Property of the
Lancaster City and County Medical Society
No
/
I
THE
AMERICAN JOURNAL
OP THE
MEDICAL SCIENCES.
EDITED BY
ISAAC HAYS, M.D.,
FELLOW OF THE PHILADELPHIA COLLEGE OF PHYSICIANS ; MEMBER OF THE AMERICAN MEDICAL ASSOCIATION | OF THE AMERICAN PHILOSOPHICAL SOCIETY | OF THE ACADEMY OF NATURAL SCIENCES OF PHILADELPHIA ; ASSOCIATE FELLOW OF THE AMERICAN ACADEMY OF ARTS AND SCIENCES,
&c. &c. &c.
NEW SERIES.
VOL. XXXIV.
PHILADELPHIA: BLANCHARD & LEA.
1857.
69460
Entered according to the Act of Congress, in the year 1857, by BLANC HARD AND LEA,
in the Office of the Clerk of the District Court of the United States in and for the Eastern District of the State of Pennsylvania.
PHILADELPHIA: T. K. AND P. G. COLLINS, PRINTERS.
A 513
^(9 READERS AND CORRESPONDENTS.
Communications have been received from Drs. Dalton, Coolidge, Hamilton, McDowell, Earle, Curtis, Fleming, Finkham, and Wells, which shall receive early attention.
The following works have been received : —
Lettsomian Lectures on Insanity. By Forbes Winslow, M. D., D. C. L., &c. &c. London, 1854. (From the Author.)
On the Diseases, Injuries, and Malformations of the Rectum and Anus, with Remarks on Habitual Constipation. By T. J. Ashton, Surgeon to Blenheim Dispensary, F. R. C. S., &c. &c. Second edition. London, 1857. (From the Author.)
Notes on Belgian Lunatic Asylums: including the Insane Colony of Gheel. By John Webster, M. D., F. R.'S., &c. &c. (From the Author.)
Notices sur Hyeres et Cannes. Par Edwin Lee, M. D. Suivies d'observa- tions sur l'influence du climat dans la Phthisie pulmonaire. Paris, 1857. (From the Author.)
Principles of Medicine: An Elementary View of the Causes, Nature, Treat- ment, Diagnosis, and Prognosis of Disease. With brief Remarks on Hygienics, or the Preservation of Health. By Charles J. B. Williams, M. D., F. R. S» A new American from the third Revised London Edition. Philadelphia: Blanchard & Lea, 1857. (From the Publishers.)
On Diseases of the Skin. By Erasmus Wilson, F. R. S. Fourth American from the fourth and enlarged London edition. Philadelphia: Blanchard & Lea, 1857. (From the Publishers.)
On the Diseases of Women: Including those of Pregnancy and Childbed. By Fleetwood Churchill, M. D., T. C. D., M. R. I. A., Vice-President of the King's and Queen's College of Physicians in Ireland; One of the Presidents of the Obstetrical Society, etc. etc. A new American edition revised by the author. With notes and additions. By D. Francis Condie, M.D., Fellow of the College of Physicians of Philadelphia, etc. etc. Philadelphia: Blanchard & Lea, 1857. (From the Publishers.)
Manual of Physiology. By William Senhouse Kirkes, M. D., Fellow of the Royal College of Physicians, etc. With two hundred illustrations. Phila- delphia: Blanchard & Lea, 1857. (From the Publishers.)
A Manual of Examinations upon Anatomy, Physiology, Surgery, Practice of Medicine, Chemistry, Obstetrics, Materia Medica, Pharmacy, and Thera- peutics. Especially designed for Students of Medicine. To which is added a Medical Formulary. By J. L. Ludlow, A. M., M. D. A new edition, tho- roughly revised and much enlarged. With three hundred and seventy illus- trations. Philadelphia: Blanchard & Lea, 1857. (From the Publishers.)
Indigenous Races of the Earth: or, New Chapters of Ethnological Inquiry; Including Monographs on Special Departments of Philology, Iconography, Cranioscopy, Palaeontology, Pathology, Archaeology, Comparative Geography, and Natural History. Contributed by Alfred Maury, Bibliothecaire de l'ln- stitut de la France, etc.; Francis Pulszky, of Lubocz and Cselfalva, and J. Aitken Meigs, M. D., Prof, of the Inst, of Med. in the Phil. Coll. of Med. (With Communications from Prof. Jos. Leidy, M. D., and Prof. L. Agassiz, LL. D.) Presenting Fresh Investigations, Documents, and Materials. By J. C. Nott, M. D., Mobile, Ala. and Geo. R. Gliddon, Formerly U. S. Consul at Cairo, Authors of Types of Mankind. Philadelphia: J. B. Lippincott & Co. London: Trubner & Co., 1857. (From the Publishers.)
A Manual of the Detection of Poisons by Medico-Chemical Analysis. By Dr. Fr. Jul. Otto, Professor of Chemistry in Caroline College, Brunswick. Translated from the German, with Notes and Additions by William Elderhorst, M. D., Prof, of Chem. in the Rensselaer Polytechnic Institute, Trov, N. Y. New York : H. Baillure, 1857. (From the Publishers.)
The Transactions of the New York Academy of Medicine. Instituted 1847. Vol. I., Part IX. ; Vol. II., Part I. Printed for the Academy. New York: S. S. & W. Wood, 1857. (From Dr. Isaacs.)
4
TO READERS AND CORRESPONDENTS.
Transactions of the Medical Society of the State of New York. Transmit- ted to the Legislature Feb. 9, 1857.
Smithsonian Contributions to Knowledge. Investigations, Chemical and Physiological, relative to certain American Vertebrata. By Joseph Jones, M. D., Professor of Chemistry in the Savannah Medical College. Washington City : Published by the Smithsonian Institution, July, 1856. (From the Au- thor.)
Catalogue of Human Crania, in the Collection of the Academy of Natural Sciences of Philadelphia. Based upon the third edition of Dr. Morton's " Ca- talogue of Skulls," &o. By J. Aitken Meigs, M. D., Librarian of the Academy of Natural Sciences of Philadelphia, &c. Philadelphia: J. B. Lippincott & Co., 1857.
The Transactions of the Academy of Science of St. Louis. (With Plates Illustrating Papers.) St. Louis, 1857.
Constitution and By-Laws of the West Chester County (New York) Medical Society, and the Proceedings of the Society at its Annual Meeting held in the Village of Sing Sing, June 2, 1856. Sing Sing, 1857.
On Dysentery and its Treatment. By Henry Tiedemann, M. D., Member of the College of Physicians, and of the Acad, of Nat. Sciences at Philadelphia. Philadelphia, 1857. (From the Author.)
Fourteenth Annual Report of the Managers of the State Lunatic Asylum. Transmitted to the Legislature Jan. 7, 1857. Albany, 1857.
Seventieth Annual Report of the Regents of the University of the State of New York. Transmitted to the Legislature Jan. 22, 1857. Albany, 1857.
Fortieth Annual Report of the State of the Asylum for the Relief of Per- sons deprived of the use of their Reason. Published by direction of the Con- tributors, third month, 1857. Philadelphia, 1857.
Annual Report of the Physician in Chief of the Marine Hospital at Quaran- tine. Presented to the Legislature Feb. 4, 1857. Albany, 1857. (From Dr. E. Harris.)
Fourteenth Annual Report relating to the registry and return of Births, Mar- riages, and Deaths in Massachusetts for the year 1855. Boston, 1857. (From Dr. Edward Jarvis.)
Twenty-fourth Annual Report of the Trustees of the State Lunatic Hospital at Worcester, Dec. 1856. Boston, 1858. (From Dr. Edward Jarvis.)
Eighth Annual Report of the Massachusetts School for Idiotic and Feeble- minded Youth. Cambridge, 1856. (From Dr. Edward Jarvis.)
Report of the Board of Trustees of the Massachusetts General Hospital pre- sented to the corporation at their annual meeting Jan. 28, 1857. Boston, 1857. (From Dr. Edward Jarvis.)
Fourth Annual Report to the General Assembly of Kentucky relating to the Registry and Returns of Births, Marriages, and Deaths, in the State of Ken- tucky, from January 1 to December 1, 1855.
An Inaugural Thesis on Intra-Capsular Fractures of the Cervix Femoris. By John Geo. Johnson, of Mass. (Reprinted from New York Journ. Med., May, 1857.) New York, 1857. (From the Author.)
First Anniversary of the Woman's Hospital, held at Clinton Hall, Astor Place, New York, Feb. 9, 1856. New York, 1856.
Constitution and Second Annual Report of the Woman's Hospital Associa- tion. Presented by the Board of Managers at the Anniversary Meeting, Jan. 12, 1857. New York, 1857.
Memorial to the Honourable the Legislature of the State of New York, for founding a Woman's Hospital, 1857. New York, 1857.
An Act to Found a Woman's Hospital for the State of New York, passed April 8, 1857. New York, 1857.
Professor Mitchell's Charge to the Graduates of the Jefferson Medical Col- lege of Philadelphia, Ma^ch 7, 1857. With a list of Graduates. (From the Author.)
Valedictory Address to the Class of Graduates of the Missouri Medical Col- lege at the Annual Commencement of the Session of 1856-57. By E. S. Fra- zer, M. D., Prof, of Obstetrics and Diseases of Women and Children. St. Louis, Mo., 1857.
TO READERS AND CORRESPONDENTS.
5
An Introductory Lecture on Medicinal Education delivered at the Philadel- phia College of Medicine March 9, 1857. By Henry Hartshorne, M. D., Prof, of Theory and Pract. Med. (Published by the Faculty.) Philadelphia, 1857.
The Physicians of the Last Century, A Lecture introductory to the Course at the Philad. Assoc. for Med. Instruction, March 23, 1857. By J. Da Costa, M. D., Lect. on Prin. and Pract. Med. Published by the Class. Philadelphia, 1857. (From the Author.)
Knowledge of the only Guide to Action. An Address to the Graduates of the St. Louis Medical College. Delivered Feb. 28, 1857. By Prof. J. H. Wal- ters, M. D. (Published by request of the Class.)
Eulogy on Samuel McClellan, M. D. Prepared by order of the Medical So- ciety of the State of New York, and read at the Annual Meeting in Albany, Feb. 3, 1857. By Thomas W. Blatchford M. D. Albany, 1857.
Semi-Centennial Address. Delivered before the Medical Society of the State of New York and Members of the Legislature in the Capitol at Albany Feb. 4, 1857. By Alden March, M. D., President of the Society. Albany, 1857.
Catalogue of the Officers and Students in the Cleveland Medical College. Session of 1856-57. Cleveland, 1857.
Savannah Medical College. Circular and Catalogue of the Trustees, Faculty, and Students. Announcement of Lectures, Session 1857-58. Savannah, 1857.
Catalogue of the Medical College of Virginia. Session 1856-57. Richmond,
Catalogue Raisonne of the Medical Library of the Pennsylvania Hospital. By Emil Fischer, M. D. Printed by order of the Board of Managers. Phila- delphia: Printed by T. K. & P. G. Collins, 1857. (Advance Copy from the Hospital.)
The following Journals have been received in exchange : —
Moniteur des Hopitaux. Redacteur en chef, M. H. De Castelnau. March, April, May, 1857.
L'Art Dentaire. Par MM. Fowler et Preterre. January, February, March, April, 1857.
Medical Times and Gazette. April, May, June, 1857.
Edinburgh Medical Journal. March, April, May, 1857.
British Medical Journal, being the Journal of the British Medical Associa- tion. Edited by Andrew Winter, M. D. March, April, May, 1857.
The Dublin Hospital Gazette. March, April, May, 1857.
The British and Foreign Medico-Chirurgical Review. April, 1857.
The Journal of Psychological Medicine and Mental Pathology. Edited by Forbes Winslow, M. D. April, 1857.
The Dublin Quarterly Journal of Medical Science. May, 1857.
The Indian Annals of Medical Science. October, 1856.
The Sanitary Review and Journal of Public Health, including Transactions of the Epidemiological Society of London. Edited bv B. W. Richardson, M. D. March, 1857.
The Glasgow Medical Journal. April, 1857.
The Medical Chronicle, or Montreal Monthly Journal of Medicine and Sur- gery. Edited by Drs. Wright and McCallum. February, March, April, May, June, 1857.
The Virginia Medical Journal. Edited by Drs. McCaw and Otis. April, May, June, 1857.
The Peninsular Journal of Medicine. Edited by Z. Pitcher, M. D. and A. B. Palmer, M. D. April, May, June, 1857.
The Southern Journal of the Medical and Physical Sciences. Edited by Richard 0. Currey, M. D., &c. April, May, June, 1857.
The American Journal of Dental Science. Edited by Chapin A. Harris, M.D., D. D. S., and A. Snowden Piggott, M. D. April, 1857.
The Western Lancet. Edited by Geo. C. Blackman, M. D. April, May, 1857.
The Medical and Surgical Reporter. Edited by S. W. Butler, M. D. April, June, 1857.
6
TO READERS AND CORRESPONDENTS.
Atlanta Medical and Surgical Journal. Edited by Jos. P. Logan, M.D. and W. F. Westmorland, M. D. April, May, 1857.
American Journal of Science and the Arts. Conducted by Profs. B. Silli- man, B. Silliman, Jr., and J. D. Dana. May, 1857.
The Medical Independent. Edited by E. Kane, M. D. and L. G. Robinson, M. D. April, 1857.
Southern Medical and Surgical Journal. Edited by Henry F. Campbell, M. D., and Robert Campbell, M. D. April, May, June, 1857.
The American Journal of Insanity. Edited by the Medical Officers of the New York State Lunatic Asylum. April, 1857.
The New York Journal of Medicine. Edited by S. S. Purple. M. D., Stephen Smith, M. D., and H. D. Bulkley, M.D. January, May, 1857.
The American Journal of Pharmacy. Edited by Wm. Proctor, M. D. May,
The Buffalo Medical Journal. Edited by Sanford B. Hunt, M. D. April, May, 1857.
Iowa Medical Journal. Conducted by the Faculty of the College of Physi- cians and Surgeons of the Iowa University. November and December, 1856.
The North American Medico-Chirurgical Review. Edited by S. D. Gross, M. D., and T. G. Richardson, M. D. May, 1857.
The Ohio Medical and Surgical Journal. Edited bv John Dawson, M. D. May, 1857.
Charleston Medical Journal and Review. Edited by C. Happoldt. Mav, 1857.
New Orleans Medical News and Hospital Gazette. Edited by Drs. Chappin, Beard, and Brickell. May, June, 1857.
The New Orleans Medical and Surgical Journal. Edited by Bennet Dow- ler, M. D. May, 1857.
Memphis Medical Recorder. Edited by A. P. Merrill, M. D. May, 1857.
The American Medical Gazette. Edited by D. Meredith Reese, M. D., &c. April, May, June, 1857.
Nashville Journal of Medicine and Surgery. Edited by W. K. Bowling, M. D., assisted by Paul F. Eve, M. D. April, May, June, 1857.
St. Louis Medical and Surgical Journal. Edited by M. L. Linton, M. D., and W. M. McPheeters, M. D. March, May, 1857.
The Cincinnati Medical Observer. Edited by Drs. Mendenhall, Murphey, and Stevens. April, May, June, 1857.
The North-Western Medical and Surgical Journal. Edited by N. S. Davis, M. D. March, May, 1857.
The California State Medical Journal for Jan. 1857. Edited by J. F. Morse, M.D.
The New Hampshire Journal of Medicine. Edited by Geo. H. Hubbard, M. D. April, May, 1857.
The Monthly Stethoscope. Edited by G. A. Wilson, M. D., and R. A. Lewis, M. D. April, May, 1857.
Communications intended for publication, and Books for Review, should be sent, free of expense, directed to Isaac Hays, M. D., Editor of the American Journal of the Me- dical Sciences, care of Messrs. Blanchard & Lea, Philadelphia. Parcels directed as above, and (carriage paid) under cover, to John Miller, Henrietta Street, Covent Gar- den, London; or M. Hector Bossange, Lib. quai Voltaire, No. 11, Paris, will reach lis safely and without delay. We particularly request the attention of our foreign corre- spondents to the above, as we are often subjected to unnecessary expense for postage and carriage.
Private communications may be addressed to the Editor, at his residence, 1525 Locust St.
All remittances op money, and letters on the business of the Journal, should be addressed exclusively to the publishers, Messrs. Blanchard & Lea.
Jg^° The advertisement-sheet belongs to the business department of the Journal, and all communications for it should be made to the publishers.
CONTENTS
or THE
AMERICAN JOURNAL
OF THE
MEDICAL SCIENCES.
NO. LXVII. NEW SEEIES. JULY, 1857.
ORIGINAL COMMUNICATIONS.
MEMOIRS AND CASES.
ART. PAGE
I. Phenomena of the Capillary Circulation. By Austin Flint, Jr., M. D. - 13
II. On the Treatment of Scarlatina by the Diluted Acetic Acid. By B. F. Schneck, M. D., of Lebanon, Pa. ------ - - 27
III. Cases of Partio-General Paralysis, or the Paralysis of the Insane. By Pliny Earle, M.D. - - - 36
IV. Reports of Cases treated in the Pennsylvania Hospital. By John H. Packard, M. D., late Resident Physician at the Pennsylvania Hospital. - 51
V. Statistics of Obstetrical Cases. By Daniel Pierson, M. D., Augusta, 111. (Prepared for, and read before the Hancock Co. (111.) Medical Associa- tion, and communicated to the Am. Journ. Med. Sci. for publication, in compliance with a vote of the Society.) -------56
YI. Chlorate of Potash in Mercurial Stomatitis. By Thomas J. Gallaher, M. D., one of the Physicians to the Western Pennsylvania Hospital, Pittsburg. 64
VII. Chlorate of Potash Injections in Leucorrhoea and Ulceration of the Os Uteri. By Bedford Brown, M. D., Caswell County, N. C. - - - 66
YIII. The Use of Water in the Treatment of Fever. By Isaac Casselberry, M. D., Evansville, Ind. 68
IX. Does Pregnancy accelerate or retard the Development of Tubercles of the Lungs in persons predisposed to this Disease ? By Edward Warren, M. D., of Edenton, North Carolina. The Dissertation to which the Fiske Fund Prize was awarded, June 4, 1856. (Published by request of the Rhode Island Medical Society.) 87
REVIEWS.
X. Statistical Report on the Sickness and Mortality in the Army of the United States, compiled from the Records in the Surgeon-General's Office ; embracing a period of Sixteen Years, from 1839 to 1855. Prepared under the direction of Brevet-Brigadier-General Thomas Lawson, Surg. Gen. U. S. Army, by Richard H. Coolidge, M. D., Assistant Surgeon U. S. Army. Washington, 1856. - 119
8
CONTENTS.
ART. PAGE
XL Traite Therapeutique du Quinquina et de ses Preparations. Par P. Briquet, Medecin a THopital de La Charite, &c. &c. Deuxieme edition. Paris, 1855.
Therapeutical Treatise on Cinchona and its Preparations. By P. Briquet, Physician of La Charite, &c. &c. Second edition, Paris, 1855. - - 142
XII. Traite de Chimie Anatomique et Physiologique, Normale et Patholo- gique, ou des Principes Imraediats Normaux et Morbides qui constituent le Corps de l'Homme et des Mammif eres. Par Charles Robin et F. Ver- deil. 3 volumes, et Atlas de 45 Planches. Paris, 1855.
Treatise on Anatomical and Physiological Chemistry, Normal and Patholo- gical ; or of the Immediate Principles, Normal and Morbid, which con- stitute the Body of Man and of the Mainmiferse. By Charles Robin and F. Verdeil. 3 vols., and an Atlas of 45 Plates. Paris, 1853. - - 158
BIBLIOGRAPHICAL NOTICES.
XIII. A Claim of Priority on the Discovery of, and also the Naming of the Excito-Secretory System of Nerves. By Henry Fraser Campbell, M. D., of Augusta, Georgia, U. S. A., Member of the American Medical Asso- ciation, etc. etc. 8vo. pp. 16. 177
XIV. Reports of American Institutions for the Insane.
1. Of the, New Jersey State Asylum, for the year 1856.
2. Of the Pennsylvania Hospital for the Insane, for 1856.
3. Of the Pennsylvania State Hospital, for 1856.
4. Of the Western Pennsylvania Hospital, for 1856.
5. Of the Mount Hope Institution, for 1856.
6. Of the North Carolina State Asylum, for 1856.
7. Of the South Carolina State Asylum, for 1856.
8. Of the Indiana State Hospital, for 1856.
9. Of the Illinois State Hospital, for 1856. 10. Of the Missouri State Asylum, for 1856.
11. Of the California State Asylum, for 1855. 180
XY. On Dysentery and its Treatment. By Henry Tiedemann, M. D., Mem- ber of the College of Phvsicians, and of the Academy of Natural Sciences at Philadelphia. 12mor pp. 29. Philadelphia, 1857. - - - - 192
XVI. Clinical Lectures on Certain Diseases of the Urinary Organs, and on Dropsies. By Robert Bentley Todd, M. D., F. R. S., Physician to King's College Hospital. 8vo. pp. 283. Philadelphia: Blanchard & Lea, 1857. 197
XVII. On the Diseases of Women, including those of Pregnancy and Child- bed. By Fleetwood Churchill, M. D., T. C. D., M. R. I. A., etc. etc. A new American edition, revised by the Author. With notes and addi- tions by D. Francis Condie, M. D., etc. etc. 8vo. pp. 768. Philadel-
phia: Blanchard & Lea, 1857. 198
XVIII. Manual of Physiology. By William Senhouse Kirkes, M. D., etc. etc. A new and revised American, from the last London edition. With two hundred illustrations. 12mo. pp. 584. Philadelphia: Blanchard
& Lea, 1857. - 201
XIX. A Manual of the Detection of Poisons by Medico-Chemical Analysis. By Dr. Fr. Jul. Otto, Professor of Chemistry in Caroline College, Bruns- wick. Translated from the German by Wm. Elderhorsz, M. D., Profes- sor of Chemistry in the Rensselaer Polytechnic Institute, Troy, N. Y. 12mo. pp. 178. New York, 1857. 201
CONTENTS.
QUARTERLY SUMMARY
OF THE
IMPROVEMENTS AND DISCOVERIES IN THE MEDICAL SCIENCES.
