North American Medical and Surgical Journal, Vol. 2, No. 3, July, 1826

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Title: North American Medical and Surgical Journal, Vol. 2, No. 3, July, 1826
Author: Various
Language: English
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SURGICAL JOURNAL, VOL. 2, NO. 3, JULY, 1826***

THE

NORTH AMERICAN

MEDICAL AND SURGICAL

JOURNAL.

CONDUCTED BY

HUGH L. HODGE, M.D. | CHAS. D. MEIGS, M.D.
FRANKLIN BACHE, M.D. | B. H. COATES, M.D.

AND

R. LA ROCHE, M.D.

NON DOCTIOR, SED MELIORE IMBUTUS DOCTRINA.

VOL. II.

PHILADELPHIA:

PUBLISHED BY J. DOBSON, AGENT.

JESPER HARDING, PRINTER.

1826.

_Eastern District of Pennsylvania, to wit_

BE IT REMEMBERED, that on the 31st day of March, in the 50th year of the
Independence of the United States of America, A. D. 1826, Hugh L. Hodge,
Franklin Bache, Charles D. Meigs, Benjamin H. Coates, and René La Roche,
of the said District, have deposited in this office the Title of a Book,
the right whereof they claim as Proprietors, in the words following, to
wit:

"_The North American Medical and Surgical Journal. Conducted by Hugh L.
Hodge, M. D., Franklin Bache, M. D., Chas. D. Meigs, M. D., B. H.
Coates, M. D., and R. La Roche, M. D. Non doctior, sed meliore imbutus
doctrina. Vol. II._"

In conformity to the act of Congress of the United States, intituled,
"An act for the encouragement of learning, by securing the copies of
maps, charts, and books, to the authors and proprietors of such copies,
during the times therein mentioned;"--and also to the act, entitled, "An
act supplementary to an act, entitled, "An act for the encouragement of
learning, by securing the copies of maps, charts, and books, to the
authors and proprietors of such copies, during the times therein
mentioned," and extending the benefits thereof to the arts of designing,
engraving, and etching historical and other prints."

D. CALDWELL, Clerk of the Eastern District of Pennsylvania.

CONTENTS

OF VOL. II.

No. III.

ORIGINAL COMMUNICATIONS.

ART. PAGE.

I. Description of the Gangrenous Ulcer of the mouths of children.
By B. H. Coates, M. D., one of the Physicians to the Philadelphia
Children's Asylum, &c. 1

II. Case of Purpura in an Infant, attended with extraordinary
symptoms. By R. M. Huston, M. D. 24

III. History of the Natural and Modified Small Pox, or of the
Variolous and Varioloid Diseases, as they prevailed in
Philadelphia, in the years 1823 and 1824. By John K. Mitchell,
M. D., and John Bell, M. D., attending physicians at the
then Small Pox Hospital. With a plate. 27

IV. Remarks on the Pathology and Treatment of Yellow Fever.
Arranged from the notes of Dr. J. A. Monges, of Philadelphia. 53

V. Remarks on the Prophylactic Treatment of Cholera Infantum.
By Joseph Parrish, M. D., one of the Surgeons to the Pennsylvania
Hospital. 68

VI. Case of Neuralgia cured by Acupuncturation. Communicated
by J. Hunter Ewing, M. D. 77

ANALYTICAL REVIEWS.

VII. Researches into the Nature and Treatment of Dropsy in the
Brain, Chest, Abdomen, Ovarium, and Skin. By Joseph Ayre,
M. D., &c. 79

VIII. An Essay on Venereal Diseases, and the Uses and Abuses of
Mercury in their Treatment. By Richard Carmichael, M. R. I. A.
With Practical Notes, &c. By G. Emerson, M. D. 109

IX. Remarks on some Means employed to destroy Tænia, and expel
them from the Human Body. By Louis Frank, M. D.
Privy Counsellor of her Majesty, Maria Louisa, Duchess of
Parma. 114

X. Researches, Physiological and Pathological, instituted principally
with a View to the Improvement of Medical and Surgical
Practice. By James Blundell, M. D., Lecturer on
Physiology and Midwifery at the United Hospitals of St.
Thomas and Guy. 119

XI. An Inquiry into the Nature and Treatment of Diabetes, Calculus
and other Affections of the Urinary Organs. By William
Prout, M. D., F. R. S. With Notes and Additions, by S.
Colhoun, M. D. 125

MEDICAL LITERATURE.--RETROSPECTIVE REVIEW.

XII. Tractatus de Ventriculo et Intestinis, cui præmittitur alius, de
Partibus continentibus in Genere, et in Specie de iis Abdominis.
Authore Francisco Glissonio. Lond. 1677, 4to. 138

QUARTERLY SUMMARY OF MEDICAL AND SURGICAL INTELLIGENCE.

ANATOMY, 155

1, Papillæ of the Tongue. 2, Villi of the Stomach and Intestines. 3,
Minute distribution of the Vessels of the Liver. 4, Trachea perforating
the Aorta. 5, Monsters. 6, Malformation of the Heart. 7, Acephalous
Mummy. 8, New Anatomical Plates. 9, A Manual of Osteology. 10,
Soemmering's Work on the Anatomy of the Ear. 11, Does the conjunctiva
run over the Cornea?

PHYSIOLOGY, 158

12, Electro-Galvanic phenomena of Acupuncturation. 13, Variations in
Milk. 14, Hyoscyamus dilates the Pupils of the Eyes. 15, Worms in the
Eye. 16, Digestion.

PATHOLOGY, 161

17, Dothinenteria--Pustules of the small Intestines. 18, Dr. Broussais.
19, Whooping Cough. 20, Antiperistaltic Globus--Globus Hystericus.
21, Non-contagion of Yellow Fever.

THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE, 166

22, Iodine. 23, Non-mercurial Treatment of Syphilis. 24, Cancer treated
by Antiphlogistics. 25, Essential Oil of Male Fern as a remedy in Cases
of Tænia. 26, Tincture of Bastard Saffron for the expulsion of Tænia.
27, Oil of Turpentine in Tænia. 28, Action of the Oil of the Euphorbia
Lathyris. 29, Medicinal Properties of the Apocynum Cannabinum or Indian
Hemp. 30, Remarkable Effects from the external application of the
Acetate of Morphia. 31, Cure of Urinary Calculi, by means of the
internal use of the Bicarbonate of Soda. 32, Attempt to cure Abdominal
Dropsy by exciting Peritoneal Inflammation. 33, Artificial Respiration.
34, Secale Cornutum. 35, Animal Magnetism. 36, Sketch of the Medical
Literature of Denmark, Sweden, and Norway. 37, Erysipelatous Mumps or
Angina Parotidiana. 38, Tænia. 39, Scrophula. 40, Digitalis.

SURGERY, 192

41, Dr. Physick's Operation for Artificial Anus denied to have been
performed. 42, Gangrenous Sore Mouth of Children. 43, Operation for
Phymosis. 44, Lunar Caustic on Wounds and Ulcers. 45, Hæmorrhage from
Lithotomy. 46, Extirpation of the Parotid Gland. 47, Aneurism from a
Wound, cured by Valsaiva's method. 48, Protrusion and Wound of the
Stomach. 49, Oesophagotomy. 50, Retention of Urine, caused by a
Stricture of the Urethra, relieved by a forcible but gradual Injection.
51, Tracheotomy. 52, Fistula Lachrymalis. 53, Aneurisma Herniosum. 54,
Extirpation of the Two Dental Arches affected with Osteo-sarcoma. 55,
Traumatic Erysipelas. 56, Obliteration of a portion of the Urethra,
remedied by an Operation. 57, Artificial Joint cured by Caustic. 58,
Epilepsy cured by Trephining.

MIDWIFERY, 205

59, Gastrotomy. 60, Cæsarian Operation, performed with safety to the
Mother and Foetus. 61, Extirpation of the Uterus. 62, Uterine Hæmorrhage.

CHEMISTRY AND PHARMACY, 208

63, State in which Morphia exists in Opium. 64, Peculiar Principles of
Narcotic Plants. 65, Relative quantities of Cinchonia and Quinia with
indention in the most esteemed Varieties of Peruvian Bark. 66, Sulphate
of Quinia, extracted from the Cinchona Bark, exhausted by Decoction.
67, Analysis of Rhubarb. 68, Alkaline Lozenges of Bicarbonate of Soda.
69, Presence of Mercury in Samples of Medicinal Prussic Acid. 70, Proposed
Method of preparing Protoxide of Mercury by precipitation, for
Medical Employment. 71, Goulard's Extract of Lead.

QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS, 214-16

No. IV.

ORIGINAL COMMUNICATIONS.

ART.

I. On the Epidemic of 1825 in Natchez, Miss. By Ayres P.
Merrill, M. D. 217

II. History of the Natural and Modified Small Pox, or of the Variolous
and Varioloid Diseases, as they prevailed in Philadelphia,
in the years 1823 and 1824. By John K. Mitchell,
M. D., and John Bell, M. D., Physicians at the then Small
Pox Hospital. (Concluded from page 53.) 238

III. Cases of Nervous Irritation, exhibiting the Efficacy of Cold as
a Remedy. By S. Jackson, M. D. 250

IV. Remarks on the Pathology of Jaundice. By G. B. Wood, M. D. 260

V. Account of a Case in which a New and Peculiar Operation for
Artificial Anus was performed in 1809. By Philip Syng Physick, M. D.,
Professor of Surgery in the University of Pennsylvania, &c. Drawn up for
publication by B. H. Coates, M. D. 269

VI. Observations on Asphyxia from Drowning, to which is added
a Case of Resuscitation. By Edward Jenner Coxe, M. D. 276

ANALYTICAL REVIEWS.

VII. Traité Zoologique et Physiologique, Sur les Vers Intestinaux de
l'Homme. Par M. Bremser, D. M. Traduit de l'Allemande
par M. Grundler, D. M. P. Revue et Augmentée de Notes.
Par M. de Blainville, D. M., &c. Avec un Atlas. Paris, 1824.

Anatomie des Vers Intestinaux, Ascaride, Lombricoide, et
Echynorhynque Geant. Memoire Couronné par l'Academie
Royale des Sciences, qui en avoit mit le sujet au Concours,
pour l'année 1818. Avec 8 Planches. Par Jules Cloquet,
&c. &c. A Paris, 1824 297

VIII. Precis Theorique et Pratique, sur les Maladies de la Peau.
Par M. S. L. Alibert. 2 Tomes. 8vo. Paris, 1810-1820. 322

IX. Thoughts on Medical Education, and a Plan for its Improvement;
addressed to the Council of the University of London.
Dictu Necessaria. Plin. London, 1826.

Projet de Loi, presenté aux Chambres dans la Séance du 14
Fevrier 1825, par S. E. le Ministre de l'Intérieur, Sur les
Ecoles Secondaries de Medécine, les Chambres de Discipline,
et les Eaux Minerales Artificielles. 344

MEDICAL LITERATURE--RETROSPECTIVE REVIEWS.

X. Recherches sur le Tissu Muqueux, ou l'Organe Cellulaire, et
Sur Quelques Maladies de la Poitrine. Par Théophile Bordeu,
Docteur en Medécine des Facultés de Paris, et de
Montpélier. Paris, 1767, 12mo. 376

QUARTERLY SUMMARY OF IMPROVEMENTS IN MEDICINE AND
SURGERY

ANATOMY, 395

1, Notice of a Double Male Foetus, by W. E. Horner, M. D., &c. 2,
Imperfect Development of the Cerebral Organs in Monsters. 3, Imperforate
Vagina. 4, Fallopian Tubes. 5, Monsters. 6, Foetus grafted into
the Chest of another. 7, Foetus without a Stomach, Head or Anus. 8,
Congenital Hydrocephalus, with Transposition of the Viscera. 9, Unusual
Arrangement of the Aortic Branches.

PHYSIOLOGY, 403

10, Influence of the Great Sympathetic Nerve on the Functions of Sense.
11, Cutaneous Absorption. 12, Abstinence. 13, Hippomane Mancinella.
14, Cutaneous Absorption. 15, Regeneration of Divided Arteries.
16, Mineral Poisons.

PATHOLOGY, 406

17, Are we followers of Dr. Broussais? 18, Influenza. 19, Diarrhoea
Infantum. 20, Tetanus. 21, Small Pox.

THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE. 411

22, Tincture of Iodine in Gonorrhoea, Bubo, Scrofula, &c. 23, Acetate
of Lead and Tincture of Opium in Dysentery. 24, Powers of Digitalis in
Palpitatio Cordis. 25, Tartar-Emetic Ointment in Epilepsy. 26,
Antiphlogistics
in Recent Cases of Epilepsy. 27, On the Efficacy of Nitrate
of Silver in the Treatment of Zona or Shingles. 28, On the Remedial
Effects of Camphor in Acute and Chronic Rheumatism. 29, Examination
of the Question, whether the Medical Use of Phosphorus internally, is
useful, injurious, or equivocal. 30, Nitrous Acid and Opium in Dysentery,
Cholera and Diarrhoea. 31, Tartar Emetic in Pneumonia Biliosa. 32,
Bark of the Ampelopsis in Catarrhal Consumption. 33, Obstinate Vomiting
cured with Extract of Marigold. 34, Vomiting of Fat and Blood. 35,
Rupture of the Spleen. 36, Chilblains cured with Chloride of Lime. 37,
Local Spontaneous Combustion. 38, Dr. Painchaud on Tic Douloureux.
39, Duration of Life among the Romans. 40, Difference of Mortality
from 1775, to 1825. 41, New Method of Percussion of the Thorax. 42,
Acid Nitrate of Mercury. 43, Effects of Ardent Spirits. 44, Colombo
Root. 45, Poison of Mushrooms. 46, Antisyphilitic Decoction of Zittmann.
47, Acetate of Ammonia, a Remedy for Drunkenness. 48, Mortality
of Leeches. 49, Black Drop. 50, Doses of Calomel in days of
yore. 51, Buying a good Practice. 52, Sore Nipples. 53, Anderson's
Quarterly. 54, Antiquity of Cow Pox and Origin of Small Pox from it.

SURGERY, 431

55, Lithotritie, on Breaking the Stone in the Bladder. 56, The High
Operation. 57, Sutures in Wounds of the Bladder. 58, Paracentesis
Thoracis. 59, Stricture of the Oesophagus. 60, Wound of the Brain. 61,
Luxation of the Metatarsus; the history drawn up by M. Dusol, D. M.

MIDWIFERY, 438

62, Uterine Hæmorrhage. 63, Polypi of the Uterus. 64, Cæsarian
Section. 65, Case of Difficult Parturition. 66, Case of the Pelvis becoming
enlarged.

CHEMISTRY AND PHARMACY, 440

67, L'Artigue's Process of preparing the Watery Extract of Opium. 68,
Berzelius' Method of Detecting Arsenic in the bodies of Persons poisoned
by it. 69, Action of Certain Metallic Substances on the Animal Economy.

QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS, 444-48

CONTENTS

ORIGINAL COMMUNICATIONS.

PAGE

ART. I. Description of the Gangrenous Ulcer of the Mouths
of Children. By B. H. Coates, M. D. one of the
Physicians to the Philadelphia Children's Asylum,
&c. 1

II. Case of Purpura in an Infant, attended with extraordinary
Symptoms. By R. M. Huston, M. D. 24

III. History of the Natural and Modified Small-pox, or
of the Variolous and Varioloid Diseases, as they
prevailed in Philadelphia in the years 1823 and
1824. By John K. Mitchell, M. D., and John
Bell, M. D., attending Physicians at the then
Small-pox Hospital.--With a plate. 27

IV. Remarks on the Pathology and Treatment of Yellow
Fever. Arranged from the Notes of Dr. J.
A. Monges, of Philadelphia. 53

V. Remarks on the Prophylactic Treatment of Cholera
Infantum. By Joseph Parrish, M. D., one of the
Surgeons to the Pennsylvania Hospital. 68

VI. Case of Neuralgia, cured by Acupuncturation.
Communicated by J. Hunter Ewing, M. D. 77

ANALYTICAL REVIEWS.

VII. Researches into the Nature and Treatment of
Dropsy in the Brain, Chest, Abdomen, Ovarium,
and Skin. By Joseph Ayre, M. D., &c. 79

VIII. An Essay on Venereal Diseases, and the Uses and
Abuses of Mercury in their Treatment. By
Richard Carmichael, M. R. I. A., with Practical
Notes, &c. by G. Emerson, M. D. 109

IX. Remarks on some means employed to destroy
Tænia, and expel them from the Human Body.
By Louis Frank, M. D., Privy Counsellor of her
Majesty, Maria Louisa, Duchess of Parma. 114

X. Researches Physiological and Pathological, instituted
principally with a View to the Improvement
of Medical and Surgical Practice. By James
Blundell, M. D., Lecturer on Physiology and
Midwifery, at the United Hospitals of St. Thomas
and Guy. 119

XI. An Inquiry into the Nature and Treatment of Diabetes,
Calculus, and other Affections of the Urinary
Organs. By William Prout, M.D. F.R.S.
With Notes and Additions, by S. Colhoun, M. D. 125

MEDICAL LITERATURE.

XII. Retrospective Review.--Tractatus de Ventriculo
et Intestinis, cui præmittitur alius, de Partibus
continentibus in Genere, et in Specie de iis Abdominis.
Authore Francisco Glissonio. Lond.
1677, 4to. 138

QUARTERLY SUMMARY OF MEDICAL AND SURGICAL
INTELLIGENCE.

I. Anatomy. 155

II. Physiology. 158

III. Pathology. 161

IV. Therapeutics, Materia Medica, and the Practice of Medicine. 166

V. Surgery. 192

VI. Midwifery. 205

VII. Chemistry and Pharmacy. 208

QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS. 214

FOOTNOTES:

THE

NORTH AMERICAN

Medical and Surgical Journal.

JULY, 1826.

ORIGINAL COMMUNICATIONS.

FOOTNOTES:

ARTICLE I.--_Description of the Gangrenous Ulcer of the Mouths of
Children._ By B. H. Coates, M. D. one of the Physicians to the
Philadelphia Children's Asylum, &c.

Having had opportunities of witnessing the ravages and unmanageable
character of this destructive disease, I have long and deeply felt the
want of some written account, both of the malady, and of a proper mode
of treatment. Some research and observation, made in consequence of this
feeling, have terminated in the acquisition of more fixed ideas, and of
a practice hitherto successful. This convinced me, that it became my
duty to lay the result of these inquiries before the public, for the
benefit of others. There is, perhaps, no stronger and more peculiar
reason for wishing American physicians to write, than the opportunities
they possess, of describing and recording many important varieties of
morbid affection, which were either unknown to our predecessors, or the
descriptions of which, uncombined and uncompared, are only to be found
by searching among the more neglected tomes of a public library. Of
this, the present case will afford a fair example; as well as an
instance of an American physician, who had described the disease from
nature, having, from want of encouragement, false modesty, or some other
cause, kept it back from publication.

Ever since the establishment of the Children's Asylum, under the care
of a committee of the guardians of the poor, of the city and liberties
of Philadelphia, in the spring of 1819, this useful institution has been
annually visited by the new and distressing scourge of which we are
treating. It has here prevailed in a considerable number of cases,
forming the principal source of anxiety and trouble during the winter
season, and annually sweeping off its little victims, in a manner
rendered peculiarly awful by its insidious approach, its loathsome
effects, and its apparently uncontrollable progress. Various scattered
cases of a similar affection have come within my knowledge, during the
last few years; occurring in the practice of several physicians, as well
as in my own. In no place, however, near Philadelphia, other than the
above, has there existed, so far as I know, a sufficient number of cases
at the same time, to enable a physician to examine it in much detail, or
to make comparative trials of different modes of treatment, so as
clearly to determine the most successful.

_References to Authors._--The notices of this complaint given by
authors, to which I have been enabled to refer, are few, and generally
too scanty to supply much means of forming a satisfactory judgment, or a
practice in which confidence can be reposed. They consist, principally,
of the mere mention of an affection resembling that of which we treat;
and, in some instances, it is even doubtful whether they are describing
the same disease. No notice is taken of this affection in any of our
common books; with the exception of the last edition of COOPER'S
Surgical Dictionary,[1] and of UNDERWOOD'S work on diseases of children.
It is there described under the erroneous title of _cancrum oris_. A
reference is given to PEARSON'S Surgery; and the article in the
Dictionary is taken exclusively from that work. As this is the only
authority with which I am acquainted, that gives a tolerably full
account of a disease somewhat similar to that of which we are treating,
I have concluded to extract the whole passage, in the words of the
author.

"The canker of the mouth is a deep, foul, irregular, foetid ulcer,
with jagged edges, which appears upon the inside of the lips and cheeks;
and is attended with a copious flow of diseased saliva.

"This disease is seldom seen in adults; but it most commonly attacks
children, from the age of 18 months, to that of 6 or 7 years. When the
ulceration begins at the inner part of the lip, it exhibits a deep,
narrow, sulcated appearance, and quickly spreads along the inside of the
cheek; which becomes hard, and tumefied externally. The gums are very
frequently interested in this complaint, and, in such cases, the teeth
are generally found in a loose and diseased state; matter is often found
in their sockets, and abscesses sometimes burst externally through the
cheek, the lip, or a little below the maxilla inferior: and it is not
uncommon to see an exfoliation of the alveolar processes, or even of the
greater part of the lower jaw. Among the children of poor people, where
this disease is neglected or mismanaged at the beginning, a dreadful
gangrene will sometimes supervene.

"The remote causes that give origin to this disease are not very
obvious. I think it occurs most frequently among children that live in a
marshy situation; that are sustained by unwholesome food; and where a
due attention to cleanliness has been wanting. The cancrum oris has been
described by some writers, as a complaint very common in England and
Ireland, where it is sometimes epidemical among infants. It, however, is
commonly seen in other kingdoms, and prevails more especially in those
houses where a great number of children are crowded together. I am not
able to determine whether it is or is not contagious.

"But adults are not wholly exempted from this morbid affection, and it
is not easy in all cases, to distinguish the cancrum oris from a
cancerous or venereal ulcer in the mouth; since the uvula, tonsils or
fauces may be the seat of each disease. I have seen ulcerations on the
uvula and tonsils, with all the marks of a venereal sore, in patients
where the presence of such a virus could not be suspected; and by
treating them as canker of the mouth, they have been speedily cured.

"The canker of the mouth ought to be distinguished from aphthæ, the
epulis and parulis, scurvy, cancerous ulcers, venereal ulcers and
exulceration from the use of mercury.

"_The mode of treatment._--It will be proper,

"1. To remove the diseased teeth, bone, &c. if possible.

"2. To prescribe a milk and vegetable diet, and to allow a prudent use
of fermented liquors.

"3. It will be adviseable to exhibit such remedies as, Peruvian bark;
sarsaparilla; elm bark; mineral acids.

"The external applications that I have generally found successful have
consisted of such as the following:

"_Preparations of copper_; a diluted mineral acid; burnt alum; decoction
of bark with white vitriol; tincture of myrrh, &c."[2]

Of the above articles, those which we have indicated by italics are
omitted in the last edition of COOPER'S Dictionary; and, in a former
one, they are directly prohibited with strong reprobation. Nevertheless,
it is among these that we have found, beyond comparison, the most
successful one.

Mr. PEARSON prefixes to the preceding article a list of synonymes, with
references to authors, in the manner of writers on natural history. They
are as follow: _Aphthæ Serpentes._--SENNERTUS; Medicinâ Practicâ.
_Labrosulcium, seu Cheilocace._--ARNOLDUS BOOTIUS. _Oris
Cancrum._--MUYS. STALPAART VANDER WIEL. _Gangræna Oris._--VAN SWEITEN.
_Gangrene scorbutique des Gencives._--Auctores Gallici.

Of these, SENNERTUS[3] merely mentions, under the article aphthæ, that
the latter sometimes spread around the frænum and tongue, occasionally
corroding the subjacent parts. He is so far from giving a clear
description, under the head of Aphthæ Serpentes, of any affection
analogous to that we are about to record, that he quotes GALEN as
remarking, very properly, that these are not aphthæ at all, but putrid
ulcers.

ARNOLD BOOTIUS, in his little treatise "de morbis omissis," of diseases
omitted in the books, published in London, in 1649,[4] gives, from his
own observation, an account of a disease, to which he applies the names
above attributed to him. It differs from the cases which have attracted
our attention, chiefly in its situation. He describes it as an ulcer,
soon becoming black and foetid, corroding the inside of both lips,
separating them widely from the gums and allowing them to fall outwards
upon the face; thus producing a horrible deformity. Besides this, the
author states, that a deep fissure usually extended down each half of
the inside of each lip; thus adding four deep and ghastly ramifications
to the ulcer. This shocking affection is stated to have prevailed
extensively, both in England and Ireland; in which latter country the
author practised and held several important offices. It occasionally
became epidemic, and then destroyed great numbers of children. It
principally prevailed between 2 and 4 years of age; though it was
occasionally met with both earlier and later in life. It was frequently,
but not always, accompanied with aphthæ.

This disease was, in general, successfully treated by our author, with a
decoction of "Chærephyllum, Quinquefolium, Myrrhis, Rosæ et Salvia;" in
which was dissolved a "sat magna copia" of white vitriol.--A combination
about as precise as some of the prescriptions which have been
recommended to me, for the present disease, in this country. With this
mixture, he touched the ulcers several times a day; and then washed them
with a liniment of acetate of lead, aqua plantaginis, and oleum
rosaceum. He also used _issues_ in both arms; and confined the patient,
in more obstinate cases, for drink, to a decoction of sarsaparilla,
china, and several other articles, which we will spare our readers. To
this disease, BOOTIUS devotes about five small 18mo. pages, forming his
tenth chapter.

VANDER WIEL cites BOOTIUS, and expresses his belief, that the disease
described by the latter was identical with one which he saw himself.
This last, however, though described in a cursory manner, appears to
resemble much more nearly the disease of the Children's Asylum;
beginning in the gums, and extending to the adjacent parts. He treats it
by the following lotion:

R. Mel. Rosar. [Symbol: ounce]i
---- Ægyptiaci, [Symbol: dram]ij
Olei Vitrioli, gtt. _aliquot._
misce.

Under this treatment, and by removing the teeth, when loose, the small
number of cases he saw recovered in a few days.

VANDER WIEL was a practitioner in Holland; and, though he does not
specify the fact, his cases were probably in a marshy country.[5]

MUYS, in a little treatise entitled "Chirurgia Rationalis,"[6] published
in 1684, has an account of a disease, which is evidently supposed by
PEARSON to be that which he describes. This also, however, appears to
have been a "labrosulcium;" an ulcer between the lips and the incisor
teeth. There is but little to be gathered from his paper; as it is
principally occupied with an attempt to prove, that this ulcer is owing
to an accumulation of _acidity_ in the blood, increased, at this point,
by the putrescence of particles of food which collect there. He
illustrates this doctrine by an examination of a _burnt rag_ under a
microscope; and this he considers as in a state analogous to the
gangrene. "Opinionum commenta delet dies," &c. We give his treatment;
which is aimed at acidity.

R. Theriaci, [Symbol: dram]ijss
Ung. Egypt. [Symbol: dram]iss
Gum. Laccæ, et
Spirit. Sal. _Armon._ aa [Symbol: scruple]ij
---- Cochleariæ, [Symbol: dram]ij
_m._ ft. ung.

To be softened with a little alcohol, the part washed with the mixture
six times a day, and a rag moistened with the same compound left in the
ulcer. Here we take leave of the Chirurgia _Rationalis_.

In the 14th volume of the Memoirs of the French Royal Academy of
Surgery, are papers containing accounts of two cases, which have some
points in common with the disease of which we treat; but the identity of
at least one of which it is hard to establish. The first piece is
entitled, "_Sur la gangrene scorbutique des gencives dans les enfans.
Par feu M. Berthe._"[7] The author is described, in a note, as a young
surgeon of great promise, who was carried off by an early death. M.
BERTHE commences by quoting FABRICIUS HILDANUS; who describes a gangrene
of the gums, occuring principally at about 4 years of age, and of which
all the patients died. FABRICIUS takes the occasion to give a caution to
young surgeons, to avoid being too sanguine in predicting recovery from
gangrenes. Next a case is given us, drawn from M. SAVIARD, in which
death was the result. This author seems, subsequently, to have had
somewhat better success, but at the expense of horrible disfigurements;
such as great holes through the cheek, and the loss of a large piece of
the jaw; which, indeed, are described as having been worse than death.
In another case, recorded by M. POUPART, in the "Histoire de l'Academie
des Sciences," this affection terminated in death; preceded, however,
and in the opinion of the author, caused, by the production of two
tumours, one by the side of the tongue, the other inside of the cheek.
This is not at all unlike the progress, which will be hereafter
mentioned to have taken place in many of the Asylum cases.

M. BERTHE then remarks, that the greater number of instances of gangrene
of the gums had terminated unfavourably.

His own patient was ill from April to September, 1753; and exhibited
swelled and bleeding gums, frequently projecting beyond the
teeth,--black and foetid stools, foetid urine, and ecchymoses over
the surface of the body. He treated it with antiscorbutics, internally
and externally, and apparently with success. The patient, however,
relapsed in January, 1754; when M. BERTHE proceeded to a very different,
and far more severe treatment. The gums were pared away, in many
successive operations; and the wounds were washed with aluminous water.
A roll of linen was, during the intervals, kept fastened in the
patient's mouth, for the purpose of allowing the escape of the fluids of
the part; which he apprehended to possess a putrid character, and to
aggravate the original disease, whenever they passed into the stomach.
At length, his patient recovered, and continued well.

It appears to the writer of these notes to be hardly necessary to state,
that M. BERTHE evidently mistook the disease; the latter being in
reality scorbutic, and not a single symptom of gangrene being described
during its whole history.

The same, however, cannot be said of M. CAPDEVILLE; whose "_Observations
sur les effets rapides de la pourriture des gencives_" appear in the
same volume with the foregoing, and immediately subsequent to it.[8]
This writer's case took place after a fever, and no tumefaction of the
gums nor ecchymoses of the skin are mentioned as occurring in it. M.
CAPDEVILLE attended this case in consultation, in 1764; and complains of
too feeble means being employed, as the case was trusted to
antiscorbutics. This treatment ended in death. M. C. refers to VAN
SWEITEN, whose correct account we shall mention; and it is evident that
it was the disease of the Children's Asylum: though he manifests a
strong propensity to connect it with scorbutus, and the "blanchet," or a
species of aphthæ, which destroyed a great number of children in the
Foundling Hospital, in 1746. Reference is also made to cases which
occurred in "La Pitié," under the care of CHOPART. Of these, a very
scanty account is given. They terminated in death; after a treatment by
lotions of honey of roses and spirit of vitriol, with emollient and
resolvent cataplasms.

VAN SWEITEN, in the article devoted to the consideration of gangrene,[9]
has left us a far more exact description of the disease, into which we
are inquiring. Practising in a marshy country, he had frequent
opportunities of meeting with it; and his account of it, and his mode of
treatment, though brief, are every way worthy of the close, practical
inquirer into nature, and the sound medical philosopher. His description
is not unmixed with strong expressions of horror and commiseration at
its ravages. He describes it in a manner so similar to that in which it
now prevails, that no doubt can exist of the identity of the diseases.
He acknowledges, however, "rubedo, calor, dolor," among its symptoms.
Cochlearia, theriaca and similar articles, according to him, are almost
always injurious. If no foetor exist, (and, of coarse, no actual
mortification,) he applies a solution of sal ammoniac or nitre, with
some vinegar or lemon juice; sometimes as a lotion, sometimes by keeping
a rag imbued with it always in the ulcer. Hard rubbing he reprobates. If
the disease have made progress, and foetor exist, muriatic acid is
used: in the less aggravated stages, diluted with honey of roses and
water; in the worst cases, pure. This practice he states never to have
failed him, unless where the bone was affected.

In an early edition of Dr. UNDERWOOD'S Treatise on Diseases of Children,
in the library of the Pennsylvania Hospital, no mention is made of this
disease; although an article is devoted to "_gangrenous erosion of the
cheek_." The account is wholly borrowed from a work by Mr. DEASE, of
Dublin, "on the diseases of lying-in women," &c. also in the library.
Mr. DEASE describes this affection as occurring from 2 to 6 or 8 years
of age; especially in unhealthy children, including such as have been
subject to worms. The whole body often appeared cold upon the approach
of the disease. A black spot then occurred, but _without marks of
inflammation_, on one of the cheeks or lips. The whole cheek was
sometimes destroyed, and the lower jaw fell down upon the breast.
Muriatic acid, infusion of roses, the effervescing draught, and, in the
decline of the disease, bark, broths, jellies, and wine, besides
magnesia or rhubarb, to remove the putrid matters swallowed, were the
internal remedies employed. The parts were washed and injected with
muriatic acid, diluted with chamomile or sage tea; and afterwards
dressed with the acid, mixed with honey of roses, and, over this, a
carrot poultice. By this practice, Mr. DEASE lays claim to almost total
success.

In the Philadelphia republication of Dr. UNDERWOOD'S book, taken from
the sixth London edition, there is an article entitled Cancrum Oris. The
author appears to have read PEARSON'S account; but as his description
does not at all agree with the disease of which we are treating, nor
with that of Mr. PEARSON, we shall not stop longer to analyse it.

I have no doubt, from views that will be hereafter developed, that many
of the above writers have had cases similar to those which we are about
to describe; but have mistaken them, from the want of a sufficiently
early and close inspection of the ulcers. In the second stage, this
disease much resembles an inflamed sore between the lips and gums,
extending to the latter; although I hope to prove that this state of
things is secondary.

_Locality of the Disease._--The Philadelphia Children's Asylum is
situated in South Fifth street, between Prime and Federal streets, in
the district of Southwark. The soil is what is called alluvial, or
rather diluvial; as is well known to be the case with all that district,
lying south of Philadelphia, as well as the southern part of the city
itself. The house was built, and for many years occupied, as a mansion,
by the head of a most respectable and wealthy family. Its situation
possesses some of the qualities usually selected in choosing the site of
a country seat. The buildings stand on a swell of ground, leaving an
open lawn, now interrupted by several unoccupied streets, and extending,
on the right hand, to the banks of the Delaware, and, on the left, to
the Navy Yard and part of the suburb of Southwark. Towards the north,
it is not far from the edge of a thickly built appendage of the city.

The district immediately south of the Asylum is marshy, and has long
been noted for the prevalence of intermittent fevers; but the slightly
elevated site of the building had been generally healthy, and continued
so, till the universal and distressing epidemic, which infested all the
outskirts of Philadelphia, in 1822 and 1823. Even at this period, the
persons resident at the Asylum, were far from suffering so severely as
the adjacent neighbourhood; and, since those years, it has again become,
in general, tolerably healthy. In 1819, 1820, 1821, and 1822, a lot,
situated at a short distance, on which were deposited the contents of a
number of privies, proved a source of great inconvenience, and some
disease, at the Asylum. This focus of effluvia, together with the
general and copious use of similar materials in manuring the adjacent
fields, occasioned an intolerable stench, and generated diarrhoeas, in
the early part of the spring. When the grass and weeds, however, were
grown sufficiently to protect the surface of the soil from the sun and
wind, this effect entirely ceased; and I know not that any other
inconvenience was experienced from the same source, unless we attribute
to this, as may fairly be done, the destruction of the purity of the
well. This formerly afforded very good water; and, since that period, it
has much improved. When the corporations of Southwark and Moyamensing
shall introduce, as it is to be hoped they will, the Fairmount water
into their streets, one remaining cause of inconvenience and ill health,
will be removed from the Children's Asylum.

_Prevalent Diseases._--Ophthalmias and furuncular eruptions, the latter
principally on the face, are epidemic every year; generally in the
spring and early summer months. When prevalent in the city, the measles,
small pox, and varioloid disease have reached the Asylum; the scarlatina
has, at no period, I believe, been peculiarly troublesome there.
Intermittents, which were anticipated by many, from the nature of the
situation, have seldom, if ever, prevailed in the house, to any very
considerable extent. One of the worst visitations which it has
experienced, in this respect, was in the autumn of 1823. In many cases,
it was in patients who had been labouring under disease of this
description, that the ulcer we are about to describe exhibited itself;
but it was by no means confined to those who were known to have so
suffered. Many, perhaps, most of the children affected, were free from
any apparent ailment; although it is by no means impossible that the
little, uncomplaining subjects were, at the time, labouring under what
has been called "febricula" or "inward fever."

_Regimen._--To the impurity of the water we have already adverted. The
diet of the children furnishes them with meat every day, with the
exception, during a part of the existence of the institution, of two
days in every week. Molasses was freely used; indian mush was greatly in
demand; and the breakfast and supper were of bread and milk. During the
summer months, this diet was abundantly nourishing; but in winter, it
was thought that an additional quantity of animal food was desirable;
and, accordingly, it was, during the two last winters, given every day.

_Description of the Disease._--The ulcer of which we speak, may begin in
many parts of the mouth. In by far the greater number of cases, however,
it commences immediately at the edges of the gums, in contact with the
necks of the teeth, and, most generally, of the two lower incisors. A
separation is found here; which exhibits a slight loss of substance at
the extreme edge of the gums, and, as far as I have observed, a
whitishness of the diseased surface. In some instances, though not very
frequently, this is preceded by a slight swelling and redness. In this
state, the disease may continue for a long time; and I have reason to
believe, that patients have remained thus affected, during the whole
period of three months, for which I attended the Asylum. At one time,
when the disease was at its height, threatening several patients with
destruction, I found upwards of 70 children, out of a population
amounting to about 240, more or less affected with these ulcerations. No
remarkable change is at this stage observable in the functions of the
little sufferer; except a general air of languor and weakness. The
appetite and the muscular activity continue, but are somewhat reduced;
not sufficiently, however, to disable the child from attending school,
taking the air, or continuing his ordinary practices. In this state, no
symptoms of irritation have been at all discovered. The skin is cool
during the day, no pain is complained of; and no account has ever been
given me of any nocturnal paroxysm of fever. It would appear to be
purely a state of asthenia. We are, however, by no means certain, that
there was no concealed irritation in the system. We were, of necessity,
obliged to depend, in a great measure, upon the reports of nurses, and
other females; and these were liable to overlook, or mistake for mere
weakness, the signs of an obscure disease. In this manner, commencing
cases were frequently not discovered, and nothing was done, till the
affection had made further progress; and this continued until the
ascertained existence of the epidemic in the house, combined with the
recollection of its former ravages, had excited an alarm, which led to
the inspection of the mouths of all the children in the institution.

The disease, in this form, must be within the curative powers of nature;
as, if this were not the case, we should hear of more numerous
unfavourable terminations. It has seldom, however, if at all, been
within my power to witness this tendency; and, when not controlled by a
particular treatment, the cases have almost always either remained
stationary, or increased in severity. Its first progress is, most
generally, by extending to the edges of the gums round other teeth;
frequently affecting a large portion of the dental arches. A very early
progress is, however, mostly effected, down the length of the tooth, in
the direction of the socket; and, in this way, the disease commits great
and unsuspected ravages. When it reaches the edges of the bony socket,
the tooth begins to be loose, and when drawn, exhibits portions of the
fang, including parts which had been contained within the alveolus,
entirely denuded of their periosteum. Indeed, from observation, I should
say, that the latter membrane was the part, which was the most
peculiarly liable to injury and death from this disease; and it is by no
means clear, to my apprehension, that this is not frequently the
commencement of the complaint. The injury generally proceeds with
augmenting rapidity; especially when it has affected the deeper parts:
and it is while in the act of rapidly spreading, that it occasions
gangrene.

In the production of gangrenous sloughs, it much resembles the
descriptions usually given of sloughing ulcers. A portion of the parts
immediately subjacent to the ulcer loses its life; this rapidly
separates; and, before or after a complete removal, a fresh slough is
formed in the same manner. The sloughs are generally black, with
ash-coloured edges. I have not been able to discern a change of colour,
the production of vesicles, or any material tumefaction, as antecedent
to the gangrene. There is generally, by this time, an increased heat in
the parts; with the sensation termed "calor mordens." The discharge now,
for the first time, becomes acrimonious; giving pain when it comes in
contact with cuts in the finger; and excoriations are produced on all
parts in contact with the sloughing ulcerations; as the lips, the
cheeks, the tongue, and the adjoining surface of the part where the
ulcer is situated.

As soon as the external gangrene has reached the level of the edge of
the bony socket, and frequently much sooner, the adjacent portion of the
latter is found deprived of its life; forming a necrosis. The death of
the periosteum in the socket, at least that of the fang of the tooth,
precedes, by some interval of time, that of any portion of the bone
itself.

When gangrene is formed, a fever of irritation is generally developed.
In regard to the time at which this takes place, there is a great
diversity in different constitutions. It has appeared to me to depend,
principally, upon the inflammation of the mouth, which is secondary to
the original disease, and, in most cases, to arise from the acrimony of
the discharge. It is aggravated by loss of rest, want of nourishment,
and, probably, by putrid matter finding its way into the stomach. To the
latter cause I also refer a diarrhoea, which almost uniformly comes
on, towards the close.

There are accounts of a similar disease having begun on the inside of
the cheeks. I have, however, never seen a well-marked instance of this;
the cases which were supposed to be such having, in every instance, been
also found to exhibit ulcerations at the edges of the gums. That the
disease spreads from the gums to the cheek, is a fact which have often
seen exemplified. It is, indeed, the most usual termination of bad
cases. After producing gangrene and necrosis in the gums and alveoli,
and after the discharge becomes, as above stated, acrimonious, a
gangrenous spot is not unfrequently found about the opening of the
Stenonian duct, on the inside of the upper or lower lip, opposite the
incisors, in some other part of the inside of the lip or cheek, or in
more than one of these situations at the same time. Whether this be
owing to excoriation from the discharge, or to some other cause, I
cannot say; it has, however, in every instance which I have seen
sufficiently early to witness its rise, been subsequent to the symptoms
previously described.

When the gangrene reaches the cheek or lip, however, very active
inflammatory symptoms are uniformly developed. In the cellular substance
of these parts, they assume the well known characters which have been
attributed to the _phlegmonous_ species. We have a great thickening,
forming, in the cheek, a large, rounded, prominent tumour, with great
heat and pain. Sometimes redness is perceived externally; but, more
frequently, the great distension of the skin of the cheek seems to empty
the cutaneous vessels; giving to the part, a smooth, polished, dense,
white appearance, very much resembling the effect of a violent
salivation. I have no doubt that this is the tumour described by
POUPART, and alluded to in an earlier part of this paper. Great
thickness and hardness have always occurred, in the other situations
where this gangrene has approached the external cellular masses of the
face; in the lip, however, they are less remarkable, perhaps from the
smaller amount of cellular matter. After reaching this stage, a black
spot is frequently seen on the outer surface of the swelling. This
spreads rapidly; and has always been, in my own experience, the
immediate harbinger of death. It is proper to state, however, that I
have heard it said, that cases had recovered in this city, in which the
gangrene had produced a hole through the cheek. Under what physician's
care this occurred, I have never learned.

In two cases it commenced in the fauces; and was marked by the same
unsuspected progress. In one of these, the little patient was remarked
to be languid, but had no positive external marks of disease. The mouth
was examined, and found healthy; but no suspicion of the real situation
of the disease was entertained, till after 3 or 4 days more, when he
complained of a slight sore throat. A large gangrene of the tonsils,
half-arches and pharynx, was now found; and the event need hardly be
told.

The closing stage of this affection is marked by large gangrenous
patches in the gums; deep fissures between these and the teeth; the
latter loose, or falling out; large pieces of the alveolar processes,
often containing the roots of several teeth, in a state of entire
necrosis; the whole lining membrane of the mouth suffering a violent
excoriation; the whole adjacent external cellular substance, hard and
swelled; large gangrenous spots in the inside of the cheek or lips,
occasionally extending quite through to the outer surface; a total
incapability to sleep, or to take the least food; fever; a swelled
abdomen, and diarrhoea.

_Dissection._--The inspection of the body after death had never thrown
much light upon this obscure affection. Since I began to prepare
materials for this paper, I have been able to dissect but one subject.
The appearances were as follow:

_Exterior_, emaciated.

_Alimentary canal_, externally and internally, altogether in a natural
state, except what appeared to me to be owing to the subsidence of blood
to depending portions of the intestines. The mucous membrane was
carefully examined throughout its whole length; but not being at that
time aware of the importance, attached, by some pathologists, to small
rednesses in this organ, it is highly probable that some such may have
been overlooked.

_Liver and Spleen_, enlarged, but of a natural appearance.

_Heart, thoracic oesophagus, and one kidney_, (the other not
examined,) natural.

_Lungs_, containing much mucus in the bronchial cavities. The fore part
of their substance contained much hepatization.

_Pathology._--The nature and production of this disease are certainly
very obscure. We may, however, as in other branches of knowledge,
attempt to develop and record what knowledge we possess respecting it;
carefully separating truth and reason from conjecture. We have already
said, that its access was very frequently preceded by no marks of
visible disease, or at least none that attracted attention. The little
subjects were, apparently, in merely a drooping or enfeebled state. In
other instances, the ulceration followed a common remittent or
intermittent fever; insomuch that, at one time, whenever a child was
brought to the nursery for fever, it was expected, as a matter of
course, that his mouth would become sore. In the other cases, as we have
already had occasion to say, it is quite possible that a concealed
"inward fever" may have existed; and this is rendered the more probable,
by the circumstance of their losing their appetites. In the instance
where the body was opened, we have seen that the original disease was
hepatization of the lungs; and yet it is quite probable, that this
affection had caused, as it often does, that species of disease, which
a rapidly spreading pathology refers to a slow inflammation of the
stomach and intestines. With regard to marks of this last not having
been detected by me, it is evident that I am in the same situation with
a very numerous body of other observers.

The local appearances, at the commencement, did not appear to be of an
_inflammatory_ nature, at least generally. If the gums were really the
first part affected, it was not so; as these parts when inflamed, as
they frequently are in affections of the teeth, exhibit decided
soreness, pain, swelling, and an increase of redness. The ulcerated part
was, in about nine cases out of ten, paler than natural; and then
neither soreness nor increased heat was perceptible, except in a few
cases, in which the mouth was generally hotter than natural, though it
was not, in a striking manner, referrible to the gums. In a few cases,
distinct redness, and a slight swelling, were perceptible round the
ulcer. These patients generally did better than the others.

If, on the other hand, we suppose the original derangement to have taken
place in the periosteum, we shall be enabled, more easily, to explain
some of the phenomena. We then reason thus: The whole of the body had
shrunk considerably, from disease, and, the circulation being deprived
of a part of its usual vigour, the periosteum, a part possessed of
little vitality, was unable to bear the additional extension, which it
underwent, across the unyielding bone of the tooth. The blood ceased to
circulate in it, and it died. Ulceration of the adjacent parts followed,
as a matter of course; and these parts, especially the periosteum, being
possessed of but little sensibility, the sympathies of the other parts
of the system were but little interested, until an extensive portion of
the mucous membrane of the mouth, or a mass of cellular substance,
became affected. We certainly see that, in every case but two, the
disease commenced in contact with the teeth. This doctrine will also
explain the rapid and deep penetration of the ulcer along the roots of
the teeth; and the destruction of the bone. We may recur to the
statement, that a portion of the fang of every loose tooth was always
found deprived of its periosteum.

In the two cases excepted, we have seen it apparently begin in the
mucous membrane of the fauces; and indeed the manner in which it
generally spreads from the gums to the cheek and lips, seems to me,
unquestionably, to indicate a greater liability than common to gangrene
in more than one part of the mouth.

The soreness and pain of the socket, which forms a part of most
tooth-achs, might have been reasonably expected here; but neither was
ever complained of, even when the teeth were loosening: and, as no fever
existed at this time, the original irritation can hardly be considered
as inflammatory; excepting perhaps the cases which exhibited redness,
and slight swelling of the gums.

_Is this disease scorbutic?_--I never observed ecchymoses, nor in more
than a single instance any the minutest red specks upon the cutis, which
might be thought to resemble petechiæ. The patients never fainted; the
gums were never spongy, nor did they bleed more than those of any other
child would have bled, under an equal degree of violence. I however
requested my friend, Dr. HARRIS, who has had ample opportunities of
making himself acquainted with scorbutus, to see some patients with me.
He complied, with his usual kindness, and pronounced their disease not
at all to resemble the scurvy.

_The teeth._--But few cases occurred during the second dentition; and it
is doubtful whether any one took place during the first. It should be
remarked, however, that children under 2 years, were not admitted to the
institution, unless by deception on the part of the parents. No child
ever lost a tooth of the second set; and, indeed, the second dentition
seemed often to cure the complaint. The greater number of cases occurred
between 2 and 5 years of age, but some as late as 8 or 10. In several
instances, the ulcer destroyed a portion of the enamel capsule; and the
teeth were then cut, with _very perfect enamel_ upon the lower part,
while the bone was entirely bare at the ulcerated portion of the
capsule. This singular fact proves that no inflammation of the capsule,
sufficient to interrupt the function of its remaining portion, took
place in consequence of the opening of its cavity.

_Prevalence of this disease in our own country._--Many elderly persons
remember during different periods of their lives, a tradition and
particular instances of a formidable disease of the mouth, by the name
of "Black Canker."[10] Round Philadelphia, it appears to have been
rare. Having been informed by a friend, that the disease had prevailed
extensively at Salem, New Jersey, under the notice of my friend, Dr.
THEOPHILUS R. BEESLEY, I addressed a letter to that gentleman, to which
he furnished me with an obliging and instructive reply, which I have
unfortunately mislaid. Numerous cases have occurred, in that vicinity,
within the last 30 years; and were, in general, successfully treated by
the women. Cases seldom came under the view of physicians, until
gangrene had commenced; and of these, many died: so that the old women
were generally more in vogue for its cure, than the regular
practitioners. Dr. BEESLEY, Dr. VANMETER, and my friend Dr. E. Q.
KEASBEY, had met with much of this complaint; and the result of many of
their observations had been combined in a thesis, written, but,
according to our unfortunate custom, not published, by the younger Dr.
VANMETER. It was there considered as a sequela of intermittent and slow
remittent fevers, and seldom occurred but in marshy districts, and among
the poor. It generally prevailed between the ages of 2 and 10 years. Of
the remedies employed we shall again speak. Dr. SAMUEL TUCKER has also
seen it in marshy situations near Burlington. I have heard of its
existence on the Schuylkill. Dr. PARRISH has for several years noticed a
stage of this complaint, under the name of "a disease resembling the
effects of mercury," in his private lectures. Drs. PHYSICK, HARTSHORNE,
HEWSON, MEIGS, WOOD, RHEA BARTON, and REMINGTON, and several others who
will pardon me for omitting their names, have also met with cases.

_Prevention._--Our precautionary measures should be directed to the
predisposed or commencing state already described; to the prevention and
cure of fevers, to the removal of "febricula," and other internal
disorders, and to the general restoration of strength. Finally, its
commencing stage should be watched, and promptly met; and success, I
believe, will always attend our endeavours.

At the Children's Asylum, all the weakly children were made to take
bitters, of different descriptions; and Dr. SYLVESTER'S antiscorbutic
drink, composed of cream of tartar and juniper berries, infused in
water. As the disease declined in the house, under this administration
of bitters, it is highly probable that they had a preventive agency. I
much question, however, whether Dr. SYLVESTER'S drink was productive of
any advantage.

One question of some importance yet remains. _Has mercury any agency in
producing this affection?_ The salivary glands have never been observed
to be affected in it. Dr. PARRISH informs me, that, after a strict
examination, he has come to the conclusion that the previous use of
mercury does not bring on, or aggravate this complaint, as he has
noticed it. I have made the same observation; and, not being peculiarly
sparing of the use of calomel in fevers, have had opportunities to
verify it. I think I can add, that, in some cases, by shortening and
moderating an attack of fever, calomel has been useful in preventing the
ulceration. Given during the progress of one, and that a fatal case, it
did not appear to aggravate it.

There is no evidence whatever tending to excite the suspicion of
_contagion_.

_Treatment._--A variety of remedies had been tried within my knowledge;
most of them with but little success, and one or two with somewhat
better. Feeling much disappointed with the results of my practice, in
the small number of cases which fell under my care in the spring months
at the Asylum, as well as elsewhere, I wished to exchange with another
physician for a period when the disease was more prevalent; for the
purpose of studying it, and making comparative trials of different
remedies. Dr. JOS. G. NANCREDE was so polite as to indulge me. Having
then a large number of patients under my care, I was enabled to make
more extensive observations, and with more precision; the results of
which course gave me the first satisfaction I had ever felt relative to
this disease. Trials were made of every thing that was suggested by
friends, and generally upon 4 or 5 selected patients at a time. Thus,
choosing them in the ulcerative stage, and having several at a time
before our eyes, the result was seen in a very few days, much sooner
than if patients had been successively subjected to the remedies; and no
material time was lost in appealing to the article which appeared to
answer best.

The remedy which beyond all comparison succeeded best, was sulphate of
copper. The usefulness of this substance, though known at Salem, New
Jersey, was discovered, at the Asylum, by the mistake of a nurse. It had
been previously used, in lotions of the strength of gr. ij or iij to the
ounce of water; and with little advantage. Observing that the empirical
remedies said to have succeeded, were, as I considered them,
immoderately strong, I furnished the nurse with a common solution of
sulphate of copper, and with a vial containing 72 grains of the sulphate
in an ounce of water, for the purpose of being progressively added to
the other at different periods. This stronger solution was applied, by
mistake, instead of the diluted one; and it was the first remedy which
had produced a rapid tendency to a cure. I finally settled down, after
various trials, in the employment of the following:

R. Sulph. Cupri, [Symbol: dram]ij
Pulv. Cinchonæ, [Symbol: ounce]ss
Aquæ, [Symbol: ounce]iv _m._

S. To be applied twice a day, very carefully, to the full extent of the
ulcerations and excoriations.

The cinchona here is not absolutely necessary; but operates by retaining
the sulphate longer in contact with the edges of the gums.

Simple ulcerations and small gangrenes, as well as the troublesome
excoriation, when not in the last stage, yielded promptly to this
remedy; the good effect being generally visible from the first
application.

Dr. FOX, my friend and fellow-labourer in the Asylum, had already taught
me that it was important early to extract the teeth. I was not, however,
sensible of the full extent of this rule, till after examining the fangs
of some of them which were drawn. The separation of a portion of the
periosteum from the fang, within the socket, which was universally found
whenever the tooth was loose, among two or three hundred specimens,
proved the existence of the disease in a deep, narrow crevice, into
which it was impossible, by any contrivance, to insinuate the lotion.
This cavity was laid open by extracting the tooth; and when the remedy
was applied, the sanatory effect was surprisingly prompt. From this
period, forwards, the universal rule was to extract all teeth, the
moment they were discovered to be in the slightest degree loose; and
"the blue wash" above described, became the standing remedy.

It is at all times a dangerous boast for a physician to make, to say
that, in the treatment of any complaint, he has always succeeded. He is
frequently not credited; and he can never know at what moment disbelief
may be borne out by his subsequent failures. A faithful adherence to
fact, and justice to the medical art, oblige me to say that it was owing
to the observation of these means, that I never had an opportunity of
making a dissection, after the one mentioned in a preceding page.
Upwards of 120 ulcerated gums came under my notice in the course of
three months; of which 70 were affected at one time. Of these, by far
the greater number would, unquestionably, have escaped gangrene. The
experience of past winters, however, and that of the preceding autumn,
justifies the belief that there would have been several gangrenous
cases, and some deaths; unless interrupted by remedial means. Some 3 or
4 suffered small spots of mortification, and one, by the delay arising
from the tardy report of a nurse, suffered necrosis in a portion of an
alveolus; but they were speedily arrested, and the production of more
such cases, I believe, prevented, by the employment of the above means.

I have been once, since then, called in consultation to a case in which
this remedy failed; but this was only two days previous to death, and
during the existence of swelled cheek, and of a thick gangrenous eschar,
and it was in fact only once imperfectly applied.

The farthest advanced of all the cases which I have seen, since that
time, relieved by this remedy, was in the practice of my friend, Dr. R.
M. HUSTON. He aided it by the application of a poultice with lead-water
to the external surface of the cheek. This was thought to be productive
of much relief.

Great attention and care are requisite on the part of the physician, to
see that every part of the ulceration and excoriation is made visible,
and brought under the influence of the applications employed. Without
this entire knowledge of the extent of the evil, the result will be
failure. The disgusting sloughs and discharge, and the fear of an
imaginary _contagion_, make the nurses very unwilling to introduce their
fingers into the reluctant little patient's mouth, and without this
scrutiny all is in vain. The physician is compelled to set the example,
to try the looseness of the teeth with his own fingers, and to ensure
the nurse's entire knowledge of the extent of the disease.

Dr. BEESLEY writes that the women in his neighbourhood, frequently used
considerable _roughness_ in applying the lotions. _Certainty_ is
absolutely necessary.

After the remedy had been thus accidentally discovered in the Asylum,
and used for a few days, I received Dr. BEESLEY'S letter mentioned
above; and I then learned that the sulphate of copper was the principal
dependence of the physicians at Salem. As, however, I had never seen Dr.
VANMETER'S thesis, the use of it at the Asylum was new to me.

An excellent remedy, and one on which the sole dependence should be
placed, were we not in possession of one which possesses a decided
superiority, is one which was communicated to me by Dr. PARRISH. It is
as follows, including a slight correction made by the apothecary:

R. Sulph. Zinci, [Symbol: dram]i
Aquæ, [Symbol: dram]ij Solve.
Dein adde, Mellis Despum. et
Tinct. Myrrhæ, aa [Symbol: ounce]ij

To be used in the manner described above. Some bad cases yielded to the
following:

R. Sulph. Zinci, [Symbol: dram]ij
Aquæ, [Symbol: ounce]i _m._

It is useful to record failures and unsuccessful trials; as they serve
to deter others from unnecessary risk. We therefore record the following
as not having succeeded in our hands:

R. Mellis et
Tinct. Myrrhæ, aa [Symbol: ounce]i _m._

The same, with the addition of powdered bark.

R. Aluminis, [Symbol: scruple]ij
Tinct. Myrrhæ, et
Mellis, aa [Symbol: ounce]ij _m._
R. Pulv. Cinchonæ, [Symbol: ounce]i
Myrrhæ et
Pulv. Carbonis. a [Symbol: ounce]ss _m._ et adde
Succ. Limonum, q. s. ad massam
faciendam, quâ illineantur gingivæ.

Caustic potassa; and nitrate of silver.

Pyroligneous acid, both pure and variously diluted with water. This had
but a very limited effect, even in destroying the foetor; and I am by
no means sure that it was of any use in arresting the disease.

Muriatic acid, though praised by such high authorities, did not seem
productive of any distinct useful effects. Nitric acid, variously
diluted, and sulphuric acid, which was tried in one case, diluted with
an equal quantity of water, were entirely useless.

