends, would deprive the brain of the power to secrete the fluid,
the escape of which through the nervous ramifications produces, ac-
cording to him, the salutary effect of delirium and convulsions ; and
the fluid not being secreted, could neither escape, producing delirium
or convulsions, nor accumulate, producing coma or paralysis.

The case above reported to you, was one in which the true disease
was marked, and rendered latent, by the sympathetic affections of the
stomach. In our autumnal diseases we frequently see this action in-
verted, and a disease of the stomach marked by a sympathetic affec-
tion of the brain. It will be seen that for four days there had been
no pain, nor delirium of consequence. There had been excessive gas-
tric irritability, with a slow, soft, Compressible pulse ; and although the
pulse in meningitis may admit of all varieties, pain and delirium are
generally marked characteristics, till effusion has taken place, when
there is coma or paralysis. Even pain and delirium are not al-
ways present, (as in this case, until the fifth day, when he became de-
lirious,) when the difficulty of diagnosis is very much increased. The
case is also remarkable for the periodicity of its exacerbations, a cir-
cumstance which also led off on a false trail, and very much in-
creased the difficulty of diagnosis.

I have not attempted to treat meningitis systematically, for it can
be found in the books much better done than I can do it ; and will, in
conclusion, only say, that when cases of great gastric irritability per-
sist in obstinacy in spite of active treatment addressed to the stomach,
look to the brain, and the seat of the disease will be found there much
more frequently than I believe is generally suspected.

A Case of Injury from a puncture made in the Scrotum and
Groin, by a Stick Weed — Operation.

BY P. C. SPENCER, M. D., PETERSBURG, VA.

Master T. P , aged 8 years, of this place, in the fall of 1836,

was in eager anxiety to get over a fence, and leaping from the top
down, received, as he passed, a stick weed, entering the lower por-
tion of the right scrotum, and passing in front of the testicle. It con-
tinued its course upwards and in front of Poupart's ligament of the
same side, penetrating between the two oblique muscles, nearly in a
straight line upwards, and six or eight inches in length. It was so
completely imbedded in the parts, that to ascertain its course, it was
necessary to relax the wall of the abdomen by position. It could then
be traced by the hardness and firmness underneath the fingers; and by
making an incision three or four inches long over the indurated parts,
the offending body was reached and removed. It measured five inches,
and was believed to be the whole of the extraneous body; but in an
after and closer search of the wall of the abdomen, a parallel hard-
ness was found, but of much less importance than the one operated
on ; and as it was doubtful whether any of the offending body remained,
a second operation was declined. The parts were dressed by ap-

440 dunn's worm case.

proximating the edges, and holding them together by adhesive plas-
ter and bandages, and he was placed in the recumbent position. In
eight or ten days he recovered entirely, as was supposed; but some
weeks afterwards, when the suppurative process took place, fragments
of the stick weed passed out, which accounted for the hardness in the
wall of the abdomen after the principal offending body had been re-
moved.

The subject of this operation recovered entirely, and enjoys per-
fect health.

A Case of Intestinal Obstruction from Worms.

BY THOMAS DUNN, M. D. OF FRANKFORT, HAMPSHIRE CO. VA.

June 19th, 1851. — I was called in haste to visit an interesting little
girl, daughter of Jas. G. Lash, Esq. of our village, setat 6 years, deli-
cate make and constitution, black hair and eyes, nervous temperament,
cheerful and sprightly. She has had several attacks of convulsions
heretofore, from improper diet and worms irritating the bowels. At
these times I have always attended her. Although seriously menaced,
she has always partially recovered from these attacks. She was
taken some two weeks since with diarrhoea, which is epidemic here,
and has been for some weeks. Her parents undertook to treat her,
with two or three others of their children. She had taken ol. ric. and
tinct. opii several times, 3 doses of calomel, decoct, rad. spigelia, &c.
and had passed several worms. I was called in on account of her
bowels not moving under the influence of the above medicine, and
that she had called their attention to a considerable tumor in the ab-
domen, lender to the touch, from which colicky pains diffused them-
selves over the abdomen. Her stomach had also become irritable
and rejected the medicines, &c. and her bowels had not moved for 30
hours. On examination her pulse was quick, not much tension,
tongue covered with yellow mucus, white underneath, narrow and
pointed, rather red at the edges, not very dry, skin rather dry, and
warm abdomen — general intumescence moderate. The tumor above
alluded to was situated in the right lumbar and hypochondriac re-
gions, extending from about the head of the colon up under the ribs
above in a gentle curve. Its base or large end was below, and it
grew smaller as it passed upwards. Its length was six or seven
inches, and as thick as my wrist ; towards the lower end its surface
was irregular and knotty. Its touch gave the idea of something
pretty solid, yet elastic, quite tender, though not discolored from in-
flammation on the surface. It seemed to be attached to some inter-
nal organ ; but upon insinuating my fingers under its edge, I found it
could be moved with facility. On mature deliberation, taking the pa-
tient's former habits into account, my diagnosis was, obstipatio, with
threatened ileus, from a mass of convoluted worms mechanically
blocking up the alimentary canal at or near the ileo-ccecal valve and
caput coli, &c.

dunn's worm case. 441

fy Hydraig. chlorid. gr. iv. every four hours; infus. senna et man.
in aqua menth. virid ; decot. rad. spigel. As much of these articles as
the stomach would bear; injections of salt water between every dose
of calomel ; sinapism of mustard to the epigastrium ; cloths wrung
out of hot spirits to the tumor and lower abdomen.

At 9 P. M. Visited her again — bowels had not moved — she had
kept all the medicine given — injection retained without anything
else — she had been on the close vessel several times — a little more
tension about the abdomen — tumor about as it was — ordered the same
course kept up through the night.

20th, 6 A. M. Visited her again — things pretty much as they were
last night — bowels had not moved, although she had taken the medi-
cine freely, retained it, and had several injections — she had been up
to the vessel several times — nothing passed save what had been
thrown up the bowels — abdomen more tumid — more fever — tongue
more contracted and dry — red on the edges and point — not much re-
sistance in the pulse, though irritable and quick.

?- Hydrarg. chlorid. gr. iv. continued as above ; decoct, rad. spi-
gel. continued also ; ol. ric. a large spoonful ; ol. terebinth, rect. tea
spoonful. These articles to be given between each calomel powder —
fomentations to the tumors and abdomen continued.

12 M. Visited her again — found her as I left her in the morning —
she had retained all the medicine — been up often to the vessel, but no-
thing passed except what had been thrown up — tension of the abdo-
men increased a little — tenderness of the tumor also increased a little —
more general uneasiness. I concluded to give her the injection my-
self, and placed her on her mother's lap, so as to relax the abdomen,
with a view lo distend the bowels as much as possible with safety. I
introduced the point of the instrument, but had scarcely moved the
piston, when by an involuntary effort, the bowels moved slightly, upon
which I desisted. I found that matter had passed from above the
stricture in a small quantity. In a few minutes they moved again
more freely, with several lumbrici dead and stiff — in an hour or so they
moved the third time still more freely, with a knot of convoluted lum-
brici, 29 in number, upon which the urgent symptoms abated con-
siderably. The tumor could still be felt distinctly, although the ten-
sion and tenderness had much abated. Ordered the course continued
through the evening.

6 P. M. Bowels had moved several times, worms passing in every
stool. She passed about 65 altogether this afternoon. Ordered the
medicine at more distant intervals, 6 hours.

21st. — 6 A. M. Much improved — bowels moved two or three
times through the night — worms still passing in every stool. I now
substituted the infus. sen. et man. for the ol. ric. and turpentine — the
rad. spigel. continued — all general intumescence of the abdomen had
now disappeared — the tumor was still to be felt, but very much less-
ened. Sensibility not much on pressure. Under this course she im-
proved, passing off worms for several days, until she passed upwards
of 100. At this time, 27th, she is pla}ring about with the other chil-
dren as lively and sprightly as ever.

442 WILSON ON" PUERPERAL FEVER.

We take the liberty of publishing the subjoined extract from a pri-
vate letter from Dr. Dunn. We are glad to say that we have received
many letters from different parts of the state, shewing that the work
of organization is going on, and that societies are being formed.

Dear Sir : — I had the above case under treatment, when a medi-
cal friend handed me your May No. of the Stethoscope. I was struck
with the analogy of it to the one published by Dr. Joynes of Acco-
mack county, in the above Number. The symptoms much the same —
the locality of the obstruction different in his case — the obstruction no
doubt was in the ileum-intestinum mem. in the lower part of the same
bowel, where it ends in the colon and also in the ascending colon —
about the ileo-ccecal valve seemed to be the most solid and tender
part of the tumor. As this case has the same bearing as his on
those pathological subjects brought up in his observations, you can
publish it if you think proper to do so. Verminous diseases are com-
mon in this country. Diarrhoea is epidemic here, mild in character
and easily controlled if prudently managed, but assuming a dysen-
teric shape if trifBed with.

I am fully impressed with the importance of state organization, and
the other subject touched upon in connection therewith, in the above
Number, and hope you will continue to press these subjects on the
profession. I have been trying to organize a medical society in this
and Hardy counties for some time, and as there is more stir on the sub-
ject at this time than usual, I think it will soon be effected.

Prophylaxis of Puerperal Peritonitis.

BY GOODRIDGE A. WILSON, M. D., RICHMOND CITY.

The prevention of disease is the highest exercise of the medical
art. We would withhold no praise from the skilful pilot who safely
steers his vessel amidst dangers which threatens its destruction. But
that must be a higher science and a nobler power which averts ca-
lamities rather than enabling us to bear them and live, and which re-
moves the hidden dangers which beset the pathway of life, instead of
merely strengthing us for a painful, doubtful conflict.

Such a system of medical prophylaxis, based upon intimate know-
ledge of the laws of life, and the causes and modes of death, is the
highest ambition of the medical philanthropist, and the nearest ap-
proach which mortals can ever make to that power which spoke the
" withered arm" into strength.

It will not be contended that we have as yet attained much pro-
gress in the science of prophylaxis in the enlarged sense of the term.

Secret endemic and epidemic influences still devastate the world,
extending from section to section and continent to continent, gathering
strength, and scattering death in their progress, despite of quarantine
regulations and " cordons sanitaire."

To give exemption from such pestilences presupposes a knowledge

WILSON ON PUERPERAL FEVER. 443

of the nature of causes, which defy all efforts at analysis, and are
only presumed to exist from their effects.

We have no art to extract the poison from the tainted breeze, or
power to place a sentinel at the citadel of life, to challenge the ingress
of hurtful agents — all attempts of this sort are as impotent as the
talismen and magical incantations of ancient superstition.

But have we not some right to expect that the rapid advances now
making in organic and inorganic chemistry, and their agencies in the
phenomena of life, will dispel the mists from this subject, and unfold to
our view a higher philosophy.

But though thus ignorant of proximate and predisposing causes,
the medical man must not relax his efforts to mitigate the calamities
of the pestilence " that walketh in darkness."

He may do much in an humbler sphere. By patient observation of
the laws and phenomena of disease, a rigid analysis and skilful inter-
pretation of symptoms, he may do much towards breaking the force
of the fell destroyer — " scotch the snake if not kill it."

The remote cause of Asiatic cholera is as much a mystery as when
it commenced its ravages in the delta of the Ganges — like a bird of
evil omen, " it goeth where it listeth," stultifying our wisest predic-
tions, but never failing to disappoint us in its absolutely unmanageable
character when fully developed. Still it will not be contended that
the dearly bought experience of the world is of no avail in this disease.

Dietetic regulations, avoidance of what has been ascertained to be
the ordinary and immediate exciting causes — above all, the discovery
of the fact, that in a large proportion of cases, this mighty giant has an
embryo existence when it may be shorn of its strength — these together
have unquestionably done much to lessen the number of its victims.
In the application of his knowledge in these particulars, the cultivator
of medicine has a wide field for the exercise of his humane profession.

By patient observation and assiduous attention, he may learn how,
and where and when to watch for an insidious enemy — to detect the
first blush of disorder — and fend off mischief, which all the resources
of science cannot repair.

The truth of the above remarks is strikingly exemplified in most of
the disorders incident to the puerperal state, and by none of them
more forcibly than puerperal peritonitis. To this formidable malady
all parturient females are liable from the simplest natural to the most
protracted complicated labor. Indeed when the pregnant state, with
its pathological proclivities, is intelligently considered — the violent con-
vulsions of labor — the nervous exhaustion — anxiety of mind — the
changes to be effected after the parturient act — the cause of wonder
is that so many escape the assaults of violent inflammation. Perito-
nitis in such subjects usually runs its course with great rapidity — once
setting in, the whole peritoneal lining of the abdomen is speedily in-
volved. The distinguished Dr. Meigs forcibly likens it to a "prairie
on /ire."

The disease is admitted on all hands to be exceedingly difficult to
manage, a large proportion terminal ing fatally under the most favora-
ble circumstances of treatment. The lime for the interposition of

444 WILSON ON PUERPERAL FEVER.

efficient rational means is limited to the first 12 or 14 hours of the
assault.

With these facts it is no wonder that puerperal peritonitis should be
a " word of fear" to the practitioner. Who that has witnessed its
ravages fails to experience the truth of the homely adage that an
" ounce of prevention is worth a pound of cure."

The writer has lately read an article in the Stethoscope from the
pen of Dr. J. P. Mettauer on this interesting subject. This distin-
guished surgeon relies with great confidence on the prophylactic
powers of purgation. He recommends their administration within a
few hours after delivery — more remotely after delivery — and in all
cases of delivery.

The observation and experience of the writer had led him to a dif-
ferent conclusion and a different practice. Indeed he is forced to re-
gard the almost universal custom, as practised by nurses, of dosing
all their lying-in patients with purgatives in some short time after
delivery, as the immediate exciting cause of this formidable com-
plaint, as well as other accidents of a less grave character.

The following abstract of two cases, which occurred early in my
professional life, will serve to illustrate my views, as I am sure sub-
sequent experience has sustained the deductions and practical indica-
tions deducible from them :

Case I. — M., a robust, healthy woman, slave of Mr. H., was de-
livered of her second child on the night of the 6th of December 1839.
Nothing unusual characterised the labor. On the 8th, (the patient
doing perfectly well,) the nurse gave her a tablespoonful of Epsom
salts. This dose operated with great harshness during that night and
the next day. On the night of the 9th, the patient, whilst at stool,
had a severe chill, followed by high fever, with intermittent pains in
the abdomen. These symptoms increasing, on the 10th I was de-
sired to see her, and found her on the morning of the 11th as follows :

Lying on her back, knees drawn up, skin hot, abdomen exceed-
ingly tender, swollen and tympanetic ; pulse about 140 per minute,
small, somewhat tense ; lochial discharge scant ; mind wandering; no
purging during the night, the patient having taken an opiate. Although
so late, I determined to give her the chance of benefit from blood
letting. It was accordingly practised, and carried as far as the pa-
tient's strength would warrant, without any improvement of circula-
tion or general and local symptoms. A large blister was applied to
the abdomen, with directions- to follow with fomentations.

12th. Found my patient worse ; delirious all night ; face and neck
bedewed with perspiration ; pulse very rapid and small ; slight dis-
charge of urine ; no accumulations in the bladder; countenance ca-
daverous. I need scarcely add that my patient did not survive the
next twenty-four hours.

Case II. — Mrs. D., aged 32, a delicate, nervous woman, mother of
three children, was delivered, on the 13th of February 1841, of a
healthy child. Nothing unusual occurred until the 16th. On that
day she took a dose of oil, which produced hypercatharsis for near
twenty-four hours. On the 17th, she had rigors, followed by high

SCOTT ON THE FIBRINE OF THE BLOOD. 445

fevers and pain, supposed to be after pains, and for which she took
camphor and paregoric. On the 18th I was desired to see her, and
gathered from her neighbors the above history. She told me the medi-
cine had operated very much, and she feared she had taken cold. I
found her with all the symptoms of extensive puerperal peritonitis.

I need not detail the particular efforts that were made for my pa-
tient's recovery ; suffice it to state that they were all unavailing, and
my patient died on the 21st. Now, is it not fair to conclude that the
purgatives had a powerful agency in developing the frightful disease
which shortly ensued ?

In both cases they were administered without any special demand,
but from a prevalent idea that all patients ought to be purged shortly
after delivery.

Why should such a patient be subjected to the perturbating influ-
ence of agents the measure of whose effects we have no means of
estimating? Would it not be safer to inculcate the opposite doctrine
and practice, if any general rule must be laid down ? After labor is
completed and full contraction of the uterus secured, enjoin perfect
quietude of mind and rest to the bodily functions — rest, rest, the great
restorer of enfeebled and debilitated organs. What good can result
from throwing the whole abdominal viscera of a patient on the verge
of peritonial inflammation into violent commotion? Who would pre-
scribe active exercise for a knee-joint in danger of inflammation ?

One single observation will close this paper. Error and mischief
almost uniformly result from efforts at too great a generalization in
practical medicine. With such an endless variety of constitution and
temperament, each case must at last be managed on its own indi-
viduality. In the language of the venerable Dr. Chapman, " He who
would practise medicine successfully must attend to the states of the
system and prescribe accordingly."

Observations on the condition of the Blood in certain Diseases.

BY MARTIN P. SCOTT, M. D. OF RICHMOND CITY.

[Read before the Medical Society of Virginia, at its July Meeting.]

Dr. Meriwether, in his paper on the value of an increase of fibrine
in the blood in different diseases, as a guide to treatment, concludes
by saying, that he has established that this alone, taken as a guide,
would lead to gross errors of treatment. I should not now trouble
the society, but that this article was looked upon as a reply to a posi-
tion advocated by some of us when the subjects of scarlet and typhoid
fevers were under discussion before you ; and it might be supposed, if
nothing was now said, that we had on that occasion attempted to
maintain the position that is refuted in the article now before us. I
wish merely to say that if such was the doctor's object, he has put
himself to a vast deal of unnecessary trouble in examining the various
analyses of the blood which have been made by the distinguished
men of our profession. He might have saved himself the labor of
52

446 SCOTT ON THE FIBRINE OF THE BLOOD.

reading Andral's work, or examining Chelius, or hunting over Cyclo-
pedias of medicine, had he chosen first to inform himself of the points
raised at previous meetings and advocated. No such ground was
taken that we should be guided solely and wholly in the treatment of
all diseases where this excess of fibrine exists by this sign alone ; as
well might he make us all humoralists and place all diseases in the
blood, and that the bad humors of which should be eliminated before
a cure could be effected. No one, I imagine, could be found in what
is called the regular medical profession, who would be willing to say
that he looked upon any one symptom or sign to guide him, and that
he would follow it no matter what the other circumstances of the case
might be. There has been a time when all diseases were by some
supposed to have their origin in the stomach — by others, that the solids
were always the seat of disease. The humoralists ascribed every ma-
lady to some change wrought in the blood. Taking such views, there
might be found some who would always follow a particular course,
no matter under what circumstances. The Broussaist would direct
his remedies to the stomach ; the solidist would always be possessed
with the idea that he had an inflammation to contend with, having at
the same time a somewhat vague idea of what was an inflammation,
supposing at any rate, be it what it may, he must attack it boldly,
vigorously, armed with the lancet in one hand and redoubtable calo-
mel in the other. The humoralist would discourse learnedly upon the
blood, tell us its importance in maintaining life, in supplying the ma-
terials for the reproduction of tissues ; in disease he would direct his
remedies to getting out the humors which have diseased this fluid and
thus contaminated the whole system. Following the theories which
located all diseases in any one part, comes the quack with his one re-
medy, his cure all. The Thompsonian sweats out the humors; the
Hydropathist washes them out, and the Homcepathist gets them out
by hocus pocus ; and as offshoots from these respectable parent stems,
we have the Peters and the Brandreths with pills and panaceas ; herb
doctors et id omne genus, all of whom have some particular theory of
disease, and most of whom pretend to purify the blood by their par-
ticular remedy, revealed to them in the most mysterious manner, and
only known' to themselves.

Now, relying upon one sign in treatment of disease, without having
regard for the attending circumstances, is to me closely allied to rely-
ing upon any one pill or nostrum to cure a disease. One follows the
other as naturally as an effect a cause ; and for this reason, 1 wish to
correct the doctor, and explain to him the position we took when the
question whether scarlet or typhoid fevers were inflammatory in their
nature, came up for discussion. In this age of advancement and im-
provement in every art and science, the science of medicine has not
stood still. We too can boast of great discoveries made and benefits
flowing from them ; and though nothing like certainty exists in the
treatment of disease, yet great advances have been made — discoveries
in physiology and chemistry have thrown great light upon many points
heretofore enveloped in darkness. Laennec's great discovery of his
method of exploring the diseases of the thorax and abdomen is a mo-

SCOTT ON THE FIBRINE OF THE BLOOD. 447

dern one ; and that these advances have been followed by the most
beneficial results, is proved by comparing the tables of the average
duration of life which have been made from time to time, when it will
be seen that the average duration of life is on the increase, and much
of which is due to the improvements which have been made in the
treatment of disease founded upon a juster appreciation of its nature.
All these discoveries have shewn us that the Broussaist, the solodist
and humoralist, were all wrong in confining disease to any particular
part or to any system ; a more comprehensive view is now taken.
Pathological anatomy shews us that the solids are altered in various
ways, according to the nature of the disease ; chemistry, by enabling
us to analyze the blood, reveals to us the fact that this fluid is liable
to changes, which in turn operate upon the whole animal economy.
Marshall Hall has shewn us how to explain hitherto incomprehensible
symptoms in the simplest manner, by explaining the physiological ac-
tion of certain portions of the nervous system. These all tend to
prove how fallacious it is to adopt any one theory as to the production
of all diseases; of using any one remedy for the cure of all complaints;
and lastly, of following any one symptom or sign in treatment, without
due regard for all the attending circumstances.

It will be recollected by you, that when scarlet fever and typhoid
fever were discussed, that the use of calomel and occasional bleeding
was on the one hand contended for as the proper treatment of those
diseases ; and if I understood the advocates of this plan, the reason
given was, that these diseases were inflammatory in their nature.
This plan of treatment was opposed by some of us, on the ground
that they were not inflammatory diseases, and therefore did not call
for antiphlogistic remedies ; hence arose a discussion of the nature of
inflammation and the state of the blood in inflammation. Upon ex-
amining various authors who have written upon this point, it was
found that an excess of fibrine always existed in the blood of a per-
son suffering under inflammation, whether acute or chronic ; and An-
dral goes so far as to say that an excess of fibrine is a pathognomonic
sign. Now, as in scarlet fever and typhoid fever, there was found not
only an increase, but actually a diminution of fibrine, we argued, that
admitting our premises to be true, these could not be inflammatory
diseases, and therefore did not demand antiphlogistic treatment.

This was given as one of the reasons. This was laid down as a
principle to guide us in our diagnosis, and which was to prevent us
from pursuing an antiphlogistic plan. Other reasons were given at
the time, which it is unnecessary to repeat. For myself, I relied upon
the principle so emphatically laid down by Andral. This was the
ground taken by us, so far as the state of the blood was concerned.
Now, from this Dr. Meriwether thinks it fair to infer, that because in
diseases where the fibrine (which to us was the sign of inflammation)
was diminished in quantity, it would not be proper to make use of
antiphlogistic remedies. That therefore, when this element existed in
excess, we must give calomel and bleed, without regard to the condi-
tion of the patient. The specific nature of the disease, in a word,
should follow this sign to the death. And as he proves the absurdity

448 SCOTT ON THE FIBRINE OF THE BLOOD.

of that, concludes that the sign is worthless or of little value, and these
conclusions he draws from reading Andral upon the changes which
the blood undergoes in various diseases. No such deduction as he
draws is admissible. We use this sign as a means to detect the pre-
sence of inflammation, but we do not pretend to say that inflamma-
tion under all the circumstances should be treated by bleeding and
calomel. For example — in phthisis there is an excess of fi brine, de-
noting the existence of inflammation — other symptoms prove this to
be true — due, however, to the presence of tubercle in the lungs.
Here it is an important sign and guide to treatment ; but the specific
nature of this disease prevents a resort to calomel, or to heroic prac-
tice of any kind. Hence we blister, and sometimes leech or cup, or
resort to means of controlling the heart's action, &c. It is not, how-
ever, that we look upon phthisis as an inflammatory disease. Surely
in this disease the excess of fibrine is of value as a diagnostic sign ;
nor does it follow of course that the antiphlogistic plan must be here
pursued ; although we are aware of the existence of inflammation,
the general condition of the patient may forbid it, and various contin-
gencies might arise forbidding it. This should not, however, be an
argument against the value of any symptom ; because, for other and
stronger reasons, the course indicated by that symptom cannot be
carried out. Such is the case in erysipelas, where there is a high rate
of fibrine ; but the state of the brain and nervous system forbids a
resort to the lancet ; yet it is important to know that we have inflam-
mation superadded to the specific disease, so that we can use proper
means to combat it when other circumstances do not forbid. As an
instance of the value of attending to the condition of the nervous
system and its influence upon treatment, I will instance concussion of
the brain. In the beginning, if the patient is bled he will die ; subse-
quently, when the nervous system has recovered from the shock, if
he is not bled he will die. Sometimes we even stimulate in order
that we may bleed. It is useless to pursue this branch of the subject
further. I might go on and enumerate various diseases, such as pneu-
monia, pleurisy, &c, where this excess of fibrine was a guide to diag-
nosis, and therefore to treatment, but deem it unnecessary.

The doctor in the course of his article has brought forward anemia
as an example of a disease in which he states there is an excess of
fibrine in the blood ; and if this is to be followed as a guide, it would
lead to erroneous treatment. The indication to us should be to use mer-
cury, &c. He has here fallen into the error of supposing that the
buffy coat which the blood presents under certain circumstances is
always a sign of an increase in the quantity of fibrine ; if this was
the case, then he would be correct in supposing that in anemia such a
state existed, and this would be a strong argument against the princi-
ple laid down by Andral ; but this buffy coat is not always an evi-
dence of an increase of fibrine, although when this principle is in ex-
cess the buffed appearance presents itself. The quantity and firm-
ness of the coagulum should be taken into consideration in judging of
the quantity of fibrine.

In accounting for this buffed appearance, Andral remarks that the

SCOTT ON THE FIBRINE OF THE BLOOD. 449

blood of a chlorotic has preserved all of its fibrine, and has lost a por-
tion of its globules, giving thus a relative excess of fibrine ; hence the
coagulum will be smaller and firmer. A buffy coat is also present,
but the crust is comparatively soft and much thinner than when in-
flammation occurs. If under these circumstances the blood be ana-
lysed the fibrine will be found in its normal quantity. By noting then
the quantity and firmness of the coagulum, and thickness and consis-
tence of the buffy crust, we have the means of correcting any error
that we might otherwise fall into ; but because such an error might
occur in this disease, is no argument against the sign of an excess of
fibrine as a guide in inflammation, as we have the means of correcting
it. Now, physicians are expected to be able to make proper discrimi-
nations— to be aware of these facts. Our science is not an exact one,
and therefore judgment and observation must supply the place of
rules and axioms. Anemia then is not, according to our guide to diag-
nosis, an inflammatory disease, nor by following this guide would we
be led into gross errors of treatment.

Having fallen into the error of supposing the buffy coat to be al-
ways indicative of an increase of fibrine, it was natural that in an-
other part of his article, when treating of rheumatism, and the effect
of copious and repeated bleeding, he should fall into another error of
supposing that copious and repeated bleeding would not diminish the
quantity of fibrine as the buffy coat still presented itself. And for an-
other reason, that an actual increase of fibrine is sometimes observed
after a second bleeding has been practised. This last is quite true,
and when it does occur, shews that a high degree of inflammation
prevails, or that in the interval between the bleedings inflammation
has increased. Here he seems to think that the ground we took was,
that an excess of fibrine was the cause of inflammation. No such po-
sition was assumed ; nor do we contend that the only benefit to be
derived from bleeding is the diminution of the fibrine. An excess of
fibrine we regard only as a sign denoting the existence of inflamma-
tion ; the treatment depends upon the idea we may have of its na-
ture and cause, and our remedies relied upon according to our opi-
nion of their modus operandi, and the benefit following their use.

That the quantity of fibrine is diminished by bleeding is probable,
from the fact that we witness constantly a diminution and disappear-
ance of the buffy coat following blood letting. That this is the case may
be inferred if we reflect, first, that the quantity of blood contained in
the vessels is diminished, and that when this has been carried to a
certain extent, that absorption of fluids contained in the system takes
place, whereby the blood is rendered more fluid. When blood is
drawn, there is also a greater diminution of the red globules than of
the fibrine, and albumen is also taken from the mass of the circulation,
so that now we have, after copious depletion, a buffy coat ; and owing
to the fact that the fibrine is relatively in excess, the same condition
exists as we have already noticed in anemia ; and in this manner it
can be explained why the last bleeding may present the buffy coat,
even after all inflammatory action has subsided. Bearing this in mind,
there is little danger of being led into errors of treatment, even if we

450 SCOTT ON THE FIBRINE OF THE BLOOD.

relied solely and wholly upon our guide. If we reflect upon the mode
of production of fibrine, the time that must elapse before its repro-
duction under ordinary circumstances, and the comparatively short
time before the fluids may be supplied, we must be led to the conclu-
sion that bleeding will diminish its rate ; the fluids are absorbed in a
very short time, whereas the fibrine has to be formed from food taken
into the stomach, which has to undergo the process of digestion and
assimilation, or it may be formed directly from the albumen of the
blood ; but we have seen that the albumen is also diminished by
bleeding ; and as the elements which furnish fibrine are diminished in
quantity, it is reasonable to infer that the fibrine is likewise decreased ;
for this reason, we recommend a simple diet in treatment of inflam-
mation, an abstinence from animal food, et cetera.

Now, calomel acts, it seems to me, as an antiphlogistic somewhat
in the same manner as blood letting. By its action the more solid
constituents of the blood are diminished, the red globules, according
to all authorities, are lessened in quantity ; it acts so as to increase
greatly the secretion of the liver, which, besides the materials neces-
sary for carrying on digestion, secretes a large quantity of excremen-
titious matter. Indeed, this agent seems to possess the power of in-
creasing most of the secretions tending to the same end. That it like-
wise diminishes the quantity of fibrine is most probable, and such we
are informed by some of the highest authorities is the fact. Trous-
seau says that the blood under its action becomes more fluid — is ren-
dered less plastic ; by which I suppose he means that it contains a
less quantity of fibrine. Perira says, that at first there is a slight in-
crease of the fibrine, but subsequently it is diminished — the red glo-
bules are likewise lessened in quantity. I have always myself looked
upon this agent as one of the most efficient in the treatment of inflam-
mation, and it was upon this ground, I believe, that the advocates for
its use in the treatment of scarlet fever contended that it was indi-
cated. The doctor has knocked this proof from under them, (assu-
ming that scarlatina is inflammatory,) by denying the efficacy of this
agent in subduing inflammation.

I cannot pretend to explain the fact stated, that in stomatitis caused
by "he use of calomel, there is found an increase of the fibrine of the
blood. We see, however, a somewhat similar occurrence in typhoid
fever, which certainly has a tendency, in some unknown manner, to
defibrinate the blood, when during the course of the disease inflamma-
tion of some organ takes place.

I am not wedded to any particular theory as to action of calomel ;
indeed we know so little of its modus operandi, that it would be folly
to adopt any one, and I hold nryself ready to discard it in the treat-
ment of inflammation when it shall be proved not to act as an anti-
phlogistic.

HASKINS ON THE FIBRINE OF THE BLOOD. 451

In continuation of the same debate, Dr. Haskins said :

He deemed it unnecessary to add anything to the remarks which
had been submitted by his friend, Dr. Scott, in reply to the point
chiefly argued by Dr. Meriwether in the paper which he had the
honor to present to the society at a former meeting. It had been a
matter of surprise to him that such a point, even though it had been
made, should have been thought worthy of a grave discussion.

There had, however, incidentally grown out of this discussion
questions which he regarded of the very first importance, and he
hoped they would be freely and full}) discussed. He alluded to the
effects which venesection and the administration of mercury had in
altering the quantity and quality of the blood.

Dr. Meriwether had e'xpressed the opinion that the amount of fibrine
was increased, and in confirmation of this opinion, adduced the fact
that in the analyses which had been made of the blood when vene-
section had been repeated several times, it had been observed that
instead of being diminished it had steadily increased.

Dr. H. said, that while the result of these analyses had been cor-
rectly stated, he thought that an illegitimate deduction had been made
from. them. For, it should be recollected that each one of the speci-
mens which had been the subject of examination had been obtained
from persons suffering from an inflammatory disease ; an inflamma
tion too of such a degree of acuteness and violence, as to demand
most active depletion, unless there had been a most culpable disre-
gard of the value of human life on the part of the attending physi-
cians. He thought that the continued and increasing violence of the
inflammation, notwithstanding the active depletion, was sufficient to
account for the high rate of fibrine.

To determine the effect of blood letting upon the increase or dimi-
nution of this constituent of the blood, he contended that it was ne-
cessary that blood of health}7 persons, or of those suffering from dis-
eases which were not characterized by an increase of this element,
should be used for the experiments. He did not know of any one
who had been such an enthusiastic votary of science as to submit to
the repeated operation of venesection in health, with a view of de-
termining this point. But Andral and Govarret had made forty-one
analyses of the blood of persons suffering from typhoid fever, from
several of whom blood had been drawn ; and it was a remarkable fact
that in every case of uncomplicated typhoid fever, where venesection
was repeated several times, that there was a decided diminution of
the amount of fibrine after each bleeding. He further contended that
in the absence of a sufficient number of experiments to determine this
question, that it appeared to him legitimate to settle it, for the present
at least, by inductive reasoning. He then went into an explanation of
the theories which had been put forth concerning the mode of forma-
tion of fibrine. That given by Mulder, and confirmed by Becquerel
and Rodier, that it was but a higher oxidation of one of the proteine
compounds of the blood, and would be increased by circumstances
operating to introduce more oxygen into the blood, and to circulate it
more freely and rapidly through that fluid.

452 HASKINS ON THE FIBRINE OF THE BLOOD.

That put forth by Simon, who contended that fibrine was the pro-
duct of the transformation of the red corpuscles of the blood, while
he was unprepared to adopt either of these theories as satisfactory, it
appeared to him that it was enough to know for our present purpose,
that in the opinion of those who had most investigated the subject, it
was either introduced into the same manner as the other proteine ele-
ments of the blood, or else it was formed from them in the blood.

When a vein was opened and blood abstracted, it was well known
that there was taken from the whole mass all the elements of the
blood just in the ratio in which they entered into its composition; but
upon a subsequent venesection and examination of the blood of the
same individual, it will be found that the effect of this bleeding upon
the blood has been to diminish very perceptibly the red gloubules,
less perceptibly the albumen, and still less the fibrine. The saline,
extractive matters and the water have been considerably increased.
This qualitative alteration of the blood can readily be explained by
reference to the facility with which these constituents are respectively
introduced into and re-formed in the circulating mass. The water, for
example, is introduced immediately, either by atmospheric pressure, or
physiologically, by endosmotic action. The red corpuscles, the albu-
men and the fibrine on the other hand have to be replaced by the
process of digestion and assimilation. The red corpuscles are re-
placed with more difficulty — the albumen with less, and the fibrine
still less — so that the effect of blood letting is to dilute the blood and
render it watery — to despoil it temporality of its most important and
characteristic elements ; and just in proportion as you diminish those
elements, albumen and red corpuscles, will you take away the mate-
rial out of which is elaborated fibrine — so that even if it does not di-
rectly, it certainly does indirectly diminish the amount of fibrine.

Dr. H. said the buffy coat or inflammatory crust had been referred
to by other gentlemen who had preceded him, as an index or sign of
the amount of fibrine existing in the blood. He contended that it was
not a sign to' be relied upon, and proceeded to shew that there were
so many accidental circumstances which were capable of modifying
the appearance of the buffy coat of the blood, that unless they were
understood and appreciated by the observer, so far from rendering him
any assistance, they would frequently lead him into error.

The modifying circumstances particularly alluded to were, density
of the blood, contact of the atmospheric air, nature of the recipient,
the agitation which the blood is submitted to, and the rapidity with
which it flows.

Dr. H. said the rapidity of coagulation and firmness of the clot
formed, had also been relied upon as an indication of the amount of
fibrine, and proceeded to shew that this too was an error — contending
that rapidity of coagulation depended rather upon the densit}^ of the
blood and the relative amounts of solid constituents, red corpuscles,
albumen and fibrine, coagulation taking place more rapidly when the
blood is less dense, and red corpuscles and albumen are less in quan-
tity. This he said was to be explained by the fact that when the blood
was less dense it allowed the red corpuscles to sink, leaving the par-

EDITORIAL. 453

tides of fibrine floating upon the top with less material interposed be-
tween and separating them. For a very interesting series of experi-
ments upon this subject, he referred to those published in the Annali
Universal! in 1843-47, by Dr. Polli.

Registration of Births, Deaths and Marriages.

We hail with joy the action of the constitutional convention on the
subject of a registration act. It is known to most of our readers that
a clause has been engrafted in the new constitution requiring the le-
gislature to make such enactments as may be necessary to establish an
accurate registry of the births, deaths and marriages of all whites,
and of the births and deaths of all the colored inhabitants of the com-
monwealth. The perfection of the system is now left to the legisla-
ture. Though in the convention, as we were told, " not a word was
spoken on the subject, because its propriety was manifest to all," we
fear that the legislators, whose duty it will be to frame the law, will
not pay the necessary attention to its details to make it of any very
great value to the profession. We hope that the physicians generally
will take a sufficient interest in the subject to acquaint the represen-
tatives with their wishes, and to impress them with a due sense of the
importance of a perfection of the system. Unless they do, we fear
that an act somewhat similar to that; which now rests as a dead letter
on the statute book, in regard to the recording of marriages by the
ministers, will be passed, and all the advantages of a perfect system
will be lost. These remarks are rather intended to draw attention to
the subject than anything else. We will pursue them at some future
time in connection with the coroners system.

Our Patrons.

We take this occasion to thank numerous correspondents and pa-
trons who have written us letters of encouragement in our enterprise.
The Stethoscope is now firmly established and has a wide circulation,
but its size and its cost require encouragment in several different
ways. We solicit, 1st, communications, reports of cases of interest
and practical essays; 2ndly, an extended list of payivg subscribers.
As the price of the journal is too low in comparison to its cost to af-
ford compenstion to agents, we may be excused for asking the favor

of subscribers to act as agents for us, and to aid in circulating our
53

454: , EDITORIAL.

work in their neighborhoods. To the many who have already done
so, we return our grateful acknowledgments.

We very much regret that Dr. G. Lane Corbin was prevented from
attending the meeting of the Medical association at Charleston, S. C,
by dangerous and protracted illness. We learn that he had intended
to advance some strong ideas adverse to the generally received opi-
nion as to malarious influences producing " intermittent fever," and to
have related some experiments sustaining his views.

We are glad to hear that Dr. C. has regained his health, and we
hope soon to publish an interesting paper on the above subject from
him.

We must again apologise for the poverty of the present Number in
selected papers. Hereafter we shall give more practical or valuable
matter, selected from the American and foreign medical journals.

Dr. Howard, editor of the Ohio Medical Journal, is writing inter-
esting letters from Europe. He speaks highly of the attentions paid
to Americans by the London profession. He takes occasion however,
in his letter, to oppose the lengthening of the lecture terms, so gene-
rally insisted on by the profession in the United States. This does
not come well from Dr. Howard, as he himself is connected with a
medical college which seems little disposed to risk the loss of a stu-
dent by adopting any of the reforms.

We have received the circular of the New York medical college,
from which we see that it has adopted the long course of lectures,
(five months,) and practically separated the teaching and licensing
power. All candidates for graduation are examined before censors,
who are in no way connected with the college. We learn that other
schools will soon adopt this plan.

Southern Planter. — This cheap and valuable monthly is now
edited by Frank G. Ruffin, Esq., a practical farmer of energy and
talent. We take great pleasure in exchanging and in recommending
it to the agricultural community.

Among the newspapers which are sent to the Stethoscope is the
Magnolia, a spirited and capital weekly family journal, edited by
Oliver P. Baldwin, Esq. of this city — $2 per annum. As a literary
family paper it has no superior.

Notices of other publications received are necessarily deferred.

MEDICAL SOCIETY OF VIRGINIA.

455

Medical Society of Virginia-~July Meeting.

C. P. Johnson, second vice-president, in the chair.

(Present — twenty-six members.)

After the reading of the minutes, the following gentlemen were
ballotted for and declared duly elected members of the society :r .

N. F. Rives, M. D., Petersburg,

J. F. Peebles, M. D., do.

J. H. Claiborne, M. D., do.

P. S. Carrington, M. D., Richmond.

Peterfield Trent, M. D-, do.

L. N. Ligon, M. D., Nelson C. H.

Zachary Lewis, M. D., King Sf Queen.

W. B. Cochran, M. D., Middleburg, Va.

T. M. Boyle, M. D., Loudoun.Co.

R. A. Lewis, M. D., Richmond.

Jas. Johnson, M. D., Hicks' Ford, Va.

John C Coleman, M. D., Richmond.

P. H. Cabell, M. D., do.,

O. L. Drake, M. D., Powhatan C. H.

One nomination was laid over till the November meeting, and ano-
ther was withdrawn by unanimous consent.

Letters of application were read from several gentlemen, whose
nominations were seconded and laid on the table under the rule.

Dr. James Beale, first vice-president, took the chair.

The resolution in relation to apothecaries who prescribe, coming up
as the first business in order, several gentlemen expressed their opi-
nions in regard to the necessity of taking some steps which would ac-
complish the objects in view more effectually than the mere passage
of this resolution. After some debate, the subject was referred to a
committee, consisting of Drs. Haskins, Deane, Johnson, Mills and G.
A. Wilson, to report what action ought to be; taken at the: next meet-
ing.

The paper read by Dr. Meriwether at the last meeting, and pub-
lished in our July Number, on the ji brine of the blood in certain diseases,
was then called up as the regular subject of the evening.

A long, able and very interesting discussion then ensued, in which
Drs. Meriwether, G. A. Wilson, Little, Haskins, Gibson, Deane, C.
P. Johnson and Scott took part.

[The remarks of Drs. Scott and Haskins will be found in the
original department of the present Number. We regret that we have
not the material from which we could make an abstract of the re-
marks of the other gentlemen who participatedin the debate, and We
are unwilling to do them injustice by giving a meagre report of them.]

On motion of Dr. G. A. Wilson, Uterine Displacements was made
the subject for the August meeting.

Dr. James Bolton presented a specimen of extensive caries of the
bones of the leg. He read a history of the Gase, and contributed the
preparation to the pathological cabinet of the society.

The committee to devise and procure a suitable seal for the society;
presented one of the following design, viz : A shield bearing in its
centre a winged rod wreathed with a 'serpent. The words " Medical
Society of Virginia" appear on the margin, with the date of the incor-
poration of the society (1824) at the apex. This was then adopted
as the seal of the body for the future. It was executed by William
Alderton, of New York, and gave general satisfaction.

The chair then announced the following list of committees, appointed
under resolution passed at the annual meeting :

456 MEDICAL SOCIETY OF VIRGINIA.

1st. On the present condition of medicine and the interests of the
profession in the state of Virginia:

Ro. W. Haxall, Richmond City.

Walter F. Jones, Petersburg. Frank Powell, Middleburg, Va.

J. Prosser Tabb, Gloucester C. H. Landon Rives, Richmond.

2d. On medical education and literature, and the progress of pro-
fessional and popular quackery :

J. F. Peebles, Petersburg.
J. J. Thweatt, Petersburg. J. Wistar Walke, Wmterpock, Va.

C. S. Mills, Richmond. G. A. Wilson, Richmond.

3d. On hygiene and public health, and the medical topography and
statistics of Virginia:

Wm. A. Patteson, Richmond.
A. T. B. Merritt, Richmond. G. Lane Corbin, Warwick.

L. S. Joynes, Accomack C. H. M. H. Houston, Wheeling.

4th. On practical medicine and pathology :

W. D. Haskins, Richmond.

T. H. Laird, Boydton. John A. Cunningham, Richmond.

D. H. Tucker, Richmond. Wm. Selden, Norfolk.

5th. On surgery:

H. H. McGuire, Winchester.

C. B. Gibson, Richmond. P. CI. Gooch, Richmond.

P. C. Spencer, Petersburg. Jas. Bolton, do.

6th. On anatomy and physiology :

C. P. Johnson, Richmond.
M. P. Scott, Richmond. F. W. Roddy, Richmond.

J. L. Cabell, University of Virginia. W. Ottway Owen, Lynchburg.

7th. On obstetrics :

F. H. Deane, Richmond City.
Sam'l A. Patteson, Manchester. B. R. Wellford, Fredericksburg.

Dan'l Trigg, Abingdon. J. F. Peebles, Petersburg.

8th. On materia medica and chemistry :

S. Maupin, Richmond.

A. E. Peticolas, Richmond. L. W. Chamberlayne, Richmond.

J. H. Claiborne, Petersburg. Jno. N. Broocks, do.

9th. On the indiginous botany of Virginia:

Geo. F. Terrill, Junction, Hanover.
W. J. Clark, Richmond. T. A. Cox, Henrico.

J. A. Smith, Montpelier, Hanover. P. M. Watson, Smyth C. H.

10th. On those pursuits so connected, directly or indirectly, with
the profession as to demand its attention — such as dentistry, dispen-
sing physic, manufacturing of instruments, apparatus, &c. &c. :

James Bolton, Richmond.
Wm. W. Parker, Richmond, John P. Little, Richmond.

W. B. Pleasants, do. Nat. F. Rives, Petersburg.

11th. On the springs and mineral waters of Virginia :

Wm. Burke, Richmond.
S. Maupin, Richmond. M. P. Scott, Richmond.
Strother, Warm Springs. - — Hunter, Blue Sulphur Springs.

BIBLIOGRAPHICAL NOTICES. 457

Dr. Bolton gave notice that he would bring up a plan for the ex-
tension of the society, and said that as there was sometimes much
difficulty about the nominations and elections of gentlemen who were
not well known to the members, he would, at a future meeting, offer
the following resolution : " That a standing committee be appointed,
to whom shall be referred the names of all applicants for membership
of the societ3r."

Dr. C. P. Johnson offered the following:

Resolved, That in future the consideration of the regular subject of
discussion for the evening be never postponed later than 10 o'clock in
the summer, and 9£ in the winter. Adopted.

The society then adjourned.

Reviews and Bibliographical Notices.

".Operative Surgery — Bij Frederick C. Skey, F. R. S." Phila-
delphia: Blanchard & Lea. 1851. 8vo. 661 p. From the pub-
lishers— Through Morris & Brother.

When this work was announced we looked forward for one of the
fullest and most valuable treatises on the operative department of mo-
dern surgery. The very extensive field of experience and observation
occupied by a surgeon to St. Bartholomew's hospital soon attains for
him a position in his profession which renders his name a high autho-
rity. The reputation of Mr. Skey as an operator, and his great ex-
perience, will no doubt cause his new work to be adopted as a stand-
ard text. It will soon be in the hands of many who allow their think-
ing to be done by authors, and who will refer to it as a guide in their
practice. Now, with all due deference for Mr. Skey's great name, and
for the commendations given to his book by the medical press gene-
rally, we feel in duty bound to express the opinion that its readers will
be disappointed with it.

The preface like the title page reads well, and indeed its perusal
led us to the disappointment we experienced with the book.

"The following work was undertaken in compliance with the advice of some professional
friends, who equally felt with myself the want of a book on the subject of Operative Sur-
gery, which might become, not pimply a guide to the actual operation, and embrace the
practical rules required to justify the appeal to the knife, but would embody, at the same
time, such principles as should constitute a permanent guide to the practitioner of Opera-
tive Surgery, and without which, all claim to its scientific character is lost.'1

* * * # # #

"To write a work on Operative Surgery, which should consist of merely mechanical
rules for the performance of an amputation, for example, would be to leave the work more
than half unfinished, simply because the knowledge, which determines the necessity of the
undertaking, is far more valuable, and far more difficult of attainment, than that which is
required to qualify a surgeon for its performance. The one qualification involves both the
moral feeling and the intellect of the surgeon. The other demands the exercise of his
physical functions only." *****

After having dilated on the responsibility, &c. of the operator, the
author very justly remarks :

"There is no department of medical practice more attractive to the younger members of
our profession than that of Operative Surgery. Its brilliancy, its eclat, its critical influence
on disease, all contribute to this popularity, and attach an interest to it in the minds of the
student of medicine far beyond that connected with the study of any other department.

458 skey's operative surgery.

The value of a hospital is appreciated by the number of its operations, not by the exhibi-
tion of the cura'ive power of its surgical staff, and still less by the success which follows
the frequent resort to the knife. The operating theatre is a place of weekly resort, the
'high change' of the institution, at which we find united the largest assemblage of profes-
sors, of students, and their friends. Is not this enthusiasm somewhat misapplied? Between
the claims to respect of Curative and Operative Surgery, there is no comparison. I-ven-
ture to say, with all respect to my many superiors in surgical acquirement, that it is the duty
of the teacher to expatiate with all the power of his authority on the superiority of the one
over the other.

" There is no greater obstacle to the advance of high classed surgery, than the man who,
having acquired the reputation of a dextrous operator, regards the world as the great field
of his experiments. A man who has the reputation of a 'splendid operator' is ever a just
object of suspicion ; and I firmly believe that the bad operator, conscious of his weakness,
will be found to have ever been the larger contributor to scientific surgical knowledge."
— " I am old enough in my profession to have witnessed in past times much of wrong ; I
hope to live long enough to see this wrong converted into right. I have endeavored, as
an English metropolitan surgeon, to carry into execution at least one primary object, viz. to
strip the science of Operative Surgery of a false glare, mistaken by the ignorant for the
brightness of real excellence, to check a spirit of reckless experiment, and to repress rather
than encourage the resort to the knife as a remedial agent."

The first chapter is devoted to general considerations, and is perhaps
the best part of the work. Chloroform is recommended in many cases
as a matler of the first importance. The preparatory and after treat-
ment and the expediency of operations are touched on. But we think
that these considerations should be spoken of in connection with the
individual operations. The second chapter is very much a continua-
tion of the first. The principles of incisions, instruments and their uses,
haemorrhage, unions and sutures, wounds and dressings, ligature of
arteries and tetanus, are treated of at some length, and many good
hints may be obtained from it, but it is well that one would not be
likely to consult a book on Operative Surgery for the treatment of
tetanus; for if they do, and this is the only one at their command,
they will be left in as total darkness as before. From the text we
are to consider Mr. Skey a believer in idiopathic tetanus.

Dislocations and fractures are then taken up, having an intermediate
chapter on bandages, and are very well treated of, with some omis-
sions. Compound dislocations are slighted, and gutta percha splints
and fixtures are not mentioned once. Amputations and other cutting
operations succeed. We fully agree with the author in his preference
generally for the circular operations, either simple or modified, where
there is one bone only. And Mr. S. deserves praise for denouncing a
folly, not more absurd than it is common, of attaching too much' im-
portance to the rapidity of operating. Now that the pain is notefelt,
by the resort to anesthesia, we hope the use of a watch in operations
will be dispensed with. We have not room for, nor do we think that the
work demands, a review by chapters. Though there are many parts
of it which challenge admiration, still upon the whole we do not think
that Mr. Skey's book has " supplied the want of a complete guide
and reference book on the subject." In the contracted limits to which
the author has confined himself, he has dilated too much upon the
principles and too little upon the mechanical or operative part of sur-
gery, and the treatise is very defective in the details of particular ope-
rations. Symes' beautiful operation of amputation at the ankle joint,
leaving the astragalus, and his favorite and successful excision of the
elbow joint, leaving an artificial joint and an useful arm, are not ta-ught

UNITED STATES PHARMACOPOEIA. 459

correctly. Excisions and resections are grossly neglected. Nobody
could learn to extirpate a diseased maxillary bone by studying Mr.
Skey's account of the procedure. His operation for hare-lip is good,
but he omits to give his opinion as to the most favorable period for
operating. In the simple excision of tonsils, he reminds us of danger
by haemorrhage from an irregular distribution of the tonsilitic artery,
but suggests no treatment for the accident. Ovariotomy is not only
regarded as justifiable, but as demanded in many cases. The in-
crease of the temperature of the room beyond a pleasant degree, as is
recommended by Dr. F. Bird and others, is censured ; but here again
the operation and attending accidents and circumstances are not suffi-
ciently expatiated upon. Mr. Skey recommends, like Dr. Gross, the
use of the simple knife in cutting for stone in the bladder. Indeed
the gorget has been abandoned we believe by all lithotomists of any
eminence, save Dudley of Kentucky and Gibson of Philadelphia. For
the best description of perineal section for the radical cure of old
strictures of the urethra, we cannot refer to Mr. Skey. His remarks
on that subject are too indefinite.

In conclusion, it is due to the work to say that it abounds in well
executed wood cuts.

The Pharmacopoeia of the United States of America — By authority of
the National Medical Convention, held at Washington, A. D. 1850.
8vo. 317 p. Philadelphia: Lippincott, Grambo & Co. 1851. Through
Nash & Woodhouse.

[For the subjoined review we are indebted to the kindness of our
friend, Mr. Joseph Laidley, a gentleman of intelligence and talent,
and a graduate of the Philadelphia College of Pharmacy, now con-
nected with the drug house of Adie & Gray of this city. — Ed. Steth.~]

More than three months have now elapsed since the fourth decennial
edition of the United States Pharmacopoeia was issued from the press;
and late as is the day at which we notice it, yet we cannot let the
opportunity pass without expressing our opinion of both the work it-
self, and of the faithful and masterly manner in which the committee*
appointed for that purpose have accomplished the work confided to
them.

The beautiful system of nomenclature, first adopted in the first
American Pharmacopoeia, has been carefully adhered to, and where
practicable, extended in the new edition, as, for instance, in the edition
of '42. " iEther sulphuricus" indicated the product of the action of
sulphuric acid upon alcohol — the preparation which is now recognised
as simply "aether" because it is pure ether; the oxyde of ethyle, and
not a compound of that substance and the elements of sulphuric acid,

*The committee consisted of ten members from various parts of the Union; but the ac-
tive portion of it. were Professors G. 13. Wood and Joseph Carson, of the University of
Pennsylvania, Win. Procter, jr., of the Philadelphia College of Pharmacy, and F. Bache,
of the Jefferson Medical College, Philadelphia.

460 UNITED STATES PHARMACOPOEIA.

as the old name indicated. There are numerous other equally appro-
priate changes in nomenclature observable throughout the work.

To the list of the materia medica there have been added eighteen
medicines, including acetic acid, (formerly among the preparations.)
To the preparations are added fifty-three formula? for new medicines ;
among these are aconitia, iodide of arsenic, chloroform, solution of
citrate of magnesia, iodide of lead, &c. ; but the most important ad-
dition to this division of the work is the introduction of the fluid ex-
tracts— a class of medicines, the value of which fully entitles them to
so prominent a position ; among these we must mention the fluid ex-
tracts of sarsaparilla, and of spigelia and senna ; the former is, un-
doubtedly, the best preparation of sarsaparilla now in use, and phy-
sicians and pharmaceutists would be doing a service not less to them-
selves than to the public, by discouraging the use of the various quack
nostrums purporting to be preparations of that valuable remedy,
which are now foisted in such wholesale quantities upon those who
are credulous enough to believe the extraordinary but ofien manufac-
tured stories told in their favor. The same remarks will apply to the
fluid extract of spigelia and senna, which is an excellent vermifuge,
and well worthy of the confidence and patronage of the profession
and the public.

Numerous changes in the formulas have been made throughout the
work, which will have the effect of greatly lessening the trouble of
preparing some medicines and improving the quality of others, and
in these it is that the practical character of the work is manifest. It
does not present a collection of tedious and complicated formulas,
which, in many instances, could not be understood, except indeed by
the most scientific and experienced in the business; but its formulae
are all as explicit, short and simple as it was possible to make them ;
in fact, two cardinal objects appear to have constantly guided the
deliberations and influenced the actions of the committee ; the first,
to embrace in the work all the medicines whose importance or use
would justify their admission — to acknowledge all the remedies that
the wants of the community require; the second, to present such
simple and intelligible formulas for preparing Lhese remedies, as would
enable any one in the business to properly conduct the necessary pro-
cesses. In the preparations of vinegars of squills and colchicum, alco-
hol has been left out, which, from its stimulating property, was, in many
cases, an objectionable addition ; but. as they will now be more liable
to spoil than when alcohol was added, pharmaceutists will have to pre-
pare them in smaller quantities and more frequently, in order to have
them always good. Camphor, cinnamon, peppermint and spearmint
waters, each contain more of the active ingredient, from the amount
of the carbonate of magnesia, with which the camphor and oils are
triturated, having been increased. Aromatic sulphuric acid and tinc-
ture of muriate of iron are now prepared in a less number of hours
than they formerly required days. Cyanuret of silver is prepared by
an improved process. Extracts of hemlock and dandelion are pre-
pared by processes that secure as perfectly as it can be done, the
presence of all the virtues of these plants. The consistence and flavor

UNITED STATES PHARMACOPOEIA. 461

of honey of roses has been improved. Pills of carbonate of iron are
made of better consistence, and other practical improvements are
made in the formulae for preparing the mass. Sulphate of quinia pills
will retain their consistence better with honey than when made with
syrup, as formerly. The manipulation for and consistence of soap
plaster has been improved. Solution of iodide of iron keeps better
when made with sugar than with honey ; hence the substitution of the
former for the latter. Cyanuret of potassium is prepared by a pro-
cess which yields a much larger product than the old plan ; and al-
though it is not as pure, yet it is sufficiently so for all practical pur-
poses. Iodide of potassium is manufactured pure; it has heretofore
almost invariably contained some carbonate of potassa — frequently a
considerable amount. Compound spirit of juniper and spirits of
pimento and rosemary are prepared with much less trouble than for-
merly. The formulae for syrups of ginger, ipecacuanha, rhatany, rhu-
barb, tolu and compound sarsaparilla have undergone important im-
provements. So also have the formulae for citrine, iodine and stramo-
nium ointments.

Among not the least important changes, are those made in the
strengths of acetic and nitric acids : the former, in the old edition, was
so strong, as to render its preparation difficult, and its cost compara-
tively expensive ; the consequence of which was, that a weaker acid,
the " No. 8," took the place of the stronger — a change which was at-
tended with no disadvantage, as the acid has always to be largely dilu-
ted for use. The " No. 8," the weaker and cheaper acid, is now the offi-
cinal standard. Nit. acid was required to have the sp. gr. of 1.5., which
was much stronger than necessary, and the manufacture of it also was
attended with much difficulty, especially to obtain it pure. To remedy
these inconveniences, advantage has been taken of the curious fact,
that no matter what the strength of nitric acid may be, whether stronger
or weaker, boiling it will always bring it to the specific gravity 1.42,
(which contains about 76 per cent, of liquid acid ;) consequently, this
standard is adopted in the new Pharmacopoeia. The " Preliminary
Notices" are a new and important feature in this edition.

The test notes, or rules, for ascertaining the purity of the substances
to the general description of which they are appended, are short and
concise, yet full and explicit ; they have been prepared with a great
deal of care and accuracy; and attention to their requirements would
enable any one to test the quality of the articles they are intended for ;
a precaution which all engaged in preparing or vending medicines
should occasionally take, as it would either confirm the purity, or ex-
hibit the impurity of his remedies; the satisfaction of knowing that
his medicines are what they ought to be, would be worth to the honest
dealer the little trouble testing them might occasion him ; and on the
other hand, if anything should, on applying the test, prove not equal
to the standard, he becomes acquainted with the fact and can supply
himself with those that are good : but the great benefit resulting from
such a course would be the securing of uniformly good and genuine
remedial agents, upon which the physician's reputation and success,
54

462 UNITED STATES PHARMACOPOEIA.

not less than the lives of his patients, so greatly depends. We hope
the tests will be applied by those interested, as occasion may present.
We have thus, in a very cursory manner, noticed some of the most
important changes in the new edition of the Pharmacopoeia — we would
gladly go more into detail, but the space allotted to us in the " Stetho-
scope" will not permit it. The work, as now presented to the Ame-
rican profession, is undoubtedly the best of its kind extant ; we hope
to see it ere long in the hands of every physician, student and apo-
thecary in the Union — we want to see both doctors and druggists fa-
miliar with its contents, and more especially, with its nomenclature
and formulas — a knowledge of, and strict adherence to the former,
would prevent, to a great extent, the mistakes which frequently oc-
cur— mistakes, occasioned not more by the carelessness of apotheca-
ries than by thoughtlessness in prescribing — at least, thoughtlessness
so far as giving the prober names in prescriptions is concerned — but
if the pharmacopoeial synonyme were written, we would always have
one definite, uniform name for the same article : take calomel for an
example, hydrargyri chloridum mite is the officinal name — prescrip-
tions now come to us for this one substance under the names and ab-
breviations now given, viz : Hydrargyri chloridum mite, hyd. chlor.
mit., hyd. mur. mit., hydrarg. sub. chlorid., hyd. chlor. dulcis., hyd.
mur. dulc, hyd. protochloride, mere. mur. dulc, hyd. sub. mur., hyd.
submurias, mere, submur., mere, dichlorid., and numerous other mix-
tures of English and Latin — then plain English, as sweet precipitate,
sweet sublimate, calomel, protochloride of mercury — and some dozen
others — but if the officinal name were adopted by all, one great source
of confusion would be removed — one great guard against mistakes
would be established. Such would be some of the advantages of
every one engaged in prescribing or dispensing medicines, having,
and studying the Pharmacopoeia : the last edition of which, notwith-
standing perhaps a few defects, is as perfect as the wants of medicine
require, or the present state of pharmacy permits ; it has had the ad-
vantages of the wisdom and experience of the ablest chemists, the
most accomplished physicians, the most scientific botanists, and the
most practical pharmaceutists in the country — men who are at the
head ©f their respective professions in the United States, and the fame
fof whose scientific attainments is known wherever knowledge is es-
teemed, •©r learning is appreciated. With such a concentration of ta-
leat, brought to bear upon a single object, there can be no doubt that
the result of their arduous labors is worthy of the professions they
represent, and of the country of which their work is the national me-
dical standards

GROSS ON THE URINARY ORGANS. 463

A Practical Treatise on the Diseases and Injuries of the Urinary Blad-
der, the Prostate Gland, and the Urethra. By S. D. Gross, M. D.,
Professor of Surgery in the University of Louisville, Member of the
American Medical Association, author of " Elements of Pathological
Anatomy," etc., etc. 8vo. 726 p. — With one hundred and six illus-
trations. Blanchard & Lea. 1851. Through Morris & Brother.

The present volume will add to the already high reputation of Dr.
Gross. From his known ability, both as a teacher of surgery and a
writer on pathological anatomy, we had formed high expectations of
this work, which expectations, on its perusal, we find to be fully rea-
lized. After a brief account of the anatomy of the parts treated of
in the book, accompanied by suitable illustrations, he proceeds to dis-
eases and injuries of the bladder. Upon the whole, his account of
their symptomology, pathology, treatment, &c, is highly satisfactory.
His remarks on retention of urine, catheterization and puncture of the
bladder are especially worthy of attention, and the more so, as the
latter is an operation easily, and we apprehend too frequently unne-
cessarily performed by the young surgeon. Though not agreeing
with Desault, that the operation is never required, yet he is decidedly
of the opinion that the bladder has been many times needlessly punc-
tured, when by persevering effort, aided by rest and anodynes, the
catheter might have been introduced even after repeated previous fai-
lures. Says the author : " It is only in cases of excessive enlarge-
ment of the prostate gland, attended with great tenderness and
swelling of the surrounding parts ; in laceration of the urethra and in-
filtration of urine into the scrotum ; and in deep-seated impassable
stricture that the operation is even admissable. All other forms of re-
tention will, there is reason to believe, yield to the catheter, aided by
time and soothing measures."

By far the most interesting portion of the work is that relating to
urinary deposits and stone in the bladder. He is remarkably clear
and precise in his account of the symptoms, both rational and physi-
cal, denoting the presence of a stone in the bladder, the pathological
effects, the treatment, both medical and surgical, either for its remo-
val from, or solution in the bladder, the different operations for its re-
moval, as well as the treatment, both preparatory and subsequent to
its removal. He gives (and in this he is sustained by the vast majo-
rity of surgeons) the preference to the lateral operation, and discards
the gorget as being more clumsy and less safe in making the pros-
tatic section than the simple scalpel.

The average mortality has been set down at one in five, but in com-
paring the cases of a number of our most distinguished surgeons,
much more favorable results will be found in this country at least to
be obtained. The author has himself operated in twenty-four cases,
detailed notes of which he publishes, and has yet to lose his first pa-
tient.

After disposing of injuries and diseases of the bladder, he next
passes to those of the prostate gland, and then of the urethra, treat-
ing them in a clear and concise manner.

464 COOPER ON DISLOCATIONS AND FRACTURES.

To the country practitioner, this volume will prove especially valu-
able, treating as it does, many diseases in detail, touched but superfi-
cially in general works on surgery.

With the exception of a few omissions, which we hope to see sup-
plied in a subsequent edition, we think that the author has succeeded
in " filling a void in medical literature," and in " performing for the
bladder, the prostate gland and the urethra, what has been so well done
by Lawrence and McKenzie for the eye, Hope for the heart, Budot
for the liver, and Curling for the testes." C.

A Treatise on Dislocations and Fractures of the Joints — By Sir Ast-
ley Cooper, F. R. S., &c. — A new edition, much enlarged — edited by
Bransby Cooper, F. R. S., &c. — with additional observations, and a
memoir of the author. A new American edition., with numerous illustra-
tions. 8vo. 496 p. Philadephia. 1851. Blanchard & Lea.

The original edition of this work soon became exhausted, and its
popularity both in Europe and America caused it to run through five
more. The one before us has been edited with great care by Mr.
Bransby Cooper, one of the surgeons to Guy's hospital, and has had
some additions made to it by the American editor, amongst which are
some observations on dislocations and fractures of the thigh bone, by
Prof. Warren, of Boston. No commendations are necessary to en-
sure a continuation of the esteem in which this capital work has been
held hy the profession since it was first introduced to their notice.
This last edition is handsomely executed and illustrated.

Report to the Louisiana State Medical Society on the Meteorology, Vi-
tal Statistics and Hygiene of the State of Louisiana. By E. H. Barton,
A. M., M. D., President of the Society, Member American Medical
Association, etc. — With an appendix — shewing the experience of various
life insurance offices, and the laws of probability of life, according to E?ig-
lish calculation. By H. G. Heart, Esq. Svo. 66 p. New Orleans.
Davies, Son & Co.

We have received the above document from the author, and regret
that it is not largely circulated among the profession. It is a model
of a paper, and evinces not only the great talent and energy of the
learned author for scientific research, but an indefatigable industry
rarely met with among American physicians. So highly were the la-
bors of his production esteemed by the civil authorities and citizens
of New Orleans, that they requested the privilege of printing and cir-
culating it, to which Dr. Barton consented, and dedicates it to the mu-
nicipal authorities of New Orleans and Lafayette. An appreciation
of the labors of medical societies, and of the great value of such produc-
tions to every member of the community, will aid greatly in the encourage-
ment and advancement of the "science of life." But as drones are
so numerous in the medical ranks, as well as out of them, we can ex-

barton's meteorological report. 465

pect but little to be done for science by those whose duty it is to
foster it.

Accompanying the above report are several large charts, giving at
one glance the variations in the climaie, the mortuary returns, the in-
fluence of climate on race, &c, &c.

We have room but for one or two extracts. In speaking of the
main causes of the insalubrity of the city, Dr. B. remarks :

" Bad water is probably more injurious to health than bad air, as it
acts far more rapidly when taken into the stomach than when taken
into the lungs, for venous absorption admits of no selection ; it is taken
immediately into the lungs and circulated through the system, and as
water is capable of holding in solution a greater quantity of foreign
matter than air, it is more concentrated. Professor Hoffman has
stated that 1000 gallons oi water will dissolve 25 gallons of nitrogen,
6 gallons of oxygen, 1000 gallons of carbonic acid, 50,000 gallons of
ammonia — the very gas which escapes so largely from privies and the
police filth of every dirty town, carrying with it vegetable and animal
matters in a high state of putrescency. Hence it is that our cisterns,
and particularly when near the privies, (as they usually are!) are sure
to be contaminated thereby, and, indeed, every sourse of iilth in its
neighboorhood.*

" It must be highly gratifying to every intelligent mind to be ena-
bled here to apply the facts derived from the deductions of science in
the true explanation of this vitally important subject. You will agree
with me, 1 am sure, in the belief that the -utility of science is to be
estimated from its capacity to be applied to the practical purposes of
life — advancing our comforts and heightening our enjoyments. We
have this beautifully exemplified in the important fact stated in the
former part of this report (and other and abundant evidences could
be furnished) of the connection of a still atmosphere with disease, and
both with a high dew-point. This presses on us, with all its force, the
necessity of ventilation, and it becomes doubly important when with
the damp, still air of our back yards, the accumulation of the concen-
trated filth of a family, including the privy and kitchen offal, in the
direct neighborhood of that which is of the last importance to keep
pure, viz. the water we drink and use for all domestic wants. Then
comes the additionally important fact, derived from science, (men-
tioned before,) that all the noxious gases, given off' above by these ex-
crementitious remains, are absorbed, with destructive rapidity, by this
very water ! Thus the force and value of the highly satisfactory ex-
planation becomes too apparent to be questioned, and too important
to be overlooked.

"It is impossible to overlook the effects of intemperance, especially
in a warm climate. Probably no cause is so effective in undermining
the constitution, impairing the vis-vitcc, and increasing the liability to

* Since the delivery of this report, sever.il who heard it have had their attention called to
the subject, and consulted me in relation to sources of impurity of the water in their cis-
terns, from some cause to them unknown. On examination, it was satisfactorily ascertained
that, in several instances, it was most palpably attributable to the vicinage of their privies;
in others, to coal containing much sulphur, &c.

466 BARTON ON ACCLIMATION.

disease, as it. There is no disease it does not aggravate ; there is no
constitution it benefits. The most cursory examination of our ceme-
tery reports of the causes of death will satisfy any professional man,
at least, how vast have been the additions to it from an undue indul-
gence in this vicious habit, and especially of all that large class which
gives so baneful a reputation to this climate, I mean the zymotic."

We quote in full Dr. B.'s remarks on the perplexing subject of ac-
climation :

" The true philosophy of what is very loosely called ' acctimation,'
is very little understood — the materials do not exist. We know that
one latitude or zone of the earth is different in what is technically
called its ' climate,' from another; that these even differ in their longi-
tudes ; that elevation or depression, and the vicinage of mountains,
plains or great bodies of water materially influence it ; but farther we
cannot go. How difference of soil affects it we know not ; that it
does affect plants is undeniable ; and that even contiguous fields pro-
duce different varieties of fruit and other productions; but the cause
here is palpable enough — they derive what supports their existence
from it — we never do. All we can say, then, positively, and from
which to reason is, that from these positions result a difference of me-
teorological condition. The exponent, then of climate, so far as our
present positive knowledge extends, is meteorology. Now, from our
ignorance of meteorological conditions, with almost one exception, of
different countries, we are limited to the explanation which that one
furnishes — I mean difference of temperature. Let us see, then, what
this supplies. The inhabitants of the northern or cool regions are
generally of the sanguine temperament, with a large development of
their sanguiferous and pulmonary systems, with a corresponding power
of generating heat, to adapt them to the wants of such a climate. On
the contrary, the natives of hot regions have usually the bilious tem-
perament, with the reverse organization, because the requirements of
this climate are different, and they get rid of their excess of carbonic
acid through other emunctories, and they take in less through their
lungs, it not. being required, and if it was taken in, they would be
over-heated by the combustion it would excite in their systems ; hence,
then, the predominance of the bilious temperament in hot climates ;
and it is a matter of observation that temperaments are convertible by
long residence — certainly the sanguine becomes bilious through gene-
rations— and in accordance with these principles we find the visitor
from the North, of the bilious temperament, is more easily accommo-
dated to the South than he of the sanguine. Dr. Cartwright has clearly
shewn that the negro requires less pure or oxygenated air than the
white man, in their much greater adaptation to hot climates. Here,
then, is, one 'positive fact by which acclimation is explained ; and as
man is almost the only animal that can adapt himself to different cli-
mates, he clearly accomplishes it by the exercise of his intellectual
powers in accommodating himself to different temperatures, mainly,
by changes in his dress and mode of living; while other animals who
survive this change, in a great degree lose the coverings which pro-
tected them from nothern rigors, on coming to the South. Is there

STOKER ON MEDICAL JURISPRUDENCE. 467

any other positive, undeniable fact upon the subject ? Habituation to a
climate to constitute it — that is, habituation to a certain fixed atmos-
pherical condition — (and it is owing to our ignorance of the other de-
partments of meteorology that we are at present compelled to limit it
to this) — is, then, but habituation to a certain range of temperature. All
other explanations are hypothetical — but petitiones principii — and based
upon assumptions that are unphilosophical to admit, and I pass them
by. The troops transferred by the Pacha of Egypt to the compara-
tively cold mountains of Greece, from the torrid regions of Southern
Egypt and Nubia, perished like rotten sheep, without apparent disease.
The Laplander, transplanted to Louisiana, would die from excessive
heat, if his ordinary power of generating caloric for his indispensable
wants, in his cold regions, was not immediately restrained here. Ne-
groes, transferred to colder climates from Africa or the South, suffer
great mortality from the change, and particularly from pulmonary dis-
ease, from the increased activity required through this system of sup-
plying heat. Monkeys carried to England all die speedily, and mainly
of the same disease, if not confined to an atmosphere artificially heated
for them ; and these illustrations could be vastly extended in corobo-
ration of the position assumed.

" In this view of the subject, acclimation has a wider range and a
more specific application, and is not confined to those coming South
from the North. But they are, I believe, unnecessary ; for actual ex-
perience, when properly tested, is against the admission of the absolute
necessity of acclimation, to any great extent, from one temperate re-
gion to another; at all events, it must be abandoned so far as it de-
pends upon a fixed physical condition, as it regards us, for that we have
not had for many years."

Transactions of the New York Academy of Medicine, vol. i, part i,
8vo. 166 p. Printed for the academy, by S. S. & W. Wood. 1851.

This is the first of a regular series of publications which the New
York academy will make. It is we presume the controlling medical
body of the state, as we see the best New York names on its list of
300 fellows.

The work before us is creditable to the New York profession, and
from the eleven papers and reports which it contains, we may in future
take many valuable extracts.

An Address on Medical Jurisprudence; its claims to greater regard
from the Student and the Physician, delivered before the fellows of the
Massachusetts Medical Society, at the annual meeting, May 1851. By
David Humphreys Storer, M. D.

Our thanks are due to the author for this able appeal in faVor of so
important but neglected a branch of medical education as medical
jurisprudence. There are few men in even the larger cities who are
competent experts in criminal cases, or even before coroners' juries.

468 STRINGFELLOW ON MINERAL WATERS.

This is illustrated and the general ignorance of the subject is displayed
whenever an opportunity occurs. We know that our friend Dr. Sto-
rer, (who is an effective speaker and handsome writer,) impressed his
auditory with the importance of his subject, and we wish that his ad-
dress could be very generally read.

A New Sign Language for Deaf Mutes ; a Graduating Thesis sus-
tained before the Buffalo University. By Albert J. Meyer. Pub-
lished by vote of the faculty.

The author of this thesis very ingeniously establishes the practica-
bility of the alphabet used for Bains' telegraph, and its superiority
over others in use for conversing with deaf mutes. Its chief advan-
tage seems to us to consist in its usefulness in the dark, or by touch,
as well as by sight. The thesis has been well received by the unfor-
tunate class for whom it was intended, and is an useful invention.

Two Letters on Cases of Cure at Fauquier White Sulphur Springs;
embracing also Mineral Waters in general. By Reverend T. String-
fellow. 8vo pamphlet, 18 p. Washington, 1851.

This is a pamphlet which was sent to us by some kind, unknown
friend. We paid no attention to it until we found that it had been
thickly distributed among all classes in all places, and gratis. We
do not know but that it has been used as a profitable means of ad-
vertising the already popular watering place which it lauds so highly.
If so, it may be no affair of ours to know why a spiritual adviser
should lend himself to such a purpose. If its object was solely a
philanthropic one, "for the benefit of suffering humanity," then, per-
haps, our reverend pathologist may be excused for saying, that " to be
silent while so many hopeless sufferers are strangers to this merciful
provision of a gracious God, would be a sin." But such is the language
of both quack and empiric. And, not to judge our neighbor unad-
visedly to be of the former class, we must make an earnest remon-
strance with him for his empiricism. If the Reverend Mr. String-
fellow had appended the two letters M. D. to his name, we should
have considered his pamphlet not worth noticing, as a professional
production ; but as the thing is circulated far and wide upon the
merits of a religioso-medico testimonial, to exhort our patients, va-
riously afflicted, to go out of our hands, and seek "the peculiar pro-
visions of the Almighty for them in the fountains of healing waters,
gushing forth from the laboratory of God," ( ! ) we "think it a sin to
be silent." Mr. S. says :

" To medical men the right belongs of settling the category to
which a particular case belongs. When, therefore, an invalid ascer-
tains tot what class or family of disease his belongs, he then wishes
to know, in reading a communication of this kind, whether the water
has cured diseases of that class or character. If it has, then a
ground of hope is furnished that his may be cured also."

STRINGFELLOW ON MINERAL WATERS. 469

" I have used all the caution 1 could to guard against pathological
mistakes."

He ascertained the names of the diseases, and writes that many
of them were incurable by the best men of science, so he urges
(or his effect is to urge) all such to come up to Fauquier.* Among
the numerous ailments which he says these waters will cure,
are the following: Dyspepsia, ten cases are given; Dropsy, eight
cases; Kidney Disease, (Bright's perhaps,) five cases; Chronic Diar-
rhoea, four cases. Female Complaints: "the effect is truly gratifying
in cases which baffle the highest professional skill. * *

Thousands would resort to these waters if they were apprised of
their alterative power and vitalizing energy.'1 Schirrhus Affec-
tions: "these springs cure, while the others aggravate cancer."
Chronic thrush: " after the efforts of science were defied, these waters
soon rendered a lady as fine a specimen of health as I ever saw."
Bronchial Affections, Chronic Rheumatism, Snake Bites : " this water has
been resorted to and furnished entire relief in a very short time." Is
not the old woman's remedy of getting drunk more reliable? Affec-
tions of the Lmigs: " cases of a very hopeless type have been cured by
the use of this water, almost as far back as the memory of man
reaches." Eruptions of the Skin, Poison Oak, and so on, are nothing
now; and indeed we must all go there from the " tideivater region."
Hear :

" I was struck with what seemed to be a peculiar effect of this
water on persons apparently in health, from the tidewater regions of
the state. It appeared to act as a specific on their liver and skin,
throwing out bile in considerable quantities from the liver, and a
large amount of purulent matter through the skin. During the
escape of this matter, and through these organs, debility prevailed,
and subsequently the system was toned up with astonishing ra-
pidity."

But we must conclude with this pamphlet lest just complaints be
made of giving it more importance than it deserves. In doing so,
however, let us be understood. We believe the Fauquier White Sul-
phur springs to be valuable to invalids, and as a place of resort, they
are surpassed by few of the watering places of Virginia; but as for
the water being a panacea, or the advice of any admiring minister of
the gospel being relied on by invalids, they are preposterous. With
such trash as the pamphlet before us the uneducated opinion and dis-
eased bodies of the public are fed. To aid in counteracting injurious
consequences and averting sad disappointments, we have thus freely
spoken our candid opinion of Mr. Stringfellow' shook. He is doubt-
less a very good, worthy man, but " Burkes Work on the Mineral Wa-
ters of Virginia" will doubtless give better medical advice than this
pamphlet ; and if the industrious parson has any facts to furnish, the
committee on mineral waters of the medical society will, we dare say,
be glad to receive them.

* Rev. Mr. S., by virtue of his profession, does not pay doctors' bills, nor perhaps hotel
bills. He also gives medical advice gratis. How is it with funeral expenses at the springs ?

55

470 PREACHERS AND PHYSIC.

In this connection, we have a few words to say in regard to
Preachers and Physic.

The. influence of the clerical profession over the public mind in
matters temporal as well as spiritual, is unduly great in this country,
and we are sorry to say that this influence is courted and exercised
on every occasion and in every affair of man where it will be tolerated.
Not only the whining, shaved head, ignorant or hypocritical brawler,
clothed in the straight laced garb of psalm singing fanaticism, or in
the armor of popular bigotry or religious sectarianism, but the meek,
mild, philosophic, unpresuming, educated and good devotee to chris-
tian labor, seems to regard himself as a general agent and adviser of
everybody in everything. The ancient priests, some of whom were
possessed of treasures of medical knowledge, are abused for every-
thing bad, still their modern successors seem determined to hold fast
to many of their ways, and are loath to give up the position of medi-
cal as well as spiritual adviser. Without being at all disposed to
make a captious and uncalled for criticism on this privileged class,
(and we know that any remarks on the Touch-me-not family will not
do us any good,) we are sorry to say that the preachers are the greatest
quacks and the most influential dead weights to the progress of medi-
cal science in the country. From their peculiar studies and associa-
tions, being always looked up to as indisputable authorities, and never
being denied or controverted, they very naturally become dogmatical
and positive men, both in conversation and in dissertation. They
surely have enough to occupy them in their own profession, and have
ample field and scope for industry and genius ; but it is a part of their
vocation to visit many sick chambers, where, like the old women, they
soon pick up some little idea of symptoms and the uses of physic,
which not knowing how to apply, and having an irresistible desire to
attempt it, they abuse, and not unfrequently too, to the detriment of
scientific medicine as well as of the poor object of their officious kind-
ness. From their influence over the public mind, their names become
valuable appendages to the credentials and certificates of all the hum-
bugs, quacks, charlatans and impostors who have such a sway over
the land.