FOREIGN INTELLIGENCE. Anatomy and Physiology.
page
1. On the Physiological Mechanism of the Formation of Sugar in the Liver. By CI. Bernard. - - 203
2. Researches relative to the Influ- ence of Alkalies and Alkaline Carbonates in Destroying Glu- cose. By M. Jeannel. - - 205
3. On a but little known Function of the Pancreas, the Digestion of Azotized Food. By M. L. Corvisart. 206
4. Digestion and Absorption of Fatty Substances without the Concurrence of the Pancreatic Juice. By M. Colin. - - 206
page
5. Alcoholic Fermentation. By
M. Berthelot. - - - - 207
6. On the Mode of Action of the Gastric Juice. By Dr. Blondlot. 207
7. Quantity of Air inspired at every 5, 15, and 30 minutes of the Day and Night, and under the Influence of Exercise, Food,, and Medicines — on the Tempe- rature of the Body, &c. By Ed- ward Smith. - - - - 208
8. Complete Obliteration of the Thoracic Aorta. By Mr. Sid- ney Jones. .... 211
Materia Medica and Pharmacy.
9. Experiments on the Action of Pepsin. By Edward H. Sieve- king. - - - - ^ - 212
10. Chemical and Physiological Properties of Pepsin. By M. Boudault. 214
11. Therapeutic Employment of the Pvrophosphate of Iron. By
M. E.'Robiquet. - - - 215
12. Therapeutic Properties of Io- dide of Potassium. By MM. Demarquay and Gustin. - - 217
13. Employment of Amylene for Children. By M. Giraldes. - 217
14. External Use of Clay. By Dr. Betz. ..... 217
Medical Pathology and Therai
15. On the Diseases of the Army of the East during the winter of 1854-5. By Dr. Tholozan. - 217
16. On the Identity of the Specific Causes of Typhus and Typhoid Fever. By Dr. Gibbon. - - 220
17. Analysis of Fifty-two Cases of Epilepsy. By Dr. Sieveking. - 222
18. On the Curable Stage of Phthi- sis. By Dr. Edward Smith. - 224
19. Diagnosis of Apneumatosis (Pulmonary Collapse). By Dr. Graily Hewitt. - 226
eutics, and Practical Medicine.
20. Rupture of the Heart. By Dr. O'Ferrall. - - - < - - 227
21. Diabetes and Saccharine Con- ditions of the Urine. By Dr. A.
B. Garrod. - - - - 229
22. On the Prevention of Consti- pation. By Prof. Phoebus. - 230
23. Lactic Acid a Remedy for Dys- pepsia. By Dr. Nelson. - - 231
24. Creasote in Erysipelas. By
Dr. Delarue. - - - - 232
25. Iodide of Ammonium. By Dr.
B. W. Richardson. - - - 232
10
CONTENTS.
PAGE
26. Liquor Sodae Chlorinatse as a Local Application in Smallpox.
By Mr. John Gabb. - - -232
27. Fumigations of Essence of Turpentine in Itch. By Dr. A. Anselmier. - 232
28. Progressive Fatty Degenera-
tion and Atrophy of the Volun- tary Muscles. By Mr. Leggatt. 232
29. On the Pathology of the Arti- cular Cartilages. By Thomas Bryant, Esq. .... 234
30. Unusual and Obstinate Form of Swelling. By Mr. J. L. Mil- ton. 235
Surgical Pathology and Therapeutics, and Operative Surgery.
31. Concussion of the Spinal Cord.
By Dr. J. S. Hughes. _ - - 237
32. The Constitutional Origin and Treatment of Cancer. By Mr. Weeden Cooke. - _ - - 240
33. Necrosis of Cancer and its Con- sequent Enucleation. By M. Moullin. - - . - - 241
34. Subclavian Aneurism Cured by Displacing a Portion of its Fibrinous Contents. By Mr. Robert Little. - - - - 244
35. Ligature of Arteries in Suppu- rating Wounds. ByM.Nelaton. 246
36. Forcible Extension and Rup- ture of the Uniting Medium of Partially Anchylosed Surfaces.
By Mr. Brodhurst. - - - 246
37. Excision of the Head of the Femur and Floor of the Aceta- bulum for Caries combined with Febrile Abscess. By Mr. Henry Hancock. 248
38. Treatment of Certain Diseases of the Knee-joint by the Ope- ration of Resection. By Mr. Price. 249
39. Bony Union after Fracture of the Cervix Femoris within the Capsule. By T. Bryant, Esq. - 252
40. Ununited Fracture Remedied by Operation. By James Syme, Esq. - 252
41. Case of Mvopathic Luxation.
By Dr. Friedberg. - - - 253
42. Inflammation and Rupture of the Rectus Abdominis. By Vir- chow. 255
43. New Method of Operating for Impermeable Urethra. By Mr. Syme. 255
44. Excision of an Enlarged Third Lobe of the Prostate in a Litho- tomy Operation. - 257
45. Vesico- Vaginal Fistula. By
Dr. Jas. H. Sawyer. - - - 258
46. Valvular Nature of Strangu- lated Hernia. By Prof. Roser. 260
47. Herniotomy in an Infant seven weeks old. By Mr. Win. Ray-
48. Ovarian Dropsy treated by Io- dine Injection. By Dr. J. B. Brown. 261
Ophthalmology.
49. On the Employment of the Ophthalmoscope in the Investi- gation of Deep-seated Disease of the Eye. By Holmes Coote. - 261
50. Sympathetic Inflammation of the Globe. By Dr. R. Bell. - 263
51. Loss of Vision following the Blow of a Whip; Recovery. - 265
52. The Relation of Cataract to Heart Disease. By Mr. T. F. Jordan. 266
53. Ought both Eyes, when Cata- ractous and equally affected, to be Operated on at the same time? By Dr. John Sloan. -267
Midwifery.
54. Puerperal Fever. By Prof. Murphy. - - - - " - 269
55. Saccharine Urine in Nursing Women. - - - * ,.- - 271
56. Iodine in Vomiting in Preg- nancy. By Dr. J. B. Schmitt. 272
57. Sterility. By Dr. Carl Mayer. 272
58. Involuntary Production of the Lacteal Secretion by Electricity.
By Dr. A. Auber. - - - 273
59. Pregnancy in a Two-homed Uterus. By Dr. Lumpe. - - 273
CONTENTS.
11
Medical Jurisprudence and Toxicology.
page
60. Death from the Inhalation of Chloroform. By Jos. Allen, Jr., Esq. 273
61. Death from Amylene. By Dr. John Snow. .... 375
62. Poisoning from the Applica- tion of the Belladonna Plaster to the Skin. By Dr. Wm. Jen- ner. - - - - - - 278
PAGE
63. A New Poison. By M. De Luca. 279
64. Alleged Mental Unsoundness associated with Old Age. - 280
65. Transformation of Amygdaline into Hydrocyanic Acid within the Body. By Prof. Kolliker and Dr. Miiller. - - - 282
Miscellaneous.
66. Ophthalmological Congress. --------- 282
AMERICAN INTELLIGENCE. Original Communications.
Note of the Delivery of a Female, one of whose Lower Limbs had been Disarticulated at the Hip- Joint, by Dr. Duffie, seventeen years since, for Morbus Coxa- rius. By John H.Packard, M.D. 283
Case of Fracture of the Pelvis dur- ing Pregnancy. By J. Whita- ker, M.D. 283
Ovariotomy Successful. By E. P. Bennett, M. D. - - - - 284
Death following the Inhalation of
a Mixture of Ether and Chloro-. form. By R. Crockett, M. D. - 284
Mental Influence of Mother on Foetus in Utero exerted through two successive Pregnancies. By S. L. Kerr, M. D. - - - 285
Case of Arrest of Development. By S. L. Kerr, M. D. - - 286
Case of Fibrinous Plugs in the Ab- dominal Aorta, Right Iliac, and Right Subclavian Arteries. By G. A. Wilbur, M.D. - 286
Domestic Summary.
Excision of the Tonsils. By Dr. J. Mason Warren. - - - 287
Complete Dislocation of the Cervi- cal Vertebras. By Dr. Daniel Ayres. 289
Femoral Aneurism Cured by Ve- ratrum Viride, Manipulation and Compression. By Dr. Geo. C, Blackman. - - - - 290
Paracentesis Thoracis. By Dr. Henry J. Bowditch. - - -291
Chalk and Vinegar in Intermittent Fever. By Dr. Hodsden. - - 292
Gunshot Wound of the Heart and Stomach. By Dr. J. H. Grant. 292
Dislocation of the Femur reduced by Reid's Method. By Dr. T. G. McElbright. - - - 292
Wutzer's Operation for the Radical Reduction of Hernia. By Prof. Geo. A. Blackman. - - - 292
Spina Bifida, with Malformation of the Genitals. By Dr. S. Knee- land, Jr. - - - - - 292
Treatment of Erysipelas with To- bacco. By J. G. Stephenson. - 292
. . .#
t
THE
AMERICAN JOURNAL OF THE MEDICAL SCIENCES
FOR JULY 1 8 5 7.
Art. I. — Phenomena of the Capillary Circulation. By Austin Flint, Jr., M. D.1
The statements which I shall make from my own observation concerning the capillary circulation, are based upon examinations made from time to time during the past summer, nine of which have been carefully recorded. The recorded observations were made on the web of the frog, although I have made examinations of the various other parts where the circulation can be conveniently exhibited, to which I shall refer.
The microscope used was the large instrument of Nachet, and, unless other- wise stated, with a magnifying power of 165 diameters.
I shall first point out what I have found to be the most convenient methods of conducting examinations of the circulation in the frog, and then proceed to describe the various phenomena of the circulation as viewed by means of the microscope, and then draw my deductions from these observations.
The parts of the frog which I have subjected to examination, are the web of the foot, the tongue, the peritoneum, and the lungs. All parts but the peritoneum require to be examined by transmitted light, but, in examining the circulation in the latter situation, we are compelled to use reflected light.
It is exceedingly inconvenient to make observations while the frog has the power of motion, and in securing it to the frog-plate in a proper position, we are apt to interrupt or modify the circulation by constricting the vessels with the bands which we must use. Under these circumstances, we are not able to apply medicated solutions conveniently to the entire surface, and mechanical or chemical irritation of any part occasions struggles which greatly increase
1 An Inaugural Dissertation laid before the faculty of Jefferson Medical College in February, 1857.
No. XLYII. — July 1857. 2
14
Flint, Phenomena of the Capillary Circulation.
the difficulty of the experiment. By breaking up the medulla oblongata, or even the posterior part of the brain (for it is not easy to invariably reach the medulla without some practice), we are enabled to observe all the phenomena of the circulation with great facility, avoiding the necessity of forcibly retain- ing the frog in the desired position, with the consequent liability to constric- tion of the vessels and shifting of the field of observation. I shall hereafter refer to experiments of E. Brown Sequard, M. D., of Paris, and two of my recorded examinations, which show that observations of the circulation may be made with as much accuracy on a frog after the medulla has been destroyed, as though it had not been subjected to the operation. The operation may be performed by introducing a dissecting needle into the cranium, a line or two behind the eyes, passing it backwards and a little downwards to the articula- tion of the spine with the skull, and then thoroughly breaking up the medulla. The web of the foot maybe examined in the following manner: "We first break up the medulla oblongata in the manner just described, the frog will then remain perfectly motionless in any position. The web may be stretched over the opening in the frog-plate, and secured in position by means of pins ; care being taken not to extend the web too forcibly, and to put no pins above the foot, but nearly at the extremities of the toes, as in either case the circu- lation may be disturbed. The part should then be moistened, and the lenses of the microscope protected from the evaporation by a glass cover, broken to fit between the toes.
The entire surface of the frog should be moistened from time to time with cool water.
The magnifying power best adapted to such observations, is one of from 150 to 200 diameters.
In examining the tongue, we draw it out of the mouth, and stretch it so as to form a thin transparent film, by means of the forceps and pins. The cir- culation may be exhibited in the peritoneum by merely exposing that mem- brane and examining it, with a power of 60 or 70 diameters, by reflected light. The process of exhibiting the circulation in the lungs of the frog is much more complicated and difficult than either of the preceding experiments, but when successfully performed, it is one of the most beautiful and curious demonstrations in the whole range of microscopic science.
Dr. Kobert Willis, in his edition of Wagner's Physiology, refers to the appearances of the pulmonary circulation in the water newt. He directs that the newt be strangled after an inspiration. " The abdomen is then to be laid open, arjd the entire animal, being held in the hands, is placed upon a glass plate a porte-objet, and one of the lungs brought into the field of view." He observes, however, that the circulation lasts but a short time. The frog appears to me to be a much better subject for this experiment, and as I have never seen the process of showing the pulmonary circulation in this animal detailed in the books, I shall describe it with some minuteness as practised by Prof. John C. Dalton, of New York, and as repeated frequently by myself.
1857.] Flint, Phenomena of the Capillary Circulation. 15
In undertaking it, a large sized frog should be selected. After Laving broken up the medulla oblongata, a ligature is to be placed around the larynx in the following manner: The mouth being widely opened, the larynx is seen just in front of the oesophagus. A ligature is now carried just under the mucous membrane by means of a small curved needle. This is effected by making four or five stitches, the needle being introduced at the point where it came out at each preceding stitch, so that the ligature shall smoothly encircle the larynx, and its extremities emerge at the same point. This being done, a small blowpipe is introduced into the windpipe, and the ligature held in readiness to be drawn tight by an assistant when required. The lungs must now be moderately distended and the ligature tightened, at the same time removing the blowpipe. If the side be now carefully opened the lung will protrude, and may be examined by transmitted light.
It is very much more difficult to exhibit the circulation in the lungs than in any other part. The chief difficulties to be encountered are the following : First, it is no easy matter to fix the ligature properly around the larynx; but when we have done this, if we distend the lungs too forcibly, they will either burst or the circulation will be greatly impeded ; and if we do not distend them sufficiently, they will not protrude when the side is opened. There is also always some difficulty in introducing the blowpipe, and its delicate orifice is often occluded by the secretion of the part. When we succeed, however, in exhibiting the circulation in the lungs, the capillaries are seen encircling the air-cells, which are quite large in the frog. This is an extremely beautiful and interesting sight— but more as a scientific curiosity than as a field for useful investigation. It was observed by Dr. Willis, and confirmed by Wag- ner and Glluge, that the transparent plasma which we find occupying the space next to the walls of the capillaries, in most situations, while the blood-disks occupy the centre, constituting the still layer of Kirkes, is not observed in the capillaries of the lungs ; in other words, the vessels are crowded to their very walls with corpuscles.
For this remarkable deviation from a general law they offer no explanation.
I have never observed this peculiarity, as my attention was not directed to it when examining the pulmonary circulation. Those who believe the heart is solely instrumental in propelling the blood through the capillaries would not be able to account for this phenomenon; but it seems to me it can be explained in the following manner: The blood circulating in the systemic capillaries nourishes the tissues by the liquor sanguinis, and thus the attract- ive vital force operates on this constituent. The plasma then is nearest the tissues and next the walls of the vessels ; but the pulmonary capillaries are for the aeration of the blood, a process which is effected by the globules and not by the plasma — since the great mass of blood is not sent to the lungs for purposes of nutrition, but for aeration ; hence, the globules, which here feel the force of attraction for oxygen, occupy tho space next the walls of the ves- sels.
16 Flint, Phenomena of the Capillary Circulation. [July
Taking the view which I do of the causes of the capillary circulation, this explanation is satisfactory.
Before proceeding to describe minutely the phenomena of the capillary cir- culation, we will briefly consider the anatomical structure of the capillaries and of the blood.
M. Robin recognizes three varieties of capillaries. The first variety is from *° 8 3 0 °f an mcn m diameter, and is composed of a transparent homogeneous membrane, 2 5V 0 °f an mcn m thickness, with nuclei, and some- times nucleoli, projecting into the calibre of the vessel. The nuclei are oval, with their longest diameter in the direction of the vessel. These are embraced under the head of the " true capillaries" of Prof. Kolliker.
The second variety, M. Robin describes as having two coats : the membrane with the longitudinal nuclei of the first variety, and, investing it, a second membrane with transverse nuclei. The diameter of the second variety varies from to 3-^5 of an inch. This variety also probably comes under the head of the "true capillaries" as described by Kolliker, though he does not mention the second investing membrane.
The third variety, M. Robin calls venules and arterioles, Kolliker, venous and arterial transitionary vessels. Their diameter is from ^\ to of an inch, and they have added to the two coats of the second variety a third coat of areolar tissue. It seems to me most convenient and proper to consider the first two varieties of M. Robin, or the " true capillaries" of Prof. Kolliker, simply as capillaries (their tunic being a prolongation of the inner coat of the arteries), and the third variety of M. Robin as venules and arterioles. We may easily distinguish the arterioles from the venules, by noticing that the arterioles give off branches, while the venules receive them; that the arterioles diminish in size as we follow them in the direction of the current of blood, while the venules increase in size.
The blood consists of a transparent plasma holding two kinds of corpuscles in suspension, called the red and the white, or colorless. In the human sub- ject the red corpuscles are disks like pieces of coin, but thinner in the centre than at the edges. They have no nuclei, though the difference in thickness causes the centre to appear dark when the edges are in focus. They are 3 of an inch in diameter. The white corpuscles are larger than the red, being of an inch in diameter; they are globular, white, and granular. If water be applied to them they are rendered transparent, and we can distinguish a nucleus. They are much less numerous than the red corpuscles. In the frog, the red corpuscles are oval and large, with a central rounded nucleus. They are q of an inch in their long diameter. The white globules are smaller and proportionally more numerous than in man. The blood-disks in nearly all animals are red by reflected light, but of a pale amber colour by transmitted light.
Having given an abstract of the anatomy of the capillaries and of the blood, we are prepared to consider the phenomena of the circulation in these vessels.
1857.]
Flint, Phenomena of the Capillary Circulation.
17
In a paper communicated to the Medical Examiner, August, 1852, by E. Brown Sequard, M. D., of Paris, entitled " Experimental Kesearches applied to Physiology and Pathology," I find some very interesting observations on the effect, or more properly the absence of effect, on the capillary circulation, of the section of various nerves. This observer, with the assistance of Dr. Siebert, found, " after the section of all the nerves (the sympathetic and cerebro-spinal) in the legs of a number of frogs, that there was no appearance of trouble in the capillary circulation, either in one hour or three or four days after the division of the nerves." He concludes, from another experiment, that the nervous action (that of the sympathetic as well as the cerebro-spinal nerves) is not necessary for the change of colour of the blood in the capillaries. It is proved, by this experiment, that the capillary circulation is not immedi- ately dependent, in any measure, on nervous influence.
A curious fact has been observed by Bernard, viz : that, after a section of the sympathetic in the neck, the corresponding side of the face, and more par- ticularly the ear, becomes warmer and more sensitive than the other side. The bloodvessels appear more numerous than before, and are enlarged. Brown Sequard has repeated this experiment, and concludes that the increase of tem- perature and sensibility is due merely to passive dilatation of the vessels from paralysis of their coats and consequent congestion. I have myself seen the experiment performed by Prof. Dalton, of New York, and concur with him in the opinion that the increase in temperature and sensibility is rather due to an exaggeration of the nutrition of the parts : for specimens of blood drawn from the two ears have been compared, and there has been found a marked difference in their actual chemical composition.
These considerations are interesting in connection with animal heat, as pro- duced by the molecular changes in the various tissues, and appear, also, to bear in some measure on the subject of the capillary circulation.
I shall hereafter take the ground that the capillary circulation is, in a great measure, dependent upon an attraction of a chemico-vital character between the tissues and the nutrient fluid.
Now, if the nutrition of the part be augmented, the congestion is due to the greater attraction of the tissues for the blood, the capillaries being first affected by its influence. The nutrition is affected, because the blood actually undergoes greater change than on the other side. The capillary circulation, then, in this case, seems clearly to be in a measure dependent on the process of molecular regeneration and disintegration. There is no new action induced in the part, but simply an augmentation of the usual processes ; and if this be so, a cause of the capillary circulation is the chemico-vital attraction of the tissues for the blood. The fact that there can be a greater supply of blood, circulating with greater force, on one side of the body than in the correspond- ing part on the other side, seems to me an insuperable objection to the idea that the heart alone circulates the blood in the capillaries ; but I have antici- pated, in some degree, the points which I shall hereafter consider more fully.
18 Flint, Phenomena of the Capillary Circulation. [July
When I commenced to describe the manner of making observations on the capillary circulation in various parts, I asserted that destruction of the medulla oblongata had no appreciable effect on the capillaries. Brown Sequard has demonstrated, by experiment, that frogs are able to live perfectly well for three or four months after extirpation of the medulla, and that all the functions, except pulmonary respiration, continue to go on apparently as usual.
Before I met with these observations, I made two experiments with refer- ence to the reliability of observations made on a frog after breaking up the medulla or the posterior part of the brain.
In my first experiment, the posterior part of the brain was broken up in an unsuccessful attempt to reach the medulla.
The circulation was observed for seven hours, and was but slightly retarded when the experiment was concluded. For the first two hours, the circulation appeared as usual. I have made numerous unrecorded observations on this point, and have always arrived at the same result, i. e., I have introduced a dissecting needle at the back of the head, sometimes reaching the medulla and sometimes not, but always rendering the frog perfectly quiet and manage- able; and I have been unable to discover any effects upon the circulation, or the phenomena produced by irritants.
After making this experiment, I made several dissections so as to be able to reach the medulla oblongata with certainty, and succeeded, in doing so, in making the following observations : —
I examined the circulation for five hours with the same results as in the preceding experiment, i. e., there was no alteration from the appearances of the circulation in the uninjured frog, at least for the first two or three hours.
From these observations, added to my unrecorded experiments, I have no hesitation in asserting that observations on frogs after breaking up the medulla oblongata or the posterior part of the brain, are equally valuable with those made on uninjured frogs; therefore, all the subsequent observations were made after breaking up the medulla, unless otherwise stated.
Dr. Wilson Philip made an experiment which is interesting, though not throwing any light upon the causes of the capillary circulation. " While Dr. Hastings was observing the circulation, he crushed the brain by the blow of a hammer. The vessels of the web instantly lost their power, the circulation ceasing ; an effect which we have seen cannot arise from the ceasing of the action of the heart. (Dr. Philip here refers to experiments by which it is ascertained that the blood will circulate for several minutes after the interrup- tion of the heart-action.) In a short time the blood began to move, but with less force." I will here add the notes of a similar experiment performed by myself. The brain of the frog was crushed while Prof. Flint was examining the circulation, which was brisk and regular; the motion instantly ceased, but commenced again in a few seconds, though it proceeded more slowly.
