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+The Project Gutenberg eBook, North American Medical and Surgical Journal,
+Vol. 2, No. 3, July, 1826, by Various, Edited by Hugh L. Hodge, Franklin
+Bache, Charles D. Meigs, Benjamin Homer Coates, and René La Roche
+
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+
+
+
+Title: North American Medical and Surgical Journal, Vol. 2, No. 3, July, 1826
+
+
+Author: Various
+
+Editor: Hugh L. Hodge, Franklin Bache, Charles D. Meigs, Benjamin Homer
+Coates, and René La Roche
+
+Release Date: July 4, 2009  [eBook #29307]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+
+***START OF THE PROJECT GUTENBERG EBOOK NORTH AMERICAN MEDICAL AND
+SURGICAL JOURNAL, VOL. 2, NO. 3, JULY, 1826***
+
+
+E-text prepared by Juliet Sutherland, Josephine Paolucci, and the Project
+Gutenberg Online Distributed Proofreading Team (http://www.pgdp.net)
+
+
+
+Note: Project Gutenberg also has an HTML version of this
+      file which includes the original illustration.
+      See 29307-h.htm or 29307-h.zip:
+      (http://www.gutenberg.org/files/29307/29307-h/29307-h.htm)
+      or
+      (http://www.gutenberg.org/files/29307/29307-h.zip)
+
+
+
+
+
+THE
+
+NORTH AMERICAN
+
+MEDICAL AND SURGICAL
+
+JOURNAL.
+
+
+CONDUCTED BY
+
+HUGH L. HODGE, M.D.  | CHAS. D. MEIGS, M.D.
+FRANKLIN BACHE, M.D. | B. H. COATES, M.D.
+
+AND
+
+R. LA ROCHE, M.D.
+
+NON DOCTIOR, SED MELIORE IMBUTUS DOCTRINA.
+
+VOL. II.
+
+PHILADELPHIA:
+
+PUBLISHED BY J. DOBSON, AGENT.
+
+JESPER HARDING, PRINTER.
+
+1826.
+
+
+_Eastern District of Pennsylvania, to wit_
+
+BE IT REMEMBERED, that on the 31st day of March, in the 50th year of the
+Independence of the United States of America, A. D. 1826, Hugh L. Hodge,
+Franklin Bache, Charles D. Meigs, Benjamin H. Coates, and René La Roche,
+of the said District, have deposited in this office the Title of a Book,
+the right whereof they claim as Proprietors, in the words following, to
+wit:
+
+"_The North American Medical and Surgical Journal. Conducted by Hugh L.
+Hodge, M. D., Franklin Bache, M. D., Chas. D. Meigs, M. D., B. H.
+Coates, M. D., and R. La Roche, M. D. Non doctior, sed meliore imbutus
+doctrina. Vol. II._"
+
+In conformity to the act of Congress of the United States, intituled,
+"An act for the encouragement of learning, by securing the copies of
+maps, charts, and books, to the authors and proprietors of such copies,
+during the times therein mentioned;"--and also to the act, entitled, "An
+act supplementary to an act, entitled, "An act for the encouragement of
+learning, by securing the copies of maps, charts, and books, to the
+authors and proprietors of such copies, during the times therein
+mentioned," and extending the benefits thereof to the arts of designing,
+engraving, and etching historical and other prints."
+
+     D. CALDWELL, Clerk of the Eastern District of Pennsylvania.
+
+
+
+
+CONTENTS
+
+OF VOL. II.
+
+
+No. III.
+
+ORIGINAL COMMUNICATIONS.
+
+ART.                                                                  PAGE.
+
+I. Description of the Gangrenous Ulcer of the mouths of children.
+By B. H. Coates, M. D., one of the Physicians to the Philadelphia
+Children's Asylum, &c.                                                   1
+
+II. Case of Purpura in an Infant, attended with extraordinary
+symptoms. By R. M. Huston, M. D.                                        24
+
+III. History of the Natural and Modified Small Pox, or of the
+Variolous and Varioloid Diseases, as they prevailed in
+Philadelphia, in the years 1823 and 1824. By John K. Mitchell,
+M. D., and John Bell, M. D., attending physicians at the
+then Small Pox Hospital. With a plate.                                  27
+
+IV. Remarks on the Pathology and Treatment of Yellow Fever.
+Arranged from the notes of Dr. J. A. Monges, of Philadelphia.           53
+
+V. Remarks on the Prophylactic Treatment of Cholera Infantum.
+By Joseph Parrish, M. D., one of the Surgeons to the Pennsylvania
+Hospital.                                                               68
+
+VI. Case of Neuralgia cured by Acupuncturation. Communicated
+by J. Hunter Ewing, M. D.                                               77
+
+
+ANALYTICAL REVIEWS.
+
+VII. Researches into the Nature and Treatment of Dropsy in the
+Brain, Chest, Abdomen, Ovarium, and Skin. By Joseph Ayre,
+M. D., &c.                                                              79
+
+VIII. An Essay on Venereal Diseases, and the Uses and Abuses of
+Mercury in their Treatment. By Richard Carmichael, M. R. I. A.
+With Practical Notes, &c. By G. Emerson, M. D.                         109
+
+IX. Remarks on some Means employed to destroy Tænia, and expel
+them from the Human Body. By Louis Frank, M. D.
+Privy Counsellor of her Majesty, Maria Louisa, Duchess of
+Parma.                                                                 114
+
+X. Researches, Physiological and Pathological, instituted principally
+with a View to the Improvement of Medical and Surgical
+Practice. By James Blundell, M. D., Lecturer on
+Physiology and Midwifery at the United Hospitals of St.
+Thomas and Guy.                                                        119
+
+XI. An Inquiry into the Nature and Treatment of Diabetes, Calculus
+and other Affections of the Urinary Organs. By William
+Prout, M. D., F. R. S. With Notes and Additions, by S.
+Colhoun, M. D.                                                         125
+
+
+MEDICAL LITERATURE.--RETROSPECTIVE REVIEW.
+
+XII. Tractatus de Ventriculo et Intestinis, cui præmittitur alius, de
+Partibus continentibus in Genere, et in Specie de iis Abdominis.
+Authore Francisco Glissonio. Lond. 1677, 4to.                          138
+
+
+QUARTERLY SUMMARY OF MEDICAL AND SURGICAL INTELLIGENCE.
+
+ANATOMY,                                                               155
+
+1, Papillæ of the Tongue. 2, Villi of the Stomach and Intestines. 3,
+Minute distribution of the Vessels of the Liver. 4, Trachea perforating
+the Aorta. 5, Monsters. 6, Malformation of the Heart. 7, Acephalous
+Mummy. 8, New Anatomical Plates. 9, A Manual of Osteology. 10,
+Soemmering's Work on the Anatomy of the Ear. 11, Does the conjunctiva
+run over the Cornea?
+
+
+PHYSIOLOGY,                                                            158
+
+12, Electro-Galvanic phenomena of Acupuncturation. 13, Variations in
+Milk. 14, Hyoscyamus dilates the Pupils of the Eyes. 15, Worms in the
+Eye. 16, Digestion.
+
+PATHOLOGY,                                                             161
+
+17, Dothinenteria--Pustules of the small Intestines. 18, Dr. Broussais.
+19, Whooping Cough. 20, Antiperistaltic Globus--Globus Hystericus.
+21, Non-contagion of Yellow Fever.
+
+THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE,            166
+
+22, Iodine. 23, Non-mercurial Treatment of Syphilis. 24, Cancer treated
+by Antiphlogistics. 25, Essential Oil of Male Fern as a remedy in Cases
+of Tænia. 26, Tincture of Bastard Saffron for the expulsion of Tænia.
+27, Oil of Turpentine in Tænia. 28, Action of the Oil of the Euphorbia
+Lathyris. 29, Medicinal Properties of the Apocynum Cannabinum or Indian
+Hemp. 30, Remarkable Effects from the external application of the
+Acetate of Morphia. 31, Cure of Urinary Calculi, by means of the
+internal use of the Bicarbonate of Soda. 32, Attempt to cure Abdominal
+Dropsy by exciting Peritoneal Inflammation. 33, Artificial Respiration.
+34, Secale Cornutum. 35, Animal Magnetism. 36, Sketch of the Medical
+Literature of Denmark, Sweden, and Norway. 37, Erysipelatous Mumps or
+Angina Parotidiana. 38, Tænia. 39, Scrophula. 40, Digitalis.
+
+SURGERY,                                                               192
+
+41, Dr. Physick's Operation for Artificial Anus denied to have been
+performed. 42, Gangrenous Sore Mouth of Children. 43, Operation for
+Phymosis. 44, Lunar Caustic on Wounds and Ulcers. 45, Hæmorrhage from
+Lithotomy. 46, Extirpation of the Parotid Gland. 47, Aneurism from a
+Wound, cured by Valsaiva's method. 48, Protrusion and Wound of the
+Stomach. 49, Oesophagotomy. 50, Retention of Urine, caused by a
+Stricture of the Urethra, relieved by a forcible but gradual Injection.
+51, Tracheotomy. 52, Fistula Lachrymalis. 53, Aneurisma Herniosum. 54,
+Extirpation of the Two Dental Arches affected with Osteo-sarcoma. 55,
+Traumatic Erysipelas. 56, Obliteration of a portion of the Urethra,
+remedied by an Operation. 57, Artificial Joint cured by Caustic. 58,
+Epilepsy cured by Trephining.
+
+MIDWIFERY,                                                             205
+
+59, Gastrotomy. 60, Cæsarian Operation, performed with safety to the
+Mother and Foetus. 61, Extirpation of the Uterus. 62, Uterine Hæmorrhage.
+
+CHEMISTRY AND PHARMACY,                                                208
+
+63, State in which Morphia exists in Opium. 64, Peculiar Principles of
+Narcotic Plants. 65, Relative quantities of Cinchonia and Quinia with
+indention in the most esteemed Varieties of Peruvian Bark. 66, Sulphate
+of Quinia, extracted from the Cinchona Bark, exhausted by Decoction.
+67, Analysis of Rhubarb. 68, Alkaline Lozenges of Bicarbonate of Soda.
+69, Presence of Mercury in Samples of Medicinal Prussic Acid. 70, Proposed
+Method of preparing Protoxide of Mercury by precipitation, for
+Medical Employment. 71, Goulard's Extract of Lead.
+
+QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS,                    214-16
+
+
+No. IV.
+
+ORIGINAL COMMUNICATIONS.
+
+ART.
+
+I. On the Epidemic of 1825 in Natchez, Miss. By Ayres P.
+Merrill, M. D.                                                         217
+
+II. History of the Natural and Modified Small Pox, or of the Variolous
+and Varioloid Diseases, as they prevailed in Philadelphia,
+in the years 1823 and 1824. By John K. Mitchell,
+M. D., and John Bell, M. D., Physicians at the then Small
+Pox Hospital. (Concluded from page 53.)                                238
+
+III. Cases of Nervous Irritation, exhibiting the Efficacy of Cold as
+a Remedy. By S. Jackson, M. D.                                         250
+
+IV. Remarks on the Pathology of Jaundice. By G. B. Wood, M. D.         260
+
+V. Account of a Case in which a New and Peculiar Operation for
+Artificial Anus was performed in 1809. By Philip Syng Physick, M. D.,
+Professor of Surgery in the University of Pennsylvania, &c. Drawn up for
+publication by B. H. Coates, M. D.                                     269
+
+VI. Observations on Asphyxia from Drowning, to which is added
+a Case of Resuscitation. By Edward Jenner Coxe, M. D.                  276
+
+
+ANALYTICAL REVIEWS.
+
+VII. Traité Zoologique et Physiologique, Sur les Vers Intestinaux de
+l'Homme. Par M. Bremser, D. M. Traduit de l'Allemande
+par M. Grundler, D. M. P. Revue et Augmentée de Notes.
+Par M. de Blainville, D. M., &c. Avec un Atlas. Paris, 1824.
+
+Anatomie des Vers Intestinaux, Ascaride, Lombricoide, et
+Echynorhynque Geant. Memoire Couronné par l'Academie
+Royale des Sciences, qui en avoit mit le sujet au Concours,
+pour l'année 1818. Avec 8 Planches. Par Jules Cloquet,
+&c. &c. A Paris, 1824                                                  297
+
+VIII. Precis Theorique et Pratique, sur les Maladies de la Peau.
+Par M. S. L. Alibert. 2 Tomes. 8vo. Paris, 1810-1820.                  322
+
+IX. Thoughts on Medical Education, and a Plan for its Improvement;
+addressed to the Council of the University of London.
+Dictu Necessaria. Plin. London, 1826.
+
+Projet de Loi, presenté aux Chambres dans la Séance du 14
+Fevrier 1825, par S. E. le Ministre de l'Intérieur, Sur les
+Ecoles Secondaries de Medécine, les Chambres de Discipline,
+et les Eaux Minerales Artificielles.                                   344
+
+
+MEDICAL LITERATURE--RETROSPECTIVE REVIEWS.
+
+X. Recherches sur le Tissu Muqueux, ou l'Organe Cellulaire, et
+Sur Quelques Maladies de la Poitrine. Par Théophile Bordeu,
+Docteur en Medécine des Facultés de Paris, et de
+Montpélier. Paris, 1767, 12mo.                                         376
+
+
+QUARTERLY SUMMARY OF IMPROVEMENTS IN MEDICINE AND
+SURGERY
+
+ANATOMY,                                                                395
+
+1, Notice of a Double Male Foetus, by W. E. Horner, M. D., &c. 2,
+Imperfect Development of the Cerebral Organs in Monsters. 3, Imperforate
+Vagina. 4, Fallopian Tubes. 5, Monsters. 6, Foetus grafted into
+the Chest of another. 7, Foetus without a Stomach, Head or Anus. 8,
+Congenital Hydrocephalus, with Transposition of the Viscera. 9, Unusual
+Arrangement of the Aortic Branches.
+
+PHYSIOLOGY,                                                            403
+
+10, Influence of the Great Sympathetic Nerve on the Functions of Sense.
+11, Cutaneous Absorption. 12, Abstinence. 13, Hippomane Mancinella.
+14, Cutaneous Absorption. 15, Regeneration of Divided Arteries.
+16, Mineral Poisons.
+
+PATHOLOGY,                                                             406
+
+17, Are we followers of Dr. Broussais? 18, Influenza. 19, Diarrhoea
+Infantum. 20, Tetanus. 21, Small Pox.
+
+THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE.            411
+
+22, Tincture of Iodine in Gonorrhoea, Bubo, Scrofula, &c. 23, Acetate
+of Lead and Tincture of Opium in Dysentery. 24, Powers of Digitalis in
+Palpitatio Cordis. 25, Tartar-Emetic Ointment in Epilepsy. 26,
+Antiphlogistics
+in Recent Cases of Epilepsy. 27, On the Efficacy of Nitrate
+of Silver in the Treatment of Zona or Shingles. 28, On the Remedial
+Effects of Camphor in Acute and Chronic Rheumatism. 29, Examination
+of the Question, whether the Medical Use of Phosphorus internally, is
+useful, injurious, or equivocal. 30, Nitrous Acid and Opium in Dysentery,
+Cholera and Diarrhoea. 31, Tartar Emetic in Pneumonia Biliosa. 32,
+Bark of the Ampelopsis in Catarrhal Consumption. 33, Obstinate Vomiting
+cured with Extract of Marigold. 34, Vomiting of Fat and Blood. 35,
+Rupture of the Spleen. 36, Chilblains cured with Chloride of Lime. 37,
+Local Spontaneous Combustion. 38, Dr. Painchaud on Tic Douloureux.
+39, Duration of Life among the Romans. 40, Difference of Mortality
+from 1775, to 1825. 41, New Method of Percussion of the Thorax. 42,
+Acid Nitrate of Mercury. 43, Effects of Ardent Spirits. 44, Colombo
+Root. 45, Poison of Mushrooms. 46, Antisyphilitic Decoction of Zittmann.
+47, Acetate of Ammonia, a Remedy for Drunkenness. 48, Mortality
+of Leeches. 49, Black Drop. 50, Doses of Calomel in days of
+yore. 51, Buying a good Practice. 52, Sore Nipples. 53, Anderson's
+Quarterly. 54, Antiquity of Cow Pox and Origin of Small Pox from it.
+
+SURGERY,                                                               431
+
+55, Lithotritie, on Breaking the Stone in the Bladder. 56, The High
+Operation. 57, Sutures in Wounds of the Bladder. 58, Paracentesis
+Thoracis. 59, Stricture of the Oesophagus. 60, Wound of the Brain. 61,
+Luxation of the Metatarsus; the history drawn up by M. Dusol, D. M.
+
+MIDWIFERY,                                                             438
+
+62, Uterine Hæmorrhage. 63, Polypi of the Uterus. 64, Cæsarian
+Section. 65, Case of Difficult Parturition. 66, Case of the Pelvis becoming
+enlarged.
+
+CHEMISTRY AND PHARMACY,                                                440
+
+67, L'Artigue's Process of preparing the Watery Extract of Opium. 68,
+Berzelius' Method of Detecting Arsenic in the bodies of Persons poisoned
+by it. 69, Action of Certain Metallic Substances on the Animal Economy.
+
+
+QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS,                    444-48
+
+
+
+
+CONTENTS
+
+
+ORIGINAL COMMUNICATIONS.
+
+                                                                      PAGE
+
+ART. I. Description of the Gangrenous Ulcer of the Mouths
+of Children. By B. H. Coates, M. D. one of the
+Physicians to the Philadelphia Children's Asylum,
+&c.                                                                      1
+
+II. Case of Purpura in an Infant, attended with extraordinary
+Symptoms. By R. M. Huston, M. D.                                        24
+
+III. History of the Natural and Modified Small-pox, or
+of the Variolous and Varioloid Diseases, as they
+prevailed in Philadelphia in the years 1823 and
+1824. By John K. Mitchell, M. D., and John
+Bell, M. D., attending Physicians at the then
+Small-pox Hospital.--With a plate.                                      27
+
+IV. Remarks on the Pathology and Treatment of Yellow
+Fever. Arranged from the Notes of Dr. J.
+A. Monges, of Philadelphia.                                             53
+
+V. Remarks on the Prophylactic Treatment of Cholera
+Infantum. By Joseph Parrish, M. D., one of the
+Surgeons to the Pennsylvania Hospital.                                  68
+
+VI. Case of Neuralgia, cured by Acupuncturation.
+Communicated by J. Hunter Ewing, M. D.                                  77
+
+
+ANALYTICAL REVIEWS.
+
+VII. Researches into the Nature and Treatment of
+Dropsy in the Brain, Chest, Abdomen, Ovarium,
+and Skin. By Joseph Ayre, M. D., &c.                                    79
+
+VIII. An Essay on Venereal Diseases, and the Uses and
+Abuses of Mercury in their Treatment. By
+Richard Carmichael, M. R. I. A., with Practical
+Notes, &c. by G. Emerson, M. D.                                        109
+
+IX. Remarks on some means employed to destroy
+Tænia, and expel them from the Human Body.
+By Louis Frank, M. D., Privy Counsellor of her
+Majesty, Maria Louisa, Duchess of Parma.                               114
+
+X. Researches Physiological and Pathological, instituted
+principally with a View to the Improvement
+of Medical and Surgical Practice. By James
+Blundell, M. D., Lecturer on Physiology and
+Midwifery, at the United Hospitals of St. Thomas
+and Guy.                                                               119
+
+XI. An Inquiry into the Nature and Treatment of Diabetes,
+Calculus, and other Affections of the Urinary
+Organs. By William Prout, M.D. F.R.S.
+With Notes and Additions, by S. Colhoun, M. D.                         125
+
+
+MEDICAL LITERATURE.
+
+XII. Retrospective Review.--Tractatus de Ventriculo
+et Intestinis, cui præmittitur alius, de Partibus
+continentibus in Genere, et in Specie de iis Abdominis.
+Authore Francisco Glissonio. Lond.
+1677, 4to.                                                             138
+
+
+QUARTERLY SUMMARY OF MEDICAL AND SURGICAL
+INTELLIGENCE.
+
+I. Anatomy.                                                            155
+
+II. Physiology.                                                        158
+
+III. Pathology.                                                        161
+
+IV. Therapeutics, Materia Medica, and the Practice of Medicine.        166
+
+V. Surgery.                                                            192
+
+VI. Midwifery.                                                         205
+
+VII. Chemistry and Pharmacy.                                           208
+
+QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS.                       214
+
+FOOTNOTES:
+
+
+
+
+THE
+
+NORTH AMERICAN
+
+Medical and Surgical Journal.
+
+JULY, 1826.
+
+
+ORIGINAL COMMUNICATIONS.
+
+FOOTNOTES:
+
+
+
+
+ARTICLE I.--_Description of the Gangrenous Ulcer of the Mouths of
+Children._ By B. H. Coates, M. D. one of the Physicians to the
+Philadelphia Children's Asylum, &c.
+
+
+Having had opportunities of witnessing the ravages and unmanageable
+character of this destructive disease, I have long and deeply felt the
+want of some written account, both of the malady, and of a proper mode
+of treatment. Some research and observation, made in consequence of this
+feeling, have terminated in the acquisition of more fixed ideas, and of
+a practice hitherto successful. This convinced me, that it became my
+duty to lay the result of these inquiries before the public, for the
+benefit of others. There is, perhaps, no stronger and more peculiar
+reason for wishing American physicians to write, than the opportunities
+they possess, of describing and recording many important varieties of
+morbid affection, which were either unknown to our predecessors, or the
+descriptions of which, uncombined and uncompared, are only to be found
+by searching among the more neglected tomes of a public library. Of
+this, the present case will afford a fair example; as well as an
+instance of an American physician, who had described the disease from
+nature, having, from want of encouragement, false modesty, or some other
+cause, kept it back from publication.
+
+Ever since the establishment of the Children's Asylum, under the care
+of a committee of the guardians of the poor, of the city and liberties
+of Philadelphia, in the spring of 1819, this useful institution has been
+annually visited by the new and distressing scourge of which we are
+treating. It has here prevailed in a considerable number of cases,
+forming the principal source of anxiety and trouble during the winter
+season, and annually sweeping off its little victims, in a manner
+rendered peculiarly awful by its insidious approach, its loathsome
+effects, and its apparently uncontrollable progress. Various scattered
+cases of a similar affection have come within my knowledge, during the
+last few years; occurring in the practice of several physicians, as well
+as in my own. In no place, however, near Philadelphia, other than the
+above, has there existed, so far as I know, a sufficient number of cases
+at the same time, to enable a physician to examine it in much detail, or
+to make comparative trials of different modes of treatment, so as
+clearly to determine the most successful.
+
+_References to Authors._--The notices of this complaint given by
+authors, to which I have been enabled to refer, are few, and generally
+too scanty to supply much means of forming a satisfactory judgment, or a
+practice in which confidence can be reposed. They consist, principally,
+of the mere mention of an affection resembling that of which we treat;
+and, in some instances, it is even doubtful whether they are describing
+the same disease. No notice is taken of this affection in any of our
+common books; with the exception of the last edition of COOPER'S
+Surgical Dictionary,[1] and of UNDERWOOD'S work on diseases of children.
+It is there described under the erroneous title of _cancrum oris_. A
+reference is given to PEARSON'S Surgery; and the article in the
+Dictionary is taken exclusively from that work. As this is the only
+authority with which I am acquainted, that gives a tolerably full
+account of a disease somewhat similar to that of which we are treating,
+I have concluded to extract the whole passage, in the words of the
+author.
+
+"The canker of the mouth is a deep, foul, irregular, foetid ulcer,
+with jagged edges, which appears upon the inside of the lips and cheeks;
+and is attended with a copious flow of diseased saliva.
+
+"This disease is seldom seen in adults; but it most commonly attacks
+children, from the age of 18 months, to that of 6 or 7 years. When the
+ulceration begins at the inner part of the lip, it exhibits a deep,
+narrow, sulcated appearance, and quickly spreads along the inside of the
+cheek; which becomes hard, and tumefied externally. The gums are very
+frequently interested in this complaint, and, in such cases, the teeth
+are generally found in a loose and diseased state; matter is often found
+in their sockets, and abscesses sometimes burst externally through the
+cheek, the lip, or a little below the maxilla inferior: and it is not
+uncommon to see an exfoliation of the alveolar processes, or even of the
+greater part of the lower jaw. Among the children of poor people, where
+this disease is neglected or mismanaged at the beginning, a dreadful
+gangrene will sometimes supervene.
+
+"The remote causes that give origin to this disease are not very
+obvious. I think it occurs most frequently among children that live in a
+marshy situation; that are sustained by unwholesome food; and where a
+due attention to cleanliness has been wanting. The cancrum oris has been
+described by some writers, as a complaint very common in England and
+Ireland, where it is sometimes epidemical among infants. It, however, is
+commonly seen in other kingdoms, and prevails more especially in those
+houses where a great number of children are crowded together. I am not
+able to determine whether it is or is not contagious.
+
+"But adults are not wholly exempted from this morbid affection, and it
+is not easy in all cases, to distinguish the cancrum oris from a
+cancerous or venereal ulcer in the mouth; since the uvula, tonsils or
+fauces may be the seat of each disease. I have seen ulcerations on the
+uvula and tonsils, with all the marks of a venereal sore, in patients
+where the presence of such a virus could not be suspected; and by
+treating them as canker of the mouth, they have been speedily cured.
+
+"The canker of the mouth ought to be distinguished from aphthæ, the
+epulis and parulis, scurvy, cancerous ulcers, venereal ulcers and
+exulceration from the use of mercury.
+
+"_The mode of treatment._--It will be proper,
+
+"1. To remove the diseased teeth, bone, &c. if possible.
+
+"2. To prescribe a milk and vegetable diet, and to allow a prudent use
+of fermented liquors.
+
+"3. It will be adviseable to exhibit such remedies as, Peruvian bark;
+sarsaparilla; elm bark; mineral acids.
+
+"The external applications that I have generally found successful have
+consisted of such as the following:
+
+"_Preparations of copper_; a diluted mineral acid; burnt alum; decoction
+of bark with white vitriol; tincture of myrrh, &c."[2]
+
+Of the above articles, those which we have indicated by italics are
+omitted in the last edition of COOPER'S Dictionary; and, in a former
+one, they are directly prohibited with strong reprobation. Nevertheless,
+it is among these that we have found, beyond comparison, the most
+successful one.
+
+Mr. PEARSON prefixes to the preceding article a list of synonymes, with
+references to authors, in the manner of writers on natural history. They
+are as follow: _Aphthæ Serpentes._--SENNERTUS; Medicinâ Practicâ.
+_Labrosulcium, seu Cheilocace._--ARNOLDUS BOOTIUS. _Oris
+Cancrum._--MUYS. STALPAART VANDER WIEL. _Gangræna Oris._--VAN SWEITEN.
+_Gangrene scorbutique des Gencives._--Auctores Gallici.
+
+Of these, SENNERTUS[3] merely mentions, under the article aphthæ, that
+the latter sometimes spread around the frænum and tongue, occasionally
+corroding the subjacent parts. He is so far from giving a clear
+description, under the head of Aphthæ Serpentes, of any affection
+analogous to that we are about to record, that he quotes GALEN as
+remarking, very properly, that these are not aphthæ at all, but putrid
+ulcers.
+
+ARNOLD BOOTIUS, in his little treatise "de morbis omissis," of diseases
+omitted in the books, published in London, in 1649,[4] gives, from his
+own observation, an account of a disease, to which he applies the names
+above attributed to him. It differs from the cases which have attracted
+our attention, chiefly in its situation. He describes it as an ulcer,
+soon becoming black and foetid, corroding the inside of both lips,
+separating them widely from the gums and allowing them to fall outwards
+upon the face; thus producing a horrible deformity. Besides this, the
+author states, that a deep fissure usually extended down each half of
+the inside of each lip; thus adding four deep and ghastly ramifications
+to the ulcer. This shocking affection is stated to have prevailed
+extensively, both in England and Ireland; in which latter country the
+author practised and held several important offices. It occasionally
+became epidemic, and then destroyed great numbers of children. It
+principally prevailed between 2 and 4 years of age; though it was
+occasionally met with both earlier and later in life. It was frequently,
+but not always, accompanied with aphthæ.
+
+This disease was, in general, successfully treated by our author, with a
+decoction of "Chærephyllum, Quinquefolium, Myrrhis, Rosæ et Salvia;" in
+which was dissolved a "sat magna copia" of white vitriol.--A combination
+about as precise as some of the prescriptions which have been
+recommended to me, for the present disease, in this country. With this
+mixture, he touched the ulcers several times a day; and then washed them
+with a liniment of acetate of lead, aqua plantaginis, and oleum
+rosaceum. He also used _issues_ in both arms; and confined the patient,
+in more obstinate cases, for drink, to a decoction of sarsaparilla,
+china, and several other articles, which we will spare our readers. To
+this disease, BOOTIUS devotes about five small 18mo. pages, forming his
+tenth chapter.
+
+VANDER WIEL cites BOOTIUS, and expresses his belief, that the disease
+described by the latter was identical with one which he saw himself.
+This last, however, though described in a cursory manner, appears to
+resemble much more nearly the disease of the Children's Asylum;
+beginning in the gums, and extending to the adjacent parts. He treats it
+by the following lotion:
+
+     R. Mel. Rosar.        [Symbol: ounce]i
+        ---- Ægyptiaci,    [Symbol: dram]ij
+        Olei Vitrioli,     gtt. _aliquot._
+                                misce.
+
+Under this treatment, and by removing the teeth, when loose, the small
+number of cases he saw recovered in a few days.
+
+VANDER WIEL was a practitioner in Holland; and, though he does not
+specify the fact, his cases were probably in a marshy country.[5]
+
+MUYS, in a little treatise entitled "Chirurgia Rationalis,"[6] published
+in 1684, has an account of a disease, which is evidently supposed by
+PEARSON to be that which he describes. This also, however, appears to
+have been a "labrosulcium;" an ulcer between the lips and the incisor
+teeth. There is but little to be gathered from his paper; as it is
+principally occupied with an attempt to prove, that this ulcer is owing
+to an accumulation of _acidity_ in the blood, increased, at this point,
+by the putrescence of particles of food which collect there. He
+illustrates this doctrine by an examination of a _burnt rag_ under a
+microscope; and this he considers as in a state analogous to the
+gangrene. "Opinionum commenta delet dies," &c. We give his treatment;
+which is aimed at acidity.
+
+     R. Theriaci,               [Symbol: dram]ijss
+     Ung. Egypt.                [Symbol: dram]iss
+     Gum. Laccæ, et
+     Spirit. Sal. _Armon._ aa   [Symbol: scruple]ij
+     ---- Cochleariæ,           [Symbol: dram]ij
+                                  _m._ ft. ung.
+
+To be softened with a little alcohol, the part washed with the mixture
+six times a day, and a rag moistened with the same compound left in the
+ulcer. Here we take leave of the Chirurgia _Rationalis_.
+
+In the 14th volume of the Memoirs of the French Royal Academy of
+Surgery, are papers containing accounts of two cases, which have some
+points in common with the disease of which we treat; but the identity of
+at least one of which it is hard to establish. The first piece is
+entitled, "_Sur la gangrene scorbutique des gencives dans les enfans.
+Par feu M. Berthe._"[7] The author is described, in a note, as a young
+surgeon of great promise, who was carried off by an early death. M.
+BERTHE commences by quoting FABRICIUS HILDANUS; who describes a gangrene
+of the gums, occuring principally at about 4 years of age, and of which
+all the patients died. FABRICIUS takes the occasion to give a caution to
+young surgeons, to avoid being too sanguine in predicting recovery from
+gangrenes. Next a case is given us, drawn from M. SAVIARD, in which
+death was the result. This author seems, subsequently, to have had
+somewhat better success, but at the expense of horrible disfigurements;
+such as great holes through the cheek, and the loss of a large piece of
+the jaw; which, indeed, are described as having been worse than death.
+In another case, recorded by M. POUPART, in the "Histoire de l'Academie
+des Sciences," this affection terminated in death; preceded, however,
+and in the opinion of the author, caused, by the production of two
+tumours, one by the side of the tongue, the other inside of the cheek.
+This is not at all unlike the progress, which will be hereafter
+mentioned to have taken place in many of the Asylum cases.
+
+M. BERTHE then remarks, that the greater number of instances of gangrene
+of the gums had terminated unfavourably.
+
+His own patient was ill from April to September, 1753; and exhibited
+swelled and bleeding gums, frequently projecting beyond the
+teeth,--black and foetid stools, foetid urine, and ecchymoses over
+the surface of the body. He treated it with antiscorbutics, internally
+and externally, and apparently with success. The patient, however,
+relapsed in January, 1754; when M. BERTHE proceeded to a very different,
+and far more severe treatment. The gums were pared away, in many
+successive operations; and the wounds were washed with aluminous water.
+A roll of linen was, during the intervals, kept fastened in the
+patient's mouth, for the purpose of allowing the escape of the fluids of
+the part; which he apprehended to possess a putrid character, and to
+aggravate the original disease, whenever they passed into the stomach.
+At length, his patient recovered, and continued well.
+
+It appears to the writer of these notes to be hardly necessary to state,
+that M. BERTHE evidently mistook the disease; the latter being in
+reality scorbutic, and not a single symptom of gangrene being described
+during its whole history.
+
+The same, however, cannot be said of M. CAPDEVILLE; whose "_Observations
+sur les effets rapides de la pourriture des gencives_" appear in the
+same volume with the foregoing, and immediately subsequent to it.[8]
+This writer's case took place after a fever, and no tumefaction of the
+gums nor ecchymoses of the skin are mentioned as occurring in it. M.
+CAPDEVILLE attended this case in consultation, in 1764; and complains of
+too feeble means being employed, as the case was trusted to
+antiscorbutics. This treatment ended in death. M. C. refers to VAN
+SWEITEN, whose correct account we shall mention; and it is evident that
+it was the disease of the Children's Asylum: though he manifests a
+strong propensity to connect it with scorbutus, and the "blanchet," or a
+species of aphthæ, which destroyed a great number of children in the
+Foundling Hospital, in 1746. Reference is also made to cases which
+occurred in "La Pitié," under the care of CHOPART. Of these, a very
+scanty account is given. They terminated in death; after a treatment by
+lotions of honey of roses and spirit of vitriol, with emollient and
+resolvent cataplasms.
+
+VAN SWEITEN, in the article devoted to the consideration of gangrene,[9]
+has left us a far more exact description of the disease, into which we
+are inquiring. Practising in a marshy country, he had frequent
+opportunities of meeting with it; and his account of it, and his mode of
+treatment, though brief, are every way worthy of the close, practical
+inquirer into nature, and the sound medical philosopher. His description
+is not unmixed with strong expressions of horror and commiseration at
+its ravages. He describes it in a manner so similar to that in which it
+now prevails, that no doubt can exist of the identity of the diseases.
+He acknowledges, however, "rubedo, calor, dolor," among its symptoms.
+Cochlearia, theriaca and similar articles, according to him, are almost
+always injurious. If no foetor exist, (and, of coarse, no actual
+mortification,) he applies a solution of sal ammoniac or nitre, with
+some vinegar or lemon juice; sometimes as a lotion, sometimes by keeping
+a rag imbued with it always in the ulcer. Hard rubbing he reprobates. If
+the disease have made progress, and foetor exist, muriatic acid is
+used: in the less aggravated stages, diluted with honey of roses and
+water; in the worst cases, pure. This practice he states never to have
+failed him, unless where the bone was affected.
+
+In an early edition of Dr. UNDERWOOD'S Treatise on Diseases of Children,
+in the library of the Pennsylvania Hospital, no mention is made of this
+disease; although an article is devoted to "_gangrenous erosion of the
+cheek_." The account is wholly borrowed from a work by Mr. DEASE, of
+Dublin, "on the diseases of lying-in women," &c. also in the library.
+Mr. DEASE describes this affection as occurring from 2 to 6 or 8 years
+of age; especially in unhealthy children, including such as have been
+subject to worms. The whole body often appeared cold upon the approach
+of the disease. A black spot then occurred, but _without marks of
+inflammation_, on one of the cheeks or lips. The whole cheek was
+sometimes destroyed, and the lower jaw fell down upon the breast.
+Muriatic acid, infusion of roses, the effervescing draught, and, in the
+decline of the disease, bark, broths, jellies, and wine, besides
+magnesia or rhubarb, to remove the putrid matters swallowed, were the
+internal remedies employed. The parts were washed and injected with
+muriatic acid, diluted with chamomile or sage tea; and afterwards
+dressed with the acid, mixed with honey of roses, and, over this, a
+carrot poultice. By this practice, Mr. DEASE lays claim to almost total
+success.
+
+In the Philadelphia republication of Dr. UNDERWOOD'S book, taken from
+the sixth London edition, there is an article entitled Cancrum Oris. The
+author appears to have read PEARSON'S account; but as his description
+does not at all agree with the disease of which we are treating, nor
+with that of Mr. PEARSON, we shall not stop longer to analyse it.
+
+I have no doubt, from views that will be hereafter developed, that many
+of the above writers have had cases similar to those which we are about
+to describe; but have mistaken them, from the want of a sufficiently
+early and close inspection of the ulcers. In the second stage, this
+disease much resembles an inflamed sore between the lips and gums,
+extending to the latter; although I hope to prove that this state of
+things is secondary.
+
+_Locality of the Disease._--The Philadelphia Children's Asylum is
+situated in South Fifth street, between Prime and Federal streets, in
+the district of Southwark. The soil is what is called alluvial, or
+rather diluvial; as is well known to be the case with all that district,
+lying south of Philadelphia, as well as the southern part of the city
+itself. The house was built, and for many years occupied, as a mansion,
+by the head of a most respectable and wealthy family. Its situation
+possesses some of the qualities usually selected in choosing the site of
+a country seat. The buildings stand on a swell of ground, leaving an
+open lawn, now interrupted by several unoccupied streets, and extending,
+on the right hand, to the banks of the Delaware, and, on the left, to
+the Navy Yard and part of the suburb of Southwark. Towards the north,
+it is not far from the edge of a thickly built appendage of the city.
+
+The district immediately south of the Asylum is marshy, and has long
+been noted for the prevalence of intermittent fevers; but the slightly
+elevated site of the building had been generally healthy, and continued
+so, till the universal and distressing epidemic, which infested all the
+outskirts of Philadelphia, in 1822 and 1823. Even at this period, the
+persons resident at the Asylum, were far from suffering so severely as
+the adjacent neighbourhood; and, since those years, it has again become,
+in general, tolerably healthy. In 1819, 1820, 1821, and 1822, a lot,
+situated at a short distance, on which were deposited the contents of a
+number of privies, proved a source of great inconvenience, and some
+disease, at the Asylum. This focus of effluvia, together with the
+general and copious use of similar materials in manuring the adjacent
+fields, occasioned an intolerable stench, and generated diarrhoeas, in
+the early part of the spring. When the grass and weeds, however, were
+grown sufficiently to protect the surface of the soil from the sun and
+wind, this effect entirely ceased; and I know not that any other
+inconvenience was experienced from the same source, unless we attribute
+to this, as may fairly be done, the destruction of the purity of the
+well. This formerly afforded very good water; and, since that period, it
+has much improved. When the corporations of Southwark and Moyamensing
+shall introduce, as it is to be hoped they will, the Fairmount water
+into their streets, one remaining cause of inconvenience and ill health,
+will be removed from the Children's Asylum.
+
+_Prevalent Diseases._--Ophthalmias and furuncular eruptions, the latter
+principally on the face, are epidemic every year; generally in the
+spring and early summer months. When prevalent in the city, the measles,
+small pox, and varioloid disease have reached the Asylum; the scarlatina
+has, at no period, I believe, been peculiarly troublesome there.
+Intermittents, which were anticipated by many, from the nature of the
+situation, have seldom, if ever, prevailed in the house, to any very
+considerable extent. One of the worst visitations which it has
+experienced, in this respect, was in the autumn of 1823. In many cases,
+it was in patients who had been labouring under disease of this
+description, that the ulcer we are about to describe exhibited itself;
+but it was by no means confined to those who were known to have so
+suffered. Many, perhaps, most of the children affected, were free from
+any apparent ailment; although it is by no means impossible that the
+little, uncomplaining subjects were, at the time, labouring under what
+has been called "febricula" or "inward fever."
+
+_Regimen._--To the impurity of the water we have already adverted. The
+diet of the children furnishes them with meat every day, with the
+exception, during a part of the existence of the institution, of two
+days in every week. Molasses was freely used; indian mush was greatly in
+demand; and the breakfast and supper were of bread and milk. During the
+summer months, this diet was abundantly nourishing; but in winter, it
+was thought that an additional quantity of animal food was desirable;
+and, accordingly, it was, during the two last winters, given every day.
+
+_Description of the Disease._--The ulcer of which we speak, may begin in
+many parts of the mouth. In by far the greater number of cases, however,
+it commences immediately at the edges of the gums, in contact with the
+necks of the teeth, and, most generally, of the two lower incisors. A
+separation is found here; which exhibits a slight loss of substance at
+the extreme edge of the gums, and, as far as I have observed, a
+whitishness of the diseased surface. In some instances, though not very
+frequently, this is preceded by a slight swelling and redness. In this
+state, the disease may continue for a long time; and I have reason to
+believe, that patients have remained thus affected, during the whole
+period of three months, for which I attended the Asylum. At one time,
+when the disease was at its height, threatening several patients with
+destruction, I found upwards of 70 children, out of a population
+amounting to about 240, more or less affected with these ulcerations. No
+remarkable change is at this stage observable in the functions of the
+little sufferer; except a general air of languor and weakness. The
+appetite and the muscular activity continue, but are somewhat reduced;
+not sufficiently, however, to disable the child from attending school,
+taking the air, or continuing his ordinary practices. In this state, no
+symptoms of irritation have been at all discovered. The skin is cool
+during the day, no pain is complained of; and no account has ever been
+given me of any nocturnal paroxysm of fever. It would appear to be
+purely a state of asthenia. We are, however, by no means certain, that
+there was no concealed irritation in the system. We were, of necessity,
+obliged to depend, in a great measure, upon the reports of nurses, and
+other females; and these were liable to overlook, or mistake for mere
+weakness, the signs of an obscure disease. In this manner, commencing
+cases were frequently not discovered, and nothing was done, till the
+affection had made further progress; and this continued until the
+ascertained existence of the epidemic in the house, combined with the
+recollection of its former ravages, had excited an alarm, which led to
+the inspection of the mouths of all the children in the institution.
+
+The disease, in this form, must be within the curative powers of nature;
+as, if this were not the case, we should hear of more numerous
+unfavourable terminations. It has seldom, however, if at all, been
+within my power to witness this tendency; and, when not controlled by a
+particular treatment, the cases have almost always either remained
+stationary, or increased in severity. Its first progress is, most
+generally, by extending to the edges of the gums round other teeth;
+frequently affecting a large portion of the dental arches. A very early
+progress is, however, mostly effected, down the length of the tooth, in
+the direction of the socket; and, in this way, the disease commits great
+and unsuspected ravages. When it reaches the edges of the bony socket,
+the tooth begins to be loose, and when drawn, exhibits portions of the
+fang, including parts which had been contained within the alveolus,
+entirely denuded of their periosteum. Indeed, from observation, I should
+say, that the latter membrane was the part, which was the most
+peculiarly liable to injury and death from this disease; and it is by no
+means clear, to my apprehension, that this is not frequently the
+commencement of the complaint. The injury generally proceeds with
+augmenting rapidity; especially when it has affected the deeper parts:
+and it is while in the act of rapidly spreading, that it occasions
+gangrene.
+
+In the production of gangrenous sloughs, it much resembles the
+descriptions usually given of sloughing ulcers. A portion of the parts
+immediately subjacent to the ulcer loses its life; this rapidly
+separates; and, before or after a complete removal, a fresh slough is
+formed in the same manner. The sloughs are generally black, with
+ash-coloured edges. I have not been able to discern a change of colour,
+the production of vesicles, or any material tumefaction, as antecedent
+to the gangrene. There is generally, by this time, an increased heat in
+the parts; with the sensation termed "calor mordens." The discharge now,
+for the first time, becomes acrimonious; giving pain when it comes in
+contact with cuts in the finger; and excoriations are produced on all
+parts in contact with the sloughing ulcerations; as the lips, the
+cheeks, the tongue, and the adjoining surface of the part where the
+ulcer is situated.
+
+As soon as the external gangrene has reached the level of the edge of
+the bony socket, and frequently much sooner, the adjacent portion of the
+latter is found deprived of its life; forming a necrosis. The death of
+the periosteum in the socket, at least that of the fang of the tooth,
+precedes, by some interval of time, that of any portion of the bone
+itself.
+
+When gangrene is formed, a fever of irritation is generally developed.
+In regard to the time at which this takes place, there is a great
+diversity in different constitutions. It has appeared to me to depend,
+principally, upon the inflammation of the mouth, which is secondary to
+the original disease, and, in most cases, to arise from the acrimony of
+the discharge. It is aggravated by loss of rest, want of nourishment,
+and, probably, by putrid matter finding its way into the stomach. To the
+latter cause I also refer a diarrhoea, which almost uniformly comes
+on, towards the close.
+
+There are accounts of a similar disease having begun on the inside of
+the cheeks. I have, however, never seen a well-marked instance of this;
+the cases which were supposed to be such having, in every instance, been
+also found to exhibit ulcerations at the edges of the gums. That the
+disease spreads from the gums to the cheek, is a fact which have often
+seen exemplified. It is, indeed, the most usual termination of bad
+cases. After producing gangrene and necrosis in the gums and alveoli,
+and after the discharge becomes, as above stated, acrimonious, a
+gangrenous spot is not unfrequently found about the opening of the
+Stenonian duct, on the inside of the upper or lower lip, opposite the
+incisors, in some other part of the inside of the lip or cheek, or in
+more than one of these situations at the same time. Whether this be
+owing to excoriation from the discharge, or to some other cause, I
+cannot say; it has, however, in every instance which I have seen
+sufficiently early to witness its rise, been subsequent to the symptoms
+previously described.
+
+When the gangrene reaches the cheek or lip, however, very active
+inflammatory symptoms are uniformly developed. In the cellular substance
+of these parts, they assume the well known characters which have been
+attributed to the _phlegmonous_ species. We have a great thickening,
+forming, in the cheek, a large, rounded, prominent tumour, with great
+heat and pain. Sometimes redness is perceived externally; but, more
+frequently, the great distension of the skin of the cheek seems to empty
+the cutaneous vessels; giving to the part, a smooth, polished, dense,
+white appearance, very much resembling the effect of a violent
+salivation. I have no doubt that this is the tumour described by
+POUPART, and alluded to in an earlier part of this paper. Great
+thickness and hardness have always occurred, in the other situations
+where this gangrene has approached the external cellular masses of the
+face; in the lip, however, they are less remarkable, perhaps from the
+smaller amount of cellular matter. After reaching this stage, a black
+spot is frequently seen on the outer surface of the swelling. This
+spreads rapidly; and has always been, in my own experience, the
+immediate harbinger of death. It is proper to state, however, that I
+have heard it said, that cases had recovered in this city, in which the
+gangrene had produced a hole through the cheek. Under what physician's
+care this occurred, I have never learned.
+
+In two cases it commenced in the fauces; and was marked by the same
+unsuspected progress. In one of these, the little patient was remarked
+to be languid, but had no positive external marks of disease. The mouth
+was examined, and found healthy; but no suspicion of the real situation
+of the disease was entertained, till after 3 or 4 days more, when he
+complained of a slight sore throat. A large gangrene of the tonsils,
+half-arches and pharynx, was now found; and the event need hardly be
+told.
+
+The closing stage of this affection is marked by large gangrenous
+patches in the gums; deep fissures between these and the teeth; the
+latter loose, or falling out; large pieces of the alveolar processes,
+often containing the roots of several teeth, in a state of entire
+necrosis; the whole lining membrane of the mouth suffering a violent
+excoriation; the whole adjacent external cellular substance, hard and
+swelled; large gangrenous spots in the inside of the cheek or lips,
+occasionally extending quite through to the outer surface; a total
+incapability to sleep, or to take the least food; fever; a swelled
+abdomen, and diarrhoea.
+
+_Dissection._--The inspection of the body after death had never thrown
+much light upon this obscure affection. Since I began to prepare
+materials for this paper, I have been able to dissect but one subject.
+The appearances were as follow:
+
+_Exterior_, emaciated.
+
+_Alimentary canal_, externally and internally, altogether in a natural
+state, except what appeared to me to be owing to the subsidence of blood
+to depending portions of the intestines. The mucous membrane was
+carefully examined throughout its whole length; but not being at that
+time aware of the importance, attached, by some pathologists, to small
+rednesses in this organ, it is highly probable that some such may have
+been overlooked.
+
+_Liver and Spleen_, enlarged, but of a natural appearance.
+
+_Heart, thoracic oesophagus, and one kidney_, (the other not
+examined,) natural.
+
+_Lungs_, containing much mucus in the bronchial cavities. The fore part
+of their substance contained much hepatization.
+
+_Pathology._--The nature and production of this disease are certainly
+very obscure. We may, however, as in other branches of knowledge,
+attempt to develop and record what knowledge we possess respecting it;
+carefully separating truth and reason from conjecture. We have already
+said, that its access was very frequently preceded by no marks of
+visible disease, or at least none that attracted attention. The little
+subjects were, apparently, in merely a drooping or enfeebled state. In
+other instances, the ulceration followed a common remittent or
+intermittent fever; insomuch that, at one time, whenever a child was
+brought to the nursery for fever, it was expected, as a matter of
+course, that his mouth would become sore. In the other cases, as we have
+already had occasion to say, it is quite possible that a concealed
+"inward fever" may have existed; and this is rendered the more probable,
+by the circumstance of their losing their appetites. In the instance
+where the body was opened, we have seen that the original disease was
+hepatization of the lungs; and yet it is quite probable, that this
+affection had caused, as it often does, that species of disease, which
+a rapidly spreading pathology refers to a slow inflammation of the
+stomach and intestines. With regard to marks of this last not having
+been detected by me, it is evident that I am in the same situation with
+a very numerous body of other observers.
+
+The local appearances, at the commencement, did not appear to be of an
+_inflammatory_ nature, at least generally. If the gums were really the
+first part affected, it was not so; as these parts when inflamed, as
+they frequently are in affections of the teeth, exhibit decided
+soreness, pain, swelling, and an increase of redness. The ulcerated part
+was, in about nine cases out of ten, paler than natural; and then
+neither soreness nor increased heat was perceptible, except in a few
+cases, in which the mouth was generally hotter than natural, though it
+was not, in a striking manner, referrible to the gums. In a few cases,
+distinct redness, and a slight swelling, were perceptible round the
+ulcer. These patients generally did better than the others.
+
+If, on the other hand, we suppose the original derangement to have taken
+place in the periosteum, we shall be enabled, more easily, to explain
+some of the phenomena. We then reason thus: The whole of the body had
+shrunk considerably, from disease, and, the circulation being deprived
+of a part of its usual vigour, the periosteum, a part possessed of
+little vitality, was unable to bear the additional extension, which it
+underwent, across the unyielding bone of the tooth. The blood ceased to
+circulate in it, and it died. Ulceration of the adjacent parts followed,
+as a matter of course; and these parts, especially the periosteum, being
+possessed of but little sensibility, the sympathies of the other parts
+of the system were but little interested, until an extensive portion of
+the mucous membrane of the mouth, or a mass of cellular substance,
+became affected. We certainly see that, in every case but two, the
+disease commenced in contact with the teeth. This doctrine will also
+explain the rapid and deep penetration of the ulcer along the roots of
+the teeth; and the destruction of the bone. We may recur to the
+statement, that a portion of the fang of every loose tooth was always
+found deprived of its periosteum.
+
+In the two cases excepted, we have seen it apparently begin in the
+mucous membrane of the fauces; and indeed the manner in which it
+generally spreads from the gums to the cheek and lips, seems to me,
+unquestionably, to indicate a greater liability than common to gangrene
+in more than one part of the mouth.
+
+The soreness and pain of the socket, which forms a part of most
+tooth-achs, might have been reasonably expected here; but neither was
+ever complained of, even when the teeth were loosening: and, as no fever
+existed at this time, the original irritation can hardly be considered
+as inflammatory; excepting perhaps the cases which exhibited redness,
+and slight swelling of the gums.
+
+_Is this disease scorbutic?_--I never observed ecchymoses, nor in more
+than a single instance any the minutest red specks upon the cutis, which
+might be thought to resemble petechiæ. The patients never fainted; the
+gums were never spongy, nor did they bleed more than those of any other
+child would have bled, under an equal degree of violence. I however
+requested my friend, Dr. HARRIS, who has had ample opportunities of
+making himself acquainted with scorbutus, to see some patients with me.
+He complied, with his usual kindness, and pronounced their disease not
+at all to resemble the scurvy.
+
+_The teeth._--But few cases occurred during the second dentition; and it
+is doubtful whether any one took place during the first. It should be
+remarked, however, that children under 2 years, were not admitted to the
+institution, unless by deception on the part of the parents. No child
+ever lost a tooth of the second set; and, indeed, the second dentition
+seemed often to cure the complaint. The greater number of cases occurred
+between 2 and 5 years of age, but some as late as 8 or 10. In several
+instances, the ulcer destroyed a portion of the enamel capsule; and the
+teeth were then cut, with _very perfect enamel_ upon the lower part,
+while the bone was entirely bare at the ulcerated portion of the
+capsule. This singular fact proves that no inflammation of the capsule,
+sufficient to interrupt the function of its remaining portion, took
+place in consequence of the opening of its cavity.
+
+_Prevalence of this disease in our own country._--Many elderly persons
+remember during different periods of their lives, a tradition and
+particular instances of a formidable disease of the mouth, by the name
+of "Black Canker."[10] Round Philadelphia, it appears to have been
+rare. Having been informed by a friend, that the disease had prevailed
+extensively at Salem, New Jersey, under the notice of my friend, Dr.
+THEOPHILUS R. BEESLEY, I addressed a letter to that gentleman, to which
+he furnished me with an obliging and instructive reply, which I have
+unfortunately mislaid. Numerous cases have occurred, in that vicinity,
+within the last 30 years; and were, in general, successfully treated by
+the women. Cases seldom came under the view of physicians, until
+gangrene had commenced; and of these, many died: so that the old women
+were generally more in vogue for its cure, than the regular
+practitioners. Dr. BEESLEY, Dr. VANMETER, and my friend Dr. E. Q.
+KEASBEY, had met with much of this complaint; and the result of many of
+their observations had been combined in a thesis, written, but,
+according to our unfortunate custom, not published, by the younger Dr.
+VANMETER. It was there considered as a sequela of intermittent and slow
+remittent fevers, and seldom occurred but in marshy districts, and among
+the poor. It generally prevailed between the ages of 2 and 10 years. Of
+the remedies employed we shall again speak. Dr. SAMUEL TUCKER has also
+seen it in marshy situations near Burlington. I have heard of its
+existence on the Schuylkill. Dr. PARRISH has for several years noticed a
+stage of this complaint, under the name of "a disease resembling the
+effects of mercury," in his private lectures. Drs. PHYSICK, HARTSHORNE,
+HEWSON, MEIGS, WOOD, RHEA BARTON, and REMINGTON, and several others who
+will pardon me for omitting their names, have also met with cases.
+
+_Prevention._--Our precautionary measures should be directed to the
+predisposed or commencing state already described; to the prevention and
+cure of fevers, to the removal of "febricula," and other internal
+disorders, and to the general restoration of strength. Finally, its
+commencing stage should be watched, and promptly met; and success, I
+believe, will always attend our endeavours.
+
+At the Children's Asylum, all the weakly children were made to take
+bitters, of different descriptions; and Dr. SYLVESTER'S antiscorbutic
+drink, composed of cream of tartar and juniper berries, infused in
+water. As the disease declined in the house, under this administration
+of bitters, it is highly probable that they had a preventive agency. I
+much question, however, whether Dr. SYLVESTER'S drink was productive of
+any advantage.
+
+One question of some importance yet remains. _Has mercury any agency in
+producing this affection?_ The salivary glands have never been observed
+to be affected in it. Dr. PARRISH informs me, that, after a strict
+examination, he has come to the conclusion that the previous use of
+mercury does not bring on, or aggravate this complaint, as he has
+noticed it. I have made the same observation; and, not being peculiarly
+sparing of the use of calomel in fevers, have had opportunities to
+verify it. I think I can add, that, in some cases, by shortening and
+moderating an attack of fever, calomel has been useful in preventing the
+ulceration. Given during the progress of one, and that a fatal case, it
+did not appear to aggravate it.
+
+There is no evidence whatever tending to excite the suspicion of
+_contagion_.
+
+_Treatment._--A variety of remedies had been tried within my knowledge;
+most of them with but little success, and one or two with somewhat
+better. Feeling much disappointed with the results of my practice, in
+the small number of cases which fell under my care in the spring months
+at the Asylum, as well as elsewhere, I wished to exchange with another
+physician for a period when the disease was more prevalent; for the
+purpose of studying it, and making comparative trials of different
+remedies. Dr. JOS. G. NANCREDE was so polite as to indulge me. Having
+then a large number of patients under my care, I was enabled to make
+more extensive observations, and with more precision; the results of
+which course gave me the first satisfaction I had ever felt relative to
+this disease. Trials were made of every thing that was suggested by
+friends, and generally upon 4 or 5 selected patients at a time. Thus,
+choosing them in the ulcerative stage, and having several at a time
+before our eyes, the result was seen in a very few days, much sooner
+than if patients had been successively subjected to the remedies; and no
+material time was lost in appealing to the article which appeared to
+answer best.
+
+The remedy which beyond all comparison succeeded best, was sulphate of
+copper. The usefulness of this substance, though known at Salem, New
+Jersey, was discovered, at the Asylum, by the mistake of a nurse. It had
+been previously used, in lotions of the strength of gr. ij or iij to the
+ounce of water; and with little advantage. Observing that the empirical
+remedies said to have succeeded, were, as I considered them,
+immoderately strong, I furnished the nurse with a common solution of
+sulphate of copper, and with a vial containing 72 grains of the sulphate
+in an ounce of water, for the purpose of being progressively added to
+the other at different periods. This stronger solution was applied, by
+mistake, instead of the diluted one; and it was the first remedy which
+had produced a rapid tendency to a cure. I finally settled down, after
+various trials, in the employment of the following:
+
+     R. Sulph. Cupri,    [Symbol: dram]ij
+     Pulv. Cinchonæ,     [Symbol: ounce]ss
+     Aquæ,               [Symbol: ounce]iv _m._
+
+S. To be applied twice a day, very carefully, to the full extent of the
+ulcerations and excoriations.
+
+The cinchona here is not absolutely necessary; but operates by retaining
+the sulphate longer in contact with the edges of the gums.
+
+Simple ulcerations and small gangrenes, as well as the troublesome
+excoriation, when not in the last stage, yielded promptly to this
+remedy; the good effect being generally visible from the first
+application.
+
+Dr. FOX, my friend and fellow-labourer in the Asylum, had already taught
+me that it was important early to extract the teeth. I was not, however,
+sensible of the full extent of this rule, till after examining the fangs
+of some of them which were drawn. The separation of a portion of the
+periosteum from the fang, within the socket, which was universally found
+whenever the tooth was loose, among two or three hundred specimens,
+proved the existence of the disease in a deep, narrow crevice, into
+which it was impossible, by any contrivance, to insinuate the lotion.
+This cavity was laid open by extracting the tooth; and when the remedy
+was applied, the sanatory effect was surprisingly prompt. From this
+period, forwards, the universal rule was to extract all teeth, the
+moment they were discovered to be in the slightest degree loose; and
+"the blue wash" above described, became the standing remedy.
+
+It is at all times a dangerous boast for a physician to make, to say
+that, in the treatment of any complaint, he has always succeeded. He is
+frequently not credited; and he can never know at what moment disbelief
+may be borne out by his subsequent failures. A faithful adherence to
+fact, and justice to the medical art, oblige me to say that it was owing
+to the observation of these means, that I never had an opportunity of
+making a dissection, after the one mentioned in a preceding page.
+Upwards of 120 ulcerated gums came under my notice in the course of
+three months; of which 70 were affected at one time. Of these, by far
+the greater number would, unquestionably, have escaped gangrene. The
+experience of past winters, however, and that of the preceding autumn,
+justifies the belief that there would have been several gangrenous
+cases, and some deaths; unless interrupted by remedial means. Some 3 or
+4 suffered small spots of mortification, and one, by the delay arising
+from the tardy report of a nurse, suffered necrosis in a portion of an
+alveolus; but they were speedily arrested, and the production of more
+such cases, I believe, prevented, by the employment of the above means.
+
+I have been once, since then, called in consultation to a case in which
+this remedy failed; but this was only two days previous to death, and
+during the existence of swelled cheek, and of a thick gangrenous eschar,
+and it was in fact only once imperfectly applied.
+
+The farthest advanced of all the cases which I have seen, since that
+time, relieved by this remedy, was in the practice of my friend, Dr. R.
+M. HUSTON. He aided it by the application of a poultice with lead-water
+to the external surface of the cheek. This was thought to be productive
+of much relief.
+
+Great attention and care are requisite on the part of the physician, to
+see that every part of the ulceration and excoriation is made visible,
+and brought under the influence of the applications employed. Without
+this entire knowledge of the extent of the evil, the result will be
+failure. The disgusting sloughs and discharge, and the fear of an
+imaginary _contagion_, make the nurses very unwilling to introduce their
+fingers into the reluctant little patient's mouth, and without this
+scrutiny all is in vain. The physician is compelled to set the example,
+to try the looseness of the teeth with his own fingers, and to ensure
+the nurse's entire knowledge of the extent of the disease.
+
+Dr. BEESLEY writes that the women in his neighbourhood, frequently used
+considerable _roughness_ in applying the lotions. _Certainty_ is
+absolutely necessary.
+
+After the remedy had been thus accidentally discovered in the Asylum,
+and used for a few days, I received Dr. BEESLEY'S letter mentioned
+above; and I then learned that the sulphate of copper was the principal
+dependence of the physicians at Salem. As, however, I had never seen Dr.
+VANMETER'S thesis, the use of it at the Asylum was new to me.
+
+An excellent remedy, and one on which the sole dependence should be
+placed, were we not in possession of one which possesses a decided
+superiority, is one which was communicated to me by Dr. PARRISH. It is
+as follows, including a slight correction made by the apothecary:
+
+             R. Sulph. Zinci,           [Symbol: dram]i
+                Aquæ,                   [Symbol: dram]ij Solve.
+     Dein adde, Mellis Despum. et
+                Tinct. Myrrhæ, aa       [Symbol: ounce]ij
+
+To be used in the manner described above. Some bad cases yielded to the
+following:
+
+     R. Sulph. Zinci,           [Symbol: dram]ij
+        Aquæ,                   [Symbol: ounce]i _m._
+
+It is useful to record failures and unsuccessful trials; as they serve
+to deter others from unnecessary risk. We therefore record the following
+as not having succeeded in our hands:
+
+     R. Mellis et
+     Tinct. Myrrhæ, aa        [Symbol: ounce]i _m._
+
+The same, with the addition of powdered bark.
+
+     R. Aluminis,            [Symbol: scruple]ij
+       Tinct. Myrrhæ, et
+       Mellis, aa            [Symbol: ounce]ij _m._
+     R. Pulv. Cinchonæ,      [Symbol: ounce]i
+       Myrrhæ et
+       Pulv. Carbonis. a     [Symbol: ounce]ss _m._ et adde
+       Succ. Limonum,        q. s. ad massam
+         faciendam, quâ illineantur gingivæ.
+
+Caustic potassa; and nitrate of silver.
+
+Pyroligneous acid, both pure and variously diluted with water. This had
+but a very limited effect, even in destroying the foetor; and I am by
+no means sure that it was of any use in arresting the disease.
+
+Muriatic acid, though praised by such high authorities, did not seem
+productive of any distinct useful effects. Nitric acid, variously
+diluted, and sulphuric acid, which was tried in one case, diluted with
+an equal quantity of water, were entirely useless.
+
+Of _constitutional_ treatment, the disease seemed to admit very little.
+In the early stage, the means employed, were the same mentioned above as
+means of prevention. It was by no means evident that any of these were
+useful in retarding the progress of the complaint. Towards the decline
+of the worst cases, aromatic sirup of rhubarb, with magnesia, were
+employed, to remove the putrid matters swallowed; and to relieve the
+diarrhoea which generally took place, by the astringent operation of
+the first mentioned medicine. It is extremely doubtful whether these
+means were productive of any benefit.
+
+       *       *       *       *       *
+
+While the above was in press, I have met with the article, "_Gangrene de
+la bouche des enfans_," in the Dictionnaire de Medicine; written by M.
+MARJOLIN. The author in the Dictionnaire des Sciences Medicales, has
+given nothing material but references to some of the writers mentioned
+above; with one or two which were not within my reach. M. MARJOLIN has
+evidently identified the disease. He cites FABRICIUS HILDANUS, though we
+have not found a distinct account of it in that writer's works. He
+remarks that it is identical with the _necrosis infantilis_ of SAUVAGES.
+He also refers to SAVIARD, VAN SWEITEN, whom he justly mentions with the
+highest praise, UNDERWOOD, BERTHE, CAPDEVILLE, M. BARON, and the
+inaugural thesis of M. ISNARD. As we have no means of referring to the
+two last, we must judge of them by M. MARJOLIN'S statements. He observes
+the dissimilarity of BERTHE'S case. From the thesis of M. ISNARD, he
+gives us an account of the disease which corresponds very nearly,
+indeed, with that of VAN SWEITEN, and with the appearances observed at
+the Children's Asylum.
+
+"Almost all the infants affected with this disease in the hospitals of
+Paris," says M. MARJOLIN, "sink under it." He recommends, after VAN
+SWEITEN, the use of muriatic acid, which he mixes with honey in equal
+proportions. Thick sloughs he cuts away with a bistouri or with
+scissors. MM. JADELOT, GUERSENT, and BARON, have employed the actual
+cautery with success in several instances. M. MARJOLIN has cured three
+cases; one by the actual cautery, one by caustic potassa, and a third by
+_muriate of soda!_ which, he believes, will always destroy the foetor.
+It would be interesting, undoubtedly, to make repeated trials of this
+simple remedy; and we shall endeavour to do so in cases which admit of
+delay.
+
+FOOTNOTES:
+
+[1] Vol. I. p. 319, Anderson's edition.
+
+[2] Principles of Surgery; by JOHN PEARSON. Lond. 1788. p. 262, et seq.
+
+[3] Opera omnia. Vol. II. p. 271. In the Loganian Library.
+
+[4] Ibidem.
+
+[5] See CORNELII STALPAART VANDER WIEL Observationes Medico-Anatomicæ.
+p. 167. Note by the editor, P. STALPAART VANDER WIEL. Amsterdam, 1687.
+In the Loganian Library.
+
+[6] In the Loganian Library.
+
+[7] Page 193.
+
+[8] Page 217.
+
+[9] Commentaria.--Edit. Lugd. Bat. 1742. Vol. I. pp. 766, 767.
+
+[10] This name may be either from the ancient English or the low Dutch;
+if the one, by tradition, if the other, from the use of it by medical
+men. _Cancrum_ is an odd grammatical blunder; being, in reality, nothing
+but the accusative of Cancer, put instead of the nominative. The latter
+name was, as is well known, frequently applied by the older surgeons, in
+a vague manner, to any terrific and unmanageable ulcer; and, in
+particular, it was often applied to gangrene. The error appears to have
+been first made by Pearson, and copied by Mr. Cooper. Compare Muys and
+Vander Wiel, with Pearson, at the above references.
+
+
+
+
+ARTICLE II.--_Case of Purpura in an Infant, attended with Extraordinary
+Symptoms._ By R. M. HUSTON, M. D., &c.
+
+
+On the 28th of August last, A---- V----, after a moderate labour of four
+hours' continuance, was delivered of a female child. About a month
+previously, she had laboured under an attack of intermittent fever,
+which yielded, in a few days, to the ordinary treatment. She was 23
+years of age, an English-woman by birth, had generally enjoyed good
+health, and was as well as usual at the time of her confinement. Her
+labour was strictly natural, and her delivery accomplished without any
+extraordinary assistance.
+
+At birth there was nothing remarkable about the child. Its breathing was
+natural, its skin of the usual colour and appearance; in short, all the
+common indications of a continuance of life and health were present. A
+few hours, however, after birth, it became uneasy, cried much, and
+showed signs of colic. The nurse, supposing these symptoms to arise from
+flatulence, administered some warm tea; but without any apparent
+advantage. On the following day, I saw it again, and learned, that it
+had evacuated a considerable quantity of urine, and some intestinal
+matter, of the ordinary appearance after birth. The spasms continuing at
+intervals, a teaspoonful of castor oil was ordered, to evacuate any
+remaining meconium, that might lie in the bowels, producing irritation;
+upon the presence of which, it was presumed the spasms depended. It
+operated well, but without producing the desired relief. On the next
+day, viz. forty-eight hours after birth, a number of bluish or purple
+spots were observed on different parts of the child's body, but most
+numerous on the extremities. They were of various sizes, from that of a
+mustard seed, up to that of a grain of Indian corn. Some were slightly
+elevated, but most of them were not in the least so. In the majority,
+there was a minute central spot, or little point, more red or pink
+coloured than the blue areola, by which it was surrounded. In many
+instances, these little points projected, so as to become manifest to
+the touch. In the course of twenty-four hours, the spots, which had
+first appeared, began to decline, leaving a greenish mark, very like the
+remains of a bruise; but much more rapidly than these declined, others
+of larger size appeared on different parts of the child's body.
+
+On the third day after birth, large blotches appeared, one behind each
+ear. These rapidly increased, until they covered the whole extent of the
+parietal bones, and considerably elevated the skin, giving it a puffy or
+tumid appearance, like that caused by a blow from a large or blunt
+instrument. The parts soon became hot and tender to the touch; and this
+tenderness extended over the greater part of the scalp. A blotch,
+similar to those upon the exterior surface, was likewise observed within
+the mouth, covering the whole extent of the palate bones. The child
+experienced great difficulty in swallowing after the third day; and the
+_nurse_ thought the spasms were often excited by attempts of this kind.
+
+But the most singular feature of the case was the appearance, on the
+night of the second day, of a discharge from the vagina, _resembling_
+the menstrual flux. It resembled that flux in _colour_, _consistence_,
+_want of coagulability_, and in being, withal, accompanied by a
+considerable quantity of _slimy or mucous matter_. Every diaper which
+was used during that night, and the greater part of the next day, was
+stained more or less with this discharge. It was also observed, that,
+during the flow of this fluid, the spasms ceased; and that, whenever the
+discharge was suppressed, even for a very short time, they uniformly
+returned. In this manner they alternated at intervals of a few hours,
+until the occurrence of the death of the child, which happened on the
+eighth day after birth.
+
+As this case is related more for its singularity than from an
+expectation that any practical suggestions will be furnished by its
+perusal, but few remarks will be necessary, either upon its pathology or
+treatment. Although it will be perceived by the scientific reader, that
+the disease observed, differed materially from any of the forms of
+_purpura_, described by systematic writers on diseases of the skin;
+still I apprehend it may be justly considered as more nearly allied to
+that genus, than to any other.
+
+The spots were evidently caused by an effusion of blood beneath the
+cutis, and the presumption is strong, that it issued from the little
+point discoverable in the centre of each spot. Those points were, in all
+probability, _arterial_. That they were arterial terminations, I think
+is evident, from the great extent to which the cellular membrane was
+injected, especially over the parietal bones. The force exerted must
+have been very considerable to elevate so large a portion of scalp, and
+yet no pulsation could be discovered in any one of the points.
+
+But whence came the vaginal discharge? That it issued from the _vagina_
+was most certain; but whether it was furnished by that canal, or by _the
+uterus_, was not ascertained. To assert that it was menstrual, would be
+hazarding more than a prudent regard for truth would justify. But, if
+not, why the pain and spasms which preceded it, and the alternation of
+these symptoms with each other? and, especially, why the slimy
+appearance, mixed with red matter, without a trace of any thing like
+coagula? Certainly we do not find these appearances in ordinary cases of
+hæmorrhage. So that there is no other way of accounting for the
+discharge in this case, except by considering it as having been secreted
+by the vessels of the parts from which it came.
+
+From the difficulty which the child experienced in swallowing, but
+little food could be taken; and the same difficulty precluded the
+administration of medicines. What caused this impediment could not be
+ascertained, but it was supposed to result from a spasmodic action of
+the muscles of the part.
+
+The only medicine attempted to be given was a weak infusion of bark, and
+this was soon abandoned.
+
+The spots, particularly the large ecchymosed surface on the head,
+exhibited no change in appearance, when _viewed superficially_, a few
+hours after death. No other examination was permitted.
+
+FOOTNOTES:
+
+
+
+
+ARTICLE III.--_History of the Natural and Modified Small-Pox, or of the
+Variolous and Varioloid Diseases, as they prevailed in Philadelphia in
+the years 1823 and 1824._ By JOHN K. MITCHELL, M. D., and JOHN BELL, M.
+D. attending physicians at the then Small-Pox Hospital. With a Plate.
+
+
+In a question of less moment, some apology might seem due for once more
+directing public attention to that which has been so oft discussed and
+described by many eminent physicians and experienced observers. But, if
+descriptions of any disease be valuable; if to record faithfully an evil
+be among the first steps for its removal and prevention; and, still
+more, if additional confidence, derived from enlarged experience, can be
+imparted to the means hitherto adopted to guaranty the human frame
+against a mortal and loathsome malady, our efforts at this time may
+claim the favourable notice of our professional brethren, and of the
+community at large.
+
+Sedulously abstaining from the parade of erudite research or indulgence
+in speculations, however ingenious, it is our intention to describe with
+accuracy all that we saw; and if, in so doing, we shall be found
+repeating what others have said before us, and proposing inferences
+previously drawn, the observations and deductions are to be considered
+as not the less our own, since we only speak from conviction, founded on
+the evidence presented to our senses. Our opportunities for accurate
+judgment were most ample, being derived as well from an attendance of
+nine months on the hospital for the reception of the poor, labouring
+under the disease, as from one of us prescribing, during a part of the
+time, for the Philadelphia Dispensary, added to the cases furnished us
+by private practice, and very many others, the records of which have
+been kindly placed at our disposal by professional friends.
+
+The ravages committed by the small-pox in Baltimore, and the fact of
+many who had been previously vaccinated having been attacked by the
+disease during the years 1821 and 1822 were notorious to us all, but
+were productive of little alarm in Philadelphia. The non-appearance of
+the scourge in the greater part of the period, when the former city was
+suffering under it, justified, to a certain extent, this feeling of
+security, and seemed to call more on our sympathies for our neighbours
+than on our fears for ourselves.
+
+In the month of September, 1823, some cases of fever, with pustular
+eruption, first arrested the attention of the medical faculty, some of
+whom were, of course, called on to render professional assistance. The
+residence of some of the persons, thus attacked, in Water street, and
+their emigration from Europe, naturally induced a suspicion of this
+disease being no other than the small-pox, imported by, or brought in
+with them. Very nearly about the same time, however, some scattered
+cases of a similar eruptive disease, were noticed in the upper or
+western portion of the city, without our being able to trace any
+intercourse or connexion between these and the others in the lower or
+eastern part, viz. Water street.
+
+The first return of death from small-pox, furnished by the Board of
+Health, was in the week between the 13th and 20th of September. The next
+was between the 4th and 11th of October. From this time to the end of
+the year there was a progressive increase of mortality, and the annual
+return for 1823, presented no fewer than one hundred and sixty deaths by
+small-pox. The greatest mortality in any one week was thirty-three, from
+December 20 to 27. During the months of January, February and March,
+1824, the disease prevailed extensively, and was fatal to many. In the
+following months its violence subsided, and in the month of June our
+attendance on the temporary hospital[11] was discontinued, in
+consequence of a resolution of the Managers of the Alms House to close
+it. Though a few patients were afterwards received into it, yet the
+malady soon disappearing, justified its final closure. The annual return
+for 1824 exhibited three hundred and twenty-four deaths by small-pox.
+The entire mortality from this cause was four hundred and seventy-three,
+in a period of twelve months, from November 1, 1823, to November 1,
+1824. The deaths before the first, and after the second date, were but
+eleven.[12] Contagious as this disease unquestionably was, we cannot, at
+the same time, withhold our belief of its having been in a measure
+subjected to epidemical influences, viz. in a particular character of
+the seasons and atmospherical changes. It is then within our province,
+as historians of events, rather than as expounders of causes, to present
+our readers with a summary account of the weather during the years 1823
+and 1824. We do this both from a sense of duty, considering it as
+pertinent to our present labour, and from a wish to encourage others by
+our example to preserve and transmit the meteorological registers, in
+their respective districts, of those years, marked by new or aggravated
+diseases.
+
+                     METEOROLOGICAL REGISTER.[13]
+------------------------------------------------------------------------
+|             |      |       |       |       |Winds--Days.|             |
+|             |      |       |       |Snow & |------|-----|             |
+|             |      |       |       |Rain   |N. W. |N. E.|             |
+|             |Mean  |Variat.|Variat.|Water. | to   | to  |             |
+|    1823.    |Temp. |Therm. |Barom. |Inches.|S. W. |S. E.|             |
+|-------------|------|-------|-------|-------|------|-----|    The      |
+|January,     | 31   |  44   | 0.94  | 3.38  |  22  |   8 |             |
+|February,    | 25   |  42   | 1.17  | 1.93  |  22  |   6 |temperature  |
+|March,       | 37   |  52   | 1.65  | 6.87  |  21  |   9 |             |
+|April,       | 55   |  47   | 1.08  | 1.77  |  16  |  14 |     of      |
+|May,         | 61   |  52   | 0.88  | 1.60  |  19  |   8 |             |
+|June,        | 68   |  46   | 0.65  | 0.87  |  20  |  10 |    the      |
+|July,        | 72   |  30   | 0.58  | 6.12  |  23  |   6 |             |
+|August,      | 72   |  35   | 0.60  | 4.68  |  21  |   8 |   wells     |
+|September,   | 63   |  51   | 0.61  | 3.46  |  15  |  12 |             |
+|October,     | 53   |  42   | 0.60  | 2.02  |  21  |   9 |    and      |
+|November,    | 38   |  38   | 0.81  | 2.47  |  21  |   9 |             |
+|December,    | 34   |  31   | 1.07  | 7.37  |  21  |  10 |  springs,   |
+|             |      |       |       |-------|------|-----|             |
+|For the year,|50-3/4|  88   | 1.70  |42.54  | 242  | 109 |     in      |
+|-------------|------|-------|-------|-------|------|-----|             |
+|   1824.     |      |       |       |       |      |     |    and      |
+|January,     | 36   |  48   | 1.25  | 3.67  |  24  |   7 |             |
+|February,    | 31   |  59   | 1.55  | 3.94  |  21  |   7 |    near     |
+|March,       | 40   |  39   | 0.71  | 2.63  |  16  |  15 |             |
+|April,       | 50   |  45   | 1.08  | 4.54  |  22  |   8 |Philadelphia,|
+|May,         | 60   |  44   | 0.88  | 1.59  |  24  |   7 |             |
+|June,        | 73   |  46   | 0.69  | 6.09  |  25  |   5 |             |
+|July,        | 74   |  30   | 0.38  | 8.80  |  19  |   8 |     is      |
+|August,      | 70   |  36   | 0.45  | 6.39  |  20  |  11 |             |
+|September,   | 64   |  41   | 0.65  | 6.60  |  17  |   7 |     52°     |
+|October,     | 54   |  43   | 0.65  | 1.53  |  23  |   5 |             |
+|November,    | 42   |  38   | 0.89  | 2.49  |  24  |   6 |Fahrenheit.  |
+|December,    | 37   |  43   | 0.95  | 2.11  |  24  |   7 |             |
+|             |      |       |       |-------|------|-----|             |
+|For the year,|52-1/2|  85   | 1.55  |50.38  | 259  |  93 |             |
+------------------------------------------------------------------------
+
+                              1823.
+
+Maximum of Therm. 91, June 19.    Maximum of Barom. 30.45, Nov. 29.
+Minimum     "      3, Feb.  7.    Minimum      "    28.75, March 30.
+                  --                                -----
+  Variation,      88                                 1.70
+
+                              1824.
+
+Maximum of Therm. 90, June 8.     Maximum of Barom. 30.45, Feb.  6.
+Minimum     "      5, Feb. 2.     Minimum      "    28.90, Feb. 26.
+                  --                                -----
+  Variation,      85                                 1.55
+
+The amount of water which fell in rain and snow during the four years,
+from 1822 to 1825, inclusive, was,
+
+           1822.           1823.           1824.           1825.
+Inches,    35.20     |     42.54     |     50.38     |     33.26 |
+
+We next subjoin a summary of deaths by fever, erysipelas and measles, in
+the above period; being more desirous of narrating all the circumstances
+associated with the appearance and continuance of the small-pox, than of
+insisting on them as supporting causes or necessary connexions. It will
+appear from the accompanying statement, that the diseases febrile and
+eruptive were in number, violence and mortality unusually great, in the
+above mentioned years, as we discover by comparison with the returns for
+1822 and 1825.
+
+                       Deaths by
+        Fevers.   Erysipelas.    Measles.     Small-pox.
+1822        510         4             0            0
+1823        758        24           156          160
+1824        654        28           102          324
+1825        375        12            38            6
+
+In New York and Baltimore, the coincidence between increase of fevers,
+measles and erysipelas, and the mortality from small-pox, is not so well
+marked.
+
+               In New York--Deaths by
+
+           Fevers.        Erysipelas.        Measles.      Small-pox.
+1822        393[14]              6               1              0
+1823        192[15]             13             117             18
+1824        191[16]             14             100            394
+1825        445                20              53             40
+
+                  In Baltimore--Deaths by
+
+           Fevers.   Erysipelas.  Measles.  Small-pox.
+1821        400            0          2        21
+1822        430            1          4       122
+1823        304            2        175         2
+1824        183            3         14         2
+1825        138            0          9         3
+
+We now proceed to give a brief sketch of the disease called the natural
+small-pox, (occurring in persons unprotected by previous vaccination or
+inoculation,) and the deaths from which are given in the above
+statements. We must, in advance, insist on the great diversity in the
+appearance of the eruption in different individuals; so great, that an
+attempt to make an accurate picture of one case pass for a faithful
+representation of the many, must be deceptive and injurious.
+
+In the premonitory symptoms, constituting the characters of the fever
+precursory to the eruption, there was considerable uniformity: the
+complaint of nearly all those attacked being at first chills and rigors;
+pains in the loins, head and limbs, with thirst and want of appetite;
+with which were soon associated gastric uneasiness, and in many,
+soreness of throat, rendering deglutition painful, hoarseness and
+weeping eyes. The duration of these symptoms, aggravated by febrile
+exacerbations, varied from one to three days, more usually the latter,
+after which the eruption begins to appear. It is first seen round the
+forehead and temples, near the hairy scalp; then on the cheeks and
+breast and back; on the arms near the shoulders; the abdomen and thighs;
+and subsequently on the fore-arms and hands, and finally on the legs and
+feet. The appearance of the eruption is that of red or scarlet papulæ,
+presenting to the touch a sensible resistance, but not much raised, and
+without roughness or hardness. These papulæ, becoming more and more
+defined and elevated, are after a day or two converted into vesicles,
+with small elevated centres or bodies of a yellowish-white, and more
+diffused red and somewhat hard bases or margins. The redness extending
+as the eruption becomes copious, converts the skin, especially of the
+face, neck, and hands, into a red ground, from which project, in relief,
+the whitish vesicles. Similar appearances, but of a less marked nature,
+owing to the eruption being more scattered, are found on the trunk. The
+vesicles, containing at first a thin, semi-transparent fluid, become
+gradually larger, fuller and yellower, and filled with a thick,
+tenacious matter. This change is completed, and the pustules are
+entirely formed, after a lapse of time from the first eruptive effort,
+which varies from the fifth to the ninth day, and is occasionally
+longer. The mean for the beginning of maturation, or the finishing of
+the secretion of matter in the pustule, may be received as five days for
+the face, and eight or nine days for the body generally. The stages of
+the eruption, as regards its appearance, may be very properly called
+papular, vesicular, and pustular. This last having attained its height,
+completes what is termed the period of maturation, during which the
+pustules retain their fulness and spheroid figure; and exhibit the
+greatest proportion of whitish-yellow shining surface of their body, and
+diminished extent of redness at their base. A yellow dry point on the
+summit of the pustule, which loses thereby somewhat of its former
+spheroidal shape, by becoming flatter, or slightly indented, indicates
+beginning desiccation, at which time the body exhales that peculiar
+odour, so unpleasant, and so readily recognizable, after it has once
+been perceived. There is no uniformity in the size of the pustules on
+the body generally, nor any equality among them on a particular part:
+more usually one larger and fuller is surrounded by others less so. Nor
+is it to be supposed that the changes above mentioned are gone through
+in regular succession on all parts of the surface, uniformly. It was no
+uncommon thing to see the eruption papular on the legs, vesicular on the
+trunk and arms, and pustular on the face, at the same epoch. One part
+even, as the arm for instance, has exhibited to us the three forms at
+the same time.
+
+Maturation complete and desiccation going on, the pustules break, and
+have their thin coverings converted into a yellow hard coat or crust, to
+which adheres the pus that was not removed by absorption, and the
+residue, by evaporation of its watery part, is now converted into a scab
+of varying thickness, firm and prominent in its centre, and made up
+outwardly of concentric circles. The margins of the pustules, before of
+a distinct red, now assume a bluish-red or purplish colour, and the skin
+begins to desquamate.
+
+The constitutional sympathies, or the symptoms in the milder and regular
+variety of the disease, are not of any great violence or intensity. The
+premonitory pains, diminishing or disappearing, after the coming out of
+the eruption, leave in their place a regular fever. The action of the
+heart and capillaries is hurried during the papular and vesicular
+stages; but becomes more equable while maturation is going on. During
+the former period, the loaded and not unfrequently furred tongue
+evidences disordered stomach, the cravings of which are for cold drinks.
+The somewhat laborious respiration may, in some cases, depend on the
+swelling and soreness of the fauces and pharynx; in others, on the
+eruption extending along the lining membrane of the larynx; whilst in
+others, it may be caused by bronchial engorgement.
+
+The febrile symptoms, which abate during the process of maturation, are
+apt to return during desiccation; and when the skin begins to
+desquamate, they then constitute what is called secondary fever. The
+skin which had suffered so much, occasionally exhibits at this time an
+erysipelatous blush, accompanied by an inflammation of the subjacent
+cellular tissue, and the formation of troublesome boils, or infiltration
+of serum, especially where there is much laxity of structure, as in the
+eyelids, cheeks, lips, &c. The cutaneous system, during and immediately
+after the removal of its cuticle, and much of its rete mucosum, is of
+course very sensible, as well to the impression of clothes as to
+atmospherical extremes, and particularly cold. This is with many a
+critical time. It not unfrequently happened that persons, who had passed
+through the different stages of the disease, and were advancing rapidly
+to convalescence, were suddenly seized with an affection of the chest,
+pleurisy, bronchitis or pneumonia, and speedily carried off by the
+violence of the inflammation. The skin, exquisitely sensible in its
+denuded state to atmospherical vicissitudes, transmits with great
+promptness the morbid impression to the lungs, already prone to take on
+disease, in consequence of the active part they are compelled to play
+during the eruptive fever.
+
+The anomalous varieties, if we can admit any standard form of the
+disease, were numerous. Those which most fixed our attention were the
+_confluent_, the _roseate_, the _tuberculous_, and the _erysipelatous_.
+
+The _confluent_ was ushered in by symptoms of greater febrile disorder
+than the regular distinct variety: the throat was sorer; eyes more
+suffused and watery, and more intolerant of light; gastric and pulmonic
+uneasiness, and oppression more aggravated. In place of the papulæ being
+separate, or merely in clusters, they are so crowded, that on the
+progress of the eruption the vesicles first and then the pustules are
+contiguous at their bases, and often run into each other, forming at
+times, a large irregular bag filled with pus, and technically called
+blebs, or else exhibiting over a considerable space of skin the
+appearance of imperfect vesication. The vesicles and pustules are, in
+such cases, flattened, and with indented centres, which latter display
+at times a dark point or spot, while the edges are of a livid red. This
+is the appearance of the limbs and trunk. The cheeks and forehead during
+the process of maturation present a continuous puffy elevation of a
+pearly white colour. The eyes are nearly closed by the swelling of the
+lids, and the thick copious secretion from the borders and the
+conjunctiva; the lips are tumid and the angles of the mouth ulcerated.
+In fact the human face divine, deprived of all lineaments and
+expression, is now a foul, misshapen mass. Associated with this state
+are swelled throat, rendering deglutition very painful--salivation,
+cough--occasional vomiting, delirium, sometimes phrenitical, sometimes
+evidencing itself in low mutterings and jactation.
+
+The _roseate_ variety of small-pox might, without creating much
+confusion, be ranked with the confluent, which it closely resembles in
+its second stage. The first is characterized by the rose or pink colour
+of the face, which is covered with a copious eruption of papulæ, some
+with dry points, while from others, the bases of which are small and
+hard, arise minute vesicles of a pearly colour, which soon dry away. The
+inflammation, however, still continues, but spreads under the cuticle,
+which is raised in large patches of a white colour, but not vesicular,
+or distinctly pustular, or containing fluid: they approximate and
+produce the continuous puffy elevation already described. On the trunk
+and extremities, the eruption is either of confluent patches or of
+pustules dry and flat, with indented centres, the intermediate skin
+being of a deep red or crimson colour.
+
+The constitutional disorder runs high in these cases,--delirium and
+great gastric distress being very common symptoms. The tongue,
+especially at its border, is frequently the seat of eruption, which may
+be compared to the vesicular stage on the skin, with the summits cut
+off. The lining membrane of the mouth and fauces and pharynx, are, we
+presume, similarly affected, judging from the soreness of these parts,
+and the thick muco-purulent matter sometimes mixed with blood, which is
+spit out or brought up by screatus. The subjects most liable to the
+roseate eruption, were the intemperate and debauched of the sanguine
+temperament.
+
+The _tuberculous_ variety of small-pox was most frequent among the
+negroes. The eruption at first consisted of broad papulæ, which were
+converted into hard, rough, and knotted prominences, tuberculous at base
+and flattened in the centre. This was not unaptly called by some the
+seal skin eruption. Sore throat, causing the greatest difficulty in
+deglutition, and delirium were the almost invariable concomitants of
+this variety. Occasionally the patient was in a state of stupor and
+disinclination to motion--at other times wakeful and restless, and
+requiring coercive means to confine him to his bed. In many instances,
+the muscular strength was retained to within a few hours of death. The
+fatal termination in these three varieties, confluent, roseate, and
+tuberculous, was in the second period of the disease, that is, in the
+one corresponding with the completion of maturation, and the absorption
+and drying away of the pus in the simple distinct form of small pox.
+After some experience, we were enabled, from the appearance of the
+eruption at the outset, to presage the event, which in the above
+described kinds, was almost universally fatal.
+
+The _erysipelatous_ variety was more an adventitious conversion of the
+primary form of the disease, by hospital air and delicacy of the
+cutaneous tissue induced by prior irregularities of life, than a
+distinct kind to be met with in general practice. It was most commonly
+presented to us in persons who had a very copious eruption, interesting
+to a great degree the whole cutaneous surface, and in whom the process
+of maturation was complete, and the cuticle began to lose its adhesion
+to the subjacent tissue. In some cases, even after desquamation was
+almost completed, and the skin nearly dry and smooth, erysipelatous
+inflammation would supervene, and seem to be repeated on the pulmonary
+and gastric surfaces, producing great trouble in respiration and
+derangement in the digestive functions, accelerated pulse, and other
+symptoms of fever.
+
+We could readily pourtray other nicer shades of the natural small-pox,
+but the originals might not perhaps be so readily recognized by
+succeeding observers, or their nature well understood by our
+readers.[17] Our object being to convey practical knowledge, we pass on
+to a notice of the subjects, most liable to suffer from exposure to the
+variolous poison.
+
+The African race would seem to be peculiarly obnoxious to the small-pox:
+the actual number of people of colour brought to the hospital being
+greater than the whites, and the proportionate mortality much more
+considerable; being as four deaths to six cases of disease in the
+former, and two deaths to four cases of disease in the latter. As
+regards sex, the proportion of deaths among the males was three-fifths,
+among the females two-fifths, of the entire number under treatment in
+the hospital. In both, the violence of the disease, and the number of
+anomalous symptoms and complications, depended greatly on their prior
+dissolute life. Drunkards among the men, and prostitutes among the
+women, rarely escaped death. The former had the roseate eruption, and
+the latter the confluent, on which dark spots as if gangrenous were a
+frequent appearance. Menorrhagia, at any time in the course of the
+disease, was a bad augury.
+
+The better to elucidate the nature of this dire malady, we shall now
+give from our records some cases of fatal termination, and add an
+account of the appearances on _post mortem_ examination of these same
+subjects.
+
+CASES.--I. Wilhelmina Smith, white, aged nineteen years, of irregular
+habits, has a well defined circular scar, with smaller pits in it, on
+the left arm; but has no recollection of having been vaccinated, nor
+does she remember ever having heard her parents, who are now dead, speak
+of it.
+
+She was taken sick on Thursday night, the 11th of March, 1824, and in
+the morning had vomiting and pains in the back. On the 13th in the
+afternoon, the eruption first appeared.
+
+15th. Admitted and visited. Eruption on face slightly prominent, is red,
+tuberculous and rough--small and scattered on the arms, like flea bites.
+Legs nearly clear: they have many cicatrices, especially on the shin and
+outer part. There is at present an ulcer above the inner ancle. Tongue
+yellow, and furred in centre, white at borders. Pulse small and
+threaded.
+
+16th. Eruption rising vesicular from face and limbs; no fever; tongue
+greenish and loaded; coughs much.
+
+17th. Eruption fine, dry, flat, and partly indented in centre on the
+face, which burns much; skin red and inflamed; on limbs same appearance,
+but eruption less copious; pulse small, threaded, and frequent; tongue
+furred and yellow in centre; complains of pain in deglutition; cough.
+
+18th. Eruption on face dry, flat, white and small in size, and copious;
+rather more elevated on limbs and neck; tongue dry and furred; pulse
+frequent and threaded; throat sore.
+
+19th. Eruption same as yesterday; pulse scarcely to be felt; skin cool;
+coughs with an appearance of choking.
+
+Dead at midnight. She retained her muscular strength and ability to sit
+up to the last.
+
+_Examination_ in the afternoon of March 21.--On removing the sternum and
+anterior portion of the ribs, the anterior mediastinum was found filled
+with a frothy adipo-mucous collection of a yellowish colour. The lungs
+on both sides adherent to the thorax, and the left lobes to each other.
+A sanguineo-serous effusion on both sides, probably a quart on the
+right, the lungs of which were changed in texture, and shrunk. The
+pericardium contained a large quantity of the same kind of fluid, which
+was found in the cavity of the thorax. The heart was highly injected. On
+removing the lungs and the trachea, and larynx, the lining membrane of
+the two last showed a brownish-red, coated with mucus, and deeply
+injected. Same appearances in a more marked degree in the bifurcations
+of the trachea.
+
+The oesophagus next examined, was found of a natural appearance,
+except near the stomach, where it was injected and assumed a red hue,
+contrasting with the whiteness of its upper part. The mucous membrane
+of the stomach near the cardiac orifice was in some parts of a roseate
+hue, in others a brownish-red; while in others it was ash-coloured, and
+dotted with red and yellow points. Towards the pyloric orifice, less
+disease. The stomach contained nothing but dark green bile and mucus.
+The duodenum was also highly injected. Lower down, the small intestines
+were in places lined with a dark red and brown, and the mesentery highly
+injected in the portions corresponding to these spots. Intestines much
+inflated, and omentum dark and injected. The uterus was not examined.
+The ovaria were large, white and soft; in the left was a small sac of
+dark blood, which readily burst on pressure.
+
+The liver was very large, of a soft texture and white colour;
+gall-bladder full of dark green bile, which had in part transuded
+through its coats.
+
+On looking at the trachea after it was washed, it exhibited in places
+whitish elevated spots, having all the appearance of an eruption.
+
+II. Ann Collins, white, aged 18 years, unprotected, became sick on
+Tuesday evening, March 23, 1824, and was taken to the Alms House, as one
+having the measles, on Wednesday. On Thursday evening, some eruption was
+visible; on Saturday evening, March 27, admitted.
+
+28th. Visited. Face covered with a red, flat, dry eruption, particularly
+on the cheeks; small and vesicular on the chin and around the mouth. On
+the arms, it has the appearance of measles; on the hands, it is of a
+deep scarlet, with central vesicular elevations; on the legs is slight;
+tongue loaded and yellow, except at the borders, which are clean; pulse
+natural; complains much of pain in the back and sickness of stomach.
+
+30th. Eruption covering the face, vesicular on a deep red ground with
+some tumefaction; rising vesicular on the limbs with scarlet bases.
+Tongue smooth and shining anteriorly, and with vesicles on it. Throat
+sore. Salivation. Pulse small and feeble. Has had menorrhagia since her
+admission into the hospital.
+
+31st. The menorrhagia continues. Had last night epistaxis. Pulse small
+and slow. Tongue furred and red. Eruption confluent with indented and
+dark centres. Surface white and dry. Skin between, red and inflamed.
+Very slight eruption on legs, and none on feet.
+
+April 1. Menorrhagia continues. Pulse small and labouring. Respiration
+laborious and hurried. Face swelled. Surface smooth, with white spots to
+represent the pustules. On breast and arms the eruption is in confluent
+patches which are nearly continuous--some pustules flat and indented,
+others smooth, with appearance of radii, and some more elevated forming
+blebs. Skin of the feet cold, and blue in spots; no elevated eruption on
+lower extremities. Tongue furred and yellowish. Throat sore. Eruption
+very copious on body, generally with blebs.
+
+_Vespere_; pulse hardly perceptible. Anxiety and distress great. Dead at
+10, P. M.
+
+_Examination_ April 2nd, in the afternoon.--On opening the thorax, the
+lungs and heart were found of the natural appearance and size. The
+larynx and trachea being divided, exhibited all the way down to the
+lungs an injected surface with whitish irregular spots, having nearly
+the same appearance as the flat smooth eruption on the face: in parts it
+was more evidently pointed, and showed, by the aid of the microscope, a
+pustular appearance. In the lungs, the inner surface was still darker.
+The root of the tongue was covered with large and rather hard papillæ,
+with open summits. The oesophagus was smooth and white. The stomach
+near the cardia injected, and of a brownish-red in spots: the remaining
+portion white, presenting no diseased appearance. The spleen was very
+large and covered with copious miliary points. The omentum, to
+appearance gangrened, was dark, and altered in texture. The peritoneum,
+especially in the pelvis, was injected and inflamed, being of a
+semi-opaque dark colour. The uterus, small and firm, contained some
+bloody mucus in its cavity.
+
+III. Joseph Foster, white, aged 22 years, unprotected, became sick on
+Monday evening 8th of March. The eruption began to show itself on
+Wednesday morning, 10th.
+
+12th. Admitted and visited. Face covered with a red, dry, tubercular
+eruption, with some few yellow pustules. Same on arms, but no pustular
+appearance; partly tuberculous, partly vesicular. More sparse and
+scattered on breast and legs: none on feet. Slight cough. Tongue white,
+clammy, and loaded in middle--red at borders. Pulse rather frequent.
+
+14th. Face covered with a pustulo-vesicular eruption, with whitish
+summits, red and inflamed bases. Skin between, of same colour. Eruption
+dry and hard; very red, copious on limbs; less so on trunk. Tongue moist
+and less loaded. Pulse regular.
+
+15th. No fever. Face of a deep red colour; eruption rising from it
+rather flat, irregular in figure and white at summits. Eyes inflamed. On
+limbs the eruption is red at base, vesicular in body and summit: on
+trunk in clusters. Tongue yellowish and rather furred. No complaint
+made; rests easy; sleeps well.
+
+16th. No fever: tongue moist and a little loaded. Pustules nearly white.
+Some yellow, and beginning to dry on summits. Skin between still of a
+deep red. Eruption filling on limbs and trunk.
+
+17th. Pulse strong and frequent; skin hot; tongue moist and loaded.
+Pustules scabbing on face. Not yet entirely filled on limbs, where they
+are in clusters with inflamed bases.
+
+18th. Pustules full and matured on limbs. Running into each other in
+places. Tongue dry, brown, and furred in centre, yellow and loaded at
+sides. Pulse quick and frequent. Lies easy.
+
+19th. Blebs formed on arms; pustules running into each other, beginning
+to shrink; matter oozing out. Tongue covered with a dark crust. Pulse
+quick and frequent. Erysipelas of eyelids and ophthalmia. Throat sore.
+
+20th. Blebs larger and more numerous on hands and arms; purulent matter
+oozing out from some of the pustules. Face nearly scabbed over. Some
+small white pustules formed on the eyelids. Pulse frequent and
+vibrating. Tongue as yesterday. Gums tender.
+
+21st. Pulse weaker. Desquamation going on; pustules shrunk and drying on
+limbs. Tongue as yesterday.
+
+22nd. Matter much absorbed on limbs, leaving a shrunk cuticle. Face
+covered with a brown and yellow scab and scurf. Tongue black and furred;
+clear at apex.
+
+23d. Some erysipelatous inflammation of the skin; pustules all nearly
+disappeared from arms, trunk and thighs; some few, white and soft remain
+scattered over breast. Pulse frequent. Tongue black and incrusted.
+
+24th. Was brought into town from Bush Hill.
+
+30th. Desquamation nearly complete. Low frequent pulse. Respiration slow
+and laboured. Tongue incrusted.
+
+April 2nd. Dead at 10, A. M.
+
+Calomel had been freely given to this man in the earlier stage of his
+disease: and during the last week, spts. terebinth. and nutritive
+farinaceous food.
+
+_Examination._--The pericardium, of a greenish colour and its
+capillaries finely injected, was full of yellow serum. The lining
+membrane of the larynx and trachea was of a greenish-yellow colour
+throughout, and in the spaces between the cartilages ulcerated and
+disorganized in several spots. Beneath the membrane was a venous
+injection. About the bifurcation it was injected; and in the
+ramifications of the trachea were seen several inflamed, and in places
+abraded and disorganized spots. A chocolate coloured liquor with a
+sediment filled the bronchiæ and the larger tracheal subdivisions.
+
+The oesophagus was sound. The stomach showed clusters of bright red
+and brownish-red spots, in stellated and other regular figures extending
+along the smaller curvature. The duodenum, at its commencement and in
+its course, presented similar clusters. The rest of the intestine was
+healthy. The brain was to appearance in a natural state.
+
+IV. Peter Johnson, black man, aged 38 years, unprotected, was taken sick
+on Monday, 29th March, in Sandy Hook. Eruption of small-pox appeared
+April 3d, Saturday morning. Admitted same day.
+
+4th. Eruption copious on face; papular and of irregular figure. Eyes
+suffused and red. On arms, same appearance as on face, but less
+tuberculous. On breast and body, eruption small and pointed; beginning
+to show on legs. Throat sore. Tongue yellow and loaded at sides; red in
+centre. Pulse full, equal, and rather frequent. Cough.
+
+5th. Much anxiety and moaning. Eruption rough and tuberculous on face.
+On arms, it is in parts papillary and pointed, and in parts flat with
+indented centres. Pulse slow and equal.
+
+6th. Eruption hard and tuberculous on face and arms; small and pointed
+on breast. Pulse slow; throat less sore; mind wandering. Is sitting up
+in bed, dressed. Tongue moist and yellow.
+
+7th. Delirious through the preceding night; is now dozing. Eruption same
+as yesterday. Not so thick on legs, but hard and tuberculous.
+
+8th. Tongue black and incrusted. Throat very sore. Eruption hard and
+flat. Pulse active.
+
+9th. In a comatose state. Pulse slow. Skin cool.
+
+10th. In the same condition. Drawn down in the bed, the thighs flexed on
+the abdomen, and lies on his side.
+
+11th. Dead at six A. M.
+
+_Examination._--The upper surface of the tongue of a brownish yellow,
+full of holes and rough. At the posterior part, in place of the larger
+papillæ, were ulcers and cavities. The posterior nares and pharynx were
+covered with holes, formed by ulceration, and of a brownish hue,
+adjoining injected and apparent pustular parts. Tonsils ulcerated, and
+their investing membrane mostly destroyed. The oesophagus immediately
+below the glottis, smooth and sound. Yellowish matter flowing from the
+glottis. On opening the larynx, it was found half filled with a viscid
+light olive-coloured fluid; on removing which, the whole lining
+membrane, down to the bifurcation of the trachea, was found covered with
+clusters of ulcerated pustules of a yellow colour, with the intervening
+spaces of a brownish-red, highly injected, and destitute of its natural
+smooth, shining appearance. The internal surface of the glottis and
+epiglottis was in a similar but less marked state as the larynx and
+trachea. The pustular surface extends to the minute ramifications of the
+bronchiæ, and their cells beyond were highly injected.
+
+On opening the abdomen, the omentum was found dark and shrunk. Stomach
+contracted. Intestines distended, shining, and very vascular, with
+capillary injection when viewed externally. The peritoneal covering of
+the stomach showed a similarly injected appearance.
+
+The stomach being opened, displayed at its upper curvature, spaces
+studded with spots of a deep red or purple; apparently effusions
+surrounded by a vascular net-work. Same appearance towards the pyloric
+orifice, and in places on the duodenum, which, together with the
+jejunum, particularly the latter, is of a dark leaden colour, and
+injected.
+
+The diaphragm on its upper surface, highly injected, as was also the
+pleura lining the thorax. The pericardium healthy.
+
+The brain was not, unfortunately, examined.
+
+V. Jacob Fry, black man, aged 30 years, unprotected, was taken sick on
+Sunday, 11th April, 1824. Eruption appeared on Thursday, April 15th.
+
+16th. Admitted and visited. Eruption copious and papular on face; smooth
+and flat, with dark centres, on trunk and arms. Tongue loaded. Cough.
+Tenderness of epigastrium on pressure. Throat sore. Pulse small and
+threaded. Eyes muddy.
+
+18th. Eruption flat and rough; diffused over face. On breast red and
+flat; on limbs in clusters, shrunk, and hollow in centre. Pulse small.
+
+19th. Tongue moist. Pulse small and frequent. Throat much swelled.
+Restless, and somewhat delirious.
+
+20th. In a comatose state; but is roused to attention by calling him.
+
+21st. Dead at five P. M.
+
+_Examination._ April 22nd.--On opening the thorax, the lungs were seen
+to appearance healthy. Both adhered to the pleura costalis. The pleura
+lining the diaphragm, and also the pericardium, were finely injected.
+Fauces inflamed, injected, and ulcerated. From the tonsils oozed out
+pus.
+
+The larynx contains a light olive coloured fluid, muco-serous, which
+likewise covered the trachea and bronchiæ. The lining membrane
+throughout was rough, and exhibited a net-work of a brownish-red colour,
+finely injected.
+
+The oesophagus about half way down, has its lining membrane removed
+for one-third its length, showing miliary points on its muscular coat.
+The stomach on its outer surface, and near its upper end, showed a black
+spot, like effusion of black blood, under the peritoneal coat. On
+examining the oesophagus near the cardia, it was found of a dark
+colour in lines. From the cardia, half over the inner surface of the
+stomach, radiates inflamed membrane of a deep red colour, and corroded
+at the place corresponding to the dark spot above mentioned. Red spots
+near the pyloric orifice. Intestines not diseased. Liver adherent by its
+right lobe to the ribs; this lobe was of a greenish leaden colour. No
+alteration of its structure. Brain injected in its arachnoid coat.