Each newspaper, nostrum bottle and quack circular, will bear us
out in the above assertion. And why are they thus arrayed against
the medical corps ? The two professions should rank together — both
are, or ought to be, devoted to the great cause of good to the human
race. In practical, self-denying philanthrop}^ physicians are not sur-
passed by any. Their charity deeds are more numerous and more
onerous than those even of missionaries. Small compensation and
heavy expense attend them always. They have to " pay the parson"
for getting married and for getting buried, while the parson don't
" pay the doctor." Though the former may be surrounded in his
rent-free parsonage by all the comforts, even luxuries of life, enjoying
by way of present, a bit of all the good things which come in possession
of any of his numerous flock, rarely subject to tavern bills, and generally
receiving in fees or fixed stipend a handsome salary, he merely asks
for his poor doctor's bill, never expecting it to be rendered. Even

SELECTIONS. 471

though the minister be under a salary of one or two hundred dollars
only, he has every comfort of life free, snve some little considerations ;
he pays no doctors' and few other hills, but at ihe same time he requires
punctual attendance, must know all sorts of things about the kind of
physic he takes, its object, &c. &c.

On leaving his well attended and cared for Rev. invalid, the doctor
perhaps is called to see some poor widow or orphan girl, who makes
by her industry $ 100 or $ 150 per annum, with which she rents her
room, keeps it and herself so tidy and neat that the medical man has
little idea of her occupation and resources. After a most patient
sickness and ill-afforded loss of time, she sends for her bill, and it is
paid, or a painful apology is received. These poor honest souls are
sorely grieved to give the doctor trouble, and then be considered by
him objects of charity. They however are ever mindful of the
slightest kindness received, and stiive to advance the interests of
their doctor in every manner in their power.

How is it with the Gospel man ? He may have received the gra-
tuitous services of some striving physician for years, but upon the ad-
vent of some brother of his own church or congregation, the ties of
family physician are suddenly rent asunder, and " Brother New-
comer" receives the distinguished honor of being made physician to
the parson. This is not all — Brother New-comer is recommended
warmly and knowingly to the congregation, and through them favora-
bly introduced to the public. The practice of the unpaid doctor is
lessened — bread must be taken from his mouth for Brother New-comer
Sectarian. These things are of two frequent occurrence for denial,
and it is time that the antiquated custom of practising gratuitously
upon clergymen and their families should be abandoned, for it is no
longer a sensible custom. Of course if they cannot afford to pay, they
belong to the class of indigent, patients, and must be charged like pau-
pers, with gratitude.

All the exchanges and many other publications have been received.
Notices of many of them are omitted only on account of the crowded
condition ot the present Number.

Trial for alleged Rape — Curious question of fact — Judge, jury
and counsel in a dilemma.

[Reported by J. H. D., M. D., South Carolina.]

At our April term in this district, a man was tried for the crime of
rape. The rape was alleged to have been committed in the erect po-
sition. The defence was based on the supposition that it was impossi-
ble that such an act could be consummated in that posture; and the
jury acquitted the prisoner.

I am not aware that it has ever been attempted to demonstrate that
a rape could be committed on a woman in the erect position. I in-
fer this, from the fact that no reference was had by counsel, on the tri-
al, to any case of the kind. Chitty, in his Medical Jurisprudence, is
silent on this question ; nor have I met with anything on the subject
in any work I have read.

472 SELECTIONS.

The state's attorney admitted he could not conceive how such a
thing could be done, but contended that a rape had been clearly
proved. Judge E , in his charge to the jury, stated, that the find-
ing of guilty, or not guilty, turned entirely on the question at issue.
The jury, after an absence of about twenty minutes or half an hour,
returned with a verdict of " not guilty."

The woman left the house of the prisoner, where she had been stay-
ing all night. She had not gone far before he overtook her ; they
walked side by side, he embracing her all the time and treating her
with great rudeness. Upon crossing a branch, he said he would "do
it or die." She replied she would "die" before he should. Upon
this, he confined her left hand under his right arm, with his right arm
around her body, and forced her back against a tree, in which posi-
tion the act was consummated, as alleged b}' the woman.

It was proved that the plaintiff had on her back or loins an in-
jury of some kind, which disabled her about three weeks ; the plain-
tiff swore that the hurt was received in the act. This injury could
not be accounted for, and was supposed to be a common boil or rising.

It was proposed by counsel to submit the question to physicians, as
a question of science, as to whether a rape could be committed in the
erect position. The judge objected, saying it was not a question of
science, and that any other person could explain it as well as physi-
cians.

Now let us enquire, what are the essential conditions necessary to
commit a rape in any position? The first and most essential condi-
tion is, that the body of the victim be fixed — immovably fixed — so
that lateral motion or rotation be impossible, and her hands be so con-
fined that she could not use them to any advantage ; these conditions
would be indispensable in the horizontal position. Could they be
possibly secured in the erect position? Could the act of copulation be
consummated in the erect posture by a man and woman, if both were
willing ? I think no one will deny this. If, then, the woman can be
brought by force and against her will, into the necessary posture, and
the other essential conditions secured, there is no reason to deny the
possibility of the consummation of such an act.

In the horizontal position the ground would furnish the point d'appui,
and in the erect position a tree would answer the same purpose.
Suppose a man in an attempt to commit a rape in the horizontal po-
sition should find himself foiled in consequence of his inability to fix
his victim, or secure the conditions above specified, would he not be
greatly aided in his efforts b}r fixing his hold on any immovable object
that mi^ht present itself, as a root or bush, &c? Would not such
hold give him greatly the advantage when there was nearly a prepon-
derance or strength on the part of the female. Who lias not witnessed
wrestlers resort to this means to mantainthe advantage they had gain-
ed over their antagonists, when without such aid they could not have
succeeded in their object.

It was contended to be impossible that in the erect position he
could have introduced the virile organ, without the use of his hands,
into the vagina. The woman swore that she felt his " private part

SELECTIONS. 473

in her body." The counsel for the prisoner related an anecdote of
England's Virgin Queen," who, in conversation with one of her cour-
tiers on this indelicate subject, expressed the opinion that the consum-
mation of such an act was impossible under any circumstances. Ta-
king down a sword and unsheathing it, she requested him to introduce
it (the sword) into the scabbard while she held it; every attempt to
do so, however, was foiled by an adroit movement of the scabbard.
This anecdote, though productive of considerable merriment, contain-
ed not a particle of argument, as it excluded one of the essential con-
ditions, viz. the fixedness of the vagina.

In regard to the erect position, it is evident the introduction of the
penis into the vagina would be no more difficult, other things being
equal, than in the horizontal posture — their bodies bearing the same
relation to each other erect as horizontal. On the ground they would
be parallel — erect, they would be the same.

Again, it was contended that it was impossible that he could hold
her in that position till he could accomplish his object. The prisoner
was a strong and active man, and could entirely overpower a weak
woman, (for she was not a very strong woman,) and keep her still in
that position as well as in the horizontal, with the aid which the tree
would afford him.

In answer to many questions put to her in reference to the position
of her arms and his — how he held her, &c. — she replied, that she was
so frightened and agitated that she could not recollect all the minutias.

It was contended she might have used her right hand in preventing
the final consummation of the act; but it must be recollected her right
hand as well as her left was confined and pressed between him and
the tree, which greatly aided him at the same time it rendered her
arms powerless and useless. If she attempted to extricate her arms,
her elbows would come in contact with the tree, and render all at-
tempts of the kind nugatory. If we suppose he passed his arms
around the tree, which was proved to be a " spruce pine," the tre-
mendous pressure he would be enabled to exert on her body would
have the effect to fix and render her immovable and powerless ; while
on the other hand the support the tree would afford would enable
him to maintain the erect position and accomplish his diabolical design
as effectually as on the ground.

The tree, which was a spruce pine, does not grow very large in this
region. The bark of this tree grows very thick, and is divided into
deep, longitudinal fissures, in which he would be enabled to fix his
hold, and would afford him all the advantages necessary to enable
him to accomplish his object, and that as effectually as in the horizon-
tal position Upon this principle also we are enabled to account for
the injury proved to have existed on her back. The rude pressure
against the rough bark of this tree would not only aid him in render-
ing her immovable, but the muscles of her lumbar region would be
contused, and inflammation and suppuration wrould ensue.

Further, it was contended that the separation of her thighs and the
introduction of his virile member could not have been effected with-
out the use of his hands. But I cannot conceive how this would be
more difficult in the erect posture, other essential conditions having

474 SELECTIONS.

been secured, than in the horizontal ; and an argument based upon
such a supposition would be equally forcible against the possibility of
such an act being committed in the horizontal position.

Case of Malformation in a Child.

BY M. EMANUEL, M. D.

I was called to attend Mrs. H. in labor with her fifth child, and in
about an hour she was delivered. In dividing the cord, I observed
some malformation about the umbilicus; and as there was considerable
flooding, I handed the child over to the nurse, and said nothing until
after the expulsion of the placenta, to the upper end of which was at-
tached a sac, containing a pint of coagulated blood. As soon as the
mother was relieved, 1 examined the child, which had the following
singular malformation: At each side of the umbilical opening, two
small glands projected half an inch externally, resembling the testes,
and very vascular. There was no penis, but a Well formed scrotum,
without testes, and no orifice at the anus. The right leg, from the
knee joint to the ankle, was half the leugih of the other, and in place
of a foot, there was a continuation of cartilaginous substance about
four inches in length, resembling a finger, with an extensor and flexor
attached to the end, movable at will. I made an incision in the peri-
neum, and introduced a female catheter, without any difficult}', three
inches up the rectum, but no discharge came away. Before leaving,
I left directions with the nurse to notice if the child had any evacua-
tions, and where they escaped. In all other respects, it was a fine,
healthy looking child. I thought I would not say anything, to the
mother at the time ; but as I was leaving the room, she enquired
if the child was marked with the figure of a horse, as she said that a
little before she found herself in the family way she had a fright; that
one of her children had fallen between a horse and cart, and she fan-
cied the horse had kicked him and forced his entrails out. This im-
pression was strongly on her mind during the whole period of her preg-
nancy, although the boy was very little hurt. On visiting her the next
day, the nurse said the child took some food, was very lively, and
that it had passed both urine and feces, but that it all escaped at the
navel. On making further examination, I noticed something of the
shape and size of a French bean between the twosmall glands before
mentioned, with an orifice in the centre of the flat surface from which
the urine escaped. On the second and third day the child took the
breast, the evacuations continuing as before, although the passage
into the rectum was perfectly i'vee. On the night of the third day the
child was taken sick, and died on the fourth day. after its birth. I
visited her every day, though several miles from my residence, with
the intention of obtaining the child after its death, for the purpose
of making a preparation. Unfortunately on that day I was so much
engaged that I could not get there, and they buried it immediately,
I know not where, to prevent my having it. You are aware how dif-
ficult it is for country practitioners to g< t a post mortem examination,
or obtain parts for preparation — Med. Examiner.
Marcus Hook, Dei. Co. June 1851.

SELECTIONS. 475

Professional Secrecy to be inviolable even in Courts of Justice.

We call the attention of our readers to the subjoined extract from
the " Charge," delivered by Professor S. H. Dickson to the graduating
class of the medical college of the state of South Carolina, in March
1851. Emanating from this distinguished source, these views must
carry great weight with them, and if practically adopted, will vindi-
cate the whole body of the profession from the imputation of moral
delinquency of this character, of which a few have been guilty. All
honor, then, to him who suffered imprisonment rather than betray the
confidence professionally reposed in him ! — Charleston Med. Jour.

" The sacred confidence placed in you, from the necessity of your
relations with those who commit themselves to your care, is a trust
never to be violated. 1 know of no contingency that should form an
exception to this stringent rule. It is but recently, however, that a
member of our profession in France has fallen under the penalties of
the law, for a refusal to give testimony in open court, that would have
included a revelation of secrets confided to him by a patient under
medical treatment; and although strong remonstrances have been
made to government in his behalf by his brethren and associates, yet
the support thus given him, I regret to say, has not been, as it should
be, unanimous. A small party has been enlisted in opposition, and
one respectable journal at least has advanced the opinion, that for the
purposes of justice, a physician should be compelled to testify to facts
that can be known to him only in his quality of professional adviser.

" I protest against the introduction of any such doctrine into our
code of ethics. Confidence between us and our patients should, and
must be, as implicit and inviolable, as between the pious Catholic and
his confessor; as between the culprit indicted at the bar, and the at-
torney provided for his defence by the court.

The persons of both these functionaries are protected by universal
usage, if not by any positive statute, against any compulsion or pe-
nalty for a refusal to communicate what may have become known to
them by the peculiar intercourse arising under the inevitable necessi-
ties of the occasion. If we are not similarly protected, let us sacrifice
ourselves freely for a great principle, which will soon be established
by firm resolution on our parts. Let us hold him infamous and an
outcast., who under any threat, or any infliction, shall divulge a fact
voluntarily made known to him under the seal of professional honor,
and for the purpose of obtaining aid from the art of healing. The
ends of justice can never be permanently furthered b}r any course that
shall imply a dereliction of that mutual faith, upon which all human
compacts must be founded. I will not deny the possibility that some
wretch, under the abused sanction of an alleged professional interest,
and in shameless infraction of the sacred trust invested in him, may
lend himself to assist in the perpetration of crime, and in the conceal-
ment of guilty purposes. But this perversion of the high offices and
privileges of our profession always arouses against the offender the
unsparing anger of those whose fraternity he has thus disgraced ; and
even a well loundedand reasonable suspicion, unless clearly removed,
leads infallibly to his prompt denunciation and public expulsion."

476 CIRCULAR.

Be kind enough, Mr. Editor, to find a place in the Stethoscope for
the subjoined circular to the physicians of" Virginia and North Caro-
lina. It is hoped that every medical man rna}7 consider himself as
individually addressed, and may find it convenient to furnish the
required information.

Richmond City, July 1851. RO. W. HAXALL.

Sir: — The American medical association, which convened at
Charleston in May last, have appointed the undersigned a committee
to report to the next annual meeting, which will be held in Richmond
on the first Tuesda}7 in May 1852, on the epidemics of Virginia and
North Carolina.

The committee desire to embrace in their report the years 1850 and
1851; and as they are not aware that any record, is anywhere to be
found of the epidemics of these two years, or, indeed, of any other,
they are constrained to seek information from the practitioners of
medicine dispersed throughout the various towns and counties of the
two states.

In order to render the information to be received as uniform and as
precise as possible, the committee beg leave to propound the follow-
ing propositions. It is earnestly hoped that answers may be returned
by the 1st day of January 1852. This will allow time for the several
members of the committee to compare notes, and make out a full
report.

Stale :

1st. The topography of the region of country in which vou re-
side.

2d. The geological features of the same.

3d. The mean monthly temperature and other climatic charac-
teristics.

4th. The epidemics of both years (1850 and 1851.)

In connection w7ith each epidemic, state :

(a)The period of the year when the earliest cases appeared, and
the length of time the epidemic continued.

(6)If confined to any particular section of the district in which
you practise, state its topographical peculiarities.

(c)The trades and occupations of individuals attacked ; their ha-
bitual exposure to weather, the use of ardent spirits,
usual diet, &c.

(c^)The symptoms of the several stages of the disease.

(e)The post mortem appearances.

(/)The treatment pursued.

(g)The rate of mortality.

Physicians residing West of the Blue Ridge will direct their replies
to Dr. James L. Cabell of the Universit}'- of Va. All on the Eastern
side of the same, to Dr. R. W. Haxall, Richmond.

RO. W. HAXALL. M. D. }

JAMES L. CABELL, M. D. > Committee.

JOHNSON B. JONES, M. D. S

THE

AND

VIRGINIA MEDICAL GAZETTE.

No. 9.]

RICHMOND, SEPTEMBER 1851.

[Vol. I.

Reports of American Asylums for the Insane.

With one or two exceptions, we have before us the latest reports of
all the asylums for the insane in America. And we would go on to
extract from these documents such facts and opinions as are calculated
to interest the medical world ; and secondly, aught like a novelty in
relation to the subject of insanity. These reports are calculated to
prove interesting to those having the management of the insane. But
taken as a whole, and to the general reader, they are of course liable
to the same disadvantages that attend all articles in the shape of mono-
graphs. In other words, not unfrequently the most valuable produc-
tions of this character will least please the mass of readers. Still the
greater part of the reports of American asylums are composed in a
plain, clear style of writing, with few technical terms, and, as far as
possible, rendered somewhat suitable to the public at large. With
regard to their characteristic features, it may not be amiss to refer to
the following flattering remarks of the learned and accomplished edi-
tor of the great organ of medico-psychological science in Great Bri-
tain. Whilst speaking of analogous documents coming from English
asylums, he goes on to observe, " So far as reports are concerned, we
may with justice assert, that they manage these things better in the
United States. We have had occasion from time to time to notice
some of the Trans-Atlantic reports, and we unwillingly acknowledge
that, in many essential points, they are greatly superior to most of the
pamphlets under notice."

The State lunatic hospital at Worcester, until the last few years,
was under the care of Dr. Woodward. The trustees, in regretting
his recent decease, remark in their report for 1850, that " This hos-
pital may henceforth be regarded, and by the grateful hearts of a
long succession of trustees, officers and patients, it will be always re-
cognized, as the Woodward monument." A portion of the commu-
nity in the neighborhood testified their estimation for the services thus
referred to, by presenting to the hospital a bust of Dr. Woodward.

Of the 3598 patients who have been inmates of the hospital at
Worcester, according to the report, seventeen committed suicide.
56

478 REPORTS OF AMERICAN ASYLUMS FOR THE INSANE.

Concerning epileptic lunatics, the most hopeless of all cases of men-
tal disease, Dr. Chandler, the superintendent, remarks in his report —
" Most epileptics enjoy the pleasing delusion of believing that their
fits are constantly becoming lighter and more unfrequent." We have
witnessed this same phenomena in many of these unfortunates. It
seems an instance of the law of compensation running through the
operations of nature ; thus the Divine Love ever " tempers the wind
to the shorn lamb." As to the treatment of epileptic insanity, Dr.
Chandler very truly observes, that " little can be done effectually in the
way of medical treatment. In slight cases, stramonium, nitrate of sil-
ver and sugar of lead have got some reputation. In a few cases, uncon-
nected with insanity, a mitigation and a cure even has followed their
protracted use. But the instances of recovery are rare. The pros-
pect before them is always cloudy; and experience tells us that it
will invariably grow darker." During the spring twenty-five cases
of erysipelas occurred. It was noticed that those patients who occu-
pied rooms nearest the hot-air furnace were most liable to its invasion.
The air here is rather hot and dry than otherwise. Some of the floors
where this disease prevailed are but seldom wet.

In the report of the Maine state hospital an account is given of the
awful catastrophe attending the burning of a part of that institution.
This has already appeared in the columns of the daily press. The
acting superintendent, Dr. Harlow, advances some remarks as to the
medical treatment of insanity. He states that he rarely resorts to
bleeding, and that drastic cathartics are usually objectionable. Laxa-
tives and the milder cathartics he uses freely. An emetic he thinks
occasionally advantageous. Blisters, setons and other counter-irri-
tants he considers valuable and efficient agents in certain cases.
But his main reliance is on tonics, sedatives, narcotics and revo-
lutionists. Particular attention is paid to the skin, and warm and
cold bathing, according to the indications, are employed to restore
this emunctory to its natural functions.

In the report of the Boston hospital Dr. Stedman makes the fol-
lowing judicious remarks concerning the treatment of insanity: "In
the treatment of recent and curable cases medicine is often but not
always resorted to. By medicine I mean articles of the materia
medica which are known or supposed to produce a remedial effect
on the recipient. I make this explanation, because it is thought
strange by some that an insane person should recover without being
potently drugged : whereas the simple fact is, that the remedies
most in use in our asylums are not sought for in the apothecary's
store. Everything — every object recognized by the senses — the food
taken, the air inhaled, the rest obtained, the restraint imposed, the
exercise, occupation and amusement engaged in ; the architectural
arrangements — even the size or situation of a window or of a door, a
grating or a fence ; the objects of the natural world — a tree, a plant, a
bird — all or each of these may exert an influence more or less direct
and powerful for the recovery of the patient, which all the hellebore
of the ancients, with all the opium of the moderns, alone never could
effect."

REPORTS OF AMERICAN ASYLUMS FOR THE INSANE. 479

In the report of the McLean asylum is recorded the extraordinary
munificence of William Appleton, Esq., as displayed by him to this
institution. In 1843 he made a donation of ten thousand dollars to
aid such patients as might otherwise, from straitened means, be com-
pelled to leave the institution without a perfect cure ; and during the
year included in the present report he placed twenty thousand dollars
at the disposal of the trustees, in order to erect two edifices, designed
to accommodate each eight inmates. These additions are intended
for the very wealthiest class; in other words, to furnish such luxurious
and appropriate accommodations as have never been found elsewhere
before, perhaps, in any country whatsoever.

With regard to having schools in lunatic asylums, Dr. Nichols re-
marks, in the report of the Bloomingdale asylum, " Within a few years
great and praiseworthy efforts have been made to educate idiots and
imbeciles, and the results have been most encouraging ; and I believe
that results of a similar kind, and not less extraordinary, might be
achieved upon a considerable class of incurables to be found in our asy-
lums, if they could be subjected to continuous and systematic bodily
and mental training, by persons fully competent for such a duty."

The lunatic asylum for the poor of the city of New York is situ-
ated on Blackwell's island. It is an object of peculiar interest, in the
fact of containing a larger number of insane inmates than any other
establishment for lunatics on this continent. It stands in the same re-
lation to our great commercial emporium that the Salpetriere and Bi-
cetre bear to Paris, and the Middlesex county asylum at Hanwell to
London. But whilst from these foreign asylums more has emanated
in relation to the subject of insanity and the treatment of the insane
than from any other source, no fruits in this regard have attended the
extensive collection of unfortunates on Blackwell's island. The ef-
forts and writings of Pinel and Conolly, physicians respectively at
the Bicetre and at the Middlesex asylum, will never be forgotten ; and
a number of other medical men might be mentioned, who have effected
the most essential service to the insane generally, from the expe-
rience which they gained at these institutions. Dr. Ranney, the resi-
dent physician at the Blackwell's island asylum, and the visiting
physicians also, deserve all credit for the great exertions which they
have exhibited to remedy the defects which they found on taking
charge of this establishment. The numerical majority in the city of
New York controls all the institutions of that corporation ; the poor
constitute this majority, and it is from their afflicted relatives that are
derived the denizens of the mammoth lunatic asylum j it is then
strange that this majority should have suffered defects to exist there
year after year, without apparently the least attempt to abate them,
or to make this asylum hold the same honorable position, both in a
scientific and in a benevolent point of view, for which similar estab-
lishments attached to large European cities have long been distin-
guished. One regulation which has been very much condemned is,
that instead of providing suitable attendants for the patients, crimi-
nals from the neighboring prison have been taken to fulfil this deli-
cate duty. Dr. Ranney observes, that "the employment of a night

480 REPORTS OF AMERICAN ASYLUMS FOR THE INSANE.

watchman and hired attendants, instead of criminals, is to be re-
garded as one of the most important improvements made since the
establishment of the institution. This change has been repeatedly-
solicited for several years. The prisoners not only steal the clothing
of the patients, but anything else of value which falls in their reach.
As an illustration, the following case may be mentioned as one from
a great number of cases of a similar character : a few years ago, a
young lady who had been insane for some time, was admitted, and
although partially demented, yet her self-esteem was gratified by the
possession of a beautiful head of hair. The morning after admission
it was observed that her head was completely shorn, and after a long
examination the ringlets so highly valued were found in the possession
of a prison aid of the hall, who had committed the theft for the
purpose of selling it to a peruke maker. The prisoner was imme-
diately returned to the penitentiary, and another of the same class (per-
haps worse) was sent in her place."

The trustees of the state lunatic asylum at Utica, New York, men-
tion the purchase of the library of Dr. Brigham by the institution, the
legislature having appropriated fifteen hundred dollars for that pur-
pose; and they remark that they consider it a valuable acquisition,
containing as it does most of the European and American works rela-
tive to insanity, as well as many medical works. In this opinion we
heartily coincide ; it would be, we think, a good plan to have an
analogous library attached to every institution for the insane. The
superintendent of the asylum, Dr. Benedict, touches in his report
upon the medical treatment of insanity. Speaking of chronic cases,
he observes that it requires much attention to preserve the activity of
their functions, particularly a healthy condition of the bowels and
skin. Many, says he, are benefitted by the occasional or continual
use of laxatives and tonics, a few by anodynes, and the paroxysmal
cases by sedatives. As laxatives, he uses aloes, especially the com-
bination entitled the dinner pill, the confection and fluid extract of
senna, magnesia and saline laxatives. As tonics, he prefers the dif-
ferent preparations of iron, the sesquioxide, protocarbonate, and iron
reduced by hydrogen. He also employs sulphate of quinine and ex-
tracts of gentian, valerian, conium, hyoscj'amus and belladonna. Of
cases of acute mania, many come to the asylum in a perfect fury of
excitement, raving, struggling and resisting, exhausted by the journey,
and having taken no food or rest for days. It cannot, therefore, be
surprising, he goes on to say, that a few die. His practice in such
cases is to confine the patient to his room and to his bed at night, and
for a part of the day ; the medical treatment consists of hot baths with
cold applied to the head, prolonged from thirty to sixty minutes, and
frequently repeated at intervals of from six to twelve hours ; free
evacuations of the bowels, if the patient's strength will permit of it, by
the compound powder of jalap, compound cathartic pills, Seidlitz
powders, or citrate of magnesia. In no case has he found local or
general bleeding admissible, but, on the contrary, nutritious diet and
brandy punch are generally demanded. He gives from half a pint to
twelve ounces of brandy a day, and continues it for weeks, as he does

REPORTS OF AMERICAN ASYLUMS FOR THE INSANE. 481

in mania a potu, the two diseases he thinks resembling each other in
their symptoms and post mortem appearances, and admitting of, if
not demanding similar treatment. As a remedy in insanity he em-
ploys the tincture of opium in doses from half a drachm to four
drachms, frequently repeated, more frequently than other narcotics,
alone or with ipecacuanha or antimony. This combination he often
prescribes, and thinks with advantage in paroxysms of mania. Suici-
dal cases he places in associated dormitories, the hands being re-
strained at night. The medicines most usually indicated, he observes,
are laxatives and morphia, and warm baths are also demanded. The
number of patients in the asylum during the year was eight hundred
and sixteen, leaving at the date of the report four hundred and twenty-
nine. The state lunatic hospital of Pennsylvania has been recently
completed near Harrisburg. In the code of laws governing this estab-
lishment, and to the preparation of which the greatest care has been
given, we find several items of interest, peculiarly so in the fact that
they are the latest opinions of the best authorities on the subject. The
board of trustees are appointed by the governor, with the advice and
consent of the senate. Of the nine three go out of office each year.
Another law of the state is, that the "superintending physician shall
appoint and exercise entire control over all subordinate officers and
assistants in the institution, and shall have entire direction of the
duties of the same." With regard, indeed, to the appointment of
these, and indeed all other persons connected with the management
of the asylum, in several of the institutions most recently established,
the strictest precaution is taken so to conduct the fundamental laws of
the state, that no influence can be sensibly exerted save in direct
reference to the real qualifications of an individual for each particular
official station. Another provision directs, that " in order of admis-
sion the indigent insane of the commonwealth shall always have pre-
cedence of the rich." Again, an example of progress is found in the
by-laws, to the effect that the superintendent H may also employ one
male and one female teacher for the instruction of the patients."

In the report of the Ohio lunatic asylum, the trustees state that they
had appointed Dr. Samuel Hanbury Smith in place of Dr. Awl, who
had previously been superintendent from the foundation of the institu-
tion up to the date of his resignation. Dr. Smith is an English gentle-
man of the highest accomplishments. In his appointment we augur
favorably for the cause of the insane in the progressive and growing
West, and the trustees of the asylum deserve credit in rejecting all
other considerations in bestowing so responsible a trust save those of
capability. The board recommend, as more than once heretofore,
that the legislature shall abolish the distinction of pay and pauper
patients, and shall support all alike in the asylum at the expense of
the state. They also suggest the erection of two additional institutions
for the insane — one in the northern and the other in the southern part
of Ohio. They contemplate establishing at the asylum a botanic gar-
den and an arboretum. Dr. Smith's report is a very able and well
written document. Respecting the management of the insane, he
observes, that " that indescribable qualification, the possession of tact,

4S2 PALMORE ON OBSTETRIC PRACTICE IN VIRGINIA.

is of primary importance, and the art of conversation, of talking well,
is only second to it." Concerning food he speaks as follows : " It
may not be superfluous to remark that the insane not only require as
much, but often much more food, of the very best quality, than the
sane, together with every variety that can possibly be offered them.
They are not convicts, nor paupers, to be fed as simply and cheaply
as possible, but sick persons, in whose treatment a generous diet forms
a very important item."

From the report of the state asylum of South Carolina, we see the
same plan relative to colored lunatics has been adopted as in Vir-
ginia— buildings being appropriated to them at this institution, in-
stead of having a separate asylum for them. The beneficial results
seem also to be analogous to those in our own commonwealth, as was
foreseen before the law fully provided for the colored race in Virginia.

We cannot conclude without referring to the commendable spirit
evinced in all these reports. In all there seems a disposition to fos-
ter and encourage every effort to still farther ameliorate the condition
of the insane, and to test and discuss every improvement in this re-
gard, from whatever source it may originate, whether on this or on
the other side of the Atlantic. J. M. G.

July 1851.

Observations on the Condition of the Obstetric Practice of

Virginia

BY C R. PALMORE, M. D., OF CUMBERLAND COUNTY.

Of the many causes which oppose the advance of medicine to that
station amongst the sciences which it should occupy, and which it
has so indefatigably labored to attain, none present more obstacles
than that hydra-headed monster, empiricism. Whether we consider
it in relation to the infamous doctrines it so sedulously inculcates into
the minds of the people ; whether we view it in reference to its ver-
satile talent of opposition which it exhibits to the medical profession ;
or whether we consider it in its peculiar power of taking to itself the
cloak of that profession, and thus shielding its malignant actions, we
are forced to the conclusion that it bears upon its brazen front the
stigma of being the most implacable enemy to medical advance, the
most irresistible foe to the profession, and the most terrible scourge
with which a civilized community is afflicted.

Had Pandora's box with its dread contents been emptied upon the
medical profession alone, it could not have wrought more direful and
abiding evil than this Janus faced incubus, quackery. Having the
peculiar power of taking upon itself the most incongruous shapes,
endowed with the most unblushing effrontery, totally regardless of
the manner it attains its ends — at one time openly at variance with all
the rules of society, law, order, religion or medicine — at another time
shielding its malignant body behind any of these which might suit its
convenience ; knowing no fear ; ready to meet or circumvent any

PALMORE ON OBSTETRIC PRACTICE IN VIRGINIA. 483

opposition ; and last, with a reckless assurance, it presents the most
depraved, the most infamous, but at the same time the most insidious
and formidable obstacle which exists to medical advance.

With this powerful antagonist both openly opposed to and insi-
diously laboring at the downfall of the profession, it does not become
us to remain supinely indifferent ; but knowing our cause to be that
of suffering humanity, we should be bold and unflinching in our oppo-
sition to so vile and despicable a monster. The whole power of the
profession should be brought to oppose it, and thus the escutcheon of
medicine be cleared of so foul a contamination.

But I do not intend writing a monograph upon the subject of em-
piricism. I only propose making a few observations upon the present
and perhaps prospective condition of the obstetric practice in this
state, more especially with reference to the country practice. I wish
to point out the empiricism which exists in this connection ; so that
some older and more experienced person may suggest some good
system, which may supersede the present imperfect and eminently
unprofessional one ; and thus the object which we all have at heart —
a lofty and exalted profession, untrammelled by empirical connec-
tion— may be at least assisted in its advancement, if not attained.

It would be entirely supererogatory for me to insist upon the im-
portance of this subject. The perils of childbirth, its antecedent and
succedent dangers, are so generally known and commonly admitted,
that it would be useless to insist upon it ; and I have often wondered
that people of known sense and respectability should have the blind
temerity to entrust to the care of ignorant and conceited women
their wives, the partners of their bosoms, whom they are bound by
all laws human and divine, as well as by their own love, to cherish,
in this their time of trial and affliction. Yet this, which should fall
with grating effect upon our ears, is a stubborn fact. I speak advi-
sedly when I state that at least one half the white, and full five-sixths
the black women of the country, are attended in parturition by fe-
males ; and of those which are attended by physicians a portion is
attended only in name ; the midwife treats the case, reporting to the
physician from time to time the progress made ; and it sometimes
happens the physician don't see his patient till after the delivery.
In these cases, if anything should go wrong, his assistance is then re-
quired. Is not this a humiliating fact ? And why is it so? Why
does the profession suffer this state of things to exist ? and why does
a portion of the profession rather encourage it by its negative action ?
These are questions much more easily asked than answered.

False and fatally foolish notions of delicacy, amounting in this
country to prejudice, and the humble adoration with which the peo-
ple worship their tyrannical ruler, custom, may be mentioned as the
most prominent causes why this state of things should exist. Physi-
cians have been remiss in disabusing the public mind of this fallacious
prejudice. This is rather an omission than a fault. I know the power
of prejudice. I know full well that custom sways the people with a
dictatorial will — consequently, I can lay no charge for this at the
physician's door.

484 PALMORE ON OBSTETRIC PRACTICE IN VIRGINIA.

The better to understand the empiricism that exists in this connec-
tion, I will suppose a case :

A young and timid lady is seized with labor. This is her first
pregnancy. Instead of calling in the family physician at once, the
friends, actuated by these false notions of delicacy and by prejudice,
but above all, by the fatal custom of the country, send for the nearest
midwife, an old woman of no education, perhaps incapable of writing
her own name, but filled with her own self-importance and that of
her office. She makes a vaginal examination, and pronounces " all
things right." How does she arrive at this conclusion ? Can she,
who has had no instruction, tell if the os tincae is dilated or not?
Can she distinguish the os tineas ? But suppose it dilated, can she
distinguish the anterior from the posterior fontanel, those Drummond
lights to the intelligent accoucheur? Can she tell the breech from a
shoulder presentation ? I answer emphatically, no. Then why does
she so sanguinely pronounce "all things right?" Because she hap-
pens to know that a large majority of obsterical cases will be de-
livered sua sponte ; and she trusts her case to this fallacious and terri-
bly destructive reasoning. I will pass over her fearful descriptions
of cases that she has managed, which she now volubly recounts to
the bystanders, in hearing of the timid patient, who must be sorely
afflicted by them. I will not describe the hairbreadth escapes made
by her patients under her judicious management, nor will I attempt
to narrate the denunciations which she sometimes metes out against
the profession, nor the eulogiums upon her own peculiar system — all
going to prove her own distinguished invincibilit}r, and the consequent
degradation of her compeers.

But I pass to the second scene in this drama of life. The labor
becomes more and more tedious. The pains are fewer and less se-
vere. The patient is excessively wearied, both with the pains and
the granny's discourse. The midwife herself is fatigued. She there-
fore administers ergot, which she calls by the euphonious name of
forcing powders. The pains by this means are increased, and now
become of fearful violence. The woman is almost frantic with exces-
sive suffering. The midwife becomes uneasy, and the friends, now
awaking to the knowledge of their folly, and perceiving, when too
late, upon what a slender reed they have rested, immediately send
for a physician. He arrives, and quickly understands the state of af-
fairs. Perhaps he has a case of puerperal convulsions, brought on
by the ergot, to deal with, or a rupture of the womb, or else a face
presentation, with the chin to the sacrum. What can he do? Per-
haps nothing. Had he been sent for at first, the convulsions might
not have occurred, for he would not have given ergot, unless he knew
it was required. So with the rupture. And the face presentation
might have been changed to one of the vertex. But now his hands
are tied, and either the child or mother, and perhaps both, must be
sacrificed to satisfy the blind and destructive custom of trusting to ig-
norance things of such infinite importance as the life of a wife or
child. This is a very imperfect picture of what is continually occur-
ring to the country practitioner. No one can say it is overdrawn.

PALMORE ON OBSTETRIC PRACTICE IN VIRGINIA. 485

Now I ask, how long will we suffer this blot to remain on the es-
cutcheon of medicine?

I have heard one of these midwives recount how she had on one
occasion, after the child was born, tied the cord around the bed post,
for the purpose, as she very solemnly observed, " of keeping the after-
birth from going up." These are the persons upon whom the people
of this state so blindly rely in this their hour of trial.

Swift, in his unique and inimitable manner, has described a worthy
follower of Esculapius, that flourished in his day, who wished to con-
vince the people of England that they were all wormy ; and succeeded
so far as to dispose of large quantities of his universal vermifuge. We
all smile at the ludicrous folly and mischievous humbug here glaringly
exhibited. But we do not think of the time that this occurred.

The intellect of man, obscured for so many centuries by the dark
and grovelling superstition of the middle ages, had now just com-
menced emerging from its chrysalis state and giving promise of its
future brilliancy. The medical profession had scarce commenced its
ascent from the crude and imperfect theories of the alchymists, the
humorists and the solidists. The light which the reformation had
thrown upon society had not yet been developed, and man was yet
a fit subject for the quackery of designing men. Then we should not
wonder, much less smile, that this empiricism should exist ; and that
charlatans should grow rich on the ignorance and credulity of the peo-
ple. But in a free, an enlightened, an eminently intellectual country —
in a state whose highest boast is to be perfectly independent of all
corrupting circumstances, and whose hatred to all things low and des-
picable is so well known — at a time when society, having advanced
with gigantic strides, has attained its present exalted pinnacle ; when
medicine, untrammeled by the chains which for so many centuries held
it pinioned to the earth, assisted in its ascent by the mighty genius of
the Hunters, a Bcerhaave, a Sydenham, a Cullen, a Rush, and illumi-
nated by the flood of lights which the brilliant luminaries of the nine-
teenth century have poured upon it, has approached that exalted sta-
tion amongst the sciences which its votaries have so long wished.
Should we not wonder, should we not smile, should we not deprecate
and despise the low, the paltry, yet successful humbugs with which
the people of Virginia have been so long afflicted, and from which the
medical profession has suffered, and is now suffering so much con-
tumely and undeserved reproach. Do we not suffer in comparison with
Swift's physician ? Compared with the more modern empiric, Per-
kins, would we not again suffer? Does not an old negro woman (for
from this delectable class the ranks of these good Samaritans are partly
supplied,) making an examination, and old Sangrado administering his
hot water and blood letting for all the ills to which flesh is heir, form
a fair picture of imbecile ignorance and blind depravity ? And who
gains by the comparison?

That this system of trusting to ignorant females women in child-
birth is on the increase in this state, I am unable to say, and I cor-
dially hope it is not ; but that the idea of advancing women to the post
of physician is on the increase in the United States, no man who is ac-
57

486 LITTLE ON THE USES OF GUTTA PERCHA.

quainted with the progress of events can for a moment doubt. Some
miserable fanatics have obtained a charter for a female medical col-
lege in Philadelphia, and I see by a late announcement that the class
consisted of thirty females at the last session. Fruitful source of un-
known mischief! I read in a late number of the Stethoscope an edi-
torial justly and severely condemnatory of a pamphlet entitled " An
appeal to the medical society of Rhode Island, in behalf of woman
to be restored to her natural rights as ' midwife,'1 and elevated by edu-
cation to be physician of her own sex." Do we not frequently see
notices of women applying to our colleges for the right to offer for di-
plomas ? What does all this indicate, but a decided increase of this
fanatical spirit. And to what does it tend ? I answer emphatically, to
the degradation of the profession. Then why do we stand all the day
idle and suffer this spirit to spread, when a decided stand by the pro-
fession would do so much to confine it within its present limits, if not
entirely eradicate it. And how can we better attain this end than by
a firm and determined opposition to the infamous system which I have
been attempting to describe as existing in Virginia.

I have thus feebly and very imperfectly presented some of my
views on this subject, which I consider of paramount importance to
our profession. I have refrained from offering any plan by which the
evils herein so imperfectly portrayed might be alleviated. I have
been actuated in this, partly because I was fully sensible of my ina-
bility to mature such a plan, but more especially from my belief that
the whole subject should be attended to by some authoritative body,
as for instance the Virginia medical society; and whatever plan it
might determine upon would carry with it its corresponding weight.

Stony Point Mills, August 1, 1851.

G-utta Fercha — Its uses to the Physician and Surgeon.

BY JOHN P. LITTLE, M. D., RICHMOND CITY.

As this article is not as well known as it should be, I have put to-
gether some account of its uses and advantages, and of the manner in
which it is wrought into various shapes. My wish is to call the at-
tention of country physicians to the fact that it will save them much
trouble if they possess and know how to use this excellent substance.
It is a product of the East Indies — the dried juice of a tree ; a tough,
fibrous substance, of a dark brown color. As it seems scarcely acted
on by any other agent than heat, and as when heated it will take
any form you give it ; as it is very tough and strong, and is unaffected
either by the temperature or by the secretions of the body, the physi-
cian will at once perceive its great value and the variety of uses to
which it may be put. Of it are made splints, stethoscopes, bou-
gies, catheters, uterine and ear specula, stomach tubes, pessaries,
handles for surgical instruments, caustic holders, tents, e}'e-glasses,
sheets of water proof stuff for dressing injuries, &c, &c, &c. The
good sense of each physician will teach him how to make use of it in
various cases. It will be found specially adapted to fracture occurring
in children, to fractured jaw, or to injuries of joints.

LITTLE ON THE USES OF GUTTA PERCHA. 487

To ascertain a good article, take a small piece, soften it by heat
and roll it ; if when cold it is tough and strong, the gutta is good ;
sometimes it breaks like a pipe stem and is good for nothing.

To prepare it for use it should be cut into pieces and torn into
strips, that impurities may be easily shaken out. Let it be then softened
by boiling water, and rolled out in thin sheets. When these are dry,
a stiff brush passed over them will sweep away the remaining impu-
rities. The gutta should be then softened frequently and rolled to-
gether, its fibres mixed thoroughly, that it may become a homoge-
neous mass. In making catheters it is necessary to select the best gutta
and prepare it with care ; having well selected and well prepared the
article, take a small piece, soften it, pierce it with a wire, and on
this roll it carefully, softening it as it is needed ; when it has thus ob-
tained half the length and double the thickness of the catheter re-
quired ; let it cool, and then, fastening one end to the tube securely, lay
hold of the other with a pair of forceps and pull it out. It will be
found that it can be pulled out to twice its length and no farther, un-
less force enough be used to break it. Insert a wire of proper size,
close one end by heat and make orifices ; the catheter is complete.
A polish may be put on it by passing it rapidly through the dry flame
of a spirit lamp. This excellent catheter resists better than the gum
elastic ones the action of urine, can be made of any size by the sur-
geon whenever it is needed, and does not cost more than half a cent
in price of material. Some mix lampblack with the gutta, to render
it less easily softened by heat ; any mixture however makes it brittle.
Flexible stethoscopes can be made in a similar manner. It is a pe-
culiarity of gutta percha that when pulled out in this manner it be-
comes elastic ; a property it had not before possessed. These are
only some few uses to which it can be put ; they are endless, and ex-
tend from serving to rub out lead pencil marks to making artificial
palates. Out of the profession shoesoles, horsewhips, bridles, water-
pipes, picture frames, &c. &c. are made with it.

Gutta percha resists cold and moderate heat ; it is not acted on by
the secretions ; the acids and alkalies do not affect it, or but very
slightly ; iodine and nitrate argentum do not alter it ; sether and
alcohol leave it untouched ; only two substances dissolve it — chloro-
form and boiling turpentine, and of these solutions I will speak a few
words. Forty grains of gutta percha dissolved in an ounce of chloro-
form make a reddish brown liquid, similar in properties to collodion,
although not quite equal to it. I have applied it to sore nipples and
to ulcers, over which it forms a transparent cuticle, protecting from
external injuries and allowing the healing process to go on. It serves
as a styptic to fresh cuts and to leech bites, and might be of use in
chilblains, in preventing the effects of pressure forming bed sores, in
protecting the heel from injurious pressure in cases of fracture, or
perhaps in annoying eruptions a covering of it would allay the
irritation.

One use that I have put it to is, to protect surgical instruments
from rusting. By dipping them into this solution they become coated
with a thin pellicle of gutta percha, which protects them from air and

488 CORBIN ON COLLODION IN AMPUTATIONS.

moisture, and which can be easily rubbed off or wiped off when the
instrument is used. It serves also as a covering for packages of
vaccine matter ; although the common gutta percha, rolled out and
applied by heat, serves even better for such a purpose.

Another use is to render pills tasteless by dipping each one in this
solution ; the covering formed prevents the taste and does not hinder
the effect of the medicine. Capsules could be formed of it for ad-
ministering copaiva or other nauseous medicines.

The other solution is made by cutting up from half an ounce to an
ounce of gutta percha and dropping it into a pint of boiling turpen-
tine. It makes a good application to burns ; the turpentine is of use
in such cases, and the gutta would form a covering to the injured
part. Waterproof paper is made by saturating it with this solution,
and can be put to many uses. It serves a purpose similar to thin
sheets of gutta in using water dressings ; or, as oiled silk does, it
will retain volatile stimulant applications to any part. As the
strongest aqua ammonias has no effect on it, we can apply this power-
ful stimulant by simply pouring it on the paper and binding it tightly
to the part. Opiates, turpentine, tincture cantharides, &c. can be
thus applied and over large surfaces. The lower extremities can be
wrapped up in sheets of this paper, or the whole chest stimulated by
means of it ; nervous headache, nauseated stomach, or any local pain
can be similarly treated.

Of course in applying it we should use moderate heat, that it may
fit more closely. From its toughness and strength it will last a long
time and serve for many applications. Another use of this turpen-
tine solution is to brush it over anatomical preparations. It protects
from air and moisture and also from the attacks of worms ; or it may
be used to cover bottles of alcohol containing wet preparations.

These are but some of the uses to which gutta percha can be put ;
its many valuable qualities and its easy applicability to various uses
recommend it to the medical profession.

Collodion on Stumps of Amputated Limbs.

To the Editor of the Stethoscope.
Dear Sir, — I have long been of opinion that suppuration after am-
putation is a cause of protracted and in many cases injurious import,
sometimes wasting the already feeble patient, and leading to ulterior
consequences prejudicial to the health and well being of the general
system, inducing in very many instances hectic fever and a great waste
of strength. Recently I have had to perform several minor operations,
such as amputation of the fingers and toes ; the fingers were for some
months previous to my being consulted the seat of paronychia, and
from improper treatment the bones in all cases became carious, ren-
dering amputation necessary. I had been informed they had been
suppurating for six or eight weeks. The persons thus affected had
lost much time, and one of the cases had been extremely hard to
manage, she having left home for medical aid several times. The

CORBIN ON COLLODION IN AMPUTATIONS. 489

finger had been laid open by a physician, and poultices used for
weeks ; this treatment proving abortive, the wound had been dressed
with dry lint and Turner's cerate, and very tightly bandaged ! After
some two or three weeks on this plan and still no relief, I was con-
sulted. I very readily ascertained the bone was carious, and forthwith
advised amputation ; and as the caries was pretty extensive I resolved
to amputate at the third phalanx, ascertaining satisfactorily that the
caries extended no further. Having thus operated I simply dressed
the stump with cold water for two days, after which I covered it well
with collodion every morning ; this dressing acted delightfully, and in
the space of eight days the stump had healed and was perfectly
smooth and well. I am at this time treating a patient whose toe I
amputated some weeks since in the same way and with the most
satisfactory results. The case was very bad — of date since the first of
March ; the foot enormously swollen, and general symptoms of oedema
of the leg. In this case the physician in attendance had laid open the
toe, and various different sorts of dressing had been used ; the wound
continued to suppurate and the foot and leg continued to swell, and
from the wound discharged a very offensive purulent matter, and
some sanguineous exudation. By the use of my probe I readily de-
tected caries of the first, second, and a part of the third phalanges.
The amputation was performed at the joint, well up to the foot ; the
cold water dressing applied the first week ; the oedema of the foot and
leg subsiding, the collodion was applied as before mentioned. The
swelling returned but for a short time, one or two days, and that pro-
bably from improper motion of the limb ; the patient is now fast re-
covering and his foot entirely reduced in size to its natural dimensions.
I have thought these cases interesting, and have supposed old ulcers,
situated in old cicatrices, the pest of every surgeon, might be treated
successfully in the same way. One very great advantage the applica-
tion has is, that it makes a covering itself, excludes the atmosphere,
and effectually keeps off flies and other insects that might prove in-
jurious, especially where proper care and attention are not bestowed
by the patient or nurse. This 1 consider of moment in regard to our
slave population, whose negligence and inattention to such matters
must have attracted the notice of the most superficial observer.

Very respectfully,

G. LANE CORBIN, M. D.,

Of Laneville, Warwick Co.

P. S. In applying the collodion, whenever a crack or fissure appears
over the stump I have had it filled up with the article, so as to have
the coating perfect all the time the patient is undergoing treatment.

[ We have effected union by the first intention, with scarcely a trace of a cicatrix, after the
excision of tumors and sections of the skin on the exposed parts of the body, by adjusting
the part nicely and applying collodion, or by sticking a couple of pieces of kidskin near the
edges of the wound, and then with a common needle and thread lacing them together. — Ed.]

490 Jennings' case of wound of abdomen.

Report of two Surgical Cases in Private Practice.

BY ROBERT G. JENNNIGS, M. D., OF CHURCH HILL, HALIFAX CO., VA.

Case of Wound of Abdomen, with Protrusion of Intestines.

Radford, a very robust and. healthy negro, aged 33 years, was
thrown from a horse (Jane 1st, 1851,) against a rail fence, and be-
sides various bruises about the back, shoulders and thigh, had a per-
foration made by the end of a rail in the abdomen, on the margin of
the left hypochondriac region, about four inches long, directly across
the belly. Being close at hand we saw him immediately, and found
a large mass of intestines protruded through the orifice, a good deal
dirtied by the sand and grit in the road on which he fell. This mass
included nearly the whole of the large intestine, much distended with
feces. Besides one or more discolorations, we found that the peri-
toneal coat had been entirely torn off for a space about the size of a
dollar, near the lower end of the colon. The bowel was washed
with tepid water, returned into the abdomen, and the orifice closed
with the interrupted suture, over which were placed adhesive strips, a
compress and a bandage — pulse weak and extremities cool. A little
toddy was given him, and warm rocks applied to his feet. In a short
time he threw up the toddy together with his dinner, after which he
lay pretty quiet, only complaining of his shoulder when moved. In
about six hours reaction occurred ; his extremities became warm
and his pulse returned to the natural standard.

June 2. Patient rested well last night, and feels comfortable when
still ; complaining principally of his shoulder on motion — pulse some-
what excited, and abdomen tense. Ordered purgative injection,
which operated freely and softened the belly and pulse somewhat.
Opened a vein ; but his pulse beginning to give way when about lij
were drawn, the orifice was closed. Pres : quiet, low diet and slip-
pery elm injections every two hours. In afternoon found pulse 84
and abdomen rather tense, with complaint of general soreness. Or-
dered purgative enema.

June 3. Patient comfortable — pulse 68 — tongue white and mouth
tastes badly. The wound looks well, though there is a circumscribed
swelling around it, pressure on which causes an audible rush of air.
He has had a free passage from injection, and in the afternoon broke
out into a full comfortable sweat.

Directed purgative injection every morning, and slippery elm injec-
tions occasionally during the day.

June 4. Patient comfortable — pulse 50 — abdomen softer and small-
er— tongue white — emaciation evident. Master gave a cup of hot
water lea this morning, with a piece of biscuit crumbled in it, which
he relished. He has had a small passage from injection. He was
allowed three cups of hot water tea per day, with injections as before.

June 5. Patient comfortable — pulse 54 — tongue rather white. Ab-
domen soft, and bears pressure without complaint. He ate a piece of
stale bread last evening, and a biscuit in his tea last night. He was
much troubled with colicky pains during the night, which were re-
lieved by a free passage this morning.

JENNINGS' CASE OF POLYPUS UTERI. 491

Diet and treatment as before.

June 6. Patient comfortable — pulse 50 — tongue nearly clean.

June 7. Patient complaining only of the sore on his side, which
has not been dressed since the 3d — pulse 50 — wound closed, and
suppurating a little, stitches firm, swelling as before, but more tender,
and crepitation observed.

Reapplied dressings with simple cerate. Diet, &c. as before.

June 8. Patient comfortable — pulse natural — tongue clean — belly
soft and patient of pressure except over wound.

June 9. Patient as before — stitches loosening in wound, which is
healing — swelling gone down.

Pres : Wound to be kept clean, and adhesive straps applied when
required, and caution enjoined as to diet and exercise.

June 10. Patient as at last visit — wound healing and stitches loose.
The swelling has returned about the wound, where the vermicular mo-
tions of the intestines were very evident through the walls of the ab-
domen. As the prominence varied in form and size with these mo-
tions, they seemed evidently caused by the distended gut pressing
against the weakened parietes.

June 14. Patient with rather more excitement than at last visit —
pulse 64.

June 18. Patient doing well — wound closed and stitches all gone —
swelling slight — healthy passage every day. He has a good appetite,
and is recruiting in flesh and strength.

From this time Radford improved steadily, and is now (Aug. 4th)
employed about his usual work in the field.

Case of Polypus in the Womb.

Mrs. J****, aged 56 years, of a bilious temperament, and the mo-
ther of 12 children, always enjoyed good health till within the last
ten years. For the first few years within this period, she suffered
much from headache and sick stomach during her monthly courses.
Afterwards she was troubled with pains in the hips and loins, short-
ness of breath and violent pains in the womb, resembling those of
labor, with occasional severe floodings. About five years ago she
discovered a tumor in the vagina, about the size of a pullet's egg,
which continued to increase in size rapidly. Mrs. J. considered it
a prolapsed womb, and always kept it back in the vagina, until while
stooping in the morning of July 22d, she sneezed, and the tumor es-
caped from the vagina. On the evening of the 23d I was called to
see her, and found a polypus the size of a child's head, and very vas-
cular, with a stem about as large as a man's thumb, which passed
through the os uteri into the cavity of the womb. This stem felt firm
and consistent. Having no wire in my case, I passed a silk ligature,
by means of a double canula around the stem, as high up as the os
uteri, drew it tight, and secured it by wrapping the ends of the ligature
around shoulders of the canula.

I saw her again on the evening of the 25th, and found her pale,
with sick stomach, which she attributed to the mass having become

492 bolton's case of amputation for caries.

offensive. She was very solicitous to have it removed immediately.
Being satisfied that the operation would be safe, in consequence of
the previous application of ligature, I divided the stem immediately
below it, and removed the -offensive mass. This operation, as well
as the previous one, caused no pain to the patient.

The polypus weighed \\ lbs.

August 1. The ligature has come away, with a portion of the re-
maining neck, and Mrs. J**** says that she feels better than she has
done for five years.

Report of a case of Caries of the Tibia, with extensive Disease
of that Bone and of the Fibula — Amputation.

BY JAMES BOLTON, M. D.

[Presented to the Medical Society of Virginia, with the pathological specimen, at its July

meeting.]

J. A., male, aet. 45, colored — house servant.

History of the Case. — Since about ten years of age has suffered
rheumatic pains of left leg. About nine years since pains increased
and an abscess opened five inches below the knee, which has con-
tinued to discharge fetid pus, mixed with debris of bone.

Last fall he suffered from endocarditis, probably with ascites and
anasarca of the scrotum and legs. Since then he has remained in a
state of cachexia.

April 26. — Present Condition. — Large abscess about the middle of
the shin. The upper half of the tibia enormously increased in size —
this condition has existed several years. A cloaca exists on the an-
terior ridge of the tibia, about five inches below the knee, which
penetrates the bone to its centre. It occupies the site of the abscess
mentioned above.

Operation. — Anaesthetized the patient with chloroform — laid open
the abscess throughout its extent about four inches, and gave exit to a
large quantity of excessively fetid, ill-conditioned pus — probed bottom
of abscess and felt rough denuded surface of tibia the entire extent of
the abscess.

28. — Determined to trace the extent of the disease with the view
of its removal if possible.

Anaesthetized the patient with chloroform — extended the incision
upwards to the insertion of the ligament of the patella, and down-
wards about two inches below the abscess. Found disease affecting
the bone through the whole of this extent, passing back to the inter-
osseous ligament and involving the fibula. It was therefore impossi-
ble to remove the diseased bone, and the only alternatives which re-
mained were leaving the patient in the hazardous condition of ca-
chexia, induced by long continued and extensive disease, aggravated
by the extensive examination, and that too at the commencement of
warm weather, or to remove the source of constitutional irritation by
amputation.

bolton's case of amputation for caries. 493

The latter was decided by consultation as probably giving the pa-
tient the best and perhaps the only chance for his life.

Amputation by double flap, above and below, was performed as
near to the joint as possible. The arteries were secured , the wound
cleansed, and closed by stitches, adhesive plaster and roller.

Examination of Leg and Portion of Femur.

Portion of femur removed measures six and a half inches. A
crested ridge of exostosis extends around the articular surface at the
line of attachment of the capsular ligaments Articular faces inflamed
and ulcerated.

Tibia.— 'Circumference of upper extremity, - - lOf- inches.

Do. 3 in. below upper articular surface, 9f-

Do. 10 do. do. - 7

Do. 4f

Cloaca 4y inches from superior articular; surface. Diameter f
of an inch and •§■ deep. Longitudinal section exhibits a carious
cavity occupying the place of the medullary canal, extending into the
cancellated structure of the bone.

Carious Cavity commences 1-j inch from the upper
articular surface — length, - - - - 4|- inches.

Greatest diameter, - - ;- - 1-j

The shaft of. the tibia from the knee to the ankle nearly covered
with exostosis, especially about the extremities. Fibula in same
condition. Bone of the foot sound. The patient did well, except
being troubled with hickup during the first ten days..

In five weeks stump healed, except two fistulous openings, which
communicated.

Patient sent into the country to recruit. Returned in a fortnight,
complaining of pain near the inner extremity of the cicatrix, where
there was a bony deposit pressing against; it. A probe passed, into
one of the fistulous openings passed through the projection of bone.

Operation.-*- Anaesthetized the patient with chloroform and excised
the protruding bone.

July 14. — The patient is now doing well.

Remarks. — This patient was kept under the influence of chloroform
on the occasion of the amputation nearly two hours, by the use of l£3
chloroform. His pulse, which was previously about one hundred
per minute, rose during part of the time to upwards of one hundred
and fifty. He awaked in ten or fifteen minutes after discontinuing
the use of chloroform, and was surprised to find himself minus a leg..
The time was consumed in making examinations, with the view, if
possible, of adopting some means of saving his limb. There were
no alarming symptoms.

It is remarkable that the disease should have existed so long, pror
bably thirty-five years, making such slow progress, and producing
so little constitutional disturbance.

58

494 Johnson's clinical case of double hydrocele.
Clinical Report of a Surgical Case at the Almshouse.

SERVICE OF PELOFESSOR 0. F. JOHNSON.

Remarkable Case of Double, Hydrocele — Reported by Dan. S. Evans,
M. D., Resident Student in the Richmond Almshouse.

The following case was presented to the class on October 19th,
1850, by Professor Carter P. Johnson, then in attendance upon the
surgical wards of the almshouse :

The patient, a negro man about 70 years of age, had been admit-
ted into the almshouse on May 18th, 1849, laboring under a tumor of
the scrotum. This tumor had existed for two or three years, and ori-
ginated, in the opinion of the patient, from a local injury to the part,
done by the kick of a cow. From the date of his admission the tu-
mor regularly increased, and at present exhibits an immense size.
Apparently, it equally affects both sides of the scrotum ; its size and
weight are such that the integuments of the abdomen have been very
considerably drawn downwards to such an extent as entirely to con-
ceal the penis, which can be felt lying in a sort of groove in the supe-
rior surface of toe tumor. In the bent position which the old man
constantly assumes, the tumor hangs down to within two inches of the
knees and separating the thighs from each other, interferes so much
with the locomotion of the patient as almost to prevent his taking any
exercise.

The pathology of hydrocele, its causes and symptoms, and the
mode of diagnosticating it from other scrotal tumors, were carefully
pointed out to the class. The difficulty attending the diagnosis when
the tumor has reached a very large size, and especially in the negro,
where the principal diagnostic sign, transparency, is absent, was well
illustrated in this case.

After stating the different modes of cure proposed for this disease,
and expressing the opinion that a radical cure was by no means im-
possible, Professor Johnson proceeded to operate upon the right scro-
tum. Upon puncturing the tumor and introducing the canr/ala, forty-
four ounces (1 quart and 3 gills) of serum were drawn off. The scro-
tum was injected with the following preparation : Iodide potass. 3i,
aqua Ivi, tinct. iodine f i. M.— and the patient put to bed.

On Nov. 2d, two weeks after the operation in right side, the same
operation was done upon the left scrotum, and fifty-two ounces (1
quart, 1 pint and 1 gill) of serum was drawn off. This was injected
with the same preparation. On this side a radical cure was effected
by the first operation. But on the right side, inflammation not follow-
ing the operation to a sufficient extent, the fluid re-accumulated, and on
the 23d of November, 5 weeks after the first operation, the tumor was
again punctured, and twenty-four ounces of fluid evacuated. On the
1st of February again eight ounces were drawn off, and again about
the first of April six ounces were withdrawn. Each time the tunica
vaginalis was injected, and since the last operation no re-accumu-
lation has taken place.

PRACTISING BY THE YEAR AND USING NOSTRUMS. 495

The patient is now entirety relieved- — the scrotum is not very much
larger than ordinary, and with a common suspensory he is enabled
not only to walk about, but also does a good deal of work in a garden
attached to the almshouse. His penis has emerged from its sheath,
and he can pass his water without any danger of excoriation.

A Voice from the Country on Professional Improprieties.

Mr. Editor — The portion of our state in which I reside is but
sparsely settled, and for that reason somewhat behind hand with the
great improvements of the age. The axe, however, is plied diligently,
and agriculture, with her concomitant interests, is making gigantic
strides. But, sir, whilst every other improvement is being adopted,
those connected with the science of medicine alone meet with but lit-
tle encouragement. Our statesmen, our lawyers and our tradesmen
will compare favorably with those of any country, but our physicians,
most of them, are standing still. I hope, however, that a new era is
about commencing ; the " Stethoscope" is finding its way to the most
of us, and its circulation will be life blood to the profession. But I
am not coming to my subject. My object in writing this communica-
tion is to call your attention to certain practices which obtain here to
a considerable extent, but which should everywhere be frowned down.

The custom of practising in families by the year is the first to which I
shall call your attention. This is a most contemptible method of getting
a job, and is even unworthy of a tradesman. This habit prevails to
some extent here, but it is scouted by the most respectable practition-
ers amongst us, and I think, with an occasional broadside from you,
the day is not far distant when it will be put down. But as you have
touched upon this subject several times, I will say no more for the
present upon it.

Again : I would call to your notice a practice which calls still more
loudly for reform, viz: using, and even in some cases making, quack
medicines. This is done in the one case to save the trouble of making
out prescriptions, or perhaps oftener for the purpose of catering to the
false notions of the patient or his friends. In the other case it is done
for pelf.

Every tyro in medicine must know that quackery is an evil of the
first magnitude to the human race, both directly by poisoning thern.,
and indirectly by bringing the real science into disrepute. No phy-
sician who has any love for his fellow creature, or any respect for him-
self, should ever countenance the use of such agents. He is the guar-
dian of the public health, and therefore commits a moral error in lead-
ing the people to use medicines which will injure them. It is also
very irrational to give countenance to any course which has a ten-
dency to disgrace his calling in the estimation of all sensible men.
This practice is far from uncommon even among men who would be
very unwilling to be thought out of the pale of the profession'.

There is one very common breach of etiquette which I hope you
will notice some time : The visiting of each other's patients, without

496 MEDICAL SOCIETY OF VIRGINIA.

an invitation from the attending physician, under the pretence of friend-
ship. Now it is perfectly right for a physician to feel an interest in his
friends, whether they are his patients or not, but he can very easily
make his visit while the attending physician is present, or request per-
mission to do so of him.

North West.
August 1851.

Medical Society of Virginia— August Meeting.

; Dr. James Beale, first vice-president, in the chair.

{Present — thirty members.)

After the minutes of the last meeting were read and approved, the
following gentlemen were balloted for and declared duly elected
members of the society :

J. L. Dorsett, M. D., of Chesterfield.
E. H. Smith, M. D., of Dinwiddie courthouse.
Jesse F. Winfree, M. D., of Henrico.
W. A. L. Potts, M. D., of Richmond city.
A. C. Pleasants, M. D., of Richmond city.

Letters of application for membership were read from a number of
gentlemen from different parts of the state, who were duly nominated
and seconded, and laid over for a month under the rule.

Uterine Displacements being the subject of discussion for the
evening, Dr. Goodridge A. Wilson proceeded to read

A Paper containing a few Practical Hints on Prolapsus Uteri

The frequent occurrence of uterine displacements, their serious
effects upon the health and usefulness of females, and the small
measure of success attendant upon efforts at cure, all combine to throw
peculiar interest around this class of affections.

The reader of this paper will not attempt an elaborate essay on
these fruitful subjects. Every member of the society has equal access
with himself to many valuable works recently issued from the press,
containing full descriptions of the uterus, its anatomical relations, its
functions, and the progress attained in the study of its pathological
states.

The limits of this paper will be confined to prolapsus uteri as it
usually presents itself to the practitioner, and to the illustration of a
few practical points in immediate connection with it, in which the
writer has been driven to entertain opinions at variance with the great
mass of writers and teachers of medicine.

I shall forbear entering the discussion as to the particular anatomical
arrangement by which the uterus is maintained in situ naturali. We
know that this arrangement, whatever it is, is very imperfect, as the

WILSON ON PROLAPSUS UTERI. 497

frequent occurrence Of this class of affections- abundantly proves.
Were the uterus bound down by firm, inelastic ligaments, or propped
up by rigid, unyielding, unrelaxing vaginal tissue, these conditions
would defeat the progressive changes and final completion of the great
function of utero gestation. The imperfect anatomical arrangement
then, on which this whole class of affections depend, is an indispen-
sable necessity to the exercise of the function for which the organ was
made.

But before going farther, iet us have a clear idea of the disease under
consideration. What is the state of organs in prolapsus uteri? — what
its pathology? Whatever opinion is entertained as to the ultimate
cause of the disease, whether it depends upon a preternatural laxity
of the ligaments proper, or the superincumbent weight of a hypertro-
phied womb, or an ulcerated or engorged os, it must be admitted that
the disease consists essentially in a shortened vagina. Any abbrevia-
tion of the natural distance between the os uteri and the external
vaginal orifice can only be at the expense of the tissues of the latter.
In every case of this disease then, the vagina is pressed down, bent
or doubled upon, or invaginated within itself. The ligaments above
may be ever sO lax, the superincumbent uterus ever so ponderous, the
os ulcerated to any extent, but unless the vaginal walls give way no
descent or falling of the womb can take place. The full appreciation
of this idea is deemed essential to a just comprehension of the disease
and of proper measures for its relief.

Designated as it is prolapsus uteri, the mind is naturally led to
look to the womb and its superior attachments exclusively. The real
defect exists in the base on which it rests, in the loss of tonicity — the
absence of that erectile or contractile property inherent in the healthy
submucous tissues of the vagina.

It is a common error to regard this latter organ as an open cavity.
In a state of health the areolar tissue surrounding the vagina and the
action of the sphincter keep the sides of the vagina in close apposi-
tion—" the mucous corrugations mutually ingrained, to the perfect
exclusion of the air."

Whitehead reminds us that this contractile property of the tissues
of the vagina " may be admirably verified by the aid of the speculum,
in the withdrawal of which the walls of the vagina may be seen to
fall firmly together, presenting at every move an almost horizontal
surface ; and so energetic is this contractile power, that ere the instru-
ment has receded three-quarters of an inch from the cervix the organ
can no longer be seen," on account of the close approximation of the
vaginal parietes, due to the exercise of this property.

The existence of this physiological property of these tissues should
be constantly borne in mind. It leads us to regard the healthy
vagina as a sac completely shut, or even as a solid cylinder, rather
than an open tube. It is the loss of this property on which the dis-
ease under consideration depends, and on its restoration alone can
we hope for a cure.

The causes of prolapsus are all such as are capable of destroj'ing
this tonicity of tissues and producing relaxation, whether these causes
act on the system generally or locally on the pelvic viscera.

498 MEDICAL SOCIETY OF VIRGINIA.

Organic diseases of the uterus, particularly of its neck, are fre-
quently attended with prolapsion ; but this can only take place by
implicating the general system, or the direct extension of the morbid
action to the vaginal tissues. The accomplished Prof. Meigs says
ninety-five per cent, of the cases are caused by gestation and labor.
This would probably be the united testimony of medical men, preg-
nancy, labor and lactation being the fruitful source of that degree of
relaxation which is the condition precedent to a prolapsus. The
disease is almost confined to the child-bearing period, never occurring
before puberty and but rarely after the menstrual life.

I will not detain the society with a detail of the ordinary symptoms
ofprdlapsus. Whilst the immediate effects of such displacements on
contiguous organs are comparatively few and readily appreciated,
the remotely reflected irritations are as numerous as migl't be ex-
pected from the free nervous intercommunications of an organ which
in health gives character to the entire being of its possessor.

The amount of distress in each case depends greatly on the tem-
perament of the patient, a very slight descent in some producing the
most distressing train of nervous symptoms, whilst others will bear a
much greater degree of prolapsion, and complain only of the local
symptoms produced by the unnatural position of the organs.

It is very important to distinguish between the symptoms proper of
this disease and those which follow more remotely, as, in the opinion
of the writer, important practical inferences are to be deduced from
the distinction.

Unquestionably the most serious consequence of the disease and
prolific source of ill is the want of exercise, the confinement to which
the patient is subjected, and in which her sensations so naturally
prompt her to indulge. As a consequence, indigestion with its hosts
of morbid sympathies, swell the catalogue of evils which assail the
system of a patient already alive to every agency and impression,
from a uterine displacement, and confined to the horizontal posture
nine-tenths of her time. These symptoms, primary and secondary,
act and re-act on each other until it is but a poor expression of her
sufferings to say " life is a burden."

The following will be admitted a fair representation of the disease
as it usually presents itself to the practitioner: A female having
married early in life and borne children rapidly, is observed to grow
thin and feeble during the active period of lactation. In a short time
pain and other unpleasant sensations about the pelvis are complained
of; these latter increasing progressively until the usual exercise is pre-
vented, and the patient incapacitated for ordinary participation in do-
mestic duties, she soon finds the recumbent posture necessary for
relief from her morbid sensations, and is naturally and easily per-
suaded that a position giving so much relief, if persevered in, will
finally cure. Adhering to this regime she soon becomes the prey of
indigestion and its consequences, her general health broken down, her
whole sensitive being but the generator and reflector of morbid im-
pressions. The mind participates largely in the general wreck — is
the subject of every conceivable sort of anxiety, until the patient pre-

"WILSON ON PROLAPSUS UTERI. 499

sents that most pitiable spectacle of a young person in the heyday of
life cut off from its social enjoyments and from the pleasant duties
which maternal affection suggests. She drags on from day to day,
her hopes for the future obscured by the gloom of present perceptions.
But let us hurry on to the consideration of the remedies of these ills —
of the means of cure which the medical art proposes.

It must be confessed that a candid view of results is but little calcu-
lated to cheer the hopes of this class of unfortunates. Is it not a fact,
that even the skillful application of the remedies almost uniformly
recommended by authors and teachers is seldom rewarded by any
permanent relief? I believe this want of success to be due in a great
measure to a fundamental error in treatment, and this error consists in
the use of mechanical means of support, and the neglect of such medi-
cation as will impart tone to the tissues and general strength to the
system.

My main object in appearing before the society on this subject is to
enforce these views.

The pessary is a very ancient contrivance, having long been sanc-
tioned by medical men. I shall not speak of the many petty annoy-
ances or occasional serious consequences which attend their use ; but
take stronger ground, and maintain that they in nowise contribute to
the radical cure of the malady, but on the contrary defeat the resto-
ration of the tissues with which they are brought in contact, to the
enjoyment of those vital properties and healthy functions which alone
can prevent this disease.

In speaking of the pathology of prolapsus, I endeavored to give
prominence to the fact that the healthy vagina is always a closed sac —
a cavity obliterated by the contractile power of the tissues — and that
it is the loss of this power — no matter by what agency- — which con-
stitutes the essence of the disease. When the tissues exercise their
natural function, collapse of the vagina and prolapse of the womb is
a physical impossibility.

In view of these facts, in what manner can the distension of the
upper portion of the vaginal canal, by a pessary of sufficient size and
density to maintain itself in position, contribute to the restoration of
the tonicity of the relaxed organ.

On the contrary, will not its presence mechanically (to say nothing
of the irritation it occasions) defeat the return of the parts to that con-
dition which alone can ensure against prolapsion. How can the organ,
widely distended by a metallic globe or segment of a circle, resume its
natural siate — that of an obliterated cavity ? The presence of the
prolapsed uterus surely cannot operate to the same extent as an irri-
tant or as a mechanical hindrance to the natural contraction. The
eminent Prof. Meigs, who has contributed so largely to the elucidation
of this and kindred affections, says that he uses a pessary for the same
purpose that he would a suspensory bandage for orchitis, or a splint
for a fracture. But is a suspensory to be tolerated which prevents
resolution in the one instance, or defeats re-union of bone in the other?

It is true he enjoins constant care to diminish the size of the instru-
ment so that this contraction may take place. But is it not plain that

500 MEDICAL SOCIETY OF VIRGINIA.

a pessary of sufficient dimensions, so to imbed itself in the tissues of
the vagina as to act as a suspensory for the womb, in opposition to
the varied action of contiguous organs, and of the diaphragm and
abdominal muscles, must effectually defeat the return of the parts to
a natural state ?

I will merely allude to the fact, that these instruments almost uni-
formly produce excessive and unhealthy vaginal discharges—r-a state
very unfavorable to healthy tonicity.

But although then' priori reasoning is thus decided against the use
of pessaries, it would be of little value unless sustained by the results
of experience. And to what conclusion does a candid review of
these results lead ? Will it be maintained that their use has been fol-
lowed by results so successful as to demand the rejection of the pre-
mises which have been assumed, and the conclusions drawn from
them.

Although I have been a diligent enquirer, I have never yet found
the man who had seen a case of prolapsus cured during the use of
the pessary.

Hundreds of females are annually sent from the South to the
Northern cities, for the express purpose of being supplied with pessa-
ries made to order. The writer himself pleads guilty to the absur-
dity. He is acquainted with the history of some 12 or 15 cases —
the patients of himself and his intimate medical friends — who have
been sent North for the benefit of skillful treatment.

They became the patients of the most distinguished men. Pessa-
ries of various forms were devised, adjusted and re-adjusted during a
residence of several months— and in some of the cases, during re-
peated visits and protracted stays for the purpose ; and yet disap-
pointment has been the invariable result, not one of the patients ex-
periencing any permanent benefit, or indeed any improvement at all,
more than might have been expected from the same amount of travel
in any other direction, and freedom from domestic cares.

The following case, which occurred to me several years since, so
fully illustrates my views, and in fact contributed so largely to the
formation of opinions which led to a more successful practice, that
at the risk of being tedious, I will as briefly as possible narrate it :

Mrs. ****, a delicate, nervous lady, who had married early in life
and borne children rapidly, of capacious pelvis, suffered much in the
latter stage of her sixth pregnancy from precipitation of the uterus.
Despite of much care at her accouchment, and during the month, she
complained occasionally of the ordinary symptoms of prolapsus. These
symptoms however gave but little trouble, until she had undergone
the demands of lactation for about eight months. After that period
her general health declined rapidly. The uterine symptoms soon
became so distressing that no posture save the recumbent could be
maintained in comfort. The patient rapidly became the victim of in-
digestion and the whole train of nervous disorders, physical suffering
and mental disquietude, so characteristic of the disease. After seve-
ral months of unsuccessful effort at treatment, in which a great va-
riety of pessaries were used, it was determined to take her to a.

WILSON ON PROLAPSUS UTERI. 501

Northern city, for the benefit of more skillful counsel and better con-
trived instruments. My patient commenced the journey comfortably
fixed on a bed, both her general debility and local symptoms demanding
it. The motion of the vehicle produced such severe neuralgic symp-
toms, that the propriety of abandoning the undertaking was seriously
discussed. It was determined however to proceed. The patient soon
found herself more comfortable in the public conveyances. She soon
commenced rallying, and by the time she had reached her destina-
tion, was less fatigued than her attendants — indeed in better condi-
tion than she had been for many months, having of her own accord
abandoned her bed. She was placed under the care of a distinguished
practitioner. During a stay of some two months she was supplied
with pessaries just suited to her case. Under judicious general treat-
ment, and the attraction of novelties around her, the patient improved
greatly, and returned home full of hope and with renewed relish for
life.

The first menstrual period, however, brought back the " source of
all her woes." Pessary and uterus were found resting on the peri-
neum. The next succeeding several months were passed in adjusting
and adapting her mechanical support to the varying degree of relaxa-
tion of her tissues, her general health and comfort vibrating with
the local malady, until she finally relapsed into the condition she was
when she first set out to the North. At this juncture it became desi-
rable for her to visit a distant state. She was encouraged to do so —
all pessaries were dispensed with — she was supplied bountifully with
pills of ext. gentian and iron — directed to make free use of cold bath,
general and local, and supplied with an elastic bandage of simple
construction, affording comfortable support to the relaxed perineal and
abdominal walls. In two months my patient returned home, having
made the circuit of a large portion of the United States, free from all
her harassing symptoms, in good general health, and, indeed, able to
visit her neighbors on horseback. This improved state of health con-
tinued for three years — until after a subsequent pregnancy and de-
livery, when they returned — but were promptly relieved by pursuing
the outlines of treatment which had been successful before, and fol-
lowing up the indications which the case had revealed.

I would here repeat that the most serious consequence of this dis-
order is the confinement to which patients are prompted by their sen-
sations to doom themselves. In this self-indulgence, to the extent of
almost constantly maintaining the horizontal posture for months, they
are too often encouraged by medical advice. In cases of this disease,
uncomplicated with any organic affection (constituting seven-tenths
of the cases) dependent entirely upon undue relaxation of the tissues,
surely nothing can be more pernicious.

It is a difficult task to induce patients to act so much in opposition
to their own sensations, as to disabuse their minds of the almost uni-
formly erroneous idea that exercise would end in serious bodily injury.

The writer has abundant reasons to know that many poor women
spend useful and comfortable lives with a degree of prolapsus that
would embitter the existence of those whose circumstances enabled
59

502 MEDICAL SOCIETY OF VIRGINIA.

them to be more self-indulgent. Their necessities required a degree
of activity which secured their general health, and fortified their sys-
tems against those varied sympathies which follow in the train of
luxury and ease.

Is it not true that a large majority of the patients who consider
themselves cured of this disease still have a shortened vagina?
They are free from all of its disagreeable sensations and distressing
effects, because their systems no longer sympathize with the displace-
ment—-a cure near akin to that which comes with the decay of active
uterine life and the final cessation of menstruation.

It has already been mentioned that the disease under consideration
is occasionally associated with and dependent on organic disease,
such as active engorgement, ulcerations, granulations or erosions of
the os, or leucorrhcea, uterine or vaginal. These complications fre-
quently occur in the sterile and unmarried. I have already endea-
vored to shew that they can only produce prolapsus by their direct
extension or sympathetic action on the vagina.

No one would advocate the use of pessaries under such circum-
stances, the cure of the organic disease by appropriate general and
local treatment being followed by prompt relief of all the symptoms.
A more interesting question is the true relation which these organic
affections bear to prolapsus, whether as causes or effects.

In the opinion of the writer they rarely exist in the early stages of
that great class of cases produced by utero-gestation, being confined
to old cases, having been long abused by the use of pessaries. In
the published reports of cases of diseased os uteri it is instructive
to notice what a large proportion have been treated with these
instruments.

A very brief recapitulation will close this paper.

My own experience, which, it is just to state, has been more ample
than satisfactory, has led me decidedly to the following conclusions :

1st. That pessaries should never be used where any hope is enter-
tained of a radical cure of the disease, but confined to cases hope-
lessly incurable, and to be worn through life.

2d. The great indication of cure consists in the skillful selection of
such agents, and adoption and observance of such hygienic rules, as
will impart tone and vigor to the general system.

3d. Injections of simple cold water have more efficacy in imparting
healthy tonicity to the tissues than the whole batch of astringents and
stimulants, the use of the latter being only indicated by a diseased
state of the mucous membrane and its secreting accessories.

4th. Bandages, though scoffed at by high authority, when so con-
structed as to give support especially to the perineum and external
genitals, greatly promote comfort in the process of treatment.

Dr. John P. Little, during the discussion, read the following
embodiment of his views on the subject :

The abdomen is the only great cavity whose organs admit of and
require great increase of size, and consequently its walls are capable
of great dilatation. Of these walls, the upper one, the diaphragm,

LITTLE ON PROLAPSUS UTERI. 503

being strongly muscular and kept in place by the heart and lungs,
and the back, consisting of bones and powerful muscles, cannot give
place ; the front, consisting of thin muscle, and the floor, of bones
and perineal muscles, can and do permit distension to take place by
yielding to the pressure of the enlarged organs.

If these enlargements are excessive in size, or if they last a long
time, or if the general health be feeble, these muscles may remain
flaccid, and after or before a return of the organs to their normal con-
dition, a descent or protrusion or displacement will result from this
muscular flaccidity. The prolapsus keeps up the flaccidity and the
flaccidity increases the prolapsus. The abdominal organs are kept
in place by this uniform pressure on each other, and by the resist-
ance of the abdominal walls, especially those of the front and floor.

In the falling of the womb there will be found relaxation of the
front wall of the abdomen and a descent of the intestines upon the
fundus of the womb. There will commonly be found enlargement of
that organ itself; or if it exist not then, it will have existed at some
previous time, either in pregnancy or in menstruation ; there will be
found also debility and tendency to protrusion of the perineum.
This is often accompanied with piles or with other disease of the
rectum. These conditions are especially observed in long continued
prolapsus of the womb ; the tendency to them exists in all cases. I
leave out of view disorders of the womb itself or of the vagina. It
is asserted that prolapsus arises from relaxation of the vagina and of
the round ligaments, and that by contracting the one and shortening
the other, we reduce it. They may be among the causes ; I am
more inclined to consider them results of prolapsus. The round
ligaments and the vagina can have no other relation to the womb
than the ureters and the urethra have to the bladder. Enlargement
of the urethra for the passage of a calculus no more produces pro-
lapsus of the bladder than vaginal distension does that of the uterus.