This observation thus in every respect confirms that of Dr. Philip.
This, as I have before remarked, cannot be thought to show that the capil«
1857.] Flint, Phenomena of the Capillary Circulation.
19
lary circulation is dependent upon nervous influence, but merely that a violent shock is able to arrest momentarily all the vital functions. In several of my observations, I have minutely recorded the appearances of the capillary circu- lation, and have noticed the following phenomena : —
Observation 4th. I examined the web of a young frog.
From a careful and prolonged examination, it is evident that there is a dif- ference between the modes of circulation in the arterioles and the venules. The blood moves more freely in the former, and the motion appears to be dependent on an attractive force — this is not as evident, however, here as in the capillaries ; there the blood shoots off to different parts of the tissues in a manner which cannot be dependent upon a " vis a tergo." It also moves much more rapidly in some of the capillaries than in others, the velocity vary- ing in the same vessel at different times. In the venules, the movement is more sluggish, the globules apparently crowding each other along, and, on care- ful examination, making a decided contrast to the movement in the arterioles. The number of colourless globules is greater in the venules ; they adhere to the walls of the vessels, and appear to be pushed along by the central mass, moving very much more slowly, and occasionally remaining stationary for a time.
Obs. 6th. In this observation, the same points attracted attention as in the preceding one, and, in addition, the following phenomena : —
A small transverse capillary, admitting but a single globule at a time, was abruptly bent at a certain point. The globules passed along in single file, irregularly isolated from each other, and were bent nearly double in passing the sudden turn in the vessel. This caused the globules to present a singular appearance at this point; they seemed to move by volition, like animate beings. The motion of the globules, under the above circumstances, is supposed to denote an attractive force.
In several instances the walls of the vessels were distinctly seen ; they were perfectly motionless, evidently taking no active part in the circulation. The darting of single globules through small vessels, at a velocity greater than the velocity of the circulation in the vessel from which they branch, was repeat- edly remarked.
Obs. 7. The points noticed in Observation 4th were here confirmed. I was forcibly struck with the great difference in the velocity of the circulation in different parts of the field, both in vessels of the same size and of unequal sizes. I also remarked a difference of velocity in the same vessels, especially capillaries, at different times.
An attractive force is evident j a certain condition of the disks is necessary in order that the force should operate. This condition, we may presume, is effected by respiration.
The appearances of the capillary circulation in the web of the foot may be described in the following manner : —
When the web is subjected to examination after the plan already stated,
20 Flint, Phenomena of the Capillar}/ Circulation. [July
we have vessels of various sizes in the field, consisting of arterioles and venules which vary most in their diameters, and the true capillaries which are all of nearly equal diameters. The blood is seen coursing along the vessels with great rapidity, especially in the arterioles, where we may observe a slight pulsatory movement.
In the arterioles, blood moves with unvarying rapidity as a general rule ; and here especially we notice a space next the walls of the vessels, which is not occupied by the red globules, but along which the colourless globules move at a diminished rate, appearing to have a tendency to adhere to the walls of the vessels, and sometimes even remaining entirely stationary for a time, to be pushed along again by the central mass. This constitutes the still layer of Dr. Kirkes.
The white or colourless corpuscles are much fewer than the red, and they move at least ten or twelve times more slowly than the central mass. On careful examination, I have been able to remark a decided difference be- tween the circulation in the arterioles and the venules. In the latter the movement is not so rapid, the globules appearing to be impelled more by a "vis d tergo" and to feel less the "vis a fronte" which seems to operate in the arterioles. The comparative number of the white corpuscles is greater, but the " still layer" appears to occupy a smaller proportion of the calibre of the vessel.
In the true capillaries, the movements are less regular, and apparently dependent in a great measure on a force which acts directly upon them ; the "capillary power," as it is designated by Dr. Carpenter. This will be more fully touched upon presently, when we consider the causes of the capillary circulation.
In the true capillaries, the blood moves in every possible direction, at dif- ferent rates of speed in different vessels, also at different times in the same vessel. In one instance, I remarked a capillary branching from a vessel at an obtuse angle (that is, turning almost directly opposite to the current in the main vessel), and individual globules shooting through it with great rapidity. In many instances, I have observed an entire stasis in one or two of the capil- lary vessels, but it existed only for a moment, and then recommenced with its original vigour. Dr. Carpenter has remarked a stasis followed by a current in a direction opposite to the original one.
It frequently happens that a globule is caught at the point of junction of two vessels, and remains stationary until it is carried along by the current of blood. G-lobules are frequently bent upon themselves as they pass from one vessel to another, but as soon as the cause is removed, they regain their ori- ginal conformation.
The walls of the vessel are motionless, and do not take an active part in the normal circulation, as was supposed by some of the older writers.
Pigment-cells are observed scattered over the field, and when they are very
1857.] Flint, Phenomena of tlie Capillar?/ Circulation.
21
numerous, obscuring the view of the circulation ) therefore, it is best to select a light coloured frog for demonstrations.
The pavement variety of epithelium may also be seen.
This is a description of the capillary circulation as it appeared to me under the most favourable circumstances : more minute, but not otherwise differing from the ordinary description in works on Physiology.
We now come naturally to a consideration of the causes of the capillary circulation. I say causes, because I shall take the ground that it is not pro- duced by a single cause, namely, the heart's contraction, as was supposed by the great discoverer of the circulation. While it may be that the action of the heart is sufficient to propel the blood through the whole round of the cir- culation, as is contended by Magendie, by Dr. Allen Thompson, in the Cyclo- pedia of Anatomy and Physiology Dr. Kirkes, and others, I believe that there are other causes which operate, and are able to carry on the circulation unas- sisted, as was the case in the acardiac foetus of Dr. Houston, reported in the Dublin Medical Journal, 1837, where, of course, the circulation was stopped at the birth of the child by the want of due aeration of the blood.
Harvey, followed by Magendie, Kirkes, and other eminent physiologists, supposed that the heart was alone concerned in the production of the circula- tion, and some very striking arguments were made use of to prove it, It is found that, under the most favourable circumstances, a very inconsiderable force is required to propel a bland fluid from the arteries through the capillaries and out again by the veins. The pulsative movements, which we observe under some circumstances in the capillaries, is also brought forward as an argument. Dr. Kirkes dismisses the subject with the remark that "there is no need of an hypothesis of any action of the capillaries for regular propul- sion of the blood through them, nor is it probable they have such an office. " This appears to me a most unphilosophical mode of treating a very important subject. The circulation of the blood is a process immediately necessary to existence, and even should we agree with him that the action of the heart is capable of carrying on the circulation, it would not be out of place to inquire if there were not some other force which also operates to this end, and could take on, in some degree, the function of circulating the blood, should the heart become weakened from any cause. We know that, in the performance of that essentially vital function, namely, respiration, we commonly use but about one- third of the entire capacity of the lungs, and though the lungs seem to be only aerating organs, they divide that function with the skin. We might as well say that, as the diaphragm is sufficient to carry on respiration, there is no need of supposing that there are any other respiratory muscles. It is the duty of the physiologist to endeavour to ascertain all the causes of any of the vital phenomena.
There are several phenomena which are difficult of explanation by the theory of the sole action of the heart in producing the circulation. In the first place, it is difficult to understand how the heart could impel the blood through the
22 Flint, Phenomena of the Capillary Circulation. [July
second set of the capillaries in the portal system. Then the experiments of Dr. Dowler show that the blood probably circulates in the capillaries, in patients dead from yellow fever, after the heart's action has ceased.
In the frog, Dr. Carpenter asserts, and I have myself seen, that the blood will circulate in the capillaries after complete excision of the heart. Carpenter also mentions instances where the heart has suffered such a degree of fatty degeneration, or replacement, that there existed scarcely a trace of muscular fibre, and the circulation must have been chiefly dependent on the " capillary power." Hassal records a most remarkable phenomenon, namely, the con- tinuance of circulation in a portion of the tongue which had been entirely detached from the organ. He states that, while examining the tongue of a frog, a small portion was torn off, which he placed between two plates of glass, and was astonished to see the circulation continuing in many of the smaller vessels with unabated vigour. This phenomenon he observed for several hours, in connection with several medical gentlemen, and, on examining it the next day, preserving it under water in the mean time, the circulation still continued to some extent. This seems almost incredible, but coming from such authority, the fact cannot be doubted. Hassal appears to have made no subsequent experiments with reference to this point. After seeing this statement, I made two or three experiments, and once saw a slight movement in a portion of the tongue entirely detached ; these experiments were not made, however, under favourable circumstances, the weather being cold, and the frog in a state of torpor, until partially aroused by immersion in tepid water.
A case is mentioned by Dr. Carpenter of an acardiac foetus which was sub- jected to examination by Dr. Houston, where the organs were tolerably well developed, with the exception of the heart, and the circulation could only be effected by the "capillary power." These cases which I have described, are amply sufficient to disprove the theory that the heart is the sole agent of the circulation. In addition to them, the phenomena of inflammation as seen under the microscope, the normal appearances of the capillary circulation, which appear to the eye to be in some measure dependent on an attraction of the molecules of the tissues for the blood ; the experiment of the section of the sympathetic in the neck of the rabbit, which I have previously noticed, and which produced an augmentation of this attractive force in the correspond- ing ear and side of the face, and comparison with the circulation in some aquatic plants, which we know is not dependent upon the action of a heart, all these go to prove that the heart alone does not produce circulation.
Prof. Draper, of the University of New York, has put forward a theory in regard to the circulation, which makes the heart of minor importance. His is the theory of capillary attraction and affinity. He starts from the proposi- tion that, "if two liquids communicate with each other through a capillary tube, for the substance of which they have affinities of different intensities, movement will ensue \ the liquid having the highest affinity will occupy the tube, and may even drive the other from it ; the same effect will ensue in a
1857.] Flint, Phenomena of the Capillary Circulation.
23
porous object." He believes that this is the great cause of the circulation, namely, an affinity between the blood and the tissues ; that thus the blood is forced into the veins, and that the action of the heart is limited to filling the arteries and presenting a supply of blood to the capillaries. The blood circu- lates in the lungs chiefly from its affinity for oxygen.
This theory cannot be sustained. The heart undoubtedly has a much more important office in the production of circulation. When we cut a small artery, we see the blood forcing itself in a jet to a distance of several feet; and this happens after it had entirely lost the influence of the capillary force. The illustration of Prof. Dunglison, namely, the law that fluids confined in tubes will rise to the same level, and that thus the blood in the veins, by a simple hydrostatic principle, would rise as high as the right auricle in a line with the blood in the left ventricle, shows how slight a force from the heart would be propagated through the capillaries to the veins, and be sufficient to return the blood.
Dr. Dowler, -of New Orleans, believes in a distinct capillary action. In some of the experiments which he adduces in support of his position, and which are noticed by Dr. Dunglison in his Human Physiology, bodies of yel- low fever patients were carried to the dissecting room a few moments after death. " The external veins sometimes became distended, and when punc- tured, the blood flowed in a good stream ; the operation of bleeding at the arm was imitated, and as the muscles were moved, the blood shot forth for some distance." Other experiments on the veins, of a similar character, are recorded by him.
These observations seem to show that there is some action in the capillaries after death, and inferentially during life, which is independent of the heart's action. The entire emptying of the arteries after death cannot be perfectly explained by the mere contraction of the vessels.
What causes seem to operate to produce the capillary circulation, judging merely from the appearances under the microscope? In the observations which I have recorded on this point, we have noted an irregularity of the movement in the capillaries, both in different vessels at the same time, and in the same vessel at different times; the irregularity sometimes amounting to entire cessation of the circulation in a single vessel, and then a current in an opposite direction ; a shooting off of single globules through vessels which were before empty, the darting off of globules through capillary branches with a velocity greater than that of the blood in the main vessel; and in short, all the phenomena which are presented to the eye, seem to indicate that there is an attractive force, resident in the solid particles, which operates on the blood in the capillaries.
We are not supposing the existence of a force with the operation of which we are unacquainted. The present school of physiology teaches us that the processes of nutrition, of molecular disintegration, and of secretion, are depend- ent on a vital force resident in the solid particles of the organism, which are
24
Flint, Phenomena of the Capillary Circulation. [July
essentially vitalized. Inflammation is now supposed to be due to a perversion of this force.
In what other way could we explain the fact that every tissue takes from the mass of arterial blood the substances which are required for its nutrition. The blood sent to the systemic capillaries by the heart is the same in all parts of the body, but when the great change which is effected in the capillaries has taken place, we find that the blood which has thus been rendered venous is not the same in all the veins; for example, the blood in the renal vein is almost as florid as arterial blood.
The existence of a distinct capillary action is now believed by the highest authorities. Lehmann believes that a chemico-vital attraction of the blood for the tissues, together with the physical capillary attraction, produces the movement of the blood in the capillaries, and forces it into the veins. Dr. Carpenter believes that there exists a "capillary power" which is superadded to the force of the heart. Prof. Dunglison teaches that there is an independ- ent power resident in the tissues about the capillaries, and that, "by the united action of the heart, arteries and capillaries, or intermediate system of vessels, the blood attains the veins." Even those who recognize the heart as the only efficient organ of circulation yield that the capillaries possess a "distributive force;" that is, though the circulation is effected by the heart's unassisted action, that the tissues have an attraction or affinity for the blood, which distributes it for their nutrition to each and every part of the body.
Taking into consideration everything which I have seen bearing on this point, it seems to me to be clearly proved that the normal capillary circulation is dependent, in the first place, on the action of the heart. It cannot be denied that the heart has a considerable share of the duty of capillary circula- tion. Taking into account the conditions of the blood and vessels, apparently a slight force is capable of propelling the blood through the capillary system. When a small artery is divided, the force with which the blood pumps out is considerable, and appears sufficient to exert a decided effect on the motion of the blood in the capillaries. It is impossible to estimate with much accuracy the proportional influence which the heart has in producing capillary circula- tion. The vital affinity between the tissues and the blood, which I suppose to be the other power concerned in this function, never ceases ; still, as the action of the heart is frequently much interfered with, as in cases of exces- sive fatty degeneration, and as the heart has been removed from the frog, the capillary circulation nevertheless continuing, we cannot think that its power is greater than the attractive force, or Carpenter's "capillary power," which I hold to be essentially concerned in the performance of this function. The value of the heart's action is also variable, both in different individuals, and in the same individual ac different times.
The only other force which has any share in the production of the capillary circulation, unless it be a slight suction force from the veins, is the "capillary power." This seems to me to play the more constant and effective part.
1857.] Flint, Phenomena of tlie Capillary Circulation. 25
When this ceases to act the animal dies, and the blood refuses to circulate in spite of the heart. This is the great vital force of nutrition which is con- stantly operating, and which is so wonderful and inexplicable. We know the fact that there is such a force, and that it continually acts, but what it consists of, or what is its essential character, is beyond the wisdom of man to explain. It is life. Lastly, the following inquiry suggests itself : What conditions are necessary to the healthy performance of the capillary circulation ?
First, a healthy condition of the vital particles, which is produced by healthy nutrition. Secondly, a particular condition of the blood, which is produced by respiration.
No arguments appear to be necessary to prove the former statement, but I have made experiments, which I shall proceed to describe, which conclusively establish the second point.
The following experiment, made by Dr. J. Reid, and reported in the Edin- burgh Med. and Surg. Journal, April, 1841, is quoted by Dr. Carpenter: —
Dr. Reid found that when the ingress of air through the trachea of a dog was prevented, and the asphyxia was proceeding to the stage of insensibility, the pressure in the femoral artery, indicated by the hsemadynamometer, was much greater than usual.
Upon applying a similar test to a vein, however, the pressure was propor- tionally diminished, whence it became apparent that there was an unusual obstruction to the passage of the venous blood (the blood being venous in the arteries) in the systemic capillaries.
Before seeing an account of this experiment, I had made the following observations, carefully recording them, with reference to the same point : —
Obs. 1st. The medulla of a middle sized frog was broken up, and the web submitted to microscopic examination. The frog was bathed with sulphuric ether, care being taken not to allow any to touch the web under examination, and the circulation was watched for ten minutes. No effect could be dis- covered. The object of this experiment was to determine whether the phe- nomena in the succeeding experiment were in any degree dependent on the ether which is contained in collodion. The frog was then painted over with an impermeable coating of collodion, care being taken as before not to touch the web. The effect on the circulation was immediate. It instantly became less rapid, until, at the expiration of twenty minutes, it had entirely ceased.
The smaller vessels were the first to become affected, the larger arterioles resisting it longest. One of the first effects was a pulsative movement in ves- sels where the blood had previously flowed in a continuous stream, showing, as it seems, that the attractive force is lost, hut that the heart's action is felt. The fact of the first arrest of the blood in the capillaries, seems to indicate that the blood is now unfit to supply wants of the tissues, and that the attract- ive force ceases to be operative. The arrest of the circulation was steady, and at the expiration of twenty minutes the motion had entirely ceased.
26 Flint, Phenomena of the Capillary Circulation.
The entire coating of collodion was now instantly peeled off, and the effect on the circulation was instantaneous. Quite a rapid circulation immediately commenced, but it soon began to decline, and in twenty minutes had almost ceased. The heart was now exposed, and found contracting regularly. In this experiment, all respiration was abolished, the medulla being broken up, and an impervious coating applied to the entire surface.
Obs. 2d. I painted a frog with a thick coating of collodion, without destroying the medulla. It struggled vigorously at first, but soon became quiet, and the web was put under the microscope.
The circulation was affected in the same manner as in the preceding experi- ment, and entirely ceased in twenty-five minutes.
During the first few minutes, the nostrils dilated and contracted rapidly, but soon became motionless. Care was taken not to obstruct the nostrils with collodion, though it was applied effectually to all other parts excepting the foot under observation.
The experiment of Dr. Reid proves the fact inferentially, namely, that the blood, deprived of oxygen, as in asphyxia, is retarded in the systemic capil- laries ; but the experiments just related, bring the processes directly under the eye, and we can see clearly that when the blood is not aerated it will not circulate, though the heart contracts, and that it is retarded in the capillaries. My second experiment demonstrated the comparatively small part which the lungs of the frog take in respiration; the blood circulating in the frog, in which the pulmonary respiration was not interfered with, only five minutes longer than in the frog after destroying the medulla. Capillary circulation will go on in the lungs of the frog after tying the trachea, as I stated when describing the circulation as seen in various parts of the animal, the blood being sufficiently aerated by means of the skin.
Thus it is experimentally proved that an oxygenated state of the blood is an indispensable condition for its circulation through the capillaries. When the process of respiration or aeration of the blood is established, the blood cannot circulate. This we know to be the fact, but we demonstrate, by the preceding experiments, that, in asphyxia, the impediment to the circulation takes place in the capillaries ; that the condition of oxygenation is necessary to the performance of the vital functions, and it may be that the entire want of the "capillary power" throws all the onus on the heart, and that the heart is insufficient for the labour. In one of my experiments, after the capillary circulation had entirely ceased, the chest was opened, and the heart found beating regularly.
1857.] Schneck, Treatment of Scarlatina by Diluted Acetic Acid. 27
Art. II. — On the Treatment of Scarlatina by the Diluted Acetic Acid. By B. F. Schneck, M. D., of Lebanon, Pa.
During the past twelve or fourteen months a severe epidemic of scarlatina has prevailed in my neighbourhood. Of 190 cases of the disease treated by me in accordance with the method recommended by our best authorities, I lost 1 in 8J to 9.
Dissatisfied with this result, I was induced to try the diluted acetic acid as recommended by Dr. I. B. Brown, whose work1 I had the good fortune to meet with at the commencement of the present year. Of 60 < cases treated subsequently by this plan, I did not lose one. The disease at this time had not undergone any abatement from its former violence ; for among the sixty recoveries there were cases of such malignancy, as would inevitably have perished under the best directed previous efforts. It is true that two of the sixty afterwards died of thoracic and cerebral dropsy ; and one, after a nearly two weeks' convalescence, from purpura hemorrhagica, with epistaxis, hgenia- turia, &c. ; but these cases cannot be regarded as affecting the integrity of the plan in question. I am thus enabled to bear a flattering testimony to the success of Dr. B.;s method.
Many medical men, after unsatisfactory trials of all the ordinary modes of treatment, now declare that the less there is done for scarlatina the better. All such will be apt to think lightly of Dr. Brown's method ; if, indeed, they do not condemn what they may choose to call his nimia cura medici. Let such rest assured, however, that this is a disease which, like weeds, flourishes most when least attended to ; and further, that the character of medical adviser must be merged, for the time, in that of nurse also, to a certain extent, if his ministrations are to be successful. He should see his patients several times in a day — the oftener the better; and, following the example of our author, he should even be found holding nightly vigils by the bedside, if the urgency of the case required it. The daily dressings of the fauces with caustic should, if possible, be made by himself ; he should direct the frequency of the repetition of stimulants; and even the minutest details should ever be under his imme- diate cognizance. Thus fully occupied, although he may be able to take charge of fewer patients, he will save more lives; and only thus will he be able to realize the truth of the otherwise almost incredible statement of a friend of the author's engaged in extensive practice, who writes, " that the number of fatal cases occurring to him under this treatment did not exceed four." This gratifying result, it is the writer's firm conviction, will be the reward of all who will adopt and faithfully carry out the plan.
1 On the Treatment of Scarlatina by the Acidum Aceticum Dilutum of the Pharma- copoeia. By h B. Brown, M. D. London, 1846.
28 Schneck, Treatment of Scarlatina by Diluted Acetic Acid. [July
The following is a synopsis of Dr. Brown's views : —
1. Scarlatina is always and essentially a disease of debility, or tending to debility, and not of an inflammatory nature. Its poison acts primarily and most fatally upon the blood, producing a dissolved, semi-vitalized and putres- cible condition of that fluid ; so that it posesses more serum and less fibrin than in its normal state. " Consequently the serum percolates, or is effused into the cellular tissue and cavities, through the coats of the vessels. Salines favour this dissolved state of the blood ; but acetic acid prevents the separation of the serum from the fibrin."
2. Acetic acid is an excellent antiseptic; "it gives tone to the blood in scarlatina, and prevents the separation of the serum from the fibrin." It also " acts as an astringent upon the lymphatic system and serous membranes, and so effectually prevents dropsy."
3 . It is a grateful refrigerant.