+Ventricles contained some serum. Tela choroides dark and gorged.
+
+VI. William Lawrence, aged 18 years, unprotected, became sick on
+Saturday, April 17th. On Sunday taken to the Alms House, and on
+Wednesday, 21st was transferred to the Hospital.
+
+21st. Eruption fine and papillary on face; red and scarcely raised on
+arms. None on legs. Has cough since yesterday. Pulse slow and regular.
+Tongue brown, and incrusted in centre. Moist on sides.
+
+22nd. Eruption confluent and red. Papulo-vesicular on face and arms.
+Flat, dry, and copious all over the trunk. Scattered and small on legs
+and feet. Pulse small and regular. Tongue loaded and brown in middle.
+Eyes sparkling. Is delirious and very restless.
+
+23rd. Eruption very copious all over the body, rising vesicular from red
+margin. Pulse small and slow. Tongue loaded, furred, and yellow. Head
+and back easier. Has slept well. Face deeply suffused with red.
+
+24th. Cough. Eruption flat, indented centres, dark in places. It is now
+coming out on legs. Pulse small and firm. Skin cool. Much uneasiness and
+hurried breathing.
+
+25th. Dead at seven A. M.
+
+This man had been bled twice before his admission, and once again on the
+22nd. Cold affusions had been freely used.
+
+_Examination_, on the 26th April.--Pericardium sound, but contained much
+sanguinolent serum. Pleura sound. Lining membrane of pharynx partly
+destroyed. No ulceration. Tonsils give out pus on pressure.
+
+Oesophagus of a dark red, and partly lost its inner membrane. Larynx
+and trachea injected; but the membrane lining them is entire, without
+pustules or ulceration. Some frothy effusion in bronchiæ.
+
+Liver healthy. Spleen large. Omentum sound, and of a natural white
+colour, traversed by some large veins. Stomach externally of a brown-red
+colour; and when opened, presents, spread out from the cardiac orifice,
+dark brown-red streaks; and towards the pyloric orifice and upper side,
+an extensive surface shaded over with vermillion and darker spots. Near
+the duodenum, the surface is white. Intestines slightly injected.
+Bladder dotted all over with bright red spots on its inner surface,
+which is covered with a fine capillary reticulated structure.
+
+VII. An infant, white, unprotected, aged three weeks, child of Clarissa
+Clarke, who had been inoculated twenty-one years ago. Taken sick on
+Sunday, 2nd May. Eruption appeared Thursday, 6th. Admitted 9th.
+
+10th. Eruption copious, and in confluent patches, with red bases, and
+flat vesicular summits. Has also aphthæ.
+
+13th. Eruption confluent, in large white patches on face. Throat very
+sore.
+
+15th. Dead at eight A. M.
+
+_Examination._--The stomach of a light colour, perfectly healthy. Folds
+and plaits of mucous membrane strongly marked. Mucous surface of trachea
+nearly healthy.
+
+VIII. Infant, female, of a woman who died in the Alms House of varioloid
+disease, shortly after giving birth to this child. It is three weeks
+old; was admitted Sunday, 25th April, second day of the eruption. Dead
+on Thursday, 29th. The skin became livid after death..
+
+_Examination._--Pharynx inflamed, and the eruption on it extending all
+the way down the oesophagus, to near the cardiac orifice; the lining
+membrane being also in part destroyed. Stomach of a fine clear red, and
+beautifully injected to the minutest capillaries all over the mucous
+surface. Intestines, both large and small, red and injected.
+
+The larynx has some eruption on its lining membrane. The trachea and
+bronchiæ nearly healthy; there being no eruption or secretion on their
+surface.
+
+Doctor DARRACH was present at the majority of the above detailed
+examinations, and kindly officiated at some of them. This gentleman,
+well known for his zeal in the study of comparative and morbid anatomy,
+made many interesting microscopical examinations of the various kinds of
+variolous pustules, and the corresponding changes in the cutaneous
+tissue, the results of which, we hope, he will make public.
+
+Having thus freely described what we saw, we wish it were in our power
+to lay down next, for the benefit of those who come after us, a
+satisfactory method of treating small-pox. The hospital returns are not
+of such an encouraging nature as to make our self-love predominate over
+observation and experience, and lead us to inferences which might seem
+to sanction the utility of this or that medicine, or curative plan. We
+had to deal, it is true, with the worst portion of the community;
+persons of constitutions exhausted or perverted by excess of sensual
+indulgences, or by poverty, or both conjoined. In private and even
+dispensary practice, where the subjects were of a better physical and
+moral nature, we often saw the disease subside, and health return, after
+less attention to administer medical aid, or to supply other wants, than
+was exhibited at the hospital. We are, notwithstanding, sanguine enough
+to anticipate useful results from our attentive study of the symptoms of
+the disease, in connexion with that of the post mortem examinations, and
+to consider ourselves as in possession of lights to guide us with more
+certainty than before. Let us see how far a cautious analysis will tend
+to dispel old errors, and establish useful truths.
+
+The gastric distress, and the associated uneasiness and pain in the
+head, back, and limbs, with evening exacerbations of fever, for the
+three days preceding the eruption, evince conclusively a disease to
+which the skin is a stranger, except by its usual sympathies of heat and
+coldness, moisture and dryness. The appearance of the tongue, the loss
+of appetite, thirst, nausea, and occasionally vomiting, are testimonies
+to the impeded function of the stomach in this first period, or that of
+precursory fever: and if to this we add the soreness of the fauces and
+pharynx, producing impeded deglutition, we cannot refuse our assent to
+the belief that the mucous surface, on which the _preparatory process_
+of digestion takes place, is mainly affected. The next leading symptom
+is the appearance of the eruption on the skin. The character of the
+disease is now fixed, and the physician feels himself compelled to
+respect the cutaneous inflammation, throughout its entire course,
+naturally enough regarding it as the disease itself, rather than the
+last link in the chain of morbid actions. To support the circulatory
+system at such a degree as shall enable the skin to secrete this new
+matter of small-pox, is nearly as much as he proposes to himself. But
+here arises a question of great practical moment. To what extent, if
+any, is the eruption a natural or necessary sequence of the previous
+symptoms or condition of the system. Perhaps in the existing state of
+medical science, we hardly dare reply positively to this question. This
+much we know, that there is no correspondence in general between the
+intensity of the precursory fever, and the copiousness of the after
+eruption. We are, moreover, well apprized of the fact of very many, who
+had been protected in earlier life by inoculation or vaccination, being
+seized with all the symptoms of the precursory fever of the small-pox,
+and remaining seriously indisposed for a few days, yet with very little
+eruption in some cases, and without any in others.
+
+Next we may inquire, what control, salutary or otherwise, we can
+exercise over the skin in reference to its eruption, by adopting certain
+methods in medicine and hygeine, during the period of invasion or of
+precursory fever. To foster the germ of the poison, as yet only
+affecting the inner surfaces, into efflorescence on the outer or
+cutaneous one, by hot air, warm and heavy clothes, and cordial drinks,
+is a practice, which, though at one time advocated on what was thought
+very sufficient theory, is now abandoned as at war with experience. Of
+these means, clothing acts primarily on the skin, and we will suppose
+heat to do the same: the cordial drinks must however affect this organ
+by stimulating and irritating the gastric and intestinal surface.
+Against all stimulation of this surface we are then bound, from
+knowledge and theory, to object.
+
+The cooling regimen as it is called, was substituted for the
+alexipharmic, in so far as regards light clothing and cool air. Can
+emetics and purgatives be viewed as a part of this regimen, and exert as
+such a salutary influence over the second period of the disease, or that
+when the eruptive effort takes place? Admitting they are but local
+stimulants, can they as such be with advantage applied to a surface, as
+that of the stomach and intestines, already highly irritable, and which,
+as the disease advances, becomes inflamed? If our object be in this
+first period to diminish the violence of the second or eruptive one, we
+doubt whether our expectations will be at all met by any kind of
+stimulant to parts, which so promptly transfer their irritation to the
+cetaceous surface. Whatever may be thought of these suggestions; whether
+they are to be regarded as well-founded, or merely speculative, must be
+a subject of future investigation; since we are as yet compelled to deny
+that experience can be adduced in favour of the practice of vomiting and
+purging to the first period of variolous disease.
+
+On the same line with the remedies just mentioned, have been placed
+bleeding, general and local, though as we apprehend, very erroneously.
+There is not in bleeding as in purging, conflicting and alternating
+effects of debility from evacuation, and irritation, primary and
+sympathetic, from local stimulation; but a direct diminution of morbid
+action, more tranquil movements of the heart and capillary system, that
+is of the circulatory apparatus, and of the membranes, mucous, serous
+and cutaneous, &c. Bleeding, unlike most other remedial agents, produces
+a direct calmness and ease in the animal economy: it does not like them
+substitute one disturbance for another, or make the great appear the
+lesser evil. The experienced physician well knows the value of this
+remedy, in the first period or invasion of the phlegmasiæ, and of some
+fevers called general. He is fully aware, that if he cannot produce by
+it a decided impression on the malady in the commencement, he is but too
+often afterwards a prey to doubts and anxieties, wishing to relieve, but
+unknowing what to attempt. Conceding, however, the power of venesection,
+in the forming stage of the disease, now under review, so that we by
+this remedy may control the series of morbid actions in the second
+period, and diminish the extent of the eruption; it may yet be seriously
+asked, whether we can with safety and propriety prevent or destroy the
+succession of changes to which the skin is subjected, from the first
+papulæ on to desiccation. On this point, we believe, has turned the
+practice of the profession at all times, whether in the ages of
+humoralism, or in the reign of solidism. In addition to the reasons
+already assigned, which would lead us to doubt the necessity of the
+eruption being left uncontrolled, or even suffered to run its course, we
+may appeal to the practice of inoculation, which as effectually
+saturated the system, and indisposed to subsequent attacks, as if the
+skin had formed a continuous pustular surface; and yet this benefit was
+often gained by the trifling tax of a few days' fever, and half a dozen
+of pustules. Where the fever runs high and the respiration is much
+affected, in the first period of measles, and before there is the
+slightest appearance of eruption, we conceive it often so be our duty to
+bleed freely, without reference to the subsequent disease of the skin,
+or any nicety of calculation about this latter going through its regular
+stages. Indeed, we have usually reason to congratulate ourselves for
+having, by this means, rendered the subsequent disease milder and more
+tractable. That affection of the urethra termed gonorrhoea, the
+product of contagion, will, if left to itself, go through its several
+stages; and, if rest and regimen be enjoined, will often leave the
+subject healthy as before. But we can, notwithstanding, cut it short
+with perfect impunity, by suitable remedies, and thereby prevent
+numerous unpleasant symptoms and effects, which are often present when
+the disease is left to nature. Syphilis has its several stages, each
+marked by characteristic symptoms; but the skilful treatment of the
+first stage prevents, how beneficially we all know, the appearance of
+the others. We must then in small-pox, as well as in other diseases,
+beware how we confound a common and even natural, with a necessary and
+unavoidable succession of symptoms and periods.
+
+The precursory fever in small-pox is seldom marked by the same common
+inflammatory symptoms as that in measles; and does not seem, by its
+actual violence, to urge the physician to deplete with freedom, if he
+only have regard to the existing condition, rather than to the impending
+danger and complication. The diversity in the two diseases consists not
+so much in the greater intensity of the latter, as in the more decided
+gastro-enteritic derangement in the former. Experience has not yet
+sanctioned the benefit of copious bleeding from the arm, in incipient
+disease, or irritation verging to inflammation of the intestinal
+surface, as in small-pox; while its efficacy is admitted in measles. But
+conceding its doubtful character, local bleeding, as by cupping, and
+leeching on the abdomen, might be serviceably employed in the form of
+disease now under consideration; as we know it to have been in other
+febrile affections, where the same parts were diseased. Topical
+depletion does unquestionably exercise the best effect on membranous
+inflammation. In addition to cool air, we may with some confidence have
+applied at this time to the skin, cool, if not cold, affusions; while
+cold or cool drinks, and these of mucilaginous kind, would constitute
+the principal ingestæ and medicines. Our own experience was little
+favourable to the efficacy of cold water, applied to the surface during
+the eruptive stage; and we apprehend, that, if decided benefit can grow
+out of its use, it must be during the first or precursory fever, before
+the formation of vesicles has commenced, when every thing is to be
+attempted to sooth irritation, and prevent febrile reaction.
+
+The first period over, the eruption on the skin now appears, and
+constitutes a leading and exceedingly important symptom of the disease.
+This eruption, like many others the product of gastric derangement,
+acts for a time as a counter-irritant, and as such affords temporary
+relief to the internal organs; but when continued, as in the farther
+progress of the disease, it, in common with all irritants on the skin,
+returns with interest to the digestive tube, the irritation which it
+first received from this latter.
+
+We must not lose sight of the state of the lining membrane of the lungs
+during this time. It cannot be said so much to sympathize with the skin,
+as to be affected by continuous disease; since the eruption on the
+mucous membrane of the larynx, trachea, and its ramifications, undergoes
+nearly the same changes, in the same time with that on the cutaneous
+surface. The danger and violence of a disease in which the three
+surfaces, cutaneous, pulmonary, and gastric, are all organically
+affected at the same time, must be very apparent. Even though there be
+no eruption on the internal coat of the stomach, its appearance after
+death, of high vascularity and sanguineous injection, corresponding
+precisely in appearance with the circles found in the lungs, of which
+the pustules were the centres, justifies this belief of its being
+organically affected. Each of the three above mentioned surfaces is in
+degree ancillary to the others, and each may, on occasions, partially
+supply their functions; but in this period of variolous disease, our
+hopes of such vicarious action must be very faint indeed, and hence the
+hazard attending any application to any one of them.
+
+Are we from these appearances to pronounce the eruption a phlegmasia of
+the skin and lungs, associated with a previous one of the stomach, and
+recommend the free use of venesection? Life may occasionally be
+prolonged, or at times saved by this means; but the disease will not be
+thereby materially arrested in its course, or modified in its
+appearance. We shall find that the inflammation of the membranes,
+consisting as most of them do of cellular tissue and minute capillary
+vessels, is often not susceptible of being checked by general depletion,
+carried even so far as to almost empty the larger arteries, and arrest
+the heart's motion.
+
+Still more will this inflammation persist, if it have gone to the extent
+of forming new parts, whether phlegmons or pustules. The intensity of
+the inflammation may be somewhat moderated, but it cannot be conquered
+now as at the commencement, or during the first period, or that of
+invasion. We cannot, from our own experience, speak favourably of the
+remedy in the second, or eruptive stage. It did not answer our
+expectations, though employed in subjects apparently the best
+constituted to derive the good effects proposed from it. We must at the
+same time grant, that it was complicated with other remedies. Of topical
+bleeding, we are unable to speak, not having seen it tried. In this
+period of the disease, it must be of very difficult execution. Still
+less reason have we to boast of the good effects of purging. Though the
+skin may for a while be relieved by the watery secretions from the
+intestinal canal; yet the irritation of the latter, consequent on
+purging, is soon communicated to the cutaneous surface with the effect
+of aggravating the eruption. To the class of stimuli or stimulating
+diaphoretics, the same objections apply with increased force. As on the
+one hand, in cases of high fever, seeming to call for great depletion,
+the surfaces are often not relieved by general bleeding, but retain
+their own vitality; so on the other, in cases of apparent prostration,
+and feebleness of circulation, they often retain all their morbid
+activity, and will of course be materially injured by stimulation,
+either of hot air to the skin, or heating drinks to the gastric and
+intestinal surface. Of the various diaphoretics employed, we had reason
+to be least dissatisfied with the combination of opium and ipecacuanha
+in small doses. In some few cases, tartrate of antimony and cream of
+tartar, dissolved in rice or barley water, and the solution used as a
+drink, seemed to be beneficial. Several grains of the former were thus
+taken in the 24 hours, without its producing vomiting or purging. But in
+very many other instances of the disease, this medicine had no
+ameliorating effects. Calomel alone, or in combination with opium, was
+given, and in a few cases caused _ptyalism_. We did not lose persons
+thus affected, but we cannot speak with any confidence of the propriety
+of the treatment.
+
+The application of cold water to the skin, was tried by us on the
+strength of its alleged good effects in this disease, but in no case had
+we reason to be satisfied with it. The state of the cutaneous surface,
+during the vesicular and pustular stages, is such as to prevent its
+transmitting the usual impressions to the interior. Cold may deaden it,
+and hasten the disorganization of its tissue, but cannot arrest and
+suspend morbid capillary action here, as in ordinary fevers, or diseases
+with great local determination, as to the head, &c. If useful at all,
+it will, we apprehend, be in the forming stage of the disease, before
+the skin is altered by the eruptive effort. The same objections do not
+hold against the internal use of cool or cold liquids. We have in this
+instance to be regulated by the usual precautions, as in all febrile
+disease where the gastric system is the greatest sufferer. More benefit
+will follow the sustained use of cool, than the occasional
+administration of very cold draughts; since in the former case the
+morbid action of the mucous surface may be restrained in due bounds,
+without the risk and danger of reaction, and increase of heat and
+thirst, which are apt to ensue from the latter. The same principle will
+guide us in the temperature of the air to be inhaled by the lungs.
+
+The secondary diseases, erysipelas, catarrh, and pneumonia, occurring on
+the decline or subsidence of the variolous disease, would, we may now
+presume from the phenomena in life, and the autopsic examinations, bear
+and require a treatment, nearly similar to that used in these diseases
+arising under other circumstances. Perhaps leeching and cupping ought to
+be substituted, in such emergencies, for bleeding from the arm.
+
+The extension unavoidably given to this first branch of our subject,
+requires that we should defer the history of the modified small-pox, or
+varioloid disease, to the next quarter, when it shall appear in the
+corresponding number of this Journal.
+
+
+EXPLANATION OF THE PLATE.
+
+Figures 1, 2, 3, represent various appearances of the lining membrane of
+the stomach.
+
+Fig. 4, is a portion of the oesophagus; but the red bands ought to run
+vertically, and not horizontally, as in the plate.
+
+Fig. 13, is another appearance of the stomach.
+
+Fig. 12, indicates the eruption having gone on to ulceration in the
+pharynx.
+
+Fig. 6, displays the appearance of the lining membrane of the trachea,
+on the 6th day of the eruption, as in the case of Ann Collins.
+
+Fig. 5, is intended to represent the same part in an advanced stage of
+the disease, as in the case of Joseph Foster.
+
+Resembling this is the case of Peter Johnson, as far as regards the
+ulceration and dark colour of the intermediate surface; but differing in
+the disorganization of the membrane being less.
+
+Figs. 7, 8, 9, 10, and 11, represent the progress of the eruption, in a
+female, from its incipient to its maturated state. The same section of
+skin is represented from the 1st to the 5th day of the eruptive stage,
+on which day the patient died. On the 2nd day, (fig. 8,) the vesicles
+began to exhibit a central lividness, which was augmented on the
+subsequent days. The patient had been some years before successfully
+vaccinated. She was delivered of a child on the 1st day of the eruptive
+stage. The minutes of this case have been mislaid; but the post mortem
+appearances were indicative of high action, if not inflammation, of the
+uterus and its appendages. The infant of this woman, forming Case VIII.
+died of small-pox three weeks afterwards, on the sixth day of the
+eruption.
+
+This plate, together with some others yet unpublished, are from the
+accurate pencil of Mr. now Dr. HARRINGTON, of this city.
+
+(TO BE CONTINUED.)
+
+FOOTNOTES:
+
+[11] This was first at Bush Hill, and subsequently at the Sugar House,
+near the Alms House.
+
+[12] The largest proportion of these deaths was in the six months from
+the 1st of November, 1823, to 1st of May, 1824, being in that period
+about four hundred.
+
+[13] Kept by Reuben Haines, at Germantown, seven miles from the city.
+The thermometrical mean is that from daily observations made by this
+gentleman at sunrise and at 2 P. M.
+
+[14] Of these 165 were by yellow fever.
+
+[15] The deaths from inflammation of the different viscera, were as
+reported in this year, 290, and from infantile flux and cholera morbus,
+177.
+
+[16] Same proportion of inflammations as last year, viz. 339.
+
+[17] Should it be hereafter necessary, we can illustrate other varieties
+of the disease by drawings which were taken at the same time with those,
+of which coloured engravings are now furnished.
+
+
+
+
+ARTICLE IV.--_Remarks on the Pathology and Treatment of Yellow Fever._
+Arranged from the Notes of Dr. J. A. MONGES, of Philadelphia.
+
+
+I arrived at St. Domingo in the year 1785, and from that period to the
+time of my departure from thence, I had very ample opportunities of
+observing and treating the diseases of that island, both in the country
+and at the Cape. During the whole time of my residence there, the
+ordinary febrile diseases of hot climates were of very frequent
+occurrence, especially among the new comers, and those not acclimated;
+but the real yellow fever, or vomito negro, never prevailed. So that
+when I reached this city in 1793, I never had had an opportunity of
+observing this disease.
+
+As introductory to the subject more particularly before us, I shall
+offer a few remarks on the nature and treatment of the fever, which
+prevailed in that island. It was usually of the remittent type, of a
+bilious nature, and rather violent in its character; presenting very
+often symptoms of a typhoid, or malignant condition of the system. In
+almost every case, it was attended with great gastric irritability and
+pain; and, in very many instances, accompanied with vomiting of dark
+green, and even of black bilious matter,--determination to the brain
+producing delirium, coma, &c. &c. In general, this fever differed but
+little from the bilious fevers of this country; except, perhaps, in its
+greater severity, and in a larger quantity of bile commonly evacuated.
+The treatment of this disease, at the time of my arrival, was generally
+attended with some difficulty, owing to the great prejudice prevailing
+against the use of the lancet; not only among the mass of the
+population, but even among the old physicians of the island. Experience,
+however, having taught me, that venesection was essentially necessary in
+fevers of the same sort, which I had noticed in other places, I resorted
+to it, notwithstanding the existing opinion; and am now convinced, that
+by its means I saved many patients. Nor was I the only one to adopt this
+mode of practice; as it was commonly resorted to by all _new_
+physicians, who were soon found to be more successful than the older
+practitioners. To arrest the violent vomiting, already alluded to, it
+was of the highest utility, and, in many instances, the only remedy that
+could be depended upon. Emetics were very commonly used, and sometimes
+with great benefit; but, in many instances, they were contraindicated by
+the pain and irritation of the stomach.
+
+Cooling and saline purgatives were advantageously employed, as well as
+the saline mixture, and nitre and camphor in small and repeated doses, a
+very favourite practice in the place. In a more advanced period, and
+when the fever assumed a typhoid type, blisters, bark, and serpentaria
+were resorted to.
+
+I arrived in Philadelphia on the 20th of August, 1793, and on the 22nd
+of the same month, began to see patients. The epidemic was then at its
+height, and such was the demand for physicians, and the prevalence of
+the idea, that, as I came from the West Indies, I must be familiar with
+the yellow fever, that I soon became very extensively employed. Such,
+indeed, was soon the extent of my engagements, that I was compelled for
+a time to refuse my attendance on many patients, and to limit my visits
+from Race to Dock streets, and from the water to Third street.
+
+From the first time I had an opportunity of seeing the yellow fever, I
+perceived that there existed but a very distant, if any, analogy between
+it and the fevers I had been in the habit of treating in the West
+Indies. And this opinion I have ever since entertained, in opposition to
+the statement of many respectable authorities; but in conjunction with
+some highly respectable physicians and friends, who, like myself, had
+had an opportunity of treating both diseases. The points of difference
+between these fevers will be noticed in a subsequent part of these
+observations. But although entertaining this sentiment, I very early
+came to the conclusion, that the yellow fever was the effect of a
+gastro-duodenic inflammation, somewhat modified by some unknown
+cause,--requiring the usual remedies for such a complaint, proportioned
+only to the strength of the patient, and the force of reaction in the
+system; and all my subsequent experience has only served to confirm me
+in this belief. Differing from many physicians respecting its bilious
+character, I have been led to believe, that the liver is very seldom
+implicated in the disease;--the secretion of bile, in the majority of
+cases, being very little, if at all altered. This may very readily be
+discovered by an attentive examination of the symptoms of the disease,
+as well as by the appearances noticed on dissection; the lining membrane
+of the stomach and duodenum presenting in almost every case, marks of
+inflammation, and giving passage to a large quantity of black matter,
+which I have always been led to regard as altered blood, mixed with
+mucus. The liver, on the contrary, so rarely showed marks of disease,
+that when it did, it was natural to regard its alteration as secondary.
+
+Such being my opinion respecting the pathology of yellow fever, I cannot
+view otherwise than as secondary to the gastric affection, all the
+morbid conditions of other organs, indicated during life by their
+peculiar symptoms, and revealed on dissection by the ordinary marks of
+inflammation; such as affections of the lungs, kidneys, &c. This view of
+the subject will cease to be regarded as merely hypothetical, when it is
+recollected, that these symptoms and morbid appearances are occasionally
+not found; whilst the symptoms referrible to the gastric and duodenic
+irritation, being the true characteristics of the disease, are always
+present. Indeed, what would authorize us to regard any subject as
+affected with yellow fever, who would not present the pain in the
+stomach, the redness of the tip of the tongue, the thirst, irritability
+of the stomach, and vomiting either of simple mucus, or black matter?
+And, on the other hand, how many have died with these symptoms, who were
+not affected with all the others we have noticed, and, on dissection,
+have shown no mark of disease, except in the digestive apparatus?
+Finally, can pain in the head, affections of the kidneys, vomiting of
+bile, &c. constitute yellow fever, without the concurrence of some of
+the gastric symptoms we have enumerated?
+
+With respect to the characteristic features of yellow fever, and the
+different signs, by which it may be distinguished from bilious fever, I
+must be very brief; as a great deal having been written on the subject,
+any long details in this place would occasion undue repetition of what
+is already known to the profession. A few words, however, may not be
+improper. Every one who has had frequent opportunities of seeing the
+yellow fever, must have noticed, among its most habitual signs, a
+peculiar inflamed glassy appearance of the eye, easily recognised, but
+difficult to describe. It is one, however, on which I should be willing
+to place considerable reliance, in establishing my diagnosis of this
+disease; as I do not recollect to have noticed it in any other form of
+febrile affection. Together with this, there is, in the majority of
+cases, an intense supra-orbitar pain, apparently unconnected with great
+disordered action of the brain, as the intellectual functions are
+generally unimpaired. These two signs, together with pain in the loins,
+and, in more advanced periods, the peculiar appearance of the skin, the
+vomiting of the coffee grounds matter, the intermission on the 4th day,
+the retention of muscular strength, and suppression of urine, are the
+only signs by which the yellow fever, so far as I am prepared to say,
+may be recognised. In regard to the supposed identity of this fever with
+the bilious, a great deal has been written; but I must confess, that I
+feel inclined to doubt the correctness of this opinion, for the
+following reasons:
+
+1st. Bilious fever is almost always a remittent fever, presenting
+regular exacerbations, and, unless arrested by medical aid or some
+effort of nature, running its course, in a progressive manner, either to
+a happy or fatal termination; whereas the yellow fever is almost
+invariably a continued fever, presenting obscure and irregular, or even
+_no_ remissions. On the fourth day, it generally presents so perfect a
+remission, as to cause the patient, in many cases, to imagine himself
+perfectly free from disease, and induce him to get up, and even
+sometimes to walk out. This remission, which sometimes amounts to an
+intermission, so far as an experience of upwards of forty years can
+authorize me to decide, is never found to attend in bilious fever, in
+which, if there be any remission, and recurrence of the unpleasant
+symptoms, the former is always a real convalescence, and the latter an
+accidental relapse.
+
+2nd. The red colour of the eye, to which I have alluded above as
+occurring in the early stage of the yellow fever, and its peculiar
+yellow tinge in the after part of the disease, are different from the
+redness and yellowness of the same organ in bilious fever; in the first
+stage of which the eye presents a more fiery redness, and in the
+subsequent period, a more saffron yellowness.
+
+3d. The colour of the skin in the two diseases presents also some
+difference, being more constantly noticed in yellow fever, and
+disappearing much more rapidly than in bilious fever. In yellow fever,
+moreover, it assumes, most commonly, a yellowish-brown or even mahogany
+tinge; whereas in bilious fever, when it occurs, it does not differ from
+the ordinary jaundice colour, of a lighter or deeper shade.
+
+4th. These fevers may likewise be distinguished by an attention to the
+state of the intellectual faculties, and of the muscular strength; these
+remaining often unimpaired to the last in yellow fever, whereas, in a
+very large majority of cases of bilious fever, the mind becomes soon
+involved in the disorder of the system, and the greatest muscular
+debility prevails, even from the very onset of the attack.
+
+5th. The matter vomited might of itself serve to distinguish the two
+diseases. Independently of the difference we shall notice when speaking
+of the black vomit, we may mention that patients complain, even
+sometimes from the commencement of the attack, of the acidity of the
+vomited matter; whereas in bilious fever, the mouth is bitter, and the
+matter ejected of the same taste.
+
+6th. As a further mark of difference, we may state, that, in yellow
+fever, the tongue, except at the tip, the skin, and the pulse are
+sometimes little altered; whereas in bilious fever they are usually
+pretty much so.
+
+7th. In respect to the duration of the two diseases, we may state as a
+general rule, that yellow fever runs its course to death or
+convalescence, in a much shorter time than bilious fever. Nor is the
+promptness of recovery from yellow fever less different from the
+slowness of convalescence, noticed in most cases of bilious fever.
+
+8th. The suppression of urine is a frequent attendant on the last stage
+of yellow fever, and is seldom noticed in bilious fever.
+
+9th. I have never witnessed a second attack of yellow fever in the same
+individual; whilst on the contrary, so far as I have seen, there is no
+limitation to the number of times a person may be affected with the
+other form of fever.
+
+_Prognosis._--As regards the prognosis in yellow fever, I shall merely
+state, that I generally found, an early evacuation from the alimentary
+canal, and a disposition to diaphoresis during the first twenty-four or
+thirty-six hours, and its continuance during the course of the disease,
+to be favourable omens. When the disease continued beyond the 7th, 9th,
+or 11th day, greater hopes might be entertained. It was likewise found,
+that the mortality was much smaller among patients, who remained free
+from apprehensions as to the nature and termination of the disease. To
+this cause, more than any other, do I refer my greater success among
+Quakers; who, being generally surrounded and comforted by their friends,
+retained more than any other class of people, the necessary tranquillity
+of mind.
+
+Among the unfavourable signs may be mentioned, a discoloration of the
+skin before the fourth day. This symptom was, indeed, almost always a
+fatal one. Obstinate vomiting and costiveness, hæmorrhages from
+different parts of the body, unattended with an abatement of the
+symptoms, and vomiting of black matter, were very unfavourable; whilst a
+suppression of urine, agreeably to my experience, was always a fatal
+sign.
+
+_Black Vomit._--In a preceding part of these observations, in alluding
+to the black vomit, I took occasion to express my views respecting its
+nature,--stating that I regard it as consisting of mucous flakes, mixed
+with a large proportion of altered blood. That such is the true nature
+of this substance, on which so much has been said and written, I have
+had sufficient reason to be convinced. The opinion that it consists of
+altered bile, I deem totally untenable, for the following reasons: The
+matter is occasionally voided in large quantities, in cases in which the
+liver is not at all affected, and in which, after death, the gall
+bladder is discovered to be more or less filled with _natural_ bile.
+Independently, of this, it may be stated, that the appearance of the two
+substances is very dissimilar;--the black bile vomited in bilious fever
+being of a homogeneous nature, and of a black or deep green colour;
+whilst the matter of the black vomit is, in a large majority of cases, a
+compound of a mucous, flaky substance, and a sanguineous matter, bearing
+some resemblance to the grounds of coffee, and, for the most part, of a
+brown tinge. When mixed with water, the two substances produce very
+different effects,--the bile mixing with and imparting a greenish tinge
+to it without difficulty, whilst the grounds of the other, float on the
+surface of the water, without mixing with and colouring it, in the same
+manner as bran, deprived of all its mucilage, or rather like mahogany
+saw-dust. This I consider as one of the best modes of distinguishing
+these two substances,--serving at the same time to establish a
+difference between the fevers, I was in the habit of observing in the
+West Indies, and the yellow fever of this country. Nor are these the
+only reasons for rejecting the supposition of the black vomit of yellow
+fever being of a bilious nature; for I have known this substance (and I
+suppose other practitioners have observed the same fact) occasionally to
+exude from surfaces, from which, in all probability, bile is excluded. I
+allude particularly to the skin and verous membranes. Thus it has often
+happened, that the application of a blister, especially in the advanced
+stage of the disease, has been followed by a copious exudation of a
+fluid, resembling, in all respects, the matter ejected from the stomach;
+an occurrence which was strikingly exemplified in a case, which fell
+under my immediate observation during the last visitation of the disease
+in this city, in 1820. During the same epidemic, I had occasion to
+attend a Mrs. H. about 70 years of age, who presented a curious example
+of the exudation of a similar substance from the peritoneum. She had not
+been exposed to the causes of the yellow fever, and indeed presented
+none of its ordinary pathognomonic signs. She was attacked very early in
+the morning with violent colic, attended with fever, great tenderness of
+the abdomen, and high colour of the face. She was bled at 10 o'clock; at
+11 vomited a large quantity of coffee ground matter, and died in about
+12 or 15 hours from the commencement of the attack. The next morning her
+body was examined in the presence of several highly respectable and
+experienced physicians, who all coincided in the opinion, that the
+matter vomited and which continued to be discharged from the nose, was
+identical with that discharged in yellow fever. The stomach as well as
+the intestines were found to contain a large quantity of a similar
+substance. The cavity of the peritoneum being likewise found filled with
+a large portion of it, we at first suspected the existence of an opening
+in the intestines, by which an effusion had taken place. After a careful
+and minute examination, however, no such opening was discovered. Our
+attention was now directed to the condition of the peritoneum itself,
+which was highly inflamed. It was, moreover, found, that the substance
+in question exuded from its surface,--the membrane, in many places,
+especially the portion of it which covers the liver, being coated so
+thickly with the grounds, that they could readily be scraped off with
+the back of a scalpel.
+
+These cases show conclusively, that the matter of the black vomit,
+occurring in yellow fever, should not be regarded as altered bile; and
+that the supposition of its consisting of a secretion of the mucous
+membrane of the stomach, does not rest on a much more solid foundation.
+For bile can hardly be admitted to exude from the skin and serous
+membranes, and we cannot suppose, that fluids, similar in every respect,
+can be secreted from two surfaces, so very distinct in their
+organization, and in the nature of their ordinary products, as those of
+the mucous and serous membranes.
+
+From these facts I am led to regard the black vomit as a true
+hæmorrhage, resulting from a state of previous irritation of the surface
+which furnishes it. That inflammation may be cause of it, we have a
+sufficient proof in the fact, that a similar fluid is occasionally
+vomited in cases of puerperal fever, when the irritation progresses from
+the serous to the mucous membrane of the intestines; as well as in cases
+of inflammation from blows on the stomach, and the action of poisons. A
+case of this kind, arising from a kick of a horse, was attended by
+myself and two respectable physicians in consultation, a few years ago;
+and another case arising from a large dose of carbonate of potassa,
+swallowed by mistake, occurred in my practice not long since. But as it
+would occupy too much time to give them here in detail, I pass them by
+without further notice.
+
+That the matter of the black vomit is the product of a hæmorrhage, I
+have thought may also be inferred from the fact, often noticed by myself
+and others, of large portions of coagulated blood being found in the
+intestines; the surface having the appearance of the common black
+matter, whilst on cutting into them, the centre is found to consist of a
+red solid coagulum. I have also sometimes noticed, that the duodenum
+contained the coffee ground matter, and the intestines, coagulated
+blood. In such cases, in order to adopt the opinion of secretion, we
+must believe, that the same vessels, occupied in the secretory process,
+afforded, at the same time, passage to a portion of common blood; for we
+can hardly admit, that the mucous follicles are the organs secreting the
+black matter. Besides, is this not a mere dispute about words; and is it
+proved that what are called sanguineous secretions are not the result of
+the same action, which gives rise to hæmorrhagic exudations? and is
+there any other difference between the hæmorrhage of yellow fever, and
+of ordinary cases of hematemesis, than that arising from a difference in
+the _quality_ of the blood?
+
+Nor do I find much difficulty in believing, that the colour of the skin,
+which is more frequently brown than yellow, as well as the petechiæ, &c.
+are the effects of the stagnation of blood, altered by the capillaries
+of the surface, in the same manner as that exuding from the mucous
+surfaces. I believe that this opinion, suggested by some European
+writers, is supported by the fact, that this fluid exudes from the
+orifices made by the bites of leeches and the incisions of scarified
+cups; as well as from the raw surface occasioned by blisters; and that
+the vibices contain a serous fluid mixed with blood.
+
+_Analogy to Plague._--On comparing the symptoms of the yellow fever of
+this country with those of plague, as detailed so minutely and, I
+believe, accurately by authors, and especially by the physicians who
+accompanied Bonaparte to Egypt, I have been led to regard these diseases
+as bearing a closer analogy to each other than has hitherto been
+admitted. I do not pretend to assert that they are the same disease, but
+only that they are so nearly allied, as on some occasion, to lead even
+an experienced observer into an error of diagnosis. The great difference
+between them consists in the frequency of the affection of the lymphatic
+glands in the plague, and its comparative rareness in yellow fever; and
+in the greater predominance of gastric symptoms in the latter.
+Nevertheless, I have had, on many occasions, during our different
+epidemics, opportunities of noticing buboes, situated in the same parts
+as those mentioned by writers on the plague, running the same course,
+and curable by the same means. Carbuncles are frequently seen in both
+diseases, though not so frequently in yellow fever as in the plague.
+Both diseases present what are called the walking cases. Patients in
+both, though more frequently in yellow fever, retain their muscular
+strength as well as their intellectual faculties. So far as we are
+informed, the mortality in both is pretty nearly the same, and the
+treatment similar.
+
+_Contagion of Yellow Fever._--The question of the contagion or
+non-contagion of yellow fever has so long occupied the attention of the
+profession and been discussed so extensively, that I deem it unnecessary
+to devote much space to it here. Nevertheless, as I have had frequent
+opportunities of noticing the disease under all circumstances; in all
+parts of the city, and in the country; among the wealthy and the poor, I
+may without much impropriety offer, in a few words, the result of my
+observations and reflections on this head. I must unhesitatingly
+declare, that, establishing my opinion on what I have seen, I am led to
+the conviction, that the yellow fever is not a contagious disease; that
+it never has been carried hither in the way mentioned by contagionists;
+and that it has invariably proved an infectious disease, using this word
+to express a malady arising from a local source of contamination, other
+than a living body. It is plain, that this view of the subject does not
+exclude the possibility of a vessel carrying the disease to this or any
+other port; but, in that case, the vessel itself or its cargo, must be
+the source of infection, and not the individuals on board. And this may
+take place, when the port from whence the vessel sailed is free from the
+disease. That such has been the case, there cannot be any doubt; and
+that the idea, predicated on it, of the contagiousness of the fever is
+erroneous, I have not the least hesitation in believing.
+
+How else than on the principle of infection, and not of contagion, can
+we explain the attack of individuals frequenting those parts of the
+city, where the disease had originated, and which (all the inhabitants
+having been removed to some distant situation) had been barricaded? How
+could we, in any other way, account for the exemption from the fever of
+individuals, who, out of the infected district, nursed, touched, and
+even slept with their diseased relatives and friends; and not always in
+clean and well ventilated apartments and parts of the city; but, in very
+many instances, in the filthiest hovels, and alleys, and among the
+lowest classes of society. Striking and unanswerable facts of the sort
+have frequently presented themselves to my observation, during our
+various epidemics. Children have sucked their parents, affected with the
+fever, and, in one case which fell under my notice, the child continued
+attached to the breast after its mother's death; and in all such
+instances with impunity. I have constantly reprobated the practice of
+burning the clothes and bedding of the dead, and have never found any
+bad results to occur to those who followed my advice. From a
+consideration of all these facts, I must once more express it as my
+decided opinion, that the yellow fever, so far as I have had an
+opportunity of observing it, is not a contagious disease.
+
+_Treatment._--Whatever opinion we may entertain respecting the specific
+nature of yellow fever, I was early convinced that this disease was not
+to be treated by specific remedies, and that our curative indications
+should be formed on an attentive consideration of the condition of the
+system in general, and of particular organs, as pointed out by the
+symptoms during life and the morbid lesions after death.
+
+In a former part of these remarks, I suggested the opinion, that the
+yellow fever is a gastro-duodenic inflammation, (perhaps of a specific
+kind,) and that it required a mode of treatment appropriate to this
+morbid state; but proportioned to the strength of the patient, to the
+violence of the attack, and to the power of re-action. In general,
+however, I have not found active depletion by the lancet, as easily
+borne in this, as in bilious and other fevers;--the disease assuming
+more rapidly, under this plan, a state of prostration or adynamia. Nor
+can this appear surprising, since the same circumstance of a disease
+being of an inflammatory nature, but, under a peculiar condition of the
+system, contraindicating ample depletion, is a subject of frequent
+notice during certain epidemics; for example, of scarlatina, pneumonia,
+&c. With the exception of those cases, therefore, occurring in very
+robust and plethoric constitutions, and accompanied with much pain in
+the head, high febrile excitement, and hard pulse, either large or
+small, I have seldom resorted freely to the lancet. When, however, these
+symptoms presented themselves, especially the hardness of the pulse, I
+have not been sparing of blood-letting, and have sometimes repeated it
+several times with the most decided success. But even under these
+circumstances, I have seldom found that _large_ bleedings were as
+beneficial as small and repeated ones;--the system not reacting always
+as energetically as could have been desired, and symptoms of prostration
+occurring with much more rapidity. I do not recollect to have bled with
+advantage, patients presenting a large, full, but _compressible_ pulse,
+owing to the want of reaction; although the other symptoms might seem to
+indicate the propriety of the practice. The effect of bleeding on the
+vomiting was very different in this, from what I mentioned it to have
+been in the bilious fevers of the West Indies; owing probably to the
+circumstance, that, when, in yellow fever, the irritation of the stomach
+became sufficiently violent to give rise to this symptom, the state of
+the system was very often such as to contraindicate the use of the
+lancet.
+
+The application of scarified and dry cups to the epigastrium and head,
+when there existed pain in these regions, was often resorted to, and
+afforded much relief. And I very much regret, that, during our
+epidemics, it was out of my power to make use of leeches to the former
+part, as so warmly recommended, at the present day, by the French and
+Spanish physicians; as I am inclined to the opinion, from the view I
+have adopted respecting the pathology of the disease, that, used early
+and in large numbers, they would prove very serviceable.
+
+In conjunction with general and local bleeding, fomentations were had
+recourse to in almost every case, and applied to the epigastrium in the
+form of poultices, or flannels wrung out of warm emollient decoctions.
+In order to excite perspiration and to determine action to the surface,
+a tepid bath was occasionally prescribed, and in some cases afforded
+considerable relief; but as it was an inconvenient remedy, pediluvia,
+and hot bricks on which water, or water mixed with vinegar was poured,
+were substituted. In cases, however, in which much arterial action
+existed, these last means were not prescribed, until the pulse had been
+brought down by the lancet, and other remedies presently to be
+mentioned.
+
+On the subject of emetics, I shall not enlarge; as I can safely assert,
+that I very seldom saw a patient recover from yellow fever, to whom
+tartarized antimony, or any other active remedy of the same class, had
+been administered. Of the impropriety and danger of this practice in the
+present disease, I was early convinced from a careful analysis of the
+symptoms, indicating an acute irritation of the stomach and upper
+portion of the small intestines, and from the circumstance, that, of the
+first family in which I was called to prescribe, five members, to whom
+emetics had been administered, had already fallen victims to the fever,
+under the care of a very respectable physician, and that three
+succeeding ones, who were treated agreeably to my view of the pathology
+of the disease, recovered. From these facts and reflections, I was
+induced to watch the effects of these remedies in subsequent cases, in
+my own practice, and in the practice of other physicians, and was soon
+led, from this extended experience, to abandon totally the use of tartar
+emetic in the treatment of this malady. Ipecacuanha in emetic doses was
+also tried by me; but although, thus administered, it did not occasion
+the bad effects resulting from the exhibition of the preceding article,
+yet it was often productive of harm, and never of benefit. These
+remarks, however, apply more particularly to the use of tartar emetic
+during the state of excitement of the fever, and not to that of collapse
+which sometimes precede it, and in which it is recommended by some
+physicians of the southern states. In this condition of the system, I
+have never resorted to it, and, I must confess, could not easily be
+persuaded to do so; suspecting that even in such cases, the digestive
+organs are already too far implicated, to justify the use of so powerful
+and acrid a remedy.
+
+It would seem that the bad effects of emetics, and more particularly of
+tartarized antimony, resulted, not only from their irritating qualities,
+but also from the efforts of vomiting, during which the stomach is
+compressed by the abdominal muscles, and made to contract very forcibly.
+To this opinion I am naturally led from the circumstance, that
+purgatives, whose action is certainly primarily irritating, are very
+advantageously employed in yellow fever. It is not my intention to
+attempt here an explanation of this seeming contradiction. Leaving to
+others the accomplishment of this difficult task, I shall content myself
+with stating, that during the whole course of my long practice, I have
+seldom seen a patient die of this disease, whose bowels had been well
+evacuated, and in whom perspiration had been excited within the first
+twenty-four hours after the attack. I exhibited purgatives in almost
+every instance _every day_, until copious evacuations had been procured,
+and I generally found, that the mild purges were of greater service than
+those of a severe and irritating nature. Senna, acidulated with lemon
+juice or tamarinds, answered sometimes remarkably well, when the stomach
+could retain it. Castor oil, manna, salts, magnesia, were frequently
+employed by me with advantage; and although I did not make an extensive
+use of calomel in this disease, yet I prescribed it to children, and to
+adults, who, owing to great irritability of the stomach, could not
+retain other purgative medicines. When I resorted to it, I generally did
+so in doses sufficient to ensure a purgative effect, and never with a
+view of exciting ptyalism. In doing this, I was not guided, however, by
+any fear of the effects of a salivation, since I was well aware that a
+ptyalism occurring in malignant diseases is often a favourable crisis;
+but by a knowledge of the great difficulty experienced in producing it,
+and from the observation, that in cases in which it was obtained, much
+valuable time had been lost, and the patient might have recovered
+without.
+
+To promote the operation of the above remedies, purgative enemata were
+resorted to, in the early stage of the fever; and were followed by the
+frequent use of injections, composed of emollient decoctions, from which
+the patient derived considerable relief and comfort.
+
+As counter-irritants, blisters and sinapisms were used, and often with
+great advantage. They were found of much value when applied to the
+epigastric region, for the purpose of arresting the vomiting. Sinapisms
+were in general preferred to blisters, as being more prompt in their
+effects and more easily renewed. Blisters were sometimes applied to the
+extremities in the different stages of the disease; but so far as I can
+judge, from my experience, not with much real benefit.
+
+I seldom derived much advantage from the use of tonics and stimuli in
+yellow fever; except when the powers of life seemed to fail, and
+petechiæ, vibices, hæmorrhages, and other signs of malignancy had
+occurred. In general, under such circumstances, the Peruvian bark,
+either alone or combined with serpentaria, was administered in
+preference to any other remedy of the same class. In cases, however,
+unattended with reaction, tonics and diffusible stimuli internally, and
+revulsives of all sorts externally, were had recourse to from the
+commencement of the attack, and sometimes with the desired effect of
+arousing the powers of the system. _Opium_ was never found beneficial,
+on account of its tendency to aggravate or produce coma, as well as from
+its effect in suppressing intestinal evacuations.
+
+Whilst making use of the above remedies, the plentiful exhibition of
+diluent drinks was not neglected,--care being taken, however, not to
+load unduly the stomach, and to select such drinks as would suit the
+taste of the patient. In almost every case, acids did not answer so well
+as the bland mucilaginous infusions. The drinks were almost universally
+allowed cold, except when there existed a tendency to perspiration;
+under which circumstances they were administered slightly warm and a
+little aromatic.
+
+During the course of the yellow fever, some of the symptoms demanded
+particular attention. Influenced by the idea of prostration and
+dissolution, many practitioners, and myself for some time among the
+rest, resorted to the bark and other tonics for the purpose of arresting
+the black vomit, and of correcting that condition of the organs, which
+gave rise to this effusion; but after many unsuccessful trials, I was
+led to abandon this practice and to resort to other means. Of all the
+remedies employed to attain this effect, calcined magnesia mixed in a
+thick solution of gum arabic seemed to me to answer best; for whilst it
+succeeded, in many cases, in arresting the vomiting, it tended to keep
+the bowels open. Together with this, revulsive remedies were applied to
+the skin, and sometimes succeeded very well,--a sufficient proof, I
+think, that this hæmorrhage is the effect of an increased action of the
+mucous membrane of the digestive tube, and not of a passive condition of
+the capillaries of the parts. For the purpose of controlling the great
+irritability of the stomach, and arresting the vomiting occurring in the
+early stage of the disease, besides the usual remedies used in such
+cases, I found advantage in the use of small and frequently repeated
+injections with a solution of salts, an infusion of senna, or the like
+substances. Such a practice, however, did not seem to succeed so well in
+the latter stage of the disease.
+
+With the intention of promoting the secretion of urine, in cases in
+which it was suppressed, all the diuretics, as well as every external
+stimuli, were in vain employed;--this symptom, as I have already
+mentioned, being, in all instances which fell under my immediate
+observation, the forerunner of death.
+
+
+
+
+ARTICLE V.--_Remarks on the Prophylactic Treatment of Cholera Infantum._
+By JOSEPH PARRISH, M. D., one of the Surgeons to the Pennsylvania
+Hospital.
+
+
+The great mortality of cholera infantum renders it one of the most
+interesting diseases, which come under the notice of the physician. Its
+ravages among the infant population of our large cities, are too well
+known, and too strongly felt, to require any comment. No disease
+contributes so largely to swell our bills of mortality during its
+prevalence; and were it not restricted to the summer season, it would
+prove a greater scourge to the community than consumption itself.
+
+This mortality is owing less to our ignorance of the nature of the
+complaint, and the proper mode of treatment, than to the continued
+operation of the causes by which it is produced. I have often compared
+our endeavours to cure cholera infantum, while these causes remain, to
+an attempt to relieve inflammation in a part, while a thorn is sticking
+in the flesh. We may resort to bleeding and leeching; we may restrict
+our patient to the lowest diet, and the most perfect rest; we may employ
+all those remedies, which are ordinarily best calculated to reduce
+inflammation: but so long as the thorn continues in the wound, our
+efforts will be fruitless. Thus it is with cholera. We may obviate the
+more violent symptoms; we may procure temporary relief; we may even
+flatter ourselves that a cure has been effected: but the original causes
+have not lost their power; an increased susceptibility to their
+operation remains; relapse upon relapse is experienced; and at last the
+little sufferer, worn out by the successive attacks, sinks beyond the
+reach of medicine, and expires. Unhappily, the nature of the causes is
+such, that, in very many instances, their removal is exceedingly
+difficult, if not altogether impossible; and, under such circumstances,
+the patient who has once been severely affected, seldom recovers in the
+end. Hence it becomes of the greatest importance to prevent the
+occurrence of the disease; and attention to the prophylactic treatment
+is no less essential than the adoption of curative measures. It is with
+the view of calling the attention of the profession to this subject,
+that I have been induced to offer the following observations.
+
+It is obvious, that, in the preventive treatment, two objects demand
+attention; first, to remove, as far as possible, the causes of the
+disease; and secondly, where their entire removal is not attainable, to
+fortify the system against their influence. On each of these, I shall
+offer a few observations.
+
+I. Excessive and continued heat is, perhaps, the most fruitful source of
+cholera. Thus we find, that the disease makes its first appearance in
+the commencement of the hot weather, increases and becomes more fatal
+with the rise of the thermometer, and declines with the return of cool
+weather in autumn. During its continuance, it may be observed to vary
+with every permanent change of temperature. A few very hot days in
+succession, in the 6th month, are sufficient to call it into action; and
+during the height of its prevalence, a spell of cold weather will
+diminish, if not suppress it. In the summer of 1806, which was
+remarkably cool and pleasant, there was very little of the disease; and
+generally in moderate summers, it is much less prevalent than in those
+of a contrary character.
+
+I believe that it is by a direct operation on the system, and not by the
+generation of miasmata, that heat proves so deleterious to the infant.
+In the country, where miasmata are most abundant, there is comparatively
+little cholera; for the heat of the sun is there moderated by the free
+circulation of the air; and the debilitating operation of the high
+temperature of the day is counteracted by the refreshing coolness of the
+morning and evening. It is in the close air of cities, that the
+complaint flourishes with greatest vigour; and the most confined
+situations are the most favourable to its production. Let any one take
+a walk, in a summer's morning, through the thickly built lanes and
+alleys of Philadelphia. He will be struck with the appearance of the
+children, reclining their heads, as if exhausted, upon the breast of
+their mothers, with a pale and languid countenance, a cool and clammy
+skin, a shrunk neck, and other signs of debility, arising from their
+confinement, during the night, to close and hot apartments. It will
+readily be believed, that such places are the very hot beds of cholera.
+
+Heat, therefore, connected with confined air, being among the most
+frequent causes of the complaint, it is necessary, as far as possible,
+to counteract them. Should a strong predisposition to cholera be
+suspected, the best plan will be to send the child into the country
+during the summer. Both as a preventive and a remedy, country air is
+decidedly the most effectual, to which we can resort. But in most
+instances, it would be exceedingly inconvenient, sometimes impossible
+for mothers to leave their homes and occupations in the city; and, under
+such circumstances, it becomes necessary to substitute measures, which
+may produce, as nearly as possible, the same effects. To keep the child
+cool, and expose him to the fresh air, are the ends to be obtained. For
+this purpose, he should be carried frequently into the open squares, or
+beyond the suburbs of the city. I am in the habit of recommending to
+parents, whose circumstances will not allow of a removal from the city
+during the summer season, to make frequent excursions across the
+Delaware, and into the neighbouring woods of New Jersey. The refreshing
+effects of the air on the river are truly surprising. The brightened eye
+and animated countenance of the infant, give speedy proof of their
+favourable influence; and when labouring under the disease, even in its
+lowest stage, the little patient will often exhibit immediate signs of
+amendment.
+
+In the prevention of cholera, much may also be expected from a proper
+attention to the lodging of children. Many parents have a great dread of
+the night air; and exclude it from their chambers, as sedulously as if
+it were infected with poison. But, in guarding their children from
+taking cold, they expose them to a much greater danger. Observe their
+mode of treatment. The doors and windows are carefully closed; the child
+is placed in a feather bed, with his parents on each side, and almost
+smothered with the bed-clothes. Perhaps other children are lodged in the
+same apartment; and thus the delicate system of the infant is exposed to
+the debilitating influence of great heat and stagnant air, combined with
+the effluvia, which, in such a situation, must be abundantly generated.
+Simply to enter such a room in the morning, is almost sufficient to
+sicken a healthy individual; how much more injurious must be its effects
+upon the lodgers themselves. Examine in the morning a child, who has
+passed the night thus confined. You will find him limber as a rag,
+exhausted by perspiration, wholly destitute of animation, without
+appetite, and on the very verge of cholera. I should recommend an
+entirely different plan of management. Instead of a feather bed, the
+child should be placed on a hard mattress, or on blankets folded and
+laid upon the floor. The covering should be light, but comfortable. The
+doors and windows should be open; so that fresh air, that _pabulum
+vitæ_, without which health cannot be sustained, may be freely admitted.
+Thus treated, instead of the feeble and sickly appearance before
+mentioned, he will present a lively countenance, with all that activity
+of motion, and enjoyment of existence, which are natural to his age, and
+afford the surest criterion of vigorous health. Experience has fully
+convinced me of the great importance of attention to the lodging of
+children, as a prophylactic measure; and this renders me desirous of
+impressing upon the profession generally, the truth of my own
+convictions on the subject.
+
+With the same design of obviating the injurious effects of a high
+temperature upon the infantile system, I advise frequent ablutions with
+cool water, and its free employment as a beverage. Infants, unable to
+make their wants known, often suffer exceedingly from the inability of
+their attendants to understand them. During the heat of summer, the
+increased evaporation from their surface is necessarily productive of
+increased thirst, which, if unsatisfied, renders them uneasy and
+restless. To quiet them, the breast or bottle is offered. Aliment is
+thus given, where drink only was required; and the stomach, overloaded
+and oppressed, is apt to become irritable, and is thus brought into a
+condition most favourable to the occurrence of cholera. By attention to
+the peculiar language of infants, expressed not by words, but by signs,
+I have often been able to detect their wants; and, in many instances,
+have afforded the most decided relief, by simply giving them a little
+cool water for drink. From the dread which some individuals have for
+cool air and cold water, it would seem that they were considered rather
+as destructive poisons than as absolute necessaries. I have no fear of
+either, when judiciously employed; and as prophylactics in cholera, I do
+not think their place can be supplied.
+
+But heat is not the only cause of this complaint. Dentition is well
+known both to predispose the system to its attack, and, after it has
+occurred, to increase its violence, and diminish the chances of
+recovery. In the employment, therefore, of preventive measures, it is
+highly necessary to attend to the state of the gums, and to remove or
+counteract this source of irritation. If at all swelled or painful, they
+should be lanced freely, and the operation should be repeated as often
+as their inflammatory condition may demand. In severe cases, much good
+may be expected from the application of blisters behind the ears. The
+irritation thus receives an external direction, and the stomach and
+bowels are in less danger of an attack. I was led to this practice, by
+observing that the eruption, which, during dentition, is apt to make its
+appearance behind the ears, often proves a most salutary effort of
+nature; and that, while it continues, the infant generally enjoys an
+exemption from those dangerous disorders, incident to this critical
+period of life. To imitate nature as closely as possible, the discharge
+from the blistered surface should be maintained for some time by
+stimulating dressings. I have witnessed the most beneficial effects from
+the practice, and can strongly recommend it to the attention of the
+profession.
+
+II. At the same time that we endeavour to remove or diminish the causes
+of cholera, we should not neglect to put the system of the child in such
+a condition, as may enable it most effectually to resist their
+operation. As cholera is a disease of irritation, originating generally
+in a debilitated state of the alimentary canal, I believe this end may
+be most easily attained, by preserving the natural tone of the digestive
+organs. For this purpose, all flatulent and indigestible food should be
+carefully avoided. During the first year, the mother's milk is, in
+general, the most appropriate nutriment. When the stomach of the infant
+is very delicate, the diet of the mother should be strictly regulated;
+and, in all cases, it would be adviseable for her to avoid articles of a
+flatulent nature. While the child is still at the breast, if a
+predisposition to cholera be suspected, I would recommend the occasional
+use of nutritious animal juices. The sucking of small pieces of salt
+meat, as ham or dried beef for example, will sometimes be found
+productive of advantage. After weaning, animal food should always enter
+into the diet of the child. Many parents, fearing to render their
+children gross and unhealthy, restrict them altogether to vegetable
+aliments; and thus, by weakening the powers of digestion, prepare the
+way for that very result which they are most anxious to avoid.
+
+With the same view of giving tone to the stomach, aromatics should be
+used habitually during the summer, in those cases, in which there is
+strong reason to apprehend the occurrence of cholera. While they produce
+a cordial impression on the stomach, and invigorate generally the
+digestive powers, they are liable to none of those objections which may
+be urged against the employment of the narcotic stimulants. Indeed,
+nature herself seems to have pointed them out as prophylactics against
+the diseases of hot weather. Our most powerful and valuable spices are
+the products of warm countries. Cinnamon, ginger, pepper, the clove, the
+nutmeg, are to be found only in tropical climates. In this arrangement,
+we see the hand of a beneficent Creator, who has provided, that, by the
+same high temperature, which renders the equatorial regions so fruitful
+of cholera, and other disorders of the bowels, the growth of those
+plants should be promoted, which are best calculated to invigorate the
+alimentary canal, and to fortify it against the inroads of disease.
+Facts are not wanting to prove the efficacy of spices in preventing
+intestinal complaints. We are informed by DEWAR, in his treatise on the
+Diarrhoea and Dysentery, by which the British army in Egypt was
+attacked, that among the Mamalukes of that country, it was a universal
+practice, when they apprehended the approach of these disorders, to make
+use of cinnamon or ginger, with the almost uniform effect of averting
+them; and where the same practice was followed by the British soldiers,
+equal advantages were experienced. In the French army, so highly was the
+prophylactic power of the aromatics estimated, that every soldier was
+provided with a box of spices, which he was directed to use freely with
+his diet of fruit and melons.
+
+When attending surgeon of the Alms-house hospital in this city, I had
+occasion frequently to prescribe in a syphilitic ward, which being
+situated directly under the roof, in a large garret, was liable, in the
+summer season, to become very much heated. As the patients were
+numerous, and the windows insufficient to admit of proper ventilation,
+the air became much contaminated; and the consequence was, that bowel
+complaints were very frequent and troublesome. I have often entered the
+ward on a summer's morning, and found almost every patient affected more
+or less with diarrhoea or cholera. It occurred to me, that the free
+use of some of the aromatics might be found serviceable in preventing
+the occurrence of these complaints. I accordingly directed, that every
+individual in the ward should drink a portion of strong ginger tea
+daily. I also ordered, that salt meat should be used twice in the week.
+By the steady pursuit of this plan, a very considerable change for the
+better was effected.
+
+The employment of aromatics as prophylactics is not less beneficial in
+children than in adults. I would not, however, advise, that they should
+be given indiscriminately to all children, during the summer. It is only
+to those cases, in which a predisposition to cholera infantum exists,
+that I consider them peculiarly applicable; and here I believe they are
+capable of producing much good.
+
+Before dismissing the subject of the paper, I will simply remark, in
+addition to what has been already said, that the occasional use of the
+cold bath, by the vigour it imparts to the system generally, and through
+it to the digestive organs, will often be found an excellent
+preservative against the summer complaint of children.
+
+In this short account of the preventive treatment of cholera infantum, I
+have been less anxious to give a dissertation, embracing all that might
+be said on the subject, than to communicate those particular measures,
+which, according to my own experience, I have found most effectual. I
+will conclude the paper by the relation of a case, in which a strong
+predisposition to the disease was successfully counteracted. It will be
+proper, however, to premise, that the treatment of this case is by no
+means held out as an example to be generally followed with every
+infant, which may possibly become the subject of cholera. It is
+applicable in all its details only to those, in which, as in the present
+instance, there is every reason to apprehend, that the only alternative
+is between almost certain death, and the most careful prophylactic
+treatment.
+
+CASE.--A gentleman of this city, whose wife had arrived at a period of
+life, when she could not expect to be the mother of many more children,
+consulted me respecting an infant daughter, their only surviving child.
+I was informed, that they had already lost eight children, all of whom,
+with one exception, had died of cholera. It may readily be imagined,
+that every feeling of parental anxiety was awakened for their babe; and
+that no degree of attention on their part was considered too great,
+which might contribute to its preservation. It was placed under my care,
+not to be cured, but that I might, if possible, devise some plan of
+management which would avert the disease they had so much reason to
+apprehend. I felt the responsibility of the trust, and endeavoured to
+find it to the best of my ability. Every opportunity which I could
+desire was afforded me; for the infant, from its birth was submitted to
+my direction; and both the disposition and ability existed, on the part
+of the parents, to carry implicitly into effect every measure which I
+might recommend.
+
+As the mother was unable to furnish sufficient nourishment, the first
+step was to provide a healthy wet-nurse, who might be willing to submit
+to the necessary regulations in respect to diet.
+
+I believed the children of these parents to possess a constitutional
+weakness in the alimentary canal; and, on inquiry, I was told, that they
+had been kept upon a vapid diet, under the impression that it would
+contribute to their health. In the present case, therefore, the
+principal object was to communicate strength to the stomach and bowels.
+With this view, the child was accustomed, from an early period of
+infancy, to a generous diet. When very young, portions of ginger tea
+were given to it daily; and as soon as it was old enough to suck the
+juice of meat, it was encouraged to do so. The nurse, during the warm
+season, was kept upon a nutritious diet, consisting principally of
+animal food, with the occasional use of ginger tea; and every
+description of recent fruit and fresh vegetable food was forbidden.
+Under this management, the first summer was passed without any symptom
+of the disease; but I looked forward to the second with no little
+anxiety, when the child would have to struggle with the irritation
+arising from dentition.
+
+The same plan was continued during the second summer, and still more
+rigidly enforced. The child was now old enough to take animal food
+freely in addition to the breast. It was allowed as much salt fish, ham,
+beef-steak, essence of beef, &c. as it desired; ginger tea was given
+daily; a little sound old port wine was occasionally directed; and both
+the child and the nurse were restricted from every species of flatulent
+and indigestible aliment. So anxious, indeed, were the parents, and so
+careful to carry my directions into full effect, that they allowed no
+forbidden article of food to enter the house, and denied themselves
+their wonted comforts, lest possibly their child might be injured.
+
+The gums were carefully attended to, and lanced whenever the operation
+appeared to be requisite. All those measures, which I have before
+mentioned as serviceable in obviating the effects of great heat, so far
+as they were applicable to the case, were adopted. The second summer was
+spent wholly in the country.
+
+Very little medicine was required, and none was administered, except of
+the mildest description. Frequently, when summoned to visit the babe, I
+have found the mother trembling with fear, and anxious that something
+might be done; and often, under such circumstances, have I begged it off
+from a dose of physic, having determined to avoid a resort to every
+thing of the kind, unless real necessity should demand it.
+
+By a strict adherence to the plan above detailed, the period of
+dentition was passed in safety; and it is with heartfelt pleasure I can
+say, that no symptom of cholera afterwards made its appearance.
+
+
+
+
+ARTICLE VI.--_Case of Neuralgia cured by Acupuncturation._ Communicated
+by J. HUNTER EWING, M. D.
+
+
+The attention of the medical public having been of late much excited on
+the subject of acupuncturation, I am induced to communicate the
+following case.
+
+For eighteen months, Miss ---- had been afflicted, at intervals, with a
+severely painful affection of the nerves of the right cheek, immediately
+below the orbit of the eye, and extending to the angle of the lower jaw.
+On the 14th of January 1826, she was attacked more violently than usual,
+and the remedies, which had previously afforded some relief, now failed.
+Stimulating cataplasms, warm embrocations, laudanum, internally and
+externally, heat applied externally to the cheek by means of very hot
+flannels, produced not the slightest mitigation of the pain; and she
+continued to suffer excessively until the afternoon of the 15th; when
+acupuncturation being proposed, she consented to the operation with this
+remark,--"any thing to relieve me from this agony."
+
+The needles were immediately procured, and three inserted about an inch
+from each other. Two in a line parallel with the inferior edge of the
+orbit of the eye, and half an inch below it; and a third below, and
+equidistant from the others. The first two were introduced to the depth
+of three-fourths of an inch; the last, a full inch. They were inserted
+very gradually and with a rotary motion.
+
+The second needle was scarcely introduced, before the patient exclaimed,
+"the pain has entirely left me." When the third was introduced, she
+experienced a stiffness in the muscles of the cheek, and a creeping
+sensation, as if a spider's web had been drawn across the face; but no
+painful sensation whatever.
+
+Such was the exhausted state of her system from the excessive pain she
+had suffered, that when thus relieved, she requested a pillow to rest
+her head on, and fell into a gentle slumber.
+
+About two hours after the insertion of the needles, I again visited my
+patient, and found her still perfectly free from pain, and seated at a
+table reading. She thanked me for the relief I had been the means of
+affording her, and requested me not to withdraw the needles, lest the
+pain might return. Upon being apprised of the risk that might attend
+their being allowed to remain, she observed, that she would rather have
+a servant to watch her whilst she slept. The propriety of their removal
+being further urged, she at last consented. There was no return of pain.
+
+The next morning, the patient remarked, that the stiffness of the cheek,
+and a numbness of the whole right side, continued through the night; and
+though she did not sleep very soundly, she was free from pain and rested
+well.
+
+By the third day, the stiffness and numbness had passed away, and there
+was no return of pain. Several weeks have now passed, and she has had no
+relapse; although often since exposed to causes, which, heretofore, had
+always excited violent attacks. Previous to the operation, she seldom
+passed as many days without severe suffering.
+
+Although I have performed this operation many times, and been present
+when others have performed it, I have never seen a case, in which its
+efficacy was so decided, or in which the relief afforded was more
+unquestionably attributable to the action of the needles.
+
+
+
+
+ANALYTICAL REVIEWS.
+
+
+
+
+ARTICLE VII.--_Researches into the Nature and Treatment of Dropsy in the
+Brain, Chest, Abdomen, Ovarium, and Skin, in which a more correct and
+consistent Pathology of these Diseases is attempted to be established,
+and a new and more successful method of treating them, recommended and
+explained._ By JOSEPH AYRE, M. D. &. London, 1825.
+
+
+We have read the present work with the liveliest pleasure, and we dare
+hope with considerable benefit, and hasten to lay a review of its
+contents before our readers. Dr. AYRE is already advantageously known in
+this country, where his Essay on Marasmus has had an extensive
+circulation; but we are disposed to think, that, however he might be
+esteemed for the talent he displayed in his former composition, he is
+entitled to much more credit for his able researches into the nature and
+treatment of dropsy. We confess that we enter upon our editorial duties
+on the present occasion, with the two-fold intention of offering to our
+readers what we regard, on the whole, as a very correct view of the
+pathology of dropsy, and of showing to some of our medical friends, who
+shudder at the mere mention of what they denominate _hunch theories_,
+that the English physicians, or at least some of the most intelligent
+among them, so far from considering these theories as dangerous and
+unphilosophical, are beginning to entertain similar views with their
+Gallic brethren, in respect to the inflammatory nature of many diseases
+too long regarded as resulting from a state of debility, and classed by
+nosologists among the Cachexiæ.
+
+By most writers upon the subject, dropsy has too long been considered as
+a _disease_,--constituted into a separate class, and divided into many
+species. Dr. AYRE entertains, however, a very different and, we believe,
+a much more correct view of the pathology of this complaint; regarding
+it as only one in a series of effects of a disease, and not always the
+last of that series. He remarks, that the true disease is to be sought
+for in that particular condition of the solids by which the effusion is
+produced; and that to appreciate justly the nature and treatment of
+dropsy, it is necessary to understand the nature of that condition,
+which constitutes the disease, and of which the serous and watery
+effusion is merely the result.
+
+Of all the hypotheses that have been advanced to account for the nature
+of the morbid state, which gives rise to general and local dropsy, there
+are only three which our author regards as entitled to our notice.
+According to these, all dropsical accumulations arise either, 1st, From
+a want of tone or energy in the absorbent vessels, giving rise to a
+deficient absorption. 2nd, From an increased exhalation of the natural
+fluid, through a similar want of tone in the exhalents; and 3d, From a
+mechanical obstruction to the free return of blood by the veins,
+produced by tumours of various kinds, &c., by which a greater portion of
+it is forced into the exhalents, and a greater effusion of their proper
+fluids thereby occasioned. With these hypotheses, however, Dr. AYRE is
+not satisfied, and he endeavours, in the following manner, to show their
+insufficiency.
+
+     "1st. The opinion of a want of tone in the absorbents, as a
+     cause of dropsy, is contradicted by the fact, that in those
+     cases, in which it is assumed to prevail, it is found, that the
+     adipose matter, or fat of the body, is removed by the
+     absorbents; or, in other words, that emaciation takes place to
+     as great an extent, and as rapidly in this, as in other
+     diseases; and emaciation can only be effected by means of
+     absorption. Besides, in these cases of dropsy, mercury, when
+     rubbed upon the surface, or received internally, is absorbed as
+     readily, and affects the system as early as under other states
+     of the body. There is also no accumulation of the fluids in the
+     joints, or in the _bursæ mucosæ_ in these cases, which,
+     nevertheless would happen, if there was a general debility of
+     the absorbent system; and _ecchymoses_ or livid spots, though
+     easily induced in anasarcous limbs, are likewise easily removed
+     from them by the absorbents.
+
+     "2nd. The opinion of a want of tone or energy in the exhalants
+     involves in it one of the following conditions: namely, either,
+     1st, that the fluid of dropsy may escape mechanically from
+     them, and that the fluid thus _mechanically_ separated may be
+     identified in its sensible and chemical qualities with another
+     fluid which is confessedly secreted; or 2nd, that if the fluid
+     of dropsy be secreted, then that an _increase_ in the quantity
+     of a secretion may continue an indefinite period, under a
+     _decrease_ in the energy of its secreting vessels; conclusions
+     to which experience and analogy are alike opposed."
+
+In answer to the third hypothesis, Dr. A. remarks, that such an
+obstruction as contemplated, has never been shown to exist.
+
+     "In the case of the liver, which is commonly considered, when
+     in a scirrhous or enlarged state, to be the seat of these
+     mechanical obstructions, and thus, to be the cause of abdominal
+     dropsy, we have no satisfactory instance yet shown to us, of
+     any such precise condition of that organ. There are, indeed,
+     numerous instances of abdominal dropsies, in those labouring
+     under a scirrhous or enlarged state of the liver; but there are
+     also, numerous examples of such states of the liver, as well as
+     of the spleen and other organs, without any such effusion; and
+     in many cases, when such effusion has taken place, it has been
+     carried off by the natural passages or by tapping, without any
+     return of the dropsy; and yet, without any visible change in
+     the structural condition of the liver."
+
+Dr. A. further remarks, that if the cause were mechanical and existed in
+the liver, the effect should be constant; which, however, is not the
+case. Besides, were this mechanical cause necessary, how could we
+account for the appearance of abdominal dropsy, where there is no
+disease of the liver, or in other cavities, where no mechanical cause is
+asserted to be present, and where the remedies by which the cure is
+effected, have no relation to such causes? Again, if the discharge
+depended upon a mechanical cause, the water should in every case be of a
+uniform fluidity, and the progress of its accumulation likewise uniform;
+so that the operation of tapping should have no tendency to induce a
+more rapid refilling of the cavity. Yet, the contrary of all this is a
+subject of daily observation. In addition to this, Dr. A. calls the
+attention to the fact, that in experiments, in which obstruction has
+been artificially made, by tying the vena cava for example, the
+experimenter has committed an error, in reasoning from the lower animal
+to man--assuming, that as ascites had arisen in dogs, it would in like
+manner have occurred in human subjects.
+
+     "But there was an effect, here overlooked, which was to be
+     expected to take place in the abdomen of the dog, from the
+     injury done to the surrounding parts by the operation itself,
+     and which would be quite independent of any effect arising out
+     of the experiment. In the human subject, the effect would be
+     the highest form of inflammation, by which coagulable lymph or
+     pus would be poured upon the surface of the peritoneum. There
+     would, therefore, be inflammation excited in the abdomen of the
+     dog; but as the lower animals are less easily acted on than
+     man, the inflammation would in this case be in a lower degree.
+     But every degree of inflammation has its particular product.
+     The highest occasions a discharge of pus, whilst the lowest,
+     when seated in a serous membrane, is a larger portion of its
+     proper serous fluid. This, therefore, might be the product of
+     the inflammation, which was produced incidentally by the
+     experiment in the abdomen of the dog; and it would be just as
+     reasonable to regard the coagulable lymph in the human subject,
+     which would result from such an experiment, as an effect of the
+     mechanical obstruction, as to consider the fluid effusion in
+     the dog to be so."
+
+In respect to those instances of diseases of the liver, connected with
+ascites, in which, in addition to its other morbid states, a partial
+occlusion of the vena portæ, by the effusion of coagulable lymph into
+it, is said to have existed, our author remarks, that they are very few
+in number, occurring, perhaps, in one out of several hundred cases of
+ascites with hepatic disease; and that we are justified, from analogy,
+to assume, that any obstruction given to the circulation by diseased
+vessels, would be quickly relieved by the enlargement of the
+anastomosing branches, and that no effusion of water into the abdomen
+would result from it. After referring to some cases, related by the late
+Mr. WILSON, in which the vena cava was completely obliterated, and no
+effusion took place; and some cases of morbid condition of the heart of
+an analogous kind, by which the course of the circulation became greatly
+obstructed, and yet, without being followed by effusion; our author
+concludes, that from these facts and others, to be presently noticed, it
+appears evident,
+
+     "That the dropsical effusion, in whatever part it may be
+     seated, does not arise from any want of tone in the exhalant or
+     absorbent system, or from a mechanical obstruction in the liver
+     or other viscus; but, that it proceeds from a morbid action in
+     the cellular or serous tissues, and that this action, as we
+     shall now proceed to show, is allied in its nature to
+     inflammation."
+
+In support of this opinion, Dr. AYRE remarks, that all the phenomena
+belonging to cases of watery effusion, met with under one or other of
+the forms of inflammation, are common to those of dropsy. Thus the
+fluid, discharged under the cuticle in erysipelas or in inflammation
+induced by heat or a blister, or in cases of pemphigus, is a secretion,
+and resembles in all respects the fluid found in dropsy. In some cases
+of acknowledged inflammation, the fluid effused is found to vary greatly
+in its degree of tenuity, so as to be sometimes of quite a viscid
+nature. The same circumstance is met with in dropsy; the fluid of which
+varies sometimes in different forms of the disease, and at different
+periods in the same patient. With regard to the absence of pain, in
+ordinary cases of local or general dropsy, which, in the minds of many
+physicians, might seem to militate against this view of the
+subject,--since pain accompanies the inflammation of a blister, Dr. A.
+very justly says, that the difference is referrible to a different
+degree of sensibility of the parts affected; that, moreover, in
+pemphigus there is no pain, and that chronic inflammation of the serous
+membranes is little painful.
+
+That the morbid action producing the effusion is only a modification of
+inflammation, our author thinks may be further shown by the fact that it
+obeys the same laws--being translated occasionally, like it, from one
+part of the body to another. On this subject, Dr. AYRE makes the very
+pertinent remark, that in these cases, the fluid alone has been thought
+to be translated; but that the metastasis, is without doubt, exclusively
+of the action which produces the serous discharge. Analogous also to
+what occurs in inflammation, especially of the erysipelatous kind, the
+action occasioning the effusion, as seen in anasarca, commences at a
+given point, and gradually extends from thence in a continuous course.
+It ought also to be noticed, that the results of common inflammation
+vary according to the intensity of the cause; the lowest degree of it,
+occasioning an increase in the quantity of the proper fluids of the
+part,--a higher degree, yielding for its product coagulable lymph, and a
+still higher one producing pus. All these several products of common
+inflammation, are more or less remedial of their cause; or in other
+words, are the immediate means of the cessation or abatement of the
+inflammation which produces them. This same power is likewise a
+property, though in a much less degree, of the hydropic effusion, when
+the inflammation which produces it, is idiopathic; or in other words,
+not created by a visceral or other disease, or some particular
+excitement of the general system, as is seen in cases of anasarca.
+
+     "And here," continues our author, "it may be proper to remark
+     upon a common error, committed by those, who, mistaking the
+     nature of the action which produces the serous effusion, look
+     in the _post mortem_ examination, for some of the common signs
+     of an inflammation having existed; and who conclude, upon not
+     finding such, that the water was derived from some mechanical
+     or other cause foreign to the true one. But in the higher forms
+     of abdominal inflammation, the products are pus or lymph, and
+     these are found upon the surface of the peritoneum, with
+     sometimes a thickening and discoloration or ulceration of its
+     substance; whilst in the lowest form of that increased action
+     to which the serous membranes are subject, the only product is
+     the serous fluid, and there can be, therefore, no visible
+     alteration produced by it in the structure of the serous
+     tissue."
+
+     "By the hydropic or serous inflammation, obeying the same laws
+     which govern the other degrees of common inflammation, it
+     follows, that upon a higher excitement being superinduced upon
+     it, the serous effusion should cease. This, therefore, is found
+     to happen in every case, where such higher excitement is
+     brought on. This increased inflammation is sometimes occasioned
+     by design or accident, and at other times, it occurs in the
+     natural and progressive course of some disease, formed within
+     the cavity, which is the seat of the dropsical effusion."
+
+This is exemplified in the effects of the operation for the radical cure
+of hydrocele; or in the operation of tapping in some cases of ovarian
+dropsy; or even in some instances, of ascites from chronic inflammation
+of the liver, spleen, mesentery, &c. In all these cases, the serous
+membrane, which directly or indirectly was affected to a sufficient
+degree to occasion a serous effusion, takes on, from the extension of a
+visceral disease, or from some other cause, a higher degree of
+inflammation--lymph is thrown out, and the cavity becomes obliterated.
+
+     "Now from these, and similar examples, which have fallen under
+     my observations, I think it may be assumed, that ascites, when
+     proceeding from some visceral disease, (and the principle
+     applies to hydropic effusions from the pressure of disease in
+     other cavities,) does so by the gradual extension of the
+     chronic inflammation of the internal cellular or serous tissues
+     of the diseased organ, to its outer external coverings; and
+     that, commencing here as from a point, the serous or hydropic
+     inflammation is progressively propagated through the whole of
+     the serous membrane of the cavity. By the disease within the
+     cellular tissue of the diseased viscous increasing, a
+     corresponding increase, in these cases, will ensue of the
+     disease on the surface of the membrane investing it; until at
+     length a susceptibility to take on a higher action is induced,
+     which only requires any slight occasional cause to establish.
+     Under this condition of an increased excitement in the
+     peritoneal or other serous membrane, coagulable lymph is
+     discharged into its cellular tissue, and a thickening of it
+     takes place; until at length the operation of paracentesis,
+     which in the early stage of the disease was attended with only
+     inconsiderable inconvenience, becomes an adequate cause of a
+     still higher inflammation, which terminates perhaps in
+     suppuration; and, in the _post mortem_ examination the serous
+     fluid is found so mixed with coagulable lymph, and purulent
+     matter, as to give a whey or milk-like appearance to the mass.
+     The quantity of serous fluid, in these cases, is generally
+     small, when compared with what was accumulated in the
+     intervals of former tappings; for the vascular excitement
+     which occasions the discharge of coagulable lymph, is
+     destructive of that which pours out the serous fluid."
+
+Dr. A. remarks, that, besides the particular facts deduced from
+observations on dropsy as a local disease, and which prove its relation
+to diseases of local excitement, there is a further support to be given
+to these views by various proofs that are afforded from observations
+upon the urine, of serous inflammation producing local dropsy, being
+frequently connected with one of a general kind. "So that the
+inflammatory state of the system becomes sometimes a cause of the
+effusion into a cavity, and at other times an effect of this state."
+After giving full credit to Drs. WELLS and BLACKALL for their researches
+into the state of the urine in dropsy, our author remarks, that there
+are certain conclusions deducible, which appear not to have been
+contemplated by those gentlemen, but which are strictly accordant with
+the pathological views he has endeavoured to establish in the present
+work.
+
+     "According to these facts, it appears, that when the disease of
+     dropsy is under a sub-acute form, and of the anasarcous kind,
+     it is usually idiopathic, and, often originating from cold; and
+     in this state, as well as in the symptomatic form, though in a
+     less degree, the urine is found to contain a portion of serum.
+     It is nearly peculiar to this disease, and denotes, according
+     to the quantity of it contained in the urine, the amount of
+     that excitement in the cellular tissue, and of the general
+     vascular system, which may be termed serous inflammation: for
+     it is met with most considerably in those forms of the disease,
+     in which these particular states of the body are most
+     apparent."
+
+Serum is therefore found in greater abundance, when anasarca precedes
+the local dropsy, which, in Dr. A.'s opinion, denotes the operation of a
+general cause. This is found to be the case especially in anasarca after
+scarlet fever. In cases of anasarca, the skin, kidneys, and bowels are
+very defective in their operation. Serum is also found, though in a
+smaller quantity, in those cases in which the anasarca has followed the
+local dropsy; for the disease of the viscus, which is the cause of the
+inflammation in the serous membrane of the cavity, may produce an
+adequate degree of the vascular excitement which gives rise to a
+discharge in the cellular tissue. Our author sums up his observations on
+this subject, by remarking, that there appear to be four distinct
+conditions of the system by which the occurrence of serum in the urine
+is regulated.
+
+     "1. It is in the greatest quantity, where along with a copious
+     and continued effusion, there is a nearly corresponding
+     quickness in the absorption of the serous fluid, and which will
+     occur most commonly when the general excitement precedes, and
+     is cause of the local one.
+
+     "2. It is consequently, _cæteris paribus_, in a less quantity
+     where the general hydropic excitement of the system succeeds,
+     and is dependent on the local one.
+
+     "3. It is absent, or found only in a minute proportion, in all
+     those cases where the local increased excitement in the serous
+     membrane is only partially extended to the rest of the system,
+     and where the absorption from the part is inconsiderable; as
+     particularly happens in the encysted kinds, or,
+
+     "4. Where the effusion of the serous fluid has proved remedial
+     of the inflammation producing it; in which case the disease, as
+     it respects the presence of water in a part, may visibly
+     resemble another example, and yet be essentially different from
+     it, by the serous inflammation, which produced it in both,
+     having ceased, on its occurrence, in one of them."
+
+Dr. A. discovers a further evidence of the relation which dropsy bears
+to diseases of local excitement, in the effects it produces on the
+general system. Thus, during the continued effusion of serum in
+anasarca, there is sometimes a large quantity absorbed and carried out
+of the body; by which a regular draught is made upon the nutrient
+principles of the blood, which must naturally create effects like those
+arising from the continued discharge of pus from a suppurating surface.
+In both cases the local disease, when extensive and of long duration,
+will necessarily occasion an exhaustion of the vital powers, by which
+that condition of the system termed cachexy will be induced.
+
+     "The exhausted or cachectical state, therefore, of the system,
+     which has been so variously accounted for, and so frequently
+     assigned as a principal cause of both local and general dropsy,
+     is a direct consequence of the agency of some power diminishing
+     the vital strength at its source; and in the case of a chronic
+     and long continued serous inflammation, it will proceed from
+     the daily abduction from the circulation of a portion of its
+     vital fluid: and whether it be pus or serum that is drawn from
+     the body; or whether it be from any permanent failure in the
+     supplies of nutriment to it, the effect will be the same, as if
+     a certain quantity of blood was daily abstracted from the
+     system."
+
+Dr. A. continues to remark that, under these circumstances, a
+suppurating surface will readily become gangrenous, from any cause
+temporarily exciting it, and that, in like manner, a higher
+inflammation may sometimes supervene upon an oedematous limb, as in
+the former case, and terminate in gangrene.
+
+     "Hence, therefore, the tendency of dropsical parts to fall into
+     gangrene, and which has been urged, as an argument, in proof of
+     debility being the cause of the serous effusion, is only what
+     is common to other forms of local inflammation, under a similar
+     condition of the body."
+
+From the view he has adopted of the nature of dropsy, Dr. AYRE thinks
+that the excitement of the parts, giving rise to the effusion, may be
+either 1st. Sub-acute or chronic. 2nd. Symptomatic or idiopathic. In
+other words, that it may arise from a local disease, or from the common
+causes of inflammation; and that these causes may be either general or
+particular. 3d. That the serous inflammation may be either local or
+general, giving rise to a general or local effusion.
+
+After offering so copious an analysis of Dr. AYRE'S sentiments
+respecting the pathology of dropsy, it is unnecessary to enlarge very
+fully on the application of his theory to the particular forms of that
+disease. We shall, however, offer a rapid review, of some of his
+opinions, and next detail the method of treatment he proposes for the
+cure of these dangerous maladies. We commence with hydrocephalus, which
+he remarks has been divided into an acute and chronic form. This
+division, our author thinks, is correct in a certain sense; for the
+disease varies much in duration,--running its course, sometimes in a few
+days; and at other times continuing several weeks. Yet, he continues,
+the terms acute and chronic must be understood as restricted to that
+particular form of inflammation producing a serous effusion, and not as
+denoting the highest and lowest degrees of common inflammation. It is
+from the want of this distinction that much confusion has arisen in our
+speculations relative to the pathology of hydrocephalus.
+
+Dr. AYRE calls our attention to the fact, that the forms of
+hydrocephalus denominated by Dr. GOLIS hyperacute and acute, do not
+differ from the sub-acute phrenitis of nosologists, in which pus and
+coagulable lymph are the proper products, with sometimes a serous
+effusion into the ventricles as an accidental effect; all of which forms
+of inflammation, the serous membranes of the brain, and of other
+cavities are liable to take on; and adds:
+
+     "Now, the true hydrocephalus internus stands distinguished from
+     these, in the nature of the inflammation of which it consists,
+     in the same way, precisely, that the serous inflammation of the
+     pleura, producing simple hydrothorax, is distinct from that
+     higher degree of vascular excitement, which occasions an
+     effusion of pus or lymph. Relatively to these, therefore, the
+     disease is in a chronic form; and consists, we may repeat, of
+     that lowest degree of inflammation to which serous membranes
+     are subject, and the effect of which is to increase the natural
+     secretion of the part, so as to cause, in regard to the brain,
+     an accumulation of that fluid in its cavities."
+
+Dropsy of the brain is usually divided into three stages. In the first,
+continues our author, vascular excitement exists, as denoted by pain in
+the head increasing in acuteness with the increase of the disease; and
+in infants by a restless movement of the head upon the pillow, moaning,
+occasional screamings, sickness, retching, impatience of light and
+noise, contractions of the pupils, delirious terrors, &c. The second
+stage is indicated by signs of pressure on the brain by effused fluid,
+and by an absence of pain, excepting upon raising or moving the head,
+convulsions, permanent dilatation of the pupils, squinting, blindness,
+slow intermitting pulse, hemiplegia, and a peculiar placid expression of
+the countenance, &c. The third stage is made up of some of these
+symptoms, together with other ulterior ones which follow the vascular
+reaction. On this subject, Dr. A. offers the following remarks:
+
+     "With respect, however, to the division thus formed of this
+     disease, it is, I think, somewhat questionable, whether it be
+     pathologically correct; for strictly speaking, the true disease
+     is comprised between the incipient beginnings of the
+     inflammation, and its termination by the effusion; since the
+     symptoms which follow, and compose what are called the second
+     and third stages, are little more than the consequences of the
+     disease, and arise from the mechanical pressure of the water
+     upon the brain. The progress, therefore, of what may be
+     strictly considered the disease, should perhaps be considered
+     as terminating with the occurrence of the effusion, which is
+     often remedial of the excitement causing it; and the whole
+     disorder, to be thus made up of two distinct states, the first
+     consisting of symptoms, which commencing with the excitement,
+     terminate with the serous discharge; whilst the second is
+     composed of those of a secondary kind, and which are wholly
+     dependent for their origin and continuance, on a mechanical
+     pressure from the effused fluid."
+
+Hydrocephalus may occur, either as an idiopathic or symptomatic
+affection. As the first, it may arise, where there exists a
+predisposition in the brain, from various injuries inflicted on the head
+by slight blows;--from all the general causes of inflammation--from the
+sudden drying up of long established discharges--the sudden repulsion of
+cutaneous eruptions, or the imperfect evolution of that or other
+sanative actions of the system, at the close of some febrile diseases,
+usually denominated defect of crisis. When, on the other hand, the
+disease is symptomatic, it may arise from a particular cause seated
+within the head, or in some distant part of the body. The former variety
+is not common among children, and when it does occur, it is the result
+of some chronic disease, as a tumour or a thickened state of the
+arachnoid or other membranes of the brain, resulting from a former
+inflammation. "Sometimes, adult patients wholly recover from chronic or
+sub-acute inflammation, which induced the structural disease, and this
+last becomes, at some future period, the occasional cause of the
+hydropic one." At other times, the chronic inflammation continues, and
+finally extends to the serous membrane, giving rise to the effusion.
+
+     "The most usual cause of the disease, however, particularly in
+     children, is an irritation which is sympathetically
+     communicated to the brain, from a disturbance in the
+     chylopoietic organs; and particularly from a functional
+     disorder of the liver. The cerebral disorder, to which a
+     derangement in the digestive functions thus gives rise, is only
+     one of those numerous effects which arise out of sympathies,
+     subsisting between these organs and different parts of the
+     system. In many cases, the same sympathetic irritation is
+     successively and variously directed to different parts of the
+     system. It will thus leave one organ or part, and suddenly move
+     to another; and through the operation of causes, which are not
+     always obvious, but which have a relation to some particular
+     predisposition, inherent or acquired. In this way, an
+     irritation may occasion an eruption upon the skin, and thence
+     be translated to the bronchial lining, producing a cough; and
+     next perhaps, to the serous tissue of the brain, exciting there
+     a turgescent or congestive state of the cerebral vessels, by
+     which symptoms are produced, through the pressure of the
+     congestive vessels, that simulate those of hydrocephalus; or
+     the true disease is brought on by an arterial re-action,
+     ensuing upon the congestion, which is resolved by a serous
+     effusion."
+
+Dr. GOLIS, from observing the marked connexion "between the turgescent
+state of the brain from chylopoietic disturbance, and its serous
+inflammation, has concluded, that it essentially pertains to it;"
+consequently, that "whenever it occurs, it is a part of it;" that it
+should be considered as forming the first stage of the disease, and that
+in all instances, it precedes the excitement. He has, for the same
+reason, constituted all the symptoms of the chylopoietic disease into
+the first stage of hydrocephalus. Dr. AYRE shows, however, that this
+state of turgescence, is not essential to the disease, and is only a
+sympathetic effect, which in the majority of instances, requires no
+treatment, (at least a very subordinate one,) other than that of the
+primary affection. He concludes his remarks on hydrocephalus, with the
+following words.
+
+     "The cerebral turgescence and disturbance, therefore, in
+     whatever degree they may exist, are only, when sympathetically
+     produced, to be considered as morbid causes, whose presence,
+     where the predisposition prevails, may lead to a serous
+     inflammation of the tissues of the brain, but which do not
+     form, in any sense, parts of the disease itself; since, under
+     every degree of them, they are so frequently remediable, by
+     means which are alone available, for the removal of their
+     distant and sympathetic cause."
+
+Of _Hydrothorax_, Dr. AYRE very justly remarks, that, as its name
+imports and as defined by Nosologists, it consists of symptoms, which
+strictly speaking, pertain only remotely to the true disease--arising,
+as they do, from a certain disturbance given to the lungs, by the
+pressure of water upon them. They are only the symptoms, therefore, of
+the effusion, and as the excitement sometimes terminates with the
+occurrence of the serous discharge, its existence, in many cases, is
+discoverable only by its effects--there existing no signs, which clearly
+point out the presence of that state, previous to the appearance of the
+effusion; and what are usually called, by writers on the subject,
+premonitory symptoms, being only those of an inferior degree of the
+effusion which has already commenced.
+
+Like hydrocephalus, hydrothorax may be idiopathic or symptomatic; and
+proceed from a local or general cause--the nature of the inflammation
+being the same in both cases. It may likewise be divided into an acute
+and chronic form. When the disease is symptomatic, and arises from a
+local cause, it is generally chronic. When it arises secondarily from a
+disease of the lungs, our author thinks, that
+
+     "The mode by which this state is induced in the serous
+     membranes, is by the chronic inflammation that exists in the
+     diseased organ extending to them; and not by the same form of
+     inflammation being set up in them, by a certain sympathy or
+     consent of parts, which, from a loose analogy, has been thought
+     to subsist between similar structures."
+
+All diseases of the thoracic organs, are not equally prone to occasion
+effusion; some of these also, are only dangerous to life, in proportion
+to their disposition in occasioning such an effusion; whilst in other
+cases, if it occurs at all, the effusion is only the sequel of a disease
+essentially fatal.
+
+     "To distinguish between these two conditions, is a desideratum
+     pathology. Modern writers on pathological anatomy have
+     prosecuted with considerable zeal and ability, their researches
+     into the nature of the diseases of the organs within the chest,
+     but they have done but little towards elucidating the true
+     relation, which subsists between the diseases of the several
+     viscera, and the serous effusions which take place into their
+     cavities; for, by limiting their views to the disease which the
+     _post mortem_ examination exhibited, they have overlooked those
+     intermediate actions or states of excitement which connect the
+     organic disease with such effusions."
+
+Whenever the excitement, producing hydrothorax, is idiopathic and
+independent of an organic disease of the lungs, heart, &c. its remote
+causes may be either of a general or local kind; and are the same which
+produce, when applied in a higher degree, or under different states of
+the system, the other forms of inflammation. The effusion may take place
+in those cases in which, the individual being predisposed, the
+inflammation, owing to some peculiarity in the cause, does not reach
+beyond its lowest grade; or in those in which the inflammation being
+high, and treated too late, or by insufficient means, a chronic form
+succeeds to the acute one, which may produce a watery effusion; or some
+structural disease remains and eventually becomes a cause of the
+effusion. The occurrence of this effect, in those latter cases, is
+sometimes attributed to a debility, resulting from the large depletion
+required in consequence of the severity of the previous inflammation.
+
+     "That such opinions, however, are founded in error, may be
+     shown from this, that the effusion, thus imputed to debility,
+     does not occur sometimes, until some weeks or months after the
+     period when the bleeding was employed; and although the
+     debility is confessedly of a general kind, yet the effusion is
+     local, and is precisely in the very cavity where the disease
+     existed, which required the unjustly condemned evacuations. The
+     truth of the matter is, that in such cases, either the
+     depletory means have been employed in an insufficient degree,
+     or too late." "The imperfect recovery of such patients from
+     their first attack, and, which is attributed to the depletion,
+     arises from the disease which is left by it, and to the
+     injudicious means, perhaps, that are employed by the too
+     anxious attendants, with the view of restoring the strength."
+
+Among the ordinary predisposing and exciting causes of the inflammation
+which produces hydrothorax, Dr. A. mentions a certain congestive or
+plethoric state of the circulation, which is brought on in some persons
+of particular habits, by indulging in the pleasures of the table, and
+taking little exercise. These cases are analogous to those occurring in
+the brain, and giving rise, by rupture, to a sanguineous apoplexy, or,
+by arterial reaction, inducing an effusion of serum.
+
+Dr. A. next proceeds to the subject of _ascites_, the symptoms of which
+he remarks are at first so obscure, that the disease is sometimes with
+difficulty detected. The remote causes of ascites may be either
+symptomatic or idiopathic, and either local or general. When
+symptomatic, it may be seated in some diseased viscus, as the liver,
+spleen, or in the mesenteric glands, &c.
+
+     "To produce, however, a dropsical effusion into the abdomen
+     from this cause, it is necessary that the disease of this
+     viscus should be making progress; for, in its indolent state,
+     or, in other words, if inflammation be not present in it, it is
+     incapable from its mere bulk, as is commonly but erroneously
+     supposed, of producing this effect." "Nor does the serous
+     discharge always take place into the abdomen, in every case
+     where these organs are morbidly affected, but only where their
+     peritoneal covering participates in the disease; for the
+     chronic inflammation in those cases, where it occasions
+     ascites, does so by extending from the cellular tissue of the
+     internal structure of the organ, to the serous tissue investing
+     in it." "When ascites is an idiopathic affection, it may
+     proceed from all the common causes of inflammation. The most
+     frequent cause is cold, and which may act either locally or
+     generally. When in the latter mode, the ascites is usually
+     combined with anasarca, and the disorder generally comes on
+     suddenly, and has a rapid progress. The vascular system is
+     excited, and there is more than usual thirst; the blood when
+     drawn exhibits the buffy appearance; and the urine, when
+     subjected to heat, is found to coagulate strongly, from the
+     large quantity of serum contained in it. In some of the severer
+     cases, the effusion into the abdomen takes place very suddenly,
+     and yet, by a copious bleeding the disease may be at once
+     arrested, and the water be afterwards absorbed."
+
+Unlike what occurs in hydrothorax and hydrocephalus, the effusion in the
+present form of dropsy is of inconsiderable importance, compared to the
+visceral disease which is its remote cause. When, however, the
+accumulation becomes very considerable, the pressure of the fluid may
+affect the organs, and more particularly the peritoneal lining, which
+from the irritation induced in it, may take on a higher grade of
+inflammation, terminating in effusion of coagulable lymph or pus, and in
+death. The necessity which arises of tapping, where the effusion is very
+considerable, proves sometimes a farther cause, perhaps, of aggravating
+the disease of the affected viscus, and either of renewing or extending
+the hydropic excitement, or of converting it into a higher or more
+destructive form of inflammation.
+
+By most writers on dropsy, anasarca has been maintained to originate, in
+all instances, in debility, and to be curable only by a tonic and
+invigorating plan. It is true that some writers, especially among the
+ancients, (for we can hardly class PORTAL among the moderns,) have
+spoken of the disease as arising occasionally from a plethoric state of
+the circulation, and enforced the necessity, under these circumstances,
+of venesection. This view of the pathology of anasarca, although leading
+in many instances to a successful practice, was, however, vague and
+often unsatisfactory. To the late Dr. RUSH, and to Dr. PARRY, much
+credit is certainly due for their labours on this subject; but so far as
+we are informed, it was not until within a few years, that the subject
+was cleared of part of the obscurity in which is was involved, and that
+the disease, at least the active sort, has been referred to an
+irritation of the cellular tissue. Following up this opinion, and
+generalizing still more than the French pathologists, our author asserts
+that anasarca invariably consists in an inflammation of the cellular
+membrane of the body, with a serous effusion as its result. The
+accumulation, he continues, may be either idiopathic or symptomatic, and
+either general or local; occurring only under two forms, the one being
+of greater intensity that the other. In general, the disease derives all
+its importance from the nature of the remote cause.
+
+     "When it is idiopathic and proceeding from cold, it is usually
+     unimportant, for though the progress of the swelling be rapid,
+     and the appearance of the disease formidable, yet it readily
+     subsides under proper treatment, as the effusion proves in
+     these cases, either partially or fully corrective of its cause;
+     and little more, under such circumstances, is required in its
+     treatment, than to promote the absorption of the water. In some
+     cases of general anasarca, however, the disease is more severe;
+     for sometimes the action of the heart and arteries is
+     increased, the urine becomes loaded with serum, and there is
+     thirst and other indications of general vascular excitement,
+     similar to the state which was noticed, as producing effusion
+     into the brain, or the other cavities of the body."
+
+In some cases, the serous effusion appears to be translated from one
+part to another. Our author very justly adds, however, that this
+translation is not of the serous fluid, but only of the serous
+inflammation giving rise to the effusion. It usually takes place from
+one portion of the cellular membrane to another; but sometimes from this
+membrane to the serous tissue of the brain, chest, or abdomen.
+
+Oedema of the feet and ankles is often symptomatic of chylopoietic
+disturbance, and particularly in young women, in whom the menstrual
+function is obstructed. In these cases, as well as in the oedema
+following gout or rheumatism, the swelling usually commences with
+considerable pain and stiffness of the parts, and hardness of the
+swelling.
+
+     "But the most common form of anasarca is that which is
+     symptomatic of some visceral disease; and which, as it
+     ordinarily appears, arises from a state of the system that
+     answers to the hydropic diathesis of systematic authors."
+
+This form of the disease begins in the lower extremities, and is rarely
+attended with strong signs of local excitement so obvious in anasarca of
+the idiopathic kind. Its occurrence has been referred to various causes.
+When combined with ascites, it is supposed to arise from pressure of the
+iliac veins by the fluid accumulated in the abdomen,--an opinion which
+our author combats by repeating, in great measure, the arguments we have
+already noticed.
+
+     "But here let me observe, that the denial of ascites producing
+     an anasarcous state of the legs, from the water compressing the
+     iliac veins, must not be understood as implying, that a
+     mechanical compression of a vein will not in other cases
+     produce an effect of this kind. A pressure made on the brachial
+     vein and its branches by scirrhous glands in the axilla, is a
+     common cause of this state. The remote cause is here, indeed,
+     of a mechanical kind, but not so the proximate cause of the
+     effusion. By the resistance given, in this case, to the blood's
+     return by the principal veins of the limb, a reaction is
+     occasioned in the extremities of the arteries leading into the
+     corresponding extreme branches of the veins, and which reaction
+     is in this, as in a multitude of other occasions of congestive
+     fulness in these vessels, a sanative effort of nature to
+     overcome the primary obstruction."
+
+The disease has often been referred, when occurring under these
+circumstances, to a local and general debility; and this opinion is
+thought to be supported by the facts that the swelling is increased by a
+depending position of the limb, and diminished by a horizontal one--by
+the occurrence of an inflammatory state of the parts being incompatible
+with such a degree of debility, and lastly by the absence of
+preternatural heat on the surface of an oedematous part. To these
+pretended arguments, Dr. A. opposes, that the effusion cannot be
+attributed purely to debility; because the effects are in no
+correspondence with the assigned cause,--the debility being, in some
+instances of chronic and acute disease, very considerable, and the
+effusion small, and vice versa;--because anasarcous limbs will occur in
+the strongest individuals when the limbs have remained a long time in an
+erect posture,--because there is in certain fatal chronic diseases, a
+tendency in the lower limbs to take on an inflammatory action, often of
+an erysipelatous kind,--and because the fact of oedema increasing by
+an erect posture and diminishing in the horizontal one is readily
+explained by the greater congestion of the vessels induced in the limb
+by such a position, as it occurs in the higher grades of inflammation.
+
+     "And with respect to the temperature of the surface of
+     oedematous parts not being preternaturally raised, the
+     objection, if of any force, must apply to all, for all have
+     this peculiarity, and yet some cases of oedema confessedly
+     arise from inflammation; differing not, in this respect, from
+     several other morbid states, as those for instance, of chronic
+     rheumatism, and which are indubitably, as indicated by the
+     nature of their causes and remedies, of a truly inflammatory
+     kind."
+
+Dr. AYRE, therefore, regards all these cases as secondary to a serous
+inflammation seated in a cavity; and lastly as arising from some
+disturbance in the digestive functions, by which this and other distant
+irritations are produced through the operation of that law of the animal
+economy, denominated sympathy.
+
+Having thus offered, in the preceding pages, an analysis of Dr. AYRE'S
+views of the pathology of the principal forms of dropsy, we must be
+allowed, before proceeding to the treatment of the disease, to make a
+few remarks. It appears to us that Dr. A. has treated the subject in a
+very able manner, and contributed greatly to remove many objections,
+that could be adduced against the opinion of the inflammatory nature of
+some of the more obscure cases of dropsy. We cannot help thinking,
+however, that he is too exclusive in his theories, and that he has
+rejected too positively the idea of a passive dropsy; in other words, of
+a dropsy independent of inflammation. Some cases of the disease which
+follow extensive losses of blood, (profuse uterine hemorrhages, for
+example) and which are cured by tonics and an invigorating diet, without
+the aid of diuretics, cannot always, though they may sometimes, be
+accounted for by admitting the existence of inflammation. Such instances
+have fallen under our own observations, and could not be explained by
+supposing that the effusion had relieved the inflammation; since there
+had not existed, at least as far as we could ascertain, any local
+inflammation. In one case it followed abortion, attended with profuse
+hemorrhage, and produced, not by disease, but by an accident.
+
+In the second and fifth volumes of the _Archives Générales de Médecine_,
+Dr. BOUILLAUD has related many cases of partial and general dropsy,
+which undoubtedly originated in obstruction to the venous circulation,
+from adhesion of the parietes of the principal veins. It is true that
+Dr. A. is compelled to admit this among the causes of dropsy; but
+faithful to his theory, he supposed the supervention of an arterial
+reaction resulting in an effusion of serum. It does not appear to us,
+however, that this arterial reaction is admissible in all cases of the
+sort, and we prefer on the whole the explanation of the mechanism of the
+effusion, originally given, by DONALD MONRO, and lately by Drs.