Is the pessary a proper remedy in these cases ? It is an instru-
ment placed in the vagina between the perinenm and the uterus, by
which that organ is supposed to be kept in place, and the fellen in-
testines and relaxed muscles of the abdomen and perineum' are re-
stored and strengthened. It is like putting a prop into a falling
house, between the ceiling and floor, when the sides are bulging out
and the foundation giving way ! Even if a pessary does bear up the
womb, it does so by pressure upon the perineum. It cannot produce
contraction of an enlarged vagina, (if that be assumed a cause of pro-
lapsus,) any more than a bougie introduced, for precisely opposite
purposes, into the rectum or urethra, will produce their contraction.
There is also the irritation that results from the use of a pessary, in
creating or aggravating disease of the womb or vagina. Its only ser-
vice is to prevent sexual intercourse in cases where that would pro-
duce injury. I believe it to be of no manner of use whatever in
curing uterine prolapsions : its introduction to practice is a great
medical mistake. Our aim should be to assist nature in her own
way, and by means of well regulated pressure upon the perineum)
and upon the muscular front of the abdomen, to restore and keep in
place the womb and other viscera.

504 MEDICAL SOCIETY OF VIRGINIA.

The causes of prolapsus uteri are, then,

1st. Enlargement or other disease of the womb.

2d. Pressure of the abdominal viscera. This may be also accom-
panied by disease of these viscera, or they may cause pressure by
their enlargement.

3d. Relaxation of the muscular walls and of the vagina and round
ligaments.

In endeavoring to cure this disease it will be more conformable to
nature and will afford a better prospect of success in treatment, if we,

1st. Remove enlargement and other disease of the parts and restore
the general health, by rest in the horizontal position and by a ju-
dicious medicinal and dietetic course.

2d. Relieve pressure of the viscera, restore the womb to its place,
and support the relaxed muscles of the perineum and abdomen. To
do this, use an abdominal supporter, from the front plate of which
let a spring, terminating in a pad, pass to make pressure on the
perineum.

Dr. Bolton said he had nothing particular to say in regard to this
subject, but he used the pessary in some cases, and he should not give
it up. In a late case of old prolapsus he had applied a stem pessary,
made of gutta percha and supported by a T bandage. His patient is
now doing very well under this management. Dr. B. described the
instrument.

Dr. Conway said that although his experience in these affections
was limited, he could not entirely accord with the views presented by
the essayist, either in the causation or in the treatment of prolapsus.
The ligaments of the uterus are the most prominent appendages
affected, and generally the emaciation and broken health of the patient
are the products of the complaint and not the cause. Where the
cervix and os uteri are hypertrophied or ulcerated there are other in-
dications, but in most cases he believed that mechanical support was
necessary. He could not think that modern men of such experience
and talent as Hodge, Meigs, and hundreds of others, could be so much
mistaken as to adopt the pessary (handed down to us from the father
of medicine) if it were not an invaluable instrument. He had used
various forms of pessary, but much preferred the saucer-shaped one.
He thought that the most important condition in the use of any of them
was their proper adjustment.

Dr. Cunningham said that the principles of the subject were well
understood by all present, and he would only give his experience in
the treatment of his cases. He agreed with the essayist generally,
and the history of all the Meigs and Hodge cases which had come
under his observation proved that their plan of treatment only afforded
temporary palliation.

Dr. Deane said his experience was the same. He had often used
the instruments, and found, as a general rule, that the benefit was
slight. Except in a few rare cases, the benefit was not permanent. He
thinks the pathology still doubtful, but believes that there are many
cases of prolapsus where the patient is unconscious of it. This usually
occurs in field negresses, and others who are subject to active occupa-

MEDIQAL SOCIETY OF VIRGINIA. 505

tion. This teaches us that a sedentary life is not good for those labor-
ing under the tendency to a falling of the womb.

Dr. Snead said he had rarely used the instruments. He considered
them abominable things, which very often are productive of the most
serious and irreparable injury. He was much astonished that a man
like Hodge should make use of such a thing as his pitchfork, or, as it
is more commonly called, horseshoe. A simple pessary may be use-
ful sometimes for a little while, but the great indications of treatment
are, baths, astringents, local applications and general constitutional
treatment. So far as the comparison between the support afforded
by the instrument and that by the pelvic bones after the fourth month
of pregnancy was concerned, he considered it no simile. The sup-
port is not the same, and not in the same place.

Dr. Conway said he was surprised to find himself alone in advo-
cating the plan of treatment adopted by the most distinguished men
of the present day, as well as those of other ages. These men could
not have so deceived themselves as to be using a method which would
not bear the test. For his own part, though his number of cases was
not great, he had frequently tested the pessary to very great advan-
tage, and thought that others would experience the same happy re-
sults if they would take the necessary care to get an instrument justly
adapted to the case, and to apply it properly. If it be placed above
the sphincter vaginae and exactly across the axis of the canal, the
pressure will be on the perineum and there will be no irritation. Ill
health, either as a cause or a consequence of the disease, must be at-
tended to by general means.

Dr. Gibson said he had some experience in the treatment of pro-
lapsus, and he thought that we do not sufficiently distinguish (by the
use of the speculum, &c.) between cases where there exists mere re-
laxation or congestion of the cervix. He believed that the ligaments
have much to do in the causation of the disease, and that simple re-
laxation or laxity of the vaginal support was not the only cause. In
many cases he found a pessary indicated, and he was well satisfied
with their employment. In some, however, he did not employ them.
Dr. G. said he thought it unfair to condemn the Philadelphia men for
their mal-success in the cases which relapsed after their return home.
It was in many instances to be attributed to the fact that these pa-
tients fall into hands not so skilled in the application of the instru-
ment.

Dr. Cox, of Henrico, said his experience was too limited to detail
experience in these cases. He however narrated the history of a case
which was relieved by caustic applications, &c. after it had resisted
every other plan of treatment for six or seven years.

Dr. G. A. Wilson said that these complaints had given him more
trouble than any other, and had occupied much of his thought. He
wished to be understood as taking the ground that pessaries never cure
the disease, not that they are never useful to palliate. A philosophical
reason against the instruments seemed to him to be this — that the va-
gina is always relaxed and flabby, and the womb falls for want of sup-
port ; then, to sustain it by an instrument, one must be employed which
is large enough to impinge on the extra vaginal structures, or it would

506 MEDICAL SOCIETY OF VIRGINIA.

not remain in situ. The lateral distension of the vagina permanently by
pessaries, constitutes the great objection to their use. This distending
the canal approximates its ends and brings the uterus lower down.
That organ is not suspended by the ligaments, because it was an ana-
tomical fact that the uterine attachments of the broad ligaments were
higher than the pelvic attachments. His opposition to the pessaries
arises from Hodge's and Meig's failure, and not his awkwardness with
them. He could not extort from Dr. Hodge, in a long conversation
with him on this subject, a declaration that he had effected a single
cure by the use of pessaries.

[A conversation here ensued between Drs. C. and W. on the point as to whether the in-
strument shortened the vagina by distending its walls, or elongated it by holding the uterus
higher up in the pelvis.]

Dr. C. P. Johnson said the broad ligaments (as they are termed) are
triangular folds, having their apex towards the pelvis and their bases
to the uterus — the lower uterine attachment of the ligament is below
the level of the pelvic attachment, so the broad ligaments hold the
uterus in situ, and he believed that these lateral bands do afford great
upward support to the organ.

Dr. Beale said he agreed with the essayist in all that he had
said about the abominable instruments, but that he did not coincide
entirely with him in regard to the causation of the disease. He had
seen last night a case in which there was entire relaxation, but no pro-
lapsus. One great cause which had not been mentioned is the relaxa-
tion of the abdominal walls, allowing the superincumbent mass of in-
testines to act as a dead weight on an ill-supported uterus. In these
cases the various forms of uterine supporters and abdominal bandages
were very valuable.

[The discussion was continued till a late hour, and was one of much interest. The
above meagre sketch of the main views advanced by the participants in it was written off
very hastily from rough notes taken during the meeting.]

On motion of Dr. Deane, Asthma was made the subject for the
September meeting.

Dr. C. P. Johnson, second vice-president, in the chair.

Dr. Deane said he would call the attention of the society to a re-
medy, which he had lately seen in some journal, for deficient lacta-
tion. It was the plant of the ol. ricini. He proceeded to narrate a

case in which he had used it with success. Mrs. , of robust

and good constitution, in her first confinement had not suffered in the
least from fever or other complication, but did not afford a single
drachm of milk — all remedies and applications failed. A few weeks
ago Dr. D. attended her in her second confinement, and finding the
same state of things existing, he was induced to make trial of the
above new remedy. He accordingly ordered a strong decoction of it
to be taken, and wet leaves of it to be applied to the mammae. Hard-
ness, &c. of the breasts ensued in an hour or two, and on the next
day lactation had set in plentifully. He hoped members would give
it a fair trial whenever an opportunity presented, and report the results.

BOLTON 8 CASE OF NECROSIS. 507

Case of Removal of Ramus of the Inferior Maxilla for Ne-
crosis— Recovery.

Dr. Bolton presented a portion of the inferior maxillary bone of a
child which he had removed, and read the following account of it :

Patient, a girl, set. 6. (August 1, 1851.) Two years since received
a violent contusion of the right side of the face in front of the ear. Con-
siderable swelling of the part ensued, with difficulty of mastication.
After some time there was a considerable fetid discharge of pus with
an occasional fragment of bone. This has continued to the present
time. The discharge has generally occurred within the mouth, but it
has also occurred behind the angle of the jaw, the place of which is now
marked by a cicatrix and depression. Two teeth have been extracted.

Present condition. — Very great tumefaction of the whole of the right
cheek. Opening the mouth exposes the rough end of necrosed bone
projecting near the right commissure of the lips.

Operation. — The child was fully anaesthetized with chloroform. The
bone was then seized with a strong pair of forceps, and as it was felt
to be detached from the surrounding bones, it was entirely removed
by a twisting and sawing motion without the use of the knife. The
child was then kept in a state of anaesthesia until a careful explora-
tion was made of the hard and soft parts of the right side of the
mouth. No further necrosis could be detected.

Examination of necrosed bone. — The fragment consists of the right
ramus of the lower maxilla. The condyle is entire, with more than
half the sigmoid notch. The coronoid process is mostly gone. The
posterior part of the ramus, down to the angle, is in good preserva-
tion. The inner table of the flat portion of the ramus is destroyed.
Most of the outer table remains.

Result.— Cessation of discharge, with entire recovery.

Dr. Haskins, chairman of a special committee appointed at the
last meeting to report what action ought to be taken in regard to pre-
scribing and practising apothecaries, &c, reported a code of ethics to
be adopted by the Medical society of Virginia, for the regulation of
the conduct of physicians and apothecaries respectively towards each
other and the public. The code is substantially the same as that
adopted by the college of physicians and the college of pharmacy of
Philadelphia. On motion of Dr. Bolton, the subject was deferred to
an adjourned meeting, to be held at the hall on Tuesday evening,
September 2nd prox.

Several amendments to the constitution were offered, all having for
their object the adaptation of the society to the organization of the
profession of the whole state, and in anticipation of a general conven-
tion to be held before the next meeting of the American medical as-
sociation.

On motion, the amendments, together with the constitution, were re-
ferred to a committee of five, to report such alterations of it as may

508 EDITORIAL.

be deemed necessary. The committee consists of Drs. C. P. John-
son, (chairman by vote,) Haskins, Bolton, Mills and Gooch.

Dr. Parker offered the following :

Resolved, That no member of this society shall consult with any
physician whose application for membership has been rejected.

On motion of Dr. Snead, the resolution was laid on the table until
the next meeting.

A number of bills were presented and ordered to be paid ; after
which the society adjourned, to meet again on Tuesday evening Sep-
tember 2d, at 8 o'clock P. M.

EBITOIBHAILi 11® MEB©31ILILAM31©IDFSo

State Organization.

We desire to call the attention of the profession of Virginia to the
fact, that the next meeting of the American medical association will be
held here in May next, and to urge the necessity of taking some steps
to receive it, and to have Virginia well represented. As the body is a
representative one, and not a mere convention of physicians, organiza-
tion is necessary for representation, and we earnestly hope that our
state will not be found by our brethren to be behindhand in the work.
As district or county societies are few and far between in the state,
the mass of the medical body must be represented through the Medi-
cal society of Virginia ; and in order that it may be the central and
effectual organization desired, and embrace on its roll all the prac-
titioners of respectable standing, a general convention of the profes-
sion of the state has been suggested. The time for the meeting of this
convention should be fixed at some day before the 1st of May ; but
whether it be during the winter or the last of April, just before the
meeting of the national association, is an open question. Be the time
what it may, we have no doubt but that medical men of every section
will respond to the call, and the good to be accomplished will be
effected with ease by a hearty and united effort. The spirit of
advance and improvement is abroad in our state ; and though our cor-
respondent Northwest thinks that the doctors are standing still in his
region, we can inform him that such is not the case generally. The
pages of this journal and its increasing circulation, the applications for
membership to the Medical society and the spirit of the private letters
received clearly indicate that such is not the case anywhere in Vir-
ginia. But that there are hundreds of men everywhere who have
been duly dubbed M. D., and who think that they have done all re-

EDITORIAL. 509

quired of them save making all the money they can by closing the
people, is too true, but it is only what was to be expected under the
stand still system. These men need stirring up — they need to be told
and taught (unfortunately though the majoriry of them can't be taught
anything) the necessity of lending their mite of aid in the progress of
science and the encouragement of its interests. " What's the use of
it," or "I don't care," is the most common and the most fatal objec-
tion urged by Virginians and Southerners generally to every move of
improvement. And this is frequently illustrated when we ask gentle-
men if they are members of the Medical society. They do not grudge
the dollar which it costs to be admitted, nor can they allege any rea-
son for not joining its ranks. They are willing enough to assent to
every object it has in view, and are earnest advocates for high stand-
ards and high ethics in medicine, but they are guilty of the most cul-
pable neglect and apathy. We are aware of the difficulty which
exists in the country of attending medical societies regularly enough to
keep them in existence ; but where the practitioners are sufficiently
numerous to infringe upon one another's domain, or to give rise to
bickerings or unpleasant feelings, they are certainly thickly enough
settled to meet monthly, and the happy consequences would soon fol-
low of an uniformity in the rates of charges and of professional con-
duct as well as the mutual benefit and improvement incident to a free
and frequent interchange of knowledge and opinion. These are
objects which are desirable to all, and they merit the little exertion
which is necessary to effect them, by even one or two individuals in
each county. We hope, then, soon to see the local societies more nu-
merous and more prosperous ; but to prosecute the great work of a
strong and effectual organization, now so well under way, it is neces-
sary that every man who is qualified, and who feels that he is worthy
of fellowship with his brethren, should send his application for mem-
bership to the state society. Even though he does not see how it is to
benefit him directly the day after he joins it, or though he may expect
rarely to attend its annual meetings, a moment's reflection would con-
vince any drone of the incalculable advantages which would follow
the organization of the whole corps medical into an institution estab-
lished by the state, and which would exert an influence over itself,
the public mind and the legislature which is so necessary to produce
a healthy tone in medical affairs.

60

510 EDITORIAL.

Going to Philadelphia for Pessaries.

In the debate on the pessary in prolapsus uteri, of which we pub-
lish a brief sketch in this issue, allusion was made by many members
to the large number of patients who are constantly flocking to Phila-
delphia " to have a pessary applied." This would cast an imputa-
tion upon the Southern practitioners which is unjust, and it would
reflect the undue credit upon our Philadelphia friends of curing our
patients for us. Now we do not wish to detract from the high charac-
ter and deserved fame of those eminent men, Drs. Meigs and Hodge;
but that they ride high hobbies and fling dust in our faces with an
eclat which is humiliating to us, injurious to the public and unjust to
the profession of the South, is true, and requires an expose from some
quarter. We think this expose of the results of the Philadelphia prac-
tice on those cases which have gone from Virginia for treatment was
fully made in the debate above alluded to. It was there stated by
many gentlemen of ability and extensive observation, that they had
not known a single instance in which a cure was effected by the
Philadelphia practice, though they had ample opportunity to observe
the patients after their return. Among the number are Drs. Beale,
Cunningham and Deane, and, on the other hand, no one said or
could say that he had ever seen a case bring back more than a tem-
porary palliation. Then why this expensive delusion of running to
Philadelphia to have a pessary fitted ?

Medical Schools.

We call attention to the advertisements in this Number of the seve-
ral medical schools. We hope that Virginia students at least will not
forget that it is a part of their patriotic duty to aid in building up our
own institutions of learning, and that their practical encouragement
of them is worth thousands of high flown protestations of state pride
and southern rights resolves in the newspapers.

We learn that the prospects of the Hampden Sidney Medical Col-
lege for an unprecedented increase in its class are very flattering. We
hope that the highest expectations of the faculty may be realized.

Among the great advantages afforded by our city for medical edu-
cation are the excellent and plentiful opportunities of private instruc-
tion and office pupilage.

EDITORIAL. 511

Transactions of the American Medical Association.

We are authorized to state that a large number of the three vo-
lumes of these transactions which have been issued still remains on
hand, and that permanent members, or members of bodies which
have been represented in the association, can obtain the full series
by transmitting $4, or $1 50 for any odd volume, to Dr. Isaac Hays,
treasurer of the association. Hereafter these volumes will be of very
great value, as they will be composed of papers containing the re-
searches and experience of the most distinguished men of the country,
on special subjects confided to them, and they ought to be found in
every library as a standard work on American medicine. We would
caution persons now to take the full series, lest when they may want
them hereafter the first volumes may be out of print. We will take
pleasure in ordering copies for any who may desire them, if they will
remit us the amount as above, and indicate through what channel
they may be forwarded. The forthcoming volume, or Transactions
for 1851, is now at press, and when ready will be furnished at $5
for three copies, as usual.

To Correspondents.

Communications have been received from several gentlemen, but
too late for the present Number. We must decline the publication of
one or two papers which have been sent to us. They will be re-
turned, if desired, and the reasons will be given privately.

We again request that papers for publication should be written on
one side only, and that names and technical terms be written legibly
and distinctly.

To Delinquent Subscribers.

All must be aware that the " Stethoscope" is published at very
great cost, and it is not possible to carry it on at the present very
low price, unless every subscriber pays up punctually. We are
punctual to the day in our issue, and we beg a return of the courtesy
on the part of our delinquent subscribers — otherwise we cannot get
along.

P. S. We will not quarrel with any for just sending us what they
owe, even if they do not send the names and cash along for half a
dozen new subscribers.

512 churchill's theory and practice of midwifery.

Our Exchanges.

Our exchanges have all been duly received, but considering it use-
less in every Number to devote a page or more to their names, we
omit it, and will whenever it is necessary, notice them and their con-
tents all together. Any of our co-laborers who do not receive this
journal regularly will please say so and the missing numbers shall be
sent.

Errata in the last Number.

In the publication of Dr. Brodnax's paper on Meningitis, in our last
Number, several material errors occurred, viz : On page 438, in the
5th line from the top, for " mucous" read nervous. On same page,
17th line, the first word " have" should read of. On page 439, 8th
line, " marked" should read masked, and so also in 10th line of same
page, " marked" should read masked.

Omission.

In the circular of the committee on the epidemics of Virginia and
North Carolina, the post-office of Dr. Jones was omitted. Persons
residing in or near North Carolina having information to furnish to
this committee are requested to forward their communications to Dr.
Johnson B. Jones, Chapel Hill, North Carolina.

Reviews and Bibliographical Notices.

The Theory and Practice of Midwifery — By Fleetwood Churchill,
M. D., M. R. I. A., Hon. Fellow of the College of Physicians of
Ireland, Corresponding Member of the American National Institute,
Sfc, 8fc, with Notes and Additions by D. Francis Condie, M. D., Se-
cretary College of Physicians, Member of American Medical Associa-
tion, Member American Philosophical Society, &fc., &fc, with one hun-
dred and thirty-nine Illustrations. A new American, from the last im-
proved Dublin edition, Svo. 510 p. Philadelphia: Blanchard fy Lea.
1851.

The late edition before us has been gotten out in their usual hand-
same style, by Messrs. Blanchard & Lea, under the editorial supervi-
sion of Dr. Condie, who has much improved the work by making nu-
merous notes and additions of valuable matter. So far as the bod}'
of the work is concerned, it is much the same as the preceding edi-
tions of it, for the author savs :

Churchill's theory and practice of midwifery. 513

" I have made no change in the principles inculcated in the first edition, because, after a
searching investigation and some experience, none has appeared to me to be required;
nor in the practice, except to add any recent information which I have obtained."

In the preface, the author calls the attention of the reader to the
value and importance of obstetric statistics. After pointing out the
errors and fallacies to those who rely on them too implicitly, he
says:

" They lead to a habit of definite thought and statement ; so that instead of general
terms, we use numbers or proportions, and in so far as accuracy is attained, we give a fixed
and scientific character to our observations.

" As Dr. Simpson, in his valuable essay on the value and necessity of statistics in opera-
tive surgery, has remarked, ' statistics offer a test by which the impressions of our recorded
and limited experience are corrected ; and they furnish a mode of investigation capable of
resolving many existing practical problems in surgery.'

" They afford us in general the only true and ultimate ' measure of value' of any proposed
alternative operation, or of any new practice in surgery or midwifery.

" For these and other reasons I still hold the opinion that numerical calculations, applied
to midwifery, are of great value, notwithstanding the numerous chances of error, and the
impossibility of drawing conclusions from them with absolute accuracy."

Valuable and extensive tables of statistics are spread before the
reader, and he is generally permitted to make his own deductions.

The illustrations are numerous and well executed, which is a fea-
ture of importance to the student, for they are as necessary to explain
the text to a learner as are manikin and diagrams for lectures.

As previous editions have been well received by the public, and as
this is only an improvoved one, it is not necessary that we should do
more than refer to the additions and amendments which have been
made by Dr. Churchill and the editor.

About four and a half pages are devoted to the subject of anaesthe-
tics in midwifery. Chloroform is decidedly preferred to ether, and its
use is urged in all operations.

"As to its exhibition in natural labor: as I do not believe that in the large majority of
cases, convalescence is impeded by the suffering, I cannot see the necessity or even the pro-
priety of urging the employment of anaesthesia in every case, and never do it, but, on the
other hand, I have not felt justified in refusing a moderate dose of it when the patient
urgently desired it, and when none of the indications were present which seemed to me to
counter-indicate it." — " In hysterical or nervous patients, in those laboring under nervous
affections, or organic disease of the lungs or heart, &c, I do not think we ought to use it.
In any operation for the termination of labor in a case of convulsions, I should be unwil-
ling to use chloroform on account of the nervous excitement it occasionally produces, not-
withstanding that it is said to have been employed beneficially in the treatment of that dis-
ease : in like manner I should fear to use it in cases of alarming haemorrhage, lest it should
give rise to severe collapse."

The objections to anaesthesia in obstetric practice are so puerile that
they are easily refuted by the author, and he distinctly asserts that
" no death has occurred which can be fairly and directly attributed to
chloroform." At the time of the author's writing he only had up-
wards of 3000 cases to draw his conclusions from. Since that time a
far larger figure does not shew any fatal case.

In many instances we have been somewhat disappointed in the
doubtful or non-committal expressions of Dr. Churchill, as for in-
stance, the power of the secale cornulum to originate uterine contrac-
tion, and the nature of puerperal fever. His article on that subject is
rather a compilation of the views of many other writers than an
article of his own. We were rather surprised, too, to find that

514 BIRD ON URINARY DEPOSITS.

several much improved obstetrical instruments, which have been in
use for some time, are omitted : Weiss's perforator, a better form of
short forceps, &c.

In the chapter on Puerperal Mania we find several statements
which more than astonish us : " Puerperal mania is by no means a
rare disease ;" — " there is no reason to believe that it arises from in-
flammatory action in the brain ;" — " there are few cases which require
venesection," are three propositions which are, to say the least, ex-
ceedingly debatable, but our author gets rid of the whole subject in
a couple of pages.

We have not room to make a more extended notice of this book ;
it may be obtained in Richmond of Messrs. Morris & Bro. for a
moderate price.

Urinary Deposits : their Diagnosis, Pathology and Therapeutical Indi-
cations— By Golding Bird, A.M., M. D., F. R. S., F. L.S., As-
sistant Physician to and Lecturer on Materia Medica and Therapeutics
at Guy's Hospital, 8fc. Second American, from the third revised and
enlarged London Edition. 12mo. 337 p. Philadelphia : Blanchard
fy Lea. 1851.

The rapid advance made within the last few years in organic che-
mistry and physiology has given a tremendous impetus to the study
of pathology, and has created a revolution in special therapeutics.
In no branch has this been more felt than that of urinary diseases,
and to none are we more indebted than to Prout, Leibig and Bird ;
the latter of whom, having enjoyed for nearly twenty years the ex-
cellent opportunities afforded by Guy's hospital, has labored most in-
dustriously in collecting facts and making observations on the urinar}'-
organs, their functions and their diseases. The results of his labors
have been furnished to the world in the neat and handy volume
before us. It is a complete vade mecum for him " who purposes
making himself acquainted with the important bearings of urinary pa-
thology on the practice of his profession;" and the author has been
careful not to plunge into the difficulties of his subject without giving
such minute instructions to his readers as will enable the worst in-
formed of them to follow him. Directions for the analysis and exami-
nation of urine for particular normal or abnormal constituents are
given minutely. The optical characters and physiology of healthy
urine being taught, they are brought to bear upon the pathology,
diagnosis and curative indications in its various changes in disease.
Illustrative cases are detailed, which render the applicability of all
the theories and principles easy.

Dr. Golding Bird being admitted as probably the highest living
authority on these subjects, his book is one which ought to be in the
hands of every practitioner of medicine. It would be needless to take
up the different divisions of this valuable work, but in chap. XIII the
author makes some remarks on the therapeutical employment of
remedies influencing the functions of the kidneys which are of such a

ranking's half yearly abstract of medical sciences. 515

practical nature that we would be glad to have room to copy the
whole chapter. After alluding to the doubtful character of diuretics
and their capricious action as a class, the author lays down certain
laws regulating them, and he severally explains these laws.

" Law I. All therapeutical agents intended to reach the kidneys must either be in solu-
tion when administered, or capable of being dissolved in the fluids contained in the stomach
or small intestines after being swallowed.

" Law II. Bodies intended to reach the kidneys must, to ensure their absorption, have
their solutions so diluted as to be of considerably lower density than either the liquor san-
guinis, or serum of blood, (i. e. below 1.028.)

" Law III. If a sufficient quantity of water cannot be received into the small intestines,
or the circuit through the portal system in the vena cava ascendants, or thence through the
lungs and heart into the systematic circulation, be obstructed, or if there be extensive disor-
ganization of the kidneys, the due secretion of urine cannot be effected."

After explaining these laws, the author concludes by saying :

"From the above observations the following practical conclusions may be drawn:

" 1. Whenever it is desirable to impregnate the urine with a salt, or to excite diuresis by
a saline combination, it must be exhibited in solution, so diluted as to contain less than five
per cent, of the remedy, or not more than about twenty-five grains in an ordinary draught.
The absorption of the drug into the capillaries will be ensured by a copious draught of
water, or any diluent immediately after each dose.

" 2. When the urine contains purpurine, or presents other evidence of portal obstruction,
the diuretics or other remedies employed should be preceded or accompanied by the ad-
ministration of mild mercurials — taraxacum, hydrochlorate of ammonia, or other cholitic
remedies. By these means, or by local depletion, especially by leeches to the anus, the
portal vessels will be unloaded, and a free passage obtained to the general circulation.

" 3. In cases of valvular or other obstructions existing in the heart and large vessels, it is
next to useless to endeavor to excite diuretic action, or appeal to the kidneys by remedies
intended to be excreted by them. The best diuretic will in such cases be found in whatever
tends to diminish the congested state of the vascular system, and to moderate the action of
the heart, as digitalis, colchicum and other sedatives, with mild mercurials."

Ranking' s Half Yearly Abstract of the Medical Sciences; a Practical and
Analytical Digest of the Contents of the Principal British and Conti-
nental Medical Works : Published during the six months from January
to June 1851. 8vo. 324 p. Lindsay 8f Blackiston: Philadelphia.

This valuable and cheap publication, already so popular with the
profession in this country, has been furnished us by Morris & Brother.
It contains 93 articles and 4 reports on the progress of medicine.
Considering the amount and character of the matter contained, and
the price, we consider this the cheapest medical publication issued.
The price of each number at the book stores is 75 cents, or it will be
sent to any person ordering it, by mail, for $1, free of postage.

We have not received the 22d and 23d parts of the kindred publi-
cation of the above, " Braithwaite's Retrospect.''''

Notices of "Walker on Intermarriage,'1'1 and " The Microscopist^ by
Joseph H. Wythes, M. D., both received through Morris & Brother,
from the publishers, Messrs. Lindsay & Blackision, are necessarily
crowded out of the present number for want of room. They will
appear in our next.

516 SELECTIONS.

We have received the Transactions of the Belmont Medical Society,
Bridgeport, Ohio, 16mo. 90 p. They consist of four essays, five
cases, and a lengthy report on quackery as well as one on the im-
provement in medicine. J. G. Affleck, (practitioner, we suppose,)
printer of the above and a member of the society, also forwards us
the Belmont Farmer, of which he is editor. It is a queer little sheet,
devoted to taking " cracks at creation," — " asks for no pay, but a rea-
sonable share of abuse, which he (the editor) hopes to merit." In
reply to the query " how will we exchange ?" we most respectfully
reply, for $ 3 per annum.

We have received the Annual Announcement of the 2d Course of
Lectures in the Medical Department of Georgetown College. Washing-
ton, D. C. If this new department is conducted and established upon
the sound basis of the academic one of this venerable and famed in-
stitution, it must merit and meet success. We hope, though, soon to
see its faculty heed the voice for reform in medical education. Now,
in its youth, is the time to establish it firmly upon high principles.

We have also received the Annual Announcement of Rush Medical
College, Chicago, Illinois. We are sorry to see this school debasing
the dignity of the profession and disgracing itself by adopting means
to secure students which are worse than the practice adopted by out-
siders to get patients, viz : " the fees for the full course are $ 35" ! ! Seven
professors at $ 5 each per head. Medical students are as cheap as
calves in the west, it seems, and this college (?) turned out 31 regu-
lar (?) and 2 honorary doctors at its last commencement. Of course
the lectures only last sixteen weeks, and good board can be had for
almost nothing. What is the profession coming to in this country?
What sort of factories are not springing up ?

Other publications have been received, but cannot be noticed for
want of room.

Fourth Annual Meeting of the American Medical Association.

We copy from the Charleston Medical Journal and Review for
July, the following account of the opening of the meeting in Charles-
ton in May last :

It was composed of delegates, many of high distinction, from twenty-
one states of our Union, and a more respectable assemblage has sel-
dom been convened on any former occasion. The president, Dr. R.
D. Mussey, of Cincinnati, took the chair at 11 o'clock, and extended
a cordial salutation to the members upon their re-union, and congra-
tulations upon the many benefits resulting from these annual assem-
blages of the wisdom and experience from all parts of the Union.

Upon being seated, the committee of reception advanced, and,
through their chairman, Dr. T. Y. Simons, addressed the president
and members in the following terms :

SELECTIONS. 517

" Mr. President and Gentlemen — It is my pleasing and honorable
duty, as chairman of a committee representing the South Carolina
Medical Association, to express to you the high appreciation of your
acceptance of the invitation of that body, and gratification in behold-
ing so many of our medical brethren, of every section of the Union,
assembled in Charleston, the ancient metropolis of South Carolina,
and to tender to you, with the deepest emotions, our most heartfelt
welcome.

" We will cheerfully unite with you in all efforts to elevate the
moral and intellectual excellence of our profession, and promote the
cause of science and humanity, but beyond this, we desire to extend
to you, individually and collectively, all the social hospitalities of
which we are susceptible.

" The assembly of so large a number of medical gentlemen from
all parts of the Union, holding eminent positions in the profession,
coming, in many instances, from a great distance, at considerable ex-
pense, inconvenience and personal sacrifice, for the promotion of me-
dical improvement, and thus likewise subserving the cause of science
and humanity, is, in my opinion, a sublime spectacle. We seek no
honors nor trophies ; we crave no ambition, pomp, nor self-aggrandise-
ment ; we desire only, and if we succeed the reward is ample, to do
good to mankind. We unite with you as brothers, in these noble and
benevolent efforts, and we invoke, on this solemn occasion, the bless-
ings of the Great Supreme.

" Mr. President and gentlemen, I shall not detain you, except again
to repeat, that with our warmest feelings we bid you a most hearty
welcome."

To which Dr. Mussey replied substantially as follows :

" Mr. Chairman and Gentlemen of the Committee — It is with no ordi-
nary feelings that I respond in behalf of the American Medical Asso-
ciation, and express our gratification at your warm and hospitable re-
ception.

"Charleston has been long renowned for the hospitality of her citi-
zens, and the enlightened character of her physicians, both as regards
moral and intellectual endowments. High, however, as she stood, I
was not aware until I arrived here, that the Medical Society of South
Carolina was the first body that proposed that means should be
adopted for the improvement of medical education. I now, Mr. Chair-
man, return you our thanks for your kind, and hospitable, and warm
reception ; and feel confident that we will harmoniously unite in the
promotion of the grand objects of the association."

The committee on nominations having reported, through their chair-
man, suitable candidates for the offices of the association for the en-
suing year, the same was confirmed, and Dr. James Moultrie, of
South Carolina, was declared president of the association.

The president elect then took the chair, and returned thanks for
the honor thus conferred upon him, in the following terms :

" Gentlemen of the Association — I know not in what terms suitably to
express my sincere acknowledgments for this unlooked for manifesta-
tion of appreciation and kindness.
61

518 SELECTIONS.

" When I look around, and recognize the man}*- superior intellects
and higher professional acquirements by which I am surrounded, I
feel that I am about to occupy a position which more rightfully be-
longs to another.

" But, if a life devoted to the interests of the profession, and the
promotion of the objects for which this institution is founded, give me
any claim to consideration, I have the assurance that the mantle of
my illustrious predecessors may not be unworthily or ungracefully
worn.

" In the language of the first of them, I have ever ' loved my pro-
fession ;' nay more, I am proud of it. I have loved it for its sympa-
thies and suavities ; its benignities and charities ; its activities and
self-sacrifices ; for the boundless scope of knowledge which is opened
before it ; its disinterested pursuit of the true, the beautiful, and the
good ; the exalted mission which has been appointed to it on earth ;
and the universal appreciation in which it is held, and confidence re-
posed in it, by mankind ; and I am proud of it, not alone for what
has thus been adverted to, but for its habitual singleness of purpose ;
its almost immunity from prison discipline ; the little notoriety it en-
joys in the statistics of crime ; and the little trouble it has given to the
tribunals of justice, or of civil jurisprudence.

" Never, however, have I been so proud of it as when, four years
ago, I enjoyed the gratification of meeting so large an assemblage, in
the city of ' Brotherly Love,' characterized by so much intelligence,
so much urbanity, so much dignity, and so much condescension ;
convened for the purpose of systematizing the principles of profes-
sional prosperity, and cultivating those habits of social harmony, the
practice of which have immemorially obtained for it the definite epi-
thet of ' the paternity :' or when, two years afterwards, at the modern
abode of the 'Humanities,' its labors of usefulness and love were re-
newed, amidst the outpourings of hospitalities, which could only have
issued from heads and hearts the most highly cultivated and refined.

" The accidents of life, and the visitations of Providence, which
come unto all of us in turn, I have to regret, denied me the gratifica-
tion of being also present, on the intermediate occasions, in the great
valley of the Mississippi, and the commercial emporium of the Chesa-
peake.

" For the privilege, as well as the distinction, of presiding over a
body constituted of such elements, I am profoundly grateful. I thank
you, gentlemen, again and again ; and when our present labors shall
have closed, and we shall have once more reached our respective
homes, I hope we shall be able to realize, in our experience, that ' it
was good for us,' in like manner, ' to have been here.' "

SELECTIONS.

519

The following is a correct list of the number of states represented,
and the number of delegates from each :

1. Massachusetts,

10 delegates.

14. Louisiana,

2 delegates

2. Rhode Island,

5

15. Tennessee,

3

<«

3. Connecticut,

3

16. Kentucky,

4

«

4. New York,

17

17. Ohio,

5

it

5. New Jersey,

6

18. Indiana,

1

ti

6. Pennsylvania,

35

19. Illinois,

1

"

7. Delaware,

2

20. Missouri,

3

«

8. Maryland,

5

21. District of Columbia,

2

ii

9. Virginia,

11

10. North Carolina,

7

Total,

185

11. South Carolina,

38

Permanent members,

10

12. Georgia,

23

13. Alabama,

1

Grand Total,

195

Medical Reform.

BY JAMES H. STUART, M. D.

" But yesterday, and physic might have stood against the world ;
now, none so poor to do her reverence. " Our profession is rapidly
declining in respectability. This is a very bold proposition, but, un-
fortunately, so self-evidently true, that there is no risk of its being dis-
puted. We make great boasts of the vast discoveries annually made
in the scientia medicina, of the talent and learning enlisted in its behalf,
of the wealth expended upon it, and of its great usefulness to suffering
humanity, and all is true ; yet the stigma still remains. Year after
year we hear more and more of suits for malpractice, more instances
of gross ignorance in medical men, more carping at the writing of pre-
scriptions in Latin. We can almost see a sneer of contempt when the
profession is named. Why is this ? Is it because of the prevalence
of quackery ? It is because Thompsonianism, homcepathy, et id genus
innumerabile of quack systems have arisen and pinned themselves to
the skirts of medicine? No. For, though with the uneducated vulgar
such association would bring us into disrepute, the intelligent man
would distinguish and draw the line of demarkation. The evil rests
with ourselves. We are accountable for it. Can it be wondered at
that men will despise a profession containing individuals who, as in
a recent case published in the papers, write oleum ricini oleum resini,
and have done so for twenty years ? Oh, time-honored ignorance,
what hast thou and thy coadjutor — impudence — not done for thy vo-
taries ? No wonder the laity call for a reform, and because they can-
not hope to strike the root of the evil, suggest the milder one of writing
prescriptions in English, thus practically saying to us, " You are igno-
rant asses ; we cannot trust you to meddle with a learned language,
and will, at all events, take pains that your ignorance is not fatal to
us." This is painful, but it is true. There certainly are many in the
profession, regularly furnished with their diaplomas (as one of them
termed it,) who not only are unable to write a Latin prescription, but
would be sorely puzzled to get through an English sentence without
the most amusing natural phonography. Hundreds crowd every year

520 SELECTIONS.

to our medical schools who are destitute of the rudiments of a com-
mon school education, and duly emerge in the spring with moustache
and parchment, lancets and tight boots. As Burns says —

" They gang in stirks and come out asses."

And on their return, their fellow townsmen open their eyes in astonish-
ment that the lazy Tom, Dick or Harry has turned out " a real
doctor." Can we blame them that they do not place much confidence
in medical men ? Is it not the most common thing in the world to
hear that some brainless whelp, for whom you entertain a perfect con-
tempt, has commenced "studying medicine?" The profession is now
far overstocked. Every little village contains three times the neces-
sary number. At least one-half now in it must be starved out, yet
the cry is " still they come." They do come, and they come because
they well know there is no such thing as failing in this profession. Me-
dical colleges are springing up like mushrooms over the country, and if
they cannot graduate at one, it is the easiest thing in the world to go
to another and " be put through" there. It is almost enough to make
one heart-sick to think of the companionship he is subjected to. To
know that at any moment he may be called upon to recognize the pro-
fessional equality of some ignoramus whom in society he would never
think of noticing ; to feel that you cannot travel in peace without hearing
the low-looking fellow at your elbow styled " doctor" by some gaping
ninny who is proud of the acquaintance of a " professional gentleman ;"
without seeing some "nice young man " in spectacles, mincing along
with the gravity of an owl, and carrying under his arm the unmistaka-
ble red morocco pocket case. Truly we will soon begin to envy the
title of plain "Mr." as a distinguishing mark. And, withal, we have
the ladies? They talk of " lovely subjects" and " charming dissec-
tions" with ^sangfroid and apparent pleasure that the greenest of first
course students might well envy. But, alas! it is no jesting subject.
Ignorance is fearfully rife among us. The evil would, in time, work
its own remedy, but we cannot wait. And yet what is to be done?
Legislation cannot avail even were the legislators willing to assist
ns, which they are not. Against any hint of reform are arrayed the
interests of all concerned in teaching medicine. Every country doc-
tor who has a private pupil must get his own pet through and receive
his fee fork; every city physician, with his class of three or four,
has his interest proportionally increased, and the colleges are of course
anxious for as many pupils as they can get. Would that medical
men had but the honesty to tell applicants for seats in their offices the
candid truth ! To say to one, "Your health is too feeble ; you will
die under hard study ; to another, " Your mind is unfitted for the pro-
fession ; }rou will never make a physician;" and, to a third "Stick
to your shoemaking — you can live at that :" to let them know the
troubles and anxieties of the profession, the wearying mental toil, the
hard bodily labor, the lack of equally distributed time, and the inade-
quacy of the remuneration of medical men. Would they do this, we
might hope soon to see the number of doctors decreasing, and their re-
spectability increasing. We would then have only robust men with

SELECTIONS. 521

good minds, and men actuated, not by the love of money, but who,
like Aben Ben Adhem, say —

"Write me as one who loves my fellow men."

Men who are willing to undergo suffering and toil, to expose them-
selves to cold and damp, to ingratitude, and even poverty, for the sake
of alleviating some of the misery that "flesh is heir to." Failing of
this mode of purifying the profession, another more general one, hav-
ing reference to examinations for practice, should be resorted to. This
might be accomplished by the joint consent of the schools, or by action
of the National Association. But my article is growing longer than
I had intended, and, for the present, I must cease. Perhaps in a
future number I may amplify, with your consent, on the idea just
thrown out. At present, I conclude by quoting from an unpublished
poem of O. Wendell Holmes, which accidentally came under my no-
tice, the following excellent advice to any one thinking of medicine :

J'But thou, poor dreamer, who hast vainly thought
To live by knowledge which thy brain has bought,
Go, shun the art which every boon denies
Till age sits glassy in thy sunken eyes ;
Go, shun the treasury which withholds its store
Till hope grows cold and blessings bless no more."

N. J. Med. Reporter.

Professors and Laymen.

The letter which appeared in our last Number from Dr. Yardley, of
Philadelphia, correcting an erroneous impression which exists with re-
gard to the motive of the authors of the resolution to which he refers,
seems to demand of us a passing notice. The resolution was pre-
sented at the late meeting of the American medical association at
Charleston, S. C, and proposes an alteration in the constitution of the
association, which, if adopted, would rescind that provision of it by
which delegates from all medical colleges, hospitals, lunatic asylums,
&c. are admitted. As this is still an open question, we feel at liberty
to say a few words upon the propriety of adopting the resolution which
emanated from the Philadelphia county medical society. It is as fol-
lows : " Resolved, That the constitution of said association should be
altered so as to admit only delegates from county or state medical so-
cieties." We conceive that great good would result from such an ar-
rangement, inasmuch as it would inspire a greater interest in the mass
of the profession to form themselves into county and state medical so-
cieties, there being no means that can be adopted for the mutual im-
provement of physicians, both in their professional and social capa-
city, that can be compared in importance to such organizations ; and
while a great good would be accomplished in this way, and a stimu-
lus given to medical reform, the unequal representation now com-
plained of would be avoided, and the meetings of the association con-
ducted on those principles of republican equality which belong to the

522 SELECTIONS.

genius of our country. There does not seem to us a single valid rea-
son why the representation from medical schools, hospitals, &c. should
be three times greater than that of the whole profession ; and we do
not believe that the jealousies which have already poisoned the cur-
rent of harmony that is wont to refresh and invigorate the entire body,
are in anywise necessary to the maintenance of the association ; hence
we would be glad to see them all abandoned ; and as we believe their
foundation is in the spirit of rivalry between the different schools, and
of suspicion between those who are professors, and those who are not,
we would rejoice to see the wall of partition broken down.

Medical schools generally spring up as the result of private enter-
prise, organized and sustained in view of personal emolument ; and
they ought not to be allowed, in matters of common interest, to exer-
cise an unequal and overbearing influence. We do not charge those
to whom they belong, with any motive of injustice towards others ; but
we do believe that in a general assembly of physicians, met together
from all parts of our country, for the purpose of improvement in sci-
ence, and the advancement of mutual interests, there should be no
line of difference drawn between professors and hymen; and that there
should be no doctrines taught that may be arrayed before us as school,
or anti-school. That there is such a spirit among us, is evident. The
very fact of the resolution itself confirms the assertion. The great
cause of dissension in the medical world, not as regards opinions in
practice, but as relates to the policy and government of medical or-
ganizations, and professional intercourse with each other, is jealousy —
that strong passion of the human heart, which arises from fear that a
rival will gain an advantage which we had hoped to gain, or that he
may be exalted to a position which we had anticipated.

That this spirit may be rooted out of our noble and ennobling pro-
fession, we do most heartily desire ; because, wherever it may be
found, in the private walks of daily professional life, or in our more
public engagements connected with medical societies, it is the spirit
of discord. It must be avoided, if we would have prosperity ; and
if we would hide it from the sight of the multitude in our public meet-
ings, we must hide it from one another in our daily life; and let the
tribute of gratitude be freely offered to those, who, with a strong de-
sire to serve the profession and the cause of science, have come for-
ward with a suggestion which promises so much benefit. To them
let the language be addressed,

" Whoever has qualities to alarm our jealous}7, has excellence to de-
serve our fondness."

We hope the question involved in the resolution will be fully consi-
dered. It does not contemplate to exclude professors from the meet-
ings of the association, but to do away with all exclusive privileges,
while it equalizes the legislative power of what ought to be our medi-
cal congress. — N. J. Medical Reporter.

SELECTIONS. 523

Medical Statistics of Paris.

The number of physicians in Paris has diminished this year, but
not in as great a proportion as in 1848. There are now in Paris 1351
physicians; in 1S49 there were 1389, making a diminution of 38.
Among the 1389 physicians of 1849, 68 are dead and 86 have left
Paris ; of these 86, 12 have gone to California. Among the 1351 phy-
sicians that compose the list of 1851, there are 113 new names ; there
were 114 new names in the list of 1848.

There are now -178 officers of health, which are more than the num-
ber of medical men during the reign of Louis the XIV. The number
of druggists is 381, and the sages- femmes number 380. The number
of graduates slightly increased in 1851 — there were then 236, whilst
in 1849 there were 230. — Jour, des Connaissance.

Case of Stricture of the Urethra.

BY JAMES F. CRUIKSHANK, M. D., DALMELLINGTON, AYRSHIRE, SCOTLAND.

The recent introduction, by Mr. Syme, of a method of treating
stricture of the urethra by incision, has brought within the range of
surgical relief a certain class of cases, which hitherto have been re-
garded as irremediable by the usual method of dilatation, and which
in some cases even demanded immediate relief by puncture of the
bladder. But as new methods of operating are generally slow in being
adopted, more especially when such surgical interference finds a place
among the minor operations of surgery, 1 think that medical men,
and chiefly those practising in large country districts, are bound to re-
cord their experience, when they have had any opportunities of putting
new methods of cure to the test. Upon the principle, also, that every
case ought to be recorded in which any new operation has had a fair
trial, whether the result shall have been favorable or not, I beg to
publish the following case : I have withheld its history till now, for
this reason, " that strictures which have been cured in the ordinary
way, by dilatation, are often apt to return in some degree upon exposure
to cold and wet, even when gonorrhoea has not been again contracted."

About the beginning of November 1849, James Macrae, a miner,
45 years of age, and of rather intemperate habits, consulted me in re-
gard to a stricture of the uretha, from which he had suffered with
more or less seventy for about three years, the result of an acute gonor-
rhoea, which had lasted some weeks, and had given way under the
ordinary treatment, without injections.

The stricture was a very tight one (admitting with difficulty No. 2
bougie,) and situated at the bulb of the uretha. During a period of
about two months 1 continued to dilate it regularly, in the usual way,
by the introduction of metallic bougies, till No. 8 of the scale could be
introduced. Gradually, however, he began to suffer much pain from
the passage of the instrument through the canal, and latterly had ri-
gors, succeeded by severe constitutional irritation, which confined him

524 SELECTIONS.

to bed for some days. I did not venture to introduce the bougie for
more than a week after his recovery from this attack, and on doing
so, I found that the stricture had contracted to its original size, so that
I could with difficulty introduce bougie No. 2. A small, hard
swelling, with indistinct fluctuation, now appeared at the seat of stric-
ture. Being under the necessity of working constantly, and, from the
nature of his employment, to sit on the wet ground, (circumstances
which tended to aggravate his complaint,) he was naturally anxious for
some effectual and speedy cure. At this time I had occasion to be
in Edinburgh for a day or two, and availed myself of the opportunity
of seeing Mr. Syme perform his operation for the relief of stricture
upon two patients. I determined, accordingly, to try it; and, on the
30th January 1850, with the ready consent of the patient and the
help of my assistant, the late Dr. M'Curdy, I performed the operation
as directed by Mr. S. I introduced a grooved bougie, of very small
dimensions, (about No. 2,) and made an incision in the raphe of the
perineum, over the seat of stricture, which I completely divided. On
making the incision, a small quantity of matter escaped, which had
formed in the tumor I have already noticed as existing. I then intro-
duced No. 9 catheter, which was retained during forty-eight hours,
without much uneasiness. The urine continued to come by the wound
for five days, when it began to flow by the natural channel ; and in
three weeks after the operation, he was able to resume his work, the
wound having healed slowly and well. I introduced catheters
Nos. 11, 12 and 13, once a month for three months, with ease, and
without pain or rigors. He then left this part of the country, and I
saw no more of him till about the end of March 1851, when he ap-
peared quite well, and informed me that he had been constantly at
work since his recovery from the operation ; and, in order to test the
efficacy of the cure, I introduced No. 13 bougie without the least
difficulty. — Edinburgh Monthly Journal of Medical Science.

A Case of Obstruction of the Colon relieved by an Operation
performed at the Groin.

BY JAMES LUKE, SENIOR SURGEON TO THE LONDON AND ST. LUKE'S

HOSPITALS.

The subject of this report was a man aged 60, who on December 16,
1850, first complained to the author of feeling generally unwell. He
had no pain, but his countenance was depressed, his eyes sallow, and
his tongue coated. The bowels were confined, and lately medi-
cines had acted with difficulty on them. An aperient was ordered,
and on the following day he passed a small lumpy motion, but with-
out relief to the symptoms ; castor oil was ordered, but after a time was
rejected by vomiting. On the 18th there was no relief from the bow-
els, and he vomited everything he took. From this time he progres-
sively got worse in spite of all the means resorted to for his relief.
He complained of pain chiefly about the region of the caecum. The

SELECTIONS. 525

transverse arch of the colon could be felt distended and tympanitic.
A careful observation of the case had led the author to believetheie
was obstruction in the bowel about the sigmoid flexure of the colon,
and it was resolved as a last resource to operate upon the patient. The
operation was performed on the 23rd. Not thinking it prudent to assume
that the conclusion respecting the seat of the obstruction was certainly
correct, the author determined to adopt that operation which would give
him some opportunity of extending- his search, provided he did not find
the obstruction at the point where it was supposed to be. He there-
fore opened the abdominal parietes near the groin, by an incision four
inches in length, a little to the outside of the course of the epigastric
artery, the lower extremity of which incision terminated a little above
Poupart's ligament. The peritoneum was opened to the extent of
about two inches. On passing the finger down the surface of the intes-
tine, which now protruded, a diseased mass could be felt, which
appeared to encircle the intestines. The bowel was then opened above
this part; a large quantity of feculent matter came away and the pa-
tient expressed himself as relieved. On now passing the finger into
the bowel it was found to be impervious about two inches below the
aperture. After the operation the recover}^ of the patient was rapid.
On the second day, foeces passed per anum, and continued to do so
for more than a month, when their passage through their natural open-
ing ceased; it was again partially restored, but from this time the
greater part of the foeces passed by the wound. This was closed by a
well fitted pad, and he has been enabled since to pursue his ordinary
occupation almost without interruption. The author then proceeds to
remark on the danger of protracted delay in attempting to relieve such
cases — a delay which is, however, to a great extent rendered necessary
by the difficulties of diagnosis. The distension of the colon, and the
evidence.afforded by the proper introduction of the long tube, are point-
ed out as the two means of diagnosis on which reliance may be gene-
rally placed for the purpose of determining the seat of obstruction,
when it is situated at the lower part of the colon. The advantages
of the operations ofAmussat and Littre are then compared, and the
author, while admitting the advantage gained by operating in the loins,
as proposed by the former — of not opening the peritoneal cavity — yet
thinks that the operation in the groin offers certain advantages which
render it in many cases preferable. By the operation in the loins
nothing more could be done than opening the intestine ; but this might in
some cases be improper — as where obstructions were produced by fi-
brous bands overling the intestine, or by strangulations, the result of
causes acting exteriorly to its tunics. In these cases, the proper treat-
ment is to divide the bands, or relieve the cause of strangulation.
In the event, too, of an error of diagnosis, the opening in the loins does
not provide any facilities for correcting the error. The danger of to-
tal failure of affording relief consequent upon this state of things, must
therefore be attributable as a demerit to the operation in the loins.
There are besides the minor evils in this operation, that the opening
cannot be conveniently attended to by the patient himself, and that
there exists frequently a great disposition to contraction, arising from
62

526 SELECTIONS.

the great depth of the wound, which requires renewed surgical inter-
ference. In all these particulars, with the exception of the necessary
attendant of peritoneal section, the operation of opening the abdominal
parietes at the groin, in all cases of obstruction or suspected obstruc-
tion, in the lower part of the colon, appears to the author to be the ope-
ration which should be preferred. It affords facilities for modifying the
treatment, either by opening the intestine, when incapable of relief by
other means, or by dividing or removing any existing cause of stran-
gulation. It enables the surgeon to extend his search within a limited
range, in the event of the diagnosis proving incorrect ; it allows him
to open the bowel as close as possible to the seat of obstruction ; and
it secures to the patient the facilities for attending to his own comfort,
which appears almost a necessary condition to make life endurable
under such circumstances — Dub. Med. Press.

Observations on the Nature and Treatment of certain Diseases.

BY ROBERT J. GRAVES, M. D., F. R. S., &C.

Neuralgic Rheumatism.

In December 1848, I was called to see a gentleman of middle age
and robust constitution, who was attacked by a very singular variety
of " neuralgic rheumatism." He had caught cold from wet feet, and
was seized with feverish symptoms, and violent pains in the nerves of
the lower extremities. All the muscles of the thighs, calves, legs and
feet seemed to be more or less affected, and the pain was most agoniz-
ing, being accompanied by spasms of the muscles, in violence and
intensity resembling those witnessed in Asiatic cholera. I caused the
affected limbs to be constantly stuped with a decoction of poppy-
heads, and rubbed with an oily narcotic liniment. Finding, however,
that the relief obtained by these means was only partial, I gave him
internally large doses of Dover's powder combined with James' pow-
der, and took blood from his arm ; and I caused the lower extremities
to be bandaged carefully, commencing at the toes, and proceeding up-
ward to the thighs. These means were effectual, and cured the dis-
ease in less than two days ; but after the pain had ceased there was,
however, (as might be expected,) some loss of power in the extremi-
ties for a short time. This was the second time that the patient had
been attacked in this singular way.

I have seen a person nearly suffocated by acute pleurodynia, when
this disease attacked the intercostal muscles of both sides of the chest,
and I have no doubt that suffocation may happen from the spasms of
cholera when they attack the muscles of respiration generally, or those
of the glottis in particular.

Thus I recollect attending, at Merrion, in 1834, with Mr. R. Wil-
kinson of Blackrock, a lady affected with Asiatic cholera, in whom
the spasms of the intercostal muscles at both sides were so continu-
ous and so violent — and in whom, consequently, the respiratory move-

SELECTIONS. 527

ment was proportionately painful, that the affection had nearly proved
fatal by the impediment it threw in the way of the motion necessary
for carrying on the act of breathing. Among the numerous patients
whom I have seen affected with cholera, this was the only case where
the spasms occupied the intercostal muscles.

Atonic Gout.

The following case exhibits some interesting particulars as to the
causes which are capable of exciting gout in a constitution heredita-
rily predisposed to that disease. A watch glass maker, of regular ha-
bits and steady conduct, enjoyed a robust state of health until he ar-
rived at the age of eighteen years, when he undertook a journey to
America, and was constantly sea-sick for the first five days of the
voyage ; at the end of which time the constant throwing up of bile
and the nausea ceased, but gout suddenly appeared in both his feet,
and the characteristic redness and swelling of the balls of the great
toes were accompanied by agonizing pain. Among the books which
he had taken with him was a copy of " Buchan," in which he found
it recommended to take abundance of wine, in order to keep the gout
out of the stomach. He followed this advice, and in about a week
the gout left him, and he was perfectly well when he arrived at New
York, after a voyage of twenty-three days. He had no fit of gout for
twenty-three years after ; since then, however, he has had repeated
attacks, and I am now (19th January 1849,) attending him in his six-
tieth year, in a violent paroxysm of the disease, occupying both feet
and one of his knees. The causes which brought on the gout in his first
attack are interesting, inasmuch as the circumstances of the case
prove, first, that a nausea and vomiting, continuing several days, ac-
companied, as always happens in sea-sickness, by an unusual dis-
charge of bile, is not capable of preventing an attack of gout. Se-
condly, that the operation of whatever debilitates the system predis-
poses the patient to an attack of gout. Upon this subject Dr. Todd
has made some very judicious observations in his treatise on gout.
Thirdly, we may learn from the particulars of this case that the treat-
ment adapted for gout differs much from that to which we have re-
course in rheumatism and other inflammations. I lately saw a stri-
king illustration of this in a gentleman whom I was attending with
Mr. Hamilton. We had been obliged to exhibit mercury rather co-
piously for the cure of certain venereal symptoms, and had brought
on a profuse salivation. Two days after the salivation had com-
menced our patient was attacked with a violent and regular fit of po-
dagra in the ball of the great toe ; this fit lasted several days, during
the whole of which time the salivation continued.

It is worth remarking that a hereditary disposition to gout may lie
dormant in the system during a long series of years. Of this I saw
a remarkable instance in a lady upwards of seventy years of age, when
I first commenced m}' attendance on her. Her parents had. been mar-
tyrs to gout, and the dyspeptic symptoms, of which she chiefly com-
plained, were such as are often observed in gouty persons. Accord-

528 • SELECTIONS.

ingly, I gave it as my opinion that she had a gouty diathesis. This
opinion was not verified until she had attained to the age of eighty-
two years, when she had a violent attack of gout, first in her right
foot, and afterwards in her left.

Dr. Neligan has furnished me with an illustrative example of this
fact, in the case of the Hon. E. M., in whose family gout has long been
an heir-loom. His first attack occurred when he was in his seventy-
first year, and he died, from a third attack, in about three months af-
terwards ; his sister, also, was attacked with the disease, for the first
time, in her sixty-fifth year ; yet several members of his family,
amongst others his only son, were martyrs to gout from their youth.

A fact I observed very lately tends also to corroborate the opinion
that the local inflammation of gout may be induced by debility : a
gentleman dying of long-continued diarrhoea, combined with a drop-
sical tendency, was seized with podagra forty-eight hours before
death.

Spontaneous formation of Poison in the Human Body.

On a former occasion I detailed the particulars of several cases
which seemed to prove that wounds and accidents affecting external
parts may give rise to symptoms plainl}' denoting the operation on
the constitution of a poison manufactured, if I may use the expres-
sion, in the injured skin and subcutaneous tissue. The following facts
corroborate that conclusion :

A healthy child, the daughter of a friend of mine, scratched her
nose with a blunt nail. The wound inflamed, and subsequently fes-
tered, and in several days after, the face, forehead, and at a later pe-
riod, the trunk, became more or less covered with an eruption some-
what resembling ecthyma. The child got well in a fortnight, under
the local application of soothing remedies and the internal use of lime-
water with milk, which was given to obviate a looseness of bowels
that followed the appearance of the eruption. It is curious that the
matter from the pustules infected three of her little nursery play-fel-
lows. As soon as this fact was noticed, the children were separated
from each other, and the nascent pustules were checked in their pro-
gress by applying a weak solution of nitrate of silver. They all re-
covered. The case is interesting, as affording an additional proof, not
only that an injury may cause the human body to manufacture a poi-
son capable of infecting the constitution of the individual, but that
the matter so formed may be capable of infecting by contact other
persons.

In the case of Miss G , aged sixteen years, who labored under

fever, bed-sores formed on the sacrum and hips, which gave much
trouble and were very obstinate ; but, notwithstanding, there seemed
to be some chances of her recovery, when, on the twenty-fifth day of
her fever, during the nocturnal delirium, she bit off a large portion of
her right thumb nail, and injured it to the quick ; it inflamed rapidly,
and the finger swelled, the lymphatics of the right arm became indu-
rated, and the whole extremity swollen. After a few days the body

SELECTIONS. 529

was covered with large vesicles, many of which were confluent, and
contained an opaque whitish serum ; there was also an increase of
constitutional irritation and of fever. She died on the thirty-second
day. In this case it is doubtful whether the poison originated in the
bed-sores, or in the injured thumb.

I saw, in the spring of 1848, another young lady who labored un-
der typhus fever, and who, after a long struggle, was apparently about
to undergo a favorable crisis, when suddenly the skin of her scalp,
that had been blistered previously, and had healed but imperfectly,
became erysipelatous. The disease spread slowly at first to the fore-
head and eye-lids, in which matter formed abundantly, and was after
some days let out with the lancet. The erysipelas now extended to
the neck and between the shoulders, assuming daily a more unfavor-
able character, and producing, as it spread, much subcutaneous oedema
attended with the formation of sero-purulent matter, as is usual in cases
of diffuse inflammation. Her state became rapidly worse — vesicles con-
taining sero-purulent matter formed on her skin, and at last many of
her joints, both large and small, became the seats of puriform deposi-
tion shortly before her death.

I think I have been able to trace many of the symptoms observed
in mjpia cachectica, and in the worst forms of secondary lues and pseu-
do-syphilis to the operation of a poison formed in irritated ulcers, whe-
ther in the throat or other parts. Hitherto pathologists have consi-
dered these constitutional effects to be the result of a poison intro-
duced into the system from without. I hope on a future occasion to
discuss this important question with the care it deserves.

The Therapeutical Powers of Aconite.

Although the medicinal properties of this plant have been long ago
described by continental authors, yet we are much indebted to Pro-
fessor Fleming (now of Queen's college, Cork,) for the accurate ob-
servations and cases which form the basis of his treatise on its virtues —
a treatise to which must be ascribed its general introduction into me-
dical practice in Great Britain. I still continue to find it useful in
certain obstinate cases of neuralgia ; while in other cases of this dis-
ease its effects have disappointed me : however, this is all that can be
expected from any medicine which acts upon the nervous system. It
is impossible that it could invariably produce beneficial effects, yet the
practical physician will be satisfied if it exhibits its powers in a given
proportion of cases.

Aconite failed to give relief in the case of a lady laboring under
chronic lumbago and sciatica, although it was pushed as far as pru-
dence would allow. Its failure in this case disappointed me much ;
but at the same time I may remark that there was something in this
lady's malady which rendered it particularly intractable, and caused
all the medicines that were employed to produce little or no good ef-
fect until, after many months, I tried strychnia internally, which proved
a speedy and perfect cure.

In another case, in which the patient, a middle aged gentleman of

530 SELECTIONS.

robust constitution, suffered from a cutaneous neuralgia affecting va-
rious parts of the skin at different times, and not sparing any part of
the body, so as to render his life miserable during the paroxysm, the
aconite likewise failed, as did all other remedies. The result was
more encouraging in the following cases :

I attended, with Mr. Nicholls, of Dawson street, an officer aged
about sixty-five years, who long labored under the effects of heredi-
tary gout, and who sent for me during an excruciating gouty neural-
gia, affecting the nerves on one side of his face. He was speedily
and completely relieved by the tincture of aconite, applied locally.

I attended also, with Mr. Nicholls, a gentleman from Roscommon,
who was attacked with rheumatic fever during a temporary residence
in Nassau street ; in the latter part of the fever he was tortured by
pains darting from the front to the back of the chest, or vice versa, or
else from one side to another — in fact these pains occupied successively
nearly the whole extent of the diapragmatic attachments. In this case
the aconite proved itself a most valuable auxiliary remedy ; as it did
likewise in a very similar case that I had in Harcourt street, which I
attended along with Surgeon Adams. In the latter instance it is ne-
cessary to remark, that the gentleman had been frequently cupped
over the seat of the pains with relief; and that he was, at the time of
taking the aconite, in a debilitated state ; under these circumstances
eight drops of the tincture, given in the morning, and repeated in four
hours afterwards, seemed suddenly to check the pains ; but it at the
same time brought on indistinctness of vision, a failing of the pulse,
and a diminution of general heat, which were for the moment very
alarming symptoms, but yielded in a few hours to stimulants, such as
brandy and wine. No bad effect remained ; but the specific action
of the medicine deterred us from having recourse to it again, when
the diaphragmatic pain returned in two days, though with diminished
violence. — Dub. Qiiar. Jour. Med. Sci.

Dr. J. Henry Bennett's Treatment of the Local Element in In-
flammatory Affections of the Cervix Uteri.

The treatment of the local element in inflammatory affections of the
neck of the uterus, which I adopt, may be given in a few words ; it
is the treatment followed in all chronic inflammatory diseases situated
in a position attainable by surgical means. If there be any acute or
subacute inflammation present, it must be subdued by antiphlogistics
and astringents. When once this has been accomplished the morbid
action still persisting must be modified and converted into healthy
vital action by stimulants. Thus in the first stage of treatment, we
use emollients, leeches and astringent lotions ; in the second, we apply
to the diseased surface caustics, in order, secondarily, to set up healthy
action. The eschar, which they produce, is eliminated and thrown off
by a process of vital inflammation, which tends to restore the healthy
condition of the diseased surface. The intensity of the stimulant to
be used depends on the chronicity and sluggishness of the disease, and

SELECTIONS. 531

on its resistance to therapeutic means. In recent and slight cases, the ni-
trate of silver is sufficient ; but when the morbid state penetrates below
the surface and the submucous tissues are diseased and hypertrophied,
it is generally insufficient, and stronger agents — agents which produce
a greater reaction — are required. Then it is that the mineral acids
should be used. Occasionally, however, even these fail when the
disease, has existed many years, and there is considerable deep-seated
chronic inflammation and hypertrophy. It is in such instances that
potassa fusa or potassa cum calce proves a most invaluable remedy ;
inasmuch as, by its means, any amount of vital reaction that is re-
quired, can be obtained. Since I have known its use, that is, for the
last fourteen years, I have not met with any case of inflammatory
disease of the cervix which has not eventually given way. But it is
more especially since I have simplified the application of potassa cum
calce, by running it into fine cylinders, like those of nitrate of silver,
that it has proved invaluable to me ; inasmuch as it has thus been ren-
dered nearly as easy of use, and as free from risk in application, as
the nitrate of silver; moreover, it may thus be much more easily gra-
duated at the will of the operator. I must, however, again impress
on my readers that I never apply potassa cum calce to destroy tissues,
but merely to set up healthy eliminatory inflammation, under the in-
fluence of which, indurated and hypertrophied tissues melt and are
resolved, and morbid surfaces become healthy and heal.

I was induced some years ago empirically to apply, with great
caution, the smallest sized potassa cum calce cylinders to the cervical
canal, in intractable inflammation, as "a last resource, and with great
success. This success I now attribute to the fact of its reaching, by
its more powerful action, the inflamed mucous follicles which lie be-
tween the radiations of the arbor vitas, and are thus subtracted from
the influence of milder agents.

Potassa fusa was first introduced as a remedy in these forms of ute-
rine inflammation by M. Gendrin of Paris, but had not been adopted
by the profession when I left that city, nine years ago ; although, I
believe, it has since been more favorably received. I can myself claim
the merit of having introduced it into practice in this country, and of
having simplified its use as above mentioned. I am continually using
it, with proper precaution, avoiding scrupulously the acute or sub-
acute stages of disease, and never meet with any accident. I may
say the same, as far as I am aware, of the numerous practitioners who
have adopted it throughout the country, on my recommendation. I
must, however, caution those who would use it inside the os, to apply
it very gently, and to guard against the too great closing of the cer-
vical orifice, as the surface touched heals. For want of these pre-
cautions, in several cases treated in the country, in which I have been
consulted, the os uteri has been all but closed. The dilatation of the
contracted os is always easily accomplished when this is the case, by
means of graduated bougies ; but such contraction had better be
prevented, by proper judgment and care in the first treatment of the
patient. — London Journal Med.

532 CIRCULAR.

Results of Surgical Operations in Malignant Diseases.

To the Medical Profession of the United States.

The undersigned having been appointed at the last
meeting of the American medical association chairman of the com-
mittee on the " Results of surgical operations in malignant diseases,"
respectfully solicits contributions to the subject, founded upon personal
observation. To place the subject in as tangible a form as possible,
he begs leave to direct attention to the following points :

1. The difference between cancerous and cancroid diseases, or
those affections which are truly malignant, and those which are only
partially so. In the former category are comprised scirrhus, ance-
phaloid and melanosis ; in the latter, certain maladies of the skin and
mucous tissues, as lupus, cheloid, eiloid and cancer of the lip.

2. The precise seat of the disease, as the skin and subcutaneous
cellular tissue ; the eye, ears, nose, face, lips, tongue, salivary glands,
jaws and gums; the lymphatic ganglions of the neck, axilla, groin,
and other regions; the mammary gland, uterus, ovary, vulva and va-
gina, penis and testis; the anus and rectum; and finally, the ex-
tremities.

3. The age, sex, temperament, residence and occupation of the pa-
tient.

4. The cause of the disease, its progress, and the state of the part
and of the system at the time of operation.

5. Mode of operation ; whether by the knife, caustic or ligature.

6. Time of death, or relapse, after the operation.

7. Examination of the morbid product ; how conducted — whether
by the unassisted eye alone, or by means of the microscope, and
chemical tests.

The undersigned hopes that the importance of the subject confided
to him as chairman of the committee above referred to, will be suffi-
ciently appreciated by his professional brethren to induce them to aid
him in carrying out the washes of the American medical association.
The subject is one of absorbing interest, and cannot fail, if properly
treated, to elicit matter of the greatest benefit. It is very necessary
that all communications upon the subject should be sent to the chair-
man of the committee by the 1st of January 1852.

Medical journals and newspapers friendly to the interests of medi-
cal science, will confer a favor upon the undersigned by inserting the
above notice.

S. D. GROSS, M. D.

University of Louisville, June 29, 1851.

THE

AND

VIRGINIA MEDICAL GAZETTE.

No. 10.1

RICHMOND, OCTOBER 1851.

[Vol. I.

Surgical Cases — with Remarks.

BY J. J. THWEATT, M. D., PETERSBURG, VA.

Case 1. — In 1845 I was requested to see a negro child, about 6 to 8
months old, with deformity of both feet, which could only be relieved,
as it was thought, by an operation. On examination I found the de-
formity to consist of that form of club foot, denominated talipes equi-
nus, complicated with varus. The child was healtlry, and born of
healthy parents. I advised an immediate division of the tendo
achillis, the unnatural retraction of which was the cause of the de-
formity. Consent to the operation was given, and it was performed
in the following manner : The child was placed upon its belly, the
foot firmly held by an intelligent assistant, and the tendon stretched.
A small puncture of the integuments over the tendon was made about
an inch and a half from the os calcis ; then by introducing the teno-
tome, and dividing the tendon, the foot immediately assumed its nor-
mal position. The tendon of the other foot was divided in the same
manner and with the same result. There was no haemorrhage, and
the child apparently did not feel the operation. Adhesive straps were
applied to the wound, over which a light dressing was used ; and an
anodyne was directed to be given if the child was restless. On the
third day the wound was entirely healed and only a slight deformity
remained. To retain the feet in their proper direction, I employed
the following simple apparatus : Two small splints with graduated
compresses were placed on each side of the leg, extending from the
knee to about two inches beyond the malleoli, and over them a band-
age. A gaiter, made of strong cloth, was applied over the feet, and
to the gaiter ribbon bands were sewed, which were brought up and
attached to the splints ; the feet were in this way kept in an extended
position. The apparatus was removed every five or six days, so that
the divided tendon might be examined. Under this treatment the
deformity almost entirely disappeared.
63

534 thweatt's surgical cases.

Case 2. — In 1850, M , a fine healthy girl, about four or five

years of age, was born with a deformity of both feet. The tendon
achillis was retracted and the feet turned inwards. When she
walked or stood it was on the outer edge of the feet. The deformity
was of that form called talipes varus. Manual manipulations and
various mechanical means had been resorted to to relieve the de-
formity, but with partial success. My advice was solicited, and I re-
commended the section of the tendon achillis. Consent to the ope-
ration was readily given. The child was placed on her belly ; an
assistant extended the foot ; the tendon being tense and prominent, a
small opening in the skin over the tendon was made, the tenotome
introduced and the tendon divided transversely ; the division of the
tendon was accompanied with a distinct crack ; no blood followed
the operation. Adhesive straps were applied and the little patient
put to bed, with directions to keep her quiet until I saw her again.
On the third day the small wound of the skin had healed by the first
intention, and the feet were only slightfy curved. The apparatus of
Messrs. Yerger and Ord was applied, and the child allowed to walk
about. The deformity has yielded to the treatment.

Remarks. — Modern surgery can boast of no greater achievement
than tenotomy or division of tendons for the removal of various de-
formities of the human body. At one period in the history of surgi-
cal science, the division of tendons was regarded by the highest au-
thorities as fraught with danger. To the genius and labors of Del-
pech and Stromeyer, we are indebted for the introduction of this ope-
ration into surgical science. These eminent surgeons have proved the
entire innocence of tenotomy as well as its eminent utility ; other dis-
tinguished surgeons have since added their valuable testimony to its
practicability and success. We will now offer a few reflections on
the nature and treatment of club foot, and especially on the division
of the tendo achillis. Much diversity of opinion exists among sur-
geons with regard to the origin of club foot. Some attribute it to the
position of the foetus in utero ; others to derangement of the cerebro
spinal system ; but the most received, and by far the most philoso-
phical opinion is, that which confines its origin to an arrest of de-
velopment, with deficiency of nervous power in the muscles. Before
the operation of division of tendons, the treatment of club foot con-
sisted of various stimulating embrocations, oils, &c. ; but the chief re-
liance was in the application of various mechanical means. Stimu-
lating embrocations are now abandoned ; but many surgeons still rely
on mechanical contrivances for the cure of this species of deformity.
It would be too tedious, and not at all compatible with the design of
this paper, to enter into a description of the innumerable machines
which have been invented and recommended for the treatment of this
deformity. Suffice it to say, that the treatment of club foot by me-
chanical means, however ingeniously managed, is slow, tedious and
painful, and in a large majority of instances is attended with but
poor success. At present mechanical means are resorted to after the
division of the tendon, in order to keep the feet in their natural posi-
tion. There are three forms of club toot in which the tendo achillis

thweatt's surgical cases. 535

is divided, to wit: the talipes equinus, talipes varus and talipes val-
gus. The two first are frequently met with, the last is seldom seen.

The early tenotomists were in the habit of dividing at the same
time the tendo achillis, tibialis anticus, posticus, and sometimes the
plantar fascia, for the relief of talipes equinus and varus; but expe-
rience has shewn that the division of the tendo achillis is amply suf-
ficient for the relief of the deformity. After the division of this
tendon, the contraction of the others can be overcome by properly
adjusted mechanical means. In talipes valgus, or splay foot, the ten-
dons of the peroneous longus and medius are divided. It is, how-
ever, the opinion of Stromeyer, that no material advantage is derived
from a division of these tendons — an opinion in which we fully concur.

The section of the tendo achillis can be made at all ages; and we
do not hesitate to say, that the sooner it is made, the more effectual
will be the operation. One great and important advantage in an
early operation is, that you can, in many cases, by judicious manual
manipulations, supersede the necessity of a resort to mechanical means
in the after treatment; and if compelled to resort to them, the simple
apparatus that was used in the first mentioned case will answer every
purpose. Different methods have been recommended for dividing the
tendo achillis. The early tenotomists divided it from behind, making
two openings in the integuments: a modification of this method is
adopted by some surgeons.

The tenotome or small straight pointed bistoury is introduced be-
hind the tendon, the patient being placed on the belly, and by a
sawing movement divides it : by this mode only one opening is made
in the skin. Both of these methods are now abandoned for the sub-
cutaneous, which is performed in the following manner: The patient
is placed on the belly; the tendon is relaxed by flexing the foot. The
surgeon with the fingers of the left hand draws up the integuments in
front of the tendon, introduces the tenotome by a small opening in the
skin on the internal side of the tendon, and extends the foot suddenly
and divides it.

The method of Bouvier, with a slight modification, is the one which
we prefer. The patient is placed upon his abdomen; an assistant
seizes the foot and extends it: the tendon is thus rendered tense and
prominent. The surgeon, with the fingers of the left hand on each
side of the tendon, by gentle pressure, makes the tendon still more
prominent : with his right hand he makes a small opening in the skin
in front of the tendon, about two inches from the heel, inserts the te-
notome and divides the tendon by cutting from behind forwards.
After the division of the tendon, adhesive straps should be applied to
the wound of the skin, and over these a light dressing, and the pa-
tient allowed to remain quiet for two or three days : after which time
the feet are placed in a right direction and retained so by a well ad-
justed apparatus. The after treatment of club foot is of great im-
portance, and demands the utmost care and circumspection in the
surgeon. All harshness should be studiously avoided, and the appa-
ratus selected should be applied with the utmost care and gentleness.

In order to keep up extension after the division of the tendo achillis*

536 thweatt's surgical cases.

various apparatuses have been invented and commended. The sur-
geon can exercise his taste or judgment in the selection of either
Scarpa's or Delpech's or Stromeyer's or Pauli's or Stromer's ap-
paratus, a full description of which can he found in any systematic
work on surgery.

When the operation is performed in early infancy, we prefer the
simple apparatus described in case first, and we can safely venture
the declaration that with care and attention it will fulfil every indi-
cation.

In older children we prefer Desault's apparatus for fractures of the
femur, as modified by Dr. Physick. The use of this apparatus should
be confined to the early stages of treatment: it should not be con-
tinued longer than four weeks — a much shorter time is often suffi-
cient : after which the apparatus of Scarpa, or which is far prefer-
able, an apparatus, invented by Messrs. Yerger & Ord of Philadelphia,
should be properly applied, and the patient allowed to walk about.
The duration of the after treatment of club foot depends upon many
contingencies. Generally after the lapse of two months, the appa-
ratus should be occasionally removed and the child allowed to walk
about without it: this course should be pursued until the deformity is
entirely removed.

Case 3. — 1851. Mr. B. consulted me for an affection of the kidneys.
On interrogating him relative to his general health, habits, etc., I as-
certained that he had been subject to bleeding piles for some time, nearly
fifteen years, and his general appearance fully indicated disease of con-
siderable duration ; his present sufferings were confined to the kidneys ;
he complained of great pain in the lumbar region ; urine scanty,
high colored, depositing a thick sediment on standing ; he had fever, no
appetite, bowels constipated, restless nights ; on testing the urine with
nitric acid and heat, it was found to be highly albuminous ; my efforts
at first were directed to the condition of the kidneys, stating at the
same time my belief that the disease of the kidneys was in a measure
connected with the diseased condition of the rectum ; he replied that
he wanted relief from his present sufferings — the piles could be treated
afterwards, and that he had not suffered much from them since the
disease of the kidneys had commenced. During the treatment I was
suddenly summoned one morning to see him ; I found him suffering
intense pain from a protrusion of the piles, which he had been en-
deavoring to return, but without success ; on examination there was a
prolapsus of about two inches of the mucous membrane of the rectum,
and a large bunch of haemorrhoidal tumors of a bright red color,
which were acutely sensible to the touch, and bled freely on handling
them. On a more minute enquiry into the history of the affection of
the rectum, he stated that he had the piles for more than fifteen
years, that the gut came down every time he went to stool, which
was a source of great annoyance ; the haemorrhage was often very
abundant, and there was always some blood in the stools ; he had re-
ceived treatment from several medical gentlemen, and had employed
of his own accord various remedies ; he had never received but tem-
porary relief from any plan of treatment. I urged him to allow me

thweatt's surgical cases. 537

to try the effects of cauterization with nitric acid ; he after some time
reluctantly consented. Placing him in a proper position, 1 dipped a
large size hair pencil in nitric acid (officinal preparation) and rubbed
it over the haemorrhoidal tumors until it produced a change of color;
he complained of very little pain ; the parts were dressed with lint
and sweet oil, and was directed to use an emollient enema if the pain
should be troublesome. On the second day I found him entirely free
from pain ; no fever or nervous excitability ; had passed a comforta-
ble night ; the piles were less congested and slightly diminished in
size ; the bright red color was changed into a dirty brown ; a small
portion of the protruded gul had returned ; he was required to strain
as if at stool ; this brought in view more tumors, which were situated
higher up the intestine. The nitric acid was freely applied as before ;
he complained more of pain this time ; described it as of a burning,
stinging character; the same dressing with the same directions was
ordered. On the third day the piles were again cauterized, which
occasioned a good deal of pain — anodyne emollient injections were
given, which soon removed the pain ; the protruded intestine was now
easily returned ; the piles had diminished in size and number ; he was
ordered to take a gentle laxative and remain quiet. On visiting him
again I found his general condition much improved ; he was free from
pain, slept well, good appetite, pulse calm and quiet, bowels open, and
only a slight prolapsus of the intestine ; no blood passed with the
stools ; on inspecting the rectum no tumors were visible ; on inserting
the finger up the intestine I found the parts contracted, and two or
three tumors, which were hard and insensible. The patient is now
doing well ; has had no return of his original disease.