4. No medicine has a more decided influence in promoting digestion than this acid. We are further directed, while administering it, to " allow pa- tients almost anything they fancy; it will seldom hurt them in severe and even dangerous disease."
These four points lie at the foundation of Dr. Brown's very simple and very successful treatment. The specialities of his method will now be given, as applicable to the several forms of the disease.
Whatever may be the type, he prepares the system for the acid, by giving
1. An aperient of 3 to 5 grs. of calomel, to be followed in two hours by castor oil. All saline aperients are condemned; " salines favour a dissolved state of the blood." If, from great gastric irritability, the oil is rejected, he recommends an aperient mixture (rhubarb and magnesia), which contains no saline substance.
2. Apply a piece of flannel round the throat from ear to ear, saturated with soap lin. f^j; camphor lin., laudanum, aa ^ij.— -M.
3. After the operation of the oil, give — for a patient nine years old — dis- tilled vinegar, diluted, * f^j ; syrup f5iv; distilled water f^iv. — M. Two tablespoonfuls every four hours. This mixture is to be continued throughout the entire duration of the case, whatever the form of the disease ; and for one or two weeks afterwards, or until desquamation is well over. "It acts as an astringent upon the lymphatic system and serous membranes, and so effectually prevents dropsy."
4. Whenever, in scarlatina simplex, there is slight delirium in the begin- ning, with a thick, viscid phlegm on the tonsils, apply daily — nitr. silver grs. x; distilled water f^j. — M. You thus prevent s. anginosa. If the throat require it, a linseed poultice may be placed over the flannel, and kept there constantly.
5. On the third or fourth day, in simple cases, allow mutton-broth.
1 R. — Distilled vinegar, offic., one part: water, seven parts. — M.
1857 ] Schneck, Treatment of Scarlatina by Diluted Acetic Acid. 29
6. As soon as desquamation comes on, order a warm bath or two, and keep the patient strictly in bed during the whole process.
S. Anginosa. — Here the treatment is the same, except that the caustic must be used more frequently, and the proportion of acid in the solution must be increased. A good rule is to increase the strength according to the violence of the attack, in bad cases giving it as strong as the patient can take it. Poultices to throat. Should symptoms of adynamia come on, give arrow- root, with a spoonful of brandy in it; add comp. sp. ether to acid solution; wash face, hands, legs, and chest with tepid vinegar (£) and water (f). If restless at night, give tinct. hyoscyam., or ^ to J gr. morphia, according to age. The decoction of bark may also be added to the acid mixture. When- ever, in s. anginosa, symptoms of adynamia come on, dress the throat fre- quently with caustic, and increase the quantity of acid from day to day ; you thus prevent s. maligna.
For adults, in cases partaking of the nature of s. maligna, the following formula is given: R. — Distilled vinegar {$iv ; syr. red poppies f5iv; dis- tilled water f^iv. — M. One-fourth part to be taken every four hours.
In s. maligna the same course of treatment is to be pursued ; calomel, oil, caustic, acid mixture (strong), liniment or sinapism to throat, followed by poultices ; brandy or port wine every four to six hours, with arrowroot, beef- tea, or mutton-broth; morphia at bedtime, or whenever restless, and sponging with tepid vinegar and water. All the bed furniture, carpets, &c, to be removed from the room, and chloride of lime to be sprinkled about the floor. During desquamation, the patient is not to sit up at all. Give at this time one or more warm baths. Use wine and brandy in s. maligna, even in the febrile stage; when combined with the acid, which so powerfully assists digestion, no harm will ever accrue from their use.
This is a brief statement of Dr. Brown's views and practice in this terrible malady. To the work itself we must refer for a number of valuable cases, illustrating most happily the treatment which he advocates, and interspersed with many highly practical remarks. I cannot help transcribing at length, as a fitting close to this portion of the subject, the following observations, which I have copied from his work : —
''Very much depends on careful watching in this disease ; there is always, in one or the other of the stages, a critical moment. For instance, in the eruptive stage, even in s. simplex, delirium will come on, and the throat will become more clogged with viscid secretion in a few hours ; and if attention be not promptly given, and this phlegm, which impedes free respiration, be not removed, the delirium and laborious breathing will increase, and the disease will soon run into the second or anginose form. In this case, the throat must be promptly cleansed, and some gentle nourishment be given. Again, in s. anginosa, it will not seldom happen that the tonsils and fauces will suddenly become worse, or great sickness or sudden prostration will come on ; now, unless the throat be instantly attended to, delirium, laborious breathing, difficult deglutition, and restlessness will make serious ravages upon the patient, and all remedies will quickly become unavailing ; or, where sudden prostration should arise, then we
No. LXVIL— July 1857. 3
30 Schneck, Treatment of Scarlatina by Diluted Acetic Acid. [July
must promptly and unsparingly administer stimulants and cordials till the pulse exhibits more steadiness and power."
The practical importance of these directions cannot be over-estimated. As assisting the cleansing of the fauces from viscid secretions, I have, for several years past, been in the habit of injecting the diluted chlorinated soda into the nares, with the happiest effects. Extensive ulceration, not only of the pos- terior nares, but of the entire nasal tract, with an abundant secretion of a peculiar tenacious mucus, are an attendant on every bad case; and these passages cannot be long obstructed without great distress and imminent dan- ger. The daily or bi-daily injection of Labarraque's solution, therefore, while it effectually clears away the obstruction (as any other liquid would as well), exerts besides an alterative and healing influence upon the ulcerated surface itself ; and it destroys, while it removes, the morbid products which, if swal- lowed, as they are otherwise sure to be, disturb so seriously the intestinal canal ; and last, but not least, it corrects the fetor which is so disagreeable a concomitant of such cases. So signal is the relief derived from this pro- cedure, that, unpleasant though the sensation must be, I have seen the little patients, instead of shrinking from the operation, instinctively court the repe- tition of it, and if old enough, ask for it. It is a measure which, in the class of cases referred to, cannot be dispensed with, without loss. But as it may happen that a considerable quantity of the injection may be swallowed, and the blood be thereby impaired, it will be proper always to precede or follow the injection with a strong dose of acetic acid, so as to neutralize the saline ingredient.
The preparation of the acetic acid solution may be varied somewhat from the formulas given above, and so simplified, without in the least affecting the result. Instead of first diluting the concentrated acid to the strength of vine- gar, and then using the dilution for the preparation of the solution, I have been accustomed merely to add from f5j to f3iv of the officinal acid to f^iv water, and ordering a tablespoonful overy few hours, sweetening at the time of administering it. We must, however, never forget to increase the strength in proportion to the threatening nature of the symptoms.
In the use of stimulants, also, a little license has been taken with our author's directions. Having ventured upon the guarded employment of brandy, beef-essence, &c, as a precautionary step, earlier in the attack than he allows, without detriment, I now administer brandy in graduated doses, two or three times a day from the beginning in the malignant form, or on the second or third day in anginose cases; and I have seen no reason to regret this course. If the tongue becomes red like a strawberry, with the papillae as large as a pin's head, or on the contrary, brown, dry, fissured, with sordes on the teeth; and if there be, besides, a recession of the eruption, a pulse fluttering and not to be counted, or even delirium, " then we must unsparingly admin- ister stimulants and cordials, until the pulse exhibits more steadiness and power." Carb. ammonia, quinia, and even capsicum, have here all failed me ;
1857.] Schneck, Treatment of Scarlatina hy Diluted Acetic Acid. 81
this last having proved alike ineffectual as an arterial stimulant, and as a local application to the fauces.
If scarlatina were an inflammatory disease, as the advocates of bleeding and antiphlogistics would have us to believe, such a stimulant course could not fail to result disastrously in nearly every instance; but the reverse is actually the fact. The violent excitement in severe attacks, as indicated by burning skin, rapid pulse, delirium, &c, is not an evidence of phlogosis, but of irrita- tion. And when death takes place in such cases, it is not so much from in- flammatory disorganization of any vital part, as from sheer exhaustion; the inevitable consequence of the excitement into which the system had worked itself, in its vain struggles against the fatal poison which was oppressing it.
Dr. Brown's silence in regard to the use of emetics is a significant fact ; although more celebrated authorities than he, recommend them highly. Their adoption at all, as part of the treatment, was probably suggested by the nausea and vomiting which almost always usher in the attack ; under the supposition of the presence of acrid ingesta, which they were designed to remove. It may be, that when the mildest article is selected, solely with this view, they may do no harm ; but when administered indiscriminately, fatal results must occa- sionally follow the practice.
Dentition, improper food, the hot months, and a hereditary predisposition, may all, in scarlatina, favour the occurrence of serious gastro-intestinal dis- ease, from the least exciting cause ; and an emetic, especially if containing tart, antimony as advised by some, may be this cause. In the month of July, 1856, I was called to see a child aged 20 months, ill with s. anginosa, run- ning into maligna, with scarcely any eruption. Notwithstanding the child had vomited, an emetic of ipecacuanha with calomel was given, after a warm bath ; to be followed by sp. nitric ether and bicarb, soda in solution, with capsicum infusion. The vomiting became unmanageable, attended with a copious diarrhoea ; gastritis supervened, with peritonitis and enormous ab- dominal distention ; and on the fourth day the child died in convulsions. The emetic most probably had killed it.
What, let us ask, does the gastric irritability of this disease mean ? Is it not the first appreciable alarm given by nature of the introduction of the poison, and an ineffectual attempt on the part of the system, to get rid of it at the outset ? But as the morbific matter is introduced, and the blood satu- rated with it, many days it may be before it actually develops itself, how can we expect emesis, whether spontaneous or artificial, to dislodge it ? If, instead of vomiting, scarlatina began with diarrhoea, would we be justified in giving an active purgative, with the same object ? Assuming Dr. Brown's view to be correct, would it not be malpractice to bring to bear the depressing effects of a nauseating emetic upon a disease whose tendency from the beginning is towards debility ? The unfortunate result above related has convinced me that the use of emetics, as a matter of routine, is fraught with great danger; and
32 Schneck, Treatment of Scarlatina by Diluted Acetic Acid. [July
that their employment is indicated in very few, and very special cases, if at all.
The following cases, representing the worst forms of s. anginosa and malig- na, are selected out of a number of similar ones, from my case-book, as illus- trating the gratifying success of the acetic acid treatment, even when under the most unfavourable circumstances.
Case I. — Dec. 27, 1856. Saw a girl of Jos. Heilman, aged 13, in an at- tack of s. ang. threatening maligna. On the evening of the 28th found more fever, very frequent, angry pulse, constant sighing and heaving of the breath, with increased impulse of heart. Suspicion of pericarditis, and tempted to bleed. Concluded to postpone till next morning; ordering sinapisms to ex- tremities, and dose calomel. Was prevented from seeing her until next day towards evening.
29th. Pericarditis now clear. Bled viii oz. ; epispastic to left chest ; cal. and op. aa \ gr. every 2 hours ; sinapisms to extremities. Eruption well out. Teaspoonful brandy at one, to be continued 3 or 4 times a day, with beef- essence.
30^/i. Effusion around heart; impulse scarcely perceptible to hand, or audible ; at times delirious ; eruption well out ; slight epistaxis. Inunction with mercurial oint., and same to blister. Continue remedies.
31st. Homing. Pulse more full, and a shade slower; impulse of heart more perceptible, and less muffled ; had 3 or 4 evacuations. Continue treatment, with alternate doses of pulv. scillse and digital., aa J gr., cal. \ gr.
Evening. Cardiac trouble decidedly better; but alarming prostation, from epistaxis to the extent of a pint. Partial coma ; tongue dry, and papillae very much elevated ; four alvine discharges. Cold cloths to head and neck ; Dover's p. 3 grs., digital. £ gr., acet. lead \ gr. every 2 hours (having omitted former powders); 10 drops elix. vitriol every 2 hours. Sinapisms to extremities; iced lemonade for a drink ; may die to-night.
Jan. 1, 1857. Morning. Bled a pint or more at two several times, to-night; extremely exhausted ; but one dose of the medicines ordered last evening was given ; family expecting her death hourly. This being contrary to my express orders, I at once directed a resumption of the treatment, including brandy and essence of beef.
Evening. Has taken remedies all day ; no bleeding. Pulse a little fuller, and slightly slower. Tongue dry, and covered with crusts of blood. Erup- tion apparently about to decline on upper part of body, but well out on lower extremities. Continue treatment, at three hours' interval.
2d Noon. Pulse a little slower ; circumscribed flush on each cheek ; face
sunken ; tongue very dry ; skin dusky, and whole case typhoid. Turpentine emulsion and elix. vitriol, with beef-essence, and brandy and milk.
3d. Tongue a little more moist. Continue remedies.
4th. Improving ; pulse a little slower. Will recover.
bth to Qth. Has great appetite. Slowly convalescent.
Remarks. — Bleeding, in scarlet fever, is not necessarily an injurious mea- sure, especially if its otherwise depressing effect be guarded against, imme- diately afterwards, by suitable doses of stimulants and nourishment. In this instance, the venesection most assuredly saved life, by moderating and favour- ing the resolution of the cardiac inflammation ; which, although it had gone
1857.] Schneck, Treatment of Scarlatina hy Diluted Acetic Acid. 33
on to the effusion of serum, was nevertheless relieved by it, and by the sub- sequent use of squill, digitalis, and calomel. The recession of the eruption, which might otherwise have fallowed the bleeding, was also prevented by the prompt administration of small doses of brandy. In a similar case of peri- carditis in the course of scarlatina, I should feel emboldened to bleed largely, giving stimulants and beef-tea generously immediately afterwards, as the only mode promising success.
Case II. — S. Anginosa running into Maligna Dec. 30, 1856. Girl of
Geo. Strohm, aged 4 years. Vomiting; very rapid, irritable pulse; eruption of a vivid red colour; tonsils greatly enlarged, and covered with lymphy ex- udations. Solid caustic to throat; cal. oil, and strong acid solution.
Jan. 1, 1857 — Morning. Symptoms of great malignancy; fauces of a dark purple hue ; face mottled with white patches, where the eruption showed a dis- position to recede ; excessive restlessness all night, getting out of bed in the delirium ; surface of an intensely deep red colour ; pulse rather feeble, and slow. Solid caustic to throat; sinapism externally, to be followed by poultices. Teaspoonful of brandy every five or six hours, if not gone to sleep. Beef- essence ; acid solution stronger.
Evening. Has slept some hours ; face more uniformly red; pulse more fre- quent; surface hot. Sol. 10 grs. nitr. silver to ^j water, to fauces twice a day; chlorinated soda injections into nares. Continue remedies.
2d. Same as last evening. Comp. camph. lin. to throat, which is much swollen ; caustic, injections, brandy, and beef-tea.
3c?. Desquamation already beginning on different parts of the body, being only the fifth day — a bad sign. Continue remedies.
ith. Throat very much swollen externally ; tonsils deeply ulcerated ; case very malignant ; sinking, and very restless ; surface pale and cool.
10 P. M. Was sent for; supposed to be dying. Prognosis very bad. Solid caustic to throat ; injection into nares ; brandy every two or three hours, and continue remedies.
hth. Pulse a shade slower. Family did not attend to throat this morning. Applied caustic at once, and injected chlor. soda into nares, bringing away large masses of viscid secretions, with great relief. Quite rational.
6th to 10th Pulse slower. Gradually convalescent.
Remarks. — This case exhibited what I have repeatedly seen in this epi- demic— a succession of pure white patches in the midst of the eruption, on the face most generally; appearing in the course of a few minutes, and per- sisting sometimes for half a day, or longer. Having met with this symptom only in cases of a malignant character, with a cool skin, and other signs of adynamia, I have come to regard it as an indication for the prompt use of stimulants.
The early occurrence of desquamation in this case — on the fifth day of the eruption — is also worthy of note, as indicating great pravity of system. In September, 1856, I met with a case in which desquamation began, all over the body, in extensive patches, on the fourth day of the eruption. The skin was as though it had been seethed or scalded ; the cuticle separating first at the points of pressure from the motions of the patient, incident to her changes
34 Schneck, Treatment of Scarlatina by Diluted Acetic Acid. [July
of posture in the delirium — as the elbows, hips, &c. — but finally comiDg away wherever the clothing lay in contact with it. These denuded surfaces were literally raw; when recent, serum standing upon them in minute drops. The patient, a girl of 15 years, died rapidly of pericarditis.
Case III. — Purpura folloiving S. Anginosa and Maligna. — Feb. 23, 1857. In this instance, as in a considerable number of others in this epidemic, I ob- served that the eruption on the arms was most fully out along the course of the nervous trunks, there being a broad belt, of an intensely red colour, in the line of the bloodvessels and lymphatics, from the hand to the axilla. Having never seen this symptom noticed, and having observed it only in the worst forms of the disease, I have been led to regard it as indicating either phlebitis, or inflammation of the absorbents, and, as such, a serious complication of the case. The details of this case are very similar to those previously given, and hence need not be gone over. It is sufficient to say that the child recovered with the greatest difficulty ; but by the end of the first week of March he was clearly convalescent, although greatly reduced, and very pale. He, however, took nourishment, with acid mixtures, and it was hoped he would do well.
March 13. I was informed this morning that his mouth bled slightly, and that the blood appeared to ooze from the gums. Sent him tinct. chlorid. iron, and saw him in the afternoon. Found that epistaxis had set in ; the blood looking pale red in colour, like a mixture of currant-juice and water. Purpura patches had appeared over the whole of the lower extremities. Prognosis very unfavourable. Beef-essence and elix. vitriol at short intervals, alternating with sol. potassio-tartr. iron.
14th. Gretting worse rapidly. Purpura on arms and breast. In the course of the day, vomiting of coagulated blood, which had evidently passed into the stomach from posterior nares. Vomiting continued ; everything was rejected; and in the afternoon, after having passed some bloody urine, the child died, perfectly blanched.
Remarks. — This case is interesting, as confirming, to some extent, Dr. Brown's views of the pathology of scarlatina. Here was, first, a deficiency of red globules in the blood, as was evident from its pale red colour. We infer, also, an increased tenuity in this fluid, as manifested by the hemorrhagic tend- ency, and which may have been caused either by a deficiency of fibrin, or a preponderance of serum, from paucity of red corpuscles. However we may explain the morbid result, the occurrence of purpura is almost inexplicable under the constant administration of the strongest nourishment and acid solu- tion, unless we admit the coexistence of the scarlatina poison, acting upon the blood to bring it into this dissolved state. At least, this was not congestive or inflammatory purpura.
Would it not be advisable, in every case of s. anginosa and maligna, espe- cially the latter, to administer, as soon as the disease has subsided, and des- quamation is beginning, a mild preparation of iron? Might not the fatal termination in this casj perhaps have been averted by the earlier employment of a ferruginous tonic? Further, would not also the iron, by increasing the crasis of the blood, lessen the chance of dropsy? Or, on the other hand, would the iron be capable of increasing the tendency to dropsy, by rendering
1S57 ] Schneck, Treatment of Scarlatina oy Diluted Acetic Acid. 35
the blood inflammatory, and so favouring the renal disease, which is so promi- nent a symptom (if not the cause) of the dropsy ? This is quite possible, regarding, as I do, the condition of kidney in the dropsy of scarlatina as a real, though temporary, acute Bright' s disease.
Supposing, however, as does Dr. Brown, that the watery condition of the blood after scarlatina is the cause of the effusion, how can we reconcile with this the benefit derived from venesection in dropsy? If this supposition be correct, are we not, by the abstraction of blood, and the consequent still fur- ther impoverishment of that fluid, increasing the tendency to effusion ? In- stead of which, we find the swelling mostly soon to disappear rapidly after bloodletting. At least, such has been my experience, repeatedly, in bad cases of cerebral and cardiac dropsy ; and Watson, in similar cases, gives bleeding his unqualified approval.
These facts militate strongly against the causation of dropsy, as explained by Dr. Brown. For the present, then, we know of no solution of the diffi- culties presented to us above, and must be content to follow apparently oppo- site indications, if correct and successful, without being able to reconcile differences.
Case IY. — Scarlatina in Childbed. Scarlatina Neonati. — On the 2d of July, 1856, I was requested to see the wife of Fred. Schaffer, in an attack of s. anginosa. She was at the end of her pregnancy, and expected her confine- ment daily. Both of her children had just passed through a severe attack of the disease, and she had been their only nurse. Knowing the disastrous con- sequences to be apprehended from scarlatina during confinement, I undertook the case with no little anxiety. On the 4th, the premonitory symptoms of labour appeared, which I treated with anodynes, hoping to put off the evil day as long as possible. Moreover, dreading the exhaustion which would be likely, in such a case, to follow the excitement of labour, and still more the debility consequent upon the lochia (which would act as a drain upon the system), I sought to prepare the patient for the crisis by moderate doses of carbonate of ammonia, serpentaria, and beef-essence. By a cautious use of opiates, the labour was kept off until the afternoon of the 6th, when the woman was de- livered of a mature female child, which, however, lived only three or four hours. This child was covered from head to foot with the eruption, of an in- tensely red colour ) and, lest I might have mistaken the naturally florid colour of many newly-born children for scarlatina, I examined the fauces, and was surprised to find prominent anginose symptoms, and the soft palate thickly studded with red points. The infant soon became cold, and the eruption changed to a purple hue, which, before death, gave place to an almost indigo colour.
My precautions in regard to the mother proved to be well-timed. In addi- tion to the supporting plan adopted before confinement, she now bore well a generous supply of wine. She made a good recovery ; but, a week afterwards, was attacked with subacute rheumatism of the wrists, which yielded to Dover's powders and vinum colchici.
Remarks. — Bamsbotham, in his work on Parturition, highly recommends a stimulating and supporting treatment of the scarlatina of puerperal women,
36
Earle, Partio- General Paralysis.
[July
as the only method likely to prove successful ; and the above case is interest- ing, as confirming not only his own views, but also those of Dr. Brown. Mor- ris, in his Lectures on Scarlet Fever, says that "to pregnant and puerperal women it is almost inevitably fatal. I have known several cases which proved mortal, but have never heard of a recovery/7
These cases, from my own observation, must suffice for my present purpose. They confirm, and correspond with, Dr. Brown's teachings and cases very fully ; and this correspondence between two epidemics thus widely separated as to time and space is certainly more than a mere coincidence. It seems to indicate a certain general principle, which underlies, and so essentially deter- mines the nature of this, as of every other affection, through all the variations of climate, locality, and prevailing type of disease. Whether this principle, which Dr. Brown professes to have discovered as regards scarlatina, be the correct one, can only be determined after extensive and frequently repeated experiments.