+BOUILLAUD and BROUSSAIS, who refer it to an obstruction in the venous
+circulation and to a consequent deficient venous absorption. By
+admitting this explanation, it is readily perceived, that we admit a
+passive dropsy, and we think the view well exemplified by a case which
+occurred last summer. The individual had recently recovered from a
+violent attack of disease, and was left much debilitated. Induced by
+this circumstance to travel to the north, he had occasion to notice that
+when seated long in a stage with his feet depending on the veins
+compressed, oedema invariably came on, and that it as invariably went
+off the next day if he did not ride. This occurred so often as to lead
+us to think there could not always be an arterial reaction occasioning
+the effusion, and that this effect arose from the mere obstruction to
+the venous circulation.
+
+In making these remarks we are not actuated by the desire of detracting
+from the merits of Dr. A.'s views of the pathology of dropsy; convinced
+as we are, that the great majority of cases of the disease, which are
+thought by many physicians to arise from debility, do not owe their
+origin to this condition of the system, but to an increased excitement
+of the membranes or cellular tissue. Were it otherwise, how could we
+account for the fact, that dropsy is generally _local_, whilst the
+_debility_ to which it is in most instances referred, is general?
+
+But whilst maintaining the correctness of many of Dr. A.'s views, we are
+inclined to the opinion, that he may do some injury to the doctrine he
+is advocating, by invariably making use of the word _inflammation_, to
+express that condition of the vessels, giving rise to an excessive
+secretion of serous fluid. We are ready to admit, and we dare hope, that
+few will refuse to do so, that _inflammation_, strictly speaking, will
+occasion such an effect; yet, it often happens, that effusion will occur
+in cases, where no inflammation can be detected. In such instances, the
+vessels are evidently in a state of increased excitement; or in other
+words, in a state of irritation, but not of inflammation, which always
+implies congestion. This latter morbid condition, may supervene on the
+irritation, and occasion a suppression of the serous effusion, and the
+formation of coagulable lymph or pus. It is true, it may be said, that
+both these states (irritation and inflammation) being an increase of the
+life of the part, and requiring the same treatment, may be designated by
+the same name. Nevertheless, to prevent confusion, and the quibbling of
+some of the opponents of the theory of inflammation in dropsy, we are
+inclined to believe, that it is better to substitute the word
+irritation, whenever there is merely an increased secretion, and reserve
+the word inflammation, to designate those cases, in which there are
+decided marks of local excitement and congestion, attended or not with
+general fever.
+
+Dr. AYRE, adopting the opinion of Dr. PARRY, regards some cases of local
+dropsy as an effect of a general hydropic diathesis, or of a general
+inflammatory action of the vascular system, occasioning a local
+excitement, ending in dropsy. This is a natural consequence of the
+views, entertained by many physicians in Europe and this country, that
+fever produces local inflammation. We must confess, however, that all
+Dr. A. has said on the subject, is not calculated to carry conviction to
+our minds. Thus, one of his reasons for regarding some cases, as arising
+from this general vascular excitement is, that they are produced by what
+he considers as a general cause,--as cold, for example. But cold
+produces local diseases, occasioning, and not preceded by, a febrile
+excitement; and if it can, and does occasion anasarca, who will pretend
+to assert, from its being a _general_ cause, that this anasarca is a
+general disease? Does not cold occasion also ascites, which, in many
+cases, is regarded by every one as a local disease, sometimes
+terminating in anasarca? If so, why shall we regard anasarca, ending in
+ascites, as a general disease? The cases are analogous, and the action
+in both should not be explained differently. If the action of such a
+cause were really general, and extended to all parts of the body, then
+the effects should also be general, and the dropsy should be universal,
+which is very far from being always the case.
+
+2nd. It is also said in support of this opinion, that where anasarca is
+idiopathic, it is attended with fever, but that this latter does not
+exist, when the disease follows ascites. This difference appears to us
+to be very readily explained by the fact, that the disease in the former
+case, is more acute, and that the heart sympathises more actively with
+the irritated cellular tissue, than in the second case, when the disease
+is milder, or more gradual in its progress.
+
+3d. It is also maintained, that when anasarca is idiopathic, there
+exists a large quantity of serum in the urine; and this is brought
+forward in order to distinguish these cases from local dropsies. But it
+is also admitted, that serum is found in the urine in cases of anasarca
+following ascites. Consequently, if there be none in cases of simple
+ascites, and if it only appears when anasarca supervenes, the only
+conclusion that may be drawn from these facts, is, that anasarca is the
+only form of dropsy, in which serum is absorbed, and passed off by the
+kidneys; and if there be a greater quantity discharged when anasarca is
+primary, it is only because the disease is more violent, and generally
+more extensive. But, surely all this is far from proving, that primary
+anasarca is a general disease, and owes its origin to a primary arterial
+excitement of the whole system. When fever exists first, and terminates
+in dropsy, who has proved, that there existed no local irritation
+producing the fever, and that the hydropic irritation has not supervened
+by metastasis. This takes place in scarlatina and other eruptive
+diseases, which Dr. A. would surely not be justified in calling general
+diseases. Dropsy follows the suppression of cutaneous diseases,
+unattended with fever; consequently, when there happens to be a febrile
+excitement, we are at a loss to know, why we should call this latter to
+our aid, in our explanation of the dropsical effusion, and not account
+for it on the same principle, as we did in the former cases; namely, by
+metastasis. If febrile symptoms are sufficient to make us regard a
+disease as general, then there is no local disease, except when
+apyretic.
+
+We now proceed to notice the mode of treatment, recommended by our
+author, for the different forms of dropsy. From what we have seen, it is
+natural to conclude, that as Dr. AYRE regards the proximate cause of the
+several forms of the effusion, or in other words, the _disease_, to be
+the same under all its conditions, he will be of opinion, that "the same
+general principles of treatment, are alike applicable to all--subject
+only to such modifications, as arise from differences in the nature and
+intensity of the remote cause, and those general or local relations of
+the parts implicated in the serous effusion, with the diseases of the
+organs, which incidentally produce it." Founding upon these views the
+indications of cure, he states them to be; 1st. To remove the visceral,
+or such other disease or state, which, when present, proves a remote
+cause of the effusion; 2nd. To remove the morbidly increased action in
+the serous membrane or tissue, which is its proximate cause. 3d. To
+promote the absorption of the effused fluid.
+
+Agreeably to Dr. A. the treatment of hydrocephalus internus, is
+divisible into three general heads:
+
+     "The first, consisting of means to correct, with its causes,
+     that turgescent state of the brain, which may produce the
+     arterial re-action and effusion; the second, of those which
+     shall subdue the excitement, when formed; the third, to correct
+     or relieve, as far as it is practicable, the effects of the
+     effusion, and procure, if possible, its absorption."
+
+With respect to the general causes, tending to produce that congestive
+state of the brain, precursory to its inflammation, he remarks, that
+they are of three kinds; 1st. Those acting through the general system,
+and consisting of an irritation, from some obstructed or required
+evacuation; 2nd. A local disease, seated in the head, or a local injury
+inflicted on it; 3d. Chylopoietic disturbance, acting sympathetically
+upon the brain. When the first of these causes appears to have been
+instrumental, in occasioning this condition of the brain, it is plain
+that it must be removed, and the obstructed emunctory corrected,--the
+suppressed evacuation promoted, or a new and artificial one substituted.
+When there exists any structural disease within the head, or a relic of
+a former state of excitement, a serous inflammation may be reasonably
+apprehended, and to avert it, the most rigid and undeviating attention
+must be paid to regimen, whilst cupping and leeching must be employed,
+and a seton fixed in the neck.
+
+     "For the object of the treatment, in these cases, is not to
+     remove, but to avert the inflammation, and which, from the
+     strong disposition to it, conferred by the organic disease, can
+     only be effected by avoiding, not merely the causes of
+     inflammation, but likewise, all those agents, which are
+     calculated, in any way, to increase the momentum of the
+     circulation." "Beyond those, the common precautions against
+     morbid irritations, little else can be done."
+
+When the turgescent state of the brain, arises from a disturbance in the
+digestive organs, it will be remedied, by means directed to this cause.
+Our author locates the primary seat of this disturbance, in most cases,
+in the liver; though he admits, it may occasionally be in the stomach
+and intestines. He places great reliance for correcting and increasing
+the secretion of bile, on small doses of calomel,--purging off the
+contents of the intestines by aperient medicines; and recommends, at the
+same time, the application of cups and leeches to the temples, as a
+measure of precaution. He very properly lays considerable stress on the
+necessity of combating this secondary affection of the head;
+
+     "For though the means applied, to correct the disorder in the
+     digestive organs, may be sufficient to remove the turgescent
+     state of the brain, which arose from it, yet, those means will
+     have little or no control over the excitement, which that
+     turgescent state has created; and still less can they avail in
+     subduing an excitement, that may even survive its remote cause,
+     and continue independently of it. By overlooking these facts,
+     much distrust and disappointment have arisen with many, who
+     confided in the opinion, delivered by some writers, of the
+     uniform prevalency of chylopoietic disturbance, as a cause of
+     this disease, and of the sufficiency of calomel to remove it."
+
+When the inflammation exists, and is a sequel of some pre-existing
+structural disease in the brain or membranes, all that can be reasonably
+expected, is to _palliate_ it by the antiphlogistic plan; but when it is
+idiopathic it may readily be cured, by the same remedies, graduated to
+the age and strength of the patient and to the violence of the attack.
+Dr. A. seems to rely principally on cups and leeches;--not excluding, in
+some cases, bleeding from the arm. Blisters to the summit of the head
+and afterwards a cold evaporating lotion to the temples, are also
+recommended. As soon as, by these means, an impression is made on the
+disease, mild diaphoretic medicines, assisted by the tepid bath, or the
+pediluvium, maybe prescribed;--the bowels are to be kept open by small
+doses of calomel, followed after two hours by a draught of some aperient
+medicine,--the antiphlogistic regimen should be rigidly enforced, and
+light and noise carefully excluded.
+
+     "Many practitioners give the mild preparations of mercury, and
+     particularly calomel, freely in this disease, under a notion of
+     its having some specific power in subduing it; but it never
+     should be so used, excepting in cases where the disease is
+     symptomatic of some functional disturbance in the liver and
+     other chylopoietic organs, where it is calculated, in
+     conjunction with the local bleeding, &c. to afford the most
+     important service."
+
+With a view of pointing out some characteristic sign, by which to
+distinguish those cases in which the affection of the bowels is primary
+from those in which it is secondary, he remarks--
+
+     "The condition of the stools at the period when a child is
+     labouring under the disease, will afford to such persons but an
+     imperfect notion of its true nature; for the disturbance of the
+     brain will often create a disorder in the secretions, both of
+     the liver and the other chylopoietic organs, producing green
+     looking stools; and there is often a congestive state of the
+     brain for a short time preceding the full development of the
+     idiopathic excitement, which may, in like manner, by reacting
+     upon the liver, create a disorder there. In cases, however,
+     which are symptomatic of this cause, the chylopoietic
+     disturbance will be found to have existed several days or even
+     weeks; and the origin of the disorder, in like manner, may be
+     commonly traced to some irregularity of diet, or other obvious
+     causes, and frequently in infants to those which are connected
+     with premature weaning; and sometimes even the cerebral
+     disorder itself will have been only the last of a series of
+     effects in the system, to which such disturbance had given
+     rise."
+
+Agreeably to Dr. A., it is not proper to discontinue those means,
+immediately upon the occurrence of what appears to be symptoms of
+effusion, since, frequently, these symptoms, as it respects the
+effusion, will immediately manifest their fictitious character, and
+disappear under a treatment no wise adapted to such a state, and with a
+rapidity, too, which equally betrays their true nature. He notices,
+though we believe not in its proper place, a modification of the disease
+in which the effusion takes place in the cellular membrane of the
+substance of the brain, and thinks this species more likely to be
+recovered from than when the water accumulates in the ventricles. He
+concludes this section by remarking, that
+
+     "Of the means to be employed to promote the absorption of the
+     water, under these or other circumstances of its accumulation
+     in the brain, little satisfactory can be said. The treatment
+     must be founded on the use of such means as shall avert the
+     risk of renewing an inflammation in the organ. To this end,
+     occasional blistering the head will be proper; the diet must be
+     spare, and the several secretions, particularly those of the
+     kidneys, must be cautiously promoted."
+
+We next turn to the treatment of hydrothorax and ascites. As the
+existence of hydrothorax in its early stage is difficult to ascertain,
+and as what have been called premonitory symptoms are only those proper
+to the mildest forms of the disease, and not of that condition of the
+parts which gives rise to the effusion, the treatment is somewhat
+difficult, and, in too many instances, our remedies are directed, not to
+the disease itself, but to one of its effects. Faithful to his view of
+the pathology of dropsy, Dr. A. remarks, that the plan of treatment to
+be pursued at an early stage of symptomatic hydrothorax, must consist in
+the use of those means which shall subdue the chronic excitement of the
+serous membrane, as well as the chronic inflammation of the diseased
+organ. To attain this end, the antiphlogistic and revulsive plans,
+graduated to the age and strength of the patient, and to the violence of
+the disease are recommended. In general the frequent application of
+leeches are held by Dr. A. as preferable to venesection, unless the
+patient be plethoric, and the disease arise from a local congestion
+within the chest, which, according to him, is often a cause of serous
+inflammation of the thoracic tissue, independently of any previous
+disease. Dr. AYRE calls attention to the fact, that topical bleeding is
+particularly adapted to correct that chronic inflammation of the serous
+membranes, which causes an effusion from them, and which is neither the
+result of any inflammatory excitement of the general system, nor of a
+nature to produce it; and that when properly conducted, it has the
+advantage of acting only slightly on the general system, and therefore
+only slightly on the general strength, and very considerably on the
+local disease. Together with leeches, blisters are to be used, and after
+the chronic action existing in the serous membrane is subdued by these
+means, a seton fixed in the integuments of the chest will be found of
+great utility.
+
+The same treatment will be found equally serviceable, not only to
+correct the chronic excitement existing in the peritoneal membrane and
+giving rise to ascites, but very commonly to cure or palliate the
+visceral disease producing it. In respect to the very common practice
+of resorting to mercury in this complaint, our author makes the
+following judicious remarks.
+
+     "With too many practitioners, it is the practice to employ
+     mercury freely in every case of abdominal dropsy, under the
+     vague notion of there existing some mechanical obstruction in
+     the liver or other viscus, as a cause of it; and under the
+     equally vague notion, that mercury so employed will remove it.
+     The practice, however, to speak of it in the mildest terms, is
+     founded on erroneous views of the pathology of these diseases;
+     and employed, therefore, as it is by some, on all the occasions
+     in which they meet with them, must be frequently very
+     injurious. For, independently of the injury to be inflicted by
+     it, when given freely in some of the forms of liver disease,
+     there is an effect produced by it on the urine, when given to a
+     person in health, resembling that which arises from the
+     specific excitement of dropsy. Under a salivation, the urine
+     becomes charged with serum. Any condition of the system,
+     therefore, approaching even to a state of salivation, must be
+     injurious, by the tendency it must have to increase that morbid
+     state of the body, which is nearest allied to the hydropic one.
+     Hence the mercurial salivation has been numbered amongst the
+     remote causes of dropsy; and the resemblance between the
+     dropsical and mercurial excitement, thus established by the
+     common resemblance of the urine in these states, goes far to
+     prove this connexion; and it is not improbable, that the
+     mercurial inflammation, when considerable, may survive its
+     specific cause, and degenerate at length into the purely
+     hydropic state. When, however, mercury is given in minute
+     doses, so that these its specific morbid effects are not
+     produced, it is capable of becoming highly useful, as we shall
+     presently have occasion to notice."
+
+In conjunction with bleeding and other means just noticed, drastic
+purges have an important influence in subduing the disease; not merely
+by removing the water, but likewise by contributing to subdue the
+chronic excitement which occasions its effusion. This latter effect Dr.
+A. very justly refers to the counteraction and irritation these
+medicines excite on the mucous membrane of the bowels, by which the
+excitement of the serous tissue or of the diseased viscus is removed. He
+remarks that drastic purgatives are sometimes inadmissible in ascites,
+when an affection of the liver or mesentery is its remote cause, and
+there is a tendency to a spontaneous diarrhoea, which even the mildest
+purgatives would increase. "In the case of the mesentery, such a mode of
+treating dropsy would speedily destroy the patient." Dr. A. ought,
+perhaps, to have explained the real cause of the danger attending the
+practice, and not referred it merely to the tendency to diarrhoea,
+which itself can only be an effect of a morbid condition of the bowels.
+The fact is, that most cases of hepatitis, and all cases of mesenteric
+disease, are attended, whether as cause or effect we care not, with
+inflammation of the stomach or bowels, which purgatives can only tend to
+aggravate. In general, the practice of administering drastic purgatives
+is more serviceable in hydrothorax, and especially in anasarca, or in
+_idiopathic_ serous inflammation of the peritoneum. Dr. A. prefers the
+gamboge to all other medicines of the same class, and gives it to the
+amount of four or five grains in a single dose, with the same quantity
+of some aromatic powder, and triturated with a few crystals of the
+supertartrate of potassa; or in urgent cases of hydrothorax, he
+prescribes ten or twelve grains, divided into four doses, one of which
+is to be given every three hours. When the strength admits of it, the
+purgative may be given every four or five days.
+
+Dr. A. next notices diuretics.
+
+     "The sensible operation of these medicines," he says, "as is
+     well known, is to promote the secretion of the kidneys. There
+     appears to me, however, to be farther effects produced by them
+     upon the system, or particular parts of the system, which is
+     not referrible to the mere evacuation of a certain quantity of
+     fluid from the body; and these effects, it is probable, consist
+     in promoting the natural discharges by this and, perhaps, the
+     other emunctories, whose partial suppression may either produce
+     this disease, or serve materially to continue it; and likewise
+     in occasioning a derivation of blood to the kidneys, and
+     therefore to a part distant from the morbid one; and that thus,
+     whilst they are contributing materially to the removal of the
+     fluid, they are serving like the purgative, an important end,
+     in assisting to subdue the cause of it. The medicines which I
+     am accustomed almost entirely to rely on in this disease, are
+     the powder of dried squill and digitalis, given in combination
+     in the form of pills, and in doses, which, from their
+     smallness, will probably excite no little surprise in the minds
+     of some of my readers. The dose of the squill is something less
+     than a grain, and of the digitalis only a sixth part of a
+     grain, given uninterruptedly every third or fourth hour."
+
+To render these medicines more effectual, a third or half a grain of
+calomel may be given nightly, and an infusion of dandelion, or some
+other popular diuretic, may be taken _ad libitum_. Our author speaks in
+terms of merited disapprobation of the practice pursued by some
+physicians, of allowing their patients daily, potions of gin punch, with
+the view of aiding the operation of the diuretic medicine, and
+supporting their strength. He shows, that, although by these means the
+water may be promptly evacuated, the disease is not cured, and the
+effusion is soon renewed with redoubled violence and danger to the
+patient.
+
+In the idiopathic form of hydropic inflammation, attacking the serous
+membranes of the chest and abdomen, and which, agreeably to our author,
+may be strictly local, or consist in a general specific excitement of
+the system, leading to a general watery effusion, the lancet is
+particularly advantageous, and should be had recourse to. The pulse is
+generally hard, the blood exhibits a buffy appearance, and the urine
+coagulates when subjected to heat. Leeches, in pretty large numbers,
+must also be used, as well as all the remedies already enumerated. But
+as in these cases, which according to Dr. AYRE are more common among
+females than males, and among the younger than those of middle and
+advanced age, the disease is of a more acute nature, a greater reliance
+is to be placed on an active antiphlogistic plan; and if this be
+steadfastly persevered in, comparatively little difficulty will be
+experienced in effecting a discharge of the water.
+
+When hydrothorax occurs after scarlatina, and is combined with anasarca,
+its course is generally rapid, and the cure difficult; partaking, as it
+often does, of the two-fold state of debility and excitement. When
+detected early, the lancet must be promptly used. Cups and leaches,
+followed by the warm bath, blisters, and cathartics, must also be
+resorted to.
+
+     "Diuretics, which are so beneficial in the less acute forms of
+     dropsy, are commonly too inert and slow in this, unless given
+     in doses to act immediately upon the vascular system, when the
+     infusion of digitalis, as given by many practitioners in all
+     the other states of the disease, may be resorted to; since the
+     treatment here is not so much to remove the water, as to
+     prevent, if possible, its farther effusion; for when a
+     discharge suddenly takes place into the chest after scarlet
+     fever, it will generally prove fatal, even though the quantity
+     collected be inconsiderable, and only such as would occasion,
+     if gradually effused, a moderate degree of inconvenience to the
+     lungs."
+
+In respect to tapping, our author remarks, that the circumstances
+calling for this operation are, where, from the very considerable
+accumulation of water, and the consequent distension it occasions, a
+permanent and morbid stimulus is given to the peritoneal membrane, by
+which its serous inflammation is perpetuated or increased; or where so
+much pain and irritation are produced, as to risk inducing a similar
+disease in the chest, and of bringing on likewise an ulcerative form of
+inflammation in the peritoneal lining of the abdomen.
+
+     "Whilst the objections to its employment consist in the danger
+     which is incurred, where there is much visceral disease, of its
+     causing a destructive form of inflammation in the peritoneum;
+     and the probability of its occasioning, under the most
+     favourable condition of the disease, a more rapid renewal of
+     the serous accumulation."
+
+Our limits not allowing us to enter on the treatment of ovarian dropsy,
+we proceed to offer a few remarks on the means recommended by Dr. A. for
+the cure of anasarca. As in the treatment of every other form of dropsy,
+it is necessary, in attempting the cure of anasarca, to advert to the
+nature and causes of the disease.
+
+     "If it be idiopathic, and unconnected with any dropsy of a
+     circumscribed cavity, and the pulse at the same time be soft,
+     and the urine free from serum, it may be treated solely with
+     the view of procuring the absorption of the effused fluid, as
+     in such cases, the watery discharge in all probability will
+     have removed, in a considerable degree, the excitement which
+     caused it."
+
+It is in such cases that recoveries take place under almost any plan of
+treatment, and that bark and other tonics have been found beneficial.
+Their utility, however, in these cases is very limited, consisting only
+in aiding the removal of the effects of the disease, and keeping up the
+strength of the system, whilst the absorbents perform their function,
+and remove the fluid. Dr. A. recommends, in these cases, puncturing and
+bandages; but he very justly adds, that they must not be employed,
+whenever there remains any inflammation in the parts, as they would then
+tend to aggravate it.
+
+     "To oedematous swellings, in which the serous local
+     inflammation, whether symptomatic or idiopathic, still
+     subsists, I am accustomed to direct the application of leeches
+     and cold evaporating lotions, observing not to commence the use
+     of the latter, until twelve hours after the leeches have been
+     used, that inflammation may not be produced in the wound."
+     "When anasarca arises from a general excited state of the
+     system, as denoted by the pulse, and by the serous quality of
+     the urine, venesection becomes necessary, combined with the use
+     of leeches, applied to the extremities, or to those parts of
+     the body, in which the serous tissues are most affected, along
+     with the active use of the general means already alluded to."
+
+In anasarca, an error is sometimes committed, especially by young
+practitioners, of estimating the degree of danger, and the necessity for
+active treatment, by the single consideration of the extent of the
+oedematous swelling. This, however, should be guarded against, as the
+swelling may be very considerable, and the disease subsided, or of
+little consequence; whilst, in other instances, the reverse may be the
+case. In the first instance, where the disease is not seen early, the
+treatment must sometimes be limited to those means which promote the
+absorption of the water, and neither venesection nor leeches will be
+required. In such cases, the practitioner must be guided by the state of
+the pulse and urine; the presence or absence of vascular excitement; the
+history given of the case up to the period when visited, and
+particularly by the progress of the swelling.
+
+     "When the dropsy of the skin is considerable and long
+     protracted, and symptomatic of some visceral disease, as it
+     most commonly is in these cases, and is attended by a serous
+     state of the urine, and a general failure of the strength, the
+     cachetical state of the system may be considered as
+     established, and the treatment is then beset with difficulties.
+     For the general means, which are useful in the earlier states
+     of the disease, and when the vital strength is entire, become
+     injurious in this, by the tendency they have, aided by the
+     effects of the visceral disease, to diminish farther the vigour
+     of the system; whilst, at the same time, the treatment, which
+     is suited to support the declining strength, can contribute
+     nothing towards lessening the constitutional and local
+     diseases, but will frequently increase the morbidly excited
+     state of the circulation, which, analogous to what occurs in
+     diabetes, will continue and increase under the most decided
+     marks of general constitutional weakness. Pending the
+     continuance of that inflammatory state of the system, in which
+     the urine is charged with serum, the debility will be mainly
+     derived from that drain of its nutrient parts, which is thus
+     established in the body, assisted by the weakening effects of
+     the organic disease. If blood be drawn, it will be found, in
+     many of these cases, to exhibit the usual signs of
+     inflammation; and the treatment of the tonic kind, when
+     employed to support the strength, will be found to act
+     unfavourably.
+
+     "The plan to be pursued must consist in the use of such means
+     as shall assist the powers of digestion and assimilation; so
+     that, by a highly nourishing but plain diet, the drain from the
+     system may be somewhat counteracted; and, at the same time, the
+     cause of the effusion is to be corrected by the use of local
+     depletion and blistering, and by the temperate employment of
+     those general means, which are useful in the less aggravated
+     forms of the disease."
+
+The diet of patients, in the symptomatic forms of dropsy, should be
+plain and unirritating; and in the idiopathic states, the antiphlogistic
+regimen should be rigidly enforced; particularly an abstinence from all
+fermented liquors, until the inflammatory period of the disease be
+removed. The clothing should be moderately warm, and selected of that
+kind, best suited to promote the insensible perspiration of the surface.
+
+Before taking leave of Dr. AYRE, we cannot omit adverting, in a very few
+words, to a circumstance noticed in his preface, and which we think of
+some importance. He remarks, that if, in the prosecution of his task, he
+has had no acknowledgments to make to any individual as his guide and
+authority, he is nevertheless indebted for many important facts to the
+writings of the late Dr. WELLS, and of Drs. BLACKALL, ABERCROMBIE, and
+DUNCAN, jun. and particularly to the system of pathology of Dr. PARRY.
+He further remarks, that he entertained and taught for many years, the
+views advocated in this work, and that, after the manuscript had been
+sent to press, he had seen a copy of an abridged edition of the
+elaborate Dictionnaire des Sciences Medicales, in which the doctrine of
+dropsy, maintained in the larger work, is relinquished; whilst others
+are given in their place, conformable, in the main, with those which it
+is the object of his treatise to establish. Now it would appear, from
+these expressions, that Dr. AYRE wishes to inculcate the idea, that the
+English writers, whom he has cited, were the only ones who had published
+anything valuable, and conformable to his doctrine; and that prior to
+1823, the year of the publication of the Dictionary above mentioned, the
+French entertained very different views of the pathology of the disease.
+We think it our duty, however, to rectify our author in this respect,
+and to show to our readers, that, even allowing full credit to Drs.
+WELLS, BLACKALL, ABERCROMBIE, &c. for their researches into the nature
+and treatment of dropsy, the American, French, and Italian pathologists
+are entitled to a much larger share than is allowed to them in the
+present work. A few references will be sufficient. Many years ago, our
+celebrated RUSH taught, that general dropsies "depend on a certain
+morbid excitement of the arteries;" and that hydrocephalus, "in its
+first stage, is the effect of causes, which produce a less degree of
+that morbid action in the brain which constitutes phrenitis." In 1812,
+Dr. BRESCHET, of Paris, published an excellent dissertation on active
+dropsies. In the early writings of BROUSSAIS, though more particularly
+in the propositions prefixed to his _Examen_, the opinion is maintained,
+that all active dropsies depend on irritability, either primary or
+secondary, of the serous and cellular tissues,--a theory more closely
+allied to Dr. A.'s, than all that is contained in the writings of Drs.
+WELLS, PARRY, &c. But what, perhaps, is more to our purpose, Dr.
+GEROMINI, of Cremona, published a work, in 1816, on the origin and cure
+of dropsy, in which he compares the dropsical accumulation to that of
+serum produced by the inflammation of a blister, or by fire; and in
+which he also maintains, that a slight inflammation occasions a flow of
+limpid serous fluid, whilst a higher degree gives rise to the formation
+of pus. From these circumstances, he concludes, that the hydropic fluid,
+which contains little albumen, is the product of a lower grade of
+inflammation. In the same work, he finally asserts, that in more than
+200 individuals who had died of dropsy, he invariably found marks of
+inflammation or its effects; views which our readers will readily
+discover to be nearly allied to those supported by Dr. A. In making
+these remarks, however, we do not wish to be understood as asserting,
+that the theory advanced by our author did not originate also with him.
+We have too favourable an opinion of his honesty, to accuse him of
+plagiarism. Our sole intention has been to render unto each the degree
+of praise to which he is entitled, and, by pointing out this coincidence
+of opinion, to derive a further proof of the correctness of most of the
+pathological views, so ably defended in the present work.
+
+
+
+
+ARTICLE VIII.--_An Essay on Venereal Diseases, and the Uses and Abuses
+of Mercury in their Treatment._ By RICHARD CARMICHAEL, M.R.I.A. _With
+Practical Notes, &c._ by G. EMERSON, M. D. Philadelphia, J. Harding,
+1825; pp. 360.
+
+
+One of the most important improvements in practice, which modern
+experience has established, is the reformed method of treating venereal
+diseases.
+
+To the labours of several distinguished military physicians and surgeons
+of Great Britain, we are chiefly indebted for the facts and researches
+connected with this interesting subject. And although we may have much
+to learn in regard to the true nature of these complaints; yet the plan
+adopted by Mr. CARMICHAEL, of determining their distinct pathological
+characteristics, and applying the remedies accordingly, is the only one
+likely to subvert the empirical routine of prescribing mercury on all
+occasions, a practice which derives such strong support both from the
+indolence and prejudices of the profession.
+
+In this country, many eminent practitioners have contributed to restrain
+the abuse of mercury; and it is believed, that Professor CHAPMAN has for
+many years, in his lectures, disseminated the most enlightened doctrines
+on this point. Dr. HARRIS and other surgeons of the navy have made a
+fair trial of the non-mercurial treatment, and with the most
+satisfactory results.
+
+The great object, so desirable of attainment, is to form a correct
+discrimination between the diseases, which may be cured or benefited by
+the exhibition of mercury, and those which do not require this medicine,
+or become aggravated by its use; for it seldom fails to do injury, when
+its advantages are not very obvious.
+
+Mr. CARMICHAEL has taken the most conspicuous part in this investigation
+for the last fifteen years, and from the extensive theatre, in which his
+inquiries were conducted, has had the best opportunities of arriving at
+the truth. He, therefore, who undertakes the management of these
+affections, may be justly pronounced culpable, if he neglect to make
+himself acquainted with the experience of this eminent surgeon.
+
+In this enlarged and improved edition of his work, several subjects have
+not been treated of so copiously by the author, as was requisite to
+render it acceptable as a book of reference; but the judicious notes of
+Dr. EMERSON, whose attention has been profitably directed to the
+investigation of venereal diseases, have well supplied the deficiency.
+
+A brief outline is here presented of the contents.
+
+The author describes the various symptoms in plain and intelligible
+terms; rejecting such unmeaning appellations as syphiloidal,
+pseudo-syphilis, &c. as designating no particular phenomena, and
+therefore of no use in describing a disease.
+
+He thinks there is a plurality of venereal poisons, and has divided the
+disease into four classes, from their different primary and secondary
+symptoms; making the eruptions on the skin the most certain criterion of
+distinguishing them from each other. These classes are:--the papular
+venereal disease; the pustular; The phagedenic; and the scaly venereal
+disease. The latter is the true syphilis.
+
+First, the Papular. This is the most common disease, and the most easily
+cured. Its primary symptoms are, a simple ulcer without induration,
+without elevated edges, and without phagedena. Sometimes there is a
+patchy excoriation of the glans penis, attended with a purulent
+discharge. This disease and gonorrhoea are caused by the same poison.
+The constitutional symptoms are:--fever; pain in the head, shoulders,
+and larger joints, pain in the chest; dyspnoea; a papular eruption on
+the forehead, chest, and back, sometimes extending in a more scattered
+way over the extremities. It is often attended with iritis. It never
+gives rise to nodes. The sore throat is different from that of syphilis;
+the latter having deep excavated ulcers. If buboes accompany it, they
+are mostly of an indolent nature. The eruptions do not all appear at
+once; but follow each other. When on the decline, they are of a pale red
+or copper colour, not scaly, as in syphilis, but papular; disappearing
+and recurring repeatedly, and ending in desquamation.
+
+_Remedies._--Venesection; cathartics; antiphlogistic regimen;
+antimonials, combined with decoction of sarsaparilla. Alterative does of
+calomel and antimonials, when the eruption declines.
+
+The local treatment consists in astringent washes and simple dressings.
+
+Iritis is to be cured by venesection, cathartics, mercury, blisters, and
+belladonna.
+
+This disease will yield to the powers of the constitution. Mercury is
+always injurious in the early stage.
+
+Second, Pustular venereal disease.
+
+Primary ulcer of a reddish-brown colour; borders closely on the
+phagedenic character. The edges raised and well defined; not excavated,
+but on a level with or above the surrounding skin. In the commencement,
+a small itchy pustula; distinguished from the ulcer attending the
+papular disease by its well defined and elevated edges, and by the
+absence of the smooth fungous surface of the former; from the phagedenic
+by its well defined margin and its corroded-like surface, and the
+absence of acute pain; and from chancre by the absence of the callous
+edges and base. These ulcers are of a chronic nature, showing little
+disposition to spread. The ulcers from buboes partake of the same
+character, the edges being hard and the ulcer disposed to burrow. These
+edges Mr. C. removes with the knife. The disease is rendered extremely
+obstinate, where full courses of mercury have been given. The more
+closely the eruption approaches the papular, the more mild and
+manageable will be the disease.
+
+_Constitutional symptoms._--The eruption is pustular, and often exhibits
+simultaneously new pustules; also scabbing ulcers, the crusts of which
+fall off, and leave discoloured patches of skin after healing. For these
+ulcers of the skin, the best remedies are, sulphur fumigations,
+nitro-muriatic acid baths, and ointment of tar and sulphur.
+
+_Remedies._--Rest; gentle astringents; mild ointments; antimonials and
+sarsaparilla:--for the constitutional symptoms; venesection; cathartics;
+antimonials; sarsaparilla.
+
+Mercury is decidedly injurious, until the disease is on the wane, when
+alterative doses may accelerate the cure.
+
+Third, Phagedenic venereal disease.
+
+The primary ulcer has a corroded appearance. It exhibits neither
+granulations nor induration. It spreads sometimes rapidly, sometimes
+slowly; healing in one part, while ulcerating in another. It is mostly
+situated on the glans and prepuce, and often attended with hemorrhage.
+In this disease, buboes most frequently appear.
+
+The sloughing ulcer occurs also in this disease. Mercury is extremely
+pernicious, always rendering the disease more inveterate and rapid in
+its progress.
+
+_Constitutional symptoms._--High fever precedes the eruption, but abates
+afterwards. Nocturnal headachs; tenderness of the scalp; slight
+dyspnoea; tenderness of the sternum on pressure; soreness of the
+chest; an eruption of tubercles, or pustules, or spots of a pustular
+tendency, which quickly degenerate into ulcers, with thick crusts, that
+heal from the centre, while they extend from the circumference, with
+phagedenic borders. The crusts are often of a conical figure. The
+ulceration of the throat is of the most formidable nature. It commences
+in the form of a small white aphthous sore; which usually attacks the
+velum or posterior part of the pharynx, mostly the latter. It extends
+rapidly, destroying the parts, and at last attacks the bones. It often
+attacks the larynx, after which, the patient seldom recovers. The
+affection of the bones of the nose is never joined with the papular
+eruption, nor with the scaly syphilitic lepra; but in every case with
+the pustular description, and when scales and ulcers were present. At
+the time of the eruption, pains in the knees, wrists, and ankles occur,
+attended with swelling and redness. He has never seen nodes in the
+disease, except in cases where mercury had been given. Full courses of
+mercury introduce the disease into the deep seated parts; for the bones
+are seldom or never affected in this disease, unless mercury has been
+given.
+
+_Remedies for the primary symptoms._--Absolute rest; venesection;
+nauseating doses of antimonials; warm poultices and fomentations; opium;
+hyosciamus and cicuta in sufficient doses to lessen pain and irritation.
+For the sloughing ulcer, stimulating applications are often useful; such
+as Venice turpentine or balsam copaibæ, mixed with olive oil.
+
+_For the secondary symptoms:_--Venesection; antimonials; sarsaparilla;
+Dover's powder. Mercury increases the ravages of the disease, except
+when on the wane, when it may be given in alterative doses, with safety
+and advantage. For the pain in the head, a blister to the nape of the
+neck. If the eruption appear scaly, then mercury is likely to be useful.
+If the throat and skin are affected, muriate of mercury in solution, and
+decoction of sarsaparilla. If the ulcer in the throat be small, touch it
+with the oxymel æruginis, or solution of nitrate of silver, grs. v a x
+to an ounce of water; but if there exist extensive ulcerations,
+fumigations with red sulphuret of mercury ought to be employed.
+
+Fourth, Scaly Venereal Disease, or Syphilis.--Primary ulcer of a
+circular form, excavated, without granulations, with matter adhering to
+the surface, and with a thickened edge and base. The hardening is very
+circumscribed, not diffusing itself gradually or imperceptibly into the
+surrounding parts, but terminating rather abruptly. Its progress is
+slow, sometimes assuming a tawny appearance.
+
+_Constitutional symptoms._--Sometimes the skin, at other times the
+throat, is first affected. There is headach, restlessness, and fever.
+The scaly eruption appears, but does not relieve the fever, as in the
+other diseases. This eruption commences with a small hard reddish
+protuberance; and as it advances, the sides are raised, and centre
+depressed or flat, and covered with thin white scales. It terminates in
+ulcerated blotches. This eruption appears on the forehead, breast, back
+of the neck, and groin; often in large copper coloured blotches, in
+parts near the hair. The ulcers of the throat mostly affect the tonsils,
+and come on without much previous pain or swelling; although there soon
+appears a considerable excavation of the tonsil, attended with evident
+loss of substance. The ulcer is foul, with thick white matter adherent
+to it, which cannot be washed away. The bones then become affected,
+those nearest the surface being most liable to attack; such as the
+tibia, sternum, clavicle, and cranium.
+
+The remedies for syphilis are full courses of mercury, for both primary
+and secondary symptoms; except where a tendency to phthisis, or a
+delicate constitution forbids them. He thinks syphilis a rare disease
+now, compared with what it was formerly.
+
+
+
+
+ARTICLE IX.--_Remarks on some Means employed to destroy Tænia, and expel
+them from the Human Body._--By LOUIS FRANK. M. D. Privy Counsellor of
+her Majesty, Maria Louisa, Duchess of Parma. [Lond. Med. Rep. April
+1825.]
+
+
+The symptoms produced by the presence of tape worm in the human body,
+are exceedingly distressing, and the sufferings of the patient are
+increased, by the obstinacy, with which these animals resist the
+operation of the most disgusting, and even painful and dangerous
+remedies. Improvements in the mode of attacking and expelling them,
+therefore, should be gladly received, and widely made known.
+
+The numerous reports which we have received, concerning oil of
+turpentine as a remedy for tænia solium, have already given to that
+remedy the highest character; but many cases have been only partially
+relieved by it. The ol. tereb. seems to be capable of causing the
+separation and expulsion of portions of the animal; but while the head
+remains unexpelled, it is supposed to be capable of reproducing the
+joints, to a degree not yet ascertained. If we may believe medical
+writers, the tænia has been observed of the enormous length of 700 feet.
+It is probable that the reproduction, after the loss of large numbers
+of joints, is often very rapidly effected; as was the case in a patient
+treated at the Carey Street Dispensary, mentioned in their report for
+Aug. 1813,[18] This person always discharged very considerable
+quantities of joints or fragments, after the use of oil of turpentine;
+after which he remained free from the complaint for a few months, until
+the tænia recovered a troublesome magnitude; when it was again easily
+reduced to less uncomfortable dimensions.
+
+We are not able to state positively, how long the oil of turpentine has
+been in use as a remedy for tænia. The Carey Street Report for Feb.
+1810, informs us, that a mechanic in Durham, having been very successful
+in the treatment of tænia by means of this article, the circumstance was
+communicated by Dr. SOUTHEY, of that place, to Dr. LAIRD of London; and
+it was accordingly prescribed in doses of [Symbol: ounce]ss. to [Symbol:
+ounce]ij. at several of the London charities. It had been found, says
+the report, that ol. tereb. might be thus given, as safely as so much
+gin, and frequently caused the expulsion in two hours: Dr. KNOX says it
+has been in use in Germany for fifty years for the expulsion of tænia.
+
+The experience of Dr. KNOX, concerning tænia, at the Cape of Good Hope,
+is the most extraordinary that we are acquainted with. Dr. SPARMAN, the
+traveller, had observed, that worms were exceedingly common in the
+northern parts of the colony; but Dr. KNOX, who was there in 1819, did
+not notice any special prevalence of verminous disorders, "previous to
+Oct. 1819, when the _tape worm became so general among the troops, as to
+resemble an epidemic_."[19]
+
+Most of these troops had been employed on a short campaign to the east
+of the great fish river. They had been compelled to live on very bad
+beef and mutton, driven and starved half to death; and Dr. KNOX thinks
+he has proved, that the tænia in these cases did "arise from the use of
+unwholesome animal food; from the flesh of animals, which had been
+diseased." Two out of five of the troops, who had been thus employed and
+fed, were affected with worms. Of a detachment of 86 vigorous, healthy
+young men, 36 were found, on inquiry, to have _tape_ worm. Those who
+remained in the colony did not suffer so much, as those who had been out
+on the campaign, the ratio being as one to four; whereas of the others,
+it was two to five. Dr. KNOX had ample experience of the utility of
+turpentine during this singular prevalence of tænia. Concerning the 36
+men above mentioned, he says, "the cure of all, who chose to adopt the
+means, was easily effected by small doses of the spts. of turpentine,
+after the failure of purgatives and various other remedies."
+
+He considers ol. tereb. as the _most efficacious remedy_. He does not
+approve of large doses, because of headach, vertigo, and delirium, which
+have been produced by them in "many patients."
+
+"I have generally found," says he, "that from one to two drachms of ol.
+tereb., given in a little water, morning and evening, for three
+successive days, were sufficient to destroy the tænia solium, (even in
+the most obstinate cases,) and cause it to leave the intestines, without
+the aid of any purgative medicine." He advises, however, to give a
+little castor oil each day about noon.
+
+It has been a very common observation in regard to the dose of
+turpentine, that the patient suffers more cephalic distress when it is
+given in small quantity, than in a large dose. The writer of this has
+been obliged to desist from the exhibition of oil turpentine, in doses
+of [Symbol: dram]ij twice a day, in consequence of a vertigo so
+considerable, as to alarm and distress his patient very much. Perhaps
+there might have been in this case some peculiar liability to nervous
+excitation, which in another patient would not have been worthy of much
+notice. Dr. KNOX'S opinion is of great weight.
+
+The celebrated remedy of CHABERT, Dr. KNOX thinks, owes its efficacy to
+the ol. terebinth. combined with it.
+
+Dr. FRANK, whose name stands at the head of this article, was informed
+by the celebrated helminthologist, Dr. BREMSER, at Vienna, in 1814, that
+he had for ten years preferred the use of CHABERT'S remedy, and with
+invariable success.
+
+CHABERT was a veterinary surgeon of Alfort, who used the animal oil of
+Dippel in many diseases of animals, as well as those of men. This oil he
+often gave for the purpose of removing tænia in his animals. He often
+combined it with spt. terebinth. and gave equal parts of these
+substances, in doses of [Symbol: dram]i.[20] The London Medical
+Repository states, that CHABERT'S remedy is prepared from
+
+     Ol. Corn. Cerv. Foetid.    1 part.
+     Ol. Terebinth,               3 parts.
+
+These are well mixed, and left at rest four days; they are then
+distilled in a sand bath, till three-fourths of the liquor has passed
+over. It must be kept tightly stopped, out of the light.[21]
+
+The great objection to CHABERT'S remedy is its disgusting flavour; which
+is the more obnoxious, because the remedy must be continued for a length
+of time. Dr. FRANK cured two persons affected with tænia solium, after
+considerable perseverance with it: he cured two other persons with a
+preparation as follows:
+
+     Ol. Terebinth.               [Symbol: ounce]ss
+     Æther Sulphuric.             [Symbol: dram]ij
+     Pulv. G. Arab.               [Symbol: ounce]ss
+     Aq. Flor. Chamam. distil.    [Symbol: ounce]xvj _m._
+
+     Two spoonfuls morning and evening.
+
+Four of these mixtures were sufficient to cure the patients, who
+remained well two years afterwards.
+
+A fifth patient, unable to take the last named medicines, was cured by
+the boluses subjoined:
+
+     Sem. Santonic. pulv.    [Symbol: ounce]ss
+     Pulv. Jalap.
+     Ferri Sulphat.   aa     [Symbol: dram]i
+     Ol. Corn. Cervi,        gtt. viij.
+     Syrup.                  q.s.
+                       Make 20 boluses.
+
+One to be taken morning and evening. These 20 boluses being repeated
+three times, the patient found himself perfectly well. In the above 5
+cases, the tænia was discharged in fragments.
+
+Dr. FRANK does not say much concerning the bark of pomegranate root,
+which has come into vogue lately as a remedy for tænia. He refers to the
+Med. Chirurg. Transact. Vol. XII. for accounts by some English
+physicians, and remarks, that Dr. GOMEZ, the Portuguese physician, had
+cured 14 cases with this bark.
+
+Dr. POLLOCK (vide Ed. Med. and Surg. Journal, Oct. 1819) treated a
+child, aged 14 months, with the decoction of bark of pomegranate root,
+so far back as the year 1811. This infant, under the use of the
+medicine, discharged at several times upwards of 30 feet of tænia
+solium, and was cured. We learn also from the Med. Repository,[22] that
+MM. DESLANDES, SOURYA, and BOURGEOISE, have employed pomegranate with
+great success; that the decoction generally expelled the worm in two
+hours; that it sometimes occasioned vomiting and griping pains; and that
+it has been a common remedy for tape worm, in the East Indies, and among
+the blacks of St. Domingo.
+
+From the same source we are informed, that the French pharmaceutists
+recommend, before boiling the bark, that it should be allowed to swell
+(macerate) in cold water. [Symbol: ounce]ij of bark should be boiled in
+lbij of water to [Symbol: ounce]xii. Of this decoction, [Symbol:
+ounce]ij may be taken every half hour. The worm is here said to be
+passed often in twelve hours instead of two. It may be necessary to
+continue this plan four or five days, taking care to suspend the
+medicine, in case any vertigo, or intestinal disease supervenes. A dose
+of castor oil is recommended after the 4th bottle; even though the worm
+be happily for the patient expelled.
+
+In the Revue Medicale is a case, in which pomegranate succeeded in
+discharging three ells of tænia; but the patient broke off the worm in
+attempting to extract it with too much violence. This circumstance
+recalls us to the consideration of Dr. FRANK'S communication. He
+recommends much caution in the extraction of those portions of tænia,
+which have remained partly in the intestine; and says that Dr. CAGNOLA
+proposed touching the extruded portion with prussic acid, in hopes of
+killing the whole animal by means of this violent poison. Dr. GARLEKE
+adopted this plan on an extruded portion of four inches in length, and
+in one hour afterwards the _whole animal came away dead_. Dr. F.
+suggests, that the electric shock might weaken the tænia, so as to cause
+it to let go its hold, and thus be unresistingly extracted. BRERA
+recommended that the worm should be tied with a piece of silk. In this
+manner, it is retracted into the bowel, but begins to descend again not
+long afterwards. He dissuades from any attempt at forcible extraction,
+which excites the most distressing sensations in the bowels, and causes
+the risk of bringing on convulsions.
+
+We are informed by Dr. FRANK, that a surgeon of St. Petersburg succeeded
+by passing the worm through a canula, and the canula through the
+sphincter ani muscle, so as to obviate the resistance caused by its
+contraction. In this manner, he easily succeeded in withdrawing the
+tænia _whole_, which is always desirable.
+
+The writer of this article succeeded in removing many pieces of tænia
+from a female, by means of the tincture of black hellebore, given in
+doses of a teaspoonful for another object. The patient has since been
+affected with the same symptoms, and took to-day, Oct. 19th, in doses of
+[Symbol: ounce]iss, repeated every hour, sixteen ounces of a decoction
+of the rind of pomegranate fruit, (none of the cort. rad. being
+procurable); after which she took a dose of castor oil. It is said, we
+know not on what authority, in a French journal, that this preparation
+possesses the same powers as the root. It may be so; but this patient
+had no discharge of the tape worm, after swallowing the whole of this
+very astringent decoction, and following up the plan by taking [Symbol:
+ounce]iij of ol. ricini.
+
+Perhaps the tænia had been effectually destroyed before. She has seen
+none of the joints for 18 months. The accounts, however, of the
+expulsion of tænia by the bark of the root, are so encouraging, that we
+have much pleasure in recommending it to the notice of the medical
+public in this country.
+
+FOOTNOTES:
+
+[18] Ed. Med. and Surg. Jour.
+
+[19] Ed. Med. and Surg. Jour. July, 1821.
+
+[20] Dict. des Sciences Medicales.
+
+[21] There can be no particular benefit derived from the distillation.
+The simple mixture of the materials, above indicated, is all that is
+necessary. CHABERT'S remedy is therefore easily prepared.
+
+[22] Lond. Med. Repos. April, 1825.
+
+
+
+
+ARTICLE X.--_Researches Physiological and Pathological, instituted
+principally with a View to the Improvement of Medical and Surgical
+Practice._ By JAMES BLUNDELL, M. D., Lecturer on Physiology and
+Midwifery at the United Hospitals of St. Thomas and Guy. London, 1824,
+pp. 146, 8vo.
+
+
+Dr. BLUNDELL is the author of some celebrated experiments on the
+physiology of generation, and the transfusion of blood. The work at
+present under consideration consists of physiological observations
+and experiments, the substance of a paper read before the
+Medico-Chirurgical Society of London, in the year 1823, and not
+heretofore published; of experiments on a few controverted points,
+respecting the physiology of generation; and lastly, of some remarks on
+the operation of transfusion.
+
+The first part seems intended to ascertain what degree of lesion, or
+losses by extirpation, the body may sustain without inducing death; and
+thus, to open a way for improvements in surgery, by rendering the
+surgeon not only more bold and fearless, but more frequently successful
+in his attempts to preserve life, or counteract the inconvenient effects
+of disease and accidents. We shall make a short analysis of the first
+paper.
+
+In four experiments, Dr. B. removed the left kidney of the rabbit, by
+incision on the outer edge. Ligatures were applied to prevent bleeding.
+
+Two died; one in 60 hours, the other in 4-1/2 days: both of
+inflammation. One recovered, and lived 5 or 6 weeks, and then died. The
+4th also recovered, but died in 5 or 6 weeks. On examination, a sac was
+found (in place of the kidney) filled with a semi-fluid substance,
+resembling custard, p. 4.
+
+In seven rabbits, removed the spleen. One recovered permanently, and one
+lived six months. p. 5.
+
+In five rabbits, opened the abdomen, and punctured the fundus of the
+bladder with a lancet. Three of them recovered entirely. p. 6.
+
+In two rabbits, cut off one-fourth of the bladder with scissors, having
+applied a ligature first. One died in seven months; the other still
+lives in good health.
+
+Into the peritoneum of four rabbits, threw [Symbol: ounce]i of human
+urine; then washed it out by injecting tepid water. One died of collapse
+in less than 24 hours, and two of inflammation, in 60 and 19 hours
+respectively. The fourth is now (12 months) in good health. p. 7.
+
+In seven, injected [Symbol: ounce]xi decoct. quercûs into the
+peritoneum. Only one recovered.
+
+Dr. B.'s inferences from the foregoing experiments are:
+
+     1st. "Large apertures into the peritoneum of the rabbit, do not
+     immediately induce a dangerous prostration, of strength." p. 9.
+
+     2ndly. "Large apertures into the peritoneal sac of the rabbit,
+     are not necessary, nor perhaps generally, productive of fatal
+     inflammation."
+
+     3dly. "In the rabbit, the kidney, the spleen, and a large piece
+     of the bladder may be extirpated, without necessarily causing
+     death; though death under the first operation is probable." p.
+     10.
+
+     4thly. "When the abdomen is laid open, and parts are removed
+     from it in the rabbit, the first danger arises apparently from
+     collapse; the second from general inflammation; and the last
+     from chronic disease." (Vide experiments.)
+
+     5thly. "The rabbit's abdomen is very tender, probably no less
+     so than that of man." See exper.
+
+     6thly. "Success in abdominal operations on the rabbit,
+     furnishes a presumption in favour of success in similar
+     operations on the human abdomen; and, therefore, from these
+     experiments, we may infer, _presumptively_, that moderate
+     openings into the human peritoneum will not necessarily, nor
+     even generally prove fatal from inflammation or otherwise; and
+     further, that certain viscera or parts of viscera, not
+     essential to the welfare of our structure, may be removed from
+     the belly, without necessarily, or even generally, producing
+     death. The extirpation of the kidney must be highly dangerous;
+     but there is a presumption in favour of the successful removal
+     of the spleen, the ovaries, or even of large pieces of the
+     bladder." p. 11, 12.
+
+Dr. B. having stated the foregoing results and inferences, proceeds by
+relating instances of severe injury sustained by the _human_ body,
+without being followed by death. These are confirmatory of his
+inferences from the experiments on rabbits. The instances given are--an
+os uteri torn off; extensive laceration of the uterus and rectum in
+labour; four uteri extirpated on account of chronic inversion, (p. 13.)
+One of these last under his own care. It was removed by a wire, and came
+off in 11 days, without one bad symptom, (p. 14.) Rupture and laceration
+of the abdominal coverings, four fingers' breadth, the bowels hanging
+out, (p. 14.) Two spleens removed; one in a soldier after the battle of
+Dettingen, who recovered without inconvenience afterwards; the other in
+a Mexican, whose case is related by Dr. O'BRIEN, in his Inaugural Essay,
+Edinb. 1818, (p. 15.) Three cases of rupture of the dropsical ovary. Two
+cases of opening into the abdomen, for the extirpation of dropsical
+ovaries, (p. 18.) Five cases of laceration of the uterus by natural
+efforts. Four of the women died, but in the fifth, Dr. BLUNDELL turned
+and delivered, after the child had escaped into the peritoneal sac, and
+the woman recovered, (p. 20.) Cesarian operation, three times by friend
+of Dr. HAIGHTON; once successfully, (p. 22.)
+
+Dr. B. says, "From these (facts) few as they are, I feel conscious that
+no certain inference can yet be drawn; though _presumptive_ inferences
+certainly may, and they seem to me to be the following:
+
+     "1st. Small wounds, as tapping, hernia, &c. do not induce fatal
+     peritonitis; and therefore the vulgar opinion that inflammation
+     in a spot of the peritoneum will almost invariably diffuse
+     itself over the greater part of it, is probably unfounded.
+
+     "2nd. Extensive divisions of the peritoneum are not necessarily
+     fatal by inflammation or otherwise, and _probably_ not
+     generally so.
+
+     "3d. That the womb, spleen, and ovaries, may be removed in the
+     mode mentioned, without necessarily, and, _presumptively_,
+     without generally destroying life.
+
+     "4th. That the gravid uterus may be torn open; the child may
+     escape into the peritoneal sac; the os uteri may be torn off:
+     not indeed, so far as these cases may be relied on, without
+     great danger, but twice, in seven instances, without death. p.
+     28.
+
+     "5th. The peritoneum and abdominal viscera will bear more
+     injury than the British surgeons seem disposed to admit.
+
+     "6th. That the above observations on the human abdomen, are in
+     unison with those drawn from observations on the rabbit; and
+     that observations made on the brute have more correspondence
+     with those on the human being, than is generally believed."
+
+Dr. BLUNDELL next remarks, that the facts related create a suspicion
+that a bolder abdominal surgery would not be unattended with success,
+and recommends the following operations to "_consideration_ merely, and
+not to practice, except in otherwise desperate cases."
+
+     1st. "When the Cesarian section is performed, divide or remove
+     a small piece of Fallopian tube, so as to prevent the danger of
+     reimpregnation, without destroying the sexual propensity. The
+     need for a second operation might thus be certainly prevented,
+     without scarcely increasing the danger."
+
+     2ndly. "Extirpation of healthy ovaries."
+
+     3dly. "The extirpation of the ovarian cyst in scirrhus,
+     combined with dropsy, or in simple dropsy." He remarks, "This
+     operation will, I am persuaded, ultimately come into general
+     use; and if the British surgeons will not patronize and perform
+     it, the French and American surgeons will." p. 26.
+
+     4thly. "The removal of a large circular piece of the cyst in
+     ovarian dropsy, when the sac itself cannot be extirpated."
+
+     5thly. "The removal of the cancerous womb, when the ulceration
+     first makes its appearance. Might not the womb be taken out
+     above the symphysis pubis, or through the outlet of the
+     pelvis?" &c. 27.
+
+     6thly. "Extirpation of the puerperal uterus." He suggests the
+     removal of the whole womb after the Cesarian section, in order
+     that the smaller might take place of the larger and more
+     formidable wound through the uterus--but says expressly, "No
+     operation perhaps can be more unpromising, shall I say more
+     unjustifiable, in the _present state of our knowledge_; but I
+     thought it proper to mention it." &c. p. 28.
+
+     7thly. "Should the bladder give way into the peritoneum," he
+     asks, "Why should we not lay open the abdomen, tie up the
+     bladder, discharge the urine, and wash out the peritoneum
+     thoroughly, by the injection of warm water?" p. 28.
+
+     8thly. - - - - -
+
+     9thly. Injection of astringents into the ovarian cyst or
+     peritoneal sac, unjustifiable.
+
+     10thly. "In cases of strongly characterized introsusception,"
+     why not make an opening into the peritoneum; and "pass the
+     small intestines, fold by fold, through the fingers." Dr. B.
+     has repeatedly done this in the dog and rabbit, without
+     producing death, or extensive and dangerous inflammation.
+
+     11thly. In the rabbit, he has tied an abdominal artery, and
+     carried the end of the ligature with a broad needle out through
+     the back, opposite to the place of the vessel. This ligature
+     can come away, and is a better mode than to leave it hanging
+     out at the abdomen, or entirely among the bowels, where it
+     forms a sac of puriform matter, and to appearance lays the
+     foundation of chronic disease. p. 30.
+
+Dr. BLUNDELL closes this paper by saying, that since the substance of it
+was read before the Medico-Chirurgical Society in 1823, Dr. RITZIUS, a
+Swedish physician, had informed him in London, "that the complete
+removal of the cancerous womb had been, to his personal knowledge,
+performed on the Continent five times. All the patients recovered from
+the operation," &c. "The womb was removed through the outlet of the
+pelvis." p. 36.
+
+Since we read Dr. BLUNDELL'S recommendations to the new operations, we
+have been astonished to notice in the Ed. Med. and Surg. Journal, July,
+1825, that a German surgeon had actually treated a case of ileus in the
+manner recommended by Dr. B. It is from Hufeland's Journal of Feb. 1825.
+After it was ascertained that an immoveable introsusception existed--
+
+     "The patient was placed on a convenient table. We examined
+     accurately the situation of the hardening, (_which marked the
+     diseased part_), and determined on opening the abdomen at the
+     outer edge of the right rectus muscle, about two inches above
+     the navel. After dividing the integuments with a common
+     scalpel, and making a small opening in the peritoneum, I
+     introduced my finger, and with a blunt pointed scalpel divided
+     the peritoneum, so as to make it correspond with the external
+     opening, which was between two and three inches. I then
+     besmeared my hand with oil, and carried it into the abdomen, in
+     order to feel for the indurated part. Scarcely had I introduced
+     my hand, than an attack of the pain came on, and a portion of
+     the intestines was protruded through the wound, which was
+     immediately replaced by my assistant. On continuing the
+     examination, I discovered in a transverse portion of the ileum,
+     a foreign substance, just where the hardened intestine was to
+     be felt. I drew the intestine out, in order to examine it more
+     minutely. The intestine was neither inflamed nor expanded, but
+     it contained in its cavity a soft coherent and compact mass,
+     which at its upper part was somewhat compressed, and thus felt
+     harder than the rest. So far as I could follow this part of the
+     intestine, this contained matter was to be felt: I also here
+     immediately detected an intus-susception, but in spite of all
+     my efforts I could not reach the commencement of it, so as to
+     bring it out. Two modes of proceeding were open to me, in order
+     to remove the intus-susception; either to make a transverse
+     incision in the integuments, from the right to the left side,
+     or to open the intestine itself. The last mode seemed to me the
+     most adviseable, both because the patient was already very much
+     exhausted, and because the operation would be sooner completed.
+     The intestine was opened at the end of the discovered
+     intus-susceptio, and immediately a part of the strictured
+     intestine came into view. I introduced my finger into the
+     opening in the intestine, which was made about two inches in
+     length, and gradually pushed the intus-suscepted part back from
+     the right to the left side, whilst I gently drew that part of
+     the intestine which contained the intus-susceptio towards me.
+     By this means I fortunately succeeded in unfolding the tangled
+     intestine, which amounted to two feet in length. There was not
+     the slightest trace of inflammation, nor any thing unnatural to
+     be discovered in the part; there was merely a round worm, which
+     was situated in the upper part of the intus-susceptio. The
+     intestine was brought together by means of six spiral stitches,
+     after the manner of the glover's suture, and the end of the
+     silk was allowed to hang out of the external wound in the
+     abdomen."
+
+The sutures were removed on the 8th day. On the 14th day, the man was
+cured, and continues well up to the date of the account.
+
+
+
+
+ARTICLE XI.--_An Inquiry into the Nature and Treatment of Diabetes,
+Calculus, and other Affections of the Urinary Organs._ By WILLIAM PROUT,
+M. D., F. R. S. _From the second London Edition, published in 1825; with
+Notes and Additions_, by S. COLHOUN, M.D. Philadelphia, Towar & Hogan,
+1826; pp. 308.
+
+
+A very acceptable service has been done to the medical profession in
+this country, by the present republication of Dr. PROUT'S work on
+affections of the urinary organs. The American physician will now have
+it in his power, at a reasonable cost, to possess one of the best
+treatises on this interesting subject. From the known accuracy of Dr.
+PROUT as a chemist, and his reputation as an accurate observer of
+nature, much new light was naturally expected as the result of his
+observations. Nor indeed have these high expectations been disappointed.
+After a careful perusal of his work, we have formed the highest opinion
+of his powers, both as an original thinker, and experimental inquirer.
+
+Dr. PROUT begins his treatise with some introductory remarks on the
+composition of the urine, and on urinary derangements generally. After
+giving a comparative tabular view of the composition of the blood, and
+healthy and diseased urine, he proceeds to notice in succession, their
+principal constituents. As albuminous urine is of frequent occurrence in
+dropsical complaints, and its presence regulates in some degree the
+practice proper to be pursued, the following characters, given to it by
+Dr. PROUT, should be well understood.
+
+     "Albuminous urine, on being exposed to a temperature of about
+     150° becomes opaque, and deposites this principle in a
+     coagulated state. The precipitate varies considerably in its
+     appearance in different instances. Sometimes it is of a firmer
+     character, and similar to that formed by the serum of the
+     blood, from which, in this case, it may be supposed to be
+     derived; at other times it is very delicate and fragile in its
+     texture, and somewhat resembles curd, when it may be supposed
+     to be of chylous origin. In some instances, the effects of heat
+     upon albuminous urine are increased by the addition of nitric
+     acid. But the most delicate test of albuminous matter in
+     general is dilute acetic acid, and the prussiate of potash." p.
+     6.
+
+Dr. PROUT combats very successfully the opinion, generally entertained
+by chemists, that the power of healthy urine to redden litmus depends
+on the presence of free lithic acid.[23] That this power cannot depend
+upon lithic acid uncombined, is made evident to Dr. P. by its sparing
+solubility; it requiring, according to our author, 10,000 times its
+weight of water to dissolve it, or six times as much as is stated by Dr.
+HENRY. The reddening power of the urine is attributed by Dr. PROUT to
+the presence of lithate of ammonia, and superphosphate of ammonia: the
+former of which, contrary to what might be expected, is found capable of
+reddening litmus, and of remaining in solution with the latter, without
+decomposition.
+
+The following interesting remarks are made by Dr. PROUT on the effects
+of muriatic acid, in precipitating lithic acid gravel:
+
+     "The muriatic acid, in combination with soda and potash, occurs
+     both in the blood and in the urine; thus appearing to pass
+     through the kidneys unchanged. This acid and its compounds
+     formerly appeared to be of less importance in a pathological
+     point of view than any other similar principles existing in the
+     urine: but since the unexpected fact has been ascertained, that
+     muriatic acid in a free state exists abundantly in the stomachs
+     of animals during the process of digestion, I have attended a
+     little more closely to the appearance of this principle in the
+     urine, and am disposed to believe, in consequence, that it is
+     the cause of the precipitation of lithic acid gravel from the
+     urine more frequently than any other acid. I do not mean to
+     say, that it is the _immediate_ cause of the precipitation of
+     this acid; for in most instances, it acts like all powerful
+     acids do under similar circumstances, namely, by liberating the
+     weaker acids, which are thus enabled to act in their turn, and
+     separate those having still weaker affinities than themselves.
+     Thus, in the present instance, the muriatic acid may be
+     supposed to separate the lactic, while the latter precipitates
+     the lithic, &c. If this opinion be well founded, as I believe
+     is the case, the muriatic acid may be considered of very great
+     importance, not only in a pathological, but a physiological
+     point of view; for if the muriatic acid, found in the urine in
+     such instances, be supposed to have its origin in the digestive
+     organs, we see at once the reason why the deposition of gravel
+     is so liable to be influenced by the derangements in general,
+     and more especially by the acidity, of the stomach."
+
+     "The muriatic acid may be shown to exist in the urine by the
+     white curdy precipitate insoluble in nitric acid, which is
+     formed, when the nitrate of silver is added to it, after the
+     sulphuric and phosphoric acids have been removed by the nitrate
+     of barytes or lead." pp. 20 and 21.
+
+After finishing these introductory subjects, Dr. PROUT proceeds to the
+consideration of the diseases of the urinary organs themselves; which he
+divides into functional, mechanical, and organic. Under functional
+diseases, we have _first_, those, in which principles _soluble_ in the
+urine are morbidly deranged in quantity or quality, embracing three
+chapters; and _secondly_, those affections, in which principles
+_insoluble_ in the urine are morbidly deranged in quantity or quality,
+comprising six additional chapters. Under the first subdivision, the
+first chapter is on the affections, characterized by albuminous urine;
+the second, on diseases, in which an excess of urea is the
+characteristic symptom; and the third, on diabetes.
+
+The diseased derangement, consisting in an excess of urea in the urine,
+has not been particularly noticed by any writer before Dr. PROUT, who
+believes that it has probably been confounded with that form of
+diabetes, called diabetes _insipidus_. The state of the urine and
+symptoms in this species of urinary derangement are thus described by
+our author:
+
+     "The average specific gravity of the urine seems to be a little
+     above 1.020, and occasionally to vary from 1.015 to 1.030. Most
+     generally it is pale, but occasionally it is high coloured, and
+     exhibits somewhat the appearance of porter, more or less
+     diluted with water; and this variety in appearance not
+     unfrequently takes place in the urine of the same person. When
+     first voided, it reddens litmus paper. For the most part, it is
+     entirely free from sediment, except the mucous cloud of healthy
+     urine; and the only remarkable property which it appears to
+     possess, is that of containing abundance of urea; so that on
+     the addition of nitric acid, crystallization speedily takes
+     place. From the quantity of urea present, it is very prone to
+     decomposition, and soon becomes alkaline, especially in warm
+     weather.
+
+     "There is almost constantly in these diseases, a frequent and
+     urgent desire of passing water both by night and day. This
+     desire is for the most part evidently excited by actual
+     _diuresis_, or the increased quantity of urine; but frequently
+     it cannot be ascribed to this cause, as the quantity voided at
+     one time is often by no means considerable; though in almost
+     every instance that has fallen under my observation, the total
+     quantity voided during any given time has appeared to be
+     greater than natural. The quantity appears also to be
+     particularly liable to be increased by cold weather, and by all
+     causes producing mental agitation. There is sometimes a sense
+     of weight or dull pain in the back, but this is by no means a
+     constant symptom. There is also occasional irritation about the
+     neck of the bladder, which sometimes extends along the urethra.
+     The functions of the skin appear to be natural; at least in
+     every case which has come under my own observation,
+     perspiration has been rather easily induced. The pulse is not
+     affected. There is no remarkable thirst, nor craving for food,
+     except in extreme cases; nor are the functions of the stomach
+     and bowels much deranged. Hence for the most part the tongue is
+     clean, and the dejections regular and apparently natural.
+
+     "In most of the cases of this disease, which have hitherto
+     fallen under my own immediate observation, the subjects have
+     been middle-aged men, of thin and spare habit, with a sort of
+     hollow-eyed anxiety of expression in their countenance, free
+     from gout and constitutional disease in general, and, as far as
+     could be ascertained, from any organic defect in the urinary
+     organs. In every instance they had been induced to apply for
+     medical advice, not so much from the pain, as from the
+     inconvenience of the disease, and the dread of its ending in
+     something worse; and, what may be worth remarking, in several
+     instances confessed, that they had been addicted to
+     masturbation from very early youth," p. 41, et seq.
+
+The remedy for this morbid derangement in the urinary secretion, most
+successful in the hands of Dr. PROUT, was opium, either administered
+alone, or in conjunction with alkaline medicines. It is rather a rare
+affection. When not arrested, it is liable, according to Dr. PROUT, to
+pass into diabetes.
+
+In his chapter on diabetes, our author makes many interesting remarks;
+but the space we are enabled to devote to this analysis, will permit us
+only to make an extract, which seems to prove a close connexion between
+the disease characterized by an excess of urea, and diabetes.
+
+     "It has been mentioned in the preceding pages, that an excess
+     of urea frequently precedes the appearance of saccharine matter
+     in the urine. Now it is a remarkable fact, that in diabetes, in
+     proportion as the saccharine matter diminishes, that of urea
+     generally increases; and in such instances, the presence of the
+     former principle can not only be no longer distinguished by the
+     sensible properties of the urine, but scarcely be demonstrated
+     by the utmost skill of the most experienced chemist, though the
+     specific gravity of the urine may at the same time be nearly
+     1.040. I have recently been favoured by Dr. ELLIOTSON with the
+     most complete and remarkable change of this description that
+     has yet occurred to me. The patient, besides being diabetic,
+     was in the last stage of phthisis, of which he died shortly
+     afterwards. The quantity of urine passed daily, when I first
+     examined it, was six or eight pints; its specific gravity was
+     1.038, and it contained a large proportion of very white sugar
+     and very little urea. Dr. ELLIOTSON under these circumstances
+     gave opium, beginning with gr. i, and increasing the dose to
+     gr. iii, thrice a day. The opium produced stupor, and was
+     obliged to be discontinued; but the effects produced upon the
+     urine by its means were most remarkable. _In about 60 hours,
+     the quantity of urine diminished to two pints, its specific
+     gravity was reduced to 1.0174, the saccharine matter had
+     apparently disappeared, and was superseded by urea, the
+     quantity of which had become excessive._ This alternation of a
+     principle containing nearly half its weight of azote, with
+     another containing no azote at all, is perhaps, one of the most
+     singular facts occurring in physiology." p. 74.
+
+The second subdivision of functional urinary diseases comprises six
+chapters: _first_, on urinary gravel and calculi; _second_, on the data,
+showing the comparative prevalency of different forms of urinary
+deposite, and the order of their succession; _third_, on the lithic acid
+diathesis in general; _fourth_, on the mulberry or oxalate of lime
+diathesis; _fifth_, on the cystic oxide diathesis, and _sixth_, on the
+phosphatic, or earthy diathesis.
+
+Under the first chapter, we have an account of I. Pulverulent or
+amorphous sediments; II. Crystallized sediments, or gravel; and III.
+Solid concretions, or urinary calculi. Of the latter, our author
+enumerates thirteen species.
+
+1. The lithic acid calculus.
+
+2. The lithate of ammonia calculus.
+
+3. The oxalate of lime, or mulberry calculus.
+
+4. The cystic oxide calculus.
+
+5. The bone earth, or phosphate of lime calculus.
+
+6. The triple phosphate of magnesia-and-ammonia calculus.
+
+7. The calculus, composed of a mixture of the phosphate of lime, and
+triple phosphate of magnesia-and-ammonia, or fusible calculus.
+
+8. The alternating calculus.
+
+9. The mixed calculus.
+
+10. The carbonate of lime calculus.
+
+11. The xanthic oxide calculus.
+
+12. The fibrinous calculus.
+
+13. The prostate calculus.
+
+Of these, the 2nd, 4th, 5th, 9th, 10th, 11th, 12th, and 13th species are
+more or less rare, and consequently of less interest. The remaining 5
+are of much more frequent occurrence, and are thus described by our
+author:
+
+     "_The lithic acid calculus_ is generally of a brownish-red, or
+     fawn colour; but occasionally of a colour approaching to that
+     of mahogany. Its surface is commonly smooth, but sometimes
+     finely tuberculated; and upon being cu t through, it is usually
+     found to consist of concentric laminæ. Its fracture generally
+     exhibits an imperfectly crystallized texture, sometimes an
+     amorphous or earthy one, in which case, it usually contains a
+     mixture of other substances. This is one of the most common
+     species of calculi.--_Chemical characters._ Before the
+     blow-pipe, this calculus blackens, emits a smoke having a
+     peculiar odour, and is gradually consumed, leaving a minute
+     quantity of white ash, which is generally alkaline. It is
+     completely soluble in caustic potash, and precipitable again by
+     any acid in the form of a white granular powder. Lastly, if to
+     a small particle, a drop of nitric acid be added, and heat
+     applied, the lithic acid is dissolved; and if the solution be
+     evaporated to dryness, the residue assumes a beautiful pink or
+     carmine colour."
+
+     "_The oxalate of lime, or mulberry calculus_, is generally of a
+     very dark brown colour, approaching to black. Its surface is
+     very rough and tuberculated (hence the epithet of _mulberry_.)
+     It is usually hard, and when cut through exhibits an
+     imperfectly laminated texture. This species of calculus seldom
+     surpasses the medium size, and is rather common. There is a
+     variety of it remarkably smooth, and pale coloured. These are
+     always of small size; and from their colour and general
+     appearance, have been termed the _hempseed_
+     calculus.--_Chemical characters._ Before the blow-pipe, this
+     species of calculus expands into a kind of white efflorescence,
+     which, when moistened and brought into contact with turmeric
+     paper, stains it red. This white alkaline substance is the
+     caustic lime deprived of its oxalic acid."
+
+     "_The triple phosphate of magnesia-and-ammonia calculus_ is
+     always nearly white; its surface is commonly uneven, and
+     covered with minute shining crystals. Its texture is not
+     laminated, and it is easily broken and reduced to powder. In
+     some rare instances, however, it is hard and compact, and when
+     broken exhibits a crystallized texture, and is more or less
+     transparent. Calculi composed entirely of the triple phosphate
+     of magnesia-and-ammonia are rare; but specimens, in which this
+     salt constitutes the predominant ingredient, are by no means
+     uncommon.--_Chemical characters._ Before the heat of the
+     blow-pipe, this calculus gives off the odour of ammonia, and at
+     length melts with difficulty. It also gives off ammonia, when
+     treated with caustic potash. It is much more soluble than the
+     preceding species in dilute acids, from which it is again
+     readily precipitated by ammonia in its original crystallized
+     form.
+
+     "_The calculus composed of a mixture of the phosphate of lime
+     and triple phosphate of magnesia-and-ammonia, or the fusible
+     calculus_, is commonly whiter and more friable than any other
+     species, resembling sometimes a mass of chalk, and leaving a
+     white dust on the fingers. This species is generally not
+     laminated. Occasionally, however, it separates readily into
+     laminæ, the interstices of which are often studded with
+     sparkling crystals of the triple phosphate. The variety of this
+     species which is not laminated often acquires a very large
+     size, and assumes the form of a spongy friable whitish mass,
+     evidently moulded to the contracted cavity of the bladder in
+     which it has been formed. This species of calculus occurs very
+     frequently.--_Chemical characters._ It may be readily
+     distinguished by the ease with which it melts before the
+     blow-pipe. It also dissolves readily in acids, and particularly
+     in dilute muriatic acid; and if to the solution, oxalate of
+     ammonia be added, the lime is precipitated alone, and the
+     magnesium may be afterwards separated by the addition of pure
+     ammonia.
+
+     "_The alternating calculus_, as the name imports, may consist
+     of different layers of any of the preceding species. Hence its
+     general appearance, texture, &c. will depend entirely on the
+     composition, and may be very varied. Most commonly it is
+     composed of a lithic acid or mulberry nucleus, and an external
+     crust of the fusible calculus. In some rare instances, it is
+     composed of laminæ of all three of these substances, and
+     sometimes of even more--the mixed phosphates still continuing
+     to constitute the external crust. This species of calculus
+     often acquires a very large size and is very common.--_Chemical
+     characters._ The chemical characters must of course vary with
+     the composition; and as the different substances of which it is
+     composed must almost certainly be some of the preceding, the
+     nature of the different laminæ can be readily ascertained by
+     what has been already stated," p. 79, et seq.
+
+In the chapter on the comparative prevalency of different forms of
+urinary deposite; and the order of their succession, we have a number of
+important facts and observations. Dr. PROUT calculates, from the data
+collected by him, that about one-third of the urinary calculi which
+occur, are of the lithic acid species, and that another third are formed
+on a nucleus of this acid. Hence, "we may assert," says he, "that at
+least _two-thirds_ of the whole number of calculi originate from lithic
+acid; that is to say, if a lithic acid nucleus had not been formed and
+detained in the bladder, two persons at least out of three, who suffer
+from calculus, would have never been troubled with that affection. This
+is a most important fact, and deserves to be constantly borne in mind."
+
+The relative prevalency of the oxalate of lime calculus is very various.
+The average proportion, as determined by Dr. PROUT is about one in
+seven. Of the calculi, examined by Mr. BRANDE, 1 in 25 was of the
+mulberry species; while in the Norwich and Guy's Hospital collections,
+the proportion is about 1 in 4. In the Bristol collection, one-sixth of
+the whole, was composed of oxalate of lime, nearly pure; while,
+including all the concretions containing more or less of the oxalate,
+the proportion was nearly _one-half_! This great disparity in the
+proportional frequency of this calculus in different districts of
+England, clearly shows the great influence of local causes, in
+determining the character of urinary concretions.
+
+From a careful observation of the order of deposition of different
+species of calculous matter, Dr. PROUT has been enabled to deduce the
+following general law; "_that, in urinary calculi, a decided deposition
+of the mixed phosphates is not followed by other depositions_." So that
+it would appear, that a redundancy in the earthy phosphates is the last
+link in the chain of diseased alterations, to which the urinary
+secretion is liable.
+
+In the third chapter, under the second subdivision of functional urinary
+diseases, Dr. PROUT describes the lithic acid diathesis, and
+communicates several important original observations. After remarking
+that the dyspeptic are particularly predisposed to lithic acid
+deposites, he enumerates, as exciting causes of this species of gravel,
+1st. _Errors in diet_; 2nd. _Unusual or unnatural exercise of the body
+or mind, particularly after eating, and the want of proper exercise at
+all other times_; and 3d. _Debilitating causes_. Under errors of diet,
+an unusually heavy meal, especially of animal food, and the use of
+heavy, unfermented bread, or compact, hard-boiled, fat dumplings or
+puddings, salted and dried meats, acescent fruits, malt liquors, and
+acescent wines, are enumerated as particularly hurtful in the lithic
+acid diathesis.
+
+The above remarks refer to the amorphous lithic deposites, consisting of
+lithate of ammonia. In regard to crystallized sediments, or, more
+properly speaking, gravel, our author makes the following remarks:
+
+     "Crystallized sediments, or red gravel, consist of lithic acid,
+     nearly pure. Lithic acid, as has been before stated, exists in
+     a state of combination in healthy urine; and in such a
+     proportion, as to be held in a state of solution at all
+     ordinary temperatures. Sometimes, however, a free acid is
+     generated by the kidneys, which precipitates the lithic acid in
+     the pure crystallized state we see it--a phenomenon easily
+     imitated artificially, as is well known, by the addition of a
+     few drops of any acid to healthy urine. The precipitation of
+     crystallized lithic acid does not, therefore, necessarily
+     indicate an excess of lithic acid in the urine, but the
+     presence only of some free acid in that fluid; though such an
+     excess does, for the most part, exist in this form of disease,
+     as will be shown hereafter. With respect to the nature of the
+     precipitating acid, it is probably not always the same. Most
+     generally it appears to be the _muriatic_, sometimes the
+     _phosphoric_ or _sulphuric_, and occasionally other acids. In
+     general, however, it is to be understood, as noticed
+     elsewhere, that when the mineral acids are present in excess,
+     these are the _immediate_ cause of the preternatural acidity in
+     the urine, and consequently of the precipitation of the lithic
+     acid. The stronger acids act by decomposing saline compounds,
+     into which destructible acids, such as the lactic acid, &c.
+     enter, and setting them free. Hence the _immediate_ cause of
+     the deposition of lithic acid gravel is generally a
+     destructible acid of very weak powers: even, perhaps, in some
+     instances, the carbonic acid. When the urine contains a free
+     acid, it is commonly more transparent than usual, and of a
+     bright copper colour." p. 112.
+
+The treatment recommended by Dr. PROUT in this species of gravel is as
+follows: First, a strict attention to diet, avoiding the hurtful
+articles already enumerated. Secondly, the use of _alkaline_ remedies;
+but those must not be depended upon, without the aid of other means,
+more especially of alteratives and purgatives. Accordingly we are
+informed that
+
+     "The pil. submur. hydrarg. comp., or a pill composed of the
+     pil. hydrarg. and pulv. antimonialis, may be taken twice or
+     thrice a week at bed time, and followed up the next morning by
+     an active dose of the sub-sulphate of magnesia, or a mixture of
+     Rochelle salts and magnesia, or carbonate of soda. A little of
+     either of these compounds may be also taken twice or thrice in
+     the day, so as to keep the urine constantly neutral or
+     alkaline, and the bowels freely open; or gr. x to xx of
+     magnesia may be taken for the same purpose in a glass of soda
+     water, as often as it may be found necessary."
+
+In the chapter on the mulberry, or oxalate of lime diathesis, Dr. PROUT
+gives a number of cases, from which he draws the following conclusions:
+
+     "1st. That this form of disease occurs in both sexes; that it
+     may exist before puberty, and at all ages between that and 40
+     or 50, at which time it seems to occur most frequently; but
+     that no case occurs beyond the age of sixty. Hence that it is
+     probably not a disease of old age.
+
+     "2nd. That it is not incompatible with gout, but seems
+     occasionally to be associated with it. I have also seen it
+     connected, as lithic acid frequently is, with a tendency to
+     cutaneous disease.
+
+     "3d. That this variety of calculous affection occurs in
+     individuals of sound constitutions, and who ordinarily enjoy
+     good health; and that it rarely occurs a second time, except at
+     long intervals, during which the intermediate health is good;
+     which latter facts, it may be proper to observe, are confirmed
+     by other observers, and particularly by Mr. BRANDE and Dr.
+     MARCET.
+
+     "4th. That the urine is acid, and apparently but slightly
+     deranged in this form of calculus, and remarkably free from all
+     sorts of sediment and gravel.
+
+     "5th. That as renal calculi of the oxalate of lime often
+     subsequently acquire considerable magnitude in the bladder, it
+     may be inferred, that the formation of this compound is
+     connected with a distinct diathesis, excluding the existence of
+     other diatheses, and that is not an accidental occurrence,
+     happening in common with many others to the urine.
+
+     "6th. That from the dissection of calculi, formerly mentioned,
+     it appears that the oxalate of lime diathesis is preceded and
+     followed by the lithic acid diathesis; a circumstance which
+     seems to be peculiar to these two forms of deposite, and which,
+     when taken in conjunction with the other circumstances, already
+     related, appears to show, that they are of the same general
+     nature; or in other words, that the oxalic acid merely takes
+     place as it were of the lithic acid, and by combining with the
+     lime naturally existing in the urine, forms the concretion in
+     question.
+
+     "7th. That the diathesis being of a similar nature, the
+     principles of treatment adapted for counteracting the original
+     tendency to it must be also similar, that is to say, of an
+     antiphlogistic character; great attention being at the same
+     time paid to the digestive and assimilative functions." p. 137,
+     et seq.
+
+The diagnostic signs of the oxalate of lime diathesis are very obscure,
+as will appear from the following extract:
+
+     "With respect to the means of determining when this diathesis
+     is going on in the system, I am sorry that I can give but
+     little positive information. The absence of urinary sediment,
+     &c. are of a negative character, and lead to no inference,
+     where other circumstances are wanting, as is most generally the
+     case. But if there be pain in the region of the kidney, and
+     other symptoms of gravel, without any appearance of sediment;
+     and if the urine be acid, and of the yellow tint above alluded
+     to, the stomach deranged, and an inflammatory diathesis, either
+     general or local (i.e. about the urinary organs), be present;
+     and if all these are associated with suppressed gout, or
+     tendency to cutaneous disease,--the existence of this form of
+     the disease may be suspected, and means immediately taken to
+     counteract it." p. 138.
+
+We omit any analysis of the next chapter on the cystic oxide diathesis,
+on account of the rare occurrence of this state of the system.
+
+The next chapter of our author is on the phosphatic, or earthy
+diathesis.
+
+The phosphatic deposites are of two kinds; the _crystallized_,
+consisting almost invariably of the triple phosphate of
+magnesia-and-ammonia, and exhibiting the appearance of white, shining
+crystals; and the _amorphous_, consisting always of a mixture of the
+phosphate of lime, and the triple phosphate of magnesia-and-ammonia.
+
+The causes apt to produce a deposition of the triple phosphate of
+magnesia-and-ammonia, are thus enumerated by Dr. PROUT:
+
+     "Any thing acting generally, and producing _a nervous state of
+     the system_, such as the distressing passions, and particularly
+     _mental anxiety_ or _fear_, will frequently produce in many
+     people an excess of this salt in the urine. The same is also
+     true of many articles of food or medicine that produce a
+     hurried secretion of the urine, and act as diuretics; as the
+     neutral salts in some cases, and particularly the Rochelle
+     salts and other saline compounds, in which the acid is of
+     vegetable origin. So also, a long continued use of alkaline
+     remedies, or of mercury, in irritable habits more especially,
+     will likewise produce a tendency to an excess of this salt, as
+     well as of the phosphates in general, and even lead to an
+     actual deposition of them from the urine. The same sediment
+     also frequently abounds, or is easily induced, in the urine of
+     those who have long been in bad health, and in whom the
+     constitution may be considered as giving way, or, to use a
+     common expression, breaking up. In general, it is to be
+     understood, that the slighter causes affect only the
+     predisposed, and those in particular who are subject to other
+     diseases of the urinary organs or urine. It may be also
+     remarked, that children are more subject to this form of
+     deposition than adults; a circumstance, perhaps, to be referred
+     to the irritability of the system at this age, and the great
+     derangement of the digestive organs, to which they are
+     subject." p. 151.
+
+The above mentioned causes are stated to be equally productive of
+amorphous phosphatic sediments.
+
+Our author next enumerates the very distressing symptoms, by which the
+deposition of the earthy phosphates is attended. They consist in great
+irritability; derangement of the chylopoietic viscera, evinced by
+flatulency, nausea, obstinate costiveness, or peculiarly debilitating
+diarrhoea; extremely unnatural stools, nearly black, or clay-coloured,
+and sometimes resembling yest; pain, uneasiness, or weakness in the back
+or loins; sallow, haggard expression of countenance; and finally, if the
+disease be not arrested, great languor and depression of spirits,
+coldness of the legs, and complete anaphrodisia, as occur in diabetes.
+
+A curious and important fact has been stated in regard to the remote
+causes, producing the phosphatic state of the urine. It has been
+observed by Dr. PROUT, that a large proportion of cases of this
+complaint may be traced _to some injury of the back_ from mechanical
+violence, such as a fall from a horse, &c.
+
+The remedies for this diseased state of the urine, found most successful
+by Dr. PROUT, are,--opium, in from one to five grain doses, repeated two
+or three times a day, until the unnatural irritability of the system is
+relieved,--the same remedy in more moderate doses, in conjunction with
+the mineral acids, cinchona, uva ursi, and the different preparations of
+iron,--a large pitch, soap, or galbanum plaster to the loins,--and
+setons or issues in the back, when the disease manifestly arises from
+local injury. With respect to the bowels, Dr. PROUT remarks, that they
+are very difficult to regulate. He has occasionally seen serious
+consequences to arise from the exhibition of a small dose of calomel,
+such as diarrhoea and debility, much aggravating the disease, and
+endangering the life of the patient. For the regulation of the bowels,
+small doses of castor oil, and laxative injections are most to be relied
+on; while saline purgatives, more especially Rochelle salt and Seidlitz
+powders, as containing vegetable and therefore destructible acid, must
+be avoided.[24] Mercury, in all its forms, is also inadmissible.
+
+     "Alkaline remedies of every description, must be most carefully
+     avoided, their use in every point of view being most
+     mischievous when the phosphates are concerned. Indeed all
+     remedies that act as diuretics should, in general, be shunned,
+     and the patient should be prohibited from drinking too much.
+     With respect to drinks, in general, they should be of a
+     soothing, demulcent character, and prepared with distilled or
+     the softest water that can be procured; as hard waters are
+     literally poison in this form of disease."
+
+The second division of the work under review treats of the mechanical
+and organic diseases of the urinary organs. This portion of the subject
+is handled with the same ability as the first. We regret, however, that
+our space will not permit a further development of the author's views.
+We trust, nevertheless, that we have imparted to our readers adequate
+notions of the scope of the work, to render them sensible of its value
+as a manual of urinary diseases. It is illustrated by a good coloured
+plate, representing the principal varieties of urinary calculi.
+
+The additions of Dr. COLHOUN consist of foot notes, and paragraphs
+inserted in the text of the original work. We would not, however, wish
+to be considered as approving of the course, for the most part pursued
+by Dr. C., of inserting his amplifications in the text of the author,
+merely distinguished by brackets. Besides the absence of sufficient
+distinction between the matter of the author and commentator, the text
+of the former is thus injuriously disjointed, and dependent sentences
+sometimes widely separated.
+
+In regard to the execution of the present edition, we regret to say that
+it is wanting in typographical accuracy.
+
+FOOTNOTES:
+
+[23] The reader will bear in mind, that this acid is the same as the
+uric, the name by which it is generally known.
+
+[24] The reason of this exclusion of salts, containing a vegetable acid
+is, that they become real alkalies in the course of assimilation by the
+destruction of their acid, and therefore add alkaline properties to the
+urine, already too alkaline.
+
+
+
+
+MEDICAL LITERATURE.
+
+
+
+
+ARTICLE XII.--RETROSPECTIVE REVIEW.--_Tractatus de Ventriculo et
+Intestinis, cui proemittitur alius, de Partibus continentibus in
+Genere, et in Specie de iis Abdominis._ _Authore_ FRANCISCO GLISSONIO,
+&c. &c. Lond. 1677, 4to.
+
+
+As it is not our intention to confine our remarks to the work above
+mentioned, we shall deem no apology necessary for the somewhat excursive
+nature of this article, which would not answer our present purpose, if
+we were obliged to follow the costive details of the venerable FRANCIS
+GLISSON, whose villanous bad style, and execrable latin, are only to be
+excused or overlooked in consideration of the great importance of the
+topics which he handles, and the profound reflections which he makes on
+them. GLISSON is recognised as author of the physiological term
+_Irritability_, and as the assertor of the inherent activity of matter.
+HALLER says of him in his XIth book. "FRANCISCUS GLISSON, qui universis
+elementis corporum, vim motricem tribuit, etiam nostram vim,
+Irritabilitatem vocavit," &c.
+
+He was a native of Dorsetshire, and was appointed professor of physic at
+Oxford in 1627. This post he occupied during forty years, and is much
+distinguished by his treatise de vita naturæ, and by the work which
+forms our caption. As he is the first who used the physiological term
+irritability, we have thought that some researches on this subject in
+general, and more particularly on his peculiar sentiments, might
+profitably occupy our retrospective department; for it is very evident
+that this subject is in general but vaguely discussed, both in medical
+writings and conversation.
+
+The ancient philosophers did not agree among themselves as to the nature
+and origin of matter; some of them considering it as eternal in its
+essence, and others as mutable and changeable in form. The theory of
+atoms, published by DEMOCRITUS, and subsequently carried out so
+elaborately by EPICURUS and his disciples, seems to have reached even
+to our own times, with an increasing reputation and acceptance.
+According to this theory, the kinds of matter, or elements, must he
+regarded as infinitely various. HERACLITUS, who taught philosophy about
+550 years before Christ, considered all things as derived from an
+elemental heat or fire;[25] a philosophy which seems to us to have
+formed the basis of the Hippocratic doctrines of life. Like HERACLITUS,
+HIPPOCRATES tells us, that the calidum was the first principle of
+things, and that by an expansion or extension of itself, it constitutes
+all the objects of the material world. He expresses himself in the
+following manner. That which we call warmth, or heat, seems to me to be
+something immortal; something which comprehends all things, which sees
+and knows all things, as well present as future. Thus assuming as a
+basis, that the calidum is an almighty, all-wise being, or in other
+words, a God, all in all, the cosmogony was developed as follows: Chaos
+he regarded as that condition of the calidum, which preceded any
+exertion of the Almighty faculties. In emerging from the chaotic state,
+the greatest part of the heat having assumed the uppermost place, formed
+the æther; another part having gained the lowermost place, constituted
+earth; a third portion, midway between earth and æther, became air; and
+a fourth part, establishing itself between the two latter, became water.
+So that by means of the extension of this all-wise, elemental calidum,
+we have the four elements, earth, air, fire, and water, out of which are
+ultimately composed all the aggregates of the material world.[26] Now,
+to apply this general principle to the formation of the living being
+man, who seems to be a sort of microcosm in himself, we are told, that
+that portion of heat which remained with earth, being expanded and
+spread abroad in divers places, in some more, in others less, the earth
+became dry, and something like membrane or pellicle was formed; the
+matters contained in which, being heated as by a sort of putrefaction,
+some parts became bone, some nerve, some veins and their contents, and
+some formed the cavities and their contents, as the urinary bladder, for
+example.[27]
+
+The full exposition of the opinions of HIPPOCRATES was left for GALEN,
+and we prefer to make reference to him on this theory, which by his
+genius and talent was so much embellished, that it became the glory of
+science, exercising an almost undisputed authority during a long lapse
+of ages. Indeed the gigantic intellect of this great man, still
+continues to shed its vast illumination over the world of science,
+particularly that of medicine; which, if it owes its birth to the divine
+old man of Cos, is not less indebted for its nurture and growth to the
+celebrated native of Pergamus. GALEN is the facile princeps of
+physicians. His astonishing industry, perseverance, and acquirements,
+his ingenious arguments, and persuasive eloquence, give him an
+unquestionable claim to the title of princeps, so long accorded to him;
+and those who even in the present enlightened period, will study his
+works, shall find themselves almost irresistibly led away by the charm
+of his suasion.
+
+GALIEN est le seul des anciens qui ait donné un corps complet de
+medecine: Quoique formé des débris de toutes les doctrines précédentes,
+son systeme offre cependant, malgré les contradictions ou il tombe assez
+souvent, une unité remarquable dans toutes ses parties; un ensemble
+séduisant, qu'un genie de l'ordre le plus élevé pouvoit seul imprimer à
+un pareil édifice. Ramenant tout à un petit nombre de principes
+généraux, qui s'ils ne peuvent satisfaire la raison, fournissent du
+moins une réponse facile a tout, ce systême dut être adopté avec
+empressement, et sa fortune ne peut étonner.--_Biographie Medicale, Tom.
+IV._
+
+GALEN may perhaps be justly regarded as an eclectic; but it is manifest,
+that he mainly walked after the steps of his great predecessor, and
+recognised model. The following passage seems to contain ideas not much
+differing from those of HIPPOCRATES which we have presented above: "Who
+is there, says he, that judging from the origin and constitution of
+animated beings, doth not immediately infer the existence of a mind,
+possessed of wonderful energies, extending to, and pervading every
+portion of the universe! We every where perceive animals procreated,
+which are possessed of the most admirable structure, and yet what
+portion of the universe can be more ignoble than this earth of ours? Yet
+a grand intelligence is seen to have reached even it from the celestial
+bodies, which for their beauty are so astonishing, and which, as they
+are for purity far more excellent than our earth, so they are the seats
+of intelligences, far more pure and perfect than those which inhabit
+these lower regions." He proceeds to remark, that animals, worthy of the
+greatest admiration, are produced out of the slime and mud of ponds and
+ditches, and even in putrefying vegetables, which, as they indicate the
+miraculous properties of their author, also show us in what estimation
+we should hold the higher orders of being. "We may even perceive a
+rational nature in men, if we refer to such examples as PLATO,
+ARISTOTLE, HIPPARCHUS, ARCHIMEDES, and many others. If, therefore, in
+such a colluvies as the human body, (for by what better name can we
+characterize a mixture of blood, bile, and phlegm,) a mind is formed of
+such great and excellent faculties, what must we think of the excellence
+of that which exists in the superior bodies?"
+
+It may be said that GALEN expresses, in these passages, the Platonic
+dogma of an _anima mundi_. But they certainly agree with the sentiments
+of HIPPOCRATES; and whether he derived them from the former or the
+latter, matters not, as both of them have invested matter with certain
+qualities, which render it active, whether it be so essentially or by
+the act of the Creator. GALEN may be also regarded as partially an
+Epicurean; for he insists that there are several sorts of matter, or as
+we should say, several elements; but he differs from that sect again in
+affirming for it a passible quality. To show that there must be more
+than one element, or kind of matter, he says, that if there was only one
+element, or a unit, it would be impassible; it could undergo no change
+whatever. For there would be nothing by which it could be made to suffer
+any alteration, or into which it could be altered. Whatever is changed,
+is changed into something else, and whatever suffers, suffers from
+something extrinsic: therefore he affirms, that of necessity there must
+be several sorts of matter, or elements. He says, "there are only two
+theories on this subject deserving our attention; one of which affirms
+that sentient bodies are composed of elements possessing the faculty,
+(cum patiendi tum sentiendi,) both of suffering and perceiving an
+alteration;" while the other affirms that such bodies are formed (ex
+patibilibus, sed sensu expertibus) out of passible, but not sentient
+elements. Neither of these doctrines does he consider tenable, so long
+as only one element is affirmed, as earth, air, or fire alone, which
+could never become capable of that great variety of actions we witness
+in living bodies: but, admit several elements, and we suppose that the
+mutual interchange of powers would yield a compound body, capable of all
+the vital phenomena. Such, therefore, says he, as consider the human
+body to be composed of fire, air, earth, and water, mutually transmuted,
+alternated, and reduced to a given temperament, and thereby vested with
+a sentient faculty, speak reasonably; and it is evident that there must
+be more than one element, and that these elements are passible bodies.
+
+PLATO had taught, that, though all bodies are formed of matter, yet
+matter itself is not a body; and the same idea is conveyed by ARISTOTLE,
+in the Lib. de partibus animal. & earum causis, II c.i. "Prima statui
+potest ea quæ ex primordiis conficitur, iis quæ nonnulli elementa
+appellant terram dico, aquam aërem & ignem: sed melius fortasse dici
+potest ex virtutibus confici elementorum, iisque non omnibus sed ut ante
+expositum est humiditus enim, & siccitas, & caliditas, and frigiditas,
+materia sunt corporum compositorum."
+
+GALEN also states, that in fire there exists a perfect heat and
+dryness, in earth a perfect coldness and dryness, and so on of the rest
+of the elements. For you cannot expect to find in nature a perfectly
+simple and isolated element; because they are always mixed two or more
+together. Hence the real terram, aquam, aërem, and ignem, become rather
+a metaphysical abstraction, than a real entity. That is to say, matter
+has no real existence, but is mere quality; for earth is not the mere
+representation of dry or siccum; it is the representative of siccitas,
+or dryness: fire is not the eidolon of calidum, but of caliditas; water
+of humiditas, and air of frigiditas. Yet all these elements are in
+nature possessed of more than one property. Fire is hot and dry, earth
+is dry and cold, water is cold and moist, &c. If we refer, however, to
+his account of the soul, we perceive at once, that these inseparable
+qualities of the elements are the real active agents of life. He plainly
+declares, that the soul is the mere result of organization, and perishes
+with the structure in which it dwells. He thinks, "corporis temperiem
+censendum est." As to the active powers of the four primary qualities,
+he says, "At mihi quidem tam venæ, quam reliquarum particularum singulæ,
+ob certam quandam temperiem quam ex quatuor sunt qualitatibus nactæ, hoc
+vel illo modo videntur agere."--De nat. fac. I.
+
+It is plain he thinks, that the elements consist of a materia and
+qualitas; but they are elemental by the _qualitas_ and not by the
+_materia_.
+
+After establishing that there are four elements, which are the common
+and simple bases of all things, he goes on to show, that the proper
+proportion and admixture of these, constitute the healthy state of
+living bodies. If the calidum, for example, be unduly increased, the
+body is destroyed; if it be improperly diminished by excess of the
+frigidum, it will also perish. The business of the physician is to keep
+the proportions just and harmonious; but, as no pure element exists
+alone, the physician must employ the qualitas in conjunction with the
+materia. These (to make a phrase) substantive qualities, are found in
+medicines or food, which, like all objects of sense, are either cold,
+hot, dry, or moist, and available of course in the management of a cold,
+hot, dry, or moist derangement of the living body.
+
+The elements of the human body exist in the four humours, blood, bile,
+atrabilis and pituita; and these four humours correspond in quality
+with the elements. Blood, which is the reservoir or continent of them
+all, is a temperate humour. Bile, being the representative of calidum,
+is hot and dry. Melancholy represents, in our microcosm, the element
+earth or siccum, and is dry and cold. But pituita, which is moist and
+cold, corresponds with the humidum element. Air exists in animals nearly
+pure, as we learn from the phenomena of the pulse and of respiration. It
+answers to frigidum.
+
+He shows us in his lib. de naturalib. facultat. that, out of the
+humours, all the parts are formed, and these parts are either _similar_
+or _dissimilar_; i. e. simple or compound. Bone is a similar part, that
+is, it is a simple part; so is an artery, or vein, or ligament. Each of
+these is so constituted, as that it has a predominance of one element in
+its nature; and it is therefore dry, or cold, or moist, &c. But if an
+adust element be, by accident or disease, accumulated in a part
+naturally cold, the function of such part is morbidly affected. The
+natural tendency, however, of similar humours to unite, causes each part
+to receive its regular supply; a principle which BICHAT has since
+characterized as, _contractilité organique insensible_.
+
+To show the wonderful simplicity of the Galenical system, which for
+plainness and easy attainment may be compared with the improved
+nomenclature of chemistry, we will cite a passage from ARGENTERIUS, who,
+perhaps, was as learned in this kind of lore as any man of his time. In
+his Tractatio de calidi significationibus, he says; "If any body would
+undertake to give a general enumeration of those circumstances, in which
+this term calidum and the others (frigidum, humidum, &c.) are applicable
+to the explanation of this warmth, he shall find truly, that they are
+the elements, the humours, the parts, the whole body, medicines, food,
+air, climate, the weather, the season of the year, and even ages; for
+these all are either temperate, or hot, or cold, or humid, or dry."
+
+The animal body is moved and governed by two principles; one of them
+corresponds to the _vie animale_ of BICHAT, and the other to the _vie
+organique_. Since the power of sensation and of voluntary or elective
+motion, says he, is a property of animals, and since that of growth and
+nutrition is common both to animals and plants; the former may be called
+attributes of the soul, and the latter attributes of nature. Whence we
+say, that animals are governed by the soul and by nature, while plants
+are governed by nature alone.
+
+The powers of the body are faculties; and these are either natural,
+vital, or animal: but they are so subdivided, that we have as many
+faculties as there are sorts of action. Under the class of natural
+faculties, we find three principal sorts; to wit, a facultas generatrix,
+an auctrix, and a nutrix. But if you ask, says GALEN, how many faculties
+there be, which result from the action of these on each other, you will
+find them as numerous and diverse as there are numbers and diversities
+of the animal parts. For example, we have an attractrix faculty, a
+retentrix, alteratrix, expultrix, &c. &c., all of which are variously
+modified, according to the nature of the similar or dissimilar parts
+they are exercised in, or, in other words, according to the nature of
+the tissues or organs, in which they reside.
+
+Need we go further to show, that GALEN, believing all matter essentially
+conjoined with the hypothetical caliditas, frigiditas, &c. &c., taught
+that it was gifted with such a degree of inherent activity, as to render
+it capable under certain states of combination, of exhibiting all the
+phenomena of organic and animal life? It is certain that he regarded
+these active qualities, as the causes of all the phenomena, whether of
+living or dead matter.--GLISSON ought not certainly then to be regarded
+as the author of this dogma in medical philosophy. PLATO certainly
+taught it. VAN HELMONT could not get along without investing matter with
+what he called a "seminal likeness, which is the more inward spiritual
+kernel of the seed," &c. But we will let him speak for himself.
+"Whatsoever," says V. H., "cometh into the world, must needs have the
+beginning of its motions, the stirrer up and inward director of
+generation. Therefore all things, however hard and thick they are, yet
+before that their soundness, they inclose in themselves an air, which
+representeth the inward future generation to the seed in this respect
+fruitful, and accompanies the thing generated, even to the end of the
+stage: which air, although it be in some things more plentiful, yet, in
+vegetables it is pressed together in the show of a juice, as also in
+metals it is thickened with a most thick homogeniety or sameliness of
+kind. Notwithstanding this gift hath happened to all things, which is
+called _archeus_, or chief workman, containing the fruitfulness of
+generations or seeds, as it were the internal efficient cause; I say
+that workman hath the likeness of the thing generated, unto the
+beginning whereof, he composeth the appointments of things to be done.
+But the chief workman consists of the _conjoining of the vital air_, as
+of the matter, with the seminal likeness, which is the more outward
+spiritual kernel, containing the fruitfulness of the seed; but the
+visible seed is only the husk of this. This image of the master workman,
+issuing out of the first shape or idea of its predecessor, or snatching
+the same to itself out of the cup or bosom of outward things, is not a
+certain dead image, but made famous by a full knowledge, and adorned
+with necessary powers of things to be done in its appointment; and so it
+is the first or chief instrument of life and feeling. But since every
+corporeal act is limited into a body, hence it comes to pass, that the
+archeus, the workman and governor of generations, doth clothe himself
+presently with a bodily clothing. For in things soulified, he walketh
+thorow all the dens and retiring places of his seed, and begins to
+transform the matter according to the perfect act of his own image; for
+here he placeth the heart, but there appointeth the brain, and he every
+where limiteth an unmoveable chief dweller, out of his whole monarchy,
+according to the bounds of requirance of the parts and appointments. At
+length that president remaineth the overseer and inward ruler of the
+bounds, even until death; but the other, floating about and being
+assigned to no member, keeps the oversight over the particular pilots of
+the members, being clear and never at rest or keeping holiday."