Of _constitutional_ treatment, the disease seemed to admit very little.
In the early stage, the means employed, were the same mentioned above as
means of prevention. It was by no means evident that any of these were
useful in retarding the progress of the complaint. Towards the decline
of the worst cases, aromatic sirup of rhubarb, with magnesia, were
employed, to remove the putrid matters swallowed; and to relieve the
diarrhoea which generally took place, by the astringent operation of
the first mentioned medicine. It is extremely doubtful whether these
means were productive of any benefit.

* * * * *

While the above was in press, I have met with the article, "_Gangrene de
la bouche des enfans_," in the Dictionnaire de Medicine; written by M.
MARJOLIN. The author in the Dictionnaire des Sciences Medicales, has
given nothing material but references to some of the writers mentioned
above; with one or two which were not within my reach. M. MARJOLIN has
evidently identified the disease. He cites FABRICIUS HILDANUS, though we
have not found a distinct account of it in that writer's works. He
remarks that it is identical with the _necrosis infantilis_ of SAUVAGES.
He also refers to SAVIARD, VAN SWEITEN, whom he justly mentions with the
highest praise, UNDERWOOD, BERTHE, CAPDEVILLE, M. BARON, and the
inaugural thesis of M. ISNARD. As we have no means of referring to the
two last, we must judge of them by M. MARJOLIN'S statements. He observes
the dissimilarity of BERTHE'S case. From the thesis of M. ISNARD, he
gives us an account of the disease which corresponds very nearly,
indeed, with that of VAN SWEITEN, and with the appearances observed at
the Children's Asylum.

"Almost all the infants affected with this disease in the hospitals of
Paris," says M. MARJOLIN, "sink under it." He recommends, after VAN
SWEITEN, the use of muriatic acid, which he mixes with honey in equal
proportions. Thick sloughs he cuts away with a bistouri or with
scissors. MM. JADELOT, GUERSENT, and BARON, have employed the actual
cautery with success in several instances. M. MARJOLIN has cured three
cases; one by the actual cautery, one by caustic potassa, and a third by
_muriate of soda!_ which, he believes, will always destroy the foetor.
It would be interesting, undoubtedly, to make repeated trials of this
simple remedy; and we shall endeavour to do so in cases which admit of
delay.

FOOTNOTES:

[1] Vol. I. p. 319, Anderson's edition.

[2] Principles of Surgery; by JOHN PEARSON. Lond. 1788. p. 262, et seq.

[3] Opera omnia. Vol. II. p. 271. In the Loganian Library.

[4] Ibidem.

[5] See CORNELII STALPAART VANDER WIEL Observationes Medico-Anatomicæ.
p. 167. Note by the editor, P. STALPAART VANDER WIEL. Amsterdam, 1687.
In the Loganian Library.

[6] In the Loganian Library.

[7] Page 193.

[8] Page 217.

[9] Commentaria.--Edit. Lugd. Bat. 1742. Vol. I. pp. 766, 767.

[10] This name may be either from the ancient English or the low Dutch;
if the one, by tradition, if the other, from the use of it by medical
men. _Cancrum_ is an odd grammatical blunder; being, in reality, nothing
but the accusative of Cancer, put instead of the nominative. The latter
name was, as is well known, frequently applied by the older surgeons, in
a vague manner, to any terrific and unmanageable ulcer; and, in
particular, it was often applied to gangrene. The error appears to have
been first made by Pearson, and copied by Mr. Cooper. Compare Muys and
Vander Wiel, with Pearson, at the above references.

ARTICLE II.--_Case of Purpura in an Infant, attended with Extraordinary
Symptoms._ By R. M. HUSTON, M. D., &c.

On the 28th of August last, A---- V----, after a moderate labour of four
hours' continuance, was delivered of a female child. About a month
previously, she had laboured under an attack of intermittent fever,
which yielded, in a few days, to the ordinary treatment. She was 23
years of age, an English-woman by birth, had generally enjoyed good
health, and was as well as usual at the time of her confinement. Her
labour was strictly natural, and her delivery accomplished without any
extraordinary assistance.

At birth there was nothing remarkable about the child. Its breathing was
natural, its skin of the usual colour and appearance; in short, all the
common indications of a continuance of life and health were present. A
few hours, however, after birth, it became uneasy, cried much, and
showed signs of colic. The nurse, supposing these symptoms to arise from
flatulence, administered some warm tea; but without any apparent
advantage. On the following day, I saw it again, and learned, that it
had evacuated a considerable quantity of urine, and some intestinal
matter, of the ordinary appearance after birth. The spasms continuing at
intervals, a teaspoonful of castor oil was ordered, to evacuate any
remaining meconium, that might lie in the bowels, producing irritation;
upon the presence of which, it was presumed the spasms depended. It
operated well, but without producing the desired relief. On the next
day, viz. forty-eight hours after birth, a number of bluish or purple
spots were observed on different parts of the child's body, but most
numerous on the extremities. They were of various sizes, from that of a
mustard seed, up to that of a grain of Indian corn. Some were slightly
elevated, but most of them were not in the least so. In the majority,
there was a minute central spot, or little point, more red or pink
coloured than the blue areola, by which it was surrounded. In many
instances, these little points projected, so as to become manifest to
the touch. In the course of twenty-four hours, the spots, which had
first appeared, began to decline, leaving a greenish mark, very like the
remains of a bruise; but much more rapidly than these declined, others
of larger size appeared on different parts of the child's body.

On the third day after birth, large blotches appeared, one behind each
ear. These rapidly increased, until they covered the whole extent of the
parietal bones, and considerably elevated the skin, giving it a puffy or
tumid appearance, like that caused by a blow from a large or blunt
instrument. The parts soon became hot and tender to the touch; and this
tenderness extended over the greater part of the scalp. A blotch,
similar to those upon the exterior surface, was likewise observed within
the mouth, covering the whole extent of the palate bones. The child
experienced great difficulty in swallowing after the third day; and the
_nurse_ thought the spasms were often excited by attempts of this kind.

But the most singular feature of the case was the appearance, on the
night of the second day, of a discharge from the vagina, _resembling_
the menstrual flux. It resembled that flux in _colour_, _consistence_,
_want of coagulability_, and in being, withal, accompanied by a
considerable quantity of _slimy or mucous matter_. Every diaper which
was used during that night, and the greater part of the next day, was
stained more or less with this discharge. It was also observed, that,
during the flow of this fluid, the spasms ceased; and that, whenever the
discharge was suppressed, even for a very short time, they uniformly
returned. In this manner they alternated at intervals of a few hours,
until the occurrence of the death of the child, which happened on the
eighth day after birth.

As this case is related more for its singularity than from an
expectation that any practical suggestions will be furnished by its
perusal, but few remarks will be necessary, either upon its pathology or
treatment. Although it will be perceived by the scientific reader, that
the disease observed, differed materially from any of the forms of
_purpura_, described by systematic writers on diseases of the skin;
still I apprehend it may be justly considered as more nearly allied to
that genus, than to any other.

The spots were evidently caused by an effusion of blood beneath the
cutis, and the presumption is strong, that it issued from the little
point discoverable in the centre of each spot. Those points were, in all
probability, _arterial_. That they were arterial terminations, I think
is evident, from the great extent to which the cellular membrane was
injected, especially over the parietal bones. The force exerted must
have been very considerable to elevate so large a portion of scalp, and
yet no pulsation could be discovered in any one of the points.

But whence came the vaginal discharge? That it issued from the _vagina_
was most certain; but whether it was furnished by that canal, or by _the
uterus_, was not ascertained. To assert that it was menstrual, would be
hazarding more than a prudent regard for truth would justify. But, if
not, why the pain and spasms which preceded it, and the alternation of
these symptoms with each other? and, especially, why the slimy
appearance, mixed with red matter, without a trace of any thing like
coagula? Certainly we do not find these appearances in ordinary cases of
hæmorrhage. So that there is no other way of accounting for the
discharge in this case, except by considering it as having been secreted
by the vessels of the parts from which it came.

From the difficulty which the child experienced in swallowing, but
little food could be taken; and the same difficulty precluded the
administration of medicines. What caused this impediment could not be
ascertained, but it was supposed to result from a spasmodic action of
the muscles of the part.

The only medicine attempted to be given was a weak infusion of bark, and
this was soon abandoned.

The spots, particularly the large ecchymosed surface on the head,
exhibited no change in appearance, when _viewed superficially_, a few
hours after death. No other examination was permitted.

FOOTNOTES:

ARTICLE III.--_History of the Natural and Modified Small-Pox, or of the
Variolous and Varioloid Diseases, as they prevailed in Philadelphia in
the years 1823 and 1824._ By JOHN K. MITCHELL, M. D., and JOHN BELL, M.
D. attending physicians at the then Small-Pox Hospital. With a Plate.

In a question of less moment, some apology might seem due for once more
directing public attention to that which has been so oft discussed and
described by many eminent physicians and experienced observers. But, if
descriptions of any disease be valuable; if to record faithfully an evil
be among the first steps for its removal and prevention; and, still
more, if additional confidence, derived from enlarged experience, can be
imparted to the means hitherto adopted to guaranty the human frame
against a mortal and loathsome malady, our efforts at this time may
claim the favourable notice of our professional brethren, and of the
community at large.

Sedulously abstaining from the parade of erudite research or indulgence
in speculations, however ingenious, it is our intention to describe with
accuracy all that we saw; and if, in so doing, we shall be found
repeating what others have said before us, and proposing inferences
previously drawn, the observations and deductions are to be considered
as not the less our own, since we only speak from conviction, founded on
the evidence presented to our senses. Our opportunities for accurate
judgment were most ample, being derived as well from an attendance of
nine months on the hospital for the reception of the poor, labouring
under the disease, as from one of us prescribing, during a part of the
time, for the Philadelphia Dispensary, added to the cases furnished us
by private practice, and very many others, the records of which have
been kindly placed at our disposal by professional friends.

The ravages committed by the small-pox in Baltimore, and the fact of
many who had been previously vaccinated having been attacked by the
disease during the years 1821 and 1822 were notorious to us all, but
were productive of little alarm in Philadelphia. The non-appearance of
the scourge in the greater part of the period, when the former city was
suffering under it, justified, to a certain extent, this feeling of
security, and seemed to call more on our sympathies for our neighbours
than on our fears for ourselves.

In the month of September, 1823, some cases of fever, with pustular
eruption, first arrested the attention of the medical faculty, some of
whom were, of course, called on to render professional assistance. The
residence of some of the persons, thus attacked, in Water street, and
their emigration from Europe, naturally induced a suspicion of this
disease being no other than the small-pox, imported by, or brought in
with them. Very nearly about the same time, however, some scattered
cases of a similar eruptive disease, were noticed in the upper or
western portion of the city, without our being able to trace any
intercourse or connexion between these and the others in the lower or
eastern part, viz. Water street.

The first return of death from small-pox, furnished by the Board of
Health, was in the week between the 13th and 20th of September. The next
was between the 4th and 11th of October. From this time to the end of
the year there was a progressive increase of mortality, and the annual
return for 1823, presented no fewer than one hundred and sixty deaths by
small-pox. The greatest mortality in any one week was thirty-three, from
December 20 to 27. During the months of January, February and March,
1824, the disease prevailed extensively, and was fatal to many. In the
following months its violence subsided, and in the month of June our
attendance on the temporary hospital[11] was discontinued, in
consequence of a resolution of the Managers of the Alms House to close
it. Though a few patients were afterwards received into it, yet the
malady soon disappearing, justified its final closure. The annual return
for 1824 exhibited three hundred and twenty-four deaths by small-pox.
The entire mortality from this cause was four hundred and seventy-three,
in a period of twelve months, from November 1, 1823, to November 1,
1824. The deaths before the first, and after the second date, were but
eleven.[12] Contagious as this disease unquestionably was, we cannot, at
the same time, withhold our belief of its having been in a measure
subjected to epidemical influences, viz. in a particular character of
the seasons and atmospherical changes. It is then within our province,
as historians of events, rather than as expounders of causes, to present
our readers with a summary account of the weather during the years 1823
and 1824. We do this both from a sense of duty, considering it as
pertinent to our present labour, and from a wish to encourage others by
our example to preserve and transmit the meteorological registers, in
their respective districts, of those years, marked by new or aggravated
diseases.

METEOROLOGICAL REGISTER.[13]
------------------------------------------------------------------------
| | | | | |Winds--Days.| |
| | | | |Snow & |------|-----| |
| | | | |Rain |N. W. |N. E.| |
| |Mean |Variat.|Variat.|Water. | to | to | |
| 1823. |Temp. |Therm. |Barom. |Inches.|S. W. |S. E.| |
|-------------|------|-------|-------|-------|------|-----| The |
|January, | 31 | 44 | 0.94 | 3.38 | 22 | 8 | |
|February, | 25 | 42 | 1.17 | 1.93 | 22 | 6 |temperature |
|March, | 37 | 52 | 1.65 | 6.87 | 21 | 9 | |
|April, | 55 | 47 | 1.08 | 1.77 | 16 | 14 | of |
|May, | 61 | 52 | 0.88 | 1.60 | 19 | 8 | |
|June, | 68 | 46 | 0.65 | 0.87 | 20 | 10 | the |
|July, | 72 | 30 | 0.58 | 6.12 | 23 | 6 | |
|August, | 72 | 35 | 0.60 | 4.68 | 21 | 8 | wells |
|September, | 63 | 51 | 0.61 | 3.46 | 15 | 12 | |
|October, | 53 | 42 | 0.60 | 2.02 | 21 | 9 | and |
|November, | 38 | 38 | 0.81 | 2.47 | 21 | 9 | |
|December, | 34 | 31 | 1.07 | 7.37 | 21 | 10 | springs, |
| | | | |-------|------|-----| |
|For the year,|50-3/4| 88 | 1.70 |42.54 | 242 | 109 | in |
|-------------|------|-------|-------|-------|------|-----| |
| 1824. | | | | | | | and |
|January, | 36 | 48 | 1.25 | 3.67 | 24 | 7 | |
|February, | 31 | 59 | 1.55 | 3.94 | 21 | 7 | near |
|March, | 40 | 39 | 0.71 | 2.63 | 16 | 15 | |
|April, | 50 | 45 | 1.08 | 4.54 | 22 | 8 |Philadelphia,|
|May, | 60 | 44 | 0.88 | 1.59 | 24 | 7 | |
|June, | 73 | 46 | 0.69 | 6.09 | 25 | 5 | |
|July, | 74 | 30 | 0.38 | 8.80 | 19 | 8 | is |
|August, | 70 | 36 | 0.45 | 6.39 | 20 | 11 | |
|September, | 64 | 41 | 0.65 | 6.60 | 17 | 7 | 52° |
|October, | 54 | 43 | 0.65 | 1.53 | 23 | 5 | |
|November, | 42 | 38 | 0.89 | 2.49 | 24 | 6 |Fahrenheit. |
|December, | 37 | 43 | 0.95 | 2.11 | 24 | 7 | |
| | | | |-------|------|-----| |
|For the year,|52-1/2| 85 | 1.55 |50.38 | 259 | 93 | |
------------------------------------------------------------------------

1823.

Maximum of Therm. 91, June 19. Maximum of Barom. 30.45, Nov. 29.
Minimum " 3, Feb. 7. Minimum " 28.75, March 30.
-- -----
Variation, 88 1.70

1824.

Maximum of Therm. 90, June 8. Maximum of Barom. 30.45, Feb. 6.
Minimum " 5, Feb. 2. Minimum " 28.90, Feb. 26.
-- -----
Variation, 85 1.55

The amount of water which fell in rain and snow during the four years,
from 1822 to 1825, inclusive, was,

1822. 1823. 1824. 1825.
Inches, 35.20 | 42.54 | 50.38 | 33.26 |

We next subjoin a summary of deaths by fever, erysipelas and measles, in
the above period; being more desirous of narrating all the circumstances
associated with the appearance and continuance of the small-pox, than of
insisting on them as supporting causes or necessary connexions. It will
appear from the accompanying statement, that the diseases febrile and
eruptive were in number, violence and mortality unusually great, in the
above mentioned years, as we discover by comparison with the returns for
1822 and 1825.

Deaths by
Fevers. Erysipelas. Measles. Small-pox.
1822 510 4 0 0
1823 758 24 156 160
1824 654 28 102 324
1825 375 12 38 6

In New York and Baltimore, the coincidence between increase of fevers,
measles and erysipelas, and the mortality from small-pox, is not so well
marked.

In New York--Deaths by

Fevers. Erysipelas. Measles. Small-pox.
1822 393[14] 6 1 0
1823 192[15] 13 117 18
1824 191[16] 14 100 394
1825 445 20 53 40

In Baltimore--Deaths by

Fevers. Erysipelas. Measles. Small-pox.
1821 400 0 2 21
1822 430 1 4 122
1823 304 2 175 2
1824 183 3 14 2
1825 138 0 9 3

We now proceed to give a brief sketch of the disease called the natural
small-pox, (occurring in persons unprotected by previous vaccination or
inoculation,) and the deaths from which are given in the above
statements. We must, in advance, insist on the great diversity in the
appearance of the eruption in different individuals; so great, that an
attempt to make an accurate picture of one case pass for a faithful
representation of the many, must be deceptive and injurious.

In the premonitory symptoms, constituting the characters of the fever
precursory to the eruption, there was considerable uniformity: the
complaint of nearly all those attacked being at first chills and rigors;
pains in the loins, head and limbs, with thirst and want of appetite;
with which were soon associated gastric uneasiness, and in many,
soreness of throat, rendering deglutition painful, hoarseness and
weeping eyes. The duration of these symptoms, aggravated by febrile
exacerbations, varied from one to three days, more usually the latter,
after which the eruption begins to appear. It is first seen round the
forehead and temples, near the hairy scalp; then on the cheeks and
breast and back; on the arms near the shoulders; the abdomen and thighs;
and subsequently on the fore-arms and hands, and finally on the legs and
feet. The appearance of the eruption is that of red or scarlet papulæ,
presenting to the touch a sensible resistance, but not much raised, and
without roughness or hardness. These papulæ, becoming more and more
defined and elevated, are after a day or two converted into vesicles,
with small elevated centres or bodies of a yellowish-white, and more
diffused red and somewhat hard bases or margins. The redness extending
as the eruption becomes copious, converts the skin, especially of the
face, neck, and hands, into a red ground, from which project, in relief,
the whitish vesicles. Similar appearances, but of a less marked nature,
owing to the eruption being more scattered, are found on the trunk. The
vesicles, containing at first a thin, semi-transparent fluid, become
gradually larger, fuller and yellower, and filled with a thick,
tenacious matter. This change is completed, and the pustules are
entirely formed, after a lapse of time from the first eruptive effort,
which varies from the fifth to the ninth day, and is occasionally
longer. The mean for the beginning of maturation, or the finishing of
the secretion of matter in the pustule, may be received as five days for
the face, and eight or nine days for the body generally. The stages of
the eruption, as regards its appearance, may be very properly called
papular, vesicular, and pustular. This last having attained its height,
completes what is termed the period of maturation, during which the
pustules retain their fulness and spheroid figure; and exhibit the
greatest proportion of whitish-yellow shining surface of their body, and
diminished extent of redness at their base. A yellow dry point on the
summit of the pustule, which loses thereby somewhat of its former
spheroidal shape, by becoming flatter, or slightly indented, indicates
beginning desiccation, at which time the body exhales that peculiar
odour, so unpleasant, and so readily recognizable, after it has once
been perceived. There is no uniformity in the size of the pustules on
the body generally, nor any equality among them on a particular part:
more usually one larger and fuller is surrounded by others less so. Nor
is it to be supposed that the changes above mentioned are gone through
in regular succession on all parts of the surface, uniformly. It was no
uncommon thing to see the eruption papular on the legs, vesicular on the
trunk and arms, and pustular on the face, at the same epoch. One part
even, as the arm for instance, has exhibited to us the three forms at
the same time.

Maturation complete and desiccation going on, the pustules break, and
have their thin coverings converted into a yellow hard coat or crust, to
which adheres the pus that was not removed by absorption, and the
residue, by evaporation of its watery part, is now converted into a scab
of varying thickness, firm and prominent in its centre, and made up
outwardly of concentric circles. The margins of the pustules, before of
a distinct red, now assume a bluish-red or purplish colour, and the skin
begins to desquamate.

The constitutional sympathies, or the symptoms in the milder and regular
variety of the disease, are not of any great violence or intensity. The
premonitory pains, diminishing or disappearing, after the coming out of
the eruption, leave in their place a regular fever. The action of the
heart and capillaries is hurried during the papular and vesicular
stages; but becomes more equable while maturation is going on. During
the former period, the loaded and not unfrequently furred tongue
evidences disordered stomach, the cravings of which are for cold drinks.
The somewhat laborious respiration may, in some cases, depend on the
swelling and soreness of the fauces and pharynx; in others, on the
eruption extending along the lining membrane of the larynx; whilst in
others, it may be caused by bronchial engorgement.

The febrile symptoms, which abate during the process of maturation, are
apt to return during desiccation; and when the skin begins to
desquamate, they then constitute what is called secondary fever. The
skin which had suffered so much, occasionally exhibits at this time an
erysipelatous blush, accompanied by an inflammation of the subjacent
cellular tissue, and the formation of troublesome boils, or infiltration
of serum, especially where there is much laxity of structure, as in the
eyelids, cheeks, lips, &c. The cutaneous system, during and immediately
after the removal of its cuticle, and much of its rete mucosum, is of
course very sensible, as well to the impression of clothes as to
atmospherical extremes, and particularly cold. This is with many a
critical time. It not unfrequently happened that persons, who had passed
through the different stages of the disease, and were advancing rapidly
to convalescence, were suddenly seized with an affection of the chest,
pleurisy, bronchitis or pneumonia, and speedily carried off by the
violence of the inflammation. The skin, exquisitely sensible in its
denuded state to atmospherical vicissitudes, transmits with great
promptness the morbid impression to the lungs, already prone to take on
disease, in consequence of the active part they are compelled to play
during the eruptive fever.

The anomalous varieties, if we can admit any standard form of the
disease, were numerous. Those which most fixed our attention were the
_confluent_, the _roseate_, the _tuberculous_, and the _erysipelatous_.

The _confluent_ was ushered in by symptoms of greater febrile disorder
than the regular distinct variety: the throat was sorer; eyes more
suffused and watery, and more intolerant of light; gastric and pulmonic
uneasiness, and oppression more aggravated. In place of the papulæ being
separate, or merely in clusters, they are so crowded, that on the
progress of the eruption the vesicles first and then the pustules are
contiguous at their bases, and often run into each other, forming at
times, a large irregular bag filled with pus, and technically called
blebs, or else exhibiting over a considerable space of skin the
appearance of imperfect vesication. The vesicles and pustules are, in
such cases, flattened, and with indented centres, which latter display
at times a dark point or spot, while the edges are of a livid red. This
is the appearance of the limbs and trunk. The cheeks and forehead during
the process of maturation present a continuous puffy elevation of a
pearly white colour. The eyes are nearly closed by the swelling of the
lids, and the thick copious secretion from the borders and the
conjunctiva; the lips are tumid and the angles of the mouth ulcerated.
In fact the human face divine, deprived of all lineaments and
expression, is now a foul, misshapen mass. Associated with this state
are swelled throat, rendering deglutition very painful--salivation,
cough--occasional vomiting, delirium, sometimes phrenitical, sometimes
evidencing itself in low mutterings and jactation.

The _roseate_ variety of small-pox might, without creating much
confusion, be ranked with the confluent, which it closely resembles in
its second stage. The first is characterized by the rose or pink colour
of the face, which is covered with a copious eruption of papulæ, some
with dry points, while from others, the bases of which are small and
hard, arise minute vesicles of a pearly colour, which soon dry away. The
inflammation, however, still continues, but spreads under the cuticle,
which is raised in large patches of a white colour, but not vesicular,
or distinctly pustular, or containing fluid: they approximate and
produce the continuous puffy elevation already described. On the trunk
and extremities, the eruption is either of confluent patches or of
pustules dry and flat, with indented centres, the intermediate skin
being of a deep red or crimson colour.

The constitutional disorder runs high in these cases,--delirium and
great gastric distress being very common symptoms. The tongue,
especially at its border, is frequently the seat of eruption, which may
be compared to the vesicular stage on the skin, with the summits cut
off. The lining membrane of the mouth and fauces and pharynx, are, we
presume, similarly affected, judging from the soreness of these parts,
and the thick muco-purulent matter sometimes mixed with blood, which is
spit out or brought up by screatus. The subjects most liable to the
roseate eruption, were the intemperate and debauched of the sanguine
temperament.

The _tuberculous_ variety of small-pox was most frequent among the
negroes. The eruption at first consisted of broad papulæ, which were
converted into hard, rough, and knotted prominences, tuberculous at base
and flattened in the centre. This was not unaptly called by some the
seal skin eruption. Sore throat, causing the greatest difficulty in
deglutition, and delirium were the almost invariable concomitants of
this variety. Occasionally the patient was in a state of stupor and
disinclination to motion--at other times wakeful and restless, and
requiring coercive means to confine him to his bed. In many instances,
the muscular strength was retained to within a few hours of death. The
fatal termination in these three varieties, confluent, roseate, and
tuberculous, was in the second period of the disease, that is, in the
one corresponding with the completion of maturation, and the absorption
and drying away of the pus in the simple distinct form of small pox.
After some experience, we were enabled, from the appearance of the
eruption at the outset, to presage the event, which in the above
described kinds, was almost universally fatal.

The _erysipelatous_ variety was more an adventitious conversion of the
primary form of the disease, by hospital air and delicacy of the
cutaneous tissue induced by prior irregularities of life, than a
distinct kind to be met with in general practice. It was most commonly
presented to us in persons who had a very copious eruption, interesting
to a great degree the whole cutaneous surface, and in whom the process
of maturation was complete, and the cuticle began to lose its adhesion
to the subjacent tissue. In some cases, even after desquamation was
almost completed, and the skin nearly dry and smooth, erysipelatous
inflammation would supervene, and seem to be repeated on the pulmonary
and gastric surfaces, producing great trouble in respiration and
derangement in the digestive functions, accelerated pulse, and other
symptoms of fever.

We could readily pourtray other nicer shades of the natural small-pox,
but the originals might not perhaps be so readily recognized by
succeeding observers, or their nature well understood by our
readers.[17] Our object being to convey practical knowledge, we pass on
to a notice of the subjects, most liable to suffer from exposure to the
variolous poison.

The African race would seem to be peculiarly obnoxious to the small-pox:
the actual number of people of colour brought to the hospital being
greater than the whites, and the proportionate mortality much more
considerable; being as four deaths to six cases of disease in the
former, and two deaths to four cases of disease in the latter. As
regards sex, the proportion of deaths among the males was three-fifths,
among the females two-fifths, of the entire number under treatment in
the hospital. In both, the violence of the disease, and the number of
anomalous symptoms and complications, depended greatly on their prior
dissolute life. Drunkards among the men, and prostitutes among the
women, rarely escaped death. The former had the roseate eruption, and
the latter the confluent, on which dark spots as if gangrenous were a
frequent appearance. Menorrhagia, at any time in the course of the
disease, was a bad augury.

The better to elucidate the nature of this dire malady, we shall now
give from our records some cases of fatal termination, and add an
account of the appearances on _post mortem_ examination of these same
subjects.

CASES.--I. Wilhelmina Smith, white, aged nineteen years, of irregular
habits, has a well defined circular scar, with smaller pits in it, on
the left arm; but has no recollection of having been vaccinated, nor
does she remember ever having heard her parents, who are now dead, speak
of it.

She was taken sick on Thursday night, the 11th of March, 1824, and in
the morning had vomiting and pains in the back. On the 13th in the
afternoon, the eruption first appeared.

15th. Admitted and visited. Eruption on face slightly prominent, is red,
tuberculous and rough--small and scattered on the arms, like flea bites.
Legs nearly clear: they have many cicatrices, especially on the shin and
outer part. There is at present an ulcer above the inner ancle. Tongue
yellow, and furred in centre, white at borders. Pulse small and
threaded.

16th. Eruption rising vesicular from face and limbs; no fever; tongue
greenish and loaded; coughs much.

17th. Eruption fine, dry, flat, and partly indented in centre on the
face, which burns much; skin red and inflamed; on limbs same appearance,
but eruption less copious; pulse small, threaded, and frequent; tongue
furred and yellow in centre; complains of pain in deglutition; cough.

18th. Eruption on face dry, flat, white and small in size, and copious;
rather more elevated on limbs and neck; tongue dry and furred; pulse
frequent and threaded; throat sore.

19th. Eruption same as yesterday; pulse scarcely to be felt; skin cool;
coughs with an appearance of choking.

Dead at midnight. She retained her muscular strength and ability to sit
up to the last.

_Examination_ in the afternoon of March 21.--On removing the sternum and
anterior portion of the ribs, the anterior mediastinum was found filled
with a frothy adipo-mucous collection of a yellowish colour. The lungs
on both sides adherent to the thorax, and the left lobes to each other.
A sanguineo-serous effusion on both sides, probably a quart on the
right, the lungs of which were changed in texture, and shrunk. The
pericardium contained a large quantity of the same kind of fluid, which
was found in the cavity of the thorax. The heart was highly injected. On
removing the lungs and the trachea, and larynx, the lining membrane of
the two last showed a brownish-red, coated with mucus, and deeply
injected. Same appearances in a more marked degree in the bifurcations
of the trachea.

The oesophagus next examined, was found of a natural appearance,
except near the stomach, where it was injected and assumed a red hue,
contrasting with the whiteness of its upper part. The mucous membrane
of the stomach near the cardiac orifice was in some parts of a roseate
hue, in others a brownish-red; while in others it was ash-coloured, and
dotted with red and yellow points. Towards the pyloric orifice, less
disease. The stomach contained nothing but dark green bile and mucus.
The duodenum was also highly injected. Lower down, the small intestines
were in places lined with a dark red and brown, and the mesentery highly
injected in the portions corresponding to these spots. Intestines much
inflated, and omentum dark and injected. The uterus was not examined.
The ovaria were large, white and soft; in the left was a small sac of
dark blood, which readily burst on pressure.

The liver was very large, of a soft texture and white colour;
gall-bladder full of dark green bile, which had in part transuded
through its coats.

On looking at the trachea after it was washed, it exhibited in places
whitish elevated spots, having all the appearance of an eruption.

II. Ann Collins, white, aged 18 years, unprotected, became sick on
Tuesday evening, March 23, 1824, and was taken to the Alms House, as one
having the measles, on Wednesday. On Thursday evening, some eruption was
visible; on Saturday evening, March 27, admitted.

28th. Visited. Face covered with a red, flat, dry eruption, particularly
on the cheeks; small and vesicular on the chin and around the mouth. On
the arms, it has the appearance of measles; on the hands, it is of a
deep scarlet, with central vesicular elevations; on the legs is slight;
tongue loaded and yellow, except at the borders, which are clean; pulse
natural; complains much of pain in the back and sickness of stomach.

30th. Eruption covering the face, vesicular on a deep red ground with
some tumefaction; rising vesicular on the limbs with scarlet bases.
Tongue smooth and shining anteriorly, and with vesicles on it. Throat
sore. Salivation. Pulse small and feeble. Has had menorrhagia since her
admission into the hospital.

31st. The menorrhagia continues. Had last night epistaxis. Pulse small
and slow. Tongue furred and red. Eruption confluent with indented and
dark centres. Surface white and dry. Skin between, red and inflamed.
Very slight eruption on legs, and none on feet.

April 1. Menorrhagia continues. Pulse small and labouring. Respiration
laborious and hurried. Face swelled. Surface smooth, with white spots to
represent the pustules. On breast and arms the eruption is in confluent
patches which are nearly continuous--some pustules flat and indented,
others smooth, with appearance of radii, and some more elevated forming
blebs. Skin of the feet cold, and blue in spots; no elevated eruption on
lower extremities. Tongue furred and yellowish. Throat sore. Eruption
very copious on body, generally with blebs.

_Vespere_; pulse hardly perceptible. Anxiety and distress great. Dead at
10, P. M.

_Examination_ April 2nd, in the afternoon.--On opening the thorax, the
lungs and heart were found of the natural appearance and size. The
larynx and trachea being divided, exhibited all the way down to the
lungs an injected surface with whitish irregular spots, having nearly
the same appearance as the flat smooth eruption on the face: in parts it
was more evidently pointed, and showed, by the aid of the microscope, a
pustular appearance. In the lungs, the inner surface was still darker.
The root of the tongue was covered with large and rather hard papillæ,
with open summits. The oesophagus was smooth and white. The stomach
near the cardia injected, and of a brownish-red in spots: the remaining
portion white, presenting no diseased appearance. The spleen was very
large and covered with copious miliary points. The omentum, to
appearance gangrened, was dark, and altered in texture. The peritoneum,
especially in the pelvis, was injected and inflamed, being of a
semi-opaque dark colour. The uterus, small and firm, contained some
bloody mucus in its cavity.

III. Joseph Foster, white, aged 22 years, unprotected, became sick on
Monday evening 8th of March. The eruption began to show itself on
Wednesday morning, 10th.

12th. Admitted and visited. Face covered with a red, dry, tubercular
eruption, with some few yellow pustules. Same on arms, but no pustular
appearance; partly tuberculous, partly vesicular. More sparse and
scattered on breast and legs: none on feet. Slight cough. Tongue white,
clammy, and loaded in middle--red at borders. Pulse rather frequent.

14th. Face covered with a pustulo-vesicular eruption, with whitish
summits, red and inflamed bases. Skin between, of same colour. Eruption
dry and hard; very red, copious on limbs; less so on trunk. Tongue moist
and less loaded. Pulse regular.

15th. No fever. Face of a deep red colour; eruption rising from it
rather flat, irregular in figure and white at summits. Eyes inflamed. On
limbs the eruption is red at base, vesicular in body and summit: on
trunk in clusters. Tongue yellowish and rather furred. No complaint
made; rests easy; sleeps well.

16th. No fever: tongue moist and a little loaded. Pustules nearly white.
Some yellow, and beginning to dry on summits. Skin between still of a
deep red. Eruption filling on limbs and trunk.

17th. Pulse strong and frequent; skin hot; tongue moist and loaded.
Pustules scabbing on face. Not yet entirely filled on limbs, where they
are in clusters with inflamed bases.

18th. Pustules full and matured on limbs. Running into each other in
places. Tongue dry, brown, and furred in centre, yellow and loaded at
sides. Pulse quick and frequent. Lies easy.

19th. Blebs formed on arms; pustules running into each other, beginning
to shrink; matter oozing out. Tongue covered with a dark crust. Pulse
quick and frequent. Erysipelas of eyelids and ophthalmia. Throat sore.

20th. Blebs larger and more numerous on hands and arms; purulent matter
oozing out from some of the pustules. Face nearly scabbed over. Some
small white pustules formed on the eyelids. Pulse frequent and
vibrating. Tongue as yesterday. Gums tender.

21st. Pulse weaker. Desquamation going on; pustules shrunk and drying on
limbs. Tongue as yesterday.

22nd. Matter much absorbed on limbs, leaving a shrunk cuticle. Face
covered with a brown and yellow scab and scurf. Tongue black and furred;
clear at apex.

23d. Some erysipelatous inflammation of the skin; pustules all nearly
disappeared from arms, trunk and thighs; some few, white and soft remain
scattered over breast. Pulse frequent. Tongue black and incrusted.

24th. Was brought into town from Bush Hill.

30th. Desquamation nearly complete. Low frequent pulse. Respiration slow
and laboured. Tongue incrusted.

April 2nd. Dead at 10, A. M.

Calomel had been freely given to this man in the earlier stage of his
disease: and during the last week, spts. terebinth. and nutritive
farinaceous food.

_Examination._--The pericardium, of a greenish colour and its
capillaries finely injected, was full of yellow serum. The lining
membrane of the larynx and trachea was of a greenish-yellow colour
throughout, and in the spaces between the cartilages ulcerated and
disorganized in several spots. Beneath the membrane was a venous
injection. About the bifurcation it was injected; and in the
ramifications of the trachea were seen several inflamed, and in places
abraded and disorganized spots. A chocolate coloured liquor with a
sediment filled the bronchiæ and the larger tracheal subdivisions.

The oesophagus was sound. The stomach showed clusters of bright red
and brownish-red spots, in stellated and other regular figures extending
along the smaller curvature. The duodenum, at its commencement and in
its course, presented similar clusters. The rest of the intestine was
healthy. The brain was to appearance in a natural state.

IV. Peter Johnson, black man, aged 38 years, unprotected, was taken sick
on Monday, 29th March, in Sandy Hook. Eruption of small-pox appeared
April 3d, Saturday morning. Admitted same day.

4th. Eruption copious on face; papular and of irregular figure. Eyes
suffused and red. On arms, same appearance as on face, but less
tuberculous. On breast and body, eruption small and pointed; beginning
to show on legs. Throat sore. Tongue yellow and loaded at sides; red in
centre. Pulse full, equal, and rather frequent. Cough.

5th. Much anxiety and moaning. Eruption rough and tuberculous on face.
On arms, it is in parts papillary and pointed, and in parts flat with
indented centres. Pulse slow and equal.

6th. Eruption hard and tuberculous on face and arms; small and pointed
on breast. Pulse slow; throat less sore; mind wandering. Is sitting up
in bed, dressed. Tongue moist and yellow.

7th. Delirious through the preceding night; is now dozing. Eruption same
as yesterday. Not so thick on legs, but hard and tuberculous.

8th. Tongue black and incrusted. Throat very sore. Eruption hard and
flat. Pulse active.

9th. In a comatose state. Pulse slow. Skin cool.

10th. In the same condition. Drawn down in the bed, the thighs flexed on
the abdomen, and lies on his side.

11th. Dead at six A. M.

_Examination._--The upper surface of the tongue of a brownish yellow,
full of holes and rough. At the posterior part, in place of the larger
papillæ, were ulcers and cavities. The posterior nares and pharynx were
covered with holes, formed by ulceration, and of a brownish hue,
adjoining injected and apparent pustular parts. Tonsils ulcerated, and
their investing membrane mostly destroyed. The oesophagus immediately
below the glottis, smooth and sound. Yellowish matter flowing from the
glottis. On opening the larynx, it was found half filled with a viscid
light olive-coloured fluid; on removing which, the whole lining
membrane, down to the bifurcation of the trachea, was found covered with
clusters of ulcerated pustules of a yellow colour, with the intervening
spaces of a brownish-red, highly injected, and destitute of its natural
smooth, shining appearance. The internal surface of the glottis and
epiglottis was in a similar but less marked state as the larynx and
trachea. The pustular surface extends to the minute ramifications of the
bronchiæ, and their cells beyond were highly injected.

On opening the abdomen, the omentum was found dark and shrunk. Stomach
contracted. Intestines distended, shining, and very vascular, with
capillary injection when viewed externally. The peritoneal covering of
the stomach showed a similarly injected appearance.

The stomach being opened, displayed at its upper curvature, spaces
studded with spots of a deep red or purple; apparently effusions
surrounded by a vascular net-work. Same appearance towards the pyloric
orifice, and in places on the duodenum, which, together with the
jejunum, particularly the latter, is of a dark leaden colour, and
injected.

The diaphragm on its upper surface, highly injected, as was also the
pleura lining the thorax. The pericardium healthy.

The brain was not, unfortunately, examined.

V. Jacob Fry, black man, aged 30 years, unprotected, was taken sick on
Sunday, 11th April, 1824. Eruption appeared on Thursday, April 15th.

16th. Admitted and visited. Eruption copious and papular on face; smooth
and flat, with dark centres, on trunk and arms. Tongue loaded. Cough.
Tenderness of epigastrium on pressure. Throat sore. Pulse small and
threaded. Eyes muddy.

18th. Eruption flat and rough; diffused over face. On breast red and
flat; on limbs in clusters, shrunk, and hollow in centre. Pulse small.

19th. Tongue moist. Pulse small and frequent. Throat much swelled.
Restless, and somewhat delirious.

20th. In a comatose state; but is roused to attention by calling him.

21st. Dead at five P. M.

_Examination._ April 22nd.--On opening the thorax, the lungs were seen
to appearance healthy. Both adhered to the pleura costalis. The pleura
lining the diaphragm, and also the pericardium, were finely injected.
Fauces inflamed, injected, and ulcerated. From the tonsils oozed out
pus.

The larynx contains a light olive coloured fluid, muco-serous, which
likewise covered the trachea and bronchiæ. The lining membrane
throughout was rough, and exhibited a net-work of a brownish-red colour,
finely injected.

The oesophagus about half way down, has its lining membrane removed
for one-third its length, showing miliary points on its muscular coat.
The stomach on its outer surface, and near its upper end, showed a black
spot, like effusion of black blood, under the peritoneal coat. On
examining the oesophagus near the cardia, it was found of a dark
colour in lines. From the cardia, half over the inner surface of the
stomach, radiates inflamed membrane of a deep red colour, and corroded
at the place corresponding to the dark spot above mentioned. Red spots
near the pyloric orifice. Intestines not diseased. Liver adherent by its
right lobe to the ribs; this lobe was of a greenish leaden colour. No
alteration of its structure. Brain injected in its arachnoid coat.
Ventricles contained some serum. Tela choroides dark and gorged.

VI. William Lawrence, aged 18 years, unprotected, became sick on
Saturday, April 17th. On Sunday taken to the Alms House, and on
Wednesday, 21st was transferred to the Hospital.

21st. Eruption fine and papillary on face; red and scarcely raised on
arms. None on legs. Has cough since yesterday. Pulse slow and regular.
Tongue brown, and incrusted in centre. Moist on sides.

22nd. Eruption confluent and red. Papulo-vesicular on face and arms.
Flat, dry, and copious all over the trunk. Scattered and small on legs
and feet. Pulse small and regular. Tongue loaded and brown in middle.
Eyes sparkling. Is delirious and very restless.

23rd. Eruption very copious all over the body, rising vesicular from red
margin. Pulse small and slow. Tongue loaded, furred, and yellow. Head
and back easier. Has slept well. Face deeply suffused with red.

24th. Cough. Eruption flat, indented centres, dark in places. It is now
coming out on legs. Pulse small and firm. Skin cool. Much uneasiness and
hurried breathing.

25th. Dead at seven A. M.

This man had been bled twice before his admission, and once again on the
22nd. Cold affusions had been freely used.

_Examination_, on the 26th April.--Pericardium sound, but contained much
sanguinolent serum. Pleura sound. Lining membrane of pharynx partly
destroyed. No ulceration. Tonsils give out pus on pressure.

Oesophagus of a dark red, and partly lost its inner membrane. Larynx
and trachea injected; but the membrane lining them is entire, without
pustules or ulceration. Some frothy effusion in bronchiæ.

Liver healthy. Spleen large. Omentum sound, and of a natural white
colour, traversed by some large veins. Stomach externally of a brown-red
colour; and when opened, presents, spread out from the cardiac orifice,
dark brown-red streaks; and towards the pyloric orifice and upper side,
an extensive surface shaded over with vermillion and darker spots. Near
the duodenum, the surface is white. Intestines slightly injected.
Bladder dotted all over with bright red spots on its inner surface,
which is covered with a fine capillary reticulated structure.

VII. An infant, white, unprotected, aged three weeks, child of Clarissa
Clarke, who had been inoculated twenty-one years ago. Taken sick on
Sunday, 2nd May. Eruption appeared Thursday, 6th. Admitted 9th.

10th. Eruption copious, and in confluent patches, with red bases, and
flat vesicular summits. Has also aphthæ.

13th. Eruption confluent, in large white patches on face. Throat very
sore.

15th. Dead at eight A. M.

_Examination._--The stomach of a light colour, perfectly healthy. Folds
and plaits of mucous membrane strongly marked. Mucous surface of trachea
nearly healthy.

VIII. Infant, female, of a woman who died in the Alms House of varioloid
disease, shortly after giving birth to this child. It is three weeks
old; was admitted Sunday, 25th April, second day of the eruption. Dead
on Thursday, 29th. The skin became livid after death..

_Examination._--Pharynx inflamed, and the eruption on it extending all
the way down the oesophagus, to near the cardiac orifice; the lining
membrane being also in part destroyed. Stomach of a fine clear red, and
beautifully injected to the minutest capillaries all over the mucous
surface. Intestines, both large and small, red and injected.

The larynx has some eruption on its lining membrane. The trachea and
bronchiæ nearly healthy; there being no eruption or secretion on their
surface.

Doctor DARRACH was present at the majority of the above detailed
examinations, and kindly officiated at some of them. This gentleman,
well known for his zeal in the study of comparative and morbid anatomy,
made many interesting microscopical examinations of the various kinds of
variolous pustules, and the corresponding changes in the cutaneous
tissue, the results of which, we hope, he will make public.

Having thus freely described what we saw, we wish it were in our power
to lay down next, for the benefit of those who come after us, a
satisfactory method of treating small-pox. The hospital returns are not
of such an encouraging nature as to make our self-love predominate over
observation and experience, and lead us to inferences which might seem
to sanction the utility of this or that medicine, or curative plan. We
had to deal, it is true, with the worst portion of the community;
persons of constitutions exhausted or perverted by excess of sensual
indulgences, or by poverty, or both conjoined. In private and even
dispensary practice, where the subjects were of a better physical and
moral nature, we often saw the disease subside, and health return, after
less attention to administer medical aid, or to supply other wants, than
was exhibited at the hospital. We are, notwithstanding, sanguine enough
to anticipate useful results from our attentive study of the symptoms of
the disease, in connexion with that of the post mortem examinations, and
to consider ourselves as in possession of lights to guide us with more
certainty than before. Let us see how far a cautious analysis will tend
to dispel old errors, and establish useful truths.

The gastric distress, and the associated uneasiness and pain in the
head, back, and limbs, with evening exacerbations of fever, for the
three days preceding the eruption, evince conclusively a disease to
which the skin is a stranger, except by its usual sympathies of heat and
coldness, moisture and dryness. The appearance of the tongue, the loss
of appetite, thirst, nausea, and occasionally vomiting, are testimonies
to the impeded function of the stomach in this first period, or that of
precursory fever: and if to this we add the soreness of the fauces and
pharynx, producing impeded deglutition, we cannot refuse our assent to
the belief that the mucous surface, on which the _preparatory process_
of digestion takes place, is mainly affected. The next leading symptom
is the appearance of the eruption on the skin. The character of the
disease is now fixed, and the physician feels himself compelled to
respect the cutaneous inflammation, throughout its entire course,
naturally enough regarding it as the disease itself, rather than the
last link in the chain of morbid actions. To support the circulatory
system at such a degree as shall enable the skin to secrete this new
matter of small-pox, is nearly as much as he proposes to himself. But
here arises a question of great practical moment. To what extent, if
any, is the eruption a natural or necessary sequence of the previous
symptoms or condition of the system. Perhaps in the existing state of
medical science, we hardly dare reply positively to this question. This
much we know, that there is no correspondence in general between the
intensity of the precursory fever, and the copiousness of the after
eruption. We are, moreover, well apprized of the fact of very many, who
had been protected in earlier life by inoculation or vaccination, being
seized with all the symptoms of the precursory fever of the small-pox,
and remaining seriously indisposed for a few days, yet with very little
eruption in some cases, and without any in others.

Next we may inquire, what control, salutary or otherwise, we can
exercise over the skin in reference to its eruption, by adopting certain
methods in medicine and hygeine, during the period of invasion or of
precursory fever. To foster the germ of the poison, as yet only
affecting the inner surfaces, into efflorescence on the outer or
cutaneous one, by hot air, warm and heavy clothes, and cordial drinks,
is a practice, which, though at one time advocated on what was thought
very sufficient theory, is now abandoned as at war with experience. Of
these means, clothing acts primarily on the skin, and we will suppose
heat to do the same: the cordial drinks must however affect this organ
by stimulating and irritating the gastric and intestinal surface.
Against all stimulation of this surface we are then bound, from
knowledge and theory, to object.

The cooling regimen as it is called, was substituted for the
alexipharmic, in so far as regards light clothing and cool air. Can
emetics and purgatives be viewed as a part of this regimen, and exert as
such a salutary influence over the second period of the disease, or that
when the eruptive effort takes place? Admitting they are but local
stimulants, can they as such be with advantage applied to a surface, as
that of the stomach and intestines, already highly irritable, and which,
as the disease advances, becomes inflamed? If our object be in this
first period to diminish the violence of the second or eruptive one, we
doubt whether our expectations will be at all met by any kind of
stimulant to parts, which so promptly transfer their irritation to the
cetaceous surface. Whatever may be thought of these suggestions; whether
they are to be regarded as well-founded, or merely speculative, must be
a subject of future investigation; since we are as yet compelled to deny
that experience can be adduced in favour of the practice of vomiting and
purging to the first period of variolous disease.

On the same line with the remedies just mentioned, have been placed
bleeding, general and local, though as we apprehend, very erroneously.
There is not in bleeding as in purging, conflicting and alternating
effects of debility from evacuation, and irritation, primary and
sympathetic, from local stimulation; but a direct diminution of morbid
action, more tranquil movements of the heart and capillary system, that
is of the circulatory apparatus, and of the membranes, mucous, serous
and cutaneous, &c. Bleeding, unlike most other remedial agents, produces
a direct calmness and ease in the animal economy: it does not like them
substitute one disturbance for another, or make the great appear the
lesser evil. The experienced physician well knows the value of this
remedy, in the first period or invasion of the phlegmasiæ, and of some
fevers called general. He is fully aware, that if he cannot produce by
it a decided impression on the malady in the commencement, he is but too
often afterwards a prey to doubts and anxieties, wishing to relieve, but
unknowing what to attempt. Conceding, however, the power of venesection,
in the forming stage of the disease, now under review, so that we by
this remedy may control the series of morbid actions in the second
period, and diminish the extent of the eruption; it may yet be seriously
asked, whether we can with safety and propriety prevent or destroy the
succession of changes to which the skin is subjected, from the first
papulæ on to desiccation. On this point, we believe, has turned the
practice of the profession at all times, whether in the ages of
humoralism, or in the reign of solidism. In addition to the reasons
already assigned, which would lead us to doubt the necessity of the
eruption being left uncontrolled, or even suffered to run its course, we
may appeal to the practice of inoculation, which as effectually
saturated the system, and indisposed to subsequent attacks, as if the
skin had formed a continuous pustular surface; and yet this benefit was
often gained by the trifling tax of a few days' fever, and half a dozen
of pustules. Where the fever runs high and the respiration is much
affected, in the first period of measles, and before there is the
slightest appearance of eruption, we conceive it often so be our duty to
bleed freely, without reference to the subsequent disease of the skin,
or any nicety of calculation about this latter going through its regular
stages. Indeed, we have usually reason to congratulate ourselves for
having, by this means, rendered the subsequent disease milder and more
tractable. That affection of the urethra termed gonorrhoea, the
product of contagion, will, if left to itself, go through its several
stages; and, if rest and regimen be enjoined, will often leave the
subject healthy as before. But we can, notwithstanding, cut it short
with perfect impunity, by suitable remedies, and thereby prevent
numerous unpleasant symptoms and effects, which are often present when
the disease is left to nature. Syphilis has its several stages, each
marked by characteristic symptoms; but the skilful treatment of the
first stage prevents, how beneficially we all know, the appearance of
the others. We must then in small-pox, as well as in other diseases,
beware how we confound a common and even natural, with a necessary and
unavoidable succession of symptoms and periods.

The precursory fever in small-pox is seldom marked by the same common
inflammatory symptoms as that in measles; and does not seem, by its
actual violence, to urge the physician to deplete with freedom, if he
only have regard to the existing condition, rather than to the impending
danger and complication. The diversity in the two diseases consists not
so much in the greater intensity of the latter, as in the more decided
gastro-enteritic derangement in the former. Experience has not yet
sanctioned the benefit of copious bleeding from the arm, in incipient
disease, or irritation verging to inflammation of the intestinal
surface, as in small-pox; while its efficacy is admitted in measles. But
conceding its doubtful character, local bleeding, as by cupping, and
leeching on the abdomen, might be serviceably employed in the form of
disease now under consideration; as we know it to have been in other
febrile affections, where the same parts were diseased. Topical
depletion does unquestionably exercise the best effect on membranous
inflammation. In addition to cool air, we may with some confidence have
applied at this time to the skin, cool, if not cold, affusions; while
cold or cool drinks, and these of mucilaginous kind, would constitute
the principal ingestæ and medicines. Our own experience was little
favourable to the efficacy of cold water, applied to the surface during
the eruptive stage; and we apprehend, that, if decided benefit can grow
out of its use, it must be during the first or precursory fever, before
the formation of vesicles has commenced, when every thing is to be
attempted to sooth irritation, and prevent febrile reaction.

The first period over, the eruption on the skin now appears, and
constitutes a leading and exceedingly important symptom of the disease.
This eruption, like many others the product of gastric derangement,
acts for a time as a counter-irritant, and as such affords temporary
relief to the internal organs; but when continued, as in the farther
progress of the disease, it, in common with all irritants on the skin,
returns with interest to the digestive tube, the irritation which it
first received from this latter.

We must not lose sight of the state of the lining membrane of the lungs
during this time. It cannot be said so much to sympathize with the skin,
as to be affected by continuous disease; since the eruption on the
mucous membrane of the larynx, trachea, and its ramifications, undergoes
nearly the same changes, in the same time with that on the cutaneous
surface. The danger and violence of a disease in which the three
surfaces, cutaneous, pulmonary, and gastric, are all organically
affected at the same time, must be very apparent. Even though there be
no eruption on the internal coat of the stomach, its appearance after
death, of high vascularity and sanguineous injection, corresponding
precisely in appearance with the circles found in the lungs, of which
the pustules were the centres, justifies this belief of its being
organically affected. Each of the three above mentioned surfaces is in
degree ancillary to the others, and each may, on occasions, partially
supply their functions; but in this period of variolous disease, our
hopes of such vicarious action must be very faint indeed, and hence the
hazard attending any application to any one of them.

Are we from these appearances to pronounce the eruption a phlegmasia of
the skin and lungs, associated with a previous one of the stomach, and
recommend the free use of venesection? Life may occasionally be
prolonged, or at times saved by this means; but the disease will not be
thereby materially arrested in its course, or modified in its
appearance. We shall find that the inflammation of the membranes,
consisting as most of them do of cellular tissue and minute capillary
vessels, is often not susceptible of being checked by general depletion,
carried even so far as to almost empty the larger arteries, and arrest
the heart's motion.

Still more will this inflammation persist, if it have gone to the extent
of forming new parts, whether phlegmons or pustules. The intensity of
the inflammation may be somewhat moderated, but it cannot be conquered
now as at the commencement, or during the first period, or that of
invasion. We cannot, from our own experience, speak favourably of the
remedy in the second, or eruptive stage. It did not answer our
expectations, though employed in subjects apparently the best
constituted to derive the good effects proposed from it. We must at the
same time grant, that it was complicated with other remedies. Of topical
bleeding, we are unable to speak, not having seen it tried. In this
period of the disease, it must be of very difficult execution. Still
less reason have we to boast of the good effects of purging. Though the
skin may for a while be relieved by the watery secretions from the
intestinal canal; yet the irritation of the latter, consequent on
purging, is soon communicated to the cutaneous surface with the effect
of aggravating the eruption. To the class of stimuli or stimulating
diaphoretics, the same objections apply with increased force. As on the
one hand, in cases of high fever, seeming to call for great depletion,
the surfaces are often not relieved by general bleeding, but retain
their own vitality; so on the other, in cases of apparent prostration,
and feebleness of circulation, they often retain all their morbid
activity, and will of course be materially injured by stimulation,
either of hot air to the skin, or heating drinks to the gastric and
intestinal surface. Of the various diaphoretics employed, we had reason
to be least dissatisfied with the combination of opium and ipecacuanha
in small doses. In some few cases, tartrate of antimony and cream of
tartar, dissolved in rice or barley water, and the solution used as a
drink, seemed to be beneficial. Several grains of the former were thus
taken in the 24 hours, without its producing vomiting or purging. But in
very many other instances of the disease, this medicine had no
ameliorating effects. Calomel alone, or in combination with opium, was
given, and in a few cases caused _ptyalism_. We did not lose persons
thus affected, but we cannot speak with any confidence of the propriety
of the treatment.

The application of cold water to the skin, was tried by us on the
strength of its alleged good effects in this disease, but in no case had
we reason to be satisfied with it. The state of the cutaneous surface,
during the vesicular and pustular stages, is such as to prevent its
transmitting the usual impressions to the interior. Cold may deaden it,
and hasten the disorganization of its tissue, but cannot arrest and
suspend morbid capillary action here, as in ordinary fevers, or diseases
with great local determination, as to the head, &c. If useful at all,
it will, we apprehend, be in the forming stage of the disease, before
the skin is altered by the eruptive effort. The same objections do not
hold against the internal use of cool or cold liquids. We have in this
instance to be regulated by the usual precautions, as in all febrile
disease where the gastric system is the greatest sufferer. More benefit
will follow the sustained use of cool, than the occasional
administration of very cold draughts; since in the former case the
morbid action of the mucous surface may be restrained in due bounds,
without the risk and danger of reaction, and increase of heat and
thirst, which are apt to ensue from the latter. The same principle will
guide us in the temperature of the air to be inhaled by the lungs.

The secondary diseases, erysipelas, catarrh, and pneumonia, occurring on
the decline or subsidence of the variolous disease, would, we may now
presume from the phenomena in life, and the autopsic examinations, bear
and require a treatment, nearly similar to that used in these diseases
arising under other circumstances. Perhaps leeching and cupping ought to
be substituted, in such emergencies, for bleeding from the arm.

The extension unavoidably given to this first branch of our subject,
requires that we should defer the history of the modified small-pox, or
varioloid disease, to the next quarter, when it shall appear in the
corresponding number of this Journal.

EXPLANATION OF THE PLATE.

Figures 1, 2, 3, represent various appearances of the lining membrane of
the stomach.

Fig. 4, is a portion of the oesophagus; but the red bands ought to run
vertically, and not horizontally, as in the plate.

Fig. 13, is another appearance of the stomach.

Fig. 12, indicates the eruption having gone on to ulceration in the
pharynx.

Fig. 6, displays the appearance of the lining membrane of the trachea,
on the 6th day of the eruption, as in the case of Ann Collins.

Fig. 5, is intended to represent the same part in an advanced stage of
the disease, as in the case of Joseph Foster.

Resembling this is the case of Peter Johnson, as far as regards the
ulceration and dark colour of the intermediate surface; but differing in
the disorganization of the membrane being less.

Figs. 7, 8, 9, 10, and 11, represent the progress of the eruption, in a
female, from its incipient to its maturated state. The same section of
skin is represented from the 1st to the 5th day of the eruptive stage,
on which day the patient died. On the 2nd day, (fig. 8,) the vesicles
began to exhibit a central lividness, which was augmented on the
subsequent days. The patient had been some years before successfully
vaccinated. She was delivered of a child on the 1st day of the eruptive
stage. The minutes of this case have been mislaid; but the post mortem
appearances were indicative of high action, if not inflammation, of the
uterus and its appendages. The infant of this woman, forming Case VIII.
died of small-pox three weeks afterwards, on the sixth day of the
eruption.