Finally, to all the evidence adduced by Dr. Brown in favour of the pre- servative effects of acetic acid upon the blood, it is proper to oppose the testi- mony of our best American authority, as to its injurious effects in large and long-continued doses. Dr. Wood, in his Therapeutics, says that, thus ad- ministered, besides producing gastric and intestinal irritation, "it lowers the organic functions of the system generally, impairing nutrition, depraving the blood, producing anaemia and emaciation, and ultimately, it is said, inducing a condition analogous to the scorbutic." The same writer refers to its liability to develop the tubercular diathesis, when taken habitually, as it sometimes is, with a view to obviate fatness. Whether, and to what extent, Dr. Brown's use of the article should be considered toxical, it would be difficult to say ; but probably the diluted state in which it is given, and the comparatively short time that it is administered, will save it from being so regarded, except in so far as many of our best remedies are poisons, in over-doses.
Art. III. — Cases of Partio- General Paralysis, or the Paralysis of the Insane. By Pliny Earle, M. D.
In previous issues of the American Journal of the Medical Sciences, I published two series of cases of that peculiar disease termed, by the French physicians, Paralysie generale, and by the English and the Americans, para- lysis of the insane, but for which I ventured to suggest the name, partio- general paralysis.
Those cases included all the distinctive characteristics of the disease, and the number of autopsies was sufficient to furnish a pretty clear idea of its
1857.]
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cerebral pathology. Most of the cases, a report of which it is proposed' to include in this article, present peculiarities, or exceptional characteristics, which render them worthy of preservation. In the one first presented, the disease ran its course so rapidly that the patient was exhausted before the extreme symptoms of paralysis had appeared.
Case I. — Mr. was born in the interior of the State of New York.
He was of medium stature ; his hair was light-brown, his eyes blue, and his temperament bilious-nervous.
He learned the business of printing, and worked at it for some years. His intellect was above mediocrity, and his acquirements became such, that at length, and during a term of several years, he was an assistant editor of a newspaper in the city of New York.
In business, he was industrious and persevering; in habits, generally es- teemed correct, although, from early life, it is supposed that he gave a pretty free rein to the venereal propensity. He also drank wine, but perhaps never to intoxication. He was married, and had several children. It is said that his parents were both " eccentric," if not insane.
In the summer of 1847, it was observed that he had become unnaturally irritable. This disposition increased upon him through the ensuing autumn and winter, and, in the spring, there were some evident symptoms of insanity. He, however, continued in his business until about the 1st of May, when the disease prevented the further performance of his duties. On the 10th of May, at the age of forty-two years, he was brought to the Bloomingdale Asylum.
Condition on admission. — He is restless, excited, and incessantly talking, if any one be present. Countenance animated j pupils contracted, unequal — that of the right eye the smallest ; tongue moist, pallid, smooth, and very slightly coated ; pulse considerably accelerated. No abnormal sound of the heart.
May \lth. He occupies one of the best rooms, and, if alone, is quiet. He says the Common Council will give this Asylum to him. He will have four hundred mechanics here, and will raise vegetables enough to sup- ply the city. He will want two or three clerks, and three secretaries. He will give ten thousand dollars to stay three weeks and carry out his plans ; or he will buy the place in less than a week, pay one hundred and fifty thou- sand dollars for it, which will not be more than a cent to him, will have all luxuries, and supply all the other patients with them, and will cure all the patients by a special course of treatment.
He has a very slight impediment in his speech. In the midst of conver- sation, he stops to whistle or to sing.
13th. He says he is the cream of American patriotism, and that Grod' has revealed to him all the events of the last six weeks. He is restless, loqua- cious, petulant; sheds tears, and asks if Washington is not here.
Ikth. He mentions the names of several attendants and patients, claims them as his illegitimate brothers, and offers each of them " a carriage, horses, and twenty thousand dollars, to start upon." Says that he shall be the next President of the United States, and that the Supreme came down last night, and rested on the window-sash, and is still in that cloud (pointing upwards through the window), ready to come down at his bidding.
lbth. He asserted that he is the "Duke of Gloucester, and entitled to the throne of England, of which Yictoria is not the legal possessor." A few
38
Earle, Partio- General Paralym
[July
minutes afterwards, he said he was President of the Uuited States and King of England ; that his legs are iron, and that he wound up the sun yesterday.
lQth. He calls one of his fellow-patients the Pope, and to several others gives the titles of some of the English nobility.
20th. His excitement has gradually increased from the time of admission. Having become very boisterous, by both day and night, and having begun to destroy furniture and clothing, he was now removed to the ward for violent patients.
21st. He declares that he is the son of the King of the world ; that he was in the Crusades ; that the writings of Shakspeare and Scott are merely a record of his life ; and that he had a conversation with the Black Prince night before last.
22d. Says he killed Abel, in the garden ; that Eve was his mother ; that all the people in the world are descended from him ; and that the Dutch Queen had such an affection for him that it made a tumour grow on his right side. He is much excited, very noisy at night, and destroys clothing.
23(7. On entering his room, I said : " You are noisy !" " I've a right to be," he answered. " I'm the god of thunder !" His tongue, as usual, is covered with a thin, white, strongly adherent, pasty fur; bowels habitually costive ; right pupil smallest — both contracted ; pulse 96, regular ; sounds of heart normal; general sensation obtuse. He has emaciated constantly since admission.
2Qth. He tore his bed to tatters " to find his cattle;" says he can jump over the house, but is so large he cannot go through the door; tells the physician that he can hold him on his little finger, and could sustain the weight of the world if he had a foothold.
Neither his mental nor physical symptoms changed during the early part of June. On the 19th, his scalp, forehead, and right arm, were much tume- fied and ecchymosed, as if beaten against the wall. Being asked how it was done, he laughed, and said: " Jesus Christ did it." Towards the end of the month, and in the early part of July, he became more emaciated and feeble ; his excitement was less constant, but occasionally, even in the latter part of J uly, he was very turbulent. At the close of the month he was nearly ex- hausted, all the worst symptoms, both mental and physical, above mentioned, continuing. Almost the last words he uttered were an assertion that he was one of the men mentioned in the Old Testament. Died, August 2d, 1848.
Treatment. — Purgatives, alteratives, and tonics. A seton was inserted in the back of the neck on the 23d of May, and continued until his death. The discharge from it was never copious. Regardless of all medication, the dis- ease regularly proceeded towards its fatal termination.
Autopsy, sixteen hours after death. — Pericranium pretty strongly attached to the skull, and but little blood in the vessels. Cranium adheres more than normally strong to the dura mater. It is of ordinary thickness, and not un- usually hard. The dura mater adheres to the subjacent membranes on the anterior lobes, and for three inches over the vertex, on the border of each hemisphere, beside the longitudinal sinus. The latter attachments can be separated by dissection alone. The whole brain, when removed from its cavity, appears unnaturally soft or flaccid, and its weight, when laid upon its base, partially tears asunder the corpus callosum. The arachnoid is thick- ened, semi-opaque, and strongly adherent to the pia mater upon the whole surface of the cerebrum, except the base, where it is normal. The pia mater adheres so strongly to the cortical substance, that, on removal, it brings off small patches of it. Bloodvessels not remarkably injected. The cortical
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matter is of normal colour, but is decidedly softened. The brain being cut, the surface of the medulla is interspersed with some bloody points, but they are not numerous. The corpora striata, and the medullary matter around them, are thought to be somewhat softened — the most so in the right hemisphere. The fornix is very soft. The pineal gland contains very little sabulous matter. There are filamentous adhesions between proximate surfaces in the fourth ventricle, and at the base of the brain. One ounce of serum in the ventricles and at the base. Cerebellum thought to be somewhat softened. Its investing arachnoid apparently normal.
Considering the protracted course of the next case, and the comparatively extreme degree of the paralysis of the voluntary muscles, it is remarkable that the functions of the digestive organs were so little impaired, and that the patient was exempted from those sloughing ulcerations which are one of the most striking characteristics of the disease in its severer forms.
Case II. — Mr. was a native of the State of New York. He was
tall in stature, his hair black, eyes blue, temperament sanguine-bilious, the bilious greatly predominating, constitution mediocre. His intellectual facul- ties were fair, and he received a good English education. Being devoted to mercantile pursuits, he emigrated to a southern State, at the age of between 25 and 30 years, established himself in business and was sufficiently success- ful. He was never married. It was said that his habits were correct, but by persons who had no intimate knowledge of his course of life. His mother was eccentric, but it was asserted that he inherited no predisposition to men- tal disorder. At the age of 35 years he had scarlatina; and at the age of 43, what is described as a " slight attack" of paralysis. He lost his property and became excited with political affairs, but whether prior or subsequently to the commencement of insanity, could not be accurately ascertained.
Having become insane, he was brought by sea to New York. On board the vessel he was so violent that he was most of the time kept in a strait- jacket.
On the 18th of March, 1848, at the age of 45 years, he was taken, as a patient, to the Bloomingdale Asylum. He was then emaciated, his skin sal- low; the tongue furred and pasty; bowels costive; pupils unequal, the left being the larger; speech imperfect and hesitating; gait faltering. He ap- peared bewildered, thought he was in Savannah; said he saw an angel on the previous night; would begin to speak, and, forgetting the idea, run to an- other subject.
He slept but little, at night, during the first few weeks after admission; but he could not bear opiates. One morning his forehead was severely bruised, probably, as has occurred in other cases of the kind, by running against the walls. On being asked how it was done, he said, " The raft slid into the river and many people were killed, but the ladies walked across the plank of the steamboat and were saved." On the 14th of April he said that he was in a southern city, and that on the previous night they " stuck him into a rotunda to sleep." A copy of a New York newspaper being handed to him, he appeared much astonished and remarked that " it must have come by telegraph." General sensation was then very obtuse. On the 16th, he said that in the night he saw five or six hundred little soldiers, beautifully dressed, and on horseback; they were not larger than his forefinger, but they " fought the Bostonians courageously, like tigers." His bed being wet and emitting a strong odour of urine, he was asked the cause of it; and answered
40
Earle; Partid- General Paralysis.
[July
that some person opened his window, and a shower coming up, it rained upon him — hut it was warm rain. The night was clear. On the 20th, his appe- tite was good, and he was gaining flesh and improving in general health. He said he had some barrels of the best wine in the world ; and, assuming a very earnest, business-like manner, requested to be let out into Broadway, as he was going to the banks and was afraid he should be too late.
In the summer he took LugoPs solution of iodine; and a "seton, which was introduced on the 4th of April, caused a free discharge. He gained flesh, and his general health was good. His mental condition varied, but was at no time much, if any, better than at the time of his admission. He had but little memory of recent events. Soon after a visit from his mother, he said it was more than a year since he had seen her. In the early part of August it was perceived that he had lost the sense of taste. He ate all kinds of food with equal relish. In the early part of September, his feet were cedematous for a few days.
On the 17th of November his pulse was 76, regular; pupils unequal, the left being the larger; appetite voracious; face and feet cedematous; gait un- stable. He walked with his feet far apart, like an infant; the grip of the hand and the strength of the arm were feeble; speech considerably impeded, but less so than at some former times. At this time, he occasionally tore his bedclothes and upset the furniture in the room. On the night of the 29th of November, he thought the earth was sinking, and, in order to save him- self, he turned his bedstead up, upon the side, and seated himself astride it. He said he was thus enabled, by using his utmost exertions, to save himself from being engulfed. His speech was now much more impaired than at any previous time. G-eneral sensation was nearly null, but existed to a greater extent upon the legs than upon the superior portions of the body. His feet and hands were somewhat cedematous. He asserted that he could run twenty- five miles in an hour, or walk twenty miles, and that he owned six hundred acres of land at the South and one hundred acres in Harlem, occupying the latter as a barber's shop. Being requested to write a letter to his mother, he sat down, and, after much labour, hesitation, and alteration of orthography, produced a document, of which the following is a copy : —
" Mrs. Deear Motherr
Vder as this 29th Jurly
b — o gond to
$18. S. DOOCCKET."
The signature bears no resemblance to the name of the patient, except that the initial letters of the former are the first two of the three which belong to the latter.
There was no material change in his general condition at the time I left the asylum, in May, 1849. Neither was there, as I am informed by my suc- cessor, Dr. Nichols, throughout that year. During the whole of his residence in the asylum he never recognized, as an acquaintance, any person except his mother. During the last six months of his life he did not know even her. In the early part of 1850, the power of the voluntary muscles visibly dimi- nished, but most rapidly in the lower extremities. For six months before his death he could not walk without aid. His digestive functions remained but slightly impaired until the 5th of August, 1850, when he was attacked with diarrhoea and died on the following day. No autopsy.
The third case is exceptional, so far as my observation is concerned, in the striking similarity of its earlier symptoms to those of mania-d-potH. The
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disease was rapid in its course, and all its other characteristics would probably have soon assumed their worst form had not the patient been carried off in an attack of cerebral congestion.
Case III. — C. was a native of Ireland. His constitution was strong,
frame robust, stature medium, hair sandy, eyes gray, temperament sanguine, intellect mediocre, education common. At the age of about 22 he emigrated to America, settled in the city of New York, and established himself as a retailer of liquors. He was subsequently married. He afterwards became addicted to the daily use of alcoholic drinks, though not frequently to intoxi- cation.
In September, 1846, when he was at the age of 28 years, he lost a favour- ite child3 and his friends say that his insanity appeared immediately after- wards. He was subjected to no medical treatment. For four weeks he gradually grew worse : was restless and talkative, and indulged in extravagant schemes of business, made imprudent purchases, and wandered about the city, apparently without any definite object. At length, having determined to go to Ireland, he went to a wharf, jumped into a boat, and rowed himself out into the river. His determination then changing, he leaped into the water and swam to the shore.
A day or two after this occurrence, and on the 16th of October, he was brought to the Bloomingdale Asylum. His friends asserted that he inherited no predisposition to mental disorder, and had always enjoyed good bodily health.
During the first three days after his admission, he had all the symptoms of a person labouring under a severe attack of delirium tremens.
He was excited, sleepless, turbulent; had hallucinations of vision, and would keep no clothing upon himself, excepting a blanket thrown over his head, or wrapped about his body. His tongue was tremulous, his pulse rapid.
After catharsis with cal. et jal. followed by compound cathartic pills, he took mass, ex hydrarg. gr. ij. t. d. and, subsequently, a portion of pulvis pur- gans. On the 23d, he was so much improved that he was permitted to be in the hall and to go out of doors; and, on the 24th, he began to take a tonic vegetable infusion. He rapidly gained strength, and on the 29th the medi- cine was stopped. During this period there was a partial bewilderment in his aspect and manner. He was careless of his personal appearance, at times tore his clothing, and was otherwise mischievous. His appetite was now good. He generally ate voraciously, and required occasional purgatives. This was the only medical treatment to which he was subjected, with the exception that, a few days before his discharge, he took Fowler's solution gtt. v. t. d.
November 10. For several days past he has uttered the most extravagant ideas. He now says he owns the asylum premises, and is worth two hundred thousand billions of dollars. He also declares that he is the head of the church throughout the world, and is going to turn the earth into a paradise, and manage it all himself.
11th. He went to the school-room and wrote a letter to his wife, from which the following extracts are made : —
" I am at the reading school and am one hundred times as smat as any of them they they are the greatest dunces in Eternity I shall commence travelling next week Please God and the first place I will go to is to my native own green Isle" * * * "I would not trust the word no but the Oath of G. and 0. I wd not
42
Earle, Parilo- General Paralysis.
Trust them in an Empty room or a room full of Mill stones I am tak as many friends as go with me By their Paying Expences it wud not not mak much of a difference I shl have High life all over the continet and all the Corners in the World which I will make a Parridise of all the world and Have shepherds to take care of them so that has Plenty
Resp ful
Head of the C. Church all over the world
12i7i. The pupils are unequal, the right being the larger. There is an evident stammering in his speech, and general sensation is so obtuse that he can barely feel the most severe pinch.
He says he is worth ten times as much as John Jacob Astor. Being seen to make some strange gesticulations, he was asked what he was doing, and answered that he was blowing himself up; that he could blow himself so large that he would be thirty feet in height, or reduce himself to the size of twopence. On being requested to blow himself up, he put the end of the forefinger of each hand into the ear of the corresponding side, elevated his head, rolled his eyeballs as far upwards as possible, compressed his mouth, puffed up his cheeks with air, stretched himself upwards, standing upon tip- toe, and thus exerted himself until his body was in a general tremor. Upon being told that that was enough, he said, " Oh, that is nothing ; I only went up to nine feet."
IQth. He is endeavouring, with but little success, to sing; says he hears and sees music throughout his body, and can sing better than any man at the Italian opera. He asked for writing materials, for the purpose of w corre- sponding with all the different governments on the subject of converting the world into a paradise." Being permitted in the afternoon to go to the school, he wrote a long letter to his wife. It was so badly written as to be almost illegible, and closed with a postscript consisting of two verses of pretended poetry, but, so far as it could be deciphered, contained no rhyme and but little reason. From this time his delusions continued unchanged.
23(7. Sphincter of the bladder apparently paralyzed. He says he can swell to the height of more than a hundred feet. He is very noisy at night; chews and swallows pieces of woollen rags, picks his clothes to pieces in the daytime, and empties the straw from his bed at night.
2bth. He shuts his eyes, and says he sees "gold and all the brilliants in their shape and lustre manufactured ;" says he weighs five hundred pounds, can run thirty miles in an hour, and walk twenty. He frequently " blows himself up;" attempts to sing, talks of his wealth and of his proposed con- version of the world into a paradise. He exhibits little or no interest in his relatives and friends.
On the 26th he fell into a state of coma, with very slight spasms of the limbs of the right side. This resisted the usual remedies for more than twelve hours, when he partially revived. He continued in bed, rarely speaking, and with but imperfect use of the right arm and leg, until the 29th, when he was removed from the asylum, and died at home on the following day.
No autopsy.
The subjoined is the most remarkable case of the kind that has ever fallen under my observation. It is the only case of recovery from the partio-general paralysis that I have ever known, and the second of which I have ever heard
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as occurring in this country. Mr. Calmeil, who first minutely described the disease, and who had for more than twenty years been connected with the hospital for the insane at Charenton, near Paris, where hundreds, perhaps thousands, of cases had been treated by him, informed me, in 1849, that he had never known a case of complete recovery. He had had patients who improved sufficiently to return to their homes, and, in some instances, to pur- sue their occupations, but in every one of them the disease had resumed its course.
Case IV. — Mr. was a native and resident of one of the interior coun- ties of the State of New York. He was of medium stature, with brown hair, gray eyes, and lymphatico-nervo-sanguine temperament. His constitution was strong; his intellect above mediocrity. After pursuing a classical course of study, he read and practised law, and became eminent in his profession. He was married at the age of 34 years. Although not intemperate, according to the common acceptation of the term, yet it was said that he "liked good living, and indulged freely in the luxuries of the table/' One of his paternal uncles was insane, and a maternal aunt was affected with melancholia.
In August, 1847, he was much afflicted by the death of a favourite child ; and in September, having involved himself in pecuniary difficulties, he became melancholy. In the early part of 1848 he had an epileptiform fit, which was followed by another upon the same day, and, subsequently, by several others. It was said, however, by his friends, that previously to this his speech had become defective, and the muscles of his arms so much impaired in their action that he was unable to write. His disease continued gradually but slowly to progress, and for some time he was under the care of the local physicians. On the 30th of July, 1848, at the age of 42 years, he was received into the Bloomingdale Asylum.
At the time of admission he was much excited, constantly in motion, walk- ing to and fro, talking incessantly and incoherently, mostly upon pecuniary matters. He wanted to go to Wall Street, where he said he would purchase $35,000 worth of railroad stock, and make a great speculation. He spoke rapidly, but frequently dropped a syllable, and sometimes hesitated, from in- ability to utter a word. The pupils were contracted, but of equal size; tongue furred j pulse somewhat accelerated. After the administration of a dose of pulvis purgans, he was put upon the use of twenty drops of antimonial wine, with ten drops of the tincture of digitalis, three times daily.
31st. He is still much excited, shouting that he wishes to get out of the house and go to W all Street. His speech is more imperfect than it was yes- terday. No evacuation of the bowels. R. — Cal. et jal. aa grs. x.
August 1. There having been but a slight alvine movement, another por- tion of pulvis purgans was administered. This produced free catharsis, and his excitement was considerably subdued.
Qth. The pupil of his left eye is larger than that of the right, and there is an evident partial paralysis of all his limbs.
11th. His excitement has almost entirely subsided, and the paralysis has so far increased that he cannot walk without support. Stop the vin. ant. and tinct. digital., and give a tonic vegetable infusion three times daily.
14$. His ideas of wealth, of station, and of power have been constantly increasing since his admission. He now says that he began business with a borrowed capital of three hundred dollars, and from that has accumulated a fortune of five millions ; that in the town of Oswego he has one hundred and
44
Earle, Partio- General Parayhis.
[July
fifty mills, each containing five runs of stone, and the whole turning out twenty- five thousand barrels of flour each week ; that a million of dollars has been cleared by this operation ; that he has seven ships at sea, four of them on whaling voyages, two bound to China for cargoes of tea, and one to the Medi- terranean for fruit ; that he has purchased the whole of the United States, except New York and Philadelphia, together with the wheat lands in Canada, and the whole of Mexico, for all of which he paid but one million of dollars; that he owns two coal-mines, one in Virginia and the other in Mexico, all the copper-mines in Wisconsin, one gold-mine in Africa, all of those in Mexico, as well as all other mines of gold and of iron, and that his income from each of these mines is seventy thousand dollars in three weeks; that among the rest of his property are — 1, the Bank of Milwaukee, with a capital of three hundred thousand dollars; 2, three hundred thousand dollars invested at twelve per cent, interest in New York ; 3, stock to the value of five and a half mil- lions in the Hudson River Railroad; and 4, a factory in one of the towns upon the Hudson River ; and that he is about to establish a bank in New York, with a capital of two millions of dollars.