+
+Notwithstanding the affected and euphuistic jargon of the above
+passages, it is evident that VAN HELMONT'S idea is very similar to that
+of GALEN. By seminal likeness, we are to understand an aptitude in
+matter to take on certain determinate forms, and this may be supposed to
+differ not very essentially from those laws, which govern matter in
+crystallization. But even this seminal likeness, as we perceive, is a
+sort of abstraction, very analogous to the Galenical caliditas; for it
+is the more inward spiritual kernel of the seed, whereby the matter is
+enabled to enjoy a certain degree of activity, the degree of which is
+much increased by the union of the air, or archeus, with it. So the
+caliditas of GALEN, which, after all, is matter, gives to its subject
+the powers which it enjoys. GLISSON, speaking of the natura seminalis,
+says that it is a certain or specific essence, superadded to mere
+elementary principles, by means of which mixt bodies adopt certain
+determinate forms, and acquire the faculty of performing essential
+operations, more noble than those which belong to naked elements.
+
+We regret very much that we have been unable to procure a copy of
+GLISSON'S treatise de vita naturæ, which, so far as we know, can not be
+had in this country. We shall, therefore, furnish our readers with the
+following passage from the Biographie Medicale, from the pen of
+JOURDAIN.
+
+"The name of GLISSON occupies an honourable place in the history of
+medicine, because to him we are indebted for the first elements of the
+physiological doctrine of the present day. Instead of directing his
+attention to movements alone, as the iatro-mathematicians, and even, to
+a certain extent, the animists had done, he referred to vitality all the
+phenomena of nature, of whatever kind, and attempted to reduce them to
+one, common principle. To this end he admitted, that matter is
+originally endued with forces inherent in it, and that living bodies in
+particular, are invested in their organs with a radical force, which,
+put in play by stimulants, whether internal or external, gives rise to
+all the phenomena of life. He even went so far as to assert, that
+sympathy may be explained by referring to the intercommunication of this
+force, to which he gave the name of irritability."
+
+We shall also cite from SPRENGEL, a passage which throws some light on
+his theory.
+
+"When they became unwilling, like DESCARTES and STAHL, to have constant
+recourse in their explanations, to the soul, they tried to find a
+philosophic proof of the existence of material forces, to show that
+matter, as mere matter, is endowed with particular forces, with which
+they might satisfactorily explain a great many of its phenomena. No one
+had hitherto sought for a similar proof; for ARISTOTLE had contented
+himself with an axiom, that all natural things contain in themselves the
+sufficient cause of their movement and rest. GLISSON and LEIBNITZ set
+themselves in search of this proof; but it was reserved for the immortal
+KANT to find it in the nature of matter itself.
+
+"FRANCIS GLISSON may with propriety be considered as the precursor of
+LEIBNITZ. What he tried to demonstrate by scholastic subtlety, and by
+thousands of syllogisms, was developed by LEIBNITZ with a clearness and
+ability, which secured the suffrages, even of the unenlightened. Both of
+them went too far, in attributing life and sensation to matter, instead
+of claiming for it the two simple and primordial forces of attraction
+and repulsion.
+
+"GLISSON sets out with the idea of substance, but he does not explain it
+with sufficient precision. Every substance has three substantial
+rudiments,--_fundamental_ substance, by means of which it
+exists,--_energetic_ substance, by means of which it acts,--and
+_additional_ substance, which determines its accidental qualities. All
+matter, as substance, must have an energetic substance or nature, which
+is the internal principle of movement. Therefore whatever moves
+spontaneously, and in virtue of an internal force, must _feel_ this
+motion, _and desire it_. All matter feels that it is, and that it exists
+by itself. It has therefore, consciousness of its own nature. Life
+consists in the activity of the internal substantial energetic nature.
+Death is the dissolution of the triple alliance of the internal
+energetic substantial nature, with the vegetative and animal natures,
+which two last belong to the _additional_ substance."[28]
+
+In applying his theory to physiology, GLISSON'S idea is, that the fibres
+of the human body are endowed with a force, which he divides into three
+kinds; to wit, natural or inherent force, (robur insitum)--vital force,
+(robur vitale)--and animal force, (robur animale.)
+
+Natural or inherent force, is a part of the constitution of the fibre,
+and is as much a property of its organization as are its tenacity,
+tensibility, &c. The sum of this force varies, in proportion as the
+constitution of the fibre is more or less perfect. It is strongest in
+athletic men and strong animals, and weaker in relaxed and debilitated
+persons. It may be compared with the contractilité de tissu of BICHAT.
+
+The second, or vital force, is something superadded to the inherent
+sort. It is an _influxus_, derived to any fibre or set of fibres, from
+that greater sum of force, which arises out of a more elaborate,
+complex, and exalted organization. It varies in proportion as the vital
+spirits flow with more or less freedom; and in proportion as their
+quality is more or less perfect.
+
+The third kind, or robur animale, may be supposed to depend on the
+organic constitution of the brain and nerves, and varies according to
+the state of that organization. We cannot help adverting to the
+resemblance between these two latter kinds, and the contractilité
+organique, and contractilité animale, of BICHAT; and this robur
+comprises, as we shall show hereafter, both the contractilité and
+sensibilité of the French physiologist.
+
+GLISSON, in his chapter de Irritabilitate fibrarum, commences by
+remarking that a motive faculty existing in any fibre, unless it were of
+an irritable nature, would leave such fibre in one of the two following
+states: 1. It would either never cease from action, or 2ndly, being once
+at rest, its motion could never be reproduced; but the varieties and
+differences which we see in the actions of fibres, clearly demonstrate
+them to be possessed of irritability: i.e. if a fibre may be by turns in
+a state of action and repose, it is evidently possessed of a quality,
+whereby it can be induced to move if in a state of rest; this quality he
+terms irritable, or irritability. The next inference from this power of
+alternate activity and repose is, that the fibre is possessed of a
+faculty, whereby it can _perceive_ an irritation offered to it; but this
+perception of irritation further implies an _appetence_ for a change of
+its actual state, before the motion can really take place. Perception,
+appetence, and motion, make a triunit. "In the mean time, says he, as
+sensitive appetence, and sensibility, are frequently confounded with
+natural perception, in this irritation of the fibres," he divides it
+into three kinds, viz. Natural Perception, Sensitive Perception, and
+Perception regulated by animal appetency.
+
+Natural Perception is that principle whereby a fibre perceiving any
+alteration offered to it, whether pleasing or displeasing, is excited
+either to accept that change, or to avoid it, and moves accordingly.
+
+Sensitive Perception, is that kind, in which a fibre, perceiving a
+change effected in some other organ, is impelled ad aliquid appetendum,
+and to move conformably.
+
+The third sort, or Perception regulated by animal appetency, is that in
+which the brain directs from within, such movements of the muscular
+fibres, as are requisite for the execution of any purpose.
+
+"Some persons," says GLISSON, "may doubt whether there really exists a
+natural perception of irritation in the fibres; but we have elsewhere
+asserted in general the reality of natural perception, to wit, in my
+work, de Vita Naturæ; and whoever has known it, will readily admit this
+quality in fibres imbued with inherent, influent, and vital spirits. We
+do not expect, in this place, to establish it as a general principle;
+but if any proof, derived from a knowledge of the structure, uses, and
+actions of the fibres, can be adduced, it may be here attempted."
+
+"It is indubitable that the fibres are alternately at rest and in
+motion; for, during sleep, they are all relaxed, with the exception of
+such as subserve the functions of respiration and circulation, and even
+these are by turns quiet and active. During waking again, they are all
+in a state of moderate tonic motion; and moreover, during all movements
+of the limbs, the antagonist muscles yield spontaneously, the abductors
+being active, while the adductors are relaxed, and vice versa. Hence it
+is manifest, that the fibres are alternately quiescent and active: but,
+since they are not _principal_ or sui arbitrii agents, it is necessary,
+in order to the new movement, that they should be irritated from some
+source: for, it is impossible that a fibre in repose, can be set in
+action without an irritating cause; nor can we conceive of a part being
+irritated without _perceiving_ the irritation. It is like speaking to a
+deaf man, or trying to awaken a dead one."
+
+"If you say, fibres are possessed of sensibility, and can be excited by
+virtue thereof, I confess that they are sensible parts, and may thereby
+perceive some, not all irritating causes; but whether sensation excites
+them immediately, or rather, is transmitted to the brain, and irritates
+the animal appetency; and further, whether the animal appetence, effects
+a movement in them directly, and to what sort of perception this
+irritation may be properly and immediately ascribed, is detailed in
+order below, when we come to explain sensitive perception, and
+perception à phantasia imperata."
+
+"Let us now go on to point out those cases, in which no suspicion of
+_sensation_ can be entertained. The pulsation of the heart is neither
+effected nor affected by sensation; its fibres, in virtue of the
+irritation occasioned by the blood in its ventricles, are excited to
+contract, and thus occasion the pulsation, but when the irritation is
+remitted they relax, and recover the natural state. Now it cannot be
+denied that this is an evident case of irritation of the fibres, for
+according as is the irritation, so is the rythm of the pulsation, which
+varies at times, as in febrile and other affections: nor is it right to
+pretend that there is any sensation in this case; because this
+perception of irritation _per vices_, is exercised as well during sleep,
+when the senses are all locked up, as in the waking condition. The
+fibres do not, therefore, _perceive_ in these actions by a sensitive,
+_but by a natural perception_, the irritation of the vital blood, which
+animates them to alternate contraction and relaxation. This is
+corroborated by those tumultuous irregular motions which continue in
+animals after decapitation; so also the intestines when still warm in a
+recently opened animal, move and twist about; the muscles in dead
+animals also, excited by the perception of cold, contract with a strong
+tonic movement, and render the body rigid. The hearts of some animals
+too, when torn out of the body, and even when dissected, continue their
+endeavours to pulsate. Is there any further evidence wanting? We may
+hence infer with sufficient confidence that the fibres (without the aid
+of the senses) may _perceive_ irritation, and move themselves
+conformably."
+
+In the next place he examines the nature of sensitive perception of
+fibres, and goes on to show how an impression made on an external part,
+or a natural perception, becomes converted into sensation, and thus made
+known to the sensorium. But his disquisition is not only very long but
+very dark, and we shall therefore pass it by with the exception of the
+following.
+
+"Natural perception includes within itself a _rationem positivam_, and a
+_negationem formalem_.
+
+"The ratio positiva is the perception of the idea, or image of the
+object moving or changing the fibre.
+
+"The negatio formalis is a denial or refusal to communicate this image
+to the sensorium. In the process of transformation into sensation, the
+positive ratio is not changed, but remains the same, and is the first
+part, or basis, both of internal and external sensation.
+
+"The negatio formalis is destroyed or abolished in any case of
+impression communicated to the sensorium. Natural perception, in its
+ratio positiva, is not abolished or degraded by being converted into
+sensation, but is rather exalted, or gifted with a more dignified
+nature. By as much as public or general knowledge is preferable to
+private, or public advantage to that of an individual, by so much is
+sensation preferable to natural perception. Hence nature formed so many
+organs of sense, that the phantasy might have notice of what ought to be
+done, desired, or avoided."
+
+He does not doubt that external sensibility is inherent in the nervous
+parts of the external organ, whence he infers that it may readily incite
+the fibres of such organ ad appetendum et movendum; for, as external
+sensation is communicated to the brain by means of the nerves, it must
+of necessity be true, that these nerves and nervous parts (such as the
+fibres,) are the subjects of it. Since then sensibility causes its
+subject to feel, it consequently enables it to desire and move
+comformably. For perception in any subject is vain, unless it can
+desire, and appetence is useless, unless it can move. External
+sensibility, therefore, may be said to render the fibres _actu
+irritabiles_, for example, as often as the irritating cause is
+perceived; but as the irritation is perceived, not by a sensibility, but
+by a mere natural perception, this it is which constitutes their
+irritability.
+
+Thus we may perceive that the triunit consisting of perception,
+appetence, and motion, constitutes the celebrated irritability of our
+author. But he has been too latitudinarian in his application of the
+theory; for he did not limit it, as HALLER has subsequently done, to one
+sort of fibres, or indeed to fibres alone, for he says in cap. IX., "It
+is to be remarked that natural perception belongs to other parts of the
+body besides fibres; to wit, to the parenchymata, bones, marrow, fat,
+blood, recrementitious juices, humours of the eye, and such like, all
+which are irritable, and increase the irritable constitution of the
+parts, but these parts hardly admit of the existence of animal
+perception." HALLER blames GLISSON for having gone so far in his
+application of the theory, and it is well known that he himself
+restrained it to the single tissue of muscular fibres, and denominated
+it vis insitum, or inherent force; whereby he distinguished it from his
+vis mortua or elastic contraction, on the one hand, and the vis nervosum
+or voluntary power, on the other; the former being something less, and
+the latter something more than irritability. GLISSON'S theory, when
+fully explained, which we cannot for want of space do here, will be
+found to bear a very strong resemblance, in many points, to that of
+BICHAT, who has invested the matters of the body with vital powers, far
+beyond those attributed by HALLER; and as we are not furnished in the
+present article with sufficient space, we hope in some subsequent
+number, to place this matter in a plainer light before our readers. In
+the mean time we may remark, that GLISSON seems to be the first of those
+who have placed the subject fairly before the medical public; for
+although faint traces of a similar theory may be perceived before him,
+especially by translating terms into their equivalents, yet he has the
+merit of using a term which, in spite of all subsequent modifications,
+is in daily use.
+
+GLISSON'S latitudinarianism may be contrasted with HALLER'S rigid
+application: for the latter says, "I call that an irritable part of the
+human body, which on being touched by a foreign body, renders itself
+shorter;" thus while GLISSON attributes his triunit of perception,
+appetence, and motion to all the tissues and fluids, HALLER confines it
+to muscular fibre alone. No one can doubt that the membranes of the body
+are endowed with vital properties, but yet they do not shorten
+themselves on being touched by a foreign body. BICHAT has distinguished
+their vitality as organic vitality, and the contractile qualities
+displayed are divided into insensible organic contractility, and into
+contractility of tissue: but these sorts of contractility mount up by
+insensible gradations. He says, that "entre la contractilité obscure
+mais réelle, necessaire a la nutrition des ongles, des poils, &c. et
+celle que nous presentent les mouvements des intestins, de l'estomac,
+&c. il est des nuances infinies, qui servent de transition: tels sont
+les mouvements du dartos, des arteres, de certaines parties de l'organ
+cutané," &c. We will close with a comparison between GLISSON'S
+irritability, and BICHAT'S contractility. At page 70 of the Treatise
+_sur la Vie & la Mort_, BICHAT supposes that a "muscle enters into
+action, 1st. by the influence of the nerves which it receives from the
+brain, and this is a case of contractile animale," (which differs in no
+respect from perception regulated by animal appetency of GLISSON).
+2ndly. According to BICHAT, the muscle enters into action "by the
+excitation of a chemical or physical stimulant applied to it, and which
+artificially determines a movement of the whole muscle, analogous to
+what is natural to the heart, and other involuntary muscles. This is
+sensible organic contractility or irritability," and corresponds to the
+sensitive perception of the old English physiologist. In the 3d place
+it enters into action by the stimulus of the fluids which circulate in
+it, and this is insensible organic contractility or tonicity of BICHAT,
+and is nothing different from GLISSON'S natural perception. BICHAT makes
+a fourth case; as for example, when a muscle is divided across, it
+contracts by a _contractilité de tissue_, or _par defaut d'extension_.
+We do not perceive how GLISSON'S natural perception can be applied to
+this case, but he treats of it in his fifth chapter under the head of
+Cessatio: it is that state to which a fibre is reduced when left to
+itself, and freed from all stimulus.
+
+BICHAT has attributed to some fibres the power of active elongation. On
+this subject GLISSON says, "Impossible enim est, ut simplex fibra, sua
+sola actione, se secundum longitudinem distendat, nec modus quo hæc fiat
+concipi nedum effari queat non negavero quin in distensione hac,
+aliqualis fibræ actio includatur, sed ea tota contractiva est, &
+distensioni ab extranea causa factæ reluctatur." A doctrine as sound as
+that of the 47th proposition; a doctrine too, without admitting which,
+we think no man can understand the theory either of simple inflammation,
+or of the febrile affections. We hope to resume this subject at an early
+period.
+
+FOOTNOTES:
+
+[25] Hæc ei generatim videbantur, ex igne omnia constare eodemque
+interire. Diogenes Laertius.
+
+[26]
+     Quatuor æternus genitalia corpora mundus
+     Continet; ex illis duo sunt onerosa, suoque
+     Pondere in inferius, tellus atque unda, feruntur,
+     Et totidem gravitate carent, nulloque premente
+     Alta petunt, aer atque aere purior ignis.--OVID--_Metamorph._
+
+[27] Lib. de Carnibus, HIPPOCRATES says: Quod Calidum vocamus, id mihi
+immortale esse videtur, cunctaque intelligere, videre et audire,
+sentireque omnia, tum præsentia tum futura: cujus pars maxima cum omnia
+perturbata essent in supremum ambitum secessit; quod, mihi veteres
+æthera appellasse videntur. Altera pars locum infimum sortita, terra
+quidem appellatur, frigida et sicca multas que motiones habens, et in
+qua multum sane calidi inest. Tertia vero pars medium aeris locum nacta
+est, calidum quid existens. Quarta pars terræ proximum locum obtinens
+humidissima et crassissima. His igitur in orbem agitatis cum turbata
+essent, calidi magna pars alias in terra relicta est, partim quidem
+magna, partim vero minor, alias etiam valde parva, sed in multas partes
+divisa. Et temporis successu a calido resiccata est terra, ista in ea
+tanquam in membranis contenta circumse putredines excitant, ac longo
+tempore incalescens quod quidem ea terræ putredine pinguedinem sortitum
+est et minimum humidi habet, id citissime exustum ossa produxit. Quæ
+vero naturam glutinosiorem sortita sunt et frigidi communionem habent,
+ea neque calefacta exuri potuerunt, neque etiam humida fieri ideo formam
+longe ab aliis diversam nacta sunt et nervi solidi exciterint, cum non
+multum in iis frigidi inesset. At venæ frigidi multum habebant cajus
+pars circumcirca ambiens et quod erat glutinosissimum, a calido
+exassatum membrana extitit. Quod vero erat frigidum, a calido superatum,
+dissolutum est ideoque humidum evasit.
+
+[28] K. SPRENGEL, Hist. de la Medicine.
+
+
+
+
+QUARTERLY SUMMARY
+
+OF MEDICAL AND SURGICAL INTELLIGENCE.
+
+
+I. ANATOMY.
+
+1. _Papillæ of the Tongue._--At the upper surface of the tongue, say MM.
+LEURET and LASSAIGNE, in their recent work on digestion, the mucous
+membrane presents projections of three different species; and these are,
+the sensitive papillæ, the epidermoid papillæ, and the mucous cryptæ.
+The sensitive papillæ are numerous. They occupy the anterior four-fifths
+of the tongue, on which they are implanted by a narrow pedicle. The
+rounded head of these papillæ is much more prominent in the living
+subject, than after death; but injections are capable of restoring them
+to their pristine form. Nervous fibres from the lingual branch of the
+fifth pair have been distinctly traced to their roots. These papillæ are
+of various sizes; at the root of the tongue they form a V. They are all
+vascular and nervous. The sense of taste is referred by these writers
+almost exclusively to the above papillæ.
+
+The epidermoid papillæ are of a nature similar to those retroverted
+prominences so remarkable on the tongue of the cat; as well as in the
+lion, and some other animals. They are larger in many species than in
+man, and, in general, the sensibility of the tongue appears to diminish
+in proportion to the remoteness of the subject from the human structure.
+The epidermoid papillæ are separated from the tongue along with the
+epidermis, or rather, epithelium, by maceration for a few days in
+vinegar. They are pyramidal in form. They are grouped round the
+sensitive papillæ, except on the edges and point of the tongue, where
+they are rare. Their base is perforated, and always gives outlet to a
+crypta. In an epithelium separated from the tongue, these minute and
+numerous perforations are easily distinguished from the larger ones left
+by the sensitive papillæ.
+
+The office of the epidermoid papillæ appears purely mechanical.
+
+The only cryptæ which produce, of themselves, a visible projection on
+the surface of the tongue, are situated at its base. They are formed by
+the mucous membrane, like other cryptæ, and are scattered between the
+sensitive papillæ.
+
+In the tongue of birds, there is always a bone or cartilage; and the
+external membrane is dense. In reptiles the tongue is soft, possessed of
+little sensibility, and capable of great elongation. In fishes it is
+endowed with little motion, and is often wanting.--_Bulletin Medicale._
+
+2. _Villi of the Stomach and Intestines._--MM. LEURET and LASSAIGNE
+state that the villi can be easily injected; most conveniently from the
+vena portæ, though the arteries may be employed. In the latter case,
+the matter of injection is effused into the intestinal or gastric
+cavity. The villi are peculiar to these parts; they are inversely
+conical, adhering to the membrane by their smaller end. The best mode of
+exhibiting them, is to tie the vena portæ of a living animal, when they
+erect themselves by the afflux of blood. These diminutive organs, about
+3/100 of an inch long, then exhibit distinctly, under the microscope,
+four red longitudinal lines, being probably vessels.
+
+Injections made retrograde from the thoracic duct, pass through the
+villi into the intestines. When the stomach of a man, who died of some
+complaint not deranging its condition, is examined, we sometimes find
+its lining membrane covered with a multitude of minute white points.
+These are the villi in a flaccid state. In those who have died during
+digestion, they are erected, and of a rosy colour.
+
+When the intestine of a living animal is examined under a microscope,
+after being carefully washed, a great number of orifices are seen, from
+each of which exudes a minute drop of a transparent fluid. These rapidly
+disappear; and then the villi attract attention. What these foraminula
+are, the reviewer, M. DU FERMON, does not tell us.--_Ibid._
+
+3. _Minute distribution of the Vessels of the Liver._--M. CRUVEILHIER
+gives, in his lectures, an account of the results he has obtained from a
+minute injection of the liver. He finds, 1. The acini surrounded with a
+dense, cellular texture, paler than themselves; 2. The ramifications of
+the hepatic artery distributed to this cellular envelope; 3. Those of
+the vena portæ spread around the acini, or granulations of the liver;
+and 4. Those of the biliary ducts, and of the hepatic veins, emerging
+from the cavities of these bodies.
+
+Our readers will observe a great similarity, in this, to the arrangement
+of the lobules of the kidneys.--_Ibid._
+
+4. _Trachea perforating the Aorta._--This odd distribution of parts, was
+observed by M. ZAGORSKY, at St. Petersburg, in 1802. The aorta divided
+itself, at its arch, into two branches, which received the trachea
+between them, and again united, exactly fitting the organ they received.
+They were found to have compressed the trachea, and probably produced
+difficulty of breathing.
+
+In another case, in 1808, the right subclavian artery, instead of its
+usual origin, arose from the left extremity of the arch of the aorta,
+and crossed behind the trachea, thus including the latter between it and
+the aorta.
+
+Why do we call the common trunk of the right subclavian and carotid, the
+arteria innominata? Is coining words so difficult a task, that we
+cannot find a proper and expressive name for it? The French
+call it _brachio-cephalic_, and this expresses its office and
+distribution.--_Ibid._
+
+5. _Monsters._--These productions, hitherto considered as mere objects
+of wonder, from the study of which no useful inference could be drawn,
+have recently attracted a good deal of attention in Paris. There seem to
+be some close affinities discoverable in many of them, not only with
+the natural and complete forms of animals of various tribes, but even
+with the actual condition of their own species, while in the foetal
+state.
+
+The views of M. GEOFFROY ST. HILAIRE seem to us rather mystical and
+vague. Those of BRESCHET, and the other practical anatomists, we can
+understand much better.
+
+6. _Malformation of the Heart._--Drs. BAILLIE,[29] LANGSTAFF,[30] and
+FARRE[31] have each published cases; and M. TIEDEMANN, in his journal of
+Physiology, now adds a fourth, in which the aorta and pulmonary artery
+were found to have changed places. In professor TIEDEMANN'S case, the
+two circulations were entirely distinct; the systemic blood passing from
+venæ cavæ to right auricle, from right auricle to right ventricle, and
+from this, through the aorta, to the body at large; while the pulmonary
+blood ran through an equally simple circle, by the route of pulmonary
+veins, left auricle, left ventricle, and pulmonary artery. The only
+communications between the two circulations, were the foramen ovale, the
+ductus arteriosus, and, in the opinion of M. TIEDEMANN, the
+inosculations between the branches of the _pulmonary_ and _bronchial_
+arteries.
+
+The infant is recorded to have presented _no peculiar appearances_ till
+the ninth day; when attacks of suffocation came on, attended with the
+blackish blue colour, and followed by death, at the end of twelve days.
+Similar histories are said to be given of the cases mentioned above, and
+the references to which we have copied. We have not the time to consult
+them.--_Ibid._
+
+7. _Acephalous Mummy._--M. GEOFFROY ST. HILAIRE has read a memoir of
+some length to the Academy of Sciences, on an acephalous mummy. It was
+found in a catacomb, destined, with this exception, exclusively to
+animals. It had an amulet suspended round its neck, being an earthen
+figure of a cynocephalus, for which it was very probably mistaken by the
+Egyptians. The collector, M. PASSALACQUA, who obtained it, showed it to
+M. G. ST. H. as a monkey, of which he wished to know the species. Yet
+the latter observes that these amulets were only put on human mummies.
+
+M. G. concludes that the monkeys, elephants, &c. said by Livy, Valerius
+Maximus, Pliny, and others, to have been born of women in their times,
+and considered as omens of public calamity, were acephala.
+
+8. _New Anatomical Plates._--Messrs. E. W. TYSON and GEORGE SIMPSON are
+publishing anatomical plates, in London. They are spoken of with
+approbation. The labours of the latter are designed for the use of
+painters.
+
+9. _A Manual of Osteology_ has been undertaken by Dr. WEBER, of Bonn,
+and one volume published.
+
+10. _Soemmering's fine work on the anatomy of the ear_, has been
+translated into French, and his splendid folio plates copied in
+lithography.
+
+11. _Does the conjunctiva run over the cornea?_ Messrs. LECOQ, LEBLANC,
+and ARTUS, state that they have each seen a case in which regular _skin_
+and _hair_ were seen, forming a small patch on the cornea of the eye of
+a quadruped. This is considered as a proof of the existence there of a
+membrane naturally analogous to the skin; which must, of course, be the
+conjunctiva. An officer saw another case, in which a hair was seen in
+the middle of the eye of a horse.--_Bulletin._
+
+
+II. PHYSIOLOGY.
+
+12. _Electro-Galvanic phenomena of Acupuncturation._--M. POUILLET, after
+making a complete circuit, through a needle introduced in acupuncture,
+through wires, and through the patient's mouth, found, by means of a
+multiplier of SCHWEIGHER with a magnetic needle, that the
+electro-magnetic rotation could be readily produced; at least so far as
+to effect small vibrations backwards and forwards. On repeating it with
+two needles, one of them run into an artery and another into a vein, or
+one into the medulla spinalis, at the neck, and another into an
+extremity, in a rabbit, no effect whatever took place.--_Magendie's
+Journ. de Physiologie._
+
+13. _Variations in Milk._--Milk, says M. VALLOT, in his memoir read to
+the Academy of Dijon, may be _red_. The cause of this is unknown, though
+it has given rise to superstitious fears. Some have observed that the
+cow's teats are then tender. Whether this be cause or effect has not
+been ascertained.
+
+_Yellow milk_ is said to have been produced by the cow's eating the
+caltha palustris, (marygold.) _Blue milk_, from a cause still unknown,
+in the departments of Seine-inférieure and Calvados. Some have ascribed
+it to the hyacinthus comosus; others to butomus umbellatus.
+
+The _green milk_ of some writers is supposed to be only blue. _Milk not
+coagulable_ is produced by feeding on husks of green peas, and on mint.
+_Bitter milk_, from wormwood, sonchus alpinus, and the leaves of the
+artichoke; and in goats, from eating freely of elder, (sambucus nigra,)
+and potato-tops; _a disagreeable taste_, from turnips, in Upper Canada.
+_Garlicky milk_, from causes well known. _Insipid milk_, and
+_lead-coloured butter_, from equisetum fluviatile. _Milk unnaturally
+sweet and luscious_, (sucré,) from alpine clover, (trifolium alpinum;)
+and _red butter_, from the ripe berries of asparagus.--_Bulletin._
+
+14. _Hyoscyamus dilates the pupils of the eyes_, the same manner as
+stramonium, several Eastern species of datura, and belladonna, which the
+Europeans use. The strongest species was datura fastuosa.--_Oriental
+Magazine, apud Du Fermon._
+
+15. _Worms in the Eye._--Several cases of worms in the eye are mentioned
+in the Bulletin des Sciences Medicales, for Feb. 1826. DEGUILLEME saw
+several in the eye of a cow; and the case was published by GORIER, a
+veterinary teacher, in his memoirs. In the report of the proceedings of
+the veterinary school at Lyons, in 1822-3, there is the case of a mule,
+in which a knot of worms (crinons) was seen in one eye. _Two_ were
+extracted; (why no more is not said;) and another subsequently. No
+inflammation was produced; but a violent nervous agitation of the head,
+and a turning of it to the left side took place. Next follows an account
+of a memoir read before the Medical Society of Calcutta, but of which
+the name of the author is not given. He is represented as stating, that
+the strongylus armatus minor of RUDOLPHI, and the _filiaris_ (filaria)
+papillosa, are frequently found in the eyes of the horses in India, but
+much more so in the cellular membrane, particularly about the loins. He
+believes that they make their way into the blood-vessels, and, through
+them, into the eye. Their most ordinary seat is the cellular membrane of
+the loins; where they exist for years, producing emaciation, and, at
+length, paralysis of the hind legs. This last the Calcutta author is
+represented as ascribing to the penetration of the spinal marrow; but he
+does not appear to have verified it by dissection. TREUTTLER says, he
+has seen the strongylus armatus in _aneurisms_ of the mesenteric artery
+of the horse; but the writer in the Bulletin doubts whether any have
+ever been found in sound arteries.
+
+Dr. KENNEDY, in the Edinburgh Philosophical Transactions, describes a
+worm, which he calls _ascaris pellucidus_, (pellucida,) as being common
+in the eyes of horses in India. A review of BREMSER'S work on worms is
+expected in our next, and inferences will then be drawn from these
+singular facts.
+
+16. _Digestion._--MM. LEURET and LASSAIGNE, in their very interesting
+and valuable experimental essay on this subject, have met with many
+curious results.
+
+They found no remarkable difference in the saliva of carnivorous and
+herbivorous animals. The purest saliva was obtained for their
+experiments directly from the parotid duct, in man, the horse, and dog.
+The composition was as follows:
+
+Water, 99 parts; mucus, traces; albumen, soda, chloride of sodium,
+chloride of potassium, carbonate of lime, and phosphate of lime, 1 part.
+Total, 100.
+
+Their experiments on the bile confirmed the results of THENARD and
+CREVREUIL.
+
+The pancreatic juice is of the specific gravity 1.0026; at 15° of the
+thermometer: (centigrade, we presume.) Its composition is:
+
+Water, 99.1 parts; animal matter soluble in alcohol, animal matter
+soluble in water, traces of albumen, mucus, soda, chloride of sodium,
+chloride of potassium, and phosphate of lime, 0.9 parts. Total, 100.
+This greatly confirms the analogy long observed between the pancreatic
+liquor and the saliva.
+
+In the _gastric liquor_, there are:
+
+Water, 98 parts; _lactic acid_, muriate of ammonia, chloride of sodium,
+animal matter soluble in water, mucus, and phosphate of lime, 2 parts.
+Total, 100.
+
+Dr. PROUT and Mr. CHILDREN have announced the gastric acid, of which so
+much has been said, to be the muriatic, while M. CHEVREUIL had stated it
+to be the lactic. MM. LEURET and LASSAIGNE confirm the results of
+CHEVREUIL, and that with great confidence in their own accuracy. They
+found the contents of all the four stomachs of ruminating animals acid.
+MM. PREVOST and LEROYER had stated those of the three first to be
+alkaline. The observations of LEURET and LASSAIGNE agree with those of
+MONTEGRE, (vide Dict. des Sci. Med.) who believes digestion to produce
+acidity as a result of the regular process.
+
+The _fæces_ become alkaline.
+
+_Substances which contain no azote, from whatever class they are
+obtained, cannot serve for nutrition._ We cannot understand this,
+especially when compared with what follows. "If, on the contrary, they
+are soluble, one part is absorbed and another is expelled, either by
+urine or by the anus; such are sugar, gum, &c." This seems to us like a
+contradiction.
+
+It is impossible, in the present state of science, to determine the
+chemical change which aliments undergo in the digestive organs; both on
+account of their mixture and the insufficiency of our means of analysis.
+
+"The absorption of chyle takes place by the villi." "These communicate
+directly with the lacteals and the vena portæ."
+
+"The transference of the chyle takes place by the lacteals;
+nevertheless, if they are obliterated, _this may be done through the
+vena portæ_."
+
+_The section of the pneumo-gastric nerves does not stop the dilution of
+aliments in the stomach, or chylification._
+
+The juices secreted by the liver and pancreas, are poured into the
+intestines in greater quantity during digestion than at any other
+period; in consequence of the contact of the acid chyme with the biliary
+and pancreatic orifices.
+
+The pancreatic juice is analogous to the saliva.
+
+The spleen is an appendage to the liver; it swells during the absorption
+of liquids by the vena portæ.
+
+Liquid aliments are digested, just as much as solid; but they do not
+require so great a quantity of gastric and intestinal juices.
+
+Watery drinks are absorbed in the stomach and intestines, by the
+radicles of the vena portæ. Spirituous drinks occasion an afflux of the
+gastric juices, become acid, and are absorbed.
+
+Excrements owe their colour and odour to the bile, and their
+consistence to the absorption of a portion of the water they contain.
+They carry off a large amount of the nutriment.
+
+Great obscurity still remains as to the cause of hunger.
+
+Thirst is thought to be produced by the drying which the pharynx
+undergoes, from the passage through it of the air used in respiration,
+and at a time when the supply of mucous fluid is scanty.
+
+Our readers will have perceived, long ere this, that here are several
+propositions at war, not only with our received opinions, but with the
+experimental researches of some others among the modern physiologists.
+We do not know what Dr. WILSON PHILIP would say to his observations
+being so cavalierly dismissed: they seem scarcely to condescend to
+mention his name in France. Not having the original, we could do no
+better than translate, almost literally, the conclusions of these
+experimenters, as stated in the Bulletin; and the result of this is what
+we have just given our readers. From the words "the absorption of
+chyle," to the end, is nearly verbatim the language of the review.
+
+
+III. PATHOLOGY.
+
+17. _Dothinenteria. Pustules of the small Intestines._--From [Greek:
+dothinê], a pustule, and [Greek: enteron], an intestine. This name is
+given to a disease which has been described by M. BRETONNEAU, of Tours,
+and, after him, by SERRES, BROUSSAIS, ANDRAL, and several others, and
+consists in pustules, generally situated at the lower end of the ileum.
+
+We are constantly lamenting to ourselves the contracted bounds allotted
+to our Quarterly Summary. Indeed, were it not for other objects, it
+might occupy, with advantage, half of the number, and most of the time
+employed in the preparation of the work. Every thing must be curtailed,
+though cut off at the most interesting and valuable point; and the
+painful exertion of the attention, necessary to condense information for
+our readers' use, of the amount of which they cannot possibly be aware,
+can only be equalled by the constant feeling of disappointment at
+rejecting so much important matter.
+
+We are told that this pustular disease is as common and as destructive
+as the _small pox_, (indeed!) the measles or the scarlatina; that few
+persons spend the whole of their lives without having, at some period,
+suffered by it; that it never affects individuals but once; and that it
+is suspected of being contagious.
+
+M. BRETONNEAU has prepared a set of specimens, taken from the bodies of
+those who have died in various stages of this complaint. He traces the
+malady day by day, with a precision which we will not copy here. The
+seat of this affection is the glands of PEYER and BRUNNER. The former
+are found in groups, throughout the lower half of the jejunum and the
+whole of the ileum, gradually increasing in the size and number of their
+clusters, till they reach the valve of the colon, where they cease. They
+have been mistaken by some dissectors of the modern school for the
+effects of inflammation. They are found in honey-combed patches; which
+are agglomerations of mucous glands. The glands of BRUNNER are thinly
+dispersed mucous follicles which are scattered singly throughout the
+whole length of the small intestines, with nearly equal frequency. These
+organs are well described by HALLER in the great Physiology. They are
+not seen well, unless in a young subject, and by cutting into the
+intestine very close to the mesentery.
+
+When inflamed, they swell and thicken, and, after some days, the
+membrane around them assumes a reddish tint. The mesenteric glands are
+enlarged. M. BRETONNEAU has seen one as large as a hen's egg: they
+generally equal in size that of a pigeon. The disease spreads and
+affects an additional number of glands. It reaches its acme generally on
+the 9th day; after which sometimes all, and always a part of the
+affected glands return to their natural condition, by resolution of the
+inflammation. Those which are to run the full course of the disease
+continue to augment in size and projection into the intestine. On the
+13th and 14th days they are discovered tinged with bile, which
+penetrates their substance, and thus proves the occurrence of
+disorganization. On the 15th and 16th, the sloughs separate, and leave
+from one to six ulcers. These penetrate the gland, and with it the
+mucous membrane, of which it forms a part, and next, the cellular tissue
+of the intestine. In numerous instances they perforate the muscular
+coat, leaving nothing but peritoneum at the bottom; and frequently,
+passing this, they induce inflammation of the cavity of the belly, and
+death.
+
+The cases of simple resolution terminate in three weeks: those in which
+sloughs are formed, in from 30 to 40 days, if not fatal. If death be
+from peritonitis, it is of course soon after the 15th and 16th days; if
+from exhaustion, at periods varying according to the strength of the
+sufferer. Dothinenteria occurs in many of the cases commonly called
+typhus fever, gastro enteritis, &c. It is proper to remark that both the
+author and the journal are in opposition to Dr. BROUSSAIS.--_Archives._
+
+18. _Dr. Broussais._--While the opinions of this celebrated reformer
+have been gradually becoming more extensively known among our
+countrymen, the war has prevailed with increased heat in his native
+land. The most vehement attacks are made, from various quarters, upon
+his system of _medicine physiologique_. No one appears to deny that he
+has clearly proved the existence of mucous gastritis and enteritis in
+many or most fevers, or the propriety of directing a part of the
+remedies to them. Criticisms and invectives are freely emitted: but they
+are only levelled against the too extensive application of this
+doctrine, and the inconsistencies, unquestionably often real, of the
+system of which he has made it the foundation. Indeed, if the quotations
+given are correct, we think no one who has not assumed a party, can
+refrain from concurring in their condemnation.
+
+"Those who understand our doctrine never attack it; they speak of it
+only to express their admiration: above all, they never think of wishing
+to modify it, because they know that its fundamental dogmas are
+unshakeable." "Surtout ils ne s'avisent jamais de vouloir la modifier,"
+&c. A man who assumes such ground as this, had need be very careful in
+assuming his positions, indeed; and should particularly avoid any thing
+like self-contradiction.
+
+The _Lettres a un medecin de province_, in a style of lively criticism,
+labour to show a great variety of inconsistencies in this immoveable
+doctrine. The review of this publication in the Revue Medicale,
+including copious extracts, coincides with, and evidently wishes to aid,
+the author's satire. In the same journal are a series of criticisms on
+some of the elementary propositions of Dr. BROUSSAIS, published in a
+late edition of his Examen; (nearly the same which were published here,
+some time since, in the American Medical Recorder, having been
+translated by Dr. ATKINS.) In these critiques, great severity is shown,
+in dealing with the new dogmas, and the doctrine is treated as one of
+dangerous tendency; while, at the same time, high praise is awarded to
+their author, for his discoveries in the diseases of the alimentary
+mucous membranes.
+
+In the other journals, there is a division; some favouring the new
+opinions, while others oppose them with more or less of vehemence.
+
+That the doctrine of gastritis has made a great impression at Paris,
+that almost every one believes in it, to a greater or less extent,
+appears undeniable; but there, as well as here, most of the more
+rational, and moderate minded men are evidently of the only school a
+physician ought to belong to, the _eclectic_. Borrowing largely from
+BROUSSAIS, and having had their minds powerfully stimulated by the
+succession of striking and novel ideas which he has introduced, they
+think it unmanly to "bind themselves to his chariot-wheel," but form
+conclusions for themselves from every resource within their power. If
+the great French reformer really wishes to establish as absolute a power
+over the minds of his followers, as MAHOMET or PYTHAGORAS did, and as
+the above-quoted extract seems pretty fairly to indicate, he must
+certainly undergo many mortifications. Notwithstanding the
+"inebranlable" nature of his dogmas, M. MIQUEL has furnished us with
+several variations from them, in the writings of Messrs. BOISSEAU,
+ROCHE, SANSON, REMUSAT, RICHOND, and BEGIN; and the last-named
+individual has had a public dispute with his preceptor.
+
+M. BEGIN has produced his promised work on surgery, according to the
+principles of the new school. We have not seen the volume, but have read
+a review of it in the Revue Medicale, by M. BELLANGER. The latter
+describes it as a cursory work, having for its object the adaptation of
+surgery to a set of general principles, rather than a detailed system
+of instructions how to proceed in each individual case. It contains only
+what is easy to be remembered, and omits those matters for which it is
+usual to refer to books. Thus two pages only are appropriated to
+fractures of the body and neck of the femur! and twenty-six for the
+whole subject of fractures, wounds, and six or eight of the most
+important diseases, of bones! Yet all this criticism is not without a
+compliment, well-merited at least by the former productions of the same
+author, to his talents and ingenuity.
+
+19. _Whooping-cough._--"There is no disease of children, in which the
+resources of medicine are more manifestly serviceable than in an
+obstinate whooping-cough." Such, in amount, was the opinion of Dr.
+UNDERWOOD, and Dr. WATT uses language almost equally strong. Certainly,
+we are not at all times equally successful or equally sanguine in
+America.
+
+Dr. A. CAVENNE considers whooping-cough a true bronchitis, a pulmonary
+catarrh; accompanied with greatly heightened nervous symptoms, owing to
+the irritable period of life at which it occurs, and particularly to its
+frequent existence in nervous constitutions. Professor TOURTELLE calls
+it a pneumo-gastric, pituitous catarrh; and certainly, the pupils of a
+modern school will find no difficulty in recognizing symptoms of
+gastritis in its severer forms. The further inferences drawn by Dr.
+CAVENNE, are as follows:
+
+1. That the whooping-cough, in an individual of a sanguine temperament,
+requires, in general, the use of bleeding, and a debilitating regimen.
+
+2. That bleeding and a debilitating treatment are equally necessary,
+whatever be the temperament, in whooping-cough of the chronic form.
+
+3. The antispasmodics are necessary in nervous constitutions.
+
+4. That blood-letting and the debilitating treatment should be rejected,
+when the subject is endowed with a lymphatic temperament. This
+observation, says our author, is equally applicable to early infancy, in
+which lymph predominates over the red blood, and the fluids are more
+diluted.
+
+Finally, if the disease be obstinate and there be disturbance in several
+functions, there is certainly reason to believe that a lung, a viscus of
+the abdomen, or the brain, is in an unfavourable condition; (the author
+means of the inflammatory kind;) and this is ground for the moderate
+abstraction of blood.--_Journ. Univ. Feb._
+
+20. _Antiperistaltic globus. Globus hystericus._--Dr. TROLLIET, of
+Lyons, observes that hysteria cannot, with propriety, be said to exist
+in the male sex; that it arises, as its name imports, from derangement
+of the uterus, and that CULLEN and SYDENHAM have done wrong, and stand
+alone, in teaching the contrary. When there exists a real hysteria, the
+contractions are not confined to the intestinal regions, but invade the
+neighbouring parts; (quere, which of them contract?) they are always
+accompanied, when existing in a high degree, with convulsions and loss
+of the mental powers. In the intervals, the patients affected can
+satisfy their appetite.
+
+Antiperistaltic globus may occur from various causes; and either in the
+intestines or the oesophagus.
+
+That of the intestines is met with chiefly in advancing age; and is
+generally produced by daily and often-repeated pressure on the abdomen,
+as practised in various professions. Hard labour and bad diet also
+greatly aggravate it. At first pain in the intestines occurs, aggravated
+by labour; together with derangement of digestion.
+
+The sensation of a globe then appears on the lower and left side of the
+abdomen; and, after performing various circuits, finally reaches the
+stomach; from which is soon after discharged, with great relief, a
+quantity of gas, issuing from the mouth. Vomiting of an acid and burning
+fluid, as also of the food, is not uncommon as an accompaniment. This
+ball is about the size of a man's fist, and is sensible to the external
+touch, and even to the sight. The patients possess the power, to a
+certain extent, of controlling its motions, and relieving the pain,
+which is often extremely violent, by pressure.
+
+Indigestible food always aggravated the disease. Some could only
+tolerate milk, broth, and other fluids. A weaver was obliged to quit his
+profession, from the pressure on the abdomen which it required,
+occasioning the paroxysms.
+
+The treatment consisted in
+
+1. Avoiding the original causes.
+
+2. The use of a species of corslet, (plastron,) to prevent future
+pressure on the abdomen.
+
+3. A rigid diet. We do not understand why, firstly, articles containing
+a great deal of fecula, and, as it is said, "requiring a great action of
+the intestines," are forbidden, while, in the second place, rice is
+recommended. "Bouillon aux herbes," (a laxative decoction,) rice-cream,
+and milk, were found the best. Wine was injurious. Assafoetida and
+camphor were useful, and were administered in boluses. Purgatives were
+injurious. Emolient enemas were useful.
+
+Of antiperistaltic globus in the oesophagus our author saw only two
+cases, which were not complicated with hysteria. The patients had both
+been subject to rheumatism; and, in one of them, this had been
+supplanted by an eruption Of tetter: on the disappearance of which last
+the globus appeared. These cases were cured, the latter by a severe,
+light diet, and some antispasmodics, the names of which are not
+mentioned; the other by curing the rheumatism.
+
+Dissections are somewhat difficult to obtain; unless where some other
+more mortal disease exists. In one, scirrhus of the pylorus was found;
+the stomach greatly enlarged; the small intestines contracted, _red
+outside and gray within_. (Where was the redness situated; in the
+peritoneal or the muscular coat? We must _guess_ the latter.) The
+stomach was pale gray, and thickened. The large intestines were dilated,
+and gray.--_Journ. Univ._
+
+21. _Non-contagion of Yellow Fever._--Dr. VALENTINE, of Nancy, has
+printed a pamphlet of a single sheet, in which he finds himself involved
+in all the turmoil, through which American physicians passed during the
+period which intervened between 1793 and 1805. Dr. V. gives his
+authority decidedly in favour of the non-existence of a contagion in
+this disease; and grounds his opinion upon the innumerable cases of
+patients affected with the disease and otherwise, who have escaped from
+infected districts, without communicating the malady in any instance, to
+the persons with whom they lived; upon the healthiness of ports, from
+which it has been said to have been introduced, &c. Dr. V. is not, as
+some of his countrymen have been, unwilling, from some unimaginable
+cause, to make use of the immense mass of American evidence; though he
+observes, and with justice, that experiments should be repeated in
+France, in order to set the public mind at rest in that kingdom. He
+proposes the employment of criminals for this purpose; and recommends
+every mode of the most close contact which his imagination could
+suggest. He mentions experiments of this kind having been made in the
+United States; and by M. GUYON, of Martinique, on his own person.
+
+He quotes Dr. CHERVIN's labours, with great and just applause. This
+indefatigable and daring physician has now spent upwards of ten years in
+accumulating proofs upon this single question.
+
+At the commencement of the pamphlet, the arrangement of which does not
+seem to us to be quite clear and easy, Dr. V. gives a sketch of the
+situation and localities of Leghorn. He traces the fevers of that place
+to putrid matters, perceptible by the sense of smell; and principally to
+obstructed drains. He does not give the exact degree of heat, but merely
+states that it was excessive, and followed by heavy rains.
+
+
+IV. THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE.
+
+22. _Iodine._--In the former numbers of this journal, we offered some
+observations respecting the medicinal properties of iodine, intending
+then to present in one of our future numbers an elaborate analysis of a
+valuable work on this subject, by Dr. Manson, which appeared in England
+sometime last year.[32] Fearing, however, that the want of room and time
+will prevent us from fulfilling this task, as soon as soon as might be
+desired, we have thought that a condensed notice of its contents would
+be acceptable in this place.
+
+It appears that previously to the discovery of iodine as a medicinal
+agent, our author used the burnt sponge in bronchocele, a disease very
+common in the neighbourhood of Nottingham, where he practices. But when
+the effects of the former remedy was announced, Dr. M. prepared a
+tincture composed of one drachm of iodine to two ounces and a half of
+rectified spirit, (spec. grav. 916.) and prescribed it very extensively
+in doses of from 10 to 30 drops three times a day, according to the age
+and strength of the patient. Dr. MANSON has presented a tabular view of
+116 cases of bronchocele treated by iodine, and also a detailed account
+of 15 more cases, with appropriate remarks. Of the former, there were,
+viz:--
+
+     Males--Cured,                          10
+            Much relieved,                   1
+            Discharged for non-attendance,   1
+            Improving under treatment,       3--Total 15
+     Females--Cured,                        66
+            Much relieved,                   9
+            Not relieved,                    2
+            Discharged for non-attendance,  10
+            Improving under treatment,      14--101--116
+
+Whilst using the tincture internally, Dr. MANSON occasionally had
+recourse externally to a liniment composed of
+
+     Liniment. Sap. Comp.   [Symbol: ounce]i
+     Tinct. Iodinæ,         [symbol: dram]i _m._
+
+Some patients can bear this quantity rubbed into the tumour once, and
+sometimes twice a day; though in some, the skin is so tender, that the
+liniment cannot be so frequently used. Dr. M. prefers this liniment to
+the common iodine ointment, as less liable to evaporation. In France, we
+believe Dr. RICHOND prefers rubbing in the tincture itself. The
+following remarks are useful:
+
+"In some _individuals_, after the preparations of iodine have been given
+internally for some time, they are apt to occasion headach, giddiness,
+sickness of stomach, with some degree of nausea, langour, and inaptitude
+for exertion; when these unpleasant sensations and effects occur, the
+best plan to remove or obviate them is to suspend, for a time, the use
+of the medicine, or to reduce the dose, as may seem most expedient." A
+reduction of dose, from fifteen to twelve drops, was the plan adopted by
+our author on this occasion.
+
+2d. _Paralysis._--Want of success with the ordinary modes of treating
+this disease, induced Dr. MANSON to try the effects of iodine.
+
+"The wonderful powers of iodine, which I had recently witnessed; and a
+long previous acquaintance with the same remedy as it exists in burnt
+sponge, in reducing morbid enlargements of the thyroid gland, led me
+from analogy, to think, that in cases of palsy, from tumours or fluids
+pressing on the brain or spinal cord, or from morbid thickening of the
+investing membrane of the cord itself, iodine might prove a useful
+remedy not only by stimulating the nervous system, and removing morbid
+tumefaction and effusion, but also by correcting the strumous state of
+the constitution that often gives rise to the disease."
+
+The following interesting case as abridged in the Medico-Chirurgical
+Review, for January 1826, we take the liberty to transcribe.
+
+"J. Watterton, aged 19, was admitted into the General Hospital of
+Nottingham, on the 27th of March, 1821, having been ailing since
+October, 1819. Stated that he had at first been attacked with pain in
+the bowels, which having ceased, the lower extremities became swelled
+and painful.
+
+"After this, his neck became stiff and painful, with shooting pains from
+the neck into the left side of the head. These also disappeared, and did
+not afterwards return. This was about nine months ago, and, at that
+time, he suddenly lost the power of the left arm, and in a short time
+afterwards, that of the left lower extremity. Some time after this, he
+recovered, partially, the use of the left arm; the leg remaining
+paralytic. About this time, the _right_ half of the body was
+instantaneously and completely palsied. He has continued ever since in
+this wretched state, getting worse rather than better, passing his
+stools and urine, involuntarily. He lies on his back, and, with the
+exception of the left arm, he is completely paralytic on both sides,
+from the neck downwards. The sense of feeling is very much
+impaired--there is no distortion of the face, nor impediment of
+speech. Is troubled with twitchings in the lower extremities.
+_Purgatives--blisters to the nape of the neck, and to be kept open._
+
+"It appears that, about two years ago, he had a bloody purulent
+discharge from both ears. The left still continues to discharge a
+purulent looking matter. Purgatives were continued till the 6th of
+April, when the tincture of iodine, in doses of 15 drops, was given
+thrice a day. April 9, can raise the right arm nearly to the head; but
+the power of the lower limbs has not improved. The twitchings have
+decreased. Purgatives--the tincture of iodine to be increased to 20
+drops ter in die. 10th. Evinces some muscular power in the lower
+extremities to day--feels stronger--can retain his urine for some time.
+14th. Continues to improve. The left foot is become exquisitely
+sensible, and that extremity is often drawn up spasmodically towards the
+body. The iodine to be increased to 25 drops. 16th. The paralytic
+symptoms continue to yield to the powerful influence of the iodine. When
+his meat is cut, he can now feed himself with the left hand;--can raise
+the right hand to the chin, and draw the right upper extremity up
+towards the body. He continues to hold his water. The iodine is
+increased to 30 drops, thrice a day--from this date to the 7th of May,
+the medicine was occasionally obliged to be intermitted and again
+commenced in smaller doses. At this period, however, the patient could
+walk from his bed room to the day ward with very little assistance.
+19th. He can walk without any assistance, except that of a stick to
+steady him. June 9th, can walk without a stick. He is gradually
+recovering the power of motion and sense of feeling. Drops agree.
+Appetite good, and is allowed full diet. July 3d, the patient was
+discharged cured."
+
+Besides this highly interesting case, 24 more of paraplegia, hemiplegia,
+and partial paralysis, are given in detail, in which the iodine was
+exhibited with various success. In his prefatory remarks to this
+chapter, Dr. MANSON observes, that although he has been able to cure
+only a proportion of the cases of palsy that have come under his care
+since April 1821, yet he has been much more successful in his practice
+since that time, than he was previously with the use of all the ordinary
+means.
+
+Having succeeded so well in paralysis, Dr. MANSON was induced to try the
+effects of iodine in chorea, which he thinks is more closely allied to
+palsy than is supposed, and is linked to it by that species of the
+disease called shaking palsy. Of chorea treated with iodine, and showing
+the efficacy of the remedy, Dr. MANSON details eleven cases, and
+concludes this section with a tabular view of 72 cases treated at the
+General Hospital near Nottingham, between the 6th of October, 1812, and
+the 5th of October, 1824. In all the cases detailed by our author, the
+iodine was administered after purgatives, and throughout the treatment,
+the bowels were carefully regulated by aperient medicines.
+
+Dr. MANSON next records the results of his experience with iodine in
+scrofula--detailing three cases of scrofulous enlargement of the
+conglobate glands--two of scrofulous ulcers, and four of scrofulous
+ophthalmia; in all of which, the most beneficial effects were obtained.
+Our author details eleven cases of fistula lachrymalis, in which iodine
+produced the happiest results. He was led to prescribe iodine in this
+disease from the circumstance, that one of the individuals to whom he
+gave it for paralysis, laboured under the fistula, and was promptly
+relieved of it, whilst under the use of the remedy.
+
+Dr. MANSON has likewise detailed nine cases of deafness cured, or
+greatly relieved, by iodine. In most of these cases, the disease
+originated from obstruction of the Eustachian tube, the consequence of
+swelling of the tonsils, or of the membrane of the tube itself, from
+previous inflammation.
+
+Seven cases of dysphagia, eleven of white swelling, four of morbus
+coxarius, and eleven of distortion, form the subjects of the four
+succeeding sections. The medicine in all these cases, manifested so very
+decided a power in arresting the progress, and even in curing the
+disease, that we think ourselves safe in recommending a trial of it in
+similar cases. As the iodine, however, is a powerful stimulant, we would
+advise it not to be prescribed when there exists any fever, and
+especially when there are any decided signs of gastric irritation, as it
+would be likely to aggravate it.
+
+23. _Non-mercurial treatment of Syphilis._--In the first number of this
+Journal, we inserted an essay on this subject, by Dr. THOMAS HARRIS, of
+this city, in which the author confirms, by the results of his public
+and private practice, the statements of the British army surgeons
+respecting the efficacy and safety of the non-mercurial treatment.
+Since that period, having noticed that, by the worthy editor of a
+respected cotemporary, it is asserted that though mercury fails, "yet
+from the most ample experience in Europe, the present practice of Paris,
+England, Ireland, and the Continent generally, we must lean to the idea,
+that its use, under proper regulations, must be always adopted, as the
+only safe mode of cure in these diseases," we deem it but justice
+towards Dr. H. to call the attention of our readers to the result of the
+extensive experience of some physicians on the continent of Europe. Not
+to mention BROUSSAIS himself, who appears to have rejected mercury
+almost entirely in the treatment of primary or secondary symptoms, we
+may cite Mr. RICHOND, who reports that he treated, at the military
+hospital of Strasburgh, nearly 3000 cases of syphilis in all its grades,
+the vast majority of which were completely cured without mercury, and
+simply by means of antiphlogistics, emollients, and revulsives. Mr.
+RICHOND, besides some essays in the Archives Medicales, and a summary of
+his experience in the preface to his work on apoplexy, has lately
+published an elaborate work on the subject. In the October number of the
+Annales de la Médecine Physiologique, Mr. BECQUART of the military
+hospital of Bayonne, details twenty-six cases of gonorrhoea,
+inflammation of the testicles, chancres on the glans and lips, buboes,
+excrescences around the anus, &c., all of which were cured without
+mercury, and with the same remedies as were employed by Mr. RICHOND. We
+might adduce the testimony of other French physicians, and particularly
+of M. BEGIN, but we deem it unnecessary, as the above will be sufficient
+to show that in France the practice meets with the support of many very
+intelligent physicians. We annex the conclusions of Dr. OTTO of
+Copenhagen, drawn from an extended personal experience, and from his
+researches on the subject. Dr. OTTO'S essay is contained in a late
+number of Gräafe's and Walther's Journal, and the conclusions are
+published in the Edinburgh Medical and Surgical Journal. Dr. O. remarks:
+
+1. That the cure of syphilis, without mercury, has been asserted by so
+many authorities, that the fact can no longer be doubted. If, then, the
+disease could formerly be cured without mercury, it may certainly now be
+much easier, as it has lost much of its violence and obstinacy.
+
+2. Syphilis can undoubtedly be radically cured in this manner; but then
+the cure is of longer duration, and the diet requires considerable
+restriction.
+
+3. The secondary symptoms, and a return of the complaint, are certainly
+more frequent; but the symptoms are not so difficult of removal; and the
+treatment has a much more speedy effect.
+
+4. As the treatment without mercury requires a longer time, it appears
+more practicable in hospital than in private practice; and on the other
+hand, the patient can be better watched in a hospital, which, on account
+of the diet, is of great importance.
+
+5. As ulcers on the genitals are often not syphilitic, and the use of
+mercury is contraindicated from a predisposition to scrofula or phthisis
+existing in the individual, it is consolatory to learn from the results
+of experience, that this medicine is not always necessary, and that a
+radical cure, by more simple and innocent means, can sometimes be
+effected. Where, however, the physician is anxious to avoid the possible
+evils which mercury is capable of producing, and also to prevent loss of
+time, there remains a middle way, namely, to employ mercury, whose
+specific action can scarcely be denied, in moderate doses.
+
+It results from a report of the cases of syphilis admitted into the
+public institutions of Sweden, that 3,574 were treated in 1822; 3,465 in
+1823, and 3,355 in 1824. During the course of this last year, 55-3/10
+per centum of all the patients were treated by the mercurial method, and
+35-1/10 per centum by the non-mercurial method, and by low diet; 2-1/2
+per centum by means of fumigations. MM. KESSLER, WURSTER, RONBERG, and
+SANDMARK, prefer the dietetic method, and consider it as the surest of
+all those hitherto employed. Relapses are rare. In 1822 they amounted in
+relation to the whole number of cases, to 11-2/3 per centum; in 1823 to
+10-1/4, and in 1824 to 10-2/3. After the treatment by starvation, they
+amounted in 1822 to 7-3/4 per centum; to 7-1/3 in 1823; and to 8-1/3 in
+1824. After the mercurial treatment, in 1822 to 17-1/2 per centum; in
+1823 to 14-1/16; and in 1824 to 14-1/2. _Bulletin des Sci. Med._
+
+We hope to lay before our readers at some future period, an analysis of
+Mr. RICHOND's work above alluded to, as well as of one on the same
+subject by Mr. JOURDAN of Paris, author of some essays on the origin of
+syphilis, translated and published here a few years ago.
+
+24. _Cancer treated by Antiphlogistics._--Of all diseases classed among
+the opprobria medicorum, cancer has hitherto been justly viewed as
+holding the most conspicuous rank, and it is only within a short time,
+that it appears to have been treated on correct principles, and that
+cures have been detailed by individuals of undoubted veracity. The idea
+of the inflammatory nature of cancer, and of the propriety of treating
+it by means of antiphlogistics, has been held many years ago, and
+supported by VASALVA in Italy, FEARON in England, HUFELAND in Germany,
+POUTEAU and VACHER in France, not to mention other high authorities.
+But, notwithstanding the success attending this practice, it was too
+simple for the supporters of cancerous humours and specific
+inflammations, and seemed, in consequence, to have been abandoned by
+them, in their search after anti-cancerous or specific remedies; and
+little was heard of it, until revived by the disciples of the
+physiological school of France, and particularly by its founder
+professor BROUSSAIS, and by professor LALLEMAND of Montpellier, the
+result of whose experience is published in a thesis, lately defended at
+Montpellier by Dr. MARESCHEL.
+
+We have been led to these reflections from reading the above essay, and
+another on the same subject, published by Dr. J. A. PUEL, in a late
+number of the Archives Générales de Medecine. Dr. P. details many
+cases, which were treated by his father, by means of leeches,
+emollients, purgatives, &c. so early as 1807. In most of these cases,
+the practice appears to have been very successful. As it is our wish to
+impress our readers with the propriety of making a fair trial of this
+method, in cases of scirrhus and cancer, we shall select and translate a
+few cases from the latter essay. It is proper to premise, however, that
+the practice must not be viewed as completely successful in _every_
+case, and that the older the complaint, the less confident we ought to
+be, in respect to the happy results of the case. Nor is it to be
+expected, that _boldness_ in the employment of the lancet and leeches,
+will answer as well as a perseverant, constant, but moderate use of
+these means. Chronic inflammations are not to be removed by storm, but
+by a _chronic_ use of remedies, and particularly by attention to diet.
+
+We cannot at present determine precisely the proportion of cures
+effected, by this method, of scirrhus or cancer, in a given number of
+cases, and how far it will surpass, in point of success, the common
+method of treatment by _specific_ narcotics and escharotics; but, even
+supposing that it is not more successful, (which we are disposed to
+deny,) it has at least the vast advantage of being more _comfortable_,
+and much less painful to the patient.
+
+Mrs. D. enjoying good health, and mother of three children, was brought
+to bed in 1823, of a healthy child, which, however, she did not suckle.
+With a view of suppressing the secretion of milk, irritating
+applications to the breast were resorted to, which brought on an
+inflammation of that organ. Emollient poultices were now applied; these,
+however, did not prevent the formation of an abscess, which was opened
+by means of caustic potash. The suppuration, for a few days, was
+abundant and the matter discharged healthy. Purgatives were prescribed,
+with the view of suppressing the discharge, and mercurial ointment was
+rubbed on the tumour, to produce its absorption. These remedies were not
+successful, because no means were employed to arrest the inflammation,
+which gave rise to the suppuration.
+
+When the patient applied for advice, she had been sick already four
+months, and presented the following symptoms. She was very much
+emaciated, and laboured under fever, resulting from a gastro-enteritic
+inflammation, kept up by purgatives and deostruents, (_fondans_,) which,
+from the commencement of the attack, were prescribed for her. The
+ulceration of the mamma was of the size of a five frank piece, unequal
+and gray, and gave issue to an ichorous and foetid purulent matter.
+The edges were thick and everted, and surrounded with an erysipelatous
+inflammation. The whole mamma was large and hard, and the seat of
+lancinating pain. Thirty-five leeches were applied around the tumour,
+and gave rise to a profuse hæmorrhage, which continued many hours. From
+this, the patient experienced so much relief from pain, as to be able to
+take some repose, of which she had been deprived for some weeks.
+Emollient poultices and drinks were prescribed, and a low diet enjoined.
+By all these means, the pain was lessened, and the swelling much
+diminished. Leeches were again applied, and the other remedies
+continued. The wound gradually improved, and in forty five days, was
+completely healed.
+
+Mr. P. was called on the 25th of September, 1817, to attend a lady, who
+had been affected for two days with uterine hæmorrhage, which he
+succeeded in arresting. The following history of her complaint was given
+to him: she had aborted about 18 months before, and since that time, had
+experienced every fortnight an uterine hæmorrhage, which generally
+lasted five or six days. During the intervals, she complained of deep
+seated pain, numbness and cramps, in the lower part of the abdomen, in
+the thighs and groins. The pain was much aggravated when she had a
+stool--walking, especially when long continued, was painful, and
+attended with a sense of dragging, which was only relieved by repose.
+From the same period, her disposition had changed from gay and lively,
+to melancholy and morose--her digestive functions were slow and
+painful--she was affected with leucorrhea, and during coition, felt much
+pain, and often lost some blood. On examination per vaginam, it was
+found, that the neck of the uterus was elongated--the anterior lip of
+the same organ was soft to the feel--the orifice somewhat enlarged, and
+painful when the finger was introduced into it. On the inferior lip
+there was a small unequal and painful spot, which was regarded as a
+superficial ulceration; the uterus was a little prolapsed, and somewhat
+enlarged; the pulse small and frequent; febrile exacerbations every
+evening; sleep not refreshing, and interrupted by short lancinating pain
+in the uterus.
+
+The disease was judged by Mr. P. to be a chronic metrites, with
+ulceration, and all the symptoms usually attending incipient cancer.
+Guided by this belief, and notwithstanding the already long duration of
+the disease, and the debility of the patient, the following treatment
+was adopted--complete repose in the horizontal posture--leeches to the
+vulva, repeated several times--vaginal injections, with emollient
+decoctions--hip baths--very low diet. After persevering in this plan
+twenty days, the patient appeared much better, and was allowed to sit
+up. General baths were substituted for the partial ones. The same
+treatment was continued, with the exception of the leeches, and at the
+end of thirty days more, all the symptoms of the disease had completely
+disappeared. Mrs. P. was allowed to spend the following spring in the
+country, from whence she returned in very excellent health. She has
+since continued to enjoy it, and has borne several children.
+
+Cases nearly similar, are detailed by Mr. MARESCHAL, as having occurred
+in the practice of professor LALLEMAND. The same gentleman, also gives
+the history of two cases of external cancerous sores, in which the same
+treatment was adopted. The patients having died during the progress of
+the cure, of other diseases, an opportunity was offered, of examining by
+dissection, the changes that had occurred in the parts. We cannot
+enlarge on the subject in this place, and can only remark, that these
+changes were such, as to lead us to hope, that less difficulty will be
+experienced in the treatment of sores reputed cancerous, by the local
+antiphlogistic plan, than is commonly supposed. At any rate, recommended
+by such high authorities, the practice deserves a trial.
+
+The Revue Medicale for February 1826, contains the details of a case
+lately cured at La Pitié, by Mr. LISFRANC. The patient, a woman, aged 36
+years, of a strong and good constitution, had suffered the removal of a
+cancerous breast, 18 months previous to her admission into the Hospital,
+on the 10th October, 1825. The following symptoms were observed. On the
+whole surface of the cicatrix were felt a number of engorged ganglia,
+and an induration situated on the large and small pectoral muscles, and
+spreading from the clavicle to all the external and superior part of the
+thorax, and as far as the axilla, where other swollen ganglia were felt.
+The enlarged surface was elevated about half an inch above the level of
+the chest. Severe lancinating pains were at short intervals felt by the
+patient--which came on without any evident cause, and were particularly
+severe on the least pressure of the swollen part.
+
+This patient was treated by means of frequent and copious bleeding from
+the arm--the very frequent application of leeches to the inflamed part,
+and to the upper and interior part of the thighs, to bring on
+the menstrual discharge--digitalis to remedy the frequent
+palpitations--emollient applications, and low diet. On the 10th of
+January, she was considered well;--the swellings and pain having
+disappeared--the menstrual discharge being well established, and the
+movement of the arm (which during the progress of the disease had been
+impeded from the swelling in the axilla) perfectly free.
+
+We are happy to learn that this practice is pursued with success by the
+Spanish physicians, as may be readily found by a reference to a late
+number of the Periodico de la Sociedad Medico Quirurgica de Cadiz, which
+contains cases of scirrhous mamma cured by the repeated application of
+leeches.
+
+25. _Essential oil of Male Fern, as, a remedy in Cases of Tænia._--The
+male fern has long been regarded as a valuable anthelmintic medicine;
+but, as every powder administered in large doses, its exhibition is
+difficult and disagreeable; so much so, indeed, that many patients
+refuse to make a sufficiently constant use of it to ensure its
+beneficial effects. Struck with this inconvenience, M. PERCHIER, a
+pharmaceutist of Geneva, has lately made some experiments with a view of
+discovering its active principle, and to see whether this latter may be
+administered with equal success with the powder or infusion of the
+plant. We are happy to learn that the result of his experiments are very
+satisfactory. We translate the following observations from a memoir on
+the subject, read on the 7th of October last, by Mr. GENDRIN, before the
+medical society of the department of the Seine. "This medicine, which
+is a fatty oil extracted by distillation from the æther, in which the
+powder of the root of the male fern has been macerated, has caused in
+many cases, the expulsion of the tænia, without occasioning nausea,
+colics, or any other morbid phenomena." "It is exhibited at bed time,
+either in an oily potion, in pills, or incorporated in an electuary, in
+doses of 18 or 20 drops. On the following morning, a similar dose is
+given, and two hours after, two ounces of castor oil are administered.
+In most cases, the tænia is expelled in the course of the day, but if
+this does not occur, the same doses of the oil are given in the same
+way, and followed by a similar quantity of the castor oil. The fatty oil
+of fern, has an æthereal and empyreumatic smell; its colour is brown,
+and its consistence rather greater than that of castor oil; it is,
+however, easier to separate in drops. Its taste is acrid, pungent,
+empyreumatic, and very disagreeable."--_Propagateur des Sciences
+Medicales, Janvier 1826._
+
+26. _Tincture of Bastard Saffron[33] for the expulsion of Tænia._--Dr.
+CHISHOLM, of Canterbury, has lately used with success, in a case of
+tænia of many years standing, the vinous tincture of bastard saffron.
+The patient had already undergone various plans of treatment, and had
+especially used the oil of turpentine in very large doses. Dr. C. was
+induced to try the above remedy, from having noticed, that in a case in
+which it had been prescribed for the cure of rheumatism, a large portion
+of tænia had been expelled. He consequently administered two ounces of
+the tincture; advising the patient to take a table spoonful more of it
+mixed in a little water, two or three times a day. On the third or
+fourth day after commencing the use of this remedy, the patient voided a
+large portion of the worm, and has since been free from the usual
+symptoms of the disease.
+
+27. _Oil of Turpentine in Tænia._--Although the oil of turpentine is
+used in many parts of this country, in cases of tænia, we have good
+reasons for believing, that some physicians continue, notwithstanding
+the testimony in its favour, to hesitate exhibiting it in doses
+sufficiently large to destroy and promote the expulsion of the worm.
+Such being our opinion, we are induced to offer here a few remarks on
+the subject, and to notice a memoir published by Dr. DE POMMER, in a
+late number of Hufeland's Journal. The employment of this remedy in such
+cases, is not of recent origin, having been resorted to many years ago
+by the Swedish practitioners, and subsequently revived by the English.
+In Germany it has recently been used by Professor OSAN, and we believe
+particularly by Dr. DE POMMER, who appears to have prescribed it boldly
+in very many instances, and in some, after the ineffectual employment of
+all other anthelmintics. Dr. P. adds, that he never saw any bad effects
+resulting from its use, and that patients are very little liable to
+relapses when treated by it.
+
+Among the cases detailed by Dr. DE POMMER, we select the following, as
+calculated to show the manner in which the Dr. uses the remedy.
+
+"G.K..., a soldier aged 21 years, thin, tall, and who during his infancy
+had been subject to ascarides, has occasionally voided during more than
+10 years past, portions of tænia. He had used several purgative
+medicines, by which several yards of this worm had been expelled; but
+annoyed with so many attempts at obtaining its total expulsion, he had
+ceased, three years before, the use of all sorts of anthelmintics. But
+the phenomena resulting from the presence of the animal being
+aggravated, the patient applied for advice to Dr. DE POMMER, who found
+him labouring under the following symptoms:--Frequent pain in the
+abdomen, and especially in the umbilical region, accompanied with a
+sense of burning heat, and alternate distension and depression of the
+abdomen. Appetite sometimes keener than in health; at others nearly
+lost. In the morning before breakfast, the patient was seized with
+extraordinary weakness, and general uneasiness, accompanied with
+trembling of the limbs, ineffectual attempts to vomit, a sense of
+constriction in the throat, and a profuse salivation. All these symptoms
+disappeared after K... had taken food; but reappeared two hours after.
+Milk and farinaceous aliments were the only articles of which he could
+make use without an aggravation of his disease. The pulse was febrile;
+sleep good, but attended with dreams. The pupils were in the natural
+state. From the symptoms, and from the history of the case, Dr. P. was
+induced to make use of the oil of turpentine in the following manner.
+The patient was ordered in the morning, before breakfast, three table
+spoonsfuls of the remedy, at half an hour's interval. The first doses
+produced only a few borborygma. Two more table spoonfuls occasioned a
+vomiting of mucous matter. Three more table spoonfuls were exhibited,
+and followed by a stool of solid fæces, mixed with which were five small
+pieces of tænia. The patient not finding himself incommoded, took in the
+space of an hour, three more table spoonfuls of the remedy, after which
+he experienced some pain in the head, and vomited about one pint of
+bilious liquid. An hour after, the same quantity of the medicine was
+taken, and followed again by vomiting, but after a repose of half an
+hour K... discharged, per anum, firm and greenish fæces, and with them
+five ells of tænia. The urine discharged had the smell of violets. He
+again took a few spoonfuls of the vermifuge, which were not followed,
+however, with any fæcal discharge, and only with some vomiting of mucus,
+and slight vertigo. In the afternoon the patient felt well, and
+experienced a great appetite, in which he indulged. From this moment he
+recovered, and has ever since enjoyed good health. The quantity of the
+remedy used was six ounces."
+
+It appears, from the observations of Dr. P., that the gastric irritation
+occasioned by the spirits of turpentine, has never amounted to
+phlogosis, and has generally subsided after the remedy had been
+discontinued. Nevertheless, as the spirit of turpentine is a very
+powerful stimulant, we would not venture to recommend its use, when
+there exists an inflammation in the gastro-enteritic system. We are
+aware that it is resorted to in burns, and highly eulogized in puerperal
+and yellow fever. In the first, it is certainly very useful, but on what
+principle we know not, except perhaps that its stimulus is different
+from that existing in the diseased part. But in the second case, it
+acts, not on the diseased surface, but by revulsion, on the mucous
+membrane; and as regards its virtues in yellow fever, we are rather
+sceptical in respect to what has been said on the subject. In this
+opinion we are supported by the testimony of our friend Professor RHEES,
+whose situation of house surgeon to the fever hospital, during the
+epidemic of 1820, afforded him ample opportunities of testing the
+propriety of the practice.
+
+In the number for March 1826, of the Revue Medicale, M. MAUDRU relates
+two cases in which large portions of tænia were expelled, and the
+patients cured, by means of a strong decoction of the bark of
+pomegranate. The first patient took, in one day, two pounds of the
+decoction made with four ounces of the remedy. The second patient took
+six ounces of the bark in decoction, in the course of forty-eight hours.
+In neither case did the medicine occasion unpleasant effects, with the
+exception, in the second patient, of slight colicky pains.
+
+28. _Action of the Oil of the Euphorbia Lathyris._--At a meeting of the
+Academy of Medicine, (section of pharmacy) M. BALLY read the results of
+some clinical experiments made by him at the hospital of La Pitié, on
+the action of the oil of the euphorbia lathyris. The preparation used by
+him, had been made by means of alcohol and expression. It appears to be
+a little more active than the other preparations. Administered to
+fifteen individuals of different ages, it did not produce very various
+results, nor prove very active in its purgative effects. As a purgative,
+indeed, it is far less active than the croton oil, and requires to be
+given in much larger doses; as much as six or ten drops. It has also the
+bad property of exciting emesis, by which it is rejected from the
+stomach. On the other hand, however, it does not, like the croton oil,
+produce salivation, and is, on the whole, regarded by M. BALLY,
+especially when fresh, as a useful purgative in diseases of
+children.--_Archives Generales, Decembre, 1825._
+
+29. _Medicinal properties of the Apocynum Cannabinum, or Indian
+Hemp._--In an essay on this plant, submitted to the medical faculty of
+Jefferson College, by Dr. M. L. KNAPP, we are informed, that in doses of
+15 or 30 grains it possesses emetic properties. It was besides, on
+trial, found to be cathartic, expectorant, diuretic and diaphoretic. It
+appears to have been generally administered in powder, and Dr. K.
+remarks, that "in decoction, it seems to lose some of its emetic
+properties, and to act more upon the bowels as a hydragogue cathartic."
+"The root possesses all the medicinal properties of the plant, and is
+active throughout, both in its cortical and ligneous portions. Water or
+proof spirit is its proper menstruum."
+
+This article was prescribed with success in dropsy, by Dr. KNAPP, and
+by Dr. PARRISH of this city. It was likewise used in intermittent fever,
+in bilious affections, amaurosis, hernia humoralis, dysentery, chronic
+rheumatism, &c. Dr. KNAPP appears to have derived benefit from its use
+as an alterative in a case of fever in a child, attended with disordered
+bowels. "The powders (gr. ii. each at intervals of three hours,) were
+regularly persisted in for a week, and the child's health went on
+gradually improving. Neither vomiting nor purging was produced, but the
+morbid heat and thirst were allayed, the stools became natural, the skin
+soft and moist, and the functions of digestion and assimilation were
+gradually restored, and the child is at this time fat and
+healthy."--_American Medical Review, &c. April_ 1826.
+
+30. _Remarkable effects from the external application of the Acetate of
+Morphia._--M. DUBOURG has recently published the result of an experiment
+made at the hospital de la Pitié, with the acetate of morphia, which we
+regard as sufficiently interesting to be noticed in this place. The
+patient had been affected twelve months before with puerperal peritoneal
+inflammation, complicated with cerebral symptoms, from which,
+notwithstanding a most energetic antiphlogistic treatment, she never
+entirely recovered. When she was admitted into the hospital, she
+presented the following symptoms:--"considerable emaciation; skin hot
+and pungent to the feel; pulse small and frequent; tongue of a pale rose
+colour, dry at the tip and edges, brown and smooth in the centre as far
+as the basis; severe pain on the least pressure on the epigastrium and
+over the whole abdomen; cardialgia, nausea, vomiting of all solid and
+liquid aliments, and during the empty state of the stomach, violent
+efforts to vomit occurring at irregular intervals; abdomen tense and
+tympanitic; violent intermittent pain along the course of the
+intestines; constipation; sensation of fatigue and lassitude in the
+lumbar region and in the extremities; dragging pains in the
+inter-scapular region; extinction of the voice; urine red and scanty;
+the face animated and bearing no marks of profound suffering; agitation,
+and total want of sleep."
+
+The disease was regarded as a chronic gastro-entero-peritonitis, and
+treated accordingly, by the antiphlogistic regimen; but no benefit was
+derived from this plan. The patient continued to vomit almost every
+thing she took, with the exception of sugar and a paste made with the
+Iceland moss. A blister was applied to the epigastrium on the 15th of
+February, seven days after her admission. Called to her assistance on
+the 22nd of February, on account of an aggravation of the vomiting, M.
+LAMBERT, one of the house pupils of the hospital, endeavoured to calm
+the symptoms by means of the acetate of morphia in powder, applied to
+the raw surface of the blister. Half a grain was used in this way, and
+in a few minutes the vomiting disappeared, and the patient passed a
+better night than she had yet done. M. SERRES having authorized the
+continuance of this method, M. DUBOURG the next day applied half a grain
+in the same way; and the patient slept the whole night. The remedy was
+applied every day with the same effect, and was gradually increased to
+two grains and a half. From the first application of the remedy, the
+symptoms gradually subsided; aliments were retained and properly
+digested; the pain and swelling of the abdomen disappeared, and on the
+14th of March the patient was regarded as in a fair way of
+recovery.--_Archives Generales, March_ 1826.
+
+In some remarks which accompany this interesting case, M. DUBOURG, seems
+to doubt the correctness of the first diagnosis, and to view the disease
+as a nervous, rather than as an inflammatory affection of the abdominal
+viscera.
+
+31. _Cure of Urinary Calculi by means of the internal use of the
+Bicarbonate of Soda._--At a late meeting of the Academy of Medicine, Mr.
+ROBIQUET read a memoir on the use of this salt in cases of urinary
+calculi. Having learnt from Mr. DARCET, that the use of the waters of
+Vichy changes the quality of the urine from acid to alkaline, Mr. R.
+conjectured, that this effect should be attributed to the bicarbonate of
+soda contained in them; and from this circumstance, he was led to
+administer this salt internally, in cases of calculi composed of uric
+acid. In July last, he made the experiment on a man 74 years of age, who
+had laboured under symptoms of the disease since the month of February,
+and in whom, by means of the sound, a small and soft calculus had been
+detected. Mr. R. ordered him 10 grains of the bicarbonate in the course
+of the day, dissolved in two pounds of water--prescribing at the same
+time, hip baths, injections, &c. At the end of fifteen days, much
+benefit had already resulted from this treatment; and in a month, the
+patient appeared to be cured. Nevertheless, the remedy was continued
+until November, when the patient passed through the urethra, a small
+calculus composed of uric acid, which appeared to have been the nucleus
+of a much larger one, the exterior strata of which had been worn off.
+From that period, the patient has not experienced any unpleasant
+symptom; but the sound was not resorted to, to ascertain whether the
+first calculus before felt, could be detected.--_Archives Generales,
+February, 1826._
+
+32. _Attempt to cure Abdominal Dropsy, by exciting Peritoneal
+Inflammation._--In the number of the London Medical and Physical Journal
+for April, 1826, a case of ascites is related by H. R. OSWALD, Esq. in
+which the cure was attempted to be effected, by exciting peritoneal
+inflammation. The following symptoms were noticed at the time of
+application for advice: the abdomen measured nearly six feet in
+circumference, was exceedingly hard and tense; but not tender. The
+patient "could hardly walk across her cabin from dyspnoea and
+debility, and the weight and tension of the tumour; which caused her to
+bend the body much forward, leaning her hands on her knees. The
+emaciation was very considerable; the appetite good; thirst
+considerable; tongue clean; pulse 120, and small; skin dry, harsh, and
+rough; bowels habitually costive; urine scanty." "This affection
+commenced about twelve months ago, after an obstruction of the
+catamenia for nearly a year, arising, as was supposed, from exposure to
+cold. The swelling was preceded by lancinating pains in the abdominal
+and lower part of the thoracic cavities, but which, after a few months,
+ceased entirely; and the disease had, in a chronic manner, gradually
+arrived at its present oppressive form."
+
+Paracentesis was performed several times; cathartics, diuretics, the
+lancet, blisters, and tonics were resorted to, with relief from some of
+the symptoms. The tumour, however, returned several times, so that M.
+OSWALD despairing of effecting a cure by following the same plan, and
+recollecting a case of ascites, which was cured apparently by an
+inflammation having supervened in the peritoneum, from the orifice made
+by tapping remaining open, attempted to produce the same effect in the
+present patient, by keeping the orifice of the wound open by means of a
+small tent. In this he partly succeeded, for in the course of a few
+months, all symptoms of the effusion had disappeared; health and
+strength had much improved, and the patient had experienced a return of
+the menstrual discharge, which had been suppressed for nearly three
+years.
+
+About a year afterwards, however, the disease returned. Paracentesis was
+again performed several times, and a tumour was perceived to have formed
+in the lower part of the abdomen. The patient died in about five or six
+months from the re-appearance of the effusion. On dissection, much water
+was found in the abdominal cavity, which was lined by a dense, white,
+and rough looking membrane, of a fragile and diseased structure. The
+intestines behind this membrane, were unusually small, and of a dark
+leaden colour. The tumour above alluded to, was discovered to be
+situated in the region of the right ovarium; it was a tubercular,
+carcinomatous, and pale coloured fungus, possessing a structure not
+unlike that of the placenta, and was formed in the interior of the sac,
+which being traced further back, was found to be the cyst of a dropsy,
+originating in the right ovarium at the fundus of the sac, or "more
+properly speaking of its neck."
+
+"The foregoing statement," Mr. O. remarks, "involves four facts and
+questions of considerable importance in pathology. 1st. The great
+quantity of fluids evacuated in so short a space of time: no less than
+ninety-six quarts in eight months, by four operations; and fifty-nine
+quarts from August to December, 1824, by three. 2nd. The variety in the
+nature, consistence and colour of these fluids. 3d. The possibility of
+curing ascites and dropsy of the ovaria, by exciting inflammation in the
+abdominal sac, either by the admission of air into it, or mechanical
+irritation; and 4th. The possibility of a thickening of the parietes of
+the abdomen by inflammation, or by an exudation of a carcinomatous sort,
+being mistaken for a tumour rising out of the pelvis."
+
+33. _Artificial Respiration._--Dr. J. WARE of Boston, relates in the New
+England Jour. for April last, that he was led by the experiments of the
+justly celebrated physiologist Mr. BRODIE, to employ artificial
+respiration in the case of an infant 9 weeks old, whose system was
+prostrated from an over dose of laudanum. "The action of the heart was
+reduced to an occasional throb; the pulse had entirely ceased, and the
+efforts at respiration, which for some time had consisted merely in an
+occasional gasp, became more and more unfrequent." The child had been
+afflicted for five or six weeks with hooping-cough, and had been very
+sick and feeble when the laudanum (about 15 drops) was administered.
+
+By means of the stem of a tobacco-pipe, artificial respiration was
+excited, and continued for several minutes: the action of the heart was
+immediately renewed, and the pulse could be again felt. At the end of an
+hour, during which the artificial respiration was repeated at intervals;
+"the respiration became natural, the pulse distinct and tolerably
+strong, and the heat began to return." A fit of coughing, preceded by a
+livid appearance of the forehead and face, arrested the breathing,
+"which did not return till assisted by the artificial process." The
+child, assisted by these measures, and by attention to the more usual
+means of recovery, struggled through the night, but died during a
+paroxysm of coughing in the morning.
+
+The conclusions of Mr. BRODIE are, that narcotics destroy life through
+the organs of respiration, and hence, if respiration can be artificially
+carried on until the effects of the narcotic subside, life may be
+preserved. Dr. WARE'S case would seem to confirm this idea; for it is
+_probable_ his patient would have recovered from the effects of the
+narcotic, if the paroxysms of coughing had not interfered.
+
+34. _Secale Cornutum._--Mr. CHARLES WALLER has lately published (London
+Medical and Physical Journal, April 1826,) several cases illustrative of
+the action and efficacy of secale cornutum. We have not room for any of
+the cases, and content ourselves with transcribing Mr. W.'s inferences.
+These are: "That the secale cornutum is a remedy which is capable of
+increasing the force of the uterine contractions in a most remarkable
+manner, under certain circumstances; but that the effect is doubtful,
+unless there be some degree of action present. In other words, that,
+although it will increase the contractions when already present, it will
+not always renew them when they are suspended.
+
+"That the effect is more certain if the infusion be of greater strength
+than is usually recommended; two drachms of the secale to six ounces of
+water being barely sufficient for the purpose.
+
+"That it appears to be a stimulus peculiarly fitted for irritable, and
+what are generally termed _nervous_ habits.
+
+"That the fears entertained by some practitioners of its proving
+detrimental to the child, are groundless.
+
+"But, although it is in general necessary, not only that there should be
+a disposition for labour, but that this process should have actually
+commenced, before we can expect the secale cornutum to have any effect
+upon the uterus, still one solitary case has indirectly come to my
+knowledge (and I will vouch for the authenticity of it,) where this
+remedy was given for the purpose of producing abortion in a female,
+about the second month of utero-gestation; and this effect was
+accomplished in a few hours after its exhibition."
+
+35. _Animal Magnetism._--This strange doctrine begins to acquire
+considerable vogue in France, and other European countries, from which
+it seemed to have been expelled, by the contempt and ridicule which it
+met with, from most of the learned of the latter part of the last
+century. ANTHONY MESMER, the great choroegus of the magnetic mummers,
+was born in 1733, and excited a vast deal of attention, by the enormous
+pretensions which he set forth on the subject of magnetism. MESMER came
+from Austria to Paris in 1778. He addressed the Academy of Sciences, and
+that of Medicine, but no attention was paid to him, till a commission
+was appointed to examine carefully into the merits of the question. This
+commission in 1784, so fully exposed the fallacy of MESMER'S theories
+and practice, that he soon afterwards quitted Paris, and retired to
+England under a feigned name. He subsequently went to Germany, and died
+in obscurity, in the year 1815.
+
+In December last, M. HUSSON (for himself, and MM. ADELON, BURDIN, MARC,
+and PARISET,) read a report to the Royal Academy of Medicine, on the
+question, whether it was fitting for the section to undertake new
+researches on animal magnetism, as it had been thought to be
+definitively settled by the decisions of 1784. The report concluded
+affirmatively, for several reasons; among which the principal seems to
+be, that magnetism has at present fallen into the hands of the learned,
+whereas it was formerly under the domain only of quacks and the vulgar.
+
+M. HUSSON'S report was discussed at subsequent sittings of the Academy,
+for the purpose of ascertaining whether a new commission should be
+appointed; and as this topic is certainly one of the greatest novelties
+of the day, we shall give some account of the discussions, making free
+use of the report of them, contained in the Revue Medicale, Mars. 1826.
+
+M. DESGENETTES, declared against the appointment of a commission,
+because he considered the magnetism of the present day, quite as much a
+matter of jugglery as that of 1784; and he informs us, that the
+publicity given to the report, had already increased the audacity of the
+magnetisers, who look on it as an approbation of their art.
+
+M. VIREY, regretted that the report had not spoken in strong terms,
+against the ridiculous practices, and shameful jugglery, which disgrace
+the cause of magnetism; he wished the committee had announced an
+intention, to make only physiological, or psychological researches, on
+the influence, which magnetism really appears to exercise on the nervous
+system; and gave his voice for the formation of a commission of
+experiments.
+
+M. BALLY, voted against it for several reasons, and among others,
+because of the fact announced by all the magnetisers, that the person
+who magnetises, acquires a sovereign power over the magnetisee; and he
+inferred from this, all the inconvenient and even dangerous consequences
+which may result to public morals!--Finally, he voted against it,
+because magnetism is ridiculed every where, because it is all darkness
+and confusion, and especially, because it being an inexhaustible mine of
+empiricism, the section ought not to lay open such a fertile field for
+those gentry who live by quackery.
+
+M. ORFILA, (eheu!) defended the propositions of the reporters. It is
+opposed, said he, on the three grounds following: 1st. Because the
+section has not been invited to the examination now recommended. 2nd.
+Because magnetism is nothing but juggling. 3d. Because commissions will
+not commonly do any work. The first ground is not correct: M. FOISSAC, a
+physician of Paris, has invited our attention to it, and offered to
+subject a magnetic somnambulist to its exploration; and very reputable
+physicians, members of the Academy, MM. ROSTAN, (the ramollissement man,
+is his head soft too?) and GEORGET, have in their recent publications
+called the attention of the learned to this subject. Secondly, if there
+be any jugglery, in the magnetic phenomena we are told of; it is
+nevertheless certain, that the whole of them are not simulated. The
+testimony of well taught physicians, ought to be received on this head.
+That the phenomena are extraordinary, is no argument; for those of
+electricity must have been quite as marvellous, at the period of their
+discovery, &c. &c.
+
+M. DOUBLE, blamed the report as being nothing more than an apology for
+magnetism, which is tarred with the same stick as that of 1784, and only
+modified a little, by the esprit de notre temps, &c. &c. He said he had
+made magnetism a special subject of study, and _never saw a phenomenon
+produced by it_.----He thinks the commission could only do injury to
+science, and compromit the Academy, &c. &c. He would vote against the
+appointment, and advised the section to wait until some scientific
+memoirs should be sent to it.
+
+M. LAENNEC, agreed with M. DOUBLE, because after studying the subject
+for twenty years, he is satisfied, that it is almost nothing but
+deception and juggling; although, when he commenced the study, he was
+prejudiced in its favour. According to M. LAENNEC, among the magnetic
+influences, there are several, attributable to the impressions, which
+one individual naturally makes on another in correlation with him; and
+he cited a mistake, which he saw committed by a somnambulist woman. She
+was magnetised by two persons, one of whom was handsome, but
+anaphrodisiac, the other ugly, yet possessing in integrity, the genital
+faculties. She received no impression, except from the first individual;
+so that the impression which this female had received by the organs of
+vision, before the experiment, superseded that, which the pretended
+magnetic sense ought to have made on her. He thinks, the academy ought
+to _observe_ the magnetisers, but what he has seen, has convinced him,
+that nine-tenths of the facts in magnetism are supposititious. The
+phenomena effected by magnetism, and the oracles uttered by the
+somnambulist, vary with every magnetiser. MESMER excited convulsions;
+DESLIN effected crises, such as are seen in diseases. The somnambulists
+of Mr. DELEUZE, a learned man, are much better taught than those of
+PUYSEGUR, who is ignorant of the sciences, and finally, Mr. LAENNEC has
+seen a somnambulist under the direction of a pharmacien, who was quite
+distinguished, by the art with which she compounded the medicines, she
+recommended. The discussion was now adjourned to the next sitting.
+
+On the 24th of January, it was resumed.
+
+M. CHARDEL, bears witness to a reality of the magnetic phenomena, as he
+has witnessed them himself, in a case of what is called somnambulism. He
+dares not pronounce on the question of magnetism, as a therapeutical
+agent; but is disposed to think it ought, if ever, to be used with great
+reserve. Whether it consist of nervous phenomena of a particular order,
+or whether it be a product of the imagination, in either case, it
+deserves to be studied, &c. &c.
+
+M. RONCHOUX, thought the proposed examination would be impossible; for
+the magnetisers assert, that if one of the parties have a will opposed
+to that of the magnetiser, no phenomena can be produced. Their confessed
+inability to surmount any opposite will, seems to Mr. RONCHOUX, an
+invincible obstacle to any exploration to be attempted by a commission.
+
+M. MARC, gave some explanation of the labours undertaken in Germany.
+According to the opposition, nothing conclusive can be derived from
+these labours; because Germany is the native soil of sects and of
+thaumaturgæ but, Mr. M. proved by citations, that they are not to be
+attributed to excited imaginations, as has been urged, but to the most
+celebrated Savans of that country, as for example, OERSTDT, KLAPROTH,
+and HUFELAND, to learned bodies, and to governments. The Royal Academy
+of Berlin, offered in 1818, a prize of 3300 francs, for an essay on this
+topic.
+
+The governments of Prussia, Russia, and Denmark, have founded medical
+commissions for the examination of it, and subjected its therapeutical
+application to certain regulations. He thought, therefore, that the
+Academy could follow without compromising its dignity, such good
+examples. He added, that the examination was absolutely necessary,
+unless they desired that every French practitioner should hereafter
+reject the whole subject, and for ever abandon its employment to
+jugglers and credulous fools.
+
+M. NACQUART thought, that as magnetic somnambulism is something wholly
+independent of organical, physical, or physiological laws; that as the
+senses here have no need of organs; as time, space, and intermediate
+bodies, wholly disappear; we can avail ourselves of no method of
+appreciating magnetical facts, and consequently, the Academy ought not
+to trouble their heads about it--a very good joke truly: but M. ITARD
+said, that jokes had nothing to do with the question, because they are
+meant only for the abuses and extravagancies of magnetism; but we want
+to get at the truth, and to eschew the folly. Magnetism, says he, is
+either a real or imaginary agent; it ought to be examined. To refuse
+this, is to despise the path of experiment, which can alone lead to
+truth, &c. &c.
+
+M. RECAMIER, could add nothing to the observations of MM. DESGENETTES,
+BALLY, and DOUBLE; but he wished the section to know, that he been a
+witness to the magnetic phenomena--he had been present at the oracles of
+the marichale of M. DE PUYSEGUR, who was represented as the most lucid
+of all possible somnambulists. He had reason to suspect a cheat in this
+case, as he was denied the means of dissipating his doubts; and heard
+this woman repeat what he had before said to the patient himself. How
+ridiculous, moreover, is it, to hear one drachm of glauber's salt
+prescribed as a transcendental remedy for phthisis pulmonalis! He also
+attended at the Hotel Dieu, at experiments made on one woman and two
+men. He saw the woman go to sleep (as was asserted,) at the simple will
+of the magnetiser, who for that purpose was concealed in a closet of the
+apartment. The only mode adopted, to prove that she was really asleep,
+consisted in some slight pinching of her ears, and some noises; yet, in
+the recital, these slight impressions have been transformed into most
+painful tortures. In the experiments made on the men, he employed a more
+powerful proof, which was the application of moxa; and that he did,
+because it was indicated by a coxalgia, with which the patient was
+affected: it is _a fact_, says he, that the man did not awake, or show
+_the slightest sensibility_. Mr. R. believes, therefore, in magnetical
+action; but does not think it can ever be available in the practice of
+physic. In Germany, said he, where magnetism is so much employed, do
+they cure better than elsewhere? And has magnetism been the occasion of
+any therapeutical discovery any where? In somnambulism there is only a
+disordered sensibility, and not an increase of it; and the pretended
+clairvoyance of the somnambulists, has no real existence, &c. &c.
+
+M. GEORGET, cited in proof of the existence of magnetic power, the names
+of many physicians, members of the Academy, as MM. ROSTAN and
+FOUQUIER--he cited the experiments made at the Hotel Dieu, by Dr.
+DUPORTET, in the presence of many members, who had signed the results,
+as MM. HUSSON, GEOFFROY, RECAMIER, DELENS, PATISSIER, MARTIN, SOLON,
+BRICHETEAU and KERGARADEC. If there be any analogy between magnetic and
+natural somnambulism, ought we to be astonished at the production of the
+former by certain practices? The magnetisers conceal nothing, but
+publish all their proceedings, and do you call these the tactics of
+jugglers and charlatans?
+
+M. MAGENDIE thought the examination expedient, and wished commissioners
+to be appointed to examine the somnambulist, offered by Dr. FOISSAC.
+
+M. GUERSENT was in the affirmative: he himself had magnetised, and
+witnessed several phenomena, &c.
+
+The discussion was then adjourned to the next setting, and on the 14th
+February, after hearing M. GASC against, and M. LHERMINER for the
+report, M. HUSSON the reporter was heard. The section then closed the
+discussion, and it was decided by a majority of ten, (35 to 25,) that a
+commission should be appointed to examine animal magnetism.
+
+We are indebted for the above account to the Revue Medicale for
+March--the No. for February, also contains a review of M. DUPAU'S
+Lettres Physiologiques et Morales sur le Magnetisme Animal, 8vo. Paris,
+1826. In order to show our readers how they manage these matters, we
+shall translate the following from p. 269.
+
+"Here, says M. ROSTAN, is an experiment that I have often repeated, but
+which I was finally obliged to interrupt, because it fatigued my
+somnambulist prodigiously, who assured me, that if I continued, it would
+make her go mad. This experiment was made in presence of my colleague
+and friend, M. FERRUS. I took my watch, which I placed three or four
+inches from her occiput. I asked my somnambulist, if she saw any thing:
+"certainly, I see something that shines; it hurts me." Her countenance
+was expressive of pain, and ours expressed astonishment. We looked at
+each other, and M. FERRUS breaking silence, said, if she sees something
+shine, she can doubtless tell what it is. "What do you see that
+shines?--Oh! I don't know, I can't tell. Look at it well--Stop, it
+fatigues me, wait--(and after a moment of great attention) _It's a
+watch_." More astonishment. But, if she sees the watch, said M. FERRUS,
+she will doubtless see what o'clock it is. "Could you tell me what
+o'clock it is?--Oh! no, it is too difficult." "Look at it, try." "Wait
+then, I'll try; may be I can tell the hour, but I never shall be able to
+see the minutes;" and after the greatest attention--"It wants ten
+minutes of eight o'clock:" which was exact. M. FERRUS now desired to
+make the experiment himself, and repeated it with the same success. He
+made me turn the hands of his watch several times, and when presented to
+her (occiput we suppose,) without her having seen it, she never made any
+mistake."
+
+These statements we have thought fit to lay before our readers, who will
+observe the respectable names which are connected with them. We shall
+seize the first opportunity to give the report of the new commission,
+and if they confirm the miracles, we can still say, credat Judaeus
+apella. If it will make no cure, it will probably make much pay; since
+MESMER got upwards of 340,000 francs for his mumming exhibitions, to the
+_spectacle_ loving quidnuncs of Paris. The commission consists of 11
+members, viz. LEROUX, BOURDOIS, DOUBLE, MAGENDIE, GUERSENT, LAENNEC,
+THILLAYE, MARC, ITARD, FOUQUIER and GUENEAU DE MUSSY.
+
+36. _Sketch of the Medical Literature of Denmark, Sweden, and
+Norway--by_ Dr. C. OTTO, _of Copenhagen, apud Bulletin des Sci. Med.
+Feb. and March._--"Denmark is richer in medical literature, than the
+other countries which in conjunction with it, composed the ancient
+Scandinavia. Although it does not in this respect, bear a comparison
+with France, Germany, England, and Italy, nevertheless, medicine, of all
+the sciences, seems to be that which is most successfully cultivated,
+and Copenhagen contains a great number of learned, and able physicians."
+In proof of what Denmark has done, Dr. O. refers us to the great names
+of the two BARTHOLINS, of STENO, of WINSLOW, of CALLISEN, &c.
+
+"In the 16th century, Denmark possessed the anatomical works of the two
+BARTHOLINS: (_Instit. Anatomicæ de vasis lymphaticis, &c._) and other
+works of the same kind, which have been translated into all the
+languages of Europe. STENO, the disciple of THOMAS BARTHOLIN, followed
+the career of his master, with an equal success. HALLER never spoke of
+this anatomist, without the highest admiration. RODE enriched the
+literature of Germany and Denmark, with works which have made his name
+illustrious, wherever science is cultivated. Among these, we may chiefly
+distinguish his Bibliotheca, and Materia Medica." The Danes are indebted
+to him for several popular works on medicine, which are in the judgment
+of Dr. OTTO, chef d'oeuvres of this sort of writing. He published more
+than 13 volumes on these topics. "To the celebrated CALLISEN, who is
+recently deceased, we are indebted for 1st, a _Systema Chirurgiæ
+Hodiernæ_, a work of the highest merit, and which has reached a fourth
+edition. 2nd, a Medical Topography of Copenhagen, published in Danish.
+(2 _vols._ _8vo. Copen._ 1807.) 3d, the Director of the Academy of
+Surgery. He is also the author of several important memoirs, inserted in
+those of the _Roy. Soc. of Sciences_, of Denmark, and in some other
+collections. The late professor MATH. SAXTORPH, composed an excellent
+_manual of labours_, for the use of midwives. A second edition with
+plates, appeared in 1804. T. L. BANG, has given a _Praxis Medica_, an
+excellent guide to young physicians in their first outset in practice.
+HERHOLDT has shed some lustre on Danish Physiology: his dissertations on
+the life of the foetus, and on the question, whether vision is
+performed with both eyes, or with one only, bear testimony to his genius
+and penetration: he is also author of a memoir on penetrating wounds of
+the Chest, inserted, as well as the former dissertation, and many other
+pieces, in various medical journals.
+
+"TYSCHEN published in 1804, a _Treatise on Pharmacy_, in Danish; and
+professor MYNSTER, gave a work on Pharmacology, of which two volumes
+only had appeared, when death interrupted his useful labours. In 1794,
+he commenced the publication of a journal, the _Bibliothek for Physik
+Oeconomic og Medicin_, which was continued in 1799, by BAHN, and
+afterwards under several names, till 1807. We now come to the existing
+state of Danish medical literature.
+
+"The Royal Medical Society of Copenhagen, which, without contradiction,
+holds the first rank among those of Scandinavia, celebrated its 50th
+anniversary in 1822. It publishes at irregular periods, its memoirs,
+under the title of _Nova Acta Societatis Medicæ Havniensis_. The last
+volume appeared in 1821. Professor JACOBSEN, is ardently devoted to the
+study of Comparative Anatomy, and has published several works on the
+subject, inserted in the Mem. of the Roy. Soc. of Sciences, extracts
+from which have appeared also in several foreign journals. The
+collection we have just now cited, (for 1824, V. I.) contains a memoir
+of Dr. GARTNER, which confirms the opinion entertained by the ancients,
+as to the presence of a glandular body in the uterus of some animals.
+The author has added a plate to this interesting dissertation. Dr. OTTO
+has enriched the physiological sciences with his _Phrenology_, and is
+zealously occupied with all that relates to this subject. Professor
+WENDT, physician to the General Hospital of Copenhagen, has recently
+published several small medical works. We may cite his _Historical and
+Chemical Supplements, to the knowledge of some therapeutical agents, of
+the class Euphorbiæ_; some notices on _small pox_, _vaccina_, and
+_modified small pox_.
+
+"Denmark possesses three periodical journals of medicine, without
+counting those of the Royal Societies of Sciences and of Medicine of
+Copenhagen. The first and best of these journals, is the _Bibliothek for
+Læger_, published by a society instituted for the advancement of medical
+studies. CLASSEN, the founder of this association, bequeathed to it a
+sum of money, to purchase annually, some foreign medical works. This
+collection is composed of original memoirs, extracts, and announcements
+of other works, and a review of the _course_ of the faculty of medicine.
+It is specially consecrated to the practical department of the
+art--(three numbers per ann. of 70, to 100 pages each.) The 2nd
+collection, is the _Nye Hygæa_, the editor of which, (M. OTTO,) embraces
+in his plan, all the medical sciences. This journal, although specially
+devoted to physicians, is in reach of all those persons of education,
+who can be interested in a variety of important medical questions. It
+contains original memoirs, and extracts from foreign works, (five leaves
+per month.) The 3d collection, Archives for the History of Medicine in
+Denmark, (_Archiv. for lægevidens kabens historie in Danmark_,) does not
+appear periodically, but at indefinite times. Professor HERHOLDT, the
+editor, has only published one number, in 1823.
+
+"As to inaugural dissertations for the doctorate, the number amounts
+only to three or four in the space of ten years; because the title of M.
+D. is not requisite to the practitioner in Denmark."
+
+The above is taken from the Bulletin for February, the ensuing portion
+of the sketch is contained in the March number of the same journal.
+
+"The medical literature of Sweden, must have been very insignificant in
+past ages, if we may form an opinion, from the total want of documents
+in relation to it. There existed no scientific lien between the
+physicians of that country, or even among those of the capital. A
+medical society might in vain have been sought for there, at a period,
+when they were common in all other countries. The Royal Academy of
+Sciences, published some essays relating to medicine, from time to time,
+but until 1807, a work on this topic was regarded as a sort of rarity.