Remarks. — The above case is interesting in several particulars :
First. Duration of the hemorrhoids. Here was a patient who had
been afflicted with the piles for fifteen years, during which time his
suffering had been often intense, always sufficient to render life un-
pleasant ; he had been treated by medical men of distinction, who no
doubt applied the remedies so often vaunted as a cure for the piles ;
he had recourse to quackery and tried its infallible remedies, all with-
out relief — his general health became affected — he was nervous and
irritated — complained of great muscular debility — constipation of the
bowels, anorexia, insomnia, etc. This is not an exaggerated picture.
Second. Affection of the kidneys. This case is but another fact of
the erroneous opinion of Dr. Bright. In this case the affection of the
kidneys was beyond disputation a secondary one, dependent entirely
on sympathetic irritation. There was no symptom of organic lesion,
unless the albuminous urine be recognized as one. It is well known
that Dr. Bright maintains that albuminous urine is pathognomonic of a
peculiar morbid condition of the kidneys — denominated by him as a
granular degenerescence of the kidneys ; that albumen is found inde-
pendent of any organic lesion of the kidneys, is a fact well established
by the observations of distinguished medical men in this country as
well as in Europe. In the case reported there could be no question
with respect to its origin ; its total disappearance after the cure of the
haemorrhoids removes all ground for any speculation. Third. The
rapidity and completeness of the cure, the remedy, etc.

538 thweatt's surgical cases.

In the 7th number of Braithwaite's Retrospect, there is an article
on the pathology and treatment of haemorrhoidal tumors, by Dr. John
Houston of Dublin, replete with interest. It was from his high re-
commendation of the nitric acid as an escharotic in piles, that I was
induced to try its powers in the case reported. It must be confessed
that it was resorted to with no small amount of therapeutic scepticism ;
and it is but feint praise to say that I was astonished at the benignity
and efficiency of its powers. When we take into consideration the
frequency of haemorrhoids, their obstinate character, the distress which
they often entail upon the life of the unfortunate patient, the variety
of remedial agents, external and internal, which are alternately and
unsuccessfully administered for their cure — and lastly, the painful and
often dangerous operations to which patients are ultimately subjected —
I repeat, when we take all these things into consideration, too much
praise cannot be bestowed on Dr. Houston for the introduction of a
remedy, which is easy of application, mild and efficacious in its
effects. The doctor regards the intense suffering which patients un-
dergo who are affected with piles to depend on a particular morbid
condition of the mucous membrane covering the piles. There are
two varieties of this pathological condition of the mucous membrane :
in the first, there is an anastomosis of the small vessels of the mucous
membrane and submucous tissue ; in the second variety, the mucous
membrane is congested, hypertrophied and sensible, and of a chronic,
inflammatory character. The nitric acid is fully capable of removing
the above morbid conditions. The condition of the parts in the case we
have reported corresponds entirely to the graphic description given in
the article published by Dr. Houston. The mucous membrane which
covered the haemorrhoidal tumors was deeply congested, acutely
sensible, of a strawberry color ; bled frequently, and especially when
touched. The nitric acid not only removed this condition of the
mucous membrane, but completely destroyed the piles, by producing
adhesive inflammation. It not only cured the piles, but the prolapsus
of the intestine was also cured. A question now arises, and we in-
vite the particular attention of the profession to it — May not the pro-
lapsus ani, so frequently met with in children, depend upon this
morbid condition of the mucous membrane ? Would not the nitric
acid be a remedy worthy of trial in such cases ? We shall endeavor
to give a categorical answer to these questions in a future number of
the Stethoscope.

In conclusion, we hope that surgeons will experiment with nitric
acid in the treatment of piles, no matter what may be their peculiar
views of their pathology or modus operandi of the remedy. We want
more facts of the efficiency of nitric acid as an excharotic in the
treatment of piles.

BROOCKS ON ACUTE PERITONITIS. 539

Acute Peritonitis.

BY J. N. BROOCKS, M. D., RICHMOND, VA.

This is one of the most formidable maladies that afflicts the human
race. It involves the most extensive serous membrane of the body,
and one most intimately united and blended with many of its most im-
portant organs. It covers all of the viscera contained within the ca-
vity of the abdomen, and lines this entire cavity. When acutely in-
flamed, therefore, great embarrassment of the functions of these or-
gans and great disturbance of the general system might naturally be
expected to arise. The peritoneum is very susceptible of inflamma-
tion, and when one part is affected it soon spreads over the entire or
greater portion of its surface. It is sometimes, though rarely, of
limited extent. The features of this disease are so marked, that it
may be so readily recognized by an observing practitioner, it will not
be necessary to enter into a minute and full history of them. I shall
endeavor to give only its most prominent and characteristic symp-
toms. In its forming stage there is usually observed rigors or a chill,
soon followed by reaction and fever, pain of the abdomen, which is
increased by pressure, and in the course of a few hours this tender-
ness or pain is so much augmented that the patient cannot bear the
weight of the bed-clothes; the abdomen is swollen, and the bowels
are generally costive; there is head-ach, hot and sometimes moist
skin, ardent thirst, nausea and vomiting; the tongue is coated with
a whitish crust or mucus; the pulse accelerated, small, hard and
corded; the patient lies on the back with the legs drawn up to relax
the muscles of the abdomen. This disease, when violent and not ar-
rested by suitable remedies, soon terminates in death. The pain sud-
denly ceases — the pulse sinks, vomiting of dark matter takes place,
cold clammy sweats appear on the forehead, whilst the abdomen is
hot and dry, and the extremities cold — the countenance is haggard,
and hickup supervenes. These are the phenomena, which are gene-
rally witnessed in acute peritonitis — they are often modified by the
idiosyncrasy of the patient, and by the disease being complicated with
other affections.

Autopsy. — The peritoneum is found to be minutely injected with
blood — the convolutions of the intestines glued together — a serous or
puriforrn fluid in the abdominal cavity and also in the cellular tissue
beneath the peritoneum, and, according to Dr. Cragie, the peritoneum
sometimes becomes thick and assumes a pulpy appearance, and
sometimes, though rarely, ulcerates. Bichat found gangrene to occur.
Previous to his researches it was believed that the inflammation of the
serous tissues never terminated in gangrene. He thinks that the pe-
ritoneum is more susceptible of gangrene than any other serous mem-
brane. The peritoneum is sometimes found to exhibit no red appear-
ance, owing perhaps to the escape from it of blood just before or in
the struggle of death — or, as the great Bichat contends, that in the
acute phlegmasia? the blood is confined to the inflamed part, by irrita-
tion, and this ceasing with death, it gravitates and is lodged in the

540 BROOCKS ON ACUTE PERITONITIS.

surrounding tissues. All ages and sexes are liable to attacks of this
disease, and at all seasons of the year.

Causes. — It is most generally induced by cold in some form, as
other inflammatory diseases are, as cold air combined with moisture —
drinking cold water and eating ice-cream when the body is heated —
by the use of ardent liquors — drastic purgatives administered soon
after parturition — by violence, as straining, leaping, &c. — by sup-
pression of wonted discharges — by fluid extravasated into the cavity
of the abdomen by perforation of the bowels — by metastasis — as the
recession of gout and erisypelas from the surface and attacking this
membrane. The suppuration of an external wound is often followed
by peritonitis, owing to the close sympathy which exists between the
cellular tissue and the serous membranes. — (Broussais.) Parturition
is a very fruitful source of the disease — and it does not seem to de-
pend on the difficulty of labor, for in most of the women in whom it
occurred, parturition was remarkably easy, and the placenta was cast
off after a proper interval, and without more than usual pain. — (Arm-
strong.) This opinion is concurred in by many of the most eminent
and extensively engaged accoucheurs — and it is certainly a very cu-
rious fact, unless it is attributable as Dr. Denman thinks, to prophy-
lactic measures being oftener used after difficult than easy labors. Puer-
peral peritonitis was at one time believed by some medical authors
of high respectability to be contagious, but few entertain this opinion
now.

Diagnosis. — It may be distinguished from colic by the latter being
unattended with fever, by the pain being intermittent and relieved, in-
stead of being aggravated by pressure ; from enteritis, when the in-
flammation is confined to the mucous coat of the bowel — from the
pain being more lancinating and pungent, and increased by a deep in-
spiration and the erect posture and the tendency to diarrhoea in this
affection ; from affections of the kidneys, by the pulse being in these
diseases slow, and the pain not increased by pressure. The progno-
sis is uncertain and often unfavorable, owing to the very rapid progress
of this disease ; for a few hours delay will put the sufferer beyond the
reach of our science — but when called at the onset of an attack, we
may by a bold and decided course of practice very frequently restore
our patients to health again. The degree and extent of pain and the
constitution of the patient should, in a great measure, govern the
medical man having the charge of the case in the opinion he shall give
as to its result. When the phlogosis is diffuse and extended over
nearly the whole surface of the membrane, the pain great and the
patient of a weak and delicate habit, the prognosis is very unfavora-
ble— when cold sweats appear on different parts of the body, the pulse
becomes very weak, very frequent, tremulous or fluttering, the counte-
nance cadaverous ; and when sudden abatement of pain, vomiting of
dark matter like coffee grounds and hickup occur, the patient's disso-
lution is near at hand. But when the pulse becomes more open and
expanded, the temperature of the surface equal on all parts of the
body, when warm and general sweats break out and the countenance
puts on its natural and pleasant expression, and the urine deposits a

BROOCKS ON ACUTE PERITONITIS. 541

copious lateritions sediment, we may with great confidence predict a
favorable result.

Treatment. — No disease requires greater promptitude, boldness
and skill to conduct it to a favorable termination than this — and none
is better calculated to excite greater solicitude and just alarm for the
life of the patient, and to induce a medical man more fully to appre-
ciate the high and awful responsibility of his position — for many
cases, perhaps the larger number of them, especially when occurring
in child-bed, will resist his best directed skill, even under the most
favorable circumstances, and rend asunder the strongest and tenderest
ties that can ever bind a human being to this world. " Surely if there
be one object which can interest the head and heart of a medical
practitioner more than another, it is a woman dying in child-bed. The
husband too is intimately concerned; no circumstances can grieve
him so much as the death of his wife in the puerperal state, not only
because he becomes by the death of his wife perhaps the father of a
motherless family, but he looks upon himself as almost the murderer
of his wife ; and can you, dare you refuse, to repay the confidence he
reposes in you ? Amidst such circumstances too the infant is apt to
be neglected ; and thus, if you fail to use decisively and promptly the
talents which you have received from God for the use of your fellow-
creatures, you may have the galling consideration, in the evening of
your life, that but for your misconduct the flower and the stem would
not have withered at once." How eager then should the medical man
be to inform himself of all the means which have been found in the
experience of others to be successful in the treatment of this disease,
to enable him not " to violate that duty which he owes to the patient,
and betray the most sacred and hallowed trust which one human
being can confide to another." The treatment of this disease is by no
means established, but it is very variant. From the imperfect history
which has been given of it, I hope it appears sufficiently evident
that this disease is one of a very high grade of inflammatory action,
and demands usually the abstraction of blood very freely and abund-
antly by venesection. We should not be intimidated by the debility
which is sometimes apparently indicated by the pulse, unless con-
firmed by other signs of this slate. It should be permitted to flow
until a decided impression be made on the disease — until the pain
abates, the general excitement subdued, the face turn pale, and some
disposition to syncope be manifested — and venesection should be re-
peated as soon as reaction takes place, if it be accompanied with a
return of the violent symptoms, and as often as it may be necessary
to control and subdue them — the abstraction of blood should be regu-
lated entirely by the effect produced, and not by the quantity drawn.
Unfortunately there is no symptom which positively indicates the de-
gree of inflammatory action, and which serves as a certain guide in the
use of the lancet — the pulse is often deceptive — heat and pain perhaps
afford less equivocal evidences of the continuance of inflammation—
but the pain is frequently continued after the inflammatory process has
been subdued by nervous and not by sanguine irritation — and for the
purpose of allaying this irritation, I use opium very freely after vene-
64

642 BROOCKS ON ACUTE PERITONITIS.

section, combined with alterative quantities of calomel. Between
nervous and sanguine irritation there is a very close connection — ner-
vous irritation, if it be active and maintained for any length of time,
will excite inflammation, by being carried to the brain and thence to the
heart, causing an increase of its action and febrile movements. Opium
allays this irritation, prevents irritative fever and reaction, and con-
tributes greatly to the ease and comfort of the patient. A distin-
guished writer says, that " inflammation being made up of vascular
and nervous action, of the afflux of blood to a part, and of pain, it is
not irrational to act on both the elements of the malady at the same
time, or in periods shortly consecutive of each other." The happy
influence of this valuable agent is not limited to its action on the ner-
vous system, but is extended to the capillary system, equalizing its
circulation and inducing general perspiration. When given in large
doses after copious blood letting, it prevents subsequent reaction — the
return of pain produces perspiration and induces tranquil sleep. —
(Armstrong.) Very free leeching over the abdomen will now be
highly beneficial — blood drawn in this way produces a greater in-
fluence in checking the disease than is effected by the same quantity
drawn from the general vascular system by venesection — and it no
doubt has been noticed by all who are familiar with the use of
leeches, that their effect is much more decided when placed imme-
diately over the seat of the diseased action than when applied more
remotely and at a distance from it. Their greater effect, therefore,
may be owing in part to some inexplicable sympathy of contiguous
parts, and to the blood being taken directly from the same character
of vessels that are engaged in the morbid process, and to the revulsive
irritation of their bites. After the leeches are taken off, the abdomen
should be covered with a large poultice or warm fomentation. Some
advise cold applications — they may be useful when the heat of the
surface is very great. When the general excitement has been sub-
dued, the abdomen tumid and tympanitic, and when lymph and se-
rum have been most probably freely secreted, I have obtained great
benefit from the application of a large blister — large enough to cover
the whole abdomen. If by ihese remedies the disease should not be
controlled, the mercury should be pushed to ptyalism. In this stage
of the disease a distinguished and successful practitioner formerly ad-
ministered some of the preparations of bark with decided benefit. I
have never done so, but I am disposed to believe that after the gene-
ral excitement of the vascular system has passed off, that it may be
an useful auxiliary to the other treatment. The operation of cinchona
appears to be manifested either directly or indirectly through the ner-
vous system, on the capillary, molecular or nutritive circulation,
causing an equilibrium in its movements, by inviting blood into its
every part. The power which this medicine exerts over intermittent
fever he ascribed to the influence which it exerts over the capillary
circulation, preventing the development of the congestion or the cold
stage, and thus warding off the paroxysm, by counteracting the inter-
mittent irritation. If this be its modus operandi in intermittents, it
might readily be inferred that it would be useful in this stage of peri-

BROOCKS ON ACUTE PERITONITIS. 543

tonitis, when the disease is contracted and limited to the capillary or
molecular circulation of the peritoneum, by diverting the blood and
excitement from it. The regimen should be strictly antiphlogistic —
the room kept well ventilated, darkened and quiet — the nervous system
is highly and morbidly sensible to all disturbing causes. The diet
ought to be mucilaginous, consisting of barley water, gum water, rice
water, apple water, lemonade, &c. Animal food in every form is
highly pernicious.

Purgatives. — Most writers think highly of this class of medicines
in the treatment of this disease, and use them very freely. Candor
compels me to say that I have had but little experience with them,
for 1 very early formed a decided impression against their use in this
disease, which time and subsequent reflection have strengthened. I
shall notice only two of the arguments in favor of purgatives, and I
believe they are mostly relied upon to vindicate their administration.
The first is the loaded state of the intestines by acrimonious fceces,
causing irritation and fever. This I regard to be more imaginary than
real, and will not occur if the patient's diet be properly regulated ;
but should these accumulations take place and become irritating, will
they not effect their own expulsion, by calling into action the muscular
coat, precisely as purgatives do by exciting the mucous one ? This
seems to be proved by the well known fact, that if an indigestible ar-
ticle of food be taken into the stomach, and it be not digested, it
passes down into the intestinal tube, excites irritation and produces
catharsis ; and severe diarrhoea from this cause often occurs. The
other is acrid secretions. This is also a delusive cause of alarm.
There seems to be a friendly relationship subsisting between secreted
fluids and the secreting surfaces and the surfaces upon which they
have temporarily to repose before being expelled from the system.
Bile does not irritate the gall bladder when retained longer than
usual, nor urine the urinary bladder, although highly irritating to other
surfaces. For example, if the urine be extravasated into the adja-
cent cellular tissue, a high and destructive inflammation will be in-
stantly lighted up. This relation seems to be retained when these
surfaces depart from their normal state, and become anormal. The
fluids of hydro-thorax and ascites do not irritate the pleura and peri-
toneum. The tears, in purulent or Egyptian ophthalmia, excoriate
the cheeks in passing down them, but manifest no such action on the
conjunctiva and edges of the eyelids. But should these intestinal
secretions accumulate and become irritating from any cause, is it not
perfectly obvious that they will be expelled as other offending matters
are? I not only regard purgatives as unnecessary, but as highly and
positively injurious in this disease. Bichat observes, that " inflam-
mation of the serous tissues renders them sensible and dry, and that
the motions of the organs they cover are wonderfully painful." In
this disease the whole or the greater portion of the peritoneum — that
lining the muscular walls of the abdomen and that covering the va-
rious folds of the intestinal tube, and which in fact forms its outer and
serous coat — is in a high state of inflammation. That dew-like fluid
which is secreted in health, and which enables the intestinal convo-

544 BROOCKS ON ACUTE PERITONITIS.

lutions to glide smoothly and softly over each, (as the synovial fluids
do the opposing surfaces of the joints,) and without exciting the least
unpleasant friction, is now not formed ; its secretion has been arrested ;
they are dry ; the movements of their opposing surfaces upon each
other excite pain ; this is the cause of much suffering in inflammation
of the knee joint when the patient attempts to walk ; cathartics put
in motion the affected parts ; the contraction of the abdominal muscles
and of the muscular coat of the bowels which occur during their ope-
ration cause the convolutions of the intestines to rub their inflamed
surfaces against each other, now deprived of their lubricating fluid, and
increase the irritation and inflammation precisely as the motions of the
joints under similar circumstances do. The constipated condition of
the bowels, which usually exists, is a wise provision of nature, and is
eminently calculated to facilitate the resolution of the inflammation,
by keeping the inflamed parts at rest. It appears to be an estab-
lished pathological law, that when the serous covering of an organ is
inflamed, the functions of that organ are either suspended or di-
minished. For instance, when the pleura costalis is inflamed, respi-
ration is carried on almost exclusively by the diaphragm, and the
least motion of the ribs is attended with excruciating pain ; when the
pleura pulmonalis of one lung is inflamed, the function of the lung of
that side is greatly abated, and respiration is chiefly performed by the
lung of the sound side, &c. This emphatic teaching of the vis me&i-
catrix natures should not be lightly regarded by the medical man who
is charged with the fearful responsibility of treating so dangerous and
fatal a disease, but it should warn him — as he values the life of his
patient and his own reputation — to avoid the use of purgatives, and
instead of using them, to order an opiate enema when necessary to
restrain the motions of the bowels and to keep still the inflamed parts.

The following cases will present more fully and in detail the general
principles of treatment which I have endeavored to inculcate in this
paper.

Case 1. — " Mary Smith, set. 20 ; temperate habits, nervous or lymph-
atic temperament ; subject to epileptic attacks ; skin of a dusky
yellowish hue, hair flaxen, eyes blue ; has been unwell for some time ;
had, on the 8th December, several fits, followed next day by pain in
the head ; was cupped and took a dose of calomel and jalap, which
relieved the head ; on Thursday found her laboring under a cold, sore
throat and pain in the side ; the usual antiphlogistic means were used;
venesection, cups, leeches, foot bath and blister ; strangury was pro-
duced by the blister and relieved by the usual remedies. On the
evening of the 11th the patient was found to be laboring under peri-
tonitis ; the pain, which had come on a little before, was acute, sharp,
lancinating and confined to the left iliac and hypogastric regions ; the
affected part exquisitely tender, increased by the weight of a hop fo-
mentation ; right side little affected ; temperature of skin not very
much increased, rather relaxed ; tongue covered with a thin, milk-like
fur ; considerable nausea ; much thirst ; bowels had been opened by
an injection during the afternoon ; head hot ; face flushed ; pulse 120,
tense and quick j venesection ad deliquium animi; 50 leeches to abdo-

BROOCKS ON ACUTE PERITONITIS. 545

men ; 10 o'clock — bowels were again opened immediately after the
bleeding; pulse very much reduced and rather wreak ; blister dressed
with sulp. morphia 1 gr. ; 12 o'clock, much better; pain greatly re-
lieved ; slept indifferently well last night ; slight sickness of stomach ;
skin good ; pulse 85, somewhat forcible, though compressible ; no
headach. & sulp. morph. gr. ij. every 3 hours to blistered surface;
4 o'clock — slept nearly all the morning ; 6 grs. of sulp. morp. have
been applied ; entirely free from pain, except when pressure is made ;
considerable irritability of stomach ; pukes whenever a quantity of
liquid is swallowed, which she is tempted to do from great thirst ;
pulse weaker than in the morning; continue pulv. and give a table-
spoonful of cold* water every £ hour to allay thirst and calm irrita-
bility of stomach. At 10 o'clock, as the blister had so much dried up,
and vomiting continuing, 2 grs. of sulp. morph. were dissolved in 8
ounces of water, and a tablespoonful was given every £ hour. I?- Ca-
lomel 8 grs., g. arabic water q. s., made into 4 pills — one given every
3 hours. 13th — Slept well ; much better ; no pain of abdomen ; pulse
very good ; sickness of stomach continues ; bowels not opened since
evening of accession, ft Aq. calc. and milk aa. ? i., m. ft. haust. bib.
q. h. ; 3 o'clock — vomiting ceased. 14th — Slept well ; continues to
improve ; tongue clammy ; pulse good ; no sickness ; ordered arrow-
root and milk. 15th — Some oyster soup. 18th — Convalescent ; bowels
opened b}r an injection."

Case 2. — "This is one of puerperal peritonitis. Rebecca Willis,
aged 21, unmarried, was confined with her first child Monday, De-
cember 5th. She had gone her full time — nothing unusual as regards
the delivery of the child — pains came on briskly in the morning about
9 o'clock, and expelled the child a few minutes before 2 o'clock, P. M. ;
but owing to a suspension of the uterine contractions, the placenta was
retained two hours and a half, and was brought away by 40 grs. of
secal. cornut. The patient appeared to be doing well, with the ex-
ception of some slight rigors towards evening — no febrile symptoms —
discharge natural. She continued in this state until Wednesday the
8th inst., when, from slight exposure, she was attacked with a chill
early in the morning — considerable pain and soreness of the abdo-
men, skin moist and hot, tongue slightly furred, no sickness of sto-
mach, no headach, pulse rather frequent and soft, bowels not moved
since the day previous — lochia excessive — sanguineous — 50 leeches
were applied to the painful part, followed by fomentations of hops,
a common injection and a pill of 5 grs. of calomel, and £ of a grain
of sulp. morphia ordered every 3 hours. 2 o'clock P. M. — bowels
loose, pain increased, very acute, face flushed, much headach, head
hot, skin soft and moist, pulse more frequent and compressible, with
little fulness, bowels not opened by injection, venesection to o j. and
continue fomentations. 7 o'clock — pain unabated, abdomen exquisitely
tender, so much so that the fomentations add to her agony — pain par-
tially left her head and centered in abdomen, through the lower part of
which it darts, and is particularly violent in left iliac region — venesec-
tion to 1 viij. when she felt faint in the horizontal posture — hops removed
and 100 leeches applied to affected part — J gr. sulp. morphia added to

546 BROOCKS ON ACUTE PERITONITIS.

each pill, venesection to 1 x. in the horizontal position — complete syn-
cope came on which continued several minutes. Two hours after-
wards, the pulse not admitting of farther depletion, and skin relaxed,
a large blister was applied on the 9th. 9 o'clock — patient slept more
during past night, still great pain, tongue much furred, sickness of
stomach, pulse less frequent, 120 — discharge of lochia less abundant —
secretion of milk little affected — blood buffed and cupped — coagulum
firm and large — £ gr. sulp. morphia given per os — pills continued and
blister kept on until 12 o'clock, and then dressed with £ gr. s. morp.,
and ordered to be repeated every 3 hours. 3 o'clock — in the same
state — pulse 113 and small — venesection 1 viij. ad del. anim. and pill.
10 o'clock, P. M. — some relief since last bleed ing— pain aggravated
by paroxysms — has slept \ of last hour — pulse 100 — more open —
affected by narcotism. 12 o'clock — has vomited — complains less of
pain — is asleep — discontinue the pills, and dress blister with powder
every 4 hours. 9th, 9 o'clock — patient slept \ hour last night before
1 o'clock — still complains of pain in the side — nausea and vomiting —
tongue covered with a thick, whitish fur, red at edges — no pain in
head, skin moist, bowels not open, pulse 130 — more open and forcible,
much thirst, secretion of milk diminished, lochia disappeared, gums
soie, mercurial odor — not so well as at time of last report, but much
better than yesterday — venesection 1 x. to incip. s3mcope — 6 pulv. have
been put on blister — continue them, and give effervescent draught
every half hour. 10 o'clock — no pain since last bleeding — had a re-
freshing sleep during evening — countenance much better — pulse 120 ;
blood not so much buffed and cupped — stomach irritable — give cold
water alone, as the effervescent draught disagrees. 11th — did not
rest well last night — free from pain — tongue broad, whitish and po-
lished— bowels unopened — milk suppressed — very slight discharge of
lochia — irritability of the stomach continues — the powders stopped — at
3 o'clock the pain recurred, face flushed, skin moist, pulse 132 — more
tense and resisting — venesection 3 xvi. and 2 grs. s. morphia every 2
hours to the blister. 6 o'clock — patient free from pain, pulse 140,
weak and unresisting — went to sleep soon afterwards. 12th — slept
well last night — took £ gr. s. morp. during the night — no pain in ab-
domen— pulse 116, quick, perhaps from ptyalism and extent of de-
pletion— vomiting ceased — bowels constipated — ordered an injection —
very light farinaceous nourishment and opiates. $ Sulp. morp. i.
aq. font. 1 viij. m. a tablespoonful every hour. 10 o'clock — slight
nausea during evening and faintness — a tablespoonful of wine in pa-
nada was given, and spirits of camphor applied to nostrils. 13th —
slept tolerably well — improving, pulse same, bowels opened in the
night and loose all day, discharges dark colored — no vomiting since
early this morning — chicken water allowed. 14th — better, bowels
not opened since last night — in the evening complained of a slight
degree of pain of abdomen — an anodyne was administered. 15th —
doing well. 16th — convalescing, laboring under the effects of ptyal-
ism and depletion."

METTAUER ON PROPHYLAXIS OF PUERPERAL FEVER. 547

Prophylaxis of Puerperal Peritonitis.

BY JOHN P. METTAUER, M. D., L. L. D.,

Professor of the Principles and Practice of Medicine and Surgery of the
Medical Department of Randolph Macon College, Virginia.

In no disease is prophylaxis of more importance than in puerperal
fever, because of the great danger to life after its complete develop-
ment, the acknowledged difficulty of treating it successfully, and the
many fatal instances of its termination. If an attempt at innovation
in treating any human disease ever can be justified, after so many
years have elapsed with very inconsiderable change, even if it should
inculcate views and a treatment at variance with established modes,
such a disease is puerperal fever.

In a paper on the prophylaxis of puerperal fever I had the honor
to have republished in the April Number of the " Stethoscope," I ven-
tured to present to the profession a plan of preventive treatment that
had been successfully employed by me more than 20 years. In that
paper I advocated the doctrine of the inflammatory nature of puer-
peral fever, especially in its commencement; but, like other inflam-
matory diseases, and even those connected with pure inflammation,
the degree of phlogosis is of different degrees of intensity. These
views I have entertained from my medical pupilage, and nothing has
ever occurred during my whole professional life calculated in the
slightest degree to change them ; on the contrary, they have been
confirmed.

The prophylactic treatment of puerperal fever I now employ was
not the result of any preconceived notions of its suitableness to the
condition following delivery ; but having often found a similar treat-
ment to prevent traumatic inflammation, when employed a few hours
after surgical operations and lesions involving the abdominal organs,
it struck me that it would be applicable likewise to the early post par-
turient state as a means of preventing puerperal fever. In my first
trial of it I was most agreeably surprised at the result ; and although
it seemed to have prevented an attack of puerperal fever, I did not
by any means regard the trial as conclusive. Another opportunity,
however, soon presented itself for a repetition of the treatment, and
under circumstances calculated to remove all doubt as to the me-
nacing nature of the symptoms of the case, and their indubitable ten-
dency to end in puerperal peritonitis. In this case the result was
also most satisfactory, and left no doubt on my mind of the efficacy
as well as the perfect safety of the treatment I had employed in pre-
venting an attack of puerperal kver. From this time it has been in-
variably resorted to in all cases after delivery, especially when threat-
ening symptoms followed or preceded delivery, and without a solitary
failure in 62 cases, many of which were most threatening.

I deny that the slate of the organs concerned in gestation and la-
bor after delivery is that of fatigue, demanding for its correction
" rest." It is a very different condition,- as it is compounded of hy-

548 METTAUER ON PROPHYLAXIS OF PUERPERAL FEVER.

perirophy, congestion, disturbed innervation, absorption, secretion, and
exhaustion of the organs concerned in pregnancy and parturition. The
wounded and lacerated condition of the uterine surface, from the forci-
ble separation of the placenta and membranes, is virtually a state of
traumatic irritation, differing essentially from fatigue. Labor doubt-
less induces fatigue in the organs concerned in the process ; but the
anatomical conditions of the organs chiefly involved, both in that pro-
cess and gestation, are changed so as to induce in them a pathologi-
cal state that continues for some time after delivery ; and it is this con-
dition that constitutes the chief element in the series of causation pre-
disposing to puerperal fever. The uterus, together with the other or-
gans, is left in a condition after delivery not very unlike that follow-
ing the removal of a large accumulation of water in ascitic dropsy.
In this latter affection the peritoneum and the organs invested by it,
as well as the soft walls of the abdomen, are anatomically as well as
physiologically modified in some degree. Frequently the peritoneum
is thickened, and its absorbing and secreting functions, both effusing
and nutritive, are changed. In this state of things the sudden with-
drawal of the distending fluid from the cavity of the abdomen, by the
operation of paracentesis, removes the stimulus of distention as well
as the compressing support of the organs, which induces a state of
collapse more or less complete in them. In this state there is com-
parative inaction, diminished or otherwise disturbed secretion, absorp-
tion and innervation, superadded to the change of the anatomical
condition of the organs implicated in the dropsical affection. Doubt-
less there is some exhaustion of the organs, from having sustained
such undue weight for a length of time as is usual in ascitic dropsy;
but it is a mere incidental condition, and not. always to be expected.
If in this state of things the patient should be left to get well, after
being tapped, only from the support of the bandage and " rest," the
chances would be decidedly adverse to recover}'- ; and, for fear of in-
creasing the exhausiion of the organs in their fatigued state, or harass-
ing them, purging, the only efficient remedy likely to restore the or-
gans to their proper anatomical and physiological conditions, should
be withheld. The condition of the organs concerned in gestation and
parturition, however, is more altered as respects their anatomical and
physiological relations than in ascites. The uterus and its appendages
are greatly thickened as well as expanded and enlarged, and the phy-
siological exercises too are correspondingly modified, and their con-
dition continued for an uncertain period after delivery, which, as long
as l hey remain, subject the organs to inflammation and the woman to
child-bed fever of different degrees of intensity. What course of
treatment has been found most beneficial in correcting engorged and
hy-jXMtrophied organs, more especially when implicating the abdomi-
nal organs? Has not purging more generally afforded relief in such
e i ;es than any other therapeutical agency yet employed by the pro-
i -ion? In my own sphere of observation, and in the treatment of
such affect :ons, I have uniformly relied on it both in acute and sub-
acute examples, and have found it more constantly successful than
any other plan of treatment. And, if the uterus as well as its ap-

METTAUER ON PROPHYLAXIS OF PUERPERAL FEVER. 549

pendages are really in a thickened condition before and after delivery,
as they certainly are, can we trust to " rest, rest," for its cure, espe-
cially when symptoms have marked the close of gestation, and con-
tinued after delivery, decidedly pathological? I answer unhesita-
tingly, we cannot, and do ourselves and our patients justice. During,
pregnancy we have disease of the uterus and its appendages, as well
as of most of the organs contiguous to them. After parturition that
state continues, and like many other diseases, demands treatment of
different degrees of activity, as the case is violent and intense, or
otherwise. It is not once in a hundred instances that puerperal wo-
men recover after delivery, without the employment of purgatives
during the month ; and in a vast number of instances these valuable
remedies have been resorted to by non-professional as well as profes-
sional persons, at every period after delivery, from one hour to thirty
days, without injury to the woman, nay, with great benefit to her ;
and, if they were more generally employed in the early stage after de-
livery, recoveries would be more rapid, especially in the cases charac-
terized by decided disturbance of the digestive system, undue abdo-
minal tenderness, a tardy subsidence of the abdomen, &c, and wo-
men would be less liable to the many little diseases of the lying-in
period. I do not rely, however, upon the quasi argumentation that I
have been attempting in this paper, to shew the safety as well as to
prove the efficacy of early purging as a means of prophylaxis in puer-
peral fever, or to repel the insinuation directed against me, of incul-r
eating a rash and dangerous practice (deduced from wrong notions*
of the essential nature of puerperal fever) in the management of that
formidable disease, but upon 62 cases in which I have employed it
with undeviating success, and without the semblance of injury in a
solitary case. And my 62 cases, although merely referred to, I think
will fully offset the two reported by my intelligent }Toung friend, Dr.
G. A. Wilson of Richmond, Virginia. I will not dare, as Dr. Wilson
seems to do towards me, insinuate that he is incapable of distinguish-
ing disease from fatigue with lying-in women ; and, if I cannot always
succeed, it is very possible that I may have chanced to hit upon a
state of disease in some of my cases ; or possibly all of them were of
that description, as the 62 yielded to the purging plan, which ought
not to have been the result, if fatigue was the prominent condition of
the organs, according to the views of Dr. Wilson. I have, indeed,
purged 62 females, and some of them pretty freely, after delivery,
varying from 3 or 4 hours to 12, without a solitary accident, and in-
variably with the speedy and perfect recovery of the patients ; and if
Dr. Wilson's " rest" notions are correct, and my purging views wrong,
I am at a loss to account for the very striking diversity of results of
the same therapeutical means with my 62 fortunate cases and his two
unfortunate ones, unless I suppose his cases were examples of an in-
sidious form of puerperal fever that occasionally steals upon the or-
gans constituting the local affection so slowly as to seal the fate of the
woman in death almost simultaneously with the manifestation of the
first open phenomena of the disease. In the cases of Dr. Wilson, the
cathartic commotion and development of puerperal fever occurred
65

550 METTAUER ON PROPHYLAXIS OF PUERPERAL FEVER.

nearly simultaneously ; and I think it probable they were such ex-
amples of the disease as above referred to. Cases of this description
now and then occur with females of strongly marked strumous con-
stitutions, and are not unusually ushered in by symptoms of acute
-diarrhoea ; or, if a cathartic is administered, by hypercatharsis. In
Dr. Wilson's cases there must either have been predisposition to puer-
peral peritonitis, so strongly impressed upon the organs usually impli-
cated in the local affection as to be just verging on the disease at the
time the cathartics were in operation, or the disease actually was ra-
pidly but insidiously advancing.

It will be impossible for physicians of experience in the manage-
ment of abdominal inflammations, to believe that a remedy so impor-
tant in the treatment of these inflammations — even in puerperal in-
flammations of those organs — could have induced the attacks of puer-
peral fever in Dr. Wilson's cases ; but they would regard them rather
as accidental coincidences. I cannot conceive how cathartics, espe-
cially Epsom salts and oil, the cathartics used by Dr. Wilson's pa-
tients, could excite puerperal peritonitis, acting chiefly upon the mu-
cous lining of the intestinal canal as they do. Where cathartics are
used as therapeutical agents in puerperal fever, one of the objects is
to induce revulsion from the serous to the mucous surfaces of the in-
testines, with the design of counteracting inflammation of the serous
lunic, as well as of the peritoneum generally — the usual seat of puer-
peral inflammation. In a majority of cases the mucous coat is more
or less unimpressible to the action of cathartics ; and if diarrhoea
comes on, it is due rather to chemical reactions taking place in the
gastro-enteritie cavity than to mucous irritation as a necessary con-
comitant of puerperal fever, and the gruelly discharges to be met with
are very probably the product of such reactions. It is very certain they
are not caused by mucous inflammation of the intestines in the early
stage of the disease, when it is to be supposed their serous coat (as
well as the peritoneum generally) is the chief seat of inflammation.

If the views I have advanced in relation to the condition of the
organs implicated in pregnancy and parturition before and after de-
livery be correct, (and I believe the profession generally will concede
that they are,) I think I have fully responded to the interrogatory of
Dr. Wilson, " Why should a patient be subjected to the perturbing in-
fluence of agents, the measure of whose effects we have no means of
estimating ?" And I think I have in a degree disproved the safety of
the doctrine intimated through his second interrogatory, that is,
14 Would it not be safer to inculcate the opposite doctrine," not to
purge, "• if any general rule must be laid down," but to " enjoin
perfect quietude of mind and rest to the bodily functions — rest, rest,
the restorer of enfeebled and debilitated organs ?" In reply to the
3d and 4th interrogatories of Dr. Wilson, that is. " What good can re-
sult from throwing the whole abdominal viscera of a patient on the
verge of peritoneal inflammation into violent commotion ?" — and
*' Who would prescribe active exercise for a knee-joint in danger of in-
flamm;,tion?" I will remark in the first place, that the idea that a
cathaitic throws the whole abdominal viscera into violent commotion

MBTTAUER ON PROPHYLAXIS OF PUERPERAL FEVER. 551

is entirely gratuitous and unfounded, unless agents are employed of
violently irritating and drastic qualities, which no practitioner of
judgment and prudence would be likely to do in puerperal cases ;
but the reverse is the case in many diseases of these organs, as it
tranquilizes and composes them when they are already disquieted.
Would any judicious practitioner be unwilling to purge patients la-
boring under the abdominal disturbances consequent on colic, after the
spasms have subsided, for fear of harassing them in their fatigued con-
dition, and thereby endangering them from inflammation? Would
Dr. Wilson himself withhold purging under such circumstances, for
fear of superinducing inflammation in those organs? And yet he
would inculcate the paradoxical doctrine, not to purge after delivery,
for fear of perturbing the fatigued organs concerned in pregnancy and
labor, while he would advise an immediate resort to it after the sub-
sidence of the spasm and pain of colic, to prevent inflammation in the
intestines, and in conditions of the organs in both cases very nearly
identical. I would remark also, in response to this interrogatory, that
I have conclusively shewn by my 62 cases, that the idea that purging
harasses the organs concerned in pregnancy and labor after delivery
is entirely gratuitous and unsupported, as in not one of them did the
patient complain of the slightest harass or ill effect from the purging
plan : and I think the 62 cases also furnish very strong presumptive
evidence of the beneficial effects of purging in the prophylaxis of
puerperal fever, not however by "throwing the whole abdominal
viscera of a patient on the verge of peritoneal inflammation into vio-
lent commotion," but by restoring to the organs concerned in preg-
nancy and parturition their normal physiological actions. Certainly
no one in his senses would " prescribe active exercise for a knee-joint
in danger of inflammation," because experience has abundantly
shewn that it is improper, while that excellent teacher has also de-
monstrated, in numerous instances, that the peristaltic action of the
intestines can be safely and beneficially excited by cathartics in the
treatment of enteritis. Besides, the intestines are not always involved
to any great extent in puerperal inflammation, but the disease is con-
fined to the uterus and its appendages, the parietic peritoneum, bladr
der, &c. And in the inflammations of these organs cathartics are our
best remedies after venesection, both as prophylactic and curative
measures ; and these organs purging could hardly exert a perturbing
influence ; and if Dr. Wilson's views are correct, perhaps the 62
cases were of this description, as the treatment did not harass the pa-
tients nor induce puerperal fever, as seemed to be the result of purg-
ing in his cases.

I agree in the sentiment, that "error and mischief are liable to re-
sult from efforts at too great a generalization in practical medicine."
In my paper on the prophylaxis of puerperal fever, I have candidly
stated my views in relation to my plan of prophylaxis in that formi-
dable disease; and I have based my commendation of it upon 62
cases. In Dr. Wilson's paper there is an implication of an attempt
on my part at " too great a generalization" in relation to the prophy-
laxis of puerperal fever ; but it is more applicable to its author than

552 MERIWETHER ON THE FIBRINE OF THE BLOOD.

myself, as he formed his notions of " rest, rest," as a means of proprry-
laxis upon only two cases, while my purging predilections are de-
duced from and based on 62 successfully treated. Dr. Wilson con-
cedes that the organs concerned in gestation and delivery, after par-
turition, are on the verge of inflammation ; and if so, their condition
must be something more than a state of exhaustion and debility; con-
sequently its correction will demand something more than " rest," or
a state decidedly pathological would certainly follow. But I have al-
ready shewn that a condition essentially pathological — as much so as
any other tumefaction — pre-exists, co-exists and succeeds delivery ;
and if there is exhaustion also, which I am willing to concede, the
condition cannot possibly be one of pure debility or exhaustion, the
only states of the organs likely to be corrected by " rest, rest" The
febrile reaction invariably supervening upon delivery in 8 or 10
hours, or a little later, clearly proves to my mind that a pathological
state either co-exists or speedily follows delivery. The same thing
follows surgical operations in greater or less degrees of intensity ; and
all will admit that a state decidedly pathological succeeds their exe-
cution.

In conclusion I will remark, that my aim in this notice of Dr. Wil-
son's paper, has been to caution the more inexperienced of the pro-
fession against the dangerous tendency of his "rest" notions, in their
attempts to ward off an attack of so formidable a disease as puerpe-
ral fever. If my remarks seem to savor of unkindness towards him,
I here declare that I have entertained no such feelings. My object is
truth, and the subjects examined in this paper have been canvassed
in reference to that end. Had Dr. Wilson been a less prominent
member of our profession, I doubt very much if I should have noticed
his criticism publicly; and the great, nay, vital importance of the
topics at issue between us wih\ I trust, atone for the apparent need-
less length to which this notice hasHbeen extended.

Prince Edward C. H., Va., Sept. 4, 1851.

Observations on the Fibrine of the Blood, in Reply to those
published by Drs. Scott and Haskins, in the August Num-
ber of the Stethoscope, on the same subject.

BY WILLIAM D. MERIWETHER, M. D.

Mr. Editor — Do me the favor to insert a short reply to the remarks
of Drs. Scott and Haskins, published in the August No. of the
" Stethoscope."

It is not my intention to notice all the topics touched upon by Drs.
Scott and Haskins, my object being only to correct certain statements
made by them in relation to the pathology of the blood, in the de-
bate on that subject before the Medical society. In doing so, I shall
take it for granted that the authorities relied upon by themselves are
sufficient.

Dr. Scott thinks that I might have avoided a great deal of unne-
cessary trouble, in discussing the opinions advanced by himself and

MERIWETHER ON THE FIBRINE OF THE BLOOD. 553

others on the state of the blood in fevers, had I chosen first to inform
myself of the points actually raised and advocated in the debate
upon that subject ; or in other words, that as I have stated the ques-
tion erroneously, my argument does not apply. This, however, is
simply a matter of opinion, and I must still insist upon the correct-
ness of the position I assumed, viz : that nearly the whole argument
against the use of antiphlogistic remedies in fevers was founded upon
the idea of a constant deficiency of the fibrine of the blood. I agree
with the doctor, that it is unnecessary to repeat other reasons which
were given ; they were few, and but little was said concerning them ;
as he observes very truly, " for myself, I relied upon the principle so
emphatically laid down by Andral," in his work upon the blood.

I will state briefly my recollection of the circumstances which in-
duced me to call the attention of the society, in my first paper, to a
subject which had been so recently discussed. In the course of the
debates upon the typhoid and eruptive fevers, several members who
have enjoyed a large experience in our profession, gave us the benefit
of their views in relation to the treatment of these diseases ; among
other remedies, they recommended the occasional use of mercury and
blood letting.

It was contended on the other side by Drs. Scott and Haskins, that
the antiphlogistic treatment was entirely contra-indicated by the state
of the blood, certain discoveries in pathology shewing that it was
always deficient in fibrine ; hence they concluded that there could be
no inflammation, nor any necessity for a resort to active measures.

The great error at the foundation of their whole argument was the
supposition that the fibrine is always deficient in fevers. It will be re-
collected by every one who was present at the debate to which I re-
fer, that Dr. Haskins made a statement to that effect, and appealed to
Dr. Scott, who confirmed his opinion. It was upon the strength of
this assumption that Dr. H. denied even the existence of inflamma-
tory complications. It is true that Dr. Scott, in a paper read at the
same time, hinted at the possibility of such accidents. He says cases
might be cited, complicated with " something else," demanding the use
of the lancet, &c, but he will not allow that such cases are " genuine,"
nor I suppose that the "something else" is an inflammation, for that
would be to yield the question at once. They omitted also the dis-
tinction between the simple, purgative action of calomel, and its al-
terative or constitutional effects. Its use in the treatment of fevers was
denounced indiscriminately.

The theory then may be stated as follows : An excess of fibrine in
the blood always indicates inflammation — in fevers there is always a
deficiency of fibrine — therefore, there is no inflammation in fevers, and
no necessity for mercury or blood letting.

Now, Andral and all the authorities I have been able to obtain
agree on this point, and I presume it will no longer be disputed
that an excess of fibrirae in th*1 blood of fever patients is by no means
uncommon, and that it is coincident with inflammatory complications.

Had Drs. Scott and Haskins, therefore, taken the trouble to inform
themselves more correctly, they would not have pushed their theories

554 MERIWETHER ON THE FIBRINE OF THE BLOOD.

so far as to deny entirely the occurrence of inflammation and the value
of antiphlogistic treatment in fevers.

Dr. Scott says, " No such ground was taken, that we should be
guided wholly and solely, in the treatment of all diseases where this
excess of fibrine exists, by this sign alone ;" but from the following
sentence — unless I mistake the context — he seems to think it reasona-
ble : After explaining that in anemia there may be a buffy coat from
relative excess of fibrine, he says, " Bearing this in mind, there is little
danger of being led into errors of trealment, even if we relied solely
and wholly upon our guide." But I did not attribute such an opinion
to the doctor; he attempted to establish a general rule, excluding a
large and important class of remedies from the treatment of all dis-
eases in which there is a deficiency of fibrine, and it seemed to me
perfectly fair in order to prove the unsoundness of his position, to
make the rule work both ways — to apply the same rule to inflamma-
tion in which there is excess of fibrine, that he applied to fevers, in
which he supposed a constant deficiency.

The doctor says, " Having fallen into the error of supposing the
bufFy coat to be always indicative of an increase of fibrine, it was
natural that in another part of this article, when treating of rheuma-
tism and the effect of copious and repeated bleeding, he should fall
into another error of supposing that copious and repeated bleeding
would not diminish the quantity of fibrine as the buffy coat still pre-
sented itself." The doctor has detected a slight error in my paper,
and makes it the subject of a large portion of his remarks. In quoting
a passage from Andral, I omitted an exception which he makes (and
it is the only one) that the buffy coat always indicates a state of in-
flammation, and of course an excess of fibrine, being itself nothing
but the fibrine in an unusual quantity. The passage is as follows :
" Except the cases in which its presence (the buffy coat) is connected
with a state of anemia, this product indicates constantly a state of
inflammation." But even this exception is only partial. Andral found,
in sixteen cases of mild anemia, 3 as the average of fibrine, but in
twenty-four confirmed cases, an average of 3.3, which we see is above
the healthy standard, 3. Becquerel and Rodier, whose average in
health is 2.2, report six cases — average 3.4 — maximum 5. I think,
then, that I have but little reason to modify the expression alluded to
by Dr. Scott. As to the "error of supposing that copious and re-
peated bleeding would not diminish the quantity of fibrine," it will
only be necessary to refer again to the doctor's favorite author, Andral,
to prove that the " error" is not on my part. " It is found, that how-
ever copious and frequent the bleedings, the fibrine always continues
to increase if these bleedings are practised during the first stages of
an inflammation," &c. Andral says again, treating of haemorrhages,
" Every haemorrhage diminishes surety the quantity of globules, whilst
it must be greatly prolonged or very abundant to cause an appreciable
diminution of the fibrine." •

In another part of his article the doctor says, " that the fibrine is
diminished by bleeding is probable, from the fact that we witness con-
stantly a diminution and disappearance of the buffy coat following
blood letting."

MERIWETHER ON THE FIBRINE OF THE BLOOD. 555

If the statement were correct, it would not he probable — it would be
certain — that the fi brine was diminished in quantity. If he means that
a diminution of the buffy coat takes place after each bleeding, during
the increase of an inflammation, he is certainly wrong. According to
the authority above quoted, and if this "disappearance" occurs on
the decline of the disease, how is it reconcilable with his own words,
" we have, after copious depletion, a buffy coat," from relative excess
of fibrine, an anemic condition? Besides, inflammations are not al-
ways so tractable ; a patient may be bled in rheumatism again and
again, until he is really anemic, as Dr. Scott describes, yet the inflam-
mation may continue with unabated intensity, and the buffy coat will
constantly be present, due both to the inflammation and to the anemic
condition. In such a case, how could one discover from the appear-
ance of the blood that the patient was anemic and that his powers
were exhausted, and how could he avoid errors of treatment, if he re-
lied wholly and solely upon this guide?

Unfortunately, the error has occurred too often to admit of doubt
that it may again take place.

The doctor next attempts to prove this asserted effect of blood let-
ting from the mode of production of the fibrine; the albumen and
other elements which furnish it being diminished in quantity, he thinks
it reasonable to infer that the fibrine is diminished also ; but it is not
so — the new production of fibrine occurring in inflammation is inde-
pendent of the general poverty of the blood and of any condition of
the system; for in animals starved to death there is always found an
increase of fibrine in the blood, which is accounted for by the inflam-
matory changes in the mucous membrane of the stomach. Andral
and Govarret state, that " in typhus, as soon as symptoms of conva-
lescence appear the fibrine begins to increase, before the organism
could contribute a supply by increased nutriment." Becquerel and
Rodier conclude, from numerous experiments, that " the fibrine is quite
uninfluenced by venesection — its amount is determined by the nature
and intensity of the disease."

These facts prove conclusively, " that when once the blood be-
gins to produce an excess of fibrine, it requires a certain time to
wear out this disposition, whatever may be done to prevent it," —
(Andral.)

The doctor is mistaken in supposing that I have denied the efficacy
of mercury in subduing inflammation — I only objected to his theory of
its modus operandi.

Dr. Haskins thinks it best, " in the absence of a sufficient number
of experiments," to determine the effect of venesection on the fibrine
of the blood by "inductive reasoning," and gives us a long theory to
prove that its quantity must be diminished. This is a novel method
of applying the inductive philosophy, and I think far inferior to the
old Baconian system, of first collecting the facts and then making the
deductions. If the doctor had followed this plan, he would have been
spared the trouble of constructing the theory that he lias offered.

Dr. H.'s paper contains some curious objections !o the inferences
which I drew from the analyses of Andral : " It should be recollected

556 MADISON ON THE PATHOLOGY OF PERTUSSIS.

that each one of the specimens which had been the subject of exami-
nation, had been obtained from persons suffering from inflammatory
disease," &c. It was necessary that the blood of healthy persons
should be examined, but " he did not know of any one who had been
such an enthusiastic votary of science as to submit to the repeated
operation of venesection in health, with a view of determining this
point." Now, a superficial examination of any treatise or report on
the subject, will satisfy any one that it has been thoroughly investi-
gated, and may be considered as settled. Besides the numerous dis-
orders, independent of inflammation, for which it is necessary to ab-
stract blood, nature presents us, in spontaneous haemorrhage, with an
opportunity of witnessing the effect of its loss in large quantities. We
have also numerous experiments on the lower animals, detailed by
Andral and others. I have given sufficient evidence on this subject,
when speaking of Dr. Scott's paper, to prove that venesection has not
the power of diminishing the proportion of fibrine in the blood; but
as the doctor has referred us especially to the work of Polli, it may not
bo amiss to quote his opinion : " Abstraction of blood does not di-
minish the proportion of fibrine remaining in the economy; it may
even increase it at the expense of the globules dissolved by the
new serosity, or those which are obtained from the substance of the
muscles." — (Lancet 1849.)

Pertussis — its Treatment, based on a Conjectural Pathology.

BY R. L. MADISON, M. D., PETERSBURG, VA.

The wide-spread prevalence of this distressing disease — the ra-
pidity with which it propagates itself — the formidable sequelae by
which it is followed — and, above all, the fearful manner in wThich it
decimates the ranks of childhood, gives to it a pre-eminence in the
scale of diseases, equaled scarcely by any other, and causes it to be
viewed by the physician with an apprehension which he only can ap-
preciate.

Notwithstanding the great antiquity of hooping cough — notwith-
standing the careful attention which it has received at the hands of
ancient and modern investigators — and in spite of the revelations of
the microscope, almost the same obscurity now rests upon its patho-
logy as in the days of De Thou, Sauvages, or Conario!

That the " pathology of pertussis" consisted in a bronchitis exagge-
rated by epidemic influence, was for a long period a part of the pro-
fessional creed — again it was supposed to be superinduced by pneu-
monic inflammation — by some it was considered to be an irritation of
the peripheral extremity of the pneumogastric nerve — while others be-
lieved that the cough was essentially spasmodic in its character, and
that the irritation inducing it was located in the brain !

Now with all due respect, to the high authorities who have promul-
gated the above-mentioned theories, it appears to me that they have
invariably mistaken effects for causes, and signs for s3rmptoms of dis-

MADISON ON THE PATHOLOGY OF PERTUSSIS. 557

ease. The simple fact that bronchitis occurs so frequently in chil-
dren, without being accompanied by any of the phenomena of hoop-
ing cough, proves conclusively that the disease does not consist in this,
and that we must push our investigations further before we can arrive
at correct conclusions. If inflammation either of the lungs or of the
brain could originate hooping cough, certainly pneumonia or cerebritis
would constantly attend it; whereas they are known to be merely ac-
cidental lesions, or rather complications following, and evidently
caused by, the violence, of the cough.

Whoever has seen a child attacked by a paroxysm of hooping
cough, and has witnessed its painful struggles — the convulsive and
suffocative cough — the laryngismal spasm, and the sudden determi-
nation of blood to the brain — must be surprised that congestion and in-
flammation of the lungs, bronchi, larynx and brain do not more fre-
quently occur !

It was conjectured by the late Dr. Sey of England, that an enlarge-
ment of the cervical glands by a " specific animal poison," similar to
that of the parotids in mumps, constituted the essence of hooping
cough, by causing from their enlargement an irritation of the pneu-
mogastric and recurrent nerves. But here also the effect seems mis-
taken for the cause ; for swelling of these glands often occurs as the
result of pulmonary and bronchitic irritations, and when present in
hooping cough, they make their appearance not at the commencement
but at the height or towards the termination of the disease !

Now, a careful investigation of a good many cases, which have re-
cently presented themselves to my observation, induces me to believe
that the cough is essentially nervous in its character, developed by a
specific irritation of the spinal cord extending from the origin of the
eighth pair down to that of the phrenic nerve. This conclusion is ar-
rived at by a species of negative induction. If the cough were de-
pendent upon pneumonic inflammation, we should have all the physical
signs of pneumonia constantly developed. If it originated in a bron-
chitic irritation, we should have hooping cough with every attack of
bronchitis. If irritation of the peripheral extremity of the pneumo-
gastric nerve were its cause, that in itself would be sufficient to pro-
duce pneumonia in every case ! Inasmuch therefore as these causes
seem evidently inadequate to develop the characteristic phenomena of
hooping cough, and since these phenomena are clearly of a nervous
character, and the parts involved in the disease are only those to
which the eighth pair and phrenic nerves are distributed, I am forced
to believe that the source of irritation — the cause of the disease — is to
be found in the spinal cord at the roots of these nerves.

Acting in accordance with this belief, I have adopted a method of
treatment remarkably simple and eminently successful. It consists in
the application of a blister to the nucha, which, upon the principle of
counter-irritation, speedily and permanently relieves all the distressing
symptoms of the cough. In a large majority of cases a single appli-
cation of the blister will suffice for an instantaneous cure. Those
which resist the first application yield to a second, aided by the inter-
nal administration of quinine, or of iron combined with quinine in the
66

558 BROOCKS AND BOSWELL's CASE OF PRIAPISM.

form of the citrate. I would not recommend the use of the blister in
case of infants of a very tender age ; but pustulation by means of the
unguentum antimonii or the ol. tigli will accomplish the desired
object.

Now, whether these brief views in regard to the " pathology of per-
tussis," be correct or not — whether they be condemned as theoretical,
and the treatment as empirical — certainly the success which has at-
tended my efforts, justifies me in warmly recommending it to the at-
tentive consideration of my professional brethren.

A Case of Priapism.

BY DRS. BROOCKS AND BOSWELL, OF MILTON, N. C

June 24th, 1851, at 11 o'clock P. M., we were called to see T. M.,
a youth about 15 years of age. On reaching his place of abode,
we found him couched on the floor, with his head resting on his mo-
ther's knee, his body bent forwards, and his legs drawn up, a position
not very unlike that of a female laboring under a severe attack of
puerperal peritonitis, and apparently asleep. After some general en-
quiries respecting his attack, &c, we awoke the young man from his
pretended slumber ; and after propounding severalquestions, we learned
that he had been complaining for some four or five days of severe
pain in the perineal region, on motion; partial retention of urine, and
extreme rigidity of the penis. The question now naturally arose,
What can be the cause of these phenomena? A minute examination
of the parts, and a careful consideration of all the disorders with
which they are liable to be affected, led us to the conclusion that the
cause was not a local one. We next considered our patient's general
health — he was pale and anemic — his appetite was bad, and had
been so for months past — his digestion was imperfect — his bowels
were very irregular — his tongue was pale, tremulous, and coated with
a white fur — his eyes were sunken and inanimate — pulse about 75,
quick, weak and irregular — skin a little below the usual temperature —
in a word, judging from surrounding circumstances, he had long been
deprived of those articles of diet so essential to the building up and
preservation of health. Basing our reasons upon these latter observa-
tions, we diagnosticated his complaint a case of bad general health,
marked with that rare feature of disease (priapism) so seldom met
with in one's professional career.

Treatment. — Before administering any medicinal agent, we pre-
pared him a bed that would keep him in that doubled up posture,
(before alluded to,) which he preferred on account of its giving him
more ease than any other. We then, with the help of an assistant,
lifted him from the floor to his bed, though not without giving him
severe pain, manifested by expressions of countenance and loud
shrieks. After he became somewhat composed, we directed him to
take the following : fy Tinct. opii. gtt. 20 — ant. et pot. tartrat, gr. iV
two hours. Cold applications to the parts, Rheipulv grs. 15

snyder's case of wound of the brain, with recovery. 559

on the following morning — entire rest, &c. We left our patient with
directions as above, for the remainder of the night, and saw him on
the next (day 25th) at 10 o'clock, A. M., at which time there was no
perceptible alteration in his complaint. He rested tolerably well after
we left him the first time, evacuated half teacupful of urine early
next morning — bowels moved also — stool clay colored, and contained
some portions of undigested food that he had taken the day before —
skin cool — pulse about the same as when we saw him first. He com-
plained of a dull pain in the thighs and perineal region, fy Hydrar-
gyri chloridium mite. grs. 8, gum camphor grs. 16, opium grs. 2, made
into 8 pills, one every three hours. With the above prescription we
left our patient, and saw him on the 27th, at 10 o'clock, A. M., with
some alteration — rigidity not so tense — we left him, with directions to
continue the last prescription, and in addition to use the hip bath. On
the 28th we found him much better — rigidity almost entirely gone — no
pain, and no tension of the pirineum. On the 29th we dismissed
him, cured of his local complaint, with directions to use an appro-
priate diet and chalybeate tonics for the improvement of his general
health.

We report the above case, not for its individual interest as one of
severity, or from any peculiarity in its course, mode of treatment or
termination — nor do we wish to be understood as calling the attention
of the members of the profession to it as a complaint which they are
often called upon to treat — but rather from its rare and novel occur-
rence do we note it. To the young practitioner we would say that it
will prove a stumbling block in his way whenever met with, from the
fact of there having been so little said about it in books. We know of
but two cases on record. One by Jno. W. Tripe, Esq. in the Bulle-
tin of Medical Science, vol. iii. for 1845, page 302. The second was
published by Calloway, in the Medical Repository for April 1824.

Remarkable Case of Recovery from Fractured Skull and Loss

of Brain.

BY J. SNYDER, M. D., ROMNEY, HAMPSHIRE COUNTY, VA.

On the 15th of April 1851, a son of Col. Vaus Fox, about 8 years
old, was run over by a horse and thrown violently upon a rock jutting
out of the ground, which fractured the skull very extensively. About
two hours after the occurrence of the accident I was called to the
case, and upon examination found the injury to be at the middle por-
tion of the temporal arch, between the parietal protuberance and fron-
tal suture, implicating a portion of the frontal bone. A portion of the
parietal bone, precisely one inch and a half in length, and of an elon-
gated triangular form, was forced endwise into the middle lobe of the
brain, penetrating its investing membranes and entering its substance.
Parts of the parietal frontal and temporal bones were fractured into
5 or 6 pieces, making a comminuted, depressed space of four inches,

560 snyder's case of wound of the brain, with recovery.

which presented a perfectly concave appearance, with a wound in the
centre of the depression about one inch in length. With the assist-
ance of my friend, Dr. Pratt, after removing the hair, the wound was
enlarged to the extent of one inch and three-quarters, to facilitate the
extraction of a portion of the parietal bone completely hidden in the
cerebral mass. After the wound was enlarged, I extracted the piece
of bone with forceps, and removed about a dessertspoonful of the
middle lobe of the brain, which followed its extraction and forced it-
self out of the wound. This done, the little fellow seemed to arouse
up and regain his sensation — so much so as to make a considerable
struggle and effort to rise, but was forced to remain quiet by assistants.
The struggle caused a second protrusion of the brain, which being
detached from the cerebral mass, as we supposed, was cut away with
surgeon's scissors. I then proceeded to raise with an elevator the de-
pressed pieces of bone to their normal position, which was accom-
plished with considerable difficulty, being compelled to use a good
deal of force. It was, however, accomplished satisfactorily, and the
wound dressed with emp. adhsesiv. and a light compress, leaving a
small space between the strips to permit the blood, &c. to escape.
During the operation the little fellow was perfectly comatose, except
for a moment immediately after the extraction of the bone. He was
now placed in a well ventilated and quiet apartment, closely watched,
and under the constant surveillance of a doating mother. Although
a very tractable and obedient child, yet it was necessary for those
around him to watch him closely, as his position was frequently and
abruptly changed from side to side with quick and sudden tossings,
which made it necessary for his attendants to stand by to retain him
in bed and to adjust the cover. He frequently placed his hands on
the wounded part, but complained of very little pain. He was very
closely watched during the night and next day by Dr. P. and myself;
and on the following night, about thirty hours after the operation, re-
action took place, which required, for the protection of the brain, three
copious bleedings, about an hour apart. This free abstraction of blood
had the desired effect of reducing arterial action and quieting the whole
system.

On the following day it was thought best to excite the bowels to ac-
tion, which was done by enemas, and subsequently, by giving quarter
minim doses of ol. c. tiglii mixed with bread crumbs, repeated every
two hours until some effect was manifested. After this an occasional
pill of the same was given, which, by one or two repetitions, always
acted pleasantly. No further evidences of excitement manifested
themselves during the progress of the case. The head was cleansed
and dressed twice a day for a few days, and subsequently but once a
day, and recovery was unexpectedly rapid, being three weeks before
he was able to walk in his room, requiring no change of treatment ;
and the little fellow is now (August 10th) in robust health and fine
spirits. As is usual in this character of injury, I feared the occur-
rence of fungus cerebri, but these unpleasant consequences have not
shewn themselves, and it is not probable that anything of the kind
will arise, as it is now four months since the accident ; and I feel con-

A CASE OF HEMATURIA. 561

fident his intellectual faculties have not sustained the slightest degree
of injury. On the 16th of August, four months after the accident, he
had an attack of scarlatina simplex, which passed off without an un-
pleasant symptom, and without any medical treatment other than a
tepid bath and confinement to his room.

What is most remarkable in the above case is, that an injury so ex-
tensive, involving so much of the skull and a loss of so much of the
cerebral mass, should recover so soon, and with so little medical as-
sistance.

A Case of Hematuria.

BY J. R. E., OF LOVINGSTON, VA.

Mrs. B , set. about 35, of good constitution, and rather robust

than otherwise — pregnant with her sixth child, and within about two
weeks of full term, was attacked with haematuria. I saw her on the
14th day of May last, a few days after the appearance of the first
symptoms, and found her with a natural pulse, soft and regular, skin
cool and moist, appetite good, with slight pain in the region of the
kidneys, which was only felt when pressure was made. The urine
was the color of pure blood, and discharged in large quantities.

There was no pain in passing it, except when it was allowed to ac-
cumulate in the bladder for a length of time, when it would be dis-
charged in lumps.

Prescription. — Croton Tiglium to be rubbed on over the re-
gion of the kidneys, and injections of cold water to be thrown into the
rectum; if the cold water was not sufficient to move the bowels,
warm soap and water were to be substituted. In about two weeks
she was delivered of a fine healthy boy, but the haemorrhage con-
tinued about the same, being intimately and thoroughly mixed with
the urine, shewing conclusively that it came from the kidneys or
ureters. She had never suffered with anything like a calcareous af-
fection.

This bloody discharge continued unmitigated for a week after de-
livery, when it suddenly yielded to the tine, ferri. chlorid. given in the
dose of x gtts. ter die with xx grs. pulv. catechu. She had a good
getting up, and now enjoys good health.

Lovingston, Va., Aug. 1851.

562 JOYNES' CASE OF ANCIENT SUPERSTITION.

An Example of Ancient Superstition.

Accomack C. H., Va., Aug. 13, 1851.
To the Editor of the Stethoscope.

Dear Sir — I send you for publication the following curious scrap
of antiquity, which I met with some months ago, while searching the
ancient records of this county. It has seemed to me to deserve a
place in a medical journal, as a very apt illustration of a medical su-
perstition, among the most remarkable of those with which the history
of our science abounds.

Those who have paid attention to the history of medico-legal
science are aware, that in former times and for a long period, it was
a belief universally entertained, that the wounds of a murdered man
would bleed afresh, hours and days after death, on the body being
touched by the murderer ; or that some other change, not less won-
derful, wTould occur in the condition of the corpse. This superstition
being received as an undoubted truth, it was very naturally turned to
account injudicial investigations, for the purpose of detecting the guilty
and acquitting the innocent. Dr. Dunglison, in his work on Physi-
ology, refers (in the chapter on Sympathy, &c.) to several instances in
which this kind of ordeal was resorted to : and others may be found
in Beck's Medical Jurisprudence, in the chapter on Persons Found
Dead. Sir Walter Scott, who has made one of the leading incidents
of " St. Valentine's Day" turn on the practical application of this
test, in a case of murder where the other evidence was defective, de-
nominates it the " bier-ordeal,'''' or the " trial by bier-right ;" and speaks
of it as having been " often granted in the days of our Sovereign's
ancestors, approved of by bulls and decretals, and administered by
the great Emperor Charlemagne in France, by King Arthur in Bri-
tain, and by Gregory the Great, and the mighty Achaius, in this our
land of Scotland."

The confidence in the proof thus elicited seems to have been great,
inasmuch as it was regarded to be " the pleasure of Heaven, by some
hidden agency which we cannot comprehend, to leave open this mode
of discovering the wickedness of him who has defaced the image of
his Creator." This trial by " bier-right," in truth, originated in the
same notions of supernatural agency and direct divine interposition
which gave birth to the ordeals of fire, of water, and of battle. They
were all regarded in the light of appeals to Heaven for the discovery
of truth.

The facts of the case, of which the old records of our county court
furnish the history, are briefly these : On or about the 12th of January
1680, one " Mary, the daughter of Sarah, wife of Paul Carter," gave
birth to an illegitimate child, which was born alive, but died soon
after its birth. It was buried the next day by Paul Carter and his
wife in an old house, where it remained until the end of February,
when it was removed to the garden. The parties above named, who
were the only persons present at the birth and burial of the child, tes-

JOYNES' CASE OF ANCIENT SUPERSTITION. 563

tified that they endeavored to preserve its life, that it received no vio-
lence, and that it was decently buried. But suspicions of foul play
having arisen, a jury of twelve matrons was summoned, according to
the custom of those times, to investigate the case. They acted, it
seems, in the capacity of a coroner's jury, and their verdict, as copied
verbatim et literatim from the record, is as follows :

" Wee ye subscrib™ being sworne to vew ye body of a dead bastard
child confest by Mary ye daughter of Sarah Carter to be borne of her
body wch said child we caused to be taken out of the ground in the
garden where it was ver}r shallow put in then we caused Sarah the
wife of Paul Carter & mother of the said Mary to touch handle &
stroake ye childe in wch time we saw no alteration in the body of
ye childe Afterwards we called for Paul Carter to touch ye sd child
& immediately whist he was stroaking ye childe the black & setled
places above the body of the childe grew fresh & red so that blud
was redy to come through ye skin of the childe we also observed the
countenance of the said Paule Carter to alter into very much pale-
ness, the childe also appearing to us to be very much neglected in
severall respects as to ye preservacon of such an Infant, & we doe
conclude if ye child had violence it was by ye throat wch was very
black and continued so though other places wch were black altered to
red & fresh collered to wch we subscribe our hands this first day of
March 167-8V

[Here follow the signatures of Mary Hill, Margaret Jenkins, Ma-
tilda West, and nine other women, and that of " Wm. Custis, coro-
ner."]

In view of the preceding verdict, and the other evidence in the
case, the grand jury presented Paul Carter, who was supposed to be
the father of the child, for wilful murder, and he was committed to
appear for trial before the governor and council at the next general
court. As for Sarah, his wife, notwithstanding her having passed so
successfully through the ordeal of the touch, some very suspicious
circumstances in the other evidence led to a similar presentment
against her. The final result of the case, and the degree of import-
ance attached by the general court to the facts stated in the verdict
of the jury of matrons, I have no means of learning, as there is no re-
ference to the trial in the records of this county.

Considering the length of time the child had been buried, and the
season of the year, the foregoing is one of the most singular examples
of this superstition that I have met with. Somewhat analogous to it
is the case quoted by Beck from Hargrave's State Trials, in which
the body was disinterred thirty days after death, and on being touched
by one of the accused, " the brow of the dead, which was before of
a livid and carrion color," — " turned to a lively and fresh color,"
&c. But much more marvellous phenomena were sworn to have
been observed in this case, viz : the sweating of the brow, the open-
ing and shutting of the eye, the repeated motion of the finger, ^nd the
dropping of blood from it.

At the present day, it seems at first view incon uper-

564 JOYNES' CASE OF ANCIENT SUPERSTITION.

stition should ever have obtained such a complete mastery over the
popular mind, that persons apparently of good faith were read}' on
frequent occasions to bear testimony to such facts, and others as ready
to believe them. In our own case, above cited, we have the concur-
rent testimony of twelve persons under oath. Yet this strange super-
stition, like many others which have long been received and acted on
by the ignorant, has an unquestionable foundation in truth. The his-
tory of the cadaveric changes wrought by putrefaction furnishes the
key to it. It is well known that the blood, though it generally coagu-
lates in the vessels soon after death, is rendered fluid again by putre-
faction, in which condition it may be caused to flow from wounded
blood vessels, by any motion or change of position. It is also known
that the blood, thus rendered fluid, may escape from incisions sponta-
neously, in consequence of the development of gas by putrefaction in
the heart and large blood vessels. Devergie, in his description of the
phenomena of this "gazeous putrefaction," (Med. Legale, vol. i., p.
166,) remarks that thereby " the heart is emptied of blood, as well
as the large blood vessels. The decomposed blood is driven into all
the superficial veins and the general capillary system ; hence the
veins of the surface become distinct like bluish lines, visible exter-
nally, as if those vessels had been injected ; hence too, that reddish
coloration of all the white tissues, as the cellular tissue, the parietes
of the trachea and alimentary canal, of which the external aspect
may then simulate the appearance of inflammation." In this pas-
sage Devergie gives a very satisfactory explanation of the phenomena
observed in the case of the child above mentioned, after its body had
been exposed to the air for a certain period.

It is very easy to conceive that in any particular case one or more
of these cadaveric phenomena might coincide with the presence or
the touch of an individual whom other circumstances might prove to
be the murderer ; and in an age when the general tendency of the
popular mind was towards a superstitious belief in the marvelous, as
affording evidence of divine interposition, it would require but few
such coincidences to establish a general law, and furnish sufficient
ground for constituting an ordeal for deciding upon the guilt or inno-
cence of persons accused of murder. Such is, no doubt, the true
history of the origin of this " trial by bier-right."

Craving your pardon for the length to which I have allowed this
communication to run,

I am, very respectfully, &c,

L. S. JOYNES.

EDITORIAL. 565

In our last issue we suggested the necessity of a general state
medical convention, for the purpose of organizing the profession under
the charter of the Medical society of Virginia. This suggestion has
been well received, as our private letters and intercourse with our
brethren shew ; but some little difference of opinion is manifested as
to the most proper time for the assembly. This question we hope
will soon be settled ; and in the absence of better reasons, we are in
favor of the 1st of May next, because the national meeting here during
the second week in May will attract a large number, and it will en-
sure a fuller convention than could be convened at any other time.

Among others on the same subject we have received the sub-
joined letter from Dr. Patton of Greenbrier ; and lest others should
fall into the same misconceptions which Dr. P. seems to entertain, we
deem it proper to make a few observations on the subject. Dr. P.
justly says, that it is preposterous for a local society, at its monthly
meetings, to legislate for the whole profession of the state ; and one
would think that he imputes a spirit of dictation to the members of
the " Richmond society," as he terms the Medical society of Vir-
ginia as it now exists. This would be very unjust, as by reference to
the action of that body at its April meeting and the proceedings pub-
lished in this number, it will be seen that the members are doing all
they can to induce the physicians of Virginia at large to take the
valuable charter which it now holds. As will be seen by the pre-
sent constitution, (see No. 2 Stethoscope,) some preliminary legislation
is necessary to organize the body as a State society in reality. This
legislation is being gone through with as rapidly as possible, and by
the time the convention meets there will be no obstacle to prevent a
perfect organization, under charter, at once. All great works must
have a commencement and a commencer ; and in this case we cannot
conceive who could take the initiatory steps with more propriety than
a body already organized, and consisting of hundreds of members in
every quarter of the state.

" Lewisburg, Va., 8th Sept. 1851.

" Dr. Sir — In the Sept. No. of the t Stethoscope,' under the edito-
rial head, I see it is proposed to call ' a general convention of the
state' for the purpose of ' entering on the roll all the practitioners of
respectable standing, and securing a central and effectual organization
of the Medical society of Virginia.'
67

566 EDITORIAL.

" I am glad to see a proposition of this kind. It is the only method
of enlisting the whole profession, and of calling forth its united strength
for the accomplishment of the grand objects contemplated by the so-
ciety. Less than the concentrated effort of the state will fail to work
out the reforms we desire, and fail to secure the elevation of standard
at which we aim. That any plan which may be adopted will fall
short of embracing every practitioner, and of securing his hearty co-
operation, is apparent from the fact, that some are too old and too well
stricken in the ways they have been accustomed to go, to yield assent
to any measure that may prove an innovation upon established ha-
bits— and others are loo shrewd and too selfish to subscribe to terms
which may exclude them from privileges and profits to which they
were never entitled.

" Nevertheless, a large proportion of the profession of Virginia —
even in its western half, where the ' stand-still' system and the diffi-
culties referred to are hardest to be overcome — are anxiously waiting
for reform, and hail with enthusiasm every effort that promises to re-
lease medicine from the weights that beset it, and give it the promi-
nence and dignity of a science. Seeing, then, that the spirit of re-
form is abroad, and needs only a little exertion on the part of its more
zealous advocates to mature the most wholesome results, it behooves its
friends to exercise great caution in adopting only such a system of or-
ganization as will prove generally acceptable.

" That the present organization is defective, and therefore incapable
of accomplishing the objects desired, is admitted, it seems to me, by
the call for a convention, and would seem to be fully demonstrated by
the conceded reluctance of practitioners ' to send in their application
for membership.'

" Whilst the Richmond (styled the Virginia) medical society deserves
all praise for seizing upon the opportunit}7 and rescuing from forfeiture
the charter that authorized the formation of a state medical society,
and is entitled to the lasting gratitude of the profession for the heath-
ful influence it has exerted in waking up its dormant energies, and
bounding forward as the great pioneer of reform, yet societies that
have even been stimulated into existence by her example, cannot dis-
cover how she, holding her monthly meetings — reading essays — dis-
cussing subjects — electing members — transacting private business and
local matters, differs from other local societies — and will not, there-
fore, recognize her except as an elder sister, who, with greater facili-
ties, greater zeal and higher success, is striving in like manner with
themselves for the promotion of good and the elevation of the profes-
sion. If an expression of the medical opinion of the state out of
Richmond and its neighborhoods could be obtained, something like
the above sentiment, I have no question, would largely prevail.
Whatever influence, therefore, the Richmond society may have ex-
erted for good, and is calculated to effect even beyond its own limits,
it remains an obvious and I fear a stubborn truth, that she cannot
unite in herself the strength of the profession of the state, nor present
a platform upon which it will consent to stand. Indeed the very idea
of a local society — holding its monthly meetings with an attendance

EDITORIAL. 567

of from 20 to 50 members — legislating for the profession of the whole
state, and in the nature of things denying any a voice except residents
of Richmond, or the very few whom chance, business or choice may
happen to direct to that city just at the time of one of its meetings — is
in itself preposterous. The only means then of obviating these difl&T
culties, and accomplishing the ends so desirable and so essential to a
vigorous and healthful organization, is to call a convention as sug-
gested, which, under the charter held by the present state medical sot
ciety, shall adopt its own constitution and laws — determine the rela-
tion of inferior societies — select delegates to the national medical as?
sociation — and in a word, effect a complete organization of a state
medical society. When this meeting should occur and at what place
it should be held, are subjects of less importance, provided sufficient
time is allowed for maturing the business of the convention anterior
to the session of the National medical association. I would suggest,
however, the 1st of January 1852 as a suitable time. The choice is
determined by the session of the legislature, as it may be desirable to
have reference to that body. Staunton would be most central and
easiest of access to the greatest number, and is withal a common point
between the East and West, yet I would readily acquiesce in wiser
suggestions.

Yours, &c,

WM. N. PATTON.

Medical Education.

The subject of medical education is one of vital interest, not only
to the profession itself but also to the public. Until within the last
year or so it has not occupied that attention in any quarter which its
importance deserves, but no one who is a reader of the medical jour-
nals of the day can fail to see that there is at least an agitation of the
subject going on from one end of the country to the other ; and it is a
source of gratification to know that the cause of reform is receiving
support, not only from the state governments, but also from that por-
tion of the profession which is most directly interested in the subject.
It would be folly and madness for the schools, with all their alumni
influence, to attempt to stem the current of reform which is now in
motion ; and we are glad to see that some of them are wisely adopt-
ing the improvements called for. We take the liberty of publishing
the subjoined extract from a private letter received from a leading
member of the faculty, of a most promising young school in the South,
and we would only add, that the " great mass of the profession arle
waking up," and do demand alterations in the present system of ma-
nufacturing doctors for fees.

568 EDITORIAL.

" As to medical education, I think the whole system is defective.
Much more time should be required ; a system pursued which would
bring the students more in contact with the professors ; and especially
the degree conferring power separated from the teaching. But I
doubt exceedingly whether any real steps will be taken towards these
reforms till the profession demand it. And the profession will not de-
mand it till the Am. Med. Association has done its work in waking up
the great mass of physicians, and making them realize that there is
such a body as the medical profession, with its bonds of union and
influence."

Acknowledgments.

We have to acknowledge the receipt of some very interesting and
scientific pamphlets from Dr. Bennet Dowler, of New Orleans.
" The Natural History of the Alligator" and " Contributions to Phy-
siology" have added to the already exalted reputation of this most
industrious votary of natural science.

The " Minutes of the Proceedings of the Medical Society of Geor-
gia, at its second annual meeting, held at Atlanta, April 1851," are
on our table. We would like to copy, if space permitted, abstracts
from the report of the special committee on the " Character and edu-
cation necessary for a physician," made by Dr. Ford. The address
of Dr. R. D. Arnold, president of the society, on the " Reciprocal
duty of physicians and the public towards each other," is an interest-
ing paper, and one calculated to do much good, if it could be seen and
read by the public.

Personal pamphlets have been received from Drs. F. M. Robertson
and H. A. Ramsay, but we deem it unnecessary to involve our read-
ers in the merits of this controversy ; particularly as we learn that
the " matter is now done with."

Among the announcements of medical schools are those of the Uni-
versity of Nashville and Dr. Mettauer's school at Randolph Macon.

The "Dental Times," a quarterly of 44 pages, edited by Alfred
A. Blandy, M. D., D. D. S., for the small sum of $ 1 per annum, has
been added to our exchange list. It is published in Baltimore, the
first number having been issued August 1st, 1851. The leading arti-
cle presents a strong reason why the resolution excluding dental and
pharmaceutical colleges from representation in the American medical
association, which was offered by Dr. Wood, should not be adopted.
The subject is one of interest, and will doubtless be the source of a
warm debate at the next meeting.

MEDICAL SOCIETY OF VIRGINIA. 569

To Correspondents.

Communications have been received from Drs. Lewis, Bowyer,
Evans, Ballou and Brown, which shall appear in our next issue.

Several other communications have been received, which shall be
attended to.

Our thanks are due to Messrs. Blanchard & Lea, for the following
works of value which we have received through Morris & Brother of
this city. Their importance demands more time and space at our
hands than we can give them this month. " The Geological Ob-
server," by De la Beche — " Walshe on the Heart and Lungs," and
" Craigie's Elements of General and Pathological Anatomy."

Medical Society of Virginia — Called Meeting.