He asserts that he is a J udge of the Supreme Court of the State of New York, and a member elect of the next Congress; that he is to be appointed minister to England; and that he shall be elected as the next Governor of the State, and the next President of the United States after General Taylor. He proposes to start, to-morrow, on a tour to the Catskill Mountain House, the Thousand Islands, Quebec, Montreal, Oswego, Falls of Niagara, Ohio, Washington, Florida, Mexico, and Buenos Ayres, returning by the way of Mexico, Mississippi, Illinois, and Oregon. This journey, he thinks, will occupy his time for four weeks. He intends, after it is completed, to start for Europe, and spend two years in England, two in France, one in Switzer- land, one in Germany, one in Sweden, three in Russia, one in Norway, one in Turkey — in Constantinople — (" Con-con-stan-no-nople," as his impaired enunciation makes it) and one week in Africa, making, in all, eighteen years. He proposes to take his wife and children to Russia with him, in a steamer of one thousand tons burthen, which he will have built expressly for the pur- pose and named for himself and wife. He will freight it homeward with English goods which will yield a profit of $100,000. On its second voyage, he intends to return and to build twenty houses, at a cost of $10,000, each, on one of the docks in New York.
17th. His general sensation is obtuse; his taste imperfect. A portion of the sulphate of magnesia being prescribed for him, it was made into a strong solution which he drank, saying that it was u first-rate Congress water."
21st. The paralysis has extended to the sphincters of the bladder and rec- tum. The patient's speech is variable, being much more imperfect upon some days than upon others. His memory of recent events is almost entirely destroyed. He says that he has invited several guests, among whom are God and Van Buren, to dinner ; and that one of his whaling vessels arrived yes- terday with twelve hundred barrels of oil, upon which he will make a nett profit of fifty thousands of dollars. On being informed of the recent de- structive fire in Albany, he remarked that he did not " own any of the build- ings which were burned, except the Eagle Hotel, the Mansion House, the Townsend House, and the Odeon, which are all insured for their full value." He added that he has " bought all the land of the burned district, and is going to build it up with marble and that he will " immediately give one hundred dollars to the sufferers, and fifty thousand dollars by and by."
There are many sores upon different parts of his body, some of them appa-
1857.]
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45
rently having arisen without any external cause, and others the ulceration of places upon which the skin was abraded in the course of his period of high excitement. Attempting to write his name, his hand is unsteady, moving by partial jerks; and although one or two of the letters are pretty accurately made, others are very imperfect, several are entirely omitted, and there are some unmeaning marks. It takes him probably five times as long to write it as it did prior to this disease. On the second attempt he is somewhat more successful, but his writing is no better than that of a child in his first essay upon a connected fine-hand copy.
September 1. The left pupil is larger than the right; but both are con- tracted.
Sd. He says he is worth ten millions of dollars; that the Lord came down to him ; that he is now sixty-five years old, but the Lord will make him only twenty-five.
bth. Besides his fanciful ideas of wealth, he now has many religious de- lusions. He often calls himself a bishop, or a clergyman, and asserts that he is going to preach in Trinity Church.
11 tli. He says that God is up in the room, on his throne, and is going to preach to-day; asks us to go up and see him. A seton was, this day, in- serted in the back of the neck.
ISth. He talked as follows: " I went up to God, one day, and said, * God,
what is the reason that and are in hell?' His answer was, 'They
are not in the right line of succession with the church.' ' Well/ says I, ' what does the devil do with them when they are first put in there V He said they were first ground down with fire and red hot iron ; afterwards they were ground down with spirits of turpentine and saltpetre. Don't you think that will make them smart?" He then proceeded to give an account of his wealth, and concluded by saying that he was the most eloquent lawyer in the world.
21tli. His pulse is always rapid. It is now 124 per minute, small and regular; pupils nearly equal, tongue slightly coated, bowels regular, the sphincters under voluntary control, general sensation less obtuse than it has been. He writes better than he did, and can stand alone, but cannot walk without assistance. Being asked how much he was worth, he answered " Nine hundred thousand dollars," hesitated a moment, and then added, " No ; God says it is ten millions. I have made ten thousand four hundred dollars while you have been sitting there ; and I own a million dollars' worth of jewels." He then said that hey goes up to Heaven, to see his father, and offered to take his mother up' with him.
The seton produced a considerable discharge throughout the month. The tonic infusion was stopped in the early part of October, and followed, through a large part of the month, by alterative doses of the bichloride of mercury. Under this treatment the discharge from the seton almost entirely ceased, most of the sores upon the body healed, and the appetite and digestion of the patient continued to be pretty good. In the latter part of the month he was attacked with diarrhoea which was subdued by opiates. All the charac- teristic symptoms of the paralytic insanity varied from day to day, but, sub- sequently to the 27th of September, the patient was not at any time better than upon that day. The general character of his delusions remained un- changed. At one time he enumerated the different offices of which he ima- gined himself to be the acting incumbent. Among them were the presiden- cies of several banks, insurance offices, and railroads; a number of bishoprics; No. LXVIL— July 1857. 4
46
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offices under the national government, &c. &c. He made the aggregate sala- ries $76,000 per annum.
On the 3d of November, 1848, the patient was removed from the Bloom- ingdale Asylum to Dr. MacdonaloYs private institution, at Flushing. There, after a residence of some time he began to amend, and at the end of a few months was discharged, recovered. Dr. Macdonald died soon afterwards, and I had no opportunity of conversing with him in regard to this very remarka- ble case. I am informed, however, by Dr. Benjamin Ogden, that no special treatment was pursued which was supposed to have effected a cure, but that Dr. M. attributed the patient's recovery solely to an effort of Nature.
This gentleman is still living. He is in excellent health, both physical and mental, and is engaged in an extensive and successful business.
In the following case, the symptoms, not only in its earlier periods, but along its course, were such as to lead the experienced observer to the progno- sis of paralysis ; and yet, although the progress of the disease was compara- tively slow, and although some of the other most peculiar characteristics of the partio-general paralysis were present, the paralysis itself never appeared.
Case V. — Mr. , a native of the interior of New York, was of medium
stature. He had brown hair, gray eyes, and bilious-nervous temperament, the nervous greatly predominating. His talents were fair, and he received a good common education. He was active, intelligent, and of mild disposition, though excitable. His mother once had an attack of insanity. He entered into business, and when quite young accumulated great wealth by speculating in real estate during the years 1835 and 1836. This fortune, however, he subsequently lost; and afterwards engaged in various kinds of business. He was married and had children. In the winter of 1845-46 he came to the city of New York, in the hope of finding employment. Soon after his arrival his friends perceived that he was eccentric, wilful, and easily excited; more than usually talkative ; self-complacent when speaking of his business capa- city, and elated with great hopes for the future. These symptoms increased. He began to make imprudent purchases; gave away his money, lost sleep, and grew more and more excited until the 23d of February, 1846, when, at the age of 36 years, he was brought to the Bloomingdale Asylum. His friends stated that he had had a cough ever since the preceding summer.
State when admitted. — Emaciated, somewhat sallow ; pupils natural, tongue slightly furred, bowels costive, pulse 110. He is restless, and very talkative, but shows no disposition to be violent. He consents to remain, but thinks that u placing a man, so well as he is, in a Lunatic Asylum, is one of the most ridiculous farces ever imagined." His general conversation is quite rational, and no attempt is made to elicit his exalted ideas. Before his friends leave, however, he in great good humour takes some papers from his hat and re- quests the Dr. to look at some poetry which he has this day been writing. The paper contains six stanzas, the first three of which he says were written by his favourite author, Mr. Tupper. The others are a parody upon them composed by himself. After reading these lines, and hearing a history of his case, I told his friends that I thought there was but little hope of his reco- very.
February 24. R. — Blue mass gr. ij t. d., with an aloetic pill morning and evening.
1857.]
Earle, Partio- General Paralysis.
47
March 1. Skin more natural and he looks less worn; tongue clean, appe- tite and digestion good. Stop mass and pill. R. — Tinct. opii gtt. x t. d.
4th. Bears the opiate well; sleeps sufficiently. Increase tinct. opii.
Four days after admission he wrote a letter in reference to some mineral lands to a gentleman in the northern part of the State, with whom he was entirely unacquainted, requesting him to take men and teams to those lands, procure one or two thousand barrels or boxes of all kinds of minerals and send them to him in New York; stating furthermore, that if the said gentle- man had not money euough to accomplish this object, he might draw upon him. He then proceeds, by way of introducing himself to the stranger to whom this letter is directed, to give a genealogical history of himself, and of his wife. He says that if the minerals should prove to be rich and the lands valuable, the county in which they are situated will become more populous. " We will," says he, " put a bank at your place or in Peru, and it would be a good place for a college for the north of this State, better calculated than any in the State now ; for it might be used for the poor of the State, as well as those who could handsomely pay. I speak of this as an inclination, and not anything which would trouble me at all if it should not be worth anything. And as to the sum to be paid to the noble man, the owner of the farm, the soldier" of the great Revolution — why, I think I would not feel a sigh to pay him $200 a year as long as he lives, without any interest at all, if it would do him good, for I feel perfectly well off, and it would give me much pleasure and contentment to do such a thing."
About the time of the date of the foregoing communication, after reading the advertisements of several valuable houses that were to let in the city of New York, he wrote to the owners, advising them to furnish the houses, as they would then rent more profitably than if unfurnished, and made some preliminary propositions in regard to hiring them. He subsequently wrote the following letter : —
New York, March 20, 1846.
"To the Hon. Daniel Webster —
Sir : As a stranger, and having some business to have done at Washing- ton, which I know to be of great importance to me, if not to our country. * * * For three years I have known what I now write, yet have said nothing ; but now, as the great and good men of both parties, conservatives, are all together, I thought it of great importance; and it is this : That by using the bright sands of the sea-coast, and the small, round, clean stones, or other hard matters, with water-lime, you can make a road from here to the upper part of Oregon, in a month, or less ; because water-lime, mixed with clean stone or glass, or any- thing solid, will make a road much better than a railroad. So far in a month, for instance* make it soft, and mix it clean, and throw it upon the ground as far as you choose, and make it smooth, and, as soon as it is dry, it is, in my opinion, harder than rock. And should the great men of our great demo- cratic nation, now altogether to do right, believe surely, as I do, that, in one day, I could, with that mixture, by the aid of good builders, make one hundred ships a day. And now, suppose a ship was planned large enough to carry thousands. Make it three feet thick and one hundred feet wide, and flat on the bottom, having large places all along its side or bottom, to take it up if necessary, and put down again. Well, it would require no ballast ; and round the sides, from the bottom to the top, and, while it is soft, at the bottom fix a keel, as low as profitable, that can at any time be hauled up for other purposes ; such a ship, in my opinion, would draw but little. And, as far as war was concerned, no common shot or ball could hurt anyone ; for it is a rock, smooth, and the balls would slide under. Now, build as many as you please, in a month, and put them together, and in two or three days they could reach England, and everything upon the ocean could be taken without trouble, or anything else.
48
Earle, Partio- General Paralysis.
[July
The reason they would, in my opinion, go so fast, is that they could draw no water, laying so flat, with a deep tiller, if it would be thought right, and with engines of the screw to give them their power ; when they were wanted for something else, it would be well to have the engine screw put in the bottom, so that you could bring it within the ship, and have rollers under, which would cross any land one hundred feet wide ; and make a railroad or road of hard rock, and as fast as the stuff could be thrown out (I mean the sand-lime and stone), the engine within would roll the rollers under the ship, and make the road smooth and ready for use as soon as it was dry. And, before it was dry, the same material would make a fence as high as would be necessary for any- thing, by sticking them down when wet. Carriages, and everything, almost, could be made, and will be, and buildings (safe from all fire) which now cost so much, could be built by my patent for a little. Now, in my opinion, should it be thought right, and above all question, in my opinion, England could be made a State of this Union, and all Europe, and this hemisphere, and the whole world, could easily be made one democratic kingdom. And now it is useless for me to say more at present. I have wished to be secured in the Patent Office for this matter for all time. All I have acted upon was a trial in digging a hole for a post, and putting it in, and throwing in this material, and it became stone. If such an arrangement could be made with our great men, say H. C, C, the Secretary of State, Mr. A., and the best in Washington, why, I think, without spilling any blood, an arrangement might be made with England, let- ting them have their titles they now have, and making them and their great men only as farces, our own great men to rule the world. I believe it was Napoleon who said, before thirty years, that Europe would be democratic or Russian. Now, I have been reading the great argument of Senator C. upon our position with Great Britain — wonderfully correct, and, with one exception, true. But he thinks to possess Mexico. It would cost millions. Why, it is all wrong, for it would cost nothing to speak about. If it would be allowed by our Union for a man to undertake the control of Mexico on his own account, I am sure it could be done in a month, and could be done without asking a cent from the country. I would begin a road with my mixture at Washington, via New Orleans, and, at the same time, make arrangements with the wire tele- graph to use it under ground instead of above, for the use of the Government. There would be no hindrance from water or land in running such a road through to Mexico, with such a fence that few could get over on each side of it, and no guns could hurt or shatter the machine or ships. No blood would be spilt, but all taken.
" Now, not to let it be known that ships and other things are made in this way, it would be extremely necessary that the patent should be concealed, and the ships covered with sheet iron, and call them iron ships. And as to Canada and New Brunswick, it would be all the same, and I truly believe, if the ques- tion was placed by the great men of this country at England, with our ships in sight, that they would be satisfied to become part of our Government, and in doing this without much trouble. It would insure unto the United States the government of the whole world, making it democratic, or allowing the great men of their country to join with ours in the government ; and it would be a wonderful affair in respect to the religion of our Maker, for now the news of the arrival from Europe is, that England is now in war at the East, and many thousands have been killed lately ; and now is the time to put a stop to this business. If I am right in my idea of the great and wonderful power our Maker has given to this country, no argument, in my opinion, can be made which can be a conviction of truth against this : that the United States should do her most to gain the control of all they can, simply for the defence of their own liberty, and the liberty of the whole world.
" I shall say no more at present, but, at all events, as soon as you get this patented for me, and if you think I am wrong in my ideas of right, why keep this a secret, and return it to me. I would have no man see it, if your opinion is against it, as far as the Government is concerned.
Yours, respectfully, J1
"P. S. — Show this to Calhoun, and let me hear from you immediately."
*
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Earle, Partio- General Paralysis.
49
He wrote several letters to his wife. The following extracts are made from one of them : —
" My happiest moment in life is now, I am well beyond all question, and healthyer than I ever was before.
"I am so well that I have grown so strong and healthy that you would hardly know me. I was measured yesterday and found myself at least 6 feet high with boots on, my whole body looks as straight as it could be, and I cannot alter it. I feel great in my power which has been given to me by my Maker, for there is nothing I can not do in business and the following year will test the question."
* * * "I can write any thing, poetry, argument, and can sing as well as I wish, and sing without knowing any thing, but with my ear, when I get through this I will give you a happy song, of three or four verses which I think will be suitable to the occasion. I have written to W upon country matters."
* * * " I can follow Tupper and I think I can do what he has done." * * * "And now to' thro' off all nonsense I will write a few verses as I said I would
" Dear blessed sweet a dear Queen
Always so beautiful, as the sun shining Upon the Earth which our Maker, green Has given to you and to me, rising. Upon this wonderful world beautifully seen With our eyes beautifully shining, devising Our word of the great truth, upon which we lean Given by the Lamb of our Maker so, rising Above the great world, by our Redeemers will, That you and me, with holy thoughts, sighing Away our delightful selves, so still To our Redeemers ; wonderful rising From death, to his everlasting good
Which wakes you dearest, and your loving .
Tn this beautiful world our hearts always good, To Our Redeemer, which always will make us Nature Nobleman, and quean with our Dear blessed hearts in one hand, in one hand."
May 29. He has gained much flesh, his appetite, digestion, and general health are very good, and there appears to be no indication for further medical treatment.
From the time of his admission his restlessness and excitement have gra- dually subsided. He is perfectly calm; and a stranger, in a short conversation with him, might not perceive anything peculiar. To those around him, how- ever, he frequently enlarges upon his magnificent schemes. He imagines that he has more talent and skill in everything than any other man. In literature, particularly, he believes no one to be his equal. He really plays skilfully at cards and nine-pins, but is irritated at the least opposition.
After this he continued very slowly to improve, although he was subjected to no further medical treatment. He had the liberty of the premises, upon parole, and passed much of his time, during the summer, sitting or lying in the shade, reading. He less and less frequently alluded to his extravagant notions, and throughout most of the winter could not be induced either to speak or write anything in reference to them. It was believed, however, that he still secretly entertained some of them; and a degree of his self-compla- cency was still exhibited. In the course of the winter he did considerable writing for the officers of the institution, copying documents in a good, legible, and firm hand.
Discharged, much improved, January 2, 1847. He went to his home. About two months afterwards he called at the asylum, and appeared to be in nearly the same condition as when he was discharged. He now attempted to
50
Earle, Partio- General Paralysis.
[July
obtain employment in the city, but his friends were obliged to send him again to the country, as he was considered unfit for business. On the 20th of May, 1847, he was taken, handcuffed, to the Utica Asylum. For a time he was excited and somewhat destructive. His ideas were exalted, and in the daytime he was almost constantly in motion. He said he was going to be President of the United States; that he owned the State of New York, and was going to plough it all with a plough made of cement. He pretended to communicate with his wife, and with the government, by telegraphic despatches. He thought his food was poisoned, and at length refused to eat, so that it became necessary to feed him. There was no evident defect in his speech or gait. In the au- tumn he became more calm, and joined others in playing cards ; but even in his best condition, if he was alone, he was constantly walking to and fro, rub- bing his hands, and pretending to be making worlds.
After a few weeks he became more excited, and it was necessary to confine him in a darkened room, and, at length, to his bed. Here, during the day, he still talked almost incessantly — the making of worlds being a prevailing topic. In the winter he had an attack of cerebral congestion, unaccompanied by spasms. He roused from the immediate effects of this, but his mind was much more impaired than before. Afterwards he had illusions and delusions simulating those of delirium tremens. He imagined that he saw devils, and struggled in encounters with them.
During the last few weeks of his life it became necessary to feed him, and his bowels were moved only under the effect of powerful cathartics. He was emaciated and ghastly, and his mental faculties almost entirely prostrate. He died on the 2d of May, 1848.
The principal pathological appearances of the brain were as follows : Thick- ening and opacity of the arachnoid pretty general; bloodvessels enlarged; pia mater much injected; about four ounces of serum in the cranial cavity; sub- stance of the brain generally softened.
In the autumn of 1848, I was requested, by Dr. H. D. Bulkley, to see a patient then under his medical care at the New York Hospital, some of the symptoms of whose case were very similar to those of the partio-general pa- ralysis. The man died soon afterwards, and Dr. J. B. Arden, formerly one of the house physicians of the hospital, furnished me with the following brief history of the case : —
D , set. 33 years, resident of New York, boatman. About six
months ago the patient had a slight apoplectic attack, from which he so far recovered as to be able to walk about in three or four weeks; but he has never completely recovered the faculties of his mind. He has lost his memory and the ability to recall the appropriate names of objects. He has not complete control over his lower extremities ; walks with difficulty and unsteadiness ; does not complain of pain in the head. The pupil of the left eye is much the more dilated, but is slightly acted upon by light. General health good.
Nov. 2. Patient remains about the same; has no pains; walks about the hall with the aid of a stick.
Dec. 4. Patient last night had an apoplectic attack, with tonic convulsions, and in about six hours died.
Autopsy, eighteen hours after death. — On opening the cavity of the cranium, there was found a large effusion of blood under the arachnoid membrane and around the medulla oblongata. The lateral and fourth ventricles were filled
1857.] Packard, Cases treated in the Pennsylvania Hospital.
51
with fluid blood, in which were some coagula. There was no marked softening of the brain. The right vertebral and the basilar arteries presented an appear- ance resembling a varicose vein, or like a string of beads; in other words, there was aneurism of these vessels. The basilar artery was in one point as large as a pea, and this enlargement was situated under the pons Varolii. Other organs healthy, as far as examined.
Art. IV. — Reports of Cases treated in the Pennsylvania Hospital. By John H. Packard, M. D., late Resident Physician at the Pennsylvania Hospital.
Severe Injuries of the Head. — Perhaps there is no class of cases in surgery which require the exercise of nicer discrimination or more careful judgment to bring them to a successful issue, than severe injuries of the head, especially those involving fracture of the skull. Rightly to decide when and how to interfere, and when to maintain a "masterly inactivity," how long to deplete, and when properly and safely to stimulate, must always be a matter of pecu- liar nicety, as well as of weighty responsibility.
In the summer of 1855, several cases of this class were treated in the Pennsylvania Hospital ; and it is hoped that the following notes of three of them, taken at the time, may be of interest as bearing on the above-mentioned points : —
Case I. Severe Compound Fracture of the Skull, with Compression of the Brain; Recovery without Operation. — Alex. Macaulay, set. 22, a baker, of somewhat dissipated habits, was admitted into the Hospital, July 3, 1855, at 7 J P. M.; having shortly before received a severe blow on the head with an iron bar. On the right side of, and parallel to, the sagittal suture, there was a lacerated wound of about four inches in length, and a corresponding fissure in the bone ; no depression could be detected, and there had been but slight hemorrhage.
He was entirely insensible, collapsed, and showed symptoms of compression of the brain, such as stertor, and slow, laboured pulse. There was, however, no paralysis, and his pupils were entirely natural.
His head was shaved, the wound closed by adhesive strips, and cold applied ) counter-irritation, by means of sinapisms and heaters to the legs and feet, was also ordered..
Drs. Peace and Norris saw him about 10 P. M., but no operation seemed called for.
July 4. Dr. Pancoast saw him, and ordered nitrous powders every 3 hours. Calomel gr. v to be taken at once. P. M. The calomel purge not having acted, I ordered it repeated, and followed by an injection.
bth. Pulse 44 in the minute, and full. Insensibility continuing. On bleeding him to f^xij, his pulse rose to 60. Cups were afterwards applied to the back of his neck, and 30 American leeches over each ear.
Qth. He showed symptoms of erysipelas, which soon involved the whole scalp and face. This was treated with an ointment of zinci ox. ^ss ; axung. ^j.
52
Packard, Cases treated in the Pennsylvania Hospital.
9th. He is still stupid; matter discharging freely from an opening made yesterday by Dr. Pancoast, just over the left ear; the original wound healing up very kindly.
10t.h. Gums touched; stopped the powders, and began stimulating him by beef essence, brandy and quinia.
After this, his mind gradually cleared up, and his general condition steadily improved. An abscess formed over the angle of the jaw on the left side, but this healed up well after the discharge of the matter, and
Aug. 9. He left the Hospital, cured.