This plate, together with some others yet unpublished, are from the
accurate pencil of Mr. now Dr. HARRINGTON, of this city.

(TO BE CONTINUED.)

FOOTNOTES:

[11] This was first at Bush Hill, and subsequently at the Sugar House,
near the Alms House.

[12] The largest proportion of these deaths was in the six months from
the 1st of November, 1823, to 1st of May, 1824, being in that period
about four hundred.

[13] Kept by Reuben Haines, at Germantown, seven miles from the city.
The thermometrical mean is that from daily observations made by this
gentleman at sunrise and at 2 P. M.

[14] Of these 165 were by yellow fever.

[15] The deaths from inflammation of the different viscera, were as
reported in this year, 290, and from infantile flux and cholera morbus,
177.

[16] Same proportion of inflammations as last year, viz. 339.

[17] Should it be hereafter necessary, we can illustrate other varieties
of the disease by drawings which were taken at the same time with those,
of which coloured engravings are now furnished.

ARTICLE IV.--_Remarks on the Pathology and Treatment of Yellow Fever._
Arranged from the Notes of Dr. J. A. MONGES, of Philadelphia.

I arrived at St. Domingo in the year 1785, and from that period to the
time of my departure from thence, I had very ample opportunities of
observing and treating the diseases of that island, both in the country
and at the Cape. During the whole time of my residence there, the
ordinary febrile diseases of hot climates were of very frequent
occurrence, especially among the new comers, and those not acclimated;
but the real yellow fever, or vomito negro, never prevailed. So that
when I reached this city in 1793, I never had had an opportunity of
observing this disease.

As introductory to the subject more particularly before us, I shall
offer a few remarks on the nature and treatment of the fever, which
prevailed in that island. It was usually of the remittent type, of a
bilious nature, and rather violent in its character; presenting very
often symptoms of a typhoid, or malignant condition of the system. In
almost every case, it was attended with great gastric irritability and
pain; and, in very many instances, accompanied with vomiting of dark
green, and even of black bilious matter,--determination to the brain
producing delirium, coma, &c. &c. In general, this fever differed but
little from the bilious fevers of this country; except, perhaps, in its
greater severity, and in a larger quantity of bile commonly evacuated.
The treatment of this disease, at the time of my arrival, was generally
attended with some difficulty, owing to the great prejudice prevailing
against the use of the lancet; not only among the mass of the
population, but even among the old physicians of the island. Experience,
however, having taught me, that venesection was essentially necessary in
fevers of the same sort, which I had noticed in other places, I resorted
to it, notwithstanding the existing opinion; and am now convinced, that
by its means I saved many patients. Nor was I the only one to adopt this
mode of practice; as it was commonly resorted to by all _new_
physicians, who were soon found to be more successful than the older
practitioners. To arrest the violent vomiting, already alluded to, it
was of the highest utility, and, in many instances, the only remedy that
could be depended upon. Emetics were very commonly used, and sometimes
with great benefit; but, in many instances, they were contraindicated by
the pain and irritation of the stomach.

Cooling and saline purgatives were advantageously employed, as well as
the saline mixture, and nitre and camphor in small and repeated doses, a
very favourite practice in the place. In a more advanced period, and
when the fever assumed a typhoid type, blisters, bark, and serpentaria
were resorted to.

I arrived in Philadelphia on the 20th of August, 1793, and on the 22nd
of the same month, began to see patients. The epidemic was then at its
height, and such was the demand for physicians, and the prevalence of
the idea, that, as I came from the West Indies, I must be familiar with
the yellow fever, that I soon became very extensively employed. Such,
indeed, was soon the extent of my engagements, that I was compelled for
a time to refuse my attendance on many patients, and to limit my visits
from Race to Dock streets, and from the water to Third street.

From the first time I had an opportunity of seeing the yellow fever, I
perceived that there existed but a very distant, if any, analogy between
it and the fevers I had been in the habit of treating in the West
Indies. And this opinion I have ever since entertained, in opposition to
the statement of many respectable authorities; but in conjunction with
some highly respectable physicians and friends, who, like myself, had
had an opportunity of treating both diseases. The points of difference
between these fevers will be noticed in a subsequent part of these
observations. But although entertaining this sentiment, I very early
came to the conclusion, that the yellow fever was the effect of a
gastro-duodenic inflammation, somewhat modified by some unknown
cause,--requiring the usual remedies for such a complaint, proportioned
only to the strength of the patient, and the force of reaction in the
system; and all my subsequent experience has only served to confirm me
in this belief. Differing from many physicians respecting its bilious
character, I have been led to believe, that the liver is very seldom
implicated in the disease;--the secretion of bile, in the majority of
cases, being very little, if at all altered. This may very readily be
discovered by an attentive examination of the symptoms of the disease,
as well as by the appearances noticed on dissection; the lining membrane
of the stomach and duodenum presenting in almost every case, marks of
inflammation, and giving passage to a large quantity of black matter,
which I have always been led to regard as altered blood, mixed with
mucus. The liver, on the contrary, so rarely showed marks of disease,
that when it did, it was natural to regard its alteration as secondary.

Such being my opinion respecting the pathology of yellow fever, I cannot
view otherwise than as secondary to the gastric affection, all the
morbid conditions of other organs, indicated during life by their
peculiar symptoms, and revealed on dissection by the ordinary marks of
inflammation; such as affections of the lungs, kidneys, &c. This view of
the subject will cease to be regarded as merely hypothetical, when it is
recollected, that these symptoms and morbid appearances are occasionally
not found; whilst the symptoms referrible to the gastric and duodenic
irritation, being the true characteristics of the disease, are always
present. Indeed, what would authorize us to regard any subject as
affected with yellow fever, who would not present the pain in the
stomach, the redness of the tip of the tongue, the thirst, irritability
of the stomach, and vomiting either of simple mucus, or black matter?
And, on the other hand, how many have died with these symptoms, who were
not affected with all the others we have noticed, and, on dissection,
have shown no mark of disease, except in the digestive apparatus?
Finally, can pain in the head, affections of the kidneys, vomiting of
bile, &c. constitute yellow fever, without the concurrence of some of
the gastric symptoms we have enumerated?

With respect to the characteristic features of yellow fever, and the
different signs, by which it may be distinguished from bilious fever, I
must be very brief; as a great deal having been written on the subject,
any long details in this place would occasion undue repetition of what
is already known to the profession. A few words, however, may not be
improper. Every one who has had frequent opportunities of seeing the
yellow fever, must have noticed, among its most habitual signs, a
peculiar inflamed glassy appearance of the eye, easily recognised, but
difficult to describe. It is one, however, on which I should be willing
to place considerable reliance, in establishing my diagnosis of this
disease; as I do not recollect to have noticed it in any other form of
febrile affection. Together with this, there is, in the majority of
cases, an intense supra-orbitar pain, apparently unconnected with great
disordered action of the brain, as the intellectual functions are
generally unimpaired. These two signs, together with pain in the loins,
and, in more advanced periods, the peculiar appearance of the skin, the
vomiting of the coffee grounds matter, the intermission on the 4th day,
the retention of muscular strength, and suppression of urine, are the
only signs by which the yellow fever, so far as I am prepared to say,
may be recognised. In regard to the supposed identity of this fever with
the bilious, a great deal has been written; but I must confess, that I
feel inclined to doubt the correctness of this opinion, for the
following reasons:

1st. Bilious fever is almost always a remittent fever, presenting
regular exacerbations, and, unless arrested by medical aid or some
effort of nature, running its course, in a progressive manner, either to
a happy or fatal termination; whereas the yellow fever is almost
invariably a continued fever, presenting obscure and irregular, or even
_no_ remissions. On the fourth day, it generally presents so perfect a
remission, as to cause the patient, in many cases, to imagine himself
perfectly free from disease, and induce him to get up, and even
sometimes to walk out. This remission, which sometimes amounts to an
intermission, so far as an experience of upwards of forty years can
authorize me to decide, is never found to attend in bilious fever, in
which, if there be any remission, and recurrence of the unpleasant
symptoms, the former is always a real convalescence, and the latter an
accidental relapse.

2nd. The red colour of the eye, to which I have alluded above as
occurring in the early stage of the yellow fever, and its peculiar
yellow tinge in the after part of the disease, are different from the
redness and yellowness of the same organ in bilious fever; in the first
stage of which the eye presents a more fiery redness, and in the
subsequent period, a more saffron yellowness.

3d. The colour of the skin in the two diseases presents also some
difference, being more constantly noticed in yellow fever, and
disappearing much more rapidly than in bilious fever. In yellow fever,
moreover, it assumes, most commonly, a yellowish-brown or even mahogany
tinge; whereas in bilious fever, when it occurs, it does not differ from
the ordinary jaundice colour, of a lighter or deeper shade.

4th. These fevers may likewise be distinguished by an attention to the
state of the intellectual faculties, and of the muscular strength; these
remaining often unimpaired to the last in yellow fever, whereas, in a
very large majority of cases of bilious fever, the mind becomes soon
involved in the disorder of the system, and the greatest muscular
debility prevails, even from the very onset of the attack.

5th. The matter vomited might of itself serve to distinguish the two
diseases. Independently of the difference we shall notice when speaking
of the black vomit, we may mention that patients complain, even
sometimes from the commencement of the attack, of the acidity of the
vomited matter; whereas in bilious fever, the mouth is bitter, and the
matter ejected of the same taste.

6th. As a further mark of difference, we may state, that, in yellow
fever, the tongue, except at the tip, the skin, and the pulse are
sometimes little altered; whereas in bilious fever they are usually
pretty much so.

7th. In respect to the duration of the two diseases, we may state as a
general rule, that yellow fever runs its course to death or
convalescence, in a much shorter time than bilious fever. Nor is the
promptness of recovery from yellow fever less different from the
slowness of convalescence, noticed in most cases of bilious fever.

8th. The suppression of urine is a frequent attendant on the last stage
of yellow fever, and is seldom noticed in bilious fever.

9th. I have never witnessed a second attack of yellow fever in the same
individual; whilst on the contrary, so far as I have seen, there is no
limitation to the number of times a person may be affected with the
other form of fever.

_Prognosis._--As regards the prognosis in yellow fever, I shall merely
state, that I generally found, an early evacuation from the alimentary
canal, and a disposition to diaphoresis during the first twenty-four or
thirty-six hours, and its continuance during the course of the disease,
to be favourable omens. When the disease continued beyond the 7th, 9th,
or 11th day, greater hopes might be entertained. It was likewise found,
that the mortality was much smaller among patients, who remained free
from apprehensions as to the nature and termination of the disease. To
this cause, more than any other, do I refer my greater success among
Quakers; who, being generally surrounded and comforted by their friends,
retained more than any other class of people, the necessary tranquillity
of mind.

Among the unfavourable signs may be mentioned, a discoloration of the
skin before the fourth day. This symptom was, indeed, almost always a
fatal one. Obstinate vomiting and costiveness, hæmorrhages from
different parts of the body, unattended with an abatement of the
symptoms, and vomiting of black matter, were very unfavourable; whilst a
suppression of urine, agreeably to my experience, was always a fatal
sign.

_Black Vomit._--In a preceding part of these observations, in alluding
to the black vomit, I took occasion to express my views respecting its
nature,--stating that I regard it as consisting of mucous flakes, mixed
with a large proportion of altered blood. That such is the true nature
of this substance, on which so much has been said and written, I have
had sufficient reason to be convinced. The opinion that it consists of
altered bile, I deem totally untenable, for the following reasons: The
matter is occasionally voided in large quantities, in cases in which the
liver is not at all affected, and in which, after death, the gall
bladder is discovered to be more or less filled with _natural_ bile.
Independently, of this, it may be stated, that the appearance of the two
substances is very dissimilar;--the black bile vomited in bilious fever
being of a homogeneous nature, and of a black or deep green colour;
whilst the matter of the black vomit is, in a large majority of cases, a
compound of a mucous, flaky substance, and a sanguineous matter, bearing
some resemblance to the grounds of coffee, and, for the most part, of a
brown tinge. When mixed with water, the two substances produce very
different effects,--the bile mixing with and imparting a greenish tinge
to it without difficulty, whilst the grounds of the other, float on the
surface of the water, without mixing with and colouring it, in the same
manner as bran, deprived of all its mucilage, or rather like mahogany
saw-dust. This I consider as one of the best modes of distinguishing
these two substances,--serving at the same time to establish a
difference between the fevers, I was in the habit of observing in the
West Indies, and the yellow fever of this country. Nor are these the
only reasons for rejecting the supposition of the black vomit of yellow
fever being of a bilious nature; for I have known this substance (and I
suppose other practitioners have observed the same fact) occasionally to
exude from surfaces, from which, in all probability, bile is excluded. I
allude particularly to the skin and verous membranes. Thus it has often
happened, that the application of a blister, especially in the advanced
stage of the disease, has been followed by a copious exudation of a
fluid, resembling, in all respects, the matter ejected from the stomach;
an occurrence which was strikingly exemplified in a case, which fell
under my immediate observation during the last visitation of the disease
in this city, in 1820. During the same epidemic, I had occasion to
attend a Mrs. H. about 70 years of age, who presented a curious example
of the exudation of a similar substance from the peritoneum. She had not
been exposed to the causes of the yellow fever, and indeed presented
none of its ordinary pathognomonic signs. She was attacked very early in
the morning with violent colic, attended with fever, great tenderness of
the abdomen, and high colour of the face. She was bled at 10 o'clock; at
11 vomited a large quantity of coffee ground matter, and died in about
12 or 15 hours from the commencement of the attack. The next morning her
body was examined in the presence of several highly respectable and
experienced physicians, who all coincided in the opinion, that the
matter vomited and which continued to be discharged from the nose, was
identical with that discharged in yellow fever. The stomach as well as
the intestines were found to contain a large quantity of a similar
substance. The cavity of the peritoneum being likewise found filled with
a large portion of it, we at first suspected the existence of an opening
in the intestines, by which an effusion had taken place. After a careful
and minute examination, however, no such opening was discovered. Our
attention was now directed to the condition of the peritoneum itself,
which was highly inflamed. It was, moreover, found, that the substance
in question exuded from its surface,--the membrane, in many places,
especially the portion of it which covers the liver, being coated so
thickly with the grounds, that they could readily be scraped off with
the back of a scalpel.

These cases show conclusively, that the matter of the black vomit,
occurring in yellow fever, should not be regarded as altered bile; and
that the supposition of its consisting of a secretion of the mucous
membrane of the stomach, does not rest on a much more solid foundation.
For bile can hardly be admitted to exude from the skin and serous
membranes, and we cannot suppose, that fluids, similar in every respect,
can be secreted from two surfaces, so very distinct in their
organization, and in the nature of their ordinary products, as those of
the mucous and serous membranes.

From these facts I am led to regard the black vomit as a true
hæmorrhage, resulting from a state of previous irritation of the surface
which furnishes it. That inflammation may be cause of it, we have a
sufficient proof in the fact, that a similar fluid is occasionally
vomited in cases of puerperal fever, when the irritation progresses from
the serous to the mucous membrane of the intestines; as well as in cases
of inflammation from blows on the stomach, and the action of poisons. A
case of this kind, arising from a kick of a horse, was attended by
myself and two respectable physicians in consultation, a few years ago;
and another case arising from a large dose of carbonate of potassa,
swallowed by mistake, occurred in my practice not long since. But as it
would occupy too much time to give them here in detail, I pass them by
without further notice.

That the matter of the black vomit is the product of a hæmorrhage, I
have thought may also be inferred from the fact, often noticed by myself
and others, of large portions of coagulated blood being found in the
intestines; the surface having the appearance of the common black
matter, whilst on cutting into them, the centre is found to consist of a
red solid coagulum. I have also sometimes noticed, that the duodenum
contained the coffee ground matter, and the intestines, coagulated
blood. In such cases, in order to adopt the opinion of secretion, we
must believe, that the same vessels, occupied in the secretory process,
afforded, at the same time, passage to a portion of common blood; for we
can hardly admit, that the mucous follicles are the organs secreting the
black matter. Besides, is this not a mere dispute about words; and is it
proved that what are called sanguineous secretions are not the result of
the same action, which gives rise to hæmorrhagic exudations? and is
there any other difference between the hæmorrhage of yellow fever, and
of ordinary cases of hematemesis, than that arising from a difference in
the _quality_ of the blood?

Nor do I find much difficulty in believing, that the colour of the skin,
which is more frequently brown than yellow, as well as the petechiæ, &c.
are the effects of the stagnation of blood, altered by the capillaries
of the surface, in the same manner as that exuding from the mucous
surfaces. I believe that this opinion, suggested by some European
writers, is supported by the fact, that this fluid exudes from the
orifices made by the bites of leeches and the incisions of scarified
cups; as well as from the raw surface occasioned by blisters; and that
the vibices contain a serous fluid mixed with blood.

_Analogy to Plague._--On comparing the symptoms of the yellow fever of
this country with those of plague, as detailed so minutely and, I
believe, accurately by authors, and especially by the physicians who
accompanied Bonaparte to Egypt, I have been led to regard these diseases
as bearing a closer analogy to each other than has hitherto been
admitted. I do not pretend to assert that they are the same disease, but
only that they are so nearly allied, as on some occasion, to lead even
an experienced observer into an error of diagnosis. The great difference
between them consists in the frequency of the affection of the lymphatic
glands in the plague, and its comparative rareness in yellow fever; and
in the greater predominance of gastric symptoms in the latter.
Nevertheless, I have had, on many occasions, during our different
epidemics, opportunities of noticing buboes, situated in the same parts
as those mentioned by writers on the plague, running the same course,
and curable by the same means. Carbuncles are frequently seen in both
diseases, though not so frequently in yellow fever as in the plague.
Both diseases present what are called the walking cases. Patients in
both, though more frequently in yellow fever, retain their muscular
strength as well as their intellectual faculties. So far as we are
informed, the mortality in both is pretty nearly the same, and the
treatment similar.

_Contagion of Yellow Fever._--The question of the contagion or
non-contagion of yellow fever has so long occupied the attention of the
profession and been discussed so extensively, that I deem it unnecessary
to devote much space to it here. Nevertheless, as I have had frequent
opportunities of noticing the disease under all circumstances; in all
parts of the city, and in the country; among the wealthy and the poor, I
may without much impropriety offer, in a few words, the result of my
observations and reflections on this head. I must unhesitatingly
declare, that, establishing my opinion on what I have seen, I am led to
the conviction, that the yellow fever is not a contagious disease; that
it never has been carried hither in the way mentioned by contagionists;
and that it has invariably proved an infectious disease, using this word
to express a malady arising from a local source of contamination, other
than a living body. It is plain, that this view of the subject does not
exclude the possibility of a vessel carrying the disease to this or any
other port; but, in that case, the vessel itself or its cargo, must be
the source of infection, and not the individuals on board. And this may
take place, when the port from whence the vessel sailed is free from the
disease. That such has been the case, there cannot be any doubt; and
that the idea, predicated on it, of the contagiousness of the fever is
erroneous, I have not the least hesitation in believing.

How else than on the principle of infection, and not of contagion, can
we explain the attack of individuals frequenting those parts of the
city, where the disease had originated, and which (all the inhabitants
having been removed to some distant situation) had been barricaded? How
could we, in any other way, account for the exemption from the fever of
individuals, who, out of the infected district, nursed, touched, and
even slept with their diseased relatives and friends; and not always in
clean and well ventilated apartments and parts of the city; but, in very
many instances, in the filthiest hovels, and alleys, and among the
lowest classes of society. Striking and unanswerable facts of the sort
have frequently presented themselves to my observation, during our
various epidemics. Children have sucked their parents, affected with the
fever, and, in one case which fell under my notice, the child continued
attached to the breast after its mother's death; and in all such
instances with impunity. I have constantly reprobated the practice of
burning the clothes and bedding of the dead, and have never found any
bad results to occur to those who followed my advice. From a
consideration of all these facts, I must once more express it as my
decided opinion, that the yellow fever, so far as I have had an
opportunity of observing it, is not a contagious disease.

_Treatment._--Whatever opinion we may entertain respecting the specific
nature of yellow fever, I was early convinced that this disease was not
to be treated by specific remedies, and that our curative indications
should be formed on an attentive consideration of the condition of the
system in general, and of particular organs, as pointed out by the
symptoms during life and the morbid lesions after death.

In a former part of these remarks, I suggested the opinion, that the
yellow fever is a gastro-duodenic inflammation, (perhaps of a specific
kind,) and that it required a mode of treatment appropriate to this
morbid state; but proportioned to the strength of the patient, to the
violence of the attack, and to the power of re-action. In general,
however, I have not found active depletion by the lancet, as easily
borne in this, as in bilious and other fevers;--the disease assuming
more rapidly, under this plan, a state of prostration or adynamia. Nor
can this appear surprising, since the same circumstance of a disease
being of an inflammatory nature, but, under a peculiar condition of the
system, contraindicating ample depletion, is a subject of frequent
notice during certain epidemics; for example, of scarlatina, pneumonia,
&c. With the exception of those cases, therefore, occurring in very
robust and plethoric constitutions, and accompanied with much pain in
the head, high febrile excitement, and hard pulse, either large or
small, I have seldom resorted freely to the lancet. When, however, these
symptoms presented themselves, especially the hardness of the pulse, I
have not been sparing of blood-letting, and have sometimes repeated it
several times with the most decided success. But even under these
circumstances, I have seldom found that _large_ bleedings were as
beneficial as small and repeated ones;--the system not reacting always
as energetically as could have been desired, and symptoms of prostration
occurring with much more rapidity. I do not recollect to have bled with
advantage, patients presenting a large, full, but _compressible_ pulse,
owing to the want of reaction; although the other symptoms might seem to
indicate the propriety of the practice. The effect of bleeding on the
vomiting was very different in this, from what I mentioned it to have
been in the bilious fevers of the West Indies; owing probably to the
circumstance, that, when, in yellow fever, the irritation of the stomach
became sufficiently violent to give rise to this symptom, the state of
the system was very often such as to contraindicate the use of the
lancet.

The application of scarified and dry cups to the epigastrium and head,
when there existed pain in these regions, was often resorted to, and
afforded much relief. And I very much regret, that, during our
epidemics, it was out of my power to make use of leeches to the former
part, as so warmly recommended, at the present day, by the French and
Spanish physicians; as I am inclined to the opinion, from the view I
have adopted respecting the pathology of the disease, that, used early
and in large numbers, they would prove very serviceable.

In conjunction with general and local bleeding, fomentations were had
recourse to in almost every case, and applied to the epigastrium in the
form of poultices, or flannels wrung out of warm emollient decoctions.
In order to excite perspiration and to determine action to the surface,
a tepid bath was occasionally prescribed, and in some cases afforded
considerable relief; but as it was an inconvenient remedy, pediluvia,
and hot bricks on which water, or water mixed with vinegar was poured,
were substituted. In cases, however, in which much arterial action
existed, these last means were not prescribed, until the pulse had been
brought down by the lancet, and other remedies presently to be
mentioned.

On the subject of emetics, I shall not enlarge; as I can safely assert,
that I very seldom saw a patient recover from yellow fever, to whom
tartarized antimony, or any other active remedy of the same class, had
been administered. Of the impropriety and danger of this practice in the
present disease, I was early convinced from a careful analysis of the
symptoms, indicating an acute irritation of the stomach and upper
portion of the small intestines, and from the circumstance, that, of the
first family in which I was called to prescribe, five members, to whom
emetics had been administered, had already fallen victims to the fever,
under the care of a very respectable physician, and that three
succeeding ones, who were treated agreeably to my view of the pathology
of the disease, recovered. From these facts and reflections, I was
induced to watch the effects of these remedies in subsequent cases, in
my own practice, and in the practice of other physicians, and was soon
led, from this extended experience, to abandon totally the use of tartar
emetic in the treatment of this malady. Ipecacuanha in emetic doses was
also tried by me; but although, thus administered, it did not occasion
the bad effects resulting from the exhibition of the preceding article,
yet it was often productive of harm, and never of benefit. These
remarks, however, apply more particularly to the use of tartar emetic
during the state of excitement of the fever, and not to that of collapse
which sometimes precede it, and in which it is recommended by some
physicians of the southern states. In this condition of the system, I
have never resorted to it, and, I must confess, could not easily be
persuaded to do so; suspecting that even in such cases, the digestive
organs are already too far implicated, to justify the use of so powerful
and acrid a remedy.

It would seem that the bad effects of emetics, and more particularly of
tartarized antimony, resulted, not only from their irritating qualities,
but also from the efforts of vomiting, during which the stomach is
compressed by the abdominal muscles, and made to contract very forcibly.
To this opinion I am naturally led from the circumstance, that
purgatives, whose action is certainly primarily irritating, are very
advantageously employed in yellow fever. It is not my intention to
attempt here an explanation of this seeming contradiction. Leaving to
others the accomplishment of this difficult task, I shall content myself
with stating, that during the whole course of my long practice, I have
seldom seen a patient die of this disease, whose bowels had been well
evacuated, and in whom perspiration had been excited within the first
twenty-four hours after the attack. I exhibited purgatives in almost
every instance _every day_, until copious evacuations had been procured,
and I generally found, that the mild purges were of greater service than
those of a severe and irritating nature. Senna, acidulated with lemon
juice or tamarinds, answered sometimes remarkably well, when the stomach
could retain it. Castor oil, manna, salts, magnesia, were frequently
employed by me with advantage; and although I did not make an extensive
use of calomel in this disease, yet I prescribed it to children, and to
adults, who, owing to great irritability of the stomach, could not
retain other purgative medicines. When I resorted to it, I generally did
so in doses sufficient to ensure a purgative effect, and never with a
view of exciting ptyalism. In doing this, I was not guided, however, by
any fear of the effects of a salivation, since I was well aware that a
ptyalism occurring in malignant diseases is often a favourable crisis;
but by a knowledge of the great difficulty experienced in producing it,
and from the observation, that in cases in which it was obtained, much
valuable time had been lost, and the patient might have recovered
without.

To promote the operation of the above remedies, purgative enemata were
resorted to, in the early stage of the fever; and were followed by the
frequent use of injections, composed of emollient decoctions, from which
the patient derived considerable relief and comfort.

As counter-irritants, blisters and sinapisms were used, and often with
great advantage. They were found of much value when applied to the
epigastric region, for the purpose of arresting the vomiting. Sinapisms
were in general preferred to blisters, as being more prompt in their
effects and more easily renewed. Blisters were sometimes applied to the
extremities in the different stages of the disease; but so far as I can
judge, from my experience, not with much real benefit.

I seldom derived much advantage from the use of tonics and stimuli in
yellow fever; except when the powers of life seemed to fail, and
petechiæ, vibices, hæmorrhages, and other signs of malignancy had
occurred. In general, under such circumstances, the Peruvian bark,
either alone or combined with serpentaria, was administered in
preference to any other remedy of the same class. In cases, however,
unattended with reaction, tonics and diffusible stimuli internally, and
revulsives of all sorts externally, were had recourse to from the
commencement of the attack, and sometimes with the desired effect of
arousing the powers of the system. _Opium_ was never found beneficial,
on account of its tendency to aggravate or produce coma, as well as from
its effect in suppressing intestinal evacuations.

Whilst making use of the above remedies, the plentiful exhibition of
diluent drinks was not neglected,--care being taken, however, not to
load unduly the stomach, and to select such drinks as would suit the
taste of the patient. In almost every case, acids did not answer so well
as the bland mucilaginous infusions. The drinks were almost universally
allowed cold, except when there existed a tendency to perspiration;
under which circumstances they were administered slightly warm and a
little aromatic.

During the course of the yellow fever, some of the symptoms demanded
particular attention. Influenced by the idea of prostration and
dissolution, many practitioners, and myself for some time among the
rest, resorted to the bark and other tonics for the purpose of arresting
the black vomit, and of correcting that condition of the organs, which
gave rise to this effusion; but after many unsuccessful trials, I was
led to abandon this practice and to resort to other means. Of all the
remedies employed to attain this effect, calcined magnesia mixed in a
thick solution of gum arabic seemed to me to answer best; for whilst it
succeeded, in many cases, in arresting the vomiting, it tended to keep
the bowels open. Together with this, revulsive remedies were applied to
the skin, and sometimes succeeded very well,--a sufficient proof, I
think, that this hæmorrhage is the effect of an increased action of the
mucous membrane of the digestive tube, and not of a passive condition of
the capillaries of the parts. For the purpose of controlling the great
irritability of the stomach, and arresting the vomiting occurring in the
early stage of the disease, besides the usual remedies used in such
cases, I found advantage in the use of small and frequently repeated
injections with a solution of salts, an infusion of senna, or the like
substances. Such a practice, however, did not seem to succeed so well in
the latter stage of the disease.

With the intention of promoting the secretion of urine, in cases in
which it was suppressed, all the diuretics, as well as every external
stimuli, were in vain employed;--this symptom, as I have already
mentioned, being, in all instances which fell under my immediate
observation, the forerunner of death.

ARTICLE V.--_Remarks on the Prophylactic Treatment of Cholera Infantum._
By JOSEPH PARRISH, M. D., one of the Surgeons to the Pennsylvania
Hospital.

The great mortality of cholera infantum renders it one of the most
interesting diseases, which come under the notice of the physician. Its
ravages among the infant population of our large cities, are too well
known, and too strongly felt, to require any comment. No disease
contributes so largely to swell our bills of mortality during its
prevalence; and were it not restricted to the summer season, it would
prove a greater scourge to the community than consumption itself.

This mortality is owing less to our ignorance of the nature of the
complaint, and the proper mode of treatment, than to the continued
operation of the causes by which it is produced. I have often compared
our endeavours to cure cholera infantum, while these causes remain, to
an attempt to relieve inflammation in a part, while a thorn is sticking
in the flesh. We may resort to bleeding and leeching; we may restrict
our patient to the lowest diet, and the most perfect rest; we may employ
all those remedies, which are ordinarily best calculated to reduce
inflammation: but so long as the thorn continues in the wound, our
efforts will be fruitless. Thus it is with cholera. We may obviate the
more violent symptoms; we may procure temporary relief; we may even
flatter ourselves that a cure has been effected: but the original causes
have not lost their power; an increased susceptibility to their
operation remains; relapse upon relapse is experienced; and at last the
little sufferer, worn out by the successive attacks, sinks beyond the
reach of medicine, and expires. Unhappily, the nature of the causes is
such, that, in very many instances, their removal is exceedingly
difficult, if not altogether impossible; and, under such circumstances,
the patient who has once been severely affected, seldom recovers in the
end. Hence it becomes of the greatest importance to prevent the
occurrence of the disease; and attention to the prophylactic treatment
is no less essential than the adoption of curative measures. It is with
the view of calling the attention of the profession to this subject,
that I have been induced to offer the following observations.

It is obvious, that, in the preventive treatment, two objects demand
attention; first, to remove, as far as possible, the causes of the
disease; and secondly, where their entire removal is not attainable, to
fortify the system against their influence. On each of these, I shall
offer a few observations.

I. Excessive and continued heat is, perhaps, the most fruitful source of
cholera. Thus we find, that the disease makes its first appearance in
the commencement of the hot weather, increases and becomes more fatal
with the rise of the thermometer, and declines with the return of cool
weather in autumn. During its continuance, it may be observed to vary
with every permanent change of temperature. A few very hot days in
succession, in the 6th month, are sufficient to call it into action; and
during the height of its prevalence, a spell of cold weather will
diminish, if not suppress it. In the summer of 1806, which was
remarkably cool and pleasant, there was very little of the disease; and
generally in moderate summers, it is much less prevalent than in those
of a contrary character.

I believe that it is by a direct operation on the system, and not by the
generation of miasmata, that heat proves so deleterious to the infant.
In the country, where miasmata are most abundant, there is comparatively
little cholera; for the heat of the sun is there moderated by the free
circulation of the air; and the debilitating operation of the high
temperature of the day is counteracted by the refreshing coolness of the
morning and evening. It is in the close air of cities, that the
complaint flourishes with greatest vigour; and the most confined
situations are the most favourable to its production. Let any one take
a walk, in a summer's morning, through the thickly built lanes and
alleys of Philadelphia. He will be struck with the appearance of the
children, reclining their heads, as if exhausted, upon the breast of
their mothers, with a pale and languid countenance, a cool and clammy
skin, a shrunk neck, and other signs of debility, arising from their
confinement, during the night, to close and hot apartments. It will
readily be believed, that such places are the very hot beds of cholera.

Heat, therefore, connected with confined air, being among the most
frequent causes of the complaint, it is necessary, as far as possible,
to counteract them. Should a strong predisposition to cholera be
suspected, the best plan will be to send the child into the country
during the summer. Both as a preventive and a remedy, country air is
decidedly the most effectual, to which we can resort. But in most
instances, it would be exceedingly inconvenient, sometimes impossible
for mothers to leave their homes and occupations in the city; and, under
such circumstances, it becomes necessary to substitute measures, which
may produce, as nearly as possible, the same effects. To keep the child
cool, and expose him to the fresh air, are the ends to be obtained. For
this purpose, he should be carried frequently into the open squares, or
beyond the suburbs of the city. I am in the habit of recommending to
parents, whose circumstances will not allow of a removal from the city
during the summer season, to make frequent excursions across the
Delaware, and into the neighbouring woods of New Jersey. The refreshing
effects of the air on the river are truly surprising. The brightened eye
and animated countenance of the infant, give speedy proof of their
favourable influence; and when labouring under the disease, even in its
lowest stage, the little patient will often exhibit immediate signs of
amendment.

In the prevention of cholera, much may also be expected from a proper
attention to the lodging of children. Many parents have a great dread of
the night air; and exclude it from their chambers, as sedulously as if
it were infected with poison. But, in guarding their children from
taking cold, they expose them to a much greater danger. Observe their
mode of treatment. The doors and windows are carefully closed; the child
is placed in a feather bed, with his parents on each side, and almost
smothered with the bed-clothes. Perhaps other children are lodged in the
same apartment; and thus the delicate system of the infant is exposed to
the debilitating influence of great heat and stagnant air, combined with
the effluvia, which, in such a situation, must be abundantly generated.
Simply to enter such a room in the morning, is almost sufficient to
sicken a healthy individual; how much more injurious must be its effects
upon the lodgers themselves. Examine in the morning a child, who has
passed the night thus confined. You will find him limber as a rag,
exhausted by perspiration, wholly destitute of animation, without
appetite, and on the very verge of cholera. I should recommend an
entirely different plan of management. Instead of a feather bed, the
child should be placed on a hard mattress, or on blankets folded and
laid upon the floor. The covering should be light, but comfortable. The
doors and windows should be open; so that fresh air, that _pabulum
vitæ_, without which health cannot be sustained, may be freely admitted.
Thus treated, instead of the feeble and sickly appearance before
mentioned, he will present a lively countenance, with all that activity
of motion, and enjoyment of existence, which are natural to his age, and
afford the surest criterion of vigorous health. Experience has fully
convinced me of the great importance of attention to the lodging of
children, as a prophylactic measure; and this renders me desirous of
impressing upon the profession generally, the truth of my own
convictions on the subject.

With the same design of obviating the injurious effects of a high
temperature upon the infantile system, I advise frequent ablutions with
cool water, and its free employment as a beverage. Infants, unable to
make their wants known, often suffer exceedingly from the inability of
their attendants to understand them. During the heat of summer, the
increased evaporation from their surface is necessarily productive of
increased thirst, which, if unsatisfied, renders them uneasy and
restless. To quiet them, the breast or bottle is offered. Aliment is
thus given, where drink only was required; and the stomach, overloaded
and oppressed, is apt to become irritable, and is thus brought into a
condition most favourable to the occurrence of cholera. By attention to
the peculiar language of infants, expressed not by words, but by signs,
I have often been able to detect their wants; and, in many instances,
have afforded the most decided relief, by simply giving them a little
cool water for drink. From the dread which some individuals have for
cool air and cold water, it would seem that they were considered rather
as destructive poisons than as absolute necessaries. I have no fear of
either, when judiciously employed; and as prophylactics in cholera, I do
not think their place can be supplied.

But heat is not the only cause of this complaint. Dentition is well
known both to predispose the system to its attack, and, after it has
occurred, to increase its violence, and diminish the chances of
recovery. In the employment, therefore, of preventive measures, it is
highly necessary to attend to the state of the gums, and to remove or
counteract this source of irritation. If at all swelled or painful, they
should be lanced freely, and the operation should be repeated as often
as their inflammatory condition may demand. In severe cases, much good
may be expected from the application of blisters behind the ears. The
irritation thus receives an external direction, and the stomach and
bowels are in less danger of an attack. I was led to this practice, by
observing that the eruption, which, during dentition, is apt to make its
appearance behind the ears, often proves a most salutary effort of
nature; and that, while it continues, the infant generally enjoys an
exemption from those dangerous disorders, incident to this critical
period of life. To imitate nature as closely as possible, the discharge
from the blistered surface should be maintained for some time by
stimulating dressings. I have witnessed the most beneficial effects from
the practice, and can strongly recommend it to the attention of the
profession.

II. At the same time that we endeavour to remove or diminish the causes
of cholera, we should not neglect to put the system of the child in such
a condition, as may enable it most effectually to resist their
operation. As cholera is a disease of irritation, originating generally
in a debilitated state of the alimentary canal, I believe this end may
be most easily attained, by preserving the natural tone of the digestive
organs. For this purpose, all flatulent and indigestible food should be
carefully avoided. During the first year, the mother's milk is, in
general, the most appropriate nutriment. When the stomach of the infant
is very delicate, the diet of the mother should be strictly regulated;
and, in all cases, it would be adviseable for her to avoid articles of a
flatulent nature. While the child is still at the breast, if a
predisposition to cholera be suspected, I would recommend the occasional
use of nutritious animal juices. The sucking of small pieces of salt
meat, as ham or dried beef for example, will sometimes be found
productive of advantage. After weaning, animal food should always enter
into the diet of the child. Many parents, fearing to render their
children gross and unhealthy, restrict them altogether to vegetable
aliments; and thus, by weakening the powers of digestion, prepare the
way for that very result which they are most anxious to avoid.

With the same view of giving tone to the stomach, aromatics should be
used habitually during the summer, in those cases, in which there is
strong reason to apprehend the occurrence of cholera. While they produce
a cordial impression on the stomach, and invigorate generally the
digestive powers, they are liable to none of those objections which may
be urged against the employment of the narcotic stimulants. Indeed,
nature herself seems to have pointed them out as prophylactics against
the diseases of hot weather. Our most powerful and valuable spices are
the products of warm countries. Cinnamon, ginger, pepper, the clove, the
nutmeg, are to be found only in tropical climates. In this arrangement,
we see the hand of a beneficent Creator, who has provided, that, by the
same high temperature, which renders the equatorial regions so fruitful
of cholera, and other disorders of the bowels, the growth of those
plants should be promoted, which are best calculated to invigorate the
alimentary canal, and to fortify it against the inroads of disease.
Facts are not wanting to prove the efficacy of spices in preventing
intestinal complaints. We are informed by DEWAR, in his treatise on the
Diarrhoea and Dysentery, by which the British army in Egypt was
attacked, that among the Mamalukes of that country, it was a universal
practice, when they apprehended the approach of these disorders, to make
use of cinnamon or ginger, with the almost uniform effect of averting
them; and where the same practice was followed by the British soldiers,
equal advantages were experienced. In the French army, so highly was the
prophylactic power of the aromatics estimated, that every soldier was
provided with a box of spices, which he was directed to use freely with
his diet of fruit and melons.

When attending surgeon of the Alms-house hospital in this city, I had
occasion frequently to prescribe in a syphilitic ward, which being
situated directly under the roof, in a large garret, was liable, in the
summer season, to become very much heated. As the patients were
numerous, and the windows insufficient to admit of proper ventilation,
the air became much contaminated; and the consequence was, that bowel
complaints were very frequent and troublesome. I have often entered the
ward on a summer's morning, and found almost every patient affected more
or less with diarrhoea or cholera. It occurred to me, that the free
use of some of the aromatics might be found serviceable in preventing
the occurrence of these complaints. I accordingly directed, that every
individual in the ward should drink a portion of strong ginger tea
daily. I also ordered, that salt meat should be used twice in the week.
By the steady pursuit of this plan, a very considerable change for the
better was effected.

The employment of aromatics as prophylactics is not less beneficial in
children than in adults. I would not, however, advise, that they should
be given indiscriminately to all children, during the summer. It is only
to those cases, in which a predisposition to cholera infantum exists,
that I consider them peculiarly applicable; and here I believe they are
capable of producing much good.

Before dismissing the subject of the paper, I will simply remark, in
addition to what has been already said, that the occasional use of the
cold bath, by the vigour it imparts to the system generally, and through
it to the digestive organs, will often be found an excellent
preservative against the summer complaint of children.

In this short account of the preventive treatment of cholera infantum, I
have been less anxious to give a dissertation, embracing all that might
be said on the subject, than to communicate those particular measures,
which, according to my own experience, I have found most effectual. I
will conclude the paper by the relation of a case, in which a strong
predisposition to the disease was successfully counteracted. It will be
proper, however, to premise, that the treatment of this case is by no
means held out as an example to be generally followed with every
infant, which may possibly become the subject of cholera. It is
applicable in all its details only to those, in which, as in the present
instance, there is every reason to apprehend, that the only alternative
is between almost certain death, and the most careful prophylactic
treatment.

CASE.--A gentleman of this city, whose wife had arrived at a period of
life, when she could not expect to be the mother of many more children,
consulted me respecting an infant daughter, their only surviving child.
I was informed, that they had already lost eight children, all of whom,
with one exception, had died of cholera. It may readily be imagined,
that every feeling of parental anxiety was awakened for their babe; and
that no degree of attention on their part was considered too great,
which might contribute to its preservation. It was placed under my care,
not to be cured, but that I might, if possible, devise some plan of
management which would avert the disease they had so much reason to
apprehend. I felt the responsibility of the trust, and endeavoured to
find it to the best of my ability. Every opportunity which I could
desire was afforded me; for the infant, from its birth was submitted to
my direction; and both the disposition and ability existed, on the part
of the parents, to carry implicitly into effect every measure which I
might recommend.

As the mother was unable to furnish sufficient nourishment, the first
step was to provide a healthy wet-nurse, who might be willing to submit
to the necessary regulations in respect to diet.

I believed the children of these parents to possess a constitutional
weakness in the alimentary canal; and, on inquiry, I was told, that they
had been kept upon a vapid diet, under the impression that it would
contribute to their health. In the present case, therefore, the
principal object was to communicate strength to the stomach and bowels.
With this view, the child was accustomed, from an early period of
infancy, to a generous diet. When very young, portions of ginger tea
were given to it daily; and as soon as it was old enough to suck the
juice of meat, it was encouraged to do so. The nurse, during the warm
season, was kept upon a nutritious diet, consisting principally of
animal food, with the occasional use of ginger tea; and every
description of recent fruit and fresh vegetable food was forbidden.
Under this management, the first summer was passed without any symptom
of the disease; but I looked forward to the second with no little
anxiety, when the child would have to struggle with the irritation
arising from dentition.

The same plan was continued during the second summer, and still more
rigidly enforced. The child was now old enough to take animal food
freely in addition to the breast. It was allowed as much salt fish, ham,
beef-steak, essence of beef, &c. as it desired; ginger tea was given
daily; a little sound old port wine was occasionally directed; and both
the child and the nurse were restricted from every species of flatulent
and indigestible aliment. So anxious, indeed, were the parents, and so
careful to carry my directions into full effect, that they allowed no
forbidden article of food to enter the house, and denied themselves
their wonted comforts, lest possibly their child might be injured.

The gums were carefully attended to, and lanced whenever the operation
appeared to be requisite. All those measures, which I have before
mentioned as serviceable in obviating the effects of great heat, so far
as they were applicable to the case, were adopted. The second summer was
spent wholly in the country.

Very little medicine was required, and none was administered, except of
the mildest description. Frequently, when summoned to visit the babe, I
have found the mother trembling with fear, and anxious that something
might be done; and often, under such circumstances, have I begged it off
from a dose of physic, having determined to avoid a resort to every
thing of the kind, unless real necessity should demand it.

By a strict adherence to the plan above detailed, the period of
dentition was passed in safety; and it is with heartfelt pleasure I can
say, that no symptom of cholera afterwards made its appearance.

ARTICLE VI.--_Case of Neuralgia cured by Acupuncturation._ Communicated
by J. HUNTER EWING, M. D.

The attention of the medical public having been of late much excited on
the subject of acupuncturation, I am induced to communicate the
following case.

For eighteen months, Miss ---- had been afflicted, at intervals, with a
severely painful affection of the nerves of the right cheek, immediately
below the orbit of the eye, and extending to the angle of the lower jaw.
On the 14th of January 1826, she was attacked more violently than usual,
and the remedies, which had previously afforded some relief, now failed.
Stimulating cataplasms, warm embrocations, laudanum, internally and
externally, heat applied externally to the cheek by means of very hot
flannels, produced not the slightest mitigation of the pain; and she
continued to suffer excessively until the afternoon of the 15th; when
acupuncturation being proposed, she consented to the operation with this
remark,--"any thing to relieve me from this agony."

The needles were immediately procured, and three inserted about an inch
from each other. Two in a line parallel with the inferior edge of the
orbit of the eye, and half an inch below it; and a third below, and
equidistant from the others. The first two were introduced to the depth
of three-fourths of an inch; the last, a full inch. They were inserted
very gradually and with a rotary motion.

The second needle was scarcely introduced, before the patient exclaimed,
"the pain has entirely left me." When the third was introduced, she
experienced a stiffness in the muscles of the cheek, and a creeping
sensation, as if a spider's web had been drawn across the face; but no
painful sensation whatever.

Such was the exhausted state of her system from the excessive pain she
had suffered, that when thus relieved, she requested a pillow to rest
her head on, and fell into a gentle slumber.

About two hours after the insertion of the needles, I again visited my
patient, and found her still perfectly free from pain, and seated at a
table reading. She thanked me for the relief I had been the means of
affording her, and requested me not to withdraw the needles, lest the
pain might return. Upon being apprised of the risk that might attend
their being allowed to remain, she observed, that she would rather have
a servant to watch her whilst she slept. The propriety of their removal
being further urged, she at last consented. There was no return of pain.

The next morning, the patient remarked, that the stiffness of the cheek,
and a numbness of the whole right side, continued through the night; and
though she did not sleep very soundly, she was free from pain and rested
well.

By the third day, the stiffness and numbness had passed away, and there
was no return of pain. Several weeks have now passed, and she has had no
relapse; although often since exposed to causes, which, heretofore, had
always excited violent attacks. Previous to the operation, she seldom
passed as many days without severe suffering.

Although I have performed this operation many times, and been present
when others have performed it, I have never seen a case, in which its
efficacy was so decided, or in which the relief afforded was more
unquestionably attributable to the action of the needles.

ANALYTICAL REVIEWS.

ARTICLE VII.--_Researches into the Nature and Treatment of Dropsy in the
Brain, Chest, Abdomen, Ovarium, and Skin, in which a more correct and
consistent Pathology of these Diseases is attempted to be established,
and a new and more successful method of treating them, recommended and
explained._ By JOSEPH AYRE, M. D. &. London, 1825.

We have read the present work with the liveliest pleasure, and we dare
hope with considerable benefit, and hasten to lay a review of its
contents before our readers. Dr. AYRE is already advantageously known in
this country, where his Essay on Marasmus has had an extensive
circulation; but we are disposed to think, that, however he might be
esteemed for the talent he displayed in his former composition, he is
entitled to much more credit for his able researches into the nature and
treatment of dropsy. We confess that we enter upon our editorial duties
on the present occasion, with the two-fold intention of offering to our
readers what we regard, on the whole, as a very correct view of the
pathology of dropsy, and of showing to some of our medical friends, who
shudder at the mere mention of what they denominate _hunch theories_,
that the English physicians, or at least some of the most intelligent
among them, so far from considering these theories as dangerous and
unphilosophical, are beginning to entertain similar views with their
Gallic brethren, in respect to the inflammatory nature of many diseases
too long regarded as resulting from a state of debility, and classed by
nosologists among the Cachexiæ.

By most writers upon the subject, dropsy has too long been considered as
a _disease_,--constituted into a separate class, and divided into many
species. Dr. AYRE entertains, however, a very different and, we believe,
a much more correct view of the pathology of this complaint; regarding
it as only one in a series of effects of a disease, and not always the
last of that series. He remarks, that the true disease is to be sought
for in that particular condition of the solids by which the effusion is
produced; and that to appreciate justly the nature and treatment of
dropsy, it is necessary to understand the nature of that condition,
which constitutes the disease, and of which the serous and watery
effusion is merely the result.

Of all the hypotheses that have been advanced to account for the nature
of the morbid state, which gives rise to general and local dropsy, there
are only three which our author regards as entitled to our notice.
According to these, all dropsical accumulations arise either, 1st, From
a want of tone or energy in the absorbent vessels, giving rise to a
deficient absorption. 2nd, From an increased exhalation of the natural
fluid, through a similar want of tone in the exhalents; and 3d, From a
mechanical obstruction to the free return of blood by the veins,
produced by tumours of various kinds, &c., by which a greater portion of
it is forced into the exhalents, and a greater effusion of their proper
fluids thereby occasioned. With these hypotheses, however, Dr. AYRE is
not satisfied, and he endeavours, in the following manner, to show their
insufficiency.

"1st. The opinion of a want of tone in the absorbents, as a
cause of dropsy, is contradicted by the fact, that in those
cases, in which it is assumed to prevail, it is found, that the
adipose matter, or fat of the body, is removed by the
absorbents; or, in other words, that emaciation takes place to
as great an extent, and as rapidly in this, as in other
diseases; and emaciation can only be effected by means of
absorption. Besides, in these cases of dropsy, mercury, when
rubbed upon the surface, or received internally, is absorbed as
readily, and affects the system as early as under other states
of the body. There is also no accumulation of the fluids in the
joints, or in the _bursæ mucosæ_ in these cases, which,
nevertheless would happen, if there was a general debility of
the absorbent system; and _ecchymoses_ or livid spots, though
easily induced in anasarcous limbs, are likewise easily removed
from them by the absorbents.

"2nd. The opinion of a want of tone or energy in the exhalants
involves in it one of the following conditions: namely, either,
1st, that the fluid of dropsy may escape mechanically from
them, and that the fluid thus _mechanically_ separated may be
identified in its sensible and chemical qualities with another
fluid which is confessedly secreted; or 2nd, that if the fluid
of dropsy be secreted, then that an _increase_ in the quantity
of a secretion may continue an indefinite period, under a
_decrease_ in the energy of its secreting vessels; conclusions
to which experience and analogy are alike opposed."

In answer to the third hypothesis, Dr. A. remarks, that such an
obstruction as contemplated, has never been shown to exist.

"In the case of the liver, which is commonly considered, when
in a scirrhous or enlarged state, to be the seat of these
mechanical obstructions, and thus, to be the cause of abdominal
dropsy, we have no satisfactory instance yet shown to us, of
any such precise condition of that organ. There are, indeed,
numerous instances of abdominal dropsies, in those labouring
under a scirrhous or enlarged state of the liver; but there are
also, numerous examples of such states of the liver, as well as
of the spleen and other organs, without any such effusion; and
in many cases, when such effusion has taken place, it has been
carried off by the natural passages or by tapping, without any
return of the dropsy; and yet, without any visible change in
the structural condition of the liver."

Dr. A. further remarks, that if the cause were mechanical and existed in
the liver, the effect should be constant; which, however, is not the
case. Besides, were this mechanical cause necessary, how could we
account for the appearance of abdominal dropsy, where there is no
disease of the liver, or in other cavities, where no mechanical cause is
asserted to be present, and where the remedies by which the cure is
effected, have no relation to such causes? Again, if the discharge
depended upon a mechanical cause, the water should in every case be of a
uniform fluidity, and the progress of its accumulation likewise uniform;
so that the operation of tapping should have no tendency to induce a
more rapid refilling of the cavity. Yet, the contrary of all this is a
subject of daily observation. In addition to this, Dr. A. calls the
attention to the fact, that in experiments, in which obstruction has
been artificially made, by tying the vena cava for example, the
experimenter has committed an error, in reasoning from the lower animal
to man--assuming, that as ascites had arisen in dogs, it would in like
manner have occurred in human subjects.

"But there was an effect, here overlooked, which was to be
expected to take place in the abdomen of the dog, from the
injury done to the surrounding parts by the operation itself,
and which would be quite independent of any effect arising out
of the experiment. In the human subject, the effect would be
the highest form of inflammation, by which coagulable lymph or
pus would be poured upon the surface of the peritoneum. There
would, therefore, be inflammation excited in the abdomen of the
dog; but as the lower animals are less easily acted on than
man, the inflammation would in this case be in a lower degree.
But every degree of inflammation has its particular product.
The highest occasions a discharge of pus, whilst the lowest,
when seated in a serous membrane, is a larger portion of its
proper serous fluid. This, therefore, might be the product of
the inflammation, which was produced incidentally by the
experiment in the abdomen of the dog; and it would be just as
reasonable to regard the coagulable lymph in the human subject,
which would result from such an experiment, as an effect of the
mechanical obstruction, as to consider the fluid effusion in
the dog to be so."

In respect to those instances of diseases of the liver, connected with
ascites, in which, in addition to its other morbid states, a partial
occlusion of the vena portæ, by the effusion of coagulable lymph into
it, is said to have existed, our author remarks, that they are very few
in number, occurring, perhaps, in one out of several hundred cases of
ascites with hepatic disease; and that we are justified, from analogy,
to assume, that any obstruction given to the circulation by diseased
vessels, would be quickly relieved by the enlargement of the
anastomosing branches, and that no effusion of water into the abdomen
would result from it. After referring to some cases, related by the late
Mr. WILSON, in which the vena cava was completely obliterated, and no
effusion took place; and some cases of morbid condition of the heart of
an analogous kind, by which the course of the circulation became greatly
obstructed, and yet, without being followed by effusion; our author
concludes, that from these facts and others, to be presently noticed, it
appears evident,

"That the dropsical effusion, in whatever part it may be
seated, does not arise from any want of tone in the exhalant or
absorbent system, or from a mechanical obstruction in the liver
or other viscus; but, that it proceeds from a morbid action in
the cellular or serous tissues, and that this action, as we
shall now proceed to show, is allied in its nature to
inflammation."

In support of this opinion, Dr. AYRE remarks, that all the phenomena
belonging to cases of watery effusion, met with under one or other of
the forms of inflammation, are common to those of dropsy. Thus the
fluid, discharged under the cuticle in erysipelas or in inflammation
induced by heat or a blister, or in cases of pemphigus, is a secretion,
and resembles in all respects the fluid found in dropsy. In some cases
of acknowledged inflammation, the fluid effused is found to vary greatly
in its degree of tenuity, so as to be sometimes of quite a viscid
nature. The same circumstance is met with in dropsy; the fluid of which
varies sometimes in different forms of the disease, and at different
periods in the same patient. With regard to the absence of pain, in
ordinary cases of local or general dropsy, which, in the minds of many
physicians, might seem to militate against this view of the
subject,--since pain accompanies the inflammation of a blister, Dr. A.
very justly says, that the difference is referrible to a different
degree of sensibility of the parts affected; that, moreover, in
pemphigus there is no pain, and that chronic inflammation of the serous
membranes is little painful.

That the morbid action producing the effusion is only a modification of
inflammation, our author thinks may be further shown by the fact that it
obeys the same laws--being translated occasionally, like it, from one
part of the body to another. On this subject, Dr. AYRE makes the very
pertinent remark, that in these cases, the fluid alone has been thought
to be translated; but that the metastasis, is without doubt, exclusively
of the action which produces the serous discharge. Analogous also to
what occurs in inflammation, especially of the erysipelatous kind, the
action occasioning the effusion, as seen in anasarca, commences at a
given point, and gradually extends from thence in a continuous course.
It ought also to be noticed, that the results of common inflammation
vary according to the intensity of the cause; the lowest degree of it,
occasioning an increase in the quantity of the proper fluids of the
part,--a higher degree, yielding for its product coagulable lymph, and a
still higher one producing pus. All these several products of common
inflammation, are more or less remedial of their cause; or in other
words, are the immediate means of the cessation or abatement of the
inflammation which produces them. This same power is likewise a
property, though in a much less degree, of the hydropic effusion, when
the inflammation which produces it, is idiopathic; or in other words,
not created by a visceral or other disease, or some particular
excitement of the general system, as is seen in cases of anasarca.

"And here," continues our author, "it may be proper to remark
upon a common error, committed by those, who, mistaking the
nature of the action which produces the serous effusion, look
in the _post mortem_ examination, for some of the common signs
of an inflammation having existed; and who conclude, upon not
finding such, that the water was derived from some mechanical
or other cause foreign to the true one. But in the higher forms
of abdominal inflammation, the products are pus or lymph, and
these are found upon the surface of the peritoneum, with
sometimes a thickening and discoloration or ulceration of its
substance; whilst in the lowest form of that increased action
to which the serous membranes are subject, the only product is
the serous fluid, and there can be, therefore, no visible
alteration produced by it in the structure of the serous
tissue."

"By the hydropic or serous inflammation, obeying the same laws
which govern the other degrees of common inflammation, it
follows, that upon a higher excitement being superinduced upon
it, the serous effusion should cease. This, therefore, is found
to happen in every case, where such higher excitement is
brought on. This increased inflammation is sometimes occasioned
by design or accident, and at other times, it occurs in the
natural and progressive course of some disease, formed within
the cavity, which is the seat of the dropsical effusion."

This is exemplified in the effects of the operation for the radical cure
of hydrocele; or in the operation of tapping in some cases of ovarian
dropsy; or even in some instances, of ascites from chronic inflammation
of the liver, spleen, mesentery, &c. In all these cases, the serous
membrane, which directly or indirectly was affected to a sufficient
degree to occasion a serous effusion, takes on, from the extension of a
visceral disease, or from some other cause, a higher degree of
inflammation--lymph is thrown out, and the cavity becomes obliterated.

"Now from these, and similar examples, which have fallen under
my observations, I think it may be assumed, that ascites, when
proceeding from some visceral disease, (and the principle
applies to hydropic effusions from the pressure of disease in
other cavities,) does so by the gradual extension of the
chronic inflammation of the internal cellular or serous tissues
of the diseased organ, to its outer external coverings; and
that, commencing here as from a point, the serous or hydropic
inflammation is progressively propagated through the whole of
the serous membrane of the cavity. By the disease within the
cellular tissue of the diseased viscous increasing, a
corresponding increase, in these cases, will ensue of the
disease on the surface of the membrane investing it; until at
length a susceptibility to take on a higher action is induced,
which only requires any slight occasional cause to establish.
Under this condition of an increased excitement in the
peritoneal or other serous membrane, coagulable lymph is
discharged into its cellular tissue, and a thickening of it
takes place; until at length the operation of paracentesis,
which in the early stage of the disease was attended with only
inconsiderable inconvenience, becomes an adequate cause of a
still higher inflammation, which terminates perhaps in
suppuration; and, in the _post mortem_ examination the serous
fluid is found so mixed with coagulable lymph, and purulent
matter, as to give a whey or milk-like appearance to the mass.
The quantity of serous fluid, in these cases, is generally
small, when compared with what was accumulated in the
intervals of former tappings; for the vascular excitement
which occasions the discharge of coagulable lymph, is
destructive of that which pours out the serous fluid."