+However, in the course of that year, seven physicians of Stockholm,
+united in order to found a society, which received the royal sanction,
+and took the title of _Svenska Loekare Soellskapet_, (_Society of
+Swedish Physicians_.) This institution, seemed to communicate to the
+practitioners of Sweden a new existence, and then really commenced the
+æra of medical literature in that country. The number of works published
+since that period, has scarcely amounted to more than one or two per
+annum. Dr. RABEN is the author of three works, which, though not large,
+give evidence of considerable knowledge and penetration: Their titles
+are: 1st. De præcipuis causis mali Scrophul. ejusque remediis
+Commentation. Lund. 1807. 2nd. A second volume on the same subject,
+written in the Swedish language, Lund. 1819. 3d. Observationes in
+Syphilidem, ejusque curationem, ubi novæ quoque proponuntur curandi
+rationes. Lund. Goth. 1821.
+
+"We shall also mention among the works recently published in Sweden,
+1st. A biographical and literary gallery of the physicians of that
+country, from the reign of Gustavus I. down to our own times, by Dr. J.
+F. SAKLEN. 2nd. FLORMANN'S Manual of Anatomy. Finally, a collection of
+the laws of the kingdom, which relate to medicine. The Medical Society
+of Stockholm, regularly publishes its transactions, _Svenska Loekare
+Soellskapets Handlingar_, the 10th vol. of which has just appeared. In
+it, are some remarkable cases, a table of the constitution of the
+atmosphere, and of the diseases which have prevailed at Stockholm, and
+in its environs; reports on the hospitals and baths of the whole
+kingdom; extracts from Medico-legal Examinations, recent discoveries,
+&c. M. ECKSTRÖM promises to publish a complete description of the
+variolous epidemic, which prevailed last year at Stockholm, and in the
+provinces. Besides these transactions, the secretary makes an annual
+report, on what passes at the sittings. To this he adds, short notices
+of the most interesting recent discoveries and observations, which he
+derives from foreign medical literature. He publishes this collection
+once a year, and adds some nosological articles. In closing this review,
+we ought not to forget to mention the collection of theses, defended at
+the university of Upsal, which is published yearly by Dr. ZETTERSTRÖM."
+
+37. _Erysipelatous Mumps or Angina Parotidiana._--Dr. BEHR of Bernberg,
+has published in the _Journ. der Pract. Heilkund for July_, 1825, an
+account of this disease, which we find in the _Bulletin_ for Feb. 1826.
+Dr. BEHR'S "memoir is intended to pourtray the principal features of an
+epidemic prevalence of parotitis at Bernberg, in the months of
+December, 1822, and January and February, 1823. Dr. B. attributes it to
+the frequent and sudden variations of the atmosphere at that period." He
+says, "the disease is so rare in this country, that physicians of 30
+years standing had never met with it before." Bernberg contains 6000
+souls; it is divided into two parts by the Saale, and it is situated on
+the great road from Leipsic to Magdeburg, in a narrow valley, which runs
+from N. W. to S. E.
+
+The precursory symptoms were rigors followed by heat, heaviness of the
+limbs, pains in the joints, especially in the evening, sense of tension
+in the region of the lower jaw, and sometimes a difficulty in
+mastication. The appetite was usually natural, with gastric symptoms
+only in the most severe cases. On the evening of the 3d day, there was
+an increase of uneasiness with chills and heat, after which the patient
+commonly enjoyed sweet sleep. The next day, on awaking, he felt
+tolerably well, and had no more sense of heaviness in his limbs, but his
+face was swelled on one or both sides. Speech and mastication were
+effected with difficulty; the lower jaw was _comme engourdie_, and a
+dull pain was felt in the ligaments of the joints; the tumefaction
+increased and soon extended from the ear to the cheek. On a careful
+examination, it was found to affect the parotid gland, and the
+surrounding cellular tissue. The tumour was hard, diffused, and not very
+painful, except on pressure. The colour and temperature of the swollen
+part were natural. In the evening, the pulse became hard and
+accelerated, the tongue white, the stools more consistent than common,
+and the urine pale. The following night he was agitated, frequently
+awakened by lancinating pains in the affected part, and sometimes by a
+sense of tension in the head. The following day, the tumour reached its
+maximum of elevation, and sometimes comprised the submaxillary glands of
+the same side. From this time, the pains did not increase, and the skin
+became slightly red only in a very few examples.
+
+The disease having thus reached its acme, a gentle sweat commenced
+behind the ears, then extended over the whole tumour, and remained as
+long as the swelling lasted. This evening there was no fever, but a
+gentle perspiration continued throughout the night. The day following,
+being the 6th of the disease, the tumour was evidently diminished, and
+continued decreasing until its final disappearance, which occurred on
+the 9th, and sometimes on the 7th day. Until this period, abundant local
+perspirations in the day-time, less abundant, but more general ones in
+the night, were observable. When the disease was critical by urine with
+sediment, the diminution of the swelling was dated from this appearance;
+but the resolution was not perfected in some cases till the 14th day,
+and in such cases, the integuments of the part were covered with a mealy
+desquamation. Dr. BEHR did not observe any metastasis to the genitals,
+but he saw cases, in which the disappearance of the swelling, was
+followed by considerable fever with _augoisse_, and then an oedema,
+commonly situated on the head.
+
+He often saw the termination by induration, but this soon yielded to a
+proper treatment. As to the contagion of mumps, the author thinks, it
+can only occur where there is desquamation of the integuments; and
+remarks on the analogy of this circumstance, with what occurs in
+scarlatina. Dr. BEHR thinks, that antiphlogistics are rarely indicated
+in the treatment of parotitis.
+
+38. _Tænia._--In several cases in which gum. gutt., salts of tin, and
+other medicines, were unsuccessfully used for the expulsion of tape
+worm, Dr. BOUGARD succeeded in expelling them with pills compounded as
+follows: Merc. dulc. Extr. aloes, aa. gr. iij. divided into three pills.
+This dose was given every evening for eight days, and gradually
+increased or diminished, so as to procure three stools per diem. A
+rigorous diet was observed during this treatment.--_Rust's Magazin fur
+die gesamte Heilkunde apud Bulletin des Sci. Med. March_, 1826.
+
+39. _Scrophula._--Dr. WETZ recommends the employment of caustic potassa
+in scrophula. He dissolves x grs. of caustic potassa in one ounce of
+orange-peel water, and gives from xij to xx gtt. four times a day, in a
+cup of broth. A solution of caustic potassa in six ounces of distilled
+water, is applied as a wash to the ulcers.--_Ibid._
+
+40. _Digitalis._--We find in the Propagateur des Sciences Medicales for
+Feb. 1826, an account of the directions of Dr. NEUMANN of Berlin, for
+the employment of digitalis in pulmonic diseases: they are said to be
+the result of long experience. Digitalis is useless, says the writer, in
+all cases of suppuration of the lung, consequent to tubercles of that
+organ. It is of no avail in those suppurations, which succeed
+inflammatory hæmoptysis. It is employed without success in _local_
+phlegmorrhagies of the lungs; but it almost invariably cures those
+chronic catarrhs, which depend on a state of erethism of the mucous
+lining of the bronchiæ. This disease is sometimes called chronic
+bronchitis, sometimes mucous consumption, pulmonic catarrh, and
+galloping consumption. If the diagnosis in this case be well made out,
+hopes may be entertained of a cure, one of the two following conditions
+being present:
+
+A. The patient must be susceptible of the stimulant action of the
+remedy: this is often not the case. We may be sure the digitalis will
+not produce its effect, where the pulse of the patient remains _uniform
+and frequent after he has taken it for several days_. It does not suit
+such persons.
+
+B. The medicine ought to be administered in a proper manner. To be good,
+the leaves, even in the dried state, should be perfectly green and free
+from any brown spots. Two ounces of the leaves, should be infused in six
+ounces of boiling water; and the patient may take a table spoonful every
+hour, until he feels nausea, or a sense of constriction in his throat,
+or flashing of the eyes, or irregular pulse. The use of the foxglove
+should then be interrupted for seven or eight days, in which interval,
+the full action of the medicine is developed, the pulse remaining
+irregular, and the mucous secretion diminishing gradually. If the first
+trial does not remove it entirely, a second course may be commenced
+after a few days.
+
+FOOTNOTES:
+
+[29] Series of Engravings to the morbid anatomy; fasc. 1. pl. 6. fig. 1,
+2.
+
+[30] Lond. Med. Review; vol. 4.
+
+[31] Pathological Researches; Essay 1.
+
+[32] Medical Researches on the Effects of Iodine in Bronchocele,
+Paralysis, Chorea Scrofula, Fistula Lachrymalis, Deafness, Dysphagia,
+White Swelling, and Distortions of the Spine. By Alexander Manson, M.
+D., &c. London, 1825.
+
+[33] Carthamus Tinctorius.
+
+
+V. SURGERY.
+
+41. _Dr. Physick's operation for artificial anus, denied to have been
+performed!_--We have often had occasion to remark the claiming, and, we
+fully hope, the actual re-invention of American operations and practices
+among physicians on the other side of the Atlantic. As we are not a
+publishing people, it is, perhaps, not very strange that the French and
+English should be generally unacquainted with the discoveries and
+inventions which have been made among us; but here comes an actual
+denial of the invention having ever taken place!
+
+Every American who has any pretensions to the character of a surgeon, is
+most probably familiar with the proposal and performance, by Dr.
+PHYSICK, of a peculiar operation for those cases of artificial anus,
+where the two ends of the divided or opened intestine adhere laterally
+to each other, in the manner of a double-barrelled gun. We are now told
+that M. RICHERAND, in his new work "On the recent progress of Surgery,"
+"avoids giving this the least confidence." (Archives Generales, Janvier,
+1826.) The reviewer in the Archives, in a paroxysm of angry jealousy for
+the honour of French surgery, deeply wounded, as he conceives, in the
+_admissions_ by M. RICHERAND of discoveries and inventions among the
+English and others, adds no small amount of ill-nature to this unworthy
+intimation, and makes the observations which we have translated below.
+
+It is certainly an easy method of erecting reputations, to deny,
+directly, the priority of others in operations which a favourite has
+repeated. No matter though the knowledge of this priority be widely
+diffused; if readers can, by means of national predilections, be induced
+to place confidence in your denial, the effect, as far as relates to
+them, is completely obtained. Yet one would think it an ungenerous act,
+to call in question, and before partial judges, the veracity of such men
+as are here named. Where a physician reports cases which agree too well
+with his preconceived theories, we doubt the correctness of his
+observations; and with justice: for we know that an already formed
+belief will greatly tinge the most honest seeings and hearings of very
+sensible and honourable heads. But this is a far different thing from
+impeaching, in a manner entirely gratuitous, the moral honesty of the
+record of a historical fact, made by men at the head of their
+profession.
+
+The reviewer, Mr. and probably Dr. L. C. ROCHE, comments as follows:
+
+"1. Dr. PHYSICK never published any thing on this subject.
+
+"2. Dr. DORSEY, who makes the claim for him, never published the work in
+which he does so, [the Elements of Surgery,] till 1813.
+
+"3. In the English journal (?) and in that work, he contents himself
+with a simple assertion, without giving either the date of the
+operation, the name, age, or sex of the patient, the names of his
+assistants, or the details of the operation; _all points which men never
+forget to make known, when treating of the first attempt in a new
+operation of this importance_."
+
+To the first of these comments we reply, that Dr. PHYSICK, to the great
+regret of his countrymen, has never been in the habit of publishing; but
+still possesses many useful improvements in medicine and surgery, which
+he has not committed to the press. On the other hand, however, he has
+taught this operation annually, to from three to four hundred pupils, in
+his lectures, during about twelve successive years; and this is no mean
+substitute for a publication in types. M. ROCHE'S memory will supply him
+with an instance of an eminent French surgeon, whom we shall not attempt
+to defraud of his laurels, who also made it his practice to leave the
+publication of his observations and improvements to his pupils.
+
+To the second remark, the above is also a sufficient reply; but we will
+add that it was recorded in the case book of the Pennsylvania Hospital
+in 1809.
+
+Our comment on the third observation of Mr. ROCHE may be brief. It is
+that we promise an account of the case for the next number of this
+Journal. In the mean time, the patient was well known to us and to many
+persons now living. The operation was performed in 1809.
+
+In reply to that portion of the last observation, which we have marked
+with italics, we can assure the reviewer that he is mistaken; at least
+with regard to this side of the ocean. We Americans are a very peculiar
+people, and but little affected, as yet, with the cacoethes scribendi; a
+malady which the present work, in its humble sphere, is designed to
+disseminate. We are not in the habit of frequently publishing, and above
+all, of publishing volumes. Books are dear, private libraries small,
+public ones few, and encouragement for even the best original
+publications but limited. Of this we have known some melancholy
+instances. It is impossible for either a Frenchman or an Englishman to
+judge correctly of a country, which, in many important respects, is in
+such a different situation from his own.
+
+It is a thing of by no means uncommon occurrence here, to make a
+valuable discovery or improvement in the healing art, and not to make it
+public. A striking instance of this fact, at least with the exception of
+the insertion of an imperfect account in the Eclectic Repertory, which
+very probably never reached England, is mentioned in our last number. We
+allude to the extirpations of diseased ovaria, by Dr. M'DOWALL, of
+Kentucky. Here a unique and brilliantly successful operation was
+performed, successful as yet beyond European imitations, and still the
+inventor and achiever of it did not possess vanity or industry
+sufficient to treat the public with a full account of it. M. ROCHE may
+find it hard to explain modesty of this species; but we can promise him,
+should these sheets ever reach his eye, and he still continue skeptical,
+abundance of proofs, and some more instances of the same kind.
+
+42. _Gangrenous Sore Mouth of Children._--Dr. COATES begs permission to
+add the following quotation from FABRICIUS HILDANUS to the authorities
+quoted in his paper on gangrenous ulcer of the mouth, at the
+commencement of the present number.
+
+"Gingivarum inflammatio maxime in infantibus in gangrænam interdum
+degenerat. Morbus enim magnus, vehemens et peracutus; magna quoque
+requirit remedia: sed quis illa in ore adhibere ausus?"--_De Gangræna et
+Sphacelo, Cap. IV. p. 773. col. 2. Edit. Beyeri. Francofurt ad Mæn._
+1646.
+
+"Gangræna in partibus humidis, gingivis, palato, naribus, &c. raro
+sanabilis; in sphacelum autem degenerans, insanabilis."--_Cap. XI. p._
+781. _col._ 2.
+
+This is all I find in that author, relative to the subject.
+
+43. _Operation for Phymosis._--M. J. CLOQUET, has so improved this
+operation that no deformity results. He recommends the incision to be
+made at the _inferior_ surface, near, and parallel to, the frænum
+præputii. The longitudinal wound thus made, becomes transverse, as soon
+as the prepuce is drawn behind the glans penis, and cicatrizes in a line
+scarcely visible; so that the prepuce acquires in breadth what it loses
+in length. M. CLOQUET has, in this way, perfectly cured many patients;
+the prepuce appearing to possess its natural conformation.--_La
+Propagateur des Sci. Med. for March._
+
+44. _Lunar Caustic on Wounds and Ulcers._--The practice of healing
+wounds and ulcers by natural or artificial scabs, to which the attention
+of the profession was first directed by Mr. J. HUNTER, has been too much
+neglected, and the circumstances under which it is useful, have not been
+accurately stated. In a small work published by Mr. HIGGINBOTTOM, in
+January last, at London, the practice of forming an _eschar_ by the
+lunar caustic over small ulcers and recent wounds, has been strongly
+recommended as saving the patient much pain, trouble, and danger. The
+whole surface is to be pencilled with the solid caustic so as to form an
+eschar, and where this remains _adherent_, the wound or ulcer invariably
+heals with comparatively little inconvenience. When effusion occurs
+under the eschar, whether of serum or of pus, there is more difficulty;
+but if this fluid be evacuated by a puncture, and the caustic applied to
+the orifice, the eschar will often remain adherent. Sometimes the fluid
+must be frequently evacuated. If the eschar does not separate
+favourably, a cold poultice may be applied, which not only removes the
+eschar, but lessens the irritation and inflammation. Should the sore not
+be healed, Mr. H. recommends the reapplication of the caustic. To
+prevent effusion under the eschar, and to preserve it adhering, he
+advises the whole to be covered with a piece of gold-beater's skin; but
+we may add, that as this effusion arises from too much inflammation,
+more powerful means may occasionally be employed, especially a solution
+of acetate of lead. LARREY recommends with the same view, after the
+application of moxa, the use of the aq. ammoniæ. Indeed any evaporating,
+cold, astringent lotion will be advantageous.
+
+The application of the caustic, of course, produces some pain, but this
+soon subsides, and the patient experiences more ease than under any
+other mode of treatment.
+
+_Particular cases in which the Caustic is useful._--In punctured wounds,
+it should be applied to the orifice and surrounding skin, and the eschar
+allowed to dry. The terrible effects of punctured wounds, are thus
+completely prevented, whether caused by needles, hooks, bayonets, &c. So
+also of wounds from saws; of bites from leeches and animals; of the
+stings of insects; and especially of those small scratches, and
+punctures, received in _anatomical dissections_. The danger of these
+last mentioned accidents may, according to Mr. H., be completely
+arrested by the prompt and free application of the lunar caustic. Even
+in neglected cases, when a small tumour has formed under the skin,
+attended with a smart stinging pain, he advises the tumour to be
+removed, and an adherent eschar to be formed by the caustic; and in
+still more neglected and advanced cases, where inflammation of the
+absorbents has supervened, "a free crucial incision is to be made, the
+caustic to be freely applied, and afterwards, the cold poultice and
+lotion; the usual constitutional remedies being actively enforced."
+
+In _bruises_, especially of the shin, the adherent eschar from lunar
+caustic, has, with Mr. H., always effected a cure; and even when a
+slough has been produced, the application of the caustic will moderate
+the inflammation.
+
+In _ulcers_, which are small, not exposed to friction or motion, and
+discharging little, the cure by eschar will be preferable; especially in
+those little irritable and painful ulcers often seen about the ancle and
+tendo Achillis. Apply first a cold poultice, and then form the eschar,
+which may be freely exposed to the air. Should the matter, nevertheless,
+collect, it should be evacuated by puncture as often as necessary, until
+the eschar remains adherent.
+
+This practice is recommended by Mr. H., in various other affections; as
+in inflammation of the fingers; in the fungous ulcer of the navel in
+infants; in _tinea capitis_, &c. In this last case, we have ourselves
+used it with marked advantage. In all cases, the lunar caustic has a
+decided effect in _diminishing the irritability_ of the parts to which
+it is applied; and hence should usually be preferred for the purpose of
+forming a "_scab_," for such the eschar really is, in a practical view;
+and we think that our author has hardly done justice to nature's
+methodus medendi by "scabbing;" while he so ably and strenuously
+recommends his own imitation of her process. Scabs may be formed by the
+coagulation of blood; by the drying of mucus or pus; and by the
+formation of an eschar, by the actual or potential cautery. The surgeon
+may frequently reduce parts to the same situation, by the use of
+gold-beater's skin, court-plaster, or other unirritating applications,
+which prevent exposure and evaporation. In all cases, care must be taken
+to prevent the surrounding inflammation from transcending the adhesive
+stage.
+
+45. _Hæmorrhage from Lithotomy._--In the London Med. and Phys. Jour. for
+Jan. Mr. JOHN SHAW has published an account of a patient, who
+unfortunately perished from hæmorrhage, in consequence of being cut for
+the stone. The parts being injected after death, it was found, that the
+bleeding proceeded from the _unusual distribution_ of a branch of the
+pudic artery, which traversed the neck of the bladder, and lay directly
+in the way of the incision. The pudic artery was uninjured.
+
+46. _Extirpation of the Parotid Gland._--The best surgical writers have
+condemned this operation, if not as absolutely impracticable,
+nevertheless, as too dangerous to be ever attempted. Successful cases
+have however been reported, and Mr. A. COOPER, in a letter to the
+operator in the following case, avers, that he twice removed the parotid
+gland in one year. Mr. KIRBY, late president of the Royal College of
+Surgeons in Ireland, in a work published in 1825 at Dublin, on
+hæmorrhoidal excrescences, has given the details of a diseased parotid,
+and of the operation for its removal. We condense from Johnson's Review
+for April, 1826.
+
+The patient was a poor female, aged 40, who had a tumour extending from
+above the zygoma downwards on the neck, two inches below the angle of
+the jaw, stretching as far forwards as the anterior edge of the masseter
+muscle, forcing the ear backwards, and raising it outwards from its
+natural position. Above the surface, it was about the size of a
+goose-egg; immoveable; painful when handled; irregular on the surface,
+and of a deep livid colour over the prominent points. Pains of a
+lancinating character, extended over the head and neck, producing
+sickness and want of sleep.
+
+The operation was performed chiefly by the fingers and the handle of the
+knife, after dividing the integuments by a crucial incision. The
+branches of the portio dura were of course divided, and great
+embarrassment arose from a copious hæmorrhage, caused by the bursting of
+the tumour, while Mr. K. was rooting it out from between the pterygoid
+muscles. The bleeding was restrained by the finger of an assistant, and
+the complete extirpation of the diseased gland was effected. Mr. KIRBY
+says, "the space between the pterygoid muscles was void--the auditory
+tube was fully exposed--the articular capsule of the jaw was brought
+into view--the finger could trace the length of the styloid process, and
+on sponging the wound of its blood, it could be seen by those who
+surrounded the chair." The hæmorrhage was restrained by a sponge firmly
+lodged at the bottom of the wound, covered by compresses of lint, and
+the whole secured by a double-headed roller.
+
+The patient was much exhausted, slept tolerably well the next night,
+complaining of thirst and inability to swallow. On the 2nd day,
+inflammation, swelling, and fever followed--erysipelas appeared on the
+neck--patient lethargic--pulse small and frequent. Fourth day,
+suppuration--symptoms improving--no relapse. The patient completely
+recovered, without any regeneration of the tumour.
+
+In FERUSSAC'S Bulletin Universel for Jan. 1826, we observe the following
+notice, from a German Medical Magazine, conducted by M. D. Schmidt.
+
+A female, aged 33 years, had suffered for 9 years from a diseased
+parotid gland, which had gradually attained a large size. It was
+extirpated by Dr. PRIEGER, and the patient soon returned home in good
+health, and little disfigured. The tumour measured 8 inches in
+circumference, and weighed three and a half pounds. (Livres.)
+
+Dr. PRIEGER had previously extirpated a scirrhous parotid successfully.
+M. WIENHOLD affirms, that he has extirpated three parotids; the details
+of these operations are published. M. SCHMIDT, however, suggests some
+doubts, as to the _nature_ and _seat_ of the tumours removed.
+
+47. _Aneurism from a Wound, cured by Valsalva's method._--This
+interesting and valuable case, is condensed from Le Propagateur des Sci.
+Med. for March, 1826. M. Antouard, a healthy female, æt. 18, was wounded
+on the 18th of June, 1825, by a poniard, in the left carotid artery,
+below the superior extremity of the sternum; the instrument passing
+obliquely inwards and downwards. The anterior and lateral portions of
+the neck, were enormously distended with blood, and syncope supervened.
+Four days after the injury was received, an aneurismal tumour was
+observed at the edge of the sternum, the surrounding effusion being
+greatly diminished by absorption; and at the expiration of a month, when
+she was first seen by Dr. SOUCHIER, it was of the size of the two fists
+of the young female. The pulsations at this time, were nearly equal over
+the whole surface of the tumour; but rather more distinct over the
+orifice in the vessel. The surrounding blood was entirely absorbed. No
+pain was experienced, unless from the pressure of the swelling; from
+which cause also, resulted a troublesome and continued headach. Dr.
+SOUCHIER, not believing an operation adviseable, during the warm season
+of the year, and on a tumour, situated so much under the sternum,
+determined to fulfil the following indications: 1st. To lessen the
+quantity of blood; and thus, to diminish the stimulus to the heart, the
+projectile force it exercises, and consequently, the rapidity with which
+the blood escaped from the ruptured vessel, and the impulse hence
+imparted to the sides of the tumour, preventing, in some degree, the
+coagulation of the blood. 2nd. To increase the effect of general and
+local bleeding by the use of _cold_, of _pressure_, and especially, of
+the digitalis purpurea: that thus the force of the circulation may be
+lessened, the blood allowed to coagulate, and a radical cure be
+accomplished.
+
+Mademoiselle Antouard, determined to yield herself to this plan, and was
+directed: 1st. Rice-water, acidulated with lemon-juice, and an infusion
+of mallows, for _food_ and _drink_. 2nd. To employ frictions on the
+abdomen, and on the insides of the thighs, morning and evening, with
+eight grains of the pulverized leaves of digitalis, previously macerated
+for 24 hours in a sufficient quantity of saliva. 3d. To apply every day
+12 leeches, near the aneurismal tumour, and after favouring the flow of
+blood by emollient fomentations, to cover the part with compresses, wet
+with a saturated solution of the acetate of lead, to be frequently
+renewed, so as to be kept below the temperature of the skin. 4th. The
+effect of these means to be augmented by pressure, made by means of the
+base of a glass tumbler, fixed by the hands of assistants; and 5th. To
+be kept at rest, and in perfect silence.
+
+_Fourth day of treatment_, being 2nd of Aug. 1825. Pulsations more
+central; tumour very sensibly diminished; pulse less strong and reduced
+from 86 to 74 in the minute; the menses, which had been suppressed for
+two months, appeared on the 31st ulto. and still flow. _Prescription_,
+V. S. [Symbol: ounce]xviij. next day, twelve leeches, on the lateral
+parts of the tumour; gr. xxiv. of digitalis in three applications
+through the day. Continue ut supra.
+
+Aug. 8th. Patient tranquil; pulse 60, full, not active; face not
+flushed, but preserving a delicate tinge of red; headach now slight; no
+nausea; menses continued until the 6th inst. _Prescription_, V. S.
+[Symbol: ounce]xij.--fifteen leeches to-morrow; increase digitalis to
+gr. xxviij. daily; the rest, ut supra. The tumour has diminished at
+least one-fourth.
+
+Aug. 12th. Tumour reduced to 3-5ths of its former volume; pulse at 56;
+her nights are comfortable; has some headach, and lately, cardialgia;
+complains of hunger and weakness, and from the fatigue of her
+assistants, the pressure was made with a bandage less effectually than
+before. This was allowed, as the pulsations are weakened, and more and
+more central, while the elevation of the tumour is trifling. For fear
+her health might be injured, she was permitted to rise a little from
+bed, and to add to her rice water, some light jellies, (crémes) made
+from the same grain. V. S. [Symbol: ounce]x. and every 2nd day, eight
+leeches around the tumour; digitalis increased to 32 grains daily; warm
+pediluvium for one hour, morning and evening; silence as complete as
+possible.
+
+Aug. 18th. No tumour visible; pulsations can yet be felt; the skin is
+thickened; pulse at the wrist is at 50. V. S. [Symbol: ounce]viij.--six
+leeches every 4th day until menstrual period; digitalis reduced to gr.
+xx. and still to the same parts; continue the pressure; allow some rice
+jelly, vermicelli soup, gentle exercise; silence to be preserved,
+continue pediluvium, and relieve constipation by simple enemata.
+
+In 15 days, Dr. SOUCHIER again visited his patient. It required an
+experienced hand to distinguish, at the spot where the artery was
+cicatrized, an elevation rather more evident, than over the rest of the
+artery. Pulse 48 per minute; hunger great, and the remedies now
+unpleasant. Most of them were suspended, and fruit and the white flesh
+of poultry added to her diet list. The digitalis reduced to 12 grains a
+day. Compression, silence, and moderate exercise, to be continued as
+before. The menses appeared at the expiration of twenty-five days, and
+were more abundant than at the last period.
+
+At the end of a month, no trace of the tumour was discoverable. The
+young lady had carefully increased her nutriment and exercise without
+inconvenience, and all remedial measures were now omitted.
+
+During the months of December and January last, she remained free from
+any inconvenience from the tumour, and the union of the parietes of the
+artery was therefore regarded as complete.
+
+In the above account, we have only to regret that the state of the
+artery above the tumour, before and after the treatment, had not been
+noticed. Perhaps this may be supplied by Dr. SOUCHIER, in the
+commentary, which he proposes publishing on the above case.
+
+48. _Protrusion and Wound of the Stomach._--Mr. TRAVERS, in the Edin.
+Journ. of the Med. Sciences, for Jan. 1826, relates, that a female, aged
+53, and the mother of _nineteen_ children, inflicted on herself a wound
+in the abdomen, three inches in length, and in a transverse direction.
+When admitted into St. Thomas' Hospital, at the expiration of six hours,
+the greater part of the large curvature of the stomach, the arch of the
+colon, and the entire large omentum, were protruded and strangulated in
+the wound. The omentum was partially detached from the stomach, which
+organ was wounded in two places; one, half an inch long through the
+peritoneal coat; the other, a perforation of all the coats, admitting
+the head of a large probe, and giving issue to a considerable quantity
+of mucus. Patient faint; pain slight; pulse 102, and irregular; some
+hiccup. A silk ligature was placed round the small puncture in the
+stomach, and the displaced viscera returned, after enlarging the
+external wound. This last was closed by the quill suture. Warm
+fomentations and abstinence from food and drink enjoined. 2nd day, some
+re-action; had been sick in the night from some drink given; is free
+from pain; pulse 120; pain on pressure; an enema ordered. _Evening_, a
+dose of castor oil, and twenty leeches to the abdomen. 3d, much fever;
+V.S. [Symbol: ounce]xviij. and 20 leeches to the abdomen; bowels not
+opened. 4th day, two stools; pulse 98; tension of the abdomen; three
+more stools during the day. 5th, sutures removed; wound united, except
+at its right extremity, where a serous fluid is discharged in
+considerable quantities. On the 6th day, was allowed food, and on the
+23d of Dec., about two months after the accident, was discharged cured.
+
+49. _Oesophagotomy._--This operation has been objected to, not only on
+account of the dangers attending its performance, but from the alleged
+difficulty of promoting the union of the wound in the oesophagus; as
+it is seldom at rest, the lips of the incision being often separated,
+and the mucous coat adhering with difficulty under any circumstances.
+Hence we are induced to notice the following case, in which the
+operation was successfully executed on an inferior animal, by M. FELIX,
+a veterinary surgeon of Bergelac. The account is published in the Feb.
+No. of Le Propagateur des Sci. Med.
+
+A _Cow_ was threatened with immediate suffocation from the lodgment of a
+potato in the oesophagus. It had shortness of respiration, an
+incapacity of swallowing even its saliva, which flowed from the mouth,
+was in great distress, and covered with a cold sweat. Being properly
+secured in a horizontal posture, an external incision was made on the
+inside of the sterno-mastoid muscle, and a cautious dissection practised
+until the tumour was completely exposed. The oesophagus was divided by
+"an incision extending the whole length of the foreign body, which was
+extracted without any force, _which is almost always fatal_. I
+immediately made two close sutures; and also two others in the skin, on
+each side, adapting to them two pieces of packthread, more easily to fix
+the dressings. I dressed the wound with brandy, filling the opening with
+hemp soaked with brandy." The animal was kept on very little food or
+drink. On the third day the wound was dressed for the first time, and a
+digestive ointment applied.
+
+In the course of the 2nd week, the cicatrization of the oesophagus
+occurred; the part was dressed with lint; and by the 20th day after the
+operation, the animal was quite restored.
+
+This case would have been more useful, if more precision had been
+employed in describing the dressing and subsequent treatment of the
+wound. It would seem that the sutures were passed through the parietes
+of the oesophagus only, and that the external wound was kept open by
+being filled with tow. Certainly, union by the adhesive inflammation
+ought to have been attempted in all parts of the wound; but whether
+sutures in the oesophagus are advantageous, or whether the uniting
+bandage be preferable, is not so easily determined. In the two cases
+described in 3d vol. of the Mem. de l'Acad. de Chirur. the uniting
+bandage was alone employed, and with success.
+
+50. _Retention of Urine, caused by a Stricture of the Urethra, relieved
+by a forcible but gradual Injection._--The editor of Le Propagateur des
+Sci. Med. in the No. for Feb. 1826, introduces the following case, by
+observing, that it reflects great honour on M. AMUSSAT, and that his
+discovery merits the greatest praise. M. D... aged 70 years, of a
+plethoric constitution, had suffered about 30 years before from three
+attacks of gonorrhoea; since which period he has had a difficulty in
+urinating, and can never discharge more than one or two ounces of urine
+at a time.
+
+At eight o'clock, P. M. of the 1st of Feb. he tried to urinate, but
+could not succeed. He suffered great pain. Pulse agitated; face flushed;
+belly swelled, and globular at its inferior part; the subcutaneous
+abdominal veins distended, and the penis in a state of semi-erection.
+All attempts to urinate were painful and ineffectual. At ten o'clock, A.
+M., on the 2nd, M. AMUSSAT visited him, and passed a bougie. This was
+arrested by a contraction near the bulb of the urethra, and caused the
+discharge of some blood. No urine had been passed for 14 hours, while
+ordinarily he urinated 12 or 16 times through the night. The obstruction
+was so great, that none of the usual means of relief remained, except
+_the forcible introduction of the catheter_, or the _puncture of the
+bladder_. M. AMUSSAT resorted to the following plan which he had
+devised, and which completely succeeded. He injected warm water
+forcibly, but gradually, into the urethra, which, dilating the orifice
+of the stricture, forced backwards the thickened mucus which had
+obstructed it. As soon as the liquid injection met the urine, the
+patient cried out that he was saved, and immediately was able to urinate
+as formerly. At two trials, he discharged nearly two pints of thick
+urine. There was no return of the retention, the patient continuing
+well.
+
+Should subsequent experience confirm this experiment of M. AMUSSAT, this
+simple measure will be a most valuable substitute for those dangerous
+measures hitherto resorted to for retention of urine, in cases where the
+obstruction arises from thickened mucus, from small calculi closing the
+orifice of a stricture, from inflammation, or from what are termed,
+(justly or not,) spasmodic strictures.
+
+51. _Tracheotomy._--In the Amer. Med. Review for April, Dr. JOHN ATLEE,
+of Lancaster, mentions that on Wednesday, Aug. 11th, he was consulted by
+a child ten years old, who had that morning, while running, put a
+button-mould into his mouth, which during respiration was drawn into the
+trachea. He complained of uneasiness in respiration, with a slight
+rattling, and pointed towards the upper part of the sternum, as the
+situation of the button. On coughing, a rattling was heard, and
+immediately after, a sudden check to expiration, from the lodgment of
+the button near the rima glottidis, requiring a sudden and violent
+effort of inspiration to remove the sense of suffocation. An emetic was
+given with no advantage. During the night, he had two or three spells of
+coughing, threatening suffocation.
+
+An operation was urged, to avoid immediate and subsequent dangers from
+the lodgment of this extraneous body, and was agreed to by the parents,
+and by Dr. HUMES, who was called in consultation. It was performed on
+the 14th of Aug.; a cathartic, and afterwards an opiate, having been
+given.
+
+An incision, one inch and a half long, was made through the integuments,
+extending downwards from above the cricoid cartilage, and exposing the
+sterno-hyoid and thyroid muscles, which were then separated. After
+exposing the trachea, a longitudinal incision, about three-quarters of
+an inch in length, was made through its parietes at the third ring. This
+was held open, and the patient requested to cough. This was ineffectual.
+The wound being closed, the button was, by coughing, thrown up against
+the rima glottidis. A probe passed into the trachea, produced a violent
+effort to cough, by which, as soon as the instrument was withdrawn, the
+button was thrown through the wound, to some distance from the patient.
+
+The wound was dressed with two sutures and adhesive strips. Most of it
+united by the first intention: and in a few days the patient completely
+recovered.
+
+52. _Fistula Lachrymalis_--At the session of the Royal Academy, on the
+15th of December, M. J. CLOQUET related the case of a female, who, three
+years previously, had submitted to the operation for fistul. lachrym.
+according to the method of M. FOUBUT. The canula which had been allowed
+to remain in the nasal canal, had ulcerated through the floor of the
+nose, and presented its inferior extremity on the inside of the mouth.
+
+A practical commentary on this mode of operating, which is still
+recommended by able surgeons!
+
+53. _Aneurisma Herniosum._--This form of aneurism is supposed to consist
+of a dilatation of the internal and muscular coats of the artery; the
+external cellular having been destroyed. It is termed by ARNAUD, and by
+Dr. WILLIAM HUNTER, _aneurisma herniam arteriæ sistens_. Its existence
+in any case has, however, been denied by a large majority of surgeons;
+and perhaps the only cases reported are those of DUBOIS, in 1804, found
+in the thoracic and abdominal aorta of a dead subject.
+
+The reporter of the following case, quotes also MONRO, as having cited
+examples of this kind of aneurism. But what MONRO termed a "mixt
+aneurism," arose from the rupture of the coats of a "true aneurism," by
+which it was reduced to the state of a "false aneurism;" very different
+from that here contended for. SABATIER and BOYER, also, deny the
+existence of this hernia of the artery, and a good summary of facts and
+arguments is given by BOYER in his Surgery, in support of this opinion,
+(vide article Aneurism, tome i.) which it would be difficult to
+invalidate, especially by cases analogous to the following. The
+reporter, M. BONNET, of the late French army, considers this case as
+proving a hernia of the artery in a vessel of medium diameter; those of
+DUBOIS having been noticed in the largest arteries.
+
+A Prussian soldier was wounded over the femoral artery by a musket ball.
+No hæmorrhage ensued, and the wound cicatrized. In this state, M. BONNET
+visited him for a mortification of the foot of the same limb, which had
+been frozen. Amputation of the leg was performed, the stump healed
+readily, and in 12 days the ligatures came away. On the 13th day, (being
+six weeks since wounded in the thigh,) the patient perceived a tumour at
+the original cicatrix on his thigh, which had appeared during the
+preceding night. On the 14th, it had enlarged to three times its former
+size: it was painful; fluctuation was evident; but there was no
+pulsation, not even the thrilling noise, which is evident in the last
+stage of aneurism. A consultation was called, to determine whether it
+was an abscess or an aneurism. The question could not be satisfactorily
+answered, and it was determined to open it, after having made the
+necessary arrangements to secure the artery, should the tumour prove
+aneurismal. As soon as the integuments were punctured, the jet of blood
+evinced the nature of the complaint; and the artery was secured by
+ligatures above and below the tumour. The coagula were numerous, and the
+superficial ones, quite hard and cartilaginous. The patient did well,
+and there was every prospect of his recovery on the 1st day, when M.
+BONNET was forced by the movement of the armies to leave him at Meaux.
+
+Such are the facts, from which the Reporter infers, that the aneurism
+consisted of a protrusion of the internal and middle coats of the
+artery. The _reasoning_, founded on them, appears to us inconclusive;
+but we have not space to insert it, and must refer to the March No. of
+Le Propagateur des Sci. Med.
+
+54. _Extirpation of the Two Dental Arches, affected with
+Osteo-sarcoma._--Dr. GIORGI REGNOLI, physician at Pesaro, performed this
+operation on a female 35 years of age, who had from infancy, been
+troubled with pain and diseases of the teeth and jaws. When Dr. R.
+visited her, both dental arches were enormously swelled; red and
+sanguineous tumours had formed over their whole surface, and covered the
+teeth. The alveolar processes were entirely softened. The diameters of
+the mouth were greatly lessened; but by the touch, it was evident, that
+the disease was confined to the alveolar processes of the two ossa
+maxillaria. A foetid odour exhaled from the mouth. Lancinating pains
+continually tormented the patient; especially on attempting to
+masticate. The slightest touch was very painful, and was always followed
+by an effusion of blood. There was also an alteration of voice; a
+disgusting deformity of the mouth, with emaciation, fever, &c. The
+operation was performed on the 18th May, 1825.
+
+The patient was seated opposite to a window; her head being supported
+against the breast of an assistant, who, at the same time, pressed upon
+the labial arteries. The inferior lip was divided perpendicularly, and
+detached laterally from the inferior jaw, so as to expose the whole
+extent of the carcinoma. Some strokes of the saw were made on the
+anterior and most prominent part of the bone, and into the groove thus
+formed, the blade of a very strong knife was inserted, by means of
+which, aided by some slight strokes with a mallet, all the diseased
+portion was removed. The soft parts had been previously detached from
+the internal surface of the jaw. The last left molar tooth, not being
+diseased, was alone left. The hæmorrhage from the dental artery was
+arrested by the actual cautery.
+
+The dental arch of the upper jaw, was then completely removed in the
+same manner. The bleeding was here more profuse, but was arrested by a
+hot iron. The alveolar processes thus removed, were enlarged, and of a
+lardaceous colour, and the fungous growths had the appearance and
+consistence of indurated albumen.
+
+In 25 days, the patient was discharged well. Her general health was
+good; the foetor had quite gone; the cicatrix over the bone was
+regular, white, hard, and could be pressed upon without causing pain.
+The patient can triturate her food with facility; the lips are slightly
+drawn inwards, without any sensible inconvenience; and the voice is a
+little altered, but this even is daily improving.--_Le Propagateur des
+Sci. Med._ for Jan. 1826.
+
+55. _Traumatic Erysipelas._--In the Feb. No. of the Revue Medicale, is a
+clinical report of the celebrated Baron LARREY, surgeon in chief of the
+Hospital de la Garde Royale; in which he criticises severely the use of
+leeches in erysipelas, and recommends in that variety of the disease,
+arising from wounds, &c. the application of the actual cautery, as
+effectual in arresting immediately the progress of the disease. It
+causes, he says, but little pain; destroys the burning and tense pain of
+the disease, as also the redness and swelling of the part; is not
+followed by suppuration, and does not cause gangrene in the contiguous
+parts. The eschar separates, without leaving a cicatrix. Various other
+advantages are enumerated, all of which are confirmed by a list of
+cases, as treated at the hospital. We have no room for details, which
+would, if known universally, hardly render us Americans, whether
+surgeons or patients, as fond of the cautery, as our trans-atlantic
+brethren of the French school.
+
+56. _Obliteration of a portion of the Urethra, remedied by an
+operation._--M. VANIER of Cherbourgh, relates in the Jan. No. of "Le
+Propagateur des Sciences Medicales," the case of a man aged 27 years,
+who, on the 16th of June, 1815, was wounded in the penis by a musket
+ball, which completely divided the urethra at its middle portion,
+without injuring the corpora cavernosa. The wound healed up; but by
+degrees, the passage contracted, so that in May, 1819, the patient could
+pass his urine only guttatim, with pain and difficulty, and was
+threatened with inflammation, &c. of the perineum. Bougies afforded no
+relief. An incision was then made externally, in the direction of the
+urethra, so as to divide the cicatrix, and open the canal above and
+below the contracted part. The lips of the incision were drawn together
+over a sound, passed into the bladder; and by the 5th day, the wound was
+completely cicatrized. The sound was then removed, and a short bougie
+inserted, so as to pass beyond the cicatrix. This was worn occasionally,
+and the patient completely recovered. At the end of three years, he was
+able to "urinate with ease, and in a full stream."
+
+57. _Artificial Joint cured by Caustic._--Dr. J. RHEA BARTON, has
+applied the caustic potash to the extremities of the fragments of a
+broken tibia, after an artificial joint had fully formed. Exfoliation
+was produced, followed by bony union. In three months, the patient
+recovered.
+
+Dr. B. alludes to other cases, by Mr. WHITE of Manchester, and Mr. HENRY
+CLINE, thus treated with success; to two instances, in which the
+practice failed in the hands of Mr. EARLE; and finally, to one case by
+Mr. A. COOPER, the result of which he has not learnt. He does not
+recommend the operation, as usually preferable to the _seton_, for
+which, the profession is indebted to Dr. PHYSICK; but as an additional
+expedient, when other means fail.--_Med. Record. April_, 1826.
+
+58. _Epilepsy cured by Trephining._--In the 17th No. of the New-York
+Medical and Physical Journal, Dr. DAVID L. ROGERS relates an interesting
+case of a man, aged 46, who had been subject to epileptic convulsions
+for 14 years, and who, of late years, had been unable to labour, and
+rapidly sinking into a state of idiocy, from their frequent recurrence.
+
+These fits were preceded by a fracture of the os frontis, with
+depression, from which he readily recovered; but soon after he was
+attacked with convulsions. He now suffers pain on the injured side
+extending down the neck and left arm--the eye of the same side is
+diminished--the sight much impaired, and his memory almost entirely
+destroyed. A cicatrix covering a slight depression was easily found,
+above the left superciliary ridge of the frontal bone, and over the
+superior orbitar foramen. Under these circumstances, the operation of
+trephining was performed on the 7th of July, 1825, but with some
+difficulty, from the irregular thickness of the bone, and from the saw
+having to pass through the upper part of the frontal sinus. "The dura
+mater was unfortunately cut through for one-half the circumference of
+the circle." The parts were found more vascular than usual, and the
+under surface had a ridge corresponding to the internal depression, but
+too slight to have caused compression of the brain. "Having made a
+section of the frontal sinus, [with a trephine?] a part of the
+_posterior table_ was removed with the _circular_ piece. This portion of
+the internal table had been fractured, and separated to some distance
+from its inferior attachments to the frontal plate, and driven back upon
+the substance of the brain. Its sharp edge was worn round and smooth."
+This seemed to have been the cause of all the mischief.
+
+After the operation, the patient suffered from pain in his head, with
+some moderate excitement, which was relieved by cathartics. He had no
+return of fits until the 25th day, when the wound was entirely healed.
+These had been brought on by overloading his stomach with food, and were
+followed by high arterial excitement and inflammation of the brain.
+
+He was relieved in a few days by active depletion, and was discharged
+cured on the 20th of August. _Nine months_ afterwards, this man
+continued free from fits, his memory had nearly recovered its usual
+strength, and he could attend to his business without any inconvenience.
+
+
+VI. MIDWIFERY.
+
+59. _Gastrotomy_.--M. BULK, in Germany, has successfully performed this
+operation on a female, aged 36 years, of good constitution, under the
+following circumstances. The patient, during her pregnancy, suffered
+from a severe pain at the left and inferior portion of the abdomen; her
+menses were not suppressed, and every six or eight days, a clot of blood
+and mucus came from the vagina. Her general health was very good.
+
+About the middle of her 8th month, she was washing some linen, and
+suddenly felt as if something was tearing in her abdomen; at the same
+time, a swelling of the size of two fists (poings) formed on the right
+side, below the umbilicus. She fainted, and for six weeks suffered dull
+pains in the abdomen. At this time, she had _true labour pains_ for 48
+hours, and was attended by a midwife. The os uteri dilated so as to
+admit one finger only. The tumour disappeared during these pains. The
+patient recovered, with the size of the abdomen undiminished.
+
+In this state she continued for two years and three months, menstruating
+regularly. She became again pregnant, with little inconvenience until
+the 7th month, when her abdomen was painfully distended, and of a bluish
+colour, and fluctuation was induced on the least motion. At the full
+period, she was delivered of a large foetus, which she suckled for 15
+days. The infant then died of an aphthous affection.
+
+Her milk ceasing, she rapidly declined with hectic symptoms. The tumour
+reappeared below the umbilicus about the size of an egg, and soon
+opened, discharging from small orifices a little pus. The opening was
+enlarged, and some skin and hairs were removed. The patient's
+constitution was fast yielding, and gastrotomy was immediately
+performed. An incision was made, with the requisite precautions, through
+the linea alba into the cavity of the abdomen, from two and a half
+inches above the umbilicus to within nine lines of the pubis, care being
+taken to prevent the escape of the intestines. A foetus of full size,
+in which putrefaction had commenced, was found on the right side of the
+uterus. "I raised," says the operator, "the body with much care, and
+endeavoured to trace the umbilical cord. This was turned over the fundus
+of the uterus to the left side, and terminated in a vascular substance
+in a state of suppuration, (probably, the remains of the placenta,)
+which was situated below the great omentum. I pressed out, and dried up
+the pus, which covered these parts, by means of a sponge. The uterus was
+an inch and a half in length and an inch in breadth, of a pale rose
+colour, and could easily be distended (se laissait distendre aisément.)
+It was otherwise in a good condition."
+
+The wound in the abdomen was closed with sutures. The patient was in
+great danger from inflammatory symptoms for 8 days, but eventually
+recovered. She left her bed on the 55th day.
+
+60. _Cæsarian operation, performed with safety to the Mother and
+Foetus._--We condense from JOHNSON'S Review for April last, the
+following summary of a case of Cæsarian section performed by GRAEFE, on
+the 20th of September, 1825.
+
+Carolina Bechang, was admitted into GRAEFE'S Clinicum, in an advanced
+stage of pregnancy; being 30 years of age, much deformed by rickets, and
+only four feet (Rhenish) in height. On the 20th of Sept. after having
+been five days in labour at the full period, pains severe, and os uteri
+dilated, she consented to the Cæsarian section.
+
+A little after 2 o'clock, GRAEFE placed the fore finger of his left
+hand, immediately below the umbilicus, and with a large scalpel, made an
+incision downwards in the linea alba, to within one inch of the pubis;
+dividing the entire parietes, and even penetrating the substance of the
+uterus. A second incision penetrated the uterus and exposed the
+placenta; which, as had been anticipated, was found on the fore part of
+the fundus. The assistants now compressed firmly the edges of the
+divided abdominal parietes upon the uterus, to prevent the protrusion of
+the intestines, in which they succeeded; and GRAEFE carried his hand in
+a moment into the uterus, separated the placenta with his finger and
+thumb, and then withdrew it and the child almost together. The child was
+very active, and cried lustily. The uterus immediately and suddenly
+contracted, and the bleeding was inconsiderable. Not more than twelve
+ounces of blood were lost, and no ligature was required. The whole
+operation was completed in four minutes and a half. The wound was
+secured by three broad sutures, and adhesive plasters, assisted by a
+bandage round the abdomen. The child weighed six pounds and was well
+formed. During the operation, the patient was sick, and once vomited
+slightly. In two hours had pain and fever: V.S. [Symbol: ounce]xij.
+Draught with ten drops of the aqua laurocerasi was given, and repeated
+in a few hours. The patient passed a quiet night. The symptoms of pain,
+inflammation, and fever, were threatening for some days, and were
+promptly resisted by the lancet, by enamata, by narcotics, especially
+the laurocerasus and hyosciamus, by fomentations, &c. By the 9th day,
+the wound had cicatrized, excepting near the symphisis; symptoms all
+favourable. The lochia were discharged regularly; and in three weeks,
+she was able to sit up, and in three more, quite well. Early in
+November, she returned home with her child, both in perfect health.
+
+In FERUSSAC'S Bulletin Universel; for February, another case, in which
+the Cæsarian operation was performed with safety to the mother and
+infant, is copied from RUST'S Magazine.
+
+61. _Extirpation of the Uterus._--Dr. RHEINECK, of Memmingen, was
+consulted by a female, who in December, 1824, was attacked by fever,
+from which she slowly recovered. A prolapsus of the uterus, which
+gradually became inverted, followed, attended with frequent hæmorrhage
+and discharge, by which she was almost worn to the grave. The whole of
+the uterus was inverted, and without the labia externa; its surface
+loose, fungous, and in several places easily broken down upon pressure;
+but there was no hardening nor ulceration. The irritation was so great,
+as to threaten the patient's life, and after a consultation, in which it
+was agreed, that the swelling was really formed by the uterus, the
+tumour was laid hold of and drawn forwards, and a broad ligature,
+secured with a double surgeon's knot, was applied round its base. In
+about three weeks, the whole had separated, and the part above the
+ligature was cicatrized. During this period, the patient was dangerously
+ill, and was only rescued by great care and attention.
+
+The operator had before performed a similar operation, in which case,
+the patient died suddenly from hæmorrhage, on the separation of the
+ligature. OSIANDER, STRUVE, LONGENBACK, SAUTER, SIEBOLD, and ZAUG, have
+in late years performed the same operation, with various degrees of
+success.--_Johnson's Review for April_, 1826, who quotes from _Siebold's
+Journal fur Geburtshulfe_, 1826.
+
+62. _Uterine Hæmorrhage._--In the Bulletin Universel for Jan. 1826, the
+following case is detailed from the Gazette de Santé, for Dec. 1825.
+
+A female aged 32 years, was taken with labour with her first child, on
+the 12th Feb. 1825. The pains soon ceased, and on the 15th of Feb. M.
+BEDEL, physician at Schirmack, was consulted, who speedily delivered
+her, by means of the forceps, of a dead child. The hæmorrhage was so
+considerable, as to render the immediate removal of the placenta
+necessary; but the uterus did not contract, and the bleeding continued,
+with tremblings, syncope, cold sweats, &c. Irritation on the internal
+surface of the uterus, the use of cold water to the abdomen, injections
+into the uterus of cold water and vinegar, were unavailing.
+
+Plugging the vagina, and also the _uterus_, was now resorted to, as the
+only means of safety remaining. The uterus was filled with pieces of
+rags, for fear the patient could not sustain the loss of blood necessary
+to fill that cavity; while a methodic compression was at the same time
+made to the abdomen. The hæmorrhage was immediately arrested, and soon
+after reaction ensued.
+
+On the 16th, M. BEDEL extracted the plugs from the uterus, cautiously
+and in succession; and had the pleasure of finding the uterus regularly
+contracting after each removal. The lochial discharge continued, and
+there was no secretion of milk. The patient recovered slowly.
+
+It is in such cases as the above, that the physicians of the United
+States have employed the Secale Cornutum (Ergot,) the judicious use of
+which would have probably superseded the necessity of instruments, and
+prevented or arrested the hæmorrhagic discharge.
+
+
+VII. CHEMISTRY AND PHARMACY.
+
+63. _State in which Morphia exists in Opium._--In the 80th article of
+our Quarterly Summary for January, we stated that MR. ROBINET had
+announced the discovery of a new acid in opium, with which the morphia
+was combined; while the meconic acid was alleged to be united with soda.
+To the former salt, he gave the name of _codeate of morphia_. MR.
+ROBIQUET, however, has shown, that the pretended _codeate_, is a
+_muriate_ of morphia, formed by double decomposition between the muriate
+of soda, employed by MR. ROBINET in his analysis, and meconate of
+morphia. The same decomposition shows the source of the meconate of
+soda. We observe that MR. ROBINET admits his mistake.--_Archives
+Générales de Medicine._
+
+64. _Peculiar principles of Narcotic Plants._--"Dr. BRANDES of
+Sabzerflen, having been prevented by extreme illness, induced by
+investigating the peculiar principles of narcotic plants, from
+completing his inquiries, has announced the results of his labours in
+general terms. He states, that he has found a peculiar narcotic
+principle in all the narcotic plants; as belladonna, hyosciamus, conium,
+stramonium, chelidonium, digitalis, &c. The narcotic principles are
+readily soluble in alcohol, ether, acids, and water, and of a highly
+offensive odour. This odour is so great in the principle of conium, that
+it is almost impossible for an individual of an irritable habit, to
+remain in the room, where there is an etherial solution, containing only
+a few grains of it. The smell of such a solution is equal to the smell,
+arising from twenty or thirty pounds of the plants. It is also
+remarkable, that as this principle is neutralized by acid, the
+disagreeable odour disappears, or is greatly diminished; which so far
+agrees with the circumstance, that the plants themselves give little of
+their peculiar smell, because the narcotic principle is not in a free
+state. Dr. BRANDES has promised to communicate the manner of obtaining
+the principles."--_Lond. Med. Repository, Feb. 1826._
+
+65. _Relative quantities of Cinchonia and Quinia in the most esteemed
+Varieties of Peruvian Bark._--Mr. BALLY asserts, that practitioners,
+from observation, have classed the Peruvian barks in the following
+order;--first, the gray loxa bark, (_Cinchona Officinalis_;) then the
+red bark (_Cinchona Magnifolia_ of RUIZ and PAVON, or _Oblongifolia_ of
+MUTIS;) and lastly the yellow bark, or calisaya, (_Cinchona Cordifolia_
+of MUTIS, or _pubescens_ of VALLI.) The _Cinchona Officinalis_ furnishes
+much cinchonia, and little quinia; the _Cinchona Magnifolia_ affords
+about equal quantities of the two salifiable principles, while the
+_Cordifolia_ contain much quinia.
+
+Mr. BALLY, assuming it as proved, that cinchonia is the more powerful
+salifiable base of the two in a medical point of view, considers,
+therefore, that, in regard to the above barks, chemical analysis
+justifies the order of their relative value, which had been previously
+deduced from their medical employment.--_Archives Generales de
+Medecine._
+
+66. _Sulphate of Quinia, extracted from the Cinchona Bark, exhausted by
+Decoction._--Mr. JULIA-FONTENELLE, from the sparing solubility of quinia
+and cinchonia, suspected that decoctions and aqueous extracts of
+Peruvian bark contained but little of those vegetable alkalies; whence
+it would follow, that the residuum, generally rejected as having no
+febrifuge power, would still contain the greater part of them. This
+suspicion has been in a great measure verified. The aqueous extract was
+found to contain but little cinchonia and quinia; while the residuum of
+decoctions, giving the mean results, furnished two-thirds of the
+sulphate of quinia, yielded by the same weight of cinchona not acted on
+by water.
+
+As decoctions and aqueous extracts of bark are febrifuge, though
+containing inconsiderable quantities of quinia, and cinchonia, Mr.
+JULIA-FONTENELLE is led to believe, that these salifiable bases are not
+the only febrifuge principles in Peruvian bark, but that the extractive
+matter also possesses that property.
+
+His results present a striking difference between alcoholic and aqueous
+extracts of bark; for while the former contain nearly the whole of the
+salifiable principles, the latter contain very little.--_Revue
+Medicale._
+
+67. _Analysis of Rhubarb._--It is some time since Mr. NANI, an Italian
+chemist, announced the discovery of a crystallizable vegetable alkali in
+rhubarb. Mr. CAVENTOU has repeated the experiments of Mr. N. and finds
+them, in many respects, inaccurate. Upon analysing the alcoholic extract
+of rhubarb, by the aid of alcohol and ether, employed separately and
+combined, Mr. C. obtained a fatty matter, containing a little
+odoriferous volatile oil, and a yellow colouring principle, capable of
+crystallization, and of being sublimed without decomposition, which may
+be called _rhubarbin_. He also detected in the alcoholic extract, a
+brown substance, insoluble in water when pure, but rendered soluble by
+combination with rhubarbin; when it forms a compound, constituting the
+_eaphopicrite_ of some chemists, and the _rhubarbin_ of
+Psaff.--_Archives Generales._
+
+Mr. GEORGE W. CARPENTER, of this city, prepares the medicinal principle
+of rhubarb in combination with sulphuric acid, under the name of
+sulphate of rhubarb, by the following process:
+
+"Boil, for half an hour, six pounds of coarsely powdered Chinese rhubarb
+in six gallons of water, acidulated with two and a half fluid ounces of
+sulphuric acid; strain the decoction, and submit the residue to a second
+ebullition in a like quantity of acidulated water; strain as before, and
+submit it again to a third ebullition. Unite the three decoctions, and
+add, by small portions, recently powdered pure lime, constantly stirring
+it to facilitate its action on the acid decoction. When the decoction
+becomes slightly alkaline, it deposites a red flocculent precipitate,
+and the fluid is changed from a yellow to a crimson colour. The
+precipitate is then to be separated by passing it through a linen cloth,
+and dried; after which, reduce it to powder, and digest in three gallons
+of alcohol, at thirty-six degrees, in a water bath, for several hours,
+at a moderate heat. Separate this solution from the calcareous
+precipitate, and distil off three-fourths of the alcohol. There then
+remains a strong solution of rhubarbine, to which add as much sulphuric
+acid as will exactly neutralize it. Evaporate this slowly to dryness,
+without having access to atmospheric air. The residuum will be of a
+brownish-red colour, intermingled with brilliant specks, possessing a
+slightly pungent styptic taste, soluble in water, and its odour that of
+the native rhubarb." This residuum is the sulphate of rhubarb. (Sulphate
+of _rhubarbin._?)
+
+Mr. CARPENTER assures us, that this preparation contains the medicinal
+principle of the rhubarb, apart from its inert portion; and considers it
+as bearing the same relation to rhubarb, as the sulphate of quinia to
+the Peruvian bark. The Chinese rhubarb, at half the price, furnished
+twice as much rhubarbin as the reputed Russian, which Mr. C. considers
+to be spurious in the Philadelphia market, being the English prepared in
+imitation of the Russian.--_Philadelphia Journal of the Medical &
+Physical Sciences. May_, 1826.
+
+68. _Alkaline Lozenges of Bicarbonate of Soda._--Mr. D'ARCET proposes
+the following formula for these lozenges:--Take of
+
+     Bicarbonate of Soda, pure and dry, and in fine powder,    5 parts.
+     Very white Sugar, in fine powder,                        95
+     Mucilage of Gum Tragacanth,                              q.s.
+     Essential oil of Mint, pure and fresh,                   2 or 3 drops
+         for about every 3 ounces of mixture of bicarbonate and sugar.
+
+Shake the bicarbonate and sugar in a well dried bottle, with the view of
+mixing them intimately. Withdraw the mixture from the bottle, and add
+the mucilage and oil of mint, blending the whole together on a marble.
+The mass obtained, is then to be divided into lozenges, which should
+weigh, when dried, about 15 grains each. As they slightly attract
+moisture, they ought to be kept in a dry place, or in well stopped
+bottles.
+
+Mr. D'ARCET praises very highly the effects of these lozenges in
+disordered digestion, and in preventing its occurrence, as well from
+experiments made on his own person, as from observations on others. He
+believes their operation to be purely chemical, consisting in the
+saturation of the morbid acid of the stomach, and, therefore, not likely
+to be lessened by habit. Their effects are much more prompt than
+magnesia, either pure or in the state of carbonate.
+
+In the phosphatic diathesis, where the urine is disposed to be alkaline,
+it would seem that these lozenges would do harm. But, perhaps, we have
+this security against their use in these cases, that the stomach would
+not at the same time be troubled with acidity. _Annales de Chimie et de
+Physique, Jan._ 1826.
+
+69. _Presence of Mercury in Samples of medicinal Prussic Acid._--Mr.
+REGIMBEAU, apothecary at Montpellier, has detected this impurity in some
+prussic acid, prepared in Paris. Its presence was first suspected, from
+a portion of the acid, accidentally dropped, leaving a white stain on
+the copper dish of a balance. It is probable, that the impure acid,
+spoken of, had been made by passing sulphuretted hydrogen through a
+solution of cyanide of mercury, according to VANQUELIN'S process; and
+that an insufficiency of the decomposing gas had been employed.
+
+May not this accidental impurity explain the occasional salivating
+effects of prussic acid.
+
+70. _Proposed Method for preparing Protoxide of Mercury by
+precipitation, for Medical Employment._--Mr. THOMAS EVANS has published
+some observations on this subject, and justly remarks, that the blue
+pill, mercurial ointment, and other mercurial preparations, are not
+uniform compounds, but contain variable proportions of the real
+protoxide, and uncombined mercury. Some blue pill, which had been
+carefully prepared by Mr. E. by the usual process of trituration, was
+found to contain on analysis 20 per cent. of unoxidized mercury; and
+the blue mass from Apothecaries' Hall, London, furnished about the same
+proportion.
+
+As it is obviously a desideratum to procure preparations of protoxide of
+mercury of uniform strength, Mr. EVANS has been led to seek a process,
+by which to obtain this oxide in a pure state. After repeated
+experiments, he has pitched upon the following formula: Dissolve four
+ounces of caustic hydrate of potassa in a pound of water, and to the
+clear solution, decanted from any impurities, add four ounces of
+calomel, and shake the mixture frequently. Pour off the liquid, and wash
+the precipitate formed with water, and then dry it at a gentle heat.
+
+In regard to the medical efficacy of the protoxide obtained in this way,
+Mr. EVANS reports the following to be the results obtained by Dr.
+COATES, at whose suggestion the article was prepared. As a substitute
+for calomel, it is more apt to vomit and purge, two grain doses
+operating several times. As an alterative, it was found incomparably
+more efficacious than the blue pill, being more certain and regular in
+its operation. Dr. C. thinks, that one-fourth of a grain of the
+precipitated protoxide, as prepared by Mr. EVANS, is equal to three or
+four grains of the blue mass.--_Journ. of the Philad. Col. of Pharm.
+May_, 1826.
+
+The method here proposed for obtaining the black oxide of mercury by Mr.
+EVANS, was first suggested and put in practice by Mr. PHILLIPS. See his
+"Experimental Examination of the last edition of the Pharmacopoeia
+Londinensis, London, 1811," page 114. His words are, "When solution of
+potash is employed, the several inconveniences attendant upon the use of
+lime-water are avoided, and a blackish coloured protoxide is obtained
+without heating the solution. As potash is much more soluble than lime,
+it is scarcely necessary to employ one-tenth part of the quantity of
+water; this not only renders the process more convenient, but the
+quantity of air contained in the water being less, very little of the
+oxide, perhaps none of it, is converted into peroxide." See also the
+experiments, and observations of Mr. DONOVAN, on Mercurial Ointment, &c.
+published in the Medical Journals, several years ago.
+
+71. _Goulard's Extract of Lead._ Mr. DANIEL B. SMITH proposes the
+following formula for obtaining Goulard's extract of uniform strength:
+
+     Acetate of lead, crystallized,    15 ounces, troy.
+     Protoxide of lead,                 9 ounces, troy.
+     Distilled water,                   4 pints.
+
+"Boil them together for fifteen minutes and filter. The filtered liquid
+will weigh about five and a quarter pounds, is transparent, colourless,
+and of the specific gravity of 1.267. (30° Baumé.)"
+
+We conceive that Mr. SMITH has erroneously denominated the sugar of
+lead, a binacetate. The best usage is to deem that the primary saline
+compound, which contains a single proportional of acid and base.
+Accordingly we call the saturated carbonate of potassa, a
+_bicarbonate_; and Dr. THOMSON calls borax, a biborate of soda, on
+account of its containing two proportionals of acid to one of base,
+notwithstanding the alkaline qualities of this salt. Goulard's extract
+is, therefore, a sub-binacetate of lead, or according to Dr. THOMSON'S
+recently suggested nomenclature, a _diacetate_.--_Ibid._
+
+
+
+
+QUARTERLY LIST
+
+OF
+
+AMERICAN MEDICAL PUBLICATIONS
+
+
+Observations on the Autumnal Fevers of Savannah. By W. C. Daniell, M. D.
+8vo. pp. 152.--W. T. Williams, and Collins & Hanway. Savannah, 1826.
+
+An Analysis of Fever. By Charles Caldwell, M. D., Professor of the
+Institutes of Medicine, and Clinical Practice in Transylvania
+University. 8vo. pp. 97.--Lexington, K. 1825.
+
+Medical and Physical Memoirs. By Charles Caldwell, M. D., Professor, &c.
+Containing, 1. An Introductory Address, intended as a Defence of the
+Medical Profession against the charge of Irreligion and Infidelity; with
+Thoughts on the Truth and Importance of Natural Religion. 2. A
+Dissertation in answer to certain Prize Questions, proposed by his
+Grace, the Duke of Holstein Oldenburg, respecting the "Origin, Contagion
+and general Philosophy of Yellow Fever, and the Practicability of that
+Disease prevailing in high Northern Latitudes;" with Thoughts on its
+Prevention and Treatment. 3. Thoughts on the Analogies of Disease. 8vo.
+pp. 224.--Lexington, K. 1826.
+
+Florula Cestrica: an Essay towards a Catalogue of the Phoenogamous
+Plants, native and naturalized, growing in the vicinity of the borough
+of West-Chester, in Chester County, Pennsylvania; with brief notices of
+their Properties and Uses, in Medicine, rural Economy and the Arts. To
+which is subjoined an Appendix of the useful cultivated Plants of the
+same District. By William Darlington, M. D. 8vo.--West-Chester, 1826.
+
+     We are much gratified with the appearance of this little flora.
+     It is really an uncommonly neat, useful, and convenient
+     performance; and, we have no doubt, is by far the most elegant
+     and creditable botanical work, if not the only one, published
+     in any small town in America. To a country town, we would not
+     think of looking for such a production; but in fact, the county
+     of Chester has, of late years, made very considerable advances
+     in science and literature. It has produced a public library,
+     and perhaps others with the existence of which we are not
+     acquainted, several botanical and mineralogical collections, a
+     very respectable series of essays on its history, similar to
+     Mr. Jefferson's notes on Virginia, schools, teaching the higher
+     branches of the English mathematics, and one of those partly
+     literary newspapers which have recently sprung up among us.
+
+     The above title considerably explains the nature and extent of
+     the work. Of its scientific accuracy, sufficient time has not
+     yet elapsed to form an adequate judgment; but we observe that
+     the author has had the frequent assistance of Baldwin, Collins,
+     Steinhauer, Torrey, and Schweinitz: so that, if the maxim
+     "noscitur a socio" be at all applicable in the present case, it
+     is evident that he has been in the very best botanical company
+     which our land affords.
+
+     The work is executed with very great neatness, such as would do
+     credit to the press of a metropolis, and is really wonderful
+     for a moderate sized village, and for the disturbed life of a
+     country physician, its author. There is also a great deal of
+     that kind of popular explanation, which so agreeably relieves
+     the repulsiveness of dry works on natural history: such as the
+     familiar names of the plants; the derivations of the names of
+     the genera, designed to assist the student in remembering them,
+     by enabling him to associate some idea with them; occasional
+     comments on their uses and injurious effects, &c.
+
+     We may add, that from the close proximity of Chester County to
+     Philadelphia, extending to a large part of the line of the
+     Schuylkill, this little work will answer extremely well for
+     common use around this city, with the single exception of the
+     sands of New-Jersey.
+
+Memoir on the Topography, Weather, and Diseases of the Bahama Islands.
+By P. S. Townsend, M. D.--New-York, 1826.
+
+The New-England Journal of Medicine and Surgery, and Collateral Branches
+of Science. Conducted by Walter Channing, Jr. M. D., and John Ware, M.
+D. No. 2. Vol. XV.--Boston, April, 1826.
+
+The American Medical Review, and Journal of Original and Selected Papers
+in Medicine and Surgery. Conducted by John Eberle, M. D., Nathan Smith,
+M. D., George M'Clellan, M. D., and Nathan R. Smith, M. D. No. 1, Vol.
+III.--Philadelphia, April, 1826.
+
+The Medical Recorder of Original Papers and Intelligence in Medicine and
+Surgery. Conducted by Samuel Colhoun, M. D. No. 2, Vol.
+IX.--Philadelphia, April, 1826.
+
+The Philadelphia Journal of the Medical and Physical Sciences. Edited by
+N. Chapman, M. D., W. P. Dewees, M. D., and John D. Godman, M. D. No.
+V. New Series.--Philadelphia, May, 1826.
+
+The New-York Medical and Physical Journal. No. 17. Edited by John B.
+Beck, M. D., Daniel L. M. Peixotto, M. D., and John Bell, M.
+D.--New-York, April, 1826.
+
+Journal of the Philadelphia College of Pharmacy. No. 2, Vol.
+1.--Philadelphia, May, 1826.
+
+
+AMERICAN EDITIONS OF FOREIGN MEDICAL BOOKS.
+
+Manual of Surgical Operations; containing the New Method of operating,
+devised by Lisfranc; followed by two Synoptic Tables of Natural and
+Instrumental Labours. By J. Coster, M. D. and Professor of the
+University of Turin. The Translation and Notes by John D. Godman, M. D.
+12mo. pp. 265.--Carey & Lea. Philadelphia, 1825.
+
+A Treatise on Derangements of the Liver, Internal Organs, and Nervous
+System. By James Johnson, M. D. 12mo. pp. 223.--Carey & Lea.
+Philadelphia, 1826.
+
+An Inquiry into the Nature and Treatment of Diabetes, Calculus, and
+other Affections of the Urinary Organs. By William Prout, M.D. F.R.S.
+From the second London Edition, with Notes and Additions, by S. Colhoun,
+M. D. 8vo. pp. 308.--Towar & Hogan. Philadelphia, 1826.
+
+       *       *       *       *       *
+
+We are sensible that the foregoing does not present a full list of
+medical publications for the last quarter; but it is as complete as our
+opportunities have enabled us to make it. It is obviously for the
+interest of authors and publishers, to send us the titles of their
+medical publications as soon as they appear, and we invite them to do
+so.
+
+
+
+***END OF THE PROJECT GUTENBERG EBOOK NORTH AMERICAN MEDICAL AND SURGICAL
+JOURNAL, VOL. 2, NO. 3, JULY, 1826***
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+<title>The Project Gutenberg eBook of North American Medical and Surgical Journal, Vol. 2, No. 3, July, 1826, by Various</title>
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+<h1>The Project Gutenberg eBook, North American Medical and Surgical Journal,
+Vol. 2, No. 3, July, 1826, by Various, Edited by Hugh L. Hodge, Franklin
+Bache, Charles D. Meigs, Benjamin Homer Coates, and René La Roche</h1>
+<pre>
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at <a href = "http://www.gutenberg.org">www.gutenberg.org</a></pre>
+<p>Title: North American Medical and Surgical Journal, Vol. 2, No. 3, July, 1826</p>
+<p>Author: Various</p>
+<p>Editor: Hugh L. Hodge, Franklin Bache, Charles D. Meigs, Benjamin Homer Coates, and René La Roche</p>
+<p>Release Date: July 4, 2009  [eBook #29307]</p>
+<p>Language: English</p>
+<p>Character set encoding: ISO-8859-1</p>
+<p>***START OF THE PROJECT GUTENBERG EBOOK NORTH AMERICAN MEDICAL AND SURGICAL JOURNAL, VOL. 2, NO. 3, JULY, 1826***</p>
+<p>&nbsp;</p>
+<h3>E-text prepared by Juliet Sutherland, Josephine Paolucci,<br />
+    and the Project Gutenberg Online Distributed Proofreading Team<br />
+    (http://www.pgdp.net)</h3>
+<p>&nbsp;</p>
+<hr class="full" />
+<p>&nbsp;</p>
+<p>&nbsp;</p>
+<p>&nbsp;</p>
+
+<h3>THE</h3>
+
+<h2>NORTH AMERICAN</h2>
+
+<h1>MEDICAL AND SURGICAL</h1>
+
+<h2>JOURNAL.</h2>
+
+
+<h3>CONDUCTED BY</h3>
+
+<p class="center">
+HUGH L. HODGE, M.D.  | CHAS. D. MEIGS, M.D.<br />
+FRANKLIN BACHE, M.D. | B. H. COATES, M.D.<br />
+<br />
+AND<br />
+<br />
+R. LA ROCHE, M.D.<br />
+</p>
+
+<h3>NON DOCTIOR, SED MELIORE IMBUTUS DOCTRINA.</h3>
+
+<h4>VOL. II.</h4>
+
+<h4>PHILADELPHIA:</h4>
+
+<h4>PUBLISHED BY J. DOBSON, AGENT.</h4>
+
+<h4>JESPER HARDING, PRINTER.</h4>
+
+<h5>1826.</h5>
+
+
+<h2><i>Eastern District of Pennsylvania, to wit</i></h2>
+
+<p><span class="smcap">Be It Remembered</span>, that on the 31st day of March, in the 50th year of the
+Independence of the United States of America, A. D. 1826, Hugh L. Hodge,
+Franklin Bache, Charles D. Meigs, Benjamin H. Coates, and Ren&eacute; La Roche,
+of the said District, have deposited in this office the Title of a Book,
+the right whereof they claim as Proprietors, in the words following, to
+wit:</p>
+
+<p>"<i>The North American Medical and Surgical Journal. Conducted by Hugh L.
+Hodge, M. D., Franklin Bache, M. D., Chas. D. Meigs, M. D., B. H.
+Coates, M. D., and R. La Roche, M. D. Non doctior, sed meliore imbutus
+doctrina. Vol. II.</i>"</p>
+
+<p>In conformity to the act of Congress of the United States, intituled,
+"An act for the encouragement of learning, by securing the copies of
+maps, charts, and books, to the authors and proprietors of such copies,
+during the times therein mentioned;"&mdash;and also to the act, entitled, "An
+act supplementary to an act, entitled, "An act for the encouragement of
+learning, by securing the copies of maps, charts, and books, to the
+authors and proprietors of such copies, during the times therein
+mentioned," and extending the benefits thereof to the arts of designing,
+engraving, and etching historical and other prints."</p>
+
+<div class="blockquot"><p><span class="smcap">D. Caldwell</span>, Clerk of the Eastern District of Pennsylvania.</p></div><p><span class='pagenum'><a name="Page_iii" id="Page_iii">[Pg iii]</a></span></p>
+
+
+
+<hr style="width: 65%;" />
+<h2>CONTENTS</h2>
+
+<h3>OF VOL. II.</h3>
+
+<h3>No. III.</h3>
+
+<h4>ORIGINAL COMMUNICATIONS.</h4>
+
+<p><span class="smcap">Art.</span>                                                 <span class="tocnum"><span class="smcap">Page.</span></span></p>
+
+<p>I. Description of the Gangrenous Ulcer of the mouths of children.
+By B. H. Coates, M. D., one of the Physicians to the Philadelphia
+Children's Asylum, &amp;c.                                                   <span class="tocnum"><a href='#Page_1'>1</a></span></p>
+
+<p>II. Case of Purpura in an Infant, attended with extraordinary
+symptoms. By R. M. Huston, M. D.                                        <span class="tocnum"><a href='#Page_24'>24</a></span></p>
+
+<p>III. History of the Natural and Modified Small Pox, or of the Variolous
+and Varioloid Diseases, as they prevailed in Philadelphia,
+in the years 1823 and 1824. By John K. Mitchell,
+M. D., and John Bell, M. D., attending physicians at the
+then Small Pox Hospital. With a plate.                                  <span class="tocnum"><a href='#Page_27'>27</a></span></p>
+
+<p>IV. Remarks on the Pathology and Treatment of Yellow Fever.
+Arranged from the notes of Dr. J. A. Monges, of Philadelphia.           <span class="tocnum"><a href='#Page_53'>53</a></span></p>
+
+<p>V. Remarks on the Prophylactic Treatment of Cholera Infantum.
+By Joseph Parrish, M. D., one of the Surgeons to the Pennsylvania
+Hospital.                                                               <span class="tocnum"><a href='#Page_68'>68</a></span></p>
+
+<p>VI. Case of Neuralgia cured by Acupuncturation. Communicated
+by J. Hunter Ewing, M. D.                                               <span class="tocnum"><a href='#Page_77'>77</a></span></p>
+
+
+<h4>ANALYTICAL REVIEWS.</h4>
+
+<p>VII. Researches into the Nature and Treatment of Dropsy in the
+Brain, Chest, Abdomen, Ovarium, and Skin. By Joseph
+Ayre, M. D., &amp;c.                                                        <span class="tocnum"><a href='#Page_79'>79</a></span></p>
+
+<p>VIII. An Essay on Venereal Diseases, and the Uses and Abuses of
+Mercury in their Treatment. By Richard Carmichael, M. R. I. A.
+With Practical Notes, &amp;c. By G. Emerson, M. D.                         <span class="tocnum"><a href='#Page_109'>109</a></span></p>
+
+<p>IX. Remarks on some Means employed to destroy T&aelig;nia, and expel
+them from the Human Body. By Louis Frank, M. D.
+Privy Counsellor of her Majesty, Maria Louisa, Duchess of
+Parma.                                                                 <span class="tocnum"><a href='#Page_114'>114</a></span></p>
+
+<p>X. Researches, Physiological and Pathological, instituted principally
+with a View to the Improvement of Medical and Surgical
+Practice. By James Blundell, M. D., Lecturer on
+Physiology and Midwifery at the United Hospitals of St.
+Thomas and Guy.                                                        <span class="tocnum"><a href='#Page_119'>119</a></span></p>
+
+<p>XI. An Inquiry into the Nature and Treatment of Diabetes, Calculus<span class='pagenum'><a name="Page_iv" id="Page_iv">[Pg iv]</a></span>
+and other Affections of the Urinary Organs. By William
+Prout, M. D., F. R. S. With Notes and Additions, by S.
+Colhoun, M. D.                                                         <span class="tocnum"><a href='#Page_125'>125</a></span></p>
+
+
+<h4>MEDICAL LITERATURE.&mdash;RETROSPECTIVE REVIEW.</h4>
+
+<p>XII. Tractatus de Ventriculo et Intestinis, cui pr&aelig;mittitur alius, de
+Partibus continentibus in Genere, et in Specie de iis Abdominis.
+Authore Francisco Glissonio. Lond. 1677, 4to.                          <span class="tocnum"><a href='#Page_138'>138</a></span></p>
+
+
+<h4>QUARTERLY SUMMARY OF MEDICAL AND SURGICAL INTELLIGENCE.</h4>
+
+<p><span class="smcap">Anatomy</span>,                                                      <span class="tocnum"><a href='#Page_155'>155</a></span></p>
+
+<p>1, Papill&aelig; of the Tongue. 2, Villi of the Stomach and Intestines. 3,
+Minute distribution of the Vessels of the Liver. 4, Trachea perforating
+the Aorta. 5, Monsters. 6, Malformation of the Heart. 7, Acephalous
+Mummy. 8, New Anatomical Plates. 9, A Manual of Osteology. 10,
+S&oelig;mmering's Work on the Anatomy of the Ear. 11, Does the conjunctiva
+run over the Cornea?</p>
+
+
+<p><span class="smcap">Physiology</span>,                                                  <span class="tocnum"><a href='#Page_158'>158</a></span></p>
+
+<p>12, Electro-Galvanic phenomena of Acupuncturation. 13, Variations in
+Milk. 14, Hyoscyamus dilates the Pupils of the Eyes. 15, Worms in the
+Eye. 16, Digestion.</p>
+
+<p><span class="smcap">Pathology</span>,                                                   <span class="tocnum"><a href='#Page_161'>161</a></span></p>
+
+<p>17, Dothinenteria&mdash;Pustules of the small Intestines. 18, Dr. Broussais.
+19, Whooping Cough. 20, Antiperistaltic Globus&mdash;Globus Hystericus.
+21, Non-contagion of Yellow Fever.</p>
+
+<p><span class="smcap">Therapeutics, Materia Medica, and the Practice of Medicine</span>,  <span class="tocnum"><a href='#Page_166'>166</a></span></p>
+
+<p>22, Iodine. 23, Non-mercurial Treatment of Syphilis. 24, Cancer
+treated by Antiphlogistics. 25, Essential Oil of Male Fern as a remedy in
+Cases of T&aelig;nia. 26, Tincture of Bastard Saffron for the expulsion of
+T&aelig;nia. 27, Oil of Turpentine in T&aelig;nia. 28, Action of the Oil of the Euphorbia
+Lathyris. 29, Medicinal Properties of the Apocynum Cannabinum
+or Indian Hemp. 30, Remarkable Effects from the external application of
+the Acetate of Morphia. 31, Cure of Urinary Calculi, by means of the internal
+use of the Bicarbonate of Soda. 32, Attempt to cure Abdominal
+Dropsy by exciting Peritoneal Inflammation. 33, Artificial Respiration.
+34, Secale Cornutum. 35, Animal Magnetism. 36, Sketch of the Medical
+Literature of Denmark, Sweden, and Norway. 37, Erysipelatous Mumps
+or Angina Parotidiana. 38, T&aelig;nia. 39, Scrophula. 40, Digitalis.</p>
+
+<p><span class="smcap">Surgery</span>,                                                     <span class="tocnum"><a href='#Page_192'>192</a></span></p>
+
+<p>41, Dr. Physick's Operation for Artificial Anus denied to have been
+performed.
+42, Gangrenous Sore Mouth of Children. 43, Operation for
+Phymosis. 44, Lunar Caustic on Wounds and Ulcers. 45, H&aelig;morrhage
+from Lithotomy. 46, Extirpation of the Parotid Gland. 47, Aneurism
+from a Wound, cured by Valsaiva's method. 48, Protrusion and Wound
+of the Stomach. 49, &OElig;sophagotomy. 50, Retention of Urine, caused by
+a Stricture of the Urethra, relieved by a forcible but gradual Injection.
+51, Tracheotomy. 52, Fistula Lachrymalis. 53, Aneurisma Herniosum.
+54, Extirpation of the Two Dental Arches affected with Osteo-sarcoma.
+55, Traumatic Erysipelas. 56, Obliteration of a portion of the Urethra,
+remedied by an Operation. 57, Artificial Joint cured by Caustic. 58,
+Epilepsy cured by Trephining.</p>
+
+<p><span class="smcap">Midwifery</span>,                                                   <span class="tocnum"><a href='#Page_205'>205</a></span></p>
+
+<p>59, Gastrotomy. 60, C&aelig;sarian Operation, performed with safety to the
+Mother and F&oelig;tus. 61, Extirpation of the Uterus. 62, Uterine H&aelig;morrhage.</p>
+
+<p><span class="smcap">Chemistry and Pharmacy</span>,                                      <span class="tocnum"><a href='#Page_208'>208</a></span></p>
+
+<p>63, State in which Morphia exists in Opium. 64, Peculiar Principles of
+Narcotic Plants. 65, Relative quantities of Cinchonia and Quinia with<span class='pagenum'><a name="Page_v" id="Page_v">[Pg v]</a></span>
+indention in the most esteemed Varieties of Peruvian Bark. 66, Sulphate
+of Quinia, extracted from the Cinchona Bark, exhausted by Decoction.
+67, Analysis of Rhubarb. 68, Alkaline Lozenges of Bicarbonate of Soda.
+69, Presence of Mercury in Samples of Medicinal Prussic Acid. 70, Proposed
+Method of preparing Protoxide of Mercury by precipitation, for
+Medical Employment. 71, Goulard's Extract of Lead.</p>
+
+<p><span class="smcap">Quarterly List of American Medical Publications</span>,          <span class="tocnum"><a href="#Page_214">214</a>-16</span></p>
+
+
+<h3>No. IV.</h3>
+
+<h4>ORIGINAL COMMUNICATIONS.</h4>
+
+<p><span class="smcap">Art.</span></p>
+
+<p>I. On the Epidemic of 1825 in Natchez, Miss. By Ayres P.
+Merrill, M. D.                                                        <span class="tocnum">217</span></p>
+
+<p>II. History of the Natural and Modified Small Pox, or of the Variolous
+and Varioloid Diseases, as they prevailed in Philadelphia,
+in the years 1823 and 1824. By John K. Mitchell,
+M. D., and John Bell, M. D., Physicians at the then Small
+Pox Hospital. (Concluded from page 53.)                               <span class="tocnum">238</span></p>
+
+<p>III. Cases of Nervous Irritation, exhibiting the Efficacy of Cold as
+a Remedy. By S. Jackson, M. D.                            <span class="tocnum">250</span></p>
+
+<p>IV. Remarks on the Pathology of Jaundice. By G. B. Wood, M. D.        <span class="tocnum">260</span></p>
+
+<p>V. Account of a Case in which a New and Peculiar Operation for
+Artificial Anus was performed in 1809. By Philip Syng
+Physick, M. D., Professor of Surgery in the University of
+Pennsylvania, &amp;c. Drawn up for publication by B. H.
+Coates, M. D.                                                         <span class="tocnum">269</span></p>
+
+<p>VI. Observations on Asphyxia from Drowning, to which is added
+a Case of Resuscitation. By Edward Jenner Coxe, M. D.                 <span class="tocnum">276</span></p>
+
+
+<h4>ANALYTICAL REVIEWS.</h4>
+
+<p>VII. Trait&eacute; Zoologique et Physiologique, Sur les Vers Intestinaux de
+l'Homme. Par M. Bremser, D. M. Traduit de l'Allemande
+par M. Grundler, D. M. P. Revue et Augment&eacute;e de Notes.
+Par M. de Blainville, D. M., &amp;c. Avec un Atlas. Paris, 1824.</p>
+
+<p>Anatomie des Vers Intestinaux, Ascaride, Lombricoide, et
+Echynorhynque Geant. Memoire Couronn&eacute; par l'Academie
+Royale des Sciences, qui en avoit mit le sujet au Concours,
+pour l'ann&eacute;e 1818. Avec 8 Planches. Par Jules Cloquet,
+&amp;c. &amp;c. A Paris, 1824                                                 <span class="tocnum">297</span></p>
+
+<p>VIII. Precis Theorique et Pratique, sur les Maladies de la Peau.
+Par M. S. L. Alibert. 2 Tomes. 8vo. Paris, 1810-1820.                 <span class="tocnum">322</span></p>
+
+<p>IX. Thoughts on Medical Education, and a Plan for its Improvement;
+addressed to the Council of the University of London.
+Dictu Necessaria. Plin. London, 1826.</p>
+
+<p>Projet de Loi, present&eacute; aux Chambres dans la S&eacute;ance du 14
+Fevrier 1825, par S. E. le Ministre de l'Int&eacute;rieur, Sur les
+Ecoles Secondaries de Med&eacute;cine, les Chambres de Discipline,
+et les Eaux Minerales Artificielles.                                  <span class="tocnum">344</span></p>
+
+
+<h4>MEDICAL LITERATURE&mdash;RETROSPECTIVE REVIEWS.</h4>
+
+<p>X. Recherches sur le Tissu Muqueux, ou l'Organe Cellulaire, et
+Sur Quelques Maladies de la Poitrine. Par Th&eacute;ophile Bordeu,
+Docteur en Med&eacute;cine des Facult&eacute;s de Paris, et de
+Montp&eacute;lier. Paris, 1767, 12mo.                        <span class="tocnum">376</span><span class='pagenum'><a name="Page_vi" id="Page_vi">[Pg vi]</a></span></p>
+
+
+<h4>QUARTERLY SUMMARY OF IMPROVEMENTS IN MEDICINE AND
+SURGERY</h4>
+
+<p><span class="smcap">Anatomy,</span>                                    <span class="tocnum">395</span></p>
+
+<p>1, Notice of a Double Male F&oelig;tus, by W. E. Horner, M. D., &amp;c. 2,
+Imperfect Development of the Cerebral Organs in Monsters. 3, Imperforate
+Vagina. 4, Fallopian Tubes. 5, Monsters. 6, F&oelig;tus grafted into
+the Chest of another. 7, F&oelig;tus without a Stomach, Head or Anus. 8,
+Congenital Hydrocephalus, with Transposition of the Viscera. 9, Unusual
+Arrangement of the Aortic Branches.</p>
+
+<p><span class="smcap">Physiology,</span>                                                  <span class="tocnum">403</span></p>
+
+<p>10, Influence of the Great Sympathetic Nerve on the Functions of Sense.
+11, Cutaneous Absorption. 12, Abstinence. 13, Hippomane Mancinella.
+14, Cutaneous Absorption. 15, Regeneration of Divided Arteries.
+16, Mineral Poisons.</p>
+
+<p><span class="smcap">Pathology,</span>                                                   <span class="tocnum">406</span></p>
+
+<p>17, Are we followers of Dr. Broussais? 18, Influenza. 19, Diarrh&oelig;a
+Infantum. 20, Tetanus. 21, Small Pox.</p>
+
+<p><span class="smcap">Therapeutics, Materia Medica, and the Practice of Medicine.</span>  <span class="tocnum">411</span></p>
+
+<p>22, Tincture of Iodine in Gonorrh&oelig;a, Bubo, Scrofula, &amp;c. 23, Acetate
+of Lead and Tincture of Opium in Dysentery. 24, Powers of Digitalis in
+Palpitatio Cordis. 25, Tartar-Emetic Ointment in Epilepsy. 26,
+Antiphlogistics
+in Recent Cases of Epilepsy. 27, On the Efficacy of Nitrate
+of Silver in the Treatment of Zona or Shingles. 28, On the Remedial
+Effects of Camphor in Acute and Chronic Rheumatism. 29, Examination
+of the Question, whether the Medical Use of Phosphorus internally, is
+useful, injurious, or equivocal. 30, Nitrous Acid and Opium in Dysentery,
+Cholera and Diarrh&oelig;a. 31, Tartar Emetic in Pneumonia Biliosa. 32,
+Bark of the Ampelopsis in Catarrhal Consumption. 33, Obstinate Vomiting
+cured with Extract of Marigold. 34, Vomiting of Fat and Blood. 35,
+Rupture of the Spleen. 36, Chilblains cured with Chloride of Lime. 37,
+Local Spontaneous Combustion. 38, Dr. Painchaud on Tic Douloureux.
+39, Duration of Life among the Romans. 40, Difference of Mortality
+from 1775, to 1825. 41, New Method of Percussion of the Thorax. 42,
+Acid Nitrate of Mercury. 43, Effects of Ardent Spirits. 44, Colombo
+Root. 45, Poison of Mushrooms. 46, Antisyphilitic Decoction of Zittmann.
+47, Acetate of Ammonia, a Remedy for Drunkenness. 48, Mortality
+of Leeches. 49, Black Drop. 50, Doses of Calomel in days of
+yore. 51, Buying a good Practice. 52, Sore Nipples. 53, Anderson's
+Quarterly. 54, Antiquity of Cow Pox and Origin of Small Pox from it.</p>
+
+<p><span class="smcap">Surgery,</span>                                                     <span class="tocnum">431</span></p>
+
+<p>55, Lithotritie, on Breaking the Stone in the Bladder. 56, The High
+Operation. 57, Sutures in Wounds of the Bladder. 58, Paracentesis
+Thoracis. 59, Stricture of the &oelig;sophagus. 60, Wound of the Brain. 61,
+Luxation of the Metatarsus; the history drawn up by M. Dusol, D. M.</p>
+
+<p><span class="smcap">Midwifery</span>,                                                   <span class="tocnum">438</span></p>
+
+<p>62, Uterine H&aelig;morrhage. 63, Polypi of the Uterus. 64, C&aelig;sarian
+Section. 65, Case of Difficult Parturition. 66, Case of the Pelvis becoming
+enlarged.</p>
+
+<p><span class="smcap">Chemistry and Pharmacy</span>,                                      <span class="tocnum">440</span></p>
+
+<p>67, L'Artigue's Process of preparing the Watery Extract of Opium.
+68, Berzelius' Method of Detecting Arsenic in the bodies of Persons poisoned
+by it. 69, Action of Certain Metallic Substances on the Animal
+Economy.</p>
+
+<p><span class="smcap">Quarterly List of American Medical Publications</span>,             <span class="tocnum">444-48</span></p>
+
+
+
+<hr style="width: 65%;" /><p><span class='pagenum'><a name="Page_vii" id="Page_vii">[Pg vii]</a></span></p>
+<h2>CONTENTS</h2>
+
+
+<h4>ORIGINAL COMMUNICATIONS.</h4>
+
+<p><span class="tocnum">PAGE</span></p>
+
+<p><span class="smcap">Art.</span> I. Description of the Gangrenous Ulcer of the Mouths
+of Children. By B. H. Coates, M. D. one of the
+Physicians to the Philadelphia Children's Asylum,
+&amp;c.                                                        <span class="tocnum"><a href='#Page_1'>1</a></span></p>
+
+<p>II. Case of Purpura in an Infant, attended with extraordinary
+Symptoms. By R. M. Huston, M. D.                          <span class="tocnum"><a href='#Page_24'>24</a></span></p>
+
+<p>III. History of the Natural and Modified Small-pox, or
+of the Variolous and Varioloid Diseases, as they
+prevailed in Philadelphia in the years 1823 and
+1824. By John K. Mitchell, M. D., and John
+Bell, M. D., attending Physicians at the then
+Small-pox Hospital.&mdash;With a plate.                        <span class="tocnum"><a href='#Page_27'>27</a></span></p>
+
+<p>IV. Remarks on the Pathology and Treatment of Yellow
+Fever. Arranged from the Notes of Dr. J.
+A. Monges, of Philadelphia.                               <span class="tocnum"><a href='#Page_53'>53</a></span></p>
+
+<p>V. Remarks on the Prophylactic Treatment of Cholera
+Infantum. By Joseph Parrish, M. D., one of the
+Surgeons to the Pennsylvania Hospital.                    <span class="tocnum"><a href='#Page_68'>68</a></span></p>
+
+<p>VI. Case of Neuralgia, cured by Acupuncturation.
+Communicated by J. Hunter Ewing, M. D.                    <span class="tocnum"><a href='#Page_77'>77</a></span></p>
+
+
+<h4>ANALYTICAL REVIEWS.</h4>
+
+<p>VII. Researches into the Nature and Treatment of
+Dropsy in the Brain, Chest, Abdomen, Ovarium,
+and Skin. By Joseph Ayre, M. D., &amp;c.                      <span class="tocnum"><a href='#Page_79'>79</a></span></p>
+
+<p>VIII. An Essay on Venereal Diseases, and the Uses and
+Abuses of Mercury in their Treatment. By<span class='pagenum'><a name="Page_viii" id="Page_viii">[Pg viii]</a></span>
+Richard Carmichael, M. R. I. A., with Practical
+Notes, &amp;c. by G. Emerson, M. D.                          <span class="tocnum"><a href='#Page_109'>109</a></span></p>
+
+<p>IX. Remarks on some means employed to destroy
+T&aelig;nia, and expel them from the Human Body.
+By Louis Frank, M. D., Privy Counsellor of her
+Majesty, Maria Louisa, Duchess of Parma.                  <span class="tocnum"><a href='#Page_114'>114</a></span></p>
+
+<p>X. Researches Physiological and Pathological, instituted
+principally with a View to the Improvement
+of Medical and Surgical Practice. By James
+Blundell, M. D., Lecturer on Physiology and
+Midwifery, at the United Hospitals of St. Thomas
+and Guy.                                                  <span class="tocnum"><a href='#Page_119'>119</a></span></p>
+
+<p>XI. An Inquiry into the Nature and Treatment of Diabetes,
+Calculus, and other Affections of the Urinary
+Organs. By William Prout, M.D. F.R.S.
+With Notes and Additions, by S. Colhoun, M. D.            <span class="tocnum"><a href='#Page_125'>125</a></span></p>
+
+
+<h4>MEDICAL LITERATURE.</h4>
+
+<p>XII. Retrospective Review.&mdash;Tractatus de Ventriculo
+et Intestinis, cui pr&aelig;mittitur alius, de Partibus
+continentibus in Genere, et in Specie de iis Abdominis.
+Authore Francisco Glissonio. Lond.
+1677, 4to.                                                <span class="tocnum"><a href='#Page_138'>138</a></span></p>
+
+
+<h4>QUARTERLY SUMMARY OF MEDICAL AND SURGICAL
+INTELLIGENCE.</h4>
+
+<p>I. Anatomy.                                               <span class="tocnum"><a href='#Page_155'>155</a></span></p>
+
+<p>II. Physiology.                                           <span class="tocnum"><a href='#Page_158'>158</a></span></p>
+
+<p>III. Pathology.                                           <span class="tocnum"><a href='#Page_161'>161</a></span></p>
+
+<p>IV. Therapeutics, Materia Medica, and the Practice of
+Medicine.                                                 <span class="tocnum"><a href='#Page_166'>166</a></span></p>
+
+<p>V. Surgery.                                               <span class="tocnum"><a href='#Page_192'>192</a></span></p>
+
+<p>VI. Midwifery.                                            <span class="tocnum"><a href='#Page_205'>205</a></span></p>
+
+<p>VII. Chemistry and Pharmacy.                              <span class="tocnum"><a href='#Page_208'>208</a></span></p>
+
+<p><span class="smcap">Quarterly List of American Medical Publications.</span> <span class="tocnum"><a href='#Page_214'>214</a></span></p>
+
+
+
+<hr style="width: 65%;" /><p><span class='pagenum'><a name="Page_1" id="Page_1">[Pg 1]</a></span></p>
+<h2>THE</h2>
+
+<h2>NORTH AMERICAN</h2>
+
+<h3>Medical and Surgical Journal.</h3>
+
+<h3>JULY, 1826.</h3>
+
+
+
+<hr style="width: 65%;" />
+<h2>ORIGINAL COMMUNICATIONS.</h2>
+
+
+
+<hr style="width: 65%;" />
+<h2><span class="smcap">Article</span> I.&mdash;<i>Description of the Gangrenous Ulcer of the Mouths of
+Children.</i> By B. H. Coates, M. D. one of the Physicians to the
+Philadelphia Children's Asylum, &amp;c.</h2>
+
+
+<p>Having had opportunities of witnessing the ravages and unmanageable
+character of this destructive disease, I have long and deeply felt the
+want of some written account, both of the malady, and of a proper mode
+of treatment. Some research and observation, made in consequence of this
+feeling, have terminated in the acquisition of more fixed ideas, and of
+a practice hitherto successful. This convinced me, that it became my
+duty to lay the result of these inquiries before the public, for the
+benefit of others. There is, perhaps, no stronger and more peculiar
+reason for wishing American physicians to write, than the opportunities
+they possess, of describing and recording many important varieties of
+morbid affection, which were either unknown to our predecessors, or the
+descriptions of which, uncombined and uncompared, are only to be found
+by searching among the more neglected tomes of a public library. Of
+this, the present case will afford a fair example; as well as an
+instance of an American physician, who had described the disease from
+nature, having, from want of encouragement, false modesty, or some other
+cause, kept it back from publication.</p>
+
+<p>Ever since the establishment of the Children's Asylum, under<span class='pagenum'><a name="Page_2" id="Page_2">[Pg 2]</a></span> the care
+of a committee of the guardians of the poor, of the city and liberties
+of Philadelphia, in the spring of 1819, this useful institution has been
+annually visited by the new and distressing scourge of which we are
+treating. It has here prevailed in a considerable number of cases,
+forming the principal source of anxiety and trouble during the winter
+season, and annually sweeping off its little victims, in a manner
+rendered peculiarly awful by its insidious approach, its loathsome
+effects, and its apparently uncontrollable progress. Various scattered
+cases of a similar affection have come within my knowledge, during the
+last few years; occurring in the practice of several physicians, as well
+as in my own. In no place, however, near Philadelphia, other than the
+above, has there existed, so far as I know, a sufficient number of cases
+at the same time, to enable a physician to examine it in much detail, or
+to make comparative trials of different modes of treatment, so as
+clearly to determine the most successful.</p>
+
+<p><i>References to Authors.</i>&mdash;The notices of this complaint given by
+authors, to which I have been enabled to refer, are few, and generally
+too scanty to supply much means of forming a satisfactory judgment, or a
+practice in which confidence can be reposed. They consist, principally,
+of the mere mention of an affection resembling that of which we treat;
+and, in some instances, it is even doubtful whether they are describing
+the same disease. No notice is taken of this affection in any of our
+common books; with the exception of the last edition of <span class="smcap">Cooper's</span>
+Surgical Dictionary,<a name="FNanchor_1_1" id="FNanchor_1_1"></a><a href="#Footnote_1_1" class="fnanchor">[1]</a> and of <span class="smcap">Underwood's</span> work on diseases of children.
+It is there described under the erroneous title of <i>cancrum oris</i>. A
+reference is given to <span class="smcap">Pearson's</span> Surgery; and the article in the
+Dictionary is taken exclusively from that work. As this is the only
+authority with which I am acquainted, that gives a tolerably full
+account of a disease somewhat similar to that of which we are treating,
+I have concluded to extract the whole passage, in the words of the
+author.</p>
+
+<p>"The canker of the mouth is a deep, foul, irregular, f&oelig;tid ulcer,
+with jagged edges, which appears upon the inside of the lips and cheeks;
+and is attended with a copious flow of diseased saliva.<span class='pagenum'><a name="Page_3" id="Page_3">[Pg 3]</a></span></p>
+
+<p>"This disease is seldom seen in adults; but it most commonly attacks
+children, from the age of 18 months, to that of 6 or 7 years. When the
+ulceration begins at the inner part of the lip, it exhibits a deep,
+narrow, sulcated appearance, and quickly spreads along the inside of the
+cheek; which becomes hard, and tumefied externally. The gums are very
+frequently interested in this complaint, and, in such cases, the teeth
+are generally found in a loose and diseased state; matter is often found
+in their sockets, and abscesses sometimes burst externally through the
+cheek, the lip, or a little below the maxilla inferior: and it is not
+uncommon to see an exfoliation of the alveolar processes, or even of the
+greater part of the lower jaw. Among the children of poor people, where
+this disease is neglected or mismanaged at the beginning, a dreadful
+gangrene will sometimes supervene.</p>
+
+<p>"The remote causes that give origin to this disease are not very
+obvious. I think it occurs most frequently among children that live in a
+marshy situation; that are sustained by unwholesome food; and where a
+due attention to cleanliness has been wanting. The cancrum oris has been
+described by some writers, as a complaint very common in England and
+Ireland, where it is sometimes epidemical among infants. It, however, is
+commonly seen in other kingdoms, and prevails more especially in those
+houses where a great number of children are crowded together. I am not
+able to determine whether it is or is not contagious.</p>
+
+<p>"But adults are not wholly exempted from this morbid affection, and it
+is not easy in all cases, to distinguish the cancrum oris from a
+cancerous or venereal ulcer in the mouth; since the uvula, tonsils or
+fauces may be the seat of each disease. I have seen ulcerations on the
+uvula and tonsils, with all the marks of a venereal sore, in patients
+where the presence of such a virus could not be suspected; and by
+treating them as canker of the mouth, they have been speedily cured.</p>
+
+<p>"The canker of the mouth ought to be distinguished from aphth&aelig;, the
+epulis and parulis, scurvy, cancerous ulcers, venereal ulcers and
+exulceration from the use of mercury.</p>
+
+<p>"<i>The mode of treatment.</i>&mdash;It will be proper,</p>
+
+<p>"1. To remove the diseased teeth, bone, &amp;c. if possible.</p>
+
+<p>"2. To prescribe a milk and vegetable diet, and to allow a prudent use
+of fermented liquors.<span class='pagenum'><a name="Page_4" id="Page_4">[Pg 4]</a></span></p>
+
+<p>"3. It will be adviseable to exhibit such remedies as, Peruvian bark;
+sarsaparilla; elm bark; mineral acids.</p>
+
+<p>"The external applications that I have generally found successful have
+consisted of such as the following:</p>
+
+<p>"<i>Preparations of copper</i>; a diluted mineral acid; burnt alum; decoction
+of bark with white vitriol; tincture of myrrh, &amp;c."<a name="FNanchor_2_2" id="FNanchor_2_2"></a><a href="#Footnote_2_2" class="fnanchor">[2]</a></p>
+
+<p>Of the above articles, those which we have indicated by italics are
+omitted in the last edition of <span class="smcap">Cooper's</span> Dictionary; and, in a former
+one, they are directly prohibited with strong reprobation. Nevertheless,
+it is among these that we have found, beyond comparison, the most
+successful one.</p>
+
+<p>Mr. <span class="smcap">Pearson</span> prefixes to the preceding article a list of synonymes, with
+references to authors, in the manner of writers on natural history. They
+are as follow: <i>Aphth&aelig; Serpentes.</i>&mdash;<span class="smcap">Sennertus</span>; Medicin&acirc; Practic&acirc;.
+<i>Labrosulcium, seu Cheilocace.</i>&mdash;<span class="smcap">Arnoldus Bootius</span>. <i>Oris
+Cancrum.</i>&mdash;<span class="smcap">Muys. Stalpaart Vander Wiel</span>. <i>Gangr&aelig;na Oris.</i>&mdash;<span class="smcap">Van Sweiten</span>.