Case II. Compound Fracture of the Skull; Recovery. — Gr. M. C, set. 25, an American, of weak mind and dissipated habits, was kicked by a mule, July 6, 1855, at about 9 o'clock P. M.
He was taken into a drug store, and thence, at 10? P. M., to the Hospital.
At this time he was unmanageable, screaming violently when touched, and resisting any attempt at examination of his injuries. These consisted of a lacerated wound about 2 inches long, just over the right superciliary ridge, and an apparently considerable depression of the bone above. The hemor- rhage was very slight. His restlessness and excitement were so great that he had to be confined.
Dr. Peace saw him at about midnight, and etherized him with a view of trephining; but being thus enabled to examine the injury more closely, he did not consider the operation as called for. The wound was therefore closed with strips of isinglass plaster, the patient's head shaved, and cold applied, especially over the forehead. He continued very restless and excited through the night, but slept a little towards morning, and became much calmer.
July 7. His condition was much the same, except that he continued calm unless agitated by questions, or by noise in the room. His excitement returned at once if he was at all disturbed. Dr. Pancoast saw him, and ordered a diaphoretic mixture, and low diet.
8th. His pulse being slow and laboured, and his restless stupor continuing, he was bled to f^xvj, with immediate alleviation of those symptoms.
9ih. Some fever. He was ordered nitrous powders. Diaphoretic mixture also continued.
10th. His bowels having been confined a day or two, he was ordered calomel gr. v, to be followed by a purgative enema.
His excitability began to pass into mere peevishness, and he gradually acquired more command of his senses, begging to be allowed to smoke, &c.
The case progressed favourably until
17th. He became very uneasy again, so as to require confinement. Some signs of erysipelas appeared on his face ; he was placed on the use of stimuli, and the nitrous powders were stopped.
He was not so well ; stupor increased again ; pulse 86, feeble. In- creased his stimulus.
20th. A good deal of stupor; erysipelas advancing.
21st. Stupor less; pulse 44, weak. He had slight diarrhoea, which was not interfered with. Appetite bad; some apparent difficulty in swallowing. Erysipelas fading.
22<i. He seemed much better; erysipelas nearly gone; diarrhoea much less. Pulse about the same as yesterday ; appetite better. As he complained of his feet and legs being cold, they were covered with woollen socks, sprinkled on the inside with Cayenne pepper; a mustard poultice was also applied to the nape of his neck. This application was repeated once or twice afterwards.
1857.] Packard, Cases treated in the Pennsylvania Hospital.
53
He continued to improve, and
26/A. His friends removed him, apparently quite well. In January, 1856, I saw him in town, driving his sled, and perfectly well, although of course weak minded, just as before his accident.
Case III. Concussion of the Brain. — The following case afforded as in- teresting an instance as could well be imagined, of the gradual awakening of the mental powers, stupefied by a severe concussion.
J. D., aet. 25, a designer, was admitted to the Hospital at 1 o'clock P. M., August 29, 1855. An hour or two before, he had fallen three stories through a hatchway, striking first, the bystanders thought, upon his right hip.
He was entirely insensible, but restless and somewhat unmanageable. A small puffy tumour existed near the crown of the head, but there was no evidence of any fracture of the skull.
The right lower extremity, from the hip down, had been withered by chronic disease, but presented no mark of recent injury.
He had been treated, before his admission, by cut cups to the nape of the neck, and a hot mustard footbath. His pulse and skin were good ; his pupils, though not entirely unaffected by the light, did not answer well to it. He was ordered at once a hot mustard footbath, and a sinapism to the abdomen; also an enema containing ol. terebinth, f^j, suspended in starch water. Hydr. chlor. mit. gr. vj, were given internally ; to be followed by a purge.
8 P. M. No change in his condition ; his restlessness made it necessary to confine him. 10 P. M. Bled him to f^x. Ordered sinapisms, alternately applied to the calves and soles.
Aug. 30, 8 A. M. Bowels not yet moved. Ordered ol. tiglii gtt. ij. 11 \ A. M. Dr. Pancoast ordered him an enema of assafoetida 5j> suspended in a pint of water; a blister to the nape of the neck, and liq. ammon. acet., aq. camphorae, aa f3ij, every 2 hours. 10 P. M. Ordered the assafoetida enema repeated. At this time he was apparently completely unconscious, but noisy; crying out, but not talking.
31s£. Counter-irritation still kept up. Dr. Pancoast ordered a pill of gr. \ Clutterbuck's elaterium ; this opened his bowels well. As he had taken no food of any account since his admission, he was ordered beef essence. P. M. His pupils answer to the light.
Sept. 2. He began to articulate a little.
3c?. Ordered pil. cath. co. no. ii; a hot mustard footbath at noon, and again at bedtime.
\.th. The same to be repeated, with the addition of liq. ammon. acet. fjfss, every 2 hours, and an enema of assafoetida, as before, at bedtime.
Qth. His mouth being sore, he was ordered an astringent wash. His mind seems a little clearer, and his appetite good, but he has no consciousness, of his passages. He takes up his cup of gruel, and drinks, and then after trying to remember what to do with the cup, he drops it on the floor.
7th. 8 P. M. So much cerebral excitement that I bled him to about f^xvj. Ordered an enema containing 3j of assafoetida to f^iv of water.
8th. Excitement much less. His mind acts very slowly and feebly. If asked a question, he tries to answer, but slowly ; and he often has great diffi- culty in finding the word he wants. Ordered hydr. chlor. mit. gr. ij, potassse nitr. gr. v, t. d.
9th. He cries out " Oh dear !" a great deal; has done so ever since he began to talk, on the 2d. When I asked him why he said that, he said "because he could not think of anything else to say."
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10 th. Pulse 72, skin natural, appetite good. His pupils, when exposed to the light, first contract, and afterwards dilate. He does not know where he is, though more sensible. Powders stopped.
IQth. He has grown much more rational, but his passages are still in- voluntary.
18^. He was for the first time conscious of his evacuations. He got up during the day, but it caused him some headache in the evening.
After this he steadily improved, still however showing signs of mental weakness, and sometimes slight aberration. Thus he would say positively that he had had no breakfast, when he had just finished a very hearty one.
Oct. 4. He was discharged as cured, though still liable to occasional slight confusion in his ideas.
I saw him in the street, April, 1857; he was looking very well, and seemed perfectly to have recovered the use of his mind.
Case IV. — Secondary Hemorrhage occurring fifty-six days after Gunshot Wound of the Thigh; Amputation of Leg; Recovery. — Samuel Kempner, set. 21, a boatman, was admitted into the Pennsylvania Hospital, December 12, 1855, at 4 P. M.; having, at 11 A. M. of the same day, received a pistol-ball in his right thigh. He walked into the hospital, apparently without much difficulty.
A small round orifice, with ragged edges, and surrounded by slight inflam- matory redness, existed on the inner surface of the thigh, about three inches above the joint; a probe, introduced into it, passed upwards and outwards about two inches, but no ball could be felt.
He was bathed and put to bed ; wound dressed with a flaxseed poultice.
Dec. 13. Discovered an ulcer the size of a ten-cent piece, apparently simple in its character, on his penis ; he says he has had it for four weeks ; has dressed it with burnt alum. This was well cauterized with nitrate of silver, and afterwards dressed with warm water. P. M. Some fever ; ordered gr. x of Dover's powder; ol. ricini §j, in the morning.
15^. Still some fever. Much more swelling, and some redness, around the wound. Suppuration not yet free. P. M. R. — Liq. ammon. acet. f^ss, every two hours.
18f&. Some little bleeding from the wound. Applied liq. plumbi subac. dilut.
19th. Whole thigh somewhat swollen.
20th. Swelling somewhat less. Applied a poultice 8 by 10 inches over the wound ; lead-water above.
23d. Greneral condition good. Discharge from wound free, dark-coloured, and fetid. Posterior part of thigh much indurated. Some cough ; ordered syr. scillae f3j every two hours.
2Qth. Yesterday and to-day his thigh has been less swollen, and the dis- charge has been healthier. His knee has become bent and stiffened by lying in the same position so long; but he can extend it better to-day than he could a few days ago. The sore on the penis has healed up.
Jan. 3, 1856. Some fever. A hard, pointed swelling appears to have formed on the back of the thigh, at about the same level as the original wound. The discharge from this latter is very small. Ordered ol. ricini ^j; gr. x of Dover's powder at bedtime.
bth. Fever moderated. Swelling and tension quite marked. Fluctuation being distinct, I made an incision, letting out a large quantity of matter; a poultice was then applied. P. M. The discharge having diminished, I ordered gr. x of Dover's powder at bedtime.
1857.] Packard, Cases treated in the Pennsylvania Hospital.
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12th. He has had a large poultice to the thigh for several days; Very little discharge. Yesterday and to-day he has been feverish. Ordered at "bedtime gr. x of Dover's powder, and a diaphoretic mixture.
lAth. For several days he has had a good deal of pain in the original wound, which discharges a thin, yellow, ropy liquid, like synovia; that from the open- ing at the back of the thigh is thick and healthy, but not copious.
l§th. A small spot of fluctuation existing near the last orifice, an opening was made into it and the intermediate skin divided so as to lay them into one.
19th. There is a good deal of induration at the back of the thigh. He complains of cramps and numbness in the foot. His knee is a good deal flexed, and on straightening it a considerable discharge is pressed out of the openings.
No important changes in his condition occurred after this till
Feb. 3. An attempt was made yesterday to bring the knee into a straighter position by the use of a good deal of gentle force, and afterwards putting the limb on a double inclined plane. During this attempt he said he felt some- thing give way in the thigh.
To-day he feels weak and feverish, and was ordered nitrous powders.
P. M. Just after my evening visit he was reported to me to be bleeding. I hurried to him, and found a strong arterial jetting from the wound at the back of the thigh ; he was quite faint. The hemorrhage was controlled by pressure until a tourniquet could be applied. Some two hours later there was more bleeding, checked by the attendant screwing up the tourniquet. Dr. Peace saw him at about 11 P.M.; applied a horseshoe tourniquet, and ordered anodynes.
Qth, 7 A. M. Slept none during the night. Has pains and cramps occasion- ally. The lower part of the thigh is much swelled, and a clot of blood fills and is nearly pushed out of the wound, from which slight oozing has occurred. His face and lips are very pale, and he feels very weak. Ordered a wine- glassful of brandy and water.
10 J A. M. A consultation having been called, and ligature of the femoral artery decided on, this operation was performed by Dr. Peace in the usual way. The vessel was very small and its pulsations were so feeble as not to aid in finding it. Brandy had to be freely administered before and during the operation.
After this, free suppuration being established again from the back of the thigh and the wound made in ligating the artery healing kindly, all went on well until
15th. Hemorrhage occurred again from the back of the thigh to the amount of about f^x, but was checked as soon as discovered.
16^/t. A consultation was held, and it was decided to attempt to secure the vessel at the wounded part. Accordingly, the patient being placed on his face on the table and a tourniquet loosely applied (pressure being made on the artery above by the fingers), the wound was enlarged to about six inches, and all the clot turned out. After some search, the upper end of the popliteal artery (the distal portion of the wounded femoral) was found and tied. The cardiac end of the femoral was next secured by scraping away a mass of par- tially organized clot which surrounded it. (During this part of the operation, the ball was found flattened against the bone, and with some calcareous de- posit upon it.) These two ligatures were tightened ; a third was placed on another vessel in the wound. The ligatures came away about the ninth or tenth day. Some discharge was kept up from the wound for a good while after.
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Much blood was lost and free stimulation called for during the operation, and when removed to his bed the patient was a good deal prostrated; he, however, slowly reacted, and under a course of active and steady stimulation and nutritious diet did very well.
20th. Wounds doing well. Pulse 124, and pretty strong. Some discolo- ration in the foot, especially over the outer malleolus, where much of the pressure has fallen during his confinement to bed. Sensibility impaired on the anterior and under part of the foot.
The ligature came away about the eighth day.
This discoloration and loss of sensibility became more and more marked until the whole foot and leg passed into the condition of dry gangrene ; the fibula and several bones of the tarsus being laid quite bare in the course of this process. His general condition remained pretty good, but of course he required a supporting treatment.
July 16. The line of demarcation being clearly formed, and the patient's condition good, Dr. Peace amputated the leg just below the knee. Ether was given, and the operation was done by the circular method; the arteries were very small, only five or six requiring ligature ; one, in the substance of the popliteal nerve, bled quite freely and was tied.
After this he had not a single bad symptom, and, on August 21, he was discharged cured, having been 253 days under treatment.
I have been unable to find any case reported in which secondary hemor- rhage occurred later than the thirtieth day ; and the subject is only mentioned in a cursory manner in most works on surgery. The above case may, there- fore, be of interest and practical benefit, as illustrating the impossibility of laying down any precise limits to the period of danger from hemorrhage, and the necessity of constant watchfulness and attention to the processes going on in each particular case.
Art. V. — Statistics of Obstetrical Cases. By Daniel Pierson, M. D., Augusta, 111. (Prepared for, and read before the Hancock Co. (III.) Medical Association, and communicated to the Am. Jcurn. Med. Sci. for publication, in compliance with a vote of the Society?)
I cannot suppose that the brief statistics herewith presented will be con- sidered of great importance, or novel; but the hope of inducing some mem- bers of the profession to take sufficient interest to examine and note interesting points in cases under observation, and thus to add to the reliability of the statistical tables already furnished, as well as to refute errors and false state- ments that have been published, prompts me to add my mite, without any favourite theory or hobby to advocate.
It is too much the habit of many to follow in the wake of those who have gone before, without taking the trouble to stop and think — receiving their statements as truth, and yielding a ready assent to the hypotheses advanced, or the suppositions adduced as facts. The only way that truth can be surely
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discovered is by patient investigation, by collecting and collating isolated facts, and instituting full and free inquiry as to the validity of the points in ques- tion.
I am aware that it may be said of the statistics now presented, that the number of cases is too limited to have any direct and important bearing to the points set forth. It is but the multiplication of streamlets that forms the mass of the "father of waters/' which is able to bear on its current the pro- duce and population of the most flourishing nation of the universe ; and it is by the accumulation and combination of single facts, that great truths and important principles are established.
The abstract of cases from which the following is condensed, I have kept for some time for my own gratification and reference, not thinking, till re- cently, of presenting it to the profession ; but it occurred to me that it might interest some one curious in such matters.
I find by referring to my abstract, that of the cases of obstetrics that have fallen under my care, I have noted two hundred and seventy-four. I regret that I have not kept note of a larger number, as well as more full details, and upon some points not noted. I should perhaps have stated before that I do not claim originality as to the manner of arrangement; but received the plan from the paper of Jno. G-eo. Metcalf, M. D., in Am. Journ. of Med. Sci., for Oct., 1847.
1. The 274 cases of delivery gave birth to 279 children, there being five cases of twins, being 1 to 54a, 0r nearly two per cent.
2. Of the 274 mothers, 272 were married, two were unmarried, and one had been but three months — making three illegitimate children at least, or 1 to 91$. The mothers of the illegitimate children were all young ; the oldest 23 years; the others about 16 or 17. One claimed her size to be due to an en- larged spleen, "ague-cake" of five years' standing, and denied being pregnant till the last extremity. One being obliged from the constant increasing size to admit the fact, claimed to be only three months advanced in pregnancy, unless "she was eighteen months gone;" but was soon delivered of a proper nine months child. The husband of the married one proved himself innocent of being father to the child, as he was unacquainted with his wife till a few weeks before marriage.
3. Of the 274 cases the whole number of times each had been pregnant, was ascertained in 250, and were as follows: 1st pregnancy, 56; 2d, 48; 3d, 47; 4th, 32; 5th, 19 ; 6th, 14; 7th, 14; 8th, 8; 9th, 4; 10th, 4; 11th, 2; 12th, 1; 15th, 1 ; making a total of 887 pregnancies to the 250 patients, or an average of a little over 3 J to each mother, which goes far to show that the majority were young. We frequently find a difficulty in ascertaining with certainty the number of previous pregnancies, as they are often mute concern- ing abortions.
4. Duration of Labour. — It is perhaps the most difficult of all to state the exact duration of labour, from the fact that women themselves date its com-
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mencenient from very different times; some from the first uneasy sensation indicating its approach ; others from the intervention of true expulsive labour pains. I have endeavoured as far as possible to follow the latter. I have rarely if ever known the beginning of labour protracted more than 24 hours after there has been a bloody discharge called the "show," though I have known one case where there was a rupture of the membranes, and a discharge of the amniotic fluid eight days before labour, and one fifteen days, another twenty-nine days, and another forty days previous to confinement j in each there was a full and free discharge at first, and then a dribbling of water until labour; but in neither was there any discharge of water during labour, and all had unusually easy and speedy labours, and the children all did well. Of the 274 cases I have noted the duration in 228; and of this number I find 221 completed within 12 hours, and only 7 over that period; they were as follows: 2 in I of an hour, 6 in 1 hour, 1 in 1J hour, 20 in 2 hours, 1 in 2£ hours, 34 in 3 hours, 43 in 4 hours, 17 in 5 hours, 48 in 6 hours, 1 in 6j hours, 7 in 7 hours, 18 in 8 hours, 5 in 9 hours, 10 in 10 hours, 1 in 11 hours, 9 in 12 hours, 1 in 13 hours, 1 in 15 hours, 1 in 18 hours, 1 in 22 hours, 1 in 23 hours, 1 in 24 hours, 1 in 30 hours, averaging nearly 6 J hours. The case that was protracted to 30 hours was, as it were, compelled to it as follows. The patient, a young woman, primipara, close built, and carrying a large child; a "granny" was called to attend, who at every examination, and that very frequent for the first stages of labour, thrust her whole hand into the vagina; following up this procedure at almost every pain, producing of course great swelling and violent inflammation of the parts; the friends at length became dissatisfied, and sent for a neighbouring physician, but being unable to get him, sent for a Thompsonian, he being the nearest help to be obtained, who only bettered the case by not permitting the midwife to examine the pa- tient quite so frequently, though she had charge of the case with him. But as the labour progressed, the head of the child was delayed by the rigidity and swelling of the soft parts; then, in a quandary, the "steam doctor" and the "granny" held a consultation, and came to the sage conclusion, that "some- thing was the matter, and that something must be done," and that they "must get a new start;" and to that end they decided upon the following plan to accomplish it: They placed the patient topsy-turvy, standing her upon her head, spread her limbs apart, and forced the child bach by direct pressure upon the head. The patient was exhausted by this procedure, and it was some time before pains returned. They became alarmed, and sent for me in great haste, "to go and cut the child in pieces, as it could not be born whole." I found the patient completely prostrated, with but slight pains : there was intense inflammation and swelling of the vagina and external parts, so much so that she could scarcely bear the most careful touch; found the child dead; patient said it had been ever since they forced it back. Administered an. opiate, and enjoined perfect quiet and rest. When she had obtained a little sleep,
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she roused up refreshed, pains came oa with force, and was soon delivered of a fine plump child, entirely by the efforts of nature.
5. Flooding is noted to have occurred between the 6th and 9th month in 6 cases; during labour and before delivery in 12 cases; between the birth of the child and the expulsion of the placenta in 12 cases. In cases of flooding before the birth of the child, I found it greatly moderated by the rupture of the membranes, when between the birth of the child and the delivery of the pla- centa, by exciting the uterus to action and delivery of the same; if not, by the use of opium and sugar of lead, or direct cold applications. In only three cases did it become alarming, and two of those were placental presentations. In the case that assumed the most alarming symptoms, the patient, a stout and robust woman, expecting daily to be confined, was suddenly awakened at night by what she supposed to be the rupture of the membranes and escape of the liquor amnii. She called her husband to go for me as quick as possible, but before he could dress she discovered her situation, and he instantly started for me. I saw her in a few moments, and found her in a pool of blood from her shoulders to her feet, perfectly prostrated, yet flowing in a rapid stream, and without the slightest pain. Upon examination found the uterus high up, and the os uteri but slightly dilated, though not rigid. I was enabled to dis- cover that it was a placental presentation. During examination slight pains came on and arrested the hemorrhage for a short time; but the pains re- laxed and the flooding returned. A similar proceeding produced like results, but no more permanent effect. I endeavoured to induce pains, but without avail. Decided to proceed at once to turn to deliver (contrary as it is to all authority to do it in the absence of pain), but I saw the patient must die if I waited, and knowing that she could not do worse if I proceeded, thought I would be found trying for the best. Candidly stating to the patient and her friends the nature and danger of the case, and telling them that according to statistics there was only about one chance in ten to save her, they readily and freely submitted to my judgment, and wished me to proceed as quick as possible. Found some difficulty in dilating the os uteri so as not to detach the placenta entirely. The child was high up, and the membranes unbroken ; ruptured them, and proceeded to turn and deliver as carefully as possible. During the operation slight pains came on, and the womb contracted slowly; delivered her of a fine large child, weighing 12 pounds, but dead. Removed the placenta, and by the most perfect quiet and composure, dangerous hemor- rhage was averted; but for forty-eight hours the slightest effort, even to raise a hand, or turn her head, or move a foot, reproduced flowing that could alone be arrested by the application of cold water to the pubic region, and that had to be continued for some time before it would succeed, but directed always to desist when it caused a chill to the patient. She ultimately had a rapid and favourable recovery.
6. Convulsions occurred four times in the 274 cases, in three before and in one after delivery. One of each was very slight. In one case the patient
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was in most violent convulsions for five hours before I saw her — presumed to be caused by violence received from a drunken husband — she was in her eighth month. By copious bleeding and free use of antimony, the convul- sions were mitigated, but continued slightly till the child was born, after which she remained in a perfectly comatose state for forty-eight hours, when she ceased to breathe; she never appeared to be conscious but for a moment or two at a time (and that but twice) after I first saw her. The others all recovered.
7. Puerperal Fever, in five cases — about 1 in 55, including puerperal peri- tonitis and metritis, proving fatal in but one case.
8. Presentation. — Of the 279 children the presentation is noted in 265 cases, as follows: vertex, 232; occiput, 20; face to the pubis, 3; foot, 3; foot and knee, 1 ; face, 1 ; breech, 1 ; side, 1 ; placental, 2. Two of the foot-presentations were twins. The above shows a very large per cent, were vertex, and about five per cent, occipital; the percentage of the other very small. One case of face to pubis was complicated with funis presentation; labour tedious, and child still-born.