Dr. A. remarks, that, besides the particular facts deduced from
observations on dropsy as a local disease, and which prove its relation
to diseases of local excitement, there is a further support to be given
to these views by various proofs that are afforded from observations
upon the urine, of serous inflammation producing local dropsy, being
frequently connected with one of a general kind. "So that the
inflammatory state of the system becomes sometimes a cause of the
effusion into a cavity, and at other times an effect of this state."
After giving full credit to Drs. WELLS and BLACKALL for their researches
into the state of the urine in dropsy, our author remarks, that there
are certain conclusions deducible, which appear not to have been
contemplated by those gentlemen, but which are strictly accordant with
the pathological views he has endeavoured to establish in the present
work.

"According to these facts, it appears, that when the disease of
dropsy is under a sub-acute form, and of the anasarcous kind,
it is usually idiopathic, and, often originating from cold; and
in this state, as well as in the symptomatic form, though in a
less degree, the urine is found to contain a portion of serum.
It is nearly peculiar to this disease, and denotes, according
to the quantity of it contained in the urine, the amount of
that excitement in the cellular tissue, and of the general
vascular system, which may be termed serous inflammation: for
it is met with most considerably in those forms of the disease,
in which these particular states of the body are most
apparent."

Serum is therefore found in greater abundance, when anasarca precedes
the local dropsy, which, in Dr. A.'s opinion, denotes the operation of a
general cause. This is found to be the case especially in anasarca after
scarlet fever. In cases of anasarca, the skin, kidneys, and bowels are
very defective in their operation. Serum is also found, though in a
smaller quantity, in those cases in which the anasarca has followed the
local dropsy; for the disease of the viscus, which is the cause of the
inflammation in the serous membrane of the cavity, may produce an
adequate degree of the vascular excitement which gives rise to a
discharge in the cellular tissue. Our author sums up his observations on
this subject, by remarking, that there appear to be four distinct
conditions of the system by which the occurrence of serum in the urine
is regulated.

"1. It is in the greatest quantity, where along with a copious
and continued effusion, there is a nearly corresponding
quickness in the absorption of the serous fluid, and which will
occur most commonly when the general excitement precedes, and
is cause of the local one.

"2. It is consequently, _cæteris paribus_, in a less quantity
where the general hydropic excitement of the system succeeds,
and is dependent on the local one.

"3. It is absent, or found only in a minute proportion, in all
those cases where the local increased excitement in the serous
membrane is only partially extended to the rest of the system,
and where the absorption from the part is inconsiderable; as
particularly happens in the encysted kinds, or,

"4. Where the effusion of the serous fluid has proved remedial
of the inflammation producing it; in which case the disease, as
it respects the presence of water in a part, may visibly
resemble another example, and yet be essentially different from
it, by the serous inflammation, which produced it in both,
having ceased, on its occurrence, in one of them."

Dr. A. discovers a further evidence of the relation which dropsy bears
to diseases of local excitement, in the effects it produces on the
general system. Thus, during the continued effusion of serum in
anasarca, there is sometimes a large quantity absorbed and carried out
of the body; by which a regular draught is made upon the nutrient
principles of the blood, which must naturally create effects like those
arising from the continued discharge of pus from a suppurating surface.
In both cases the local disease, when extensive and of long duration,
will necessarily occasion an exhaustion of the vital powers, by which
that condition of the system termed cachexy will be induced.

"The exhausted or cachectical state, therefore, of the system,
which has been so variously accounted for, and so frequently
assigned as a principal cause of both local and general dropsy,
is a direct consequence of the agency of some power diminishing
the vital strength at its source; and in the case of a chronic
and long continued serous inflammation, it will proceed from
the daily abduction from the circulation of a portion of its
vital fluid: and whether it be pus or serum that is drawn from
the body; or whether it be from any permanent failure in the
supplies of nutriment to it, the effect will be the same, as if
a certain quantity of blood was daily abstracted from the
system."

Dr. A. continues to remark that, under these circumstances, a
suppurating surface will readily become gangrenous, from any cause
temporarily exciting it, and that, in like manner, a higher
inflammation may sometimes supervene upon an oedematous limb, as in
the former case, and terminate in gangrene.

"Hence, therefore, the tendency of dropsical parts to fall into
gangrene, and which has been urged, as an argument, in proof of
debility being the cause of the serous effusion, is only what
is common to other forms of local inflammation, under a similar
condition of the body."

From the view he has adopted of the nature of dropsy, Dr. AYRE thinks
that the excitement of the parts, giving rise to the effusion, may be
either 1st. Sub-acute or chronic. 2nd. Symptomatic or idiopathic. In
other words, that it may arise from a local disease, or from the common
causes of inflammation; and that these causes may be either general or
particular. 3d. That the serous inflammation may be either local or
general, giving rise to a general or local effusion.

After offering so copious an analysis of Dr. AYRE'S sentiments
respecting the pathology of dropsy, it is unnecessary to enlarge very
fully on the application of his theory to the particular forms of that
disease. We shall, however, offer a rapid review, of some of his
opinions, and next detail the method of treatment he proposes for the
cure of these dangerous maladies. We commence with hydrocephalus, which
he remarks has been divided into an acute and chronic form. This
division, our author thinks, is correct in a certain sense; for the
disease varies much in duration,--running its course, sometimes in a few
days; and at other times continuing several weeks. Yet, he continues,
the terms acute and chronic must be understood as restricted to that
particular form of inflammation producing a serous effusion, and not as
denoting the highest and lowest degrees of common inflammation. It is
from the want of this distinction that much confusion has arisen in our
speculations relative to the pathology of hydrocephalus.

Dr. AYRE calls our attention to the fact, that the forms of
hydrocephalus denominated by Dr. GOLIS hyperacute and acute, do not
differ from the sub-acute phrenitis of nosologists, in which pus and
coagulable lymph are the proper products, with sometimes a serous
effusion into the ventricles as an accidental effect; all of which forms
of inflammation, the serous membranes of the brain, and of other
cavities are liable to take on; and adds:

"Now, the true hydrocephalus internus stands distinguished from
these, in the nature of the inflammation of which it consists,
in the same way, precisely, that the serous inflammation of the
pleura, producing simple hydrothorax, is distinct from that
higher degree of vascular excitement, which occasions an
effusion of pus or lymph. Relatively to these, therefore, the
disease is in a chronic form; and consists, we may repeat, of
that lowest degree of inflammation to which serous membranes
are subject, and the effect of which is to increase the natural
secretion of the part, so as to cause, in regard to the brain,
an accumulation of that fluid in its cavities."

Dropsy of the brain is usually divided into three stages. In the first,
continues our author, vascular excitement exists, as denoted by pain in
the head increasing in acuteness with the increase of the disease; and
in infants by a restless movement of the head upon the pillow, moaning,
occasional screamings, sickness, retching, impatience of light and
noise, contractions of the pupils, delirious terrors, &c. The second
stage is indicated by signs of pressure on the brain by effused fluid,
and by an absence of pain, excepting upon raising or moving the head,
convulsions, permanent dilatation of the pupils, squinting, blindness,
slow intermitting pulse, hemiplegia, and a peculiar placid expression of
the countenance, &c. The third stage is made up of some of these
symptoms, together with other ulterior ones which follow the vascular
reaction. On this subject, Dr. A. offers the following remarks:

"With respect, however, to the division thus formed of this
disease, it is, I think, somewhat questionable, whether it be
pathologically correct; for strictly speaking, the true disease
is comprised between the incipient beginnings of the
inflammation, and its termination by the effusion; since the
symptoms which follow, and compose what are called the second
and third stages, are little more than the consequences of the
disease, and arise from the mechanical pressure of the water
upon the brain. The progress, therefore, of what may be
strictly considered the disease, should perhaps be considered
as terminating with the occurrence of the effusion, which is
often remedial of the excitement causing it; and the whole
disorder, to be thus made up of two distinct states, the first
consisting of symptoms, which commencing with the excitement,
terminate with the serous discharge; whilst the second is
composed of those of a secondary kind, and which are wholly
dependent for their origin and continuance, on a mechanical
pressure from the effused fluid."

Hydrocephalus may occur, either as an idiopathic or symptomatic
affection. As the first, it may arise, where there exists a
predisposition in the brain, from various injuries inflicted on the head
by slight blows;--from all the general causes of inflammation--from the
sudden drying up of long established discharges--the sudden repulsion of
cutaneous eruptions, or the imperfect evolution of that or other
sanative actions of the system, at the close of some febrile diseases,
usually denominated defect of crisis. When, on the other hand, the
disease is symptomatic, it may arise from a particular cause seated
within the head, or in some distant part of the body. The former variety
is not common among children, and when it does occur, it is the result
of some chronic disease, as a tumour or a thickened state of the
arachnoid or other membranes of the brain, resulting from a former
inflammation. "Sometimes, adult patients wholly recover from chronic or
sub-acute inflammation, which induced the structural disease, and this
last becomes, at some future period, the occasional cause of the
hydropic one." At other times, the chronic inflammation continues, and
finally extends to the serous membrane, giving rise to the effusion.

"The most usual cause of the disease, however, particularly in
children, is an irritation which is sympathetically
communicated to the brain, from a disturbance in the
chylopoietic organs; and particularly from a functional
disorder of the liver. The cerebral disorder, to which a
derangement in the digestive functions thus gives rise, is only
one of those numerous effects which arise out of sympathies,
subsisting between these organs and different parts of the
system. In many cases, the same sympathetic irritation is
successively and variously directed to different parts of the
system. It will thus leave one organ or part, and suddenly move
to another; and through the operation of causes, which are not
always obvious, but which have a relation to some particular
predisposition, inherent or acquired. In this way, an
irritation may occasion an eruption upon the skin, and thence
be translated to the bronchial lining, producing a cough; and
next perhaps, to the serous tissue of the brain, exciting there
a turgescent or congestive state of the cerebral vessels, by
which symptoms are produced, through the pressure of the
congestive vessels, that simulate those of hydrocephalus; or
the true disease is brought on by an arterial re-action,
ensuing upon the congestion, which is resolved by a serous
effusion."

Dr. GOLIS, from observing the marked connexion "between the turgescent
state of the brain from chylopoietic disturbance, and its serous
inflammation, has concluded, that it essentially pertains to it;"
consequently, that "whenever it occurs, it is a part of it;" that it
should be considered as forming the first stage of the disease, and that
in all instances, it precedes the excitement. He has, for the same
reason, constituted all the symptoms of the chylopoietic disease into
the first stage of hydrocephalus. Dr. AYRE shows, however, that this
state of turgescence, is not essential to the disease, and is only a
sympathetic effect, which in the majority of instances, requires no
treatment, (at least a very subordinate one,) other than that of the
primary affection. He concludes his remarks on hydrocephalus, with the
following words.

"The cerebral turgescence and disturbance, therefore, in
whatever degree they may exist, are only, when sympathetically
produced, to be considered as morbid causes, whose presence,
where the predisposition prevails, may lead to a serous
inflammation of the tissues of the brain, but which do not
form, in any sense, parts of the disease itself; since, under
every degree of them, they are so frequently remediable, by
means which are alone available, for the removal of their
distant and sympathetic cause."

Of _Hydrothorax_, Dr. AYRE very justly remarks, that, as its name
imports and as defined by Nosologists, it consists of symptoms, which
strictly speaking, pertain only remotely to the true disease--arising,
as they do, from a certain disturbance given to the lungs, by the
pressure of water upon them. They are only the symptoms, therefore, of
the effusion, and as the excitement sometimes terminates with the
occurrence of the serous discharge, its existence, in many cases, is
discoverable only by its effects--there existing no signs, which clearly
point out the presence of that state, previous to the appearance of the
effusion; and what are usually called, by writers on the subject,
premonitory symptoms, being only those of an inferior degree of the
effusion which has already commenced.

Like hydrocephalus, hydrothorax may be idiopathic or symptomatic; and
proceed from a local or general cause--the nature of the inflammation
being the same in both cases. It may likewise be divided into an acute
and chronic form. When the disease is symptomatic, and arises from a
local cause, it is generally chronic. When it arises secondarily from a
disease of the lungs, our author thinks, that

"The mode by which this state is induced in the serous
membranes, is by the chronic inflammation that exists in the
diseased organ extending to them; and not by the same form of
inflammation being set up in them, by a certain sympathy or
consent of parts, which, from a loose analogy, has been thought
to subsist between similar structures."

All diseases of the thoracic organs, are not equally prone to occasion
effusion; some of these also, are only dangerous to life, in proportion
to their disposition in occasioning such an effusion; whilst in other
cases, if it occurs at all, the effusion is only the sequel of a disease
essentially fatal.

"To distinguish between these two conditions, is a desideratum
pathology. Modern writers on pathological anatomy have
prosecuted with considerable zeal and ability, their researches
into the nature of the diseases of the organs within the chest,
but they have done but little towards elucidating the true
relation, which subsists between the diseases of the several
viscera, and the serous effusions which take place into their
cavities; for, by limiting their views to the disease which the
_post mortem_ examination exhibited, they have overlooked those
intermediate actions or states of excitement which connect the
organic disease with such effusions."

Whenever the excitement, producing hydrothorax, is idiopathic and
independent of an organic disease of the lungs, heart, &c. its remote
causes may be either of a general or local kind; and are the same which
produce, when applied in a higher degree, or under different states of
the system, the other forms of inflammation. The effusion may take place
in those cases in which, the individual being predisposed, the
inflammation, owing to some peculiarity in the cause, does not reach
beyond its lowest grade; or in those in which the inflammation being
high, and treated too late, or by insufficient means, a chronic form
succeeds to the acute one, which may produce a watery effusion; or some
structural disease remains and eventually becomes a cause of the
effusion. The occurrence of this effect, in those latter cases, is
sometimes attributed to a debility, resulting from the large depletion
required in consequence of the severity of the previous inflammation.

"That such opinions, however, are founded in error, may be
shown from this, that the effusion, thus imputed to debility,
does not occur sometimes, until some weeks or months after the
period when the bleeding was employed; and although the
debility is confessedly of a general kind, yet the effusion is
local, and is precisely in the very cavity where the disease
existed, which required the unjustly condemned evacuations. The
truth of the matter is, that in such cases, either the
depletory means have been employed in an insufficient degree,
or too late." "The imperfect recovery of such patients from
their first attack, and, which is attributed to the depletion,
arises from the disease which is left by it, and to the
injudicious means, perhaps, that are employed by the too
anxious attendants, with the view of restoring the strength."

Among the ordinary predisposing and exciting causes of the inflammation
which produces hydrothorax, Dr. A. mentions a certain congestive or
plethoric state of the circulation, which is brought on in some persons
of particular habits, by indulging in the pleasures of the table, and
taking little exercise. These cases are analogous to those occurring in
the brain, and giving rise, by rupture, to a sanguineous apoplexy, or,
by arterial reaction, inducing an effusion of serum.

Dr. A. next proceeds to the subject of _ascites_, the symptoms of which
he remarks are at first so obscure, that the disease is sometimes with
difficulty detected. The remote causes of ascites may be either
symptomatic or idiopathic, and either local or general. When
symptomatic, it may be seated in some diseased viscus, as the liver,
spleen, or in the mesenteric glands, &c.

"To produce, however, a dropsical effusion into the abdomen
from this cause, it is necessary that the disease of this
viscus should be making progress; for, in its indolent state,
or, in other words, if inflammation be not present in it, it is
incapable from its mere bulk, as is commonly but erroneously
supposed, of producing this effect." "Nor does the serous
discharge always take place into the abdomen, in every case
where these organs are morbidly affected, but only where their
peritoneal covering participates in the disease; for the
chronic inflammation in those cases, where it occasions
ascites, does so by extending from the cellular tissue of the
internal structure of the organ, to the serous tissue investing
in it." "When ascites is an idiopathic affection, it may
proceed from all the common causes of inflammation. The most
frequent cause is cold, and which may act either locally or
generally. When in the latter mode, the ascites is usually
combined with anasarca, and the disorder generally comes on
suddenly, and has a rapid progress. The vascular system is
excited, and there is more than usual thirst; the blood when
drawn exhibits the buffy appearance; and the urine, when
subjected to heat, is found to coagulate strongly, from the
large quantity of serum contained in it. In some of the severer
cases, the effusion into the abdomen takes place very suddenly,
and yet, by a copious bleeding the disease may be at once
arrested, and the water be afterwards absorbed."

Unlike what occurs in hydrothorax and hydrocephalus, the effusion in the
present form of dropsy is of inconsiderable importance, compared to the
visceral disease which is its remote cause. When, however, the
accumulation becomes very considerable, the pressure of the fluid may
affect the organs, and more particularly the peritoneal lining, which
from the irritation induced in it, may take on a higher grade of
inflammation, terminating in effusion of coagulable lymph or pus, and in
death. The necessity which arises of tapping, where the effusion is very
considerable, proves sometimes a farther cause, perhaps, of aggravating
the disease of the affected viscus, and either of renewing or extending
the hydropic excitement, or of converting it into a higher or more
destructive form of inflammation.

By most writers on dropsy, anasarca has been maintained to originate, in
all instances, in debility, and to be curable only by a tonic and
invigorating plan. It is true that some writers, especially among the
ancients, (for we can hardly class PORTAL among the moderns,) have
spoken of the disease as arising occasionally from a plethoric state of
the circulation, and enforced the necessity, under these circumstances,
of venesection. This view of the pathology of anasarca, although leading
in many instances to a successful practice, was, however, vague and
often unsatisfactory. To the late Dr. RUSH, and to Dr. PARRY, much
credit is certainly due for their labours on this subject; but so far as
we are informed, it was not until within a few years, that the subject
was cleared of part of the obscurity in which is was involved, and that
the disease, at least the active sort, has been referred to an
irritation of the cellular tissue. Following up this opinion, and
generalizing still more than the French pathologists, our author asserts
that anasarca invariably consists in an inflammation of the cellular
membrane of the body, with a serous effusion as its result. The
accumulation, he continues, may be either idiopathic or symptomatic, and
either general or local; occurring only under two forms, the one being
of greater intensity that the other. In general, the disease derives all
its importance from the nature of the remote cause.

"When it is idiopathic and proceeding from cold, it is usually
unimportant, for though the progress of the swelling be rapid,
and the appearance of the disease formidable, yet it readily
subsides under proper treatment, as the effusion proves in
these cases, either partially or fully corrective of its cause;
and little more, under such circumstances, is required in its
treatment, than to promote the absorption of the water. In some
cases of general anasarca, however, the disease is more severe;
for sometimes the action of the heart and arteries is
increased, the urine becomes loaded with serum, and there is
thirst and other indications of general vascular excitement,
similar to the state which was noticed, as producing effusion
into the brain, or the other cavities of the body."

In some cases, the serous effusion appears to be translated from one
part to another. Our author very justly adds, however, that this
translation is not of the serous fluid, but only of the serous
inflammation giving rise to the effusion. It usually takes place from
one portion of the cellular membrane to another; but sometimes from this
membrane to the serous tissue of the brain, chest, or abdomen.

Oedema of the feet and ankles is often symptomatic of chylopoietic
disturbance, and particularly in young women, in whom the menstrual
function is obstructed. In these cases, as well as in the oedema
following gout or rheumatism, the swelling usually commences with
considerable pain and stiffness of the parts, and hardness of the
swelling.

"But the most common form of anasarca is that which is
symptomatic of some visceral disease; and which, as it
ordinarily appears, arises from a state of the system that
answers to the hydropic diathesis of systematic authors."

This form of the disease begins in the lower extremities, and is rarely
attended with strong signs of local excitement so obvious in anasarca of
the idiopathic kind. Its occurrence has been referred to various causes.
When combined with ascites, it is supposed to arise from pressure of the
iliac veins by the fluid accumulated in the abdomen,--an opinion which
our author combats by repeating, in great measure, the arguments we have
already noticed.

"But here let me observe, that the denial of ascites producing
an anasarcous state of the legs, from the water compressing the
iliac veins, must not be understood as implying, that a
mechanical compression of a vein will not in other cases
produce an effect of this kind. A pressure made on the brachial
vein and its branches by scirrhous glands in the axilla, is a
common cause of this state. The remote cause is here, indeed,
of a mechanical kind, but not so the proximate cause of the
effusion. By the resistance given, in this case, to the blood's
return by the principal veins of the limb, a reaction is
occasioned in the extremities of the arteries leading into the
corresponding extreme branches of the veins, and which reaction
is in this, as in a multitude of other occasions of congestive
fulness in these vessels, a sanative effort of nature to
overcome the primary obstruction."

The disease has often been referred, when occurring under these
circumstances, to a local and general debility; and this opinion is
thought to be supported by the facts that the swelling is increased by a
depending position of the limb, and diminished by a horizontal one--by
the occurrence of an inflammatory state of the parts being incompatible
with such a degree of debility, and lastly by the absence of
preternatural heat on the surface of an oedematous part. To these
pretended arguments, Dr. A. opposes, that the effusion cannot be
attributed purely to debility; because the effects are in no
correspondence with the assigned cause,--the debility being, in some
instances of chronic and acute disease, very considerable, and the
effusion small, and vice versa;--because anasarcous limbs will occur in
the strongest individuals when the limbs have remained a long time in an
erect posture,--because there is in certain fatal chronic diseases, a
tendency in the lower limbs to take on an inflammatory action, often of
an erysipelatous kind,--and because the fact of oedema increasing by
an erect posture and diminishing in the horizontal one is readily
explained by the greater congestion of the vessels induced in the limb
by such a position, as it occurs in the higher grades of inflammation.

"And with respect to the temperature of the surface of
oedematous parts not being preternaturally raised, the
objection, if of any force, must apply to all, for all have
this peculiarity, and yet some cases of oedema confessedly
arise from inflammation; differing not, in this respect, from
several other morbid states, as those for instance, of chronic
rheumatism, and which are indubitably, as indicated by the
nature of their causes and remedies, of a truly inflammatory
kind."

Dr. AYRE, therefore, regards all these cases as secondary to a serous
inflammation seated in a cavity; and lastly as arising from some
disturbance in the digestive functions, by which this and other distant
irritations are produced through the operation of that law of the animal
economy, denominated sympathy.

Having thus offered, in the preceding pages, an analysis of Dr. AYRE'S
views of the pathology of the principal forms of dropsy, we must be
allowed, before proceeding to the treatment of the disease, to make a
few remarks. It appears to us that Dr. A. has treated the subject in a
very able manner, and contributed greatly to remove many objections,
that could be adduced against the opinion of the inflammatory nature of
some of the more obscure cases of dropsy. We cannot help thinking,
however, that he is too exclusive in his theories, and that he has
rejected too positively the idea of a passive dropsy; in other words, of
a dropsy independent of inflammation. Some cases of the disease which
follow extensive losses of blood, (profuse uterine hemorrhages, for
example) and which are cured by tonics and an invigorating diet, without
the aid of diuretics, cannot always, though they may sometimes, be
accounted for by admitting the existence of inflammation. Such instances
have fallen under our own observations, and could not be explained by
supposing that the effusion had relieved the inflammation; since there
had not existed, at least as far as we could ascertain, any local
inflammation. In one case it followed abortion, attended with profuse
hemorrhage, and produced, not by disease, but by an accident.

In the second and fifth volumes of the _Archives Générales de Médecine_,
Dr. BOUILLAUD has related many cases of partial and general dropsy,
which undoubtedly originated in obstruction to the venous circulation,
from adhesion of the parietes of the principal veins. It is true that
Dr. A. is compelled to admit this among the causes of dropsy; but
faithful to his theory, he supposed the supervention of an arterial
reaction resulting in an effusion of serum. It does not appear to us,
however, that this arterial reaction is admissible in all cases of the
sort, and we prefer on the whole the explanation of the mechanism of the
effusion, originally given, by DONALD MONRO, and lately by Drs.
BOUILLAUD and BROUSSAIS, who refer it to an obstruction in the venous
circulation and to a consequent deficient venous absorption. By
admitting this explanation, it is readily perceived, that we admit a
passive dropsy, and we think the view well exemplified by a case which
occurred last summer. The individual had recently recovered from a
violent attack of disease, and was left much debilitated. Induced by
this circumstance to travel to the north, he had occasion to notice that
when seated long in a stage with his feet depending on the veins
compressed, oedema invariably came on, and that it as invariably went
off the next day if he did not ride. This occurred so often as to lead
us to think there could not always be an arterial reaction occasioning
the effusion, and that this effect arose from the mere obstruction to
the venous circulation.

In making these remarks we are not actuated by the desire of detracting
from the merits of Dr. A.'s views of the pathology of dropsy; convinced
as we are, that the great majority of cases of the disease, which are
thought by many physicians to arise from debility, do not owe their
origin to this condition of the system, but to an increased excitement
of the membranes or cellular tissue. Were it otherwise, how could we
account for the fact, that dropsy is generally _local_, whilst the
_debility_ to which it is in most instances referred, is general?

But whilst maintaining the correctness of many of Dr. A.'s views, we are
inclined to the opinion, that he may do some injury to the doctrine he
is advocating, by invariably making use of the word _inflammation_, to
express that condition of the vessels, giving rise to an excessive
secretion of serous fluid. We are ready to admit, and we dare hope, that
few will refuse to do so, that _inflammation_, strictly speaking, will
occasion such an effect; yet, it often happens, that effusion will occur
in cases, where no inflammation can be detected. In such instances, the
vessels are evidently in a state of increased excitement; or in other
words, in a state of irritation, but not of inflammation, which always
implies congestion. This latter morbid condition, may supervene on the
irritation, and occasion a suppression of the serous effusion, and the
formation of coagulable lymph or pus. It is true, it may be said, that
both these states (irritation and inflammation) being an increase of the
life of the part, and requiring the same treatment, may be designated by
the same name. Nevertheless, to prevent confusion, and the quibbling of
some of the opponents of the theory of inflammation in dropsy, we are
inclined to believe, that it is better to substitute the word
irritation, whenever there is merely an increased secretion, and reserve
the word inflammation, to designate those cases, in which there are
decided marks of local excitement and congestion, attended or not with
general fever.

Dr. AYRE, adopting the opinion of Dr. PARRY, regards some cases of local
dropsy as an effect of a general hydropic diathesis, or of a general
inflammatory action of the vascular system, occasioning a local
excitement, ending in dropsy. This is a natural consequence of the
views, entertained by many physicians in Europe and this country, that
fever produces local inflammation. We must confess, however, that all
Dr. A. has said on the subject, is not calculated to carry conviction to
our minds. Thus, one of his reasons for regarding some cases, as arising
from this general vascular excitement is, that they are produced by what
he considers as a general cause,--as cold, for example. But cold
produces local diseases, occasioning, and not preceded by, a febrile
excitement; and if it can, and does occasion anasarca, who will pretend
to assert, from its being a _general_ cause, that this anasarca is a
general disease? Does not cold occasion also ascites, which, in many
cases, is regarded by every one as a local disease, sometimes
terminating in anasarca? If so, why shall we regard anasarca, ending in
ascites, as a general disease? The cases are analogous, and the action
in both should not be explained differently. If the action of such a
cause were really general, and extended to all parts of the body, then
the effects should also be general, and the dropsy should be universal,
which is very far from being always the case.

2nd. It is also said in support of this opinion, that where anasarca is
idiopathic, it is attended with fever, but that this latter does not
exist, when the disease follows ascites. This difference appears to us
to be very readily explained by the fact, that the disease in the former
case, is more acute, and that the heart sympathises more actively with
the irritated cellular tissue, than in the second case, when the disease
is milder, or more gradual in its progress.

3d. It is also maintained, that when anasarca is idiopathic, there
exists a large quantity of serum in the urine; and this is brought
forward in order to distinguish these cases from local dropsies. But it
is also admitted, that serum is found in the urine in cases of anasarca
following ascites. Consequently, if there be none in cases of simple
ascites, and if it only appears when anasarca supervenes, the only
conclusion that may be drawn from these facts, is, that anasarca is the
only form of dropsy, in which serum is absorbed, and passed off by the
kidneys; and if there be a greater quantity discharged when anasarca is
primary, it is only because the disease is more violent, and generally
more extensive. But, surely all this is far from proving, that primary
anasarca is a general disease, and owes its origin to a primary arterial
excitement of the whole system. When fever exists first, and terminates
in dropsy, who has proved, that there existed no local irritation
producing the fever, and that the hydropic irritation has not supervened
by metastasis. This takes place in scarlatina and other eruptive
diseases, which Dr. A. would surely not be justified in calling general
diseases. Dropsy follows the suppression of cutaneous diseases,
unattended with fever; consequently, when there happens to be a febrile
excitement, we are at a loss to know, why we should call this latter to
our aid, in our explanation of the dropsical effusion, and not account
for it on the same principle, as we did in the former cases; namely, by
metastasis. If febrile symptoms are sufficient to make us regard a
disease as general, then there is no local disease, except when
apyretic.

We now proceed to notice the mode of treatment, recommended by our
author, for the different forms of dropsy. From what we have seen, it is
natural to conclude, that as Dr. AYRE regards the proximate cause of the
several forms of the effusion, or in other words, the _disease_, to be
the same under all its conditions, he will be of opinion, that "the same
general principles of treatment, are alike applicable to all--subject
only to such modifications, as arise from differences in the nature and
intensity of the remote cause, and those general or local relations of
the parts implicated in the serous effusion, with the diseases of the
organs, which incidentally produce it." Founding upon these views the
indications of cure, he states them to be; 1st. To remove the visceral,
or such other disease or state, which, when present, proves a remote
cause of the effusion; 2nd. To remove the morbidly increased action in
the serous membrane or tissue, which is its proximate cause. 3d. To
promote the absorption of the effused fluid.

Agreeably to Dr. A. the treatment of hydrocephalus internus, is
divisible into three general heads:

"The first, consisting of means to correct, with its causes,
that turgescent state of the brain, which may produce the
arterial re-action and effusion; the second, of those which
shall subdue the excitement, when formed; the third, to correct
or relieve, as far as it is practicable, the effects of the
effusion, and procure, if possible, its absorption."

With respect to the general causes, tending to produce that congestive
state of the brain, precursory to its inflammation, he remarks, that
they are of three kinds; 1st. Those acting through the general system,
and consisting of an irritation, from some obstructed or required
evacuation; 2nd. A local disease, seated in the head, or a local injury
inflicted on it; 3d. Chylopoietic disturbance, acting sympathetically
upon the brain. When the first of these causes appears to have been
instrumental, in occasioning this condition of the brain, it is plain
that it must be removed, and the obstructed emunctory corrected,--the
suppressed evacuation promoted, or a new and artificial one substituted.
When there exists any structural disease within the head, or a relic of
a former state of excitement, a serous inflammation may be reasonably
apprehended, and to avert it, the most rigid and undeviating attention
must be paid to regimen, whilst cupping and leeching must be employed,
and a seton fixed in the neck.

"For the object of the treatment, in these cases, is not to
remove, but to avert the inflammation, and which, from the
strong disposition to it, conferred by the organic disease, can
only be effected by avoiding, not merely the causes of
inflammation, but likewise, all those agents, which are
calculated, in any way, to increase the momentum of the
circulation." "Beyond those, the common precautions against
morbid irritations, little else can be done."

When the turgescent state of the brain, arises from a disturbance in the
digestive organs, it will be remedied, by means directed to this cause.
Our author locates the primary seat of this disturbance, in most cases,
in the liver; though he admits, it may occasionally be in the stomach
and intestines. He places great reliance for correcting and increasing
the secretion of bile, on small doses of calomel,--purging off the
contents of the intestines by aperient medicines; and recommends, at the
same time, the application of cups and leeches to the temples, as a
measure of precaution. He very properly lays considerable stress on the
necessity of combating this secondary affection of the head;

"For though the means applied, to correct the disorder in the
digestive organs, may be sufficient to remove the turgescent
state of the brain, which arose from it, yet, those means will
have little or no control over the excitement, which that
turgescent state has created; and still less can they avail in
subduing an excitement, that may even survive its remote cause,
and continue independently of it. By overlooking these facts,
much distrust and disappointment have arisen with many, who
confided in the opinion, delivered by some writers, of the
uniform prevalency of chylopoietic disturbance, as a cause of
this disease, and of the sufficiency of calomel to remove it."

When the inflammation exists, and is a sequel of some pre-existing
structural disease in the brain or membranes, all that can be reasonably
expected, is to _palliate_ it by the antiphlogistic plan; but when it is
idiopathic it may readily be cured, by the same remedies, graduated to
the age and strength of the patient and to the violence of the attack.
Dr. A. seems to rely principally on cups and leeches;--not excluding, in
some cases, bleeding from the arm. Blisters to the summit of the head
and afterwards a cold evaporating lotion to the temples, are also
recommended. As soon as, by these means, an impression is made on the
disease, mild diaphoretic medicines, assisted by the tepid bath, or the
pediluvium, maybe prescribed;--the bowels are to be kept open by small
doses of calomel, followed after two hours by a draught of some aperient
medicine,--the antiphlogistic regimen should be rigidly enforced, and
light and noise carefully excluded.

"Many practitioners give the mild preparations of mercury, and
particularly calomel, freely in this disease, under a notion of
its having some specific power in subduing it; but it never
should be so used, excepting in cases where the disease is
symptomatic of some functional disturbance in the liver and
other chylopoietic organs, where it is calculated, in
conjunction with the local bleeding, &c. to afford the most
important service."

With a view of pointing out some characteristic sign, by which to
distinguish those cases in which the affection of the bowels is primary
from those in which it is secondary, he remarks--

"The condition of the stools at the period when a child is
labouring under the disease, will afford to such persons but an
imperfect notion of its true nature; for the disturbance of the
brain will often create a disorder in the secretions, both of
the liver and the other chylopoietic organs, producing green
looking stools; and there is often a congestive state of the
brain for a short time preceding the full development of the
idiopathic excitement, which may, in like manner, by reacting
upon the liver, create a disorder there. In cases, however,
which are symptomatic of this cause, the chylopoietic
disturbance will be found to have existed several days or even
weeks; and the origin of the disorder, in like manner, may be
commonly traced to some irregularity of diet, or other obvious
causes, and frequently in infants to those which are connected
with premature weaning; and sometimes even the cerebral
disorder itself will have been only the last of a series of
effects in the system, to which such disturbance had given
rise."

Agreeably to Dr. A., it is not proper to discontinue those means,
immediately upon the occurrence of what appears to be symptoms of
effusion, since, frequently, these symptoms, as it respects the
effusion, will immediately manifest their fictitious character, and
disappear under a treatment no wise adapted to such a state, and with a
rapidity, too, which equally betrays their true nature. He notices,
though we believe not in its proper place, a modification of the disease
in which the effusion takes place in the cellular membrane of the
substance of the brain, and thinks this species more likely to be
recovered from than when the water accumulates in the ventricles. He
concludes this section by remarking, that

"Of the means to be employed to promote the absorption of the
water, under these or other circumstances of its accumulation
in the brain, little satisfactory can be said. The treatment
must be founded on the use of such means as shall avert the
risk of renewing an inflammation in the organ. To this end,
occasional blistering the head will be proper; the diet must be
spare, and the several secretions, particularly those of the
kidneys, must be cautiously promoted."

We next turn to the treatment of hydrothorax and ascites. As the
existence of hydrothorax in its early stage is difficult to ascertain,
and as what have been called premonitory symptoms are only those proper
to the mildest forms of the disease, and not of that condition of the
parts which gives rise to the effusion, the treatment is somewhat
difficult, and, in too many instances, our remedies are directed, not to
the disease itself, but to one of its effects. Faithful to his view of
the pathology of dropsy, Dr. A. remarks, that the plan of treatment to
be pursued at an early stage of symptomatic hydrothorax, must consist in
the use of those means which shall subdue the chronic excitement of the
serous membrane, as well as the chronic inflammation of the diseased
organ. To attain this end, the antiphlogistic and revulsive plans,
graduated to the age and strength of the patient, and to the violence of
the disease are recommended. In general the frequent application of
leeches are held by Dr. A. as preferable to venesection, unless the
patient be plethoric, and the disease arise from a local congestion
within the chest, which, according to him, is often a cause of serous
inflammation of the thoracic tissue, independently of any previous
disease. Dr. AYRE calls attention to the fact, that topical bleeding is
particularly adapted to correct that chronic inflammation of the serous
membranes, which causes an effusion from them, and which is neither the
result of any inflammatory excitement of the general system, nor of a
nature to produce it; and that when properly conducted, it has the
advantage of acting only slightly on the general system, and therefore
only slightly on the general strength, and very considerably on the
local disease. Together with leeches, blisters are to be used, and after
the chronic action existing in the serous membrane is subdued by these
means, a seton fixed in the integuments of the chest will be found of
great utility.

The same treatment will be found equally serviceable, not only to
correct the chronic excitement existing in the peritoneal membrane and
giving rise to ascites, but very commonly to cure or palliate the
visceral disease producing it. In respect to the very common practice
of resorting to mercury in this complaint, our author makes the
following judicious remarks.

"With too many practitioners, it is the practice to employ
mercury freely in every case of abdominal dropsy, under the
vague notion of there existing some mechanical obstruction in
the liver or other viscus, as a cause of it; and under the
equally vague notion, that mercury so employed will remove it.
The practice, however, to speak of it in the mildest terms, is
founded on erroneous views of the pathology of these diseases;
and employed, therefore, as it is by some, on all the occasions
in which they meet with them, must be frequently very
injurious. For, independently of the injury to be inflicted by
it, when given freely in some of the forms of liver disease,
there is an effect produced by it on the urine, when given to a
person in health, resembling that which arises from the
specific excitement of dropsy. Under a salivation, the urine
becomes charged with serum. Any condition of the system,
therefore, approaching even to a state of salivation, must be
injurious, by the tendency it must have to increase that morbid
state of the body, which is nearest allied to the hydropic one.
Hence the mercurial salivation has been numbered amongst the
remote causes of dropsy; and the resemblance between the
dropsical and mercurial excitement, thus established by the
common resemblance of the urine in these states, goes far to
prove this connexion; and it is not improbable, that the
mercurial inflammation, when considerable, may survive its
specific cause, and degenerate at length into the purely
hydropic state. When, however, mercury is given in minute
doses, so that these its specific morbid effects are not
produced, it is capable of becoming highly useful, as we shall
presently have occasion to notice."

In conjunction with bleeding and other means just noticed, drastic
purges have an important influence in subduing the disease; not merely
by removing the water, but likewise by contributing to subdue the
chronic excitement which occasions its effusion. This latter effect Dr.
A. very justly refers to the counteraction and irritation these
medicines excite on the mucous membrane of the bowels, by which the
excitement of the serous tissue or of the diseased viscus is removed. He
remarks that drastic purgatives are sometimes inadmissible in ascites,
when an affection of the liver or mesentery is its remote cause, and
there is a tendency to a spontaneous diarrhoea, which even the mildest
purgatives would increase. "In the case of the mesentery, such a mode of
treating dropsy would speedily destroy the patient." Dr. A. ought,
perhaps, to have explained the real cause of the danger attending the
practice, and not referred it merely to the tendency to diarrhoea,
which itself can only be an effect of a morbid condition of the bowels.
The fact is, that most cases of hepatitis, and all cases of mesenteric
disease, are attended, whether as cause or effect we care not, with
inflammation of the stomach or bowels, which purgatives can only tend to
aggravate. In general, the practice of administering drastic purgatives
is more serviceable in hydrothorax, and especially in anasarca, or in
_idiopathic_ serous inflammation of the peritoneum. Dr. A. prefers the
gamboge to all other medicines of the same class, and gives it to the
amount of four or five grains in a single dose, with the same quantity
of some aromatic powder, and triturated with a few crystals of the
supertartrate of potassa; or in urgent cases of hydrothorax, he
prescribes ten or twelve grains, divided into four doses, one of which
is to be given every three hours. When the strength admits of it, the
purgative may be given every four or five days.

Dr. A. next notices diuretics.

"The sensible operation of these medicines," he says, "as is
well known, is to promote the secretion of the kidneys. There
appears to me, however, to be farther effects produced by them
upon the system, or particular parts of the system, which is
not referrible to the mere evacuation of a certain quantity of
fluid from the body; and these effects, it is probable, consist
in promoting the natural discharges by this and, perhaps, the
other emunctories, whose partial suppression may either produce
this disease, or serve materially to continue it; and likewise
in occasioning a derivation of blood to the kidneys, and
therefore to a part distant from the morbid one; and that thus,
whilst they are contributing materially to the removal of the
fluid, they are serving like the purgative, an important end,
in assisting to subdue the cause of it. The medicines which I
am accustomed almost entirely to rely on in this disease, are
the powder of dried squill and digitalis, given in combination
in the form of pills, and in doses, which, from their
smallness, will probably excite no little surprise in the minds
of some of my readers. The dose of the squill is something less
than a grain, and of the digitalis only a sixth part of a
grain, given uninterruptedly every third or fourth hour."

To render these medicines more effectual, a third or half a grain of
calomel may be given nightly, and an infusion of dandelion, or some
other popular diuretic, may be taken _ad libitum_. Our author speaks in
terms of merited disapprobation of the practice pursued by some
physicians, of allowing their patients daily, potions of gin punch, with
the view of aiding the operation of the diuretic medicine, and
supporting their strength. He shows, that, although by these means the
water may be promptly evacuated, the disease is not cured, and the
effusion is soon renewed with redoubled violence and danger to the
patient.

In the idiopathic form of hydropic inflammation, attacking the serous
membranes of the chest and abdomen, and which, agreeably to our author,
may be strictly local, or consist in a general specific excitement of
the system, leading to a general watery effusion, the lancet is
particularly advantageous, and should be had recourse to. The pulse is
generally hard, the blood exhibits a buffy appearance, and the urine
coagulates when subjected to heat. Leeches, in pretty large numbers,
must also be used, as well as all the remedies already enumerated. But
as in these cases, which according to Dr. AYRE are more common among
females than males, and among the younger than those of middle and
advanced age, the disease is of a more acute nature, a greater reliance
is to be placed on an active antiphlogistic plan; and if this be
steadfastly persevered in, comparatively little difficulty will be
experienced in effecting a discharge of the water.

When hydrothorax occurs after scarlatina, and is combined with anasarca,
its course is generally rapid, and the cure difficult; partaking, as it
often does, of the two-fold state of debility and excitement. When
detected early, the lancet must be promptly used. Cups and leaches,
followed by the warm bath, blisters, and cathartics, must also be
resorted to.

"Diuretics, which are so beneficial in the less acute forms of
dropsy, are commonly too inert and slow in this, unless given
in doses to act immediately upon the vascular system, when the
infusion of digitalis, as given by many practitioners in all
the other states of the disease, may be resorted to; since the
treatment here is not so much to remove the water, as to
prevent, if possible, its farther effusion; for when a
discharge suddenly takes place into the chest after scarlet
fever, it will generally prove fatal, even though the quantity
collected be inconsiderable, and only such as would occasion,
if gradually effused, a moderate degree of inconvenience to the
lungs."

In respect to tapping, our author remarks, that the circumstances
calling for this operation are, where, from the very considerable
accumulation of water, and the consequent distension it occasions, a
permanent and morbid stimulus is given to the peritoneal membrane, by
which its serous inflammation is perpetuated or increased; or where so
much pain and irritation are produced, as to risk inducing a similar
disease in the chest, and of bringing on likewise an ulcerative form of
inflammation in the peritoneal lining of the abdomen.

"Whilst the objections to its employment consist in the danger
which is incurred, where there is much visceral disease, of its
causing a destructive form of inflammation in the peritoneum;
and the probability of its occasioning, under the most
favourable condition of the disease, a more rapid renewal of
the serous accumulation."

Our limits not allowing us to enter on the treatment of ovarian dropsy,
we proceed to offer a few remarks on the means recommended by Dr. A. for
the cure of anasarca. As in the treatment of every other form of dropsy,
it is necessary, in attempting the cure of anasarca, to advert to the
nature and causes of the disease.

"If it be idiopathic, and unconnected with any dropsy of a
circumscribed cavity, and the pulse at the same time be soft,
and the urine free from serum, it may be treated solely with
the view of procuring the absorption of the effused fluid, as
in such cases, the watery discharge in all probability will
have removed, in a considerable degree, the excitement which
caused it."

It is in such cases that recoveries take place under almost any plan of
treatment, and that bark and other tonics have been found beneficial.
Their utility, however, in these cases is very limited, consisting only
in aiding the removal of the effects of the disease, and keeping up the
strength of the system, whilst the absorbents perform their function,
and remove the fluid. Dr. A. recommends, in these cases, puncturing and
bandages; but he very justly adds, that they must not be employed,
whenever there remains any inflammation in the parts, as they would then
tend to aggravate it.

"To oedematous swellings, in which the serous local
inflammation, whether symptomatic or idiopathic, still
subsists, I am accustomed to direct the application of leeches
and cold evaporating lotions, observing not to commence the use
of the latter, until twelve hours after the leeches have been
used, that inflammation may not be produced in the wound."
"When anasarca arises from a general excited state of the
system, as denoted by the pulse, and by the serous quality of
the urine, venesection becomes necessary, combined with the use
of leeches, applied to the extremities, or to those parts of
the body, in which the serous tissues are most affected, along
with the active use of the general means already alluded to."

In anasarca, an error is sometimes committed, especially by young
practitioners, of estimating the degree of danger, and the necessity for
active treatment, by the single consideration of the extent of the
oedematous swelling. This, however, should be guarded against, as the
swelling may be very considerable, and the disease subsided, or of
little consequence; whilst, in other instances, the reverse may be the
case. In the first instance, where the disease is not seen early, the
treatment must sometimes be limited to those means which promote the
absorption of the water, and neither venesection nor leeches will be
required. In such cases, the practitioner must be guided by the state of
the pulse and urine; the presence or absence of vascular excitement; the
history given of the case up to the period when visited, and
particularly by the progress of the swelling.

"When the dropsy of the skin is considerable and long
protracted, and symptomatic of some visceral disease, as it
most commonly is in these cases, and is attended by a serous
state of the urine, and a general failure of the strength, the
cachetical state of the system may be considered as
established, and the treatment is then beset with difficulties.
For the general means, which are useful in the earlier states
of the disease, and when the vital strength is entire, become
injurious in this, by the tendency they have, aided by the
effects of the visceral disease, to diminish farther the vigour
of the system; whilst, at the same time, the treatment, which
is suited to support the declining strength, can contribute
nothing towards lessening the constitutional and local
diseases, but will frequently increase the morbidly excited
state of the circulation, which, analogous to what occurs in
diabetes, will continue and increase under the most decided
marks of general constitutional weakness. Pending the
continuance of that inflammatory state of the system, in which
the urine is charged with serum, the debility will be mainly
derived from that drain of its nutrient parts, which is thus
established in the body, assisted by the weakening effects of
the organic disease. If blood be drawn, it will be found, in
many of these cases, to exhibit the usual signs of
inflammation; and the treatment of the tonic kind, when
employed to support the strength, will be found to act
unfavourably.

"The plan to be pursued must consist in the use of such means
as shall assist the powers of digestion and assimilation; so
that, by a highly nourishing but plain diet, the drain from the
system may be somewhat counteracted; and, at the same time, the
cause of the effusion is to be corrected by the use of local
depletion and blistering, and by the temperate employment of
those general means, which are useful in the less aggravated
forms of the disease."

The diet of patients, in the symptomatic forms of dropsy, should be
plain and unirritating; and in the idiopathic states, the antiphlogistic
regimen should be rigidly enforced; particularly an abstinence from all
fermented liquors, until the inflammatory period of the disease be
removed. The clothing should be moderately warm, and selected of that
kind, best suited to promote the insensible perspiration of the surface.

Before taking leave of Dr. AYRE, we cannot omit adverting, in a very few
words, to a circumstance noticed in his preface, and which we think of
some importance. He remarks, that if, in the prosecution of his task, he
has had no acknowledgments to make to any individual as his guide and
authority, he is nevertheless indebted for many important facts to the
writings of the late Dr. WELLS, and of Drs. BLACKALL, ABERCROMBIE, and
DUNCAN, jun. and particularly to the system of pathology of Dr. PARRY.
He further remarks, that he entertained and taught for many years, the
views advocated in this work, and that, after the manuscript had been
sent to press, he had seen a copy of an abridged edition of the
elaborate Dictionnaire des Sciences Medicales, in which the doctrine of
dropsy, maintained in the larger work, is relinquished; whilst others
are given in their place, conformable, in the main, with those which it
is the object of his treatise to establish. Now it would appear, from
these expressions, that Dr. AYRE wishes to inculcate the idea, that the
English writers, whom he has cited, were the only ones who had published
anything valuable, and conformable to his doctrine; and that prior to
1823, the year of the publication of the Dictionary above mentioned, the
French entertained very different views of the pathology of the disease.
We think it our duty, however, to rectify our author in this respect,
and to show to our readers, that, even allowing full credit to Drs.
WELLS, BLACKALL, ABERCROMBIE, &c. for their researches into the nature
and treatment of dropsy, the American, French, and Italian pathologists
are entitled to a much larger share than is allowed to them in the
present work. A few references will be sufficient. Many years ago, our
celebrated RUSH taught, that general dropsies "depend on a certain
morbid excitement of the arteries;" and that hydrocephalus, "in its
first stage, is the effect of causes, which produce a less degree of
that morbid action in the brain which constitutes phrenitis." In 1812,
Dr. BRESCHET, of Paris, published an excellent dissertation on active
dropsies. In the early writings of BROUSSAIS, though more particularly
in the propositions prefixed to his _Examen_, the opinion is maintained,
that all active dropsies depend on irritability, either primary or
secondary, of the serous and cellular tissues,--a theory more closely
allied to Dr. A.'s, than all that is contained in the writings of Drs.
WELLS, PARRY, &c. But what, perhaps, is more to our purpose, Dr.
GEROMINI, of Cremona, published a work, in 1816, on the origin and cure
of dropsy, in which he compares the dropsical accumulation to that of
serum produced by the inflammation of a blister, or by fire; and in
which he also maintains, that a slight inflammation occasions a flow of
limpid serous fluid, whilst a higher degree gives rise to the formation
of pus. From these circumstances, he concludes, that the hydropic fluid,
which contains little albumen, is the product of a lower grade of
inflammation. In the same work, he finally asserts, that in more than
200 individuals who had died of dropsy, he invariably found marks of
inflammation or its effects; views which our readers will readily
discover to be nearly allied to those supported by Dr. A. In making
these remarks, however, we do not wish to be understood as asserting,
that the theory advanced by our author did not originate also with him.
We have too favourable an opinion of his honesty, to accuse him of
plagiarism. Our sole intention has been to render unto each the degree
of praise to which he is entitled, and, by pointing out this coincidence
of opinion, to derive a further proof of the correctness of most of the
pathological views, so ably defended in the present work.

ARTICLE VIII.--_An Essay on Venereal Diseases, and the Uses and Abuses
of Mercury in their Treatment._ By RICHARD CARMICHAEL, M.R.I.A. _With
Practical Notes, &c._ by G. EMERSON, M. D. Philadelphia, J. Harding,
1825; pp. 360.

One of the most important improvements in practice, which modern
experience has established, is the reformed method of treating venereal
diseases.

To the labours of several distinguished military physicians and surgeons
of Great Britain, we are chiefly indebted for the facts and researches
connected with this interesting subject. And although we may have much
to learn in regard to the true nature of these complaints; yet the plan
adopted by Mr. CARMICHAEL, of determining their distinct pathological
characteristics, and applying the remedies accordingly, is the only one
likely to subvert the empirical routine of prescribing mercury on all
occasions, a practice which derives such strong support both from the
indolence and prejudices of the profession.

In this country, many eminent practitioners have contributed to restrain
the abuse of mercury; and it is believed, that Professor CHAPMAN has for
many years, in his lectures, disseminated the most enlightened doctrines
on this point. Dr. HARRIS and other surgeons of the navy have made a
fair trial of the non-mercurial treatment, and with the most
satisfactory results.

The great object, so desirable of attainment, is to form a correct
discrimination between the diseases, which may be cured or benefited by
the exhibition of mercury, and those which do not require this medicine,
or become aggravated by its use; for it seldom fails to do injury, when
its advantages are not very obvious.

Mr. CARMICHAEL has taken the most conspicuous part in this investigation
for the last fifteen years, and from the extensive theatre, in which his
inquiries were conducted, has had the best opportunities of arriving at
the truth. He, therefore, who undertakes the management of these
affections, may be justly pronounced culpable, if he neglect to make
himself acquainted with the experience of this eminent surgeon.

In this enlarged and improved edition of his work, several subjects have
not been treated of so copiously by the author, as was requisite to
render it acceptable as a book of reference; but the judicious notes of
Dr. EMERSON, whose attention has been profitably directed to the
investigation of venereal diseases, have well supplied the deficiency.

A brief outline is here presented of the contents.

The author describes the various symptoms in plain and intelligible
terms; rejecting such unmeaning appellations as syphiloidal,
pseudo-syphilis, &c. as designating no particular phenomena, and
therefore of no use in describing a disease.

He thinks there is a plurality of venereal poisons, and has divided the
disease into four classes, from their different primary and secondary
symptoms; making the eruptions on the skin the most certain criterion of
distinguishing them from each other. These classes are:--the papular
venereal disease; the pustular; The phagedenic; and the scaly venereal
disease. The latter is the true syphilis.

First, the Papular. This is the most common disease, and the most easily
cured. Its primary symptoms are, a simple ulcer without induration,
without elevated edges, and without phagedena. Sometimes there is a
patchy excoriation of the glans penis, attended with a purulent
discharge. This disease and gonorrhoea are caused by the same poison.
The constitutional symptoms are:--fever; pain in the head, shoulders,
and larger joints, pain in the chest; dyspnoea; a papular eruption on
the forehead, chest, and back, sometimes extending in a more scattered
way over the extremities. It is often attended with iritis. It never
gives rise to nodes. The sore throat is different from that of syphilis;
the latter having deep excavated ulcers. If buboes accompany it, they
are mostly of an indolent nature. The eruptions do not all appear at
once; but follow each other. When on the decline, they are of a pale red
or copper colour, not scaly, as in syphilis, but papular; disappearing
and recurring repeatedly, and ending in desquamation.

_Remedies._--Venesection; cathartics; antiphlogistic regimen;
antimonials, combined with decoction of sarsaparilla. Alterative does of
calomel and antimonials, when the eruption declines.

The local treatment consists in astringent washes and simple dressings.

Iritis is to be cured by venesection, cathartics, mercury, blisters, and
belladonna.

This disease will yield to the powers of the constitution. Mercury is
always injurious in the early stage.

Second, Pustular venereal disease.

Primary ulcer of a reddish-brown colour; borders closely on the
phagedenic character. The edges raised and well defined; not excavated,
but on a level with or above the surrounding skin. In the commencement,
a small itchy pustula; distinguished from the ulcer attending the
papular disease by its well defined and elevated edges, and by the
absence of the smooth fungous surface of the former; from the phagedenic
by its well defined margin and its corroded-like surface, and the
absence of acute pain; and from chancre by the absence of the callous
edges and base. These ulcers are of a chronic nature, showing little
disposition to spread. The ulcers from buboes partake of the same
character, the edges being hard and the ulcer disposed to burrow. These
edges Mr. C. removes with the knife. The disease is rendered extremely
obstinate, where full courses of mercury have been given. The more
closely the eruption approaches the papular, the more mild and
manageable will be the disease.

_Constitutional symptoms._--The eruption is pustular, and often exhibits
simultaneously new pustules; also scabbing ulcers, the crusts of which
fall off, and leave discoloured patches of skin after healing. For these
ulcers of the skin, the best remedies are, sulphur fumigations,
nitro-muriatic acid baths, and ointment of tar and sulphur.

_Remedies._--Rest; gentle astringents; mild ointments; antimonials and
sarsaparilla:--for the constitutional symptoms; venesection; cathartics;
antimonials; sarsaparilla.

Mercury is decidedly injurious, until the disease is on the wane, when
alterative doses may accelerate the cure.

Third, Phagedenic venereal disease.

The primary ulcer has a corroded appearance. It exhibits neither
granulations nor induration. It spreads sometimes rapidly, sometimes
slowly; healing in one part, while ulcerating in another. It is mostly
situated on the glans and prepuce, and often attended with hemorrhage.
In this disease, buboes most frequently appear.

The sloughing ulcer occurs also in this disease. Mercury is extremely
pernicious, always rendering the disease more inveterate and rapid in
its progress.

_Constitutional symptoms._--High fever precedes the eruption, but abates
afterwards. Nocturnal headachs; tenderness of the scalp; slight
dyspnoea; tenderness of the sternum on pressure; soreness of the
chest; an eruption of tubercles, or pustules, or spots of a pustular
tendency, which quickly degenerate into ulcers, with thick crusts, that
heal from the centre, while they extend from the circumference, with
phagedenic borders. The crusts are often of a conical figure. The
ulceration of the throat is of the most formidable nature. It commences
in the form of a small white aphthous sore; which usually attacks the
velum or posterior part of the pharynx, mostly the latter. It extends
rapidly, destroying the parts, and at last attacks the bones. It often
attacks the larynx, after which, the patient seldom recovers. The
affection of the bones of the nose is never joined with the papular
eruption, nor with the scaly syphilitic lepra; but in every case with
the pustular description, and when scales and ulcers were present. At
the time of the eruption, pains in the knees, wrists, and ankles occur,
attended with swelling and redness. He has never seen nodes in the
disease, except in cases where mercury had been given. Full courses of
mercury introduce the disease into the deep seated parts; for the bones
are seldom or never affected in this disease, unless mercury has been
given.

_Remedies for the primary symptoms._--Absolute rest; venesection;
nauseating doses of antimonials; warm poultices and fomentations; opium;
hyosciamus and cicuta in sufficient doses to lessen pain and irritation.
For the sloughing ulcer, stimulating applications are often useful; such
as Venice turpentine or balsam copaibæ, mixed with olive oil.

_For the secondary symptoms:_--Venesection; antimonials; sarsaparilla;
Dover's powder. Mercury increases the ravages of the disease, except
when on the wane, when it may be given in alterative doses, with safety
and advantage. For the pain in the head, a blister to the nape of the
neck. If the eruption appear scaly, then mercury is likely to be useful.
If the throat and skin are affected, muriate of mercury in solution, and
decoction of sarsaparilla. If the ulcer in the throat be small, touch it
with the oxymel æruginis, or solution of nitrate of silver, grs. v a x
to an ounce of water; but if there exist extensive ulcerations,
fumigations with red sulphuret of mercury ought to be employed.

Fourth, Scaly Venereal Disease, or Syphilis.--Primary ulcer of a
circular form, excavated, without granulations, with matter adhering to
the surface, and with a thickened edge and base. The hardening is very
circumscribed, not diffusing itself gradually or imperceptibly into the
surrounding parts, but terminating rather abruptly. Its progress is
slow, sometimes assuming a tawny appearance.