+<i>Gangrene scorbutique des Gencives.</i>&mdash;Auctores Gallici.</p>
+
+<p>Of these, <span class="smcap">Sennertus</span><a name="FNanchor_3_3" id="FNanchor_3_3"></a><a href="#Footnote_3_3" class="fnanchor">[3]</a> merely mentions, under the article aphth&aelig;, that
+the latter sometimes spread around the fr&aelig;num and tongue, occasionally
+corroding the subjacent parts. He is so far from giving a clear
+description, under the head of Aphth&aelig; Serpentes, of any affection
+analogous to that we are about to record, that he quotes <span class="smcap">Galen</span> as
+remarking, very properly, that these are not aphth&aelig; at all, but putrid
+ulcers.</p>
+
+<p><span class="smcap">Arnold Bootius</span>, in his little treatise "de morbis omissis," of diseases
+omitted in the books, published in London, in 1649,<a name="FNanchor_4_4" id="FNanchor_4_4"></a><a href="#Footnote_4_4" class="fnanchor">[4]</a> gives, from his
+own observation, an account of a disease, to which he applies the names
+above attributed to him. It differs from the cases which have attracted
+our attention, chiefly in its situation. He describes it as an ulcer,
+soon becoming black and f&oelig;tid, corroding the inside of both lips,
+separating them widely from the gums and allowing them to fall outwards
+upon the face; thus producing a horrible deformity. Besides this, the
+author states, that a deep fissure usually extended down each half of
+the inside of each lip; thus adding four deep and ghastly ramifications
+to the ulcer. This shocking affection is stated to have prevailed
+extensively, both in<span class='pagenum'><a name="Page_5" id="Page_5">[Pg 5]</a></span> England and Ireland; in which latter country the
+author practised and held several important offices. It occasionally
+became epidemic, and then destroyed great numbers of children. It
+principally prevailed between 2 and 4 years of age; though it was
+occasionally met with both earlier and later in life. It was frequently,
+but not always, accompanied with aphth&aelig;.</p>
+
+<p>This disease was, in general, successfully treated by our author, with a
+decoction of "Ch&aelig;rephyllum, Quinquefolium, Myrrhis, Ros&aelig; et Salvia;" in
+which was dissolved a "sat magna copia" of white vitriol.&mdash;A combination
+about as precise as some of the prescriptions which have been
+recommended to me, for the present disease, in this country. With this
+mixture, he touched the ulcers several times a day; and then washed them
+with a liniment of acetate of lead, aqua plantaginis, and oleum
+rosaceum. He also used <i>issues</i> in both arms; and confined the patient,
+in more obstinate cases, for drink, to a decoction of sarsaparilla,
+china, and several other articles, which we will spare our readers. To
+this disease, <span class="smcap">Bootius</span> devotes about five small 18mo. pages, forming his
+tenth chapter.</p>
+
+<p><span class="smcap">Vander Wiel</span> cites <span class="smcap">Bootius</span>, and expresses his belief, that the disease
+described by the latter was identical with one which he saw himself.
+This last, however, though described in a cursory manner, appears to
+resemble much more nearly the disease of the Children's Asylum;
+beginning in the gums, and extending to the adjacent parts. He treats it
+by the following lotion:</p>
+
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>R. Mel. Rosar.</td><td align='left'>&#8485;i</td></tr>
+<tr><td align='left'>&nbsp;&nbsp;&nbsp;&nbsp;&mdash;&mdash; &AElig;gyptiaci,</td><td align='left'>&#8488;ij</td></tr>
+<tr><td align='left'>&nbsp;&nbsp;&nbsp;&nbsp;Olei Vitrioli,</td><td align='left'>gtt. <i>aliquot.</i></td></tr>
+<tr><td align='left'></td><td align='left'>misce.</td></tr>
+</table></div>
+
+
+<p>Under this treatment, and by removing the teeth, when loose, the small
+number of cases he saw recovered in a few days.</p>
+
+<p><span class="smcap">Vander Wiel</span> was a practitioner in Holland; and, though he does not
+specify the fact, his cases were probably in a marshy country.<a name="FNanchor_5_5" id="FNanchor_5_5"></a><a href="#Footnote_5_5" class="fnanchor">[5]</a></p>
+
+<p><span class="smcap">Muys</span>, in a little treatise entitled "Chirurgia Rationalis,"<a name="FNanchor_6_6" id="FNanchor_6_6"></a><a href="#Footnote_6_6" class="fnanchor">[6]</a> published
+in 1684, has an account of a disease, which is evidently<span class='pagenum'><a name="Page_6" id="Page_6">[Pg 6]</a></span> supposed by
+<span class="smcap">Pearson</span> to be that which he describes. This also, however, appears to
+have been a "labrosulcium;" an ulcer between the lips and the incisor
+teeth. There is but little to be gathered from his paper; as it is
+principally occupied with an attempt to prove, that this ulcer is owing
+to an accumulation of <i>acidity</i> in the blood, increased, at this point,
+by the putrescence of particles of food which collect there. He
+illustrates this doctrine by an examination of a <i>burnt rag</i> under a
+microscope; and this he considers as in a state analogous to the
+gangrene. "Opinionum commenta delet dies," &amp;c. We give his treatment;
+which is aimed at acidity.</p>
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>R. Theriaci,</td><td align='left'>&#8488;ijss</td></tr>
+<tr><td align='left'>Ung. Egypt.</td><td align='left'>&#8488;iss</td></tr>
+<tr><td align='left'>Gum. Lacc&aelig;, et Spirit. Sal. <i>Armon.</i> aa</td><td align='left'>&#8456;ij</td></tr>
+<tr><td align='left'>&mdash;&mdash; Cochleari&aelig;,</td><td align='left'>&#8488;ij</td></tr>
+<tr><td align='left'></td><td align='left'><i>m.</i> ft. ung.</td></tr>
+</table></div>
+
+<p>To be softened with a little alcohol, the part washed with the mixture
+six times a day, and a rag moistened with the same compound left in the
+ulcer. Here we take leave of the Chirurgia <i>Rationalis</i>.</p>
+
+<p>In the 14th volume of the Memoirs of the French Royal Academy of
+Surgery, are papers containing accounts of two cases, which have some
+points in common with the disease of which we treat; but the identity of
+at least one of which it is hard to establish. The first piece is
+entitled, "<i>Sur la gangrene scorbutique des gencives dans les enfans.
+Par feu M. Berthe.</i>"<a name="FNanchor_7_7" id="FNanchor_7_7"></a><a href="#Footnote_7_7" class="fnanchor">[7]</a> The author is described, in a note, as a young
+surgeon of great promise, who was carried off by an early death. M.
+<span class="smcap">Berthe</span> commences by quoting <span class="smcap">Fabricius Hildanus</span>; who describes a gangrene
+of the gums, occuring principally at about 4 years of age, and of which
+all the patients died. <span class="smcap">Fabricius</span> takes the occasion to give a caution to
+young surgeons, to avoid being too sanguine in predicting recovery from
+gangrenes. Next a case is given us, drawn from M. <span class="smcap">Saviard</span>, in which
+death was the result. This author seems, subsequently, to have had
+somewhat better success, but at the expense of horrible disfigurements;
+such as great holes through the cheek, and<span class='pagenum'><a name="Page_7" id="Page_7">[Pg 7]</a></span> the loss of a large piece of
+the jaw; which, indeed, are described as having been worse than death.
+In another case, recorded by M. <span class="smcap">Poupart</span>, in the "Histoire de l'Academie
+des Sciences," this affection terminated in death; preceded, however,
+and in the opinion of the author, caused, by the production of two
+tumours, one by the side of the tongue, the other inside of the cheek.
+This is not at all unlike the progress, which will be hereafter
+mentioned to have taken place in many of the Asylum cases.</p>
+
+<p><span class="smcap">M. Berthe</span> then remarks, that the greater number of instances of gangrene
+of the gums had terminated unfavourably.</p>
+
+<p>His own patient was ill from April to September, 1753; and exhibited
+swelled and bleeding gums, frequently projecting beyond the
+teeth,&mdash;black and f&oelig;tid stools, f&oelig;tid urine, and ecchymoses over
+the surface of the body. He treated it with antiscorbutics, internally
+and externally, and apparently with success. The patient, however,
+relapsed in January, 1754; when <span class="smcap">M. Berthe</span> proceeded to a very different,
+and far more severe treatment. The gums were pared away, in many
+successive operations; and the wounds were washed with aluminous water.
+A roll of linen was, during the intervals, kept fastened in the
+patient's mouth, for the purpose of allowing the escape of the fluids of
+the part; which he apprehended to possess a putrid character, and to
+aggravate the original disease, whenever they passed into the stomach.
+At length, his patient recovered, and continued well.</p>
+
+<p>It appears to the writer of these notes to be hardly necessary to state,
+that <span class="smcap">M. Berthe</span> evidently mistook the disease; the latter being in
+reality scorbutic, and not a single symptom of gangrene being described
+during its whole history.</p>
+
+<p>The same, however, cannot be said of <span class="smcap">M. Capdeville</span>; whose "<i>Observations
+sur les effets rapides de la pourriture des gencives</i>" appear in the
+same volume with the foregoing, and immediately subsequent to it.<a name="FNanchor_8_8" id="FNanchor_8_8"></a><a href="#Footnote_8_8" class="fnanchor">[8]</a>
+This writer's case took place after a fever, and no tumefaction of the
+gums nor ecchymoses of the skin are mentioned as occurring in it. <span class="smcap">M.
+Capdeville</span> attended this case in consultation, in 1764; and complains of
+too feeble means being employed, as the case was trusted to
+antiscorbutics. This treatment ended in death. M. C. refers to <span class="smcap">Van
+Sweiten</span>, whose correct<span class='pagenum'><a name="Page_8" id="Page_8">[Pg 8]</a></span> account we shall mention; and it is evident that
+it was the disease of the Children's Asylum: though he manifests a
+strong propensity to connect it with scorbutus, and the "blanchet," or a
+species of aphth&aelig;, which destroyed a great number of children in the
+Foundling Hospital, in 1746. Reference is also made to cases which
+occurred in "La Piti&eacute;," under the care of <span class="smcap">Chopart</span>. Of these, a very
+scanty account is given. They terminated in death; after a treatment by
+lotions of honey of roses and spirit of vitriol, with emollient and
+resolvent cataplasms.</p>
+
+<p><span class="smcap">Van Sweiten</span>, in the article devoted to the consideration of gangrene,<a name="FNanchor_9_9" id="FNanchor_9_9"></a><a href="#Footnote_9_9" class="fnanchor">[9]</a>
+has left us a far more exact description of the disease, into which we
+are inquiring. Practising in a marshy country, he had frequent
+opportunities of meeting with it; and his account of it, and his mode of
+treatment, though brief, are every way worthy of the close, practical
+inquirer into nature, and the sound medical philosopher. His description
+is not unmixed with strong expressions of horror and commiseration at
+its ravages. He describes it in a manner so similar to that in which it
+now prevails, that no doubt can exist of the identity of the diseases.
+He acknowledges, however, "rubedo, calor, dolor," among its symptoms.
+Cochlearia, theriaca and similar articles, according to him, are almost
+always injurious. If no f&oelig;tor exist, (and, of coarse, no actual
+mortification,) he applies a solution of sal ammoniac or nitre, with
+some vinegar or lemon juice; sometimes as a lotion, sometimes by keeping
+a rag imbued with it always in the ulcer. Hard rubbing he reprobates. If
+the disease have made progress, and f&oelig;tor exist, muriatic acid is
+used: in the less aggravated stages, diluted with honey of roses and
+water; in the worst cases, pure. This practice he states never to have
+failed him, unless where the bone was affected.</p>
+
+<p>In an early edition of Dr. <span class="smcap">Underwood's</span> Treatise on Diseases of Children,
+in the library of the Pennsylvania Hospital, no mention is made of this
+disease; although an article is devoted to "<i>gangrenous erosion of the
+cheek</i>." The account is wholly borrowed from a work by Mr. <span class="smcap">Dease</span>, of
+Dublin, "on the diseases of lying-in women," &amp;c. also in the library.
+Mr. <span class="smcap">Dease</span> describes this affection as occurring from 2 to 6 or 8 years
+of age; especially<span class='pagenum'><a name="Page_9" id="Page_9">[Pg 9]</a></span> in unhealthy children, including such as have been
+subject to worms. The whole body often appeared cold upon the approach
+of the disease. A black spot then occurred, but <i>without marks of
+inflammation</i>, on one of the cheeks or lips. The whole cheek was
+sometimes destroyed, and the lower jaw fell down upon the breast.
+Muriatic acid, infusion of roses, the effervescing draught, and, in the
+decline of the disease, bark, broths, jellies, and wine, besides
+magnesia or rhubarb, to remove the putrid matters swallowed, were the
+internal remedies employed. The parts were washed and injected with
+muriatic acid, diluted with chamomile or sage tea; and afterwards
+dressed with the acid, mixed with honey of roses, and, over this, a
+carrot poultice. By this practice, Mr. <span class="smcap">Dease</span> lays claim to almost total
+success.</p>
+
+<p>In the Philadelphia republication of Dr. <span class="smcap">Underwood's</span> book, taken from
+the sixth London edition, there is an article entitled Cancrum Oris. The
+author appears to have read <span class="smcap">Pearson's</span> account; but as his description
+does not at all agree with the disease of which we are treating, nor
+with that of Mr. <span class="smcap">Pearson</span>, we shall not stop longer to analyse it.</p>
+
+<p>I have no doubt, from views that will be hereafter developed, that many
+of the above writers have had cases similar to those which we are about
+to describe; but have mistaken them, from the want of a sufficiently
+early and close inspection of the ulcers. In the second stage, this
+disease much resembles an inflamed sore between the lips and gums,
+extending to the latter; although I hope to prove that this state of
+things is secondary.</p>
+
+<p><i>Locality of the Disease.</i>&mdash;The Philadelphia Children's Asylum is
+situated in South Fifth street, between Prime and Federal streets, in
+the district of Southwark. The soil is what is called alluvial, or
+rather diluvial; as is well known to be the case with all that district,
+lying south of Philadelphia, as well as the southern part of the city
+itself. The house was built, and for many years occupied, as a mansion,
+by the head of a most respectable and wealthy family. Its situation
+possesses some of the qualities usually selected in choosing the site of
+a country seat. The buildings stand on a swell of ground, leaving an
+open lawn, now interrupted by several unoccupied streets, and extending,
+on the right hand, to the banks of the Delaware, and, on the left, to
+the Navy Yard and part of the suburb of Southwark. Towards the<span class='pagenum'><a name="Page_10" id="Page_10">[Pg 10]</a></span> north,
+it is not far from the edge of a thickly built appendage of the city.</p>
+
+<p>The district immediately south of the Asylum is marshy, and has long
+been noted for the prevalence of intermittent fevers; but the slightly
+elevated site of the building had been generally healthy, and continued
+so, till the universal and distressing epidemic, which infested all the
+outskirts of Philadelphia, in 1822 and 1823. Even at this period, the
+persons resident at the Asylum, were far from suffering so severely as
+the adjacent neighbourhood; and, since those years, it has again become,
+in general, tolerably healthy. In 1819, 1820, 1821, and 1822, a lot,
+situated at a short distance, on which were deposited the contents of a
+number of privies, proved a source of great inconvenience, and some
+disease, at the Asylum. This focus of effluvia, together with the
+general and copious use of similar materials in manuring the adjacent
+fields, occasioned an intolerable stench, and generated diarrh&oelig;as, in
+the early part of the spring. When the grass and weeds, however, were
+grown sufficiently to protect the surface of the soil from the sun and
+wind, this effect entirely ceased; and I know not that any other
+inconvenience was experienced from the same source, unless we attribute
+to this, as may fairly be done, the destruction of the purity of the
+well. This formerly afforded very good water; and, since that period, it
+has much improved. When the corporations of Southwark and Moyamensing
+shall introduce, as it is to be hoped they will, the Fairmount water
+into their streets, one remaining cause of inconvenience and ill health,
+will be removed from the Children's Asylum.</p>
+
+<p><i>Prevalent Diseases.</i>&mdash;Ophthalmias and furuncular eruptions, the latter
+principally on the face, are epidemic every year; generally in the
+spring and early summer months. When prevalent in the city, the measles,
+small pox, and varioloid disease have reached the Asylum; the scarlatina
+has, at no period, I believe, been peculiarly troublesome there.
+Intermittents, which were anticipated by many, from the nature of the
+situation, have seldom, if ever, prevailed in the house, to any very
+considerable extent. One of the worst visitations which it has
+experienced, in this respect, was in the autumn of 1823. In many cases,
+it was in patients who had been labouring under disease of this
+description, that the ulcer we are about to describe exhibited itself;
+but it was by no means confined<span class='pagenum'><a name="Page_11" id="Page_11">[Pg 11]</a></span> to those who were known to have so
+suffered. Many, perhaps, most of the children affected, were free from
+any apparent ailment; although it is by no means impossible that the
+little, uncomplaining subjects were, at the time, labouring under what
+has been called "febricula" or "inward fever."</p>
+
+<p><i>Regimen.</i>&mdash;To the impurity of the water we have already adverted. The
+diet of the children furnishes them with meat every day, with the
+exception, during a part of the existence of the institution, of two
+days in every week. Molasses was freely used; indian mush was greatly in
+demand; and the breakfast and supper were of bread and milk. During the
+summer months, this diet was abundantly nourishing; but in winter, it
+was thought that an additional quantity of animal food was desirable;
+and, accordingly, it was, during the two last winters, given every day.</p>
+
+<p><i>Description of the Disease.</i>&mdash;The ulcer of which we speak, may begin in
+many parts of the mouth. In by far the greater number of cases, however,
+it commences immediately at the edges of the gums, in contact with the
+necks of the teeth, and, most generally, of the two lower incisors. A
+separation is found here; which exhibits a slight loss of substance at
+the extreme edge of the gums, and, as far as I have observed, a
+whitishness of the diseased surface. In some instances, though not very
+frequently, this is preceded by a slight swelling and redness. In this
+state, the disease may continue for a long time; and I have reason to
+believe, that patients have remained thus affected, during the whole
+period of three months, for which I attended the Asylum. At one time,
+when the disease was at its height, threatening several patients with
+destruction, I found upwards of 70 children, out of a population
+amounting to about 240, more or less affected with these ulcerations. No
+remarkable change is at this stage observable in the functions of the
+little sufferer; except a general air of languor and weakness. The
+appetite and the muscular activity continue, but are somewhat reduced;
+not sufficiently, however, to disable the child from attending school,
+taking the air, or continuing his ordinary practices. In this state, no
+symptoms of irritation have been at all discovered. The skin is cool
+during the day, no pain is complained of; and no account has ever been
+given me of any nocturnal paroxysm of fever. It would appear to be
+purely a state of asthenia. We are, however,<span class='pagenum'><a name="Page_12" id="Page_12">[Pg 12]</a></span> by no means certain, that
+there was no concealed irritation in the system. We were, of necessity,
+obliged to depend, in a great measure, upon the reports of nurses, and
+other females; and these were liable to overlook, or mistake for mere
+weakness, the signs of an obscure disease. In this manner, commencing
+cases were frequently not discovered, and nothing was done, till the
+affection had made further progress; and this continued until the
+ascertained existence of the epidemic in the house, combined with the
+recollection of its former ravages, had excited an alarm, which led to
+the inspection of the mouths of all the children in the institution.</p>
+
+<p>The disease, in this form, must be within the curative powers of nature;
+as, if this were not the case, we should hear of more numerous
+unfavourable terminations. It has seldom, however, if at all, been
+within my power to witness this tendency; and, when not controlled by a
+particular treatment, the cases have almost always either remained
+stationary, or increased in severity. Its first progress is, most
+generally, by extending to the edges of the gums round other teeth;
+frequently affecting a large portion of the dental arches. A very early
+progress is, however, mostly effected, down the length of the tooth, in
+the direction of the socket; and, in this way, the disease commits great
+and unsuspected ravages. When it reaches the edges of the bony socket,
+the tooth begins to be loose, and when drawn, exhibits portions of the
+fang, including parts which had been contained within the alveolus,
+entirely denuded of their periosteum. Indeed, from observation, I should
+say, that the latter membrane was the part, which was the most
+peculiarly liable to injury and death from this disease; and it is by no
+means clear, to my apprehension, that this is not frequently the
+commencement of the complaint. The injury generally proceeds with
+augmenting rapidity; especially when it has affected the deeper parts:
+and it is while in the act of rapidly spreading, that it occasions
+gangrene.</p>
+
+<p>In the production of gangrenous sloughs, it much resembles the
+descriptions usually given of sloughing ulcers. A portion of the parts
+immediately subjacent to the ulcer loses its life; this rapidly
+separates; and, before or after a complete removal, a fresh slough is
+formed in the same manner. The sloughs are generally black, with
+ash-coloured edges. I have not been able to discern<span class='pagenum'><a name="Page_13" id="Page_13">[Pg 13]</a></span> a change of colour,
+the production of vesicles, or any material tumefaction, as antecedent
+to the gangrene. There is generally, by this time, an increased heat in
+the parts; with the sensation termed "calor mordens." The discharge now,
+for the first time, becomes acrimonious; giving pain when it comes in
+contact with cuts in the finger; and excoriations are produced on all
+parts in contact with the sloughing ulcerations; as the lips, the
+cheeks, the tongue, and the adjoining surface of the part where the
+ulcer is situated.</p>
+
+<p>As soon as the external gangrene has reached the level of the edge of
+the bony socket, and frequently much sooner, the adjacent portion of the
+latter is found deprived of its life; forming a necrosis. The death of
+the periosteum in the socket, at least that of the fang of the tooth,
+precedes, by some interval of time, that of any portion of the bone
+itself.</p>
+
+<p>When gangrene is formed, a fever of irritation is generally developed.
+In regard to the time at which this takes place, there is a great
+diversity in different constitutions. It has appeared to me to depend,
+principally, upon the inflammation of the mouth, which is secondary to
+the original disease, and, in most cases, to arise from the acrimony of
+the discharge. It is aggravated by loss of rest, want of nourishment,
+and, probably, by putrid matter finding its way into the stomach. To the
+latter cause I also refer a diarrh&oelig;a, which almost uniformly comes
+on, towards the close.</p>
+
+<p>There are accounts of a similar disease having begun on the inside of
+the cheeks. I have, however, never seen a well-marked instance of this;
+the cases which were supposed to be such having, in every instance, been
+also found to exhibit ulcerations at the edges of the gums. That the
+disease spreads from the gums to the cheek, is a fact which have often
+seen exemplified. It is, indeed, the most usual termination of bad
+cases. After producing gangrene and necrosis in the gums and alveoli,
+and after the discharge becomes, as above stated, acrimonious, a
+gangrenous spot is not unfrequently found about the opening of the
+Stenonian duct, on the inside of the upper or lower lip, opposite the
+incisors, in some other part of the inside of the lip or cheek, or in
+more than one of these situations at the same time. Whether this be
+owing to excoriation from the discharge, or to some other cause, I
+cannot say; it has, however, in every instance which I<span class='pagenum'><a name="Page_14" id="Page_14">[Pg 14]</a></span> have seen
+sufficiently early to witness its rise, been subsequent to the symptoms
+previously described.</p>
+
+<p>When the gangrene reaches the cheek or lip, however, very active
+inflammatory symptoms are uniformly developed. In the cellular substance
+of these parts, they assume the well known characters which have been
+attributed to the <i>phlegmonous</i> species. We have a great thickening,
+forming, in the cheek, a large, rounded, prominent tumour, with great
+heat and pain. Sometimes redness is perceived externally; but, more
+frequently, the great distension of the skin of the cheek seems to empty
+the cutaneous vessels; giving to the part, a smooth, polished, dense,
+white appearance, very much resembling the effect of a violent
+salivation. I have no doubt that this is the tumour described by
+<span class="smcap">Poupart</span>, and alluded to in an earlier part of this paper. Great
+thickness and hardness have always occurred, in the other situations
+where this gangrene has approached the external cellular masses of the
+face; in the lip, however, they are less remarkable, perhaps from the
+smaller amount of cellular matter. After reaching this stage, a black
+spot is frequently seen on the outer surface of the swelling. This
+spreads rapidly; and has always been, in my own experience, the
+immediate harbinger of death. It is proper to state, however, that I
+have heard it said, that cases had recovered in this city, in which the
+gangrene had produced a hole through the cheek. Under what physician's
+care this occurred, I have never learned.</p>
+
+<p>In two cases it commenced in the fauces; and was marked by the same
+unsuspected progress. In one of these, the little patient was remarked
+to be languid, but had no positive external marks of disease. The mouth
+was examined, and found healthy; but no suspicion of the real situation
+of the disease was entertained, till after 3 or 4 days more, when he
+complained of a slight sore throat. A large gangrene of the tonsils,
+half-arches and pharynx, was now found; and the event need hardly be
+told.</p>
+
+<p>The closing stage of this affection is marked by large gangrenous
+patches in the gums; deep fissures between these and the teeth; the
+latter loose, or falling out; large pieces of the alveolar processes,
+often containing the roots of several teeth, in a state of entire
+necrosis; the whole lining membrane of the mouth suffering a violent
+excoriation; the whole adjacent external cellular<span class='pagenum'><a name="Page_15" id="Page_15">[Pg 15]</a></span> substance, hard and
+swelled; large gangrenous spots in the inside of the cheek or lips,
+occasionally extending quite through to the outer surface; a total
+incapability to sleep, or to take the least food; fever; a swelled
+abdomen, and diarrh&oelig;a.</p>
+
+<p><i>Dissection.</i>&mdash;The inspection of the body after death had never thrown
+much light upon this obscure affection. Since I began to prepare
+materials for this paper, I have been able to dissect but one subject.
+The appearances were as follow:</p>
+
+<p><i>Exterior</i>, emaciated.</p>
+
+<p><i>Alimentary canal</i>, externally and internally, altogether in a natural
+state, except what appeared to me to be owing to the subsidence of blood
+to depending portions of the intestines. The mucous membrane was
+carefully examined throughout its whole length; but not being at that
+time aware of the importance, attached, by some pathologists, to small
+rednesses in this organ, it is highly probable that some such may have
+been overlooked.</p>
+
+<p><i>Liver and Spleen</i>, enlarged, but of a natural appearance.</p>
+
+<p><i>Heart, thoracic &oelig;sophagus, and one kidney</i>, (the other not
+examined,) natural.</p>
+
+<p><i>Lungs</i>, containing much mucus in the bronchial cavities. The fore part
+of their substance contained much hepatization.</p>
+
+<p><i>Pathology.</i>&mdash;The nature and production of this disease are certainly
+very obscure. We may, however, as in other branches of knowledge,
+attempt to develop and record what knowledge we possess respecting it;
+carefully separating truth and reason from conjecture. We have already
+said, that its access was very frequently preceded by no marks of
+visible disease, or at least none that attracted attention. The little
+subjects were, apparently, in merely a drooping or enfeebled state. In
+other instances, the ulceration followed a common remittent or
+intermittent fever; insomuch that, at one time, whenever a child was
+brought to the nursery for fever, it was expected, as a matter of
+course, that his mouth would become sore. In the other cases, as we have
+already had occasion to say, it is quite possible that a concealed
+"inward fever" may have existed; and this is rendered the more probable,
+by the circumstance of their losing their appetites. In the instance
+where the body was opened, we have seen that the original disease was
+hepatization of the lungs; and yet it is quite probable, that this
+affection had caused, as it often does, that species of<span class='pagenum'><a name="Page_16" id="Page_16">[Pg 16]</a></span> disease, which
+a rapidly spreading pathology refers to a slow inflammation of the
+stomach and intestines. With regard to marks of this last not having
+been detected by me, it is evident that I am in the same situation with
+a very numerous body of other observers.</p>
+
+<p>The local appearances, at the commencement, did not appear to be of an
+<i>inflammatory</i> nature, at least generally. If the gums were really the
+first part affected, it was not so; as these parts when inflamed, as
+they frequently are in affections of the teeth, exhibit decided
+soreness, pain, swelling, and an increase of redness. The ulcerated part
+was, in about nine cases out of ten, paler than natural; and then
+neither soreness nor increased heat was perceptible, except in a few
+cases, in which the mouth was generally hotter than natural, though it
+was not, in a striking manner, referrible to the gums. In a few cases,
+distinct redness, and a slight swelling, were perceptible round the
+ulcer. These patients generally did better than the others.</p>
+
+<p>If, on the other hand, we suppose the original derangement to have taken
+place in the periosteum, we shall be enabled, more easily, to explain
+some of the phenomena. We then reason thus: The whole of the body had
+shrunk considerably, from disease, and, the circulation being deprived
+of a part of its usual vigour, the periosteum, a part possessed of
+little vitality, was unable to bear the additional extension, which it
+underwent, across the unyielding bone of the tooth. The blood ceased to
+circulate in it, and it died. Ulceration of the adjacent parts followed,
+as a matter of course; and these parts, especially the periosteum, being
+possessed of but little sensibility, the sympathies of the other parts
+of the system were but little interested, until an extensive portion of
+the mucous membrane of the mouth, or a mass of cellular substance,
+became affected. We certainly see that, in every case but two, the
+disease commenced in contact with the teeth. This doctrine will also
+explain the rapid and deep penetration of the ulcer along the roots of
+the teeth; and the destruction of the bone. We may recur to the
+statement, that a portion of the fang of every loose tooth was always
+found deprived of its periosteum.</p>
+
+<p>In the two cases excepted, we have seen it apparently begin in the
+mucous membrane of the fauces; and indeed the manner in which it
+generally spreads from the gums to the cheek and lips,<span class='pagenum'><a name="Page_17" id="Page_17">[Pg 17]</a></span> seems to me,
+unquestionably, to indicate a greater liability than common to gangrene
+in more than one part of the mouth.</p>
+
+<p>The soreness and pain of the socket, which forms a part of most
+tooth-achs, might have been reasonably expected here; but neither was
+ever complained of, even when the teeth were loosening: and, as no fever
+existed at this time, the original irritation can hardly be considered
+as inflammatory; excepting perhaps the cases which exhibited redness,
+and slight swelling of the gums.</p>
+
+<p><i>Is this disease scorbutic?</i>&mdash;I never observed ecchymoses, nor in more
+than a single instance any the minutest red specks upon the cutis, which
+might be thought to resemble petechi&aelig;. The patients never fainted; the
+gums were never spongy, nor did they bleed more than those of any other
+child would have bled, under an equal degree of violence. I however
+requested my friend, Dr. <span class="smcap">Harris</span>, who has had ample opportunities of
+making himself acquainted with scorbutus, to see some patients with me.
+He complied, with his usual kindness, and pronounced their disease not
+at all to resemble the scurvy.</p>
+
+<p><i>The teeth.</i>&mdash;But few cases occurred during the second dentition; and it
+is doubtful whether any one took place during the first. It should be
+remarked, however, that children under 2 years, were not admitted to the
+institution, unless by deception on the part of the parents. No child
+ever lost a tooth of the second set; and, indeed, the second dentition
+seemed often to cure the complaint. The greater number of cases occurred
+between 2 and 5 years of age, but some as late as 8 or 10. In several
+instances, the ulcer destroyed a portion of the enamel capsule; and the
+teeth were then cut, with <i>very perfect enamel</i> upon the lower part,
+while the bone was entirely bare at the ulcerated portion of the
+capsule. This singular fact proves that no inflammation of the capsule,
+sufficient to interrupt the function of its remaining portion, took
+place in consequence of the opening of its cavity.</p>
+
+<p><i>Prevalence of this disease in our own country.</i>&mdash;Many elderly persons
+remember during different periods of their lives, a tradition and
+particular instances of a formidable disease of the mouth, by the name
+of "Black Canker."<a name="FNanchor_10_10" id="FNanchor_10_10"></a><a href="#Footnote_10_10" class="fnanchor">[10]</a> Round Philadelphia, it appears<span class='pagenum'><a name="Page_18" id="Page_18">[Pg 18]</a></span> to have been
+rare. Having been informed by a friend, that the disease had prevailed
+extensively at Salem, New Jersey, under the notice of my friend, Dr.
+<span class="smcap">Theophilus R. Beesley</span>, I addressed a letter to that gentleman, to which
+he furnished me with an obliging and instructive reply, which I have
+unfortunately mislaid. Numerous cases have occurred, in that vicinity,
+within the last 30 years; and were, in general, successfully treated by
+the women. Cases seldom came under the view of physicians, until
+gangrene had commenced; and of these, many died: so that the old women
+were generally more in vogue for its cure, than the regular
+practitioners. Dr. <span class="smcap">Beesley</span>, Dr. <span class="smcap">Vanmeter</span>, and my friend Dr. <span class="smcap">E. Q.
+Keasbey</span>, had met with much of this complaint; and the result of many of
+their observations had been combined in a thesis, written, but,
+according to our unfortunate custom, not published, by the younger Dr.
+<span class="smcap">Vanmeter</span>. It was there considered as a sequela of intermittent and slow
+remittent fevers, and seldom occurred but in marshy districts, and among
+the poor. It generally prevailed between the ages of 2 and 10 years. Of
+the remedies employed we shall again speak. Dr. <span class="smcap">Samuel Tucker</span> has also
+seen it in marshy situations near Burlington. I have heard of its
+existence on the Schuylkill. Dr. <span class="smcap">Parrish</span> has for several years noticed a
+stage of this complaint, under the name of "a disease resembling the
+effects of mercury," in his private lectures. Drs. <span class="smcap">Physick</span>, <span class="smcap">Hartshorne</span>,
+<span class="smcap">Hewson</span>, <span class="smcap">Meigs</span>, <span class="smcap">Wood</span>, <span class="smcap">Rhea Barton</span>, and <span class="smcap">Remington</span>, and several others who
+will pardon me for omitting their names, have also met with cases.</p>
+
+<p><i>Prevention.</i>&mdash;Our precautionary measures should be directed to the
+predisposed or commencing state already described; to the prevention and
+cure of fevers, to the removal of "febricula," and other internal
+disorders, and to the general restoration of strength. Finally, its
+commencing stage should be watched, and promptly met; and success, I
+believe, will always attend our endeavours.</p>
+
+<p>At the Children's Asylum, all the weakly children were made<span class='pagenum'><a name="Page_19" id="Page_19">[Pg 19]</a></span> to take
+bitters, of different descriptions; and Dr. <span class="smcap">Sylvester's</span> antiscorbutic
+drink, composed of cream of tartar and juniper berries, infused in
+water. As the disease declined in the house, under this administration
+of bitters, it is highly probable that they had a preventive agency. I
+much question, however, whether Dr. <span class="smcap">Sylvester's</span> drink was productive of
+any advantage.</p>
+
+<p>One question of some importance yet remains. <i>Has mercury any agency in
+producing this affection?</i> The salivary glands have never been observed
+to be affected in it. Dr. <span class="smcap">Parrish</span> informs me, that, after a strict
+examination, he has come to the conclusion that the previous use of
+mercury does not bring on, or aggravate this complaint, as he has
+noticed it. I have made the same observation; and, not being peculiarly
+sparing of the use of calomel in fevers, have had opportunities to
+verify it. I think I can add, that, in some cases, by shortening and
+moderating an attack of fever, calomel has been useful in preventing the
+ulceration. Given during the progress of one, and that a fatal case, it
+did not appear to aggravate it.</p>
+
+<p>There is no evidence whatever tending to excite the suspicion of
+<i>contagion</i>.</p>
+
+<p><i>Treatment.</i>&mdash;A variety of remedies had been tried within my knowledge;
+most of them with but little success, and one or two with somewhat
+better. Feeling much disappointed with the results of my practice, in
+the small number of cases which fell under my care in the spring months
+at the Asylum, as well as elsewhere, I wished to exchange with another
+physician for a period when the disease was more prevalent; for the
+purpose of studying it, and making comparative trials of different
+remedies. Dr. <span class="smcap">Jos. G. Nancrede</span> was so polite as to indulge me. Having
+then a large number of patients under my care, I was enabled to make
+more extensive observations, and with more precision; the results of
+which course gave me the first satisfaction I had ever felt relative to
+this disease. Trials were made of every thing that was suggested by
+friends, and generally upon 4 or 5 selected patients at a time. Thus,
+choosing them in the ulcerative stage, and having several at a time
+before our eyes, the result was seen in a very few days, much sooner
+than if patients had been successively subjected to the remedies; and no
+material time was lost in appealing to the article which appeared to
+answer best.<span class='pagenum'><a name="Page_20" id="Page_20">[Pg 20]</a></span></p>
+
+<p>The remedy which beyond all comparison succeeded best, was sulphate of
+copper. The usefulness of this substance, though known at Salem, New
+Jersey, was discovered, at the Asylum, by the mistake of a nurse. It had
+been previously used, in lotions of the strength of gr. ij or iij to the
+ounce of water; and with little advantage. Observing that the empirical
+remedies said to have succeeded, were, as I considered them,
+immoderately strong, I furnished the nurse with a common solution of
+sulphate of copper, and with a vial containing 72 grains of the sulphate
+in an ounce of water, for the purpose of being progressively added to
+the other at different periods. This stronger solution was applied, by
+mistake, instead of the diluted one; and it was the first remedy which
+had produced a rapid tendency to a cure. I finally settled down, after
+various trials, in the employment of the following:</p>
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>R. Sulph. Cupri,</td><td align='left'>&#8488;ij</td></tr>
+<tr><td align='left'>Pulv. Cinchon&aelig;,</td><td align='left'>&#8485;ss</td></tr>
+<tr><td align='left'>Aqu&aelig;,</td><td align='left'>&#8485;iv <i>m.</i></td></tr>
+</table></div>
+
+<p>S. To be applied twice a day, very carefully, to the full extent of the
+ulcerations and excoriations.</p>
+
+<p>The cinchona here is not absolutely necessary; but operates by retaining
+the sulphate longer in contact with the edges of the gums.</p>
+
+<p>Simple ulcerations and small gangrenes, as well as the troublesome
+excoriation, when not in the last stage, yielded promptly to this
+remedy; the good effect being generally visible from the first
+application.</p>
+
+<p>Dr. <span class="smcap">Fox</span>, my friend and fellow-labourer in the Asylum, had already taught
+me that it was important early to extract the teeth. I was not, however,
+sensible of the full extent of this rule, till after examining the fangs
+of some of them which were drawn. The separation of a portion of the
+periosteum from the fang, within the socket, which was universally found
+whenever the tooth was loose, among two or three hundred specimens,
+proved the existence of the disease in a deep, narrow crevice, into
+which it was impossible, by any contrivance, to insinuate the lotion.
+This cavity was laid open by extracting the tooth; and when the remedy
+was applied, the sanatory effect was surprisingly prompt. From this
+period, forwards, the universal rule was to extract all teeth, the
+moment they were discovered to be in the<span class='pagenum'><a name="Page_21" id="Page_21">[Pg 21]</a></span> slightest degree loose; and
+"the blue wash" above described, became the standing remedy.</p>
+
+<p>It is at all times a dangerous boast for a physician to make, to say
+that, in the treatment of any complaint, he has always succeeded. He is
+frequently not credited; and he can never know at what moment disbelief
+may be borne out by his subsequent failures. A faithful adherence to
+fact, and justice to the medical art, oblige me to say that it was owing
+to the observation of these means, that I never had an opportunity of
+making a dissection, after the one mentioned in a preceding page.
+Upwards of 120 ulcerated gums came under my notice in the course of
+three months; of which 70 were affected at one time. Of these, by far
+the greater number would, unquestionably, have escaped gangrene. The
+experience of past winters, however, and that of the preceding autumn,
+justifies the belief that there would have been several gangrenous
+cases, and some deaths; unless interrupted by remedial means. Some 3 or
+4 suffered small spots of mortification, and one, by the delay arising
+from the tardy report of a nurse, suffered necrosis in a portion of an
+alveolus; but they were speedily arrested, and the production of more
+such cases, I believe, prevented, by the employment of the above means.</p>
+
+<p>I have been once, since then, called in consultation to a case in which
+this remedy failed; but this was only two days previous to death, and
+during the existence of swelled cheek, and of a thick gangrenous eschar,
+and it was in fact only once imperfectly applied.</p>
+
+<p>The farthest advanced of all the cases which I have seen, since that
+time, relieved by this remedy, was in the practice of my friend, Dr. <span class="smcap">R.
+M. Huston</span>. He aided it by the application of a poultice with lead-water
+to the external surface of the cheek. This was thought to be productive
+of much relief.</p>
+
+<p>Great attention and care are requisite on the part of the physician, to
+see that every part of the ulceration and excoriation is made visible,
+and brought under the influence of the applications employed. Without
+this entire knowledge of the extent of the evil, the result will be
+failure. The disgusting sloughs and discharge, and the fear of an
+imaginary <i>contagion</i>, make the nurses very unwilling to introduce their
+fingers into the reluctant little patient's mouth, and without this
+scrutiny all is in vain. The physician is compelled to set the example,
+to try the looseness of<span class='pagenum'><a name="Page_22" id="Page_22">[Pg 22]</a></span> the teeth with his own fingers, and to ensure
+the nurse's entire knowledge of the extent of the disease.</p>
+
+<p>Dr. <span class="smcap">Beesley</span> writes that the women in his neighbourhood, frequently used
+considerable <i>roughness</i> in applying the lotions. <i>Certainty</i> is
+absolutely necessary.</p>
+
+<p>After the remedy had been thus accidentally discovered in the Asylum,
+and used for a few days, I received Dr. <span class="smcap">Beesley's</span> letter mentioned
+above; and I then learned that the sulphate of copper was the principal
+dependence of the physicians at Salem. As, however, I had never seen Dr.
+<span class="smcap">Vanmeter's</span> thesis, the use of it at the Asylum was new to me.</p>
+
+<p>An excellent remedy, and one on which the sole dependence should be
+placed, were we not in possession of one which possesses a decided
+superiority, is one which was communicated to me by Dr. <span class="smcap">Parrish</span>. It is
+as follows, including a slight correction made by the apothecary:</p>
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>&nbsp;&nbsp;R. Sulph. Zinci,</td><td align='left'>&#8488;i</td></tr>
+<tr><td align='left'>&nbsp;&nbsp;&nbsp;&nbsp;Aqu&aelig;,</td><td align='left'>&#8488;ij Solve.</td></tr>
+<tr><td align='left'>Dein adde, Mellis Despum. et Tinct. Myrrh&aelig;, aa</td><td align='left'>&#8485;ij</td></tr>
+</table></div>
+
+<p>To be used in the manner described above. Some bad cases yielded to the
+following:</p>
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>R. Sulph. Zinci,</td><td align='left'>&#8488;ij</td></tr>
+<tr><td align='left'>&nbsp;&nbsp;&nbsp;&nbsp;Aqu&aelig;,</td><td align='left'>&#8485;i <i>m.</i></td></tr>
+</table></div>
+
+
+<p>It is useful to record failures and unsuccessful trials; as they serve
+to deter others from unnecessary risk. We therefore record the following
+as not having succeeded in our hands:</p>
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>R. Mellis et</td></tr>
+<tr><td align='left'>Tinct. Myrrh&aelig;, aa</td><td align='left'>&#8485;i <i>m.</i></td></tr>
+</table></div>
+
+
+<p>The same, with the addition of powdered bark.</p>
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>R. Aluminis,</td><td align='left'>&#8456;ij</td></tr>
+<tr><td align='left'>&nbsp;&nbsp;Tinct. Myrrh&aelig;, et</td></tr>
+<tr><td align='left'>&nbsp;&nbsp;Mellis, aa</td><td align='left'>&#8485;ij <i>m.</i></td></tr>
+<tr><td align='left'>R. Pulv. Cinchon&aelig;,</td><td align='left'>&#8485;i</td></tr>
+<tr><td align='left'>&nbsp;&nbsp;Myrrh&aelig; et Pulv. Carbonis. a</td><td align='left'>&#8485;ss <i>m.</i> et adde</td></tr>
+<tr><td align='left'>&nbsp;&nbsp;Succ. Limonum,</td><td align='left'>q. s. ad massam</td></tr>
+<tr><td colspan="2">faciendam, qu&acirc; illineantur gingiv&aelig;.</td></tr>
+</table></div>
+
+<p>Caustic potassa; and nitrate of silver.<span class='pagenum'><a name="Page_23" id="Page_23">[Pg 23]</a></span></p>
+
+<p>Pyroligneous acid, both pure and variously diluted with water. This had
+but a very limited effect, even in destroying the f&oelig;tor; and I am by
+no means sure that it was of any use in arresting the disease.</p>
+
+<p>Muriatic acid, though praised by such high authorities, did not seem
+productive of any distinct useful effects. Nitric acid, variously
+diluted, and sulphuric acid, which was tried in one case, diluted with
+an equal quantity of water, were entirely useless.</p>
+
+<p>Of <i>constitutional</i> treatment, the disease seemed to admit very little.
+In the early stage, the means employed, were the same mentioned above as
+means of prevention. It was by no means evident that any of these were
+useful in retarding the progress of the complaint. Towards the decline
+of the worst cases, aromatic sirup of rhubarb, with magnesia, were
+employed, to remove the putrid matters swallowed; and to relieve the
+diarrh&oelig;a which generally took place, by the astringent operation of
+the first mentioned medicine. It is extremely doubtful whether these
+means were productive of any benefit.</p>
+
+<hr style='width: 45%;' />
+
+<p>While the above was in press, I have met with the article, "<i>Gangrene de
+la bouche des enfans</i>," in the Dictionnaire de Medicine; written by <span class="smcap">M.
+Marjolin</span>. The author in the Dictionnaire des Sciences Medicales, has
+given nothing material but references to some of the writers mentioned
+above; with one or two which were not within my reach. <span class="smcap">M. Marjolin</span> has
+evidently identified the disease. He cites <span class="smcap">Fabricius Hildanus</span>, though we
+have not found a distinct account of it in that writer's works. He
+remarks that it is identical with the <i>necrosis infantilis</i> of <span class="smcap">Sauvages</span>.
+He also refers to <span class="smcap">Saviard</span>, <span class="smcap">Van Sweiten</span>, whom he justly mentions with the
+highest praise, <span class="smcap">Underwood</span>, <span class="smcap">Berthe</span>, <span class="smcap">Capdeville</span>, <span class="smcap">M. Baron</span>, and the
+inaugural thesis of <span class="smcap">M. Isnard</span>. As we have no means of referring to the
+two last, we must judge of them by <span class="smcap">M. Marjolin's</span> statements. He observes
+the dissimilarity of <span class="smcap">Berthe's</span> case. From the thesis of <span class="smcap">M. Isnard</span>, he
+gives us an account of the disease which corresponds very nearly,
+indeed, with that of <span class="smcap">Van Sweiten</span>, and with the appearances observed at
+the Children's Asylum.</p>
+
+<p>"Almost all the infants affected with this disease in the hospitals of
+Paris," says <span class="smcap">M. Marjolin</span>, "sink under it." He recommends,<span class='pagenum'><a name="Page_24" id="Page_24">[Pg 24]</a></span> after <span class="smcap">Van
+Sweiten</span>, the use of muriatic acid, which he mixes with honey in equal
+proportions. Thick sloughs he cuts away with a bistouri or with
+scissors. <span class="smcap">MM. Jadelot</span>, <span class="smcap">Guersent</span>, and <span class="smcap">Baron</span>, have employed the actual
+cautery with success in several instances. <span class="smcap">M. Marjolin</span> has cured three
+cases; one by the actual cautery, one by caustic potassa, and a third by
+<i>muriate of soda!</i> which, he believes, will always destroy the f&oelig;tor.
+It would be interesting, undoubtedly, to make repeated trials of this
+simple remedy; and we shall endeavour to do so in cases which admit of
+delay.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_1_1" id="Footnote_1_1"></a><a href="#FNanchor_1_1"><span class="label">[1]</span></a> Vol. I. p. 319, Anderson's edition.</p></div>
+
+<div class="footnote"><p><a name="Footnote_2_2" id="Footnote_2_2"></a><a href="#FNanchor_2_2"><span class="label">[2]</span></a> Principles of Surgery; by <span class="smcap">John Pearson</span>. Lond. 1788. p. 262,
+et seq.</p></div>
+
+<div class="footnote"><p><a name="Footnote_3_3" id="Footnote_3_3"></a><a href="#FNanchor_3_3"><span class="label">[3]</span></a> Opera omnia. Vol. II. p. 271. In the Loganian Library.</p></div>
+
+<div class="footnote"><p><a name="Footnote_4_4" id="Footnote_4_4"></a><a href="#FNanchor_4_4"><span class="label">[4]</span></a> Ibidem.</p></div>
+
+<div class="footnote"><p><a name="Footnote_5_5" id="Footnote_5_5"></a><a href="#FNanchor_5_5"><span class="label">[5]</span></a> See <span class="smcap">Cornelii Stalpaart Vander Wiel</span> Observationes
+Medico-Anatomic&aelig;. p. 167. Note by the editor, <span class="smcap">P. Stalpaart Vander Wiel</span>.
+Amsterdam, 1687. In the Loganian Library.</p></div>
+
+<div class="footnote"><p><a name="Footnote_6_6" id="Footnote_6_6"></a><a href="#FNanchor_6_6"><span class="label">[6]</span></a> In the Loganian Library.</p></div>
+
+<div class="footnote"><p><a name="Footnote_7_7" id="Footnote_7_7"></a><a href="#FNanchor_7_7"><span class="label">[7]</span></a> Page 193.</p></div>
+
+<div class="footnote"><p><a name="Footnote_8_8" id="Footnote_8_8"></a><a href="#FNanchor_8_8"><span class="label">[8]</span></a> Page 217.</p></div>
+
+<div class="footnote"><p><a name="Footnote_9_9" id="Footnote_9_9"></a><a href="#FNanchor_9_9"><span class="label">[9]</span></a> Commentaria.&mdash;Edit. Lugd. Bat. 1742. Vol. I. pp. 766, 767.</p></div>
+
+<div class="footnote"><p><a name="Footnote_10_10" id="Footnote_10_10"></a><a href="#FNanchor_10_10"><span class="label">[10]</span></a> This name may be either from the ancient English or the
+low Dutch; if the one, by tradition, if the other, from the use of it by
+medical men. <i>Cancrum</i> is an odd grammatical blunder; being, in reality,
+nothing but the accusative of Cancer, put instead of the nominative. The
+latter name was, as is well known, frequently applied by the older
+surgeons, in a vague manner, to any terrific and unmanageable ulcer;
+and, in particular, it was often applied to gangrene. The error appears
+to have been first made by Pearson, and copied by Mr. Cooper. Compare
+Muys and Vander Wiel, with Pearson, at the above references.</p></div>
+</div>
+
+
+<hr style="width: 65%;" />
+<h2><span class="smcap">Article</span> II.&mdash;<i>Case of Purpura in an Infant, attended with Extraordinary
+Symptoms.</i> By <span class="smcap">R. M. Huston</span>, M. D., &amp;c.</h2>
+
+
+<p>On the 28th of August last, A&mdash;&mdash; V&mdash;&mdash;, after a moderate labour of four
+hours' continuance, was delivered of a female child. About a month
+previously, she had laboured under an attack of intermittent fever,
+which yielded, in a few days, to the ordinary treatment. She was 23
+years of age, an English-woman by birth, had generally enjoyed good
+health, and was as well as usual at the time of her confinement. Her
+labour was strictly natural, and her delivery accomplished without any
+extraordinary assistance.</p>
+
+<p>At birth there was nothing remarkable about the child. Its breathing was
+natural, its skin of the usual colour and appearance; in short, all the
+common indications of a continuance of life and health were present. A
+few hours, however, after birth, it became uneasy, cried much, and
+showed signs of colic. The nurse, supposing these symptoms to arise from
+flatulence, administered some warm tea; but without any apparent
+advantage. On the following day, I saw it again, and learned, that it
+had evacuated a considerable quantity of urine, and some intestinal
+matter, of the ordinary appearance after birth. The spasms continuing at
+intervals, a teaspoonful of castor oil was ordered, to evacuate any
+remaining meconium, that might lie in the bowels, producing irritation;
+upon the presence of which, it was presumed the spasms depended. It
+operated well, but without producing the desired<span class='pagenum'><a name="Page_25" id="Page_25">[Pg 25]</a></span> relief. On the next
+day, viz. forty-eight hours after birth, a number of bluish or purple
+spots were observed on different parts of the child's body, but most
+numerous on the extremities. They were of various sizes, from that of a
+mustard seed, up to that of a grain of Indian corn. Some were slightly
+elevated, but most of them were not in the least so. In the majority,
+there was a minute central spot, or little point, more red or pink
+coloured than the blue areola, by which it was surrounded. In many
+instances, these little points projected, so as to become manifest to
+the touch. In the course of twenty-four hours, the spots, which had
+first appeared, began to decline, leaving a greenish mark, very like the
+remains of a bruise; but much more rapidly than these declined, others
+of larger size appeared on different parts of the child's body.</p>
+
+<p>On the third day after birth, large blotches appeared, one behind each
+ear. These rapidly increased, until they covered the whole extent of the
+parietal bones, and considerably elevated the skin, giving it a puffy or
+tumid appearance, like that caused by a blow from a large or blunt
+instrument. The parts soon became hot and tender to the touch; and this
+tenderness extended over the greater part of the scalp. A blotch,
+similar to those upon the exterior surface, was likewise observed within
+the mouth, covering the whole extent of the palate bones. The child
+experienced great difficulty in swallowing after the third day; and the
+<i>nurse</i> thought the spasms were often excited by attempts of this kind.</p>
+
+<p>But the most singular feature of the case was the appearance, on the
+night of the second day, of a discharge from the vagina, <i>resembling</i>
+the menstrual flux. It resembled that flux in <i>colour</i>, <i>consistence</i>,
+<i>want of coagulability</i>, and in being, withal, accompanied by a
+considerable quantity of <i>slimy or mucous matter</i>. Every diaper which
+was used during that night, and the greater part of the next day, was
+stained more or less with this discharge. It was also observed, that,
+during the flow of this fluid, the spasms ceased; and that, whenever the
+discharge was suppressed, even for a very short time, they uniformly
+returned. In this manner they alternated at intervals of a few hours,
+until the occurrence of the death of the child, which happened on the
+eighth day after birth.</p>
+
+<p>As this case is related more for its singularity than from an
+expectation<span class='pagenum'><a name="Page_26" id="Page_26">[Pg 26]</a></span> that any practical suggestions will be furnished by its
+perusal, but few remarks will be necessary, either upon its pathology or
+treatment. Although it will be perceived by the scientific reader, that
+the disease observed, differed materially from any of the forms of
+<i>purpura</i>, described by systematic writers on diseases of the skin;
+still I apprehend it may be justly considered as more nearly allied to
+that genus, than to any other.</p>
+
+<p>The spots were evidently caused by an effusion of blood beneath the
+cutis, and the presumption is strong, that it issued from the little
+point discoverable in the centre of each spot. Those points were, in all
+probability, <i>arterial</i>. That they were arterial terminations, I think
+is evident, from the great extent to which the cellular membrane was
+injected, especially over the parietal bones. The force exerted must
+have been very considerable to elevate so large a portion of scalp, and
+yet no pulsation could be discovered in any one of the points.</p>
+
+<p>But whence came the vaginal discharge? That it issued from the <i>vagina</i>
+was most certain; but whether it was furnished by that canal, or by <i>the
+uterus</i>, was not ascertained. To assert that it was menstrual, would be
+hazarding more than a prudent regard for truth would justify. But, if
+not, why the pain and spasms which preceded it, and the alternation of
+these symptoms with each other? and, especially, why the slimy
+appearance, mixed with red matter, without a trace of any thing like
+coagula? Certainly we do not find these appearances in ordinary cases of
+h&aelig;morrhage. So that there is no other way of accounting for the
+discharge in this case, except by considering it as having been secreted
+by the vessels of the parts from which it came.</p>
+
+<p>From the difficulty which the child experienced in swallowing, but
+little food could be taken; and the same difficulty precluded the
+administration of medicines. What caused this impediment could not be
+ascertained, but it was supposed to result from a spasmodic action of
+the muscles of the part.</p>
+
+<p>The only medicine attempted to be given was a weak infusion of bark, and
+this was soon abandoned.</p>
+
+<p>The spots, particularly the large ecchymosed surface on the head,
+exhibited no change in appearance, when <i>viewed superficially</i>, a few
+hours after death. No other examination was permitted.</p>
+
+
+
+<hr style="width: 65%;" /><p><span class='pagenum'><a name="Page_27" id="Page_27">[Pg 27]</a></span></p>
+<h2><span class="smcap">Article</span> III.&mdash;<i>History of the Natural and Modified Small-Pox, or of the
+Variolous and Varioloid Diseases, as they prevailed in Philadelphia in
+the years 1823 and 1824.</i> By <span class="smcap">John K. Mitchell</span>, M. D., and <span class="smcap">John Bell</span>, M.
+D. attending physicians at the then Small-Pox Hospital. With a Plate.</h2>
+
+
+<p>In a question of less moment, some apology might seem due for once more
+directing public attention to that which has been so oft discussed and
+described by many eminent physicians and experienced observers. But, if
+descriptions of any disease be valuable; if to record faithfully an evil
+be among the first steps for its removal and prevention; and, still
+more, if additional confidence, derived from enlarged experience, can be
+imparted to the means hitherto adopted to guaranty the human frame
+against a mortal and loathsome malady, our efforts at this time may
+claim the favourable notice of our professional brethren, and of the
+community at large.</p>
+
+<p>Sedulously abstaining from the parade of erudite research or indulgence
+in speculations, however ingenious, it is our intention to describe with
+accuracy all that we saw; and if, in so doing, we shall be found
+repeating what others have said before us, and proposing inferences
+previously drawn, the observations and deductions are to be considered
+as not the less our own, since we only speak from conviction, founded on
+the evidence presented to our senses. Our opportunities for accurate
+judgment were most ample, being derived as well from an attendance of
+nine months on the hospital for the reception of the poor, labouring
+under the disease, as from one of us prescribing, during a part of the
+time, for the Philadelphia Dispensary, added to the cases furnished us
+by private practice, and very many others, the records of which have
+been kindly placed at our disposal by professional friends.</p>
+
+<p>The ravages committed by the small-pox in Baltimore, and the fact of
+many who had been previously vaccinated having been attacked by the
+disease during the years 1821 and 1822 were notorious to us all, but
+were productive of little alarm in Philadelphia. The non-appearance of
+the scourge in the greater part of the period, when the former city was
+suffering under it, justified, to a certain extent, this feeling of
+security, and seemed to call more on our sympathies for our neighbours
+than on our fears for ourselves.<span class='pagenum'><a name="Page_28" id="Page_28">[Pg 28]</a></span></p>
+
+<p>In the month of September, 1823, some cases of fever, with pustular
+eruption, first arrested the attention of the medical faculty, some of
+whom were, of course, called on to render professional assistance. The
+residence of some of the persons, thus attacked, in Water street, and
+their emigration from Europe, naturally induced a suspicion of this
+disease being no other than the small-pox, imported by, or brought in
+with them. Very nearly about the same time, however, some scattered
+cases of a similar eruptive disease, were noticed in the upper or
+western portion of the city, without our being able to trace any
+intercourse or connexion between these and the others in the lower or
+eastern part, viz. Water street.</p>
+
+<p>The first return of death from small-pox, furnished by the Board of
+Health, was in the week between the 13th and 20th of September. The next
+was between the 4th and 11th of October. From this time to the end of
+the year there was a progressive increase of mortality, and the annual
+return for 1823, presented no fewer than one hundred and sixty deaths by
+small-pox. The greatest mortality in any one week was thirty-three, from
+December 20 to 27. During the months of January, February and March,
+1824, the disease prevailed extensively, and was fatal to many. In the
+following months its violence subsided, and in the month of June our
+attendance on the temporary hospital<a name="FNanchor_11_11" id="FNanchor_11_11"></a><a href="#Footnote_11_11" class="fnanchor">[11]</a> was discontinued, in
+consequence of a resolution of the Managers of the Alms House to close
+it. Though a few patients were afterwards received into it, yet the
+malady soon disappearing, justified its final closure. The annual return
+for 1824 exhibited three hundred and twenty-four deaths by small-pox.
+The entire mortality from this cause was four hundred and seventy-three,
+in a period of twelve months, from November 1, 1823, to November 1,
+1824. The deaths before the first, and after the second date, were but
+eleven.<a name="FNanchor_12_12" id="FNanchor_12_12"></a><a href="#Footnote_12_12" class="fnanchor">[12]</a> Contagious as this disease unquestionably was, we cannot, at
+the same time, withhold our belief of its having been in a measure
+subjected to epidemical influences, viz. in a particular character of
+the seasons<span class='pagenum'><a name="Page_29" id="Page_29">[Pg 29]</a></span> and atmospherical changes. It is then within our province,
+as historians of events, rather than as expounders of causes, to present
+our readers with a summary account of the weather during the years 1823
+and 1824. We do this both from a sense of duty, considering it as
+pertinent to our present labour, and from a wish to encourage others by
+our example to preserve and transmit the meteorological registers, in
+their respective districts, of those years, marked by new or aggravated
+diseases.</p>
+
+<h3>METEOROLOGICAL REGISTER.<a name="FNanchor_13_13" id="FNanchor_13_13"></a><a href="#Footnote_13_13" class="fnanchor">[13]</a></h3>
+
+
+
+<div class='center'>
+<table border="1" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>&nbsp;</td><td align='left'> &nbsp;</td><td align='left'> &nbsp;</td><td align='left'> &nbsp; &nbsp;</td><td align='left'> &nbsp;</td><td colspan="2"> Winds&mdash;Days.</td></tr>
+<tr><td align='left'>&nbsp;&nbsp;&nbsp;&nbsp;1823.</td><td align='left'>MeanTemp.</td><td align='left'>Variat. Therm.</td><td align='left'>Variat. Barom.</td><td align='left'>Snow &amp; Rain Water. Inches.</td><td align='left'>N. W. to S. W.</td><td align='left'>N. E. to S. E.</td><td align='left'></td></tr>
+<tr><td align='left'>January,</td><td align='left'> 31</td><td align='left'> 44</td><td align='left'> 0.94</td><td align='left'> 3.38</td><td align='left'> 22</td><td align='left'> 8</td></tr>
+<tr><td align='left'>February,</td><td align='left'> 25</td><td align='left'> 42</td><td align='left'> 1.17</td><td align='left'> 1.93</td><td align='left'> 22</td><td align='left'> 6</td></tr>
+<tr><td align='left'>March,</td><td align='left'> 37</td><td align='left'> 52</td><td align='left'> 1.65</td><td align='left'> 6.87</td><td align='left'> 21</td><td align='left'> 9</td></tr>
+<tr><td align='left'>April,</td><td align='left'> 55</td><td align='left'> 47</td><td align='left'> 1.08</td><td align='left'> 1.77</td><td align='left'> 16</td><td align='left'> 14</td></tr>
+<tr><td align='left'>May,</td><td align='left'> 61</td><td align='left'> 52</td><td align='left'> 0.88</td><td align='left'> 1.60</td><td align='left'> 19</td><td align='left'> 8</td></tr>
+<tr><td align='left'>June,</td><td align='left'> 68</td><td align='left'> 46</td><td align='left'> 0.65</td><td align='left'> 0.87</td><td align='left'> 20</td><td align='left'> 10</td></tr>
+<tr><td align='left'>July,</td><td align='left'> 72</td><td align='left'> 30</td><td align='left'> 0.58</td><td align='left'> 6.12</td><td align='left'> 23</td><td align='left'> 6</td></tr>
+<tr><td align='left'>August,</td><td align='left'> 72</td><td align='left'> 35</td><td align='left'> 0.60</td><td align='left'> 4.68</td><td align='left'> 21</td><td align='left'> 8</td></tr>
+<tr><td align='left'>September,</td><td align='left'> 63</td><td align='left'> 51</td><td align='left'> 0.61</td><td align='left'> 3.46</td><td align='left'> 15</td><td align='left'> 12</td></tr>
+<tr><td align='left'>October,</td><td align='left'> 53</td><td align='left'> 42</td><td align='left'> 0.60</td><td align='left'> 2.02</td><td align='left'> 21</td><td align='left'> 9</td></tr>
+<tr><td align='left'>November,</td><td align='left'> 38</td><td align='left'> 38</td><td align='left'> 0.81</td><td align='left'> 2.47</td><td align='left'> 21</td><td align='left'> 9</td></tr>
+<tr><td align='left'>December,</td><td align='left'> 34</td><td align='left'> 31</td><td align='left'> 1.07</td><td align='left'> 7.37</td><td align='left'> 21</td><td align='left'> 10</td></tr>
+<tr><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&mdash;&mdash;&mdash;</td><td align='left'>&mdash;&mdash;&mdash;</td><td align='left'>&mdash;&mdash;</td></tr>
+<tr><td align='left'>For the year,</td><td align='left'>50-3/4</td><td align='left'> 88</td><td align='left'> 1.70</td><td align='left'>42.54</td><td align='left'> 242</td><td align='left'> 109</td></tr>
+<tr><td align='left'>&nbsp;&nbsp;&nbsp;&nbsp;1824.</td><td colspan="6">&nbsp;</td></tr>
+<tr><td align='left'>January,</td><td align='left'> 36</td><td align='left'> 48</td><td align='left'> 1.25</td><td align='left'> 3.67</td><td align='left'> 24</td><td align='left'> 7</td></tr>
+<tr><td align='left'>February,</td><td align='left'> 31</td><td align='left'> 59</td><td align='left'> 1.55</td><td align='left'> 3.94</td><td align='left'> 21</td><td align='left'> 7</td></tr>
+<tr><td align='left'>March,</td><td align='left'> 40</td><td align='left'> 39</td><td align='left'> 0.71</td><td align='left'> 2.63</td><td align='left'> 16</td><td align='left'> 15</td></tr>
+<tr><td align='left'>April,</td><td align='left'> 50</td><td align='left'> 45</td><td align='left'> 1.08</td><td align='left'> 4.54</td><td align='left'> 22</td><td align='left'> 8</td></tr>
+<tr><td align='left'>May,</td><td align='left'> 60</td><td align='left'> 44</td><td align='left'> 0.88</td><td align='left'> 1.59</td><td align='left'> 24</td><td align='left'> 7</td></tr>
+<tr><td align='left'>June,</td><td align='left'> 73</td><td align='left'> 46</td><td align='left'> 0.69</td><td align='left'> 6.09</td><td align='left'> 25</td><td align='left'> 5</td></tr>
+<tr><td align='left'>July,</td><td align='left'> 74</td><td align='left'> 30</td><td align='left'> 0.38</td><td align='left'> 8.80</td><td align='left'> 19</td><td align='left'> 8</td></tr>
+<tr><td align='left'>August,</td><td align='left'> 70</td><td align='left'> 36</td><td align='left'> 0.45</td><td align='left'> 6.39</td><td align='left'> 20</td><td align='left'> 11</td></tr>
+<tr><td align='left'>September,</td><td align='left'> 64</td><td align='left'> 41</td><td align='left'> 0.65</td><td align='left'> 6.60</td><td align='left'> 17</td><td align='left'> 7</td></tr>
+<tr><td align='left'>October,</td><td align='left'> 54</td><td align='left'> 43</td><td align='left'> 0.65</td><td align='left'> 1.53</td><td align='left'> 23</td><td align='left'> 5</td></tr>
+<tr><td align='left'>November,</td><td align='left'> 42</td><td align='left'> 38</td><td align='left'> 0.89</td><td align='left'> 2.49</td><td align='left'> 24</td><td align='left'> 6</td></tr>
+<tr><td align='left'>December,</td><td align='left'> 37</td><td align='left'> 43</td><td align='left'> 0.95</td><td align='left'> 2.11</td><td align='left'> 24</td><td align='left'> 7</td></tr>
+<tr><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&mdash;&mdash;&mdash;</td><td align='left'>&mdash;&mdash;&mdash;</td><td align='left'>&mdash;&mdash;</td></tr>
+<tr><td align='left'>For the year,</td><td align='left'>52-1/2</td><td align='left'> 85</td><td align='left'> 1.55</td><td align='left'>50.38</td><td align='left'> 259</td><td align='left'> 93</td></tr>
+<tr><td colspan="7"> The temperature of the wells and springs, in and near Philadelphia, is 52&deg; Fahrenheit.</td></tr>
+</table></div>
+
+
+<p><span class='pagenum'><a name="Page_30" id="Page_30">[Pg 30]</a></span></p>
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td colspan="7">1823.</td></tr>
+<tr><td align='left'>Maximum of</td><td align='left'>Therm.</td><td align='left'>91,</td><td align='left'>June 19.</td><td align='left'>Maximum of </td><td align='left'>Barom.</td><td align='left'>30.45,</td><td align='left'>Nov. 29.</td></tr>
+<tr><td align='left'>Minimum</td><td align='left'>"</td><td align='left'>3,</td><td align='left'>Feb. 7.</td><td align='left'>Minimum</td><td align='left'>"</td><td align='left'>28.75,</td><td align='left'>March 30.</td></tr>
+<tr><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&mdash;</td><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&mdash;&mdash;</td></tr>
+<tr><td align='left'>&nbsp;&nbsp;Variation,</td><td align='left'>&nbsp;</td><td align='left'>88</td><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>1.70</td></tr>
+<tr><td colspan="7">1824.</td></tr>
+<tr><td align='left'>Maximum of</td><td align='left'>Therm.</td><td align='left'>90,</td><td align='left'>June 8.</td><td align='left'>Maximum of </td><td align='left'>Barom.</td><td align='left'>30.45,</td><td align='left'>Feb. 6.</td></tr>
+<tr><td align='left'>Minimum</td><td align='left'>"</td><td align='left'>5,</td><td align='left'>Feb. 2.</td><td align='left'>Minimum</td><td align='left'>"</td><td align='left'>28.90,</td><td align='left'>Feb. 26.</td></tr>
+<tr><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&mdash;</td><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&mdash;&mdash;</td></tr>
+<tr><td align='left'>&nbsp;&nbsp;Variation,</td><td align='left'>&nbsp;</td><td align='left'>85</td><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>&nbsp;</td><td align='left'>1.55</td></tr>
+</table></div>
+
+
+<p>The amount of water which fell in rain and snow during the four years,
+from 1822 to 1825, inclusive, was,</p>
+
+
+<div class='center'>
+<table border="1" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>&nbsp;</td><td align='left'> 1822.</td><td align='left'> 1823.</td><td align='left'> 1824.</td><td align='left'> 1825.</td></tr>
+<tr><td align='left'>Inches,</td><td align='left'> 35.20</td><td align='left'> 42.54</td><td align='left'> 50.38</td><td align='left'> 33.26</td></tr>
+</table></div>
+
+<p>We next subjoin a summary of deaths by fever, erysipelas and measles, in
+the above period; being more desirous of narrating all the circumstances
+associated with the appearance and continuance of the small-pox, than of
+insisting on them as supporting causes or necessary connexions. It will
+appear from the accompanying statement, that the diseases febrile and
+eruptive were in number, violence and mortality unusually great, in the
+above mentioned years, as we discover by comparison with the returns for
+1822 and 1825.</p>
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td colspan="5">Deaths by</td></tr>
+<tr><td align='left'>&nbsp;</td><td align='left'>Fevers.</td><td align='left'>Erysipelas.</td><td align='left'>Measles.</td><td align='left'>Small-pox.</td></tr>
+<tr><td align='left'>1822</td><td align='right'>510</td><td align='right'>4</td><td align='right'>0</td><td align='right'>0</td></tr>
+<tr><td align='left'>1823</td><td align='right'>758</td><td align='right'>24</td><td align='right'>156</td><td align='right'>160</td></tr>
+<tr><td align='left'>1824</td><td align='right'>654</td><td align='right'>28</td><td align='right'>102</td><td align='right'>324</td></tr>
+<tr><td align='left'>1825</td><td align='right'>375</td><td align='right'>12</td><td align='right'>38</td><td align='right'>6</td></tr>
+</table></div>
+
+<p>In New York and Baltimore, the coincidence between increase of fevers,
+measles and erysipelas, and the mortality from small-pox, is not so well
+marked.</p>
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td colspan="5">In New York&mdash;Deaths by</td></tr>
+<tr><td align='left'></td><td align='left'>Fevers.</td><td align='left'>Erysipelas.</td><td align='left'>Measles.</td><td align='left'>Small-pox.</td></tr>
+<tr><td align='left'>1822</td><td align='right'>393<a name="FNanchor_14_14" id="FNanchor_14_14"></a><a href="#Footnote_14_14" class="fnanchor">[14]</a></td><td align='right'>6</td><td align='right'>1</td><td align='right'>0</td></tr>
+<tr><td align='left'>1823</td><td align='right'>192<a name="FNanchor_15_15" id="FNanchor_15_15"></a><a href="#Footnote_15_15" class="fnanchor">[15]</a></td><td align='right'>13</td><td align='right'>117</td><td align='right'>18</td></tr>
+<tr><td align='left'>1824</td><td align='right'>191<a name="FNanchor_16_16" id="FNanchor_16_16"></a><a href="#Footnote_16_16" class="fnanchor">[16]</a></td><td align='right'>14</td><td align='right'>100</td><td align='right'>394</td></tr>
+<tr><td align='left'>1825</td><td align='right'>445</td><td align='right'>20</td><td align='right'>53</td><td align='right'>40</td></tr>
+</table></div>
+
+<p><span class='pagenum'><a name="Page_31" id="Page_31">[Pg 31]</a></span></p>
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td colspan="5">In Baltimore&mdash;Deaths by</td></tr>
+<tr><td align='left'></td><td align='left'>Fevers.</td><td align='right'>Erysipelas.</td><td align='left'>Measles.</td><td align='left'>Small-pox.</td></tr>
+<tr><td align='left'>1821</td><td align='right'>400</td><td align='right'>0</td><td align='right'>2</td><td align='right'>21</td></tr>
+<tr><td align='left'>1822</td><td align='right'>430</td><td align='right'>1</td><td align='right'>4</td><td align='right'>122</td></tr>
+<tr><td align='left'>1823</td><td align='right'>304</td><td align='right'>2</td><td align='right'>175</td><td align='right'>2</td></tr>
+<tr><td align='left'>1824</td><td align='right'>183</td><td align='right'>3</td><td align='right'>14</td><td align='right'>2</td></tr>
+<tr><td align='left'>1825</td><td align='right'>138</td><td align='right'>0</td><td align='right'>9</td><td align='right'>3</td></tr>
+</table></div>
+
+
+<p>We now proceed to give a brief sketch of the disease called the natural
+small-pox, (occurring in persons unprotected by previous vaccination or
+inoculation,) and the deaths from which are given in the above
+statements. We must, in advance, insist on the great diversity in the
+appearance of the eruption in different individuals; so great, that an
+attempt to make an accurate picture of one case pass for a faithful
+representation of the many, must be deceptive and injurious.</p>
+
+<p>In the premonitory symptoms, constituting the characters of the fever
+precursory to the eruption, there was considerable uniformity: the
+complaint of nearly all those attacked being at first chills and rigors;
+pains in the loins, head and limbs, with thirst and want of appetite;
+with which were soon associated gastric uneasiness, and in many,
+soreness of throat, rendering deglutition painful, hoarseness and
+weeping eyes. The duration of these symptoms, aggravated by febrile
+exacerbations, varied from one to three days, more usually the latter,
+after which the eruption begins to appear. It is first seen round the
+forehead and temples, near the hairy scalp; then on the cheeks and
+breast and back; on the arms near the shoulders; the abdomen and thighs;
+and subsequently on the fore-arms and hands, and finally on the legs and
+feet. The appearance of the eruption is that of red or scarlet papul&aelig;,
+presenting to the touch a sensible resistance, but not much raised, and
+without roughness or hardness. These papul&aelig;, becoming more and more
+defined and elevated,<span class='pagenum'><a name="Page_32" id="Page_32">[Pg 32]</a></span> are after a day or two converted into vesicles,
+with small elevated centres or bodies of a yellowish-white, and more
+diffused red and somewhat hard bases or margins. The redness extending
+as the eruption becomes copious, converts the skin, especially of the
+face, neck, and hands, into a red ground, from which project, in relief,
+the whitish vesicles. Similar appearances, but of a less marked nature,
+owing to the eruption being more scattered, are found on the trunk. The
+vesicles, containing at first a thin, semi-transparent fluid, become
+gradually larger, fuller and yellower, and filled with a thick,
+tenacious matter. This change is completed, and the pustules are
+entirely formed, after a lapse of time from the first eruptive effort,
+which varies from the fifth to the ninth day, and is occasionally
+longer. The mean for the beginning of maturation, or the finishing of
+the secretion of matter in the pustule, may be received as five days for
+the face, and eight or nine days for the body generally. The stages of
+the eruption, as regards its appearance, may be very properly called
+papular, vesicular, and pustular. This last having attained its height,
+completes what is termed the period of maturation, during which the
+pustules retain their fulness and spheroid figure; and exhibit the
+greatest proportion of whitish-yellow shining surface of their body, and
+diminished extent of redness at their base. A yellow dry point on the
+summit of the pustule, which loses thereby somewhat of its former
+spheroidal shape, by becoming flatter, or slightly indented, indicates
+beginning desiccation, at which time the body exhales that peculiar
+odour, so unpleasant, and so readily recognizable, after it has once
+been perceived. There is no uniformity in the size of the pustules on
+the body generally, nor any equality among them on a particular part:
+more usually one larger and fuller is surrounded by others less so. Nor
+is it to be supposed that the changes above mentioned are gone through
+in regular succession on all parts of the surface, uniformly. It was no
+uncommon thing to see the eruption papular on the legs, vesicular on the
+trunk and arms, and pustular on the face, at the same epoch. One part
+even, as the arm for instance, has exhibited to us the three forms at
+the same time.</p>
+
+<p>Maturation complete and desiccation going on, the pustules break, and
+have their thin coverings converted into a yellow hard coat or crust, to
+which adheres the pus that was not removed by<span class='pagenum'><a name="Page_33" id="Page_33">[Pg 33]</a></span> absorption, and the
+residue, by evaporation of its watery part, is now converted into a scab
+of varying thickness, firm and prominent in its centre, and made up
+outwardly of concentric circles. The margins of the pustules, before of
+a distinct red, now assume a bluish-red or purplish colour, and the skin
+begins to desquamate.</p>
+
+<p>The constitutional sympathies, or the symptoms in the milder and regular
+variety of the disease, are not of any great violence or intensity. The
+premonitory pains, diminishing or disappearing, after the coming out of
+the eruption, leave in their place a regular fever. The action of the
+heart and capillaries is hurried during the papular and vesicular
+stages; but becomes more equable while maturation is going on. During
+the former period, the loaded and not unfrequently furred tongue
+evidences disordered stomach, the cravings of which are for cold drinks.
+The somewhat laborious respiration may, in some cases, depend on the
+swelling and soreness of the fauces and pharynx; in others, on the
+eruption extending along the lining membrane of the larynx; whilst in
+others, it may be caused by bronchial engorgement.</p>
+
+<p>The febrile symptoms, which abate during the process of maturation, are
+apt to return during desiccation; and when the skin begins to
+desquamate, they then constitute what is called secondary fever. The
+skin which had suffered so much, occasionally exhibits at this time an
+erysipelatous blush, accompanied by an inflammation of the subjacent
+cellular tissue, and the formation of troublesome boils, or infiltration
+of serum, especially where there is much laxity of structure, as in the
+eyelids, cheeks, lips, &amp;c. The cutaneous system, during and immediately
+after the removal of its cuticle, and much of its rete mucosum, is of
+course very sensible, as well to the impression of clothes as to
+atmospherical extremes, and particularly cold. This is with many a
+critical time. It not unfrequently happened that persons, who had passed
+through the different stages of the disease, and were advancing rapidly
+to convalescence, were suddenly seized with an affection of the chest,
+pleurisy, bronchitis or pneumonia, and speedily carried off by the
+violence of the inflammation. The skin, exquisitely sensible in its
+denuded state to atmospherical vicissitudes, transmits with great
+promptness the morbid impression to the lungs, already prone to take on
+disease, in consequence of the active part they are compelled to play
+during the eruptive fever.<span class='pagenum'><a name="Page_34" id="Page_34">[Pg 34]</a></span></p>
+
+<p>The anomalous varieties, if we can admit any standard form of the
+disease, were numerous. Those which most fixed our attention were the
+<i>confluent</i>, the <i>roseate</i>, the <i>tuberculous</i>, and the <i>erysipelatous</i>.</p>
+
+<p>The <i>confluent</i> was ushered in by symptoms of greater febrile disorder
+than the regular distinct variety: the throat was sorer; eyes more
+suffused and watery, and more intolerant of light; gastric and pulmonic
+uneasiness, and oppression more aggravated. In place of the papul&aelig; being
+separate, or merely in clusters, they are so crowded, that on the
+progress of the eruption the vesicles first and then the pustules are
+contiguous at their bases, and often run into each other, forming at
+times, a large irregular bag filled with pus, and technically called
+blebs, or else exhibiting over a considerable space of skin the
+appearance of imperfect vesication. The vesicles and pustules are, in
+such cases, flattened, and with indented centres, which latter display
+at times a dark point or spot, while the edges are of a livid red. This
+is the appearance of the limbs and trunk. The cheeks and forehead during
+the process of maturation present a continuous puffy elevation of a
+pearly white colour. The eyes are nearly closed by the swelling of the
+lids, and the thick copious secretion from the borders and the
+conjunctiva; the lips are tumid and the angles of the mouth ulcerated.
+In fact the human face divine, deprived of all lineaments and
+expression, is now a foul, misshapen mass. Associated with this state
+are swelled throat, rendering deglutition very painful&mdash;salivation,
+cough&mdash;occasional vomiting, delirium, sometimes phrenitical, sometimes
+evidencing itself in low mutterings and jactation.</p>
+
+<p>The <i>roseate</i> variety of small-pox might, without creating much
+confusion, be ranked with the confluent, which it closely resembles in
+its second stage. The first is characterized by the rose or pink colour
+of the face, which is covered with a copious eruption of papul&aelig;, some
+with dry points, while from others, the bases of which are small and
+hard, arise minute vesicles of a pearly colour, which soon dry away. The
+inflammation, however, still continues, but spreads under the cuticle,
+which is raised in large patches of a white colour, but not vesicular,
+or distinctly pustular, or containing fluid: they approximate and
+produce the continuous puffy elevation already described. On the trunk
+and extremities, the eruption<span class='pagenum'><a name="Page_35" id="Page_35">[Pg 35]</a></span> is either of confluent patches or of
+pustules dry and flat, with indented centres, the intermediate skin
+being of a deep red or crimson colour.</p>
+
+<p>The constitutional disorder runs high in these cases,&mdash;delirium and
+great gastric distress being very common symptoms. The tongue,
+especially at its border, is frequently the seat of eruption, which may
+be compared to the vesicular stage on the skin, with the summits cut
+off. The lining membrane of the mouth and fauces and pharynx, are, we
+presume, similarly affected, judging from the soreness of these parts,
+and the thick muco-purulent matter sometimes mixed with blood, which is
+spit out or brought up by screatus. The subjects most liable to the
+roseate eruption, were the intemperate and debauched of the sanguine
+temperament.</p>
+
+<p>The <i>tuberculous</i> variety of small-pox was most frequent among the
+negroes. The eruption at first consisted of broad papul&aelig;, which were
+converted into hard, rough, and knotted prominences, tuberculous at base
+and flattened in the centre. This was not unaptly called by some the
+seal skin eruption. Sore throat, causing the greatest difficulty in
+deglutition, and delirium were the almost invariable concomitants of
+this variety. Occasionally the patient was in a state of stupor and
+disinclination to motion&mdash;at other times wakeful and restless, and
+requiring coercive means to confine him to his bed. In many instances,
+the muscular strength was retained to within a few hours of death. The
+fatal termination in these three varieties, confluent, roseate, and
+tuberculous, was in the second period of the disease, that is, in the
+one corresponding with the completion of maturation, and the absorption
+and drying away of the pus in the simple distinct form of small pox.
+After some experience, we were enabled, from the appearance of the
+eruption at the outset, to presage the event, which in the above
+described kinds, was almost universally fatal.</p>
+
+<p>The <i>erysipelatous</i> variety was more an adventitious conversion of the
+primary form of the disease, by hospital air and delicacy of the
+cutaneous tissue induced by prior irregularities of life, than a
+distinct kind to be met with in general practice. It was most commonly
+presented to us in persons who had a very copious eruption, interesting
+to a great degree the whole cutaneous surface, and in whom the process
+of maturation was complete, and the cuticle<span class='pagenum'><a name="Page_36" id="Page_36">[Pg 36]</a></span> began to lose its adhesion
+to the subjacent tissue. In some cases, even after desquamation was
+almost completed, and the skin nearly dry and smooth, erysipelatous
+inflammation would supervene, and seem to be repeated on the pulmonary
+and gastric surfaces, producing great trouble in respiration and
+derangement in the digestive functions, accelerated pulse, and other
+symptoms of fever.</p>
+
+<p>We could readily pourtray other nicer shades of the natural small-pox,
+but the originals might not perhaps be so readily recognized by
+succeeding observers, or their nature well understood by our
+readers.<a name="FNanchor_17_17" id="FNanchor_17_17"></a><a href="#Footnote_17_17" class="fnanchor">[17]</a> Our object being to convey practical knowledge, we pass on
+to a notice of the subjects, most liable to suffer from exposure to the
+variolous poison.</p>
+
+<p>The African race would seem to be peculiarly obnoxious to the small-pox:
+the actual number of people of colour brought to the hospital being
+greater than the whites, and the proportionate mortality much more
+considerable; being as four deaths to six cases of disease in the
+former, and two deaths to four cases of disease in the latter. As
+regards sex, the proportion of deaths among the males was three-fifths,
+among the females two-fifths, of the entire number under treatment in
+the hospital. In both, the violence of the disease, and the number of
+anomalous symptoms and complications, depended greatly on their prior
+dissolute life. Drunkards among the men, and prostitutes among the
+women, rarely escaped death. The former had the roseate eruption, and
+the latter the confluent, on which dark spots as if gangrenous were a
+frequent appearance. Menorrhagia, at any time in the course of the
+disease, was a bad augury.</p>
+
+<p>The better to elucidate the nature of this dire malady, we shall now
+give from our records some cases of fatal termination, and add an
+account of the appearances on <i>post mortem</i> examination of these same
+subjects.</p>
+
+<p><span class="smcap">Cases</span>.&mdash;I. Wilhelmina Smith, white, aged nineteen years, of irregular
+habits, has a well defined circular scar, with smaller pits in it, on
+the left arm; but has no recollection of having been vaccinated, nor
+does she remember ever having heard her parents, who are now dead, speak
+of it.</p>
+<p><span class='pagenum'><a name="Page_37" id="Page_37">[Pg 37]</a></span></p>
+<p>She was taken sick on Thursday night, the 11th of March, 1824, and in
+the morning had vomiting and pains in the back. On the 13th in the
+afternoon, the eruption first appeared.</p>
+
+<p>15th. Admitted and visited. Eruption on face slightly prominent, is red,
+tuberculous and rough&mdash;small and scattered on the arms, like flea bites.
+Legs nearly clear: they have many cicatrices, especially on the shin and
+outer part. There is at present an ulcer above the inner ancle. Tongue
+yellow, and furred in centre, white at borders. Pulse small and
+threaded.</p>
+
+<p>16th. Eruption rising vesicular from face and limbs; no fever; tongue
+greenish and loaded; coughs much.</p>
+
+<p>17th. Eruption fine, dry, flat, and partly indented in centre on the
+face, which burns much; skin red and inflamed; on limbs same appearance,
+but eruption less copious; pulse small, threaded, and frequent; tongue
+furred and yellow in centre; complains of pain in deglutition; cough.</p>
+
+<p>18th. Eruption on face dry, flat, white and small in size, and copious;
+rather more elevated on limbs and neck; tongue dry and furred; pulse
+frequent and threaded; throat sore.</p>
+
+<p>19th. Eruption same as yesterday; pulse scarcely to be felt; skin cool;
+coughs with an appearance of choking.</p>
+
+<p>Dead at midnight. She retained her muscular strength and ability to sit
+up to the last.</p>
+
+<p><i>Examination</i> in the afternoon of March 21.&mdash;On removing the sternum and
+anterior portion of the ribs, the anterior mediastinum was found filled
+with a frothy adipo-mucous collection of a yellowish colour. The lungs
+on both sides adherent to the thorax, and the left lobes to each other.
+A sanguineo-serous effusion on both sides, probably a quart on the
+right, the lungs of which were changed in texture, and shrunk. The
+pericardium contained a large quantity of the same kind of fluid, which
+was found in the cavity of the thorax. The heart was highly injected. On
+removing the lungs and the trachea, and larynx, the lining membrane of
+the two last showed a brownish-red, coated with mucus, and deeply
+injected. Same appearances in a more marked degree in the bifurcations
+of the trachea.</p>
+
+<p>The &oelig;sophagus next examined, was found of a natural appearance,
+except near the stomach, where it was injected and assumed a red hue,
+contrasting with the whiteness of its upper part. The<span class='pagenum'><a name="Page_38" id="Page_38">[Pg 38]</a></span> mucous membrane
+of the stomach near the cardiac orifice was in some parts of a roseate
+hue, in others a brownish-red; while in others it was ash-coloured, and
+dotted with red and yellow points. Towards the pyloric orifice, less
+disease. The stomach contained nothing but dark green bile and mucus.
+The duodenum was also highly injected. Lower down, the small intestines
+were in places lined with a dark red and brown, and the mesentery highly
+injected in the portions corresponding to these spots. Intestines much
+inflated, and omentum dark and injected. The uterus was not examined.
+The ovaria were large, white and soft; in the left was a small sac of
+dark blood, which readily burst on pressure.</p>
+
+<p>The liver was very large, of a soft texture and white colour;
+gall-bladder full of dark green bile, which had in part transuded
+through its coats.</p>
+
+<p>On looking at the trachea after it was washed, it exhibited in places
+whitish elevated spots, having all the appearance of an eruption.</p>
+
+<p>II. Ann Collins, white, aged 18 years, unprotected, became sick on
+Tuesday evening, March 23, 1824, and was taken to the Alms House, as one
+having the measles, on Wednesday. On Thursday evening, some eruption was
+visible; on Saturday evening, March 27, admitted.</p>
+
+<p>28th. Visited. Face covered with a red, flat, dry eruption, particularly
+on the cheeks; small and vesicular on the chin and around the mouth. On
+the arms, it has the appearance of measles; on the hands, it is of a
+deep scarlet, with central vesicular elevations; on the legs is slight;
+tongue loaded and yellow, except at the borders, which are clean; pulse
+natural; complains much of pain in the back and sickness of stomach.</p>
+
+<p>30th. Eruption covering the face, vesicular on a deep red ground with
+some tumefaction; rising vesicular on the limbs with scarlet bases.
+Tongue smooth and shining anteriorly, and with vesicles on it. Throat
+sore. Salivation. Pulse small and feeble. Has had menorrhagia since her
+admission into the hospital.</p>
+
+<p>31st. The menorrhagia continues. Had last night epistaxis. Pulse small
+and slow. Tongue furred and red. Eruption confluent with indented and
+dark centres. Surface white and dry. Skin between, red and inflamed.
+Very slight eruption on legs, and none on feet.<span class='pagenum'><a name="Page_39" id="Page_39">[Pg 39]</a></span></p>
+
+<p>April 1. Menorrhagia continues. Pulse small and labouring. Respiration
+laborious and hurried. Face swelled. Surface smooth, with white spots to
+represent the pustules. On breast and arms the eruption is in confluent
+patches which are nearly continuous&mdash;some pustules flat and indented,
+others smooth, with appearance of radii, and some more elevated forming
+blebs. Skin of the feet cold, and blue in spots; no elevated eruption on
+lower extremities. Tongue furred and yellowish. Throat sore. Eruption
+very copious on body, generally with blebs.</p>
+
+<p><i>Vespere</i>; pulse hardly perceptible. Anxiety and distress great. Dead at
+10, P. M.</p>
+
+<p><i>Examination</i> April 2nd, in the afternoon.&mdash;On opening the thorax, the
+lungs and heart were found of the natural appearance and size. The
+larynx and trachea being divided, exhibited all the way down to the
+lungs an injected surface with whitish irregular spots, having nearly
+the same appearance as the flat smooth eruption on the face: in parts it
+was more evidently pointed, and showed, by the aid of the microscope, a
+pustular appearance. In the lungs, the inner surface was still darker.
+The root of the tongue was covered with large and rather hard papill&aelig;,
+with open summits. The &oelig;sophagus was smooth and white. The stomach
+near the cardia injected, and of a brownish-red in spots: the remaining
+portion white, presenting no diseased appearance. The spleen was very
+large and covered with copious miliary points. The omentum, to
+appearance gangrened, was dark, and altered in texture. The peritoneum,
+especially in the pelvis, was injected and inflamed, being of a
+semi-opaque dark colour. The uterus, small and firm, contained some
+bloody mucus in its cavity.</p>
+
+<p>III. Joseph Foster, white, aged 22 years, unprotected, became sick on
+Monday evening 8th of March. The eruption began to show itself on
+Wednesday morning, 10th.</p>
+
+<p>12th. Admitted and visited. Face covered with a red, dry, tubercular
+eruption, with some few yellow pustules. Same on arms, but no pustular
+appearance; partly tuberculous, partly vesicular. More sparse and
+scattered on breast and legs: none on feet. Slight cough. Tongue white,
+clammy, and loaded in middle&mdash;red at borders. Pulse rather frequent.</p>
+
+<p>14th. Face covered with a pustulo-vesicular eruption, with whitish
+summits, red and inflamed bases. Skin between, of same<span class='pagenum'><a name="Page_40" id="Page_40">[Pg 40]</a></span> colour. Eruption
+dry and hard; very red, copious on limbs; less so on trunk. Tongue moist
+and less loaded. Pulse regular.</p>
+
+<p>15th. No fever. Face of a deep red colour; eruption rising from it
+rather flat, irregular in figure and white at summits. Eyes inflamed. On
+limbs the eruption is red at base, vesicular in body and summit: on
+trunk in clusters. Tongue yellowish and rather furred. No complaint
+made; rests easy; sleeps well.</p>
+
+<p>16th. No fever: tongue moist and a little loaded. Pustules nearly white.
+Some yellow, and beginning to dry on summits. Skin between still of a
+deep red. Eruption filling on limbs and trunk.</p>
+
+<p>17th. Pulse strong and frequent; skin hot; tongue moist and loaded.
+Pustules scabbing on face. Not yet entirely filled on limbs, where they
+are in clusters with inflamed bases.</p>
+
+<p>18th. Pustules full and matured on limbs. Running into each other in
+places. Tongue dry, brown, and furred in centre, yellow and loaded at
+sides. Pulse quick and frequent. Lies easy.</p>
+
+<p>19th. Blebs formed on arms; pustules running into each other, beginning
+to shrink; matter oozing out. Tongue covered with a dark crust. Pulse
+quick and frequent. Erysipelas of eyelids and ophthalmia. Throat sore.</p>
+
+<p>20th. Blebs larger and more numerous on hands and arms; purulent matter
+oozing out from some of the pustules. Face nearly scabbed over. Some
+small white pustules formed on the eyelids. Pulse frequent and
+vibrating. Tongue as yesterday. Gums tender.</p>
+
+<p>21st. Pulse weaker. Desquamation going on; pustules shrunk and drying on
+limbs. Tongue as yesterday.</p>
+
+<p>22nd. Matter much absorbed on limbs, leaving a shrunk cuticle. Face
+covered with a brown and yellow scab and scurf. Tongue black and furred;
+clear at apex.</p>
+
+<p>23d. Some erysipelatous inflammation of the skin; pustules all nearly
+disappeared from arms, trunk and thighs; some few, white and soft remain
+scattered over breast. Pulse frequent. Tongue black and incrusted.</p>
+
+<p>24th. Was brought into town from Bush Hill.</p>
+
+<p>30th. Desquamation nearly complete. Low frequent pulse. Respiration slow
+and laboured. Tongue incrusted.</p>
+
+<p>April 2nd. Dead at 10, A. M.</p>
+
+<p>Calomel had been freely given to this man in the earlier stage<span class='pagenum'><a name="Page_41" id="Page_41">[Pg 41]</a></span> of his
+disease: and during the last week, spts. terebinth. and nutritive
+farinaceous food.</p>
+
+<p><i>Examination.</i>&mdash;The pericardium, of a greenish colour and its
+capillaries finely injected, was full of yellow serum. The lining
+membrane of the larynx and trachea was of a greenish-yellow colour
+throughout, and in the spaces between the cartilages ulcerated and
+disorganized in several spots. Beneath the membrane was a venous
+injection. About the bifurcation it was injected; and in the
+ramifications of the trachea were seen several inflamed, and in places
+abraded and disorganized spots. A chocolate coloured liquor with a
+sediment filled the bronchi&aelig; and the larger tracheal subdivisions.</p>
+
+<p>The &oelig;sophagus was sound. The stomach showed clusters of bright red
+and brownish-red spots, in stellated and other regular figures extending
+along the smaller curvature. The duodenum, at its commencement and in
+its course, presented similar clusters. The rest of the intestine was
+healthy. The brain was to appearance in a natural state.</p>
+
+<p>IV. Peter Johnson, black man, aged 38 years, unprotected, was taken sick
+on Monday, 29th March, in Sandy Hook. Eruption of small-pox appeared
+April 3d, Saturday morning. Admitted same day.</p>
+
+<p>4th. Eruption copious on face; papular and of irregular figure. Eyes
+suffused and red. On arms, same appearance as on face, but less
+tuberculous. On breast and body, eruption small and pointed; beginning
+to show on legs. Throat sore. Tongue yellow and loaded at sides; red in
+centre. Pulse full, equal, and rather frequent. Cough.</p>
+
+<p>5th. Much anxiety and moaning. Eruption rough and tuberculous on face.
+On arms, it is in parts papillary and pointed, and in parts flat with
+indented centres. Pulse slow and equal.</p>
+
+<p>6th. Eruption hard and tuberculous on face and arms; small and pointed
+on breast. Pulse slow; throat less sore; mind wandering. Is sitting up
+in bed, dressed. Tongue moist and yellow.</p>
+
+<p>7th. Delirious through the preceding night; is now dozing. Eruption same
+as yesterday. Not so thick on legs, but hard and tuberculous.</p>
+
+<p>8th. Tongue black and incrusted. Throat very sore. Eruption hard and
+flat. Pulse active.<span class='pagenum'><a name="Page_42" id="Page_42">[Pg 42]</a></span></p>
+
+<p>9th. In a comatose state. Pulse slow. Skin cool.</p>
+
+<p>10th. In the same condition. Drawn down in the bed, the thighs flexed on
+the abdomen, and lies on his side.</p>
+
+<p>11th. Dead at six A. M.</p>
+
+<p><i>Examination.</i>&mdash;The upper surface of the tongue of a brownish yellow,
+full of holes and rough. At the posterior part, in place of the larger
+papill&aelig;, were ulcers and cavities. The posterior nares and pharynx were
+covered with holes, formed by ulceration, and of a brownish hue,
+adjoining injected and apparent pustular parts. Tonsils ulcerated, and
+their investing membrane mostly destroyed. The &oelig;sophagus immediately
+below the glottis, smooth and sound. Yellowish matter flowing from the
+glottis. On opening the larynx, it was found half filled with a viscid
+light olive-coloured fluid; on removing which, the whole lining
+membrane, down to the bifurcation of the trachea, was found covered with
+clusters of ulcerated pustules of a yellow colour, with the intervening
+spaces of a brownish-red, highly injected, and destitute of its natural
+smooth, shining appearance. The internal surface of the glottis and
+epiglottis was in a similar but less marked state as the larynx and
+trachea. The pustular surface extends to the minute ramifications of the
+bronchi&aelig;, and their cells beyond were highly injected.</p>
+
+<p>On opening the abdomen, the omentum was found dark and shrunk. Stomach
+contracted. Intestines distended, shining, and very vascular, with
+capillary injection when viewed externally. The peritoneal covering of
+the stomach showed a similarly injected appearance.</p>
+
+<p>The stomach being opened, displayed at its upper curvature, spaces
+studded with spots of a deep red or purple; apparently effusions
+surrounded by a vascular net-work. Same appearance towards the pyloric
+orifice, and in places on the duodenum, which, together with the
+jejunum, particularly the latter, is of a dark leaden colour, and
+injected.</p>
+
+<p>The diaphragm on its upper surface, highly injected, as was also the
+pleura lining the thorax. The pericardium healthy.</p>
+
+<p>The brain was not, unfortunately, examined.</p>
+
+<p>V. Jacob Fry, black man, aged 30 years, unprotected, was taken sick on
+Sunday, 11th April, 1824. Eruption appeared on Thursday, April 15th.<span class='pagenum'><a name="Page_43" id="Page_43">[Pg 43]</a></span></p>
+
+<p>16th. Admitted and visited. Eruption copious and papular on face; smooth
+and flat, with dark centres, on trunk and arms. Tongue loaded. Cough.
+Tenderness of epigastrium on pressure. Throat sore. Pulse small and
+threaded. Eyes muddy.</p>
+
+<p>18th. Eruption flat and rough; diffused over face. On breast red and
+flat; on limbs in clusters, shrunk, and hollow in centre. Pulse small.</p>
+
+<p>19th. Tongue moist. Pulse small and frequent. Throat much swelled.
+Restless, and somewhat delirious.</p>
+
+<p>20th. In a comatose state; but is roused to attention by calling him.</p>
+
+<p>21st. Dead at five P. M.</p>
+
+<p><i>Examination.</i> April 22nd.&mdash;On opening the thorax, the lungs were seen
+to appearance healthy. Both adhered to the pleura costalis. The pleura
+lining the diaphragm, and also the pericardium, were finely injected.
+Fauces inflamed, injected, and ulcerated. From the tonsils oozed out
+pus.</p>
+
+<p>The larynx contains a light olive coloured fluid, muco-serous, which
+likewise covered the trachea and bronchi&aelig;. The lining membrane
+throughout was rough, and exhibited a net-work of a brownish-red colour,
+finely injected.</p>
+
+<p>The &oelig;sophagus about half way down, has its lining membrane removed
+for one-third its length, showing miliary points on its muscular coat.
+The stomach on its outer surface, and near its upper end, showed a black
+spot, like effusion of black blood, under the peritoneal coat. On
+examining the &oelig;sophagus near the cardia, it was found of a dark
+colour in lines. From the cardia, half over the inner surface of the
+stomach, radiates inflamed membrane of a deep red colour, and corroded
+at the place corresponding to the dark spot above mentioned. Red spots
+near the pyloric orifice. Intestines not diseased. Liver adherent by its
+right lobe to the ribs; this lobe was of a greenish leaden colour. No
+alteration of its structure. Brain injected in its arachnoid coat.
+Ventricles contained some serum. Tela choroides dark and gorged.</p>
+
+<p>VI. William Lawrence, aged 18 years, unprotected, became sick on
+Saturday, April 17th. On Sunday taken to the Alms House, and on
+Wednesday, 21st was transferred to the Hospital.</p>
+
+<p>21st. Eruption fine and papillary on face; red and scarcely raised on
+arms. None on legs. Has cough since yesterday. Pulse<span class='pagenum'><a name="Page_44" id="Page_44">[Pg 44]</a></span> slow and regular.
+Tongue brown, and incrusted in centre. Moist on sides.</p>
+
+<p>22nd. Eruption confluent and red. Papulo-vesicular on face and arms.
+Flat, dry, and copious all over the trunk. Scattered and small on legs
+and feet. Pulse small and regular. Tongue loaded and brown in middle.
+Eyes sparkling. Is delirious and very restless.</p>
+
+<p>23rd. Eruption very copious all over the body, rising vesicular from red
+margin. Pulse small and slow. Tongue loaded, furred, and yellow. Head
+and back easier. Has slept well. Face deeply suffused with red.</p>
+
+<p>24th. Cough. Eruption flat, indented centres, dark in places. It is now
+coming out on legs. Pulse small and firm. Skin cool. Much uneasiness and
+hurried breathing.</p>
+
+<p>25th. Dead at seven A. M.</p>
+
+<p>This man had been bled twice before his admission, and once again on the
+22nd. Cold affusions had been freely used.</p>
+
+<p><i>Examination</i>, on the 26th April.&mdash;Pericardium sound, but contained much
+sanguinolent serum. Pleura sound. Lining membrane of pharynx partly
+destroyed. No ulceration. Tonsils give out pus on pressure.</p>
+
+<p>&OElig;sophagus of a dark red, and partly lost its inner membrane. Larynx
+and trachea injected; but the membrane lining them is entire, without
+pustules or ulceration. Some frothy effusion in bronchi&aelig;.</p>
+
+<p>Liver healthy. Spleen large. Omentum sound, and of a natural white
+colour, traversed by some large veins. Stomach externally of a brown-red
+colour; and when opened, presents, spread out from the cardiac orifice,
+dark brown-red streaks; and towards the pyloric orifice and upper side,
+an extensive surface shaded over with vermillion and darker spots. Near
+the duodenum, the surface is white. Intestines slightly injected.
+Bladder dotted all over with bright red spots on its inner surface,
+which is covered with a fine capillary reticulated structure.</p>
+
+<p>VII. An infant, white, unprotected, aged three weeks, child of Clarissa
+Clarke, who had been inoculated twenty-one years ago. Taken sick on
+Sunday, 2nd May. Eruption appeared Thursday, 6th. Admitted 9th.<span class='pagenum'><a name="Page_45" id="Page_45">[Pg 45]</a></span></p>
+
+<p>10th. Eruption copious, and in confluent patches, with red bases, and
+flat vesicular summits. Has also aphth&aelig;.</p>
+
+<p>13th. Eruption confluent, in large white patches on face. Throat very
+sore.</p>
+
+<p>15th. Dead at eight A. M.</p>
+
+<p><i>Examination.</i>&mdash;The stomach of a light colour, perfectly healthy. Folds
+and plaits of mucous membrane strongly marked. Mucous surface of trachea
+nearly healthy.</p>
+
+<p>VIII. Infant, female, of a woman who died in the Alms House of varioloid
+disease, shortly after giving birth to this child. It is three weeks
+old; was admitted Sunday, 25th April, second day of the eruption. Dead
+on Thursday, 29th. The skin became livid after death..</p>
+
+<p><i>Examination.</i>&mdash;Pharynx inflamed, and the eruption on it extending all
+the way down the &oelig;sophagus, to near the cardiac orifice; the lining
+membrane being also in part destroyed. Stomach of a fine clear red, and
+beautifully injected to the minutest capillaries all over the mucous
+surface. Intestines, both large and small, red and injected.</p>
+
+<p>The larynx has some eruption on its lining membrane. The trachea and
+bronchi&aelig; nearly healthy; there being no eruption or secretion on their
+surface.</p>
+
+<p>Doctor <span class="smcap">Darrach</span> was present at the majority of the above detailed
+examinations, and kindly officiated at some of them. This gentleman,
+well known for his zeal in the study of comparative and morbid anatomy,
+made many interesting microscopical examinations of the various kinds of
+variolous pustules, and the corresponding changes in the cutaneous
+tissue, the results of which, we hope, he will make public.</p>
+
+<p>Having thus freely described what we saw, we wish it were in our power
+to lay down next, for the benefit of those who come after us, a
+satisfactory method of treating small-pox. The hospital returns are not
+of such an encouraging nature as to make our self-love predominate over
+observation and experience, and lead us to inferences which might seem
+to sanction the utility of this or that medicine, or curative plan. We
+had to deal, it is true, with the worst portion of the community;
+persons of constitutions exhausted or perverted by excess of sensual
+indulgences, or by poverty, or both conjoined. In private and even
+dispensary<span class='pagenum'><a name="Page_46" id="Page_46">[Pg 46]</a></span> practice, where the subjects were of a better physical and
+moral nature, we often saw the disease subside, and health return, after
+less attention to administer medical aid, or to supply other wants, than
+was exhibited at the hospital. We are, notwithstanding, sanguine enough
+to anticipate useful results from our attentive study of the symptoms of
+the disease, in connexion with that of the post mortem examinations, and
+to consider ourselves as in possession of lights to guide us with more
+certainty than before. Let us see how far a cautious analysis will tend
+to dispel old errors, and establish useful truths.</p>
+
+<p>The gastric distress, and the associated uneasiness and pain in the
+head, back, and limbs, with evening exacerbations of fever, for the
+three days preceding the eruption, evince conclusively a disease to
+which the skin is a stranger, except by its usual sympathies of heat and
+coldness, moisture and dryness. The appearance of the tongue, the loss
+of appetite, thirst, nausea, and occasionally vomiting, are testimonies
+to the impeded function of the stomach in this first period, or that of
+precursory fever: and if to this we add the soreness of the fauces and
+pharynx, producing impeded deglutition, we cannot refuse our assent to
+the belief that the mucous surface, on which the <i>preparatory process</i>
+of digestion takes place, is mainly affected. The next leading symptom
+is the appearance of the eruption on the skin. The character of the
+disease is now fixed, and the physician feels himself compelled to
+respect the cutaneous inflammation, throughout its entire course,
+naturally enough regarding it as the disease itself, rather than the
+last link in the chain of morbid actions. To support the circulatory
+system at such a degree as shall enable the skin to secrete this new
+matter of small-pox, is nearly as much as he proposes to himself. But
+here arises a question of great practical moment. To what extent, if
+any, is the eruption a natural or necessary sequence of the previous
+symptoms or condition of the system. Perhaps in the existing state of
+medical science, we hardly dare reply positively to this question. This
+much we know, that there is no correspondence in general between the
+intensity of the precursory fever, and the copiousness of the after
+eruption. We are, moreover, well apprized of the fact of very many, who
+had been protected in earlier life by inoculation or vaccination, being
+seized with all the symptoms of the precursory<span class='pagenum'><a name="Page_47" id="Page_47">[Pg 47]</a></span> fever of the small-pox,
+and remaining seriously indisposed for a few days, yet with very little
+eruption in some cases, and without any in others.</p>
+
+<p>Next we may inquire, what control, salutary or otherwise, we can
+exercise over the skin in reference to its eruption, by adopting certain
+methods in medicine and hygeine, during the period of invasion or of
+precursory fever. To foster the germ of the poison, as yet only
+affecting the inner surfaces, into efflorescence on the outer or
+cutaneous one, by hot air, warm and heavy clothes, and cordial drinks,
+is a practice, which, though at one time advocated on what was thought
+very sufficient theory, is now abandoned as at war with experience. Of
+these means, clothing acts primarily on the skin, and we will suppose
+heat to do the same: the cordial drinks must however affect this organ
+by stimulating and irritating the gastric and intestinal surface.