9. Sex. — Of the 279 children the sex is noted in 270, viz., males, 144; females, 126, being a majority of 18 males.
10. Weight. — Of the 279 children, the weight was ascertained in 248; of these, 235 were at full time; the aggregate weight of the 235 was 1923 lbs., being an average of a little over 8 lbs. ; there were 88 that weighed 9 lbs. and over, and 28 that weighed 10 lbs. and over; the heaviest weighed over 12 lbs.
11. Diseased. — Of the 279 children, 3 are noted as diseased; 2 of which had hydrocephalus, the other not stated.
12. Deformed. — None, unless we except one born with a prominence on the left clavicle, which I doubt not was caused by an intra-uterine fracture., but had become united. The mother had fallen, some six weeks previous, on the edge of a board, which hurt her very much at the time.
13. Dead-born. — Of the 279 children 19 were stillborn, being nearly 1 in 14; of these, but 7 were at full time; 2 had been dead for some time, and were putrid; 1 was killed by an officious granny. Those that were not at full time were 2 at 2d month, 4 at 3d month, 1 at 6th month, 2 at 7th month, 1 at 8th month, and 2 at 8 J month.
14. Month of Delivery. — The periods at which the 279 children were deli- vered are thus noted — Month of Pregnancy: —
No. . . . 11111 1 1 _! 6 _5_ 252 Jl_ Month . . 7 I' 7 5' 6' 6]' 7 TV 8~? 8? IP W If we call all before six months abortions, and after that and before nine months miscarriages, we have eight cases of abortion and nineteen miscar- riages. Though I have not much faith in prolonged gestation, I have one noted as such — but many have claimed that they have gone over their time — in this case I thought the patient's reasons were good, if ever they are.
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It will be seen that the child born at five months is not placed among the stillborn; I have no reason to think that the mother was further advanced than that, and she thought not quite that; yet the child lived for half an hour at least. The child that was born at six and a half months lived some six hours ; the mother was in the last stages of cancer of the breast, and though she rallied well after delivery, she lived but about twelve hours.
15. Month of the Year the Children were born, is noted as follows: — January, 32; February, 21; March, 30; April, 26; May, 17; June, 14;
July, 22; August, 26; September, 27 ; October, 22; November, 15; De- cember, 27. Which was, during the Spring months, 74; Summer, 62; Autumn, 64; Winter, 80.
16. Hour of Delivery. — Of the 279 children, 166 were born between midnight and noon, and 113 between noon and midnight.
17. Twins. — In the 274 cases of delivery there were five in which there were twins. In three cases both children were females, in the other two both were males. In one case, there was but twelve minutes between the birth of the children; in two cases fifteen minutes, each; one case half an hour, and the other one hour and ten minutes. In two of the cases there were ,two placentas for each pair, but united together. In two cases but one placenta for each pair, and in the other case two separate placentas. In three of the cases both of the children were vertex-presentations; in each of the others one child presented head and the other foot.
18. Force Deliveries. — In the 274 cases of delivery, force was used in but three cases; two of those were placental presentations, when version and de- livery were necessary to save the mothers. In the other, craniotomy was per- formed on a dead child to save the mother, who was rapidly sinking, but, by the free use of stimulus after delivery, she had a favourable recovery.
19. Time between Birth of Child and Delivery of Placenta, is noted in 252 cases, and were as follows : four were expelled immediately after or with the child — 1 in 2 minutes, 2 in 3 minutes, 73 in 5 minutes, 14 in 7 minutes, 5 in 8 minutes, 94 in 10 minutes, 6 in 12 minutes, 29 in 15 minutes, 4 in 20 minutes, 5 in 30 minutes, 2 in 40 minutes, 1 in 45 minutes, 2 in 60 minutes,
1 in 1 hour and 20 minutes, 2 in 1 hour and 30 minutes, 3 in 2 hours, 1 in
2 hours and 30 minutes, 1 in 24 hours.
It may be well to state that so soon as the child is handed to the nurse, my practice is to place my hand upon the abdomen of the mother, and if the uterus is contracted upon the placenta, without further delay I take hold of the cord and tighten it, though not to apply force, and generally pains soon supervene and discharge the placenta. I have had several cases of hour-glass contraction of the uterus retaining the placenta in the upper portion, when it has been necessary to introduce the hand to deliver it. The case that was delayed twenty-four hours, I was merely called to deliver the placenta; the physician that attended during labour — which was premature — left without delivering it, though he told them that he had found no difficulty in the No. LXVIL— July 1857. 5
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case except that it was very frail. There were one or two cases where the placenta was ossified, or points of ossification through the whole mass, and would break with decided crepitation.
20. Position of Placenta is noted in 162 cases; in 90 it was attached to the left side of the uterus, 47 to the right side, 13 to the anterior, 5 to the posterior, 5 to the fundus, and 2 to the os or cervix uteri.
I have used ergot frequently without harm to mother or child, and some- times greatly to the relief of a worn-out patience, but never, unless the os uteri is fully dilated, and there is a cessation of labour-pains.
Ether I have also administered in numerous cases, in all with great relief, some more than others, and have not known ill effects in any case. I have not used chloroform.
I have known at least two cases where menstruation has been regular dur- ing the entire period of pregnancy.
Absence of Lochia. — I have known two cases where the patients did not lose, one not a drop, and the other not a spoonful of blood during labour or afterwards, and had no lochial discharge during convalescence, and yet both had a safe and rapid recovery.
Colourless Lochia. — I have also had several cases come under my observa- tion, in which the lochial discharge was so devoid of colour as not to stain the clothes, and yet the patients did well.
We can easily conceive of a case that might require legal investigation, where there had been uninterrupted menstruation during pregnancy, followed by an absence of lochia or a colourless discharge — which might lead to some difficulty in coming to a just decision.
Unbroken Hymen. — I was called to attend upon a lady in labour, who had been married about a year, and upon making an examination to discover the progress of the labour, found that the hymen was unbroken, the orifice not being large enough to admit the tip of my finger. It was ruptured without difficulty, and the case had a happy issue.
Occlusion of the Vagina. — A case of almost complete occlusion of the vagina, caused by officious handling and unwarrantable abuse during a previous labour, producing violent inflammation and adhesion of the wall of the vagina to such an extent that the patient and her husband thought it impossible for her to become pregnant, and would not believe that she was so, till forced by attending circumstances to admit the fact. When labour supervened, I was sent for — about thirteen miles; — when I arrived, found her under the most violent expulsive pains, and the only orifice thus fully dilated would not more than admit a goose-quill. I explained the nature of the case, and the danger of an operation under such circumstances, viz., of vesico- vaginal and recto-vaginal fistulae — from the ease with which the divided parts would tear, and thus extend to the rectum and bladder. But being urged to prompt action by the patient and her friends, and knowing that the only recourse was to operate
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with care, and endeavour to support the parts during the progress of labour, I proceeded with a probe-pointed bistoury to enlarge the opening, and so soon as possible to explore with my left index finger as I advanced. The complete and firm adhesion was from one half inch at the anterior, to one and one-half inches at the posterior part of the vagina, the whole distance cutting through solid flesh or cicatrix. The adhesion was from the internal labia inward. There were also several large and rigid cicatrices still farther inward, that I was obliged to divide before the head of the child could pass — as they were hard and unyielding bands that would not admit of distension more than a whip-cord.
As I feared, and stated to the patient, the cut surface lacerated posteri- orly to the rectum, producing a very small recto-vaginal fistula, though so small as never to trouble her; it also tore anteriorly to the neck of the bladder, producing a vesico-vaginal fistula — for which I have operated, and she has since been entirely relieved from all trouble on that account. I have since attended her during labour, and she had in every respect a favourable labour and convalescence. In a medico-legal point of view, the two preceding cases go to show that pregnancy may take place without the introduction of the penis.
I have one patient in whom the secretion of milk took place at four and a half months of pregnancy — she went her full time, and " never had a dry bosom for an hour at a time, for four and a half months before delivery." The secretion was very copious.
One child numbered in the foregoing abstract was born with the membranes entire — it was the last of a pair of twins at eight and a half months.
One child was born with leucorrhcea, which lasted two days, when occurred a regular appearing menstrual discharge, which continued four days.
Pregnancy without sexual pleasure. — A very intelligent lady, who has been married for some time, had the usual symptoms of pregnancy, and the object of her inquiry was, whether such could be the case, whereas she had never enjoyed the least pleasure during copulation, but it was to her a matter of in- difference, so far as desires were concerned; yet the result proved that she was then some three or four months advanced in pregnancy. She is a lady whose word is above suspicion, and her very manner of inquiry would forbid the thought of it, and she was desirous to know wherefore these symptoms, when she thought pregnancy out of the question under the circumstances.
I have known also two other very similar cases, in which there was no pleasure arising from coition, and in one it was always a matter of repug- nance, and still pregnancy took place. One patient that had been pregnant six or eight times, has always become so whilst in the act of menstruating, and she believes that in her case it would be impossible to become so at any other time.
As already said, I am aware there is little or nothing, in this paper to ex-
64 Gallaher, Potash in Mercurial Stomatitis. [July
cite wonder, and some of the latter statements may not be considered in place in connection with the abstract; but I report them as growing out of the same cases, and on account of their rarity. Augusta, III., April, 1857.
Art. VI. — Chlorate of Potash in Mercurial Stomatitis. By Thomas J. Gallaher, M. D., one of the Physicians to the Western Pennsylvania Hospital, Pittsburg.
Mercurial stomatitis is a most loathsome and obstinate complaint. Slight attacks of this affection are comparatively of but little consequence, for, with proper precautions as to exposure, they will mostly disappear in a short time without remedial measures being resorted to. More grave forms, how- ever, in which the gums become very sore, the tongue swollen, the mucous membrane of the mouth ulcerated, the salivary and other glands in the vicinity of the neck enlarged and tender, the breath fetid, the jaws stiffened, deglutition difficult, salivary secretion increased, &c, are of more serious im- port, and demand the attention of the physician. If a case of this kind be left to itself, or if merely palliatives be employed, it will generally last some weeks, and it may be months before its complete removal by nature is effected.
Many remedies have been suggested and various plans of treatment tried for the removal of this artificial malady; but none, until the chlorate of potash was proposed, met the wants of the profession, and none gave general satisfac- tion. Hecent authors have generally contented themselves with recommend- ing exposure to a warm dry air, cathartic medicines, topical depletion, and the local application of numerous washes — demulcent, astringent, and stimu- lating— to the inflamed parts. How uncertain and unsatisfactory these means have been, the profession everywhere can answer. For my part, I may say that I have often been so dissatisfied with the slowness with which mercurial sore throat disappeared under this treatment, that I thought no good was derived from it further than temporary amelioration of disagreeable symptoms and preservation from external injurious influences. This treatment is emi- nently palliative — not specific. Present relief is afforded — while the affection is allowed, in a great measure, to run its own course.
Recently, a new remedy has been proposed which, from a pretty extensive employment of it, I now regard as much a specific for mercurial stomatitis as quinia is for intermittent fever.
Ihr was the first to recommend the use of the chlorate of potash in ulcera- tion of the mouth following salivation, but to Messrs. Herpin and Blache, of Geneva, are we indebted for a more full and satisfactory account of the
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beneficial effects of this salt in mercurial stomatitis in all its forms and stages. The first account of the discovery of these eminent physicians which appeared in this country, was published, I believe, in the April No. of the American Journal for 1855. Since that time I have had frequent opportunities for employing it, and uniformly with success. I have seen ordinary mercurial stomatitis disappear under its use in a few days, while the most loathsome forms have been observed to yield in ten. Judging from past experience, I now, with the use of this salt, can remove a mercurial disease of the mouth in from six to ten days, which, under any other proposed plan of treatment, would last from four to six weeks. I may say that I have found it equally beneficial in all stages and degrees of salivation, as well as in ulceration of the mucous membrane of the mouth, which sometimes remains after the other symptoms have disappeared.
My method of treating a patient affected with this disease is as follows : He is placed in a warm and comfortable apartment, and made to live on gruel. I then order him" ten grains of the chlorate of potash, dissolved in a table- spoonful of cold water, three or four times a day, according to the severity of the affection. Should there be ulceration of any portion of the mucous membrane of the mouth, I direct a weak solution of the salt to be applied to the denuded part several times a day. Generally, nothing else is required — the cure being accomplished in a few days. To illustrate more fully the effect of this remedy, I have appended a few cases, which have been selected from quite a number that have fallen under my notice.
Case I. The first case in which I had an opportunity of employing this remedy, was in May, 1855, on the person of a young lady, aged 26 years. Blue mass pills had been given her pretty liberally, by the family, for some imagined illness, until her gums and mouth became so sore that it was with difficulty she could swallow food. After suffering some days under these symptoms, I was called to visit her. I found her breath fetid, gums sore, mucous membrane of the mouth partially ulcerated, and other unmistakable evidences of confirmed salivation. For a few days I gave the usual mouth washes, a gentle cathartic, and required her to remain confined to her room. For about one week she used the means I suggested, with but little advantage. At this time I was made acquainted with the good effects of chlorate of potash in mercurial stomatitis, and at once determined to put it to the test. I accord- ingly prescribed it as follows : R. — Potass, chlorat. 3ij ; aquas ^vj. — M. One tablespoon ful of this solution to be taken three times a day. I saw the patient two days afterwards, and found her much better. Her mouth had commenced to heal, the mercurial fetor of the breath had diminished, and she felt able to swallow food. In a week from this time the disease was entirely removed.
The speedy relief obtained in this case gave me some confidence in the new remedy, and satisfied me that it was worthy of further trial. An opportunity soon occurred.
Case II. Miss C , aged 23 years, while employed in the capacity of a
dry nurse, was attacked in the spring of 1856, with severe neuralgia of the
66
Brown; Potash Injections in Lencorrhoea.
[July
right side of the head and upper part of the face. The physician to the family in which she for the present resided was called to see her, who pronounced it disease of the brain. Powders containing calomel were ordered. She took the medicine a few days, but her mouth becoming very sore, and her sufferings not being alleviated but rather increased, her friends determined to take her home and send for their family physician. I found the patient labouring under remitting hemicrania of most excruciating severity, accompanied with mercurial salivation. The severity of the symptoms requiring active medica- tion, I ordered at once remedies both for the neuralgia and sore mouth. A liniment, composed of chloroform and olive oil, was ordered to be applied to the head and temples, and ten grains of the sulph. of quinia to be given night and morning, for the former, while ten grains of the chlorate of potash, three times a day, was prescribed for the latter affection. In three days the hemi- eranial pain had subsided, when the quinia was suspended. The sore mouth had, in the mean time, improved. Four days' more employment of the chlorate stopped the salivary discharge, and healed up the mouth. The cure was prompt and decisive.
Case III. In January, 1857, 1 was called to visit a Mrs. M , who com- plained of a bad breath, sore mouth, loss of appetite, &c. I learned that, about one week previous to my visit, she had taken some anti-bilious pills, which were supposed to contain mercury. An examination of the mouth told at once the cause of her sufferings. She was severely salivated. Nothing had been done, further than a Dover's powder had been taken at bedtime, to work the cold off, as she expressed it, and an alum wash for the mouth had been used freely. It may not be improper to state that no advantage was derived from these. The patient was directed to remain in her room, live on spoon diet, and take the chlorate in ten grain doses, three times a day. On my visit the following day, she was much better, and declared the first dose helped her. A continuance in the remedy effected a perfect cure in a few days.
Case IY. This was a case of ulceration of the mouth following salivation. It was of nearly three weeks' continuance, and many local applications, in- cluding nitrate of silver, had been ineffectually made to it. I gave the chlorate in the usual form and frequency, and ordered the ulcer — which was situated beneath the tongue, of large size and very painful — to be washed several times a day with a weak solution of the game, and had the satisfaction of seeing it heal up in five days.
ART. VII.-— Chlorate of Potash Injections in Leucorrhoza and Ulceration of the Os Uteri. By Bedford Brown, M. D., Caswell County, N. C.
Knowing the peculiar and happy curative influence exerted by chlorate of potash in external ulcerations attended with vitiated discharges, and having been so often disappointed by the usual modes of treating such cases, the great difficulty of which all medical men acknowledge, I determined to experiment with injections of a solution of that salt in ulceration of the os uteri and cer- vical canal attended with leucorrhoea.
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The discovery of some simple and efficient means as a substitute for the uncertain astringent injections in common use, and the tedious and often unsuccessful caustic and speculum, would relieve the physician of an extremely disagreeable duty, and the patient of an almost intolerable necessity.
In those cases of leucorrhoea attended with ulceration of the os uteri or cervical canal, and enlargement of the muciparous glands of the vagina, or simple ulceration without leucorrhoea, I believe the injections of the chlorate far more certain and efficient than the ordinary astringent injections, or the local application of caustic. In these cases I have not thought proper to give detailed reports of their symptoms and progress.
Case I. A coloured woman, aged 30, who had never borne children, and had, from early life, complained of symptoms of uterine disease. At the time she came under my charge, she had profuse leucorrhoea. On examination with the speculum, the entire vaginal canal was seen highly inflamed — the os uteri very tumid, with numerous large ulcers. This woman used, by injection, a solution of the chlorate, in the proportion of 3j of the salt, dissolved in ^viij of rain water. As much of this as an ordinary female syringe contains was used twice daily. Under its influence the ulceration and inflammation, with the attendant leucorrhoea, diminished rapidly, and in two weeks all indi- cations of disease had disappeared. In this case, the locality of the disease was confined to the vagina and the os uteri.
Case II. To digress from the subject, I would report the present case as illustrating the equal powers of the chlorate of potash in gonorrhoea of the female. This patient, an unmarried female had suffered from gouorrhoeal disease, until the vaginal inflammation had become excessive with very copious, purulent, and exhausting discharges, accompanied by so much tenderness and pain as entirely to preclude the use of the speculum. The difficulty and pain of urination were such as to compel me to use the catheter frequently. The same treatment as in the previous case was adopted, and with equal success. In fact, this patient (servant) who had been perfectly disabled, in ten days after using the chlorate injections, was attending to her ordinary duties.
I strongly conjecture that gonorrhoea of the male would be equally amenable to the same treatment; and, as soon as the first opportunity presents, I design testing it. If so, a new era will be introduced in the management of that intractable disease.
Case III. This was an example of leucorrhoea originating from ulceration of the os uteri and inflammation of the cervical canal. The woman was married, and had been confined prematurely three months previous. She used the chlorate of potash injections, and remained in the recumbent position for some hours after each injection. She found equal benefit from the remedy, and is now attending to her customary duties, without any of her former symptoms.
Cases IV. and V. In these cases there was ulceration of the os uteri and cervix, with very slight leucorrhoea, though suffering from the ordinary annoy- ing symptoms of uterine affection. I both cases, the chlorate in solution healed the ulcerations in between two and three weeks, with signal relief to the patient.
68 Casselberry, Wafer in Treatment of Fever. [July
To sum up briefly, those conditions to which the chlorate of potash injec- tions are applicable, I would say those cases are appropriate, wherein ulceration and inflammation are confined to the os uteri and cervical canal and vagina, either with or without leucorrhoea.
Art. VIII. — The Use of Water in the Treatment of Fever. By Isaac Casselberry, M. D., Evansville, Ind.
Anatomy. — The skin has, in man, a superficies of about fifteen square feet. It is composed of three coats : an outer, called the cuticle, or epidermis, of a horny nature; a middle, of a soft pulpy consistence called rete mucosum, or mucous body; and an inner, of a dense resisting character called the true skin or chorion.
On the upper surface of the true skin are distributed, in great profusion, nerves and small vessels; some of these vessels convey blood; others, lymph; surrounding and penetrating the coats of these vessels to their most minute distribution are the automatic nervous branches. This is the nerve of the blood, absorbent, and secretory vessels ; and wherever they ramify they carry along with them minute branches of this nervous system. It creates, main- tains, and governs the functions of these vessels.
The cuticle has no sensibility, and is, therefore, wonderfully adapted to the protection of the nerves, glands, and vessels of the other coats. It has open- ings, or pores, which admit the escape of perspirable matter and certain gases secreted by the glands under the mucus coat and upon the true skin. These openings are not direct communications; they go some way obliquely under the cuticle before they open externally. On the upper surface of the true skin and immediately under the mucous coat are a countless number of glands of secretion and of absorption. Some of these glands display functions nearly identical with those of the lungs in respiration. They secrete the same gases and absorb the same gas as the lungs.
The community of function between some of the glands of the skin and those of the lungs is so nearly identical, that, in some animals, as the common leech, both are performed by the skin; and in others, as the frog, which will survive longer the excision of the lungs than the loss of the skin.
The skin has a continuity of structure with the lining membrane of the respiratory, the digestive, the urinary, and the uterine passages. This is the physiological reason why the states of the skin both modify and are modified by the functions of respiration, digestion, and urination. The mucous coat of the skin, in some degree, protects the vessels, nerves, and glands from com- pression and contusion. While the cuticle is hard and the true skin firm, this is soft and yielding. The cutaneous glands have a perfect glandular organ-
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ization. The arterial, venous, lymphatic, and capillary vessels, and the auto- matic nervous branches, minutely ramify through its structure.
Physiology. — Blood, rich in nutritive and effete elements, is conveyed along the arteries to the capillaries in which it undergoes a series of cellular changes, by which the nutritive are separated from the effete. Each class of these elements undergoes further molecular changes by which the former is prepared and appropriated to the nutrition of the different external tissues ; while the latter is elaborated and coalesced into various secretory elements, and removed from the cutaneous tissues in the form of compounds, as sweat, carbonic acid gas, &c. These molecular mutations are accelerated by the absorption of oxygen from the atmosphere by certain cutaneous glands in a mode nearly identical with that in which the lungs absorb atmospheric oxygen ; and oxygen in the external capillaries combines with the carbon of the food, evolves heat, and is removed by secretory action in the form of carbonic gas. When these ele- ments are combined in the lungs heat is evolved, and carbonic gas formed and secreted.
Are not the functions of the lungs and those of the skin, in this particular, identical ? They certainly produce the same results.
When the blood arrives in the external capillaries its elementary composi- tion is not the same as when it was returned from the luogs into the left side of the heart, because it is a living and growing fluid. From the time the organizing force of the automatic nervous branches at the mouths of the absorbent vessels begins to act on the organizable elements of the food and drink until the blood is conveyed to the tissues it is designed to nourish, it is in a state of constant growth, when it attains maturity and is appropriated.