At an adjourned meeting of the Society, held September 2d, Dr.
Beale, first vice-president, in the chair, the following, report which
had been deferred for the special action of an adjourned meeting, was
called up :

The committee to whom the Medical society of Virginia referred
the resolution which had been offered for the purpose of regulating
the conduct of apothecaries, have had the same under consideration,
and recommend, in lieu thereof, the adoption of the following code of
ethics, which, they deem it proper to say, is substantially the same as
that agreed upon by the college of physicians and the college of
pharmacy in Philadelphia.

W. D. HASKINS,

F. H. DEANE,
C. P. JOHNSON,
C. S. WILLIAMS,

G. A. WILSON.

A Code of Ethics, adopted by the Medical Society of Virginia,
for the regulation of the conduct of Physicians and Apothe-
caries respectively towards each other and the public.

The practice of medicine being a profession which demands know-
ledge, skill and integrity on the part of those engaged in it, and being
associated with the profession of pharmacy in the responsible duties
of preserving the public health and dispensing the useful though often
dangerous articles adapted to the cure of disease, its members should
be united on some general principles to be observed in their several
relations to each other and the public : therefore, we, the members of
the Medical society of Virginia, urge upon the physicians and apothe-
caries generally the adoption of the following principles for the go-
vernment of their conduct:

570 MEDICAL SOCIETY OF VIRGINIA.

1. As the diagnosis and treatment of disease belong exclusively to
the province of the physician, and as a pharmaceutical education does
not qualify its possessor for these responsible offices, the apothecary
should in all instances refer applicants for medical aid to a regular
physician.

2. Any connection with, or moneyed interest in, apothecary stores
on the part of practising physicians, or any effort of an apothecary
to further the interests of any particular physician, to the prejudice of
other reputable members of the medical profession, or allowing any
physician a per centage or commission on his prescriptions, should be
discountenanced, as unjust towards that profession and injurious to
the public.

3. As medical men occasionally commit errors in the phraseology
of their prescriptions, which may or may not involve ill consequences
to the patient if dispensed, and be injurious to the character of the
practitioner, it is held to be the duty of the apothecary in such cases
to have the corrections made, if possible, without the knowledge of
the patient, so that the physician may be screened from censure.
When the errors are of such a character as not to be apparent
without the knowledge of circumstances beyond the reach of the
apothecary, we hold him to be blameless in case of ill consequences,
the prescription being his guarantee, the original of which should
always be retained by the apothecary.

[Remarks made by apothecaries upon prescriptions being an inter-
ference with the practice of physicians and hazardous to their patients,
should be scrupulously avoided as an infringement of this article.]

4. Apothecaries are likewise liable to commit errors in compound-
ing prescriptions : First. From the imperfect handwriting of the phy-
sician. Secondly. Owing to the various synonyms of drugs in use
and their imperfect abbreviations. Thirdly. From the confusion
which even in the best regulated establishments may sometimes oc-
cur, arising from press of business; and Fourthly. From deficient
knowledge or ability of one or more of the assistants in the shop, or
of the proprietor himself. We hold that in the first three instances
named, it is the duty of the physician to stand between the apothe-
cary and the patient as far as possible — and in the last, that he should
be governed by the circumstances of the case — drawing a distinction
between an error made by a younger assistant accidentally engaged,
and a case of culpable ignorance or carelessness in the superior.

5. As we consider that any discovery which is useful in alleviating
human suffering or in restoring the diseased to health should be made
public for the good of humanity and the general advancement of
the healing art, no member either of the profession of medicine or
pharmacy should originate or prepare a medicine the composition of
which is kept concealed from each other or from the public.

6. As the apothecary should be able to distinguish between good
and bad drugs in most cases, and as the substitution of a weak or
inert drug for an active one may negatively be productive of serious
consequences, we hold that the intentional sale of impure drugs or
medicines, from motives of competition or desire of gain, when pure

MEDICAL SOCIETY OF VIRGINIA.

571

articles of the same kind may be obtained, is highly culpable, and
that it is the duty of every honest apothecary or druggist to expose
all such fraudulent acts as may come to his knowledge.

7. As there are many powerful substances that rank as poisons,
which are constantly kept by apothecaries and prescribed by physi-
cians, and which are only safe in their hands — as arsenious acid, ve-
getable alkaloids, ergot, cantharides, &c. — we hold that the apothe-
cary is not justified in vending these powerful agents indiscriminately
to persons unqualified to administer them, and that a prescription
should always be required, except, in those cases where the poisons
are intended for the destruction of animals or vermin — and in those
instances only with the guarantee of a responsible person.

On motion of Dr. Haxall, the report of the committee was re-
ceived, and each clause of the code was separately read and adopted
unanimously.

Dr. Gooch offered the following:

1. Resolved, That this code be received and adopted by the Medical
society of Virginia.

2. Resolved, That a committee be appointed by the chair, whose
duty it shall be to have one hundred copies of the same printed, and
to furnish each apothecary in the city with two copies, and as soon as
possible to return to this society the names of such as may signify
their intention to abide by its provisions, and also of such as do not.

Which were adopted unanimously, and the committee under the
second resolution was announced, as follow: Drs. Haxall, Cunning-
ham, Gibson, Deane, R. G. Cabell, Conway and Snead.

On motion, Dr. Beale was added.

Several letters of application for membership were read ; and after
the transaction of some unimportant business, the society adjourned.

September Meeting.

Dr. C. P. Johnson, Second Vice-President, in the Chair.

(Present — Twenty-eight Members.)

The minutes of the August meeting and adjourned meeting having
been read and approved, the following gentlemen were then balloted
for, and declared duly elected members of the society :

P. H. Christian, M. D., Bedford.

W. W. Lewis, M. D., Roanoke.

A. N. Wellford, M. D., Fredericksburg.

W. F. Carrington, M. D., Lynchburg.

W. H. Dennis, M. D.. Roanoke.

Geo. S. Upshur, M. D., Norfolk city.

Geo. C. Rawlings, M. D., Richmond city.

A. S. Payne, M. D., Fauquier.

Jno. B. Anderson, M. D., Louisa.

C. R. Palmore, M. D., Cumberland.
J. C. Vaiden, M. D., Richmond city.
Orris A. Brown, M. D., Grecncsville.
Jno. M. Gait, M. D., Williamsburg.
Rich'd P. Walton, M. D., Cartersville.

D. S. Langhorne, M. D., Lynchburg.
A. S. Dillon, M. D., Farmville.

L. S. Joynes, M. D., Accomack.

T. J. Wooldridge, M. D., Richmond city.

Letters of application for membership were read from several gen-
tlemen, who were duly nominated.

572 ASTHMA TREATED BY HYDRIODATE OF POTASH.

Asthma being the subject of discussion, Dr. F. H. Deane pro-
ceeded to read the following paper :

I beg leave, Mr. President, to give the history of the following

Cases of Asthma treated by the Hydriodate of Potash:

Before doing so, I will merely state I was induced to employ the
agent by a statement given me by a clergyman residing in the state
of Illinois. During a visit to this city two or three years before the
statement just alluded to, I attended him in a protracted and violent
attack of asthma. I found great difficulty in affording him even tem-
porary relief, although every means were most perseveringly tried.
He said, for the next two years after this attack his general health
greatly failed, and the paroxysms of asthma were so frequent and
obstinate, he was unable to preach oftener than one Sunday in
three — life had become almost a burthen to him. In this state of
things he was advised to try a sea voyage. He accordingly sailed
for Liverpool — his sufferings were not relieved during the voyage
or after reaching his port of destination. He was now advised to
visit Dublin to obtain the advice of Dr. Stokes — he was under
Stokes's care for many weeks, but did not receive the slightest
benefit — so much so that Dr. Stokes advised him to try travelling
for twelve months in the South of Europe. This was too inconve-
nient to him — therefore, he determined to return to his home in
Illinois. On reaching home he was as great a sufferer as ever.
He was now advised by a physician residing in his vicinity to try
the hydriodat. of potash — he made use of the remedy, and found re-
lief too immediately to leave any doubt as to the propriety of at-
tributing his increased comfort to this agent — that whilst he had
since been frequently threatened with a paroxysm of the disease, he
had always been able to ward it off by a resort to this medicine.
That his health had greatly improved, and he was now enabled to
preach with a degree of comfort he had been a stranger to for so
many years.

A short time after this narrative, I was summoned to see a youth
fifteen or sixteen years old. I found him suffering from a severe
attack of asthma. I was told he had been a great sufferer from this
disease for seven or eight years — that during this time he had been
under the care of three or four different medical men without expe-
riencing any sensible improvement in his health. Some of his medi-
cal attendants regarded the affection as symptomatic of some heart
affection. My own observations of the case did not verify this sup-
position. I directed him to take 5 grs. of the hydriodat. of potash
every two hours — the next morning I found him relieved, and was
told he was sensible of great relief soon after taking the second or
third dose. He was under my observation for the next eighteen
months, and during the whole of this time never had an attack of the
disease. He was however frequently threatened with it, but had al-
ways been able to ward it off by resorting to this article.

The third case I will mention, is that of a married woman, aged
thirty-five. For the last eight years she has always had an attack of

ASTHMA TREATED BY HYDRIODATE OF POTASH. 573

asthma in the month of Ma}'. The other months of the year she en-
joys uninterrupted health, and is not liable to cold, although frequently
exposed to the vicissitudes of weather. I had the opportunity of at-
tending her in one of these attacks. The disease was always ushered
in by just such symptoms as those characterizing epidemic influenza —
pain about the head and eyes, accompanied by incessant sneezing and
most copious defluxions from the nose and eyes. These symptoms
generally lasted three or four weeks, and were invariably followed by
severe asthma lasting quite as long. In this attack I used a great va-
riety of remedies, without affording any satisfactory relief. The fol-
lowing spring she was attacked in the same manner. Two or three
days after the symptoms characterizing influenza had appeared, I was
requested to see her. She was directed to take eight grains of the
hydriodat. of potash every four hours. These symptoms were greatly
mitigated during the next twenty-four hours ; and after using the
agent in this way for three days, they were so much relieved that she
was directed to discontinue the remedy. Nitric acid was substituted.
A few days after commencing the use of nitric acid, she was attacked
by a severe paroxysm of asthma. The hydriodat. of potash was di-
rected to be taken, eight grains at a time, every two hours. Before the
ensuing morning she was relieved of all symptoms of asthma. She as-
cribes the return of her asthmatic symptoms in the month of M^y to the
odor from flowers, as her house is surrounded by roses and other plants.
I have treated three or four cases besides these just related, with
this agent, and with results equally satisfactory. I presume it is un-
necessary to give an account of them, as there was nothing peculiar
in them. I regret that the cases I have mentioned are so imperfect
in some important particulars. I allude to the circumstance that I
have not informed the society upon the pathological conditions in-
volved in either of my cases. This negligence is partly owing to the
fact that when I commenced the use of this agent I had scarcely any
hope that it would relieve my patient, and in the first two or three in-
stances I was disposed to ascribe the relief felt to some natural change
in the disease itself. Subsequent trials with the remedy convinced
me that in this opinion I was mistaken. The cases I have reported,
I think, at least ought to encourage us in further trials with the re-
medy. I am disposed to believe it: will be found to be an agent
greatly mitigating the paroxysmal features of the disease, and that it
will lessen the distressing catarrh so often found existing between the
paroxysms of the affection. To give weight to what I have said in
relation to the relief obtained by my patients by the use of this article,
I will merely say, until I used it in asthma I was disposed to regard it
as destitute of medicinal value. I considered it almost as inert — as
valueless as sarsaparilla. I had given it for a great variety of disor-
ders, in larger doses too than its friends had ever dreamed of, and I
had never been able to see any effect from it whatever. I never met
with a patient who was quite sure that it increased any of the secre-
tions or excretions of the body. 'Tis true I have never had much
experience with it in the treatment of secondary syphilis — and here it
is said its good effects are most conspicuously to be seen.
68

574 MEDICAL SOCIETY OF VIRGINIA.

An interesting debate was carried on till a late hour. A dozen
members took part in it, and we regret that our unavoidable absence
prevented us from making even a short report of the many interesting
practical remarks which were elicited.

On motion of Dr. Rives, Neuralgia was made the subject for the
October meeting.

Dr. Bolton presented a piece of bone, which he extracted from the
rectum of a negro man. It had evidently been swallowed with the
food, and had passed through the entire extent of the alimentary canal
until it reached the sphincter ani. There it lodged, producing severe
tenesmus until it was removed. The fragment is of a triangular form,
and measures 10 lines long by 3£ lines wide.

Dr. B. presented to the society several months since another piece
of bone, which he extracted from the same man and from the same
situation. He was informed that this was the third occurrence of the
same kind.

Dr. B. read the following extract from a letter written by a medical
friend in New York : " We had a very interesting case reported to our
club. A lady swallowed 6 artificial teeth set on a gold plate l£ inch
long by f inch wide — produced some irritation in the stomach and
then in the coecum, but were evacuated in 10 weeks without any
accident."

Dr. B. exhibited an artificial leg, manufactured by Nicolay ofNew
York, who had been for a considerable time connected with an ortho-
pedic institution in Paris. It was well finished, and had been worn
with much comfort. Its principal advantage consists in a spring-bolt,
by which the knee may be made rigid, or may be flexed at pleasure.
It was furnished at an unusually low price.

Dr. C. P. Johnson, chairman of the committee on revision of the
constitution, read the following report :

The committee to whom was referred certain amendments to the
constitution, have had the same under consideration, and beg leave re-
spectfully to report :

Whereas this society has, by a recent action, pledged itself to the
profession of the state at large to place its affairs under their imme-
diate control as soon as the number of country members became suffi-
ciently large to justify such a step ; and as we think this condition has
now arrived, and that a most favorable opportunity for the proposed
change will be offered at the approaching meeting of the National
medical association in this city in May next ; and whereas certain
alterations in the constitution will be necessary in order to effect this
change — it is recommended,

That the 1st section of Art. I. be so altered as to read thus : " Every
candidate's application for membership shall be made to the committee
on nominations. If this committee report favorably the candidate
shall be ballotted for by the society, and the approving votes of three-
fourths of the members present shall be necessary for his admission."

That section 4th of Art. I. be stricken out.

That in section 2d of Art. II. the word "regular" be inserted in
place of the word " annual."

BE ALE S LAWS OF HEALTH.

That section 4th of Art. VII. be stricken out.

That in section 1st of Art. VIII. after " committee of publication"
the words "and a committee on nominations consisting of three mem-
bers" be inserted.

That at the end of section 1st of Art. IX. the words " and of nomi-
nation" be added.

That the following be added to Art. IX. " Section 8. It shall be
the duty of the committee of nominations to receive all applications
for membership, to consider the same, and to report upon them to the
society as early as possible."

That Art. X. be stricken out.

That section 16 of by-laws be stricken out.

On motion, the report was received, and the amendments recom-
mended by the committee were passed to their second reading.

It having been intimated that the chairman of the committee on
" The present condition of medicine and the interests of the profession in the
state of Virginia" would be prevented by other duties from preparing
the report, Dr. Landon Rives, of Richmond city, was appointed, by
vote, chairman of that committee.

The resolution offered by Dr. Parker, at the August meeting, pro-
hibiting members from holding consultations with individuals who
have been rejected by the society, was called up. Dr. Snead moved
to lay it on the table indefinitely; which motion, after debate, was
withdrawn, and Dr. Gibson moved to postpone its consideration until
Tuesday evening 30th — which motion prevailed.

The hour being late, the society then adjourned until Tuesday, 30th
September.

Reviews and Bibliographical Notices.

The Laws of Health, in relation to mind and body : a series of letters
from an old practitioner to a patient — By Lionel John Be ale, M.:
R. C. S., Svo. 295 p. Philadelphia: Blanchard Sf Lea. 1851.

This work is one of much value, and is one of a popular character.
The author has embodied in twenty-eight letters, which are plainly
though forcibly written, more valuable truths in regard to the preven-
tion of disease, the development and maturity of body and mind and
sanatary principles, than we have met with in any other non-profes-
sional work. We warmly commend it to the heads of families, as
being worth more to them than all the " Domestic Medicine" books
that have been published, for there is an old maxim which says that'
" an ounce of prevention is worth a pound of cure." It is a popular
treatise of the elements of physiology, which conveys great truths of
practical moment to everybody. If the reader finds it too incom-
plete in physiology and the laws of health, the book will have done
much to stimulate him to further enquiry and study. On the other
hand, no educated person will find it " too deep" — too complete.

676 beale's laws of health.

We will only notice a few of the topics treated on in some of the
chapters. The 1st contains facts and speculations concerning the na-
ture of life. The 2d is principally devoted to an useless history of
medical schools and discoveries. The 3d is devoted to delusions.
Mr Beale considers quackery an unavoidable evil, dependent on many
causes ; for instance, on the incurability of many diseases, the acci-
dental discovery of many remedies, the uncertainty of the operation
of medicines, that the art is somewhat empirical, and that there are
many conflicting hypotheses among the best part of the profession.

" Homoeopathy,'1 he says, " is one of the greatest delusions which
human blindness ever adopted." The startling displays of Mesmerism,
which so often convince the unwary of " impossible truths," he at-
tributes to their proper causes. The antidote to these heresies which
the author suggests is :

'■To enlighten the public mind. It is ignorance that affords patronage to secret reme-
. dies, miraculous cures, and quackeries of all sorts, both in and out of the domain of physic.
When all medical practitioners shall cease to be pretenders to more knowledge than they
really possess, then will the public cease to patronize quackery; and a more complete edu-
cation— intellectual, moral and professional — of all classes of medical practitioners, engen-
dering higher views of their duties, will cause them to rank higher in the estimation of the
public, and be productive of greater benefit than any exclusive privileges which the legis-
lature could confer upon them" — p. 43.

The next chapters abound in useful hints on physiology, which ought
to be known to all. Diet, digestion, the circulation of the blood, ani-
mal heat, the organs of respiration, clothing, exercise, temperature,
&c-. &c. are discussed at some length. The following extract will
convey an idea of the author's style and of the value of his opinions :

" Full expansion of the chest is equally essential to health as good air, for if, by our
clothing or constrained position, we impede the full expansion of the lungs, healthy respi-
ration is prevented, and the due purification of the blood impaired. Whatever compres-
ses the chest or abdomen impedes respiration, and therefore pressure from dress,
bands or stays, must always be had. How is the chest of a girl to expand with
growth if incased in these horrid inventions? No girl should wear stays till she has long
done growing, for the chest continue to expand after growth has ceased : by the use
of stays the size of the chest is limited, and the ribs are forced to overlap, as I have seen in
several instances. I question if any woman would really require stays before the age of
thirty-five or forty. The best figures of ancient and modern times have never worn any
stays. We have dismissed the swaddling clothes of our infants, and we shall succeed,
eooner or later, in annihilating stays for girls and young women. None should wear them
if they knew how much better they would be without. After having been accustomed to
the support it is very difficult to discontinue their use, because the muscles of the spine,
having been superseded in their action by the barbarous pieces of iron, bone, or wood of
these body-cases, have lost their power of maintaining the body in an upright position, and
without stays the deformities produced by these machines become visible. I hope the time
will arrive when stays will be considered antiquities of the mediaeval ages, and be only pre-
served as relics to adorn the museums and halls of the curious" — p. 64.

The next chapters are devoted to the brain — its relation to the body
and mind — the action of the brain and mind, and their effects on the
body, in health and disease. Most of this matter is good, but we
must insist that the author had much better have espoused the cause
0*" phrenology than have squinted towards it or apologised for it, as
he does in several places.

The importance of very early exercise of the faculties is thus no-
ticed:

. " It is an old remark that most great men have to thank their mothers for their success in
life ; and you will almost always find that every distinguished man has had a clever mother.
So much is learned by a child before he is two years old, that it is obvious how important

WALKER ON INTERMARRIAGE. 577

must be the tuition of the parent with whom he spends his time during his early part of
life. Probably, in most cases, the general bent of the mind is established in the nursery ;
and if the subject was understood, much might always be done at this early period in
eliciting those faculties of the mind which are the earliest developed. For example, much
good must ensue from the early exercise of one of the most important of all the mental
powers, that of attention. Whatever a child is doing it would be well if his attention was
riveted to it, until he comprehended as much as his age permits before he passed to any
thing else. Children are so volatile that they fly from one thing to another with too much
rapidity thoroughly to acquire a knowledge of one object before they begin to examine
another. The possession or the absence of the power of fixing the attention steadily to the
present pursuit constitutes much of the difference of capacity which we find among men.
We often say such a child is blessed with a retentive memory, when the power is the re-
sult of that close attention to one subject at a time which ensures the knowledge of it: you
will find that this power of abstract attention is one very distinguishing feature of
genius" — p. 121.

But in glancing over the pages of Mr. Beale's book we find so
much deserving of notice and of extracting, that we will cut these
remarks on it short, by recommending it as a booh for doctors and pa-
tients. It may be obtained in Richmond of Messrs. Morris <fc Brother,
for a sum far below its value.

Intermarriage ; or the mode in which, and the causes why Beauty,
Health and Intellect result from certain unions, and Deformity, Disease
and, Insanity from others ; demonstrated by delineations of the structure
and forms, and descriptions of the functions and capacities, which each
'parent, in every pair, bestows on children — in conformity with certain
natural laws, and by an account of corresponding effects in the breeding
of animals. With eight illustrative drawings. By Alex'r Walker.
12mo. 384 p. Philadelphia: Lindsay Sf Blackiston. 1851.

We cannot give our ideas of this book and the subject of which it
treats in better language than the following extracts do, though they
are adroitly introduced by the publishers as a puff:

"Apres nous etre occupes si curieusement desmoyensde rendre plus belles etmeilleures
les races des ahimaux on des plantes utiles et agreables; apres avoir remenie cent (bis celie
des chevaux et des chiens: apres avoir transplants, greffe, travaille de toutes les manieres,
les fruits et les fleurs. combien n'est il pas houteux de negliger totalement la race de
l'homme !" — Cabanis.

"The highly interesting subject upon which you are writing is remarkably suited to the
passing time in our country. Our aristocracy, by exclusive intermarriages among ancient
families, proceed blindly to breed in contempt of deformities, of feeble intellect, or of he-
reditary madness, under the instigation of pride or the love of wealth, until their race be-
comes extinct; while another portentous cause, that of unwholesome factories, threatens to
deteriorate the once brave manhood of England. I believe thdt, among mankind, as well
as domesticated animals, there are physical and moral influences which may be regulated so
as to improve or predispose both the corporeal and moral aptitudes; and certainly the most
obvious course is that of selecting the fit progenitors of both sexes." — Sir A. Carlisle, in a
Letter to the Author.

This work is one of much value to all classes, and like the one
noticed above, it is of a popular nature and treats of physiology. It
would soon be widely circulated, were it not for that hyper-fastidious
taste which is so fashionable and which is so opposed to the teaching
of physiology and anatomy. It is deemed indelicate that a young
woman who is a candidate for matrimony should be taught anything
about " physiological conditions connected with and terminating in

578 WYTHES' MICROSCOPIST.

love," or "the sexual relations arising from these conditions, and con-
nected with, or leading to, intermarriage," &c. All rational ideas of
the importance of studying the laws of selection, of progeny, and of
the consequences of particular crosses, are kept away from those most
interested in them. Books which treat of these things scientifically,
like the one before us, are deemed improper, while the same indivi-
duals are constantly reading the trashy novels of the day, whose sole
influence, if not object, is to excite the baser passions and minister to
a morbid taste. This state of things cannot last long — first, because
the printing press is disseminating far and wide the rich and attractive
fruits of science ; and secondly, because the necessity of a renovation
of families to prevent their extinction is becoming quite common. In
England the subject has already commanded universal attention.
Were this science more studied here, we would see less frequently
alliances made between phthisis and scrofula, or gout and plethora,
&c. We recommend this work, with the last mentioned. The two
ought to go hand in hand into every library in the country.

The Microscopist ; or a Complete Manual on the use of the Microscope :
for Physicians, Students, and all lovers of Natural Science. With illus-
trations— By Joseph H. Wythes, M. D. Philadelphia: Lindsay
fy Blackislon. 1851. 12mo. 190 p.

Microscopy is the handmaid to pathological investigation. Its de-
velopments have tended more to establish the truths of modern pa-
thology than all the reasoning power of the best minds. The use of
the microscope is becoming common, and it is now considered as a
necessary piece of apparatus in the studio. But to the beginner in
its use many difficulties of comprehending various phenomena which
it presents, arise, and to avoid these and acquire a facility in its use
some guide is necessary. The little Manual of Dr. Wythes, which
gives a full description of various forms of the instrument, its appli-
cation to every sort of substance and under all circumstances, will be
found an useful — a necessary — vade mecum to those desirous of learn-
ing the use of the instrument. Many instances have occurred where
men, who have recorded their " microscopical observations," have
made themselves ridiculous by their most wonderful discoveries.
They handle the instrument as a philosophical toy, never having
learned its use, and thus bring the instrument into an undeserved dis-
repute. Dr. Lyons, of Dublin, in an introductory to a course of lec-
tures on microscopical anatomy and pathology, makes a good " apo-
logy for the microscope," and throws the onus of all its falsities on
the general incompetency of its users.

We recommend Wythes' little book to go with the instrument al-
ways, though it is not intended to supersede more elaborate treatises
on the subject of microscopy.

SELECTIONS. 579

Case of Gunshot Wound of the Spine.

COMMUNICATED BY CHARLES S. TRIPLES., M. D., SURGEON U. S. ARMY.

The interesting and important discovery of the reflex functions of
the spinal nerves promises so much benefit to the science of medi-
cine, that no fact tending to illustrate or establish Dr. Hall's views
can be looked upon with indifference. I therefore take great pleasure
in communicating the following notes of an interesting case which I
made at the bedside of the patient a short time ago. I shall make
no remarks upon it, preferring to submit it as it is, for the use of Dr.
Hall himself, should it ever meet his eye. I may, however, be in-
dulged in suggesting that the practical surgeon may derive a hint from
it, that may save himself and his patient some trouble in a similar
case ; for, if the titillation of an afferent nerve may, through reflex
action, enable him to dispense with the use of the catheter and ene-
mata, it will be no trifling point gained.

During the protracted war with the Seminole Indians in Florida, an
officer, travelling from St. Augustine to Picolata, was waylaid and
wounded by a party of those savages. He was seated upon the floor
of a common baggage wagon; the ball passed through the side of the
vehicle before striking him. He was shot on the line of the union of
the last dorsal with the first lumbar vertebra — the ball penetrating at
the angle of the ribs on the right side two inches above the vertebra,
and passing in a direction obliquely downwards and toward the spine.
The general direction of the wound was ascertained by the probe, but
the ball could not be felt, and where it is lodged remains a mystery
to this day.

This took place on the 25th November 1839. The immediate con-
sequences were loss of motion and sensation below the wounded part,
though the sensorial recognition of the lower extremities was that of
numbness and tumefaction. When he was received into the hospital,
bottles of hot water were applied to his legs, with the effect of caus-
ing deep eschars very rapidly, but without producing any sensation.
The gunshot wound healed very readily, leaving the patient in the
following condition : The line of normal sensation began in front, at
the anterior superior spinous process of the ilium, descended almost
in the direction of Poupart's ligament about half its length, then curved
upwards, passed just below the umbilicus, described a similar curve
on the other side, and then passed around the back in nearly a right
line to the point of departure.

The bladder and the rectum were paralyzed ; the one was relieved
by the catheter, the other by castor oil. The use of the oil was con-
tinued for about two years; afterwards enemata were substituted;
lavements of water are still used occasionally. The feces are passed
without sensation. The catheter was used for about a year or a little
more. About the beginning of the year 1841, he found that the blad-
der could be induced to contract, by tickling the side of the penis, just
behind the corono glandis ; and he afterwards discovered that the same
manipulation would provoke the rectum to discharge its contents; no
sensation, in the mean while, being transmitted to the sensorium.

580 SELECTIONS.

He thinks that titillation of the left side of the penis affects the rec-
tum more than the same operation upon the right.

No sensation of distended bladder calls for relief; but contraction
of the toes and abduction of both thighs occur at this time, warning
the patient of the wants of nature.

Priapism was readily excited for a time, by friction upon the back
or breast ; but this seems to have subsided of late years.

The flexors of the toes are permanently about half contracted ; by
tickling or jerking up the scrotum and testicles, these muscles may be
made to act spasmodically.

The temperature of the paratyzed parts is good. He thinks he
feels more and more, from year to year, a consciousness of the exis-
tence of the limbs, and by an effort of the mind, to fix attention upon
them, they ache so much as to render it necessary to desist.

There is not so much corpulency of body as is usual in such cases,
nor are the paralvzed extremities so much atrophied as we might ex-
pect.

All sorts of counter-irritations, rrydropathy, homoeopathy, electri-
city, strychnia, &c, have been resorted to, but without benefit. In
1844 or '45, while trying the sulphur vapor, a jet of hot vapor was
thrown upon the sole of the left foot, and took off* the whole integu-
ment, he being totally unconscious of any sensation.

The urine was amtnoniacal and purulent for the first three or four
years, but has been less offensive since. If he assumes the erect posi-
tion, leaning upon his crutches, to empty the bladder, the urine is less
offensive than when he is obliged to lie in bed for a few days.

The color of the limbs is natural. He assures me that they were,
a few years ago, more sallow and more atrophied. — N. Y. Medical
Journal.

[From the Boston Medical and Surgical Journal.]

The Patent Medicine Business, and the duty of Physicians
-with regard to it.

Mr. Editor — I was pleased to see in the last number of your jour-
nal, that the important question has been agitated D3r some of our dis-
trict societies, and that the movement has been seconded by some of
the physicians in this city, as to whether it is not the duty of the phy-
sicians to discountenance the manufacture and sale of patent medi-
cines and nostrums, in a more decided and emphatic manner than has
heretofore been adopted.

As the matter now stands, the physician, though perhaps unwil-
lingly, is forced into the necessity of aiding and abetting quackery by
purchasing his medicines and sending his recipes to shops where pa-
tent medicines are made and sold, from the fact that all our apothe-
caries (with a few honorable exceptions) deal in nostrums to a greater
or Ipss extent.

This trade in quack medicines is a dishonest business. It is not or
ought not to be considered respectable, and it is the duty of prrysicians

SELECTIONS. 581

to discountenance it. It is a dishonest business, because, by reason of
false representations and bought or forged certificates, it holds out to
the invalid promises which cannot be fulfilled. The consumptive's
last dollar is drawn from his pocket to purchase some worthless com-
pound, which, in the simplicity of their hearts, he and his friends are
led to believe will restore him to health — a hope founded on these false
statements of the patent medicine dealer, but soon to be quenched in
death. This is but one illustration — will any one say that such a busi-
ness is honest ?

It is not a respectable business. The man who puts his decoy sign
in some alle}^ or lane of the city, and by false promises, in high-sound-
ing advertisements, and by an assumed name, promises to cure " se-
cret diseases" by secret remedies, in a short time, according to the
price the too-believing, unfortunate one is able to pay, is not called re-
spectable. We do not call the man who aids and assists him respecta-
ble, and he does not consider himself worthy of respect. He is
ashamed of himself. Is the manufacturer or dealer in such secret re-
medies, though in a more splendid establishment, and patronized by
the regular physician — is he so far above the quack doctor that some
of the censure may not apply to him? Certainly not. By misrepre-
sentation, these nostrums are placed before the public ; the apothecary,
if not directly interested in their manufacture, buys a supply, saying,
to relieve himself of the responsibility, that people will be humbugged,
and he might as well have the profit of it as others. A poor excuse,
truly.

It is the duty of physicians to discountenance it by all means in
their power, because it is a dishonest business — (one reason in itself
sufficient) — because it is or ought to be disreputable, and because, by
combining the dispensing of medicines with the trade in quack nos-
trums, the medical profession is degraded by the connection ; the vil-
lainous compounds of a Townsend, a Brandreth and a Moffatt are
vended at the same counter where the prescriptions of physicians are
compounded — the broad and comprehensive term " Pharmacy" being
made to cover the whole.

By the exertions of physicians this state of things can be remedied.
When apothecaries are aware that their shops will not be patronized
and recommended by the medical faculty as long as they continue to
deal in nostrums, they will be discarded from their shelves, and the
business confined to a few disreputable shops having no connection
with the respectable drug business. These nostrums will be made
and sold to some extent, but let us clear ourselves of all connection
with the traffic. This, I believe, is the state of feeling among the pro-
fession generally — at least, so far as I have any knowledge of it.

By these remarks, I only hope to excite a spirit of enquiry among
the members of the profession, and I hope before long to see some
decisive action taken in the matter, that the laws may no longer re-
main a dead letter on the books of the Massachusetts medical society.
A Member of the Mass. Med. Society.
69

582 SELECTIONS.

Coup de Soleil or Sun-Stroke.

In " a summary of the transactions of the Coll. of Phys. of Phila-
delphia," published in the last number of the American Journal of
Medical Sciences, are some remarks by Dr. Pepper, one of the phy-
sicians of the Pennsylvania hospital, on the above disease. " He
considered it a remarkable circumstance that this affection has re-
ceived so little attention from medical writers." — " In consulting the
standard authorities, we find but little said in reference, and that ge-
nerally vague and unsatisfactory." This fact is, in our opinion, easily
accounted for. The disease seldom occurs except in crowded com-
munities as in large cities ; and in these, only among a particular class,
the common laborers, who earn their daily bread by their daily work,
and are consequently compelled, usually, to labor during the intensest
heat of the day, when the thermometer, in the shade, ranges from 96
to 100 degrees and over, with not only the direct rays of the sun
playing full upon them, but also the reflected rays from pavements
and buildings. Added to this, as the efficient and exciting cause, we
have fatigue, intemperance, and often insufficient or improper food as
predisposing agencies. These causes do not usually exist in the coun-
try, and in small communities, where, if labor is performed in the
heat of the day, and under exposure to the sun, it is with a supply of
fresh, wholesome air, with none of the other predisposing causes ; the
powers of the constitution will, under such circumstances, generally
resist its baleful influence. The members of this class, when any ac-
cident befalls them, are almost always conveyed immediately to the
hospital ; and therefore it is rather rare for a private ph}'sician to be
called to treat a single case of coup de soleil, and of course nothing
can be furnished by him on the subject in the way of practical expe-
rience. When brought to the hospital, it is generally at an hour when
the attending physician is absent, and the case usually dies before his
next visit, or is so far recovered as not to call for his particular notice,
so that he knows but little personally of the phenomena of the dis-
ease. It is thus only seen b}7- the resident physician, who, in the dis-
charge of his multitudinous duties, takes no particular note of the
symptoms or history of the case, but sees the patient die in a few
hours, perhaps in a few minutes, after his admission, and thinks no
more of it.

Private physicians are sometimes called suddenly in the heat of the
summer, to a man who has " fallen down in a fit while at work," and
regarding the case as one of apoplexy, he pulls out his lancet, bleeds
him and sends him to the hospital. This is almost universally the
practice. Dr. Pepper says, of twenty hospital patients, all had been
bled previous to admission. This fact is, of itself, a strong indication
that some knowledge of pathology of the disease is much needed in
the medical community; for it is well known to those who have had
much experience in this disease, that venesection, if it succeeds, is al-
most certain death.

In this city the disease is quite common in the months of July and

SELECTIONS. 583

August, commencing sometimes as early as the middle of June and
ending as late as the first week in September. In the summer of
1847, if I remember rightly, there were thirty-seven cases in four
days. Most of them died so promptly that there was not time to
convey them to the hospital, the coroner being usually the only phy-
sician who saw them. Not only were men affected, but animals, om-
nibus horses especially, it being quite common to see them fall and die
in the street. During the last five years, according to our records,
forty-two cases were admitted into the hospital. Of these, twenty-
four died and eighteen survived. Fourteen occurred in the month of
August, twelve in July, twelve in June, and four in September.

The prognosis in this disease, as in cholera, depends almost entirely
upon the stage in which the disease is seen. If in the stage of col-
lapse, the stage is almost hopeless. So that one physician might have
ten cases, and all might recover ; another might have the same num-
ber, and the treatment be equally judicious, yet nine out of the ten
might die.

Nearly half of the cases that have been brought to this hospital, as
far as my own experience extends, have been in the stage of collapse,
or bordering upon it. They were usually brought in late in the after-
noon, and, of course, some hours after the inception of the attack.
They have then been comatose, with cold surface, except that of the
head, which is often very hot, feeble, frequent and fluttering pulse,
scarcely perceptible at the wrist, dilated and inactive pupils, respira-
tion labored ; sometimes stertorous. Sometimes they have lain per-
fectly motionless and paralyzed ; sometimes restless ; sometimes in con-
vulsions. Often, when in this state, under the application of a pow-
erful stimulus to the surface, as burning alcohol to the legs, a patient
has sprung up in bed, stared at those around him for a moment, asked
for a drink, taken it, and then fallen back again into his former condition.
In a less advanced or less severe stage of the disease, the patient has
presented pretty much the same symptoms, but in a less marked de-
gree. The pulse is frequent but not so feeble and irregular, the pupils
act feebly, the surface is cool, the head perhaps burning hot ; patient
is perhaps in a state of partial coma, from which he can be aroused
however by addressing him by name in a loud tone ; the respiration
is quick and labored, but not stertorous ; sometimes he has convul-
sions, quasi epileptic ; sometimes he is, extremely restless, requiring
to be held in bed. In a still earlier or less severe stage, the patient is
perhaps able to walk with assistance ; complains of intense pain in the
head, which is usually hot. The extremities are cool ; pulse not much
altered, not hard or bounding ; no infection of eyes ; pupils rather di-
lated, if altered at all.

Perhaps one or two cases by way of illustration, and briefly stated,
would not be amiss here .

C. 1st. A man, name unknown, about forty years of age, was
brought to the hospital about noon, July 27th, 1848, and admitted
under Dr. H. D. Bulkley. He had fallen in the street a short, time
previous to admission ; was in a state of complete coma, with la-
bored and irregular respiration; quick and fluttering pulse; head hot J
pupils immovably dilated.

584 SELECTIONS.

Treatment. — Sinapisms to feet, legs and stomach. Ice to head, and
stimulants. He survived but a few hours.

Autopsy, eighteen hours after death. — Brain normal — lungs slightly
congested — crepitant. Other internal organs healthy.

C. 2d. Michael Collyer, native of Ireland, laborer, was admitted
under Dr. Griscom, Aug. 11th, 1848, in a state of insensibility, having
fallen down in the street ; respiration stertorous ; pupils dilated ; pulse
quick, feeble and irregular.

Treatment. — Turpentine enema. Sinapisms to chest and limbs —
stimulants freely. Patient survived but a short time.

Autopsy, eighteen hours after death. — Brain slightly congested ; lungs
emphysematous at some points; other organs healthy.

In these cases, as has been seen, there was no marked congestion of
the internal organs. In nearly all the cases that occurred in 1850,
there was well marked congestion of these organs ; sometimes of the
lungs ; sometimes of the brain. Thus, out of eight cases recorded in
our books, there was congestion of the lungs in two, and of the brain
in four. In one of the remaining two, there was apoplexy, and this
man was bled in the hospital, being the only case out of the forty-two
in which the lancet was considered admissible ; the case proved fatal.

In the remaining case, there were well marked epileptic convul-
sions ; this case terminated favorably. The congestion of the brain
in two of the four cases was inferred from the symptoms as the cases
recovered. In the others, it was revealed by a post mortem inspec-
tion. In no case was inflammation of the brain or its membrane ob-
served ; and in all the cases the same course of treatment was pur-
sued, with the above-mentioned exception. Cups were applied to the
temples in the cases suffering from head symptoms, such as heat, di-
lated pupils, stertorous breathing, pain ; but external and internal sti-
mulation of the most active kind was indicated in all, except perhaps
in those admitted in the first degree or stage of the disease. Some-
times the patient was placed in the warm bath, and at the same time
the cold douch was applied to the head ; this usually seemed to have
some effect, though but temporary. In the cases which shewed con-
gestion of the brain, at the autopsy, the symptoms were still such as
to require prompt stimulation, the only difference iti the treatment be-
ing the local abstraction of blood from the temples, and the applica-
tion of ice to the head. I knew of one case in private practice in the
year 1847, which occurred in a high liver, of apoplectic build, and
shewed marked symptoms of apoplexy. The attack yielded with
some difficulty to large bleedings.

Insolation is almost uniformly nervous exhaustion, and is to be
treated as such. We are not to bleed because the patient is a robust
man, and has fallen in a fit at his work, which seems to be the only
circumstance taken into consideration usually by the physician who is
hurriedly summoned to such a case. The pulse is always a sure
guide. — New York Journal of Medicine.

SELECTIONS* 585

[From the Buffalo Medical and Surgical Journal.]

Case of double Ovarian Dropsy — both Ovaries successfully
removed by the large peritoneal section

BY E. R. PEASLEE, A. M., M. D.,

Professor of Surgery in the Medical School in Maine.

Professor Peaslee reports, in the American Journal of Medical Sci-
ences for April 1851, a case in which both ovaries were successfully
removed by the large peritoneal section. The length of the article
precludes our inserting it in full. The tumors removed are thus de-
scribed :

1st. The large mass first removed now resembles, as a whole, in
form and relation of parts, (it being collapsed,) the fcetal membranes
enclosing the placenta — the more solid part corresponding to the lat-
ter. Its vertical diameter is twelve inches, its transverse nine and a
half inches, its original form being ovoid. The enclosed portion is
oval and thin, being six and a half inches by four and a half inches
in diameter, and two and a half inches thick.

The external surface of the sac is perfectly smooth and nacreous in
appearance, except two inches square on the right side, and a little
less on the left, (precisely where the "friction feeling" was received,)
these surfaces being covered by the recently formed bands T had rup-
tured in breaking up the adhesions of the sac. An epithelium, but no
distinct serous membrane, can be detected by one of Chevallier's
largest microscopes. The Fallopian tube, three-sixteenths of an inch
in diameter, extends to the top of the solid tumor, accompanied by a
large vein, and an artery of the size of a wheat straw. The protu-
berance on the solid portion, felt through the abdominal walls, was a
distinct sac, as was supposed, its fluid having a specific gravity of
1023, and containing, like that of the large sac, a large quantity of al-
bumen, and scales of cholesterine. The sac itself is three-sixteenths
of an inch thick.

Its internal surface presents several large veins, and is covered
quite extensively in patches by recently exuded plasma. In general
appearance it resembles a mucous membrane.

The weight of the whole mass is two pounds thfee ounces avoir-
dupois.

2nd. The right ovarian tumor is one and a half inch long by one
and a fourth inch in diameter, consisting of a sac containing 1 iv. of a
reddish fluid, and the proper stroma of the organ hypertrophied and
indurated, and presenting a lobulated and warty appearance. Its
whole weight is 3 x.

The following extract contains a summary of the symptoms and
progress of the case of the operation :

" So far as the writer is aware, Miss G 's case is unique, as far

as the successful removal of both ovaries at the same time by the pe-
ritoneal section is concerned. It is also scarcely less singular for the

586 SELECTIONS.

very slight disturbance of any kind from the operation. The pulse
never rose above 120; never above 115 after ihe first twenty-four
hours had elapsed, except for a few minutes on Sunday night. From
Monday morning to Tuesday morning, it ranged between 93 and 114;
Tuesday to Wednesday morning, between 86 and 112 ; Wednesday
to Friday morning, between 83 and 104 ; Friday to Saturday morn-
ing 83 and 100. It never rose subsequently above 97, and averaged
90 — about her natural pulse. The respiration was 26 for half an hour
when reaction was first established ; and uniformly 23 or 24 during
the first three da}rs. It then continued at 22, till the pulse fell to 90 ;
and then became 20. The reaction also was perfect in less than five
hours, and was never excessive. Indeed, the patient may almost be
said to have recovered without a single bad symptom ; at least with-
out any severe symptoms peculiar to such an operation ; or which
might not have occurred to one of her delicacy of constitution, from
even a slight cause. Hence the medicinal part of the after-treatment
was decidedly expectant. The suppuration could not have amounted
to more than ? iss. in all, during recovery."

We give the concluding remarks of the distinguished operator:

" The success of the operation I attribute to the fortitude and con-
fidence of the patient ; the comparatively slight adhesion of the dis-
eased miss; the temperature, &c. of the room at the time and sub-
sequently ; accurate coaptation of the divided abdominal walls ; and
the judicious after-treatment of Dr. Jarvis, seconded by the faithful
attentions of the three young gentlemen before named. I am positive
that as much care and skill are necessary in closing the incision pro-
perly as in performing the preceding operation.

" Whether the operation of ovariotomy is ever justifiable, is a ques-
tion which would certainly be out of place here. It is the writer's
opinion that, if the patient's general health is rapidly failing, (but not
already too far prostrated,) and the tumor is found to be not exten-
sively adherent, so far as all the known methods, taken together, can
decide that question, the operation is justifiable ; provided the patient,
after fully understanding its nature, strongly desires to have it per-
formed, and has strong hopes of recovery therefrom. But it is an ope-
ration never to be urged, nor to be undertaken by an operator whose
care does not include the minutest particulars, both prior and subse-
quent to its performance, which can affect its results.

" And I cannot close without alluding to the obligations under
which the medical profession in our country has been placed, by the
full and precise reports of his now numerous operations for the remo-
val of ovarian diseases, which Dr. W,. L» Atlee has given from time
to time in this journal. But for these, my patients might perhaps not
have been rescued from an early death — for only accurate and mi-
nute reports of such cases are of any practical value to others ; and
this is 'the writer's apology for the length of this communication.

Dart. College, Feb. 1851.

SELECTIONS. 587

[From the Buffalo Medical Journal.]

Cesarean Operation.

Paris, January 20, 1851.

Mr. Editor : Dear Sir — I send you for publication an account, of a
case of Caesarean operation, which I have just seen performed by M.
Paul Dubois, in the hospital " Clinique d'Accouchments." This ope-
ration, although far more common than in the United States, is by no
means of frequent occurrence in Europe. M. Dubois, if 1 understood
him correctly, said he had made the section eight times before.

The subject of the operation was an in-patient of the hospital: sin-
gle woman, 24 years of age, primiparous, dwarfish, of rachitic con-
stitution, nervo-bilious and lymphatic temperament, with deformed
pelvis and inferior extremities. The pelvis was compressed so as to
leave only 1^ inch in the antero-poslerior diameter, which was in-
sufficient for the delivery of the child even after embryotomy. Labor
commenced at the full period of gestation, and had been progressing
slowly for about six hours, the amniotic fluid having been discharged
during that time. Difficulty being apprehended by the "internes"
and "chef, du clinique" in attendance, M. Dubois, physician, accou-
cher of this hospital, was called in: after examination per vaginam,
the professor, by the concurrent advice of Prof. De Paul, decided
upon the necessity of the section. This was at 9 o'clock in the even-
ing, the woman being then somewhat exhausted, and the child still
living, as shewn by auscultation : the operation was, however, de-
ferred till the next day at 10 o'clock. The patient was brought into
the amphitheatre somewhat more feeble than the night before, al-
though under the effect of anodynes and stimulants : she was laid
upon her back on the operating bed, with the thighs flexed upon the
body, and the shoulders raised.

The operation was commenced, (without chloroform,) by making
an incision just opposite the umbilicus, and extending to the symphy-
sis pubis, about eight inches : the first incision was made through the
integuments ; a small opening was then made through the peritoneum,
and the incision finished by a bistoury and grooved director : the next
incision was made through the walls of the uterus, about six inches
long, when the child appeared in sight; it was extracted by ihe feet,
dead ; the cord was tied and the placenta extracted by the same ori-
fice. The operation occupied about eight minutes, exclusive of dress-
in ». The bleeding; was only slight from the incision ; the edges of
the wound in the abdominal walls was brought into coaptation and
secured b}T interrupted quilled sutures, the incision in the uterus be-
ing perfectly closed by its contraction; adhesive straps, charpie, a
compress and bandage around the body, finished the dressing. The
patient, who suffered much from pain, and was much exhausted, was
removed to her ward, and allowed an anodyne and hot wine and wa-
ter: she, however, was unable to rest, and reaction not taking place,
she sunk rapidly, and died of collapse thirty-six hours after the ope-
ration.

5S8 SELECTIONS.

This was, doubtless, a fair case for the operation, and offered the
only hope of saving either the mother or child : but the time to save
the child was while it was alive ; and after that was dead, the mother
was too much exhausted to leave much hope of her recovery from so
severe an operation ; so that the delay in the case certainly was the
cause of losing one if not both lives. But as I intended only to give
the details of the operation, which was skillfully performed, I shall
give no opinions, but leave others to draw such conclusions, and make
such reflections as they please.

Yours, respectfully,

M. M. RODGERS, M. D.

Medical Practitioners in Boston.

There are two hundred and thirteen medical men in the city be-
longing to the State medical society. Fifty-one are unconnected with
it, acknowledging obligations to no medical association. Twenty are
denominated botanic physicians, who look upon all the others as dan-
gerous dealers in physic ; while six female physicians, quite independent
of any of the rest, complete a catalogue of three hundred and fifty per-
sons, who sustain themselves, in a population of 130,000, by prescrib-
ing and giving medicines. The number is annually increasing, not-
withstanding the fact that there are too many already for their indi-
vidual success in buisness.

There are 94 apothecaries and 45 druggists in Boston. The latter
are presumed to be wholesale dealers. It has always been considered
that a person is on the way to wealth when he trades in drugs, and we
have had no intimation that it is not so at the present moment. We
therefore congratulate our one hundred and thirty-nine friends and
fellow-citizens on their good prospects. May they never be obliged
to practice physic ! — Boston. Med. &f Sur. Jour.

Death by the carelessness of an Apothecary.

A little child of James Madison, of Somerville, died on the 3d of
this month, in consequence of the carelessness of an apothecary at
East Cambridge, who put up morphine instead of quinine, which was
ordered in the prescription. Such fatal mistakes are getting to be too
common among apothecaries, plainly shewing the necessity of some
stringent regulations, by law or otherwise, that will prevent them. If
the College of Pharmacy, which is just organized in this city, should
take these matters into consideration, no doubt the members would
suggest a remedy. — lb.

THE

AND

VIRGINIA MEDICAL GAZETTE.

No. 11.] RICHMOND, NOVEMBER 1851. [Vol. I.

Adynamic Peritonitis — with Cases.

BY L. B. ANDERSON, M. D., OF VERDON, HANOVER CO., VA.

In the section of country bordering on the North Anna river, in the
counties of Caroline and Hanover, there has latterly prevailed to
some extent an inflammatory affection, which, from the structure
most uniformly affected, and the peculiar grade of arterial action ac-
companying it, I have thought proper to denominate " adynamic
peritonitis." So distinct and dissimilar were the localities where it
prevailed and the "constitution of the atmosphere" when it originated,
that I can assign its origin to no sensible atmospherical influence or
appreciable local agency. Whatever, however, the agent may be, it
has made its impress upon many who have not been rendered so
much indisposed as to require medical aid, but have been subjected
to the necessity of resorting to purgative medicines to rid themselves
of the malaise with which they were affected. A sense of languor
and lassitude was complained of by many who were diseased to no
greater extent, though constantly in attendance upon those who were
laboring under its effects. Nor was the disease, when fully de-
veloped, alone confined to the peritoneum. In thirty cases, of more
or less intensity, for which I have prescribed, four were complicated
with pleuritis and three with arachnitis. Two of the latter class
died, before medical aid could be procured, from a sudden metastasis
of excitement to the brain, which occurrence was witnessed by Dr.
Hey in the puerperal peritonitis of Leeds in 1808. Those cases in
which pleuritis was the prominent affection progressed similarly to
the uncomplicated peritonitis, and yielded to the same remedial
means.

It was confined to no special class of persons, nor to those of any

peculiar habit or occupation ; the first cases which came under my

observation being the children of a gentleman of high respectability,

intelligence and wealth, whilst many occurred among those of mode-

70

590 ANDERSON ON ADYNAMIC PERITONITIS.

rate circumstances, or the extremely poor. Men, women and children
were alike subject to its attack, whilst most of the cases occurred in
young and previously healthy men and women. The number of
whites and blacks affected was about equal.

When it made its appearance no disease was prevailing in the im-
mediate section where it occurred, save perhaps an influenza similar
to that which preceded the invasion of cholera in 1849, though I
have understood that typhoid fever has prevailed to some consider-
able extent in several neighborhoods not far distant.

In order to describe accurately and intelligibly, as well as briefly,
this unusual disorder, I shall endeavor to give an aggregate of the
most prominent symptoms as they were developed in a majority of
the cases, and then describe the general plan of treatment adopted,
with its effects; and finally, cite two or more cases in illustration of
the same, concluding with a brief yet minute history of its progress in
a family in my immediate vicinity, in which, often affected, five have
ultimately died. Nor will it be without profit, as an illustration of
the futility of subduing any disease, the treatment of which requires
an unusual draught upon the " powers of life," unless it can be fol-
lowed by constant and kind attentions to the wants of the invalid, as
well as a strict observance and removal of everything which could
exert an unsalutary influence over his convalescence.

The following is an accurate description of a case which occurred
in the above-mentioned family, and has its counterpart in all the cases
of intensity which have come under my observation, save in the
peculiar condition of the tongue, which I view as an indication of no
peculiar condition of any tissue or viscus, but simply as a consti-
tutional peculiarity, well calculated to lead those astray unacquainted
with the fact. For with the exception of the dryness here described,
the father of this young man has a tongue exactly similar in appear-
ance when in the enjoyment of usual health ; and all the members of
his family, who seem to have inherited his peculiarities of constitution,
present, on an inspection of the tongue, this identical appearance
whenever any aberration from a healthy condition obtains, as I have
had frequent opportunities of witnessing; whilst in no case among
the blacks of this family, three of the whites, or any case elsewhere,
was this peculiarity presented, whilst in every other respect the
symptoms were identical. I repeat, therefore, that this condition of
tongue can be considered as an indication of no peculiar disease, or a
peculiar affection of any organ or tissue in the animal economy.

My attention being called to a personage toiling in his field as
though weary and worn, I approach, and find him to be a young
man, twenty-one years of age, of medium stature, light hair, blue
eyes and fair skin ; his cheeks are flushed, eyes red, flesh preterna-
turally warm, cutis irregularly bedewed with perspiration, tongue
of an unusually florid aspect throughout its whole extent, and thinly
coated with a brown tenacious mucus. He feels faint and prostrate
as noon approaches, and retires from his work earlier than usual.
He eats his accustomed meal, though he almost incessantly expe-
riences a sense of nausea. He says his food is as agreeable as when

ANDEKSON ON ADYNAMIC PERITONITIS. 591

he is well, and in no way oppresses his stomach. He resumes his
labor immediately after dinner, and continues to act as in the fore-
noon till night. He then eats with a good relish his usual quantity of
food for supper, retires to bed, and passes the night in disturbed and
restless slumber. When he awakes in the morning he attempts to
rise, but so soon as he gains the erect posture his head swims, his
knees smite together, his whole person becomes agitated and tremu-
lous, his stomach sickens and he retires to bed. On assuming the
recumbent posture a sense of coldness is experienced which amounts
to an indistinct chill — the immediate precursor of active fever. His
face now becomes exceedingly florid and puffed, the redness and tu-
mescence extending to his neck and chest ; his eyes are red and dull ;
his countenance is heavy and expressive of a sense of oppression ;
his tongue is florid, rugose, gashy, spongy and destitute of fur, dry
on the superior surface when the mouth is open, which is generally
the case, but occasionally is moist when the body is bedewed with
sweat ; his flesh is hot, most generally dry, but occasionally bathed
with perspiration. His pulse is frequent, of natural volume, and
exceedingly compressible, though rebounding with some force. He
is oppressed with a fullness and sense of weight in his stomach,
with occasional nausea ; his bowels are quiet and rather inclined
to costiveness, his evacuations being thick, copious and nearly
white. He complains of heat in the epigastric region, which he
describes as being quite superficial, "just beneath the skin." There
is considerable tenderness over the whole abdomen, much more
acute, however, in the superior portion. There is neither disten-
sion, tenesmus nor thirst, the latter being a uniform and remarkable
attendant on the disease, lasting through all its phases. There is
no pain experienced in any part of the system, save on pressing
the abdomen. The mind is always clear, calm and composed, until
the disease has reached its zenith, which was generally on the fourth
or fifth day.

As the disease progresses the tongue becomes more dry, (and in
this case brown, occasionally cracks and bleeds,) is protruded with*
difficulty unless moistened — the pulse more frequent, feeble and irregu-
lar, mounting up to 140 pulsations per minute, occasionally much
higher — the mind is disturbed and agitated — there is subsultus anct
general tremulousness on the least muscular exertion. The urine be-
comes high colored and copious — the alvine discharges black, watery
and exceedingly offensive — the quantity voided per diem being asto-
nishingly great, and yet producing no sensible prostration — a circum-
stance often witnessed by Dr. Armstrong — the abdomen distended to
some considerable extent, and very sensitive, while there are occa-
sional involuntary emissions of urine and feces. This condition
occurring within four days from the commencement of the attack, has
generally subsided under the use of calomel, opium, ipecac, muriate of
ammonia, turpentine epithems and epispastics within twenty-four or
thirty-six hours. When the pulse lessens in frequency the mind be-
comes calm, the tongue moist and less florid, the urine less unnatural,
the discharges from the bowels less dark and offensive, the skin more
generally moist and cool, the countenance more serene, the appetite

592 ANDERSON ON ADYNAMIC PERITONITIS.

less depraved, the abdomen insensible to ordinary pressure, whilst the
patient expresses himself as relieved from all unpleasant sensations,
save what would result from debility.

No one could assign the inflammation any other location than the
peritoneum, for want of all local signs, other than pain, of any other
disorder. " But is not," enquires an intelligent physician, "the affec-
tion a ' typhoid fever' modified to some considerable extent by the pe-
ritoneal inflammation ?" Typhoid fever is a disease sui generis, and
may, nay, frequently does exist along with inflammation, but is not
dependent alone on the inflammation for its existence ; and no matter
with what disease it may coexist, it makes its own peculiar impression,
which cannot easily be mistaken by the discriminating physician, and
which, I dare say, can be more readily recognized than described.
There are in typhoid fever, so far as my observation extends, and it
has been by. no means limited, chills or distinct rigors, headach, or an
unpleasant fullness in the head when shaken, ringing or buzzing in the
ears, pain in the back and limbs, a contracted, pointed tongue, fiery
red at its tip, glossy and smooth, while the greater portion is coated
with a brown rough fur, with fiery red papillae occasionally shooting
through it; burning thirst,* which though easily satiated, speedily be-
comes as extreme as ever — pungent heat in some portion of the sys-
tem, generally on the chest and abdomen, becoming extremely caustic
during the febrile paroxysm — 'morning remissions and evening ex-
acerbations, with a dull and languid state of the intellectual faculties,
and a greater or less degree of drowsiness or stupor — while in the
disease under consideration there were neither chills nor distinct ri-
gors, pain in the back nor limbs, headach nor somnolency, thirst nor
any change or modification in the febrile action, until the inflammation
had been fully discussed, exhibiting a marked difference between it
and typhoid fever. But when the progress of the disease is known,
the effect of remedial agents related, and the post mortem appearances
of the abdominal viscera described, no one can hesitate for a moment
to decide that this affection is in no way associated with or modified by
typhoid fever. In illustration of which I report the following cases :

On Monday, 26th day of April last, I was called at 9 o'clock at

night to see E C of Caroline, a lovely little boy, two years

of age. Being occasionally indisposed for an hour or two at a time
for the two days preceding my visit, but little attention was given to
the indisposition which commenced at 11 o'clock on that day, until
some time during the afternoon. He complained of sick stomach,
great abdominal uneasiness, had a high fever, flushed face, red eyes,
&c, presenting to a considerable extent all the symptoms recorded in
the general description of the disease, save those resulting from con-
stitutional peculiarities. Having taken no medicine, I directed a des-
sertspoonful of oil, with 5 grs. of calomel and four drops of lauda-
num, to be administered at once, hot bran poultices to be kept con-
stantly on the abdomen, and the operation of the medicine promoted
by enemata. Being compelled to attend Caroline court on the follow-
ing day, as a witness in a medico-legal case, I returned home with

* This is by no means an invariable attendant on the disease, but frequently observed.

ANDERSON ON ADYNAMIC PERITONITIS. 593

the promise that my father, Dr. Thos. B. Anderson of Caroline, should
see him early the next morning. On my return from court, I learned
that the medicine operated effectually early in the night, from which
he apparently derived much benefit. But just before day he became
more restless, feverish and delirious, and violent convulsions rapidly
ensuing, his existence was terminated before the arrival of my father.

A little sister of his, lour years old, was similarly affected on the
following day, less violently however, and was relieved in a short
time. The next case was an older brother of these, who was simi-
larly affected, save in the intensity of the abdominal pain, it being
much less in his than the preceding cases. He was actively treated
for three days with calomel, opium, ipecac, and chlorate of potassa,
when the inflammation lighting up in the fleura, rendered it necessary
to apply a blister. The pain was relieved thereby, but the febrile ex-
citement on the following day being still higher, and his pulse more
firm, venesection was resorted to with marked and decided benefit.
On the decline of fever, which occurred during the night of the bleed-
ing, he became extremely debilitated, and required for several days
constant attention to prevent collapse. From this time his recovery
was slow, but uninterrupted.

In the family of the father of these children there were several
cases among the blacks, three of whom were extremely ill. One. a
girl fourteen years old, was taken with this disease after a few days of
indisposition, and immediately took an active dose of calomel and
oil, and had an epispastic applied on the chest, for the relief of pain
she experienced therein. Being no better, I was summoned to see
her on the following day, May 23d. On my arrival she was com-
plaining of sick stomach and great debility, and was occupying the
position of one laboring under puerperal peritonitis, from which she
could not be induced to change. Her flesh was hot, pulse frequent
and feeble, tongue dry and rather inclined to be florid, pain in the ab-
domen quite intense, &c. A pill, composed of two grs. of calomel,
one of ipecac, and two of Dover's powder, was administered, with
four grs. of nitrate of potassa in solution, once in three hours, and a
large blister, enveloping the whole abdomen, applied. During the
drawing of the blister the abdominal pain was relieved, and an active
pleurisy developed. I directed on the following day the blistered sur-
face on the thorax to be denuded, and another plaster of cantharides
applied thereon — the pills and nitre to be continued during the night,
and a tablespoonful of oil and a drachm of turpentine to be adminis-
tered early on the following morning. The latter medicine acted
freely on her bowels prior to my visit the next day, bringing awav a
large quantity of black, oily and exceedingly offensive matter. The
inflammation being discussed, and the fever subdued by these means,
snakeroot tea and camphor were prescribed, under the use of which
she gradually recovered.

On June 7th I saw Mrs. P., to whom my father had paid two visits
during my sickness, from which I had just recovered. Her situation,
as described by him, was similar to the cases above related, with a
striking development of the peritoneal inflammation. Mrs. P. is a

594 ANDERSON ON ADYNAMIC PERITONITIS.

ajarried lady, twenty-one years of age, very delicate, the mother of
one chilil six months old — -he had taken for two days prior to my visit,
once in three hours, a pill composed of hydrarg, cum creta ii. grs.,
piiiuke cceriil. i. gr ., ipecac, i. gr., and pulv. Dov. ii. grs., and iv. grs.
of nil potass, in solution at same time. They had produced no effect
on her stomach or bowels, but she was suffering much less with the
pain in her abdomen, and there was much less heat of flesh than pre-
yiousb, . The pills were continued, as also the nitre, and hot applica-
tions to the abdomen, a statement ol" the use of which I omitted above.
On the following day I found her decidedly under the influence of
mercurv, and, which is very unusual, when ptyalism exerts a benefi-
cial influence, her pulse being much more frequent than it had pre-
viously been, being now more than 160 pulsations per minute. Yet
her flesh was cool, abdomen soft, though her bowels had not been
opened in forty-eight hours, urine copious and clear, countenance
cairn and serene, tongue clenr and moist. Her bowels were opened
with 1 ss. of castor oil and 3 i. of oil of turpentine. After its opera-
tion, which was very Copious, she took a few drops of laudanum,
which sooihed and quieted her whole system, checked her bowels, and
lessened her pulse probably 40 strokes per minute. From this time
forward she continued to improve, but very slowly, as in the foregoing
cases. I was consulted a month after I last saw her, concerning an
cedeun of the lower extremities, which yielded under the use of elder
bark tea and mild aperients. She is now enjoying good health.

J. H., the young man whose case has been reported in full in the
description of the general charaeter of the disease, was taken, at or
near the same time that Mrs. P. was, in identically the same way;
though similarly treated, was brought unexpectedly under the influence
of mercury at the same time, convalesced for two weeks much more
rapidly, was enabled to sit up all day, and walk from house to house —
while she was yet confined to her bed. And though she has been
well for two months, he is at this lime (10th September) in quite a
critical situation, having had a relapse within two weeks from the
commencement of his convalescence, and since then has relapsed four
different times from the use of improper articles of diet.

A negro man twenty years of age, the servant of Mr. H. of this
county, (the father of the young man above mentioned,) had peri-
tonitis in a very active form. He was put on the use of the calomel,
ipecac, and Dov. powder pills already mentioned, and turpentine
epiihems to the abdomen. The pills operated freely on his bowels
from the first, bringing away large quantities of dark, offensive
matter; and though laudanum was frequently directed to be given to
arrest the catharsis, it was never administered, and he was actively
purged for four consecutive days, with the effect of completely sub-
duing the disease and establishing convalescence. And though he
was reduced well nigh to collapse by the long continued and exces-
sive purgation, yet his convalescence was more rapid than any case I
have attended.

M. H. of Hanover, a young, healthy, athletic man, twenty years
of age, was taken with peritonitis on 27th of May. The symptoms

ANDERSON ON ADYNAMIC PERITONITIS. 595

were similar to those accompanying the disease in the case of his
brother already described, with, however, a more incompressible
pulse than in any other case. He took, within six hours from the
incipiency of the fever, xx. grains of calomel, ii. grains of gamboge,
and iv. grains of ipecac. It operated only once in twenty-four hours,
but then very largely, without producing any impression at all on his
pulse or the disease. I bled him on the day following his attack to
sjmcope, which followed the withdrawal of only a pint, of blood. He
was then directed to take a pill, as above described, every two hours,
with five grains of muriate of ammonia in solution, and a large epis-
pastic was applied on the abdomen. No pain was experienced after
the drawing of the plaster, and the fever gradually declined under
the use of the pills and ammonia, and in five days from the onset of
the disease he was convalescing. From some imprudence in diet,
however, he had a slight return of the disease a few days after, which
was relieved again by the same means. He improved after this so
far as to be able to walk across his room and sit up for an hour or
two at a time with no inconvenience; but being subjected to the
necessity of using the same articles of diet which produced a relapse
in his brother, he was taken with a high fever and a return of the
peritoneal disease on the same day with him. Wishing if possible to
bring him under the influence of mercury, he was directed to use the
calomel pills and ammonia, as previously directed ; but having been
so long diseased and debilitated, I soon discovered that the caehectic
predisposition which now obtained precluded the possibility of an
attainment of my object. The mercury was stopped, and ipecac, in
as large quantities as his stomach would bear, with a sufficiency of
opium to soothe irritation, and rhubarb to prevent costiveness, were
prescribed instead, and a thick pad of flannel, thoroughly saturated
with turpentine, bound on his abdomen, and his bowels freely evacu-
ated every other day, with half ounce of oil and two drachms of tur-
pentine in gum mucilage. After the administration of each close of
turpentine there was a marked improvement in his condition, until he
no longer had aught to contend with but debility and the distressingly
wretched circumstances by which he was surrounded. He improved
slowly but perceptibly for four weeks, and finally succumbed to the
operation of causes hereinafter to be mentioned, without fever or the
slightest functional derangement.

A little girl, sister of these young men, twelve years of age, had
been affected with pain and tenderness in the abdomen, and an ex-
ceedingly high fever for five days, when I saw her. Her flesh was
hot and dry, pulse frequent and feeble, tongue red and dry, abdomen
tender and tympanitic, bowels costive, and stomach nauseated ; she
had taken but little medicine, and had emaciated rapidly. She was
freely cupped over the epigastrium, and a turpentine epithem imme-
diately applied, the combination of calomel, &c. with spirits nitre
prescribed, and oil and turpentine directed to be given on the morning
of the second day. On my arrival I found her in a very distressing
situation ; suffice it to say, she presented all the usual indications of
incipient mortification. A large blister was drawn on the abdomen,

596 ANDERSON ON ADYNAMIC PERITONITIS.

and camphor and spirits nitre administeied internally, and 1 must
say with no hope of benefit. Returning at night to see her, I found
her in a state of unconsciousness, and muttering delirium, incessant
subsultus, sighing, groaning and jactitation, with a pulse so frequent
and feeble it could not be numbered. Alcohol, ammonia, camphor,
opium, &c. &c. were administered for six hours with but little inter-
mission, but without an apparent effect on the pulse. Involuntary
evacuations were pouring from the bowels with such profusion as to
render it certain that without a great and almost miraculous change
in her condition in a short time death must inevitably ensue. Oil of
turpentine in two drachm doses, suspended in gum water, was given
every hour until an ounce was administered, with the happy effect of
quieting the bowels, restoring the circulation to the extremities and
composing both body and mind. For a week from this time she
used ten drops of turpentine every two hours with the most happy
and beneficial results, and in ten da^s from tr^ second visit she was
able to sit up in bed and partake of nourishment without assistance.
Being prevented by severe indisposition from seeing her ayain for
five days, I was subjected on my return to the chagrin and mortifi-
cation of finding my patient in a relapse, and surrounded by agents
and circumstances the most distressing imaginable. From this time
for nearly four weeks her condition was very fluctuating; frequently
for four or five days together she would be free from fever and in an
improving condition, but so soon as the condition of others presented
higher claims for attention than she, she would be neglected, and con-
sequently relapse; and finally, after a protracted illness of forty-five
days, her case terminated fatally.

There were four others at that time in this family extremely ill.
One had had peritonitis in a sub-acute form for a month prior to his
confinement, but could not be prevailed on to use anything for his
relief. He was treated, as were the other cases, with a relief of all
symptoms of disease, but a "tight, drawing sensation" in the gastro-
umbilical region. His convalescence from this time, 1st of July, was
uninterrupted for ten days ; and on the 10th of July, through the un-
tiring and assiduous attentions of the Sons of Temperance, they were
all placed in such comfortable situations that there was no one in the
eight cases in this family who was not in a convalescing condition.
Unfortunately, however, F. H., who had been more recently sick,
and who had been improving rapidly for several days, being anxious
to promote his convalescence, determined to try the merits of a few
cups of rick soup and a hearty meal of morella cherries, the effect of
which was to produce a wasting diarrhoea, which, prior to my seeing
him, had so impaired the functions of the abdominal organs as to
preclude the possibility of finding any agent which wTould lie on his
stomach a minute at a time. A pellet of ice, an opium pill, a draught
of mint julep, or any article of the various classes of medicines re-
commended for such a condition, were rejected instantly, or violent
efforts to eject them would be continued until they were expelled.
Sinapisms, epispastics, (vesicatoires volants,) camphoreted oil, &c,
were all externally applied, with no effect. He died within forty-
eight hours from the act of imprudence.

ANDERSON ON ADYNAMIC PERITONITIS. 597

The effect of the death of this young man on his two brothers,
whose cases have last been described, was truly astonishing. Having
seen him succumb so rapidly, after such flattering prospects of re-
covery, despairing of all hope of a restoration to health themselves,
they refused to partake of a sufficiency of nourishment to sustain the
sinking powers of life, and died within 24 hours of each other,
without the development of a symptom indicating either the existence
of fever or disease. A partial post mortem examination of the one who
was described as laboring, during the period in which he was conva-
lescing, under a peculiar drawing sensation in the region of the stomach,
was made, the result of which was as follows : — The stomach was
filled with fluid, which had been drunk with avidity just prior to his
death ; it was healthy throughout, save a small spot as large as a dol-
lar on the left and lower extremity, which was a discoloration and
thickening of the peritoneal coat, the result apparently of recent inflam-
mation of a high grade, a remnant of which still remained. The in-
testines, so far as I could perceive, were healthy. The omentum ma-
jor was adhering to the peritoneal coat of the small intestines by a
strong union three inches in diameter — there were small spots of in-
flammation in various portions of the omentum major, but none else-
where. The gastric and hepatic reflections of that membrane were
considerably thickened in many portions, and presented an appearance
not unlike a fibrous membrane. There was no fluid in its cavity, but
a viscid, adhesive matter, (probably lymph,) effecting partial attach-
ments between the opposing surfaces of the peritoneum. It were
useless almost to say, that it is much to be regretted that circumstances
precluded the possibility of going farther into the examination; or of
effecting at all perfectly that which was made.

Since writing the above, the mother of this family of children has
died, in the sixth relapse, after a confinement to bed of one hundred
days and six hours. The period which elapsed between the origin of
the disease and the deaths of the above cases, was, in M. H. fifty-nine
days, F. H. forty-four, and H. L. H. fifty-three — while a young lady,
sister of these, is just recovering from a fifth relapse, after a confine-
ment, almost constantly, the whole time to bed, of one hundred and
thirty-two days.

Such mortality I have never witnessed before, but such trying cir-
cumstances to contend with I have never seen. At one time, during
the hotest weather in June, there lay in one small room but slightly
elevated, with only one window and a door, five young men, in a per-
fectly helpless condition, for many days together. No neighbor could
be induced to assist me in nursing them, although I believed and
affirmed that the disease was not infectious. And had it not been for the
kindness of a few young men, most of whom were not even ac-
quainted with them, they all must have died. An older brother, who
lived some distance off, assisted me for a few days in attending to his
mother, brothers and sisters, but was taken sick, as I understand
through a third person, with the same disease, and died.

As would be inferred from the description already given of this
affection, the first aberration from a healthy condition was indicated
71

598 WILSON ON PROPHYLAXIS OF PUERPERAL PERITONITIS.

by the impaired functions of the liver and kidneys. The secretion of
bile was almost entirely suspended prior to any manifestation of in-
flammatory action. And when no other means were used to subdue
peritoneal inflammation, but such as were calculated to promote the
functions of those organs, so soon as that object was attained, there
was a marked diminution of suffering and decline of inflammation.
And it was never the case, when a# bilious diarrhoea could be estab-
lished by the free use of mercury" that with each evacuation there
was not a decided impression made on the disease. And when, from
frequent relapses, mercury could no longer be used, I was delighted
with the magical effect of oil of turpentine, freely used externally and
per orem. And though the most distressing mortality has visited this
family, yet in no cases I have ever treated have I seen more reason
to be proud of the glorious achievements of our art, in again and again
subduing a most violent disease, against the greatest odds, and under
the most unfavorable circumstances I have ever witnessed.

The labor as well as the circumstances attending the practice of
medicine in the county, as also the almost entire consumption of my
time at present in the active duties of my profession, will, I hope, be
a sufficient excuse for this very badly executed portrait of Adynamic
Peritonitis.

Prophylaxis of Puerperal Peritonitis.

BY G. A. WILSON, M. D., OF RICHMOND CITY.

I furnished for the August No. of the Stethoscope a short essay on
the prophylaxis of puerperal peritonitis. That essay was called
forth by, and designed to be, a protest against what was deemed a
very unwise general rule of practice, as recommended in the paper
of Dr. J. P. Mettauer on the same subject. I did not enter into a
critical analysis of the doctor's paper, because I hoped that a simple
enunciation (with a few suggestive ideas) of the bald proposition, that
all parturient females must be purged in a few hours after delivery,
would answer the only end I had in view, viz. to cause the unwary to
pause before adopting any such sweeping and general practical rule.

But Dr. M.'s rejoinder demands farther notice. The subject is one
confessedly of great importance. If any single rule of practice is ap-
plicable to ALL cases of ALL parturient women — surely founded on
sound principles, simple and safe in its application, even promotive of
general well-being and comfort — such a rule should be uniformly
practised by all having charge of such cases. But how greatly is its
importance enhanced, when we are told that its "invariable" adop-
tion checks in its inception, or wards off the assaults of puerperal
fever — a malady that, from the days of Rachael, wife of the patriarch,
to the present, has numbered its hecatombs of victims, and still carries
to the grave more than half the whole number assailed, despite the
skillful appliance of all the resources of our art.

"WILSON ON PROPHYLAXIS OF PUERPERAL PERITONITIS. 599

PregnanCy and parturition are physiological acts and not patholo-
gical states, and yet it will be conceded that their phenomena are the
predisposing causes to many diseases of the puerperal period. Be-
sides their local effects on particular organs, the whole nervous sen-
tient system is left in a condition very impressible by morbific causes.

An attempt to explain how these phenomena operate as predisposing
causes may not be demanded by the practical reader. But a correct
appreciation of Dr. Mettauer's pathology and practical deductions
calls for a short consideration of this branch of the subject. In his
first essay he says, "After pregnancy and parturition, the uterus and
its appendages, the peritonium and abdominal organs generally, are
left in a state of inaction, debility, and to a certain extent are col-
lapsed. Whilst in this state the functional exercises of the implicated
organs are more or less disturbed, perverted, or perhaps suspended —
and it is this stale, which, if profoundly impressed on organs, or too
long continued, that predisposes to puerperal inflammation or fever.
Other causes may co-operate in some cases with this post-parturient
collapse, such as contagion, &c. But the debility and inaction of
organs concerned in pregnancy, and consequent perverted secretion,,
seem to be the intimate predisposing pathological condition of the
disease."

It is not very easy to seize upon the exact idea designed to be con-
veyed in the above very vague phraseology. That he wishes to com-
municate his belief that the uterus, peritoneum and abdominal organs
generally are in a state of debility and inaction, is clear enough ;
but I am at a loss to conjecture what he means by saying, " that the
functioual exercises of the implicated organs are more or less dis-
turbed, perverted or suspended."

What functional exercise would he have the uterus to perform? It
has undergone the progressive developments, nervous and vascular,
of the pregnant state, at the expense of a generally exalted vitality.
It has just discharged its great function. Fatigued by its own con-
vulsive efforts, and having nearly exhausted the entire nerve power of
the system, it certainly is almost inactive as to its functions, and
ought to be at rest. But yet an active work is going on in its tissues.
In a short time it passes from the gravid to the non-gravid state ; is
diminished in weight from a pound and a half to the normal average
of two ounces. Its structure is powerfully condensed and condens-
ing— diminishing the calibre of nerves and blood vessels — refusing
admittance to the torrents of blood, which in increasing quantities
have been directed thither for nine months, and which are now direc-
ted into other channels.

Now I ask again, What are the natural functional exercises of this
organ, which in Dr. Mettauer's opinion have been so " disturbed, per-
verted or suspended," as to be predisposing causes of child- bed fever,
and which he rectifies by the agency of " impressive and secernent"
purgation. Surely he cannot refer to the lochial discharge which ex-
udes from Ihe vessels left patulous by the removal of the placenta,
and which usually continues until the organ has resumed its non-
gravid state. Its arrest is usually the effect of peritonitis, not its

600 WILSON ON PROPHYLAXIS OF PUERPERAL PERITONITIS.

cause. Its presence or absence, its quality or quantity, having no re-
lation as cause of child-bed fever, unless indeed Dr. M.'s purging-
should provoke excessive absorption, and thus furnish a medium for
putrid infection. But the peritoneum is next to the uterus and its ap-
pendages in degree of implication in the processes of pregnancy and
parturition. What are its natural functional exercises? To facilitate
motion, and afford attachments for the organs it invests. The par-
turient act, by removing the cause of distension and displacement of
this tissue, promotes its functional exercises. If it is maintained that
its serous exhalations are disturbed or suspended, then is it not unwise
to provoke irritating friction of dry surfaces by an artificial excitement
of peristaltic motion ? But Dr. Mettauer embraces " the abdominal
organs generally" in his theory of predisposing causation. The nu-
tritive functions are the great offices of these organs. They receive
and prepare foreign substance to become vitalized fluids for the repro-
duction of tissues, and excrete what no longer contributes to the pur-
poses of life. During pregnancy their functions are performed with
increased energy to meet the wants of a new being. The biliary
and renal secretions are carried on with corresponding energy. It is
true the bowels are often constipated, but this is the result of me-
chanical pressure, in the latter stages.

I will not do Dr. M. the injustice to insinuate that fecal accumula-
tions, the ghosts of old fashioned scybalae, haunted his visions when
he penned his article, although the treatment he inculcates so naturally
suggests the idea.

So much for the doctor's pathology, as deducible from his first essay.
In his second he is more copious and explicit, and, we are glad to say,
rather more lucid. He here says, " The state of the organs con-
cerned in gestation and labor after delivery is compounded of hyper-
trophy, congestion, disturbed innervation, absorption, secretion, exhaus-
tion and traumatic irritation." — " These constitute a pathological state
predisposing to puerperal fever." He goes on to illustrate by an
analogy of " ascitic dropsy." After having tapped his patient, and
reduced his abdominal proportions to a state of collapse, (I suppose
he uses the word in a mechanical sense,) he says, " the chances would
be very adverse to recovery, if left only with the support of the ban-
dage and rest." The patient must be purged — and for what? The
reader will perceive the pertinency of the illustration, by recollecting
the true point of controversy between Dr. Mettauer and myself. It
is, as to the safety and efficacy of " impressive and secernent purga-
tion" immediately after delivery, as a prophylactic of puerperal peri-
tonitis.

Would Dr. M. prescribe a purgative for such an ascitic patient,
with the view of thereby preventing peritoneal inflammation ? When
given under such circumstances, is it not rather to second the design
of the operation, still farther get rid of the fluid and prevent its re-
formation by exciting increased absorption, and, if possible, over-
coming the obstruction in the portal circulation, the usual cause of
the disease. He says, " it is the only efficient remedy likely to re-
store the organs to their proper anatomical and physiological con-

WILSON ON PROPHYLAXIS OF PUERPERAL PERITONITIS. 601

ditions ; by which I suppose he means that it will arouse from this
collapsed state, and cure the flaccidity and relaxation, on what prin-
ciple I know not, unless it is, that muscular tissues contract on being
roughly used. But Dr. M. still farther develops his views, by stating
that the " uterus and its appendages are greatly thickened, expanded
and enlarged ;" and he asks, " What treatment is more appropriate
for hypertrophy of the abdominal organs than purging?" Are we to
understand Dr. M. as maintaining that the increase in the uterine
mass, commencing with conception and progressing until the full
term, is a diseased product, demanding the interference of art for its
removal? In almost the next sentence he says, "During pregnancy
we have disease of the uterus and its appendages and the contiguous
organs; after parturition that state continues, and demands treatment
like other diseases." A doctrine so monstrous needs no other com-
ment than marks of special annotation. From the moment of con-
ception diseased action commences, a veritable diseased product is
accumulating in the tissues of the womb, requiring the intelligent,
uniform and efficient interference of art !