_Constitutional symptoms._--Sometimes the skin, at other times the
throat, is first affected. There is headach, restlessness, and fever.
The scaly eruption appears, but does not relieve the fever, as in the
other diseases. This eruption commences with a small hard reddish
protuberance; and as it advances, the sides are raised, and centre
depressed or flat, and covered with thin white scales. It terminates in
ulcerated blotches. This eruption appears on the forehead, breast, back
of the neck, and groin; often in large copper coloured blotches, in
parts near the hair. The ulcers of the throat mostly affect the tonsils,
and come on without much previous pain or swelling; although there soon
appears a considerable excavation of the tonsil, attended with evident
loss of substance. The ulcer is foul, with thick white matter adherent
to it, which cannot be washed away. The bones then become affected,
those nearest the surface being most liable to attack; such as the
tibia, sternum, clavicle, and cranium.

The remedies for syphilis are full courses of mercury, for both primary
and secondary symptoms; except where a tendency to phthisis, or a
delicate constitution forbids them. He thinks syphilis a rare disease
now, compared with what it was formerly.

ARTICLE IX.--_Remarks on some Means employed to destroy Tænia, and expel
them from the Human Body._--By LOUIS FRANK. M. D. Privy Counsellor of
her Majesty, Maria Louisa, Duchess of Parma. [Lond. Med. Rep. April
1825.]

The symptoms produced by the presence of tape worm in the human body,
are exceedingly distressing, and the sufferings of the patient are
increased, by the obstinacy, with which these animals resist the
operation of the most disgusting, and even painful and dangerous
remedies. Improvements in the mode of attacking and expelling them,
therefore, should be gladly received, and widely made known.

The numerous reports which we have received, concerning oil of
turpentine as a remedy for tænia solium, have already given to that
remedy the highest character; but many cases have been only partially
relieved by it. The ol. tereb. seems to be capable of causing the
separation and expulsion of portions of the animal; but while the head
remains unexpelled, it is supposed to be capable of reproducing the
joints, to a degree not yet ascertained. If we may believe medical
writers, the tænia has been observed of the enormous length of 700 feet.
It is probable that the reproduction, after the loss of large numbers
of joints, is often very rapidly effected; as was the case in a patient
treated at the Carey Street Dispensary, mentioned in their report for
Aug. 1813,[18] This person always discharged very considerable
quantities of joints or fragments, after the use of oil of turpentine;
after which he remained free from the complaint for a few months, until
the tænia recovered a troublesome magnitude; when it was again easily
reduced to less uncomfortable dimensions.

We are not able to state positively, how long the oil of turpentine has
been in use as a remedy for tænia. The Carey Street Report for Feb.
1810, informs us, that a mechanic in Durham, having been very successful
in the treatment of tænia by means of this article, the circumstance was
communicated by Dr. SOUTHEY, of that place, to Dr. LAIRD of London; and
it was accordingly prescribed in doses of [Symbol: ounce]ss. to [Symbol:
ounce]ij. at several of the London charities. It had been found, says
the report, that ol. tereb. might be thus given, as safely as so much
gin, and frequently caused the expulsion in two hours: Dr. KNOX says it
has been in use in Germany for fifty years for the expulsion of tænia.

The experience of Dr. KNOX, concerning tænia, at the Cape of Good Hope,
is the most extraordinary that we are acquainted with. Dr. SPARMAN, the
traveller, had observed, that worms were exceedingly common in the
northern parts of the colony; but Dr. KNOX, who was there in 1819, did
not notice any special prevalence of verminous disorders, "previous to
Oct. 1819, when the _tape worm became so general among the troops, as to
resemble an epidemic_."[19]

Most of these troops had been employed on a short campaign to the east
of the great fish river. They had been compelled to live on very bad
beef and mutton, driven and starved half to death; and Dr. KNOX thinks
he has proved, that the tænia in these cases did "arise from the use of
unwholesome animal food; from the flesh of animals, which had been
diseased." Two out of five of the troops, who had been thus employed and
fed, were affected with worms. Of a detachment of 86 vigorous, healthy
young men, 36 were found, on inquiry, to have _tape_ worm. Those who
remained in the colony did not suffer so much, as those who had been out
on the campaign, the ratio being as one to four; whereas of the others,
it was two to five. Dr. KNOX had ample experience of the utility of
turpentine during this singular prevalence of tænia. Concerning the 36
men above mentioned, he says, "the cure of all, who chose to adopt the
means, was easily effected by small doses of the spts. of turpentine,
after the failure of purgatives and various other remedies."

He considers ol. tereb. as the _most efficacious remedy_. He does not
approve of large doses, because of headach, vertigo, and delirium, which
have been produced by them in "many patients."

"I have generally found," says he, "that from one to two drachms of ol.
tereb., given in a little water, morning and evening, for three
successive days, were sufficient to destroy the tænia solium, (even in
the most obstinate cases,) and cause it to leave the intestines, without
the aid of any purgative medicine." He advises, however, to give a
little castor oil each day about noon.

It has been a very common observation in regard to the dose of
turpentine, that the patient suffers more cephalic distress when it is
given in small quantity, than in a large dose. The writer of this has
been obliged to desist from the exhibition of oil turpentine, in doses
of [Symbol: dram]ij twice a day, in consequence of a vertigo so
considerable, as to alarm and distress his patient very much. Perhaps
there might have been in this case some peculiar liability to nervous
excitation, which in another patient would not have been worthy of much
notice. Dr. KNOX'S opinion is of great weight.

The celebrated remedy of CHABERT, Dr. KNOX thinks, owes its efficacy to
the ol. terebinth. combined with it.

Dr. FRANK, whose name stands at the head of this article, was informed
by the celebrated helminthologist, Dr. BREMSER, at Vienna, in 1814, that
he had for ten years preferred the use of CHABERT'S remedy, and with
invariable success.

CHABERT was a veterinary surgeon of Alfort, who used the animal oil of
Dippel in many diseases of animals, as well as those of men. This oil he
often gave for the purpose of removing tænia in his animals. He often
combined it with spt. terebinth. and gave equal parts of these
substances, in doses of [Symbol: dram]i.[20] The London Medical
Repository states, that CHABERT'S remedy is prepared from

Ol. Corn. Cerv. Foetid. 1 part.
Ol. Terebinth, 3 parts.

These are well mixed, and left at rest four days; they are then
distilled in a sand bath, till three-fourths of the liquor has passed
over. It must be kept tightly stopped, out of the light.[21]

The great objection to CHABERT'S remedy is its disgusting flavour; which
is the more obnoxious, because the remedy must be continued for a length
of time. Dr. FRANK cured two persons affected with tænia solium, after
considerable perseverance with it: he cured two other persons with a
preparation as follows:

Ol. Terebinth. [Symbol: ounce]ss
Æther Sulphuric. [Symbol: dram]ij
Pulv. G. Arab. [Symbol: ounce]ss
Aq. Flor. Chamam. distil. [Symbol: ounce]xvj _m._

Two spoonfuls morning and evening.

Four of these mixtures were sufficient to cure the patients, who
remained well two years afterwards.

A fifth patient, unable to take the last named medicines, was cured by
the boluses subjoined:

Sem. Santonic. pulv. [Symbol: ounce]ss
Pulv. Jalap.
Ferri Sulphat. aa [Symbol: dram]i
Ol. Corn. Cervi, gtt. viij.
Syrup. q.s.
Make 20 boluses.

One to be taken morning and evening. These 20 boluses being repeated
three times, the patient found himself perfectly well. In the above 5
cases, the tænia was discharged in fragments.

Dr. FRANK does not say much concerning the bark of pomegranate root,
which has come into vogue lately as a remedy for tænia. He refers to the
Med. Chirurg. Transact. Vol. XII. for accounts by some English
physicians, and remarks, that Dr. GOMEZ, the Portuguese physician, had
cured 14 cases with this bark.

Dr. POLLOCK (vide Ed. Med. and Surg. Journal, Oct. 1819) treated a
child, aged 14 months, with the decoction of bark of pomegranate root,
so far back as the year 1811. This infant, under the use of the
medicine, discharged at several times upwards of 30 feet of tænia
solium, and was cured. We learn also from the Med. Repository,[22] that
MM. DESLANDES, SOURYA, and BOURGEOISE, have employed pomegranate with
great success; that the decoction generally expelled the worm in two
hours; that it sometimes occasioned vomiting and griping pains; and that
it has been a common remedy for tape worm, in the East Indies, and among
the blacks of St. Domingo.

From the same source we are informed, that the French pharmaceutists
recommend, before boiling the bark, that it should be allowed to swell
(macerate) in cold water. [Symbol: ounce]ij of bark should be boiled in
lbij of water to [Symbol: ounce]xii. Of this decoction, [Symbol:
ounce]ij may be taken every half hour. The worm is here said to be
passed often in twelve hours instead of two. It may be necessary to
continue this plan four or five days, taking care to suspend the
medicine, in case any vertigo, or intestinal disease supervenes. A dose
of castor oil is recommended after the 4th bottle; even though the worm
be happily for the patient expelled.

In the Revue Medicale is a case, in which pomegranate succeeded in
discharging three ells of tænia; but the patient broke off the worm in
attempting to extract it with too much violence. This circumstance
recalls us to the consideration of Dr. FRANK'S communication. He
recommends much caution in the extraction of those portions of tænia,
which have remained partly in the intestine; and says that Dr. CAGNOLA
proposed touching the extruded portion with prussic acid, in hopes of
killing the whole animal by means of this violent poison. Dr. GARLEKE
adopted this plan on an extruded portion of four inches in length, and
in one hour afterwards the _whole animal came away dead_. Dr. F.
suggests, that the electric shock might weaken the tænia, so as to cause
it to let go its hold, and thus be unresistingly extracted. BRERA
recommended that the worm should be tied with a piece of silk. In this
manner, it is retracted into the bowel, but begins to descend again not
long afterwards. He dissuades from any attempt at forcible extraction,
which excites the most distressing sensations in the bowels, and causes
the risk of bringing on convulsions.

We are informed by Dr. FRANK, that a surgeon of St. Petersburg succeeded
by passing the worm through a canula, and the canula through the
sphincter ani muscle, so as to obviate the resistance caused by its
contraction. In this manner, he easily succeeded in withdrawing the
tænia _whole_, which is always desirable.

The writer of this article succeeded in removing many pieces of tænia
from a female, by means of the tincture of black hellebore, given in
doses of a teaspoonful for another object. The patient has since been
affected with the same symptoms, and took to-day, Oct. 19th, in doses of
[Symbol: ounce]iss, repeated every hour, sixteen ounces of a decoction
of the rind of pomegranate fruit, (none of the cort. rad. being
procurable); after which she took a dose of castor oil. It is said, we
know not on what authority, in a French journal, that this preparation
possesses the same powers as the root. It may be so; but this patient
had no discharge of the tape worm, after swallowing the whole of this
very astringent decoction, and following up the plan by taking [Symbol:
ounce]iij of ol. ricini.

Perhaps the tænia had been effectually destroyed before. She has seen
none of the joints for 18 months. The accounts, however, of the
expulsion of tænia by the bark of the root, are so encouraging, that we
have much pleasure in recommending it to the notice of the medical
public in this country.

FOOTNOTES:

[18] Ed. Med. and Surg. Jour.

[19] Ed. Med. and Surg. Jour. July, 1821.

[20] Dict. des Sciences Medicales.

[21] There can be no particular benefit derived from the distillation.
The simple mixture of the materials, above indicated, is all that is
necessary. CHABERT'S remedy is therefore easily prepared.

[22] Lond. Med. Repos. April, 1825.

ARTICLE X.--_Researches Physiological and Pathological, instituted
principally with a View to the Improvement of Medical and Surgical
Practice._ By JAMES BLUNDELL, M. D., Lecturer on Physiology and
Midwifery at the United Hospitals of St. Thomas and Guy. London, 1824,
pp. 146, 8vo.

Dr. BLUNDELL is the author of some celebrated experiments on the
physiology of generation, and the transfusion of blood. The work at
present under consideration consists of physiological observations
and experiments, the substance of a paper read before the
Medico-Chirurgical Society of London, in the year 1823, and not
heretofore published; of experiments on a few controverted points,
respecting the physiology of generation; and lastly, of some remarks on
the operation of transfusion.

The first part seems intended to ascertain what degree of lesion, or
losses by extirpation, the body may sustain without inducing death; and
thus, to open a way for improvements in surgery, by rendering the
surgeon not only more bold and fearless, but more frequently successful
in his attempts to preserve life, or counteract the inconvenient effects
of disease and accidents. We shall make a short analysis of the first
paper.

In four experiments, Dr. B. removed the left kidney of the rabbit, by
incision on the outer edge. Ligatures were applied to prevent bleeding.

Two died; one in 60 hours, the other in 4-1/2 days: both of
inflammation. One recovered, and lived 5 or 6 weeks, and then died. The
4th also recovered, but died in 5 or 6 weeks. On examination, a sac was
found (in place of the kidney) filled with a semi-fluid substance,
resembling custard, p. 4.

In seven rabbits, removed the spleen. One recovered permanently, and one
lived six months. p. 5.

In five rabbits, opened the abdomen, and punctured the fundus of the
bladder with a lancet. Three of them recovered entirely. p. 6.

In two rabbits, cut off one-fourth of the bladder with scissors, having
applied a ligature first. One died in seven months; the other still
lives in good health.

Into the peritoneum of four rabbits, threw [Symbol: ounce]i of human
urine; then washed it out by injecting tepid water. One died of collapse
in less than 24 hours, and two of inflammation, in 60 and 19 hours
respectively. The fourth is now (12 months) in good health. p. 7.

In seven, injected [Symbol: ounce]xi decoct. quercûs into the
peritoneum. Only one recovered.

Dr. B.'s inferences from the foregoing experiments are:

1st. "Large apertures into the peritoneum of the rabbit, do not
immediately induce a dangerous prostration, of strength." p. 9.

2ndly. "Large apertures into the peritoneal sac of the rabbit,
are not necessary, nor perhaps generally, productive of fatal
inflammation."

3dly. "In the rabbit, the kidney, the spleen, and a large piece
of the bladder may be extirpated, without necessarily causing
death; though death under the first operation is probable." p.
10.

4thly. "When the abdomen is laid open, and parts are removed
from it in the rabbit, the first danger arises apparently from
collapse; the second from general inflammation; and the last
from chronic disease." (Vide experiments.)

5thly. "The rabbit's abdomen is very tender, probably no less
so than that of man." See exper.

6thly. "Success in abdominal operations on the rabbit,
furnishes a presumption in favour of success in similar
operations on the human abdomen; and, therefore, from these
experiments, we may infer, _presumptively_, that moderate
openings into the human peritoneum will not necessarily, nor
even generally prove fatal from inflammation or otherwise; and
further, that certain viscera or parts of viscera, not
essential to the welfare of our structure, may be removed from
the belly, without necessarily, or even generally, producing
death. The extirpation of the kidney must be highly dangerous;
but there is a presumption in favour of the successful removal
of the spleen, the ovaries, or even of large pieces of the
bladder." p. 11, 12.

Dr. B. having stated the foregoing results and inferences, proceeds by
relating instances of severe injury sustained by the _human_ body,
without being followed by death. These are confirmatory of his
inferences from the experiments on rabbits. The instances given are--an
os uteri torn off; extensive laceration of the uterus and rectum in
labour; four uteri extirpated on account of chronic inversion, (p. 13.)
One of these last under his own care. It was removed by a wire, and came
off in 11 days, without one bad symptom, (p. 14.) Rupture and laceration
of the abdominal coverings, four fingers' breadth, the bowels hanging
out, (p. 14.) Two spleens removed; one in a soldier after the battle of
Dettingen, who recovered without inconvenience afterwards; the other in
a Mexican, whose case is related by Dr. O'BRIEN, in his Inaugural Essay,
Edinb. 1818, (p. 15.) Three cases of rupture of the dropsical ovary. Two
cases of opening into the abdomen, for the extirpation of dropsical
ovaries, (p. 18.) Five cases of laceration of the uterus by natural
efforts. Four of the women died, but in the fifth, Dr. BLUNDELL turned
and delivered, after the child had escaped into the peritoneal sac, and
the woman recovered, (p. 20.) Cesarian operation, three times by friend
of Dr. HAIGHTON; once successfully, (p. 22.)

Dr. B. says, "From these (facts) few as they are, I feel conscious that
no certain inference can yet be drawn; though _presumptive_ inferences
certainly may, and they seem to me to be the following:

"1st. Small wounds, as tapping, hernia, &c. do not induce fatal
peritonitis; and therefore the vulgar opinion that inflammation
in a spot of the peritoneum will almost invariably diffuse
itself over the greater part of it, is probably unfounded.

"2nd. Extensive divisions of the peritoneum are not necessarily
fatal by inflammation or otherwise, and _probably_ not
generally so.

"3d. That the womb, spleen, and ovaries, may be removed in the
mode mentioned, without necessarily, and, _presumptively_,
without generally destroying life.

"4th. That the gravid uterus may be torn open; the child may
escape into the peritoneal sac; the os uteri may be torn off:
not indeed, so far as these cases may be relied on, without
great danger, but twice, in seven instances, without death. p.
28.

"5th. The peritoneum and abdominal viscera will bear more
injury than the British surgeons seem disposed to admit.

"6th. That the above observations on the human abdomen, are in
unison with those drawn from observations on the rabbit; and
that observations made on the brute have more correspondence
with those on the human being, than is generally believed."

Dr. BLUNDELL next remarks, that the facts related create a suspicion
that a bolder abdominal surgery would not be unattended with success,
and recommends the following operations to "_consideration_ merely, and
not to practice, except in otherwise desperate cases."

1st. "When the Cesarian section is performed, divide or remove
a small piece of Fallopian tube, so as to prevent the danger of
reimpregnation, without destroying the sexual propensity. The
need for a second operation might thus be certainly prevented,
without scarcely increasing the danger."

2ndly. "Extirpation of healthy ovaries."

3dly. "The extirpation of the ovarian cyst in scirrhus,
combined with dropsy, or in simple dropsy." He remarks, "This
operation will, I am persuaded, ultimately come into general
use; and if the British surgeons will not patronize and perform
it, the French and American surgeons will." p. 26.

4thly. "The removal of a large circular piece of the cyst in
ovarian dropsy, when the sac itself cannot be extirpated."

5thly. "The removal of the cancerous womb, when the ulceration
first makes its appearance. Might not the womb be taken out
above the symphysis pubis, or through the outlet of the
pelvis?" &c. 27.

6thly. "Extirpation of the puerperal uterus." He suggests the
removal of the whole womb after the Cesarian section, in order
that the smaller might take place of the larger and more
formidable wound through the uterus--but says expressly, "No
operation perhaps can be more unpromising, shall I say more
unjustifiable, in the _present state of our knowledge_; but I
thought it proper to mention it." &c. p. 28.

7thly. "Should the bladder give way into the peritoneum," he
asks, "Why should we not lay open the abdomen, tie up the
bladder, discharge the urine, and wash out the peritoneum
thoroughly, by the injection of warm water?" p. 28.

8thly. - - - - -

9thly. Injection of astringents into the ovarian cyst or
peritoneal sac, unjustifiable.

10thly. "In cases of strongly characterized introsusception,"
why not make an opening into the peritoneum; and "pass the
small intestines, fold by fold, through the fingers." Dr. B.
has repeatedly done this in the dog and rabbit, without
producing death, or extensive and dangerous inflammation.

11thly. In the rabbit, he has tied an abdominal artery, and
carried the end of the ligature with a broad needle out through
the back, opposite to the place of the vessel. This ligature
can come away, and is a better mode than to leave it hanging
out at the abdomen, or entirely among the bowels, where it
forms a sac of puriform matter, and to appearance lays the
foundation of chronic disease. p. 30.

Dr. BLUNDELL closes this paper by saying, that since the substance of it
was read before the Medico-Chirurgical Society in 1823, Dr. RITZIUS, a
Swedish physician, had informed him in London, "that the complete
removal of the cancerous womb had been, to his personal knowledge,
performed on the Continent five times. All the patients recovered from
the operation," &c. "The womb was removed through the outlet of the
pelvis." p. 36.

Since we read Dr. BLUNDELL'S recommendations to the new operations, we
have been astonished to notice in the Ed. Med. and Surg. Journal, July,
1825, that a German surgeon had actually treated a case of ileus in the
manner recommended by Dr. B. It is from Hufeland's Journal of Feb. 1825.
After it was ascertained that an immoveable introsusception existed--

"The patient was placed on a convenient table. We examined
accurately the situation of the hardening, (_which marked the
diseased part_), and determined on opening the abdomen at the
outer edge of the right rectus muscle, about two inches above
the navel. After dividing the integuments with a common
scalpel, and making a small opening in the peritoneum, I
introduced my finger, and with a blunt pointed scalpel divided
the peritoneum, so as to make it correspond with the external
opening, which was between two and three inches. I then
besmeared my hand with oil, and carried it into the abdomen, in
order to feel for the indurated part. Scarcely had I introduced
my hand, than an attack of the pain came on, and a portion of
the intestines was protruded through the wound, which was
immediately replaced by my assistant. On continuing the
examination, I discovered in a transverse portion of the ileum,
a foreign substance, just where the hardened intestine was to
be felt. I drew the intestine out, in order to examine it more
minutely. The intestine was neither inflamed nor expanded, but
it contained in its cavity a soft coherent and compact mass,
which at its upper part was somewhat compressed, and thus felt
harder than the rest. So far as I could follow this part of the
intestine, this contained matter was to be felt: I also here
immediately detected an intus-susception, but in spite of all
my efforts I could not reach the commencement of it, so as to
bring it out. Two modes of proceeding were open to me, in order
to remove the intus-susception; either to make a transverse
incision in the integuments, from the right to the left side,
or to open the intestine itself. The last mode seemed to me the
most adviseable, both because the patient was already very much
exhausted, and because the operation would be sooner completed.
The intestine was opened at the end of the discovered
intus-susceptio, and immediately a part of the strictured
intestine came into view. I introduced my finger into the
opening in the intestine, which was made about two inches in
length, and gradually pushed the intus-suscepted part back from
the right to the left side, whilst I gently drew that part of
the intestine which contained the intus-susceptio towards me.
By this means I fortunately succeeded in unfolding the tangled
intestine, which amounted to two feet in length. There was not
the slightest trace of inflammation, nor any thing unnatural to
be discovered in the part; there was merely a round worm, which
was situated in the upper part of the intus-susceptio. The
intestine was brought together by means of six spiral stitches,
after the manner of the glover's suture, and the end of the
silk was allowed to hang out of the external wound in the
abdomen."

The sutures were removed on the 8th day. On the 14th day, the man was
cured, and continues well up to the date of the account.

ARTICLE XI.--_An Inquiry into the Nature and Treatment of Diabetes,
Calculus, and other Affections of the Urinary Organs._ By WILLIAM PROUT,
M. D., F. R. S. _From the second London Edition, published in 1825; with
Notes and Additions_, by S. COLHOUN, M.D. Philadelphia, Towar & Hogan,
1826; pp. 308.

A very acceptable service has been done to the medical profession in
this country, by the present republication of Dr. PROUT'S work on
affections of the urinary organs. The American physician will now have
it in his power, at a reasonable cost, to possess one of the best
treatises on this interesting subject. From the known accuracy of Dr.
PROUT as a chemist, and his reputation as an accurate observer of
nature, much new light was naturally expected as the result of his
observations. Nor indeed have these high expectations been disappointed.
After a careful perusal of his work, we have formed the highest opinion
of his powers, both as an original thinker, and experimental inquirer.

Dr. PROUT begins his treatise with some introductory remarks on the
composition of the urine, and on urinary derangements generally. After
giving a comparative tabular view of the composition of the blood, and
healthy and diseased urine, he proceeds to notice in succession, their
principal constituents. As albuminous urine is of frequent occurrence in
dropsical complaints, and its presence regulates in some degree the
practice proper to be pursued, the following characters, given to it by
Dr. PROUT, should be well understood.

"Albuminous urine, on being exposed to a temperature of about
150° becomes opaque, and deposites this principle in a
coagulated state. The precipitate varies considerably in its
appearance in different instances. Sometimes it is of a firmer
character, and similar to that formed by the serum of the
blood, from which, in this case, it may be supposed to be
derived; at other times it is very delicate and fragile in its
texture, and somewhat resembles curd, when it may be supposed
to be of chylous origin. In some instances, the effects of heat
upon albuminous urine are increased by the addition of nitric
acid. But the most delicate test of albuminous matter in
general is dilute acetic acid, and the prussiate of potash." p.
6.

Dr. PROUT combats very successfully the opinion, generally entertained
by chemists, that the power of healthy urine to redden litmus depends
on the presence of free lithic acid.[23] That this power cannot depend
upon lithic acid uncombined, is made evident to Dr. P. by its sparing
solubility; it requiring, according to our author, 10,000 times its
weight of water to dissolve it, or six times as much as is stated by Dr.
HENRY. The reddening power of the urine is attributed by Dr. PROUT to
the presence of lithate of ammonia, and superphosphate of ammonia: the
former of which, contrary to what might be expected, is found capable of
reddening litmus, and of remaining in solution with the latter, without
decomposition.

The following interesting remarks are made by Dr. PROUT on the effects
of muriatic acid, in precipitating lithic acid gravel:

"The muriatic acid, in combination with soda and potash, occurs
both in the blood and in the urine; thus appearing to pass
through the kidneys unchanged. This acid and its compounds
formerly appeared to be of less importance in a pathological
point of view than any other similar principles existing in the
urine: but since the unexpected fact has been ascertained, that
muriatic acid in a free state exists abundantly in the stomachs
of animals during the process of digestion, I have attended a
little more closely to the appearance of this principle in the
urine, and am disposed to believe, in consequence, that it is
the cause of the precipitation of lithic acid gravel from the
urine more frequently than any other acid. I do not mean to
say, that it is the _immediate_ cause of the precipitation of
this acid; for in most instances, it acts like all powerful
acids do under similar circumstances, namely, by liberating the
weaker acids, which are thus enabled to act in their turn, and
separate those having still weaker affinities than themselves.
Thus, in the present instance, the muriatic acid may be
supposed to separate the lactic, while the latter precipitates
the lithic, &c. If this opinion be well founded, as I believe
is the case, the muriatic acid may be considered of very great
importance, not only in a pathological, but a physiological
point of view; for if the muriatic acid, found in the urine in
such instances, be supposed to have its origin in the digestive
organs, we see at once the reason why the deposition of gravel
is so liable to be influenced by the derangements in general,
and more especially by the acidity, of the stomach."

"The muriatic acid may be shown to exist in the urine by the
white curdy precipitate insoluble in nitric acid, which is
formed, when the nitrate of silver is added to it, after the
sulphuric and phosphoric acids have been removed by the nitrate
of barytes or lead." pp. 20 and 21.

After finishing these introductory subjects, Dr. PROUT proceeds to the
consideration of the diseases of the urinary organs themselves; which he
divides into functional, mechanical, and organic. Under functional
diseases, we have _first_, those, in which principles _soluble_ in the
urine are morbidly deranged in quantity or quality, embracing three
chapters; and _secondly_, those affections, in which principles
_insoluble_ in the urine are morbidly deranged in quantity or quality,
comprising six additional chapters. Under the first subdivision, the
first chapter is on the affections, characterized by albuminous urine;
the second, on diseases, in which an excess of urea is the
characteristic symptom; and the third, on diabetes.

The diseased derangement, consisting in an excess of urea in the urine,
has not been particularly noticed by any writer before Dr. PROUT, who
believes that it has probably been confounded with that form of
diabetes, called diabetes _insipidus_. The state of the urine and
symptoms in this species of urinary derangement are thus described by
our author:

"The average specific gravity of the urine seems to be a little
above 1.020, and occasionally to vary from 1.015 to 1.030. Most
generally it is pale, but occasionally it is high coloured, and
exhibits somewhat the appearance of porter, more or less
diluted with water; and this variety in appearance not
unfrequently takes place in the urine of the same person. When
first voided, it reddens litmus paper. For the most part, it is
entirely free from sediment, except the mucous cloud of healthy
urine; and the only remarkable property which it appears to
possess, is that of containing abundance of urea; so that on
the addition of nitric acid, crystallization speedily takes
place. From the quantity of urea present, it is very prone to
decomposition, and soon becomes alkaline, especially in warm
weather.

"There is almost constantly in these diseases, a frequent and
urgent desire of passing water both by night and day. This
desire is for the most part evidently excited by actual
_diuresis_, or the increased quantity of urine; but frequently
it cannot be ascribed to this cause, as the quantity voided at
one time is often by no means considerable; though in almost
every instance that has fallen under my observation, the total
quantity voided during any given time has appeared to be
greater than natural. The quantity appears also to be
particularly liable to be increased by cold weather, and by all
causes producing mental agitation. There is sometimes a sense
of weight or dull pain in the back, but this is by no means a
constant symptom. There is also occasional irritation about the
neck of the bladder, which sometimes extends along the urethra.
The functions of the skin appear to be natural; at least in
every case which has come under my own observation,
perspiration has been rather easily induced. The pulse is not
affected. There is no remarkable thirst, nor craving for food,
except in extreme cases; nor are the functions of the stomach
and bowels much deranged. Hence for the most part the tongue is
clean, and the dejections regular and apparently natural.

"In most of the cases of this disease, which have hitherto
fallen under my own immediate observation, the subjects have
been middle-aged men, of thin and spare habit, with a sort of
hollow-eyed anxiety of expression in their countenance, free
from gout and constitutional disease in general, and, as far as
could be ascertained, from any organic defect in the urinary
organs. In every instance they had been induced to apply for
medical advice, not so much from the pain, as from the
inconvenience of the disease, and the dread of its ending in
something worse; and, what may be worth remarking, in several
instances confessed, that they had been addicted to
masturbation from very early youth," p. 41, et seq.

The remedy for this morbid derangement in the urinary secretion, most
successful in the hands of Dr. PROUT, was opium, either administered
alone, or in conjunction with alkaline medicines. It is rather a rare
affection. When not arrested, it is liable, according to Dr. PROUT, to
pass into diabetes.

In his chapter on diabetes, our author makes many interesting remarks;
but the space we are enabled to devote to this analysis, will permit us
only to make an extract, which seems to prove a close connexion between
the disease characterized by an excess of urea, and diabetes.

"It has been mentioned in the preceding pages, that an excess
of urea frequently precedes the appearance of saccharine matter
in the urine. Now it is a remarkable fact, that in diabetes, in
proportion as the saccharine matter diminishes, that of urea
generally increases; and in such instances, the presence of the
former principle can not only be no longer distinguished by the
sensible properties of the urine, but scarcely be demonstrated
by the utmost skill of the most experienced chemist, though the
specific gravity of the urine may at the same time be nearly
1.040. I have recently been favoured by Dr. ELLIOTSON with the
most complete and remarkable change of this description that
has yet occurred to me. The patient, besides being diabetic,
was in the last stage of phthisis, of which he died shortly
afterwards. The quantity of urine passed daily, when I first
examined it, was six or eight pints; its specific gravity was
1.038, and it contained a large proportion of very white sugar
and very little urea. Dr. ELLIOTSON under these circumstances
gave opium, beginning with gr. i, and increasing the dose to
gr. iii, thrice a day. The opium produced stupor, and was
obliged to be discontinued; but the effects produced upon the
urine by its means were most remarkable. _In about 60 hours,
the quantity of urine diminished to two pints, its specific
gravity was reduced to 1.0174, the saccharine matter had
apparently disappeared, and was superseded by urea, the
quantity of which had become excessive._ This alternation of a
principle containing nearly half its weight of azote, with
another containing no azote at all, is perhaps, one of the most
singular facts occurring in physiology." p. 74.

The second subdivision of functional urinary diseases comprises six
chapters: _first_, on urinary gravel and calculi; _second_, on the data,
showing the comparative prevalency of different forms of urinary
deposite, and the order of their succession; _third_, on the lithic acid
diathesis in general; _fourth_, on the mulberry or oxalate of lime
diathesis; _fifth_, on the cystic oxide diathesis, and _sixth_, on the
phosphatic, or earthy diathesis.

Under the first chapter, we have an account of I. Pulverulent or
amorphous sediments; II. Crystallized sediments, or gravel; and III.
Solid concretions, or urinary calculi. Of the latter, our author
enumerates thirteen species.

1. The lithic acid calculus.

2. The lithate of ammonia calculus.

3. The oxalate of lime, or mulberry calculus.

4. The cystic oxide calculus.

5. The bone earth, or phosphate of lime calculus.

6. The triple phosphate of magnesia-and-ammonia calculus.

7. The calculus, composed of a mixture of the phosphate of lime, and
triple phosphate of magnesia-and-ammonia, or fusible calculus.

8. The alternating calculus.

9. The mixed calculus.

10. The carbonate of lime calculus.

11. The xanthic oxide calculus.

12. The fibrinous calculus.

13. The prostate calculus.

Of these, the 2nd, 4th, 5th, 9th, 10th, 11th, 12th, and 13th species are
more or less rare, and consequently of less interest. The remaining 5
are of much more frequent occurrence, and are thus described by our
author:

"_The lithic acid calculus_ is generally of a brownish-red, or
fawn colour; but occasionally of a colour approaching to that
of mahogany. Its surface is commonly smooth, but sometimes
finely tuberculated; and upon being cu t through, it is usually
found to consist of concentric laminæ. Its fracture generally
exhibits an imperfectly crystallized texture, sometimes an
amorphous or earthy one, in which case, it usually contains a
mixture of other substances. This is one of the most common
species of calculi.--_Chemical characters._ Before the
blow-pipe, this calculus blackens, emits a smoke having a
peculiar odour, and is gradually consumed, leaving a minute
quantity of white ash, which is generally alkaline. It is
completely soluble in caustic potash, and precipitable again by
any acid in the form of a white granular powder. Lastly, if to
a small particle, a drop of nitric acid be added, and heat
applied, the lithic acid is dissolved; and if the solution be
evaporated to dryness, the residue assumes a beautiful pink or
carmine colour."

"_The oxalate of lime, or mulberry calculus_, is generally of a
very dark brown colour, approaching to black. Its surface is
very rough and tuberculated (hence the epithet of _mulberry_.)
It is usually hard, and when cut through exhibits an
imperfectly laminated texture. This species of calculus seldom
surpasses the medium size, and is rather common. There is a
variety of it remarkably smooth, and pale coloured. These are
always of small size; and from their colour and general
appearance, have been termed the _hempseed_
calculus.--_Chemical characters._ Before the blow-pipe, this
species of calculus expands into a kind of white efflorescence,
which, when moistened and brought into contact with turmeric
paper, stains it red. This white alkaline substance is the
caustic lime deprived of its oxalic acid."

"_The triple phosphate of magnesia-and-ammonia calculus_ is
always nearly white; its surface is commonly uneven, and
covered with minute shining crystals. Its texture is not
laminated, and it is easily broken and reduced to powder. In
some rare instances, however, it is hard and compact, and when
broken exhibits a crystallized texture, and is more or less
transparent. Calculi composed entirely of the triple phosphate
of magnesia-and-ammonia are rare; but specimens, in which this
salt constitutes the predominant ingredient, are by no means
uncommon.--_Chemical characters._ Before the heat of the
blow-pipe, this calculus gives off the odour of ammonia, and at
length melts with difficulty. It also gives off ammonia, when
treated with caustic potash. It is much more soluble than the
preceding species in dilute acids, from which it is again
readily precipitated by ammonia in its original crystallized
form.

"_The calculus composed of a mixture of the phosphate of lime
and triple phosphate of magnesia-and-ammonia, or the fusible
calculus_, is commonly whiter and more friable than any other
species, resembling sometimes a mass of chalk, and leaving a
white dust on the fingers. This species is generally not
laminated. Occasionally, however, it separates readily into
laminæ, the interstices of which are often studded with
sparkling crystals of the triple phosphate. The variety of this
species which is not laminated often acquires a very large
size, and assumes the form of a spongy friable whitish mass,
evidently moulded to the contracted cavity of the bladder in
which it has been formed. This species of calculus occurs very
frequently.--_Chemical characters._ It may be readily
distinguished by the ease with which it melts before the
blow-pipe. It also dissolves readily in acids, and particularly
in dilute muriatic acid; and if to the solution, oxalate of
ammonia be added, the lime is precipitated alone, and the
magnesium may be afterwards separated by the addition of pure
ammonia.

"_The alternating calculus_, as the name imports, may consist
of different layers of any of the preceding species. Hence its
general appearance, texture, &c. will depend entirely on the
composition, and may be very varied. Most commonly it is
composed of a lithic acid or mulberry nucleus, and an external
crust of the fusible calculus. In some rare instances, it is
composed of laminæ of all three of these substances, and
sometimes of even more--the mixed phosphates still continuing
to constitute the external crust. This species of calculus
often acquires a very large size and is very common.--_Chemical
characters._ The chemical characters must of course vary with
the composition; and as the different substances of which it is
composed must almost certainly be some of the preceding, the
nature of the different laminæ can be readily ascertained by
what has been already stated," p. 79, et seq.

In the chapter on the comparative prevalency of different forms of
urinary deposite; and the order of their succession, we have a number of
important facts and observations. Dr. PROUT calculates, from the data
collected by him, that about one-third of the urinary calculi which
occur, are of the lithic acid species, and that another third are formed
on a nucleus of this acid. Hence, "we may assert," says he, "that at
least _two-thirds_ of the whole number of calculi originate from lithic
acid; that is to say, if a lithic acid nucleus had not been formed and
detained in the bladder, two persons at least out of three, who suffer
from calculus, would have never been troubled with that affection. This
is a most important fact, and deserves to be constantly borne in mind."

The relative prevalency of the oxalate of lime calculus is very various.
The average proportion, as determined by Dr. PROUT is about one in
seven. Of the calculi, examined by Mr. BRANDE, 1 in 25 was of the
mulberry species; while in the Norwich and Guy's Hospital collections,
the proportion is about 1 in 4. In the Bristol collection, one-sixth of
the whole, was composed of oxalate of lime, nearly pure; while,
including all the concretions containing more or less of the oxalate,
the proportion was nearly _one-half_! This great disparity in the
proportional frequency of this calculus in different districts of
England, clearly shows the great influence of local causes, in
determining the character of urinary concretions.

From a careful observation of the order of deposition of different
species of calculous matter, Dr. PROUT has been enabled to deduce the
following general law; "_that, in urinary calculi, a decided deposition
of the mixed phosphates is not followed by other depositions_." So that
it would appear, that a redundancy in the earthy phosphates is the last
link in the chain of diseased alterations, to which the urinary
secretion is liable.

In the third chapter, under the second subdivision of functional urinary
diseases, Dr. PROUT describes the lithic acid diathesis, and
communicates several important original observations. After remarking
that the dyspeptic are particularly predisposed to lithic acid
deposites, he enumerates, as exciting causes of this species of gravel,
1st. _Errors in diet_; 2nd. _Unusual or unnatural exercise of the body
or mind, particularly after eating, and the want of proper exercise at
all other times_; and 3d. _Debilitating causes_. Under errors of diet,
an unusually heavy meal, especially of animal food, and the use of
heavy, unfermented bread, or compact, hard-boiled, fat dumplings or
puddings, salted and dried meats, acescent fruits, malt liquors, and
acescent wines, are enumerated as particularly hurtful in the lithic
acid diathesis.

The above remarks refer to the amorphous lithic deposites, consisting of
lithate of ammonia. In regard to crystallized sediments, or, more
properly speaking, gravel, our author makes the following remarks:

"Crystallized sediments, or red gravel, consist of lithic acid,
nearly pure. Lithic acid, as has been before stated, exists in
a state of combination in healthy urine; and in such a
proportion, as to be held in a state of solution at all
ordinary temperatures. Sometimes, however, a free acid is
generated by the kidneys, which precipitates the lithic acid in
the pure crystallized state we see it--a phenomenon easily
imitated artificially, as is well known, by the addition of a
few drops of any acid to healthy urine. The precipitation of
crystallized lithic acid does not, therefore, necessarily
indicate an excess of lithic acid in the urine, but the
presence only of some free acid in that fluid; though such an
excess does, for the most part, exist in this form of disease,
as will be shown hereafter. With respect to the nature of the
precipitating acid, it is probably not always the same. Most
generally it appears to be the _muriatic_, sometimes the
_phosphoric_ or _sulphuric_, and occasionally other acids. In
general, however, it is to be understood, as noticed
elsewhere, that when the mineral acids are present in excess,
these are the _immediate_ cause of the preternatural acidity in
the urine, and consequently of the precipitation of the lithic
acid. The stronger acids act by decomposing saline compounds,
into which destructible acids, such as the lactic acid, &c.
enter, and setting them free. Hence the _immediate_ cause of
the deposition of lithic acid gravel is generally a
destructible acid of very weak powers: even, perhaps, in some
instances, the carbonic acid. When the urine contains a free
acid, it is commonly more transparent than usual, and of a
bright copper colour." p. 112.

The treatment recommended by Dr. PROUT in this species of gravel is as
follows: First, a strict attention to diet, avoiding the hurtful
articles already enumerated. Secondly, the use of _alkaline_ remedies;
but those must not be depended upon, without the aid of other means,
more especially of alteratives and purgatives. Accordingly we are
informed that

"The pil. submur. hydrarg. comp., or a pill composed of the
pil. hydrarg. and pulv. antimonialis, may be taken twice or
thrice a week at bed time, and followed up the next morning by
an active dose of the sub-sulphate of magnesia, or a mixture of
Rochelle salts and magnesia, or carbonate of soda. A little of
either of these compounds may be also taken twice or thrice in
the day, so as to keep the urine constantly neutral or
alkaline, and the bowels freely open; or gr. x to xx of
magnesia may be taken for the same purpose in a glass of soda
water, as often as it may be found necessary."

In the chapter on the mulberry, or oxalate of lime diathesis, Dr. PROUT
gives a number of cases, from which he draws the following conclusions:

"1st. That this form of disease occurs in both sexes; that it
may exist before puberty, and at all ages between that and 40
or 50, at which time it seems to occur most frequently; but
that no case occurs beyond the age of sixty. Hence that it is
probably not a disease of old age.

"2nd. That it is not incompatible with gout, but seems
occasionally to be associated with it. I have also seen it
connected, as lithic acid frequently is, with a tendency to
cutaneous disease.

"3d. That this variety of calculous affection occurs in
individuals of sound constitutions, and who ordinarily enjoy
good health; and that it rarely occurs a second time, except at
long intervals, during which the intermediate health is good;
which latter facts, it may be proper to observe, are confirmed
by other observers, and particularly by Mr. BRANDE and Dr.
MARCET.

"4th. That the urine is acid, and apparently but slightly
deranged in this form of calculus, and remarkably free from all
sorts of sediment and gravel.

"5th. That as renal calculi of the oxalate of lime often
subsequently acquire considerable magnitude in the bladder, it
may be inferred, that the formation of this compound is
connected with a distinct diathesis, excluding the existence of
other diatheses, and that is not an accidental occurrence,
happening in common with many others to the urine.

"6th. That from the dissection of calculi, formerly mentioned,
it appears that the oxalate of lime diathesis is preceded and
followed by the lithic acid diathesis; a circumstance which
seems to be peculiar to these two forms of deposite, and which,
when taken in conjunction with the other circumstances, already
related, appears to show, that they are of the same general
nature; or in other words, that the oxalic acid merely takes
place as it were of the lithic acid, and by combining with the
lime naturally existing in the urine, forms the concretion in
question.

"7th. That the diathesis being of a similar nature, the
principles of treatment adapted for counteracting the original
tendency to it must be also similar, that is to say, of an
antiphlogistic character; great attention being at the same
time paid to the digestive and assimilative functions." p. 137,
et seq.

The diagnostic signs of the oxalate of lime diathesis are very obscure,
as will appear from the following extract:

"With respect to the means of determining when this diathesis
is going on in the system, I am sorry that I can give but
little positive information. The absence of urinary sediment,
&c. are of a negative character, and lead to no inference,
where other circumstances are wanting, as is most generally the
case. But if there be pain in the region of the kidney, and
other symptoms of gravel, without any appearance of sediment;
and if the urine be acid, and of the yellow tint above alluded
to, the stomach deranged, and an inflammatory diathesis, either
general or local (i.e. about the urinary organs), be present;
and if all these are associated with suppressed gout, or
tendency to cutaneous disease,--the existence of this form of
the disease may be suspected, and means immediately taken to
counteract it." p. 138.

We omit any analysis of the next chapter on the cystic oxide diathesis,
on account of the rare occurrence of this state of the system.

The next chapter of our author is on the phosphatic, or earthy
diathesis.

The phosphatic deposites are of two kinds; the _crystallized_,
consisting almost invariably of the triple phosphate of
magnesia-and-ammonia, and exhibiting the appearance of white, shining
crystals; and the _amorphous_, consisting always of a mixture of the
phosphate of lime, and the triple phosphate of magnesia-and-ammonia.

The causes apt to produce a deposition of the triple phosphate of
magnesia-and-ammonia, are thus enumerated by Dr. PROUT:

"Any thing acting generally, and producing _a nervous state of
the system_, such as the distressing passions, and particularly
_mental anxiety_ or _fear_, will frequently produce in many
people an excess of this salt in the urine. The same is also
true of many articles of food or medicine that produce a
hurried secretion of the urine, and act as diuretics; as the
neutral salts in some cases, and particularly the Rochelle
salts and other saline compounds, in which the acid is of
vegetable origin. So also, a long continued use of alkaline
remedies, or of mercury, in irritable habits more especially,
will likewise produce a tendency to an excess of this salt, as
well as of the phosphates in general, and even lead to an
actual deposition of them from the urine. The same sediment
also frequently abounds, or is easily induced, in the urine of
those who have long been in bad health, and in whom the
constitution may be considered as giving way, or, to use a
common expression, breaking up. In general, it is to be
understood, that the slighter causes affect only the
predisposed, and those in particular who are subject to other
diseases of the urinary organs or urine. It may be also
remarked, that children are more subject to this form of
deposition than adults; a circumstance, perhaps, to be referred
to the irritability of the system at this age, and the great
derangement of the digestive organs, to which they are
subject." p. 151.

The above mentioned causes are stated to be equally productive of
amorphous phosphatic sediments.

Our author next enumerates the very distressing symptoms, by which the
deposition of the earthy phosphates is attended. They consist in great
irritability; derangement of the chylopoietic viscera, evinced by
flatulency, nausea, obstinate costiveness, or peculiarly debilitating
diarrhoea; extremely unnatural stools, nearly black, or clay-coloured,
and sometimes resembling yest; pain, uneasiness, or weakness in the back
or loins; sallow, haggard expression of countenance; and finally, if the
disease be not arrested, great languor and depression of spirits,
coldness of the legs, and complete anaphrodisia, as occur in diabetes.

A curious and important fact has been stated in regard to the remote
causes, producing the phosphatic state of the urine. It has been
observed by Dr. PROUT, that a large proportion of cases of this
complaint may be traced _to some injury of the back_ from mechanical
violence, such as a fall from a horse, &c.

The remedies for this diseased state of the urine, found most successful
by Dr. PROUT, are,--opium, in from one to five grain doses, repeated two
or three times a day, until the unnatural irritability of the system is
relieved,--the same remedy in more moderate doses, in conjunction with
the mineral acids, cinchona, uva ursi, and the different preparations of
iron,--a large pitch, soap, or galbanum plaster to the loins,--and
setons or issues in the back, when the disease manifestly arises from
local injury. With respect to the bowels, Dr. PROUT remarks, that they
are very difficult to regulate. He has occasionally seen serious
consequences to arise from the exhibition of a small dose of calomel,
such as diarrhoea and debility, much aggravating the disease, and
endangering the life of the patient. For the regulation of the bowels,
small doses of castor oil, and laxative injections are most to be relied
on; while saline purgatives, more especially Rochelle salt and Seidlitz
powders, as containing vegetable and therefore destructible acid, must
be avoided.[24] Mercury, in all its forms, is also inadmissible.

"Alkaline remedies of every description, must be most carefully
avoided, their use in every point of view being most
mischievous when the phosphates are concerned. Indeed all
remedies that act as diuretics should, in general, be shunned,
and the patient should be prohibited from drinking too much.
With respect to drinks, in general, they should be of a
soothing, demulcent character, and prepared with distilled or
the softest water that can be procured; as hard waters are
literally poison in this form of disease."

The second division of the work under review treats of the mechanical
and organic diseases of the urinary organs. This portion of the subject
is handled with the same ability as the first. We regret, however, that
our space will not permit a further development of the author's views.
We trust, nevertheless, that we have imparted to our readers adequate
notions of the scope of the work, to render them sensible of its value
as a manual of urinary diseases. It is illustrated by a good coloured
plate, representing the principal varieties of urinary calculi.

The additions of Dr. COLHOUN consist of foot notes, and paragraphs
inserted in the text of the original work. We would not, however, wish
to be considered as approving of the course, for the most part pursued
by Dr. C., of inserting his amplifications in the text of the author,
merely distinguished by brackets. Besides the absence of sufficient
distinction between the matter of the author and commentator, the text
of the former is thus injuriously disjointed, and dependent sentences
sometimes widely separated.

In regard to the execution of the present edition, we regret to say that
it is wanting in typographical accuracy.

FOOTNOTES:

[23] The reader will bear in mind, that this acid is the same as the
uric, the name by which it is generally known.

[24] The reason of this exclusion of salts, containing a vegetable acid
is, that they become real alkalies in the course of assimilation by the
destruction of their acid, and therefore add alkaline properties to the
urine, already too alkaline.

MEDICAL LITERATURE.

ARTICLE XII.--RETROSPECTIVE REVIEW.--_Tractatus de Ventriculo et
Intestinis, cui proemittitur alius, de Partibus continentibus in
Genere, et in Specie de iis Abdominis._ _Authore_ FRANCISCO GLISSONIO,
&c. &c. Lond. 1677, 4to.

As it is not our intention to confine our remarks to the work above
mentioned, we shall deem no apology necessary for the somewhat excursive
nature of this article, which would not answer our present purpose, if
we were obliged to follow the costive details of the venerable FRANCIS
GLISSON, whose villanous bad style, and execrable latin, are only to be
excused or overlooked in consideration of the great importance of the
topics which he handles, and the profound reflections which he makes on
them. GLISSON is recognised as author of the physiological term
_Irritability_, and as the assertor of the inherent activity of matter.
HALLER says of him in his XIth book. "FRANCISCUS GLISSON, qui universis
elementis corporum, vim motricem tribuit, etiam nostram vim,
Irritabilitatem vocavit," &c.

He was a native of Dorsetshire, and was appointed professor of physic at
Oxford in 1627. This post he occupied during forty years, and is much
distinguished by his treatise de vita naturæ, and by the work which
forms our caption. As he is the first who used the physiological term
irritability, we have thought that some researches on this subject in
general, and more particularly on his peculiar sentiments, might
profitably occupy our retrospective department; for it is very evident
that this subject is in general but vaguely discussed, both in medical
writings and conversation.

The ancient philosophers did not agree among themselves as to the nature
and origin of matter; some of them considering it as eternal in its
essence, and others as mutable and changeable in form. The theory of
atoms, published by DEMOCRITUS, and subsequently carried out so
elaborately by EPICURUS and his disciples, seems to have reached even
to our own times, with an increasing reputation and acceptance.
According to this theory, the kinds of matter, or elements, must he
regarded as infinitely various. HERACLITUS, who taught philosophy about
550 years before Christ, considered all things as derived from an
elemental heat or fire;[25] a philosophy which seems to us to have
formed the basis of the Hippocratic doctrines of life. Like HERACLITUS,
HIPPOCRATES tells us, that the calidum was the first principle of
things, and that by an expansion or extension of itself, it constitutes
all the objects of the material world. He expresses himself in the
following manner. That which we call warmth, or heat, seems to me to be
something immortal; something which comprehends all things, which sees
and knows all things, as well present as future. Thus assuming as a
basis, that the calidum is an almighty, all-wise being, or in other
words, a God, all in all, the cosmogony was developed as follows: Chaos
he regarded as that condition of the calidum, which preceded any
exertion of the Almighty faculties. In emerging from the chaotic state,
the greatest part of the heat having assumed the uppermost place, formed
the æther; another part having gained the lowermost place, constituted
earth; a third portion, midway between earth and æther, became air; and
a fourth part, establishing itself between the two latter, became water.
So that by means of the extension of this all-wise, elemental calidum,
we have the four elements, earth, air, fire, and water, out of which are
ultimately composed all the aggregates of the material world.[26] Now,
to apply this general principle to the formation of the living being
man, who seems to be a sort of microcosm in himself, we are told, that
that portion of heat which remained with earth, being expanded and
spread abroad in divers places, in some more, in others less, the earth
became dry, and something like membrane or pellicle was formed; the
matters contained in which, being heated as by a sort of putrefaction,
some parts became bone, some nerve, some veins and their contents, and
some formed the cavities and their contents, as the urinary bladder, for
example.[27]

The full exposition of the opinions of HIPPOCRATES was left for GALEN,
and we prefer to make reference to him on this theory, which by his
genius and talent was so much embellished, that it became the glory of
science, exercising an almost undisputed authority during a long lapse
of ages. Indeed the gigantic intellect of this great man, still
continues to shed its vast illumination over the world of science,
particularly that of medicine; which, if it owes its birth to the divine
old man of Cos, is not less indebted for its nurture and growth to the
celebrated native of Pergamus. GALEN is the facile princeps of
physicians. His astonishing industry, perseverance, and acquirements,
his ingenious arguments, and persuasive eloquence, give him an
unquestionable claim to the title of princeps, so long accorded to him;
and those who even in the present enlightened period, will study his
works, shall find themselves almost irresistibly led away by the charm
of his suasion.

GALIEN est le seul des anciens qui ait donné un corps complet de
medecine: Quoique formé des débris de toutes les doctrines précédentes,
son systeme offre cependant, malgré les contradictions ou il tombe assez
souvent, une unité remarquable dans toutes ses parties; un ensemble
séduisant, qu'un genie de l'ordre le plus élevé pouvoit seul imprimer à
un pareil édifice. Ramenant tout à un petit nombre de principes
généraux, qui s'ils ne peuvent satisfaire la raison, fournissent du
moins une réponse facile a tout, ce systême dut être adopté avec
empressement, et sa fortune ne peut étonner.--_Biographie Medicale, Tom.
IV._

GALEN may perhaps be justly regarded as an eclectic; but it is manifest,
that he mainly walked after the steps of his great predecessor, and
recognised model. The following passage seems to contain ideas not much
differing from those of HIPPOCRATES which we have presented above: "Who
is there, says he, that judging from the origin and constitution of
animated beings, doth not immediately infer the existence of a mind,
possessed of wonderful energies, extending to, and pervading every
portion of the universe! We every where perceive animals procreated,
which are possessed of the most admirable structure, and yet what
portion of the universe can be more ignoble than this earth of ours? Yet
a grand intelligence is seen to have reached even it from the celestial
bodies, which for their beauty are so astonishing, and which, as they
are for purity far more excellent than our earth, so they are the seats
of intelligences, far more pure and perfect than those which inhabit
these lower regions." He proceeds to remark, that animals, worthy of the
greatest admiration, are produced out of the slime and mud of ponds and
ditches, and even in putrefying vegetables, which, as they indicate the
miraculous properties of their author, also show us in what estimation
we should hold the higher orders of being. "We may even perceive a
rational nature in men, if we refer to such examples as PLATO,
ARISTOTLE, HIPPARCHUS, ARCHIMEDES, and many others. If, therefore, in
such a colluvies as the human body, (for by what better name can we
characterize a mixture of blood, bile, and phlegm,) a mind is formed of
such great and excellent faculties, what must we think of the excellence
of that which exists in the superior bodies?"

It may be said that GALEN expresses, in these passages, the Platonic
dogma of an _anima mundi_. But they certainly agree with the sentiments
of HIPPOCRATES; and whether he derived them from the former or the
latter, matters not, as both of them have invested matter with certain
qualities, which render it active, whether it be so essentially or by
the act of the Creator. GALEN may be also regarded as partially an
Epicurean; for he insists that there are several sorts of matter, or as
we should say, several elements; but he differs from that sect again in
affirming for it a passible quality. To show that there must be more
than one element, or kind of matter, he says, that if there was only one
element, or a unit, it would be impassible; it could undergo no change
whatever. For there would be nothing by which it could be made to suffer
any alteration, or into which it could be altered. Whatever is changed,
is changed into something else, and whatever suffers, suffers from
something extrinsic: therefore he affirms, that of necessity there must
be several sorts of matter, or elements. He says, "there are only two
theories on this subject deserving our attention; one of which affirms
that sentient bodies are composed of elements possessing the faculty,
(cum patiendi tum sentiendi,) both of suffering and perceiving an
alteration;" while the other affirms that such bodies are formed (ex
patibilibus, sed sensu expertibus) out of passible, but not sentient
elements. Neither of these doctrines does he consider tenable, so long
as only one element is affirmed, as earth, air, or fire alone, which
could never become capable of that great variety of actions we witness
in living bodies: but, admit several elements, and we suppose that the
mutual interchange of powers would yield a compound body, capable of all
the vital phenomena. Such, therefore, says he, as consider the human
body to be composed of fire, air, earth, and water, mutually transmuted,
alternated, and reduced to a given temperament, and thereby vested with
a sentient faculty, speak reasonably; and it is evident that there must
be more than one element, and that these elements are passible bodies.

PLATO had taught, that, though all bodies are formed of matter, yet
matter itself is not a body; and the same idea is conveyed by ARISTOTLE,
in the Lib. de partibus animal. & earum causis, II c.i. "Prima statui
potest ea quæ ex primordiis conficitur, iis quæ nonnulli elementa
appellant terram dico, aquam aërem & ignem: sed melius fortasse dici
potest ex virtutibus confici elementorum, iisque non omnibus sed ut ante
expositum est humiditus enim, & siccitas, & caliditas, and frigiditas,
materia sunt corporum compositorum."

GALEN also states, that in fire there exists a perfect heat and
dryness, in earth a perfect coldness and dryness, and so on of the rest
of the elements. For you cannot expect to find in nature a perfectly
simple and isolated element; because they are always mixed two or more
together. Hence the real terram, aquam, aërem, and ignem, become rather
a metaphysical abstraction, than a real entity. That is to say, matter
has no real existence, but is mere quality; for earth is not the mere
representation of dry or siccum; it is the representative of siccitas,
or dryness: fire is not the eidolon of calidum, but of caliditas; water
of humiditas, and air of frigiditas. Yet all these elements are in
nature possessed of more than one property. Fire is hot and dry, earth
is dry and cold, water is cold and moist, &c. If we refer, however, to
his account of the soul, we perceive at once, that these inseparable
qualities of the elements are the real active agents of life. He plainly
declares, that the soul is the mere result of organization, and perishes
with the structure in which it dwells. He thinks, "corporis temperiem
censendum est." As to the active powers of the four primary qualities,
he says, "At mihi quidem tam venæ, quam reliquarum particularum singulæ,
ob certam quandam temperiem quam ex quatuor sunt qualitatibus nactæ, hoc
vel illo modo videntur agere."--De nat. fac. I.