+Against all stimulation of this surface we are then bound, from
+knowledge and theory, to object.</p>
+
+<p>The cooling regimen as it is called, was substituted for the
+alexipharmic, in so far as regards light clothing and cool air. Can
+emetics and purgatives be viewed as a part of this regimen, and exert as
+such a salutary influence over the second period of the disease, or that
+when the eruptive effort takes place? Admitting they are but local
+stimulants, can they as such be with advantage applied to a surface, as
+that of the stomach and intestines, already highly irritable, and which,
+as the disease advances, becomes inflamed? If our object be in this
+first period to diminish the violence of the second or eruptive one, we
+doubt whether our expectations will be at all met by any kind of
+stimulant to parts, which so promptly transfer their irritation to the
+cetaceous surface. Whatever may be thought of these suggestions; whether
+they are to be regarded as well-founded, or merely speculative, must be
+a subject of future investigation; since we are as yet compelled to deny
+that experience can be adduced in favour of the practice of vomiting and
+purging to the first period of variolous disease.</p>
+
+<p>On the same line with the remedies just mentioned, have been placed
+bleeding, general and local, though as we apprehend, very erroneously.
+There is not in bleeding as in purging, conflicting and alternating
+effects of debility from evacuation, and irritation,<span class='pagenum'><a name="Page_48" id="Page_48">[Pg 48]</a></span> primary and
+sympathetic, from local stimulation; but a direct diminution of morbid
+action, more tranquil movements of the heart and capillary system, that
+is of the circulatory apparatus, and of the membranes, mucous, serous
+and cutaneous, &amp;c. Bleeding, unlike most other remedial agents, produces
+a direct calmness and ease in the animal economy: it does not like them
+substitute one disturbance for another, or make the great appear the
+lesser evil. The experienced physician well knows the value of this
+remedy, in the first period or invasion of the phlegmasi&aelig;, and of some
+fevers called general. He is fully aware, that if he cannot produce by
+it a decided impression on the malady in the commencement, he is but too
+often afterwards a prey to doubts and anxieties, wishing to relieve, but
+unknowing what to attempt. Conceding, however, the power of venesection,
+in the forming stage of the disease, now under review, so that we by
+this remedy may control the series of morbid actions in the second
+period, and diminish the extent of the eruption; it may yet be seriously
+asked, whether we can with safety and propriety prevent or destroy the
+succession of changes to which the skin is subjected, from the first
+papul&aelig; on to desiccation. On this point, we believe, has turned the
+practice of the profession at all times, whether in the ages of
+humoralism, or in the reign of solidism. In addition to the reasons
+already assigned, which would lead us to doubt the necessity of the
+eruption being left uncontrolled, or even suffered to run its course, we
+may appeal to the practice of inoculation, which as effectually
+saturated the system, and indisposed to subsequent attacks, as if the
+skin had formed a continuous pustular surface; and yet this benefit was
+often gained by the trifling tax of a few days' fever, and half a dozen
+of pustules. Where the fever runs high and the respiration is much
+affected, in the first period of measles, and before there is the
+slightest appearance of eruption, we conceive it often so be our duty to
+bleed freely, without reference to the subsequent disease of the skin,
+or any nicety of calculation about this latter going through its regular
+stages. Indeed, we have usually reason to congratulate ourselves for
+having, by this means, rendered the subsequent disease milder and more
+tractable. That affection of the urethra termed gonorrh&oelig;a, the
+product of contagion, will, if left to itself, go through its several
+stages; and, if rest and regimen be enjoined,<span class='pagenum'><a name="Page_49" id="Page_49">[Pg 49]</a></span> will often leave the
+subject healthy as before. But we can, notwithstanding, cut it short
+with perfect impunity, by suitable remedies, and thereby prevent
+numerous unpleasant symptoms and effects, which are often present when
+the disease is left to nature. Syphilis has its several stages, each
+marked by characteristic symptoms; but the skilful treatment of the
+first stage prevents, how beneficially we all know, the appearance of
+the others. We must then in small-pox, as well as in other diseases,
+beware how we confound a common and even natural, with a necessary and
+unavoidable succession of symptoms and periods.</p>
+
+<p>The precursory fever in small-pox is seldom marked by the same common
+inflammatory symptoms as that in measles; and does not seem, by its
+actual violence, to urge the physician to deplete with freedom, if he
+only have regard to the existing condition, rather than to the impending
+danger and complication. The diversity in the two diseases consists not
+so much in the greater intensity of the latter, as in the more decided
+gastro-enteritic derangement in the former. Experience has not yet
+sanctioned the benefit of copious bleeding from the arm, in incipient
+disease, or irritation verging to inflammation of the intestinal
+surface, as in small-pox; while its efficacy is admitted in measles. But
+conceding its doubtful character, local bleeding, as by cupping, and
+leeching on the abdomen, might be serviceably employed in the form of
+disease now under consideration; as we know it to have been in other
+febrile affections, where the same parts were diseased. Topical
+depletion does unquestionably exercise the best effect on membranous
+inflammation. In addition to cool air, we may with some confidence have
+applied at this time to the skin, cool, if not cold, affusions; while
+cold or cool drinks, and these of mucilaginous kind, would constitute
+the principal ingest&aelig; and medicines. Our own experience was little
+favourable to the efficacy of cold water, applied to the surface during
+the eruptive stage; and we apprehend, that, if decided benefit can grow
+out of its use, it must be during the first or precursory fever, before
+the formation of vesicles has commenced, when every thing is to be
+attempted to sooth irritation, and prevent febrile reaction.</p>
+
+<p>The first period over, the eruption on the skin now appears, and
+constitutes a leading and exceedingly important symptom of the disease.
+This eruption, like many others the product of gastric<span class='pagenum'><a name="Page_50" id="Page_50">[Pg 50]</a></span> derangement,
+acts for a time as a counter-irritant, and as such affords temporary
+relief to the internal organs; but when continued, as in the farther
+progress of the disease, it, in common with all irritants on the skin,
+returns with interest to the digestive tube, the irritation which it
+first received from this latter.</p>
+
+<p>We must not lose sight of the state of the lining membrane of the lungs
+during this time. It cannot be said so much to sympathize with the skin,
+as to be affected by continuous disease; since the eruption on the
+mucous membrane of the larynx, trachea, and its ramifications, undergoes
+nearly the same changes, in the same time with that on the cutaneous
+surface. The danger and violence of a disease in which the three
+surfaces, cutaneous, pulmonary, and gastric, are all organically
+affected at the same time, must be very apparent. Even though there be
+no eruption on the internal coat of the stomach, its appearance after
+death, of high vascularity and sanguineous injection, corresponding
+precisely in appearance with the circles found in the lungs, of which
+the pustules were the centres, justifies this belief of its being
+organically affected. Each of the three above mentioned surfaces is in
+degree ancillary to the others, and each may, on occasions, partially
+supply their functions; but in this period of variolous disease, our
+hopes of such vicarious action must be very faint indeed, and hence the
+hazard attending any application to any one of them.</p>
+
+<p>Are we from these appearances to pronounce the eruption a phlegmasia of
+the skin and lungs, associated with a previous one of the stomach, and
+recommend the free use of venesection? Life may occasionally be
+prolonged, or at times saved by this means; but the disease will not be
+thereby materially arrested in its course, or modified in its
+appearance. We shall find that the inflammation of the membranes,
+consisting as most of them do of cellular tissue and minute capillary
+vessels, is often not susceptible of being checked by general depletion,
+carried even so far as to almost empty the larger arteries, and arrest
+the heart's motion.</p>
+
+<p>Still more will this inflammation persist, if it have gone to the extent
+of forming new parts, whether phlegmons or pustules. The intensity of
+the inflammation may be somewhat moderated, but it cannot be conquered
+now as at the commencement, or during the first period, or that of
+invasion. We cannot, from our<span class='pagenum'><a name="Page_51" id="Page_51">[Pg 51]</a></span> own experience, speak favourably of the
+remedy in the second, or eruptive stage. It did not answer our
+expectations, though employed in subjects apparently the best
+constituted to derive the good effects proposed from it. We must at the
+same time grant, that it was complicated with other remedies. Of topical
+bleeding, we are unable to speak, not having seen it tried. In this
+period of the disease, it must be of very difficult execution. Still
+less reason have we to boast of the good effects of purging. Though the
+skin may for a while be relieved by the watery secretions from the
+intestinal canal; yet the irritation of the latter, consequent on
+purging, is soon communicated to the cutaneous surface with the effect
+of aggravating the eruption. To the class of stimuli or stimulating
+diaphoretics, the same objections apply with increased force. As on the
+one hand, in cases of high fever, seeming to call for great depletion,
+the surfaces are often not relieved by general bleeding, but retain
+their own vitality; so on the other, in cases of apparent prostration,
+and feebleness of circulation, they often retain all their morbid
+activity, and will of course be materially injured by stimulation,
+either of hot air to the skin, or heating drinks to the gastric and
+intestinal surface. Of the various diaphoretics employed, we had reason
+to be least dissatisfied with the combination of opium and ipecacuanha
+in small doses. In some few cases, tartrate of antimony and cream of
+tartar, dissolved in rice or barley water, and the solution used as a
+drink, seemed to be beneficial. Several grains of the former were thus
+taken in the 24 hours, without its producing vomiting or purging. But in
+very many other instances of the disease, this medicine had no
+ameliorating effects. Calomel alone, or in combination with opium, was
+given, and in a few cases caused <i>ptyalism</i>. We did not lose persons
+thus affected, but we cannot speak with any confidence of the propriety
+of the treatment.</p>
+
+<p>The application of cold water to the skin, was tried by us on the
+strength of its alleged good effects in this disease, but in no case had
+we reason to be satisfied with it. The state of the cutaneous surface,
+during the vesicular and pustular stages, is such as to prevent its
+transmitting the usual impressions to the interior. Cold may deaden it,
+and hasten the disorganization of its tissue, but cannot arrest and
+suspend morbid capillary action here, as in ordinary fevers, or diseases
+with great local determination, as to<span class='pagenum'><a name="Page_52" id="Page_52">[Pg 52]</a></span> the head, &amp;c. If useful at all,
+it will, we apprehend, be in the forming stage of the disease, before
+the skin is altered by the eruptive effort. The same objections do not
+hold against the internal use of cool or cold liquids. We have in this
+instance to be regulated by the usual precautions, as in all febrile
+disease where the gastric system is the greatest sufferer. More benefit
+will follow the sustained use of cool, than the occasional
+administration of very cold draughts; since in the former case the
+morbid action of the mucous surface may be restrained in due bounds,
+without the risk and danger of reaction, and increase of heat and
+thirst, which are apt to ensue from the latter. The same principle will
+guide us in the temperature of the air to be inhaled by the lungs.</p>
+
+<p>The secondary diseases, erysipelas, catarrh, and pneumonia, occurring on
+the decline or subsidence of the variolous disease, would, we may now
+presume from the phenomena in life, and the autopsic examinations, bear
+and require a treatment, nearly similar to that used in these diseases
+arising under other circumstances. Perhaps leeching and cupping ought to
+be substituted, in such emergencies, for bleeding from the arm.</p>
+
+<p>The extension unavoidably given to this first branch of our subject,
+requires that we should defer the history of the modified small-pox, or
+varioloid disease, to the next quarter, when it shall appear in the
+corresponding number of this Journal.</p>
+
+
+<h3>EXPLANATION OF THE PLATE.</h3>
+
+<p>Figures 1, 2, 3, represent various appearances of the lining membrane of
+the stomach.</p>
+
+<p>Fig. 4, is a portion of the &oelig;sophagus; but the red bands ought to run
+vertically, and not horizontally, as in the plate.</p>
+
+<p>Fig. 13, is another appearance of the stomach.</p>
+
+<p>Fig. 12, indicates the eruption having gone on to ulceration in the
+pharynx.</p>
+
+<p>Fig. 6, displays the appearance of the lining membrane of the trachea,
+on the 6th day of the eruption, as in the case of Ann Collins.</p>
+
+<p>Fig. 5, is intended to represent the same part in an advanced stage of
+the disease, as in the case of Joseph Foster.</p>
+
+<p>Resembling this is the case of Peter Johnson, as far as regards<span class='pagenum'><a name="Page_53" id="Page_53">[Pg 53]</a></span> the
+ulceration and dark colour of the intermediate surface; but differing in
+the disorganization of the membrane being less.</p>
+
+<p>Figs. 7, 8, 9, 10, and 11, represent the progress of the eruption, in a
+female, from its incipient to its maturated state. The same section of
+skin is represented from the 1st to the 5th day of the eruptive stage,
+on which day the patient died. On the 2nd day, (fig. 8,) the vesicles
+began to exhibit a central lividness, which was augmented on the
+subsequent days. The patient had been some years before successfully
+vaccinated. She was delivered of a child on the 1st day of the eruptive
+stage. The minutes of this case have been mislaid; but the post mortem
+appearances were indicative of high action, if not inflammation, of the
+uterus and its appendages. The infant of this woman, forming Case VIII.
+died of small-pox three weeks afterwards, on the sixth day of the
+eruption.</p>
+
+<p>This plate, together with some others yet unpublished, are from the
+accurate pencil of Mr. now Dr. <span class="smcap">Harrington</span>, of this city.</p>
+
+<h4>(TO BE CONTINUED.)</h4>
+
+<div class="center">
+   <a id="thumbplate4"></a>
+   <a href="images/plate4.jpg" >
+     <img src="images/thumbplate4.jpg"
+        alt="plate 4"
+        title="plate 4" />
+   </a>
+</div>
+
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_11_11" id="Footnote_11_11"></a><a href="#FNanchor_11_11"><span class="label">[11]</span></a> This was first at Bush Hill, and subsequently at the Sugar
+House, near the Alms House.</p></div>
+
+<div class="footnote"><p><a name="Footnote_12_12" id="Footnote_12_12"></a><a href="#FNanchor_12_12"><span class="label">[12]</span></a> The largest proportion of these deaths was in the six
+months from the 1st of November, 1823, to 1st of May, 1824, being in
+that period about four hundred.</p></div>
+
+<div class="footnote"><p><a name="Footnote_13_13" id="Footnote_13_13"></a><a href="#FNanchor_13_13"><span class="label">[13]</span></a> Kept by Reuben Haines, at Germantown, seven miles from the
+city. The thermometrical mean is that from daily observations made by
+this gentleman at sunrise and at 2 P. M.</p></div>
+
+<div class="footnote"><p><a name="Footnote_14_14" id="Footnote_14_14"></a><a href="#FNanchor_14_14"><span class="label">[14]</span></a> Of these 165 were by yellow fever.</p></div>
+
+<div class="footnote"><p><a name="Footnote_15_15" id="Footnote_15_15"></a><a href="#FNanchor_15_15"><span class="label">[15]</span></a> The deaths from inflammation of the different viscera,
+were as reported in this year, 290, and from infantile flux and cholera
+morbus, 177.</p></div>
+
+<div class="footnote"><p><a name="Footnote_16_16" id="Footnote_16_16"></a><a href="#FNanchor_16_16"><span class="label">[16]</span></a> Same proportion of inflammations as last year, viz. 339.</p></div>
+
+<div class="footnote"><p><a name="Footnote_17_17" id="Footnote_17_17"></a><a href="#FNanchor_17_17"><span class="label">[17]</span></a> Should it be hereafter necessary, we can illustrate other
+varieties of the disease by drawings which were taken at the same time
+with those, of which coloured engravings are now furnished.</p></div>
+</div>
+
+
+<hr style="width: 65%;" />
+<h2><span class="smcap">Article</span> IV.&mdash;<i>Remarks on the Pathology and Treatment of Yellow Fever.</i>
+Arranged from the Notes of Dr. <span class="smcap">J. A. Monges</span>, of Philadelphia.</h2>
+
+
+<p>I arrived at St. Domingo in the year 1785, and from that period to the
+time of my departure from thence, I had very ample opportunities of
+observing and treating the diseases of that island, both in the country
+and at the Cape. During the whole time of my residence there, the
+ordinary febrile diseases of hot climates were of very frequent
+occurrence, especially among the new comers, and those not acclimated;
+but the real yellow fever, or vomito negro, never prevailed. So that
+when I reached this city in 1793, I never had had an opportunity of
+observing this disease.</p>
+
+<p>As introductory to the subject more particularly before us, I shall
+offer a few remarks on the nature and treatment of the fever, which
+prevailed in that island. It was usually of the remittent type, of a
+bilious nature, and rather violent in its character; presenting very
+often symptoms of a typhoid, or malignant condition of the system. In
+almost every case, it was attended<span class='pagenum'><a name="Page_54" id="Page_54">[Pg 54]</a></span> with great gastric irritability and
+pain; and, in very many instances, accompanied with vomiting of dark
+green, and even of black bilious matter,&mdash;determination to the brain
+producing delirium, coma, &amp;c. &amp;c. In general, this fever differed but
+little from the bilious fevers of this country; except, perhaps, in its
+greater severity, and in a larger quantity of bile commonly evacuated.
+The treatment of this disease, at the time of my arrival, was generally
+attended with some difficulty, owing to the great prejudice prevailing
+against the use of the lancet; not only among the mass of the
+population, but even among the old physicians of the island. Experience,
+however, having taught me, that venesection was essentially necessary in
+fevers of the same sort, which I had noticed in other places, I resorted
+to it, notwithstanding the existing opinion; and am now convinced, that
+by its means I saved many patients. Nor was I the only one to adopt this
+mode of practice; as it was commonly resorted to by all <i>new</i>
+physicians, who were soon found to be more successful than the older
+practitioners. To arrest the violent vomiting, already alluded to, it
+was of the highest utility, and, in many instances, the only remedy that
+could be depended upon. Emetics were very commonly used, and sometimes
+with great benefit; but, in many instances, they were contraindicated by
+the pain and irritation of the stomach.</p>
+
+<p>Cooling and saline purgatives were advantageously employed, as well as
+the saline mixture, and nitre and camphor in small and repeated doses, a
+very favourite practice in the place. In a more advanced period, and
+when the fever assumed a typhoid type, blisters, bark, and serpentaria
+were resorted to.</p>
+
+<p>I arrived in Philadelphia on the 20th of August, 1793, and on the 22nd
+of the same month, began to see patients. The epidemic was then at its
+height, and such was the demand for physicians, and the prevalence of
+the idea, that, as I came from the West Indies, I must be familiar with
+the yellow fever, that I soon became very extensively employed. Such,
+indeed, was soon the extent of my engagements, that I was compelled for
+a time to refuse my attendance on many patients, and to limit my visits
+from Race to Dock streets, and from the water to Third street.</p>
+
+<p>From the first time I had an opportunity of seeing the yellow fever, I
+perceived that there existed but a very distant, if any, analogy between
+it and the fevers I had been in the habit of treating<span class='pagenum'><a name="Page_55" id="Page_55">[Pg 55]</a></span> in the West
+Indies. And this opinion I have ever since entertained, in opposition to
+the statement of many respectable authorities; but in conjunction with
+some highly respectable physicians and friends, who, like myself, had
+had an opportunity of treating both diseases. The points of difference
+between these fevers will be noticed in a subsequent part of these
+observations. But although entertaining this sentiment, I very early
+came to the conclusion, that the yellow fever was the effect of a
+gastro-duodenic inflammation, somewhat modified by some unknown
+cause,&mdash;requiring the usual remedies for such a complaint, proportioned
+only to the strength of the patient, and the force of reaction in the
+system; and all my subsequent experience has only served to confirm me
+in this belief. Differing from many physicians respecting its bilious
+character, I have been led to believe, that the liver is very seldom
+implicated in the disease;&mdash;the secretion of bile, in the majority of
+cases, being very little, if at all altered. This may very readily be
+discovered by an attentive examination of the symptoms of the disease,
+as well as by the appearances noticed on dissection; the lining membrane
+of the stomach and duodenum presenting in almost every case, marks of
+inflammation, and giving passage to a large quantity of black matter,
+which I have always been led to regard as altered blood, mixed with
+mucus. The liver, on the contrary, so rarely showed marks of disease,
+that when it did, it was natural to regard its alteration as secondary.</p>
+
+<p>Such being my opinion respecting the pathology of yellow fever, I cannot
+view otherwise than as secondary to the gastric affection, all the
+morbid conditions of other organs, indicated during life by their
+peculiar symptoms, and revealed on dissection by the ordinary marks of
+inflammation; such as affections of the lungs, kidneys, &amp;c. This view of
+the subject will cease to be regarded as merely hypothetical, when it is
+recollected, that these symptoms and morbid appearances are occasionally
+not found; whilst the symptoms referrible to the gastric and duodenic
+irritation, being the true characteristics of the disease, are always
+present. Indeed, what would authorize us to regard any subject as
+affected with yellow fever, who would not present the pain in the
+stomach, the redness of the tip of the tongue, the thirst, irritability
+of the stomach, and vomiting either of simple mucus, or black<span class='pagenum'><a name="Page_56" id="Page_56">[Pg 56]</a></span> matter?
+And, on the other hand, how many have died with these symptoms, who were
+not affected with all the others we have noticed, and, on dissection,
+have shown no mark of disease, except in the digestive apparatus?
+Finally, can pain in the head, affections of the kidneys, vomiting of
+bile, &amp;c. constitute yellow fever, without the concurrence of some of
+the gastric symptoms we have enumerated?</p>
+
+<p>With respect to the characteristic features of yellow fever, and the
+different signs, by which it may be distinguished from bilious fever, I
+must be very brief; as a great deal having been written on the subject,
+any long details in this place would occasion undue repetition of what
+is already known to the profession. A few words, however, may not be
+improper. Every one who has had frequent opportunities of seeing the
+yellow fever, must have noticed, among its most habitual signs, a
+peculiar inflamed glassy appearance of the eye, easily recognised, but
+difficult to describe. It is one, however, on which I should be willing
+to place considerable reliance, in establishing my diagnosis of this
+disease; as I do not recollect to have noticed it in any other form of
+febrile affection. Together with this, there is, in the majority of
+cases, an intense supra-orbitar pain, apparently unconnected with great
+disordered action of the brain, as the intellectual functions are
+generally unimpaired. These two signs, together with pain in the loins,
+and, in more advanced periods, the peculiar appearance of the skin, the
+vomiting of the coffee grounds matter, the intermission on the 4th day,
+the retention of muscular strength, and suppression of urine, are the
+only signs by which the yellow fever, so far as I am prepared to say,
+may be recognised. In regard to the supposed identity of this fever with
+the bilious, a great deal has been written; but I must confess, that I
+feel inclined to doubt the correctness of this opinion, for the
+following reasons:</p>
+
+<p>1st. Bilious fever is almost always a remittent fever, presenting
+regular exacerbations, and, unless arrested by medical aid or some
+effort of nature, running its course, in a progressive manner, either to
+a happy or fatal termination; whereas the yellow fever is almost
+invariably a continued fever, presenting obscure and irregular, or even
+<i>no</i> remissions. On the fourth day, it generally presents so perfect a
+remission, as to cause the patient, in many cases, to imagine himself
+perfectly free from disease, and induce<span class='pagenum'><a name="Page_57" id="Page_57">[Pg 57]</a></span> him to get up, and even
+sometimes to walk out. This remission, which sometimes amounts to an
+intermission, so far as an experience of upwards of forty years can
+authorize me to decide, is never found to attend in bilious fever, in
+which, if there be any remission, and recurrence of the unpleasant
+symptoms, the former is always a real convalescence, and the latter an
+accidental relapse.</p>
+
+<p>2nd. The red colour of the eye, to which I have alluded above as
+occurring in the early stage of the yellow fever, and its peculiar
+yellow tinge in the after part of the disease, are different from the
+redness and yellowness of the same organ in bilious fever; in the first
+stage of which the eye presents a more fiery redness, and in the
+subsequent period, a more saffron yellowness.</p>
+
+<p>3d. The colour of the skin in the two diseases presents also some
+difference, being more constantly noticed in yellow fever, and
+disappearing much more rapidly than in bilious fever. In yellow fever,
+moreover, it assumes, most commonly, a yellowish-brown or even mahogany
+tinge; whereas in bilious fever, when it occurs, it does not differ from
+the ordinary jaundice colour, of a lighter or deeper shade.</p>
+
+<p>4th. These fevers may likewise be distinguished by an attention to the
+state of the intellectual faculties, and of the muscular strength; these
+remaining often unimpaired to the last in yellow fever, whereas, in a
+very large majority of cases of bilious fever, the mind becomes soon
+involved in the disorder of the system, and the greatest muscular
+debility prevails, even from the very onset of the attack.</p>
+
+<p>5th. The matter vomited might of itself serve to distinguish the two
+diseases. Independently of the difference we shall notice when speaking
+of the black vomit, we may mention that patients complain, even
+sometimes from the commencement of the attack, of the acidity of the
+vomited matter; whereas in bilious fever, the mouth is bitter, and the
+matter ejected of the same taste.</p>
+
+<p>6th. As a further mark of difference, we may state, that, in yellow
+fever, the tongue, except at the tip, the skin, and the pulse are
+sometimes little altered; whereas in bilious fever they are usually
+pretty much so.</p>
+
+<p>7th. In respect to the duration of the two diseases, we may state as a
+general rule, that yellow fever runs its course to death or
+convalescence, in a much shorter time than bilious fever. Nor<span class='pagenum'><a name="Page_58" id="Page_58">[Pg 58]</a></span> is the
+promptness of recovery from yellow fever less different from the
+slowness of convalescence, noticed in most cases of bilious fever.</p>
+
+<p>8th. The suppression of urine is a frequent attendant on the last stage
+of yellow fever, and is seldom noticed in bilious fever.</p>
+
+<p>9th. I have never witnessed a second attack of yellow fever in the same
+individual; whilst on the contrary, so far as I have seen, there is no
+limitation to the number of times a person may be affected with the
+other form of fever.</p>
+
+<p><i>Prognosis.</i>&mdash;As regards the prognosis in yellow fever, I shall merely
+state, that I generally found, an early evacuation from the alimentary
+canal, and a disposition to diaphoresis during the first twenty-four or
+thirty-six hours, and its continuance during the course of the disease,
+to be favourable omens. When the disease continued beyond the 7th, 9th,
+or 11th day, greater hopes might be entertained. It was likewise found,
+that the mortality was much smaller among patients, who remained free
+from apprehensions as to the nature and termination of the disease. To
+this cause, more than any other, do I refer my greater success among
+Quakers; who, being generally surrounded and comforted by their friends,
+retained more than any other class of people, the necessary tranquillity
+of mind.</p>
+
+<p>Among the unfavourable signs may be mentioned, a discoloration of the
+skin before the fourth day. This symptom was, indeed, almost always a
+fatal one. Obstinate vomiting and costiveness, h&aelig;morrhages from
+different parts of the body, unattended with an abatement of the
+symptoms, and vomiting of black matter, were very unfavourable; whilst a
+suppression of urine, agreeably to my experience, was always a fatal
+sign.</p>
+
+<p><i>Black Vomit.</i>&mdash;In a preceding part of these observations, in alluding
+to the black vomit, I took occasion to express my views respecting its
+nature,&mdash;stating that I regard it as consisting of mucous flakes, mixed
+with a large proportion of altered blood. That such is the true nature
+of this substance, on which so much has been said and written, I have
+had sufficient reason to be convinced. The opinion that it consists of
+altered bile, I deem totally untenable, for the following reasons: The
+matter is occasionally voided in large quantities, in cases in which the
+liver is not at all affected, and in which, after death, the gall
+bladder is discovered<span class='pagenum'><a name="Page_59" id="Page_59">[Pg 59]</a></span> to be more or less filled with <i>natural</i> bile.
+Independently, of this, it may be stated, that the appearance of the two
+substances is very dissimilar;&mdash;the black bile vomited in bilious fever
+being of a homogeneous nature, and of a black or deep green colour;
+whilst the matter of the black vomit is, in a large majority of cases, a
+compound of a mucous, flaky substance, and a sanguineous matter, bearing
+some resemblance to the grounds of coffee, and, for the most part, of a
+brown tinge. When mixed with water, the two substances produce very
+different effects,&mdash;the bile mixing with and imparting a greenish tinge
+to it without difficulty, whilst the grounds of the other, float on the
+surface of the water, without mixing with and colouring it, in the same
+manner as bran, deprived of all its mucilage, or rather like mahogany
+saw-dust. This I consider as one of the best modes of distinguishing
+these two substances,&mdash;serving at the same time to establish a
+difference between the fevers, I was in the habit of observing in the
+West Indies, and the yellow fever of this country. Nor are these the
+only reasons for rejecting the supposition of the black vomit of yellow
+fever being of a bilious nature; for I have known this substance (and I
+suppose other practitioners have observed the same fact) occasionally to
+exude from surfaces, from which, in all probability, bile is excluded. I
+allude particularly to the skin and verous membranes. Thus it has often
+happened, that the application of a blister, especially in the advanced
+stage of the disease, has been followed by a copious exudation of a
+fluid, resembling, in all respects, the matter ejected from the stomach;
+an occurrence which was strikingly exemplified in a case, which fell
+under my immediate observation during the last visitation of the disease
+in this city, in 1820. During the same epidemic, I had occasion to
+attend a Mrs. H. about 70 years of age, who presented a curious example
+of the exudation of a similar substance from the peritoneum. She had not
+been exposed to the causes of the yellow fever, and indeed presented
+none of its ordinary pathognomonic signs. She was attacked very early in
+the morning with violent colic, attended with fever, great tenderness of
+the abdomen, and high colour of the face. She was bled at 10 o'clock; at
+11 vomited a large quantity of coffee ground matter, and died in about
+12 or 15 hours from the commencement of the attack. The next morning her
+body was examined in the presence of several highly<span class='pagenum'><a name="Page_60" id="Page_60">[Pg 60]</a></span> respectable and
+experienced physicians, who all coincided in the opinion, that the
+matter vomited and which continued to be discharged from the nose, was
+identical with that discharged in yellow fever. The stomach as well as
+the intestines were found to contain a large quantity of a similar
+substance. The cavity of the peritoneum being likewise found filled with
+a large portion of it, we at first suspected the existence of an opening
+in the intestines, by which an effusion had taken place. After a careful
+and minute examination, however, no such opening was discovered. Our
+attention was now directed to the condition of the peritoneum itself,
+which was highly inflamed. It was, moreover, found, that the substance
+in question exuded from its surface,&mdash;the membrane, in many places,
+especially the portion of it which covers the liver, being coated so
+thickly with the grounds, that they could readily be scraped off with
+the back of a scalpel.</p>
+
+<p>These cases show conclusively, that the matter of the black vomit,
+occurring in yellow fever, should not be regarded as altered bile; and
+that the supposition of its consisting of a secretion of the mucous
+membrane of the stomach, does not rest on a much more solid foundation.
+For bile can hardly be admitted to exude from the skin and serous
+membranes, and we cannot suppose, that fluids, similar in every respect,
+can be secreted from two surfaces, so very distinct in their
+organization, and in the nature of their ordinary products, as those of
+the mucous and serous membranes.</p>
+
+<p>From these facts I am led to regard the black vomit as a true
+h&aelig;morrhage, resulting from a state of previous irritation of the surface
+which furnishes it. That inflammation may be cause of it, we have a
+sufficient proof in the fact, that a similar fluid is occasionally
+vomited in cases of puerperal fever, when the irritation progresses from
+the serous to the mucous membrane of the intestines; as well as in cases
+of inflammation from blows on the stomach, and the action of poisons. A
+case of this kind, arising from a kick of a horse, was attended by
+myself and two respectable physicians in consultation, a few years ago;
+and another case arising from a large dose of carbonate of potassa,
+swallowed by mistake, occurred in my practice not long since. But as it
+would occupy too much time to give them here in detail, I pass them by
+without further notice.<span class='pagenum'><a name="Page_61" id="Page_61">[Pg 61]</a></span></p>
+
+<p>That the matter of the black vomit is the product of a h&aelig;morrhage, I
+have thought may also be inferred from the fact, often noticed by myself
+and others, of large portions of coagulated blood being found in the
+intestines; the surface having the appearance of the common black
+matter, whilst on cutting into them, the centre is found to consist of a
+red solid coagulum. I have also sometimes noticed, that the duodenum
+contained the coffee ground matter, and the intestines, coagulated
+blood. In such cases, in order to adopt the opinion of secretion, we
+must believe, that the same vessels, occupied in the secretory process,
+afforded, at the same time, passage to a portion of common blood; for we
+can hardly admit, that the mucous follicles are the organs secreting the
+black matter. Besides, is this not a mere dispute about words; and is it
+proved that what are called sanguineous secretions are not the result of
+the same action, which gives rise to h&aelig;morrhagic exudations? and is
+there any other difference between the h&aelig;morrhage of yellow fever, and
+of ordinary cases of hematemesis, than that arising from a difference in
+the <i>quality</i> of the blood?</p>
+
+<p>Nor do I find much difficulty in believing, that the colour of the skin,
+which is more frequently brown than yellow, as well as the petechi&aelig;, &amp;c.
+are the effects of the stagnation of blood, altered by the capillaries
+of the surface, in the same manner as that exuding from the mucous
+surfaces. I believe that this opinion, suggested by some European
+writers, is supported by the fact, that this fluid exudes from the
+orifices made by the bites of leeches and the incisions of scarified
+cups; as well as from the raw surface occasioned by blisters; and that
+the vibices contain a serous fluid mixed with blood.</p>
+
+<p><i>Analogy to Plague.</i>&mdash;On comparing the symptoms of the yellow fever of
+this country with those of plague, as detailed so minutely and, I
+believe, accurately by authors, and especially by the physicians who
+accompanied Bonaparte to Egypt, I have been led to regard these diseases
+as bearing a closer analogy to each other than has hitherto been
+admitted. I do not pretend to assert that they are the same disease, but
+only that they are so nearly allied, as on some occasion, to lead even
+an experienced observer into an error of diagnosis. The great difference
+between them consists in the frequency of the affection of the lymphatic
+glands in the plague, and its comparative rareness in yellow fever; and
+in the<span class='pagenum'><a name="Page_62" id="Page_62">[Pg 62]</a></span> greater predominance of gastric symptoms in the latter.
+Nevertheless, I have had, on many occasions, during our different
+epidemics, opportunities of noticing buboes, situated in the same parts
+as those mentioned by writers on the plague, running the same course,
+and curable by the same means. Carbuncles are frequently seen in both
+diseases, though not so frequently in yellow fever as in the plague.
+Both diseases present what are called the walking cases. Patients in
+both, though more frequently in yellow fever, retain their muscular
+strength as well as their intellectual faculties. So far as we are
+informed, the mortality in both is pretty nearly the same, and the
+treatment similar.</p>
+
+<p><i>Contagion of Yellow Fever.</i>&mdash;The question of the contagion or
+non-contagion of yellow fever has so long occupied the attention of the
+profession and been discussed so extensively, that I deem it unnecessary
+to devote much space to it here. Nevertheless, as I have had frequent
+opportunities of noticing the disease under all circumstances; in all
+parts of the city, and in the country; among the wealthy and the poor, I
+may without much impropriety offer, in a few words, the result of my
+observations and reflections on this head. I must unhesitatingly
+declare, that, establishing my opinion on what I have seen, I am led to
+the conviction, that the yellow fever is not a contagious disease; that
+it never has been carried hither in the way mentioned by contagionists;
+and that it has invariably proved an infectious disease, using this word
+to express a malady arising from a local source of contamination, other
+than a living body. It is plain, that this view of the subject does not
+exclude the possibility of a vessel carrying the disease to this or any
+other port; but, in that case, the vessel itself or its cargo, must be
+the source of infection, and not the individuals on board. And this may
+take place, when the port from whence the vessel sailed is free from the
+disease. That such has been the case, there cannot be any doubt; and
+that the idea, predicated on it, of the contagiousness of the fever is
+erroneous, I have not the least hesitation in believing.</p>
+
+<p>How else than on the principle of infection, and not of contagion, can
+we explain the attack of individuals frequenting those parts of the
+city, where the disease had originated, and which (all the inhabitants
+having been removed to some distant situation) had been barricaded? How
+could we, in any other way,<span class='pagenum'><a name="Page_63" id="Page_63">[Pg 63]</a></span> account for the exemption from the fever of
+individuals, who, out of the infected district, nursed, touched, and
+even slept with their diseased relatives and friends; and not always in
+clean and well ventilated apartments and parts of the city; but, in very
+many instances, in the filthiest hovels, and alleys, and among the
+lowest classes of society. Striking and unanswerable facts of the sort
+have frequently presented themselves to my observation, during our
+various epidemics. Children have sucked their parents, affected with the
+fever, and, in one case which fell under my notice, the child continued
+attached to the breast after its mother's death; and in all such
+instances with impunity. I have constantly reprobated the practice of
+burning the clothes and bedding of the dead, and have never found any
+bad results to occur to those who followed my advice. From a
+consideration of all these facts, I must once more express it as my
+decided opinion, that the yellow fever, so far as I have had an
+opportunity of observing it, is not a contagious disease.</p>
+
+<p><i>Treatment.</i>&mdash;Whatever opinion we may entertain respecting the specific
+nature of yellow fever, I was early convinced that this disease was not
+to be treated by specific remedies, and that our curative indications
+should be formed on an attentive consideration of the condition of the
+system in general, and of particular organs, as pointed out by the
+symptoms during life and the morbid lesions after death.</p>
+
+<p>In a former part of these remarks, I suggested the opinion, that the
+yellow fever is a gastro-duodenic inflammation, (perhaps of a specific
+kind,) and that it required a mode of treatment appropriate to this
+morbid state; but proportioned to the strength of the patient, to the
+violence of the attack, and to the power of re-action. In general,
+however, I have not found active depletion by the lancet, as easily
+borne in this, as in bilious and other fevers;&mdash;the disease assuming
+more rapidly, under this plan, a state of prostration or adynamia. Nor
+can this appear surprising, since the same circumstance of a disease
+being of an inflammatory nature, but, under a peculiar condition of the
+system, contraindicating ample depletion, is a subject of frequent
+notice during certain epidemics; for example, of scarlatina, pneumonia,
+&amp;c. With the exception of those cases, therefore, occurring in very
+robust and plethoric constitutions, and accompanied with much<span class='pagenum'><a name="Page_64" id="Page_64">[Pg 64]</a></span> pain in
+the head, high febrile excitement, and hard pulse, either large or
+small, I have seldom resorted freely to the lancet. When, however, these
+symptoms presented themselves, especially the hardness of the pulse, I
+have not been sparing of blood-letting, and have sometimes repeated it
+several times with the most decided success. But even under these
+circumstances, I have seldom found that <i>large</i> bleedings were as
+beneficial as small and repeated ones;&mdash;the system not reacting always
+as energetically as could have been desired, and symptoms of prostration
+occurring with much more rapidity. I do not recollect to have bled with
+advantage, patients presenting a large, full, but <i>compressible</i> pulse,
+owing to the want of reaction; although the other symptoms might seem to
+indicate the propriety of the practice. The effect of bleeding on the
+vomiting was very different in this, from what I mentioned it to have
+been in the bilious fevers of the West Indies; owing probably to the
+circumstance, that, when, in yellow fever, the irritation of the stomach
+became sufficiently violent to give rise to this symptom, the state of
+the system was very often such as to contraindicate the use of the
+lancet.</p>
+
+<p>The application of scarified and dry cups to the epigastrium and head,
+when there existed pain in these regions, was often resorted to, and
+afforded much relief. And I very much regret, that, during our
+epidemics, it was out of my power to make use of leeches to the former
+part, as so warmly recommended, at the present day, by the French and
+Spanish physicians; as I am inclined to the opinion, from the view I
+have adopted respecting the pathology of the disease, that, used early
+and in large numbers, they would prove very serviceable.</p>
+
+<p>In conjunction with general and local bleeding, fomentations were had
+recourse to in almost every case, and applied to the epigastrium in the
+form of poultices, or flannels wrung out of warm emollient decoctions.
+In order to excite perspiration and to determine action to the surface,
+a tepid bath was occasionally prescribed, and in some cases afforded
+considerable relief; but as it was an inconvenient remedy, pediluvia,
+and hot bricks on which water, or water mixed with vinegar was poured,
+were substituted. In cases, however, in which much arterial action
+existed, these last means were not prescribed, until the pulse had been<span class='pagenum'><a name="Page_65" id="Page_65">[Pg 65]</a></span>
+brought down by the lancet, and other remedies presently to be
+mentioned.</p>
+
+<p>On the subject of emetics, I shall not enlarge; as I can safely assert,
+that I very seldom saw a patient recover from yellow fever, to whom
+tartarized antimony, or any other active remedy of the same class, had
+been administered. Of the impropriety and danger of this practice in the
+present disease, I was early convinced from a careful analysis of the
+symptoms, indicating an acute irritation of the stomach and upper
+portion of the small intestines, and from the circumstance, that, of the
+first family in which I was called to prescribe, five members, to whom
+emetics had been administered, had already fallen victims to the fever,
+under the care of a very respectable physician, and that three
+succeeding ones, who were treated agreeably to my view of the pathology
+of the disease, recovered. From these facts and reflections, I was
+induced to watch the effects of these remedies in subsequent cases, in
+my own practice, and in the practice of other physicians, and was soon
+led, from this extended experience, to abandon totally the use of tartar
+emetic in the treatment of this malady. Ipecacuanha in emetic doses was
+also tried by me; but although, thus administered, it did not occasion
+the bad effects resulting from the exhibition of the preceding article,
+yet it was often productive of harm, and never of benefit. These
+remarks, however, apply more particularly to the use of tartar emetic
+during the state of excitement of the fever, and not to that of collapse
+which sometimes precede it, and in which it is recommended by some
+physicians of the southern states. In this condition of the system, I
+have never resorted to it, and, I must confess, could not easily be
+persuaded to do so; suspecting that even in such cases, the digestive
+organs are already too far implicated, to justify the use of so powerful
+and acrid a remedy.</p>
+
+<p>It would seem that the bad effects of emetics, and more particularly of
+tartarized antimony, resulted, not only from their irritating qualities,
+but also from the efforts of vomiting, during which the stomach is
+compressed by the abdominal muscles, and made to contract very forcibly.
+To this opinion I am naturally led from the circumstance, that
+purgatives, whose action is certainly primarily irritating, are very
+advantageously employed in<span class='pagenum'><a name="Page_66" id="Page_66">[Pg 66]</a></span> yellow fever. It is not my intention to
+attempt here an explanation of this seeming contradiction. Leaving to
+others the accomplishment of this difficult task, I shall content myself
+with stating, that during the whole course of my long practice, I have
+seldom seen a patient die of this disease, whose bowels had been well
+evacuated, and in whom perspiration had been excited within the first
+twenty-four hours after the attack. I exhibited purgatives in almost
+every instance <i>every day</i>, until copious evacuations had been procured,
+and I generally found, that the mild purges were of greater service than
+those of a severe and irritating nature. Senna, acidulated with lemon
+juice or tamarinds, answered sometimes remarkably well, when the stomach
+could retain it. Castor oil, manna, salts, magnesia, were frequently
+employed by me with advantage; and although I did not make an extensive
+use of calomel in this disease, yet I prescribed it to children, and to
+adults, who, owing to great irritability of the stomach, could not
+retain other purgative medicines. When I resorted to it, I generally did
+so in doses sufficient to ensure a purgative effect, and never with a
+view of exciting ptyalism. In doing this, I was not guided, however, by
+any fear of the effects of a salivation, since I was well aware that a
+ptyalism occurring in malignant diseases is often a favourable crisis;
+but by a knowledge of the great difficulty experienced in producing it,
+and from the observation, that in cases in which it was obtained, much
+valuable time had been lost, and the patient might have recovered
+without.</p>
+
+<p>To promote the operation of the above remedies, purgative enemata were
+resorted to, in the early stage of the fever; and were followed by the
+frequent use of injections, composed of emollient decoctions, from which
+the patient derived considerable relief and comfort.</p>
+
+<p>As counter-irritants, blisters and sinapisms were used, and often with
+great advantage. They were found of much value when applied to the
+epigastric region, for the purpose of arresting the vomiting. Sinapisms
+were in general preferred to blisters, as being more prompt in their
+effects and more easily renewed. Blisters were sometimes applied to the
+extremities in the different stages of the disease; but so far as I can
+judge, from my experience, not with much real benefit.<span class='pagenum'><a name="Page_67" id="Page_67">[Pg 67]</a></span></p>
+
+<p>I seldom derived much advantage from the use of tonics and stimuli in
+yellow fever; except when the powers of life seemed to fail, and
+petechi&aelig;, vibices, h&aelig;morrhages, and other signs of malignancy had
+occurred. In general, under such circumstances, the Peruvian bark,
+either alone or combined with serpentaria, was administered in
+preference to any other remedy of the same class. In cases, however,
+unattended with reaction, tonics and diffusible stimuli internally, and
+revulsives of all sorts externally, were had recourse to from the
+commencement of the attack, and sometimes with the desired effect of
+arousing the powers of the system. <i>Opium</i> was never found beneficial,
+on account of its tendency to aggravate or produce coma, as well as from
+its effect in suppressing intestinal evacuations.</p>
+
+<p>Whilst making use of the above remedies, the plentiful exhibition of
+diluent drinks was not neglected,&mdash;care being taken, however, not to
+load unduly the stomach, and to select such drinks as would suit the
+taste of the patient. In almost every case, acids did not answer so well
+as the bland mucilaginous infusions. The drinks were almost universally
+allowed cold, except when there existed a tendency to perspiration;
+under which circumstances they were administered slightly warm and a
+little aromatic.</p>
+
+<p>During the course of the yellow fever, some of the symptoms demanded
+particular attention. Influenced by the idea of prostration and
+dissolution, many practitioners, and myself for some time among the
+rest, resorted to the bark and other tonics for the purpose of arresting
+the black vomit, and of correcting that condition of the organs, which
+gave rise to this effusion; but after many unsuccessful trials, I was
+led to abandon this practice and to resort to other means. Of all the
+remedies employed to attain this effect, calcined magnesia mixed in a
+thick solution of gum arabic seemed to me to answer best; for whilst it
+succeeded, in many cases, in arresting the vomiting, it tended to keep
+the bowels open. Together with this, revulsive remedies were applied to
+the skin, and sometimes succeeded very well,&mdash;a sufficient proof, I
+think, that this h&aelig;morrhage is the effect of an increased action of the
+mucous membrane of the digestive tube, and not of a passive condition of
+the capillaries of the parts. For the purpose of controlling the great
+irritability of the stomach, and arresting the vomiting occurring in the
+early stage of the disease, besides the<span class='pagenum'><a name="Page_68" id="Page_68">[Pg 68]</a></span> usual remedies used in such
+cases, I found advantage in the use of small and frequently repeated
+injections with a solution of salts, an infusion of senna, or the like
+substances. Such a practice, however, did not seem to succeed so well in
+the latter stage of the disease.</p>
+
+<p>With the intention of promoting the secretion of urine, in cases in
+which it was suppressed, all the diuretics, as well as every external
+stimuli, were in vain employed;&mdash;this symptom, as I have already
+mentioned, being, in all instances which fell under my immediate
+observation, the forerunner of death.</p>
+
+
+
+<hr style="width: 65%;" />
+<h2><span class="smcap">Article V.</span>&mdash;<i>Remarks on the Prophylactic Treatment of Cholera Infantum.</i>
+By <span class="smcap">Joseph Parrish</span>, M. D., one of the Surgeons to the Pennsylvania
+Hospital.</h2>
+
+
+<p>The great mortality of cholera infantum renders it one of the most
+interesting diseases, which come under the notice of the physician. Its
+ravages among the infant population of our large cities, are too well
+known, and too strongly felt, to require any comment. No disease
+contributes so largely to swell our bills of mortality during its
+prevalence; and were it not restricted to the summer season, it would
+prove a greater scourge to the community than consumption itself.</p>
+
+<p>This mortality is owing less to our ignorance of the nature of the
+complaint, and the proper mode of treatment, than to the continued
+operation of the causes by which it is produced. I have often compared
+our endeavours to cure cholera infantum, while these causes remain, to
+an attempt to relieve inflammation in a part, while a thorn is sticking
+in the flesh. We may resort to bleeding and leeching; we may restrict
+our patient to the lowest diet, and the most perfect rest; we may employ
+all those remedies, which are ordinarily best calculated to reduce
+inflammation: but so long as the thorn continues in the wound, our
+efforts will be fruitless. Thus it is with cholera. We may obviate the
+more violent symptoms; we may procure temporary relief; we may even
+flatter ourselves that a cure has been effected: but the original causes
+have not lost their power; an increased susceptibility<span class='pagenum'><a name="Page_69" id="Page_69">[Pg 69]</a></span> to their
+operation remains; relapse upon relapse is experienced; and at last the
+little sufferer, worn out by the successive attacks, sinks beyond the
+reach of medicine, and expires. Unhappily, the nature of the causes is
+such, that, in very many instances, their removal is exceedingly
+difficult, if not altogether impossible; and, under such circumstances,
+the patient who has once been severely affected, seldom recovers in the
+end. Hence it becomes of the greatest importance to prevent the
+occurrence of the disease; and attention to the prophylactic treatment
+is no less essential than the adoption of curative measures. It is with
+the view of calling the attention of the profession to this subject,
+that I have been induced to offer the following observations.</p>
+
+<p>It is obvious, that, in the preventive treatment, two objects demand
+attention; first, to remove, as far as possible, the causes of the
+disease; and secondly, where their entire removal is not attainable, to
+fortify the system against their influence. On each of these, I shall
+offer a few observations.</p>
+
+<p>I. Excessive and continued heat is, perhaps, the most fruitful source of
+cholera. Thus we find, that the disease makes its first appearance in
+the commencement of the hot weather, increases and becomes more fatal
+with the rise of the thermometer, and declines with the return of cool
+weather in autumn. During its continuance, it may be observed to vary
+with every permanent change of temperature. A few very hot days in
+succession, in the 6th month, are sufficient to call it into action; and
+during the height of its prevalence, a spell of cold weather will
+diminish, if not suppress it. In the summer of 1806, which was
+remarkably cool and pleasant, there was very little of the disease; and
+generally in moderate summers, it is much less prevalent than in those
+of a contrary character.</p>
+
+<p>I believe that it is by a direct operation on the system, and not by the
+generation of miasmata, that heat proves so deleterious to the infant.
+In the country, where miasmata are most abundant, there is comparatively
+little cholera; for the heat of the sun is there moderated by the free
+circulation of the air; and the debilitating operation of the high
+temperature of the day is counteracted by the refreshing coolness of the
+morning and evening. It is in the close air of cities, that the
+complaint flourishes with greatest vigour; and the most confined
+situations are the most favourable<span class='pagenum'><a name="Page_70" id="Page_70">[Pg 70]</a></span> to its production. Let any one take
+a walk, in a summer's morning, through the thickly built lanes and
+alleys of Philadelphia. He will be struck with the appearance of the
+children, reclining their heads, as if exhausted, upon the breast of
+their mothers, with a pale and languid countenance, a cool and clammy
+skin, a shrunk neck, and other signs of debility, arising from their
+confinement, during the night, to close and hot apartments. It will
+readily be believed, that such places are the very hot beds of cholera.</p>
+
+<p>Heat, therefore, connected with confined air, being among the most
+frequent causes of the complaint, it is necessary, as far as possible,
+to counteract them. Should a strong predisposition to cholera be
+suspected, the best plan will be to send the child into the country
+during the summer. Both as a preventive and a remedy, country air is
+decidedly the most effectual, to which we can resort. But in most
+instances, it would be exceedingly inconvenient, sometimes impossible
+for mothers to leave their homes and occupations in the city; and, under
+such circumstances, it becomes necessary to substitute measures, which
+may produce, as nearly as possible, the same effects. To keep the child
+cool, and expose him to the fresh air, are the ends to be obtained. For
+this purpose, he should be carried frequently into the open squares, or
+beyond the suburbs of the city. I am in the habit of recommending to
+parents, whose circumstances will not allow of a removal from the city
+during the summer season, to make frequent excursions across the
+Delaware, and into the neighbouring woods of New Jersey. The refreshing
+effects of the air on the river are truly surprising. The brightened eye
+and animated countenance of the infant, give speedy proof of their
+favourable influence; and when labouring under the disease, even in its
+lowest stage, the little patient will often exhibit immediate signs of
+amendment.</p>
+
+<p>In the prevention of cholera, much may also be expected from a proper
+attention to the lodging of children. Many parents have a great dread of
+the night air; and exclude it from their chambers, as sedulously as if
+it were infected with poison. But, in guarding their children from
+taking cold, they expose them to a much greater danger. Observe their
+mode of treatment. The doors and windows are carefully closed; the child
+is placed in a<span class='pagenum'><a name="Page_71" id="Page_71">[Pg 71]</a></span> feather bed, with his parents on each side, and almost
+smothered with the bed-clothes. Perhaps other children are lodged in the
+same apartment; and thus the delicate system of the infant is exposed to
+the debilitating influence of great heat and stagnant air, combined with
+the effluvia, which, in such a situation, must be abundantly generated.
+Simply to enter such a room in the morning, is almost sufficient to
+sicken a healthy individual; how much more injurious must be its effects
+upon the lodgers themselves. Examine in the morning a child, who has
+passed the night thus confined. You will find him limber as a rag,
+exhausted by perspiration, wholly destitute of animation, without
+appetite, and on the very verge of cholera. I should recommend an
+entirely different plan of management. Instead of a feather bed, the
+child should be placed on a hard mattress, or on blankets folded and
+laid upon the floor. The covering should be light, but comfortable. The
+doors and windows should be open; so that fresh air, that <i>pabulum
+vit&aelig;</i>, without which health cannot be sustained, may be freely admitted.
+Thus treated, instead of the feeble and sickly appearance before
+mentioned, he will present a lively countenance, with all that activity
+of motion, and enjoyment of existence, which are natural to his age, and
+afford the surest criterion of vigorous health. Experience has fully
+convinced me of the great importance of attention to the lodging of
+children, as a prophylactic measure; and this renders me desirous of
+impressing upon the profession generally, the truth of my own
+convictions on the subject.</p>
+
+<p>With the same design of obviating the injurious effects of a high
+temperature upon the infantile system, I advise frequent ablutions with
+cool water, and its free employment as a beverage. Infants, unable to
+make their wants known, often suffer exceedingly from the inability of
+their attendants to understand them. During the heat of summer, the
+increased evaporation from their surface is necessarily productive of
+increased thirst, which, if unsatisfied, renders them uneasy and
+restless. To quiet them, the breast or bottle is offered. Aliment is
+thus given, where drink only was required; and the stomach, overloaded
+and oppressed, is apt to become irritable, and is thus brought into a
+condition most favourable to the occurrence of cholera. By attention to
+the peculiar language of infants, expressed not by words, but by<span class='pagenum'><a name="Page_72" id="Page_72">[Pg 72]</a></span> signs,
+I have often been able to detect their wants; and, in many instances,
+have afforded the most decided relief, by simply giving them a little
+cool water for drink. From the dread which some individuals have for
+cool air and cold water, it would seem that they were considered rather
+as destructive poisons than as absolute necessaries. I have no fear of
+either, when judiciously employed; and as prophylactics in cholera, I do
+not think their place can be supplied.</p>
+
+<p>But heat is not the only cause of this complaint. Dentition is well
+known both to predispose the system to its attack, and, after it has
+occurred, to increase its violence, and diminish the chances of
+recovery. In the employment, therefore, of preventive measures, it is
+highly necessary to attend to the state of the gums, and to remove or
+counteract this source of irritation. If at all swelled or painful, they
+should be lanced freely, and the operation should be repeated as often
+as their inflammatory condition may demand. In severe cases, much good
+may be expected from the application of blisters behind the ears. The
+irritation thus receives an external direction, and the stomach and
+bowels are in less danger of an attack. I was led to this practice, by
+observing that the eruption, which, during dentition, is apt to make its
+appearance behind the ears, often proves a most salutary effort of
+nature; and that, while it continues, the infant generally enjoys an
+exemption from those dangerous disorders, incident to this critical
+period of life. To imitate nature as closely as possible, the discharge
+from the blistered surface should be maintained for some time by
+stimulating dressings. I have witnessed the most beneficial effects from
+the practice, and can strongly recommend it to the attention of the
+profession.</p>
+
+<p>II. At the same time that we endeavour to remove or diminish the causes
+of cholera, we should not neglect to put the system of the child in such
+a condition, as may enable it most effectually to resist their
+operation. As cholera is a disease of irritation, originating generally
+in a debilitated state of the alimentary canal, I believe this end may
+be most easily attained, by preserving the natural tone of the digestive
+organs. For this purpose, all flatulent and indigestible food should be
+carefully avoided. During the first year, the mother's milk is, in
+general, the most appropriate nutriment. When the stomach of the infant
+is very delicate,<span class='pagenum'><a name="Page_73" id="Page_73">[Pg 73]</a></span> the diet of the mother should be strictly regulated;
+and, in all cases, it would be adviseable for her to avoid articles of a
+flatulent nature. While the child is still at the breast, if a
+predisposition to cholera be suspected, I would recommend the occasional
+use of nutritious animal juices. The sucking of small pieces of salt
+meat, as ham or dried beef for example, will sometimes be found
+productive of advantage. After weaning, animal food should always enter
+into the diet of the child. Many parents, fearing to render their
+children gross and unhealthy, restrict them altogether to vegetable
+aliments; and thus, by weakening the powers of digestion, prepare the
+way for that very result which they are most anxious to avoid.</p>
+
+<p>With the same view of giving tone to the stomach, aromatics should be
+used habitually during the summer, in those cases, in which there is
+strong reason to apprehend the occurrence of cholera. While they produce
+a cordial impression on the stomach, and invigorate generally the
+digestive powers, they are liable to none of those objections which may
+be urged against the employment of the narcotic stimulants. Indeed,
+nature herself seems to have pointed them out as prophylactics against
+the diseases of hot weather. Our most powerful and valuable spices are
+the products of warm countries. Cinnamon, ginger, pepper, the clove, the
+nutmeg, are to be found only in tropical climates. In this arrangement,
+we see the hand of a beneficent Creator, who has provided, that, by the
+same high temperature, which renders the equatorial regions so fruitful
+of cholera, and other disorders of the bowels, the growth of those
+plants should be promoted, which are best calculated to invigorate the
+alimentary canal, and to fortify it against the inroads of disease.
+Facts are not wanting to prove the efficacy of spices in preventing
+intestinal complaints. We are informed by <span class="smcap">Dewar</span>, in his treatise on the
+Diarrh&oelig;a and Dysentery, by which the British army in Egypt was
+attacked, that among the Mamalukes of that country, it was a universal
+practice, when they apprehended the approach of these disorders, to make
+use of cinnamon or ginger, with the almost uniform effect of averting
+them; and where the same practice was followed by the British soldiers,
+equal advantages were experienced. In the French army, so highly was the
+prophylactic power of the aromatics estimated,<span class='pagenum'><a name="Page_74" id="Page_74">[Pg 74]</a></span> that every soldier was
+provided with a box of spices, which he was directed to use freely with
+his diet of fruit and melons.</p>
+
+<p>When attending surgeon of the Alms-house hospital in this city, I had
+occasion frequently to prescribe in a syphilitic ward, which being
+situated directly under the roof, in a large garret, was liable, in the
+summer season, to become very much heated. As the patients were
+numerous, and the windows insufficient to admit of proper ventilation,
+the air became much contaminated; and the consequence was, that bowel
+complaints were very frequent and troublesome. I have often entered the
+ward on a summer's morning, and found almost every patient affected more
+or less with diarrh&oelig;a or cholera. It occurred to me, that the free
+use of some of the aromatics might be found serviceable in preventing
+the occurrence of these complaints. I accordingly directed, that every
+individual in the ward should drink a portion of strong ginger tea
+daily. I also ordered, that salt meat should be used twice in the week.
+By the steady pursuit of this plan, a very considerable change for the
+better was effected.</p>
+
+<p>The employment of aromatics as prophylactics is not less beneficial in
+children than in adults. I would not, however, advise, that they should
+be given indiscriminately to all children, during the summer. It is only
+to those cases, in which a predisposition to cholera infantum exists,
+that I consider them peculiarly applicable; and here I believe they are
+capable of producing much good.</p>
+
+<p>Before dismissing the subject of the paper, I will simply remark, in
+addition to what has been already said, that the occasional use of the
+cold bath, by the vigour it imparts to the system generally, and through
+it to the digestive organs, will often be found an excellent
+preservative against the summer complaint of children.</p>
+
+<p>In this short account of the preventive treatment of cholera infantum, I
+have been less anxious to give a dissertation, embracing all that might
+be said on the subject, than to communicate those particular measures,
+which, according to my own experience, I have found most effectual. I
+will conclude the paper by the relation of a case, in which a strong
+predisposition to the disease was successfully counteracted. It will be
+proper, however, to premise, that the treatment of this case is by no
+means held out<span class='pagenum'><a name="Page_75" id="Page_75">[Pg 75]</a></span> as an example to be generally followed with every
+infant, which may possibly become the subject of cholera. It is
+applicable in all its details only to those, in which, as in the present
+instance, there is every reason to apprehend, that the only alternative
+is between almost certain death, and the most careful prophylactic
+treatment.</p>
+
+<p><span class="smcap">Case.</span>&mdash;A gentleman of this city, whose wife had arrived at a period of
+life, when she could not expect to be the mother of many more children,
+consulted me respecting an infant daughter, their only surviving child.
+I was informed, that they had already lost eight children, all of whom,
+with one exception, had died of cholera. It may readily be imagined,
+that every feeling of parental anxiety was awakened for their babe; and
+that no degree of attention on their part was considered too great,
+which might contribute to its preservation. It was placed under my care,
+not to be cured, but that I might, if possible, devise some plan of
+management which would avert the disease they had so much reason to
+apprehend. I felt the responsibility of the trust, and endeavoured to
+find it to the best of my ability. Every opportunity which I could
+desire was afforded me; for the infant, from its birth was submitted to
+my direction; and both the disposition and ability existed, on the part
+of the parents, to carry implicitly into effect every measure which I
+might recommend.</p>
+
+<p>As the mother was unable to furnish sufficient nourishment, the first
+step was to provide a healthy wet-nurse, who might be willing to submit
+to the necessary regulations in respect to diet.</p>
+
+<p>I believed the children of these parents to possess a constitutional
+weakness in the alimentary canal; and, on inquiry, I was told, that they
+had been kept upon a vapid diet, under the impression that it would
+contribute to their health. In the present case, therefore, the
+principal object was to communicate strength to the stomach and bowels.
+With this view, the child was accustomed, from an early period of
+infancy, to a generous diet. When very young, portions of ginger tea
+were given to it daily; and as soon as it was old enough to suck the
+juice of meat, it was encouraged to do so. The nurse, during the warm
+season, was kept upon a nutritious diet, consisting principally of
+animal food, with the occasional use of ginger tea; and every
+description of recent fruit and fresh vegetable food was forbidden.
+Under this<span class='pagenum'><a name="Page_76" id="Page_76">[Pg 76]</a></span> management, the first summer was passed without any symptom
+of the disease; but I looked forward to the second with no little
+anxiety, when the child would have to struggle with the irritation
+arising from dentition.</p>
+
+<p>The same plan was continued during the second summer, and still more
+rigidly enforced. The child was now old enough to take animal food
+freely in addition to the breast. It was allowed as much salt fish, ham,
+beef-steak, essence of beef, &amp;c. as it desired; ginger tea was given
+daily; a little sound old port wine was occasionally directed; and both
+the child and the nurse were restricted from every species of flatulent
+and indigestible aliment. So anxious, indeed, were the parents, and so
+careful to carry my directions into full effect, that they allowed no
+forbidden article of food to enter the house, and denied themselves
+their wonted comforts, lest possibly their child might be injured.</p>
+
+<p>The gums were carefully attended to, and lanced whenever the operation
+appeared to be requisite. All those measures, which I have before
+mentioned as serviceable in obviating the effects of great heat, so far
+as they were applicable to the case, were adopted. The second summer was
+spent wholly in the country.</p>
+
+<p>Very little medicine was required, and none was administered, except of
+the mildest description. Frequently, when summoned to visit the babe, I
+have found the mother trembling with fear, and anxious that something
+might be done; and often, under such circumstances, have I begged it off
+from a dose of physic, having determined to avoid a resort to every
+thing of the kind, unless real necessity should demand it.</p>
+
+<p>By a strict adherence to the plan above detailed, the period of
+dentition was passed in safety; and it is with heartfelt pleasure I can
+say, that no symptom of cholera afterwards made its appearance.</p>
+
+
+
+<hr style="width: 65%;" /><p><span class='pagenum'><a name="Page_77" id="Page_77">[Pg 77]</a></span></p>
+<h2><span class="smcap">Article VI.</span>&mdash;<i>Case of Neuralgia cured by Acupuncturation.</i> Communicated
+by <span class="smcap">J. Hunter Ewing, M. D.</span></h2>
+
+
+<p>The attention of the medical public having been of late much excited on
+the subject of acupuncturation, I am induced to communicate the
+following case.</p>
+
+<p>For eighteen months, Miss &mdash;&mdash; had been afflicted, at intervals, with a
+severely painful affection of the nerves of the right cheek, immediately
+below the orbit of the eye, and extending to the angle of the lower jaw.
+On the 14th of January 1826, she was attacked more violently than usual,
+and the remedies, which had previously afforded some relief, now failed.
+Stimulating cataplasms, warm embrocations, laudanum, internally and
+externally, heat applied externally to the cheek by means of very hot
+flannels, produced not the slightest mitigation of the pain; and she
+continued to suffer excessively until the afternoon of the 15th; when
+acupuncturation being proposed, she consented to the operation with this
+remark,&mdash;"any thing to relieve me from this agony."</p>
+
+<p>The needles were immediately procured, and three inserted about an inch
+from each other. Two in a line parallel with the inferior edge of the
+orbit of the eye, and half an inch below it; and a third below, and
+equidistant from the others. The first two were introduced to the depth
+of three-fourths of an inch; the last, a full inch. They were inserted
+very gradually and with a rotary motion.</p>
+
+<p>The second needle was scarcely introduced, before the patient exclaimed,
+"the pain has entirely left me." When the third was introduced, she
+experienced a stiffness in the muscles of the cheek, and a creeping
+sensation, as if a spider's web had been drawn across the face; but no
+painful sensation whatever.</p>
+
+<p>Such was the exhausted state of her system from the excessive pain she
+had suffered, that when thus relieved, she requested a pillow to rest
+her head on, and fell into a gentle slumber.</p>
+
+<p>About two hours after the insertion of the needles, I again visited my
+patient, and found her still perfectly free from pain, and seated at a
+table reading. She thanked me for the relief I had been the means of
+affording her, and requested me not to withdraw the needles, lest the
+pain might return. Upon being<span class='pagenum'><a name="Page_78" id="Page_78">[Pg 78]</a></span> apprised of the risk that might attend
+their being allowed to remain, she observed, that she would rather have
+a servant to watch her whilst she slept. The propriety of their removal
+being further urged, she at last consented. There was no return of pain.</p>
+
+<p>The next morning, the patient remarked, that the stiffness of the cheek,
+and a numbness of the whole right side, continued through the night; and
+though she did not sleep very soundly, she was free from pain and rested
+well.</p>
+
+<p>By the third day, the stiffness and numbness had passed away, and there
+was no return of pain. Several weeks have now passed, and she has had no
+relapse; although often since exposed to causes, which, heretofore, had
+always excited violent attacks. Previous to the operation, she seldom
+passed as many days without severe suffering.</p>
+
+<p>Although I have performed this operation many times, and been present
+when others have performed it, I have never seen a case, in which its
+efficacy was so decided, or in which the relief afforded was more
+unquestionably attributable to the action of the needles.</p>
+
+
+
+<hr style="width: 65%;" /><p><span class='pagenum'><a name="Page_79" id="Page_79">[Pg 79]</a></span></p>
+<h2>ANALYTICAL REVIEWS.</h2>
+
+
+
+<hr style="width: 65%;" />
+<h2><span class="smcap">Article VII.</span>&mdash;<i>Researches into the Nature and Treatment of Dropsy in the
+Brain, Chest, Abdomen, Ovarium, and Skin, in which a more correct and
+consistent Pathology of these Diseases is attempted to be established,
+and a new and more successful method of treating them, recommended and
+explained.</i> By <span class="smcap">Joseph Ayre, M. D.</span> &amp;. London, 1825.</h2>
+
+
+<p>We have read the present work with the liveliest pleasure, and we dare
+hope with considerable benefit, and hasten to lay a review of its
+contents before our readers. Dr. <span class="smcap">Ayre</span> is already advantageously known in
+this country, where his Essay on Marasmus has had an extensive
+circulation; but we are disposed to think, that, however he might be
+esteemed for the talent he displayed in his former composition, he is
+entitled to much more credit for his able researches into the nature and
+treatment of dropsy. We confess that we enter upon our editorial duties
+on the present occasion, with the two-fold intention of offering to our
+readers what we regard, on the whole, as a very correct view of the
+pathology of dropsy, and of showing to some of our medical friends, who
+shudder at the mere mention of what they denominate <i>hunch theories</i>,
+that the English physicians, or at least some of the most intelligent
+among them, so far from considering these theories as dangerous and
+unphilosophical, are beginning to entertain similar views with their
+Gallic brethren, in respect to the inflammatory nature of many diseases
+too long regarded as resulting from a state of debility, and classed by
+nosologists among the Cachexi&aelig;.</p>
+
+<p>By most writers upon the subject, dropsy has too long been considered as
+a <i>disease</i>,&mdash;constituted into a separate class, and divided into many
+species. Dr. <span class="smcap">Ayre</span> entertains, however, a very different and, we believe,
+a much more correct view of the pathology of this complaint; regarding
+it as only one in a series of effects of a disease, and not always the
+last of that series. He<span class='pagenum'><a name="Page_80" id="Page_80">[Pg 80]</a></span> remarks, that the true disease is to be sought
+for in that particular condition of the solids by which the effusion is
+produced; and that to appreciate justly the nature and treatment of
+dropsy, it is necessary to understand the nature of that condition,
+which constitutes the disease, and of which the serous and watery
+effusion is merely the result.</p>
+
+<p>Of all the hypotheses that have been advanced to account for the nature
+of the morbid state, which gives rise to general and local dropsy, there
+are only three which our author regards as entitled to our notice.
+According to these, all dropsical accumulations arise either, 1st, From
+a want of tone or energy in the absorbent vessels, giving rise to a
+deficient absorption. 2nd, From an increased exhalation of the natural
+fluid, through a similar want of tone in the exhalents; and 3d, From a
+mechanical obstruction to the free return of blood by the veins,
+produced by tumours of various kinds, &amp;c., by which a greater portion of
+it is forced into the exhalents, and a greater effusion of their proper
+fluids thereby occasioned. With these hypotheses, however, Dr. <span class="smcap">Ayre</span> is
+not satisfied, and he endeavours, in the following manner, to show their
+insufficiency.</p>
+
+<div class="blockquot"><p>"1st. The opinion of a want of tone in the absorbents, as a
+cause of dropsy, is contradicted by the fact, that in those
+cases, in which it is assumed to prevail, it is found, that the
+adipose matter, or fat of the body, is removed by the
+absorbents; or, in other words, that emaciation takes place to
+as great an extent, and as rapidly in this, as in other
+diseases; and emaciation can only be effected by means of
+absorption. Besides, in these cases of dropsy, mercury, when
+rubbed upon the surface, or received internally, is absorbed as
+readily, and affects the system as early as under other states
+of the body. There is also no accumulation of the fluids in the
+joints, or in the <i>burs&aelig; mucos&aelig;</i> in these cases, which,
+nevertheless would happen, if there was a general debility of
+the absorbent system; and <i>ecchymoses</i> or livid spots, though
+easily induced in anasarcous limbs, are likewise easily removed
+from them by the absorbents.</p>
+
+<p>"2nd. The opinion of a want of tone or energy in the exhalants
+involves in it one of the following conditions: namely, either,
+1st, that the fluid of dropsy may escape mechanically from
+them, and that the fluid thus <i>mechanically</i> separated may be
+identified in its sensible and chemical qualities with another
+fluid which is confessedly secreted; or 2nd, that if the fluid
+of dropsy be secreted, then that an <i>increase</i> in the quantity
+of a secretion may continue an indefinite period, under a
+<i>decrease</i> in the energy of its secreting vessels; conclusions
+to which experience and analogy are alike opposed."</p></div><p><span class='pagenum'><a name="Page_81" id="Page_81">[Pg 81]</a></span></p>
+
+<p>In answer to the third hypothesis, Dr. A. remarks, that such an
+obstruction as contemplated, has never been shown to exist.</p>
+
+<div class="blockquot"><p>"In the case of the liver, which is commonly considered, when
+in a scirrhous or enlarged state, to be the seat of these
+mechanical obstructions, and thus, to be the cause of abdominal
+dropsy, we have no satisfactory instance yet shown to us, of
+any such precise condition of that organ. There are, indeed,
+numerous instances of abdominal dropsies, in those labouring
+under a scirrhous or enlarged state of the liver; but there are
+also, numerous examples of such states of the liver, as well as
+of the spleen and other organs, without any such effusion; and
+in many cases, when such effusion has taken place, it has been
+carried off by the natural passages or by tapping, without any
+return of the dropsy; and yet, without any visible change in
+the structural condition of the liver."</p></div>
+
+<p>Dr. A. further remarks, that if the cause were mechanical and existed in
+the liver, the effect should be constant; which, however, is not the
+case. Besides, were this mechanical cause necessary, how could we
+account for the appearance of abdominal dropsy, where there is no
+disease of the liver, or in other cavities, where no mechanical cause is
+asserted to be present, and where the remedies by which the cure is
+effected, have no relation to such causes? Again, if the discharge
+depended upon a mechanical cause, the water should in every case be of a
+uniform fluidity, and the progress of its accumulation likewise uniform;
+so that the operation of tapping should have no tendency to induce a
+more rapid refilling of the cavity. Yet, the contrary of all this is a
+subject of daily observation. In addition to this, Dr. A. calls the
+attention to the fact, that in experiments, in which obstruction has
+been artificially made, by tying the vena cava for example, the
+experimenter has committed an error, in reasoning from the lower animal
+to man&mdash;assuming, that as ascites had arisen in dogs, it would in like
+manner have occurred in human subjects.</p>
+
+<div class="blockquot"><p>"But there was an effect, here overlooked, which was to be
+expected to take place in the abdomen of the dog, from the
+injury done to the surrounding parts by the operation itself,
+and which would be quite independent of any effect arising out
+of the experiment. In the human subject, the effect would be
+the highest form of inflammation, by which coagulable lymph or
+pus would be poured upon the surface of the peritoneum. There
+would, therefore, be inflammation excited in the abdomen of the
+dog; but as the lower animals are less easily acted on than
+man, the inflammation would in this case be in a lower degree.
+But every degree of inflammation has its particular product.
+The highest occasions a discharge of pus, whilst the lowest,
+when seated in a serous membrane, is a<span class='pagenum'><a name="Page_82" id="Page_82">[Pg 82]</a></span> larger portion of its
+proper serous fluid. This, therefore, might be the product of
+the inflammation, which was produced incidentally by the
+experiment in the abdomen of the dog; and it would be just as
+reasonable to regard the coagulable lymph in the human subject,
+which would result from such an experiment, as an effect of the
+mechanical obstruction, as to consider the fluid effusion in
+the dog to be so."</p></div>
+
+<p>In respect to those instances of diseases of the liver, connected with
+ascites, in which, in addition to its other morbid states, a partial
+occlusion of the vena port&aelig;, by the effusion of coagulable lymph into
+it, is said to have existed, our author remarks, that they are very few
+in number, occurring, perhaps, in one out of several hundred cases of
+ascites with hepatic disease; and that we are justified, from analogy,
+to assume, that any obstruction given to the circulation by diseased
+vessels, would be quickly relieved by the enlargement of the
+anastomosing branches, and that no effusion of water into the abdomen
+would result from it. After referring to some cases, related by the late
+Mr. <span class="smcap">Wilson</span>, in which the vena cava was completely obliterated, and no
+effusion took place; and some cases of morbid condition of the heart of
+an analogous kind, by which the course of the circulation became greatly
+obstructed, and yet, without being followed by effusion; our author
+concludes, that from these facts and others, to be presently noticed, it
+appears evident,</p>
+
+<div class="blockquot"><p>"That the dropsical effusion, in whatever part it may be
+seated, does not arise from any want of tone in the exhalant or
+absorbent system, or from a mechanical obstruction in the liver
+or other viscus; but, that it proceeds from a morbid action in
+the cellular or serous tissues, and that this action, as we
+shall now proceed to show, is allied in its nature to
+inflammation."</p></div>
+
+<p>In support of this opinion, Dr. <span class="smcap">Ayre</span> remarks, that all the phenomena
+belonging to cases of watery effusion, met with under one or other of
+the forms of inflammation, are common to those of dropsy. Thus the
+fluid, discharged under the cuticle in erysipelas or in inflammation
+induced by heat or a blister, or in cases of pemphigus, is a secretion,
+and resembles in all respects the fluid found in dropsy. In some cases
+of acknowledged inflammation, the fluid effused is found to vary greatly
+in its degree of tenuity, so as to be sometimes of quite a viscid
+nature. The same circumstance is met with in dropsy; the fluid of which
+varies sometimes in different forms of the disease, and at different
+periods in the<span class='pagenum'><a name="Page_83" id="Page_83">[Pg 83]</a></span> same patient. With regard to the absence of pain, in
+ordinary cases of local or general dropsy, which, in the minds of many
+physicians, might seem to militate against this view of the
+subject,&mdash;since pain accompanies the inflammation of a blister, Dr. A.
+very justly says, that the difference is referrible to a different
+degree of sensibility of the parts affected; that, moreover, in
+pemphigus there is no pain, and that chronic inflammation of the serous
+membranes is little painful.</p>
+
+<p>That the morbid action producing the effusion is only a modification of
+inflammation, our author thinks may be further shown by the fact that it
+obeys the same laws&mdash;being translated occasionally, like it, from one
+part of the body to another. On this subject, Dr. <span class="smcap">Ayre</span> makes the very
+pertinent remark, that in these cases, the fluid alone has been thought
+to be translated; but that the metastasis, is without doubt, exclusively
+of the action which produces the serous discharge. Analogous also to
+what occurs in inflammation, especially of the erysipelatous kind, the
+action occasioning the effusion, as seen in anasarca, commences at a
+given point, and gradually extends from thence in a continuous course.
+It ought also to be noticed, that the results of common inflammation
+vary according to the intensity of the cause; the lowest degree of it,
+occasioning an increase in the quantity of the proper fluids of the
+part,&mdash;a higher degree, yielding for its product coagulable lymph, and a
+still higher one producing pus. All these several products of common
+inflammation, are more or less remedial of their cause; or in other
+words, are the immediate means of the cessation or abatement of the
+inflammation which produces them. This same power is likewise a
+property, though in a much less degree, of the hydropic effusion, when
+the inflammation which produces it, is idiopathic; or in other words,
+not created by a visceral or other disease, or some particular
+excitement of the general system, as is seen in cases of anasarca.</p>
+
+<div class="blockquot"><p>"And here," continues our author, "it may be proper to remark
+upon a common error, committed by those, who, mistaking the
+nature of the action which produces the serous effusion, look
+in the <i>post mortem</i> examination, for some of the common signs
+of an inflammation having existed; and who conclude, upon not
+finding such, that the water was derived from some mechanical
+or other cause foreign to the true one. But in the higher forms
+of abdominal inflammation, the products are pus or lymph, and
+these are found upon the surface of the peritoneum, with
+sometimes a thickening<span class='pagenum'><a name="Page_84" id="Page_84">[Pg 84]</a></span> and discoloration or ulceration of its
+substance; whilst in the lowest form of that increased action
+to which the serous membranes are subject, the only product is
+the serous fluid, and there can be, therefore, no visible
+alteration produced by it in the structure of the serous
+tissue."</p>
+
+<p>"By the hydropic or serous inflammation, obeying the same laws
+which govern the other degrees of common inflammation, it
+follows, that upon a higher excitement being superinduced upon
+it, the serous effusion should cease. This, therefore, is found
+to happen in every case, where such higher excitement is
+brought on. This increased inflammation is sometimes occasioned
+by design or accident, and at other times, it occurs in the
+natural and progressive course of some disease, formed within
+the cavity, which is the seat of the dropsical effusion."</p></div>
+
+<p>This is exemplified in the effects of the operation for the radical cure
+of hydrocele; or in the operation of tapping in some cases of ovarian
+dropsy; or even in some instances, of ascites from chronic inflammation
+of the liver, spleen, mesentery, &amp;c. In all these cases, the serous
+membrane, which directly or indirectly was affected to a sufficient
+degree to occasion a serous effusion, takes on, from the extension of a
+visceral disease, or from some other cause, a higher degree of
+inflammation&mdash;lymph is thrown out, and the cavity becomes obliterated.</p>
+
+<div class="blockquot"><p>"Now from these, and similar examples, which have fallen under
+my observations, I think it may be assumed, that ascites, when
+proceeding from some visceral disease, (and the principle
+applies to hydropic effusions from the pressure of disease in
+other cavities,) does so by the gradual extension of the
+chronic inflammation of the internal cellular or serous tissues
+of the diseased organ, to its outer external coverings; and
+that, commencing here as from a point, the serous or hydropic
+inflammation is progressively propagated through the whole of
+the serous membrane of the cavity. By the disease within the
+cellular tissue of the diseased viscous increasing, a
+corresponding increase, in these cases, will ensue of the
+disease on the surface of the membrane investing it; until at
+length a susceptibility to take on a higher action is induced,
+which only requires any slight occasional cause to establish.
+Under this condition of an increased excitement in the
+peritoneal or other serous membrane, coagulable lymph is
+discharged into its cellular tissue, and a thickening of it
+takes place; until at length the operation of paracentesis,
+which in the early stage of the disease was attended with only
+inconsiderable inconvenience, becomes an adequate cause of a
+still higher inflammation, which terminates perhaps in
+suppuration; and, in the <i>post mortem</i> examination the serous
+fluid is found so mixed with coagulable lymph, and purulent
+matter, as to give a whey or milk-like appearance to the mass.
+The quantity of serous fluid, in these cases, is generally
+small, when compared with what was accumulated in the
+intervals<span class='pagenum'><a name="Page_85" id="Page_85">[Pg 85]</a></span> of former tappings; for the vascular excitement
+which occasions the discharge of coagulable lymph, is
+destructive of that which pours out the serous fluid."</p></div>
+
+<p>Dr. A. remarks, that, besides the particular facts deduced from
+observations on dropsy as a local disease, and which prove its relation
+to diseases of local excitement, there is a further support to be given
+to these views by various proofs that are afforded from observations
+upon the urine, of serous inflammation producing local dropsy, being
+frequently connected with one of a general kind. "So that the
+inflammatory state of the system becomes sometimes a cause of the
+effusion into a cavity, and at other times an effect of this state."
+After giving full credit to Drs. <span class="smcap">Wells</span> and <span class="smcap">Blackall</span> for their researches
+into the state of the urine in dropsy, our author remarks, that there
+are certain conclusions deducible, which appear not to have been
+contemplated by those gentlemen, but which are strictly accordant with
+the pathological views he has endeavoured to establish in the present
+work.</p>
+
+<div class="blockquot"><p>"According to these facts, it appears, that when the disease of
+dropsy is under a sub-acute form, and of the anasarcous kind,
+it is usually idiopathic, and, often originating from cold; and
+in this state, as well as in the symptomatic form, though in a
+less degree, the urine is found to contain a portion of serum.
+It is nearly peculiar to this disease, and denotes, according
+to the quantity of it contained in the urine, the amount of
+that excitement in the cellular tissue, and of the general
+vascular system, which may be termed serous inflammation: for
+it is met with most considerably in those forms of the disease,
+in which these particular states of the body are most
+apparent."</p></div>
+
+<p>Serum is therefore found in greater abundance, when anasarca precedes
+the local dropsy, which, in Dr. A.'s opinion, denotes the operation of a
+general cause. This is found to be the case especially in anasarca after
+scarlet fever. In cases of anasarca, the skin, kidneys, and bowels are
+very defective in their operation. Serum is also found, though in a
+smaller quantity, in those cases in which the anasarca has followed the
+local dropsy; for the disease of the viscus, which is the cause of the
+inflammation in the serous membrane of the cavity, may produce an
+adequate degree of the vascular excitement which gives rise to a
+discharge in the cellular tissue. Our author sums up his observations on
+this subject, by remarking, that there appear to be four distinct
+conditions of the system by which the occurrence of serum in the urine
+is regulated.<span class='pagenum'><a name="Page_86" id="Page_86">[Pg 86]</a></span></p>
+
+<div class="blockquot"><p>"1. It is in the greatest quantity, where along with a copious
+and continued effusion, there is a nearly corresponding
+quickness in the absorption of the serous fluid, and which will
+occur most commonly when the general excitement precedes, and
+is cause of the local one.</p>
+
+<p>"2. It is consequently, <i>c&aelig;teris paribus</i>, in a less quantity
+where the general hydropic excitement of the system succeeds,
+and is dependent on the local one.</p>
+
+<p>"3. It is absent, or found only in a minute proportion, in all
+those cases where the local increased excitement in the serous
+membrane is only partially extended to the rest of the system,
+and where the absorption from the part is inconsiderable; as
+particularly happens in the encysted kinds, or,</p>
+
+<p>"4. Where the effusion of the serous fluid has proved remedial
+of the inflammation producing it; in which case the disease, as
+it respects the presence of water in a part, may visibly
+resemble another example, and yet be essentially different from
+it, by the serous inflammation, which produced it in both,
+having ceased, on its occurrence, in one of them."</p></div>
+
+<p>Dr. A. discovers a further evidence of the relation which dropsy bears
+to diseases of local excitement, in the effects it produces on the
+general system. Thus, during the continued effusion of serum in
+anasarca, there is sometimes a large quantity absorbed and carried out
+of the body; by which a regular draught is made upon the nutrient
+principles of the blood, which must naturally create effects like those
+arising from the continued discharge of pus from a suppurating surface.
+In both cases the local disease, when extensive and of long duration,
+will necessarily occasion an exhaustion of the vital powers, by which
+that condition of the system termed cachexy will be induced.</p>
+
+<div class="blockquot"><p>"The exhausted or cachectical state, therefore, of the system,
+which has been so variously accounted for, and so frequently
+assigned as a principal cause of both local and general dropsy,
+is a direct consequence of the agency of some power diminishing
+the vital strength at its source; and in the case of a chronic
+and long continued serous inflammation, it will proceed from
+the daily abduction from the circulation of a portion of its
+vital fluid: and whether it be pus or serum that is drawn from
+the body; or whether it be from any permanent failure in the
+supplies of nutriment to it, the effect will be the same, as if
+a certain quantity of blood was daily abstracted from the
+system."</p></div>
+
+<p>Dr. A. continues to remark that, under these circumstances, a
+suppurating surface will readily become gangrenous, from any cause
+temporarily exciting it, and that, in like manner, a higher<span class='pagenum'><a name="Page_87" id="Page_87">[Pg 87]</a></span>
+inflammation may sometimes supervene upon an &oelig;dematous limb, as in
+the former case, and terminate in gangrene.</p>
+
+<div class="blockquot"><p>"Hence, therefore, the tendency of dropsical parts to fall into
+gangrene, and which has been urged, as an argument, in proof of
+debility being the cause of the serous effusion, is only what
+is common to other forms of local inflammation, under a similar
+condition of the body."</p></div>
+
+<p>From the view he has adopted of the nature of dropsy, Dr. <span class="smcap">Ayre</span> thinks
+that the excitement of the parts, giving rise to the effusion, may be
+either 1st. Sub-acute or chronic. 2nd. Symptomatic or idiopathic. In
+other words, that it may arise from a local disease, or from the common
+causes of inflammation; and that these causes may be either general or
+particular. 3d. That the serous inflammation may be either local or
+general, giving rise to a general or local effusion.</p>
+
+<p>After offering so copious an analysis of Dr. <span class="smcap">Ayre's</span> sentiments
+respecting the pathology of dropsy, it is unnecessary to enlarge very
+fully on the application of his theory to the particular forms of that
+disease. We shall, however, offer a rapid review, of some of his
+opinions, and next detail the method of treatment he proposes for the
+cure of these dangerous maladies. We commence with hydrocephalus, which
+he remarks has been divided into an acute and chronic form. This
+division, our author thinks, is correct in a certain sense; for the
+disease varies much in duration,&mdash;running its course, sometimes in a few
+days; and at other times continuing several weeks. Yet, he continues,
+the terms acute and chronic must be understood as restricted to that
+particular form of inflammation producing a serous effusion, and not as
+denoting the highest and lowest degrees of common inflammation. It is
+from the want of this distinction that much confusion has arisen in our
+speculations relative to the pathology of hydrocephalus.</p>
+
+<p>Dr. <span class="smcap">Ayre</span> calls our attention to the fact, that the forms of
+hydrocephalus denominated by Dr. <span class="smcap">Golis</span> hyperacute and acute, do not
+differ from the sub-acute phrenitis of nosologists, in which pus and
+coagulable lymph are the proper products, with sometimes a serous
+effusion into the ventricles as an accidental effect; all of which forms
+of inflammation, the serous membranes of the brain, and of other
+cavities are liable to take on; and adds:</p>
+
+<div class="blockquot"><p>"Now, the true hydrocephalus internus stands distinguished from
+these, in the nature of the inflammation of which it consists,
+in the same way, precisely, that the serous inflammation of the
+pleura, producing simple<span class='pagenum'><a name="Page_88" id="Page_88">[Pg 88]</a></span> hydrothorax, is distinct from that
+higher degree of vascular excitement, which occasions an
+effusion of pus or lymph. Relatively to these, therefore, the
+disease is in a chronic form; and consists, we may repeat, of
+that lowest degree of inflammation to which serous membranes
+are subject, and the effect of which is to increase the natural
+secretion of the part, so as to cause, in regard to the brain,
+an accumulation of that fluid in its cavities."</p></div>
+
+<p>Dropsy of the brain is usually divided into three stages. In the first,
+continues our author, vascular excitement exists, as denoted by pain in
+the head increasing in acuteness with the increase of the disease; and
+in infants by a restless movement of the head upon the pillow, moaning,
+occasional screamings, sickness, retching, impatience of light and
+noise, contractions of the pupils, delirious terrors, &amp;c. The second
+stage is indicated by signs of pressure on the brain by effused fluid,
+and by an absence of pain, excepting upon raising or moving the head,
+convulsions, permanent dilatation of the pupils, squinting, blindness,
+slow intermitting pulse, hemiplegia, and a peculiar placid expression of
+the countenance, &amp;c. The third stage is made up of some of these
+symptoms, together with other ulterior ones which follow the vascular
+reaction. On this subject, Dr. A. offers the following remarks:</p>
+
+<div class="blockquot"><p>"With respect, however, to the division thus formed of this
+disease, it is, I think, somewhat questionable, whether it be
+pathologically correct; for strictly speaking, the true disease
+is comprised between the incipient beginnings of the
+inflammation, and its termination by the effusion; since the
+symptoms which follow, and compose what are called the second
+and third stages, are little more than the consequences of the
+disease, and arise from the mechanical pressure of the water
+upon the brain. The progress, therefore, of what may be
+strictly considered the disease, should perhaps be considered
+as terminating with the occurrence of the effusion, which is
+often remedial of the excitement causing it; and the whole
+disorder, to be thus made up of two distinct states, the first
+consisting of symptoms, which commencing with the excitement,
+terminate with the serous discharge; whilst the second is
+composed of those of a secondary kind, and which are wholly
+dependent for their origin and continuance, on a mechanical
+pressure from the effused fluid."</p></div>
+
+<p>Hydrocephalus may occur, either as an idiopathic or symptomatic
+affection. As the first, it may arise, where there exists a
+predisposition in the brain, from various injuries inflicted on the head
+by slight blows;&mdash;from all the general causes of inflammation&mdash;from the
+sudden drying up of long established discharges&mdash;the sudden repulsion of
+cutaneous eruptions, or the imperfect<span class='pagenum'><a name="Page_89" id="Page_89">[Pg 89]</a></span> evolution of that or other
+sanative actions of the system, at the close of some febrile diseases,
+usually denominated defect of crisis. When, on the other hand, the
+disease is symptomatic, it may arise from a particular cause seated
+within the head, or in some distant part of the body. The former variety
+is not common among children, and when it does occur, it is the result
+of some chronic disease, as a tumour or a thickened state of the
+arachnoid or other membranes of the brain, resulting from a former
+inflammation. "Sometimes, adult patients wholly recover from chronic or
+sub-acute inflammation, which induced the structural disease, and this
+last becomes, at some future period, the occasional cause of the
+hydropic one." At other times, the chronic inflammation continues, and
+finally extends to the serous membrane, giving rise to the effusion.</p>
+
+<div class="blockquot"><p>"The most usual cause of the disease, however, particularly in
+children, is an irritation which is sympathetically
+communicated to the brain, from a disturbance in the
+chylopoietic organs; and particularly from a functional
+disorder of the liver. The cerebral disorder, to which a
+derangement in the digestive functions thus gives rise, is only
+one of those numerous effects which arise out of sympathies,
+subsisting between these organs and different parts of the
+system. In many cases, the same sympathetic irritation is
+successively and variously directed to different parts of the
+system. It will thus leave one organ or part, and suddenly move
+to another; and through the operation of causes, which are not
+always obvious, but which have a relation to some particular
+predisposition, inherent or acquired. In this way, an
+irritation may occasion an eruption upon the skin, and thence
+be translated to the bronchial lining, producing a cough; and
+next perhaps, to the serous tissue of the brain, exciting there
+a turgescent or congestive state of the cerebral vessels, by
+which symptoms are produced, through the pressure of the
+congestive vessels, that simulate those of hydrocephalus; or
+the true disease is brought on by an arterial re-action,
+ensuing upon the congestion, which is resolved by a serous
+effusion."</p></div>
+
+<p>Dr. <span class="smcap">Golis</span>, from observing the marked connexion "between the turgescent
+state of the brain from chylopoietic disturbance, and its serous
+inflammation, has concluded, that it essentially pertains to it;"
+consequently, that "whenever it occurs, it is a part of it;" that it
+should be considered as forming the first stage of the disease, and that
+in all instances, it precedes the excitement. He has, for the same
+reason, constituted all the symptoms of the chylopoietic disease into
+the first stage of hydrocephalus. Dr. <span class="smcap">Ayre</span> shows, however, that this
+state of turgescence, is not essential<span class='pagenum'><a name="Page_90" id="Page_90">[Pg 90]</a></span> to the disease, and is only a
+sympathetic effect, which in the majority of instances, requires no
+treatment, (at least a very subordinate one,) other than that of the
+primary affection. He concludes his remarks on hydrocephalus, with the
+following words.</p>
+
+<div class="blockquot"><p>"The cerebral turgescence and disturbance, therefore, in
+whatever degree they may exist, are only, when sympathetically
+produced, to be considered as morbid causes, whose presence,
+where the predisposition prevails, may lead to a serous
+inflammation of the tissues of the brain, but which do not
+form, in any sense, parts of the disease itself; since, under
+every degree of them, they are so frequently remediable, by
+means which are alone available, for the removal of their
+distant and sympathetic cause."</p></div>
+
+<p>Of <i>Hydrothorax</i>, Dr. <span class="smcap">Ayre</span> very justly remarks, that, as its name
+imports and as defined by Nosologists, it consists of symptoms, which
+strictly speaking, pertain only remotely to the true disease&mdash;arising,
+as they do, from a certain disturbance given to the lungs, by the
+pressure of water upon them. They are only the symptoms, therefore, of
+the effusion, and as the excitement sometimes terminates with the
+occurrence of the serous discharge, its existence, in many cases, is
+discoverable only by its effects&mdash;there existing no signs, which clearly
+point out the presence of that state, previous to the appearance of the
+effusion; and what are usually called, by writers on the subject,
+premonitory symptoms, being only those of an inferior degree of the
+effusion which has already commenced.</p>
+
+<p>Like hydrocephalus, hydrothorax may be idiopathic or symptomatic; and
+proceed from a local or general cause&mdash;the nature of the inflammation
+being the same in both cases. It may likewise be divided into an acute
+and chronic form. When the disease is symptomatic, and arises from a
+local cause, it is generally chronic. When it arises secondarily from a
+disease of the lungs, our author thinks, that</p>
+
+<div class="blockquot"><p>"The mode by which this state is induced in the serous
+membranes, is by the chronic inflammation that exists in the
+diseased organ extending to them; and not by the same form of
+inflammation being set up in them, by a certain sympathy or
+consent of parts, which, from a loose analogy, has been thought
+to subsist between similar structures."</p></div>
+
+<p>All diseases of the thoracic organs, are not equally prone to occasion
+effusion; some of these also, are only dangerous to life, in proportion
+to their disposition in occasioning such an effusion;<span class='pagenum'><a name="Page_91" id="Page_91">[Pg 91]</a></span> whilst in other
+cases, if it occurs at all, the effusion is only the sequel of a disease
+essentially fatal.</p>
+
+<div class="blockquot"><p>"To distinguish between these two conditions, is a desideratum
+pathology. Modern writers on pathological anatomy have
+prosecuted with considerable zeal and ability, their researches
+into the nature of the diseases of the organs within the chest,
+but they have done but little towards elucidating the true
+relation, which subsists between the diseases of the several
+viscera, and the serous effusions which take place into their
+cavities; for, by limiting their views to the disease which the
+<i>post mortem</i> examination exhibited, they have overlooked those
+intermediate actions or states of excitement which connect the
+organic disease with such effusions."</p></div>
+
+<p>Whenever the excitement, producing hydrothorax, is idiopathic and
+independent of an organic disease of the lungs, heart, &amp;c. its remote
+causes may be either of a general or local kind; and are the same which
+produce, when applied in a higher degree, or under different states of
+the system, the other forms of inflammation. The effusion may take place
+in those cases in which, the individual being predisposed, the
+inflammation, owing to some peculiarity in the cause, does not reach
+beyond its lowest grade; or in those in which the inflammation being
+high, and treated too late, or by insufficient means, a chronic form
+succeeds to the acute one, which may produce a watery effusion; or some
+structural disease remains and eventually becomes a cause of the
+effusion. The occurrence of this effect, in those latter cases, is
+sometimes attributed to a debility, resulting from the large depletion
+required in consequence of the severity of the previous inflammation.</p>
+
+<div class="blockquot"><p>"That such opinions, however, are founded in error, may be
+shown from this, that the effusion, thus imputed to debility,
+does not occur sometimes, until some weeks or months after the
+period when the bleeding was employed; and although the
+debility is confessedly of a general kind, yet the effusion is
+local, and is precisely in the very cavity where the disease
+existed, which required the unjustly condemned evacuations. The
+truth of the matter is, that in such cases, either the
+depletory means have been employed in an insufficient degree,
+or too late." "The imperfect recovery of such patients from
+their first attack, and, which is attributed to the depletion,
+arises from the disease which is left by it, and to the
+injudicious means, perhaps, that are employed by the too
+anxious attendants, with the view of restoring the strength."</p></div>
+
+<p>Among the ordinary predisposing and exciting causes of the inflammation
+which produces hydrothorax, Dr. A. mentions a certain congestive or
+plethoric state of the circulation, which is brought<span class='pagenum'><a name="Page_92" id="Page_92">[Pg 92]</a></span> on in some persons
+of particular habits, by indulging in the pleasures of the table, and
+taking little exercise. These cases are analogous to those occurring in
+the brain, and giving rise, by rupture, to a sanguineous apoplexy, or,
+by arterial reaction, inducing an effusion of serum.</p>
+
+<p>Dr. A. next proceeds to the subject of <i>ascites</i>, the symptoms of which
+he remarks are at first so obscure, that the disease is sometimes with
+difficulty detected. The remote causes of ascites may be either
+symptomatic or idiopathic, and either local or general. When
+symptomatic, it may be seated in some diseased viscus, as the liver,
+spleen, or in the mesenteric glands, &amp;c.</p>
+
+<div class="blockquot"><p>"To produce, however, a dropsical effusion into the abdomen
+from this cause, it is necessary that the disease of this
+viscus should be making progress; for, in its indolent state,
+or, in other words, if inflammation be not present in it, it is
+incapable from its mere bulk, as is commonly but erroneously
+supposed, of producing this effect." "Nor does the serous
+discharge always take place into the abdomen, in every case
+where these organs are morbidly affected, but only where their
+peritoneal covering participates in the disease; for the
+chronic inflammation in those cases, where it occasions
+ascites, does so by extending from the cellular tissue of the
+internal structure of the organ, to the serous tissue investing
+in it." "When ascites is an idiopathic affection, it may
+proceed from all the common causes of inflammation. The most
+frequent cause is cold, and which may act either locally or
+generally. When in the latter mode, the ascites is usually
+combined with anasarca, and the disorder generally comes on
+suddenly, and has a rapid progress. The vascular system is
+excited, and there is more than usual thirst; the blood when
+drawn exhibits the buffy appearance; and the urine, when
+subjected to heat, is found to coagulate strongly, from the
+large quantity of serum contained in it. In some of the severer
+cases, the effusion into the abdomen takes place very suddenly,
+and yet, by a copious bleeding the disease may be at once
+arrested, and the water be afterwards absorbed."</p></div>
+
+<p>Unlike what occurs in hydrothorax and hydrocephalus, the effusion in the
+present form of dropsy is of inconsiderable importance, compared to the
+visceral disease which is its remote cause. When, however, the
+accumulation becomes very considerable, the pressure of the fluid may
+affect the organs, and more particularly the peritoneal lining, which
+from the irritation induced in it, may take on a higher grade of
+inflammation, terminating in effusion of coagulable lymph or pus, and in
+death. The necessity which arises of tapping, where the effusion is very
+considerable, proves sometimes a farther cause, perhaps, of aggravating<span class='pagenum'><a name="Page_93" id="Page_93">[Pg 93]</a></span>
+the disease of the affected viscus, and either of renewing or extending
+the hydropic excitement, or of converting it into a higher or more
+destructive form of inflammation.</p>
+
+<p>By most writers on dropsy, anasarca has been maintained to originate, in
+all instances, in debility, and to be curable only by a tonic and
+invigorating plan. It is true that some writers, especially among the
+ancients, (for we can hardly class <span class="smcap">Portal</span> among the moderns,) have
+spoken of the disease as arising occasionally from a plethoric state of
+the circulation, and enforced the necessity, under these circumstances,
+of venesection. This view of the pathology of anasarca, although leading
+in many instances to a successful practice, was, however, vague and
+often unsatisfactory. To the late Dr. <span class="smcap">Rush</span>, and to Dr. <span class="smcap">Parry</span>, much
+credit is certainly due for their labours on this subject; but so far as
+we are informed, it was not until within a few years, that the subject
+was cleared of part of the obscurity in which is was involved, and that
+the disease, at least the active sort, has been referred to an
+irritation of the cellular tissue. Following up this opinion, and
+generalizing still more than the French pathologists, our author asserts
+that anasarca invariably consists in an inflammation of the cellular
+membrane of the body, with a serous effusion as its result. The
+accumulation, he continues, may be either idiopathic or symptomatic, and
+either general or local; occurring only under two forms, the one being
+of greater intensity that the other. In general, the disease derives all
+its importance from the nature of the remote cause.</p>
+
+<div class="blockquot"><p>"When it is idiopathic and proceeding from cold, it is usually
+unimportant, for though the progress of the swelling be rapid,
+and the appearance of the disease formidable, yet it readily
+subsides under proper treatment, as the effusion proves in
+these cases, either partially or fully corrective of its cause;
+and little more, under such circumstances, is required in its
+treatment, than to promote the absorption of the water. In some
+cases of general anasarca, however, the disease is more severe;
+for sometimes the action of the heart and arteries is
+increased, the urine becomes loaded with serum, and there is
+thirst and other indications of general vascular excitement,
+similar to the state which was noticed, as producing effusion
+into the brain, or the other cavities of the body."</p></div>
+
+<p>In some cases, the serous effusion appears to be translated from one
+part to another. Our author very justly adds, however, that this
+translation is not of the serous fluid, but only of the serous<span class='pagenum'><a name="Page_94" id="Page_94">[Pg 94]</a></span>
+inflammation giving rise to the effusion. It usually takes place from
+one portion of the cellular membrane to another; but sometimes from this
+membrane to the serous tissue of the brain, chest, or abdomen.</p>
+
+<p>&OElig;dema of the feet and ankles is often symptomatic of chylopoietic
+disturbance, and particularly in young women, in whom the menstrual
+function is obstructed. In these cases, as well as in the &oelig;dema
+following gout or rheumatism, the swelling usually commences with
+considerable pain and stiffness of the parts, and hardness of the
+swelling.</p>
+
+<div class="blockquot"><p>"But the most common form of anasarca is that which is
+symptomatic of some visceral disease; and which, as it
+ordinarily appears, arises from a state of the system that
+answers to the hydropic diathesis of systematic authors."</p></div>
+
+<p>This form of the disease begins in the lower extremities, and is rarely
+attended with strong signs of local excitement so obvious in anasarca of
+the idiopathic kind. Its occurrence has been referred to various causes.