The organ is " hypertrophied, congested, with disturbed inner-
vation, and traumatic irritations." Wonder that Dr. Mettauer should
be willing to risk the convulsive, agonizing, long-continued throes of
this diseased organ for the expulsion of its contents! Why not step
forward, in the exuberance of his resources, and complete the work,
finish the labor, as soon as nature gives unmistakable evidence of
readiness for expulsive efforts and his aid? In my humble judgment,
he would be as much within the province of legitimate duty as when,
under the guidance of his notions of pregnancy as a disease, he ad-
ministers an "impressive secernent" purge, "even before the secun-
dines are delivered," with the view of removing hypertrophy. Verily,
medicnl science is making rapid strides, and man's power greatly
magnified. No wonder Dr. M. descries in the distance the period
when, by means of this progress, the "days of our years" shall be
extended to patriarchal length ! But let us come more closely to the
discussion of the real practical issues between us. By reference to
Dr. Mettauer's first paper, it will be perceived that he recommends
purgation in all and every case of delivery. It must be practised in
a few hours after the pariurient act; in what he conceives to be
threatening cases, " the sooner the better, even before the deli-
very of the secundines." His purgation is not the cautious removal
of fecial matter by laxative or lavement, after a sufficient interval of
rest, and when new movements are about to take place in the
mammary glands. No; his purgation is "impressive and secer-
nent." His indications of practice are not derivable from the spe-
cial features or general complexion of a particular case; no, the
woman has had a child and must therefore be purged, the hyper-
trophied womb must be taken down ! Pregnancy and parturition
are invariably true pathological causes and states. Under all varieties
of -female constitution and the action of all adventitious circum-
stances, their effects are uniform and require the same medication.
Is the patient plethoric and inflammatory? She must be purged.
Is she pale, bloodless, hysterical, neuralgic, morbidly sensitive to

602 WILSON ON PROPHYLAXIS OF PUERPERAL PERITONITIS.

every moral emotion, almost exhausted from fatigue, (and they some-
times die outright from the nervous shock?) Is she harassed by tenes-
mic efforts excited by rectal prolapsus or haemorrhoids? Still the
same inexorable purge. Or is she like some of the doctor's naughty,
refractory patients, who " feel so well" that they can't resist their re-
pugnance to physic, unless convinced of its necessity ? Still she must
be purged. I ask the careful reader if this is not a fair representation
of Dr. Mettauer's teaching? But his special directions are not less
liable to just animadversion. He says, "purging will be demanded
in a few hours after delivery, when parturition has been protracted
and attended with great suffering." No matter whether the delay
has been occasioned by rigidity of the soft parts or contracted pelvis,
or general constitutional or specially feeble uterine action: " If the
latter stages of pregnancy have been distinguished by any symptoms
which indicate a morbidly impressible state of the uterus and con-
tiguous organs." The uterus may be morbidly impressible in states
of the system the very antipodes of each other: "If the last month is
attended with any undue restlessness, uneasiness or tenderness of the
abdominal walls, any disorder of the digestive function or bowels, or
any symptom of unusual irritation." Now, all these symptoms are
well known to depend upon a variety of causes requiring discrimina-
tion for their removal. But again, "if the liquor amnii is preter-
naturally warm or cool" — very different states; especially "has con-
siderable haemorrhage, taken place." Under all the above contin-
gencies Dr. Mettauer directs the patients to be " impressively, secer-
nently purged" — promptly, "even before the delivery of the secun-
diues." Purge! purge! purge! It is the great catholicon. It
meets all wants, answers the most opposite ends, over-rides all
counter-indications. Help the pills along with " purgative enemata
every hour." If the first close tail, "repeat and continue the treat-
ment until every threatening symptom disappears." This is what
may be called " taking a patient through a course." " Purging in all
cases of delivery" —

" It 's good for hot, it 's good for cold,
It 's good for everybody, O !"

I can hardly think that Dr. Mettauer will claim that there is any
specially harmonizing relation between his particular combination of
aloes, scammony, calomel and ipecac, and the organs of a puerperal
woman. We all have our notions or conceits about these minor
matters, and seldom dignify them with much importance.

But it is necessary to say something of my own paper, as published
in the August Number of the Stethoscope. After some general re-
marks on prophylaxis, I dissented from Dr. M.'s purging views, and
introduced an abstract of two cases which occurred in my practice
some twelve or fourteen years since, in which the administration of
Epsom salts and oil, some twenty or thirty hours after delivery, and
when I lie patients appeared to be doing perfectly well, were followed
by hypercatharsis and the prompt development of peritonitis, which
speedily ran to a fatal termination. I premised the introduction of
the cases by the statement, that my subsequent experience had sus-

WILSON ON PROPHYLAXIS OF PUERPERAL PERITONITIS. 603

tained the practical lessons taught by those cases, and yet the doctor
represents me as being guilty of the egregious folly of founding a
general rule on two observations. It is himself that would pniciise
physic by a rule and recipes — not me. This is my complaint against
him. I did express preference for " rest and quietude," if any gene-
ral rule must be laid down, believing that it would suit a larger num-
ber of cases than his purging notions. Neither have I ever occupied
the absurd position, which he generously awards me, of maintaining
that the condition of the organs after delivery is simply that of fatigue.
I believe the phenomena of parturition and pregnancy constitute pre-
disposing causes of child-bed fever — aye, that the uterus is byper-
trophied, congested, in a state of traumatic irritation, and yet insist,
that on the soundest principles I can advocate profound repose for
sixty or seventy hours after delivery as the state most favorable to
the return of organs to their non-gravid conditions, and as the state
in which they are the least likely to be morbidly impressed by acci-
dental causes or epidemic influences. Often have I witnessed the
charming effects of opiates under such circumstances, where rest
could not be procured without them.

But need I discourse farther of the value of rest as a curative
means to an old surgeon? How many diseases now incurable might
be relieved if we could suspend the functional exercises of organs,
and give a favorable state for reparation. Rest is nature's great the-
rapeutic agent. It is pointed to by every law of our organized being.
It has been made the subject of special revelation from Heaven.

When our faculties are jaded by over exertion, until every member
is sick and sore, how natural, how grateful, how common-sensed the
remedy.

Nature keeps the bowels of her puerperal patients at rest. It is
is in unison with the laws she has impressed on our organized being.
" Man would do well to imitate her example."

But if Dr. M. wishes to deplete his puerperal patients, why insist
upon doing it only by purgation? General and local blood letting are
at his service, to be graduated by his discretion, and subject to his
control. Why ruthlessly revulse upon some thirty feet of mucous
membrane without ability to pre-estimate the effects, or check action
at his bidding?

But here I must meet the argument he deduces from the treatment
of colic. He asks, "if any judicious practitioner would be afraid to
purge in this disease, after the spasm has subsided, for fear of ha-
rassing fatigued organs and exciting inflammation ?" Certainly not.
But what is the object of purgation in this case? Is it to deplete the
intestinal vessels, or revulse from a focus of irritation, and thus ward
off inflammation ? Is not the purgation designed to remove the acrid,
offending ingesta, which first excited spasm? Would Dr. Mettauer
still purge if he had indubitable evidence that the whole offending
motter had passed off' by its own irritating action?

Here again, the ghost of something in the bowels, to be purged off
as a cause of child-bed fever, presents itself in his reasonings. All
his illustrations point this way. If he means to assert that fecal mat-

604 WILSON ON PROPHYLAXIS OF PUERPERAL PERITONITIS.

ter is the cause of child-bed fever, let him say so, and the proposition
shall be considered.

But is the Dr. sustained in his purging notions by the analogy of
kindred states, even in his own speciality, surgery. He did not like
my illustration of the propriety of rest in the endangered knee joint.
In Lithotomy and the Caesarean section the great danger is from peri-
toneal inflammation. Would he put his " impressive, secernent, re-
vulsive" practice in action here. In wounds, contusions, injuries of
the abdomen endangering peritoneal inflammation, what are the pro-
phylactic teachings of the great masters ? Not (according to my
reading of them) to purge, but " quietude of body and bowels" — " Purg-
ing is out of the question." Opium is the remedy, conjoined with
blood letting. If the Dr. teaches any other doctrine, are we not jus-
tified in regarding him as a pathological specimen of medical opinion.

But after all, is there really any danger in " impressive" purgation
shortly after delivery. Is it all an idle phantom in Dr. Mettauer's
young friend, Dr. Wilson? I wish we were both younger. But
error may be chronic as well as acute — and it is not at all beyond the
range of possibility, that Dr. Wilson's observations of this particular
class of cases, though not extending through so long a term of years,
may be quite as numerous and accurately noted as Dr. Mettauer's.

But to the testimony. What say authorities on this head ? What
are the teachings of Dewees and Meigs, the heads of American obste-
tricy. The former says " on the third day after delivery, if the bowels
have not been previously moved, the woman should take some mild purge."
Dr. Meigs testifies that " an accoucheur does not like his patient to be
disturbed by a dose of physic, or even a common aperient enema for
at least the two first days of lying in." Says he, " it is not good
practice to excite perturbations in the economy of a woman who has
just gone through the pain and excitement of labor. Such a person
requires a long and profound repose of the organs and organisms, as
well as of the spirit itself, for which all sorts of complacencies should
be provided. A dose of cathartic medicine, administered within 24
hours, is sufficient in some instances to call up movements that it
would be far wiser to leave uncalled. Wake not the sleeping lion —
attacks of engorgement and inflammation have, I am sure, followed
the intempestive operation of purgative medicines, administered by
imprudent and assuming nurses. It is time enough, under all ordinary
circumstances, to cause the bowels to be moved once or twice after
the lapse of from 60 to 72 hours ; and the woman ought not to be dis-
turbed w7ith any kind of physic for at least this length of time after
delivery. An aperient ought to be selected, not a purgative. The
patient is not sick — she does not want physic — her bowels are lazy, and
merely require to be roused a little. To procure this end, select
some article that you can depend on — not magnesia, or Epsom salts,
or senna, or rhubarb, because they bring on purging, if you give a suf-
ficient dose to secure action. Castor oil is most reliable. In ten cases
of women just confined, a dessertspoonful of oil will be sufficient for
nine, and the tenth can repeat, if she chooses. I advise }7ou to follow
this method, and I confidently advise you in this way, because " haud

WILSON ON PROPHYLAXIS OF PUERPERAL PERITONITIS. 605

inexpertus loquor." "Neither my friend, Dr. Samuel Jackson, nor I
would consent to give a woman a tablespoonful of oil Tinder such cir-
cumstances. Dr. Jackson is good authority in matters of therapeu-
tics." Such is the emphatic testimony of the experienced Prof. Meigs.
But Dr. Lee is at the head of the English faculty in this department.
What are his opinions ? He says, " A puerperal woman ought to be as
careful of exposing herself and of any imprudence as an individual
who is recovering from an attack of continued fever or inflammation
of some important organ. I (says he) am an advocate for an opiate
after delivery, to soothe the nervous system if much excited by severe
and protracted suffering. If opium be useful in tranquilizing the ner-
vous system and preserving it from febrile irritation after extensive
wounds of the large cavities, surely it cannot but be beneficial after
delivery, and can do no harm, particularly if combined with a diapho-
rectic. Where labor has been severe and inflammation is dreaded, it
is not only useful to administer a sufficient quantity of an anodyne to
quiet the system, but for a day or two to give small doses of Dover's
powder to subdue irritation and promote perspiration." Churchill
says, " intestinal irritation may certainly be propagated to the neigh-
boring tissues, and under the influence of an epidemic, originate puer-
peral fever. Rest and quiet are the best and only necessary restoratives."
But there is no need of farther multiplying authorities. Neither Col-
lins, or Colambat, or Velpeau, or Cazeaux, sympathize in Dr. Met-
tauer's dread of rest, or can be fairly construed into sanctioning his
" rule of purging in all cases."

Backed as I am by such reasonings, and authorities that can num-
ber their hundreds and thousands of observations to Doctor Met-
tauer's sixty-two or my " tivo," may I not plead justification to the
soft impeachment he says I have preferred against him, " of incul-
cating a rash and dangerous practice?"

But I must here acknowledge the doctor's respectful consideration,
in not venturing " to insinuate that Dr. Wilson is incapable of distin-
guishing disease from fatigue in lying-in women." I might give him
some credit for sincerity in the premises, if he had not, in the next
breath, broadly intimated that I had'nt sagacity to distinguish stru-
mous diarrhoea from puerperal fever. But ought not Dr. Mettauer's
knowledge of the fact that strumous diarrhoea does occasionally occur
in the puerperal period, drive him from his "invariable rule?" But
he may maintain that his vaunted recipes for "impressive, revulsive,
secernent, tranquilizing" purgation, are the best treatment for stru-
mous diarrhoea.

But how are we to dispose of Dr. M.'s sixty-two puerperal cases,
in which he instituted his practice, " without the semblance of in-
jury?" The annals of medicine furnish many similar instances of
fortunate escapes. The human constitution sometimes exhibits wonder-
ful power in resisting the causes of disease, and the well-meant but
mistaken efforts at aid. The doctor should congratulate himself on
his good luck, unless, indeed, he considers his own individual obser-
vations as of more value than those of the distinguished names I have
mentioned.

72

606 WILSON ON PROPHYLAXIS OF PUERPERAL PERITONITIS.

But we have yet to consider the efficacy of early purging as a pre-
ventive of child-bed fever, and the real confidence to which it is en-
titled as a prophylactic.

Dr. Mettauer is mistaken in supposing that he has introduced an
" innovation" (as he says in both his essays) in the prophylaxis of
this disease. Dr. Gordon introduced the practice in the great epi-
demic that prevailed at Aberdeen in 1789 to 1792. He gave a
" purging bolus of calomel and jalap," and bestowed on it high en-
comiums as a preventive measure. Dr. Hey imitated his practice.
He says, " in every case of accouchment it was my practice to give
the purgative, which, if it did not prevent the disease, afforded some
advantage in the cure." But mark — Hey subsequently admits, " that
some of the'worst cases in his practice occurred after an excessive
operation of the purgative." Cotemporary writers testify that this
much-vaunted preventive did not arrest the epidemic or diminish the
number of seizures ; and Gordon and Hey kept their hands full of
child-bed fever patients, after the discovery of the prophylactic. The
judicious Dewees, after carefully weighing all the evidences in its
favor, says, "I very much doubt if it ever prevented the disease."

But Dr. Mettauer purges sixty-two puerperal females, in com-
pliance with his " invariable rule" to purge all. None of them have
the disease — therefore, purging prevents puerperal fever. All his
cases, too, are drawn from a region of country in which " not a soli-
tary case could be traced to contagion, and which, it is well known,
in comparison to cities and hospitals, is but little liable to epidemics.
I have had charge of some hundreds of puerperal females in the
course of my life. It has so happened that I have never had a case
of puerperal mania amongst them. I always direct my patients to
keep in bed nine days at least ; therefore, keeping in bed nine days
will prevent puerperal mania. Is not the conclusion as pertinent in
the one case as the other?

What evidence has Dr. M. that a single one of his cases would
have had the disease without his purge ? Drs. Lee and Meigs recom-
mend rest for some sixty hours after delivery. If I wished to estab-
lish the opposite rule to Dr. M.'s, might I not parade the hundreds
and thousands of cases undergoing their regimen and escaping the
disease, as proofs that rest is the true preventive ? But I desire to
establish no rule, but be guided by the exigencies of each particular
case. Sometimes I would even purge. The lesser danger must be
sunk in the greater hazard. John Wesley, in his " Primitive Physic,"
says, " For the bite of a mad dog plunge into cold water daily for
twenty days, and keep under as long as possible. This," he adds,
" has cured the diseases after the hydrophobia has begun ;" from
which we infer that it usually cured before the disease existed. May
not Doctor Mettauer, in like manner, have prevented what never
would have occurred ? Now, in view of all these things, I ask the
reader who has examined our positions, if I have done Dr. M. any
injustice in charging him with an " attempt at too great generalization
in practical medicine?" If I can be satisfied that the affirmative is
the general judgment, I will make him the neatest apology in my

evans's case of morbid adhesion of the placenta. 607

power. In conclusion, I desire to reciprocate Doctor Mettauer's ex-
pression of good feeling and disclaimer of " personal unkindness."
How could it be otherwise between us ? We only strike for truth ;
if anything savors of vehemence, set it down to her stern behests. I
should not thus closely have examined his papers, but that he is a
teacher of youth. Seldom have I read essays in which I could find
so little to approve. There is one recommendation, however, which
meets my cordial approbation; this is, the "pine-top tea." If not
given in over-portions, and nature is permitted to have a fair chance,
I believe she will perform her great functions successfully and
happily.

Richmond, 11th Oct. 1851.

A Case of Morbid Adhesion of the Placenta.

Granville County, N. C.

This communication is not intended to offer any new principle or
new mode of practice to the profession, but simply to report one of
the anomalies we occasionally meet with in practice.

July 23d, 1850, I was called to see a free mulatto woman, aetat.
about 30 years, for morbid adhesion of the placenta, after she had
been delivered of a healthy child by a midwife. On my arrival I
found the placenta discharged, but still adhering by its periphery to a
fibrous band about two and a half inches wide and three quarters of
an inch through its centre, tapering off to either edge thinner, and was
some six or seven inches long. I went to work and detached the
placenta ; after which I examined the situation and origin of this ab-
normal appendage. I found on inspection that it sprung from the right
inner wall of the uterus, and from so large a surface that I thought it
imprudent to interfere with it at that time. I therefore let it remain —
first, to see what nature would do in this matter before I further inter-
fered. In three or four days, as well as I recollect, it sloughed away ;
but before this took place local inflammation set up in a tumor in the
right iliac region, which previously existed there, as she informed me,
in consequence of a blow she received during her gestation by a rude
boy. This woman was very feeble during the whole time. She was
threatened with lipothymia every time she would turn over or make
much exertion, for several days. And what was more peculiar about
the case was, there was an alternate or pulsatory movement in the
opposite iliac region perceptible to the sight or touch. This was not
constant, but occasional — several times a day. She expressed its sen-
sation, like some one was fanning her. She was in a profuse perspi-
ration nearly the whole time of her illness.

Treatment. — As soon as I discovered inflammation had set in, I
ordered an emollient poultice put over the part — administered calomel
and opium every third hour, the first day. She remained very feeble..
The second, I added a small portion of sulphate of quinia to the cak*-

608 cabell's case of pulmonary fistula.

tiiel and opium. This treatment was persisted in until it produced a
slight constitutional effect — notwithstanding this, it went on to suppu-
ration, and a fetid discharge escaped through the vagina. During
this time I kept her upon a sustaining regimen.

, The discharge ceased before the pain entirely subsided. I made
her an embrocation, composed of spirit of ammonia, spirit of cam-
phor and laudanum, which, being applied over the part, gave relief.
She finally recovered, and has remained well ever since — unless she
has been taken sick within the last few days.

The above statement is a summary of facts deduced from observa-
tion ; therefore, I commit them to your better judgment whether they
are worthy of a place in your journal or not. Prosperity in your un-
dertaking and in future life.

Yours very truly,

W. B. EVANS, M. D.

A Case of Pulmonary Fistula — with Remarks on Counter-
Irritation.

BY R. G. CABELL, M. D., OF RICHMOND CITY.
[Communicated to the Medical Society of Virginia, at its October Meeting.]

I am induced to make a report of the following case, because it
exhibits a rare termination of pulmonary disease by a fistulous com-
munication through the walls of the thorax, and because it shews the
power in the system of maintaining its vitality after the most serious
injuries to a vital organ, and of adapting itself to a condition which
might at first be regarded as incompatible with life — but chiefly, be-
cause it demonstrates the great efficacy of counter-irritation in the
treatment of pulmonary affections. The medical profession are aware
of the power of this remedial means, I well know, and I do not ad-
vance it as anything new ; but the case and the reflections to which
it gave rise are here made public, because the general principle to
which the cure of the case is attributed is a great and fundamental
doctrine in pathology, and as such cannot be too often inculcated by
precept and practice.

The anatomical lesion which resulted in this case rarely occurs as
an idiopathic affection. It is seldom that it is witnessed even during
long periods of extensive private and hospital practice. It is caused
generally by penetrating gunshot and sabre wounds ; and the record
of such injuries and their treatment belong to the province of the
military surgeon.

Miss S. A., of about 30 years of age, had been for a series of years
a victim of disease. Her constitution was scrofulous, and she had a
curvature of the spine, which had been attended by repeated abscesses,
resulting from caries of the spine, which, after remaining for some in-
definite time, disappeared and healed. For several years her attacks
had been of a pulmonary character, and she had long and repeated

cabell's case of pulmonary fistula. 609

attacks of chronic bronchitis, attended with much hectic irritation and
emaciation.

My attendance on her was long, and I almost despaired of her re-
covery. She gradually, however, began to improve, and ultimately
recovered, so far as to be able to leave her room and to enjoy exercise
in the open air. I now discontinued my visits, and did not see her
again for nearly a year.

On June 12th, 1851, I was called to see her again for an attack of
acute dysentery, of which she died. I ascertained that her cough
and the other symptoms of pneumonic irritation were entirely re-
lieved, and had been so for some time. She informed me that ame-
lioration in her symptoms was simultaneous with the appearance of
an abscess on her back, which was produced by the application of a
blister during my attendance on her. The abscess was still discharg-
ing, and on examination I discovered a fistulous orifice on the right
side, situated in the intercostal space of the 8th and 9th ribs, about
half an inch anterior to the angle of the ribs. The lateral curvature
of the spinal column produced much deformity of the chest and
brought the orifice to the lumbar region, about two inches from the
crest of the ilium. This fistula proved to be in communication with
the bronchial tubes, as at each dilatation and contraction of the tho-
rax in respiration the air was drawn in and expelled with quite an au-
dible sound, accompanied with hissing and bubbles of air. The ori-
fice was about the size of a crow quill, adherent to the skin, and
bathed with a seromucous discharge, which lubricated its walls and
prevented adhesion. It admitted the introduction of a probe for a
short distance ; but to avoid unnecessary pain, no attempt was made
to insert it deeper than to be satisGed that it penetrated the walls of
the chest and was fairly in the pulmonary structure.

The termination of this case, resulting in the relief and cure of a
long continued and (as was feared) fatal disease, must be attributed
to the establishment of the abscess kept open and persistent by the
pulmonary fistula.

Nature, like a tutelary deity, stepped forward to allay the sufferings
and restore the health of the shattered constitution of this frail but
singularly gifted child of misfortune and disease. It produced an
abscess, which, by its revulsion and counter-irritation, protected the
lungs and relieved them of congestion and inflammation. Her con-
stitution, originally feeble and impaired by a long and wasting dis-
ease, was unable to bear that depletion which inflammation of the
lungs requires. Taught by the spontaneous appearance and salutary
effect of this fistulous abscess in relieving this well-marked case of
pneumonic irritation, the physician may learn to place a just estimate
on revulsion and derivation in the treatment of chronic inflammation
of the pleura, bronchial membrane, or of the parenchyma of the
lungs, and to make the proposition one of universal application of
any of the viscera in a state of chronic phlogosis.

In most of the cases where time is an element, as in chronic phlegm-
asiae generally, the vital powers are much exhausted, and depletion,
by general venesection, leeches and cupping, cannot be borne. The

610 cabell's case of pulmonary fistula.

only antiphlogistic remedies, apart from internal agents, to which we
have resort, which, while they deplete, do not reduce the strength of
the patient, are setons, issues, dry cupping, blisters, pustular irritation
and the moxa. As powerful revellents and permanent drains upon the
system, relieving congestion and transferring irritation from internal
and vital organs to the surface, preventing the deposition of coagula-
ble lymph, and the alteration of structure attending chronic pulmonary
and cardiac diseases, their use is of inestimable value. Many cases
of chronic pleurisy and bronchitis, after the ineffectual use of judicious
internal remedies, yield promptly to counter-irritation and revulsion
by the above mentioned agents. Even in that opprobrium of the
healing art, tubercular consumption, more good may be done by
counter-irritation than by any other single remedial method. For,
while it is rarely in the scope of human skill to cure that great consti-
tutional disease when tubercles are once deposited in the lungs, yet
much good is done by the action of these agents in preventing irrita-
tion and phlogosis from extending from these inorganic masses to the
surrounding tissue of the lungs, and thus adding phlegmonous inflam-
mation to tubercular phthisis. The views of Dr. Latham on this sub-
ject are original, and the work of a master spirit. He makes two
grand divisions of this disease, the mixed and unmixed phthisis. The
unmixed, proceeding from tubercular deposits, excites just enough in-
flammation of the adjacent tissues as is sufficient to eliminate the tu-
bercular matter on which the disease depends — the inflammation
being in fact the healthy reparative process by which the malady is
cured. Instances of this kind are seen in scrofulous inflammation of
the glands of the neck, in which the surrounding vesicular tissue takes
just enough of inflammation to expel the tubercular deposit which oc-
curs in this disease. The tubercular depositions being removed, all
scrofulous tumors and ulcers disappear, and the disease, is thus cured.
But in many cases of scrofula, this inflammation is liable to transgress
these healthy limits, and extend its ravages to neighboring structures,
and endanger life by inflammatory and irritative fever. So also in
tubercular phthisis, which may be called scrofula of the lungs, the
tubercular matter, inorganic in itself, and therefore incapable of vascu-
lar action, may excite in the tissues around it the inflammatory pro-
cess necessary for its expulsion. But in consequence of the great
vascularity of the pulmonary organs, more inflammation than is neces-
sary for the reparative process is excited, and infiltration, hepatization
and suppuration supervene to a fatal degree. This constitutes what
is denominated mixed phthisis. Now the indication is to prevent the
inflammation from proceeding beyond the bounds of healthy expulsive
action, and this is done by suitable antiphlogistic means, and if this
inflammation has already taken place, to check it in its career and
bring it back to what may be termed the healthy standard. This
theory is not only plausible, but its truth is sustained by the analogy
adduced of scrofulous inflammation of the cervical glands, a disease
resulting from the same extraneous deposits in constitutions of similar
diathesis. It is also fortified by tubercular cicatrixes found in the
lungs of persons dead from other diseases. The recovery of persons

cabell's case of pulmonary fistula. 611

who have expectorated tubercular calculous concretions, who have
labored under hectic irritation, and exhibited the symptoms of pulmo-
nary consumption, both general and physical, corroborates the same
position, and enables us to say, that although generally fatal, it is not
always an irremediable disease. Several cases of chronic bronchitis
simulating phthisis in the important symptoms of hectic, emaciation,
night sweats and diarrhoea, have fallen under my treatment, and have
been relieved by remedies among which counter-irritation was sedu-
lously employed. It is therefore our duty not to abandon as hopeless
all cases of tubercular phthisis. The well authenticated cases of re-
covery from this remorseless disease are lamentably few —

" Rari nantes in gurgite vasto."

Yet still one single case of recovery among a thousand deaths,
(and such instances are recorded,) shews us that our art is not en-
tirely impotent, but may be triumphant, even in this great constitu-
tional malady. In confirmation of the above views of counter-irrita-
tion, and embodying another instance in its support, and as illustra-
tive again of the process which nature takes to relieve internal organs
by antagonistical eruptions on the surface, a case of mania, dependent
on sub-acute inflammation of the meninges of the brain, is now under
my care, in which the unfortunate patient has experienced the most
beneficial results from the appearance of what in his case may be
called a critical eruption. The paroxysms of his phrensy have twice
been of the most exalted character, his delirium ferocious, resisting
the action of the strongest purgatives, the loss of blood and other anti-
phlogistic means. The appearance of an abscess, in the first case on
the chest and in the second on the nucha, has apparently equalized
the circulation, calmed the turbulent action of his brain, and for a
time restored him to his faculties. The uniformity in each instance
of the sequence of these events, (the abscess and returning reason,)
proves that they were not fortuitous occurrences, but places them in
relation of cause and effect. There are, of course, many other valu-
able therapeutic agents in the treatment of organic diseases of the
lungs and other internal viscera, which I pass over unnoticed, as it is
my design in this paper to call attention only to the cardinal one of
counter-irritation and revulsion. To be beneficial, however, the
action of the remedy should be continued for a long time — as long
as the tissue of the lungs gives evidence of inflammation pervading
those organs at a distance from the tubercular deposits. This fact is
ascertained by auscultation, when the crepitant, sibilant and mucous
rales shew the existence of common phlegmonous inflammation, in
addition to the specific inflammation of phthisis.

In confirmation of the efficacy of revulsion and counter-irritation
in protecting the organs of the chest from disease, I cite the high and
classical authorities of Henncn and Larrey. Hennen says, that na-
turally delicate and diseased lungs have been benefited by penetrating
wounds of the thorax, and that he had good reasons for saying that
strong predisposition to phthisis was suspended and spasmodic
asthma relieved by wounds of the lungs. Baron Larrey adduces the

612 BOWYER ON THE PATHOLOGY OF PHTHISIS.

case of an officer cured of a well characterized phthisis by a wound
penetrating the cavity of the chest. It is also said that King William
the Third was entirely relieved of asthma as long as the wound on his
shoulder, received at the battle of the Boyne, kept open and dis-
charged matter. From the above case then, the history of which I
have related, from the reasoning suggested by it, and the high autho-
rity adduced in its support, counter-irritation and revulsion must be
regarded of signal value, and be ranked among our sheet anchors in
all serious organic diseases, whether of a tubercular character or of
common inflammation.

In the above remarks I have framed no hypothesis to account for
the modus operandi of this important agent. The ingenuity of the
human mind has been exercised in vain to account satisfactorily for
its action. One explanation has been erected upon the ruins of
another, but the subject is still clothed in mystery, and the door is
still open for investigation. Now, whether counter-irritation and re-
vulsion act by creating a current of nervous and arterial fluids to the
surface, or by the incompatibility of two diseases, or by the substi-
tution and conversion of diseases, or by the discharge of peccant
matter, as maintained by the old humoral pathologists, are matters of
trivial moment. One thing we know is this great and important
fact, that counter-irritation is antagonistical to and supersedes internal
disease ; and we also know that it is a therapeutic agent of Herculean
power, which, judiciously and perseveringly used, will rescue many
from untimely graves.

The Pathology of Incipient Phthisis.

Rockbridge Co., Sept. 11th, 1851.

Mr. Editor — Entertaining the idea that every theory on a subject
so important as consumption of the lungs should be laid before the
medical public, if it have any shew of reason or any sanction in phy-
siological truths, I venture to suggest one which I have formed lately
from close attention to a few facts which have come under my obser-
vation.

I have been led to believe that there may exist a spasmodic con-
dition of small vessels in different parts of the system, resulting from
the debility dependent upon inordinate excitement. When the sys-
tem has been exhausted by excessive stimulation, as in the case of
those who have been long intemperate, it is well known that this
exhaustion has been speedily attended by pulmonary consumption
having induced such a state of the blood vessels of the lungs as pre-
vented them from propelling properly the blood. This state I call
spasm arising from debility, since such a condition may equally well
proceed from debility as from an opposite state. All spasm must
depend upon the function of innervation ; and if some vice in that can
produce those disorders of the muscular system which we denominate

BOWYER ON THE PATHOLOGY OF PHTHISIS. 613

spasmodic, why may not the same abnormal condition affect the blood
vessels, which are equally dependent upon nervous influence for their
action — for the proper discharge of their office? The blood being
retarded in its flow by this state of its canals, fibrine is deposited
from it, and becomes deprived of vitality, forming, as has been
proved, the substance known as tubercular matter.

It is true that it has been long known that the flow of the blood
is impeded in this disease ; but never, I believe, has this fact been ac-
counted for in the way that I propose. It has been generally sup-
posed to be caused by the deposition of tubercle opposing a me-
chanical obstacle to the circulation. This would make the retarda-
tion I speak of subsequent to the deposition, and not preceding and
causing it — would be establishing it as the effect instead of the cause.
This deposition ma}7, at a late stage of the disease, co-operate with
the cause I have suggested in producing this lesion of the vascular
function ; but spasm is undoubtedly, in my opinion, the primary
cause, and would yield to antispasmodics in the first place, and tonics
afterwards — -the former relaxing the spasm and the latter removing
the debility which is its cause. It is true that a spasmodic stricture
of some of the air-cells would arrest in a measure the circulation of
the blood, since blood that is not duly oxygenated furnishes an insuffi-
cient stimulus to the pulmonary veins; but from what I have ob-
served, I really believe that although this stricture of the air-cells
does operate to produce this effect, it is seldom so long continued as
that of the vessels, and that the latter will exist independently of the
former, and notwithstanding they may be in perfect health, the de-
bility being such as to implicate the vessels, without impairing the
function of the cells. Moreover, I have observed this spasmodic con-
dition to obtain in vessels of other parts of the body, and to yield to
similar treatment when resulting from the same cause.

For instance, I have had occasion to notice repeatedly that when
a hard, contracted state of the vessels of the conjunctival portion of
the eye has supervened upon a debilitated condition of the organ,
brought on by over- taxing its energy, remedies that relax have been
found eminently beneficial. But it may be said that the same cause
which prevents the flow of the blood in this case may be identical
with that which produces the pain of inflammation, namely, over-
distension of the vessels, the coats being so strained by the volume of
the fluid that their contractility is paralyzed. Not so, however.
The distension is not so great as in inflammation, because the redness
may be scarcely perceptible. It is certainly not sufficient, so far as I
have observed, to produce this paralysis of contractility in the coats ;
I therefore have concluded that, independently of great distension,
at any one time in these vessels of the eye, paralysis may supervene
on debility, having its origin in excessive exertion of that organ — in
other words, this effect of over-exertion becomes the cause of spasm,
which arrests the proper circulation of the blood, and produces all the
uneasiness experienced in certain forms of eye disease.

Again, I have over and over again remarked, that when the genital
organs have been for a long time unduly stimulated, this effect, in
73

614 TREATMENT OF GASTRITIS.

some of their vessels, has continued long after the cause was with-
drawn, and that so soon as antispasmodic remedies were adminis-
tered the blood has flown far more freely than before.

In this view, then, of the pathology of pulmonary consumption, I
believe that its incipient stage should be treated in the way I have
advised.

W. S. BOWYER, M. D.

The Treatment of Gastritis.

Mr. Editor — With your permission, and through the medium of
your valuable publication, I desire to call the attention of the pro-
fession, in as few words as possible, to a method of treating those
cases of gastritis which are attended with so much irritability of
stomach that remedies are obstinately ejected from it. Being aware
that my plan is not a new one, I have no long argument to urge in its
favor, but I feel convinced that external treatment is too much neglected,
and that it is a common error, and sometimes leading to fatal conse-
quences, to rely entirely, or at least too long, on the exhibition of
drugs ; and I venture to report my experience in the treatment of in-
tractable gastritis. In many cases of the most obstinate character,
where great thirst and nausea or vomiting had existed for days, and
where nothing but a little powdered ice could be retained in the
stomach, and which resisted every preparation of opium given inter-
nally, I have found an effect like magic produced by the application
of a large fly blister over the region of the stomach, sprinkling the sur-
face, after it is denuded of cuticle, with from £ to 1 grain of morphia,
and then dressing with simple cerate. By this treatment and the use
of enemata I have so invariably succeeded in tranquilizing the system
and relieving the patient — first, by inducing quiet sleep, and then by
resolving the inflammation — that I deem it proper to urge the plan, and
to say that I believe much mischief is often done by persisting in the
attempts to accomplish a cure by the administration of medicines in-
ternally.

In conclusion, let me call attention to the fact that the general cause
of failure in inducing the effects of morphia when it is applied ender-
mically, is because it is too often applied on instead of under the dead
cuticle.

Yours, respectfully,

W.

Camden Co., N. C, Sept. 1851.

LAIDLEY ON THE FLUID EXTRACTS. 615

The Fluid Extracts of the Pharmacopoeia.

BY JOSEPH LAIDLEY, PHARMACEUTIST, RICHMOND, VIRGINIA.

In the August No. of the " Stethoscope," we adverted to the fact
that a new class of remedies — fluid extracts — had been admitted into
the new national pharmacopoeia ; and, as some of the readers of this
journal may not be familiar with the medicines in question, we pro-
pose at present to give a short history of these very important prepa-
rations ; and after describing the methods of preparing them, will en-
deavor to point out some of the advantages they possess over other
remedies, and their importance to the medical practitioner.

The officinal fluid extracts, or those recognized by the pharmaco-
poeia, are seven in number, viz. fluid extracts of cubebs, black pepper,
rhubarb, sarsaparilla, spigelia and senna, senna, and valerian.

These seven form three classes of extracts — first, those known in
pharmacy as oleo-resins, viz. fluid extracts of cubebs and black pep-
per ; second, concentrated syrups, viz. rhubarb, sarsaparilla, spigelia
and senna, and senna ; third, ethereo-alcoholic tinctures, of which va-
lerian is the only one. These preparations are all of comparatively re-
cent orign ; that of sarsaparilla was the first introduced, the formula for
its preparation having been devised by Mr. William Hodgson, jr., a cele-
brated pharmaceutist of Philadelphia, in the year 1830. The next
which followed was the fluid extract of senna, for which a formula
was presented to the Philadelphia college of pharmacy in 1834, by
Mr. Chas. Ellis, another distinguished pharmaceutist of that city.
The fluid extract of spigelia and senna has been in use for a number
of years. A concentrated fluid j^reparation of these drugs had been in
use in Philadelphia for some time, when, in 1844, Mr. Thos. Eastlack
directed public attention to it, by writing a thesis upon the subject for
the above-named college, by whom his formula was published in the
American Journal of Pharmacy for that year.

The fluid extract of valerian was first brought into notice by Mr.
Evan T. Ellis, who also wrote a thesis concerning it, which was pre-
sented to the same institution as the above. His formula also was pub-
lished in the Journal of Pharmacy.

The formulas for fluid extracts of rhubarb and of cubebs were pub-
lished in 1847 by Prof. Procter, in the before-mentioned valuable re-
pository of pharmaceutical intelligence — the American Journal of
Pharmacy, of which that gentleman is the editor.

Fluid extract of sarsaparilla is a concentrated tincture of sarsapa-
rilla, mezereon, liquorice, sassafras, &c, from which very nearly all the
alcohol has been evaporated, and, in order to preserve it, a small quan-
tity of sugar is added. One fluidrachm represents sixty grains of
sarsaparilla root. This preparation we have said was devised by Mr.
Hodgson, who, after reflecting upon the methods then employed for
extracting the active portion of sarsaparilla, arrived at the conclusion
that all the then existing formula; for accomplishing this purpose were
unscientific, and failed of effecting the end in view. The present
formula of the pharmacopoeia (with but slight alteration in the ingre-
dients) was the result.

616 LAIDLEY ON THE FLUID EXTRACTS.

There are but few drugs that can be cited for illustrating so for-
cibly as does sarsaparilla the great importance of employing scientific
formulae by which to make its preparations. This root, made known
originally to the Spaniards by the Indians, was introduced into
Europe early in the sixteenth century. Popular opinion soon ran
high in its favor, (as it generally did in favor of any new remedy ;) it,
however, gradually went out of use, until, about a century ago, it
was again brought into notice by Sir W. Fordyce and Dr. William
Hunter. Since that time much diversity of opinion has prevailed
among the profession as to its intrinsic worth, which diversity has
undoubtedly been caused by the unscientific and careless manner in
which the preparations of it were made. Uniformity was not ob-
served ; and if the preparation contained any medicinal efficacy, it was
only because their rule of boiling ! was not complied with. In illus-
tration of this point we cannot do better than quote from Mr. Hodg-
son's paper,* in which the fluid extract was recommended.

" They all (i. e. the medical works of those times) direct it to be
made by decoction in water, or by long-continued hot infusion ; and we
have invariably, in consequence, two evils to endure — the presence
of a large quantity of feculent and mucilaginous matter, which causes
rapid decomposition ; and, what is still worse, the absence of nearly
all the active principle of the root, which has indeed been effectually
stewed down. The French Codex, for example, directs two pounds of
the root to be infused for twenty-four hours in twelve pounds of warm
water, then boiled a quarter of an hour, and the residuum submitted
to another, and still another boiling, with ten pounds more water each
time down to six. The mixed decoctions are then to be again boiled,
with the senna, &c. down to one half; after straining, the sugar and
honey are to be added, and the whole boiled a fifth time, in order to
form the syrup !"

Mr. H. mentions other authorities besides the Codex to shew the
extent to which this very natural, but very ineffectual method of
making the sarsaparilla preparations prevailed. With these we will
not lengthen this article ; suffice it to say, that the plan above de-
scribed was considered the most effectual one for obtaining the vir-
tues of the root. But the advances made in organic chemistry within
the last half century have opened a new field to the enquirer for
truth, and those who have explored it have thrown an immense
amount of light upon the chemical properties of organic substances.
They have shewn that morphia is the active principle of opium ;
quinia, &c, of Peruvian bark; strychnia, of mix vomica; aconitia, of
aconite ; tannin, of nut-galls, &c, &c. They have carefully examined
the characters and properties of these substances ; how they may best
be obtained ; what precautions and conditions must be taken and ob-
served in conducting the necessary processes to obtain them or their
preparations. In pursuing these investigations they have ascertained
that sarsaparilla owes its efficacy to sarsaparilline ; that this sub-
stance is soluble in some oils, alcohol and ether ; that it is but slightly
soluble in cold water, more soluble in boiling water, from which,

* See Am. Journ. of Pharmacy, vol. 2, p. 282-6.

LAIDLEY ON THE FLUID EXTRACTS. 617

however, it is precipitated on cooling. There is good reason for sup-
posing that it is volatile. It is injured by heat. From these facts
we see that the old plan of boiling was unscientific and injurious ;
the tendency of which was to effect the wow-presence of the very
substance which it was the grand object of the process to secure un-
impaired in the preparation, and, instead of having that principle in
solution, the preparation furnished a very pleasant combination of
starch, gum, &c, which we presume proved beneficial, just in pro-
portion as the method was not accurately followed, or in proportion
to the amount of faith in the patient or physician. But in the new
pharmacopoeia diluted alcohol is prescribed as the menstruum. In
this liquid the sarsaparilline is soluble ; the gum, starch, &c. (soluble
in boiling water) are insoluble. The root is exhausted with diluted
alcohol ; the resulting tincture is evaporated at a low temperature,
(below 212° F.,) and when sufficiently concentrated, and while still
hot, the sugar is dissolved in it, and the preparation immediately re-
moved from the source of heat. The extract, as thus made, is a very
fine preparation, combining the full virtues of sarsaparilla root. The
ordinary dose is one fluidrachm. It is usually given in water, three
times daily.

Fluid extract of senna is obtained by mixing the ground leaves
with diluted alcohol. The mixture is allowed to stand for twenty-
four hours ; it is then introduced into a percolator, and water, mixed
with one third its bulk of alcohol, poured on, until the requisite quan-
tity of tincture is obtained; this is evaporated, filtered, the sugar
added, and then the Hoffmann's anodyne liquor, holding in solu-
tion the oil of fennel, is added. The oil counteracts the griping pro-
perty of senna. The Hoffmann's anodyne prevents fermentation.
The amount of the latter is too small to form an objection against
its introduction, as one fluidounce contains not quite seven drops.
Water extracts the active matter of senna as well as alcohol, but
the latter prevents the solution of albumen, mucilage, &c. (con-
tained in the leaves,) which are soluble in water, and would, were it
not for the alcohol, cause the senna to swell so much as to render the
displacement process ineligible ; besides, the presence of these sub-
stances induces a tendency to fermentation. The quantity of al-
cohol is sufficient to obviate these objections.

Fluid extract of senna is used for all the indications where senna
itself is employed. The dose as a cathartic is about half an ounce,
representing 240 grains of the leaves. A common way of exhibiting
its effects is to give a tablespoonful, and after an interval of twenty
minutes, repeat the dose. A speedy and pleasant cathartic medicine is
produced by mixing with a tablespoonful of the extract half an ounce
of Epsom salts in solution.

Fluid extract of rhubarb is prepared in a manner similar to the
fluid extract of sarsaparilla. Eight ounces (troy) of root are ex-
hausted with diluted alcohol ; the tincture evaporated in a water-bath
to five fluidounces ; five ounces of sugar are added, and, when cold,
adding half an ounce of tincture of ginger, holding in solution four
minims each, of oils of fennel and anise — the last three preventing

618 LAIDLEY ON THE FLUID EXTRACTS.

any griping that the rhubarb, if alone, might occasion. One flui-
drachm represents sixty grains of the root. The dose as an aperient
is from five to twenty drops ; as a cathartic, from twenty to about
forty drops.

Fluid extract of spigelia and senna is obtained by preparing by
displacement a tincture of those drugs, evaporating the tincture to a
certain point, adding a small portion of carbonate of potassa to dis-
solve the resin of spigelia, which, as the alcohol evaporates, is pre-
cipitated— being insoluble in the remaining aqueous fluid. The resin
being re-dissolved, the sugar, having been previously triturated with
the oils of caraway and anise, is dissolved with the aid of a " gentle
heat," (a " temperature between 90 and 100 degrees F.")

This preparation has been used as a vermifuge by many members
of the medical profession, in whose hands it has proved very service-
able, and its merits, we think, are such as deservedly entitle it to a
place in the national pharmacopoeia, as well as to the confidence of
physicians. It combines the anthelmintic virtues of spigelia with the
cathartic power of senna, (the griping property of the latter being
prevented by the oils, &c.,) it almost invariably proves acceptable to
the stomach, is pleasant to the taste, and possesses the great recom-
mendations of its composition being known and uniform. We have
heard some objection made to the introduction of the carbonate of
potassa, but so far as we are aware, no reasonable objection can be
made to its presence. Professor Procter, who recommended the
preparation some three or four years ago, thus explains its use : " The
carbonate of potassa not only gives solubility to the matters deposited
by the evaporation of the alcohol, and corrects the griping tendency
of the senna in part, but itself, in the opinion of some, possesses
anthelmintic power." The quantity in a dose is, as will be seen by
reference to the table appended to this article, only one grain and
seven-eighths.

The fluid extract of valerian is a most admirable preparation of
that valuable drug. The active principles of valerian reside chiefly
in the oil and valeric acid, the latter being generally, to some extent,
dissolved in the former. These substances are both volatile ; con-
sequently, a plan of securing in a nearly concentrated form the full
amount of these principles which are contained or formed* in the
root, is the object of the process. To accomplish this, the valerian,
in coarse powder, is displaced with a mixture of alcohol and ether, in
the proportion of one fluidounce and a half of the former to half an
ounce of the latter, for every ounce of the root employed. The
ethereo-alcoholic liquid is displaced by diluted alcohol, and is al-
lowed to evaporate spontaneously till reduced to five-sixteenths of
its original bulk ; more diluted alcohol is poured on the residue until
a quantity twice as great as the evaporated etherial liquid is ob-
tained ; this is mixed with the latter. Any oleo-resinous matter ad-
hering to the sides of the vessel is dissolved in a little alcohol and
added to the extract. After standing four hours, with occasional agi-

* Valeric acid is supposed not to exist ready formed in the root; but as it is an oxide of
the oil, it is thought to result from the union of the latter with oxygen.

LAIDLEY ON THE FLUID EXTRACTS. 619

tation, the whole is filtered, and, when finished, must measure twice
as many fluidounces as the root used weighed in troy ounces. As
thus prepared it contains all the virtues of valerian root. The dose
is from one to two fluidrachms, given in water.

Fluid extracts of cubebs and black pepper are prepared alike.
One pound (troy) of the fruit is exhausted by passing 1 quart of
ether through the powdered drug ; three-fourths of the ether may be
regained by distillation, below the temperature of 120° ; the residue
is exposed in a shallow vessel till all the ether has evaporated. Fluid
extract of cubebs as thus prepared contains all the volatile oil, cubebin
and the resin, to the exclusion of most of the inactive constituents of
the berries.

The dose is from five to thirty minims, representing about from 40
to 240 grains of cubebs.

It may be given suspended in water, in pills or in emulsion ; a for-
mula for prescribing it in the latter form, suggested by Prof. Procter,
is as follows, viz :

fy Extractum cubebse fluidum, - - 3 ij.

Pulveres acaciee, - - 1 ss.

Sacchari, - - - - 3j.

Aquae, ? iiiss.

M. Ft. Emulsio.

"A tablespoonful of this emulsion represents two drachms of cu-
bebs"— the same gentleman further suggests, " should it be desirable
to use alum with it, it may be dissolved in the water."

Fluid extract of black pepper may be administered in the same
forms as the extract of cubebs. It contains all the active principles
of black pepper ; one minim represents about 15 grains of pepper.
The dose is one or two minims. A substance somewhat similar to
the above has long been in use under the title of " oil of black pep-
per." The difference between the two is, that the latter, being only a
secondary product, obtained in the process of extracting piperin, is
not uniform in strength — consequently the preference should be given
to the "fluid extract."

A precipitate is apt to occur after standing some time in both the
extracts of cubebs and pepper — in the latter it is of no consequence,
for consisting only of piperin, it does not impair the value or strength
of the fluid portion. In the former, the precipitate may be re-dissolved
by gently heating the vial by immersing it in warm water — any por-
tion remaining as a precipitate after this treatment need not be re-
garded— it is only inactive, waxy matter.

We have several times had enquiries made respecting the quanti-
ties of those substances, which are added to the fluid extracts to mo-
dify or counteract their properties ; for the convenience of those who
may wish to see at a glance how much of each ingredient is repre-
sented by a given quantity of the respective fluid extracts, the annexed
table is given :

620

LAIDLEY ON THE FLUID EXTRACTS.

FLUID EXTRACT OF

a
H
a
0
O

W

0.

su

W
PL,

a
o
■4

n

Rhubabb.

Sabsapakiixa.

Senna.

Spigelia & Senna.

FLUIDRACHM

BEPBESENTS, OF

u

•s

u

o

bb
C

'En

<w

o

c
B

0)

'3

O

5

o

a

S

Em
O

5

u
a
bp

'C

3

p.

a

o
o

a

a
"u
o

a

tr
J

3
.a

id

3

s

s

a
o

3

cm

03

45

£
a

to
60

"3

B

o
O

3

8

a

it

to

60

6
c

a

"c
0

,5
b3
c

M
a

4

.2

be
'S

to
30

B

B

c

to
15

s

OQ

45

CS

o

p.

t*-l

o
02

H
o

3
O

CO

S
o

s

1

6

e
|

a!
w

o

3
i

6

5
s

K
>

Troy grains,
Minims,

480

960

60

4

1

1 6

i

1 6

37£

60

7£

7£

23

A4

30

It must, however, be borne in mind, that the above proportions
will be found only in such preparations as are equal to the pharma-
copceial standard ; and to render them so, much care and attention are
necessary. Take for instance the above preparations of sarsaparilla,
senna, rhubarb, and valerian ; they are all more or less injured, the
latter destroyed by the action of any considerable amount of heat on
them ; the active matters of the first three are all very much injured
by a prolonged subjection to a high temperature, and, with access of
air, much of the active matter becomes insoluble and inert ; conse-
quently, in preparing any of these fluid extracts, the evaporation
should always be conducted at a temperature below that of boiling
water — this temperature cannot be exceeded without injury to the
active principle of the medicine. It is in consequence of this liability
to injury, that the pharmacopoeia directs them to be evaporated in a
water-bath, which, for small quantities, answers very well ; when pre-
pared on a large scale, the evaporation should be conducted in vacuo,
otherwise the action of the air will greatly impair the quality of the
preparation. In preparing the etherial extracts, the temperature of
120 degs. should never be exceeded. A higher degree of heat would dis-
sipate the volatile principles in which the virtues of these remedies chiefly
reside.

The fluid extracts of the pharmacopoeia, if prepared from good
materials, strictly observing the conditions necessary to secure the
presence of the active matters of the drugs from which they are
made, as stated in the pharmacopoeia, and as explained above, will
contain perfectly unimpaired the virtues of the drugs they are in-
tended to represent. To some few of the advantages which these
preparations offer to the medical practitioner, we would now invite
attention. The fluid form of administering remedies is by far the
best that can be employed, especially in such cases where it is desira-
ble that an immediate effect be produced. Pills are frequently taken
by patients in preference to any other form of medicine ; but unless
they are fresh, they are often so hard as to either require a long time
for solution in the stomach, or, as is not unfrequently the case, pass
through the system unaltered. Powders present a good form for ad-
ministering many medicines — they commence to act as soon as taken
into the stomach ; but many drugs are almost necessarily injured by

LAIDLEY ON THE FLUID EXTRACTS. 621

the drying that is requisite preparatory to powdering. Such are, cu-
bebs, valerian, &c. : These and many others, if powdered without in-
jury, yet lose their activity in the powdered form, from the fact of
their active principles being volatile ; there is a liability in some
powders to decompose — such as senna, &c. Of some, the dose is very
bulky, and inconvenient to take — of senna for instance, the dose is two
drachms — sometimes more — the powder is too bulky, the syrup too
weak — the infusion, or " senna tea," would require some time to pre-
pare ; and if done by the apothecary, would cost as much as an equi-
valent proportion of the extract ; if made in the family where it is
wanted for use, it may not be properly prepared — it would probably
be boiled, thus injuring the senna and dissipating the volatile oil of the
aromatic seeds usually introduced to prevent griping.

The fluid extract obviates all these inconveniences ; it is not, like
the syrup, liable to ferment : unlike the powder, it does not decom-
pose— it begins to act as soon as administered ; the dose is small, is
easily taken, is not unpleasant, and is always ready for use.

Another instance of the value of these preparations is afforded,
where a particular remedy has to be used for any length of time.
Sarsaparilla is a remedy that has often to be taken for many weeks, or
even months, without intermission. Besides the objections to pills,
powders, &c. in the case of senna, we have now others to contend
with — the preparations of sarsaparilla recognized by the pharma-
copoeia, and hitherto used, are, the compound decoction, extract, infu-
sion and compound syrup. The compound decoction is only the fluid
extract in a weak form, and possesses no advantage over the latter,
except that it contains no sugar ; but it will not keep for any length of
time, and would require frequent renewal, and if made in the kitchen,
is, like the senna, liable to be overdone and injured in the preparation.
The solid extract requires so much evaporation, that, unless made
with much greater care than is usually bestowed upon preparations
made for sale in most of our large cities, it will possess but little of the
virtues of sarsaparilla. The infusion is liable to the same objections
as the compound decoction, and the compound syrup contains so
much sugar, that its prolonged use often deranges the digestive
organs — a person taking a tablespoonful of the syrup, representing 52
grains of root, will take at the same time 205 grains of sugar ; if taken
three times a day, as is usually done, he will take 615 grains of sugar
daily ; but in taking one-fourth of this bulk, one fluidrachm of the
fluid extract, he will get 8 grains more of sarsaparilla and 160 grains
less of sugar, or, in one day, 24 grains more sarsaparilla and 480 grains
less sugar. Equally great or greater advantages are gained in the
other fluid extracts. We will not lengthen this article by going over
the whole list of advantages they afford, but in conclusion would say,
that the advantages common to all the members of this class of pre-
parations are, that they perfectly represent the drugs from which they
are prepared, and that they combine great strength with smallness of
bulk, as may be seen by the following table, in which is shewn how
much of the various other preparations of a particular drug represent
one fluidrachm of the fluid extract.
74

622. LOBELIA INFLATA.

Cubebs. — Tincture of, 8 ounces, equal one fluidrachm of the fluid
extract.

Black Pepper. — No other preparation of it is officinal.

Rhubarb. — Infusion 1 quart, syrup 1|- ounce ; do. aromatic 5f
ounces, tincture 2 ounces ; do. and aloes 2^ ounces ; do. and gentian
2 ounces.

Sarsaparilla. — Infusion 2 ounces, compound syrup § of an
ounce, compound decoction 1 ounce.

Senna. — Infusion 2 ounces, syrup 1 ounce, tincture of, and jalap
2 ounces.

Spigelia and Senna. — No other preparation.

Valerian. — Tincture half an ounce, ammoniated tincture half an
ounce, infusion 2 ounces.

For the Stethoscope.

Lobelia Inflata.

This valuable remedial agent has been too much neglected by the
profession generally, on account of its abuse by a set of empirics. Is
it right that we, whose object should be to search for and obtain truth
wherever it may be found, to discard entirely a remedy which is ca-
pable of fulfilling so many therapeutic indications ? An intelligent
and enlightened profession will answer, no. Lobelia inflala is an in-
digenous plant, which is a common weed throughout the United
States, beginning to flower about the end of July, and terminating on
the occurrence of frost. Its odor is owing to an essential oil which it
contains, and its effects on the system, to an alkaline principle, called
lobelina. It is an emetic, and in small doses, diaphoretic and expecto-
rant. When taken in a sufficient dose to act as an emetic, there ap-
pears to be a greater diminution of the vital powers than from the ac-
tion of ipecacuanha. It probably takes a shorter time to produce
tmesis than the last named article, and, as far as my observation has
extended, operates nearly as mildly — reaction occurs as readily — the
pulse assumes fresh vigor — a copious, warm perspiration takes place,
and the patient feels a glow over the surface of the body. Professor
Dunglison says, it is an acro-narcotic. " Narcotics are agents which
first excite and then diminish nervous action, and, in sufficient doses,
stupefy." Although I have seen it given in enormous doses, and in
many instances injudiciously, I have never seen it produce narcotism,
and it certainly does not irritate the stomach as much as ipecacuanha.
I have seen persons who had taken large doses, and it failed to pro-
duce emesis — there certainly was considerable prostration , but I have
never seen any evil effects produced by it which might not have been
produced by any other emetic of the same class, in proportionate
doses, and in the same circumstances. I was induced to try it, from
the recommendation of authors, in a case of spasmodic asthma. I
found it more effectual in relaxing the spasm, and more certain in its
effects, than any thing else. It would frequently prove beneficial,
given in drachm doses, so as to nauseate and not produce emesis. If

LOBELIA INFLATA. 623

desirable to produce emesis, from 1 ss. to 1 i. of the tincture may be
given. Prof. Wood says he has derived more advantage from it in that
disease than from any other single remedy. The same author admits
it may do good in chronic bronchitis, attended with dyspnoea ; and I
can add my testimony to his, and say that I have derived considerable
benefit from its use in the same disease, especially in children. I
think it ought to supersede the use of tobacco enemeta for the purpose
of relaxing the system, for the reduction of luxations and strangulated
hernia. It is certainly not as dangerous, and is equally as efficacious.
In laryngismus, stridulus, as well as bronchitis, tracheitis, pertussis,
associated or not with other remedies, good may be expected from its
use — so also in pneumonia, when tar, antimony or ipecacuanha are
contra-indicated from irritation or inflammation of the mucous coat of
the stomach, small doses may be given every hour or two to induce
nausea. My object in writing is not to insist that it may supersede
any emetic substance, (save tobacco,) but to give my evidence that it
is not as dangerous as it is generally thought to be, and to call the
attention of the profession generally to it. I am in hopes physicians
will be induced to try it more extensively, and that some one better
qualified than myself will do it justice.

B.
Halifax Co., Va., Aug. 1851.

We entirely coincide in the opinion expressed by Dr. B., that lobe-
lia, as a remedial agent, is neglected by the profession on account of
its abuse by a set of empirics — and we believe there are few regular
practitioners who are aware of the true cause why they do not use
the article more frequently than they do. For our own part, we must
frankly confess that our prejudice against it is more to be attributed
to the harm we have known to be done by it than to our knowledge
of or experience with the article. When unbiassed testimony, from
good sources, will shew us that it is superior to the numerous emetics
commonly used to evacuate the stomach, or that it is a better relaxant
or nauseant diaphoretic than tartar, then we will substitute it. But
the judgment of the great mass of practitioners throughout the world
seems to be rather against it ; and as it is no " new thing," we feel
quite content to hold on to that which we know to be good, rather than
to "try" this vaunted specific of the steam and herb doctors, though
warmly recommended now and then by some of our regular brethren.
But, " Je prends le lien ouje le trouve" is a maxim more particularly
applicable and good in medicine than in anything else. — [Ed. Steth.

624 lewis's case of gun-shot wound.

A Case of Grim-Shot Wound — Recovery.

Croton, King Sf Queen, Sept. 10th, 1851.

Dr. Gooch — Dear Sir — I send you a short statement of a case
which occurred in this neighborhood last winter.

On the 27th December 1850, Mr. Boulware Dyke and Mr. William
Ball set out to cross the river at Mantapike, to shoot duck in the
marsh on the opposite side of the river. When they reached the
wharf, the tide had left the boat a little. Mr. Ball taking the two guns
and putting them in the head of the boat, with the breech downwards
and the muzzles projecting over the gunwales of the boat — Mr. Dyke
just at this moment taking hold of the chain which was attached to
the head of the boat for the purpose of pushing it into the water, the
large ducking gun, charged with large duck-shot, went off. The
whole contents of the gun and fragments of clothes were driven into
the abdomen of Mr. Dyke, entering the abdomen in front of the ante-
rior superior spinous process of the ilium, just where the great obli-
quus externus abdominis and internus muscle envelope by their apo-
neuroses the rectus abdominis — penetrating through the external mus-
cles, leaving bare the fibres of the rectus abdominis, the contents
of the gun taking a course upwards and outward until they reached
the edge of the last false rib following the course of the rib, and bur-
rowing deep into the muscles of the back. Upon the happening of
the accident, I was sent for in great haste — and as I live in the imme-
diate neighborhood, I saw him in an hour after the accident. When
I arrived I found the shock had been an overwhelming one to the sys-
tem, he having been unconscious of having received an injury until
his clothes were found to be on fire. I found him cold and without
pulse at the wrist. I examined the wound, and without delay sent a
messenger to King William for my son, Dr. John S. Lewis and Dr.
Ro. H. Tebbs, to assist and advise what was best to be done. In the
mean time I stimulated Dyke to bring about reaction, which was most
happily effected before they reached Mantapike, which was about
three hours after the accident, they living a short distance across the
river.

On consultation we decided to take out the shot, if possible, which
we succeeded in doing most happily, by making an incision in the
back in front of the second and third dorsal vertebra?. There were
upwards of one hundred and fifty large duck shot, with the wadding
of the gun and fragments of clothes, taken from the wound. After
dressing the wound we left him for the night, with directions for him
to be kept as quiet as possible, and administered an anodyne. On
the 28th 1 found him free from excitement, having slept well through
the night ; had his bowels moved with a saline purgative, and di-
rected him to be kept on a low diet, to avoid active inflammation.
From day to day the case went on favorably. No unfavorable
symptoms presenting themselves, in due time suppuration took place,
and, as was to be expected, a considerable slough in the back, and
Dyke insisted that he breathed through the wound. At this time

BROWNE ON THE INCISION OF STRICTURE. 625

the wound in the back was large and deep, shewing the edge of the
rib very distinctly, and the wound in the abdomen leaving the edge
of the rectus muscle, and also the peritoneum in situ. After six or
eight days from the occurrence of the accident, I allowed him a little
wine and a nutricious diet. A healthy suppuration and granulation
went on, and in three weeks the cavities of the wound were filling up
and healing in the most favorable manner. He continued to do well,
and in two months from the time of the accident he rode on horse-
back to Richmond, and is now well. The above statement I have
taken from notes made at the time when attending Dyke. If you
think the facts stated will be of interest, you can give them a place in
your paper.

Yours, respectfully,

ZACHARY LEWIS.

Incision of Stricture of the Urethra.

Fredericksburg, Sept. 1851.

Dr. P. C. Gooch — Dear Sir — In the September number of the
Stethoscope I find the report of a case of stricture of the urethra, by
Dr. Cruikshanks of Ayrshire, Scotland, in which he operated after the
plan proposed by Mr. Syme, and which he highly commends. He
speaks of it as a new operation, and as far as the operation by incision
from without is concerned, Mr. Syme is very probably entitled to the
credit of it. But the idea of cutting through strictures within the canal
existed, to my knowledge, near half a century ago, and was much
discussed when I attended lectures in Philadelphia in the winter of
1810-11. Dr. Physic exhibited to the class several ingenious in-
struments for this purpose, all consisting of a catiula, so shaped at the
point as to contain a small lancet-shaped blade. This blade was
attached to a stilet, and when the point of the instrument was properly
adjusted to the stricture, by pushing forward the stilet, the blade en-
tered and incised the stricture. Some of these instruments were
curved to suit the curve of the urethra. For that portion of the canal
which was straight the instrument seemed well adapted to the object,
but in the curved portion difficulties presented themselves, which ren-
dered the instrument too unsafe for general use. Few, it was sur-
mised, possessed the tact requisite to enable them to apply the end of
the canula with so much accuracy as to ensure, when the cutting
point was projected, that the stricture would be properly incised, and
much mischief might ensue from pushing it forward in a wrong di-
rection.

An ingenious friend of mine, and a gentleman of deservedly high
professional reputation, formerly a resident of Richmond, but now
living in Rappahannock county, Dr. Phil. Thornton, suggested an in-
strument a few years since, which appeared to me unexceptionable,
and which would enable the operator, if any instrument could be
passed through the stricture, to divide it, to any required extent,

626 EDITORIAL.

without injury to any other portion of the urethra. The instrument
he proposed was to consist of a metallic canula with a small bulb at
the extremity, with an extremely delicate blade concealed in a slit in
the bulb, and was so constructed as by the use of the stilet this blade
could be forced out one, two or more lines, at the will of the opera-
tor. The instrument was to be passed through the stricture, the
blade forced out and the whole withdrawn, the blade cutting its way
through the stricture. After passing the stricture, the blade to be
replaced within the bulb, to prevent injury to the healthy portion of
the canal.

It is well known that a bulbed, or as it was formerly called, " a test
bougie," is more easily introduced than any instrument, flexible or
otherwise, of any other shape, as the pointed instrument is apt to
hang, especially if the stricture projects farther into the canal on one
side than on the other, and the bulb might be made so small as to
contain a blade of but a single line. If the division was not sufficient
to enable a bougie of good size to pass, it could be easily turned, and
the stricture cut on the opposite side.

It cannot be doubted that a stricture so divided could be dilated
with a facility and certainty that could not be done with one callous
and hard and covered with the lining membrane of the urethra, as we
always find them.

Yours, &c,

WM. BROWNE.

311Ef®lEiIL 111 MES©3S3L3L.AH]S(D)US,

The Western Lunatic Asylum.

During a recent visit to Staunton we had an opportunity, for the first
time, of visiting the asylums for the insane and for the deaf, dumb and
blind. Owing to a misapprehension and the want of time, we could
only take a single walk around the latter institution, but we saw
enough of it to satisfy us of the beautiful condition of the establish-
ment. The cheerful industry of the blind, and the happiness beam-
ing from the eyes of the deaf mutes, whether it were in the study
room, workshop or recreation grounds, presented a sad contrast with
the variety of condition which we saw at the sister institution. By the
kindness of that most urbane gentleman and accomplished physician,
Dr. Francis T. Stribling, we enjoyed an opportunity of inspecting
minutely the whole establishment, and of witnessing the plans of treat-
ment pursued in the various forms of mental disease which present
themselves there. All preconceived horrors of the condition of the
inmates of a mad-house vanished when we saw this palace for the un-

EDITORIAL. 627

fortunate. We say palace, for such it is. The grounds are being
beautified by the inmates themselves, and, when finished, they will
add materially to the already picturesque scenery from the edifices.
The latter are spacious and admirably planned — capable of contain-
ing four hundred and twenty inmates, making it the largest insane asy-
lum in America, except that at Utica, New York. We have not room
here to go into a detailed account of the management of the establish-
ment, but so far as we are capable of judging, it is most admirable.
The fact that the mental and not the pecuniary condition of the patient
decides the position he is to occupy in the asylum, is worthy of com-
mendation. It is almost as great an improvement as the abolition of
braces and the straight jacket. We were struck with the calm and
easy manner with which the physicians and attendants approached and
controlled the patients. Dr. Stribling seems to have been born for his
office of superintendent and physician in chief, and he is ably assisted.
For interesting particulars of this — one of the proudest monuments
and noblest charities of Virginia — we refer our readers to the annual
reports of the directors, among the public documents.

Medical Lectures.

The introductory to the course of medical lectures at the medical
department of Hampden Sidney college was delivered on Monday,
October 13th, by Prof. Tucker. We could not be present on the
occasion, but have learned that Dr. T. did himself credit, and the cus-
tomary large and fashionable audience were highly pleased with his
rapid glance at the past " history of medicine." He brought his re-
view down to the present time, and made an effectual appeal to the
students of the state and of the South to encourage, support and build
up great institutions of learning and science in their midst. We are
glad to announce that the number of the class is increased — and that
other matriculations will take place. The regular course of lectures
is now under way, and we hope that both faculty and class may en-
joy a profitable and happy session.

The medical class at the university numbers near 100 — as many,
we believe, as is desired, and as many as ensure the peculiar advan-
tages of the system of instruction pursued in that institution. Prof.
Cabell is appropriating a part of his course to comparative anatomy.
This ought to be the case with all the schools, for comparative anatomy
bears the same relation to physiology as this latter science does to
pathology.

628 EDITORIAL.

Private Medical Instruction.

We have received from Dr. Frank A. Ramsay the " announcement
rof a primary medical school" at Knoxville, Tennessee. Our friend,
Dr. W. H. Anderson, and two associates, have also opened, at Mobile,
Alabama, a preparatory medical school.

These efforts, on the part of energetic and qualified men, to improve
the system of medical education, ought to meet the most hearty appro-
val and support of the profession. It is but the commencement of a
system which was recommended some time since by the American
medical association, and which must soon become general. The de-
fects of the old plan of office instruction have been universally felt,
and it is known that eight month children of the best chartered institu-
tions are generally deemed unqualified for the practice of medicine.
But they make up the great mass of practitioners, and hence the low
condition of medicine in this country.

It also affords us pleasure to announce that Drs. Peticolas, Scott
and Haskins have associated themselves together for the purpose of
conducting daily private examinations on the lectures of the Rich-
mond medical college, and to give office instruction to such students
as may be desirous of preparing themselves for the course of lectures.
We learn that their private class is already formed, and we are sure
that they will afford great facilities to students preparing for gradua-
tion.

The Fluid Extracts.

We call attention to the article of Mr. Laidley, on the subject of
the Fluid Extracts recently added to our National Pharmacopoeia.
Those of our readers who have not yet obtained the late edition of
the Pharmacopoeia, will find all the necessary information concerning
them in the article above referred to. As to the extracts themselves,
we feel warranted in recommending them, especially to country phy-
sicians, who will find them as much more convenient to carry in their
saddle-bags as they do quinine instead of bark. There are great ad-
vantages presented in these concentrated extracts, in the reduction of
the dose, their cheapness and their being less disagreeable to take ; and
hereafter, there will be no excuse for regular medical men using Sands's,
Townsend's, and the various other quack compounds of sarsaparilla,
which are very costly, bulky, impure and inert, and are leading arti-
cles in the list of quack medicines.

EDITORIAL. 629

Messrs. Adie & Gray have sent us, neatly put up, bottles of the ex-
tracts of senna, rhubarb and valerian, which they prepared in this
city. We have tried the latter with great satisfaction. No opportu-
nity has presented itself for testing the others.

Apology.

Owing to the length of several articles, much other matter of inte-
rest is excluded from the present number. We considered it but jus-
tice to give place to Dr. Wilson's paper in reply to Dr. Mettauer ;
but now, that our readers have become wearied with the subject of
peritonitis, and a controversy on that subject would become monoto-
nous, we feel it to be a duty to them to refer any further disputation
on that subject which may be desired, to the " committee on practical
medicine," or to that " on obstetrics," of the medical society. We
have no doubt but that either of these committees will do justice to
the papers received by them, and that they would appear in the
" Transactions of the Society."

The interesting account of the strange epidemic, described by Dr.
Anderson under the name of Adynamic Peritonitis, though long, de-
mands a place and a perusal.

We recommend to our correspondents to make an effort to con-
dense their communications as much as is practicable. This would
be more apt to ensure their being read, and it would give us more
room for selected matter of value without destroying our variety of
original communications.

Several errors unavoidably crept into the last number. By some
strange trick of the type or otherwise, the name of C. S. Mills, on
page 569, was made C. S. Williams. We will do better in future.

Organization.

We are requested to announce that a meeting of the physicians of
Louisa county will be held at the courthouse on November court
day, for the purpose of organizing a county medical society, and of
seconding the efforts now being made to organize the State society.
We hope that every respectable physician in the county will attend.

Societies in other counties are being formed, and we believe the
Petersburg society is soon to hold monthly meetings.
75

630 EDITORIAL.

We have received several letters on the subject of a convention.
They are generally in favor of holding it in Richmond at the end of
April, or just before the national meeting here. One correspondent,
however, suggests Norfolk as the place, and December 18th as the
time.

We give below the views of Dr. Browne, to all which we agree,
except the suggestions of quarterly meetings, and of making the so-
ciety a representative body.

Fredericksburg, Oct. 1851.

Dr. P. C. Gooch.

Dear Sir — I am glad to see that the praiseworthy efforts which
have been made and are now making by the physicians of Richmond
to organize a general State society under the existing charter, meets
with such general favor. I trust that in all proceedings to accomplish
this desirable object, sectional feeling will be excluded. The very
terms East and West produce a sickening effect, and foreshadow diffi-
culties in our path towards an useful organization. I do hope that the
universal sentiments of the profession will point to Richmond as the
appropriate location of the parent society. It is the seat of the state
government, and the facilities for reaching it from every section are
greater than any other point in the state. Add to this our obligations
to the members of the profession in Richmond for their untiring zeal
in forwarding an object so important, and the number of physicians
located in convenient distance, which would ensure a quorum at its
regular meetings, when the inclemency of the weather might prevent
so full an attendance at any other point, and I imagine few would
doubt the advantages which attach to that location. I think the so-
ciety of Richmond not only excusable, but that it deserves the thanks
of the profession for assuming the responsibility of acting for the state
at large ; for without such action, an effective organization could not
have been formed. I would suggest, that after the society is organ-
ized, the meetings should be quarterly, each auxiliary society having
a representation, for business, &c. Should such a plan be adopted,
I should hope that the Richmond medical society, embracing all the
physicians in the adjoining counties, who could attend conveniently,
may be kept up, and monthly meetings continued on the plan hereto-
fore pursued. The essays read and the discussions on the subjects
embraced in them, are highly interesting, and will form valuable ad-
ditions to the medical literature of the state.

I write hastily, and only to let you know the views of the physi-
cians in this section with whom I have conversed, and do not wish it
published. I suppose it would be desirable to obtain the views of
the profession in every part of the state, before the meeting in May,
if practicable. It would be well for the officers of the society to adopt
some plan for this purpose. If it could be ascertained that a large
majority agreed on any one plan, it would facilitate the organization

EDITORIAL. 631

of the society, and prevent discussion, which too often results in un-
pleasant sectional feeling. Of all subjects in the world, none retard
business so much as establishing "parliamentary rules" and balancing
sectional feelings. Yours, &c.

WM. BROWNE.

Prize Essays.

The following circular should have appeared before, but we hope
that it is not yet too late to induce many of our readers to enter the
field of emulation.

American Medical Association — Prize Essays.

At the meeting of the American medical association, held in Charles-
ton, S. C, in May last, the undersigned were appointed a committee
to receive and examine such voluntary communications on subjects
connected with medical science as individuals might see fit to make,
and to award a prize to any number of them not exceeding five, if
they should be regarded as entitled to such a distinction.

To carry into effect the intentions of the association, notice is hereby
given, that all such communications must be sent, post-paid, on or be-
fore the first day of April 1852, to Geo. Hayward, M. D., Boston,
Mass. Each communication must be accompanied by a sealed
packet, containing the name of the author — which will not be opened
unless the accompanying communication be deemed worthy of a
prize. The authors of the unsuccessful papers may receive them on
application to the committee, at any time after the first of June 1852 ;
and the successful ones, it is understood, will be printed in the Trans-
actions of the Association.

Geo. Hayward, Boston.
J. B. S. Jackson, "
D. H. Storer, "

Jacob Bigelow, "
Usher Parsons, Providence, R. I.
Boston, Aug. 20, 1851.

Dr. Mandeville Thum, of Louisville, Ky., has accepted the ap-
pointment to deliver the annual address before the society of alumni
of Hampden Sidney medical college next spring, in place of Dr. J.
T. Forbes, who declined.

Prof. Agassiz is delivering a regular course of lectures on com-
parative anatomy to the class of the South Carolina medical college,
and we learn that his class is a very large one, as the ability of the
professor and the importance of the subject deserve.

632 MEDICAL SOCIETY OF VIRGINIA.

Medical Society of Virginia — Adjourned Meeting, Sept 30, '51.

Dr. James Beale, First Vice-President, in the Chair.
{Present — Seventeen Members.)

This meeting was held for the purpose of considering the following
resolution, which had been offered at a previous meeting :

" Resolved, That no member of this society shall consult with any
physician whose application for membership of the same shall have
been rejected."

After some debate, the further consideration of the subject was in-
definitely postponed by a vote of nine to eight.

The meeting then adjourned.

October Meeting.

Dr. James Beale, First Vice-President, in the Chair.

(Present — Twenty-Jive Members and several Visitors.)

After the reading of the minutes, the following gentlemen were bal-
lotted for and declared duly elected members of the society :

G. Lane Corbin, M. D., - Laneville, York.

Robert H. Power, M. D., - York.

Jas. A. Flippo, M. D., - Caroline.

Charles Williams, M. D., - Botetourt.

J. L. Woodville, M. D., - do.

J. M. Kent, M. D., - - do.

David A. McQueen, M. D., - Richmond City.

Letters of application were read from a number of gentlemen,
whose nominations were seconded and laid on the table under the rule.

The essayist for the evening, Dr. Landon Rives, being absent, the
subject of Neuralgia was not taken up.

On motion of Dr. David H. Tucker, the subject of Malaria, and
its mode of action in producing fevers, was made the regular order for
the November meeting.

Dr. Robert G. Cabell then proceeded to read the report of a case
of pulmonary fistula, with remarks. [This paper will be found
on page 608 of the present number.]

Dr. Bolton then read the report of a case of fatal tetanus ensu-
ing on the application of ligatures to hemorrhoids.

Several specimens of abdominal and spinal supporters were also
exhibited by Dr. Bolton, who said that they could be obtained from
the agents now in the city.

REVIEWS AND BIBLIOGRAPHICAL NOTICES.

The amendments to the constitution, which were offered at the last
meeting, were read a second time and passed to their third reading.

The secretary laid on the table a personal pamphlet, received from
Dr. Ramsay of Raysville, Georgia.

Many members having applied for the diploma of the society since
the alteration of its form, a committee was appointed to have a num-
ber of them prepared.

On motion, the librarian was instructed to have certain books bound
for the society.

A series of resolutions in relation to medical ethics and intercourse
with medical men who may be rejected by the society, was offered,
on which a long discussion ensued. Finally, the following was adopted
as a substitute for the whole :

" Resolved, That no member of this society shall hold professional
intercourse with any member of the profession who has been pre-
sented to the society and rejected upon grounds of professional mis-
conduct."

" Resolved further, That each member shall consider it his duty to
report to the society all cases of professional misconduct which may
come to his knowledge."

After a personal explanation by a member in regard to his conduct
towards a member of the profession, the society adjourned until Tues-
day evening, November 18th.

Reviews and Bibliographical Notices.

The Geological Observer — By Sir Henry T. De La Beche, C. B.,
F. R. S., Director General of the Geological Survey of the United
Kingdom. Philadelphia: Blanchard 8f Lea. 1851. 8vo. 695 pp.

Sir Henry De La Beche is a man of science, and is looked upon in
England as a geologist of the first class. Some years since he wrote
a work, entitled " How to observe in Geology," which soon ran out of
print. His present excellent work is especially adapted to " abridge
the labors of those who may be desirous of entering upon the study
of geology, and especially in the field. Its object is to afford a ge-
neral view of the chief points of that science, such as existing obser-
vations would lead us to infer were established ; to shew how the cor-
rectness of such observations may be tested, and to sketch the direc-
tions in which they may apparently be directed."

It is said to be one of the best elementary works on the subject in
the language. The edition before us is a very handsme re-print from
the English, beautifully illustrated, and comes to us from the publish-
ers, through A. Morris & Co., Main street.

634 TILT ON DISEASES OF MENSTRUATION.

A Practical Treatise on the Diseases of the Lungs and Heart, including
principles of Physical Diagnosis — By Walter Hayle Walshe, M.
D., Professor of the Principles and Practice of Medicine, and of Clini-
cal Medicine in University College, London, Physician to University
College Hospital, Consulting Physician to the Hospital for Consumption.
Philadelphia: Blanchard Sf Lea. 1851. 12mo. 512pp.

This book has acquired a considerable reputation, and it is a valu-
able clinical manual to the practitioner as well as the student of chest
diseases.

Part I. consists of two chapters — the first describing the facts and
principles of physical diagnosis in regard to the lungs, the second go-
ing over the same ground in regard to the heart and great vessels.

Part II. consists of three chapters, clinically describing the symp-
toms, physical signs, diagnosis and treatment of the principal diseases
of the lungs, the heart and the aorta.

Though Dr. Walshe's book is pretty complete, and a favorable ver-
dict by the critics has been rendered, we doubt if Barth and Roger's
hand-book of Auscultation and Percussion, together with Gerhard's
work on the diseases of the chest will be either superseded or injured
by it. The work may be had at Morris' bookstore.

Diseases of Menstruation and Ovarian Inflammation, in connection with
Sterility, Pelvic Tumors and Affections of the Womb — By Edward
John Tilt, M. D., Physician to the Paddington General Dispensary,
and to the Paddington Free Dispensary for the Diseases of Women and
Children. New York: Samuel S. Sf William Wood. 1851. 12mo.
2§§pp.

This most excellent little work has been reviewed or noticed with
much commendation throughout England, France and America. If
Dr. Tilt had not been already known by his able contributions to the
journals, this treatise alone would have given him an enviable fame.