It is plain he thinks, that the elements consist of a materia and
qualitas; but they are elemental by the _qualitas_ and not by the
_materia_.

After establishing that there are four elements, which are the common
and simple bases of all things, he goes on to show, that the proper
proportion and admixture of these, constitute the healthy state of
living bodies. If the calidum, for example, be unduly increased, the
body is destroyed; if it be improperly diminished by excess of the
frigidum, it will also perish. The business of the physician is to keep
the proportions just and harmonious; but, as no pure element exists
alone, the physician must employ the qualitas in conjunction with the
materia. These (to make a phrase) substantive qualities, are found in
medicines or food, which, like all objects of sense, are either cold,
hot, dry, or moist, and available of course in the management of a cold,
hot, dry, or moist derangement of the living body.

The elements of the human body exist in the four humours, blood, bile,
atrabilis and pituita; and these four humours correspond in quality
with the elements. Blood, which is the reservoir or continent of them
all, is a temperate humour. Bile, being the representative of calidum,
is hot and dry. Melancholy represents, in our microcosm, the element
earth or siccum, and is dry and cold. But pituita, which is moist and
cold, corresponds with the humidum element. Air exists in animals nearly
pure, as we learn from the phenomena of the pulse and of respiration. It
answers to frigidum.

He shows us in his lib. de naturalib. facultat. that, out of the
humours, all the parts are formed, and these parts are either _similar_
or _dissimilar_; i. e. simple or compound. Bone is a similar part, that
is, it is a simple part; so is an artery, or vein, or ligament. Each of
these is so constituted, as that it has a predominance of one element in
its nature; and it is therefore dry, or cold, or moist, &c. But if an
adust element be, by accident or disease, accumulated in a part
naturally cold, the function of such part is morbidly affected. The
natural tendency, however, of similar humours to unite, causes each part
to receive its regular supply; a principle which BICHAT has since
characterized as, _contractilité organique insensible_.

To show the wonderful simplicity of the Galenical system, which for
plainness and easy attainment may be compared with the improved
nomenclature of chemistry, we will cite a passage from ARGENTERIUS, who,
perhaps, was as learned in this kind of lore as any man of his time. In
his Tractatio de calidi significationibus, he says; "If any body would
undertake to give a general enumeration of those circumstances, in which
this term calidum and the others (frigidum, humidum, &c.) are applicable
to the explanation of this warmth, he shall find truly, that they are
the elements, the humours, the parts, the whole body, medicines, food,
air, climate, the weather, the season of the year, and even ages; for
these all are either temperate, or hot, or cold, or humid, or dry."

The animal body is moved and governed by two principles; one of them
corresponds to the _vie animale_ of BICHAT, and the other to the _vie
organique_. Since the power of sensation and of voluntary or elective
motion, says he, is a property of animals, and since that of growth and
nutrition is common both to animals and plants; the former may be called
attributes of the soul, and the latter attributes of nature. Whence we
say, that animals are governed by the soul and by nature, while plants
are governed by nature alone.

The powers of the body are faculties; and these are either natural,
vital, or animal: but they are so subdivided, that we have as many
faculties as there are sorts of action. Under the class of natural
faculties, we find three principal sorts; to wit, a facultas generatrix,
an auctrix, and a nutrix. But if you ask, says GALEN, how many faculties
there be, which result from the action of these on each other, you will
find them as numerous and diverse as there are numbers and diversities
of the animal parts. For example, we have an attractrix faculty, a
retentrix, alteratrix, expultrix, &c. &c., all of which are variously
modified, according to the nature of the similar or dissimilar parts
they are exercised in, or, in other words, according to the nature of
the tissues or organs, in which they reside.

Need we go further to show, that GALEN, believing all matter essentially
conjoined with the hypothetical caliditas, frigiditas, &c. &c., taught
that it was gifted with such a degree of inherent activity, as to render
it capable under certain states of combination, of exhibiting all the
phenomena of organic and animal life? It is certain that he regarded
these active qualities, as the causes of all the phenomena, whether of
living or dead matter.--GLISSON ought not certainly then to be regarded
as the author of this dogma in medical philosophy. PLATO certainly
taught it. VAN HELMONT could not get along without investing matter with
what he called a "seminal likeness, which is the more inward spiritual
kernel of the seed," &c. But we will let him speak for himself.
"Whatsoever," says V. H., "cometh into the world, must needs have the
beginning of its motions, the stirrer up and inward director of
generation. Therefore all things, however hard and thick they are, yet
before that their soundness, they inclose in themselves an air, which
representeth the inward future generation to the seed in this respect
fruitful, and accompanies the thing generated, even to the end of the
stage: which air, although it be in some things more plentiful, yet, in
vegetables it is pressed together in the show of a juice, as also in
metals it is thickened with a most thick homogeniety or sameliness of
kind. Notwithstanding this gift hath happened to all things, which is
called _archeus_, or chief workman, containing the fruitfulness of
generations or seeds, as it were the internal efficient cause; I say
that workman hath the likeness of the thing generated, unto the
beginning whereof, he composeth the appointments of things to be done.
But the chief workman consists of the _conjoining of the vital air_, as
of the matter, with the seminal likeness, which is the more outward
spiritual kernel, containing the fruitfulness of the seed; but the
visible seed is only the husk of this. This image of the master workman,
issuing out of the first shape or idea of its predecessor, or snatching
the same to itself out of the cup or bosom of outward things, is not a
certain dead image, but made famous by a full knowledge, and adorned
with necessary powers of things to be done in its appointment; and so it
is the first or chief instrument of life and feeling. But since every
corporeal act is limited into a body, hence it comes to pass, that the
archeus, the workman and governor of generations, doth clothe himself
presently with a bodily clothing. For in things soulified, he walketh
thorow all the dens and retiring places of his seed, and begins to
transform the matter according to the perfect act of his own image; for
here he placeth the heart, but there appointeth the brain, and he every
where limiteth an unmoveable chief dweller, out of his whole monarchy,
according to the bounds of requirance of the parts and appointments. At
length that president remaineth the overseer and inward ruler of the
bounds, even until death; but the other, floating about and being
assigned to no member, keeps the oversight over the particular pilots of
the members, being clear and never at rest or keeping holiday."

Notwithstanding the affected and euphuistic jargon of the above
passages, it is evident that VAN HELMONT'S idea is very similar to that
of GALEN. By seminal likeness, we are to understand an aptitude in
matter to take on certain determinate forms, and this may be supposed to
differ not very essentially from those laws, which govern matter in
crystallization. But even this seminal likeness, as we perceive, is a
sort of abstraction, very analogous to the Galenical caliditas; for it
is the more inward spiritual kernel of the seed, whereby the matter is
enabled to enjoy a certain degree of activity, the degree of which is
much increased by the union of the air, or archeus, with it. So the
caliditas of GALEN, which, after all, is matter, gives to its subject
the powers which it enjoys. GLISSON, speaking of the natura seminalis,
says that it is a certain or specific essence, superadded to mere
elementary principles, by means of which mixt bodies adopt certain
determinate forms, and acquire the faculty of performing essential
operations, more noble than those which belong to naked elements.

We regret very much that we have been unable to procure a copy of
GLISSON'S treatise de vita naturæ, which, so far as we know, can not be
had in this country. We shall, therefore, furnish our readers with the
following passage from the Biographie Medicale, from the pen of
JOURDAIN.

"The name of GLISSON occupies an honourable place in the history of
medicine, because to him we are indebted for the first elements of the
physiological doctrine of the present day. Instead of directing his
attention to movements alone, as the iatro-mathematicians, and even, to
a certain extent, the animists had done, he referred to vitality all the
phenomena of nature, of whatever kind, and attempted to reduce them to
one, common principle. To this end he admitted, that matter is
originally endued with forces inherent in it, and that living bodies in
particular, are invested in their organs with a radical force, which,
put in play by stimulants, whether internal or external, gives rise to
all the phenomena of life. He even went so far as to assert, that
sympathy may be explained by referring to the intercommunication of this
force, to which he gave the name of irritability."

We shall also cite from SPRENGEL, a passage which throws some light on
his theory.

"When they became unwilling, like DESCARTES and STAHL, to have constant
recourse in their explanations, to the soul, they tried to find a
philosophic proof of the existence of material forces, to show that
matter, as mere matter, is endowed with particular forces, with which
they might satisfactorily explain a great many of its phenomena. No one
had hitherto sought for a similar proof; for ARISTOTLE had contented
himself with an axiom, that all natural things contain in themselves the
sufficient cause of their movement and rest. GLISSON and LEIBNITZ set
themselves in search of this proof; but it was reserved for the immortal
KANT to find it in the nature of matter itself.

"FRANCIS GLISSON may with propriety be considered as the precursor of
LEIBNITZ. What he tried to demonstrate by scholastic subtlety, and by
thousands of syllogisms, was developed by LEIBNITZ with a clearness and
ability, which secured the suffrages, even of the unenlightened. Both of
them went too far, in attributing life and sensation to matter, instead
of claiming for it the two simple and primordial forces of attraction
and repulsion.

"GLISSON sets out with the idea of substance, but he does not explain it
with sufficient precision. Every substance has three substantial
rudiments,--_fundamental_ substance, by means of which it
exists,--_energetic_ substance, by means of which it acts,--and
_additional_ substance, which determines its accidental qualities. All
matter, as substance, must have an energetic substance or nature, which
is the internal principle of movement. Therefore whatever moves
spontaneously, and in virtue of an internal force, must _feel_ this
motion, _and desire it_. All matter feels that it is, and that it exists
by itself. It has therefore, consciousness of its own nature. Life
consists in the activity of the internal substantial energetic nature.
Death is the dissolution of the triple alliance of the internal
energetic substantial nature, with the vegetative and animal natures,
which two last belong to the _additional_ substance."[28]

In applying his theory to physiology, GLISSON'S idea is, that the fibres
of the human body are endowed with a force, which he divides into three
kinds; to wit, natural or inherent force, (robur insitum)--vital force,
(robur vitale)--and animal force, (robur animale.)

Natural or inherent force, is a part of the constitution of the fibre,
and is as much a property of its organization as are its tenacity,
tensibility, &c. The sum of this force varies, in proportion as the
constitution of the fibre is more or less perfect. It is strongest in
athletic men and strong animals, and weaker in relaxed and debilitated
persons. It may be compared with the contractilité de tissu of BICHAT.

The second, or vital force, is something superadded to the inherent
sort. It is an _influxus_, derived to any fibre or set of fibres, from
that greater sum of force, which arises out of a more elaborate,
complex, and exalted organization. It varies in proportion as the vital
spirits flow with more or less freedom; and in proportion as their
quality is more or less perfect.

The third kind, or robur animale, may be supposed to depend on the
organic constitution of the brain and nerves, and varies according to
the state of that organization. We cannot help adverting to the
resemblance between these two latter kinds, and the contractilité
organique, and contractilité animale, of BICHAT; and this robur
comprises, as we shall show hereafter, both the contractilité and
sensibilité of the French physiologist.

GLISSON, in his chapter de Irritabilitate fibrarum, commences by
remarking that a motive faculty existing in any fibre, unless it were of
an irritable nature, would leave such fibre in one of the two following
states: 1. It would either never cease from action, or 2ndly, being once
at rest, its motion could never be reproduced; but the varieties and
differences which we see in the actions of fibres, clearly demonstrate
them to be possessed of irritability: i.e. if a fibre may be by turns in
a state of action and repose, it is evidently possessed of a quality,
whereby it can be induced to move if in a state of rest; this quality he
terms irritable, or irritability. The next inference from this power of
alternate activity and repose is, that the fibre is possessed of a
faculty, whereby it can _perceive_ an irritation offered to it; but this
perception of irritation further implies an _appetence_ for a change of
its actual state, before the motion can really take place. Perception,
appetence, and motion, make a triunit. "In the mean time, says he, as
sensitive appetence, and sensibility, are frequently confounded with
natural perception, in this irritation of the fibres," he divides it
into three kinds, viz. Natural Perception, Sensitive Perception, and
Perception regulated by animal appetency.

Natural Perception is that principle whereby a fibre perceiving any
alteration offered to it, whether pleasing or displeasing, is excited
either to accept that change, or to avoid it, and moves accordingly.

Sensitive Perception, is that kind, in which a fibre, perceiving a
change effected in some other organ, is impelled ad aliquid appetendum,
and to move conformably.

The third sort, or Perception regulated by animal appetency, is that in
which the brain directs from within, such movements of the muscular
fibres, as are requisite for the execution of any purpose.

"Some persons," says GLISSON, "may doubt whether there really exists a
natural perception of irritation in the fibres; but we have elsewhere
asserted in general the reality of natural perception, to wit, in my
work, de Vita Naturæ; and whoever has known it, will readily admit this
quality in fibres imbued with inherent, influent, and vital spirits. We
do not expect, in this place, to establish it as a general principle;
but if any proof, derived from a knowledge of the structure, uses, and
actions of the fibres, can be adduced, it may be here attempted."

"It is indubitable that the fibres are alternately at rest and in
motion; for, during sleep, they are all relaxed, with the exception of
such as subserve the functions of respiration and circulation, and even
these are by turns quiet and active. During waking again, they are all
in a state of moderate tonic motion; and moreover, during all movements
of the limbs, the antagonist muscles yield spontaneously, the abductors
being active, while the adductors are relaxed, and vice versa. Hence it
is manifest, that the fibres are alternately quiescent and active: but,
since they are not _principal_ or sui arbitrii agents, it is necessary,
in order to the new movement, that they should be irritated from some
source: for, it is impossible that a fibre in repose, can be set in
action without an irritating cause; nor can we conceive of a part being
irritated without _perceiving_ the irritation. It is like speaking to a
deaf man, or trying to awaken a dead one."

"If you say, fibres are possessed of sensibility, and can be excited by
virtue thereof, I confess that they are sensible parts, and may thereby
perceive some, not all irritating causes; but whether sensation excites
them immediately, or rather, is transmitted to the brain, and irritates
the animal appetency; and further, whether the animal appetence, effects
a movement in them directly, and to what sort of perception this
irritation may be properly and immediately ascribed, is detailed in
order below, when we come to explain sensitive perception, and
perception à phantasia imperata."

"Let us now go on to point out those cases, in which no suspicion of
_sensation_ can be entertained. The pulsation of the heart is neither
effected nor affected by sensation; its fibres, in virtue of the
irritation occasioned by the blood in its ventricles, are excited to
contract, and thus occasion the pulsation, but when the irritation is
remitted they relax, and recover the natural state. Now it cannot be
denied that this is an evident case of irritation of the fibres, for
according as is the irritation, so is the rythm of the pulsation, which
varies at times, as in febrile and other affections: nor is it right to
pretend that there is any sensation in this case; because this
perception of irritation _per vices_, is exercised as well during sleep,
when the senses are all locked up, as in the waking condition. The
fibres do not, therefore, _perceive_ in these actions by a sensitive,
_but by a natural perception_, the irritation of the vital blood, which
animates them to alternate contraction and relaxation. This is
corroborated by those tumultuous irregular motions which continue in
animals after decapitation; so also the intestines when still warm in a
recently opened animal, move and twist about; the muscles in dead
animals also, excited by the perception of cold, contract with a strong
tonic movement, and render the body rigid. The hearts of some animals
too, when torn out of the body, and even when dissected, continue their
endeavours to pulsate. Is there any further evidence wanting? We may
hence infer with sufficient confidence that the fibres (without the aid
of the senses) may _perceive_ irritation, and move themselves
conformably."

In the next place he examines the nature of sensitive perception of
fibres, and goes on to show how an impression made on an external part,
or a natural perception, becomes converted into sensation, and thus made
known to the sensorium. But his disquisition is not only very long but
very dark, and we shall therefore pass it by with the exception of the
following.

"Natural perception includes within itself a _rationem positivam_, and a
_negationem formalem_.

"The ratio positiva is the perception of the idea, or image of the
object moving or changing the fibre.

"The negatio formalis is a denial or refusal to communicate this image
to the sensorium. In the process of transformation into sensation, the
positive ratio is not changed, but remains the same, and is the first
part, or basis, both of internal and external sensation.

"The negatio formalis is destroyed or abolished in any case of
impression communicated to the sensorium. Natural perception, in its
ratio positiva, is not abolished or degraded by being converted into
sensation, but is rather exalted, or gifted with a more dignified
nature. By as much as public or general knowledge is preferable to
private, or public advantage to that of an individual, by so much is
sensation preferable to natural perception. Hence nature formed so many
organs of sense, that the phantasy might have notice of what ought to be
done, desired, or avoided."

He does not doubt that external sensibility is inherent in the nervous
parts of the external organ, whence he infers that it may readily incite
the fibres of such organ ad appetendum et movendum; for, as external
sensation is communicated to the brain by means of the nerves, it must
of necessity be true, that these nerves and nervous parts (such as the
fibres,) are the subjects of it. Since then sensibility causes its
subject to feel, it consequently enables it to desire and move
comformably. For perception in any subject is vain, unless it can
desire, and appetence is useless, unless it can move. External
sensibility, therefore, may be said to render the fibres _actu
irritabiles_, for example, as often as the irritating cause is
perceived; but as the irritation is perceived, not by a sensibility, but
by a mere natural perception, this it is which constitutes their
irritability.

Thus we may perceive that the triunit consisting of perception,
appetence, and motion, constitutes the celebrated irritability of our
author. But he has been too latitudinarian in his application of the
theory; for he did not limit it, as HALLER has subsequently done, to one
sort of fibres, or indeed to fibres alone, for he says in cap. IX., "It
is to be remarked that natural perception belongs to other parts of the
body besides fibres; to wit, to the parenchymata, bones, marrow, fat,
blood, recrementitious juices, humours of the eye, and such like, all
which are irritable, and increase the irritable constitution of the
parts, but these parts hardly admit of the existence of animal
perception." HALLER blames GLISSON for having gone so far in his
application of the theory, and it is well known that he himself
restrained it to the single tissue of muscular fibres, and denominated
it vis insitum, or inherent force; whereby he distinguished it from his
vis mortua or elastic contraction, on the one hand, and the vis nervosum
or voluntary power, on the other; the former being something less, and
the latter something more than irritability. GLISSON'S theory, when
fully explained, which we cannot for want of space do here, will be
found to bear a very strong resemblance, in many points, to that of
BICHAT, who has invested the matters of the body with vital powers, far
beyond those attributed by HALLER; and as we are not furnished in the
present article with sufficient space, we hope in some subsequent
number, to place this matter in a plainer light before our readers. In
the mean time we may remark, that GLISSON seems to be the first of those
who have placed the subject fairly before the medical public; for
although faint traces of a similar theory may be perceived before him,
especially by translating terms into their equivalents, yet he has the
merit of using a term which, in spite of all subsequent modifications,
is in daily use.

GLISSON'S latitudinarianism may be contrasted with HALLER'S rigid
application: for the latter says, "I call that an irritable part of the
human body, which on being touched by a foreign body, renders itself
shorter;" thus while GLISSON attributes his triunit of perception,
appetence, and motion to all the tissues and fluids, HALLER confines it
to muscular fibre alone. No one can doubt that the membranes of the body
are endowed with vital properties, but yet they do not shorten
themselves on being touched by a foreign body. BICHAT has distinguished
their vitality as organic vitality, and the contractile qualities
displayed are divided into insensible organic contractility, and into
contractility of tissue: but these sorts of contractility mount up by
insensible gradations. He says, that "entre la contractilité obscure
mais réelle, necessaire a la nutrition des ongles, des poils, &c. et
celle que nous presentent les mouvements des intestins, de l'estomac,
&c. il est des nuances infinies, qui servent de transition: tels sont
les mouvements du dartos, des arteres, de certaines parties de l'organ
cutané," &c. We will close with a comparison between GLISSON'S
irritability, and BICHAT'S contractility. At page 70 of the Treatise
_sur la Vie & la Mort_, BICHAT supposes that a "muscle enters into
action, 1st. by the influence of the nerves which it receives from the
brain, and this is a case of contractile animale," (which differs in no
respect from perception regulated by animal appetency of GLISSON).
2ndly. According to BICHAT, the muscle enters into action "by the
excitation of a chemical or physical stimulant applied to it, and which
artificially determines a movement of the whole muscle, analogous to
what is natural to the heart, and other involuntary muscles. This is
sensible organic contractility or irritability," and corresponds to the
sensitive perception of the old English physiologist. In the 3d place
it enters into action by the stimulus of the fluids which circulate in
it, and this is insensible organic contractility or tonicity of BICHAT,
and is nothing different from GLISSON'S natural perception. BICHAT makes
a fourth case; as for example, when a muscle is divided across, it
contracts by a _contractilité de tissue_, or _par defaut d'extension_.
We do not perceive how GLISSON'S natural perception can be applied to
this case, but he treats of it in his fifth chapter under the head of
Cessatio: it is that state to which a fibre is reduced when left to
itself, and freed from all stimulus.

BICHAT has attributed to some fibres the power of active elongation. On
this subject GLISSON says, "Impossible enim est, ut simplex fibra, sua
sola actione, se secundum longitudinem distendat, nec modus quo hæc fiat
concipi nedum effari queat non negavero quin in distensione hac,
aliqualis fibræ actio includatur, sed ea tota contractiva est, &
distensioni ab extranea causa factæ reluctatur." A doctrine as sound as
that of the 47th proposition; a doctrine too, without admitting which,
we think no man can understand the theory either of simple inflammation,
or of the febrile affections. We hope to resume this subject at an early
period.

FOOTNOTES:

[25] Hæc ei generatim videbantur, ex igne omnia constare eodemque
interire. Diogenes Laertius.

[26]
Quatuor æternus genitalia corpora mundus
Continet; ex illis duo sunt onerosa, suoque
Pondere in inferius, tellus atque unda, feruntur,
Et totidem gravitate carent, nulloque premente
Alta petunt, aer atque aere purior ignis.--OVID--_Metamorph._

[27] Lib. de Carnibus, HIPPOCRATES says: Quod Calidum vocamus, id mihi
immortale esse videtur, cunctaque intelligere, videre et audire,
sentireque omnia, tum præsentia tum futura: cujus pars maxima cum omnia
perturbata essent in supremum ambitum secessit; quod, mihi veteres
æthera appellasse videntur. Altera pars locum infimum sortita, terra
quidem appellatur, frigida et sicca multas que motiones habens, et in
qua multum sane calidi inest. Tertia vero pars medium aeris locum nacta
est, calidum quid existens. Quarta pars terræ proximum locum obtinens
humidissima et crassissima. His igitur in orbem agitatis cum turbata
essent, calidi magna pars alias in terra relicta est, partim quidem
magna, partim vero minor, alias etiam valde parva, sed in multas partes
divisa. Et temporis successu a calido resiccata est terra, ista in ea
tanquam in membranis contenta circumse putredines excitant, ac longo
tempore incalescens quod quidem ea terræ putredine pinguedinem sortitum
est et minimum humidi habet, id citissime exustum ossa produxit. Quæ
vero naturam glutinosiorem sortita sunt et frigidi communionem habent,
ea neque calefacta exuri potuerunt, neque etiam humida fieri ideo formam
longe ab aliis diversam nacta sunt et nervi solidi exciterint, cum non
multum in iis frigidi inesset. At venæ frigidi multum habebant cajus
pars circumcirca ambiens et quod erat glutinosissimum, a calido
exassatum membrana extitit. Quod vero erat frigidum, a calido superatum,
dissolutum est ideoque humidum evasit.

[28] K. SPRENGEL, Hist. de la Medicine.

QUARTERLY SUMMARY

OF MEDICAL AND SURGICAL INTELLIGENCE.

I. ANATOMY.

1. _Papillæ of the Tongue._--At the upper surface of the tongue, say MM.
LEURET and LASSAIGNE, in their recent work on digestion, the mucous
membrane presents projections of three different species; and these are,
the sensitive papillæ, the epidermoid papillæ, and the mucous cryptæ.
The sensitive papillæ are numerous. They occupy the anterior four-fifths
of the tongue, on which they are implanted by a narrow pedicle. The
rounded head of these papillæ is much more prominent in the living
subject, than after death; but injections are capable of restoring them
to their pristine form. Nervous fibres from the lingual branch of the
fifth pair have been distinctly traced to their roots. These papillæ are
of various sizes; at the root of the tongue they form a V. They are all
vascular and nervous. The sense of taste is referred by these writers
almost exclusively to the above papillæ.

The epidermoid papillæ are of a nature similar to those retroverted
prominences so remarkable on the tongue of the cat; as well as in the
lion, and some other animals. They are larger in many species than in
man, and, in general, the sensibility of the tongue appears to diminish
in proportion to the remoteness of the subject from the human structure.
The epidermoid papillæ are separated from the tongue along with the
epidermis, or rather, epithelium, by maceration for a few days in
vinegar. They are pyramidal in form. They are grouped round the
sensitive papillæ, except on the edges and point of the tongue, where
they are rare. Their base is perforated, and always gives outlet to a
crypta. In an epithelium separated from the tongue, these minute and
numerous perforations are easily distinguished from the larger ones left
by the sensitive papillæ.

The office of the epidermoid papillæ appears purely mechanical.

The only cryptæ which produce, of themselves, a visible projection on
the surface of the tongue, are situated at its base. They are formed by
the mucous membrane, like other cryptæ, and are scattered between the
sensitive papillæ.

In the tongue of birds, there is always a bone or cartilage; and the
external membrane is dense. In reptiles the tongue is soft, possessed of
little sensibility, and capable of great elongation. In fishes it is
endowed with little motion, and is often wanting.--_Bulletin Medicale._

2. _Villi of the Stomach and Intestines._--MM. LEURET and LASSAIGNE
state that the villi can be easily injected; most conveniently from the
vena portæ, though the arteries may be employed. In the latter case,
the matter of injection is effused into the intestinal or gastric
cavity. The villi are peculiar to these parts; they are inversely
conical, adhering to the membrane by their smaller end. The best mode of
exhibiting them, is to tie the vena portæ of a living animal, when they
erect themselves by the afflux of blood. These diminutive organs, about
3/100 of an inch long, then exhibit distinctly, under the microscope,
four red longitudinal lines, being probably vessels.

Injections made retrograde from the thoracic duct, pass through the
villi into the intestines. When the stomach of a man, who died of some
complaint not deranging its condition, is examined, we sometimes find
its lining membrane covered with a multitude of minute white points.
These are the villi in a flaccid state. In those who have died during
digestion, they are erected, and of a rosy colour.

When the intestine of a living animal is examined under a microscope,
after being carefully washed, a great number of orifices are seen, from
each of which exudes a minute drop of a transparent fluid. These rapidly
disappear; and then the villi attract attention. What these foraminula
are, the reviewer, M. DU FERMON, does not tell us.--_Ibid._

3. _Minute distribution of the Vessels of the Liver._--M. CRUVEILHIER
gives, in his lectures, an account of the results he has obtained from a
minute injection of the liver. He finds, 1. The acini surrounded with a
dense, cellular texture, paler than themselves; 2. The ramifications of
the hepatic artery distributed to this cellular envelope; 3. Those of
the vena portæ spread around the acini, or granulations of the liver;
and 4. Those of the biliary ducts, and of the hepatic veins, emerging
from the cavities of these bodies.

Our readers will observe a great similarity, in this, to the arrangement
of the lobules of the kidneys.--_Ibid._

4. _Trachea perforating the Aorta._--This odd distribution of parts, was
observed by M. ZAGORSKY, at St. Petersburg, in 1802. The aorta divided
itself, at its arch, into two branches, which received the trachea
between them, and again united, exactly fitting the organ they received.
They were found to have compressed the trachea, and probably produced
difficulty of breathing.

In another case, in 1808, the right subclavian artery, instead of its
usual origin, arose from the left extremity of the arch of the aorta,
and crossed behind the trachea, thus including the latter between it and
the aorta.

Why do we call the common trunk of the right subclavian and carotid, the
arteria innominata? Is coining words so difficult a task, that we
cannot find a proper and expressive name for it? The French
call it _brachio-cephalic_, and this expresses its office and
distribution.--_Ibid._

5. _Monsters._--These productions, hitherto considered as mere objects
of wonder, from the study of which no useful inference could be drawn,
have recently attracted a good deal of attention in Paris. There seem to
be some close affinities discoverable in many of them, not only with
the natural and complete forms of animals of various tribes, but even
with the actual condition of their own species, while in the foetal
state.

The views of M. GEOFFROY ST. HILAIRE seem to us rather mystical and
vague. Those of BRESCHET, and the other practical anatomists, we can
understand much better.

6. _Malformation of the Heart._--Drs. BAILLIE,[29] LANGSTAFF,[30] and
FARRE[31] have each published cases; and M. TIEDEMANN, in his journal of
Physiology, now adds a fourth, in which the aorta and pulmonary artery
were found to have changed places. In professor TIEDEMANN'S case, the
two circulations were entirely distinct; the systemic blood passing from
venæ cavæ to right auricle, from right auricle to right ventricle, and
from this, through the aorta, to the body at large; while the pulmonary
blood ran through an equally simple circle, by the route of pulmonary
veins, left auricle, left ventricle, and pulmonary artery. The only
communications between the two circulations, were the foramen ovale, the
ductus arteriosus, and, in the opinion of M. TIEDEMANN, the
inosculations between the branches of the _pulmonary_ and _bronchial_
arteries.

The infant is recorded to have presented _no peculiar appearances_ till
the ninth day; when attacks of suffocation came on, attended with the
blackish blue colour, and followed by death, at the end of twelve days.
Similar histories are said to be given of the cases mentioned above, and
the references to which we have copied. We have not the time to consult
them.--_Ibid._

7. _Acephalous Mummy._--M. GEOFFROY ST. HILAIRE has read a memoir of
some length to the Academy of Sciences, on an acephalous mummy. It was
found in a catacomb, destined, with this exception, exclusively to
animals. It had an amulet suspended round its neck, being an earthen
figure of a cynocephalus, for which it was very probably mistaken by the
Egyptians. The collector, M. PASSALACQUA, who obtained it, showed it to
M. G. ST. H. as a monkey, of which he wished to know the species. Yet
the latter observes that these amulets were only put on human mummies.

M. G. concludes that the monkeys, elephants, &c. said by Livy, Valerius
Maximus, Pliny, and others, to have been born of women in their times,
and considered as omens of public calamity, were acephala.

8. _New Anatomical Plates._--Messrs. E. W. TYSON and GEORGE SIMPSON are
publishing anatomical plates, in London. They are spoken of with
approbation. The labours of the latter are designed for the use of
painters.

9. _A Manual of Osteology_ has been undertaken by Dr. WEBER, of Bonn,
and one volume published.

10. _Soemmering's fine work on the anatomy of the ear_, has been
translated into French, and his splendid folio plates copied in
lithography.

11. _Does the conjunctiva run over the cornea?_ Messrs. LECOQ, LEBLANC,
and ARTUS, state that they have each seen a case in which regular _skin_
and _hair_ were seen, forming a small patch on the cornea of the eye of
a quadruped. This is considered as a proof of the existence there of a
membrane naturally analogous to the skin; which must, of course, be the
conjunctiva. An officer saw another case, in which a hair was seen in
the middle of the eye of a horse.--_Bulletin._

II. PHYSIOLOGY.

12. _Electro-Galvanic phenomena of Acupuncturation._--M. POUILLET, after
making a complete circuit, through a needle introduced in acupuncture,
through wires, and through the patient's mouth, found, by means of a
multiplier of SCHWEIGHER with a magnetic needle, that the
electro-magnetic rotation could be readily produced; at least so far as
to effect small vibrations backwards and forwards. On repeating it with
two needles, one of them run into an artery and another into a vein, or
one into the medulla spinalis, at the neck, and another into an
extremity, in a rabbit, no effect whatever took place.--_Magendie's
Journ. de Physiologie._

13. _Variations in Milk._--Milk, says M. VALLOT, in his memoir read to
the Academy of Dijon, may be _red_. The cause of this is unknown, though
it has given rise to superstitious fears. Some have observed that the
cow's teats are then tender. Whether this be cause or effect has not
been ascertained.

_Yellow milk_ is said to have been produced by the cow's eating the
caltha palustris, (marygold.) _Blue milk_, from a cause still unknown,
in the departments of Seine-inférieure and Calvados. Some have ascribed
it to the hyacinthus comosus; others to butomus umbellatus.

The _green milk_ of some writers is supposed to be only blue. _Milk not
coagulable_ is produced by feeding on husks of green peas, and on mint.
_Bitter milk_, from wormwood, sonchus alpinus, and the leaves of the
artichoke; and in goats, from eating freely of elder, (sambucus nigra,)
and potato-tops; _a disagreeable taste_, from turnips, in Upper Canada.
_Garlicky milk_, from causes well known. _Insipid milk_, and
_lead-coloured butter_, from equisetum fluviatile. _Milk unnaturally
sweet and luscious_, (sucré,) from alpine clover, (trifolium alpinum;)
and _red butter_, from the ripe berries of asparagus.--_Bulletin._

14. _Hyoscyamus dilates the pupils of the eyes_, the same manner as
stramonium, several Eastern species of datura, and belladonna, which the
Europeans use. The strongest species was datura fastuosa.--_Oriental
Magazine, apud Du Fermon._

15. _Worms in the Eye._--Several cases of worms in the eye are mentioned
in the Bulletin des Sciences Medicales, for Feb. 1826. DEGUILLEME saw
several in the eye of a cow; and the case was published by GORIER, a
veterinary teacher, in his memoirs. In the report of the proceedings of
the veterinary school at Lyons, in 1822-3, there is the case of a mule,
in which a knot of worms (crinons) was seen in one eye. _Two_ were
extracted; (why no more is not said;) and another subsequently. No
inflammation was produced; but a violent nervous agitation of the head,
and a turning of it to the left side took place. Next follows an account
of a memoir read before the Medical Society of Calcutta, but of which
the name of the author is not given. He is represented as stating, that
the strongylus armatus minor of RUDOLPHI, and the _filiaris_ (filaria)
papillosa, are frequently found in the eyes of the horses in India, but
much more so in the cellular membrane, particularly about the loins. He
believes that they make their way into the blood-vessels, and, through
them, into the eye. Their most ordinary seat is the cellular membrane of
the loins; where they exist for years, producing emaciation, and, at
length, paralysis of the hind legs. This last the Calcutta author is
represented as ascribing to the penetration of the spinal marrow; but he
does not appear to have verified it by dissection. TREUTTLER says, he
has seen the strongylus armatus in _aneurisms_ of the mesenteric artery
of the horse; but the writer in the Bulletin doubts whether any have
ever been found in sound arteries.

Dr. KENNEDY, in the Edinburgh Philosophical Transactions, describes a
worm, which he calls _ascaris pellucidus_, (pellucida,) as being common
in the eyes of horses in India. A review of BREMSER'S work on worms is
expected in our next, and inferences will then be drawn from these
singular facts.

16. _Digestion._--MM. LEURET and LASSAIGNE, in their very interesting
and valuable experimental essay on this subject, have met with many
curious results.

They found no remarkable difference in the saliva of carnivorous and
herbivorous animals. The purest saliva was obtained for their
experiments directly from the parotid duct, in man, the horse, and dog.
The composition was as follows:

Water, 99 parts; mucus, traces; albumen, soda, chloride of sodium,
chloride of potassium, carbonate of lime, and phosphate of lime, 1 part.
Total, 100.

Their experiments on the bile confirmed the results of THENARD and
CREVREUIL.

The pancreatic juice is of the specific gravity 1.0026; at 15° of the
thermometer: (centigrade, we presume.) Its composition is:

Water, 99.1 parts; animal matter soluble in alcohol, animal matter
soluble in water, traces of albumen, mucus, soda, chloride of sodium,
chloride of potassium, and phosphate of lime, 0.9 parts. Total, 100.
This greatly confirms the analogy long observed between the pancreatic
liquor and the saliva.

In the _gastric liquor_, there are:

Water, 98 parts; _lactic acid_, muriate of ammonia, chloride of sodium,
animal matter soluble in water, mucus, and phosphate of lime, 2 parts.
Total, 100.

Dr. PROUT and Mr. CHILDREN have announced the gastric acid, of which so
much has been said, to be the muriatic, while M. CHEVREUIL had stated it
to be the lactic. MM. LEURET and LASSAIGNE confirm the results of
CHEVREUIL, and that with great confidence in their own accuracy. They
found the contents of all the four stomachs of ruminating animals acid.
MM. PREVOST and LEROYER had stated those of the three first to be
alkaline. The observations of LEURET and LASSAIGNE agree with those of
MONTEGRE, (vide Dict. des Sci. Med.) who believes digestion to produce
acidity as a result of the regular process.

The _fæces_ become alkaline.

_Substances which contain no azote, from whatever class they are
obtained, cannot serve for nutrition._ We cannot understand this,
especially when compared with what follows. "If, on the contrary, they
are soluble, one part is absorbed and another is expelled, either by
urine or by the anus; such are sugar, gum, &c." This seems to us like a
contradiction.

It is impossible, in the present state of science, to determine the
chemical change which aliments undergo in the digestive organs; both on
account of their mixture and the insufficiency of our means of analysis.

"The absorption of chyle takes place by the villi." "These communicate
directly with the lacteals and the vena portæ."

"The transference of the chyle takes place by the lacteals;
nevertheless, if they are obliterated, _this may be done through the
vena portæ_."

_The section of the pneumo-gastric nerves does not stop the dilution of
aliments in the stomach, or chylification._

The juices secreted by the liver and pancreas, are poured into the
intestines in greater quantity during digestion than at any other
period; in consequence of the contact of the acid chyme with the biliary
and pancreatic orifices.

The pancreatic juice is analogous to the saliva.

The spleen is an appendage to the liver; it swells during the absorption
of liquids by the vena portæ.

Liquid aliments are digested, just as much as solid; but they do not
require so great a quantity of gastric and intestinal juices.

Watery drinks are absorbed in the stomach and intestines, by the
radicles of the vena portæ. Spirituous drinks occasion an afflux of the
gastric juices, become acid, and are absorbed.

Excrements owe their colour and odour to the bile, and their
consistence to the absorption of a portion of the water they contain.
They carry off a large amount of the nutriment.

Great obscurity still remains as to the cause of hunger.

Thirst is thought to be produced by the drying which the pharynx
undergoes, from the passage through it of the air used in respiration,
and at a time when the supply of mucous fluid is scanty.

Our readers will have perceived, long ere this, that here are several
propositions at war, not only with our received opinions, but with the
experimental researches of some others among the modern physiologists.
We do not know what Dr. WILSON PHILIP would say to his observations
being so cavalierly dismissed: they seem scarcely to condescend to
mention his name in France. Not having the original, we could do no
better than translate, almost literally, the conclusions of these
experimenters, as stated in the Bulletin; and the result of this is what
we have just given our readers. From the words "the absorption of
chyle," to the end, is nearly verbatim the language of the review.

III. PATHOLOGY.

17. _Dothinenteria. Pustules of the small Intestines._--From [Greek:
dothinê], a pustule, and [Greek: enteron], an intestine. This name is
given to a disease which has been described by M. BRETONNEAU, of Tours,
and, after him, by SERRES, BROUSSAIS, ANDRAL, and several others, and
consists in pustules, generally situated at the lower end of the ileum.

We are constantly lamenting to ourselves the contracted bounds allotted
to our Quarterly Summary. Indeed, were it not for other objects, it
might occupy, with advantage, half of the number, and most of the time
employed in the preparation of the work. Every thing must be curtailed,
though cut off at the most interesting and valuable point; and the
painful exertion of the attention, necessary to condense information for
our readers' use, of the amount of which they cannot possibly be aware,
can only be equalled by the constant feeling of disappointment at
rejecting so much important matter.

We are told that this pustular disease is as common and as destructive
as the _small pox_, (indeed!) the measles or the scarlatina; that few
persons spend the whole of their lives without having, at some period,
suffered by it; that it never affects individuals but once; and that it
is suspected of being contagious.

M. BRETONNEAU has prepared a set of specimens, taken from the bodies of
those who have died in various stages of this complaint. He traces the
malady day by day, with a precision which we will not copy here. The
seat of this affection is the glands of PEYER and BRUNNER. The former
are found in groups, throughout the lower half of the jejunum and the
whole of the ileum, gradually increasing in the size and number of their
clusters, till they reach the valve of the colon, where they cease. They
have been mistaken by some dissectors of the modern school for the
effects of inflammation. They are found in honey-combed patches; which
are agglomerations of mucous glands. The glands of BRUNNER are thinly
dispersed mucous follicles which are scattered singly throughout the
whole length of the small intestines, with nearly equal frequency. These
organs are well described by HALLER in the great Physiology. They are
not seen well, unless in a young subject, and by cutting into the
intestine very close to the mesentery.

When inflamed, they swell and thicken, and, after some days, the
membrane around them assumes a reddish tint. The mesenteric glands are
enlarged. M. BRETONNEAU has seen one as large as a hen's egg: they
generally equal in size that of a pigeon. The disease spreads and
affects an additional number of glands. It reaches its acme generally on
the 9th day; after which sometimes all, and always a part of the
affected glands return to their natural condition, by resolution of the
inflammation. Those which are to run the full course of the disease
continue to augment in size and projection into the intestine. On the
13th and 14th days they are discovered tinged with bile, which
penetrates their substance, and thus proves the occurrence of
disorganization. On the 15th and 16th, the sloughs separate, and leave
from one to six ulcers. These penetrate the gland, and with it the
mucous membrane, of which it forms a part, and next, the cellular tissue
of the intestine. In numerous instances they perforate the muscular
coat, leaving nothing but peritoneum at the bottom; and frequently,
passing this, they induce inflammation of the cavity of the belly, and
death.

The cases of simple resolution terminate in three weeks: those in which
sloughs are formed, in from 30 to 40 days, if not fatal. If death be
from peritonitis, it is of course soon after the 15th and 16th days; if
from exhaustion, at periods varying according to the strength of the
sufferer. Dothinenteria occurs in many of the cases commonly called
typhus fever, gastro enteritis, &c. It is proper to remark that both the
author and the journal are in opposition to Dr. BROUSSAIS.--_Archives._

18. _Dr. Broussais._--While the opinions of this celebrated reformer
have been gradually becoming more extensively known among our
countrymen, the war has prevailed with increased heat in his native
land. The most vehement attacks are made, from various quarters, upon
his system of _medicine physiologique_. No one appears to deny that he
has clearly proved the existence of mucous gastritis and enteritis in
many or most fevers, or the propriety of directing a part of the
remedies to them. Criticisms and invectives are freely emitted: but they
are only levelled against the too extensive application of this
doctrine, and the inconsistencies, unquestionably often real, of the
system of which he has made it the foundation. Indeed, if the quotations
given are correct, we think no one who has not assumed a party, can
refrain from concurring in their condemnation.

"Those who understand our doctrine never attack it; they speak of it
only to express their admiration: above all, they never think of wishing
to modify it, because they know that its fundamental dogmas are
unshakeable." "Surtout ils ne s'avisent jamais de vouloir la modifier,"
&c. A man who assumes such ground as this, had need be very careful in
assuming his positions, indeed; and should particularly avoid any thing
like self-contradiction.

The _Lettres a un medecin de province_, in a style of lively criticism,
labour to show a great variety of inconsistencies in this immoveable
doctrine. The review of this publication in the Revue Medicale,
including copious extracts, coincides with, and evidently wishes to aid,
the author's satire. In the same journal are a series of criticisms on
some of the elementary propositions of Dr. BROUSSAIS, published in a
late edition of his Examen; (nearly the same which were published here,
some time since, in the American Medical Recorder, having been
translated by Dr. ATKINS.) In these critiques, great severity is shown,
in dealing with the new dogmas, and the doctrine is treated as one of
dangerous tendency; while, at the same time, high praise is awarded to
their author, for his discoveries in the diseases of the alimentary
mucous membranes.

In the other journals, there is a division; some favouring the new
opinions, while others oppose them with more or less of vehemence.

That the doctrine of gastritis has made a great impression at Paris,
that almost every one believes in it, to a greater or less extent,
appears undeniable; but there, as well as here, most of the more
rational, and moderate minded men are evidently of the only school a
physician ought to belong to, the _eclectic_. Borrowing largely from
BROUSSAIS, and having had their minds powerfully stimulated by the
succession of striking and novel ideas which he has introduced, they
think it unmanly to "bind themselves to his chariot-wheel," but form
conclusions for themselves from every resource within their power. If
the great French reformer really wishes to establish as absolute a power
over the minds of his followers, as MAHOMET or PYTHAGORAS did, and as
the above-quoted extract seems pretty fairly to indicate, he must
certainly undergo many mortifications. Notwithstanding the
"inebranlable" nature of his dogmas, M. MIQUEL has furnished us with
several variations from them, in the writings of Messrs. BOISSEAU,
ROCHE, SANSON, REMUSAT, RICHOND, and BEGIN; and the last-named
individual has had a public dispute with his preceptor.

M. BEGIN has produced his promised work on surgery, according to the
principles of the new school. We have not seen the volume, but have read
a review of it in the Revue Medicale, by M. BELLANGER. The latter
describes it as a cursory work, having for its object the adaptation of
surgery to a set of general principles, rather than a detailed system
of instructions how to proceed in each individual case. It contains only
what is easy to be remembered, and omits those matters for which it is
usual to refer to books. Thus two pages only are appropriated to
fractures of the body and neck of the femur! and twenty-six for the
whole subject of fractures, wounds, and six or eight of the most
important diseases, of bones! Yet all this criticism is not without a
compliment, well-merited at least by the former productions of the same
author, to his talents and ingenuity.

19. _Whooping-cough._--"There is no disease of children, in which the
resources of medicine are more manifestly serviceable than in an
obstinate whooping-cough." Such, in amount, was the opinion of Dr.
UNDERWOOD, and Dr. WATT uses language almost equally strong. Certainly,
we are not at all times equally successful or equally sanguine in
America.

Dr. A. CAVENNE considers whooping-cough a true bronchitis, a pulmonary
catarrh; accompanied with greatly heightened nervous symptoms, owing to
the irritable period of life at which it occurs, and particularly to its
frequent existence in nervous constitutions. Professor TOURTELLE calls
it a pneumo-gastric, pituitous catarrh; and certainly, the pupils of a
modern school will find no difficulty in recognizing symptoms of
gastritis in its severer forms. The further inferences drawn by Dr.
CAVENNE, are as follows:

1. That the whooping-cough, in an individual of a sanguine temperament,
requires, in general, the use of bleeding, and a debilitating regimen.

2. That bleeding and a debilitating treatment are equally necessary,
whatever be the temperament, in whooping-cough of the chronic form.

3. The antispasmodics are necessary in nervous constitutions.

4. That blood-letting and the debilitating treatment should be rejected,
when the subject is endowed with a lymphatic temperament. This
observation, says our author, is equally applicable to early infancy, in
which lymph predominates over the red blood, and the fluids are more
diluted.

Finally, if the disease be obstinate and there be disturbance in several
functions, there is certainly reason to believe that a lung, a viscus of
the abdomen, or the brain, is in an unfavourable condition; (the author
means of the inflammatory kind;) and this is ground for the moderate
abstraction of blood.--_Journ. Univ. Feb._

20. _Antiperistaltic globus. Globus hystericus._--Dr. TROLLIET, of
Lyons, observes that hysteria cannot, with propriety, be said to exist
in the male sex; that it arises, as its name imports, from derangement
of the uterus, and that CULLEN and SYDENHAM have done wrong, and stand
alone, in teaching the contrary. When there exists a real hysteria, the
contractions are not confined to the intestinal regions, but invade the
neighbouring parts; (quere, which of them contract?) they are always
accompanied, when existing in a high degree, with convulsions and loss
of the mental powers. In the intervals, the patients affected can
satisfy their appetite.

Antiperistaltic globus may occur from various causes; and either in the
intestines or the oesophagus.

That of the intestines is met with chiefly in advancing age; and is
generally produced by daily and often-repeated pressure on the abdomen,
as practised in various professions. Hard labour and bad diet also
greatly aggravate it. At first pain in the intestines occurs, aggravated
by labour; together with derangement of digestion.

The sensation of a globe then appears on the lower and left side of the
abdomen; and, after performing various circuits, finally reaches the
stomach; from which is soon after discharged, with great relief, a
quantity of gas, issuing from the mouth. Vomiting of an acid and burning
fluid, as also of the food, is not uncommon as an accompaniment. This
ball is about the size of a man's fist, and is sensible to the external
touch, and even to the sight. The patients possess the power, to a
certain extent, of controlling its motions, and relieving the pain,
which is often extremely violent, by pressure.

Indigestible food always aggravated the disease. Some could only
tolerate milk, broth, and other fluids. A weaver was obliged to quit his
profession, from the pressure on the abdomen which it required,
occasioning the paroxysms.

The treatment consisted in

1. Avoiding the original causes.

2. The use of a species of corslet, (plastron,) to prevent future
pressure on the abdomen.

3. A rigid diet. We do not understand why, firstly, articles containing
a great deal of fecula, and, as it is said, "requiring a great action of
the intestines," are forbidden, while, in the second place, rice is
recommended. "Bouillon aux herbes," (a laxative decoction,) rice-cream,
and milk, were found the best. Wine was injurious. Assafoetida and
camphor were useful, and were administered in boluses. Purgatives were
injurious. Emolient enemas were useful.

Of antiperistaltic globus in the oesophagus our author saw only two
cases, which were not complicated with hysteria. The patients had both
been subject to rheumatism; and, in one of them, this had been
supplanted by an eruption Of tetter: on the disappearance of which last
the globus appeared. These cases were cured, the latter by a severe,
light diet, and some antispasmodics, the names of which are not
mentioned; the other by curing the rheumatism.

Dissections are somewhat difficult to obtain; unless where some other
more mortal disease exists. In one, scirrhus of the pylorus was found;
the stomach greatly enlarged; the small intestines contracted, _red
outside and gray within_. (Where was the redness situated; in the
peritoneal or the muscular coat? We must _guess_ the latter.) The
stomach was pale gray, and thickened. The large intestines were dilated,
and gray.--_Journ. Univ._

21. _Non-contagion of Yellow Fever._--Dr. VALENTINE, of Nancy, has
printed a pamphlet of a single sheet, in which he finds himself involved
in all the turmoil, through which American physicians passed during the
period which intervened between 1793 and 1805. Dr. V. gives his
authority decidedly in favour of the non-existence of a contagion in
this disease; and grounds his opinion upon the innumerable cases of
patients affected with the disease and otherwise, who have escaped from
infected districts, without communicating the malady in any instance, to
the persons with whom they lived; upon the healthiness of ports, from
which it has been said to have been introduced, &c. Dr. V. is not, as
some of his countrymen have been, unwilling, from some unimaginable
cause, to make use of the immense mass of American evidence; though he
observes, and with justice, that experiments should be repeated in
France, in order to set the public mind at rest in that kingdom. He
proposes the employment of criminals for this purpose; and recommends
every mode of the most close contact which his imagination could
suggest. He mentions experiments of this kind having been made in the
United States; and by M. GUYON, of Martinique, on his own person.

He quotes Dr. CHERVIN's labours, with great and just applause. This
indefatigable and daring physician has now spent upwards of ten years in
accumulating proofs upon this single question.

At the commencement of the pamphlet, the arrangement of which does not
seem to us to be quite clear and easy, Dr. V. gives a sketch of the
situation and localities of Leghorn. He traces the fevers of that place
to putrid matters, perceptible by the sense of smell; and principally to
obstructed drains. He does not give the exact degree of heat, but merely
states that it was excessive, and followed by heavy rains.

IV. THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE.

22. _Iodine._--In the former numbers of this journal, we offered some
observations respecting the medicinal properties of iodine, intending
then to present in one of our future numbers an elaborate analysis of a
valuable work on this subject, by Dr. Manson, which appeared in England
sometime last year.[32] Fearing, however, that the want of room and time
will prevent us from fulfilling this task, as soon as soon as might be
desired, we have thought that a condensed notice of its contents would
be acceptable in this place.

It appears that previously to the discovery of iodine as a medicinal
agent, our author used the burnt sponge in bronchocele, a disease very
common in the neighbourhood of Nottingham, where he practices. But when
the effects of the former remedy was announced, Dr. M. prepared a
tincture composed of one drachm of iodine to two ounces and a half of
rectified spirit, (spec. grav. 916.) and prescribed it very extensively
in doses of from 10 to 30 drops three times a day, according to the age
and strength of the patient. Dr. MANSON has presented a tabular view of
116 cases of bronchocele treated by iodine, and also a detailed account
of 15 more cases, with appropriate remarks. Of the former, there were,
viz:--

Males--Cured, 10
Much relieved, 1
Discharged for non-attendance, 1
Improving under treatment, 3--Total 15
Females--Cured, 66
Much relieved, 9
Not relieved, 2
Discharged for non-attendance, 10
Improving under treatment, 14--101--116

Whilst using the tincture internally, Dr. MANSON occasionally had
recourse externally to a liniment composed of

Liniment. Sap. Comp. [Symbol: ounce]i
Tinct. Iodinæ, [symbol: dram]i _m._

Some patients can bear this quantity rubbed into the tumour once, and
sometimes twice a day; though in some, the skin is so tender, that the
liniment cannot be so frequently used. Dr. M. prefers this liniment to
the common iodine ointment, as less liable to evaporation. In France, we
believe Dr. RICHOND prefers rubbing in the tincture itself. The
following remarks are useful:

"In some _individuals_, after the preparations of iodine have been given
internally for some time, they are apt to occasion headach, giddiness,
sickness of stomach, with some degree of nausea, langour, and inaptitude
for exertion; when these unpleasant sensations and effects occur, the
best plan to remove or obviate them is to suspend, for a time, the use
of the medicine, or to reduce the dose, as may seem most expedient." A
reduction of dose, from fifteen to twelve drops, was the plan adopted by
our author on this occasion.

2d. _Paralysis._--Want of success with the ordinary modes of treating
this disease, induced Dr. MANSON to try the effects of iodine.

"The wonderful powers of iodine, which I had recently witnessed; and a
long previous acquaintance with the same remedy as it exists in burnt
sponge, in reducing morbid enlargements of the thyroid gland, led me
from analogy, to think, that in cases of palsy, from tumours or fluids
pressing on the brain or spinal cord, or from morbid thickening of the
investing membrane of the cord itself, iodine might prove a useful
remedy not only by stimulating the nervous system, and removing morbid
tumefaction and effusion, but also by correcting the strumous state of
the constitution that often gives rise to the disease."

The following interesting case as abridged in the Medico-Chirurgical
Review, for January 1826, we take the liberty to transcribe.

"J. Watterton, aged 19, was admitted into the General Hospital of
Nottingham, on the 27th of March, 1821, having been ailing since
October, 1819. Stated that he had at first been attacked with pain in
the bowels, which having ceased, the lower extremities became swelled
and painful.

"After this, his neck became stiff and painful, with shooting pains from
the neck into the left side of the head. These also disappeared, and did
not afterwards return. This was about nine months ago, and, at that
time, he suddenly lost the power of the left arm, and in a short time
afterwards, that of the left lower extremity. Some time after this, he
recovered, partially, the use of the left arm; the leg remaining
paralytic. About this time, the _right_ half of the body was
instantaneously and completely palsied. He has continued ever since in
this wretched state, getting worse rather than better, passing his
stools and urine, involuntarily. He lies on his back, and, with the
exception of the left arm, he is completely paralytic on both sides,
from the neck downwards. The sense of feeling is very much
impaired--there is no distortion of the face, nor impediment of
speech. Is troubled with twitchings in the lower extremities.
_Purgatives--blisters to the nape of the neck, and to be kept open._

"It appears that, about two years ago, he had a bloody purulent
discharge from both ears. The left still continues to discharge a
purulent looking matter. Purgatives were continued till the 6th of
April, when the tincture of iodine, in doses of 15 drops, was given
thrice a day. April 9, can raise the right arm nearly to the head; but
the power of the lower limbs has not improved. The twitchings have
decreased. Purgatives--the tincture of iodine to be increased to 20
drops ter in die. 10th. Evinces some muscular power in the lower
extremities to day--feels stronger--can retain his urine for some time.
14th. Continues to improve. The left foot is become exquisitely
sensible, and that extremity is often drawn up spasmodically towards the
body. The iodine to be increased to 25 drops. 16th. The paralytic
symptoms continue to yield to the powerful influence of the iodine. When
his meat is cut, he can now feed himself with the left hand;--can raise
the right hand to the chin, and draw the right upper extremity up
towards the body. He continues to hold his water. The iodine is
increased to 30 drops, thrice a day--from this date to the 7th of May,
the medicine was occasionally obliged to be intermitted and again
commenced in smaller doses. At this period, however, the patient could
walk from his bed room to the day ward with very little assistance.
19th. He can walk without any assistance, except that of a stick to
steady him. June 9th, can walk without a stick. He is gradually
recovering the power of motion and sense of feeling. Drops agree.
Appetite good, and is allowed full diet. July 3d, the patient was
discharged cured."

Besides this highly interesting case, 24 more of paraplegia, hemiplegia,
and partial paralysis, are given in detail, in which the iodine was
exhibited with various success. In his prefatory remarks to this
chapter, Dr. MANSON observes, that although he has been able to cure
only a proportion of the cases of palsy that have come under his care
since April 1821, yet he has been much more successful in his practice
since that time, than he was previously with the use of all the ordinary
means.

Having succeeded so well in paralysis, Dr. MANSON was induced to try the
effects of iodine in chorea, which he thinks is more closely allied to
palsy than is supposed, and is linked to it by that species of the
disease called shaking palsy. Of chorea treated with iodine, and showing
the efficacy of the remedy, Dr. MANSON details eleven cases, and
concludes this section with a tabular view of 72 cases treated at the
General Hospital near Nottingham, between the 6th of October, 1812, and
the 5th of October, 1824. In all the cases detailed by our author, the
iodine was administered after purgatives, and throughout the treatment,
the bowels were carefully regulated by aperient medicines.

Dr. MANSON next records the results of his experience with iodine in
scrofula--detailing three cases of scrofulous enlargement of the
conglobate glands--two of scrofulous ulcers, and four of scrofulous
ophthalmia; in all of which, the most beneficial effects were obtained.
Our author details eleven cases of fistula lachrymalis, in which iodine
produced the happiest results. He was led to prescribe iodine in this
disease from the circumstance, that one of the individuals to whom he
gave it for paralysis, laboured under the fistula, and was promptly
relieved of it, whilst under the use of the remedy.

Dr. MANSON has likewise detailed nine cases of deafness cured, or
greatly relieved, by iodine. In most of these cases, the disease
originated from obstruction of the Eustachian tube, the consequence of
swelling of the tonsils, or of the membrane of the tube itself, from
previous inflammation.