It is frankly confessed by the author, that he proclaims no discoveries
of his own, but that he merely attempts to do for the ovaries what
has been successfully done for most of the other organs by many emi-
nent men. He establishes the fact that the ovaries are the principal
organs of menstruation ; and gives a more complete account, than any
other one writer, " of the various ways in which sterility is produced
by the action of inflammation on the ovarian tissues ; of the great im-
portance of ovarian peritonitis as a cause of disordered menstruation,
and of the influence of ovarian inflammation in the production of
uterine disease." He attributes to some form of ovaritis, acute or
subacute, nearly all the diseases too commonly referred to the womb,
and he repudiates the terms amenorrhoza, dysmenorrhea, monorrhagia
and leucorrhcea, as inapplicable " to things substantive, because vague
and injudicious treatment must spring from vague and general terms
in medicine." — " Such words," says he, " can only be applied in an
adjective sense, to point out the different morbid conditions of the or-

craigie's pathological anatomy. 635

gans of generation, which produce in so many different ways the dis-
eases of menstruation." Then, by a sort of inductive process of rea-
soning, in his introduction and prolegomenon, of 74 pages, he brings
his' reader to the consideration of the " modus operandi by which in-
flammation, reacting on the ovaries, produces the several diseases of
menstruation."

At first we thought that Dr. Tilt had fallen into the common error
of specialists, of referring everything to the same cause and of con-
sidering too many different things the same disease. But upon peru-
sal we were led away by his statistics and reasoning, and grant, with
him, that the acute idiopathic form of ovaritis exists " much more fre-
quently than is generally believed, while the subacute variety is of
very common occurrence."

The treatise contains an immense amount of philosophy and prac-
tical information, which is drawn from observation and experience,
and is communicated in a happy, clear and unostentatious style. We
feel it due to our readers to recommend it to each one of them, as
being worth many times its price and an attentive perusal and study.

Elements of general and pathological Anatomy, presenting a view of the
general state of knowledge in these branches of science — By David
Craigie, M. D., F. R. S. E., Fellow of the Royal College of Physi-
cians of Edinburgh, and Honorary Consulting Physician to the Royal
Infirmary — second edition, enlarged, revised and improved. Philadelphia :
Lindsay Sf Blackiston. 1851. 1072 pp.

The present edition, which has just been issued in a very creditable
form by Messrs. Lindsay & Blackiston, has, we believe, been before
the British public for near four years. Dr. Craigie had succeeded in
making his first book an authority on the subject. The late edition is
much increased in value, for the reasons that it has been corrected in
accordance with the demands of modern pathology, whether in
changing old teachings or in adding new facts. It is reputed to be
one of the best compendiums of the elements of general and patho-
logical anatomy in the language. By a faithful compilation from the
most recent and reliable sources, Dr. Craigie has rendered his second
edition worthy of the praise bestowed upon the first, at the time of
its issue, by the profession generally. At some future time we may
discuss a few points touching questions of pathology, to which we
think full justice has not been done in the volume before us.

636 jervey's toxicological chart.

Cox's Companion to the Sea Medicine Chest, and Compendium of Domestic
Medicine ; 'particularly adapted for captains of vessels, missionaries and
colonists — with plain rules for taking the Medicines ; to which are added
directions for restoring suspended animation, the method of obviating the
effects of poisons, a plain, description of the treatment of fractures and dis-
locations, and a concise account of Asiatic or Spasmodic Cholera — re-
vised and considerably enlarged — By R. Davis, M. R. C. S. First
American, from the thirty-third London Edition. New York : S. S.
Sf W.Wood. 1851. 12mo.216yp.

The title of this book sufficiently indicates its character, and it
would be needless to dwell on its merits. To the ship-captain or
missionary it is serviceable ; for it gives, first, a list of medicines,
their doses and properties ; secondly, a description of dislocations
and fractures, wounds, &c, with their treatment ; and thirdly, an ac-
count of various diseases and the mode of their management. An
American editor has made smart and important additions to it.

A Toxicological Chart, exhibiting at one vieio the symptoms, treatment, an-
tidotes and tests of the various poisons, according to the most approved
classification, viz. narcotics, irritants and narcotico-irritants — By James
P. Jervey, M. D. Charleston, South Carolina. 1 sheet.

This is a most valuable and useful sheet, intended to bang on the
office wall. At a single glance, in the first column, may be found any
poison ; in the next, its symptoms ; in the next, its treatment ; in the
next, its antidotes ; and in the next, its tests. Though Dr. Jervey
lays no claim to any original information given on his chart, he has
certainly contributed something very useful to practitioners, students
and lecturers on medical jurisprudence, in the form in which a con-
cise view of toxicology is presented to them. We hope our friend
may be handsomely rewarded for his labor, and we are sure that he
will be, if the profession can once see his chart.

Notices of " Gregory on Eruptive Fevers" and other publications
received are crowded out of the present number.

We have to welcome to our table The New York Medical Times, a
neat monthly of 32 pages, edited by J. G. Adams, M. D. Terms,
$ 2 per annum. It bids fair to be a good journal, and we shall attend
to it in future. At the same time, we are called on to notice the obi-
tuary of the New York Register of Medicine and Pharmacy, which

is no more.

SELECTIONS. 637

Occlusion of the os tincae in a case of Labor, and successful
Delivery by Incision — Also, a case of removal of sixty-five
Tumors in one Operation.

[Reported, in a letter to Prof. Hamilton, by W. H. Reynale, M. D., of Dansville.]

Three weeks ago I was sent for to visit a lady, Mrs. Goodrich of
this place, in labor with her first child, of twenty-four hours' dura-
tion. When I arrived the pains were hard, frequent and pressing
down. Upon examination, I could find no os uteri. I waited four
hours, in hopes time might develop one, and made several minute
examinations during that period of time, but each examination satis-
fied me there was no os nor cervix uteri. Everything was perfectly
smooth where the natural opening ought to have been, and I could
feel the child's head distinctly pressing down upon the soft parts. I
now told the husband and ladies present the situation of the patient,
and requested another physician to be called in. Dr. Hovey was
sent for ; and subsequently Dr. Cook saw her — all agreed that the os
and cervix uteri were wanting, and that there was no natural opening
for the child to pass through. Before Dr. Cook saw the patient, Dr.
Hovey and myself made use of two vaginal speculums — one of gutta
percha, and the other of German silver — both excellent instruments.
We saw distinctly every part of the vagina — examined minutely the
back, sides and upper part, and where the os uteri naturally ought to
have been, here we examined with a probe introduced through the
speculum, but nothing in the shape of the smallest opening could be
found. Of course nothing could be done but to cut and make an arti-
ficial opening ; this was done nine hours after I first saw the patient.
I wound a spear-pointed bistoury within half an inch of its point, and
by carrying it between my index and my middle fingers, I made an
incision of about two inches in length at the exact spot where I sup-
posed the os uteri naturally ought to have been ; water followed the
incision. The opening dilated upon the contraction of the womb.
The incision continued to dilate very much as the natural os would
upon the contraction of the womb, and at the expiration of two and a
half hours she was safely delivered of a healthy female child weigh-
ing nine and a half pounds. The patient has recovered without one
bad symptom.

Fourteen months ago, I was desired to see a son of Mr. Mur-
ray, ten years of age, of Ossian, Allegany county, eight miles from
this place. I found the boy small of stature, very pale, with a large
tumor on the left side of the neck. He looked like a child with two
heads, only the tumor was the largest. It occupied the whole space
from the root of the ear to the acromion process of the scapula ; filled
up everything from the spinous processes of the cervical vertebra to
the clavicle, run from the ear along the lower side of the cheek and
jaw bone, to beyond the trachea on the opposite side of the neck ; so
that in fact it filled up and occupied a little more than the entire space
on the left side of the neck, and threw the head on the opposite
shoulder. I removed the entire mass, with the assistance of Doctors
76

638 SELECTIONS.

Endress and Patchin ; we took out sixty-five distinct tumors, attached
together by a cellular substance from the size of a goose egg and larger,
down to that of a marrowfat pea ; they were of a fatty substance, I
think. They filled a half gallon jar after their removal. The patient
recovered so as to enjoy tolerably good health for eight months, when
a number of small tubercles began to form around the margin of the
old extirpated tumor — most were on the shoulder, some near the ear,
and a few near the clavicle and spine ; all were on the circumference,
and none on the cicatrix. He soon after this began to complain of a
pain in his left side, just below and beneath the false ribs. His father
fetched him to my house ; upon an examination I found a tumor of a
large size under and coming out from beneath the ribs, and quite pain-
ful to the touch. I told the father I could do nothing for his son, the
disease was of a malignant nature, and that he would die. He lived
twelve months from the time of the operation, and died. His father
sent me word at the time of his death, according to agreement; but
in consequence of my being from home at the time, I did not get the
information, and no post mortem examination was made, which I
much regretted.

We kept our little patient fully under the influence of chloroform
during the whole of the operation, which lasted nearly two hours, but
full one half of the time we desisted from cutting, and applied resto-
ratives, as the patient sunk low. You may probably think we used
the chloroform too long ; but we weighed the chances of the patient
in our own minds, for and against the influence of chloroform on his
nervous system, before the operation. We believed he would sink
under the influence of the operation without the use of the chloroform,
and that he could but die with its use. We decided, after mature
consultation, to use the chloroform — it did, upon the whole, well —
the patient had no knowledge of pain.

After the entire mass, externally, was removed, we discovered that a
tumor of the size of a black walnut, was lying under the clavicle ;
this we removed without much difficulty ; then another was discovered
lower down, of about the same size ; this I seized with two tenacu-
lums, one in each extremity of the tumor — an assistant held them
firmly and made a little pressure upwards, when, partly by dissecting,
and partly with the handle of the scalpel, and partly with my fingers,
I succeeded in extracting this also ; but still there was another one of
the same magnitude, lying yet deeper and beneath the last one — this
laid below the second rib ; it was also seized with two tenaculums,
and firmly held by an assistant, until partly with the handle of the
knife, but mostly with my fingers, and a very little dissection with the
knife when it could not possibly be avoided, I succeeded in getting it all
out — no more could be felt. It is unnecessary to describe the situa-
tion of the patient, from day to day, during his convalescence ; for the
first few days he vacillated between hope and fear, but the powers of
nature came to our assistance, and the patient recovered so far as to
enjoy tolerably good health for eight months ; ate and slept well, the
countenance improved, and he looked better than he had for two years
before the operation. The head resumed its natural position, and the

SELECTIONS. 639

rotary motion was good. The patient went to school some two or
three months during this time. This enormous mass was only two
years in growing ; when it was first discovered it was of the size of
a filbert, or smaller, and situated directly at the root of the ear. Mr.
Murray says many applications were used to discuss the tumor, but
they all (he thinks) hastened its growth. — Buffalo Medical Journal.

Convulsions of Children.

Although there are many varieties of this disease and many differ-
ing symptoms, its pathology would justify the assertion, that its great
predominating source is found in the changes and vicissitudes occur-
ing during first dentition, and which produce those phenomena re-
sulting from a disturbance in the nervous system, or depending upon
derangement of the gastric juices, at such times when it is known
that the process of dentition is usually working a great revolution in
the whole system, and from which source arises the extreme mor-
tality of infant life, and principally from convulsions. Post mortems
rarely, if ever, shew other signs, seldom exhibiting spinal or cerebral
inflammation, and the attack having been accompanied by uneasiness,
fretfulness, diarrhoea, and other symptoms, universal attendants upon
difficult dentition.

Again, we see its prevalence in children who possess all the attend-
ing signs of tardy, difficult or irregular dentition — such as want of
good development in the muscular system, the bones small, thin and
delicate, cranium badly shaped, either in being too large or too small,
or irregular, with consequent disproportion in the brain, large abdo-
men, small limbs, a meagre and sallow complexion, with other ema-
ciated appearances — all denoting unusual difficulties in cutting of the
temporary teeth, and which process will invariably produce convul-
sions in subjects possessing the before-mentioned traits ; for, undoubt-
edly these congenital defects may exist in the constitution as latent
causes, requiring only the action or operation of a painful and dis-
turbed dentition to excite and put in force, without which they might
exist until the system was capable of correcting or opposing their con-
sequences.

Other exciting causes are sometimes found to produce convulsions —
such as the excessive nervous sensibility of an infant, cerebral inflam-
mation, anaemia, a paroxysm of fever, the presence of worms, excess
or diminution of nervous vitality, &c. &c, but by no means as fre-
quent as an idiopathic as a symptomatic disease, which, as said before,
is generally the effect of dentition. When attacks appear without any
premonitory symptoms in a delicate or nervously constituted child, of
vivacious deportment and conduct, and if after the paroxysm, it as-
sumes its wonted condition, there can be little doubt of its being pure-
ly nervous and idiopathic, which becomes a certainty by a frequent
repetition of fits, separated by intervals of undisturbed health.

Those convulsions which are purely symptomatic arise principally
from dentition, from the great afflux of the juices to the head and fol-

640

SELECTIONS.

lowing congestions and increased susceptibility to cerebral derange-
ments and nervous excitability at the same time, abundant salivation,
diarrhoea, fretfulness, and muscular spasm. The gums are swollen,
tinged and excessively tender, often so much so as to give extreme
pain to rub or even touch them ; again, the greatest satisfaction may
be expected from friction. Now, as far as we have been enabled to
learn, under these circumstances no treatment can be employed as
serviceable as the free scarification of the gums. Often, nothing will
assist the little sufFerer but this, which, when performed, operates like
magic to its almost instant relief, and, under these circumstances,
nothing can be more pernicious than to treat such patients with drugs
and medicines, for they seldom if ever recover from such debilitating
effects during so vital a period of their existence. We do not enter
into an argument with those who oppose the use of the lancet, as facts
speak for themselves, and are sufficiently numerous to establish this
point in the mind of every practitioner — that convulsions resulting
from dentition as a primary or secondary cause, must be treated first
by the free use of the lancet ; cutting the gums in a crucial incision ;
afterwards, such treatment as will tend to improve the general tone of
the health and constitution of the patient. R. M.

[Dental. Times.

The " Dublin Journal" gives the following diagnosis of Asthma and
(Edema of the Glottis, as contra-distinguished from each other:

Diagnosis between Spasmodic Asthma and Submucous La-
ryngitis or CEdema of the Glottis.

A. — Symptoms in Common.

The patient is seized with a fit of suffocation, which soon attains its
highest degree. The countenance becomes congested, the eyes start-
ing from the orbits, and at the same time the extremities become cold ;
in short, presenting the appearance of asthma in its severest form.

B. — Distinguishing Symptoms.

In CEdema of the Glottis.

1. Inspiration produces no painful sensa-
tion in the chest, but only in the larynx, to
which the patient refers all his difficulty of
breathing.

2. Every effort to draw in the breath is
accompanied by a wheezing sound.

3. Expiration goes on uninterruptedly.

4. The patient thinks there is some large
foreign body in his larynx, which he would
gladly get rid of.

5. The suffocative attack lasts only from
two to four minutes.

6. It returns in from five to ten minutes.

7. The cough is dry and of a croupy
sound.

In Asthma.

1 . The impediment to inspiration is proved
to be not so much in the larynx as in the
chest.

2. Inspiration takes place without any
peculiar sound in the larynx.

3. Expiration and inspiration are equally
difficult

4. No sensation as of a foreign body in
the larynx.

5. The asthmatic attack lasts several hours.

6. It returns at the utmost in about every
twenty-four hours.

7. The cough moist and with the usual
sound.

SELECTIONS. 641

The Gold used by Dentists.

To the Editor of the Times.

Sir — My attention was very forcibly drawn to a short paragraph
in the corner of the Times of Monday, headed " The gold used by
Dentists," and I could but regret, for the public benefit, that a caution
so valuable had not occupied a more prominent place in your widely
circulated journal.

It has happened, unfortunately, to a member of my family, that a
most severe and distressing disease has originated from the very
cause assigned by the writer of that article, namely, the impure
metal used in the construction of artificial teeth. Unhappily for me,
in my ignorance of the results, I consulted a dentist upon the strength
of a flaming advertisement, rather than upon the recommendation of
my medical attendant ; and now, while I witness the distressing re-
sults in my own family, I feel assured that your caution may be the
means of preventing others from incurring the same danger.

The writer of the paragraph proposes that all the gold used in the
manufacture of teeth should be stamped as standard gold — a very
excellent suggestion ; but I am informed that among the respectable
members of the profession the gold employed is of a standard even
higher than that which is stamped, and that from this metal no evil
results can possibly accrue, but that where a competition exists to
manufacture teeth as men would make penknives, at so much per
dozen, the quality of the metal is to be suspected. I will not occupy
more space than to express a hope that my desire to save others
from danger may be a sufficient apology for offering this for your
publication.

I am, sir, your obedient servant,

A. B.
March 20th.

Swain's Vermifuge — the American Patent Medicine.

Semen contra,
Valerian,
Rhubarb,
Spigelia,
White agaric,
Essence of tanacetum,
" cloves,

Boil the first five substances with sufficient water to form 3 kilo-
grammes of decoction ; dissolve the essence in 1 kilogramme of
alcohol ; add the decoction and filter it. — Bulletin Therajpeutique.

60

grammes.

45

(C

45

u

45

((

30

(<

2

11

3

((

642 SELECTIONS.

Examination of the G-enital Organs of a young Woman who
was Assassinated during Menstruation.

The researches of Bouchet, BischofFand others have satisfactorily
shewn that menstruation coincides with the spontaneous maturation
and discharge of ova. An observation by M. Jauzer (Medicinische
Annalen) adds another to the many recorded cases which countenance
the ovular theory.

The young woman who forms the subject of the present case com-
menced to menstruate four days prior to her murder. The autopsy
was made sixteen hours after. The surface of the left ovary presented
a dark red spot, surrounded by minutely injected capillary vessels ;
this spot was formed by a little globular mass embedded in the ovary.
The mass in question was separated from the tissue of the ovary by a
thin, yellowish envelope, composed of fibres intermixed with fat glo-
bules. In close apposition to this membrane a small, irregular spherical
body was seen, composed of cellular tissue and fat.

The right ovary contained two corpora lutea, the Fallopian tubes
were swollen, and contained a fluid resembling and composed of epi-
thelial scales. There was no trace of an ovule, or of spermatozoids.
The uterine mucous membrane was injected, and had a velvety ap-
pearance ; it was easily detached with the scalpel. It was evidently
thickened, and was covered with a thin, mucous secretion.

From this case it appears that the uterine mucous membrane, at the
menstrual period, assumes an appearance analogous to that which it
puts on during gestation, especially as regards the development of the
mucous follicles. — Provincial Medical and Surgical Journal.

Medical Reform, No. 2.

BY JAMES H. STUART, M. D.

In my last I endeavored to depict the necessity for a medical re-
form ; in my present, I purpose modestly to suggest the means. Legis-
lative interference is, as before stated, for obvious reasons, manifestly
out of the question. But we yet have left to us an unfailing resort.
The great American Medical Association is, or ought to be in the
medical world, a legislative body from whose decision there can be no
appeal. It is composed of delegates, chosen for their competency,
from all sections of the Union, and, of course, perfectly conversant
with the wants and interests of their own peculiar districts. Recom-
mendations from it have heretofore had almost the weight of law.
Witness the six months' lecture term, which was immediately adopt-
ed by that noble old institution, the University of Pennsylvania, and
has been since gradually coming into vogue among the other respect-
able schools of our country. In fact, as anything emanating from
that body is but an expression of the will of the educated practition-
ers throughout the Union, it is impossible to withstand it. Now let
the delegates to this great power once fully understand the necessity

SELECTIONS. 645

Statistics of Mortality of Baltimore, Maryland, in 1850.

BY L. S. JOYNES, M. D., OF ACCOMACK, VIRGINIA.
[Extracted from a Letter to the Editor.]

Having already furnished you with detailed statements concerning
the mortality of the city of Baltimore, during a period of fourteen
years, ending with 1849, (which statement was published iu the
American Journal for October 1850,) I will seize the present opportu-
nity to add a word in reference to the mortality for the year 1850. I
am chiefly induced to do so by the fact that the decennial census
taken in that year enables us to compare the mortality with the popu-
lation.

The population of Baltimore in 1850, as given in a publication be-
lieved to be authentic, was as follows :

White population, ----- 141,440

Free colored " - - - - 24,668

Slave " - - - - 2,946

27,614

Total, - - 169,054

Thus it appears that the total population in the decennial period
1840-'50, increased very nearly sixty-five per cent. ; the increase of
the white population was but little less than seventy-four per cent.,
and that of the black population nearly thirty per cent.

The mortality for the year 1850, as given in the annual report of
the board of health, was in the

White population, _____ 3,725

Free colored " _ _ _ _ 641

Slave " - - - - 259

900

Total. - - 4,625

Excluding the still-born, (415 in number,) the deaths amounted to
4,210.

From this it is evident that, notwithstanding the vast increase of
population which the census exhibits, the. increase of mortality has
been still greater. The deaths in 1850 are more than double the
number of those in 1840, and by referring to the tables contained in
my paper above referred to, it will be found that this disproportionate
mortality was already remarkable in the year 1849, and one or two
years preceding. Consequently the ratio of mortality to the population,
which I formerly gave, does not hold good for these more fatal years.
The ratio for 1850, (excluding the still-born,) was 1 in 40.13 of the
general population ; whereas in 1840, it was 1 in 50.13 ; and for the
nine years 1836-'44, as determined by calculation, 1 in 45.42.

The causes of this excess become evident on referring to the de-
77

646 SELECTIONS.

tailed statement of the causes of death, given in the reports of the
board of health. I have no design at present to trouble you with the
details of the tables for 1850, but will merely state that the deaths
from diseases of the bowels of the zymotic class exceed those of any for-
mer years, at least since the beginning of the period which I have
made the subject of investigation. The total number of deaths from
these diseases — cholera morbus, cholera infantum, diarrhoea and dys-
entery, was 651. The only preceding year in which their fatality at
all approaches this high number was 1849, when the aggregate was
539. In 1848, the next most fatal year from these diseases, it was
but 314. The increased fatality of dysentery is especially remarka-
ble. Thus we find that, in the thirteen years preceding 1849, the
deaths from this disease varied from 7 to 46 annually. In 1849 they
suddenly rose to 148, and in 1850 to 237. So the deaths from diar-
rhoea, which had never exceeded 15 in any one year, amounted to 69
in 1849, and 40 in 1850, and those from cholera morbus, of which
the annual maximum had been 9, amounted in those years respec-
tively to 32 and 27. The deaths from cholera infantum, (amounting
to 347 in 1850,) exhibit an increase more nearly according with the
annual increase of population.

The year 1850 also exhibits a great increase of deaths from small-
pox. Since the years 1845 and 1846, when 225 persons died of that
disease, comparatively few cases of the disease had occurred, the
deaths in the three years following numbering 1, 4 and 19 respective-
ly, to which may be added 5 deaths from varioloid and varicella. In
1850 the fatal cases of smallpox amounted to no less than 145, while
8 are set down to varioloid, and 3 to varicella, making 156 deaths due
to this group of diseases.

If the excessive mortality from the zymotic diseases which have
been mentioned was deducted from the sum total of deaths for the
year 1850, it would leave the ratio of mortality for that year almost
exactly the same with that which I formerly gave as the average rate
for the city of Baltimore. — American Journal of Medical Science.

Monstrosity.

Drs. J. Cohen and M. A. Durr, physicians of Jacksonville, Telfair
Co., Georgia, have in their office a curious natural phenomenon, in
the shape of a negro child, born upon the premises of David J. Wil-
liams of that town, which weighed twelve pounds, and had two well
formed and separate heads and necks, two arms and two spinal co-
lumns, three legs with feet attached, two in their natural position and
the other coming out on the back of the region of the hips, with two
hearts, partially joined together, two lungs, and other anomalies.

[Bosto7i Med. and Sur. Journal.

THE

4

AND

VIRGINIA MEDICAL GAZETTE.

No. 12.1

RICHMOND, DECEMBER 1851.

[Vol. I.

Report of a Successful Case of Trephining for Compression of

the Brain.

BY J. W. H. TRUGIEN, M. D., OF PORTSMOUTH, VA.

The report of the following case has been delayed until its result
could be clearly established. It has ever been too much the custom
with physicians to be hasty in the report of their cases — and many
which have been published in the journals as successful, though in
truth they were so, as far as their immediate result was concerned,
have ultimately proved otherwise ; and that, too, in some instances,
it is to be feared, before the pages which contained the record of them
had been given to the public. Such a course of proceeding is unfair,
and detrimental to the true interests of our science, even though not
so designed. The writer hopes, in the narration of his case, to avoid
the same error. The subject of this report has so far recovered as to
have resumed the active duties of life, being now engaged as a watch-
man at the railroad depot at this place. His general health is very good
— even better, according to his own statement, than before the recep-
tion of the injury. It is but fair to state, however, that the wound of
the operation is not yet entirely healed, a slight purulent discharge
continuing, owing to exfoliation of the outer table of the skull. Se-
veral pieces have been removed at different times., and a small portion
at the dressing of yesterday. Mental integrity has been completely
restored, and the special senses (with the exception of that of sight)
are unimpaired. Vision is not as good in the left eye as in the right.
In the relation of the case I shall merely transcribe my notes made
from day to day during its course.

June 25th, 1851. — Called to see J T ; occupation, laborer ;

aged 25 ; married. Stabbed in the head, a few minutes previously, with
a knife; particular kind of knife not ascertained; situation of wound
above left frontal eminence ; sitting up ; pale from loss of blood ; no
fracture or other lesion of bone discovered. Injury considered, and
treated as a simple penetrating wound of the scalp.
78

648 trugien's case of compression of the brain.

26th. — Met patient on the street, feeling very comfortable.

27th. — Called to have wound dressed. Appearance good ; union
by first intention ; feels comfortable ; some restlessness, however, the
preceding night ; bowels unmoved since infliction of injury. B-- Mag-
nesias sulph. 5j.

29th. — Again called to have wound dressed. Cicatrization com-
plete ; some uneasiness about the head, attributed (at the time) to ex-
cessive heat of weather and the thick growth of hair which covered
the head, and which the patient refused to have shaved. It is proper
to remark, in this place, that a medical friend present at the time
thought he perceived some tumefaction below the wound and above
the left eye. And as it will have some bearing upon the subse-
quent history of the case, mention must here be made of what was
afterwards learned from the patient's wife, viz : that on his return home
this day, he for the first time manifested some mental disturbance.
On entering the house he remarked to her, that he should have to go
out again to have his hair cut ; and " I want, and I want," he slow-
ly and hesitatingly continued to repeat, without the ability of telling
what it was in reality he wanted. Getting worse and worse, he did
not go out that day. From this date until July 2d, the history of the
case is imperfect, as during this time he was under the treatment of
another physician.

July 2d. — Saw patient again; found him in a half comatose condi-
tion ; stupidily of expression ; tumefaction below the wound ; skin
pitting on pressure; great disposition to sink back into the somnolent
state after being aroused ; pupils dilated ; respiration slow, but unat-
tended with stertor ; great disposition to gape and yawn ; pulse 60,
full, slow, and laboring; bowels constipated, and urinary secretion
deficient. The attending physician had very properly cupped him
back of the neck, purged him, applied counter-irritants to the lower
extremities, and placed him upon a mercurial course. No opening
had been made into the swelling, from the impression that it was of
an cedematous character. Hair had not been removed ; recommend-
ed its removal.

July 7th. — Again a gap occurs in the history of the case until the
above date, the patient not having been under the care of the writer
during this time. Hair had been cut off, and for the first time another
wound was discovered about an inch and a half above the first, and
as nearly as possible over the coronal suture ; surrounding tumefac-
tion much reduced by the discharge of pus which was issuing from the
wound. The introduction of the probe discovered the bone to be in-
jured, the knife having penetrated it — to what distance, or whether
it had passed through the diploe and internal table, could not then be
ascertained.

Symptoms. — Great somnolence; stupid, vacant expression of coun-
tenance on being roused ; much gaping and yawning ; pupils dilated ;
some ptosis of left eye-lid ; free discharge of pus ; puffiness of scalp
gone; no pain or uneasiness of head ; respiration slow; no stertor;
tongue protruded without difficulty — coated with a 3'ellowish fur;
pulse 60, full, slow, laboring ; bowels constipated, and urinary secre-

TRUGIEN S CASE OF COMPRESSION OF THE BRAIN. 649

tion deficient ; intellect much impaired; memory prominently impli-
cated ; patient unable to recall the names of even his wife and chil-
dren ; unable to tell whether he had eaten or drunk anything that day.
A watch being shewed him, he tells the hour, but not the minutes be-
fore or after a particular hour. Ordered one of the following pills
every half hour, until free purging ensued : — ft. 01. tiglii gttas ij —
micas panis q. suf. Ft. Mass. Div. in pil. No. iv. Sinapisms to the
back of the neck and lower extremities; egress of pus to be pro-
moted by warm applications to the wound ; light, unirritating diet.

8th. Symptoms same as yesterday ; no action from Croton oil. Or-
dered following enema : ft 01. tereb. ol. ricin. aa. 1 j.

9th. No improvement. Enema did not act, though thrice repeated,
ft Hyd. chl. mit. gr. xx., jalapae. pulv. gr. xxx., and repeat enemata.

10th. Much the same. Bowels twice moved.

11th. More rational to-day.

12th. Better to-day; understands questions, and replies with more
readiness. Conversed with his wife, noticed his children, and recog-
nized different individuals. Free discharge of pus from the wound.
Pupils dilated, pulse 48, full and strong. Urine voluntarily discharged.
Ate some light, nutritious food.

13th. Passed a bad night. Early in the evening restless and un-
easy ; tossing the head about, and then sinking back into a state of
somnolency, amounting to almost complete insensibility — in which
condition he was found at the visit of this morning. Utterly uncon-
scious of what is going on around. Pupils dilated, and not respond-
ing to the action of the light. Pulse full, slow, apoplectic, 44 in the
minute. Inability to protrude the tongue. Wound discharging pus
freely.

14th. No improvement. Operation of trephining determined upon,
after a fair statement of its dangers to the family.

Four o'clock, P. M. Patient lies as if in articulo mortis. In the pre-
sence of Drs. Tho's Williamson, surgeon U. S. N., J. N. Schoolfield,
Young, Maupin and Jas. Williamson of this place, Drs. Moore, Up-
shur and Wright of Norfolk city, and Dr. J. W. Garlick of King &
Queen, the operation was performed, as follows : The hair having
been shaved off to the extent of several inches around the wound, a
crucial incision two inches in extent was made over it, and carried
down to the bone. The haemorrhage from these incisions was incon-
siderable. The crown of the trephine was then applied, and with it,
for a guide, the pericranium was divided, by means of a scalpel, all
around, so as to permit the teeth of the instrument to come in contact
with the bone directly ; the centre pin adjusted and the operation of
boring commenced and gradually and carefully continued until the bone
was completely drilled through and the button removed — whereupon
a gush of purulent matter instantaneously issued from an opening in
the dura mater, and continued to flow to the extent of an ounce and a
half — the patient immediately emerging from his state of stupor and
conversing with the by-standers. The pulse, which at the commence-
ment of the operation was 44, at its close had mounted up to 80.
Wound dressed with adhesive strips and compress, one end being left

650 trugien's case of compression of the brain.

loose for the discharge of pus. Circular bandage also used to con-
fine a compress over the middle temporal artery, which had been di-
vided and was bleeding. My friend, Dr. J. Williamson, very kindly
consented to remain with him during the night, which was passed
quietly.

15th. Doing well ; perfectly rational ; pulse 70 ; has taken some
light nourishment. Wound looking well; lightly dressed.

16th. Quite comfortable; pulse 60; pas continues to flow from
opening in dura mater. A probe introduced into this opening was
passed down to the depth of two inches and a half by measurement,
in an oblique direction, towards the anterior corner of the left lateral
ventricle.

17th. Slept quietly last night ; pulse 60 ; wound looking well.

ISth. Removed 1 iss. of pus from abscess of the brain, by means
of a small glass syringe, the nozzle of which was introduced into the
opening through dura mater. Bowels confined. Ordered ol. ricini f ss.

19th. Removed half an ounce of pus from abscess.'

20th. Doing well. Found patient sitting up smoking pipe. From
this date the patient continued to improve until the present time, when
his condition is as described in the remarks prefatory to the case.

Remarks. — Injuries of the head have ever been subjects of great-
est interest to the surgeon, as well from their frequent occurrence as
from the obscure and anomalous symptoms occasioned by them. Ow-
ing to these latter circumstances, their diagnosis is complicated ;
prognosis rendered extremely fallible, and treatment undecided, and
too often inefficient, if not actually hurtful. Nor is it so much to be
wondered at, when we consider how obscure and unsettled are the
phenomena of the brain and nervous system, even in their normal ac-
tion. But when disturbed, as is most generally the case, by such inju-
ries, they are rendered doubly obscure and unintelligible. Concus-
sion and compression of the brain have ever engaged the most serious
and earnest attention of the surgeon in their investigation ; and al-
though when well marked, there can be but little difficulty in diagnos-
ing the one from the other, there are cases which puzzle the most
discriminating. The two lesions may insensibly run into each other —
what was concussion in the first instance becoming compression after-
wards. Or there may be such a combination of symptoms that we
are in doubt whether to call it a case of concussion or one of com-
pression— the two morbid conditions seeming actuall}' to co-exist. In
the foregoing case the symptoms, though at first ill defined and ob-
scure, were obviously due to compression of the brain. But what
was the compressing force, was not equally clear. A portion of the
internal table of the skull might have been detached by the force of the
blow, and caused pressure upon the cranial mass. Or the same blow
might have ruptured one or more of the delicate meningeal arteriolae,
and given rise to pressure from haemorrhage. Again — inflammation
may have been lighted up in the meninges of the brain, and caused
pressure, by the effusion of pus upon the cerebrum. In fact, some one
or all of these reasons were adduced in explanation of the symptoms,
by various medical gentlemen who saw the patient. However plau-

trugien's case of compression op the brain. 651

sible, none of these explanations were satisfactory to the writer, who,
early in the case, and before the second wound was discovered, re-
ferred them to penetration of the bony parietes of the skull, as well
as the membranes, by which inflammation and subsequent suppura-
tion had been occasioned. Hence, the gradual supervention of the
symptoms. This opinion, which he is happy to state was concurred
in by one or two of his confreres, received an ample confirmation by
the result of the operation ; for the button of bone removed by the
trephine shewed a cuneiform perforation of the third of an inch in
length, as also the dura mater to the same extent. On reversing the
button also, a spicular of bone attached to its lower angle was disco-
vered.

With regard to the treatment of this case, candor compels the ad-
mission that it might have been more actively antiphlogistic. But
whether this would have at all conduced to a more favorable result,
is very questionable. My own conviction is that it would not, and
that the freest general depletion, the only part of the antiphlogistic
course omitted, would have been unavailing in obviating the necessity
of an operation. Still, I am free to admit that under the same circum-
stances, I would most copiously deplete from the general circulation,
in order to give the patient every chance of recovering, without expos-
ing him to the risk of such an operation, which, though successful in
instances innumerable, is always attended with much danger to the
patient, and, in multitudes of cases, fatal, either from the supervention
of acute inflammation of the brain and its meninges, or the more remote
consequences of hernia cerebri. No case in medicine or surgery,
however simple, can fail, if closely studied, to afford useful and instruc-
tive practical lessons. The study of this case has been replete with
such to the writer. It adds another to the many recorded instances
of severe injury to the brain, from which recovery has taken place
under seemingly the most unfavorable circumstances, and encourages
us never to despair of affording relief even at the last extremity. A
volume might be filled with cases illustrative of what has been said.
The recorded experience of army surgeons upon this point is indeed
almost incredible, but for the undoubted veracity of the writers. The
work of Mr. Guthrie on "Injuries of the Head," is full of cases of this
kind. The conclusions of this surgeon, after the enumeration of many
cases in support thereof, are that " injuries of apparently equal extent
are more dangerous on the forehead than on the side or middle of the
head, and much less so on the back part than on the side." He
further remarks: "I have never seen a person live with a foreign
body lodged in the anterior lobe of the brain, although I have seen
several recover with a loss of a portion of the brain at this point."
The medical journals of the day have contained the records of reco-
very from the most extensive and terrible injuries of the head. Dr.
Harlow's case of "recovery from the passage of an iron bar through
the head," (vide American Journal of Medical Science, July 1850,)
must be familiar to every professional reader. Plrysiologieal experi-
ments too, as those of Flourens, Majendie, Mayo and others, clearly
demonstrate that the most severe injuries muy be inflicted upon the

652 grigg's case of strangulated hernia.

brain with comparative impunity, and that it may be even sliced
away to a very considerable extent, without destroying the animal.

Without protracting these remarks, I would, in conclusion, call
attention to two practical points connected with the case. Mention has
been made in the detail of the case of the use of the syringe in evacu-
ating the abscess of the brain of its pus. Mere position would not
have accomplished this, as it was fairly tried. Suction, by the instru-
ment, however, was entirely successful in the removal of every particle
of pus. The writer remembers having heard this plan recommended
by Dr. William Gibson, of the University of Pennsylvania, and can
bear testimony to its efficiency.

One word in regard to the construction of the trephine. As ordina-
rily made, there is no provision for the division of the penicranium;
and unless this is effected by means of a scalpel, that membrane is
mangled by the teeth of the instrument, much to the detriment of the
patient. This is entirely obviated by the use of an instrument such
as that suggested and figured by Dr. Gibson, in his Work on Surgery,
vol. ii., page 419, eighth edition.

Portsmouth, Va., November 3d, 1851.

A Case of Strangulated Hernia — Operation, with fatal result.

BY P. S. GRIGG, M. D., OF FARMVILLE, VA.

Ben Webber, colored man, ast. 48, has labored under scrotal hernia
for 20 years, and during this long time has been subject to frequent
momentary strangulations, but never failed to relieve himself, either
by position or manipulation, till the present occasion. He lives a mile
or two from town ; and while here on the 16th Sept., strangulation came
on about 8 o'clock, P. M. ; it occurred at the circus, (then exhibiting
in our village,) and of course he could not think of leaving till he saw
the dragon killed. The exhibition closed about 10 o'clock; immedi-
ately afterwards he made repeated attempts to return the bowel
in his usual manner. All means in his power proving ineffectual,
he started home, but was only able to get a short distance before
distressing pain compelled him to return. I was called to see him
at 12 o'clock ; found the sac distended to the size of a half gallon
jug — the neck as rigid as rawhide ; the poor fellow in a state of
awful anxiety and apprehension, with now and then severe retching.
The size of the sac rendered it very inconvenient to manipulate ;
yet I occupied 15 or 20 minutes in many vain attempts to return
by taxis, and am sorry to say my best directed efforts were unavail-
ing. I then gave him a dose of ol. ricini, with 30 drops laudanum,
which had no effect. Between 4 and 8 o'clock, A. M., of 17th, I
took blood nearly to syncope, nauseated with t. emetic, without the
slightest giving wa}T of the stricture. I next gave a heavy dose of
c. e. colocynth and calomel ; this was thrown back promptly, for the
retchings had continued at short intervals since I first saw him.

Finding the case becoming hourly more hopeless, I asked a consul-
tation with Dr. Lyle and Dr. Chappell of this place. Dr. Lyle sug-

grigg's case of strangulated hernia. 653

gested the propriety of tapping, feeling confident there was associated
with hernia an accumulation of fluid in the vaginal tunic ; and very
well was the diagnosis verified, when on introducing a trocar and ca-
nular, we witnessed the discharge of a pint of brownish colored se-
rous fluid. This lessened considerably the tension of the sac — still
taxis could avail nothing. We next ordered the entire sac enveloped
in ice ; and immediately on its removal, resumed our efforts at taxis,
but with no better success.

It was now 12 o'clock of the 17th, and the condition of the patient be-
ginning to threaten afatal termination. The medical gentlemen above al-
luded to being present, and favoring a timely operation, we agreed to
meet at 4 o'clock, and if by that time there was no change for the better,
to divide the stricture by cutting. We accordingly met, and finding
things growing hourly more desperate, determined to operate at once.
Having made the necessary preparation and put the man in a suita-
ble position, we found a long incision unavoidable, and as a landmark
to the operator, drew a chalk line to define the direction and distance
to be followed in the operation. Taking the knife in hand, I made a
cutaneous incision five inches long, in a direct line with the axis of the
neck of the sac, commencing three inches above Poupart's ligament.
The sub-cutaneous tissues being thin, a few touches with the knife
exposed the external oblique muscle — this being divided on the direc-
tor, the crural arch presented. Again making use of the director, I cut
through the conjoined tendon, and divided the two remaining muscles
to the extent of the original wound. At this moment there was evi-
dent slackening of the stricture — so much so, we delayed a reasonable
time, and made further warrantable attempts to reduce by taxis, ho-
ping to reduce without opening the sac ; but failing in this, we pinch-
ed up a little bit of the sac at a time, till an entrance was effected
for the director. Having made an extensive opening, we found seven
or eight feet of gut in the sac — that portion of intestine immediately
around which the stricture passed was ecchymosed, of a dark claret
color, but still we saw no sign of existing gangrene.

We could not readily return the bowel — but the difficulty encoun-
tered in doing so was chiefly due to the presence of some fluid and
much gas it contained.

The lips of the wound were now brought in apposition and fixed by
half dozen stitches, and a pretty firm compress and supporting band-
age applied. There was no artery touched, and consequently the
loss of blood did not exceed an ounce; in about half an hour he com-
plained of feeling chilly, with feeble pulse, but rallied promptly under
the use of a little brandy. We saw him again at 9 o'clock — a little
tympanitic; complaining of some tenderness over the bowels; gave
him to-night —

fr Hyd. submuriat, - gr. vi.

Pulv. opii, - - gr. i.

M.

8th. Passed a very comfortable night; no motion from bowels;
tympanitis increased ; gave him this morning —

654 grigg's case of strangulated hernia.

ft 01. ricini, - - - 1 ss.

Spt. terebinth, - - - 3 ss.

After an. hour or two, ordered warm water thrown in the bowel.
Called in the evening ; no action from bowels yet ; complains of
nothing, save tympanitic distention of the belly — for which we ordered
extensive fomentations kept up during the night ; takes calomel and
opium again to-night.

19. Quiet this morning ; no stir from bowels yet ; order ol. ricini
and spt. turpentine, as on yesterday morning ; warm water enema-
ta likewise kept up at proper intervals. Called in the evening — the
injections have been returned during the day with feculent odor and
discoloration.

20th. Had an easy night, and two pretty free operations from the
bowels since we saw him ; lips of the wound look somewhat flabby,
and are only partially united ; suppurates very little.

21st. Doing very well — bowels now acting regularly.

22d. Getting on quietly; insists on being allowed strong food.

23d. Find him entirely comibrtable, and craving food.

24th. Worried with cough, which gives him pain about the seat of
operation.

25th. Doing well ; union of wound progressing rapidly.

27th. Entirely easy.

29th. Comfortable and in fine spirits ; wound completely cica-
trized.

Oct. 1st. — We apply to-day a supporting apparatus immediately
over and around the cicatrix, and allow him to be taken home on a
cart, a distance of three miles.

Oct. 5th. — Bowels regular ; walks about the house — but complains
of seizures of severe twisting pain, at intervals of an hour or two, in
the umbilical region.

10th. Still suffering with wringing pain about the umbilicus, as on
the 5th — opiates afford only temporary relief.

15th. Griping pains continue, but less acute ; restrict his diet ;
bowels rather torpid ; patient becoming more emaciated. Immedi-
ately under, and adhering to the cicatrix, we discover to-day a semi-
solid lump the size of a ripe fig, and feel convinced adhesion has
taken place between some portion of the bowel and the wTound.

20th. Griping pain continues ; bowels more torpid, but operate
after castor oil — tenderness increasing a little at the point where ad-
hesion is suspected.

25lh. The man to-day looks badly ; his features have a pinched,
sharp appearance, with unquiet expression ; still troubled with grip-
ing, but no pain about the cicatrix ; bowels fail to act, save after cas-
tor oil ; immediate^ under the cicatrix, on percussion, we have a dis-
tinct liquid splashing, seemingly hardly skin deep.

2Gth. I was this morning at 6 o'clock called in great haste to see
this man — the messenger reporting the "place had bursted." About
4 o'clock A. M., while lying quietly in bed, there was a giving wa}7 of
the cicatrix to the extent of half an inch, and through the aperture two
pints of liquid feculent matter escaped — from the activity with which

grigg's case of strangulated hernia. 655

the nurse represented the liquid to have jetted out, we were confident
there could exist no communication between the leak in the gut and
the cavity of the peritoneum — says he is entirely free from pain —
craves and relishes food — allow him farinacea and liquids in modera-
tion.

27th. Dr. Lyle visits the patient with me to-day — contents of the
bowels still discharging freely through the artificial opening — thinks
he has gained strength since all pain has left him — walks about his
room a little — appetite good. It being evidently a case of artificial
anus, we deem it at present necessary to do nothing further than ap-
ply a thick linen compress, to be removed at the will of the patient.

Oct. 30. There was no change worth noting from the 27th until to-
day. Having made an arrangement the previous evening to be taken
a distance of 5 or 6 miles to consult Dr. J. P. Mettauer, he arose
this morning about 6 o'clock and commenced putting on his clothes,
talking in better spirits than he had done for several days — but before
getting on all his clothes he fell in the floor with what the colored peo-
ple present thought a fit — he spoke to some friends present after this,
but lived less than half an hour.

We asked permission, and were allowed a post mortem examina-
tion, which was made at 4 o'clock P. M. in the presence of Dr.
Lyle, Dr. A. S. and Dr. J. H. Dillon. We found the ilium closely
and firmly adhering to the cicatrix for at least two inches — the adhe-
sion about half encircling the cylinder of the bowel, and had so far
constricted its canal as scarcely to allow the passage of a goose quill
along it ; yet there was not complete obliteration at any point ; one of
the medical gentlemen thought the narrowing of the tube might have
been produced by adhesion of the mucous lining of the bowel — but
it is my deliberate opinion it was caused exclusively by constriction,
and the constriction due to numerous fibrous digitations taking root in
the cicatrix and reaching far out over either side of the ilium, fettering
it down with a solid fixedness not to be appreciated by others than
those who witnessed it. The break in the bowel was a little more
than two feet above the ilio-ccecal valve, and between it and the valve
the bowel bore a darkish, extravasated appearance, seemingly the re-
sult of chronic inflammation. We found not the slightest trace of any
foreign substance in the cavity of the peritoneum.

Remarks. — We used no ana?sthetic agent in the operation ; and as
the man made comparatively little complaint, we think it would hardly
have been necessary.

We believe Petit's operation, of which we hear and read so much,
would not have succeeded in the case under consideration ; for when
the partial yielding occurred, mentioned above, we delayed a reasona-
ble time, and resorted to taxis again, hoping yet to avoid opening the
sac, but by it nothing was accomplished ; there was now no alternative,
and of course the sac was cut. It will be recollected, that when the
bowel was returned there was serious lesion of the portion corded
by the stricture. This bruised and abraded surface, we think, unfor-
tunately took position immediately under the incision, it throwing out
coagulable lymph and falling in contact with the peritoneal face of the
79

656 Johnson's cases of lithotomy.

wound where there was a similar substance being secreted, is a plau-
sible, if not the most probable way of accounting for the calamitous
adhesion, which killed the man forty-five days after the operation.
We are confident no part of the bowel was sphacelated when re-
turned, and think the gap occurred in the following manner : That
portion of the intestine forming the centre of adhesion must have
been gradually destroyed by ulceration, as the circumferential agglu-
tination strengthened and extended, till finally the contents of the bowel
escaped and lodged against the cicatrix, without in any way endan-
gering the peritoneum. Even in this state of things the man might
have survived, no telling how long — perhaps years — but immediately
below the leak the contraction of the tube was greatest, arresting almost
completely the excrementitious matter, the bowel receiving its usual
quota from above, and with obstructed outlet below became so dis-
tended from the accumulated fluids as to exert pressure sufficient to
break through the cicatrix ; this, however, was a weak point, the union
being strictly cutaneous. The lips or edges of the outlet seemed to
have yielded from insupportable pressure, for we could see no signs of
ulceration.

Grouping the signs before death with developments by post mortem
examination, we are convinced the contents of the bowel were in con-
tact with the cicatrix ten days before the external outbreak. Though
the man lived five days after the formation of artificial anus, there
was no action per rectum, save an occasional discharge of gas.

Report of two Cases of Lithotomy.

BY CARTER P. JOHNSON, M. D.

Professor of Anatomy and Physiology in the Medical Department
Hampden Sidney College.

Case I. — George ShaefFer, aged fifty one, a native of Wirtemburg,
Germany, states that he has been troubled with severe irritability of
his urinary organs since his boyhood. That about twelve years since
he left Germany, came to this country, and settled in Augusta county
in this state. Soon after this the affection of his urinating organs began
to increase, and he gradually to experience all of the rational s}Tmp-
toms of stone. For the last ten or twelve months his sufferings have
been so severe as entirely to prevent the pursuit of his ordinary occu-
pation, that of a cooper, and to force him finally to place himself in
the almshouse of this city.

His general health is good, though his countenance exhibits traces
of great suffering ; his appetite sufficient, and his digestion tolerably
well performed.

I first saw him about the latter part of June, when, upon introducing
a catheter, a solid substance was discovered in the bas-fond of the
bladder. A more careful examination the next day confirmed the
suspicion, thus excited, of the presence of a stone ; and several subse-

JOHNSON S CASES OF LITHOTOMY. 657

quent examinations by myself and others, determined its existence
with positive certainty.

The patient being informed of the nature of his malady, readily
consented to the operation as the only means of restoring him to
health. He was then put upon a well regulated diet, and a pill of
blue mass and rhubarb exhibited every night for several days.

On July 2nd, having had the bowels of the patient well evacuated,

1 proceeded to the operation, assisted by Drs. Gibson and Peticolas.
Chloroform having been administered, and the patient placed in proper
position, a catheter was introduced for the purpose of injecting the
bladder, which however was found, contrary to the statement of the
patient, to contain a considerable quantity of fluid, a portion of which
escaped by the catheter. A sufficient quantity of tepid water was
then injected by means of a gum-elastic bag, and the catheter with-
drawn. The staff was then introduced and given in charge of Dr.
Gibson. The incisions for the ordinary lateral operation were next
commenced, and carried through a rather deep perineum, reaching the
groove in the staff without much difficulty. The index finger of the
left hand now guiding the knife, the membranous portion of the urethra
was opened, and the beaked knife of Dr. N. R. Smith used to com-
plete the incision through the urethra and the prostate. The index
finger of the left hand was then introduced into the bladder, and,
the staff being withdrawn, the stone was found in the upper part of
the organ. A large pair of polypus forceps introduced along the
finger seized the lower portion of the stone, the outer laminae of
which gave way in the attempt to extract it. Several ineffectual at-
tempts having been made to grasp it, a careful examination of the po-
sition of the stone was made, which shewed that it was firmly held in
the upper fundus of the bladder, which was contracted around it.
Finding such to be the situation of the stone, I endeavored to pass my
finger up above it, so as partially to dislodge it from the artificial sac
in which it was contained ; and being aided by an assistant, who forci-
bly pressed the upper fundus of the bladder downwards, I succeeded
sufficiently to enable me to enclose the stone between the blades of a
pair of curved calculus forceps passed up along the finger. With-
drawing the finger, gentle and continued traction with the forceps
in a short time sufficed to extract the stone. Upon examination of
the bladder a few fragments, broken off in the first attempts of ex-
traction, were discovered, and were carefully washed out by a stream
of tepid water thrown into the bladder from a syringe. A silver tube
was then introduced through the wound into the bladder, and secured
to a bandage around the body, and the patient placed in bed on his
right side, with his thighs and legs flexed.

The stone was ovoidal in form, and measured in its longest diameter

2 inches, and around its greatest circumference 3 inches and 3 lines.
Its weight, after being perfectly dried, was 5 drachms. Upon making
a section, it was found to be composed of a large nucleus of uric acid,
surrounded by a considerable deposit of oxalate of lime, which was
in turn encrusted with variable thicknesses of triple phosphate of
ammonia and magnesia.

658 Johnson's cases of lithotomy.

With the exception of slight arterial haemorrhage during the first
twenty-four hours, the patient manifested no unfavorable symptom until
the fifth day after the operation. On that day, after drinking some
chicken soup, he experienced a severe attack of colic, attended with
considerable febrile excitement, and followed by diarrhoea. This diar-
rhoea, which was purely feculent, continued with no little intermission
until July 15th, nine days from its commencement and thirteen days
after the operation. In the mean time all of the ordinary remedies
were used with apparently but temporary effect. Its effect was to
debilitate the general system of the patient to such an extent as to re-
quire stimulants and the most nutritious diet to sustain him, and con-
sequently to produce a most unfavorable condition of the wound, its
edges assuming a livid hue, and its whole surface becoming superfi-
cially gangrenous.

On the 14th July I ordered a blister to be put over the whole sur-
face of the abdomen, and the patient to be put upon a mixture of
*vinegar and salt, two parts of vinegar to one part of salt, a table-
spoonful to be taken every 3 hours. On the 15th the diarrhoea was
much diminished, and on the 16lh entirely checked. With the cessa-
tion of the diarrhoea the general condition of the patient began to im-
prove. His countenance became more cheerful, his appetite better,
and the extreme despondency, which had before depressed him, began
to subside; the slough soon began to separate from the wound, and
on the 21st the whole surface presented a healthy appearance. From
this period the wound continued gradually to close until the 12th of
August, when it was entirely healed.

About the 1st of August the patient began to suffer very much from
the formation of secondary abscesses — five of them forming in suc-
cession in various parts of the body — all large and deep seated. The
great drain upon his system, consequent upon the continued suppura-
tion of these abscesses, again debilitated him very much, and for
many weeks rendered the termination of his case very doubtful. A
vigorous constitution, assisted by tonic remedies and a highly nutri-
tious diet, effectually sustained him until the abscesses gradually
healed.

During the first week in September, during the existence of the
abscesses, my attention was called to a small abscess forming just under
the cicatrix — upon opening and probing which, I found a small calculus
making its way from the bladder along the track of the original wound
towards the surface. Dilating the orifice with the finger, the calculus,
which seemed of recent formation, was easily removed with a pair of
dressing forceps. The urine passed through this new opening for a
few days, after which the parts speedily healed and cicatrised again.

Since that period the patient has gradually improved, and now,
(November 17th,) four months and a half since the operation, seems
to be entirely well.

* This remedy has been much used for several years by some of our most successful prac-
titioners in obstinate diarrhoeas. Its modus operandi it may be difficult to explain ; but when
experience teaches us the utility of an agent, it matters very little whether we can or can-
not explain the mode in which it produces its effects.

Johnson's cases of lithotomy. 659

Case II. — Gideon, a mulatto boy five years of age, was born and
has always lived in Botetourt county Virginia. When between two
and three years old he began to complain on passing his urine. This
complaint has gradually increased up to the present time, (May 1st,)
when the child exhibited all the rational symptoms of stone in the
bladder. The efforts to pass urine are excessively painful, and every
attempt is accompanied with the most piercing screams, with violent
straining of the muscles of the abdomen, and with extensive prolapsus
ani. The general health of the boy is very good. With the exception
of the urinary affection, his master states that his health has always
been uniformly good.

An examination of the bladder with a metallic sound at once
detected the existence of a stone ; and the diagnosis having been con-
firmed by several subsequent examinations, it was determined to
operate at once.

Accordingly, on May 2d, the bowels having been previously evacu-
ated, the patient was placed under the influence of chloroform, and
the lateral operation of lithotomy successfully performed. The in-
struments used and the steps pursued in the operation were precisely
the same as those detailed in the first case. Upon attempting to
extract the stone it was found too large to pass through the orifice ; the
orifice was then slightly enlarged by a probe pointed bistoury, when
the stone was removed without further difficulty. The parts being
washed, a gum-elastic tube was placed in the bladder through the
wound, and the patient put to bed in a very comfortable condition.

The stone was almost regularly oval, flattened a little at each end.
Its length was one inch and ten lines — its circumference at the centre
three inches. Its weight, when perfectly dried, was four drachms.
Its section proved it to consist of a central nucleus of uric acid, com-
prising about one-third of the whole stone, the outer two-thirds
consisting of the triple phosphate.

The second day after the operation the tube was removed, and the
parts surrounding the wound painted with collodion, which very
effectually protected them from excoriation by the urine as it passed
over them.

On the eleventh day the urine began to pass through the urethra,
and the wound, which had presented a healthy appearance since the
operation, began then rapidly to fill up and to heal.

On the 16th of June, just six weeks after the operation, the patient
was discharged, perfectly well, having uniformly improved after the
operation, except for a few days during the fourth and fifth weeks,
when, in common with many other patients in the same ward, he had
a slight attack of diarrhoea.

660 ashby's case of puncture of the stomach.

A Case of Puncture of the Stomach, with Protrusion for six

hours.

reported by cha's wm. ashby, m. d., of culpeper c. h.

A negro boy, 6 years old, the property of Mr. R. B., fell upon a
pair of sheep shears, which he had in his hand, whilst running down
a hill. The instrument penetrated the stomach obliquely from above,
just grazing the left side of the sternum and edges of the ribs, making
a flap-like orifice in the integuments.

I was called in consultation by my friend, Dr. P. C. Slaughter, and
found nearly the whole stomach protruded, and discharging its con-
tents through an aperture about three-quarters of an inch in length.

Aware of the controversy which has long existed among able sur-
geons, on either side, as to the propriety of stitching the stomach or
bowels, the everted edges and gaping appearance of the wound in
the stomach made it necessary, I thought, that a stitch should be
taken. To avoid irritation, as much as possible, with the finest needle
and silk I ventured to take a single stitch through the middle of the
wound.

Before I saw the case, Dr. S. had made some efforts to restore the
organ to its natural position, but it did not occur to me at the time
that I should have any serious difficulty in replacing it, at least after
enlarging the orifice a little. But such was the unruly nature of the
boy — his violent screaming and resistance, the nausea and vomiting
which constantly attended the handling of the stomach — that notwith-
standing I enlarged the orifice several times to a considerable extent,
our best efforts not only failed to restore the organ, but it seemed to
protrude the more.

At this juncture, fearing the irritation resulting from further efforts,
I suggested the use of chloroform, notwithstanding the necessary de-
lay of having to send several miles for it. Whilst under its influence,
I found it necessary again to enlarge the aperture slightly, and then
had no farther difficulty, although the boy vomited as freely as before
from handling the organ.

The wound of the integument was rather ragged in its appearance,
and of course a little bruised by our efforts.

The wound of the stomach was brought directly opposite the tegu-
mentary wound, and gently retained within its verge. A single stitch,
patent lint, with cold water and a bandage completed the dressing.

The patient was placed on his side, absolute rest enjoined, and
soon afterwards a large dose of opium was administered.

From the time of the accident until the completion of the dressing
six hours intervened, and yet the boy retained his strength most re-
markably.

Under the influence of the opium our patient rested well the first
night.

2d day. — This morning the pulse is a little excited, and face flush-
ed— vs. to make a decided impression ; and this was repeated twice
during the day, and opium after each bleeding — absolute diet enjoined —
but the boy desires no food.

ashby's case of puncture of the stomach. 661

3d. The wound had a healthy appearance, but tenderness of the
abdomen and tympanitis greatly increased our fears as to the result.
The pulse feeble and quick — the bowels not moved since the accident.

Turpentine enema and a succession of blisters were ordered, and
after the bowels were moved the opium was resumed.

4th. Our patient evidently improved, t}7mpanitis and tenderness di-
minished, pulse more quiet, countenance and general aspect of things
more encouraging — takes a little hot water tea this morning, for the
first time — gum water and opium continued.

5th. The wound not healed by the first intention — has a dark spot
immediately over the wound of the stomach, and is discharging a
very offensive sanious matter. A soft poultice, and the same prescrip-
tion continued.

6th. The ligature came out this morning. The same prescription
continued. From this date the boy gradually recovered, without any
particular change in the treatment.

Remarks. — 1st. It has occurred to me, that possibly it would have
been better for me to have restored the stomach, at least partially, be-
fore the stitch was taken, as I ran the risk of breaking out the ligature
by the subsequent efforts at reduction ; and I am sure that the accumu-
lation of gas, though some escaped with an audible sound several
times, did not increase the difficulty.

2d. This case was admirably adapted to the use of chloroform, and
illustrates most happily its incalculable value, when used with discri-
mination.

3d. As your journal is eminently practical in its character, for the
benefit of the younger members of the profession it may not be amiss
to allude briefly to what I conceive to be a most important principle
in our profession, viz : that an inflamed or diseased organ must have rest.
In this case, the stomach, instinctively sensible of its wounded and dis-
abled condition, refused most emphatically, for four days, to receive
any nourishment — not even gum water — and but very little of anything
for about ten days, notwithstanding the entreaties of master and friends,
contrary to our orders.

An inflamed eye instinctively excludes the light from itself, so that
the physician who interrogates nature intelligently, at once gets the
idea of confining his patient to a dark room, and thus putting the or-
gan entirely to rest. When the lungs are inflamed the patient breathes
as much as possible by the abdominal muscles, and lymph is thrown
out, gluing the organ to the side, doubtless to prevent motion and fric-
tion as much as possible. The same thing is true of inflamed bowels ;
and because some constipation, the result of this principle, exists, I
have known great error — and I may say even death — to result from
goarding and stimulating the organ with drastic purgatives.

This principle of rest is susceptible of very extensive application in
practice; and any inflammation can be cured, I believe, to which it
can be applied.

The immortal Physic, always true to the laws of nature, recognized
this principle in the treatment of coxalgia and other diseases of the
joints. In conformity to this important law of the animal economy,
in the above case, we gave opium freely, to prevent nervous and vas-

662 bolton's case of tetanus.

cular reaction ; and by thus aiding in keeping the wounded organ in a
profound state of repose, it contributed, it is believed, no little to the
favorable result.

Report of a Fatal Case of Tetanus following the ligature of

Hemorrhoids.

BY JAMES BOLTON, M. D.
[Read before the Medical Society of Virginia, at its October meeting.]

M. C, colored female, aet. 35. Married. Has suffered intensely
from piles since the birth of her first child 15 years since.

Oct. 6. A mass of about the size of a hen's egg protrudes from the
anus, and separates the nates.

Operation. — The patient was fully anaesthetized. The mass was
so vascular that merely sponging with cold water caused the loss of
about half a pint of blood in a few minutes.

It was divided by sulci into three tumors. A needle was passed
through the base of each, carrying a double ligature, which was tied
on both sides of the tumor.

In forty-eight hours nearly the whole had sloughed off. Chlorine
wash was applied to correct the fcetor and to promote healthy action.

On the fourth day a moderate dose of sulphur and bitartrate of
potash was ordered to remove constipation caused by opium used to
allay the pain which was produced by the ligatures.

About three or four times the quantity ordered was given, and pro-
duced violent hypercatharsis. This was not checked until it had last-
ed several days, owing to neglect of directions.

On the 11th day the patient felt remarkably well until night, when
she suffered from cramps of the hams.

On the 12th day there were symptoms of decided tetanus. Ordered
morphiae sulph. gr. ss.; quinine di-sulph. gr. x. every second hour.
Chloroform to be used as often as necessary to subdue spasm. Direc-
tions not attended to until night.

Observing some fcetor from the anus, applied injection of strong so-
lution of nitrate of silver.

13th day. Spasms continue when free from the influence of chloro-
form. Some tendency to sink. Inability to swallow. Directed mer-
curial inunction extensively. After relaxing the patient completely
by chloroform, passed a stomach tube and injected morphiae sulph.
gr. i. ; quinine sulphate 3 i. and brandy oss. Only one spasm occur-
ed after this, but the patient continued to sink, and died without a
struggle in about four hours.

A post mortem examination was not permitted.

Remarks. — Up to the time that hypercatharsis was produced, the pa-
tient was doing very well. Pain had ceased and the appetite and
spirits were good. From that time pain returned, accompanied by phy-
sical and mental depression. It is therefore highly probable that the
irritation of the part, together with general exhaustion, which no doubt
caused the tetanus, was realty due to the improper administration of me-
dicine to the patient, already in a critical condition from the operation.

garden's case of obstruction of the bowels. 663
Case of Mechanical Obstruction of the Bowels.

BY J. B. GARDEN, M. D., WYLLIESBURG, VA.

The novelty of the following case I hope will be sufficient apology
for insertion in your periodical, and at the same time it may institute
a more minute search after mechanical causes in constipation than is
generally supposed to exist.

October 7th. I was requested to visit a negro man, ast. about 25
years, who had been for five days laboring under the ordinary symp-
toms of epidemic dysentery. Tormina and tenesmus, with scanty
discharges of a mucous character, sometimes tinged with blood, fre-
quent inclination to stool, thirst, loss of appetite, and other symptoms
indicating a febrile state of the system. There was no vomiting or
nausea throughout the whole course of the disease.

These symptoms persisted with little or no abatement until the
tenth day of his illness, with entire constipation up to this time, in des-
pite of all our endeavors to produce a discharge from the intestinal
canal. Strangury was a symptom in his case which we witnessed in
almost all the bad cases of the epidemic of this summer and fall. It
was promptly relieved by the warm bath and an anodyne administered
about fifteen minutes before entering the bath.

We commenced our treatment by the administration of a purgative
we are in the habit of using in dysentery — a combination of castor oil,
solution of carbonate of potash, tinct. opium and the essence of pep-
permint— for several days. This seemed to have no effect on the pe-
ristaltic action of the bowels, and more active purgatives were substi-
tuted, placing our chief reliance on the specificaction of mercury, in
the dose of three grains of calomel united with one grain of opium
every three hours. This treatment we concluded to persevere in,
whatever other medication might be thought advisable, until ptyalism
was induced. Injections of the solution of nitrate of silver were
freely used to allay irritability of the lower bowel, and prevent disor-
ganization of the mucous membrane, as the frequent discharges indi-
cated a highly irritated state of that organ, being fluid, of a dark ap-
pearance and very offensive odor.

Cathartic enemata, warm bath, frictions over the abdomen and ca-
thartic medicines by the mouth had no other perceptible effect than to
allay the torminaand tenesmus for a while, and produce loud roarings
and flatulence. Obstruction of the bowels from some mechanical
cause evidently gave rise to the great distress and sufferings of our
patient, for which we sought in vain, until it was deemed necessary to
distend them with warm water. This was accordingly attempted on
the fifth day of our attendance, but the obstacle which prevented the
passage of the feces downwards, and of the rectum tube upwards,
lay about two inches from the verge of the anus. The rectum with
its pouches was enormously distended with about a pint of watermel-
lon seed. It gave rise to such excruciating pain on endeavoring to
dislodge them by the gentlest means, that we abandoned all hope of
giving our patient relief without the anaesthetic agency of chloroform.

80

664 JOYNES' CASE OF COLICA PICTONUM.

Oct. 12th. Assisted by my father, Dr. T. J. Garden, who now
saw him for the first time, I proceeded to administer chloroform,
and in about five minutes profound anaesthesia was induced. The
quantity used was near 3 iii. The rectum was then readily evacuated
of its burden with entire relief to the patient, and free vent given to
the hardened scybala which had been so long impacted in the colon.
The inflammation which followed was readily overcome by appro-
priate treatment, and the case was dismissed in a few days as con-
valescent.

Case of Colica Pictonum, from the medical employment of
Acetate of Lead.— With remarks.

BY L. S. JOYNES, M. D., OF ACCOMACK.

The following case is communicated, with the hope that it may prove
a useful caution to some of the younger members of the profession,
who maybe inclined, from over-confidence in the assurances of many
of our standard authors, to make too free a use of the potent drug above
mentioned. It cannot be doubted that young practitioners in general
are too prone to adopt heroic methods of practice, and to esteem bold-
ness and decision the chief qualities of a successful physician. Of all
the rich fruits which experience brings with it, not the least valuable,
certainly, is caution in the emplo}7ment of active remedial agents — all
of which, without exception, are potent for evil as well as for good.

It has often appeared to me, that one of the most valuable contribu-
tions that could be made to the science of medicine, would be a faith-
ful record of the real experience of the profession in the use of the
class of remedies just referred to — setting forth the deleterious effects
which may be caused by antimony, opium, mercury, lead, &c, as
prominently as the good they are capable of accomplishing. Such a
record would furnish the most useful lesson of caution in practice that
could be given. A desire to contribute to this useful kind of informa-
tion has influenced me in furnishing the following case for publication
— in regard to which, I must admit that the length of time which has
elapsed since its occurrence renders my history of it less complete
than is desirable, inasmuch as I made no record of it at the time, and
am compelled to rely chiefly on memory for the details.

On the 15th of October 1843, Mr. J. J. B., merchant, age'd 25,
consulted me on account of a chronic diarrhoea, which had troubled
him from time to time for several years, and which had always been
obstinate and intractable. He had been treated by different physi-
cians, who had prescribed a great variety of remedies, nearly all of
which seemed of little efficacy. After listening to the details of his
case, I became satisfied that acetate of lead and opium would prove
the most efficient remedy ; and as none of his previous medical ad-
visers had prescribed this combination, I determined to give it a trial.
I believe I had never before prescribed the acetate of lead, but I re-
lied, very naturally, on the assurances, ever}' where to be met with in
the books, that the use of the drug is free from risk, provided a per-

JOYNES' CASE OF COLICA PICTONUM. 665

fectly pure article be employed, and acetic acid in some form be pre-
scribed in conjunction with it.

I accordingly selected the most perfect crystals of the acetate ; add-
ed more than enough of distilled vinegar to neutralize any of the car-
bonate which might be present as an impurity; then adding the opium,
I made the mass into pills. I also directed the patient, immediately
after taking each pill, to swallow a teaspoonful of vinegar. The pre-
cise formula which I employed I am unable now to state, but my
recollection is distinct, that the entire quantity taken was 30 grains, in
the course of about four days. The medicine proved most efficient in
the relief of the diarrhoea, the discharges being arrested more promptly
than by any other remedy, and without any immediate ill effects. The
patient and myself were both congratulating ourselves upon the favo-
rable result, when one day, perhaps a week after he discontinued the
pills, he complained to me of a pain in the epigastrium, radiating to
the spine. As the patient was then apparently regaining his health,
and in good spirits, I paid little attention to this complaint, supposing
it to be a momentary gastralgic affection, occasioned by some impru-
dence in diet. Not long after, I learned that he was laboring under a
severe attack of colic, and I was called on by Dr. Young of this place,
his ordinary medical attendant, who came on purpose to ascertain the
composition of the pills which the patient had been taking. The pe-
culiar character of the colic with which he was at that time suffering,
so strongly resembled those of colica pictonum, that Dr. Young had
been led to enquire of him whether he had taken any medicine recently
for diarrhoea. There could indeed be little doubt, from the account
given me of the symptoms, and the subsequent progress of the case,
that the attack was one of saturnine colic, of more than ordinary se-
verit}''.

This attack commenced on the 3d of November, about a fortnight
after the patient had taken the last pill, and continued, with occasional
slight remissions, for eight days, before any decided relief was obtain-
ed. The treatment consisted principally of free and oft-repeated doses
of calomel and opium, purgatives by the mouth, enemata, and blister-
ing. A very large quantity both of opium and colomel was adminis-
tered, and every other means employed which an experienced physi-
cian could devise, but there was no permanent relief to pain, and no
decided action of the bowels, until the eighth day, when the mouth
became affected by the mercury. The patient then slowly recovered,
but he remained for some time in a very reduced and debilitated con-
dition. It would have been some compensation for all this suffering,
if he had been permanently cured of his diarrhoea ; but no such for-
tunate result ensued. The attacks continue to recur from time to time,
and are as obstinate as ever.

If any should be disposed to doubt whether the above was truly a
case of lead colic, in view of the long interval which elapsed between
the emplo3'ment of the remedy and the manifestation of the symp-
toms, I would remark that this is entirely in accordance with the oft-
observed facts in regard to the poisonous operation of lead — slowness
of action being the general rule.

666 JOYNES ON COLICA PICTONUM.

This is the only case I have ever met with in my own practice, of
any serious result following the exhibition of the acetate of lead ; in-
deed, I rarely trifle with the drug now-a-days. (" Chat echaude craint
Veau froide. .") But I know of three other cases of the same kind,
which have occurred in this neighborhood. It is fair to add, how-
ever, that in at least two of them the remedy was freely used. There
is no lack of recorded instances of the sort ; but so far as I am in-
formed, cases are very rare, in which colic is produced by so small a
quantity of the acetate as was administered in the case which I have
just related. One such is mentioned by Dr. Burton, in a paper of
which extracts are given in Braithwaite's Retrospect, No. 2, p. 66 ;
here the patient took fifteen grains in five days, and experienced se-
vere colic. And Prof. Trousseau, in his work on Therapeutics,
quotes a case in which the patient took six grains of the neutral acetate
of lead daily for three successive days ; the fourth day, a most violent
saturnine colic supervened, with jaundice, constipation, retraction of
the belly, etc., which only yielded to the " treatment of La Charite,"
energetically employed. The most remarkable case of all is given by
Devergie, in his Med. Legale : — A student of medicine consulted Pro-
fessor Fouquier, who prescribed for him some pills containing each
one grain of acetate of lead, of which he was directed to take one
every day. The first pill produced slight colic, the second acted more
severely, and the third occasioned such violent symptoms that some
mistake of the apothecary was suspected. The pills were analysed
by Devergie, but were found to contain nothing but acetate of lead.

It may be urged, and with truth, that such cases are exceptional,
and that they may be explained by the existence of idios}Tncrasies in
the subjects of them, such as are known to exist with respect to mer-
cury, opium and other remedies. But allowing this to be true, it
must also be admitted that a prudent physician is bound to regard
such idiosyncrasies in his practice. The knowledge of their occa-
sional existence should be a warning against the use of hazardous
remedies, except under circumstances imperatively calling for their
employment.

A circumstance which has doubtless contributed in no small degree
to extend the employment of the acetate of lead as a medicine, and to
set the minds of physicians at rest in regard to any risk attending it, is
the opinion so confidently expressed by Dr. A. T. Thomson, that the
carbonate is the only poisonous preparation of lead, and that the acetate
can only become so in consequence of its decomposition by the free
carbonic acid extricated in the alimentary canal. Hence his precept
to direct a draught of vinegar to be taken with each dose of the ace-
tate, in order to prevent such decomposition, as well as (I presume)
to re-saturate with acetic acid any portion of the carbonate with
which the crystals of the acetate may be contaminated.

It requires but little examination of the facts to convince us that
this idea is entirely opposed to the well known general laws of the
action of mineral poisons. Ceteris paribus, these poisons are active in
the direct ratio of their solubility ; and on this general fact is based the
theory of antidotes. We give antidotes with the view of converting a

JOYNES ON COLICA PICTONUM. 667

soluble preparation of a metal into an insoluble one. Would it not be
a singular exception to a general rule, if the acetate, one of the most
soluble forms of lead, should be entirely innocuous, and the carbonate,
one of the least soluble, alone endowed with poisonous properties? It
is true, that small doses of the carbonate would be rendered soluble
by the acids of the gastric juice, being converted by them into the
chloride and the acetate, (assuming, in accordance with the general
opinion of chemists, that the hydrochloric or acetic acid, or both, exist
in the secretion of the stomach.) What then will become of the acetate,
when swallowed? If it meets with acetic acid in the stomach, it will
remain acetate still ; if with hydrochloric acid, it will be converted,
like the carbonate, into the chloride of lead. The two substances,
therefore, when they begin to act on the system, and are absorbed into
the blood, will be in precisely the same chemical state. Considering
the acid nature of the gastric secretion, and its probable action on all
chemical compounds capable of being affected by its ingredients, is
not Dr. Thomson's idea of the conversion of acetate of lead into car-
bonate, by the free carbonic acid in the alimentary canal, evidently a
fallacious one ? And is not therefore his employment of distilled vine-
gar in conjunction with the acetate, an illusory protection against the
dangers of lead poisoning?

But without further argument on the chemistry of the question, it
is sufficient to state that Dr. Thomson's theory is in opposition to the
concurrent testimony of the best toxicological authorities of the day,
among whom I may cite Orfila, Apjohn, Taylor, Christison and
Devergie. The latter writer, whose authority is second to none,
distinctly states that the poisonous activity of the compounds of lead is
in direct proportion to their solubility. Christison and Taylor both
(conclusively, it seems to me) combat the opinion of Thomson. I
will quote a few words from the last mentioned of those authors, bear-
ing directly upon the practical point at issue : " So far as observations
on man have yet extended, the carbonate has no more action than
the common acetate. Dr. C. G. Mitscherlich has lately proved that
the acetate is a poisonous salt, and that when mixed with acetic acid
it is more energetic than when given in the neutral state. This fact clearly
shews that the poisonous effects cannot solely depend on the assumed
conversion of the salt to the state of carbonate." (Taylor's Med. Ju-
risp., 2d ed., p. 169.)

This result of Mitscherlich's researches is precisely what a conside-
ration of the general laws of toxicology would lead us to expect.
Let physicians, therefore, take care how they rely on vinegar, or
dilute acetic acid, as a safeguard against the poisonous effects of the
acetate of lead.

668

MEDICAL SOCIETY OF VIRGINIA.

Spontaneous Recovery from an Ovarian Tumor of Twenty

Years' Duration.

BY J. F. PEEBLES, M. D., PETERSBURG, VA.

The subject of the following case is a respectable colored wo-
man, at present aged 38. She states that she was married in her 17th
year, and that two years previous to that time she had discovered
the existence of a tumor in her left side. After marriage it increased
rapidly. She came under my notice about 8 years ago, when she
presented the appearance of a woman at the full term of pregnancy.
She was a tall, thin person, and a firm but elastic tumor could be plain-
ly felt, occupying the abdominal cavity, reaching quite to the epigas-
trium.

She menstruated regularly, but had never conceived ; her health
was delicate; still, however, she was able to get about and take care
of her family.

Every year, however, she perceptibly failed in her strength, and lost
flesh. About twenty months ago, whilst standing in her }rard, a dog
ran against her so violently, that a sudden and powerful effort was
required to prevent her falling. During the effort she felt a sudden
wrenching of the weighty and unsupported tumor, which was follow-
ed by faintiness, and she had to be carried to bed. Chilliness came
on, followed by fever, with pain and exquisite tenderness over the
surface of the tumor. Active venesection and the application of leech-
es over the abdomen, often repeated, were required in the treatment.
After remaining in a critical situation for ten or twelve days, the symp-
toms subsided. In the mean time a slight purulent discharge from
the vagina had appeared, which continued for a few days. After this
attack the tumor very gradually diminished, and in three months it had
disappeared. At this lime my patient is a healthy, robust looking
woman. In the left ovarian region a tumor, with a knotted and
irregular surface, about the size of a pullet's egg, can still be felt.

Medical Society of Virginia— November Meeting.

Dr. James Be ale, First Vice-President, in the Chair.

{Present — Twenty-six Members and several Visitors.)

After the minutes were read, the following gentlemen were balloted
for and declared duly elected members of the societ}r :

J. S. Davis, M. D., University of Va.
J. L. Winfree, M. D., Henrico.
Charles Carter, M. D., Charlottesville.
F. T. Stribling, M. D., Staunton.
Ed. C. Fisher, M. D., Richmond.
David G. Smith, M. D., Mecklenburg.
R. L. Madison, M. D., Petersburg.

Wm. J. Moore, M. D., Norfolk City.
A. G. Grinnan, M. D., Madison.
Ro. C. Nelson, M. D., Clarkesville.
P. C. Venable, M. D., Mecklenburg.
Wm. Crump, jr., M. D., Poichatan.
Q.. A. Snead, M. D., Richmond.
G. C. Venable, M. D., Mecklenburg.

Several gentlemen were nominated for membership.

G0N0RRH03A. DISEASED HEART. 6G9

The subject for the evening being Malaria, and its mode of action in
the production of fevers, Dr. David H. Tucker read a long and interest-
ing essay on it.

Drs. Snead, Bolton, and Cox of Henrico also made remarks on
the subject. [We hope in future to lay before our readers an abstract
of Prof. Tucker's essay, as well as a detail of some researches on the
subject, made by Dr. Bolton. That gentleman made some very inte-
resting observations on his experiments with dew and air collected in
the Chickahominy swamp, at a season when miasmatous diseases
were prevalent, and also on the prophylactic use of gauze against mi-
asmatic influence.]

Dr. C. B. Gibson made some remarks on the treatment of Gonor-
rhoea, and exhibited an instrument which he learned was in common
use in New York, and which he thought would be found useful in cases
where it was desirable to apply caustic solution to every part of the
urethra. The instrument consists of a silver tube, containing a
sliding wire, which is rolled at its end with fine sponge. The
sponge may be saturated with any solution, and made to swab out
the urethra and touch its entire wall. The instrument was intro-
duced, he believed, by Dr. Campbell Stuart of New York, and he
learned that it was very popular.

Dr. Gooch said that the instrument could be obtained from several
of the druggists of the city, but that he did not like its construction
nor its use. Since the subject was brought up, he would take the occa-
sion to remark, that, having experienced great difficulty in the treat-
ment of this opprobrium of surgery, as Dr. Gibson had justly called
gonorrhoea, he had lately given a fair trial to the hydrastis canadensis in
five cases. He was sorry to report, however, that he had failed in ac-
complishing any good whatever with it. It is an astringent, but has no
peculiar virtues, he thought. He was induced to make trial of it many
months ago, by the recommendation of a member of the society, who
knew it as an old Philadelphia remedy. Just now, however, almost
every medical journal in the United States is copying a short article
by Dr. McCann of Ohio, in which he lays claim to originality in its
use in this disease. He thought the claim as absurd as the specific.

Pathological Specimens.

Dr. Mills exhibited a heart, in which the right ventricle was nearly
filled by a polypiform or fibrinous concretion, perfectly organized, aris-
ing by a broad base from the tricuspid valve and interventricular
septum to which it was firmly united, and extending, by a long round
stem of half an inch diameter, through the sigmoid valve along the
pulmonary artery, and some distance into its branches. The man
from whom this heart was removed was about 65 years of age, and
had usually enjoyed good health, though he stated that his doctors
had told him that his heart was diseased. He felt no pain there — his
respiration was free, and he was not subject to cough. He was sud-
denly seized with great prostration, with tendency to syncope and

670 MEDICAL SOCIETY OF VIRGINIA. TRACHEOTOMY.

tremulousness, only about four days before his death, and complained
of pain in the right hypochondrium, where the liver was very much
enlarged, which, together with the jaundiced complexion, anorexia and
sinking feeling at stomach, indicated a state of congestion about the
liver and portal vessels. As no symptom pointed directly to the
heart, no stethoscopic exploration of that organ was made. The
post mortem examination shewed the liver very much enlarged and
injected, and pushing the stomach over into the left hypochondrium.
The heart was in its natural position, but enlarged and enveloped in
adeps. The other viscera were healthy.