Seven cases of dysphagia, eleven of white swelling, four of morbus
coxarius, and eleven of distortion, form the subjects of the four
succeeding sections. The medicine in all these cases, manifested so very
decided a power in arresting the progress, and even in curing the
disease, that we think ourselves safe in recommending a trial of it in
similar cases. As the iodine, however, is a powerful stimulant, we would
advise it not to be prescribed when there exists any fever, and
especially when there are any decided signs of gastric irritation, as it
would be likely to aggravate it.

23. _Non-mercurial treatment of Syphilis._--In the first number of this
Journal, we inserted an essay on this subject, by Dr. THOMAS HARRIS, of
this city, in which the author confirms, by the results of his public
and private practice, the statements of the British army surgeons
respecting the efficacy and safety of the non-mercurial treatment.
Since that period, having noticed that, by the worthy editor of a
respected cotemporary, it is asserted that though mercury fails, "yet
from the most ample experience in Europe, the present practice of Paris,
England, Ireland, and the Continent generally, we must lean to the idea,
that its use, under proper regulations, must be always adopted, as the
only safe mode of cure in these diseases," we deem it but justice
towards Dr. H. to call the attention of our readers to the result of the
extensive experience of some physicians on the continent of Europe. Not
to mention BROUSSAIS himself, who appears to have rejected mercury
almost entirely in the treatment of primary or secondary symptoms, we
may cite Mr. RICHOND, who reports that he treated, at the military
hospital of Strasburgh, nearly 3000 cases of syphilis in all its grades,
the vast majority of which were completely cured without mercury, and
simply by means of antiphlogistics, emollients, and revulsives. Mr.
RICHOND, besides some essays in the Archives Medicales, and a summary of
his experience in the preface to his work on apoplexy, has lately
published an elaborate work on the subject. In the October number of the
Annales de la Médecine Physiologique, Mr. BECQUART of the military
hospital of Bayonne, details twenty-six cases of gonorrhoea,
inflammation of the testicles, chancres on the glans and lips, buboes,
excrescences around the anus, &c., all of which were cured without
mercury, and with the same remedies as were employed by Mr. RICHOND. We
might adduce the testimony of other French physicians, and particularly
of M. BEGIN, but we deem it unnecessary, as the above will be sufficient
to show that in France the practice meets with the support of many very
intelligent physicians. We annex the conclusions of Dr. OTTO of
Copenhagen, drawn from an extended personal experience, and from his
researches on the subject. Dr. OTTO'S essay is contained in a late
number of Gräafe's and Walther's Journal, and the conclusions are
published in the Edinburgh Medical and Surgical Journal. Dr. O. remarks:

1. That the cure of syphilis, without mercury, has been asserted by so
many authorities, that the fact can no longer be doubted. If, then, the
disease could formerly be cured without mercury, it may certainly now be
much easier, as it has lost much of its violence and obstinacy.

2. Syphilis can undoubtedly be radically cured in this manner; but then
the cure is of longer duration, and the diet requires considerable
restriction.

3. The secondary symptoms, and a return of the complaint, are certainly
more frequent; but the symptoms are not so difficult of removal; and the
treatment has a much more speedy effect.

4. As the treatment without mercury requires a longer time, it appears
more practicable in hospital than in private practice; and on the other
hand, the patient can be better watched in a hospital, which, on account
of the diet, is of great importance.

5. As ulcers on the genitals are often not syphilitic, and the use of
mercury is contraindicated from a predisposition to scrofula or phthisis
existing in the individual, it is consolatory to learn from the results
of experience, that this medicine is not always necessary, and that a
radical cure, by more simple and innocent means, can sometimes be
effected. Where, however, the physician is anxious to avoid the possible
evils which mercury is capable of producing, and also to prevent loss of
time, there remains a middle way, namely, to employ mercury, whose
specific action can scarcely be denied, in moderate doses.

It results from a report of the cases of syphilis admitted into the
public institutions of Sweden, that 3,574 were treated in 1822; 3,465 in
1823, and 3,355 in 1824. During the course of this last year, 55-3/10
per centum of all the patients were treated by the mercurial method, and
35-1/10 per centum by the non-mercurial method, and by low diet; 2-1/2
per centum by means of fumigations. MM. KESSLER, WURSTER, RONBERG, and
SANDMARK, prefer the dietetic method, and consider it as the surest of
all those hitherto employed. Relapses are rare. In 1822 they amounted in
relation to the whole number of cases, to 11-2/3 per centum; in 1823 to
10-1/4, and in 1824 to 10-2/3. After the treatment by starvation, they
amounted in 1822 to 7-3/4 per centum; to 7-1/3 in 1823; and to 8-1/3 in
1824. After the mercurial treatment, in 1822 to 17-1/2 per centum; in
1823 to 14-1/16; and in 1824 to 14-1/2. _Bulletin des Sci. Med._

We hope to lay before our readers at some future period, an analysis of
Mr. RICHOND's work above alluded to, as well as of one on the same
subject by Mr. JOURDAN of Paris, author of some essays on the origin of
syphilis, translated and published here a few years ago.

24. _Cancer treated by Antiphlogistics._--Of all diseases classed among
the opprobria medicorum, cancer has hitherto been justly viewed as
holding the most conspicuous rank, and it is only within a short time,
that it appears to have been treated on correct principles, and that
cures have been detailed by individuals of undoubted veracity. The idea
of the inflammatory nature of cancer, and of the propriety of treating
it by means of antiphlogistics, has been held many years ago, and
supported by VASALVA in Italy, FEARON in England, HUFELAND in Germany,
POUTEAU and VACHER in France, not to mention other high authorities.
But, notwithstanding the success attending this practice, it was too
simple for the supporters of cancerous humours and specific
inflammations, and seemed, in consequence, to have been abandoned by
them, in their search after anti-cancerous or specific remedies; and
little was heard of it, until revived by the disciples of the
physiological school of France, and particularly by its founder
professor BROUSSAIS, and by professor LALLEMAND of Montpellier, the
result of whose experience is published in a thesis, lately defended at
Montpellier by Dr. MARESCHEL.

We have been led to these reflections from reading the above essay, and
another on the same subject, published by Dr. J. A. PUEL, in a late
number of the Archives Générales de Medecine. Dr. P. details many
cases, which were treated by his father, by means of leeches,
emollients, purgatives, &c. so early as 1807. In most of these cases,
the practice appears to have been very successful. As it is our wish to
impress our readers with the propriety of making a fair trial of this
method, in cases of scirrhus and cancer, we shall select and translate a
few cases from the latter essay. It is proper to premise, however, that
the practice must not be viewed as completely successful in _every_
case, and that the older the complaint, the less confident we ought to
be, in respect to the happy results of the case. Nor is it to be
expected, that _boldness_ in the employment of the lancet and leeches,
will answer as well as a perseverant, constant, but moderate use of
these means. Chronic inflammations are not to be removed by storm, but
by a _chronic_ use of remedies, and particularly by attention to diet.

We cannot at present determine precisely the proportion of cures
effected, by this method, of scirrhus or cancer, in a given number of
cases, and how far it will surpass, in point of success, the common
method of treatment by _specific_ narcotics and escharotics; but, even
supposing that it is not more successful, (which we are disposed to
deny,) it has at least the vast advantage of being more _comfortable_,
and much less painful to the patient.

Mrs. D. enjoying good health, and mother of three children, was brought
to bed in 1823, of a healthy child, which, however, she did not suckle.
With a view of suppressing the secretion of milk, irritating
applications to the breast were resorted to, which brought on an
inflammation of that organ. Emollient poultices were now applied; these,
however, did not prevent the formation of an abscess, which was opened
by means of caustic potash. The suppuration, for a few days, was
abundant and the matter discharged healthy. Purgatives were prescribed,
with the view of suppressing the discharge, and mercurial ointment was
rubbed on the tumour, to produce its absorption. These remedies were not
successful, because no means were employed to arrest the inflammation,
which gave rise to the suppuration.

When the patient applied for advice, she had been sick already four
months, and presented the following symptoms. She was very much
emaciated, and laboured under fever, resulting from a gastro-enteritic
inflammation, kept up by purgatives and deostruents, (_fondans_,) which,
from the commencement of the attack, were prescribed for her. The
ulceration of the mamma was of the size of a five frank piece, unequal
and gray, and gave issue to an ichorous and foetid purulent matter.
The edges were thick and everted, and surrounded with an erysipelatous
inflammation. The whole mamma was large and hard, and the seat of
lancinating pain. Thirty-five leeches were applied around the tumour,
and gave rise to a profuse hæmorrhage, which continued many hours. From
this, the patient experienced so much relief from pain, as to be able to
take some repose, of which she had been deprived for some weeks.
Emollient poultices and drinks were prescribed, and a low diet enjoined.
By all these means, the pain was lessened, and the swelling much
diminished. Leeches were again applied, and the other remedies
continued. The wound gradually improved, and in forty five days, was
completely healed.

Mr. P. was called on the 25th of September, 1817, to attend a lady, who
had been affected for two days with uterine hæmorrhage, which he
succeeded in arresting. The following history of her complaint was given
to him: she had aborted about 18 months before, and since that time, had
experienced every fortnight an uterine hæmorrhage, which generally
lasted five or six days. During the intervals, she complained of deep
seated pain, numbness and cramps, in the lower part of the abdomen, in
the thighs and groins. The pain was much aggravated when she had a
stool--walking, especially when long continued, was painful, and
attended with a sense of dragging, which was only relieved by repose.
From the same period, her disposition had changed from gay and lively,
to melancholy and morose--her digestive functions were slow and
painful--she was affected with leucorrhea, and during coition, felt much
pain, and often lost some blood. On examination per vaginam, it was
found, that the neck of the uterus was elongated--the anterior lip of
the same organ was soft to the feel--the orifice somewhat enlarged, and
painful when the finger was introduced into it. On the inferior lip
there was a small unequal and painful spot, which was regarded as a
superficial ulceration; the uterus was a little prolapsed, and somewhat
enlarged; the pulse small and frequent; febrile exacerbations every
evening; sleep not refreshing, and interrupted by short lancinating pain
in the uterus.

The disease was judged by Mr. P. to be a chronic metrites, with
ulceration, and all the symptoms usually attending incipient cancer.
Guided by this belief, and notwithstanding the already long duration of
the disease, and the debility of the patient, the following treatment
was adopted--complete repose in the horizontal posture--leeches to the
vulva, repeated several times--vaginal injections, with emollient
decoctions--hip baths--very low diet. After persevering in this plan
twenty days, the patient appeared much better, and was allowed to sit
up. General baths were substituted for the partial ones. The same
treatment was continued, with the exception of the leeches, and at the
end of thirty days more, all the symptoms of the disease had completely
disappeared. Mrs. P. was allowed to spend the following spring in the
country, from whence she returned in very excellent health. She has
since continued to enjoy it, and has borne several children.

Cases nearly similar, are detailed by Mr. MARESCHAL, as having occurred
in the practice of professor LALLEMAND. The same gentleman, also gives
the history of two cases of external cancerous sores, in which the same
treatment was adopted. The patients having died during the progress of
the cure, of other diseases, an opportunity was offered, of examining by
dissection, the changes that had occurred in the parts. We cannot
enlarge on the subject in this place, and can only remark, that these
changes were such, as to lead us to hope, that less difficulty will be
experienced in the treatment of sores reputed cancerous, by the local
antiphlogistic plan, than is commonly supposed. At any rate, recommended
by such high authorities, the practice deserves a trial.

The Revue Medicale for February 1826, contains the details of a case
lately cured at La Pitié, by Mr. LISFRANC. The patient, a woman, aged 36
years, of a strong and good constitution, had suffered the removal of a
cancerous breast, 18 months previous to her admission into the Hospital,
on the 10th October, 1825. The following symptoms were observed. On the
whole surface of the cicatrix were felt a number of engorged ganglia,
and an induration situated on the large and small pectoral muscles, and
spreading from the clavicle to all the external and superior part of the
thorax, and as far as the axilla, where other swollen ganglia were felt.
The enlarged surface was elevated about half an inch above the level of
the chest. Severe lancinating pains were at short intervals felt by the
patient--which came on without any evident cause, and were particularly
severe on the least pressure of the swollen part.

This patient was treated by means of frequent and copious bleeding from
the arm--the very frequent application of leeches to the inflamed part,
and to the upper and interior part of the thighs, to bring on
the menstrual discharge--digitalis to remedy the frequent
palpitations--emollient applications, and low diet. On the 10th of
January, she was considered well;--the swellings and pain having
disappeared--the menstrual discharge being well established, and the
movement of the arm (which during the progress of the disease had been
impeded from the swelling in the axilla) perfectly free.

We are happy to learn that this practice is pursued with success by the
Spanish physicians, as may be readily found by a reference to a late
number of the Periodico de la Sociedad Medico Quirurgica de Cadiz, which
contains cases of scirrhous mamma cured by the repeated application of
leeches.

25. _Essential oil of Male Fern, as, a remedy in Cases of Tænia._--The
male fern has long been regarded as a valuable anthelmintic medicine;
but, as every powder administered in large doses, its exhibition is
difficult and disagreeable; so much so, indeed, that many patients
refuse to make a sufficiently constant use of it to ensure its
beneficial effects. Struck with this inconvenience, M. PERCHIER, a
pharmaceutist of Geneva, has lately made some experiments with a view of
discovering its active principle, and to see whether this latter may be
administered with equal success with the powder or infusion of the
plant. We are happy to learn that the result of his experiments are very
satisfactory. We translate the following observations from a memoir on
the subject, read on the 7th of October last, by Mr. GENDRIN, before the
medical society of the department of the Seine. "This medicine, which
is a fatty oil extracted by distillation from the æther, in which the
powder of the root of the male fern has been macerated, has caused in
many cases, the expulsion of the tænia, without occasioning nausea,
colics, or any other morbid phenomena." "It is exhibited at bed time,
either in an oily potion, in pills, or incorporated in an electuary, in
doses of 18 or 20 drops. On the following morning, a similar dose is
given, and two hours after, two ounces of castor oil are administered.
In most cases, the tænia is expelled in the course of the day, but if
this does not occur, the same doses of the oil are given in the same
way, and followed by a similar quantity of the castor oil. The fatty oil
of fern, has an æthereal and empyreumatic smell; its colour is brown,
and its consistence rather greater than that of castor oil; it is,
however, easier to separate in drops. Its taste is acrid, pungent,
empyreumatic, and very disagreeable."--_Propagateur des Sciences
Medicales, Janvier 1826._

26. _Tincture of Bastard Saffron[33] for the expulsion of Tænia._--Dr.
CHISHOLM, of Canterbury, has lately used with success, in a case of
tænia of many years standing, the vinous tincture of bastard saffron.
The patient had already undergone various plans of treatment, and had
especially used the oil of turpentine in very large doses. Dr. C. was
induced to try the above remedy, from having noticed, that in a case in
which it had been prescribed for the cure of rheumatism, a large portion
of tænia had been expelled. He consequently administered two ounces of
the tincture; advising the patient to take a table spoonful more of it
mixed in a little water, two or three times a day. On the third or
fourth day after commencing the use of this remedy, the patient voided a
large portion of the worm, and has since been free from the usual
symptoms of the disease.

27. _Oil of Turpentine in Tænia._--Although the oil of turpentine is
used in many parts of this country, in cases of tænia, we have good
reasons for believing, that some physicians continue, notwithstanding
the testimony in its favour, to hesitate exhibiting it in doses
sufficiently large to destroy and promote the expulsion of the worm.
Such being our opinion, we are induced to offer here a few remarks on
the subject, and to notice a memoir published by Dr. DE POMMER, in a
late number of Hufeland's Journal. The employment of this remedy in such
cases, is not of recent origin, having been resorted to many years ago
by the Swedish practitioners, and subsequently revived by the English.
In Germany it has recently been used by Professor OSAN, and we believe
particularly by Dr. DE POMMER, who appears to have prescribed it boldly
in very many instances, and in some, after the ineffectual employment of
all other anthelmintics. Dr. P. adds, that he never saw any bad effects
resulting from its use, and that patients are very little liable to
relapses when treated by it.

Among the cases detailed by Dr. DE POMMER, we select the following, as
calculated to show the manner in which the Dr. uses the remedy.

"G.K..., a soldier aged 21 years, thin, tall, and who during his infancy
had been subject to ascarides, has occasionally voided during more than
10 years past, portions of tænia. He had used several purgative
medicines, by which several yards of this worm had been expelled; but
annoyed with so many attempts at obtaining its total expulsion, he had
ceased, three years before, the use of all sorts of anthelmintics. But
the phenomena resulting from the presence of the animal being
aggravated, the patient applied for advice to Dr. DE POMMER, who found
him labouring under the following symptoms:--Frequent pain in the
abdomen, and especially in the umbilical region, accompanied with a
sense of burning heat, and alternate distension and depression of the
abdomen. Appetite sometimes keener than in health; at others nearly
lost. In the morning before breakfast, the patient was seized with
extraordinary weakness, and general uneasiness, accompanied with
trembling of the limbs, ineffectual attempts to vomit, a sense of
constriction in the throat, and a profuse salivation. All these symptoms
disappeared after K... had taken food; but reappeared two hours after.
Milk and farinaceous aliments were the only articles of which he could
make use without an aggravation of his disease. The pulse was febrile;
sleep good, but attended with dreams. The pupils were in the natural
state. From the symptoms, and from the history of the case, Dr. P. was
induced to make use of the oil of turpentine in the following manner.
The patient was ordered in the morning, before breakfast, three table
spoonsfuls of the remedy, at half an hour's interval. The first doses
produced only a few borborygma. Two more table spoonfuls occasioned a
vomiting of mucous matter. Three more table spoonfuls were exhibited,
and followed by a stool of solid fæces, mixed with which were five small
pieces of tænia. The patient not finding himself incommoded, took in the
space of an hour, three more table spoonfuls of the remedy, after which
he experienced some pain in the head, and vomited about one pint of
bilious liquid. An hour after, the same quantity of the medicine was
taken, and followed again by vomiting, but after a repose of half an
hour K... discharged, per anum, firm and greenish fæces, and with them
five ells of tænia. The urine discharged had the smell of violets. He
again took a few spoonfuls of the vermifuge, which were not followed,
however, with any fæcal discharge, and only with some vomiting of mucus,
and slight vertigo. In the afternoon the patient felt well, and
experienced a great appetite, in which he indulged. From this moment he
recovered, and has ever since enjoyed good health. The quantity of the
remedy used was six ounces."

It appears, from the observations of Dr. P., that the gastric irritation
occasioned by the spirits of turpentine, has never amounted to
phlogosis, and has generally subsided after the remedy had been
discontinued. Nevertheless, as the spirit of turpentine is a very
powerful stimulant, we would not venture to recommend its use, when
there exists an inflammation in the gastro-enteritic system. We are
aware that it is resorted to in burns, and highly eulogized in puerperal
and yellow fever. In the first, it is certainly very useful, but on what
principle we know not, except perhaps that its stimulus is different
from that existing in the diseased part. But in the second case, it
acts, not on the diseased surface, but by revulsion, on the mucous
membrane; and as regards its virtues in yellow fever, we are rather
sceptical in respect to what has been said on the subject. In this
opinion we are supported by the testimony of our friend Professor RHEES,
whose situation of house surgeon to the fever hospital, during the
epidemic of 1820, afforded him ample opportunities of testing the
propriety of the practice.

In the number for March 1826, of the Revue Medicale, M. MAUDRU relates
two cases in which large portions of tænia were expelled, and the
patients cured, by means of a strong decoction of the bark of
pomegranate. The first patient took, in one day, two pounds of the
decoction made with four ounces of the remedy. The second patient took
six ounces of the bark in decoction, in the course of forty-eight hours.
In neither case did the medicine occasion unpleasant effects, with the
exception, in the second patient, of slight colicky pains.

28. _Action of the Oil of the Euphorbia Lathyris._--At a meeting of the
Academy of Medicine, (section of pharmacy) M. BALLY read the results of
some clinical experiments made by him at the hospital of La Pitié, on
the action of the oil of the euphorbia lathyris. The preparation used by
him, had been made by means of alcohol and expression. It appears to be
a little more active than the other preparations. Administered to
fifteen individuals of different ages, it did not produce very various
results, nor prove very active in its purgative effects. As a purgative,
indeed, it is far less active than the croton oil, and requires to be
given in much larger doses; as much as six or ten drops. It has also the
bad property of exciting emesis, by which it is rejected from the
stomach. On the other hand, however, it does not, like the croton oil,
produce salivation, and is, on the whole, regarded by M. BALLY,
especially when fresh, as a useful purgative in diseases of
children.--_Archives Generales, Decembre, 1825._

29. _Medicinal properties of the Apocynum Cannabinum, or Indian
Hemp._--In an essay on this plant, submitted to the medical faculty of
Jefferson College, by Dr. M. L. KNAPP, we are informed, that in doses of
15 or 30 grains it possesses emetic properties. It was besides, on
trial, found to be cathartic, expectorant, diuretic and diaphoretic. It
appears to have been generally administered in powder, and Dr. K.
remarks, that "in decoction, it seems to lose some of its emetic
properties, and to act more upon the bowels as a hydragogue cathartic."
"The root possesses all the medicinal properties of the plant, and is
active throughout, both in its cortical and ligneous portions. Water or
proof spirit is its proper menstruum."

This article was prescribed with success in dropsy, by Dr. KNAPP, and
by Dr. PARRISH of this city. It was likewise used in intermittent fever,
in bilious affections, amaurosis, hernia humoralis, dysentery, chronic
rheumatism, &c. Dr. KNAPP appears to have derived benefit from its use
as an alterative in a case of fever in a child, attended with disordered
bowels. "The powders (gr. ii. each at intervals of three hours,) were
regularly persisted in for a week, and the child's health went on
gradually improving. Neither vomiting nor purging was produced, but the
morbid heat and thirst were allayed, the stools became natural, the skin
soft and moist, and the functions of digestion and assimilation were
gradually restored, and the child is at this time fat and
healthy."--_American Medical Review, &c. April_ 1826.

30. _Remarkable effects from the external application of the Acetate of
Morphia._--M. DUBOURG has recently published the result of an experiment
made at the hospital de la Pitié, with the acetate of morphia, which we
regard as sufficiently interesting to be noticed in this place. The
patient had been affected twelve months before with puerperal peritoneal
inflammation, complicated with cerebral symptoms, from which,
notwithstanding a most energetic antiphlogistic treatment, she never
entirely recovered. When she was admitted into the hospital, she
presented the following symptoms:--"considerable emaciation; skin hot
and pungent to the feel; pulse small and frequent; tongue of a pale rose
colour, dry at the tip and edges, brown and smooth in the centre as far
as the basis; severe pain on the least pressure on the epigastrium and
over the whole abdomen; cardialgia, nausea, vomiting of all solid and
liquid aliments, and during the empty state of the stomach, violent
efforts to vomit occurring at irregular intervals; abdomen tense and
tympanitic; violent intermittent pain along the course of the
intestines; constipation; sensation of fatigue and lassitude in the
lumbar region and in the extremities; dragging pains in the
inter-scapular region; extinction of the voice; urine red and scanty;
the face animated and bearing no marks of profound suffering; agitation,
and total want of sleep."

The disease was regarded as a chronic gastro-entero-peritonitis, and
treated accordingly, by the antiphlogistic regimen; but no benefit was
derived from this plan. The patient continued to vomit almost every
thing she took, with the exception of sugar and a paste made with the
Iceland moss. A blister was applied to the epigastrium on the 15th of
February, seven days after her admission. Called to her assistance on
the 22nd of February, on account of an aggravation of the vomiting, M.
LAMBERT, one of the house pupils of the hospital, endeavoured to calm
the symptoms by means of the acetate of morphia in powder, applied to
the raw surface of the blister. Half a grain was used in this way, and
in a few minutes the vomiting disappeared, and the patient passed a
better night than she had yet done. M. SERRES having authorized the
continuance of this method, M. DUBOURG the next day applied half a grain
in the same way; and the patient slept the whole night. The remedy was
applied every day with the same effect, and was gradually increased to
two grains and a half. From the first application of the remedy, the
symptoms gradually subsided; aliments were retained and properly
digested; the pain and swelling of the abdomen disappeared, and on the
14th of March the patient was regarded as in a fair way of
recovery.--_Archives Generales, March_ 1826.

In some remarks which accompany this interesting case, M. DUBOURG, seems
to doubt the correctness of the first diagnosis, and to view the disease
as a nervous, rather than as an inflammatory affection of the abdominal
viscera.

31. _Cure of Urinary Calculi by means of the internal use of the
Bicarbonate of Soda._--At a late meeting of the Academy of Medicine, Mr.
ROBIQUET read a memoir on the use of this salt in cases of urinary
calculi. Having learnt from Mr. DARCET, that the use of the waters of
Vichy changes the quality of the urine from acid to alkaline, Mr. R.
conjectured, that this effect should be attributed to the bicarbonate of
soda contained in them; and from this circumstance, he was led to
administer this salt internally, in cases of calculi composed of uric
acid. In July last, he made the experiment on a man 74 years of age, who
had laboured under symptoms of the disease since the month of February,
and in whom, by means of the sound, a small and soft calculus had been
detected. Mr. R. ordered him 10 grains of the bicarbonate in the course
of the day, dissolved in two pounds of water--prescribing at the same
time, hip baths, injections, &c. At the end of fifteen days, much
benefit had already resulted from this treatment; and in a month, the
patient appeared to be cured. Nevertheless, the remedy was continued
until November, when the patient passed through the urethra, a small
calculus composed of uric acid, which appeared to have been the nucleus
of a much larger one, the exterior strata of which had been worn off.
From that period, the patient has not experienced any unpleasant
symptom; but the sound was not resorted to, to ascertain whether the
first calculus before felt, could be detected.--_Archives Generales,
February, 1826._

32. _Attempt to cure Abdominal Dropsy, by exciting Peritoneal
Inflammation._--In the number of the London Medical and Physical Journal
for April, 1826, a case of ascites is related by H. R. OSWALD, Esq. in
which the cure was attempted to be effected, by exciting peritoneal
inflammation. The following symptoms were noticed at the time of
application for advice: the abdomen measured nearly six feet in
circumference, was exceedingly hard and tense; but not tender. The
patient "could hardly walk across her cabin from dyspnoea and
debility, and the weight and tension of the tumour; which caused her to
bend the body much forward, leaning her hands on her knees. The
emaciation was very considerable; the appetite good; thirst
considerable; tongue clean; pulse 120, and small; skin dry, harsh, and
rough; bowels habitually costive; urine scanty." "This affection
commenced about twelve months ago, after an obstruction of the
catamenia for nearly a year, arising, as was supposed, from exposure to
cold. The swelling was preceded by lancinating pains in the abdominal
and lower part of the thoracic cavities, but which, after a few months,
ceased entirely; and the disease had, in a chronic manner, gradually
arrived at its present oppressive form."

Paracentesis was performed several times; cathartics, diuretics, the
lancet, blisters, and tonics were resorted to, with relief from some of
the symptoms. The tumour, however, returned several times, so that M.
OSWALD despairing of effecting a cure by following the same plan, and
recollecting a case of ascites, which was cured apparently by an
inflammation having supervened in the peritoneum, from the orifice made
by tapping remaining open, attempted to produce the same effect in the
present patient, by keeping the orifice of the wound open by means of a
small tent. In this he partly succeeded, for in the course of a few
months, all symptoms of the effusion had disappeared; health and
strength had much improved, and the patient had experienced a return of
the menstrual discharge, which had been suppressed for nearly three
years.

About a year afterwards, however, the disease returned. Paracentesis was
again performed several times, and a tumour was perceived to have formed
in the lower part of the abdomen. The patient died in about five or six
months from the re-appearance of the effusion. On dissection, much water
was found in the abdominal cavity, which was lined by a dense, white,
and rough looking membrane, of a fragile and diseased structure. The
intestines behind this membrane, were unusually small, and of a dark
leaden colour. The tumour above alluded to, was discovered to be
situated in the region of the right ovarium; it was a tubercular,
carcinomatous, and pale coloured fungus, possessing a structure not
unlike that of the placenta, and was formed in the interior of the sac,
which being traced further back, was found to be the cyst of a dropsy,
originating in the right ovarium at the fundus of the sac, or "more
properly speaking of its neck."

"The foregoing statement," Mr. O. remarks, "involves four facts and
questions of considerable importance in pathology. 1st. The great
quantity of fluids evacuated in so short a space of time: no less than
ninety-six quarts in eight months, by four operations; and fifty-nine
quarts from August to December, 1824, by three. 2nd. The variety in the
nature, consistence and colour of these fluids. 3d. The possibility of
curing ascites and dropsy of the ovaria, by exciting inflammation in the
abdominal sac, either by the admission of air into it, or mechanical
irritation; and 4th. The possibility of a thickening of the parietes of
the abdomen by inflammation, or by an exudation of a carcinomatous sort,
being mistaken for a tumour rising out of the pelvis."

33. _Artificial Respiration._--Dr. J. WARE of Boston, relates in the New
England Jour. for April last, that he was led by the experiments of the
justly celebrated physiologist Mr. BRODIE, to employ artificial
respiration in the case of an infant 9 weeks old, whose system was
prostrated from an over dose of laudanum. "The action of the heart was
reduced to an occasional throb; the pulse had entirely ceased, and the
efforts at respiration, which for some time had consisted merely in an
occasional gasp, became more and more unfrequent." The child had been
afflicted for five or six weeks with hooping-cough, and had been very
sick and feeble when the laudanum (about 15 drops) was administered.

By means of the stem of a tobacco-pipe, artificial respiration was
excited, and continued for several minutes: the action of the heart was
immediately renewed, and the pulse could be again felt. At the end of an
hour, during which the artificial respiration was repeated at intervals;
"the respiration became natural, the pulse distinct and tolerably
strong, and the heat began to return." A fit of coughing, preceded by a
livid appearance of the forehead and face, arrested the breathing,
"which did not return till assisted by the artificial process." The
child, assisted by these measures, and by attention to the more usual
means of recovery, struggled through the night, but died during a
paroxysm of coughing in the morning.

The conclusions of Mr. BRODIE are, that narcotics destroy life through
the organs of respiration, and hence, if respiration can be artificially
carried on until the effects of the narcotic subside, life may be
preserved. Dr. WARE'S case would seem to confirm this idea; for it is
_probable_ his patient would have recovered from the effects of the
narcotic, if the paroxysms of coughing had not interfered.

34. _Secale Cornutum._--Mr. CHARLES WALLER has lately published (London
Medical and Physical Journal, April 1826,) several cases illustrative of
the action and efficacy of secale cornutum. We have not room for any of
the cases, and content ourselves with transcribing Mr. W.'s inferences.
These are: "That the secale cornutum is a remedy which is capable of
increasing the force of the uterine contractions in a most remarkable
manner, under certain circumstances; but that the effect is doubtful,
unless there be some degree of action present. In other words, that,
although it will increase the contractions when already present, it will
not always renew them when they are suspended.

"That the effect is more certain if the infusion be of greater strength
than is usually recommended; two drachms of the secale to six ounces of
water being barely sufficient for the purpose.

"That it appears to be a stimulus peculiarly fitted for irritable, and
what are generally termed _nervous_ habits.

"That the fears entertained by some practitioners of its proving
detrimental to the child, are groundless.

"But, although it is in general necessary, not only that there should be
a disposition for labour, but that this process should have actually
commenced, before we can expect the secale cornutum to have any effect
upon the uterus, still one solitary case has indirectly come to my
knowledge (and I will vouch for the authenticity of it,) where this
remedy was given for the purpose of producing abortion in a female,
about the second month of utero-gestation; and this effect was
accomplished in a few hours after its exhibition."

35. _Animal Magnetism._--This strange doctrine begins to acquire
considerable vogue in France, and other European countries, from which
it seemed to have been expelled, by the contempt and ridicule which it
met with, from most of the learned of the latter part of the last
century. ANTHONY MESMER, the great choroegus of the magnetic mummers,
was born in 1733, and excited a vast deal of attention, by the enormous
pretensions which he set forth on the subject of magnetism. MESMER came
from Austria to Paris in 1778. He addressed the Academy of Sciences, and
that of Medicine, but no attention was paid to him, till a commission
was appointed to examine carefully into the merits of the question. This
commission in 1784, so fully exposed the fallacy of MESMER'S theories
and practice, that he soon afterwards quitted Paris, and retired to
England under a feigned name. He subsequently went to Germany, and died
in obscurity, in the year 1815.

In December last, M. HUSSON (for himself, and MM. ADELON, BURDIN, MARC,
and PARISET,) read a report to the Royal Academy of Medicine, on the
question, whether it was fitting for the section to undertake new
researches on animal magnetism, as it had been thought to be
definitively settled by the decisions of 1784. The report concluded
affirmatively, for several reasons; among which the principal seems to
be, that magnetism has at present fallen into the hands of the learned,
whereas it was formerly under the domain only of quacks and the vulgar.

M. HUSSON'S report was discussed at subsequent sittings of the Academy,
for the purpose of ascertaining whether a new commission should be
appointed; and as this topic is certainly one of the greatest novelties
of the day, we shall give some account of the discussions, making free
use of the report of them, contained in the Revue Medicale, Mars. 1826.

M. DESGENETTES, declared against the appointment of a commission,
because he considered the magnetism of the present day, quite as much a
matter of jugglery as that of 1784; and he informs us, that the
publicity given to the report, had already increased the audacity of the
magnetisers, who look on it as an approbation of their art.

M. VIREY, regretted that the report had not spoken in strong terms,
against the ridiculous practices, and shameful jugglery, which disgrace
the cause of magnetism; he wished the committee had announced an
intention, to make only physiological, or psychological researches, on
the influence, which magnetism really appears to exercise on the nervous
system; and gave his voice for the formation of a commission of
experiments.

M. BALLY, voted against it for several reasons, and among others,
because of the fact announced by all the magnetisers, that the person
who magnetises, acquires a sovereign power over the magnetisee; and he
inferred from this, all the inconvenient and even dangerous consequences
which may result to public morals!--Finally, he voted against it,
because magnetism is ridiculed every where, because it is all darkness
and confusion, and especially, because it being an inexhaustible mine of
empiricism, the section ought not to lay open such a fertile field for
those gentry who live by quackery.

M. ORFILA, (eheu!) defended the propositions of the reporters. It is
opposed, said he, on the three grounds following: 1st. Because the
section has not been invited to the examination now recommended. 2nd.
Because magnetism is nothing but juggling. 3d. Because commissions will
not commonly do any work. The first ground is not correct: M. FOISSAC, a
physician of Paris, has invited our attention to it, and offered to
subject a magnetic somnambulist to its exploration; and very reputable
physicians, members of the Academy, MM. ROSTAN, (the ramollissement man,
is his head soft too?) and GEORGET, have in their recent publications
called the attention of the learned to this subject. Secondly, if there
be any jugglery, in the magnetic phenomena we are told of; it is
nevertheless certain, that the whole of them are not simulated. The
testimony of well taught physicians, ought to be received on this head.
That the phenomena are extraordinary, is no argument; for those of
electricity must have been quite as marvellous, at the period of their
discovery, &c. &c.

M. DOUBLE, blamed the report as being nothing more than an apology for
magnetism, which is tarred with the same stick as that of 1784, and only
modified a little, by the esprit de notre temps, &c. &c. He said he had
made magnetism a special subject of study, and _never saw a phenomenon
produced by it_.----He thinks the commission could only do injury to
science, and compromit the Academy, &c. &c. He would vote against the
appointment, and advised the section to wait until some scientific
memoirs should be sent to it.

M. LAENNEC, agreed with M. DOUBLE, because after studying the subject
for twenty years, he is satisfied, that it is almost nothing but
deception and juggling; although, when he commenced the study, he was
prejudiced in its favour. According to M. LAENNEC, among the magnetic
influences, there are several, attributable to the impressions, which
one individual naturally makes on another in correlation with him; and
he cited a mistake, which he saw committed by a somnambulist woman. She
was magnetised by two persons, one of whom was handsome, but
anaphrodisiac, the other ugly, yet possessing in integrity, the genital
faculties. She received no impression, except from the first individual;
so that the impression which this female had received by the organs of
vision, before the experiment, superseded that, which the pretended
magnetic sense ought to have made on her. He thinks, the academy ought
to _observe_ the magnetisers, but what he has seen, has convinced him,
that nine-tenths of the facts in magnetism are supposititious. The
phenomena effected by magnetism, and the oracles uttered by the
somnambulist, vary with every magnetiser. MESMER excited convulsions;
DESLIN effected crises, such as are seen in diseases. The somnambulists
of Mr. DELEUZE, a learned man, are much better taught than those of
PUYSEGUR, who is ignorant of the sciences, and finally, Mr. LAENNEC has
seen a somnambulist under the direction of a pharmacien, who was quite
distinguished, by the art with which she compounded the medicines, she
recommended. The discussion was now adjourned to the next sitting.

On the 24th of January, it was resumed.

M. CHARDEL, bears witness to a reality of the magnetic phenomena, as he
has witnessed them himself, in a case of what is called somnambulism. He
dares not pronounce on the question of magnetism, as a therapeutical
agent; but is disposed to think it ought, if ever, to be used with great
reserve. Whether it consist of nervous phenomena of a particular order,
or whether it be a product of the imagination, in either case, it
deserves to be studied, &c. &c.

M. RONCHOUX, thought the proposed examination would be impossible; for
the magnetisers assert, that if one of the parties have a will opposed
to that of the magnetiser, no phenomena can be produced. Their confessed
inability to surmount any opposite will, seems to Mr. RONCHOUX, an
invincible obstacle to any exploration to be attempted by a commission.

M. MARC, gave some explanation of the labours undertaken in Germany.
According to the opposition, nothing conclusive can be derived from
these labours; because Germany is the native soil of sects and of
thaumaturgæ but, Mr. M. proved by citations, that they are not to be
attributed to excited imaginations, as has been urged, but to the most
celebrated Savans of that country, as for example, OERSTDT, KLAPROTH,
and HUFELAND, to learned bodies, and to governments. The Royal Academy
of Berlin, offered in 1818, a prize of 3300 francs, for an essay on this
topic.

The governments of Prussia, Russia, and Denmark, have founded medical
commissions for the examination of it, and subjected its therapeutical
application to certain regulations. He thought, therefore, that the
Academy could follow without compromising its dignity, such good
examples. He added, that the examination was absolutely necessary,
unless they desired that every French practitioner should hereafter
reject the whole subject, and for ever abandon its employment to
jugglers and credulous fools.

M. NACQUART thought, that as magnetic somnambulism is something wholly
independent of organical, physical, or physiological laws; that as the
senses here have no need of organs; as time, space, and intermediate
bodies, wholly disappear; we can avail ourselves of no method of
appreciating magnetical facts, and consequently, the Academy ought not
to trouble their heads about it--a very good joke truly: but M. ITARD
said, that jokes had nothing to do with the question, because they are
meant only for the abuses and extravagancies of magnetism; but we want
to get at the truth, and to eschew the folly. Magnetism, says he, is
either a real or imaginary agent; it ought to be examined. To refuse
this, is to despise the path of experiment, which can alone lead to
truth, &c. &c.

M. RECAMIER, could add nothing to the observations of MM. DESGENETTES,
BALLY, and DOUBLE; but he wished the section to know, that he been a
witness to the magnetic phenomena--he had been present at the oracles of
the marichale of M. DE PUYSEGUR, who was represented as the most lucid
of all possible somnambulists. He had reason to suspect a cheat in this
case, as he was denied the means of dissipating his doubts; and heard
this woman repeat what he had before said to the patient himself. How
ridiculous, moreover, is it, to hear one drachm of glauber's salt
prescribed as a transcendental remedy for phthisis pulmonalis! He also
attended at the Hotel Dieu, at experiments made on one woman and two
men. He saw the woman go to sleep (as was asserted,) at the simple will
of the magnetiser, who for that purpose was concealed in a closet of the
apartment. The only mode adopted, to prove that she was really asleep,
consisted in some slight pinching of her ears, and some noises; yet, in
the recital, these slight impressions have been transformed into most
painful tortures. In the experiments made on the men, he employed a more
powerful proof, which was the application of moxa; and that he did,
because it was indicated by a coxalgia, with which the patient was
affected: it is _a fact_, says he, that the man did not awake, or show
_the slightest sensibility_. Mr. R. believes, therefore, in magnetical
action; but does not think it can ever be available in the practice of
physic. In Germany, said he, where magnetism is so much employed, do
they cure better than elsewhere? And has magnetism been the occasion of
any therapeutical discovery any where? In somnambulism there is only a
disordered sensibility, and not an increase of it; and the pretended
clairvoyance of the somnambulists, has no real existence, &c. &c.

M. GEORGET, cited in proof of the existence of magnetic power, the names
of many physicians, members of the Academy, as MM. ROSTAN and
FOUQUIER--he cited the experiments made at the Hotel Dieu, by Dr.
DUPORTET, in the presence of many members, who had signed the results,
as MM. HUSSON, GEOFFROY, RECAMIER, DELENS, PATISSIER, MARTIN, SOLON,
BRICHETEAU and KERGARADEC. If there be any analogy between magnetic and
natural somnambulism, ought we to be astonished at the production of the
former by certain practices? The magnetisers conceal nothing, but
publish all their proceedings, and do you call these the tactics of
jugglers and charlatans?

M. MAGENDIE thought the examination expedient, and wished commissioners
to be appointed to examine the somnambulist, offered by Dr. FOISSAC.

M. GUERSENT was in the affirmative: he himself had magnetised, and
witnessed several phenomena, &c.

The discussion was then adjourned to the next setting, and on the 14th
February, after hearing M. GASC against, and M. LHERMINER for the
report, M. HUSSON the reporter was heard. The section then closed the
discussion, and it was decided by a majority of ten, (35 to 25,) that a
commission should be appointed to examine animal magnetism.

We are indebted for the above account to the Revue Medicale for
March--the No. for February, also contains a review of M. DUPAU'S
Lettres Physiologiques et Morales sur le Magnetisme Animal, 8vo. Paris,
1826. In order to show our readers how they manage these matters, we
shall translate the following from p. 269.

"Here, says M. ROSTAN, is an experiment that I have often repeated, but
which I was finally obliged to interrupt, because it fatigued my
somnambulist prodigiously, who assured me, that if I continued, it would
make her go mad. This experiment was made in presence of my colleague
and friend, M. FERRUS. I took my watch, which I placed three or four
inches from her occiput. I asked my somnambulist, if she saw any thing:
"certainly, I see something that shines; it hurts me." Her countenance
was expressive of pain, and ours expressed astonishment. We looked at
each other, and M. FERRUS breaking silence, said, if she sees something
shine, she can doubtless tell what it is. "What do you see that
shines?--Oh! I don't know, I can't tell. Look at it well--Stop, it
fatigues me, wait--(and after a moment of great attention) _It's a
watch_." More astonishment. But, if she sees the watch, said M. FERRUS,
she will doubtless see what o'clock it is. "Could you tell me what
o'clock it is?--Oh! no, it is too difficult." "Look at it, try." "Wait
then, I'll try; may be I can tell the hour, but I never shall be able to
see the minutes;" and after the greatest attention--"It wants ten
minutes of eight o'clock:" which was exact. M. FERRUS now desired to
make the experiment himself, and repeated it with the same success. He
made me turn the hands of his watch several times, and when presented to
her (occiput we suppose,) without her having seen it, she never made any
mistake."

These statements we have thought fit to lay before our readers, who will
observe the respectable names which are connected with them. We shall
seize the first opportunity to give the report of the new commission,
and if they confirm the miracles, we can still say, credat Judaeus
apella. If it will make no cure, it will probably make much pay; since
MESMER got upwards of 340,000 francs for his mumming exhibitions, to the
_spectacle_ loving quidnuncs of Paris. The commission consists of 11
members, viz. LEROUX, BOURDOIS, DOUBLE, MAGENDIE, GUERSENT, LAENNEC,
THILLAYE, MARC, ITARD, FOUQUIER and GUENEAU DE MUSSY.

36. _Sketch of the Medical Literature of Denmark, Sweden, and
Norway--by_ Dr. C. OTTO, _of Copenhagen, apud Bulletin des Sci. Med.
Feb. and March._--"Denmark is richer in medical literature, than the
other countries which in conjunction with it, composed the ancient
Scandinavia. Although it does not in this respect, bear a comparison
with France, Germany, England, and Italy, nevertheless, medicine, of all
the sciences, seems to be that which is most successfully cultivated,
and Copenhagen contains a great number of learned, and able physicians."
In proof of what Denmark has done, Dr. O. refers us to the great names
of the two BARTHOLINS, of STENO, of WINSLOW, of CALLISEN, &c.

"In the 16th century, Denmark possessed the anatomical works of the two
BARTHOLINS: (_Instit. Anatomicæ de vasis lymphaticis, &c._) and other
works of the same kind, which have been translated into all the
languages of Europe. STENO, the disciple of THOMAS BARTHOLIN, followed
the career of his master, with an equal success. HALLER never spoke of
this anatomist, without the highest admiration. RODE enriched the
literature of Germany and Denmark, with works which have made his name
illustrious, wherever science is cultivated. Among these, we may chiefly
distinguish his Bibliotheca, and Materia Medica." The Danes are indebted
to him for several popular works on medicine, which are in the judgment
of Dr. OTTO, chef d'oeuvres of this sort of writing. He published more
than 13 volumes on these topics. "To the celebrated CALLISEN, who is
recently deceased, we are indebted for 1st, a _Systema Chirurgiæ
Hodiernæ_, a work of the highest merit, and which has reached a fourth
edition. 2nd, a Medical Topography of Copenhagen, published in Danish.
(2 _vols._ _8vo. Copen._ 1807.) 3d, the Director of the Academy of
Surgery. He is also the author of several important memoirs, inserted in
those of the _Roy. Soc. of Sciences_, of Denmark, and in some other
collections. The late professor MATH. SAXTORPH, composed an excellent
_manual of labours_, for the use of midwives. A second edition with
plates, appeared in 1804. T. L. BANG, has given a _Praxis Medica_, an
excellent guide to young physicians in their first outset in practice.
HERHOLDT has shed some lustre on Danish Physiology: his dissertations on
the life of the foetus, and on the question, whether vision is
performed with both eyes, or with one only, bear testimony to his genius
and penetration: he is also author of a memoir on penetrating wounds of
the Chest, inserted, as well as the former dissertation, and many other
pieces, in various medical journals.

"TYSCHEN published in 1804, a _Treatise on Pharmacy_, in Danish; and
professor MYNSTER, gave a work on Pharmacology, of which two volumes
only had appeared, when death interrupted his useful labours. In 1794,
he commenced the publication of a journal, the _Bibliothek for Physik
Oeconomic og Medicin_, which was continued in 1799, by BAHN, and
afterwards under several names, till 1807. We now come to the existing
state of Danish medical literature.

"The Royal Medical Society of Copenhagen, which, without contradiction,
holds the first rank among those of Scandinavia, celebrated its 50th
anniversary in 1822. It publishes at irregular periods, its memoirs,
under the title of _Nova Acta Societatis Medicæ Havniensis_. The last
volume appeared in 1821. Professor JACOBSEN, is ardently devoted to the
study of Comparative Anatomy, and has published several works on the
subject, inserted in the Mem. of the Roy. Soc. of Sciences, extracts
from which have appeared also in several foreign journals. The
collection we have just now cited, (for 1824, V. I.) contains a memoir
of Dr. GARTNER, which confirms the opinion entertained by the ancients,
as to the presence of a glandular body in the uterus of some animals.
The author has added a plate to this interesting dissertation. Dr. OTTO
has enriched the physiological sciences with his _Phrenology_, and is
zealously occupied with all that relates to this subject. Professor
WENDT, physician to the General Hospital of Copenhagen, has recently
published several small medical works. We may cite his _Historical and
Chemical Supplements, to the knowledge of some therapeutical agents, of
the class Euphorbiæ_; some notices on _small pox_, _vaccina_, and
_modified small pox_.

"Denmark possesses three periodical journals of medicine, without
counting those of the Royal Societies of Sciences and of Medicine of
Copenhagen. The first and best of these journals, is the _Bibliothek for
Læger_, published by a society instituted for the advancement of medical
studies. CLASSEN, the founder of this association, bequeathed to it a
sum of money, to purchase annually, some foreign medical works. This
collection is composed of original memoirs, extracts, and announcements
of other works, and a review of the _course_ of the faculty of medicine.
It is specially consecrated to the practical department of the
art--(three numbers per ann. of 70, to 100 pages each.) The 2nd
collection, is the _Nye Hygæa_, the editor of which, (M. OTTO,) embraces
in his plan, all the medical sciences. This journal, although specially
devoted to physicians, is in reach of all those persons of education,
who can be interested in a variety of important medical questions. It
contains original memoirs, and extracts from foreign works, (five leaves
per month.) The 3d collection, Archives for the History of Medicine in
Denmark, (_Archiv. for lægevidens kabens historie in Danmark_,) does not
appear periodically, but at indefinite times. Professor HERHOLDT, the
editor, has only published one number, in 1823.

"As to inaugural dissertations for the doctorate, the number amounts
only to three or four in the space of ten years; because the title of M.
D. is not requisite to the practitioner in Denmark."

The above is taken from the Bulletin for February, the ensuing portion
of the sketch is contained in the March number of the same journal.

"The medical literature of Sweden, must have been very insignificant in
past ages, if we may form an opinion, from the total want of documents
in relation to it. There existed no scientific lien between the
physicians of that country, or even among those of the capital. A
medical society might in vain have been sought for there, at a period,
when they were common in all other countries. The Royal Academy of
Sciences, published some essays relating to medicine, from time to time,
but until 1807, a work on this topic was regarded as a sort of rarity.
However, in the course of that year, seven physicians of Stockholm,
united in order to found a society, which received the royal sanction,
and took the title of _Svenska Loekare Soellskapet_, (_Society of
Swedish Physicians_.) This institution, seemed to communicate to the
practitioners of Sweden a new existence, and then really commenced the
æra of medical literature in that country. The number of works published
since that period, has scarcely amounted to more than one or two per
annum. Dr. RABEN is the author of three works, which, though not large,
give evidence of considerable knowledge and penetration: Their titles
are: 1st. De præcipuis causis mali Scrophul. ejusque remediis
Commentation. Lund. 1807. 2nd. A second volume on the same subject,
written in the Swedish language, Lund. 1819. 3d. Observationes in
Syphilidem, ejusque curationem, ubi novæ quoque proponuntur curandi
rationes. Lund. Goth. 1821.

"We shall also mention among the works recently published in Sweden,
1st. A biographical and literary gallery of the physicians of that
country, from the reign of Gustavus I. down to our own times, by Dr. J.
F. SAKLEN. 2nd. FLORMANN'S Manual of Anatomy. Finally, a collection of
the laws of the kingdom, which relate to medicine. The Medical Society
of Stockholm, regularly publishes its transactions, _Svenska Loekare
Soellskapets Handlingar_, the 10th vol. of which has just appeared. In
it, are some remarkable cases, a table of the constitution of the
atmosphere, and of the diseases which have prevailed at Stockholm, and
in its environs; reports on the hospitals and baths of the whole
kingdom; extracts from Medico-legal Examinations, recent discoveries,
&c. M. ECKSTRÖM promises to publish a complete description of the
variolous epidemic, which prevailed last year at Stockholm, and in the
provinces. Besides these transactions, the secretary makes an annual
report, on what passes at the sittings. To this he adds, short notices
of the most interesting recent discoveries and observations, which he
derives from foreign medical literature. He publishes this collection
once a year, and adds some nosological articles. In closing this review,
we ought not to forget to mention the collection of theses, defended at
the university of Upsal, which is published yearly by Dr. ZETTERSTRÖM."

37. _Erysipelatous Mumps or Angina Parotidiana._--Dr. BEHR of Bernberg,
has published in the _Journ. der Pract. Heilkund for July_, 1825, an
account of this disease, which we find in the _Bulletin_ for Feb. 1826.
Dr. BEHR'S "memoir is intended to pourtray the principal features of an
epidemic prevalence of parotitis at Bernberg, in the months of
December, 1822, and January and February, 1823. Dr. B. attributes it to
the frequent and sudden variations of the atmosphere at that period." He
says, "the disease is so rare in this country, that physicians of 30
years standing had never met with it before." Bernberg contains 6000
souls; it is divided into two parts by the Saale, and it is situated on
the great road from Leipsic to Magdeburg, in a narrow valley, which runs
from N. W. to S. E.

The precursory symptoms were rigors followed by heat, heaviness of the
limbs, pains in the joints, especially in the evening, sense of tension
in the region of the lower jaw, and sometimes a difficulty in
mastication. The appetite was usually natural, with gastric symptoms
only in the most severe cases. On the evening of the 3d day, there was
an increase of uneasiness with chills and heat, after which the patient
commonly enjoyed sweet sleep. The next day, on awaking, he felt
tolerably well, and had no more sense of heaviness in his limbs, but his
face was swelled on one or both sides. Speech and mastication were
effected with difficulty; the lower jaw was _comme engourdie_, and a
dull pain was felt in the ligaments of the joints; the tumefaction
increased and soon extended from the ear to the cheek. On a careful
examination, it was found to affect the parotid gland, and the
surrounding cellular tissue. The tumour was hard, diffused, and not very
painful, except on pressure. The colour and temperature of the swollen
part were natural. In the evening, the pulse became hard and
accelerated, the tongue white, the stools more consistent than common,
and the urine pale. The following night he was agitated, frequently
awakened by lancinating pains in the affected part, and sometimes by a
sense of tension in the head. The following day, the tumour reached its
maximum of elevation, and sometimes comprised the submaxillary glands of
the same side. From this time, the pains did not increase, and the skin
became slightly red only in a very few examples.

The disease having thus reached its acme, a gentle sweat commenced
behind the ears, then extended over the whole tumour, and remained as
long as the swelling lasted. This evening there was no fever, but a
gentle perspiration continued throughout the night. The day following,
being the 6th of the disease, the tumour was evidently diminished, and
continued decreasing until its final disappearance, which occurred on
the 9th, and sometimes on the 7th day. Until this period, abundant local
perspirations in the day-time, less abundant, but more general ones in
the night, were observable. When the disease was critical by urine with
sediment, the diminution of the swelling was dated from this appearance;
but the resolution was not perfected in some cases till the 14th day,
and in such cases, the integuments of the part were covered with a mealy
desquamation. Dr. BEHR did not observe any metastasis to the genitals,
but he saw cases, in which the disappearance of the swelling, was
followed by considerable fever with _augoisse_, and then an oedema,
commonly situated on the head.

He often saw the termination by induration, but this soon yielded to a
proper treatment. As to the contagion of mumps, the author thinks, it
can only occur where there is desquamation of the integuments; and
remarks on the analogy of this circumstance, with what occurs in
scarlatina. Dr. BEHR thinks, that antiphlogistics are rarely indicated
in the treatment of parotitis.

38. _Tænia._--In several cases in which gum. gutt., salts of tin, and
other medicines, were unsuccessfully used for the expulsion of tape
worm, Dr. BOUGARD succeeded in expelling them with pills compounded as
follows: Merc. dulc. Extr. aloes, aa. gr. iij. divided into three pills.
This dose was given every evening for eight days, and gradually
increased or diminished, so as to procure three stools per diem. A
rigorous diet was observed during this treatment.--_Rust's Magazin fur
die gesamte Heilkunde apud Bulletin des Sci. Med. March_, 1826.

39. _Scrophula._--Dr. WETZ recommends the employment of caustic potassa
in scrophula. He dissolves x grs. of caustic potassa in one ounce of
orange-peel water, and gives from xij to xx gtt. four times a day, in a
cup of broth. A solution of caustic potassa in six ounces of distilled
water, is applied as a wash to the ulcers.--_Ibid._

40. _Digitalis._--We find in the Propagateur des Sciences Medicales for
Feb. 1826, an account of the directions of Dr. NEUMANN of Berlin, for
the employment of digitalis in pulmonic diseases: they are said to be
the result of long experience. Digitalis is useless, says the writer, in
all cases of suppuration of the lung, consequent to tubercles of that
organ. It is of no avail in those suppurations, which succeed
inflammatory hæmoptysis. It is employed without success in _local_
phlegmorrhagies of the lungs; but it almost invariably cures those
chronic catarrhs, which depend on a state of erethism of the mucous
lining of the bronchiæ. This disease is sometimes called chronic
bronchitis, sometimes mucous consumption, pulmonic catarrh, and
galloping consumption. If the diagnosis in this case be well made out,
hopes may be entertained of a cure, one of the two following conditions
being present:

A. The patient must be susceptible of the stimulant action of the
remedy: this is often not the case. We may be sure the digitalis will
not produce its effect, where the pulse of the patient remains _uniform
and frequent after he has taken it for several days_. It does not suit
such persons.

B. The medicine ought to be administered in a proper manner. To be good,
the leaves, even in the dried state, should be perfectly green and free
from any brown spots. Two ounces of the leaves, should be infused in six
ounces of boiling water; and the patient may take a table spoonful every
hour, until he feels nausea, or a sense of constriction in his throat,
or flashing of the eyes, or irregular pulse. The use of the foxglove
should then be interrupted for seven or eight days, in which interval,
the full action of the medicine is developed, the pulse remaining
irregular, and the mucous secretion diminishing gradually. If the first
trial does not remove it entirely, a second course may be commenced
after a few days.

FOOTNOTES:

[29] Series of Engravings to the morbid anatomy; fasc. 1. pl. 6. fig. 1,
2.

[30] Lond. Med. Review; vol. 4.

[31] Pathological Researches; Essay 1.

[32] Medical Researches on the Effects of Iodine in Bronchocele,
Paralysis, Chorea Scrofula, Fistula Lachrymalis, Deafness, Dysphagia,
White Swelling, and Distortions of the Spine. By Alexander Manson, M.
D., &c. London, 1825.

[33] Carthamus Tinctorius.

V. SURGERY.

41. _Dr. Physick's operation for artificial anus, denied to have been
performed!_--We have often had occasion to remark the claiming, and, we
fully hope, the actual re-invention of American operations and practices
among physicians on the other side of the Atlantic. As we are not a
publishing people, it is, perhaps, not very strange that the French and
English should be generally unacquainted with the discoveries and
inventions which have been made among us; but here comes an actual
denial of the invention having ever taken place!

Every American who has any pretensions to the character of a surgeon, is
most probably familiar with the proposal and performance, by Dr.
PHYSICK, of a peculiar operation for those cases of artificial anus,
where the two ends of the divided or opened intestine adhere laterally
to each other, in the manner of a double-barrelled gun. We are now told
that M. RICHERAND, in his new work "On the recent progress of Surgery,"
"avoids giving this the least confidence." (Archives Generales, Janvier,
1826.) The reviewer in the Archives, in a paroxysm of angry jealousy for
the honour of French surgery, deeply wounded, as he conceives, in the
_admissions_ by M. RICHERAND of discoveries and inventions among the
English and others, adds no small amount of ill-nature to this unworthy
intimation, and makes the observations which we have translated below.