Dr. Scott exhibited a salivary calculus of cylindrical form, about
10 lines long and 3 in diameter, which had been taken from the lin-
gual duct of an individual by Dr. Chilton, of Fauquier.

Dr. C. P. Johnson then read the following

Report of an Operation of Tracheotomy, performed for the relief

of Croup.

E. S., a girl about three years of age, very large and fat, and of
sanguineous temperament, was taken on the evening of Tuesday, Oct.
21st, with slight symptoms of croup. Her father applied a plaster of
Scotch snufFover the chest, which seemed to afford relief. On Wed-
nesday night, the symptoms returning, a teaspoonful of ipecac, was
administered in broken doses, producing pretty free vomiting. On
Thursday morning she was again better, but the symptoms recurring
in the evening with increased violence, I was sent for.

When I saw the patient about 8 o'clock in the evening, I found her
with a flushed face, frequent pulse, rapid and very laborious breath-
ing and a distinctly croupy cough. Before I reached the house, the
father, alarmed for the child, had sent for a leecher, who was in the
act of applying leeches to the throat when I arrived. About eight
leeches were applied, which drew well, the bites bleeding pretty freely
after the removal of the leeches.

Ordered submur. rrydrarg. 3 j.; ipecac, grs. v., to be made into
x. powders, one to be taken every hour ; the child to be immersed at
once in a warm bath. While the bath was being prepared and the
messenger gone for the medicine, I administered about 3 j. hive syrup
with no effect.

Visited her again at 12 o'clock. The bath had been given, and three
of the powders administered ; no improvement ; no action on the
bowels; difficulty of breathing increased; ordered 5-- Tartras antimon.
and potass, grs. ij. ; syrup scillos 1 j. ; mucilage 3 ss. M. Of this I
administered a teaspoonful every half hour, continuing the powders
every hour. After the second or third dose, some nausea seemed to
be produced, though there was no vomiting, and her breathing seem-
ed improved. I left her about 3 o'clock, inclined to sleep — coughing
but little, and breathing much more easily than at any time since I
first saw her. She had a slight motion from the bowels before I left,
not characteristic of the action of the mercury.

MEDICAL SOCIETY OF VIRGINIA. TRACHEOTOMY. 671

Oct. 24th, Friday, 8^ o'clock. — Has slept a good deal ; pulse
more soft ; skin cool and moist ; breathing as when I left her last
night ; has taken all of the powders and about one-half the mixture ;
no action on the bowels ; ordered the same treatment to be contin-
ued. At 2 o'clock I was sent for in haste ; found her breathing most
laboriously, inspirations being performed with great effort ; counte-
nance very anxious ; lips livid ; eyes injected, and skin bedewed with
moisture ; since my last visit had taken three powders and had had
two small passages. I applied a blister 6X4 over the sternum, and
asked for a consultation with a view of ascertaining the expediency
of an operation.

Upon consulting with Dr. Gibson about 4 o'clock, it was deemed
advisable to recommend an operation as the only means that now
offered any hope of restoring the patient.

The parents readily consenting, the child was placed on its back on
a table, with its head held by an assistant over the edge of the table,
in an extended position, so as to put the integuments of the neck as
much upon the stretch as possible. An incision was made from the
upper portion of the trachea to the top of the sternum passing through
the integuments and a large mass of adipose tissue. Dissecting care-
fully down on the median line, the edges of the sterno-mastoid, sterno-
hyoid and sterno-thyroid muscles were turned aside and the middle
third of the trachea exposed. The lower portion of the thyroid body
and the anterior jugular vein were exposed during the dissection, but
were carefully separated and turned to one side. The trachea was
then seized with a double hook, drawn forward, and incised with a
small sharp pointed scalpel. A hissing rush of air at once announced
its division. The incision into the trachea being sufficiently enlarged,
the edges of the wound were carefully held aside and a trachea tube
inserted and secured by tapes passed behind the neck.

In a few minutes after the introduction of the tube, the breathing of
the child became regular and soft, the wheezing ceased entirely, and
the little patient, evidently much relieved, sank into a gentle sleep.
During the operation she had a large green passage.

Visit at 8 o'clock at night. Patient has rested well since the opera-
tion ; there has been no haemorrhage ; occasionally she coughs through
the tube and expels some bloody mucus. Has taken fluid food, and
seems anxious for more than it is prudent to give — swallows without
difficulty, countenance is natural, eyes bright and cheerful, complexion
perfectly natural. Ordered the powders of calomel and ipecac, to be
continued during the night at intervals of three hours. Left her at
9 o'clock.

At 11 o'clock was summoned in great haste, and found that about
an hour and a half previously difficult respiration had come on
again. When I saw her there was extreme restlessness, breathing
very rapid and very laborious, each act of respiration forcing the tube
almost out of the trachea, pulse very frequent and feeble, eyes glassy
and countenance again becoming livid. There was great thirst. She
had had several copious dark spinach green evacuations.

Deeming the case hopeless, as it was evident that the inflammatory
81

672 FATAL CASE OF TETANUS.

action had extended down into the trachea, no further remedial means
were resorted to, except to keep the orifice into the trachea, from
which the tube was expelled shortly after my arrival, as free as possi-
ble. I remained with the child during the night ; the difficulty of
breathing continuing to increase, and the pulse to become more feeble
until 10 minutes past 9 o'clock Saturday morning, just 17 hours after
the operation, when she died.

No post mortem examination was obtained.

The result of this case would teach us, as far as one case can, to
expect but little good from the operation of tracheotomy in pure in-
flammatory croup ; for the condition of the child, for some hours after
the operation, shewed that the vital powers were not too much de-
pressed at the time of its performance to forbid its recovery. It is to
be regretted, perhaps, that I did not push the mercury immediately
after the operation ; although the stools, during and after the opera-
tion, shewed that the quantity already administered had produced a
very decided effect upon the secretions of the alimentary canal, and
render it very doubtful whether any amount of mercury which could
have been introduced would have arrested the progress of the disease.

Dr. Parker then read the following report of a

Fatal Case of Tetanus supervening on Abortion.

It will doubtless be remembered by many, that a most interesting
discussion took place in this society recently, elicited by the report of
a case of tetanus presented by Dr. C. P. Johnson, and that the cause
of attack in that case gave rise to much debate. I have thought,
therefore, that at this juncture, a brief report of the following most
rapid and somewhat analagous case would not prove altogether unac-
ceptable to the society.

On the 23d of July last, I was called upon about 7 o'clock A. M.
to see a negro girl about 15 years old, of a strong and well set frame,
and apparently possessed of a fine constitution. I was informed by
her mistress that three days previously she complained of being sick,
but continued to attend to her work about the house. The following
day she took her bed, whereupon her mistress administered a dose of
some quack purgative, which acted promptly, but brought no relief.
The next day I saw her. She then complained of much pain in the
head and back of the neck, and had considerable fever. All the im-
portant functions seemed to be well performed. Upon enquiry as to
the catamenia, I was informed by the patient that she was " unwell "
about three weeks since.

I regarded the case, after examination, to be one of rheumatism
from exposure. There was, however, so much restlessness, and such
a decided indisposition to talk, that I felt somewhat uneasy about her
condition, and informed her mistress that I would call again in the
afternoon.

fy Calomel, gr. xx.

Opium, - - - gr. iij,

M. Make 2 pills.

FATAL CASE OF TETANUS. 673

To be given at intervals of three hours, and to be followed by a brisk
purgative of castor oil.

I saw her again at 7 o'clock, P. M., and found her much worse;
pulse 130 to 140, and quite unsteady ; head thrown back ; skin hot
but moist, and great alienation of mind. I at once regarded the case
as one of tetanus, and went immediately in search of medical counsel.
Met Dr. Merritt in the street, and he accompanied me to the house of
the patient. Having chloroform with me, with Dr. Merritt's concur-
rence, I administered it. The girl inhaled but a few minutes before
she was completely anaesthetized ; not, however, without at first very
high arterial excitement. She remained in this state about half an
hour, with entire or almost entire relaxation of the posterior cervical
muscles. Her head, which a few minutes before was bent at right
angles with the spine, was now most readily brought into the same
line with her body. There was but little trismus at any time during
the attack.

S- Cal. & quinine, - - aa. gr. x.

Morphine, - - gr. £.

Given immediately, and repeated in three hours.

With the cantharidal collodion, (a most valuable and convenient
agent which I have frequently used, first at the suggestion of Dr.
Bolton,) we applied a blister from the top of the sternum to the
pubes, in fact, over the whole of the anterior of the chest and ab-
domen, and also one to the spine throughout its whole length. Before
leaving, again used chloroform, and with same happy effect.

Feeling much interest in the case, I determined to see the patient
again at 1 o'clock at night, when I found she was being delivered of
a foetus of the 3d or 4th month. The placenta lodged in the vagina,
and was removed without undue haemorrhage. Respirations 35 ;
pulse 150. and of considerable force ; head hot, skin moist, and pa-
tient delirious, though conscious of the birth of the foetus and re-
moval of the afterbirth. I ordered cold applications to be made to the
head, waited the action of the medicine, and hoped the abortion
would be favorable. The blisters had not drawn.

Two hours after I left, she died, without any change in her condition
observable by her mistress.

Remarks. — On my last visit for some time 1 considered the propriety
of bleeding, but the pulse having been a few hours since rather feeble
and fluctuating, and moreover in the absence of Dr. Merritt, I decided
against it. Had it been at all convenient I should have cupped.

In regard to the cause, of tetanus in general, my own mind is not
altogether decided. Without having consulted authority and with
but a very limited knowledge of the disease, I am inclined to adhere
to the centric doctrine. It seems to me that those slight injuries which
so often and as often, according to some, give rise, seemingly, to this
disease, and also to erysipelas, are only the exciting or ostensible cause.
There is a condition of things beyond this, inscrutable to us, to which
some stimulant, or irritant, if you please, being applied, enkindles the
disease. The first chill in an attack of intermittent is evidently some-
times excited by the patient being caught out in a shower of rain, but

674' EDITORIAL.

no one would for a moment conclude that the wetting was the fans et
origo mali.

The hour being late, and there being business of importance to
transact, no remarks were made on the case.

The amendments to the constitution, having passed their third read-
ing, were then adopted.

Several reports of committees were presented. An English form of
diploma was recommended, and the subject laid on the table until the
next meeting, under the rule.

The resolution adopted at the last meeting in regard to the reporting
of professional misconduct by members was reconsidered and laid on
the table.

After the transaction of some business, not of general interest, the
society adjourned.

3EBETO3E3EAJL. 11B MES0]EJL3LAMIE©U&«

To the Subscribers of the Stethoscope.

With the present number our first volume closes, and we hope that
it will not be considered in bad taste to make, in this place, some re-
marks in relation to ourselves and our work. We have occasionally
been egotistical before, and we expect to find it necessary sometimes
in future. A retrospective view of our editorial existence is not
only satisfactory, but, indeed, highly pleasing ; but still more so are
the delightful and cheering anticipations of the future. As most of
our readers know, we are of sanguine temperament, and perhaps too
enthusiastic ; we were repeatedly told so on the appearance of our
first number, and sad predictions were made of the failure of the
Stethoscope on that account. It was justly said that so large a month-
ly medical publication could not be sustained at the low price at
which it was issued — that the field was already preoccupied to excess
with medical periodicals, and that in Virginia the profession was un-
organized and unpractised in writing, and, therefore, we could not
find enough eligible original matter for its large pages. We heeded
not these doleful predictions, but placed an abiding reliance on the
ability, liberality and pride of the Virginia profession to sustain a
work which should be gotten up handsomely, upon a liberal scale,
and conducted, if not with talent, at least with energy, fairness and
independence.

Our confidence, experience has shewn, was not misplaced. A list
of subscribers and contributors, steadily increasing up to the present

EDITORIAL. 675

writing, of which any work so young as ours might well be proud, is
pretty good evidence that our efforts to satisfy the capricious appetite of
the medical world have not been altogether vain. Our reception by our
confreres of the medical and secular press, and the constant expres-
sion of satisfaction in the letters from patrons, cause us to hope soon
to be repaid for the labor and money expended. As will be seen by
reference to the Index, #the first volume contains nearly five hundred
pages of original matter, supplied by some fifty-six contributors, many
of whom are men of eminence and ability in their profession. We
can, without being accused of vain boasting, say that this is more
original matter than any other monthly journal in the country has pub-
lished ; and the high character of the matter is fully attested by the fact
that nearly every article we have published, except the very long ones,
which would take up too much space, has been copied extensively,
either in the home or foreign journals. In respect then to contributions,
we have not been disappointed. The medical men of the country are
awakening from a lethargy which had been thought chronic, and are
giving an impetus to the observation and collection of facts which will
redound to the reputation of this age of science. As our significant
motto says, "Medicine is enriched by facts only;" and it is for facts,
the accurate detail of s}rmptoms and effects in the reports of cases,
that we ask. Of course, theoretical essays must always follow an
accumulation and comparison of facts, and are valuable when they
are based upon them. We hope a continuance of them also. Our
department for selected matter shall be improved in future, and en-
larged, unless it be at the expense of original communications. Our
reports of the transactions of the Medical society are made hastily on
the eve of going to press, and we must beg pardon for the frequent
injustice which is done to the participants in the debates. It is a great
satisfaction to observe the slow but steady, and, we hope, effectual
organization of the medical men in this and other states, which is
going on. We hope Virginia will soon present an organized body,
which will be composed of such materials as will give it the influence
and power necessary to effect a reform in the constitution and position
of medicine worthy of her. For this end we have sedulously labored,
and shall continue to do so with redoubled energy. We call upon
our brethren for assistance and for indulgence. The duties of an edi-
tor are arduous and responsible, and withal not of a very smooth and
pleasant character. If in our zeal and independence we may have
gone further than the taste or feelings of any of our friends would
justify, we beg pardon for the offence, and allege good motives in its

676 EDITORIAL.

commission, rather than unkind feeling. To please all is impossible,
and we had rather please none than to make the Stethoscope an im-
potent organ ; but as our success thus far has been flattering, if
not perfect, we are fully satisfied of the healthy tone of the corps
medical, and of a determination to support the journal. As we have
said heretofore, the cost of this publication is so great that it cannot be
kept up unless by a full list of good paying subscribers. Many have
urged us to put the price higher, and given assurances that none would
drop off; others have advised a considerable reduction in size and mat-
ter ; all, however, protest against stopping the publication. We, then,
having no means of taking the sense of the majority of its patrons,
are obliged to make the decisive step which is to be taken to be saved.
The publication shall not be discontinued; the price shall not be raised ; nor
shall its size be cut down more than just enough to leave a larger mar-
gin. This will make it look better, and bind much more neatly.
Then, to be saved, we must throw ourselves on the exertions of our
present patrons, and call upon them to support us by each one doing
two trifling services for us. The first is, to remit us his subscription
at his earliest convenience. The second is, to shew the journal to his
neighbors and solicit their subscriptions and encouragement. This
he can do during the year, and we believe that on an average each one
can get us the names of two new ones, which will give us the two
thousand subscribers which we intend to have, sooner or later. By this
means we hope to keep up the journal in its present form, and we
have little doubt but that our patrons will act thus as agents for us,
and the subscription list will run up at once.

Indigenous Botany.

The subjoined extract is from a country subscriber, who is not a
medical man, but he is a gentleman of education, and fond of scien-
tific pursuits. This subject is one of much interest, and worthy of
the attention of physicians. We must refer our correspondent, and
all others interested in the subject, to a committee of the medical so-
ciety of Virginia, which was appointed at its last annual meeting to
report on the indigenous botany of Virginia, and of which Dr. George F.
Terrill is chairman. His post office is "Junction, Hanover." We
have no doubt but that the committee (Drs. W. J. Clark, and T. A.
Cox, of this city, J. A. Smith, Montpelier, Hanover, and P. M. Watson,

EDITORIAL. 677

Smyth C. H., are the members of it,) will be glad to receive any in-
formation concerning, or specimens of, particular plants, and will
report on their value.
Our correspondent asks,

" Can you not get some of your correspondents to write notices of the common weeds
and plants of our state, with their medicinal properties, giving their common provincial as
well as botanical names? I see hundreds of plants every day which are familiar to me. but
I am ignorant of their names and properties, whilst some of them are known to be highly
valuable. For instance, there is a weed growing in our newly cleared lands, which the
negroes call butter weed, which I have little doubt exerts a more powerful specific action
over the lungs than any substance in the Pharmacopoeia."

King Wm. County, Nov. 1851.

Practice on Hirelings.

A friend and practitioner requests us to call attention to the disad-
vantageous circumstances under which physicians in this city labor in
practising upon that numerous class, the hirelings, and desires us to
make an expose of the system of giving them " board money," instead
of their being lodged and taken care of by their hirers. This is a
matter of moment to the owners of negroes, and the city council and
the newspapers are the media for remedying the evil ; but we entirely
agree with our correspondent (we cannot publish his note,) when he
says, that the doctor is frequently blamed while it is not his fault that
the negro cannot be well attended to. On one occasion we were
called to see a servant, whose master had requested us to attend
whenever he might need medical aid, and after considerable difficulty
we found him in a loft of a miserable out house, on the premises of low
people, who had no interest in taking care of him, and indeed they
did not know that he usually slept there. The patient was ill, and
only covered with a few rags, on the floor, and could get no assistance.
We promptly informed the master of his condition, and refused to
undertake the case until we could do so under more favorable circum-
stances for the treatment of it.

These things, we have reason to believe, are of too frequent occur-
rence, and are the result of that miserable system of practising by the
year, and another which has succeeded it, almost as bad, viz : of allow-
ing agents three dollars, or a fixed sum to be deducted from the hire,
and the privilege of inserting in the bond some particular physician's
name, " to be called in when sickness requires it." We once ma-
naged a severe case, to which we were called in an emergency, and at
the close of it our bill was disputed on the ground that another
physician's name was in the bond for her hire. Had we refused to

678 EDITORIAL.

do anything, the patient would most probably have died before the
doctor could be brought — then the merited scorn of the community
would have been heaped upon our heads without measure.

It is the dut}*" of medical men to have recourse to the law in all such
cases — more though for the principle than the prospect of recovering
the fee. We refer the aggrieved parties to the newspaper columns to
bring the subject to the notice of owners of negroes, that they may
effect a plan by which to protect their interests.

Epidemic.

We regret to learn that scarlatina has been very prevalent in some
parts of Hampshire county, and that it has been of a very malignant
type. Will some of our friends there give us a history of the epide-
mic and a report of their experience in its treatment?

Memphis Medical College.

This institution has lately been reorganized, and is now, we learn,
in successful operation. The chair of physiology and pathological
anatomy is ably filled by Dr. Bennett Powler, the author of nume-
rous scientific papers, containing original and profound experimental
observations on various physiological subjects. New Orleans loses
and Memphis gains much by the removal of Professor D. from the
former city.

Professor Paul F. Eve, who, with such unusual liberality, yielded
Dr. Gross's old chair to him at Louisville, is now the professor of sur-
gery in the Nashville university.

Dr. Austin Flint, editor of the Buffalo Medical Journal, and pro-
fessor of practical and clinical medicine in the University of Buffalo,
has been contributing through his valuable journal an able and in-
structive series of " Reports on Continued Fever." We hope that they
will be published in book form, as their merits deserve.

EDITORIAL. 679

The Medical News and Library finishes the publication of Mal-
gaines' Operative Surgery, with the December Number. We learn
that it is to go on with a work of great value, for the next year, but as
yet we are ignorant of its name.

New Journals.

As fast as one medical journal dies two new ones spring up in its
place. Since the death of the New York Register of Medicine and
Pharmacy, we have received the New York Medical Times, noticed in
our last, and Nos. 1 and 2 of The New Orleans Monthly Medical Re-
gister, edited by A. Foster Axson, M. D. It is a closely printed dou-
ble column octavo of 12 pages. Price % 1 per annum in advance.

The editor, in his introduction, says : " The programme of our plan
will be to give our leading columns to original cases in surgery, ob-
stetrics and general medicine, possessing interest enough to make them
worthy of record. In this respect we have an unlimited field to har-
vest, as our hospitals, both private and public, have been placed at our
command. * * In our great metropolitan hospital, the Cha-
rity, there is an annual average registration of 15,000 inmates," &c.
From the two numbers before us we cannot doubt the success of the
Register.

The Randolph Macon Magazine.

We have never noticed this monthly, because we had never seen it
until we received the November No. a few days since. It is a very
neat 8vo. of 36 pages of original matter, printed by Chas. H. Wynne,
Richmond, and edited by committees of the two literary societies of
Randolph Macon college. Terms $ 1 50, or $ 2 if not in advance.
We wish it great success, because the habit of writing ought to be
cultivated and the style improved while young men are at college.
We every day see smart men who cannot write a page because they
have never learned, never tried. If our medicine is of any service
to the students we will exchange with pleasure.

Southern Medical and Surgical Journal — Extra.

We have received from Prof. L. A. Dugas a pretty tart reply to

11 Remarks," signed " B.," in the Western Journal of Medicine and

82

680 EDITORIAL.

Surgery, on " A case of Urinary Calculus, attended with peculiar cir-
cumstances, and treated by Lithotrity, by Prof. D."

Dr. Dugas has just returned from Europe, where he was sojourning
when the strictures on his report appeared. It is a pity that scientific
subjects cannot be discussed without going into undignified and per-
sonal trains of " remarks," and of bringing men into hostile array
against one another.

Dental College.

We neglected to notice the establishment of a dental college at Sy-
racuse, New York, which has just gone into operation with six profes-
sors, who lecture on and demonstrate the following branches of the
important art long since gone from regular medicine: theory and
practice of dental surgery, and dental technology ; the institutes of
dentistry, hygiene and comp. dental anatomy ; anatomy and phy-
siology, and the general principles of surgery, special pathology and
therapeutics. A professor of chemistry and a demonstrator of me-
chanical and dental surgery.

Dentistry is a speciality of the medical art, and as such it ought to
be taught. We confidently expect in a few years to see colleges of
dental surgery so common and in such esteem that no man can prac-
tise the art unless he has graduated D. D. S.

G-utta Percha Speaking Tube.

We observe on the cover of the London Chemist an advertisement
by the gutta percha company of this novel but valuable fixture to a
physician's house. Mr. Henry Ashton says :

" I have had gutta percha tubing carried from rny front door to my bedroom, for the
transmission of communications from my patients in the night. I have it brought to my
pillow, and am able with the greatest facility to hold any communication with the messenger
in the street, without rising to open the window, incurring exposure to the night air. It
gives me great satisfaction in being able to recommend to my medical brethren an article so
cheap and easy of adoption, which will save them from the injurious effects of being ex-
posed to a current of cold air from an open window the moment they rise from their beds."

The advertisement is accompanied with a picture of a waking
iEsculapius, turning on his pillow and holding conversation with a
messenger at the door three stories below. All city physicians would
find it a great convenience ; and the miserable tamperer who would
play pranks with it merits an acid shower or a round ounce of hot
lead.

malgaigne's operative surgery. 681

Reviews and Bibliographical Notices.

Operative Surgery, based on Normal and Pathological Anatomy — By
J. F. Malgaigne, Professeur Agrege de la Faculte de Medecine de
Paris, Chirrurgien de Vhopital de Lourcine, Chevalier de la Legion
d'Honneur et du Merite Militaire de Bologne, etc., etc. Translated
from the French, by Frederick Brittan, A. B., M. D., M. R. C.
S. L. Illustrated by wood engravings, from designs by Dr. Westmacott.
Philadelphia: Blanchard Sf Lea. 1851. 8vo. pp. 565.

Medicine operatoire, or operative surgery, is now pretty universally re-
garded as a distinct and separate department of the healing art. Lec-
turers appropriate a course to operative surgery, and authors are di-
viding their works into principles, or surgical pathology, and the prac-
tice of the art. This division is comparatively recent, but it is, for
all time to come, adopted. Since Louis XIV established a special
chair in the French university for operations, that nation seems to
have held dominion over this department. Students flock to Paris
from all parts of the earth, under the impression that it is the school
for surgery, and every ambitious cutter seeks the latest French procede
to put it into his practice. The acquisition and maintenance of this
ascendency is attributable to the opportunities afforded to students by
the French schools (under government regulations) which require that
surgery shall be studied not only clinically and by lectures, but that
the operations shall be frequently repeated on the dead subject ; and
until as ample opportunities are afforded elsewhere, the dominion
over the operative art will be held by the French schools. In Paris
every procede, new and old, is taught by private instructors, who give
the pupil the mode of each master, and leave him free to adopt the
one in which he feels most skilled. With most of these instructors
Malgaigne's work is still regarded as the text. It has gone through
several editions and has been translated into six different languages.

The present translation is a simple one, nearly literal, and, while it
is not encumbered with notes, there are numerous short and valuable
additions appended, in note form, by the translator. The wood cuts,
twenty or thirty in number, are mostly intended to display particular
points of the surgical anatomy insisted on in the text; and we must
say that they are not entirely satisfactory, neither in delineation nor
execution.

The great value and reputation of this work are doubtless owing to
the fact, that at the same time that the manipulative part of operations
is described, the greatest care has been given to the surgical anatomy
involved in them; a knowledge of which, the author appropriately
remarks, is the " sole means of giving to the knife security in its
progress and to the proceeding clearness of description."

Of Mons. Malgaigne, as an operative surgeon, we have little to say.
His exalted station, as one of the very first surgeons of the French
capital and a savan of wide reputation, speaks more forcibly than any-
thing we might write of him. His motto, " Securite, simplicity celerite"

682 REVIEWS AND BIBLIOGRAPHICAL NOTICES.

is beautiful and full of meaning, and his precepts are inculcated in
accordance with the great principles of true surgery which these
words embrace. Security, efficiency, safety, first ; then simplicity,
which is always beautiful and generally least hazardous ; and lastly,
he puts celerity in its proper position, although many a Knight of the
Steel has won his reputation by his glittering knife, with the aid of a
friend and his stop-watch, to the detriment of his patient and of his
clinical class.

Malgaigne's style is brief, clear, decided, and his writings have
a great merit, now, unfortunately, not too common : i. e., one finds
the author's opinion whenever he wants it, and if the reader refers for
a hint or positive instruction in a case, he will not be put off with
non-committal circumlocution in elaborate sentences, but will be en-
abled readily to determine upon his method, according to the author or
not. Such being the case, we can with confidence recommend this
book, though we have not room to lay before our readers many of the
author's views, that they may judge for themselves. When attending
his clinique at Hopital St. Louis, his practice as well as his precepts
fully impressed us with the independence and originality of the sur-
geon. These are illustrated in the few extracts which we make
below.

In speaking of the uses of instruments, he sa}rs, " it has been thought
that scissors, acting by pressure, should be rejected in certain opera-
tions— hare-lip for instance — because they make less clean and neat
incisions by bruising and contusing the part. The contusion is a chi-
merical idea ; as for the neatness of the incision the bistoury is pre-
ferable."

On catheterism " almost all authors have recommended a move-
ment celebrated for facilitating the introduction of the catheter ; they
would have you draw the urethra on the catheter as it passes into
it. The least reflection on this manoeuvre suffices to demonstrate its
inutility."

In speaking of lithotomy our author goes on to say: " It is the pain
and inflammation which kill the patients ; and the most powerful causes
of these assuredly are the dragging, tearing and bruising of the tissues —
accidents inevitable in all the proceedings of perineal lithotomy, when
the section of the bladder is not large enough. There is only one
way of rendering perineal lithotomy less dangerous, at least as regards
the operation itself; and it consists in following a precept entirely
opposed to that which is generally laid down, viz : in dividing the
prostate freely on one side beyond its limits — in making so free a passage
for the stone that the wound may remain an incisio?i and not be com-
plicated by contusions and lacerations."

Appended to this book is a table of the new measures of length
and weight, and one shewing the exact value of the French measures
when compared with our own standards — a very useful thing to every-
body who is not familiar with foreign terms.

GREGORY ON ERUPTIVE FEVERS. 683

Lectures on the Eruptive Fevers, as now in the course of delivery at St.
Thomas's Hospital, in London — By George Gregory, M. D., Fellow
of the Royal College of Physicians of London — Physician to the Small
Pox and Vaccination Hospital at Highgate — Corresponding Member of
the National Institute af Washington, 8fc. First American edition,
with numerous additions and amendments by the author, comprising his
latest views, with notes and an Appendix, embodying the most recent opin-
ions on Exanlhematous Pathology, and also statistical tables and colored
plates — By H. D. Buckley, M. D., Physician of the New York Hos-
pital, Sfc, fyc, Sfc. Neio York: S. S. Sf W. Wood, Publishers. 1851.
800. 379 p.

Dr. Gregory's high professional attainments, and his extensive ex-
perience, as derived from twenty years connection with the small
pox and vaccine hospitals of Edinburg, give to the above work a
degree of authority which must be respected, if not acquiesced in, by
all. This work abounds with valuable information in regard to a class
of diseases of very frequent occurrence and of fearful mortality, and
we can assure our professional friends that they will be amply repaid
for a careful perusal of the whole work. The subjects of which it
treats involve so many interesting facts, that any attempt to draw up
even a general summary, would extend the limits of this notice be-
yond what is appropriate.

The two first lectures are devoted to a consideration of the charac-
ter, affinities, and management of eruptive diseases generally, which
will be found exceedingly interesting and instructive. In the subse-
quent lectures, the history, pathology, diagnosis and treatment of
variola, scarlatina, rubeola, &c, are all elaborately discussed. Dr.
Gregory's style is exceedingly good, and his descriptions of disease
are given in clear and forcible language. In most of the opinions ex-
pressed by the author we entirely concur, but regret being compelled
to differ with him in regard to a question of great practical impor-
tance, viz : the relative advantages of the protective powers of inocu-
lation and vaccination. In our opinion, the substitution of inoculation
for vaccination, would result most disastrously to the public good, by
multiplying the foci of contagion in the midst of a healthy communit}r.
In order that our readers may comprehend the views of our author,
we quote the following from his work : " You will naturally wish to
know what was the practical result of inoculation. I will tell you in
a few words. Its influence in lessening the mortality of small pox
was something quite extraordinary and scarcely credible. With or-
dinary precautions in the choice and preparations of subjects, not
more than one in five hundred cases will terminate unfavorably. The
ill success which attended the early inoculations, between the years
1722 and 173.0, arose entirely from bad management, from the most
culpable negligence in the choice of subjects, and an utter ignorance
of all the principles by which the practice of inoculation should be
governed. Had not the discovery of Jenner interfered to interrupt
its extension and improvement, inoculation would have continued to
this day increasing yearly in popularity. It cannot be doubted that

684 REVIEWS AND BIBLIOGRAPHICAL NOTICES.

improvements in medical science generally would have shed addi-
tional lustre on this practice.

Since the introduction of vaccination it has been the fashion to de-
cry inoculation, and to impute to it mischief of which it was not
guilty. The great objection made to inoculation, and that which re-
cently induced parliament to abolish it altogether under heavy penal-
ties, was, that it disseminated the virus and multiplied the foci of
contagion. Dr. Watkinson and Dr. Schwenke in 1777, and more re-
cently Dr. Adams, broke the force of this argument, by pointing out
how important a part epidemic influence plays in the diffusion of va-
riola. Had they lived m our times, how strongly would they have
fortified their argument ! We saw, in 1S38, an epidemic smallpox
raging in London, where inoculation had long been discontinued.
The admissions into the Smallpox hospital in that year exceeded those
of 1781 and of 1796. Inoculation was abolished throughout England
and Wales in 1840, and the act has been most rigidly enforced ; yet
during the last two years smallpox has visited every count}7- of Eng-
land.

Sir Gilbert Blane has attempted to prove by statistics the evils of
inoculation. He has shewn that the proportion which the mortality
by smallpox in London bore to the general mortality, increased du-
ring the last century from 7S to 94 per thousand, but many circum-
stances must receive attention before we are justified in drawing con-
clusions from this fact. The population increased prodigiously in the
interval, more indeed than would suffice to explain the increased
mortality by smallpox. But, further, the general mortality diminished.
Consequently though the actual mortality by smallpox had remained
stationary and uninfluenced by population, its ratio to the total mor-
tality would appear to augment. Thirdly, Dr. Adams has shewn that
a corresponding increase took place in scarlet fever and whooping
cough, which are not communicable by inoculation. Lastly, a differ-
ent mode of calculation would exhibit a very different result. The
sophism consists in arranging your figures so as to include or exclude
years of epidemic prevalence. If, for instance, we divide the last
ninety years of the 18th century into three periods, we shall find that
the recorded deaths by smallpox were as follows: 1711 to 1740
(when there was no inoculation,) 65,3S3 ; 1741 to 1770 (when inocu-
lation was coming into general use,) 63,308 ; 1771 to 1800 (when
inoculation was almost universal,) the deaths were only 57,268 ; so
that, by this shewing, inoculation diminished the mortality by 8115
lives !

Statistics are very useful and deservedly carry great weight with
them ; but they may be enlisted, with a little management, on both
sides of an argument.

One subject only remains for our consideration, and that is, the ques-
tion, whether any circumstances would still warrant us in recommend-
ing inoculation on scientific principles ? Concurring most cordially in
opinion that the practice of inoculation by unqualified persons ought
to have been put down (not in 1840, but forty years before that,) by
stringent legislative enactments, I still remain of opinion, that under

GREGORY ON ERUPTIVE FEVERS. 685

several circumstances it is the duty of a medical man to recommend
inoculation. These circumstances do not, indeed, often occur; but
the legislature would hardly wish to control and fetter, even in a sin-
gle case, the deliberate judgment of a physician acting for the bene-
fit of his patient. I will name to you four of these cases: 1. When a
person has been found, from peculiarity of habit, unsusceptible of vac-
cination. 2. When new sources of vaccine lymph are introduced,
and it becomes of importance to ascertain that the new virus is effi-
cient. 3. When young persons (between the ages often and twenty,)
vaccinated in early life, are proceeding as cadets to India. 4. When
small pox unexpectedly breaks out in a country district, when (even
with the facilities of a penny post) vaccine virus is not to be obtain-
ed." In our opinion, the propagation of such views should be dis-
countenanced for the following reasons : 1st. Because no physician
who is able to obtain vaccine matter has a ri°ht to resort to inocu-
lation, thereby running the risk of spreading the small pox affection
throughout a community in which there had previously existed but
few, if any cases of variolous disease. 2d. We believe that vaccina-
tion when properly performed, is almost, if not equally as protective
against variola as inoculation. 3d. The difference in the mortality of
those attacked with variola after vaccination and inoculation is by
no means so great as our author would lead us to believe. For de-
tails on this point, the reader is referred to the admirable appendix
furnished by the American editor of the work before us. 4th. The
reports furnished by the governments of France and Prussia clearly
prove that the protective power of vaccination is greatly enhanced
by a regular system of revaccination. This practice, we think, should
be adopted in all communities. Such is a brief summary of the rea-
sons which would induce us to prefer vaccination to inoculation. The
fact that the unmodified form of variola may be communicated to
healthy persons who come within the range of the contagious in-
fluence of those laboring under the inoculated disease, forms an in-
superable barrier to the substitution of inoculation for vaccination, ex-
cept in some of the cases referred to by our author. In a case occur-
ring in our own practice the following striking evidence of the pro-
tective power of vaccination was observed : one of a number of chil-
dren was seized with unmodified variola, and while the disease was
in progress the rest of the children were vaccinated. As the vaccine
disease progressed, there occurred upon each one of the children a
very slight variolous eruption ; but in none of them did the affection
assume a more severe grade. This not only illustrates the powerfully
protecting power of vaccination, but would serve to shew that it pos-
sesses this power even after the contagious effluvia have been intro-
duced into the system.

There are some other points which we should like to notice, but our
limits are already exceeded, and we must conclude by recommending
their worth to the profession at large. The American editor has
faithfully and ably discharged his duty. The typographical execu-
tion is admirable.

686 REVIEWS AND BIBLIOGRAPHICAL NOTICES.

Medical Lexicon — A Dictionary of Medical Science, containing a concise
explanation of the various subjects and terms of Physiology, Pathology,
Hygiene, Therapeutics, Pharmacology, Obstetrics, Medical Jurispru-
dence, Sfc, with the French and other synonymes ; notices of climate, and
of celebrated mineral waters ; formula for various officinal, empirical and
dietetic preparations, Sfc — By Robley Dunglison, M. D., Professor
of the Institutes of Medicine, Sfc, in Jefferson Medical College. Eighth
edition, revised and greatly enlarged. Philadelphia : Blanchard Sf Lea.
1851. 800. 927 pp.

We have no hesitation in saying that this is the best medical lexi-
con with which we are acquainted. Dr. Dunglison is a man pre-
eminently qualified for the author and editor of a work of this descrip-
tion, as the success of seven editions of his lexicon has demonstrated.
The book has no rival in this country, and is a sine qua non to the stu-
dio of the scholar as well as to the medical student. The activity of
the medical world is such as to render necessary frequent additions
of words and terms to all the branches of medical science. This last
edition contains the trifle of "four thousand terms not to be found in the
last," and we have not failed to find in it every legitimate word for
which we have searched, even of the most recent coinage. In fine,
this dictionary is not only invaluable as an epitome of medical science,
but it is indispensable to the student if he desire to understand the
numerous names and synonymes with which he meets in the study of
physic or literature.

The cost of this book is really trifling, when the enormous amount
of matter contained on the thousand finely printed pages and the
handsome and durable manner in which it is bound are taken into
consideration.

Elements of Physiology, including Physiological Anatomy — By William
B. Carpenter, M. D., F. R. S., F. G. S., Examiner in Physiology
and Comparative Anatomy, in the University of London, and author
of the " Principles of Physiology," and the "Principles of General and
Comparative Physiology," Sfc. Second American, from a new and re-
vised London edition, with one hundred and ninety illustrations. Phila-
delphia: Blanchard Sf Lea. 1851. &vo. 566 pp.

As an elementary work on this branch, Dr. Carpenter's work has
long held a high position, and is probably without a rival in the Eng-
lish language. It is the hand book of the student in the British col-
leges, and previous editions have found their way to every part of our
country. The present edition has been printed simultaneously with
the London edition, under the immediate supervision of Dr. F. G.
Smith, lecturer on physiology in the Philadelphia association. Much
of the present edition is fresh from the pen of the distinguished author,
and the late progress of the science has rendered many additions and
changes in particular departments. The chapters on the nervous sys-

horner's anatomy — beasley's formulary. 6S7

tern, generation and vital forces have been almost entirely re-written.
We commend the present edition as probably the most eligible text
book for students which they can find. It abounds in good plates and
cuts, and is not spun out too long to be read during the lecture terms.

Special Anatomy and Histology — By Wm. E. Horner, M. D., Professor
of Anatomy, University of Pennsylvania, senior Surgeon of St. Joseph's
Hospital, member of the Academy of Natural Sciences, Philadelphia,
fyc. Sfc. eighth edition, illustrated with anatomical figures. Philadel-
phia: Blanchard 8f Lea. 1S51. 2 vols. 8 vo. pp. 510 — 500.

The unbounded success of Dr. Horner's efforts to supply to the
student of anatomy a text book which would meet all his wants, has
been fully proven by the continuous demand for his work. After
seven large editions have been exhausted the author now brings out
the eighth, with many improvements. To all young medical students
a most valuable feature in anatomy is to have good plates and
plenty of them. The volumes before us have this feature, containing
as they do upwards of three hundred accurate delineations of ana-
tomical structures — many of them handsomely executed, and the
others as well done as is common with these wood cuts.

It is only necessary for us to announce that this edition is out.
The book is known and appreciated by every medical man in the
country ; and to the young men entering on the study of medicine we
commend Horner's Anatomy, because the author is the great anato-
mist of the country, with powers of description rarely equalled by
teachers of this important branch.

The PocTcet Formulary and Synopsis of the British and Foreign Phar-
macopeias, comprising standard and approved formulce for the prepara-
tions and compounds employed in medical practice — By Henry Beas-
ley, first American from the fourth London edition, corrected, improved
and enlarged. Philadelphia: Lindsay fy BlacJciston. 1852. 12mo.
443 pp.

We have to thank the publishers for this book, sent to us through
Morris. It is a useful table book in every office, because it is a sy-
nopsis of a vast amount of knowledge which the physician needs
both when he orders or when he prepares doses, compounds and all
sorts of things used in practice. Everything is arranged in alphabeti-
cal order, and great caution was observed in preparing it, as is shewn
in the fact that the remarks on any particular substance are consis-
tent, and agree to the smallest fraction of a grain with remarks on the
same substance in other parts of the book. This is not always the
case in prescription books and others of the kind.

83

688 REVIEWS AND BIBLIOGRAPHICAL NOTICES.

Meteorological Register for twelve years, from 1831 to 1842, inclusive, com-
piled from Observations made by the Officers of the Medical Department
of the Army at the Military Posts of the United States, prepared under
the direction of Brevet Brigadier General Thomas Lawson,
Surgeon General United States Army. Washington: C. Alexander,
printer. 1851. Svo. 324 pp.

Our thanks are due to Dr. Lawson for the Register. It will always
be valuable for reference, and contains the most accurate information
in regard to the temperature, winds, rain, snow, fair weather, sun-
shine and clouds at points all over our extended country. This sys-
tem was commenced in 1819 under the auspices of Mr. Calhoun, and
the volume before us is the third one published by the war depart-
ment. The importance and great value of reliable meteorological ob-
servations and statistics as materiel necessary for the solution of many
of the perplexing problems now under consideration of the scientific
world, should induce our state governments as well as the federal
government to lend some aid towards the collection of them. Such
a point as Richmond is neglected, because it is not an army station.
This should not be so — the legislature might easily require registers to
be kept by the guard at the state barracks, without inconvenience or
cost.

A Treatise on the History, Etiology and Prophylaxis of Trismus Nas-
centium — By Prof. Watson, of the University of Nashville: Svo.
30 pp. 1851. Second Edition.

This paper will be attentively read by the profession. Its practi-
cal teachings are entirely prophylactic. If stripped of some of its
technicalities, and the author had been content to express some of his
good ideas in simpler terms, it might very profitably be in the hands
of all heads of families.

This class of persons need instruction in the prophylactic treatment
of many dangerous and fatal diseases. The physician is not often
called in until the giants are full grown, and his efforts are only
curative. Dr. Watson takes ground with Dr. Colles, that trismus
nascentium is a true traumatic tetanus, dependent for its production
on " a peculiar occult state of the general system," as a predisposing
cause, and an unhealthy condition of the umbilicus as the exciting
cause. With Dr. Clarke, he maintains that the predisposition may be
destroyed by general sanitary precautions, and the immediate ex-
citing cause avoided by intelligent and skillful care of the umbilicus.
He is strengthened in these positions by a strong collection of facts,
all going to shew that on the cotton plantations of the South (where
this disease is very common,) its ravages are escaped wherever the
mistress of the family gives her personal attention to the condition of
the newly born infants.

W.

REVIEWS AND BIBLIOGRAPHICAL NOTICES. 689

The Physician's Visiting List, Diary and Boole of Engagements for 1852.

Messrs. Lindsay & Blackiston of Philadelphia have laid the pro-
fession under obligations to them for one of the greatest conveniences
ever furnished them. Here is a little pocket book, half an inch thick,
and eight by three in dimensions, which will hold memoranda of
visits, paid and to be paid, for each day of each month during the
coming year; of obstetric engagements; things wanted and lent ; the
addresses of patients and nurses ; bills and accounts asked for, &c.
&c. It is prefaced with an almanac, explanations, table of doses,
poisons and antidotes, the national code of ethics, and other things,
useful always to refer to. It has lines for twenty -five patients per
day, and with it in one's pocket anybody's bill can be made off' at
any time in a few minutes ; and at the end of the year a great deal of
information, dates &c. will be preserved, which would otherwise be
lost. It is one of the most complete things we ever have seen, and
every practitioner would secure one if he could but see it.

As the demand for them must soon exhaust the edition, we suggest
to the publishers to have the next one bound with one lid to lap over
the other, so that it may be tied like a pocket book and so that it will
not warp open.

Transactions of the Medical Society of Pennsylvania, at its Annual Session,
held in the City of Philadelphia May 1851. Vol. 1. Published by order
of the Society, by T. K. Sf P. G. Collins.

We are glad to have these proceedings. The whole compose a
neat octavo of 128 pages. The minutes of the meeting evince good
feeling and hearty co-operation of a body of men who are at worlc.
The address of the president, Dr. Worthington, was eloquent, and
urged good wholesome doctrines. He properly took the ground that
the only way to purify the profession, elevate its character and enlarge
its sphere of usefulness, is to guard with the greatest vigilance the por-
tals through which candidates are admitted to membership. Nobody
ought to be admitted to the doctorate who is not qualified at once to
go into the practice ; and, says Dr. W., "our colleges, which are en-
trusted with the power of granting degrees, should be amenable to the
entire profession." That is to say, they should heed the voice of the
great congress of the representatives of the American profession, so
often and so fervently lifted for reform in the system of manufacturing
doctors. Dr. W.'s address is like many others which have been de-
livered of late years before medical organizations ; it breathes the
right spirit throughout. But are these organizations bold and indepen-
dent enough to carry out the reforms and the standards as far as they
can ? We hope their courage will increase with their strength. But
ere long the tide will flow so strong that there will be no resisting it ;
and then we shall have a race between the schools as to which one
shall have the highest standard — which one shall be the best.

One hundred pages of these transactions are occupied with various

690 REVIEWS AND BIBLIOGRAPHICAL NOTICES.

sanitary, mortuary, topographical and special medical reports, fur-
nished by members, committees and county societies. Some of these
are able papers, and we may have room in future to draw from them.

The Quarterly Summary of the Transactions of the College of Physi-
cians of Philadelphia, from August 5th to October 7th, published by Messrs.
Lippincott, Grambo Sf Co., has been received. These Transactions
have been valuable and interesting from the first, but they are im-
proving steadily. The ability of the Philadelphia profession is exhi-
bited in them, and the knowledge and experience of the most distin-
guished men in that medical capital may be gleaned from these pages ;
being made, as their motto, " non sibi sed toti" says, a common fund.
All the large societies should publish their proceedings in this way and
exchange with one another. This would break up private medical
journals and place the profession in the position of editor of its own
press.

Minutes of the Proceedings of the Medical Society of Georgia, at its Second
Annual Meeting, held at Atlanta, April 1851.

This little pamphlet affords us gratification, inasmuch as it gives
evidence of the energy which has been enlisted in the cause of ad-
vance in Georgia, one of the great states of the South. The National
medical association is the common parent, and already she has a nu-
merous offspring. Nearly every state in the Union has now respond-
ed to her call and formed state societies. These societies already
possess more weight and influence than the mighty schools. For
where is the place where a Georgia or a Virginia or a Philadelphia
diploma of M. D. is a passport to its possessor? While on the other
hand, the diploma or certificate of membership of the medical society
of either of these states, is a pretty sure guarantee of the standing and
fair name of the possessor. Were every contributor to the journals
and every public medical character a member of the organization of
his state, we would hear nothing of the personal strife and public
suspicion of unworthiness which now constantly disgrace us before
the public.

Appended to these proceedings are two papers worthy of notice ;
one is a short report of a committee "on the character of education
necessary for a physician." This report is short, but to the point. But
why adopt such idle words ? Idle words they are ; for will the society
insist upon its standard of " the character necessary for a physician"
being adopted by the private bodies who make whomsoever they
may please full physicians ? They doubtless answer that they would
if they could get the co-operation. Very well. We will see if in a
year or two the state societies will not make " a long pull, a strong
pull, and a pull altogether," and carry out these ideas which are so just
and so true that all committees, reporters, writers, editors, professors,

REVIEWS AND BIBLIOGRAPHICAL NOTICES. 691

(in their introductories,) and presidents of societies, are obliged to re-
iterate them whenever they take pen in hand.

The second paper is the address of Dr. R. D. Arnold, president of
the society, &c. The theme selected was " The reciprocal duties of
physicians and of the public towards each other." We wish this ad-
dress could be published in all the newspapers, that everybody might
see it and read it. It is a subject much neglected by the one party
and little understood by the other.

We return our thanks to Dr. C. D. Quintard, corresponding secre-
tary of this society, for a copy of the " Laws of the State of Georgia,
relating to the practice of medicine.'''' They shall be noticed in a future
number.

Proceedings of the first Annual Meeting of the Medical Society of Ken-
tucky, held in the City of Frankfort, Oct. 1, 1851.

Our friend, Dr. R. J. Breckenridge, jr., corresponding secretary of
the society, has been kind enough to send us this pamphlet. It con-
tains an account of the assembling of the Kentucky profession in con-
vention, and the immediate formation of a state society, its constitu-
tion and the national code of ethics, which was adopted. The next
meeting of the body will be held in Louisville on the third Wednes-
day in October 1S52, when sundry committees on the great medical
topics will report. We observe that these committees are composed
of able men and are well appointed ; and as the energetic young men
of Kentucky (of whom we know something) have gone to work in the
right spirit, we confidently look forward for a grand society at no dis-
tant day.

We have received an address on " The Claims of Science," deli-
vered before the two societies of Erskine college, S. C, at its last com-
mencement, by W. C. Richards, A. M. This gentleman is a dis-
tinguished advocate of education in the South, and an enthusiastic
lover of science and literature. The address is elegant and chaste,
and appeals to the South to raise its voice in the patriotic cause of
mental cultivation among our people.

Items.

A stated monthly meeting of the New York academy of medicine
was held at the small chapel of the university on Wednesday, 8th
September, with a full attendance.

The academy, on motion of Dr. J. R. Wood, went into committee
of the whole on the state of the academy, Dr. J. Wood in the chair.
The subject under consideration was the publication of a certificate

692 ITEMS.

granted by a fellow of the academy to an oculist of this city. After
an expression of opinion by several fellows, strongly disapproving of
said certificate, a letter was read from the offending fellow expres-
sive of his regrets that he had given said certificate, and declaring
that the individual to whom it had been given had forfeited his pledge
by publishing said certificate. A letter was also read from the fellow
to said individual, forbidding any farther publication of said certifi-
cate. After much discussion, the academy, in consideration of said
letter of apology, resolved to postpone indefinitely the farther consi-
deration of the subject. — N. Y. Med. Times.

A Model Clergyman. — At a semi-centennial celebration of the
settlement of the Rev. Dr. Snell over the church in North Brookfieid,
Mass., the Rev. Dr., in addressing his people, took occasion to remark :
" One other thing I must not suppress ; I would patronize regular-bred
physicians — men of good character and well acquainted with their
profession. It is perfectly preposterous to suppose that those who ne-
ver made the human system and diseases and medicine their study,
should better know what ails the patient and what treatment his case,
under all circumstances, requires, than observation and practice.
Health and life are too valuable to be sacrificed on the shrine of ig-
norance. I would have no fellowship with ultraism, humbuggery,
quacker}*-, mesmerism or mysterious knockings — all of a sort — the
plagues of wise men and the idols of fools." We commend this to the
notice of our clerical friends who are so anxious to make proselytes to
the modern systems of medical tomfooleries. — Ibid.

Prof. Bennett, of Edinburgh, strongly advocates the converting of
the Crystal Palace into a winter garden and promenade for the bene-
fit of invalids. He thinks that consumptive patients would be greatly
benefited by breathing there a pure balmy air, taking exercise, and in
various ways amusing themselves. So favorably does this plan strike
the managers of the hospital for consumption, that they contemplate
erecting an immense greenhouse or sanatorium as a part of the insti-
tution. If we mistake not, a distinguished professor in our midst en-
tertains like views. — Ibid.

Punishment of Quacks in the days of Edward VI. — A quack
in the days of Edward VI was punished by being placed upon a
scaffold, with a paper on his breast on which his deceitful practices
were written ; after which he was set on a pillory. He was next put
on a horse's back — his face to the horse's tail — the tail placed in his
hands — a collar was put about his neck, a whetstone on his breast,
and he was led through the streets of London at the ringing of basins.
He was afterwards banished. If the quacks of our day were punish-
ed according to their deserts, what a fluttering there would be ! — Bos-
ton Med. and Sur. Journal.

Dr. Bennett Dowler, of New Orleans, has been appointed to the
chair of physiology and pathological anatomy in the Memphis medi-
cal college.

ITEMS. 693

Professor Simpson offers $ 500 to any clairvoyant or mesmerize who
can read a line of Shakspeare which he has written on a slip of paper
and enclosed in a sealed box. That's a corker !

Dr. Oldham has lately performed, at Guy's hospital, London, the
Cassarian section successfully to both mother and child. See Lancet
for particulars.

Dr. Hays has employed Cod-liver oil in the treatment of from two
hundred to two hundred and fifty cases of scrofulous ophthalmia and
granular lids, and says that the benefit resulting from its use has been
striking.

[We have used this remedy in a number of " dirt eating children,"
sometimes combining it with the syrup of the iodide of iron, and with
more satisfactory effect than any we have seen secured by other
remedies. If the bowels continued to act irritably under the use of
the medicine, enough laudanum was advised to check the evacuation.
These medicines, together with a generous diet, have, in a short time,
conquered the morbid propensity to eat dirt in several aggravated
cases of this cachexy, which is so often observed among negro chil-
dren, and not unfrequently among whites. E. L. D.]

[Trans. Med. Journal.

Ayer's Cherry Pectoral. — We have observed with astonish-
ment, that the " Transylvania university of medicine, Lexington,
Ky.," figures among the list of " high medical authorities " which
have awarded to the Cherry Pectoral "unqualified commendation."
We allude to this circumstance simply for the purpose of saying that
no such commendation has ever been conceded by Transylvania
university, and to insist upon the name of that venerable institution being
stricken from the list. We protest against such a rape of the fair fame
of our old school, and take this occasion to say, that if the testimonials
of the dragoman of the Imaum of Muscat (!) and other high functionaries
have been as unceremoniously employed as that of Transylvania, Mr.
Ayer's notions of truth and propriety may be ranked with those of
vendors of nostrums generally — made of materials more stretchy
than gum elastic. — [Ibid.

Drs. J. C. Warren, of Boston, and Mutter, of Philadelphia, who
have been absent during the summer months in Europe, have returned
to the United States.

Death of Dr. Baudelocque. — This distinguished physician has
lately sunk under a chronic malady, aged 55. He is well known to
English readers as a writer on obstetrical subjects and on scrofula.
He was physician to the hospital for sick children, and had one of
the largest midwifery practices in Paris.

694 SELECTIONS.

The Training and Teaching of Idiots.

The last number of that excellent quarterly, the American Journal
of Insanity, contains a full and very interesting report, made to the
legislature of Massachusetts by Dr. S. G. Howe, who was ap-
pointed one of the commissioners to enquire into the condition of the
idiots of the commonwealth, to ascertain their number, and whether
anything could be done in their behalf. He gives a flattering account
of the gratifying results which attended the experiments on several
cases.

The conclusions to which this commission have arrived may be
known from the following brief extract :

" I consider this experiment, therefore, to have been entirely suc-
cessful. It has demonstrated beyond question that among those
unfortunate human beings who are left to grovel in brutal idiocy,
there are many who can be redeemed and elevated, and made to be
comparatively intelligent and happy and useful. Here stand the
rescued ones, living proofs of the power of education. Let even the
most skeptical examine them closely ; their doubts will be removed.
Let those who have disapproved the project as a vain and hopeless
one. and those also who have ridiculed it as a presumptous one, (for
there have been both, and in high places too,) let them come, and see
whether they have not unwittingly been encouraging an abandonment
of their fellow-beings, who might have been saved from a condition
at which humanity shudders."

Startling Facts from the Census.

Messrs. Editors — In the interesting article on the increase of our
population, published in your paper of June 12th, you remark in the
words of The Commercial, " Either the free colored population are
voluntarily emigrating at a rate beyond what is generally supposed,
or there is something in their social condition that is entirely inimical
to their physical prosperity."

Many arguments might be adduced to prove that the latter and not
the former alternative is the real fact. And as a remarkable illustra-
tion of this truth, I send you a copy of a few items from a statistical
table which I compiled some years ago from the U. S. census of 1840,
and published in a country newspaper, without obtaining much notice,
although it exhibits, in a most striking light, the amazing prevalence
of insanity and idiocy among our free colored population over the
whites and slaves.

It is a matter of regret, that the U. S. census of 1840 groups both
these classes of unfortunates together, as if they were involved in one
and the same calamity ; and it is also to be regretted that there is no
discrimination of the prevalence of these maladies among the free
blacks and the slaves. The writer made an effort to have these im-
perfections obviated in taking the late census in 1S50 ; but he has

SELECTIONS.

695

reasons to apprehend from what he has seen of the returns, that his
feeble voice did not engage the attention of the "commissioners" who
were entrusted with the responsible duty of preparing the forms,
though they solicited suggestions from those who felt an interest in the
subject.

The census of our own state, taken in 1845, carefully distinguishes
betwen idiots and lunatics ; from which it appears that their ratio in
the state of New York is about four to five, or more nearly sixteen to
twenty-one, on the whole population ; but it makes no distinction
between the white and colored population in regard to the existence
of these maladies. It is obvious, however, from the following sche-
dule, that there is an awful prevalence of idiocy and insanity among
the free blacks over the whites, and especially over the slaves. Who
would believe, without the fact in black and white before his eyes,
that every fourteenth colored person in the state of Maine is an idiot or a
lunatic ? And though there is a gradual improvement in their condi-
tion, as we proceed West and South, yet it is evident that the free
states are the principal abodes of idiocy and lunacy among the colored
race.

Statistical Table from the United States Census of 1840.

6

Pi

jjjj

■a

'3

S q

TS

a

OS

•d

a

STATES.

2 2

*-3

S

1

_"5

9

o
•a

"3 "3

la

to O

1

*£ P<
B O
O p.

So

p.
o

Eh

P

£

in

ja

lii

£

Maine, ...

500438

537

I in 950

1355

94

i 14

New Hampshire,

284036

486

1'

584

538

19

1 '

28

Massachusetts, - .

729030

1071

I '

662

8669

200

1 '

< 43

Vermont, ...

291218

398

1 <

731

730

13

1 '

' 56

Connecticut,

301856

498

I <

606

8159

44

1 '

' 185

Rhode Island,

105587

203

1 '

520

3243

13

1 '

' 249

New York,

2378890

2116

1 '

1108

50031

194

1 '

' 257

New Jersey,

351588

369

L '

952

21718

73

1 •

' 293

Pennsylvania,

1676115

1946

1 <

861

37952

187

1 '

< 256

Delaware,

58561

52

1 '

' 1126

19524

28

1 '

' 697

Maryland,

317717

387

1 '

' 821

151515

141

1 '

' 1074

Virginia,

740968

1052

1 '

• 704

498829

381

1 '

< 1309

North Carolina,

484870

580

1 '

' 835

268549

221

1 '

1 1215

South Carolina,

259084

376

1 '

' 689

335314

137

1 '

' 2440

Georgia,

407695

294

1 •

' 1387

283697

134

1 '

' 2117

Ohio,

1502022

1195

J '

' 1257

17345

165

1 '

4 105

Kentucky,

590253

795

1 '

' 742

189575

180

1 '

' 1053

Louisiana,

158457

55

1 <

' 2873

| 193954

1 45

1 '

' 4310

In the preceding list I have aimed to give a view of this subject on
the territory occupied by the thirteen original states. I have added
Ohio and Kentucky merely to shew that the same contrast between
the old free and slave states exists in the new. Ohio and Kentucky,
though contiguous to each other, and of nearly equal age, exhibit the
same amazing difference. In the former there are just ten colored
persons who are idiots or lunatics, where there is one in the latter.

And in Louisiana, where a large majority of the population is
colored, and four-fifths of them slaves, there is but one of these poor
84

696 SELECTIONS.

unfortunates to 4,310 who are sane. In fact, the want of sense or
or reasou appears to be a rare visitation upon those who are held in
slavery. This is an ample theme for the speculations of the physi-
ologist and the moralist. — Am. Jour. Insanity.

Prof. Cenas' Cases of Difficult Labor.

Case I. — I was called on the morning of the 20th of April last, at
about 11 o'clock, to see a negro woman in labor with her eighth child.
A midwife was in attendance, who informed me that she had been
with the patient all night, and that she was induced to send for me
because, for the last six hours, the labor had made no progress.

On examination per vaginam, I found the head jammed in the brim
of the pelvis, and the integuments of the scalp so much tumified as to
convey the impression that the head itself was much lower down than
it actually was. Uterine pains were pretty active, and the parts of
the mother began to suffer from the effects of pressure, the vagina be-
ing hot, swollen, dry and painful.

Under these circumstances, immediate delivery was urgent ; and
as auscultation satisfied me that the foetus was dead, I chose the scis-
sors and crotchet as the means best calculated to effect its delivery
without injury to the parts of the mother.

By 3 o'clock my patient was entirely and safely delivered of a very
large male child, and her recovery was rapid and perfect.

Case II. — I was called to this case by my friend Dr. Stone, who
had himself been sent for only an hour before. I arrived about 6 o'clock

P. M. 20th July, and found" Mrs. P in labor with her tenth child.

A midwife was with her, who told us that the labor had commenced
the night before, had progressed slowly until within the last four hours,
and was now completely at a stand. On examination, pretty much
the same state of things was found as in the preceding case, viz : the
head jammed, the scalp swollen, and the parts of the mother begin-
ning to evince suffering from pressure.

Here, too, the necessity for delivery was urgent ; but as the child
was alive, as evinced by the circulation and movement, we decided,
notwithstanding the state of the soft parts of the mother, to give it the
chance of the forceps. The patient was placed under the partial in-
fluence of chloroform, and the forceps were applied without much
difficulty ; but it required a considerable amount of force to effect a
delivery, which was, however, done with safety to the mother. This
child was also a male, and very large ; it was still-born, but in a short
time recovered, and cried and nursed actively. But unfortunate^,
owing to gross mismanagement, did not survive more than 26 hours.

The cause of difficulty in these cases was entirely owing to the
disproportion between foetus and pelvis, for both children were un-
commonly large. It would be well to mention that the mothers were
under the impression that they had gone beyond their time. * * * *

[N. O. Medical Register.

OBITUARY RECORD. 697

OBITUARY RECORD.

Died, ai his residence, in New York, of typhoid fever, in the 58th
year of his age, on the 14th of November, Dr. J. Kearney Rogers.
Dr. R. was a man of great science, and enjoyed a fine practice and
the reputation as one of the most distinguished members of the pro-
fession in New York.

Died, at Churchville, in the county of Augusta, on the 12th March,
Dr. Edwin H. Gooch, in the 33d year of his age. Doctor G. gra-
duated at the University of Virginia in 1842, and for many years
practised his profession in Charlottesville.

Died, at the Western lunatic asylum, on the 18th October, Dr.
John H. Tompkins, in the 49th year of his age. Dr. T. graduated
at the University of Maryland in 1828, and was for many years a
practitioner of medicine in the city of Richmond.

Died, on the 1st of November, in the county of New Kent, Dr. R.
N. Hall, in the 28th }-ear of his age. Dr. H. was a graduate of the
University of Virginia, and practised medicine in the county of Hen-
rico, which county he represented in the last legislature of Virginia,
as the delegate to the house of representatives. Dr. H. came to his
death by the accidental discharge of a pistol while alone on a hunt-
ing excursion. He lingered long enough only to give an account of
the sad accident.

Died, in Brunswick, on the 26th September, in the 62d year of his
age, Dr. Jno. Field, an eminent physician and a gentleman of great
worth and moral character.

Died, on the 13th October, at his residence near Beaver Dam
depot in the county of Hanover, of hydrops pericardii, Dr. Nicholas
Terrell, in the 49th year of his age, much lamented, by all who
knew him, for his amiable and benevolent disposition.

Died, in the county of Hanover, on the 25th November, Dr. John
P. Harrison, in the 46th year of his age.

INDEX TO VOL I.

ORIGINAL, EDITORIAL AND MISCELLANEOUS ARTICLES.

Abdomen, wound of, 490

Abortion, followed by tetanus, 30, 672

Abscess on the brain, 647

Abscess, lumbar, 104

Academy of medicine of New York,

transactions of, 467

Acknowledgments, 568

Act for the registry of births, deaths and

marriages, 279

Address before the Fredericksburg Me-
dical society, 25
Addresses, introductory, 152
Addresses before Amer. Med. asso'tion, 517
Adhesion of the placenta, 607
Adynamic peritonitis, 589
Alabama Medical association, 281
Alumni of Hamp. Sid. Med. college, 220
Amenorrhoea, cases of, 142
American Med. asso'tion, 151, 349, 401, 511
" " " Virginia delegation to, 221
" " proceedings of fifth meet-
ing of 320
" " prizes offered by, for essays, 631
Amputation of leg for caries, 492
Anesthetic agents, report on, 181
Anatomy, Craigie's, 635
Ancient superstition, an example of, 562
Apology, 629
Apothecaries, code of ethics of, 569
Arsenic, testing for, 254
Asthma, treatment of, 572
Asylums for the insane, 90
" " reports of, 477
" " " the Eastern, 58
" " " the Western, 59, 626
" annual meeting of sup'dents of, 402
Auscultation and percussion, 361

Barton's report of hygiene, meteor-
ology and vital statistics, 464
Beale on the Laws of Health, 573
Bernard's experiments on digestion, 274
Bilious colic, its pathology and treatment, 241
Bird on Urinary Deposits, 514
Births, deaths and marriages, registra-
tion of, 453
Bladder, puncture of, in paralysis, 324
Blistering produced by unbroken flies, 37
Blood, observations on, 445, 451
" " on the fibrine of, 376, 552
Bolton on strabismus, 152
Botany, our indigenous, 676
Bowels, obstruction of, by worms, 271, 440
" " " watermelon seed, 663
Brain, loss of a portion and recovery, 559
Brain, opium in inflammation of, 433
" trephining for compression of, 647
Burke on the Mineral Springs of Va. 351

Calomel in scarlatina, 131

Cancerous breast, extripated, 139

Caries of tibia, amputation of leg, 492

Capenter's Physiology, 686

Catoptric test in cataract, 137

Charges, bill of professional, 177

Charleston, S. C, visit to, 349

Chart, toxicological, 636

Chloroform tested, 328

Churchill's Midwifery, 512
Cimicifuga racemosa in incipient

phthisis and chorea, 317
Circular of committee on epidemics of

Virginia and North Carolina, 476
Circulars of medical colleges and

pamphlets, 396
Clarke county Medical society, proceed-
ings of, 240
Clinique of Richmond Med. college, 144
Close of session of Richmond Medical

college, 219

Clubfoot, cases of, 533

Cod liver oil, Rushton, Clark & Co.'s, 215

Colica biliosa, 241

Colica pictonum, a case of, 664

College of physicians of Philadelphia, 690

Collodion, application on stumps, 488

Collodion in erysipelas, 38
Committees of Med. Soc. of Va. on

various subjects, 456

Congestive fever, essay on, 61

Convulsions, puerperal, cases of, 386

Cooper on dislocations and fractures, 464
C orrespondents, notices to, 155, 222, 511, 569

Correction, 217

Counter irritation, 608
Cox's Companion to the Sea Medicine

Chest, 636

Craigie's Anatomy, 635

Deformity of mouth from mercury re-
lieved by operation, with plates, 22
Delegates to American Medical associa-
tion, 221
Diagnosis of kidney disease, 152
Diagnostic and pathological excerpts, 421
Digestion of fats, the pancreatic juice, 247
Diseases of heart and lungs, Walshe on, 634
Diseases of menstruation, Tilt on, 634
Dropsy, ovarian and peritoneal, opera-
tion for, 107
Duties of practitioners, 214
Dysentery and Diarrhoea in children, 10

Eastern lunatic asylum, report of, 58

Editorial responsibility, 350

Education, medical, 567

Epidemic adynamic peritonitis, 589

700

INDEX.

Epidemics of Virginia and N. Carolina,

circular on, 476

Errata, 512, 629

Erysipelas, collodion in, 38

Ethics, a code of, for physicians and.

apothecaries, 569

Exchanges, notices of, 42, 111, 154, 218,

280, 361, 396, 454, 512, 568, 636

Extirpation of inferior maxillary bone, 144

•' a diseased testis, 145

Extracts, the fluid, 615

Fanaticism, 153

Fee bill of the Richmond profession, 177

Fenner's Southern Reports, 355

Fever, congestive, 61

" puerperal, 204

" scarlet, 81

" typhoid, 121

" prophylaxis, 598

Fibrine in the blood, 376, 552

Fistula, pulmonary, a case of, 608

Formulary, Beasley's pocket, 687

Fluid extracts, their uses, &c. 615

" " their convenience, 628

Fracture of skull and loss of brain, 559

Fracture, ununited, resection, 267

Fredericksburg Medical society, address

before, 25

Gastritis, external treatment of, 614

Geological Observer, by De La Beche, 633

Goddard's Wilson's Dissector, 355

Gonorrhoea, remarks on, 669
Graduates of Hampden Sidney medical

college for 1851, 219

Gregory on eruptive fevers, 683

Gross, Dr., circular, 532

Gross on the urinary organs, 463

Gunshot wound, case of, 624

Gutta percha, its uses, 486

Hampden Sidney medical college, gra-
duates of, for 1851, 219
Hampden Sidney medical college,

society of alumni of, 220

Heematuria, a case of, 561
Haemorrhage, uterine, in placenta praevia, 3

Health, Beale's Laws of, 573

Health of Richmond, 395

Heart, specimen of hypertrophied, 669

Hemorrhoids, case of, potassafusa used, 536
Hermaphrodism, 99, 275

Hernia, a case of strangulated, 652

Hirelings, practice on, 677

Hooker's Medical Delusions, 354

Horner's Anatomy, 687

Hospital cases in arm'ry and penitentiary, 101

Hydrastis canadensis in gonorrhoea, 669

Hydrocele, double, operation for, 494

Hydrocephalus, a case of, 263

Improprieties of medical men, 495

Incision of stricture of urethra, 625

Insane asylums, an essay on, 90
Insane institutions, proceedings of sixth

annual meeting of superintendents of, 402

Instruction, private medical, 628

Intermarriage, Walker on, 577

Intestines, protrusion of, from a wound, 490

Introduction, 1

Introductory address, 152

Iodide of potash in asthma, 572

Irregulars in the ranks of the profession, 391

Items, 692

Lectures, medical, commencing, 627
Lectures, summer course of, in Rich-
mond, 218
Lexicon of medical terms, Dunglison's, 686
Lip restored by operation, with plates, 22
Lithotomy, two cases of, 656
Liver, report of a case of an enor-
mous one, 390
Lobelia inflata, its value neglected, 622
Looseness of modern medical writing, 212
Lumbar abscess, a case of, 104
Lunatic asylums, visit to the Western, 626

Malgaigne's Operative Surgery, 681

Malignant diseases, circular concerning, 532
Maxilla inferiora, ramus of, removed for

necrosis, 507
Maxilla inferiora, removal of, 144
Measles and scarlatina, remarks on, 128
Medical association of Alabama, 281
Medical delusions, Hooker on, 354
Medical duties and observations, 214
Medical education, 567
Medical organization, 217
Medical progress alias fanaticism, 153
Medical schools of the country, 510
Medical schools of Virginia, 44
Medical societies, 45
Medical society of Clarke county, pro-
ceedings of, 240
Medical society of Virginia :

Proceedings of, 29, 120, 156, 221, 282
345, 401, 455,496, 569, 571, 632, 668
Charter of, 113
Constitution of, 115
Organization of, 565
Amendments to constitution of, 573
Medical society of Pennsylvania, trans-
actions of, 689
Medical society of Georgia, 690
Medical society of Kentucky, annual

meeting of, 691

Medical writing, modern, 212

Menstruation, Tilt on, 634

Meningitis, opium in, 433

Mercurial ointment, 384

Metastasis of mumps to the brain, 15

Meteorological register of the army, 688
Meteorology, hygiene and vital statistics,

Barton's report on, 464

Meyer's new sign language, 468

Microscopist, Wythe's manual for. 578

Midwifery, Churchill's, 512

Mineral Springs of Va., Burke on, 351

Mineral waters, (Fauquier,) 468

Miscellaneous editorial, 454, 678

Monstrosity, a case of, 276

Mumps, a case of, with metastasis, 15, 322

Necrosis of inferior maxilla, 507
New York academy of medicine, trans-
actions of, 467
Nitrate of silver in dysentery and diar-
rhoea of children, 10

Obstetrical case,

327

INDEX.

701

Obstetric practice in Virginia, 482
Obituary of medical men, 359, 697
Obstruction of intestinal canal by

worms, 271, 440

Occlusion of vagina, a case of, 209

Omission, 401

Opening for physicians in Richmond, 395

Operation for ovarian tumor, 107

Opium in inflammation of the brain, 433

Organization of Med. society ot Va., 565

" Dr. Patton's letter on, 565

Organization of the profession in Va. 277
" report of committee on

Medical society on, 283
Organization of the state 150, 217, 508, 629

Ovarian tumor, attempt at extirpation of, 107

Osteo-sarcoma, case of, 101

Ovarian disease, spontaneous cure, 668

Pallen's introductory address, 152
Pancreatic juice in digestion, 247
Penitentiary of Virginia, medical statis-
tics of, 60
Paralysis, two clinical cases of, 147
Percussion and auscultation, 361
Peritonitis adynamic, an epidemic of, 589
Peritonitis puerperal, prophylaxis of, 442
Peritonitis, acute, 539
" prophylaxis of, 547
Pertussis, its treatment and pathology, 556
Pessaries, going to Philadelphia for, 510
Pharmacopoeia of the U. S. 459
Phthisis and chorea, 317
Phthisis, the pathology of incipient, 612
Physical signs, their value. 421
Physician's Diary and Visiting List, 689
Physician's Prescription Book, 282
Physicians' and Apothecaries' Code of

Ethics, 569
Placenta proevia, 3. 262

Placenta, morbid adhesion of, 607

Polypus uteri, 471

Potassa fusa in hemorrhoids, 536

Potash, iodide of, in asthma, 572
Power's and V/eightman's chloroform

tested, 328

Preachers and physic, 470

Prevention of pitting in smallpox, 382

Priapism, a case of, 558

Private medical instruction, 628

Prize essay, Dr. Cabell's, 393
Prize for essays offered by American

Medical Association, 631
Proceedings of American Medical As-
sociation, 329
Professional improprieties, a voice on, 495
Progress, medical, 153
Prolapsus uteri, 496
Prophylaxis of puerperal fever, 442, 547, 598
Publications received, 515
Puerperal convulsions, 386
Puerperal fever, a case of, 204
Pulmonary fistula, 608

Quinine in the febrile paroxysm, 95

Ragland will case, 393

Ramsay on Diagnosis of Kidney Disease, 152

Ranking's Abstract, 515

Reception of Stethoscope, 218

Registration of births, deaths and mar-
riages, 279, 453

Regular irregulars, 391

Report of committee of Medical society
of Virginia on state organization, 283

Report of Medical society of Virginia,
committee on anassthesia,

Resection of ends of fractured femur,

Richmond city tariff of rates for pro-
fessional services,

Rush medical college,

Rushton, Clarke & Co.'s cod liver

oil, 215, 280

181

267

177
516

Sarcoma, extirpation of breast for me-

dulary, 139

Scarlet fever, 81, 259, 301

Scarlatina and measles, remarks on, 128

Scarlatina, the calomel treatment in, 131

Scirrhus of the stomach, 102

Sea medicine chest, Cox's companion to, 636
Sex, a case of doubtful, 99, 275

Skey's Operative Surgery, 457

Skull, fracture of, 559

Society of Alumni of Hampden Sidney

medical college, 220

Speculum uteri, 40

State institutions, 58

State organization, 150, 277

State organization urged by committee

of Medical society of Virginia, 283

Stethoscope, its reception and prospects, 109
Still-birth, a case of, 388

Storer's address on medical jurispru-
dence, 467
Stringfellow's letters of wonderful cures, 468
Stomach, a case of puncture of, 660
Strabismus, Bolton on, 152
Stricture of urethra, incision of, 625
Subscribers, notices to, 511
" appeal to, 674
Summer lectures, 218
Superstition, ancient, 562
Surgery, Skey's Operative, 457

Talipes equinus, case of, 533

" varus, " 534

Tariff of fees, 177

Testing for arsenic, 254

Tetanus, a case of, 105
" case of, from ligature of

hemorrhoids, 662

" discussion on, 29

" supervening on abortion, 672, 30

Thompsonianism, 16

Tilden's extracts, 112, 375, 376

Tilt on Menstruation, 634

Toxicological Chart, Jervey's, 636

Tracheotomy, operation of, 670

Transactions of the Am. Med. ass'ation, 511

" _ ofN. Y. Acad, of Med. 467

Trephining, a case of, 647

Trismus nascentium, Watson on, 688

Turpeth mineral in scarlatina, 259

Typhoid fever, an essay on, 121

IJngnentum hydrargyri, 384

Urethra, stricture of, incision, 625

Urinary deposits, by Golding Bird, 514

Urine, retention of, puncture of bladder
for, 324

702

INDEX.

Uterine haemorrhage, 3

" polypus, 491

Uterus, irritable, 211

Uterus, prolapsus of, 496

Vagina, occlusion of, 209

The vapors, 198

Variola, prevention of pitting in, 382
Virginia in the Am. Med. association, 151

" delegation " 22]

" g " present, 229

Virginia medical schools, 44

Visit to Charleston, S. C.

349

Walker on Intermarriage, 577

Walshe on Diseases of Heart and Lungs, 634

Western lunatic asylum, report of, 59

Western lunatic asylum, " 626

Worms discharged by a child, 274
Worms obstructing the bowels, 271, 440

Wound, a case of gunshot, 624

Wound of scrotum and groin, 439

Wythe's Manual for the Microscopist, 578

SELEGTED ARTICLES,

Absence of anus and rectum, 167

Aconite, therapeutical powers of, 529

American Med. Asso., opening of, 576
" " " transactions of, 57

Apothecaries' carelessness, 588

Apoplexy, singular case of, 357

Asthma, nitric acid in, 51

Asthma, spasmodic, diagnosis of, 640

Antimony, golden sulphuret of, 358

644
56

530
643
588
162
276
587
694
530
163
46
163
164, 238
524

Baltimore mortuary statistics,

Bathing,

Bennett's treatment of inflammation of

os and cervix uteri,
Bismuth, subnitrate of,
Boston practitioners, number of,
Brain, perforation of, by an iron bar,
Casuistry,
Caesarian section,
Census, startling facts from,
Cervix uteri, inflammation of,
Chloroform, a new property of,
Chloroform, purification of,
Circulars of medical colleges,
Cod liver oil in phthisis,
Colon, obstruction of,
Compensation for medical services, 232, 295
Concours, system of, 156

Consumption, cod liver oil in, 238

Convulsions in children, 639

Coroners, 299

Danger of tying up face after supposed

death,
Death by careless apothecary,
Delivery by incision of os tincae,
Dentists' gold,

Diagnosis of asthma and laryngitis,
Dropsy, ovarian, cured,

Edinburgh college of physicians on

homoeopathy,
Egyptian medicine and surgery,
Emmenagogues, Polygala Senega,
Etiology of tuberculization,
Examination of students of medicine,
Evidence, the nature of,

Foetus, a monstrous,

166

588
637
641
640

585

417

293

168
176
290

285

646

Gall bladder, a portion of, discharged

externally, 174

Genital organs during menstruation, ex-
amined, 642
Gonorrhoea, hydrastis canadensis in, 644
Gout, atonic, 527
Gunshot wound of spine, 579

Hemlock, poisoning with, 166

Haemorrhage, uterine transfusion in, 358

Homoeopathy repudiated, 417

Hydrastis canadensis in gonorrhoea, 644

Idiots, training and teaching of, 694

Inunction in scarlatina, 39

Iodine, iodide of starch, 164
Items, 177, 300

Laryngitis submucous, diagnosis of, 640

Lithotomy, fifteen operations of, 157

Malformation, case of, 474

Mange, 52

Medical organization, 172

Medical reform, 519

Medicine, uncertainty of, alleged, 359
Menstruation, examination of a young

woman during, 642
Mesmerism, 171, 644

Missouri state society, 174

Misstatement corrected, 296

Moustachios, hygienic virtues of, 240

Navy surgeons from Virginia, 239

Nitric acid in asthma, 51

Obituary record, 359, 697

Occluded os tincae, incised, 637

Organization, medical, 172

Ovarian tumor removed, 414
Ovarian cyst containing teeth and bone, 175

Ovaries removed for dropsy, 585

Patent medicine business, 580

Pelvic distortion, 356

Peritonitis, prophylaxis of, 222

Phosphenic phenomena, 168

Physicians, claims to compensation, 232

Physicians, duty towards nostrums, 580

Poison, spontaneous formation of, 528

Poisoning with hemlock, 166
Practising by the year, 55, 162

Professors and laymen, 521

Prophylaxis of peritonitis, 222

Quackery among medical men, 235

INDEX.

703

Quackery, remedy for, 54
Rape, trial for, alleged, 471
Reform, medical, 519, 642
Revaccination in Prussia, 165
Rheumatism, neuralgic, 526
Rush, Dr., always a student, 177
Secrecy, professional, inviolable, 475
Senega Polygala, an emmenagogue, 168
Sight, near, a new remedy for, 236
Smallpox, three times, after vaccina-
tion, 357
Speculum uteri, 40, 162
Statistics, mortuary, of Baltimore, 644
Statistics, medical, of Paris, 523
Stricture, urethra, 523
Students, preliminary examination of, 290
Success in medicine, 237
Sun stroke, 582
Swain's vermifuge, 641

Tapping, extraordinary case of, 420

Testicle, extrusion of a retained, 299

Testimony, credibility of, 285

Transfusion in uterine haemorrhage, 358

Trial for alleged rape, 471

Tuberculization, etiology of, 176

Tumor of neck removed, 228

Tumors, sixty-seven removed, 637

Tumor, ovarian, removed, 414

Typhoid fever, bismuth in, 643

Uncertainty of medicine alleged, 359

Urethrotomy for stricture, 523

Varix of leg, 298

Webster, Dr., sale of effects, 298

Witnesses, the credibility of, 285

Wound of spine by shot, 579

85

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