It is certainly an easy method of erecting reputations, to deny,
directly, the priority of others in operations which a favourite has
repeated. No matter though the knowledge of this priority be widely
diffused; if readers can, by means of national predilections, be induced
to place confidence in your denial, the effect, as far as relates to
them, is completely obtained. Yet one would think it an ungenerous act,
to call in question, and before partial judges, the veracity of such men
as are here named. Where a physician reports cases which agree too well
with his preconceived theories, we doubt the correctness of his
observations; and with justice: for we know that an already formed
belief will greatly tinge the most honest seeings and hearings of very
sensible and honourable heads. But this is a far different thing from
impeaching, in a manner entirely gratuitous, the moral honesty of the
record of a historical fact, made by men at the head of their
profession.

The reviewer, Mr. and probably Dr. L. C. ROCHE, comments as follows:

"1. Dr. PHYSICK never published any thing on this subject.

"2. Dr. DORSEY, who makes the claim for him, never published the work in
which he does so, [the Elements of Surgery,] till 1813.

"3. In the English journal (?) and in that work, he contents himself
with a simple assertion, without giving either the date of the
operation, the name, age, or sex of the patient, the names of his
assistants, or the details of the operation; _all points which men never
forget to make known, when treating of the first attempt in a new
operation of this importance_."

To the first of these comments we reply, that Dr. PHYSICK, to the great
regret of his countrymen, has never been in the habit of publishing; but
still possesses many useful improvements in medicine and surgery, which
he has not committed to the press. On the other hand, however, he has
taught this operation annually, to from three to four hundred pupils, in
his lectures, during about twelve successive years; and this is no mean
substitute for a publication in types. M. ROCHE'S memory will supply him
with an instance of an eminent French surgeon, whom we shall not attempt
to defraud of his laurels, who also made it his practice to leave the
publication of his observations and improvements to his pupils.

To the second remark, the above is also a sufficient reply; but we will
add that it was recorded in the case book of the Pennsylvania Hospital
in 1809.

Our comment on the third observation of Mr. ROCHE may be brief. It is
that we promise an account of the case for the next number of this
Journal. In the mean time, the patient was well known to us and to many
persons now living. The operation was performed in 1809.

In reply to that portion of the last observation, which we have marked
with italics, we can assure the reviewer that he is mistaken; at least
with regard to this side of the ocean. We Americans are a very peculiar
people, and but little affected, as yet, with the cacoethes scribendi; a
malady which the present work, in its humble sphere, is designed to
disseminate. We are not in the habit of frequently publishing, and above
all, of publishing volumes. Books are dear, private libraries small,
public ones few, and encouragement for even the best original
publications but limited. Of this we have known some melancholy
instances. It is impossible for either a Frenchman or an Englishman to
judge correctly of a country, which, in many important respects, is in
such a different situation from his own.

It is a thing of by no means uncommon occurrence here, to make a
valuable discovery or improvement in the healing art, and not to make it
public. A striking instance of this fact, at least with the exception of
the insertion of an imperfect account in the Eclectic Repertory, which
very probably never reached England, is mentioned in our last number. We
allude to the extirpations of diseased ovaria, by Dr. M'DOWALL, of
Kentucky. Here a unique and brilliantly successful operation was
performed, successful as yet beyond European imitations, and still the
inventor and achiever of it did not possess vanity or industry
sufficient to treat the public with a full account of it. M. ROCHE may
find it hard to explain modesty of this species; but we can promise him,
should these sheets ever reach his eye, and he still continue skeptical,
abundance of proofs, and some more instances of the same kind.

42. _Gangrenous Sore Mouth of Children._--Dr. COATES begs permission to
add the following quotation from FABRICIUS HILDANUS to the authorities
quoted in his paper on gangrenous ulcer of the mouth, at the
commencement of the present number.

"Gingivarum inflammatio maxime in infantibus in gangrænam interdum
degenerat. Morbus enim magnus, vehemens et peracutus; magna quoque
requirit remedia: sed quis illa in ore adhibere ausus?"--_De Gangræna et
Sphacelo, Cap. IV. p. 773. col. 2. Edit. Beyeri. Francofurt ad Mæn._
1646.

"Gangræna in partibus humidis, gingivis, palato, naribus, &c. raro
sanabilis; in sphacelum autem degenerans, insanabilis."--_Cap. XI. p._
781. _col._ 2.

This is all I find in that author, relative to the subject.

43. _Operation for Phymosis._--M. J. CLOQUET, has so improved this
operation that no deformity results. He recommends the incision to be
made at the _inferior_ surface, near, and parallel to, the frænum
præputii. The longitudinal wound thus made, becomes transverse, as soon
as the prepuce is drawn behind the glans penis, and cicatrizes in a line
scarcely visible; so that the prepuce acquires in breadth what it loses
in length. M. CLOQUET has, in this way, perfectly cured many patients;
the prepuce appearing to possess its natural conformation.--_La
Propagateur des Sci. Med. for March._

44. _Lunar Caustic on Wounds and Ulcers._--The practice of healing
wounds and ulcers by natural or artificial scabs, to which the attention
of the profession was first directed by Mr. J. HUNTER, has been too much
neglected, and the circumstances under which it is useful, have not been
accurately stated. In a small work published by Mr. HIGGINBOTTOM, in
January last, at London, the practice of forming an _eschar_ by the
lunar caustic over small ulcers and recent wounds, has been strongly
recommended as saving the patient much pain, trouble, and danger. The
whole surface is to be pencilled with the solid caustic so as to form an
eschar, and where this remains _adherent_, the wound or ulcer invariably
heals with comparatively little inconvenience. When effusion occurs
under the eschar, whether of serum or of pus, there is more difficulty;
but if this fluid be evacuated by a puncture, and the caustic applied to
the orifice, the eschar will often remain adherent. Sometimes the fluid
must be frequently evacuated. If the eschar does not separate
favourably, a cold poultice may be applied, which not only removes the
eschar, but lessens the irritation and inflammation. Should the sore not
be healed, Mr. H. recommends the reapplication of the caustic. To
prevent effusion under the eschar, and to preserve it adhering, he
advises the whole to be covered with a piece of gold-beater's skin; but
we may add, that as this effusion arises from too much inflammation,
more powerful means may occasionally be employed, especially a solution
of acetate of lead. LARREY recommends with the same view, after the
application of moxa, the use of the aq. ammoniæ. Indeed any evaporating,
cold, astringent lotion will be advantageous.

The application of the caustic, of course, produces some pain, but this
soon subsides, and the patient experiences more ease than under any
other mode of treatment.

_Particular cases in which the Caustic is useful._--In punctured wounds,
it should be applied to the orifice and surrounding skin, and the eschar
allowed to dry. The terrible effects of punctured wounds, are thus
completely prevented, whether caused by needles, hooks, bayonets, &c. So
also of wounds from saws; of bites from leeches and animals; of the
stings of insects; and especially of those small scratches, and
punctures, received in _anatomical dissections_. The danger of these
last mentioned accidents may, according to Mr. H., be completely
arrested by the prompt and free application of the lunar caustic. Even
in neglected cases, when a small tumour has formed under the skin,
attended with a smart stinging pain, he advises the tumour to be
removed, and an adherent eschar to be formed by the caustic; and in
still more neglected and advanced cases, where inflammation of the
absorbents has supervened, "a free crucial incision is to be made, the
caustic to be freely applied, and afterwards, the cold poultice and
lotion; the usual constitutional remedies being actively enforced."

In _bruises_, especially of the shin, the adherent eschar from lunar
caustic, has, with Mr. H., always effected a cure; and even when a
slough has been produced, the application of the caustic will moderate
the inflammation.

In _ulcers_, which are small, not exposed to friction or motion, and
discharging little, the cure by eschar will be preferable; especially in
those little irritable and painful ulcers often seen about the ancle and
tendo Achillis. Apply first a cold poultice, and then form the eschar,
which may be freely exposed to the air. Should the matter, nevertheless,
collect, it should be evacuated by puncture as often as necessary, until
the eschar remains adherent.

This practice is recommended by Mr. H., in various other affections; as
in inflammation of the fingers; in the fungous ulcer of the navel in
infants; in _tinea capitis_, &c. In this last case, we have ourselves
used it with marked advantage. In all cases, the lunar caustic has a
decided effect in _diminishing the irritability_ of the parts to which
it is applied; and hence should usually be preferred for the purpose of
forming a "_scab_," for such the eschar really is, in a practical view;
and we think that our author has hardly done justice to nature's
methodus medendi by "scabbing;" while he so ably and strenuously
recommends his own imitation of her process. Scabs may be formed by the
coagulation of blood; by the drying of mucus or pus; and by the
formation of an eschar, by the actual or potential cautery. The surgeon
may frequently reduce parts to the same situation, by the use of
gold-beater's skin, court-plaster, or other unirritating applications,
which prevent exposure and evaporation. In all cases, care must be taken
to prevent the surrounding inflammation from transcending the adhesive
stage.

45. _Hæmorrhage from Lithotomy._--In the London Med. and Phys. Jour. for
Jan. Mr. JOHN SHAW has published an account of a patient, who
unfortunately perished from hæmorrhage, in consequence of being cut for
the stone. The parts being injected after death, it was found, that the
bleeding proceeded from the _unusual distribution_ of a branch of the
pudic artery, which traversed the neck of the bladder, and lay directly
in the way of the incision. The pudic artery was uninjured.

46. _Extirpation of the Parotid Gland._--The best surgical writers have
condemned this operation, if not as absolutely impracticable,
nevertheless, as too dangerous to be ever attempted. Successful cases
have however been reported, and Mr. A. COOPER, in a letter to the
operator in the following case, avers, that he twice removed the parotid
gland in one year. Mr. KIRBY, late president of the Royal College of
Surgeons in Ireland, in a work published in 1825 at Dublin, on
hæmorrhoidal excrescences, has given the details of a diseased parotid,
and of the operation for its removal. We condense from Johnson's Review
for April, 1826.

The patient was a poor female, aged 40, who had a tumour extending from
above the zygoma downwards on the neck, two inches below the angle of
the jaw, stretching as far forwards as the anterior edge of the masseter
muscle, forcing the ear backwards, and raising it outwards from its
natural position. Above the surface, it was about the size of a
goose-egg; immoveable; painful when handled; irregular on the surface,
and of a deep livid colour over the prominent points. Pains of a
lancinating character, extended over the head and neck, producing
sickness and want of sleep.

The operation was performed chiefly by the fingers and the handle of the
knife, after dividing the integuments by a crucial incision. The
branches of the portio dura were of course divided, and great
embarrassment arose from a copious hæmorrhage, caused by the bursting of
the tumour, while Mr. K. was rooting it out from between the pterygoid
muscles. The bleeding was restrained by the finger of an assistant, and
the complete extirpation of the diseased gland was effected. Mr. KIRBY
says, "the space between the pterygoid muscles was void--the auditory
tube was fully exposed--the articular capsule of the jaw was brought
into view--the finger could trace the length of the styloid process, and
on sponging the wound of its blood, it could be seen by those who
surrounded the chair." The hæmorrhage was restrained by a sponge firmly
lodged at the bottom of the wound, covered by compresses of lint, and
the whole secured by a double-headed roller.

The patient was much exhausted, slept tolerably well the next night,
complaining of thirst and inability to swallow. On the 2nd day,
inflammation, swelling, and fever followed--erysipelas appeared on the
neck--patient lethargic--pulse small and frequent. Fourth day,
suppuration--symptoms improving--no relapse. The patient completely
recovered, without any regeneration of the tumour.

In FERUSSAC'S Bulletin Universel for Jan. 1826, we observe the following
notice, from a German Medical Magazine, conducted by M. D. Schmidt.

A female, aged 33 years, had suffered for 9 years from a diseased
parotid gland, which had gradually attained a large size. It was
extirpated by Dr. PRIEGER, and the patient soon returned home in good
health, and little disfigured. The tumour measured 8 inches in
circumference, and weighed three and a half pounds. (Livres.)

Dr. PRIEGER had previously extirpated a scirrhous parotid successfully.
M. WIENHOLD affirms, that he has extirpated three parotids; the details
of these operations are published. M. SCHMIDT, however, suggests some
doubts, as to the _nature_ and _seat_ of the tumours removed.

47. _Aneurism from a Wound, cured by Valsalva's method._--This
interesting and valuable case, is condensed from Le Propagateur des Sci.
Med. for March, 1826. M. Antouard, a healthy female, æt. 18, was wounded
on the 18th of June, 1825, by a poniard, in the left carotid artery,
below the superior extremity of the sternum; the instrument passing
obliquely inwards and downwards. The anterior and lateral portions of
the neck, were enormously distended with blood, and syncope supervened.
Four days after the injury was received, an aneurismal tumour was
observed at the edge of the sternum, the surrounding effusion being
greatly diminished by absorption; and at the expiration of a month, when
she was first seen by Dr. SOUCHIER, it was of the size of the two fists
of the young female. The pulsations at this time, were nearly equal over
the whole surface of the tumour; but rather more distinct over the
orifice in the vessel. The surrounding blood was entirely absorbed. No
pain was experienced, unless from the pressure of the swelling; from
which cause also, resulted a troublesome and continued headach. Dr.
SOUCHIER, not believing an operation adviseable, during the warm season
of the year, and on a tumour, situated so much under the sternum,
determined to fulfil the following indications: 1st. To lessen the
quantity of blood; and thus, to diminish the stimulus to the heart, the
projectile force it exercises, and consequently, the rapidity with which
the blood escaped from the ruptured vessel, and the impulse hence
imparted to the sides of the tumour, preventing, in some degree, the
coagulation of the blood. 2nd. To increase the effect of general and
local bleeding by the use of _cold_, of _pressure_, and especially, of
the digitalis purpurea: that thus the force of the circulation may be
lessened, the blood allowed to coagulate, and a radical cure be
accomplished.

Mademoiselle Antouard, determined to yield herself to this plan, and was
directed: 1st. Rice-water, acidulated with lemon-juice, and an infusion
of mallows, for _food_ and _drink_. 2nd. To employ frictions on the
abdomen, and on the insides of the thighs, morning and evening, with
eight grains of the pulverized leaves of digitalis, previously macerated
for 24 hours in a sufficient quantity of saliva. 3d. To apply every day
12 leeches, near the aneurismal tumour, and after favouring the flow of
blood by emollient fomentations, to cover the part with compresses, wet
with a saturated solution of the acetate of lead, to be frequently
renewed, so as to be kept below the temperature of the skin. 4th. The
effect of these means to be augmented by pressure, made by means of the
base of a glass tumbler, fixed by the hands of assistants; and 5th. To
be kept at rest, and in perfect silence.

_Fourth day of treatment_, being 2nd of Aug. 1825. Pulsations more
central; tumour very sensibly diminished; pulse less strong and reduced
from 86 to 74 in the minute; the menses, which had been suppressed for
two months, appeared on the 31st ulto. and still flow. _Prescription_,
V. S. [Symbol: ounce]xviij. next day, twelve leeches, on the lateral
parts of the tumour; gr. xxiv. of digitalis in three applications
through the day. Continue ut supra.

Aug. 8th. Patient tranquil; pulse 60, full, not active; face not
flushed, but preserving a delicate tinge of red; headach now slight; no
nausea; menses continued until the 6th inst. _Prescription_, V. S.
[Symbol: ounce]xij.--fifteen leeches to-morrow; increase digitalis to
gr. xxviij. daily; the rest, ut supra. The tumour has diminished at
least one-fourth.

Aug. 12th. Tumour reduced to 3-5ths of its former volume; pulse at 56;
her nights are comfortable; has some headach, and lately, cardialgia;
complains of hunger and weakness, and from the fatigue of her
assistants, the pressure was made with a bandage less effectually than
before. This was allowed, as the pulsations are weakened, and more and
more central, while the elevation of the tumour is trifling. For fear
her health might be injured, she was permitted to rise a little from
bed, and to add to her rice water, some light jellies, (crémes) made
from the same grain. V. S. [Symbol: ounce]x. and every 2nd day, eight
leeches around the tumour; digitalis increased to 32 grains daily; warm
pediluvium for one hour, morning and evening; silence as complete as
possible.

Aug. 18th. No tumour visible; pulsations can yet be felt; the skin is
thickened; pulse at the wrist is at 50. V. S. [Symbol: ounce]viij.--six
leeches every 4th day until menstrual period; digitalis reduced to gr.
xx. and still to the same parts; continue the pressure; allow some rice
jelly, vermicelli soup, gentle exercise; silence to be preserved,
continue pediluvium, and relieve constipation by simple enemata.

In 15 days, Dr. SOUCHIER again visited his patient. It required an
experienced hand to distinguish, at the spot where the artery was
cicatrized, an elevation rather more evident, than over the rest of the
artery. Pulse 48 per minute; hunger great, and the remedies now
unpleasant. Most of them were suspended, and fruit and the white flesh
of poultry added to her diet list. The digitalis reduced to 12 grains a
day. Compression, silence, and moderate exercise, to be continued as
before. The menses appeared at the expiration of twenty-five days, and
were more abundant than at the last period.

At the end of a month, no trace of the tumour was discoverable. The
young lady had carefully increased her nutriment and exercise without
inconvenience, and all remedial measures were now omitted.

During the months of December and January last, she remained free from
any inconvenience from the tumour, and the union of the parietes of the
artery was therefore regarded as complete.

In the above account, we have only to regret that the state of the
artery above the tumour, before and after the treatment, had not been
noticed. Perhaps this may be supplied by Dr. SOUCHIER, in the
commentary, which he proposes publishing on the above case.

48. _Protrusion and Wound of the Stomach._--Mr. TRAVERS, in the Edin.
Journ. of the Med. Sciences, for Jan. 1826, relates, that a female, aged
53, and the mother of _nineteen_ children, inflicted on herself a wound
in the abdomen, three inches in length, and in a transverse direction.
When admitted into St. Thomas' Hospital, at the expiration of six hours,
the greater part of the large curvature of the stomach, the arch of the
colon, and the entire large omentum, were protruded and strangulated in
the wound. The omentum was partially detached from the stomach, which
organ was wounded in two places; one, half an inch long through the
peritoneal coat; the other, a perforation of all the coats, admitting
the head of a large probe, and giving issue to a considerable quantity
of mucus. Patient faint; pain slight; pulse 102, and irregular; some
hiccup. A silk ligature was placed round the small puncture in the
stomach, and the displaced viscera returned, after enlarging the
external wound. This last was closed by the quill suture. Warm
fomentations and abstinence from food and drink enjoined. 2nd day, some
re-action; had been sick in the night from some drink given; is free
from pain; pulse 120; pain on pressure; an enema ordered. _Evening_, a
dose of castor oil, and twenty leeches to the abdomen. 3d, much fever;
V.S. [Symbol: ounce]xviij. and 20 leeches to the abdomen; bowels not
opened. 4th day, two stools; pulse 98; tension of the abdomen; three
more stools during the day. 5th, sutures removed; wound united, except
at its right extremity, where a serous fluid is discharged in
considerable quantities. On the 6th day, was allowed food, and on the
23d of Dec., about two months after the accident, was discharged cured.

49. _Oesophagotomy._--This operation has been objected to, not only on
account of the dangers attending its performance, but from the alleged
difficulty of promoting the union of the wound in the oesophagus; as
it is seldom at rest, the lips of the incision being often separated,
and the mucous coat adhering with difficulty under any circumstances.
Hence we are induced to notice the following case, in which the
operation was successfully executed on an inferior animal, by M. FELIX,
a veterinary surgeon of Bergelac. The account is published in the Feb.
No. of Le Propagateur des Sci. Med.

A _Cow_ was threatened with immediate suffocation from the lodgment of a
potato in the oesophagus. It had shortness of respiration, an
incapacity of swallowing even its saliva, which flowed from the mouth,
was in great distress, and covered with a cold sweat. Being properly
secured in a horizontal posture, an external incision was made on the
inside of the sterno-mastoid muscle, and a cautious dissection practised
until the tumour was completely exposed. The oesophagus was divided by
"an incision extending the whole length of the foreign body, which was
extracted without any force, _which is almost always fatal_. I
immediately made two close sutures; and also two others in the skin, on
each side, adapting to them two pieces of packthread, more easily to fix
the dressings. I dressed the wound with brandy, filling the opening with
hemp soaked with brandy." The animal was kept on very little food or
drink. On the third day the wound was dressed for the first time, and a
digestive ointment applied.

In the course of the 2nd week, the cicatrization of the oesophagus
occurred; the part was dressed with lint; and by the 20th day after the
operation, the animal was quite restored.

This case would have been more useful, if more precision had been
employed in describing the dressing and subsequent treatment of the
wound. It would seem that the sutures were passed through the parietes
of the oesophagus only, and that the external wound was kept open by
being filled with tow. Certainly, union by the adhesive inflammation
ought to have been attempted in all parts of the wound; but whether
sutures in the oesophagus are advantageous, or whether the uniting
bandage be preferable, is not so easily determined. In the two cases
described in 3d vol. of the Mem. de l'Acad. de Chirur. the uniting
bandage was alone employed, and with success.

50. _Retention of Urine, caused by a Stricture of the Urethra, relieved
by a forcible but gradual Injection._--The editor of Le Propagateur des
Sci. Med. in the No. for Feb. 1826, introduces the following case, by
observing, that it reflects great honour on M. AMUSSAT, and that his
discovery merits the greatest praise. M. D... aged 70 years, of a
plethoric constitution, had suffered about 30 years before from three
attacks of gonorrhoea; since which period he has had a difficulty in
urinating, and can never discharge more than one or two ounces of urine
at a time.

At eight o'clock, P. M. of the 1st of Feb. he tried to urinate, but
could not succeed. He suffered great pain. Pulse agitated; face flushed;
belly swelled, and globular at its inferior part; the subcutaneous
abdominal veins distended, and the penis in a state of semi-erection.
All attempts to urinate were painful and ineffectual. At ten o'clock, A.
M., on the 2nd, M. AMUSSAT visited him, and passed a bougie. This was
arrested by a contraction near the bulb of the urethra, and caused the
discharge of some blood. No urine had been passed for 14 hours, while
ordinarily he urinated 12 or 16 times through the night. The obstruction
was so great, that none of the usual means of relief remained, except
_the forcible introduction of the catheter_, or the _puncture of the
bladder_. M. AMUSSAT resorted to the following plan which he had
devised, and which completely succeeded. He injected warm water
forcibly, but gradually, into the urethra, which, dilating the orifice
of the stricture, forced backwards the thickened mucus which had
obstructed it. As soon as the liquid injection met the urine, the
patient cried out that he was saved, and immediately was able to urinate
as formerly. At two trials, he discharged nearly two pints of thick
urine. There was no return of the retention, the patient continuing
well.

Should subsequent experience confirm this experiment of M. AMUSSAT, this
simple measure will be a most valuable substitute for those dangerous
measures hitherto resorted to for retention of urine, in cases where the
obstruction arises from thickened mucus, from small calculi closing the
orifice of a stricture, from inflammation, or from what are termed,
(justly or not,) spasmodic strictures.

51. _Tracheotomy._--In the Amer. Med. Review for April, Dr. JOHN ATLEE,
of Lancaster, mentions that on Wednesday, Aug. 11th, he was consulted by
a child ten years old, who had that morning, while running, put a
button-mould into his mouth, which during respiration was drawn into the
trachea. He complained of uneasiness in respiration, with a slight
rattling, and pointed towards the upper part of the sternum, as the
situation of the button. On coughing, a rattling was heard, and
immediately after, a sudden check to expiration, from the lodgment of
the button near the rima glottidis, requiring a sudden and violent
effort of inspiration to remove the sense of suffocation. An emetic was
given with no advantage. During the night, he had two or three spells of
coughing, threatening suffocation.

An operation was urged, to avoid immediate and subsequent dangers from
the lodgment of this extraneous body, and was agreed to by the parents,
and by Dr. HUMES, who was called in consultation. It was performed on
the 14th of Aug.; a cathartic, and afterwards an opiate, having been
given.

An incision, one inch and a half long, was made through the integuments,
extending downwards from above the cricoid cartilage, and exposing the
sterno-hyoid and thyroid muscles, which were then separated. After
exposing the trachea, a longitudinal incision, about three-quarters of
an inch in length, was made through its parietes at the third ring. This
was held open, and the patient requested to cough. This was ineffectual.
The wound being closed, the button was, by coughing, thrown up against
the rima glottidis. A probe passed into the trachea, produced a violent
effort to cough, by which, as soon as the instrument was withdrawn, the
button was thrown through the wound, to some distance from the patient.

The wound was dressed with two sutures and adhesive strips. Most of it
united by the first intention: and in a few days the patient completely
recovered.

52. _Fistula Lachrymalis_--At the session of the Royal Academy, on the
15th of December, M. J. CLOQUET related the case of a female, who, three
years previously, had submitted to the operation for fistul. lachrym.
according to the method of M. FOUBUT. The canula which had been allowed
to remain in the nasal canal, had ulcerated through the floor of the
nose, and presented its inferior extremity on the inside of the mouth.

A practical commentary on this mode of operating, which is still
recommended by able surgeons!

53. _Aneurisma Herniosum._--This form of aneurism is supposed to consist
of a dilatation of the internal and muscular coats of the artery; the
external cellular having been destroyed. It is termed by ARNAUD, and by
Dr. WILLIAM HUNTER, _aneurisma herniam arteriæ sistens_. Its existence
in any case has, however, been denied by a large majority of surgeons;
and perhaps the only cases reported are those of DUBOIS, in 1804, found
in the thoracic and abdominal aorta of a dead subject.

The reporter of the following case, quotes also MONRO, as having cited
examples of this kind of aneurism. But what MONRO termed a "mixt
aneurism," arose from the rupture of the coats of a "true aneurism," by
which it was reduced to the state of a "false aneurism;" very different
from that here contended for. SABATIER and BOYER, also, deny the
existence of this hernia of the artery, and a good summary of facts and
arguments is given by BOYER in his Surgery, in support of this opinion,
(vide article Aneurism, tome i.) which it would be difficult to
invalidate, especially by cases analogous to the following. The
reporter, M. BONNET, of the late French army, considers this case as
proving a hernia of the artery in a vessel of medium diameter; those of
DUBOIS having been noticed in the largest arteries.

A Prussian soldier was wounded over the femoral artery by a musket ball.
No hæmorrhage ensued, and the wound cicatrized. In this state, M. BONNET
visited him for a mortification of the foot of the same limb, which had
been frozen. Amputation of the leg was performed, the stump healed
readily, and in 12 days the ligatures came away. On the 13th day, (being
six weeks since wounded in the thigh,) the patient perceived a tumour at
the original cicatrix on his thigh, which had appeared during the
preceding night. On the 14th, it had enlarged to three times its former
size: it was painful; fluctuation was evident; but there was no
pulsation, not even the thrilling noise, which is evident in the last
stage of aneurism. A consultation was called, to determine whether it
was an abscess or an aneurism. The question could not be satisfactorily
answered, and it was determined to open it, after having made the
necessary arrangements to secure the artery, should the tumour prove
aneurismal. As soon as the integuments were punctured, the jet of blood
evinced the nature of the complaint; and the artery was secured by
ligatures above and below the tumour. The coagula were numerous, and the
superficial ones, quite hard and cartilaginous. The patient did well,
and there was every prospect of his recovery on the 1st day, when M.
BONNET was forced by the movement of the armies to leave him at Meaux.

Such are the facts, from which the Reporter infers, that the aneurism
consisted of a protrusion of the internal and middle coats of the
artery. The _reasoning_, founded on them, appears to us inconclusive;
but we have not space to insert it, and must refer to the March No. of
Le Propagateur des Sci. Med.

54. _Extirpation of the Two Dental Arches, affected with
Osteo-sarcoma._--Dr. GIORGI REGNOLI, physician at Pesaro, performed this
operation on a female 35 years of age, who had from infancy, been
troubled with pain and diseases of the teeth and jaws. When Dr. R.
visited her, both dental arches were enormously swelled; red and
sanguineous tumours had formed over their whole surface, and covered the
teeth. The alveolar processes were entirely softened. The diameters of
the mouth were greatly lessened; but by the touch, it was evident, that
the disease was confined to the alveolar processes of the two ossa
maxillaria. A foetid odour exhaled from the mouth. Lancinating pains
continually tormented the patient; especially on attempting to
masticate. The slightest touch was very painful, and was always followed
by an effusion of blood. There was also an alteration of voice; a
disgusting deformity of the mouth, with emaciation, fever, &c. The
operation was performed on the 18th May, 1825.

The patient was seated opposite to a window; her head being supported
against the breast of an assistant, who, at the same time, pressed upon
the labial arteries. The inferior lip was divided perpendicularly, and
detached laterally from the inferior jaw, so as to expose the whole
extent of the carcinoma. Some strokes of the saw were made on the
anterior and most prominent part of the bone, and into the groove thus
formed, the blade of a very strong knife was inserted, by means of
which, aided by some slight strokes with a mallet, all the diseased
portion was removed. The soft parts had been previously detached from
the internal surface of the jaw. The last left molar tooth, not being
diseased, was alone left. The hæmorrhage from the dental artery was
arrested by the actual cautery.

The dental arch of the upper jaw, was then completely removed in the
same manner. The bleeding was here more profuse, but was arrested by a
hot iron. The alveolar processes thus removed, were enlarged, and of a
lardaceous colour, and the fungous growths had the appearance and
consistence of indurated albumen.

In 25 days, the patient was discharged well. Her general health was
good; the foetor had quite gone; the cicatrix over the bone was
regular, white, hard, and could be pressed upon without causing pain.
The patient can triturate her food with facility; the lips are slightly
drawn inwards, without any sensible inconvenience; and the voice is a
little altered, but this even is daily improving.--_Le Propagateur des
Sci. Med._ for Jan. 1826.

55. _Traumatic Erysipelas._--In the Feb. No. of the Revue Medicale, is a
clinical report of the celebrated Baron LARREY, surgeon in chief of the
Hospital de la Garde Royale; in which he criticises severely the use of
leeches in erysipelas, and recommends in that variety of the disease,
arising from wounds, &c. the application of the actual cautery, as
effectual in arresting immediately the progress of the disease. It
causes, he says, but little pain; destroys the burning and tense pain of
the disease, as also the redness and swelling of the part; is not
followed by suppuration, and does not cause gangrene in the contiguous
parts. The eschar separates, without leaving a cicatrix. Various other
advantages are enumerated, all of which are confirmed by a list of
cases, as treated at the hospital. We have no room for details, which
would, if known universally, hardly render us Americans, whether
surgeons or patients, as fond of the cautery, as our trans-atlantic
brethren of the French school.

56. _Obliteration of a portion of the Urethra, remedied by an
operation._--M. VANIER of Cherbourgh, relates in the Jan. No. of "Le
Propagateur des Sciences Medicales," the case of a man aged 27 years,
who, on the 16th of June, 1815, was wounded in the penis by a musket
ball, which completely divided the urethra at its middle portion,
without injuring the corpora cavernosa. The wound healed up; but by
degrees, the passage contracted, so that in May, 1819, the patient could
pass his urine only guttatim, with pain and difficulty, and was
threatened with inflammation, &c. of the perineum. Bougies afforded no
relief. An incision was then made externally, in the direction of the
urethra, so as to divide the cicatrix, and open the canal above and
below the contracted part. The lips of the incision were drawn together
over a sound, passed into the bladder; and by the 5th day, the wound was
completely cicatrized. The sound was then removed, and a short bougie
inserted, so as to pass beyond the cicatrix. This was worn occasionally,
and the patient completely recovered. At the end of three years, he was
able to "urinate with ease, and in a full stream."

57. _Artificial Joint cured by Caustic._--Dr. J. RHEA BARTON, has
applied the caustic potash to the extremities of the fragments of a
broken tibia, after an artificial joint had fully formed. Exfoliation
was produced, followed by bony union. In three months, the patient
recovered.

Dr. B. alludes to other cases, by Mr. WHITE of Manchester, and Mr. HENRY
CLINE, thus treated with success; to two instances, in which the
practice failed in the hands of Mr. EARLE; and finally, to one case by
Mr. A. COOPER, the result of which he has not learnt. He does not
recommend the operation, as usually preferable to the _seton_, for
which, the profession is indebted to Dr. PHYSICK; but as an additional
expedient, when other means fail.--_Med. Record. April_, 1826.

58. _Epilepsy cured by Trephining._--In the 17th No. of the New-York
Medical and Physical Journal, Dr. DAVID L. ROGERS relates an interesting
case of a man, aged 46, who had been subject to epileptic convulsions
for 14 years, and who, of late years, had been unable to labour, and
rapidly sinking into a state of idiocy, from their frequent recurrence.

These fits were preceded by a fracture of the os frontis, with
depression, from which he readily recovered; but soon after he was
attacked with convulsions. He now suffers pain on the injured side
extending down the neck and left arm--the eye of the same side is
diminished--the sight much impaired, and his memory almost entirely
destroyed. A cicatrix covering a slight depression was easily found,
above the left superciliary ridge of the frontal bone, and over the
superior orbitar foramen. Under these circumstances, the operation of
trephining was performed on the 7th of July, 1825, but with some
difficulty, from the irregular thickness of the bone, and from the saw
having to pass through the upper part of the frontal sinus. "The dura
mater was unfortunately cut through for one-half the circumference of
the circle." The parts were found more vascular than usual, and the
under surface had a ridge corresponding to the internal depression, but
too slight to have caused compression of the brain. "Having made a
section of the frontal sinus, [with a trephine?] a part of the
_posterior table_ was removed with the _circular_ piece. This portion of
the internal table had been fractured, and separated to some distance
from its inferior attachments to the frontal plate, and driven back upon
the substance of the brain. Its sharp edge was worn round and smooth."
This seemed to have been the cause of all the mischief.

After the operation, the patient suffered from pain in his head, with
some moderate excitement, which was relieved by cathartics. He had no
return of fits until the 25th day, when the wound was entirely healed.
These had been brought on by overloading his stomach with food, and were
followed by high arterial excitement and inflammation of the brain.

He was relieved in a few days by active depletion, and was discharged
cured on the 20th of August. _Nine months_ afterwards, this man
continued free from fits, his memory had nearly recovered its usual
strength, and he could attend to his business without any inconvenience.

VI. MIDWIFERY.

59. _Gastrotomy_.--M. BULK, in Germany, has successfully performed this
operation on a female, aged 36 years, of good constitution, under the
following circumstances. The patient, during her pregnancy, suffered
from a severe pain at the left and inferior portion of the abdomen; her
menses were not suppressed, and every six or eight days, a clot of blood
and mucus came from the vagina. Her general health was very good.

About the middle of her 8th month, she was washing some linen, and
suddenly felt as if something was tearing in her abdomen; at the same
time, a swelling of the size of two fists (poings) formed on the right
side, below the umbilicus. She fainted, and for six weeks suffered dull
pains in the abdomen. At this time, she had _true labour pains_ for 48
hours, and was attended by a midwife. The os uteri dilated so as to
admit one finger only. The tumour disappeared during these pains. The
patient recovered, with the size of the abdomen undiminished.

In this state she continued for two years and three months, menstruating
regularly. She became again pregnant, with little inconvenience until
the 7th month, when her abdomen was painfully distended, and of a bluish
colour, and fluctuation was induced on the least motion. At the full
period, she was delivered of a large foetus, which she suckled for 15
days. The infant then died of an aphthous affection.

Her milk ceasing, she rapidly declined with hectic symptoms. The tumour
reappeared below the umbilicus about the size of an egg, and soon
opened, discharging from small orifices a little pus. The opening was
enlarged, and some skin and hairs were removed. The patient's
constitution was fast yielding, and gastrotomy was immediately
performed. An incision was made, with the requisite precautions, through
the linea alba into the cavity of the abdomen, from two and a half
inches above the umbilicus to within nine lines of the pubis, care being
taken to prevent the escape of the intestines. A foetus of full size,
in which putrefaction had commenced, was found on the right side of the
uterus. "I raised," says the operator, "the body with much care, and
endeavoured to trace the umbilical cord. This was turned over the fundus
of the uterus to the left side, and terminated in a vascular substance
in a state of suppuration, (probably, the remains of the placenta,)
which was situated below the great omentum. I pressed out, and dried up
the pus, which covered these parts, by means of a sponge. The uterus was
an inch and a half in length and an inch in breadth, of a pale rose
colour, and could easily be distended (se laissait distendre aisément.)
It was otherwise in a good condition."

The wound in the abdomen was closed with sutures. The patient was in
great danger from inflammatory symptoms for 8 days, but eventually
recovered. She left her bed on the 55th day.

60. _Cæsarian operation, performed with safety to the Mother and
Foetus._--We condense from JOHNSON'S Review for April last, the
following summary of a case of Cæsarian section performed by GRAEFE, on
the 20th of September, 1825.

Carolina Bechang, was admitted into GRAEFE'S Clinicum, in an advanced
stage of pregnancy; being 30 years of age, much deformed by rickets, and
only four feet (Rhenish) in height. On the 20th of Sept. after having
been five days in labour at the full period, pains severe, and os uteri
dilated, she consented to the Cæsarian section.

A little after 2 o'clock, GRAEFE placed the fore finger of his left
hand, immediately below the umbilicus, and with a large scalpel, made an
incision downwards in the linea alba, to within one inch of the pubis;
dividing the entire parietes, and even penetrating the substance of the
uterus. A second incision penetrated the uterus and exposed the
placenta; which, as had been anticipated, was found on the fore part of
the fundus. The assistants now compressed firmly the edges of the
divided abdominal parietes upon the uterus, to prevent the protrusion of
the intestines, in which they succeeded; and GRAEFE carried his hand in
a moment into the uterus, separated the placenta with his finger and
thumb, and then withdrew it and the child almost together. The child was
very active, and cried lustily. The uterus immediately and suddenly
contracted, and the bleeding was inconsiderable. Not more than twelve
ounces of blood were lost, and no ligature was required. The whole
operation was completed in four minutes and a half. The wound was
secured by three broad sutures, and adhesive plasters, assisted by a
bandage round the abdomen. The child weighed six pounds and was well
formed. During the operation, the patient was sick, and once vomited
slightly. In two hours had pain and fever: V.S. [Symbol: ounce]xij.
Draught with ten drops of the aqua laurocerasi was given, and repeated
in a few hours. The patient passed a quiet night. The symptoms of pain,
inflammation, and fever, were threatening for some days, and were
promptly resisted by the lancet, by enamata, by narcotics, especially
the laurocerasus and hyosciamus, by fomentations, &c. By the 9th day,
the wound had cicatrized, excepting near the symphisis; symptoms all
favourable. The lochia were discharged regularly; and in three weeks,
she was able to sit up, and in three more, quite well. Early in
November, she returned home with her child, both in perfect health.

In FERUSSAC'S Bulletin Universel; for February, another case, in which
the Cæsarian operation was performed with safety to the mother and
infant, is copied from RUST'S Magazine.

61. _Extirpation of the Uterus._--Dr. RHEINECK, of Memmingen, was
consulted by a female, who in December, 1824, was attacked by fever,
from which she slowly recovered. A prolapsus of the uterus, which
gradually became inverted, followed, attended with frequent hæmorrhage
and discharge, by which she was almost worn to the grave. The whole of
the uterus was inverted, and without the labia externa; its surface
loose, fungous, and in several places easily broken down upon pressure;
but there was no hardening nor ulceration. The irritation was so great,
as to threaten the patient's life, and after a consultation, in which it
was agreed, that the swelling was really formed by the uterus, the
tumour was laid hold of and drawn forwards, and a broad ligature,
secured with a double surgeon's knot, was applied round its base. In
about three weeks, the whole had separated, and the part above the
ligature was cicatrized. During this period, the patient was dangerously
ill, and was only rescued by great care and attention.

The operator had before performed a similar operation, in which case,
the patient died suddenly from hæmorrhage, on the separation of the
ligature. OSIANDER, STRUVE, LONGENBACK, SAUTER, SIEBOLD, and ZAUG, have
in late years performed the same operation, with various degrees of
success.--_Johnson's Review for April_, 1826, who quotes from _Siebold's
Journal fur Geburtshulfe_, 1826.

62. _Uterine Hæmorrhage._--In the Bulletin Universel for Jan. 1826, the
following case is detailed from the Gazette de Santé, for Dec. 1825.

A female aged 32 years, was taken with labour with her first child, on
the 12th Feb. 1825. The pains soon ceased, and on the 15th of Feb. M.
BEDEL, physician at Schirmack, was consulted, who speedily delivered
her, by means of the forceps, of a dead child. The hæmorrhage was so
considerable, as to render the immediate removal of the placenta
necessary; but the uterus did not contract, and the bleeding continued,
with tremblings, syncope, cold sweats, &c. Irritation on the internal
surface of the uterus, the use of cold water to the abdomen, injections
into the uterus of cold water and vinegar, were unavailing.

Plugging the vagina, and also the _uterus_, was now resorted to, as the
only means of safety remaining. The uterus was filled with pieces of
rags, for fear the patient could not sustain the loss of blood necessary
to fill that cavity; while a methodic compression was at the same time
made to the abdomen. The hæmorrhage was immediately arrested, and soon
after reaction ensued.

On the 16th, M. BEDEL extracted the plugs from the uterus, cautiously
and in succession; and had the pleasure of finding the uterus regularly
contracting after each removal. The lochial discharge continued, and
there was no secretion of milk. The patient recovered slowly.

It is in such cases as the above, that the physicians of the United
States have employed the Secale Cornutum (Ergot,) the judicious use of
which would have probably superseded the necessity of instruments, and
prevented or arrested the hæmorrhagic discharge.

VII. CHEMISTRY AND PHARMACY.

63. _State in which Morphia exists in Opium._--In the 80th article of
our Quarterly Summary for January, we stated that MR. ROBINET had
announced the discovery of a new acid in opium, with which the morphia
was combined; while the meconic acid was alleged to be united with soda.
To the former salt, he gave the name of _codeate of morphia_. MR.
ROBIQUET, however, has shown, that the pretended _codeate_, is a
_muriate_ of morphia, formed by double decomposition between the muriate
of soda, employed by MR. ROBINET in his analysis, and meconate of
morphia. The same decomposition shows the source of the meconate of
soda. We observe that MR. ROBINET admits his mistake.--_Archives
Générales de Medicine._

64. _Peculiar principles of Narcotic Plants._--"Dr. BRANDES of
Sabzerflen, having been prevented by extreme illness, induced by
investigating the peculiar principles of narcotic plants, from
completing his inquiries, has announced the results of his labours in
general terms. He states, that he has found a peculiar narcotic
principle in all the narcotic plants; as belladonna, hyosciamus, conium,
stramonium, chelidonium, digitalis, &c. The narcotic principles are
readily soluble in alcohol, ether, acids, and water, and of a highly
offensive odour. This odour is so great in the principle of conium, that
it is almost impossible for an individual of an irritable habit, to
remain in the room, where there is an etherial solution, containing only
a few grains of it. The smell of such a solution is equal to the smell,
arising from twenty or thirty pounds of the plants. It is also
remarkable, that as this principle is neutralized by acid, the
disagreeable odour disappears, or is greatly diminished; which so far
agrees with the circumstance, that the plants themselves give little of
their peculiar smell, because the narcotic principle is not in a free
state. Dr. BRANDES has promised to communicate the manner of obtaining
the principles."--_Lond. Med. Repository, Feb. 1826._

65. _Relative quantities of Cinchonia and Quinia in the most esteemed
Varieties of Peruvian Bark._--Mr. BALLY asserts, that practitioners,
from observation, have classed the Peruvian barks in the following
order;--first, the gray loxa bark, (_Cinchona Officinalis_;) then the
red bark (_Cinchona Magnifolia_ of RUIZ and PAVON, or _Oblongifolia_ of
MUTIS;) and lastly the yellow bark, or calisaya, (_Cinchona Cordifolia_
of MUTIS, or _pubescens_ of VALLI.) The _Cinchona Officinalis_ furnishes
much cinchonia, and little quinia; the _Cinchona Magnifolia_ affords
about equal quantities of the two salifiable principles, while the
_Cordifolia_ contain much quinia.

Mr. BALLY, assuming it as proved, that cinchonia is the more powerful
salifiable base of the two in a medical point of view, considers,
therefore, that, in regard to the above barks, chemical analysis
justifies the order of their relative value, which had been previously
deduced from their medical employment.--_Archives Generales de
Medecine._

66. _Sulphate of Quinia, extracted from the Cinchona Bark, exhausted by
Decoction._--Mr. JULIA-FONTENELLE, from the sparing solubility of quinia
and cinchonia, suspected that decoctions and aqueous extracts of
Peruvian bark contained but little of those vegetable alkalies; whence
it would follow, that the residuum, generally rejected as having no
febrifuge power, would still contain the greater part of them. This
suspicion has been in a great measure verified. The aqueous extract was
found to contain but little cinchonia and quinia; while the residuum of
decoctions, giving the mean results, furnished two-thirds of the
sulphate of quinia, yielded by the same weight of cinchona not acted on
by water.

As decoctions and aqueous extracts of bark are febrifuge, though
containing inconsiderable quantities of quinia, and cinchonia, Mr.
JULIA-FONTENELLE is led to believe, that these salifiable bases are not
the only febrifuge principles in Peruvian bark, but that the extractive
matter also possesses that property.

His results present a striking difference between alcoholic and aqueous
extracts of bark; for while the former contain nearly the whole of the
salifiable principles, the latter contain very little.--_Revue
Medicale._

67. _Analysis of Rhubarb._--It is some time since Mr. NANI, an Italian
chemist, announced the discovery of a crystallizable vegetable alkali in
rhubarb. Mr. CAVENTOU has repeated the experiments of Mr. N. and finds
them, in many respects, inaccurate. Upon analysing the alcoholic extract
of rhubarb, by the aid of alcohol and ether, employed separately and
combined, Mr. C. obtained a fatty matter, containing a little
odoriferous volatile oil, and a yellow colouring principle, capable of
crystallization, and of being sublimed without decomposition, which may
be called _rhubarbin_. He also detected in the alcoholic extract, a
brown substance, insoluble in water when pure, but rendered soluble by
combination with rhubarbin; when it forms a compound, constituting the
_eaphopicrite_ of some chemists, and the _rhubarbin_ of
Psaff.--_Archives Generales._

Mr. GEORGE W. CARPENTER, of this city, prepares the medicinal principle
of rhubarb in combination with sulphuric acid, under the name of
sulphate of rhubarb, by the following process:

"Boil, for half an hour, six pounds of coarsely powdered Chinese rhubarb
in six gallons of water, acidulated with two and a half fluid ounces of
sulphuric acid; strain the decoction, and submit the residue to a second
ebullition in a like quantity of acidulated water; strain as before, and
submit it again to a third ebullition. Unite the three decoctions, and
add, by small portions, recently powdered pure lime, constantly stirring
it to facilitate its action on the acid decoction. When the decoction
becomes slightly alkaline, it deposites a red flocculent precipitate,
and the fluid is changed from a yellow to a crimson colour. The
precipitate is then to be separated by passing it through a linen cloth,
and dried; after which, reduce it to powder, and digest in three gallons
of alcohol, at thirty-six degrees, in a water bath, for several hours,
at a moderate heat. Separate this solution from the calcareous
precipitate, and distil off three-fourths of the alcohol. There then
remains a strong solution of rhubarbine, to which add as much sulphuric
acid as will exactly neutralize it. Evaporate this slowly to dryness,
without having access to atmospheric air. The residuum will be of a
brownish-red colour, intermingled with brilliant specks, possessing a
slightly pungent styptic taste, soluble in water, and its odour that of
the native rhubarb." This residuum is the sulphate of rhubarb. (Sulphate
of _rhubarbin._?)

Mr. CARPENTER assures us, that this preparation contains the medicinal
principle of the rhubarb, apart from its inert portion; and considers it
as bearing the same relation to rhubarb, as the sulphate of quinia to
the Peruvian bark. The Chinese rhubarb, at half the price, furnished
twice as much rhubarbin as the reputed Russian, which Mr. C. considers
to be spurious in the Philadelphia market, being the English prepared in
imitation of the Russian.--_Philadelphia Journal of the Medical &
Physical Sciences. May_, 1826.

68. _Alkaline Lozenges of Bicarbonate of Soda._--Mr. D'ARCET proposes
the following formula for these lozenges:--Take of

Bicarbonate of Soda, pure and dry, and in fine powder, 5 parts.
Very white Sugar, in fine powder, 95
Mucilage of Gum Tragacanth, q.s.
Essential oil of Mint, pure and fresh, 2 or 3 drops
for about every 3 ounces of mixture of bicarbonate and sugar.

Shake the bicarbonate and sugar in a well dried bottle, with the view of
mixing them intimately. Withdraw the mixture from the bottle, and add
the mucilage and oil of mint, blending the whole together on a marble.
The mass obtained, is then to be divided into lozenges, which should
weigh, when dried, about 15 grains each. As they slightly attract
moisture, they ought to be kept in a dry place, or in well stopped
bottles.

Mr. D'ARCET praises very highly the effects of these lozenges in
disordered digestion, and in preventing its occurrence, as well from
experiments made on his own person, as from observations on others. He
believes their operation to be purely chemical, consisting in the
saturation of the morbid acid of the stomach, and, therefore, not likely
to be lessened by habit. Their effects are much more prompt than
magnesia, either pure or in the state of carbonate.

In the phosphatic diathesis, where the urine is disposed to be alkaline,
it would seem that these lozenges would do harm. But, perhaps, we have
this security against their use in these cases, that the stomach would
not at the same time be troubled with acidity. _Annales de Chimie et de
Physique, Jan._ 1826.

69. _Presence of Mercury in Samples of medicinal Prussic Acid._--Mr.
REGIMBEAU, apothecary at Montpellier, has detected this impurity in some
prussic acid, prepared in Paris. Its presence was first suspected, from
a portion of the acid, accidentally dropped, leaving a white stain on
the copper dish of a balance. It is probable, that the impure acid,
spoken of, had been made by passing sulphuretted hydrogen through a
solution of cyanide of mercury, according to VANQUELIN'S process; and
that an insufficiency of the decomposing gas had been employed.

May not this accidental impurity explain the occasional salivating
effects of prussic acid.

70. _Proposed Method for preparing Protoxide of Mercury by
precipitation, for Medical Employment._--Mr. THOMAS EVANS has published
some observations on this subject, and justly remarks, that the blue
pill, mercurial ointment, and other mercurial preparations, are not
uniform compounds, but contain variable proportions of the real
protoxide, and uncombined mercury. Some blue pill, which had been
carefully prepared by Mr. E. by the usual process of trituration, was
found to contain on analysis 20 per cent. of unoxidized mercury; and
the blue mass from Apothecaries' Hall, London, furnished about the same
proportion.

As it is obviously a desideratum to procure preparations of protoxide of
mercury of uniform strength, Mr. EVANS has been led to seek a process,
by which to obtain this oxide in a pure state. After repeated
experiments, he has pitched upon the following formula: Dissolve four
ounces of caustic hydrate of potassa in a pound of water, and to the
clear solution, decanted from any impurities, add four ounces of
calomel, and shake the mixture frequently. Pour off the liquid, and wash
the precipitate formed with water, and then dry it at a gentle heat.

In regard to the medical efficacy of the protoxide obtained in this way,
Mr. EVANS reports the following to be the results obtained by Dr.
COATES, at whose suggestion the article was prepared. As a substitute
for calomel, it is more apt to vomit and purge, two grain doses
operating several times. As an alterative, it was found incomparably
more efficacious than the blue pill, being more certain and regular in
its operation. Dr. C. thinks, that one-fourth of a grain of the
precipitated protoxide, as prepared by Mr. EVANS, is equal to three or
four grains of the blue mass.--_Journ. of the Philad. Col. of Pharm.
May_, 1826.

The method here proposed for obtaining the black oxide of mercury by Mr.
EVANS, was first suggested and put in practice by Mr. PHILLIPS. See his
"Experimental Examination of the last edition of the Pharmacopoeia
Londinensis, London, 1811," page 114. His words are, "When solution of
potash is employed, the several inconveniences attendant upon the use of
lime-water are avoided, and a blackish coloured protoxide is obtained
without heating the solution. As potash is much more soluble than lime,
it is scarcely necessary to employ one-tenth part of the quantity of
water; this not only renders the process more convenient, but the
quantity of air contained in the water being less, very little of the
oxide, perhaps none of it, is converted into peroxide." See also the
experiments, and observations of Mr. DONOVAN, on Mercurial Ointment, &c.
published in the Medical Journals, several years ago.

71. _Goulard's Extract of Lead._ Mr. DANIEL B. SMITH proposes the
following formula for obtaining Goulard's extract of uniform strength:

Acetate of lead, crystallized, 15 ounces, troy.
Protoxide of lead, 9 ounces, troy.
Distilled water, 4 pints.

"Boil them together for fifteen minutes and filter. The filtered liquid
will weigh about five and a quarter pounds, is transparent, colourless,
and of the specific gravity of 1.267. (30° Baumé.)"

We conceive that Mr. SMITH has erroneously denominated the sugar of
lead, a binacetate. The best usage is to deem that the primary saline
compound, which contains a single proportional of acid and base.
Accordingly we call the saturated carbonate of potassa, a
_bicarbonate_; and Dr. THOMSON calls borax, a biborate of soda, on
account of its containing two proportionals of acid to one of base,
notwithstanding the alkaline qualities of this salt. Goulard's extract
is, therefore, a sub-binacetate of lead, or according to Dr. THOMSON'S
recently suggested nomenclature, a _diacetate_.--_Ibid._

QUARTERLY LIST

AMERICAN MEDICAL PUBLICATIONS

Observations on the Autumnal Fevers of Savannah. By W. C. Daniell, M. D.
8vo. pp. 152.--W. T. Williams, and Collins & Hanway. Savannah, 1826.

An Analysis of Fever. By Charles Caldwell, M. D., Professor of the
Institutes of Medicine, and Clinical Practice in Transylvania
University. 8vo. pp. 97.--Lexington, K. 1825.

Medical and Physical Memoirs. By Charles Caldwell, M. D., Professor, &c.
Containing, 1. An Introductory Address, intended as a Defence of the
Medical Profession against the charge of Irreligion and Infidelity; with
Thoughts on the Truth and Importance of Natural Religion. 2. A
Dissertation in answer to certain Prize Questions, proposed by his
Grace, the Duke of Holstein Oldenburg, respecting the "Origin, Contagion
and general Philosophy of Yellow Fever, and the Practicability of that
Disease prevailing in high Northern Latitudes;" with Thoughts on its
Prevention and Treatment. 3. Thoughts on the Analogies of Disease. 8vo.
pp. 224.--Lexington, K. 1826.

Florula Cestrica: an Essay towards a Catalogue of the Phoenogamous
Plants, native and naturalized, growing in the vicinity of the borough
of West-Chester, in Chester County, Pennsylvania; with brief notices of
their Properties and Uses, in Medicine, rural Economy and the Arts. To
which is subjoined an Appendix of the useful cultivated Plants of the
same District. By William Darlington, M. D. 8vo.--West-Chester, 1826.

We are much gratified with the appearance of this little flora.
It is really an uncommonly neat, useful, and convenient
performance; and, we have no doubt, is by far the most elegant
and creditable botanical work, if not the only one, published
in any small town in America. To a country town, we would not
think of looking for such a production; but in fact, the county
of Chester has, of late years, made very considerable advances
in science and literature. It has produced a public library,
and perhaps others with the existence of which we are not
acquainted, several botanical and mineralogical collections, a
very respectable series of essays on its history, similar to
Mr. Jefferson's notes on Virginia, schools, teaching the higher
branches of the English mathematics, and one of those partly
literary newspapers which have recently sprung up among us.

The above title considerably explains the nature and extent of
the work. Of its scientific accuracy, sufficient time has not
yet elapsed to form an adequate judgment; but we observe that
the author has had the frequent assistance of Baldwin, Collins,
Steinhauer, Torrey, and Schweinitz: so that, if the maxim
"noscitur a socio" be at all applicable in the present case, it
is evident that he has been in the very best botanical company
which our land affords.

The work is executed with very great neatness, such as would do
credit to the press of a metropolis, and is really wonderful
for a moderate sized village, and for the disturbed life of a
country physician, its author. There is also a great deal of
that kind of popular explanation, which so agreeably relieves
the repulsiveness of dry works on natural history: such as the
familiar names of the plants; the derivations of the names of
the genera, designed to assist the student in remembering them,
by enabling him to associate some idea with them; occasional
comments on their uses and injurious effects, &c.

We may add, that from the close proximity of Chester County to
Philadelphia, extending to a large part of the line of the
Schuylkill, this little work will answer extremely well for
common use around this city, with the single exception of the
sands of New-Jersey.

Memoir on the Topography, Weather, and Diseases of the Bahama Islands.
By P. S. Townsend, M. D.--New-York, 1826.

The New-England Journal of Medicine and Surgery, and Collateral Branches
of Science. Conducted by Walter Channing, Jr. M. D., and John Ware, M.
D. No. 2. Vol. XV.--Boston, April, 1826.

The American Medical Review, and Journal of Original and Selected Papers
in Medicine and Surgery. Conducted by John Eberle, M. D., Nathan Smith,
M. D., George M'Clellan, M. D., and Nathan R. Smith, M. D. No. 1, Vol.
III.--Philadelphia, April, 1826.

The Medical Recorder of Original Papers and Intelligence in Medicine and
Surgery. Conducted by Samuel Colhoun, M. D. No. 2, Vol.
IX.--Philadelphia, April, 1826.

The Philadelphia Journal of the Medical and Physical Sciences. Edited by
N. Chapman, M. D., W. P. Dewees, M. D., and John D. Godman, M. D. No.
V. New Series.--Philadelphia, May, 1826.

The New-York Medical and Physical Journal. No. 17. Edited by John B.
Beck, M. D., Daniel L. M. Peixotto, M. D., and John Bell, M.
D.--New-York, April, 1826.

Journal of the Philadelphia College of Pharmacy. No. 2, Vol.
1.--Philadelphia, May, 1826.

AMERICAN EDITIONS OF FOREIGN MEDICAL BOOKS.

Manual of Surgical Operations; containing the New Method of operating,
devised by Lisfranc; followed by two Synoptic Tables of Natural and
Instrumental Labours. By J. Coster, M. D. and Professor of the
University of Turin. The Translation and Notes by John D. Godman, M. D.
12mo. pp. 265.--Carey & Lea. Philadelphia, 1825.

A Treatise on Derangements of the Liver, Internal Organs, and Nervous
System. By James Johnson, M. D. 12mo. pp. 223.--Carey & Lea.
Philadelphia, 1826.

An Inquiry into the Nature and Treatment of Diabetes, Calculus, and
other Affections of the Urinary Organs. By William Prout, M.D. F.R.S.
From the second London Edition, with Notes and Additions, by S. Colhoun,
M. D. 8vo. pp. 308.--Towar & Hogan. Philadelphia, 1826.

* * * * *

We are sensible that the foregoing does not present a full list of
medical publications for the last quarter; but it is as complete as our
opportunities have enabled us to make it. It is obviously for the
interest of authors and publishers, to send us the titles of their
medical publications as soon as they appear, and we invite them to do
so.

*** End of this LibraryBlog Digital Book "North American Medical and Surgical Journal, Vol. 2, No. 3, July, 1826" ***

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