+When combined with ascites, it is supposed to arise from pressure of the
+iliac veins by the fluid accumulated in the abdomen,&mdash;an opinion which
+our author combats by repeating, in great measure, the arguments we have
+already noticed.</p>
+
+<div class="blockquot"><p>"But here let me observe, that the denial of ascites producing
+an anasarcous state of the legs, from the water compressing the
+iliac veins, must not be understood as implying, that a
+mechanical compression of a vein will not in other cases
+produce an effect of this kind. A pressure made on the brachial
+vein and its branches by scirrhous glands in the axilla, is a
+common cause of this state. The remote cause is here, indeed,
+of a mechanical kind, but not so the proximate cause of the
+effusion. By the resistance given, in this case, to the blood's
+return by the principal veins of the limb, a reaction is
+occasioned in the extremities of the arteries leading into the
+corresponding extreme branches of the veins, and which reaction
+is in this, as in a multitude of other occasions of congestive
+fulness in these vessels, a sanative effort of nature to
+overcome the primary obstruction."</p></div>
+
+<p>The disease has often been referred, when occurring under these
+circumstances, to a local and general debility; and this opinion is
+thought to be supported by the facts that the swelling is increased by a
+depending position of the limb, and diminished by a horizontal one&mdash;by
+the occurrence of an inflammatory state of the parts being incompatible
+with such a degree of debility, and lastly by the absence of
+preternatural heat on the surface of an<span class='pagenum'><a name="Page_95" id="Page_95">[Pg 95]</a></span> &oelig;dematous part. To these
+pretended arguments, Dr. A. opposes, that the effusion cannot be
+attributed purely to debility; because the effects are in no
+correspondence with the assigned cause,&mdash;the debility being, in some
+instances of chronic and acute disease, very considerable, and the
+effusion small, and vice versa;&mdash;because anasarcous limbs will occur in
+the strongest individuals when the limbs have remained a long time in an
+erect posture,&mdash;because there is in certain fatal chronic diseases, a
+tendency in the lower limbs to take on an inflammatory action, often of
+an erysipelatous kind,&mdash;and because the fact of &oelig;dema increasing by
+an erect posture and diminishing in the horizontal one is readily
+explained by the greater congestion of the vessels induced in the limb
+by such a position, as it occurs in the higher grades of inflammation.</p>
+
+<div class="blockquot"><p>"And with respect to the temperature of the surface of
+&oelig;dematous parts not being preternaturally raised, the
+objection, if of any force, must apply to all, for all have
+this peculiarity, and yet some cases of &oelig;dema confessedly
+arise from inflammation; differing not, in this respect, from
+several other morbid states, as those for instance, of chronic
+rheumatism, and which are indubitably, as indicated by the
+nature of their causes and remedies, of a truly inflammatory
+kind."</p></div>
+
+<p>Dr. <span class="smcap">Ayre</span>, therefore, regards all these cases as secondary to a serous
+inflammation seated in a cavity; and lastly as arising from some
+disturbance in the digestive functions, by which this and other distant
+irritations are produced through the operation of that law of the animal
+economy, denominated sympathy.</p>
+
+<p>Having thus offered, in the preceding pages, an analysis of Dr. <span class="smcap">Ayre's</span>
+views of the pathology of the principal forms of dropsy, we must be
+allowed, before proceeding to the treatment of the disease, to make a
+few remarks. It appears to us that Dr. A. has treated the subject in a
+very able manner, and contributed greatly to remove many objections,
+that could be adduced against the opinion of the inflammatory nature of
+some of the more obscure cases of dropsy. We cannot help thinking,
+however, that he is too exclusive in his theories, and that he has
+rejected too positively the idea of a passive dropsy; in other words, of
+a dropsy independent of inflammation. Some cases of the disease which
+follow extensive losses of blood, (profuse uterine hemorrhages, for
+example) and which are cured by tonics and an invigorating diet, without
+the aid of diuretics, cannot always, though<span class='pagenum'><a name="Page_96" id="Page_96">[Pg 96]</a></span> they may sometimes, be
+accounted for by admitting the existence of inflammation. Such instances
+have fallen under our own observations, and could not be explained by
+supposing that the effusion had relieved the inflammation; since there
+had not existed, at least as far as we could ascertain, any local
+inflammation. In one case it followed abortion, attended with profuse
+hemorrhage, and produced, not by disease, but by an accident.</p>
+
+<p>In the second and fifth volumes of the <i>Archives G&eacute;n&eacute;rales de M&eacute;decine</i>,
+Dr. <span class="smcap">Bouillaud</span> has related many cases of partial and general dropsy,
+which undoubtedly originated in obstruction to the venous circulation,
+from adhesion of the parietes of the principal veins. It is true that
+Dr. A. is compelled to admit this among the causes of dropsy; but
+faithful to his theory, he supposed the supervention of an arterial
+reaction resulting in an effusion of serum. It does not appear to us,
+however, that this arterial reaction is admissible in all cases of the
+sort, and we prefer on the whole the explanation of the mechanism of the
+effusion, originally given, by <span class="smcap">Donald Monro</span>, and lately by Drs.
+<span class="smcap">Bouillaud</span> and <span class="smcap">Broussais</span>, who refer it to an obstruction in the venous
+circulation and to a consequent deficient venous absorption. By
+admitting this explanation, it is readily perceived, that we admit a
+passive dropsy, and we think the view well exemplified by a case which
+occurred last summer. The individual had recently recovered from a
+violent attack of disease, and was left much debilitated. Induced by
+this circumstance to travel to the north, he had occasion to notice that
+when seated long in a stage with his feet depending on the veins
+compressed, &oelig;dema invariably came on, and that it as invariably went
+off the next day if he did not ride. This occurred so often as to lead
+us to think there could not always be an arterial reaction occasioning
+the effusion, and that this effect arose from the mere obstruction to
+the venous circulation.</p>
+
+<p>In making these remarks we are not actuated by the desire of detracting
+from the merits of Dr. A.'s views of the pathology of dropsy; convinced
+as we are, that the great majority of cases of the disease, which are
+thought by many physicians to arise from debility, do not owe their
+origin to this condition of the system, but to an increased excitement
+of the membranes or cellular tissue. Were it otherwise, how could we
+account for the fact,<span class='pagenum'><a name="Page_97" id="Page_97">[Pg 97]</a></span> that dropsy is generally <i>local</i>, whilst the
+<i>debility</i> to which it is in most instances referred, is general?</p>
+
+<p>But whilst maintaining the correctness of many of Dr. A.'s views, we are
+inclined to the opinion, that he may do some injury to the doctrine he
+is advocating, by invariably making use of the word <i>inflammation</i>, to
+express that condition of the vessels, giving rise to an excessive
+secretion of serous fluid. We are ready to admit, and we dare hope, that
+few will refuse to do so, that <i>inflammation</i>, strictly speaking, will
+occasion such an effect; yet, it often happens, that effusion will occur
+in cases, where no inflammation can be detected. In such instances, the
+vessels are evidently in a state of increased excitement; or in other
+words, in a state of irritation, but not of inflammation, which always
+implies congestion. This latter morbid condition, may supervene on the
+irritation, and occasion a suppression of the serous effusion, and the
+formation of coagulable lymph or pus. It is true, it may be said, that
+both these states (irritation and inflammation) being an increase of the
+life of the part, and requiring the same treatment, may be designated by
+the same name. Nevertheless, to prevent confusion, and the quibbling of
+some of the opponents of the theory of inflammation in dropsy, we are
+inclined to believe, that it is better to substitute the word
+irritation, whenever there is merely an increased secretion, and reserve
+the word inflammation, to designate those cases, in which there are
+decided marks of local excitement and congestion, attended or not with
+general fever.</p>
+
+<p>Dr. <span class="smcap">Ayre</span>, adopting the opinion of Dr. <span class="smcap">Parry</span>, regards some cases of local
+dropsy as an effect of a general hydropic diathesis, or of a general
+inflammatory action of the vascular system, occasioning a local
+excitement, ending in dropsy. This is a natural consequence of the
+views, entertained by many physicians in Europe and this country, that
+fever produces local inflammation. We must confess, however, that all
+Dr. A. has said on the subject, is not calculated to carry conviction to
+our minds. Thus, one of his reasons for regarding some cases, as arising
+from this general vascular excitement is, that they are produced by what
+he considers as a general cause,&mdash;as cold, for example. But cold
+produces local diseases, occasioning, and not preceded by, a febrile
+excitement; and if it can, and does occasion anasarca, who will pretend
+to assert, from its being a <i>general</i> cause, that this anasarca is a
+general<span class='pagenum'><a name="Page_98" id="Page_98">[Pg 98]</a></span> disease? Does not cold occasion also ascites, which, in many
+cases, is regarded by every one as a local disease, sometimes
+terminating in anasarca? If so, why shall we regard anasarca, ending in
+ascites, as a general disease? The cases are analogous, and the action
+in both should not be explained differently. If the action of such a
+cause were really general, and extended to all parts of the body, then
+the effects should also be general, and the dropsy should be universal,
+which is very far from being always the case.</p>
+
+<p>2nd. It is also said in support of this opinion, that where anasarca is
+idiopathic, it is attended with fever, but that this latter does not
+exist, when the disease follows ascites. This difference appears to us
+to be very readily explained by the fact, that the disease in the former
+case, is more acute, and that the heart sympathises more actively with
+the irritated cellular tissue, than in the second case, when the disease
+is milder, or more gradual in its progress.</p>
+
+<p>3d. It is also maintained, that when anasarca is idiopathic, there
+exists a large quantity of serum in the urine; and this is brought
+forward in order to distinguish these cases from local dropsies. But it
+is also admitted, that serum is found in the urine in cases of anasarca
+following ascites. Consequently, if there be none in cases of simple
+ascites, and if it only appears when anasarca supervenes, the only
+conclusion that may be drawn from these facts, is, that anasarca is the
+only form of dropsy, in which serum is absorbed, and passed off by the
+kidneys; and if there be a greater quantity discharged when anasarca is
+primary, it is only because the disease is more violent, and generally
+more extensive. But, surely all this is far from proving, that primary
+anasarca is a general disease, and owes its origin to a primary arterial
+excitement of the whole system. When fever exists first, and terminates
+in dropsy, who has proved, that there existed no local irritation
+producing the fever, and that the hydropic irritation has not supervened
+by metastasis. This takes place in scarlatina and other eruptive
+diseases, which Dr. A. would surely not be justified in calling general
+diseases. Dropsy follows the suppression of cutaneous diseases,
+unattended with fever; consequently, when there happens to be a febrile
+excitement, we are at a loss to know, why we should call this latter to
+our aid, in our explanation of the dropsical effusion, and not account
+for it on the same principle, as we did in the former cases; namely, by
+metastasis. If febrile symptoms<span class='pagenum'><a name="Page_99" id="Page_99">[Pg 99]</a></span> are sufficient to make us regard a
+disease as general, then there is no local disease, except when
+apyretic.</p>
+
+<p>We now proceed to notice the mode of treatment, recommended by our
+author, for the different forms of dropsy. From what we have seen, it is
+natural to conclude, that as Dr. <span class="smcap">Ayre</span> regards the proximate cause of the
+several forms of the effusion, or in other words, the <i>disease</i>, to be
+the same under all its conditions, he will be of opinion, that "the same
+general principles of treatment, are alike applicable to all&mdash;subject
+only to such modifications, as arise from differences in the nature and
+intensity of the remote cause, and those general or local relations of
+the parts implicated in the serous effusion, with the diseases of the
+organs, which incidentally produce it." Founding upon these views the
+indications of cure, he states them to be; 1st. To remove the visceral,
+or such other disease or state, which, when present, proves a remote
+cause of the effusion; 2nd. To remove the morbidly increased action in
+the serous membrane or tissue, which is its proximate cause. 3d. To
+promote the absorption of the effused fluid.</p>
+
+<p>Agreeably to Dr. A. the treatment of hydrocephalus internus, is
+divisible into three general heads:</p>
+
+<div class="blockquot"><p>"The first, consisting of means to correct, with its causes,
+that turgescent state of the brain, which may produce the
+arterial re-action and effusion; the second, of those which
+shall subdue the excitement, when formed; the third, to correct
+or relieve, as far as it is practicable, the effects of the
+effusion, and procure, if possible, its absorption."</p></div>
+
+<p>With respect to the general causes, tending to produce that congestive
+state of the brain, precursory to its inflammation, he remarks, that
+they are of three kinds; 1st. Those acting through the general system,
+and consisting of an irritation, from some obstructed or required
+evacuation; 2nd. A local disease, seated in the head, or a local injury
+inflicted on it; 3d. Chylopoietic disturbance, acting sympathetically
+upon the brain. When the first of these causes appears to have been
+instrumental, in occasioning this condition of the brain, it is plain
+that it must be removed, and the obstructed emunctory corrected,&mdash;the
+suppressed evacuation promoted, or a new and artificial one substituted.
+When there exists any structural disease within the head, or a relic of
+a former state of excitement, a serous inflammation may be reasonably
+apprehended, and to avert it, the most rigid and undeviating attention<span class='pagenum'><a name="Page_100" id="Page_100">[Pg 100]</a></span>
+must be paid to regimen, whilst cupping and leeching must be employed,
+and a seton fixed in the neck.</p>
+
+<div class="blockquot"><p>"For the object of the treatment, in these cases, is not to
+remove, but to avert the inflammation, and which, from the
+strong disposition to it, conferred by the organic disease, can
+only be effected by avoiding, not merely the causes of
+inflammation, but likewise, all those agents, which are
+calculated, in any way, to increase the momentum of the
+circulation." "Beyond those, the common precautions against
+morbid irritations, little else can be done."</p></div>
+
+<p>When the turgescent state of the brain, arises from a disturbance in the
+digestive organs, it will be remedied, by means directed to this cause.
+Our author locates the primary seat of this disturbance, in most cases,
+in the liver; though he admits, it may occasionally be in the stomach
+and intestines. He places great reliance for correcting and increasing
+the secretion of bile, on small doses of calomel,&mdash;purging off the
+contents of the intestines by aperient medicines; and recommends, at the
+same time, the application of cups and leeches to the temples, as a
+measure of precaution. He very properly lays considerable stress on the
+necessity of combating this secondary affection of the head;</p>
+
+<div class="blockquot"><p>"For though the means applied, to correct the disorder in the
+digestive organs, may be sufficient to remove the turgescent
+state of the brain, which arose from it, yet, those means will
+have little or no control over the excitement, which that
+turgescent state has created; and still less can they avail in
+subduing an excitement, that may even survive its remote cause,
+and continue independently of it. By overlooking these facts,
+much distrust and disappointment have arisen with many, who
+confided in the opinion, delivered by some writers, of the
+uniform prevalency of chylopoietic disturbance, as a cause of
+this disease, and of the sufficiency of calomel to remove it."</p></div>
+
+<p>When the inflammation exists, and is a sequel of some pre-existing
+structural disease in the brain or membranes, all that can be reasonably
+expected, is to <i>palliate</i> it by the antiphlogistic plan; but when it is
+idiopathic it may readily be cured, by the same remedies, graduated to
+the age and strength of the patient and to the violence of the attack.
+Dr. A. seems to rely principally on cups and leeches;&mdash;not excluding, in
+some cases, bleeding from the arm. Blisters to the summit of the head
+and afterwards a cold evaporating lotion to the temples, are also
+recommended. As soon as, by these means, an impression is made on the
+disease, mild diaphoretic medicines, assisted by the tepid bath, or the
+pediluvium,<span class='pagenum'><a name="Page_101" id="Page_101">[Pg 101]</a></span> maybe prescribed;&mdash;the bowels are to be kept open by small
+doses of calomel, followed after two hours by a draught of some aperient
+medicine,&mdash;the antiphlogistic regimen should be rigidly enforced, and
+light and noise carefully excluded.</p>
+
+<div class="blockquot"><p>"Many practitioners give the mild preparations of mercury, and
+particularly calomel, freely in this disease, under a notion of
+its having some specific power in subduing it; but it never
+should be so used, excepting in cases where the disease is
+symptomatic of some functional disturbance in the liver and
+other chylopoietic organs, where it is calculated, in
+conjunction with the local bleeding, &amp;c. to afford the most
+important service."</p></div>
+
+<p>With a view of pointing out some characteristic sign, by which to
+distinguish those cases in which the affection of the bowels is primary
+from those in which it is secondary, he remarks&mdash;</p>
+
+<div class="blockquot"><p>"The condition of the stools at the period when a child is
+labouring under the disease, will afford to such persons but an
+imperfect notion of its true nature; for the disturbance of the
+brain will often create a disorder in the secretions, both of
+the liver and the other chylopoietic organs, producing green
+looking stools; and there is often a congestive state of the
+brain for a short time preceding the full development of the
+idiopathic excitement, which may, in like manner, by reacting
+upon the liver, create a disorder there. In cases, however,
+which are symptomatic of this cause, the chylopoietic
+disturbance will be found to have existed several days or even
+weeks; and the origin of the disorder, in like manner, may be
+commonly traced to some irregularity of diet, or other obvious
+causes, and frequently in infants to those which are connected
+with premature weaning; and sometimes even the cerebral
+disorder itself will have been only the last of a series of
+effects in the system, to which such disturbance had given
+rise."</p></div>
+
+<p>Agreeably to Dr. A., it is not proper to discontinue those means,
+immediately upon the occurrence of what appears to be symptoms of
+effusion, since, frequently, these symptoms, as it respects the
+effusion, will immediately manifest their fictitious character, and
+disappear under a treatment no wise adapted to such a state, and with a
+rapidity, too, which equally betrays their true nature. He notices,
+though we believe not in its proper place, a modification of the disease
+in which the effusion takes place in the cellular membrane of the
+substance of the brain, and thinks this species more likely to be
+recovered from than when the water accumulates in the ventricles. He
+concludes this section by remarking, that</p>
+
+<div class="blockquot"><p>"Of the means to be employed to promote the absorption of the
+water, under these or other circumstances of its accumulation
+in the brain, little satisfactory can be said. The treatment
+must be founded on the use of<span class='pagenum'><a name="Page_102" id="Page_102">[Pg 102]</a></span> such means as shall avert the
+risk of renewing an inflammation in the organ. To this end,
+occasional blistering the head will be proper; the diet must be
+spare, and the several secretions, particularly those of the
+kidneys, must be cautiously promoted."</p></div>
+
+<p>We next turn to the treatment of hydrothorax and ascites. As the
+existence of hydrothorax in its early stage is difficult to ascertain,
+and as what have been called premonitory symptoms are only those proper
+to the mildest forms of the disease, and not of that condition of the
+parts which gives rise to the effusion, the treatment is somewhat
+difficult, and, in too many instances, our remedies are directed, not to
+the disease itself, but to one of its effects. Faithful to his view of
+the pathology of dropsy, Dr. A. remarks, that the plan of treatment to
+be pursued at an early stage of symptomatic hydrothorax, must consist in
+the use of those means which shall subdue the chronic excitement of the
+serous membrane, as well as the chronic inflammation of the diseased
+organ. To attain this end, the antiphlogistic and revulsive plans,
+graduated to the age and strength of the patient, and to the violence of
+the disease are recommended. In general the frequent application of
+leeches are held by Dr. A. as preferable to venesection, unless the
+patient be plethoric, and the disease arise from a local congestion
+within the chest, which, according to him, is often a cause of serous
+inflammation of the thoracic tissue, independently of any previous
+disease. Dr. <span class="smcap">Ayre</span> calls attention to the fact, that topical bleeding is
+particularly adapted to correct that chronic inflammation of the serous
+membranes, which causes an effusion from them, and which is neither the
+result of any inflammatory excitement of the general system, nor of a
+nature to produce it; and that when properly conducted, it has the
+advantage of acting only slightly on the general system, and therefore
+only slightly on the general strength, and very considerably on the
+local disease. Together with leeches, blisters are to be used, and after
+the chronic action existing in the serous membrane is subdued by these
+means, a seton fixed in the integuments of the chest will be found of
+great utility.</p>
+
+<p>The same treatment will be found equally serviceable, not only to
+correct the chronic excitement existing in the peritoneal membrane and
+giving rise to ascites, but very commonly to cure or palliate the
+visceral disease producing it. In respect to the very<span class='pagenum'><a name="Page_103" id="Page_103">[Pg 103]</a></span> common practice
+of resorting to mercury in this complaint, our author makes the
+following judicious remarks.</p>
+
+<div class="blockquot"><p>"With too many practitioners, it is the practice to employ
+mercury freely in every case of abdominal dropsy, under the
+vague notion of there existing some mechanical obstruction in
+the liver or other viscus, as a cause of it; and under the
+equally vague notion, that mercury so employed will remove it.
+The practice, however, to speak of it in the mildest terms, is
+founded on erroneous views of the pathology of these diseases;
+and employed, therefore, as it is by some, on all the occasions
+in which they meet with them, must be frequently very
+injurious. For, independently of the injury to be inflicted by
+it, when given freely in some of the forms of liver disease,
+there is an effect produced by it on the urine, when given to a
+person in health, resembling that which arises from the
+specific excitement of dropsy. Under a salivation, the urine
+becomes charged with serum. Any condition of the system,
+therefore, approaching even to a state of salivation, must be
+injurious, by the tendency it must have to increase that morbid
+state of the body, which is nearest allied to the hydropic one.
+Hence the mercurial salivation has been numbered amongst the
+remote causes of dropsy; and the resemblance between the
+dropsical and mercurial excitement, thus established by the
+common resemblance of the urine in these states, goes far to
+prove this connexion; and it is not improbable, that the
+mercurial inflammation, when considerable, may survive its
+specific cause, and degenerate at length into the purely
+hydropic state. When, however, mercury is given in minute
+doses, so that these its specific morbid effects are not
+produced, it is capable of becoming highly useful, as we shall
+presently have occasion to notice."</p></div>
+
+<p>In conjunction with bleeding and other means just noticed, drastic
+purges have an important influence in subduing the disease; not merely
+by removing the water, but likewise by contributing to subdue the
+chronic excitement which occasions its effusion. This latter effect Dr.
+A. very justly refers to the counteraction and irritation these
+medicines excite on the mucous membrane of the bowels, by which the
+excitement of the serous tissue or of the diseased viscus is removed. He
+remarks that drastic purgatives are sometimes inadmissible in ascites,
+when an affection of the liver or mesentery is its remote cause, and
+there is a tendency to a spontaneous diarrh&oelig;a, which even the mildest
+purgatives would increase. "In the case of the mesentery, such a mode of
+treating dropsy would speedily destroy the patient." Dr. A. ought,
+perhaps, to have explained the real cause of the danger attending the
+practice, and not referred it merely to the tendency to diarrh&oelig;a,
+which itself can only be an effect of a morbid condition<span class='pagenum'><a name="Page_104" id="Page_104">[Pg 104]</a></span> of the bowels.
+The fact is, that most cases of hepatitis, and all cases of mesenteric
+disease, are attended, whether as cause or effect we care not, with
+inflammation of the stomach or bowels, which purgatives can only tend to
+aggravate. In general, the practice of administering drastic purgatives
+is more serviceable in hydrothorax, and especially in anasarca, or in
+<i>idiopathic</i> serous inflammation of the peritoneum. Dr. A. prefers the
+gamboge to all other medicines of the same class, and gives it to the
+amount of four or five grains in a single dose, with the same quantity
+of some aromatic powder, and triturated with a few crystals of the
+supertartrate of potassa; or in urgent cases of hydrothorax, he
+prescribes ten or twelve grains, divided into four doses, one of which
+is to be given every three hours. When the strength admits of it, the
+purgative may be given every four or five days.</p>
+
+<p>Dr. A. next notices diuretics.</p>
+
+<div class="blockquot"><p>"The sensible operation of these medicines," he says, "as is
+well known, is to promote the secretion of the kidneys. There
+appears to me, however, to be farther effects produced by them
+upon the system, or particular parts of the system, which is
+not referrible to the mere evacuation of a certain quantity of
+fluid from the body; and these effects, it is probable, consist
+in promoting the natural discharges by this and, perhaps, the
+other emunctories, whose partial suppression may either produce
+this disease, or serve materially to continue it; and likewise
+in occasioning a derivation of blood to the kidneys, and
+therefore to a part distant from the morbid one; and that thus,
+whilst they are contributing materially to the removal of the
+fluid, they are serving like the purgative, an important end,
+in assisting to subdue the cause of it. The medicines which I
+am accustomed almost entirely to rely on in this disease, are
+the powder of dried squill and digitalis, given in combination
+in the form of pills, and in doses, which, from their
+smallness, will probably excite no little surprise in the minds
+of some of my readers. The dose of the squill is something less
+than a grain, and of the digitalis only a sixth part of a
+grain, given uninterruptedly every third or fourth hour."</p></div>
+
+<p>To render these medicines more effectual, a third or half a grain of
+calomel may be given nightly, and an infusion of dandelion, or some
+other popular diuretic, may be taken <i>ad libitum</i>. Our author speaks in
+terms of merited disapprobation of the practice pursued by some
+physicians, of allowing their patients daily, potions of gin punch, with
+the view of aiding the operation of the diuretic medicine, and
+supporting their strength. He shows, that, although by these means the
+water may be promptly evacuated,<span class='pagenum'><a name="Page_105" id="Page_105">[Pg 105]</a></span> the disease is not cured, and the
+effusion is soon renewed with redoubled violence and danger to the
+patient.</p>
+
+<p>In the idiopathic form of hydropic inflammation, attacking the serous
+membranes of the chest and abdomen, and which, agreeably to our author,
+may be strictly local, or consist in a general specific excitement of
+the system, leading to a general watery effusion, the lancet is
+particularly advantageous, and should be had recourse to. The pulse is
+generally hard, the blood exhibits a buffy appearance, and the urine
+coagulates when subjected to heat. Leeches, in pretty large numbers,
+must also be used, as well as all the remedies already enumerated. But
+as in these cases, which according to Dr. <span class="smcap">Ayre</span> are more common among
+females than males, and among the younger than those of middle and
+advanced age, the disease is of a more acute nature, a greater reliance
+is to be placed on an active antiphlogistic plan; and if this be
+steadfastly persevered in, comparatively little difficulty will be
+experienced in effecting a discharge of the water.</p>
+
+<p>When hydrothorax occurs after scarlatina, and is combined with anasarca,
+its course is generally rapid, and the cure difficult; partaking, as it
+often does, of the two-fold state of debility and excitement. When
+detected early, the lancet must be promptly used. Cups and leaches,
+followed by the warm bath, blisters, and cathartics, must also be
+resorted to.</p>
+
+<div class="blockquot"><p>"Diuretics, which are so beneficial in the less acute forms of
+dropsy, are commonly too inert and slow in this, unless given
+in doses to act immediately upon the vascular system, when the
+infusion of digitalis, as given by many practitioners in all
+the other states of the disease, may be resorted to; since the
+treatment here is not so much to remove the water, as to
+prevent, if possible, its farther effusion; for when a
+discharge suddenly takes place into the chest after scarlet
+fever, it will generally prove fatal, even though the quantity
+collected be inconsiderable, and only such as would occasion,
+if gradually effused, a moderate degree of inconvenience to the
+lungs."</p></div>
+
+<p>In respect to tapping, our author remarks, that the circumstances
+calling for this operation are, where, from the very considerable
+accumulation of water, and the consequent distension it occasions, a
+permanent and morbid stimulus is given to the peritoneal membrane, by
+which its serous inflammation is perpetuated or increased; or where so
+much pain and irritation are produced, as to risk inducing a similar
+disease in the chest, and of bringing<span class='pagenum'><a name="Page_106" id="Page_106">[Pg 106]</a></span> on likewise an ulcerative form of
+inflammation in the peritoneal lining of the abdomen.</p>
+
+<div class="blockquot"><p>"Whilst the objections to its employment consist in the danger
+which is incurred, where there is much visceral disease, of its
+causing a destructive form of inflammation in the peritoneum;
+and the probability of its occasioning, under the most
+favourable condition of the disease, a more rapid renewal of
+the serous accumulation."</p></div>
+
+<p>Our limits not allowing us to enter on the treatment of ovarian dropsy,
+we proceed to offer a few remarks on the means recommended by Dr. A. for
+the cure of anasarca. As in the treatment of every other form of dropsy,
+it is necessary, in attempting the cure of anasarca, to advert to the
+nature and causes of the disease.</p>
+
+<div class="blockquot"><p>"If it be idiopathic, and unconnected with any dropsy of a
+circumscribed cavity, and the pulse at the same time be soft,
+and the urine free from serum, it may be treated solely with
+the view of procuring the absorption of the effused fluid, as
+in such cases, the watery discharge in all probability will
+have removed, in a considerable degree, the excitement which
+caused it."</p></div>
+
+<p>It is in such cases that recoveries take place under almost any plan of
+treatment, and that bark and other tonics have been found beneficial.
+Their utility, however, in these cases is very limited, consisting only
+in aiding the removal of the effects of the disease, and keeping up the
+strength of the system, whilst the absorbents perform their function,
+and remove the fluid. Dr. A. recommends, in these cases, puncturing and
+bandages; but he very justly adds, that they must not be employed,
+whenever there remains any inflammation in the parts, as they would then
+tend to aggravate it.</p>
+
+<div class="blockquot"><p>"To &oelig;dematous swellings, in which the serous local
+inflammation, whether symptomatic or idiopathic, still
+subsists, I am accustomed to direct the application of leeches
+and cold evaporating lotions, observing not to commence the use
+of the latter, until twelve hours after the leeches have been
+used, that inflammation may not be produced in the wound."
+"When anasarca arises from a general excited state of the
+system, as denoted by the pulse, and by the serous quality of
+the urine, venesection becomes necessary, combined with the use
+of leeches, applied to the extremities, or to those parts of
+the body, in which the serous tissues are most affected, along
+with the active use of the general means already alluded to."</p></div>
+
+<p>In anasarca, an error is sometimes committed, especially by young
+practitioners, of estimating the degree of danger, and the necessity for
+active treatment, by the single consideration of the extent of the
+&oelig;dematous swelling. This, however, should<span class='pagenum'><a name="Page_107" id="Page_107">[Pg 107]</a></span> be guarded against, as the
+swelling may be very considerable, and the disease subsided, or of
+little consequence; whilst, in other instances, the reverse may be the
+case. In the first instance, where the disease is not seen early, the
+treatment must sometimes be limited to those means which promote the
+absorption of the water, and neither venesection nor leeches will be
+required. In such cases, the practitioner must be guided by the state of
+the pulse and urine; the presence or absence of vascular excitement; the
+history given of the case up to the period when visited, and
+particularly by the progress of the swelling.</p>
+
+<div class="blockquot"><p>"When the dropsy of the skin is considerable and long
+protracted, and symptomatic of some visceral disease, as it
+most commonly is in these cases, and is attended by a serous
+state of the urine, and a general failure of the strength, the
+cachetical state of the system may be considered as
+established, and the treatment is then beset with difficulties.
+For the general means, which are useful in the earlier states
+of the disease, and when the vital strength is entire, become
+injurious in this, by the tendency they have, aided by the
+effects of the visceral disease, to diminish farther the vigour
+of the system; whilst, at the same time, the treatment, which
+is suited to support the declining strength, can contribute
+nothing towards lessening the constitutional and local
+diseases, but will frequently increase the morbidly excited
+state of the circulation, which, analogous to what occurs in
+diabetes, will continue and increase under the most decided
+marks of general constitutional weakness. Pending the
+continuance of that inflammatory state of the system, in which
+the urine is charged with serum, the debility will be mainly
+derived from that drain of its nutrient parts, which is thus
+established in the body, assisted by the weakening effects of
+the organic disease. If blood be drawn, it will be found, in
+many of these cases, to exhibit the usual signs of
+inflammation; and the treatment of the tonic kind, when
+employed to support the strength, will be found to act
+unfavourably.</p>
+
+<p>"The plan to be pursued must consist in the use of such means
+as shall assist the powers of digestion and assimilation; so
+that, by a highly nourishing but plain diet, the drain from the
+system may be somewhat counteracted; and, at the same time, the
+cause of the effusion is to be corrected by the use of local
+depletion and blistering, and by the temperate employment of
+those general means, which are useful in the less aggravated
+forms of the disease."</p></div>
+
+<p>The diet of patients, in the symptomatic forms of dropsy, should be
+plain and unirritating; and in the idiopathic states, the antiphlogistic
+regimen should be rigidly enforced; particularly an abstinence from all
+fermented liquors, until the inflammatory period<span class='pagenum'><a name="Page_108" id="Page_108">[Pg 108]</a></span> of the disease be
+removed. The clothing should be moderately warm, and selected of that
+kind, best suited to promote the insensible perspiration of the surface.</p>
+
+<p>Before taking leave of Dr. <span class="smcap">Ayre</span>, we cannot omit adverting, in a very few
+words, to a circumstance noticed in his preface, and which we think of
+some importance. He remarks, that if, in the prosecution of his task, he
+has had no acknowledgments to make to any individual as his guide and
+authority, he is nevertheless indebted for many important facts to the
+writings of the late Dr. <span class="smcap">Wells</span>, and of Drs. <span class="smcap">Blackall</span>, <span class="smcap">Abercrombie</span>, and
+<span class="smcap">Duncan</span>, jun. and particularly to the system of pathology of Dr. <span class="smcap">Parry</span>.
+He further remarks, that he entertained and taught for many years, the
+views advocated in this work, and that, after the manuscript had been
+sent to press, he had seen a copy of an abridged edition of the
+elaborate Dictionnaire des Sciences Medicales, in which the doctrine of
+dropsy, maintained in the larger work, is relinquished; whilst others
+are given in their place, conformable, in the main, with those which it
+is the object of his treatise to establish. Now it would appear, from
+these expressions, that Dr. <span class="smcap">Ayre</span> wishes to inculcate the idea, that the
+English writers, whom he has cited, were the only ones who had published
+anything valuable, and conformable to his doctrine; and that prior to
+1823, the year of the publication of the Dictionary above mentioned, the
+French entertained very different views of the pathology of the disease.
+We think it our duty, however, to rectify our author in this respect,
+and to show to our readers, that, even allowing full credit to Drs.
+<span class="smcap">Wells</span>, <span class="smcap">Blackall</span>, <span class="smcap">Abercrombie</span>, &amp;c. for their researches into the nature
+and treatment of dropsy, the American, French, and Italian pathologists
+are entitled to a much larger share than is allowed to them in the
+present work. A few references will be sufficient. Many years ago, our
+celebrated <span class="smcap">Rush</span> taught, that general dropsies "depend on a certain
+morbid excitement of the arteries;" and that hydrocephalus, "in its
+first stage, is the effect of causes, which produce a less degree of
+that morbid action in the brain which constitutes phrenitis." In 1812,
+Dr. <span class="smcap">Breschet</span>, of Paris, published an excellent dissertation on active
+dropsies. In the early writings of <span class="smcap">Broussais</span>, though more particularly
+in the propositions prefixed to his <i>Examen</i>, the opinion is maintained,
+that all active dropsies depend on irritability,<span class='pagenum'><a name="Page_109" id="Page_109">[Pg 109]</a></span> either primary or
+secondary, of the serous and cellular tissues,&mdash;a theory more closely
+allied to Dr. A.'s, than all that is contained in the writings of Drs.
+<span class="smcap">Wells</span>, <span class="smcap">Parry</span>, &amp;c. But what, perhaps, is more to our purpose, Dr.
+<span class="smcap">Geromini</span>, of Cremona, published a work, in 1816, on the origin and cure
+of dropsy, in which he compares the dropsical accumulation to that of
+serum produced by the inflammation of a blister, or by fire; and in
+which he also maintains, that a slight inflammation occasions a flow of
+limpid serous fluid, whilst a higher degree gives rise to the formation
+of pus. From these circumstances, he concludes, that the hydropic fluid,
+which contains little albumen, is the product of a lower grade of
+inflammation. In the same work, he finally asserts, that in more than
+200 individuals who had died of dropsy, he invariably found marks of
+inflammation or its effects; views which our readers will readily
+discover to be nearly allied to those supported by Dr. A. In making
+these remarks, however, we do not wish to be understood as asserting,
+that the theory advanced by our author did not originate also with him.
+We have too favourable an opinion of his honesty, to accuse him of
+plagiarism. Our sole intention has been to render unto each the degree
+of praise to which he is entitled, and, by pointing out this coincidence
+of opinion, to derive a further proof of the correctness of most of the
+pathological views, so ably defended in the present work.</p>
+
+
+
+<hr style="width: 65%;" />
+<h2><span class="smcap">Article VIII.</span>&mdash;<i>An Essay on Venereal Diseases, and the Uses and Abuses
+of Mercury in their Treatment.</i> By <span class="smcap">Richard Carmichael, M.R.I.A.</span> <i>With
+Practical Notes, &amp;c.</i> by <span class="smcap">G. Emerson, M. D.</span> Philadelphia, J. Harding,
+1825; pp. 360.</h2>
+
+
+<p>One of the most important improvements in practice, which modern
+experience has established, is the reformed method of treating venereal
+diseases.</p>
+
+<p>To the labours of several distinguished military physicians and surgeons
+of Great Britain, we are chiefly indebted for the facts and researches
+connected with this interesting subject. And although we may have much
+to learn in regard to the true nature of these complaints; yet the plan
+adopted by Mr. <span class="smcap">Carmichael</span>, of<span class='pagenum'><a name="Page_110" id="Page_110">[Pg 110]</a></span> determining their distinct pathological
+characteristics, and applying the remedies accordingly, is the only one
+likely to subvert the empirical routine of prescribing mercury on all
+occasions, a practice which derives such strong support both from the
+indolence and prejudices of the profession.</p>
+
+<p>In this country, many eminent practitioners have contributed to restrain
+the abuse of mercury; and it is believed, that Professor <span class="smcap">Chapman</span> has for
+many years, in his lectures, disseminated the most enlightened doctrines
+on this point. Dr. <span class="smcap">Harris</span> and other surgeons of the navy have made a
+fair trial of the non-mercurial treatment, and with the most
+satisfactory results.</p>
+
+<p>The great object, so desirable of attainment, is to form a correct
+discrimination between the diseases, which may be cured or benefited by
+the exhibition of mercury, and those which do not require this medicine,
+or become aggravated by its use; for it seldom fails to do injury, when
+its advantages are not very obvious.</p>
+
+<p>Mr. <span class="smcap">Carmichael</span> has taken the most conspicuous part in this investigation
+for the last fifteen years, and from the extensive theatre, in which his
+inquiries were conducted, has had the best opportunities of arriving at
+the truth. He, therefore, who undertakes the management of these
+affections, may be justly pronounced culpable, if he neglect to make
+himself acquainted with the experience of this eminent surgeon.</p>
+
+<p>In this enlarged and improved edition of his work, several subjects have
+not been treated of so copiously by the author, as was requisite to
+render it acceptable as a book of reference; but the judicious notes of
+Dr. <span class="smcap">Emerson</span>, whose attention has been profitably directed to the
+investigation of venereal diseases, have well supplied the deficiency.</p>
+
+<p>A brief outline is here presented of the contents.</p>
+
+<p>The author describes the various symptoms in plain and intelligible
+terms; rejecting such unmeaning appellations as syphiloidal,
+pseudo-syphilis, &amp;c. as designating no particular phenomena, and
+therefore of no use in describing a disease.</p>
+
+<p>He thinks there is a plurality of venereal poisons, and has divided the
+disease into four classes, from their different primary and secondary
+symptoms; making the eruptions on the skin the most certain criterion of
+distinguishing them from each other.<span class='pagenum'><a name="Page_111" id="Page_111">[Pg 111]</a></span> These classes are:&mdash;the papular
+venereal disease; the pustular; The phagedenic; and the scaly venereal
+disease. The latter is the true syphilis.</p>
+
+<p>First, the Papular. This is the most common disease, and the most easily
+cured. Its primary symptoms are, a simple ulcer without induration,
+without elevated edges, and without phagedena. Sometimes there is a
+patchy excoriation of the glans penis, attended with a purulent
+discharge. This disease and gonorrh&oelig;a are caused by the same poison.
+The constitutional symptoms are:&mdash;fever; pain in the head, shoulders,
+and larger joints, pain in the chest; dyspn&oelig;a; a papular eruption on
+the forehead, chest, and back, sometimes extending in a more scattered
+way over the extremities. It is often attended with iritis. It never
+gives rise to nodes. The sore throat is different from that of syphilis;
+the latter having deep excavated ulcers. If buboes accompany it, they
+are mostly of an indolent nature. The eruptions do not all appear at
+once; but follow each other. When on the decline, they are of a pale red
+or copper colour, not scaly, as in syphilis, but papular; disappearing
+and recurring repeatedly, and ending in desquamation.</p>
+
+<p><i>Remedies.</i>&mdash;Venesection; cathartics; antiphlogistic regimen;
+antimonials, combined with decoction of sarsaparilla. Alterative does of
+calomel and antimonials, when the eruption declines.</p>
+
+<p>The local treatment consists in astringent washes and simple dressings.</p>
+
+<p>Iritis is to be cured by venesection, cathartics, mercury, blisters, and
+belladonna.</p>
+
+<p>This disease will yield to the powers of the constitution. Mercury is
+always injurious in the early stage.</p>
+
+<p>Second, Pustular venereal disease.</p>
+
+<p>Primary ulcer of a reddish-brown colour; borders closely on the
+phagedenic character. The edges raised and well defined; not excavated,
+but on a level with or above the surrounding skin. In the commencement,
+a small itchy pustula; distinguished from the ulcer attending the
+papular disease by its well defined and elevated edges, and by the
+absence of the smooth fungous surface of the former; from the phagedenic
+by its well defined margin and its corroded-like surface, and the
+absence of acute pain; and from chancre by the absence of the callous
+edges and base. These<span class='pagenum'><a name="Page_112" id="Page_112">[Pg 112]</a></span> ulcers are of a chronic nature, showing little
+disposition to spread. The ulcers from buboes partake of the same
+character, the edges being hard and the ulcer disposed to burrow. These
+edges Mr. C. removes with the knife. The disease is rendered extremely
+obstinate, where full courses of mercury have been given. The more
+closely the eruption approaches the papular, the more mild and
+manageable will be the disease.</p>
+
+<p><i>Constitutional symptoms.</i>&mdash;The eruption is pustular, and often exhibits
+simultaneously new pustules; also scabbing ulcers, the crusts of which
+fall off, and leave discoloured patches of skin after healing. For these
+ulcers of the skin, the best remedies are, sulphur fumigations,
+nitro-muriatic acid baths, and ointment of tar and sulphur.</p>
+
+<p><i>Remedies.</i>&mdash;Rest; gentle astringents; mild ointments; antimonials and
+sarsaparilla:&mdash;for the constitutional symptoms; venesection; cathartics;
+antimonials; sarsaparilla.</p>
+
+<p>Mercury is decidedly injurious, until the disease is on the wane, when
+alterative doses may accelerate the cure.</p>
+
+<p>Third, Phagedenic venereal disease.</p>
+
+<p>The primary ulcer has a corroded appearance. It exhibits neither
+granulations nor induration. It spreads sometimes rapidly, sometimes
+slowly; healing in one part, while ulcerating in another. It is mostly
+situated on the glans and prepuce, and often attended with hemorrhage.
+In this disease, buboes most frequently appear.</p>
+
+<p>The sloughing ulcer occurs also in this disease. Mercury is extremely
+pernicious, always rendering the disease more inveterate and rapid in
+its progress.</p>
+
+<p><i>Constitutional symptoms.</i>&mdash;High fever precedes the eruption, but abates
+afterwards. Nocturnal headachs; tenderness of the scalp; slight
+dyspn&oelig;a; tenderness of the sternum on pressure; soreness of the
+chest; an eruption of tubercles, or pustules, or spots of a pustular
+tendency, which quickly degenerate into ulcers, with thick crusts, that
+heal from the centre, while they extend from the circumference, with
+phagedenic borders. The crusts are often of a conical figure. The
+ulceration of the throat is of the most formidable nature. It commences
+in the form of a small white aphthous sore; which usually attacks the
+velum or posterior part of the pharynx, mostly the latter. It extends
+rapidly, destroying the parts, and at last attacks the bones. It often
+attacks the larynx, after which, the patient seldom recovers. The
+affection of the<span class='pagenum'><a name="Page_113" id="Page_113">[Pg 113]</a></span> bones of the nose is never joined with the papular
+eruption, nor with the scaly syphilitic lepra; but in every case with
+the pustular description, and when scales and ulcers were present. At
+the time of the eruption, pains in the knees, wrists, and ankles occur,
+attended with swelling and redness. He has never seen nodes in the
+disease, except in cases where mercury had been given. Full courses of
+mercury introduce the disease into the deep seated parts; for the bones
+are seldom or never affected in this disease, unless mercury has been
+given.</p>
+
+<p><i>Remedies for the primary symptoms.</i>&mdash;Absolute rest; venesection;
+nauseating doses of antimonials; warm poultices and fomentations; opium;
+hyosciamus and cicuta in sufficient doses to lessen pain and irritation.
+For the sloughing ulcer, stimulating applications are often useful; such
+as Venice turpentine or balsam copaib&aelig;, mixed with olive oil.</p>
+
+<p><i>For the secondary symptoms:</i>&mdash;Venesection; antimonials; sarsaparilla;
+Dover's powder. Mercury increases the ravages of the disease, except
+when on the wane, when it may be given in alterative doses, with safety
+and advantage. For the pain in the head, a blister to the nape of the
+neck. If the eruption appear scaly, then mercury is likely to be useful.
+If the throat and skin are affected, muriate of mercury in solution, and
+decoction of sarsaparilla. If the ulcer in the throat be small, touch it
+with the oxymel &aelig;ruginis, or solution of nitrate of silver, grs. v a x
+to an ounce of water; but if there exist extensive ulcerations,
+fumigations with red sulphuret of mercury ought to be employed.</p>
+
+<p>Fourth, Scaly Venereal Disease, or Syphilis.&mdash;Primary ulcer of a
+circular form, excavated, without granulations, with matter adhering to
+the surface, and with a thickened edge and base. The hardening is very
+circumscribed, not diffusing itself gradually or imperceptibly into the
+surrounding parts, but terminating rather abruptly. Its progress is
+slow, sometimes assuming a tawny appearance.</p>
+
+<p><i>Constitutional symptoms.</i>&mdash;Sometimes the skin, at other times the
+throat, is first affected. There is headach, restlessness, and fever.
+The scaly eruption appears, but does not relieve the fever, as in the
+other diseases. This eruption commences with a small hard reddish
+protuberance; and as it advances, the sides are raised, and centre
+depressed or flat, and covered with thin white scales. It<span class='pagenum'><a name="Page_114" id="Page_114">[Pg 114]</a></span> terminates in
+ulcerated blotches. This eruption appears on the forehead, breast, back
+of the neck, and groin; often in large copper coloured blotches, in
+parts near the hair. The ulcers of the throat mostly affect the tonsils,
+and come on without much previous pain or swelling; although there soon
+appears a considerable excavation of the tonsil, attended with evident
+loss of substance. The ulcer is foul, with thick white matter adherent
+to it, which cannot be washed away. The bones then become affected,
+those nearest the surface being most liable to attack; such as the
+tibia, sternum, clavicle, and cranium.</p>
+
+<p>The remedies for syphilis are full courses of mercury, for both primary
+and secondary symptoms; except where a tendency to phthisis, or a
+delicate constitution forbids them. He thinks syphilis a rare disease
+now, compared with what it was formerly.</p>
+
+
+
+<hr style="width: 65%;" />
+<h2><span class="smcap">Article IX.</span>&mdash;<i>Remarks on some Means employed to destroy T&aelig;nia, and expel
+them from the Human Body.</i>&mdash;By <span class="smcap">Louis Frank. M. D.</span> Privy Counsellor of
+her Majesty, Maria Louisa, Duchess of Parma. [Lond. Med. Rep. April
+1825.]</h2>
+
+
+<p>The symptoms produced by the presence of tape worm in the human body,
+are exceedingly distressing, and the sufferings of the patient are
+increased, by the obstinacy, with which these animals resist the
+operation of the most disgusting, and even painful and dangerous
+remedies. Improvements in the mode of attacking and expelling them,
+therefore, should be gladly received, and widely made known.</p>
+
+<p>The numerous reports which we have received, concerning oil of
+turpentine as a remedy for t&aelig;nia solium, have already given to that
+remedy the highest character; but many cases have been only partially
+relieved by it. The ol. tereb. seems to be capable of causing the
+separation and expulsion of portions of the animal; but while the head
+remains unexpelled, it is supposed to be capable of reproducing the
+joints, to a degree not yet ascertained. If we may believe medical
+writers, the t&aelig;nia has been observed of the enormous length of 700 feet.
+It is probable that the reproduction,<span class='pagenum'><a name="Page_115" id="Page_115">[Pg 115]</a></span> after the loss of large numbers
+of joints, is often very rapidly effected; as was the case in a patient
+treated at the Carey Street Dispensary, mentioned in their report for
+Aug. 1813,<a name="FNanchor_18_18" id="FNanchor_18_18"></a><a href="#Footnote_18_18" class="fnanchor">[18]</a> This person always discharged very considerable
+quantities of joints or fragments, after the use of oil of turpentine;
+after which he remained free from the complaint for a few months, until
+the t&aelig;nia recovered a troublesome magnitude; when it was again easily
+reduced to less uncomfortable dimensions.</p>
+
+<p>We are not able to state positively, how long the oil of turpentine has
+been in use as a remedy for t&aelig;nia. The Carey Street Report for Feb.
+1810, informs us, that a mechanic in Durham, having been very successful
+in the treatment of t&aelig;nia by means of this article, the circumstance was
+communicated by Dr. <span class="smcap">Southey</span>, of that place, to Dr. <span class="smcap">Laird</span> of London; and
+it was accordingly prescribed in doses of &#8485;ss. to [Symbol:
+ounce]ij. at several of the London charities. It had been found, says
+the report, that ol. tereb. might be thus given, as safely as so much
+gin, and frequently caused the expulsion in two hours: Dr. <span class="smcap">Knox</span> says it
+has been in use in Germany for fifty years for the expulsion of t&aelig;nia.</p>
+
+<p>The experience of Dr. <span class="smcap">Knox</span>, concerning t&aelig;nia, at the Cape of Good Hope,
+is the most extraordinary that we are acquainted with. Dr. <span class="smcap">Sparman</span>, the
+traveller, had observed, that worms were exceedingly common in the
+northern parts of the colony; but Dr. <span class="smcap">Knox</span>, who was there in 1819, did
+not notice any special prevalence of verminous disorders, "previous to
+Oct. 1819, when the <i>tape worm became so general among the troops, as to
+resemble an epidemic</i>."<a name="FNanchor_19_19" id="FNanchor_19_19"></a><a href="#Footnote_19_19" class="fnanchor">[19]</a></p>
+
+<p>Most of these troops had been employed on a short campaign to the east
+of the great fish river. They had been compelled to live on very bad
+beef and mutton, driven and starved half to death; and Dr. <span class="smcap">Knox</span> thinks
+he has proved, that the t&aelig;nia in these cases did "arise from the use of
+unwholesome animal food; from the flesh of animals, which had been
+diseased." Two out of five of the troops, who had been thus employed and
+fed, were affected with worms. Of a detachment of 86 vigorous, healthy
+young men, 36 were found, on inquiry, to have <i>tape</i> worm. Those<span class='pagenum'><a name="Page_116" id="Page_116">[Pg 116]</a></span> who
+remained in the colony did not suffer so much, as those who had been out
+on the campaign, the ratio being as one to four; whereas of the others,
+it was two to five. Dr. <span class="smcap">Knox</span> had ample experience of the utility of
+turpentine during this singular prevalence of t&aelig;nia. Concerning the 36
+men above mentioned, he says, "the cure of all, who chose to adopt the
+means, was easily effected by small doses of the spts. of turpentine,
+after the failure of purgatives and various other remedies."</p>
+
+<p>He considers ol. tereb. as the <i>most efficacious remedy</i>. He does not
+approve of large doses, because of headach, vertigo, and delirium, which
+have been produced by them in "many patients."</p>
+
+<p>"I have generally found," says he, "that from one to two drachms of ol.
+tereb., given in a little water, morning and evening, for three
+successive days, were sufficient to destroy the t&aelig;nia solium, (even in
+the most obstinate cases,) and cause it to leave the intestines, without
+the aid of any purgative medicine." He advises, however, to give a
+little castor oil each day about noon.</p>
+
+<p>It has been a very common observation in regard to the dose of
+turpentine, that the patient suffers more cephalic distress when it is
+given in small quantity, than in a large dose. The writer of this has
+been obliged to desist from the exhibition of oil turpentine, in doses
+of &#8488;ij twice a day, in consequence of a vertigo so
+considerable, as to alarm and distress his patient very much. Perhaps
+there might have been in this case some peculiar liability to nervous
+excitation, which in another patient would not have been worthy of much
+notice. Dr. <span class="smcap">Knox's</span> opinion is of great weight.</p>
+
+<p>The celebrated remedy of <span class="smcap">Chabert</span>, Dr. <span class="smcap">Knox</span> thinks, owes its efficacy to
+the ol. terebinth. combined with it.</p>
+
+<p>Dr. <span class="smcap">Frank</span>, whose name stands at the head of this article, was informed
+by the celebrated helminthologist, Dr. <span class="smcap">Bremser</span>, at Vienna, in 1814, that
+he had for ten years preferred the use of <span class="smcap">Chabert's</span> remedy, and with
+invariable success.</p>
+
+<p><span class="smcap">Chabert</span> was a veterinary surgeon of Alfort, who used the animal oil of
+Dippel in many diseases of animals, as well as those of men. This oil he
+often gave for the purpose of removing t&aelig;nia in his animals. He often
+combined it with spt. terebinth. and gave equal parts of these
+substances, in doses of &#8488;i.<a name="FNanchor_20_20" id="FNanchor_20_20"></a><a href="#Footnote_20_20" class="fnanchor">[20]</a> The London<span class='pagenum'><a name="Page_117" id="Page_117">[Pg 117]</a></span> Medical
+Repository states, that <span class="smcap">Chabert's</span> remedy is prepared from</p>
+
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Ol. Corn. Cerv. F&oelig;tid.</td><td align='left'>1 part.</td></tr>
+<tr><td align='left'>Ol. Terebinth,</td><td align='left'>3 parts.</td></tr>
+</table></div>
+
+
+<p>These are well mixed, and left at rest four days; they are then
+distilled in a sand bath, till three-fourths of the liquor has passed
+over. It must be kept tightly stopped, out of the light.<a name="FNanchor_21_21" id="FNanchor_21_21"></a><a href="#Footnote_21_21" class="fnanchor">[21]</a></p>
+
+<p>The great objection to <span class="smcap">Chabert's</span> remedy is its disgusting flavour; which
+is the more obnoxious, because the remedy must be continued for a length
+of time. Dr. <span class="smcap">Frank</span> cured two persons affected with t&aelig;nia solium, after
+considerable perseverance with it: he cured two other persons with a
+preparation as follows:</p>
+
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Ol. Terebinth.</td><td align='left'>&#8485;ss</td></tr>
+<tr><td align='left'>&AElig;ther Sulphuric.</td><td align='left'>&#8488;ij</td></tr>
+<tr><td align='left'>Pulv. G. Arab.</td><td align='left'>&#8485;ss</td></tr>
+<tr><td align='left'>Aq. Flor. Chamam. distil.</td><td align='left'>&#8485;xvj <i>m.</i></td></tr>
+<tr><td colspan="2">Two spoonfuls morning and evening.</td></tr>
+</table></div>
+
+
+<p>Four of these mixtures were sufficient to cure the patients, who
+remained well two years afterwards.</p>
+
+<p>A fifth patient, unable to take the last named medicines, was cured by
+the boluses subjoined:</p>
+
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Sem. Santonic. pulv.</td><td align='left'>&#8485;ss</td></tr>
+<tr><td align='left'>Pulv. Jalap.</td></tr>
+<tr><td align='left'>Ferri Sulphat. aa</td><td align='left'>&#8488;i</td></tr>
+<tr><td align='left'>Ol. Corn. Cervi,</td><td align='left'>gtt. viij.</td></tr>
+<tr><td align='left'>Syrup.</td><td align='left'>q.s.</td></tr>
+<tr><td colspan="2">Make 20 boluses.</td></tr>
+</table></div>
+
+
+<p>One to be taken morning and evening. These 20 boluses being repeated
+three times, the patient found himself perfectly well. In the above 5
+cases, the t&aelig;nia was discharged in fragments.</p>
+
+<p>Dr. <span class="smcap">Frank</span> does not say much concerning the bark of pomegranate root,
+which has come into vogue lately as a remedy for t&aelig;nia. He refers to the
+Med. Chirurg. Transact. Vol. XII. for accounts by some English
+physicians, and remarks, that Dr. <span class="smcap">Gomez</span>, the Portuguese physician, had
+cured 14 cases with this bark.</p>
+<p><span class='pagenum'><a name="Page_118" id="Page_118">[Pg 118]</a></span></p>
+<p>Dr. <span class="smcap">Pollock</span> (vide Ed. Med. and Surg. Journal, Oct. 1819) treated a
+child, aged 14 months, with the decoction of bark of pomegranate root,
+so far back as the year 1811. This infant, under the use of the
+medicine, discharged at several times upwards of 30 feet of t&aelig;nia
+solium, and was cured. We learn also from the Med. Repository,<a name="FNanchor_22_22" id="FNanchor_22_22"></a><a href="#Footnote_22_22" class="fnanchor">[22]</a> that
+MM. <span class="smcap">Deslandes</span>, <span class="smcap">Sourya</span>, and <span class="smcap">Bourgeoise</span>, have employed pomegranate with
+great success; that the decoction generally expelled the worm in two
+hours; that it sometimes occasioned vomiting and griping pains; and that
+it has been a common remedy for tape worm, in the East Indies, and among
+the blacks of St. Domingo.</p>
+
+<p>From the same source we are informed, that the French pharmaceutists
+recommend, before boiling the bark, that it should be allowed to swell
+(macerate) in cold water. &#8485;ij of bark should be boiled in
+lbij of water to &#8485;xii. Of this decoction, [Symbol:
+ounce]ij may be taken every half hour. The worm is here said to be
+passed often in twelve hours instead of two. It may be necessary to
+continue this plan four or five days, taking care to suspend the
+medicine, in case any vertigo, or intestinal disease supervenes. A dose
+of castor oil is recommended after the 4th bottle; even though the worm
+be happily for the patient expelled.</p>
+
+<p>In the Revue Medicale is a case, in which pomegranate succeeded in
+discharging three ells of t&aelig;nia; but the patient broke off the worm in
+attempting to extract it with too much violence. This circumstance
+recalls us to the consideration of Dr. <span class="smcap">Frank's</span> communication. He
+recommends much caution in the extraction of those portions of t&aelig;nia,
+which have remained partly in the intestine; and says that Dr. <span class="smcap">Cagnola</span>
+proposed touching the extruded portion with prussic acid, in hopes of
+killing the whole animal by means of this violent poison. Dr. <span class="smcap">Garleke</span>
+adopted this plan on an extruded portion of four inches in length, and
+in one hour afterwards the <i>whole animal came away dead</i>. Dr. F.
+suggests, that the electric shock might weaken the t&aelig;nia, so as to cause
+it to let go its hold, and thus be unresistingly extracted. <span class="smcap">Brera</span>
+recommended that the worm should be tied with a piece of silk. In this
+manner, it is retracted into the bowel, but begins<span class='pagenum'><a name="Page_119" id="Page_119">[Pg 119]</a></span> to descend again not
+long afterwards. He dissuades from any attempt at forcible extraction,
+which excites the most distressing sensations in the bowels, and causes
+the risk of bringing on convulsions.</p>
+
+<p>We are informed by Dr. <span class="smcap">Frank</span>, that a surgeon of St. Petersburg succeeded
+by passing the worm through a canula, and the canula through the
+sphincter ani muscle, so as to obviate the resistance caused by its
+contraction. In this manner, he easily succeeded in withdrawing the
+t&aelig;nia <i>whole</i>, which is always desirable.</p>
+
+<p>The writer of this article succeeded in removing many pieces of t&aelig;nia
+from a female, by means of the tincture of black hellebore, given in
+doses of a teaspoonful for another object. The patient has since been
+affected with the same symptoms, and took to-day, Oct. 19th, in doses of
+&#8485;iss, repeated every hour, sixteen ounces of a decoction
+of the rind of pomegranate fruit, (none of the cort. rad. being
+procurable); after which she took a dose of castor oil. It is said, we
+know not on what authority, in a French journal, that this preparation
+possesses the same powers as the root. It may be so; but this patient
+had no discharge of the tape worm, after swallowing the whole of this
+very astringent decoction, and following up the plan by taking [Symbol:
+ounce]iij of ol. ricini.</p>
+
+<p>Perhaps the t&aelig;nia had been effectually destroyed before. She has seen
+none of the joints for 18 months. The accounts, however, of the
+expulsion of t&aelig;nia by the bark of the root, are so encouraging, that we
+have much pleasure in recommending it to the notice of the medical
+public in this country.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_18_18" id="Footnote_18_18"></a><a href="#FNanchor_18_18"><span class="label">[18]</span></a> Ed. Med. and Surg. Jour.</p></div>
+
+<div class="footnote"><p><a name="Footnote_19_19" id="Footnote_19_19"></a><a href="#FNanchor_19_19"><span class="label">[19]</span></a> Ed. Med. and Surg. Jour. July, 1821.</p></div>
+
+<div class="footnote"><p><a name="Footnote_20_20" id="Footnote_20_20"></a><a href="#FNanchor_20_20"><span class="label">[20]</span></a> Dict. des Sciences Medicales.</p></div>
+
+<div class="footnote"><p><a name="Footnote_21_21" id="Footnote_21_21"></a><a href="#FNanchor_21_21"><span class="label">[21]</span></a> There can be no particular benefit derived from the
+distillation. The simple mixture of the materials, above indicated, is
+all that is necessary. <span class="smcap">Chabert's</span> remedy is therefore easily prepared.</p></div>
+
+<div class="footnote"><p><a name="Footnote_22_22" id="Footnote_22_22"></a><a href="#FNanchor_22_22"><span class="label">[22]</span></a> Lond. Med. Repos. April, 1825.</p></div>
+</div>
+
+
+<hr style="width: 65%;" />
+<h2><span class="smcap">Article X.</span>&mdash;<i>Researches Physiological and Pathological, instituted
+principally with a View to the Improvement of Medical and Surgical
+Practice.</i> By <span class="smcap">James Blundell, M. D.</span>, Lecturer on Physiology and
+Midwifery at the United Hospitals of St. Thomas and Guy. London, 1824,
+pp. 146, 8vo.</h2>
+
+
+<p>Dr. <span class="smcap">Blundell</span> is the author of some celebrated experiments on the
+physiology of generation, and the transfusion of blood. The work at
+present under consideration consists of physiological observations and
+experiments, the substance of a paper read before<span class='pagenum'><a name="Page_120" id="Page_120">[Pg 120]</a></span> the
+Medico-Chirurgical Society of London, in the year 1823, and not
+heretofore published; of experiments on a few controverted points,
+respecting the physiology of generation; and lastly, of some remarks on
+the operation of transfusion.</p>
+
+<p>The first part seems intended to ascertain what degree of lesion, or
+losses by extirpation, the body may sustain without inducing death; and
+thus, to open a way for improvements in surgery, by rendering the
+surgeon not only more bold and fearless, but more frequently successful
+in his attempts to preserve life, or counteract the inconvenient effects
+of disease and accidents. We shall make a short analysis of the first
+paper.</p>
+
+<p>In four experiments, Dr. B. removed the left kidney of the rabbit, by
+incision on the outer edge. Ligatures were applied to prevent bleeding.</p>
+
+<p>Two died; one in 60 hours, the other in 4-1/2 days: both of
+inflammation. One recovered, and lived 5 or 6 weeks, and then died. The
+4th also recovered, but died in 5 or 6 weeks. On examination, a sac was
+found (in place of the kidney) filled with a semi-fluid substance,
+resembling custard, p. 4.</p>
+
+<p>In seven rabbits, removed the spleen. One recovered permanently, and one
+lived six months. p. 5.</p>
+
+<p>In five rabbits, opened the abdomen, and punctured the fundus of the
+bladder with a lancet. Three of them recovered entirely. p. 6.</p>
+
+<p>In two rabbits, cut off one-fourth of the bladder with scissors, having
+applied a ligature first. One died in seven months; the other still
+lives in good health.</p>
+
+<p>Into the peritoneum of four rabbits, threw &#8485;i of human
+urine; then washed it out by injecting tepid water. One died of collapse
+in less than 24 hours, and two of inflammation, in 60 and 19 hours
+respectively. The fourth is now (12 months) in good health. p. 7.</p>
+
+<p>In seven, injected &#8485;xi decoct. querc&ucirc;s into the
+peritoneum. Only one recovered.</p>
+
+<p>Dr. B.'s inferences from the foregoing experiments are:</p>
+
+<div class="blockquot"><p>1st. "Large apertures into the peritoneum of the rabbit, do not
+immediately induce a dangerous prostration, of strength." p. 9.</p>
+
+<p>2ndly. "Large apertures into the peritoneal sac of the rabbit,
+are not necessary, nor perhaps generally, productive of fatal
+inflammation."</p>
+
+<p>3dly. "In the rabbit, the kidney, the spleen, and a large piece
+of the<span class='pagenum'><a name="Page_121" id="Page_121">[Pg 121]</a></span> bladder may be extirpated, without necessarily causing
+death; though death under the first operation is probable." p.
+10.</p>
+
+<p>4thly. "When the abdomen is laid open, and parts are removed
+from it in the rabbit, the first danger arises apparently from
+collapse; the second from general inflammation; and the last
+from chronic disease." (Vide experiments.)</p>
+
+<p>5thly. "The rabbit's abdomen is very tender, probably no less
+so than that of man." See exper.</p>
+
+<p>6thly. "Success in abdominal operations on the rabbit,
+furnishes a presumption in favour of success in similar
+operations on the human abdomen; and, therefore, from these
+experiments, we may infer, <i>presumptively</i>, that moderate
+openings into the human peritoneum will not necessarily, nor
+even generally prove fatal from inflammation or otherwise; and
+further, that certain viscera or parts of viscera, not
+essential to the welfare of our structure, may be removed from
+the belly, without necessarily, or even generally, producing
+death. The extirpation of the kidney must be highly dangerous;
+but there is a presumption in favour of the successful removal
+of the spleen, the ovaries, or even of large pieces of the
+bladder." p. 11, 12.</p></div>
+
+<p>Dr. B. having stated the foregoing results and inferences, proceeds by
+relating instances of severe injury sustained by the <i>human</i> body,
+without being followed by death. These are confirmatory of his
+inferences from the experiments on rabbits. The instances given are&mdash;an
+os uteri torn off; extensive laceration of the uterus and rectum in
+labour; four uteri extirpated on account of chronic inversion, (p. 13.)
+One of these last under his own care. It was removed by a wire, and came
+off in 11 days, without one bad symptom, (p. 14.) Rupture and laceration
+of the abdominal coverings, four fingers' breadth, the bowels hanging
+out, (p. 14.) Two spleens removed; one in a soldier after the battle of
+Dettingen, who recovered without inconvenience afterwards; the other in
+a Mexican, whose case is related by Dr. <span class="smcap">O'Brien</span>, in his Inaugural Essay,
+Edinb. 1818, (p. 15.) Three cases of rupture of the dropsical ovary. Two
+cases of opening into the abdomen, for the extirpation of dropsical
+ovaries, (p. 18.) Five cases of laceration of the uterus by natural
+efforts. Four of the women died, but in the fifth, Dr. <span class="smcap">Blundell</span> turned
+and delivered, after the child had escaped into the peritoneal sac, and
+the woman recovered, (p. 20.) Cesarian operation, three times by friend
+of Dr. <span class="smcap">Haighton</span>; once successfully, (p. 22.)<span class='pagenum'><a name="Page_122" id="Page_122">[Pg 122]</a></span></p>
+
+<p>Dr. B. says, "From these (facts) few as they are, I feel conscious that
+no certain inference can yet be drawn; though <i>presumptive</i> inferences
+certainly may, and they seem to me to be the following:</p>
+
+<div class="blockquot"><p>"1st. Small wounds, as tapping, hernia, &amp;c. do not induce fatal
+peritonitis; and therefore the vulgar opinion that inflammation
+in a spot of the peritoneum will almost invariably diffuse
+itself over the greater part of it, is probably unfounded.</p>
+
+<p>"2nd. Extensive divisions of the peritoneum are not necessarily
+fatal by inflammation or otherwise, and <i>probably</i> not
+generally so.</p>
+
+<p>"3d. That the womb, spleen, and ovaries, may be removed in the
+mode mentioned, without necessarily, and, <i>presumptively</i>,
+without generally destroying life.</p>
+
+<p>"4th. That the gravid uterus may be torn open; the child may
+escape into the peritoneal sac; the os uteri may be torn off:
+not indeed, so far as these cases may be relied on, without
+great danger, but twice, in seven instances, without death. p.
+28.</p>
+
+<p>"5th. The peritoneum and abdominal viscera will bear more
+injury than the British surgeons seem disposed to admit.</p>
+
+<p>"6th. That the above observations on the human abdomen, are in
+unison with those drawn from observations on the rabbit; and
+that observations made on the brute have more correspondence
+with those on the human being, than is generally believed."</p></div>
+
+<p>Dr. <span class="smcap">Blundell</span> next remarks, that the facts related create a suspicion
+that a bolder abdominal surgery would not be unattended with success,
+and recommends the following operations to "<i>consideration</i> merely, and
+not to practice, except in otherwise desperate cases."</p>
+
+<div class="blockquot"><p>1st. "When the Cesarian section is performed, divide or remove
+a small piece of Fallopian tube, so as to prevent the danger of
+reimpregnation, without destroying the sexual propensity. The
+need for a second operation might thus be certainly prevented,
+without scarcely increasing the danger."</p>
+
+<p>2ndly. "Extirpation of healthy ovaries."</p>
+
+<p>3dly. "The extirpation of the ovarian cyst in scirrhus,
+combined with dropsy, or in simple dropsy." He remarks, "This
+operation will, I am persuaded, ultimately come into general
+use; and if the British surgeons will not patronize and perform
+it, the French and American surgeons will." p. 26.</p>
+
+<p>4thly. "The removal of a large circular piece of the cyst in
+ovarian dropsy, when the sac itself cannot be extirpated."</p>
+
+<p>5thly. "The removal of the cancerous womb, when the ulceration
+first<span class='pagenum'><a name="Page_123" id="Page_123">[Pg 123]</a></span> makes its appearance. Might not the womb be taken out
+above the symphysis pubis, or through the outlet of the
+pelvis?" &amp;c. 27.</p>
+
+<p>6thly. "Extirpation of the puerperal uterus." He suggests the
+removal of the whole womb after the Cesarian section, in order
+that the smaller might take place of the larger and more
+formidable wound through the uterus&mdash;but says expressly, "No
+operation perhaps can be more unpromising, shall I say more
+unjustifiable, in the <i>present state of our knowledge</i>; but I
+thought it proper to mention it." &amp;c. p. 28.</p>
+
+<p>7thly. "Should the bladder give way into the peritoneum," he
+asks, "Why should we not lay open the abdomen, tie up the
+bladder, discharge the urine, and wash out the peritoneum
+thoroughly, by the injection of warm water?" p. 28.</p>
+
+<p>8thly. - - - - -</p>
+
+<p>9thly. Injection of astringents into the ovarian cyst or
+peritoneal sac, unjustifiable.</p>
+
+<p>10thly. "In cases of strongly characterized introsusception,"
+why not make an opening into the peritoneum; and "pass the
+small intestines, fold by fold, through the fingers." Dr. B.
+has repeatedly done this in the dog and rabbit, without
+producing death, or extensive and dangerous inflammation.</p>
+
+<p>11thly. In the rabbit, he has tied an abdominal artery, and
+carried the end of the ligature with a broad needle out through
+the back, opposite to the place of the vessel. This ligature
+can come away, and is a better mode than to leave it hanging
+out at the abdomen, or entirely among the bowels, where it
+forms a sac of puriform matter, and to appearance lays the
+foundation of chronic disease. p. 30.</p></div>
+
+<p>Dr. <span class="smcap">Blundell</span> closes this paper by saying, that since the substance of it
+was read before the Medico-Chirurgical Society in 1823, Dr. <span class="smcap">Ritzius</span>, a
+Swedish physician, had informed him in London, "that the complete
+removal of the cancerous womb had been, to his personal knowledge,
+performed on the Continent five times. All the patients recovered from
+the operation," &amp;c. "The womb was removed through the outlet of the
+pelvis." p. 36.</p>
+
+<p>Since we read Dr. <span class="smcap">Blundell's</span> recommendations to the new operations, we
+have been astonished to notice in the Ed. Med. and Surg. Journal, July,
+1825, that a German surgeon had actually treated a case of ileus in the
+manner recommended by Dr. B. It is from Hufeland's Journal of Feb. 1825.
+After it was ascertained that an immoveable introsusception existed&mdash;</p>
+
+<div class="blockquot"><p>"The patient was placed on a convenient table. We examined
+accurately the situation of the hardening, (<i>which marked the
+diseased part</i>), and determined on opening the abdomen at the
+outer edge of the right rectus muscle,<span class='pagenum'><a name="Page_124" id="Page_124">[Pg 124]</a></span> about two inches above
+the navel. After dividing the integuments with a common
+scalpel, and making a small opening in the peritoneum, I
+introduced my finger, and with a blunt pointed scalpel divided
+the peritoneum, so as to make it correspond with the external
+opening, which was between two and three inches. I then
+besmeared my hand with oil, and carried it into the abdomen, in
+order to feel for the indurated part. Scarcely had I introduced
+my hand, than an attack of the pain came on, and a portion of
+the intestines was protruded through the wound, which was
+immediately replaced by my assistant. On continuing the
+examination, I discovered in a transverse portion of the ileum,
+a foreign substance, just where the hardened intestine was to
+be felt. I drew the intestine out, in order to examine it more
+minutely. The intestine was neither inflamed nor expanded, but
+it contained in its cavity a soft coherent and compact mass,
+which at its upper part was somewhat compressed, and thus felt
+harder than the rest. So far as I could follow this part of the
+intestine, this contained matter was to be felt: I also here
+immediately detected an intus-susception, but in spite of all
+my efforts I could not reach the commencement of it, so as to
+bring it out. Two modes of proceeding were open to me, in order
+to remove the intus-susception; either to make a transverse
+incision in the integuments, from the right to the left side,
+or to open the intestine itself. The last mode seemed to me the
+most adviseable, both because the patient was already very much
+exhausted, and because the operation would be sooner completed.
+The intestine was opened at the end of the discovered
+intus-susceptio, and immediately a part of the strictured
+intestine came into view. I introduced my finger into the
+opening in the intestine, which was made about two inches in
+length, and gradually pushed the intus-suscepted part back from
+the right to the left side, whilst I gently drew that part of
+the intestine which contained the intus-susceptio towards me.
+By this means I fortunately succeeded in unfolding the tangled
+intestine, which amounted to two feet in length. There was not
+the slightest trace of inflammation, nor any thing unnatural to
+be discovered in the part; there was merely a round worm, which
+was situated in the upper part of the intus-susceptio. The
+intestine was brought together by means of six spiral stitches,
+after the manner of the glover's suture, and the end of the
+silk was allowed to hang out of the external wound in the
+abdomen."</p></div>
+
+<p>The sutures were removed on the 8th day. On the 14th day, the man was
+cured, and continues well up to the date of the account.</p>
+
+
+
+<hr style="width: 65%;" /><p><span class='pagenum'><a name="Page_125" id="Page_125">[Pg 125]</a></span></p>
+<h2><span class="smcap">Article XI.</span>&mdash;<i>An Inquiry into the Nature and Treatment of Diabetes,
+Calculus, and other Affections of the Urinary Organs.</i> By <span class="smcap">William Prout,
+M. D., F. R. S.</span> <i>From the second London Edition, published in 1825; with
+Notes and Additions</i>, by <span class="smcap">S. Colhoun, M.D.</span> Philadelphia, Towar &amp; Hogan,
+1826; pp. 308.</h2>
+
+
+<p>A very acceptable service has been done to the medical profession in
+this country, by the present republication of Dr. <span class="smcap">Prout's</span> work on
+affections of the urinary organs. The American physician will now have
+it in his power, at a reasonable cost, to possess one of the best
+treatises on this interesting subject. From the known accuracy of Dr.
+<span class="smcap">Prout</span> as a chemist, and his reputation as an accurate observer of
+nature, much new light was naturally expected as the result of his
+observations. Nor indeed have these high expectations been disappointed.
+After a careful perusal of his work, we have formed the highest opinion
+of his powers, both as an original thinker, and experimental inquirer.</p>
+
+<p>Dr. <span class="smcap">Prout</span> begins his treatise with some introductory remarks on the
+composition of the urine, and on urinary derangements generally. After
+giving a comparative tabular view of the composition of the blood, and
+healthy and diseased urine, he proceeds to notice in succession, their
+principal constituents. As albuminous urine is of frequent occurrence in
+dropsical complaints, and its presence regulates in some degree the
+practice proper to be pursued, the following characters, given to it by
+Dr. <span class="smcap">Prout</span>, should be well understood.</p>
+
+<div class="blockquot"><p>"Albuminous urine, on being exposed to a temperature of about
+150&deg; becomes opaque, and deposites this principle in a
+coagulated state. The precipitate varies considerably in its
+appearance in different instances. Sometimes it is of a firmer
+character, and similar to that formed by the serum of the
+blood, from which, in this case, it may be supposed to be
+derived; at other times it is very delicate and fragile in its
+texture, and somewhat resembles curd, when it may be supposed
+to be of chylous origin. In some instances, the effects of heat
+upon albuminous urine are increased by the addition of nitric
+acid. But the most delicate test of albuminous matter in
+general is dilute acetic acid, and the prussiate of potash." p.
+6.</p></div>
+
+<p>Dr. <span class="smcap">Prout</span> combats very successfully the opinion, generally entertained
+by chemists, that the power of healthy urine to redden<span class='pagenum'><a name="Page_126" id="Page_126">[Pg 126]</a></span> litmus depends
+on the presence of free lithic acid.<a name="FNanchor_23_23" id="FNanchor_23_23"></a><a href="#Footnote_23_23" class="fnanchor">[23]</a> That this power cannot depend
+upon lithic acid uncombined, is made evident to Dr. P. by its sparing
+solubility; it requiring, according to our author, 10,000 times its
+weight of water to dissolve it, or six times as much as is stated by Dr.
+<span class="smcap">Henry</span>. The reddening power of the urine is attributed by Dr. <span class="smcap">Prout</span> to
+the presence of lithate of ammonia, and superphosphate of ammonia: the
+former of which, contrary to what might be expected, is found capable of
+reddening litmus, and of remaining in solution with the latter, without
+decomposition.</p>
+
+<p>The following interesting remarks are made by Dr. <span class="smcap">Prout</span> on the effects
+of muriatic acid, in precipitating lithic acid gravel:</p>
+
+<div class="blockquot"><p>"The muriatic acid, in combination with soda and potash, occurs
+both in the blood and in the urine; thus appearing to pass
+through the kidneys unchanged. This acid and its compounds
+formerly appeared to be of less importance in a pathological
+point of view than any other similar principles existing in the
+urine: but since the unexpected fact has been ascertained, that
+muriatic acid in a free state exists abundantly in the stomachs
+of animals during the process of digestion, I have attended a
+little more closely to the appearance of this principle in the
+urine, and am disposed to believe, in consequence, that it is
+the cause of the precipitation of lithic acid gravel from the
+urine more frequently than any other acid. I do not mean to
+say, that it is the <i>immediate</i> cause of the precipitation of
+this acid; for in most instances, it acts like all powerful
+acids do under similar circumstances, namely, by liberating the
+weaker acids, which are thus enabled to act in their turn, and
+separate those having still weaker affinities than themselves.
+Thus, in the present instance, the muriatic acid may be
+supposed to separate the lactic, while the latter precipitates
+the lithic, &amp;c. If this opinion be well founded, as I believe
+is the case, the muriatic acid may be considered of very great
+importance, not only in a pathological, but a physiological
+point of view; for if the muriatic acid, found in the urine in
+such instances, be supposed to have its origin in the digestive
+organs, we see at once the reason why the deposition of gravel
+is so liable to be influenced by the derangements in general,
+and more especially by the acidity, of the stomach."</p>
+
+<p>"The muriatic acid may be shown to exist in the urine by the
+white curdy precipitate insoluble in nitric acid, which is
+formed, when the nitrate of silver is added to it, after the
+sulphuric and phosphoric acids have been removed by the nitrate
+of barytes or lead." pp. 20 and 21.</p></div>
+<p><span class='pagenum'><a name="Page_127" id="Page_127">[Pg 127]</a></span></p>
+<p>After finishing these introductory subjects, Dr. <span class="smcap">Prout</span> proceeds to the
+consideration of the diseases of the urinary organs themselves; which he
+divides into functional, mechanical, and organic. Under functional
+diseases, we have <i>first</i>, those, in which principles <i>soluble</i> in the
+urine are morbidly deranged in quantity or quality, embracing three
+chapters; and <i>secondly</i>, those affections, in which principles
+<i>insoluble</i> in the urine are morbidly deranged in quantity or quality,
+comprising six additional chapters. Under the first subdivision, the
+first chapter is on the affections, characterized by albuminous urine;
+the second, on diseases, in which an excess of urea is the
+characteristic symptom; and the third, on diabetes.</p>
+
+<p>The diseased derangement, consisting in an excess of urea in the urine,
+has not been particularly noticed by any writer before Dr. <span class="smcap">Prout</span>, who
+believes that it has probably been confounded with that form of
+diabetes, called diabetes <i>insipidus</i>. The state of the urine and
+symptoms in this species of urinary derangement are thus described by
+our author:</p>
+
+<div class="blockquot"><p>"The average specific gravity of the urine seems to be a little
+above 1.020, and occasionally to vary from 1.015 to 1.030. Most
+generally it is pale, but occasionally it is high coloured, and
+exhibits somewhat the appearance of porter, more or less
+diluted with water; and this variety in appearance not
+unfrequently takes place in the urine of the same person. When
+first voided, it reddens litmus paper. For the most part, it is
+entirely free from sediment, except the mucous cloud of healthy
+urine; and the only remarkable property which it appears to
+possess, is that of containing abundance of urea; so that on
+the addition of nitric acid, crystallization speedily takes
+place. From the quantity of urea present, it is very prone to
+decomposition, and soon becomes alkaline, especially in warm
+weather.</p>
+
+<p>"There is almost constantly in these diseases, a frequent and
+urgent desire of passing water both by night and day. This
+desire is for the most part evidently excited by actual
+<i>diuresis</i>, or the increased quantity of urine; but frequently
+it cannot be ascribed to this cause, as the quantity voided at
+one time is often by no means considerable; though in almost
+every instance that has fallen under my observation, the total
+quantity voided during any given time has appeared to be
+greater than natural. The quantity appears also to be
+particularly liable to be increased by cold weather, and by all
+causes producing mental agitation. There is sometimes a sense
+of weight or dull pain in the back, but this is by no means a
+constant symptom. There is also occasional irritation about the
+neck of the bladder, which sometimes extends along the urethra.
+The functions of the skin appear to be natural; at least in
+every case which has come under my own observation,<span class='pagenum'><a name="Page_128" id="Page_128">[Pg 128]</a></span>
+perspiration has been rather easily induced. The pulse is not
+affected. There is no remarkable thirst, nor craving for food,
+except in extreme cases; nor are the functions of the stomach
+and bowels much deranged. Hence for the most part the tongue is
+clean, and the dejections regular and apparently natural.</p>
+
+<p>"In most of the cases of this disease, which have hitherto
+fallen under my own immediate observation, the subjects have
+been middle-aged men, of thin and spare habit, with a sort of
+hollow-eyed anxiety of expression in their countenance, free
+from gout and constitutional disease in general, and, as far as
+could be ascertained, from any organic defect in the urinary
+organs. In every instance they had been induced to apply for
+medical advice, not so much from the pain, as from the
+inconvenience of the disease, and the dread of its ending in
+something worse; and, what may be worth remarking, in several
+instances confessed, that they had been addicted to
+masturbation from very early youth," p. 41, et seq.</p></div>
+
+<p>The remedy for this morbid derangement in the urinary secretion, most
+successful in the hands of Dr. <span class="smcap">Prout</span>, was opium, either administered
+alone, or in conjunction with alkaline medicines. It is rather a rare
+affection. When not arrested, it is liable, according to Dr. <span class="smcap">Prout</span>, to
+pass into diabetes.</p>
+
+<p>In his chapter on diabetes, our author makes many interesting remarks;
+but the space we are enabled to devote to this analysis, will permit us
+only to make an extract, which seems to prove a close connexion between
+the disease characterized by an excess of urea, and diabetes.</p>
+
+<div class="blockquot"><p>"It has been mentioned in the preceding pages, that an excess
+of urea frequently precedes the appearance of saccharine matter
+in the urine. Now it is a remarkable fact, that in diabetes, in
+proportion as the saccharine matter diminishes, that of urea
+generally increases; and in such instances, the presence of the
+former principle can not only be no longer distinguished by the
+sensible properties of the urine, but scarcely be demonstrated
+by the utmost skill of the most experienced chemist, though the
+specific gravity of the urine may at the same time be nearly
+1.040. I have recently been favoured by Dr. <span class="smcap">Elliotson</span> with the
+most complete and remarkable change of this description that
+has yet occurred to me. The patient, besides being diabetic,
+was in the last stage of phthisis, of which he died shortly
+afterwards. The quantity of urine passed daily, when I first
+examined it, was six or eight pints; its specific gravity was
+1.038, and it contained a large proportion of very white sugar
+and very little urea. Dr. <span class="smcap">Elliotson</span> under these circumstances
+gave opium, beginning with gr. i, and increasing the dose to
+gr. iii, thrice a day. The opium produced stupor, and was
+obliged to be discontinued; but the effects produced upon the
+urine by its means<span class='pagenum'><a name="Page_129" id="Page_129">[Pg 129]</a></span> were most remarkable. <i>In about 60 hours,
+the quantity of urine diminished to two pints, its specific
+gravity was reduced to 1.0174, the saccharine matter had
+apparently disappeared, and was superseded by urea, the
+quantity of which had become excessive.</i> This alternation of a
+principle containing nearly half its weight of azote, with
+another containing no azote at all, is perhaps, one of the most
+singular facts occurring in physiology." p. 74.</p></div>
+
+<p>The second subdivision of functional urinary diseases comprises six
+chapters: <i>first</i>, on urinary gravel and calculi; <i>second</i>, on the data,
+showing the comparative prevalency of different forms of urinary
+deposite, and the order of their succession; <i>third</i>, on the lithic acid
+diathesis in general; <i>fourth</i>, on the mulberry or oxalate of lime
+diathesis; <i>fifth</i>, on the cystic oxide diathesis, and <i>sixth</i>, on the
+phosphatic, or earthy diathesis.</p>
+
+<p>Under the first chapter, we have an account of I. Pulverulent or
+amorphous sediments; II. Crystallized sediments, or gravel; and III.
+Solid concretions, or urinary calculi. Of the latter, our author
+enumerates thirteen species.</p>
+
+<p>1. The lithic acid calculus.</p>
+
+<p>2. The lithate of ammonia calculus.</p>
+
+<p>3. The oxalate of lime, or mulberry calculus.</p>
+
+<p>4. The cystic oxide calculus.</p>
+
+<p>5. The bone earth, or phosphate of lime calculus.</p>
+
+<p>6. The triple phosphate of magnesia-and-ammonia calculus.</p>
+
+<p>7. The calculus, composed of a mixture of the phosphate of lime, and
+triple phosphate of magnesia-and-ammonia, or fusible calculus.</p>
+
+<p>8. The alternating calculus.</p>
+
+<p>9. The mixed calculus.</p>
+
+<p>10. The carbonate of lime calculus.</p>
+
+<p>11. The xanthic oxide calculus.</p>
+
+<p>12. The fibrinous calculus.</p>
+
+<p>13. The prostate calculus.</p>
+
+<p>Of these, the 2nd, 4th, 5th, 9th, 10th, 11th, 12th, and 13th species are
+more or less rare, and consequently of less interest. The remaining 5
+are of much more frequent occurrence, and are thus described by our
+author:</p>
+
+<div class="blockquot"><p>"<i>The lithic acid calculus</i> is generally of a brownish-red, or
+fawn colour; but occasionally of a colour approaching to that
+of mahogany. Its surface is commonly smooth, but sometimes
+finely tuberculated; and upon being cu t through, it is usually
+found to consist of concentric lamin&aelig;. Its fracture<span class='pagenum'><a name="Page_130" id="Page_130">[Pg 130]</a></span> generally
+exhibits an imperfectly crystallized texture, sometimes an
+amorphous or earthy one, in which case, it usually contains a
+mixture of other substances. This is one of the most common
+species of calculi.&mdash;<i>Chemical characters.</i> Before the
+blow-pipe, this calculus blackens, emits a smoke having a
+peculiar odour, and is gradually consumed, leaving a minute
+quantity of white ash, which is generally alkaline. It is
+completely soluble in caustic potash, and precipitable again by
+any acid in the form of a white granular powder. Lastly, if to
+a small particle, a drop of nitric acid be added, and heat
+applied, the lithic acid is dissolved; and if the solution be
+evaporated to dryness, the residue assumes a beautiful pink or
+carmine colour."</p>
+
+<p>"<i>The oxalate of lime, or mulberry calculus</i>, is generally of a
+very dark brown colour, approaching to black. Its surface is
+very rough and tuberculated (hence the epithet of <i>mulberry</i>.)
+It is usually hard, and when cut through exhibits an
+imperfectly laminated texture. This species of calculus seldom
+surpasses the medium size, and is rather common. There is a
+variety of it remarkably smooth, and pale coloured. These are
+always of small size; and from their colour and general
+appearance, have been termed the <i>hempseed</i>
+calculus.&mdash;<i>Chemical characters.</i> Before the blow-pipe, this
+species of calculus expands into a kind of white efflorescence,
+which, when moistened and brought into contact with turmeric
+paper, stains it red. This white alkaline substance is the
+caustic lime deprived of its oxalic acid."</p>
+
+<p>"<i>The triple phosphate of magnesia-and-ammonia calculus</i> is
+always nearly white; its surface is commonly uneven, and
+covered with minute shining crystals. Its texture is not
+laminated, and it is easily broken and reduced to powder. In
+some rare instances, however, it is hard and compact, and when
+broken exhibits a crystallized texture, and is more or less
+transparent. Calculi composed entirely of the triple phosphate
+of magnesia-and-ammonia are rare; but specimens, in which this
+salt constitutes the predominant ingredient, are by no means
+uncommon.&mdash;<i>Chemical characters.</i> Before the heat of the
+blow-pipe, this calculus gives off the odour of ammonia, and at
+length melts with difficulty. It also gives off ammonia, when
+treated with caustic potash. It is much more soluble than the
+preceding species in dilute acids, from which it is again
+readily precipitated by ammonia in its original crystallized
+form.</p>
+
+<p>"<i>The calculus composed of a mixture of the phosphate of lime
+and triple phosphate of magnesia-and-ammonia, or the fusible
+calculus</i>, is commonly whiter and more friable than any other
+species, resembling sometimes a mass of chalk, and leaving a
+white dust on the fingers. This species is generally not
+laminated. Occasionally, however, it separates readily into
+lamin&aelig;, the interstices of which are often studded with
+sparkling crystals of the triple phosphate. The variety of this
+species which is not laminated often acquires a very large
+size, and assumes the form of a spongy friable whitish mass,
+evidently moulded to the contracted cavity of the bladder in<span class='pagenum'><a name="Page_131" id="Page_131">[Pg 131]</a></span>
+which it has been formed. This species of calculus occurs very
+frequently.&mdash;<i>Chemical characters.</i> It may be readily
+distinguished by the ease with which it melts before the
+blow-pipe. It also dissolves readily in acids, and particularly
+in dilute muriatic acid; and if to the solution, oxalate of
+ammonia be added, the lime is precipitated alone, and the
+magnesium may be afterwards separated by the addition of pure
+ammonia.</p>
+
+<p>"<i>The alternating calculus</i>, as the name imports, may consist
+of different layers of any of the preceding species. Hence its
+general appearance, texture, &amp;c. will depend entirely on the
+composition, and may be very varied. Most commonly it is
+composed of a lithic acid or mulberry nucleus, and an external
+crust of the fusible calculus. In some rare instances, it is
+composed of lamin&aelig; of all three of these substances, and
+sometimes of even more&mdash;the mixed phosphates still continuing
+to constitute the external crust. This species of calculus
+often acquires a very large size and is very common.&mdash;<i>Chemical
+characters.</i> The chemical characters must of course vary with
+the composition; and as the different substances of which it is
+composed must almost certainly be some of the preceding, the
+nature of the different lamin&aelig; can be readily ascertained by
+what has been already stated," p. 79, et seq.</p></div>
+
+<p>In the chapter on the comparative prevalency of different forms of
+urinary deposite; and the order of their succession, we have a number of
+important facts and observations. Dr. <span class="smcap">Prout</span> calculates, from the data
+collected by him, that about one-third of the urinary calculi which
+occur, are of the lithic acid species, and that another third are formed
+on a nucleus of this acid. Hence, "we may assert," says he, "that at
+least <i>two-thirds</i> of the whole number of calculi originate from lithic
+acid; that is to say, if a lithic acid nucleus had not been formed and
+detained in the bladder, two persons at least out of three, who suffer
+from calculus, would have never been troubled with that affection. This
+is a most important fact, and deserves to be constantly borne in mind."</p>
+
+<p>The relative prevalency of the oxalate of lime calculus is very various.
+The average proportion, as determined by Dr. <span class="smcap">Prout</span> is about one in
+seven. Of the calculi, examined by Mr. <span class="smcap">Brande</span>, 1 in 25 was of the
+mulberry species; while in the Norwich and Guy's Hospital collections,
+the proportion is about 1 in 4. In the Bristol collection, one-sixth of
+the whole, was composed of oxalate of lime, nearly pure; while,
+including all the concretions containing more or less of the oxalate,
+the proportion was nearly <i>one-half</i>! This great disparity in the
+proportional frequency of<span class='pagenum'><a name="Page_132" id="Page_132">[Pg 132]</a></span> this calculus in different districts of
+England, clearly shows the great influence of local causes, in
+determining the character of urinary concretions.</p>
+
+<p>From a careful observation of the order of deposition of different
+species of calculous matter, Dr. <span class="smcap">Prout</span> has been enabled to deduce the
+following general law; "<i>that, in urinary calculi, a decided deposition
+of the mixed phosphates is not followed by other depositions</i>." So that
+it would appear, that a redundancy in the earthy phosphates is the last
+link in the chain of diseased alterations, to which the urinary
+secretion is liable.</p>
+
+<p>In the third chapter, under the second subdivision of functional urinary
+diseases, Dr. <span class="smcap">Prout</span> describes the lithic acid diathesis, and
+communicates several important original observations. After remarking
+that the dyspeptic are particularly predisposed to lithic acid
+deposites, he enumerates, as exciting causes of this species of gravel,
+1st. <i>Errors in diet</i>; 2nd. <i>Unusual or unnatural exercise of the body
+or mind, particularly after eating, and the want of proper exercise at
+all other times</i>; and 3d. <i>Debilitating causes</i>. Under errors of diet,
+an unusually heavy meal, especially of animal food, and the use of
+heavy, unfermented bread, or compact, hard-boiled, fat dumplings or
+puddings, salted and dried meats, acescent fruits, malt liquors, and
+acescent wines, are enumerated as particularly hurtful in the lithic
+acid diathesis.</p>
+
+<p>The above remarks refer to the amorphous lithic deposites, consisting of
+lithate of ammonia. In regard to crystallized sediments, or, more
+properly speaking, gravel, our author makes the following remarks:</p>
+
+<div class="blockquot"><p>"Crystallized sediments, or red gravel, consist of lithic acid,
+nearly pure. Lithic acid, as has been before stated, exists in
+a state of combination in healthy urine; and in such a
+proportion, as to be held in a state of solution at all
+ordinary temperatures. Sometimes, however, a free acid is
+generated by the kidneys, which precipitates the lithic acid in
+the pure crystallized state we see it&mdash;a phenomenon easily
+imitated artificially, as is well known, by the addition of a
+few drops of any acid to healthy urine. The precipitation of
+crystallized lithic acid does not, therefore, necessarily
+indicate an excess of lithic acid in the urine, but the
+presence only of some free acid in that fluid; though such an
+excess does, for the most part, exist in this form of disease,
+as will be shown hereafter. With respect to the nature of the
+precipitating acid, it is probably not always the same. Most
+generally it appears to be the <i>muriatic</i>, sometimes the
+<i>phosphoric</i> or <i>sulphuric</i>, and occasionally other acids. In
+general, however, it is to be understood, as<span class='pagenum'><a name="Page_133" id="Page_133">[Pg 133]</a></span> noticed
+elsewhere, that when the mineral acids are present in excess,
+these are the <i>immediate</i> cause of the preternatural acidity in
+the urine, and consequently of the precipitation of the lithic
+acid. The stronger acids act by decomposing saline compounds,
+into which destructible acids, such as the lactic acid, &amp;c.
+enter, and setting them free. Hence the <i>immediate</i> cause of
+the deposition of lithic acid gravel is generally a
+destructible acid of very weak powers: even, perhaps, in some
+instances, the carbonic acid. When the urine contains a free
+acid, it is commonly more transparent than usual, and of a
+bright copper colour." p. 112.</p></div>
+
+<p>The treatment recommended by Dr. <span class="smcap">Prout</span> in this species of gravel is as
+follows: First, a strict attention to diet, avoiding the hurtful
+articles already enumerated. Secondly, the use of <i>alkaline</i> remedies;
+but those must not be depended upon, without the aid of other means,
+more especially of alteratives and purgatives. Accordingly we are
+informed that</p>
+
+<div class="blockquot"><p>"The pil. submur. hydrarg. comp., or a pill composed of the
+pil. hydrarg. and pulv. antimonialis, may be taken twice or
+thrice a week at bed time, and followed up the next morning by
+an active dose of the sub-sulphate of magnesia, or a mixture of
+Rochelle salts and magnesia, or carbonate of soda. A little of
+either of these compounds may be also taken twice or thrice in
+the day, so as to keep the urine constantly neutral or
+alkaline, and the bowels freely open; or gr. x to xx of
+magnesia may be taken for the same purpose in a glass of soda
+water, as often as it may be found necessary."</p></div>
+
+<p>In the chapter on the mulberry, or oxalate of lime diathesis, Dr. <span class="smcap">Prout</span>
+gives a number of cases, from which he draws the following conclusions:</p>
+
+<div class="blockquot"><p>"1st. That this form of disease occurs in both sexes; that it
+may exist before puberty, and at all ages between that and 40
+or 50, at which time it seems to occur most frequently; but
+that no case occurs beyond the age of sixty. Hence that it is
+probably not a disease of old age.</p>
+
+<p>"2nd. That it is not incompatible with gout, but seems
+occasionally to be associated with it. I have also seen it
+connected, as lithic acid frequently is, with a tendency to
+cutaneous disease.</p>
+
+<p>"3d. That this variety of calculous affection occurs in
+individuals of sound constitutions, and who ordinarily enjoy
+good health; and that it rarely occurs a second time, except at
+long intervals, during which the intermediate health is good;
+which latter facts, it may be proper to observe, are confirmed
+by other observers, and particularly by Mr. <span class="smcap">Brande</span> and Dr.
+<span class="smcap">Marcet</span>.</p>
+
+<p>"4th. That the urine is acid, and apparently but slightly
+deranged in this form of calculus, and remarkably free from all
+sorts of sediment and gravel.<span class='pagenum'><a name="Page_134" id="Page_134">[Pg 134]</a></span></p>
+
+<p>"5th. That as renal calculi of the oxalate of lime often
+subsequently acquire considerable magnitude in the bladder, it
+may be inferred, that the formation of this compound is
+connected with a distinct diathesis, excluding the existence of
+other diatheses, and that is not an accidental occurrence,
+happening in common with many others to the urine.</p>
+
+<p>"6th. That from the dissection of calculi, formerly mentioned,
+it appears that the oxalate of lime diathesis is preceded and
+followed by the lithic acid diathesis; a circumstance which
+seems to be peculiar to these two forms of deposite, and which,
+when taken in conjunction with the other circumstances, already
+related, appears to show, that they are of the same general
+nature; or in other words, that the oxalic acid merely takes
+place as it were of the lithic acid, and by combining with the
+lime naturally existing in the urine, forms the concretion in
+question.</p>
+
+<p>"7th. That the diathesis being of a similar nature, the
+principles of treatment adapted for counteracting the original
+tendency to it must be also similar, that is to say, of an
+antiphlogistic character; great attention being at the same
+time paid to the digestive and assimilative functions." p. 137,
+et seq.</p></div>
+
+<p>The diagnostic signs of the oxalate of lime diathesis are very obscure,
+as will appear from the following extract:</p>
+
+<div class="blockquot"><p>"With respect to the means of determining when this diathesis
+is going on in the system, I am sorry that I can give but
+little positive information. The absence of urinary sediment,
+&amp;c. are of a negative character, and lead to no inference,
+where other circumstances are wanting, as is most generally the
+case. But if there be pain in the region of the kidney, and
+other symptoms of gravel, without any appearance of sediment;
+and if the urine be acid, and of the yellow tint above alluded
+to, the stomach deranged, and an inflammatory diathesis, either
+general or local (i.e. about the urinary organs), be present;
+and if all these are associated with suppressed gout, or
+tendency to cutaneous disease,&mdash;the existence of this form of
+the disease may be suspected, and means immediately taken to
+counteract it." p. 138.</p></div>
+
+<p>We omit any analysis of the next chapter on the cystic oxide diathesis,
+on account of the rare occurrence of this state of the system.</p>
+
+<p>The next chapter of our author is on the phosphatic, or earthy
+diathesis.</p>
+
+<p>The phosphatic deposites are of two kinds; the <i>crystallized</i>,
+consisting almost invariably of the triple phosphate of
+magnesia-and-ammonia, and exhibiting the appearance of white, shining
+crystals; and the <i>amorphous</i>, consisting always of a mixture of<span class='pagenum'><a name="Page_135" id="Page_135">[Pg 135]</a></span> the
+phosphate of lime, and the triple phosphate of magnesia-and-ammonia.</p>
+
+<p>The causes apt to produce a deposition of the triple phosphate of
+magnesia-and-ammonia, are thus enumerated by Dr. <span class="smcap">Prout</span>:</p>
+
+<div class="blockquot"><p>"Any thing acting generally, and producing <i>a nervous state of
+the system</i>, such as the distressing passions, and particularly
+<i>mental anxiety</i> or <i>fear</i>, will frequently produce in many
+people an excess of this salt in the urine. The same is also
+true of many articles of food or medicine that produce a
+hurried secretion of the urine, and act as diuretics; as the
+neutral salts in some cases, and particularly the Rochelle
+salts and other saline compounds, in which the acid is of
+vegetable origin. So also, a long continued use of alkaline
+remedies, or of mercury, in irritable habits more especially,
+will likewise produce a tendency to an excess of this salt, as
+well as of the phosphates in general, and even lead to an
+actual deposition of them from the urine. The same sediment
+also frequently abounds, or is easily induced, in the urine of
+those who have long been in bad health, and in whom the
+constitution may be considered as giving way, or, to use a
+common expression, breaking up. In general, it is to be
+understood, that the slighter causes affect only the
+predisposed, and those in particular who are subject to other
+diseases of the urinary organs or urine. It may be also
+remarked, that children are more subject to this form of
+deposition than adults; a circumstance, perhaps, to be referred
+to the irritability of the system at this age, and the great
+derangement of the digestive organs, to which they are
+subject." p. 151.</p></div>
+
+<p>The above mentioned causes are stated to be equally productive of
+amorphous phosphatic sediments.</p>
+
+<p>Our author next enumerates the very distressing symptoms, by which the
+deposition of the earthy phosphates is attended. They consist in great
+irritability; derangement of the chylopoietic viscera, evinced by
+flatulency, nausea, obstinate costiveness, or peculiarly debilitating
+diarrh&oelig;a; extremely unnatural stools, nearly black, or clay-coloured,
+and sometimes resembling yest; pain, uneasiness, or weakness in the back
+or loins; sallow, haggard expression of countenance; and finally, if the
+disease be not arrested, great languor and depression of spirits,
+coldness of the legs, and complete anaphrodisia, as occur in diabetes.</p>
+
+<p>A curious and important fact has been stated in regard to the remote
+causes, producing the phosphatic state of the urine. It has been
+observed by Dr. <span class="smcap">Prout</span>, that a large proportion of cases<span class='pagenum'><a name="Page_136" id="Page_136">[Pg 136]</a></span> of this
+complaint may be traced <i>to some injury of the back</i> from mechanical
+violence, such as a fall from a horse, &amp;c.</p>
+
+<p>The remedies for this diseased state of the urine, found most successful
+by Dr. <span class="smcap">Prout</span>, are,&mdash;opium, in from one to five grain doses, repeated two
+or three times a day, until the unnatural irritability of the system is
+relieved,&mdash;the same remedy in more moderate doses, in conjunction with
+the mineral acids, cinchona, uva ursi, and the different preparations of
+iron,&mdash;a large pitch, soap, or galbanum plaster to the loins,&mdash;and
+setons or issues in the back, when the disease manifestly arises from
+local injury. With respect to the bowels, Dr. <span class="smcap">Prout</span> remarks, that they
+are very difficult to regulate. He has occasionally seen serious
+consequences to arise from the exhibition of a small dose of calomel,
+such as diarrh&oelig;a and debility, much aggravating the disease, and
+endangering the life of the patient. For the regulation of the bowels,
+small doses of castor oil, and laxative injections are most to be relied
+on; while saline purgatives, more especially Rochelle salt and Seidlitz
+powders, as containing vegetable and therefore destructible acid, must
+be avoided.<a name="FNanchor_24_24" id="FNanchor_24_24"></a><a href="#Footnote_24_24" class="fnanchor">[24]</a> Mercury, in all its forms, is also inadmissible.</p>
+
+<div class="blockquot"><p>"Alkaline remedies of every description, must be most carefully
+avoided, their use in every point of view being most
+mischievous when the phosphates are concerned. Indeed all
+remedies that act as diuretics should, in general, be shunned,
+and the patient should be prohibited from drinking too much.
+With respect to drinks, in general, they should be of a
+soothing, demulcent character, and prepared with distilled or
+the softest water that can be procured; as hard waters are
+literally poison in this form of disease."</p></div>
+
+<p>The second division of the work under review treats of the mechanical
+and organic diseases of the urinary organs. This portion of the subject
+is handled with the same ability as the first. We regret, however, that
+our space will not permit a further development of the author's views.
+We trust, nevertheless, that we have imparted to our readers adequate
+notions of the scope of the work, to render them sensible of its value
+as a manual of urinary diseases. It is illustrated by a good coloured
+plate, representing the principal varieties of urinary calculi.</p>
+<p><span class='pagenum'><a name="Page_137" id="Page_137">[Pg 137]</a></span></p>
+<p>The additions of Dr. <span class="smcap">Colhoun</span> consist of foot notes, and paragraphs
+inserted in the text of the original work. We would not, however, wish
+to be considered as approving of the course, for the most part pursued
+by Dr. C., of inserting his amplifications in the text of the author,
+merely distinguished by brackets. Besides the absence of sufficient
+distinction between the matter of the author and commentator, the text
+of the former is thus injuriously disjointed, and dependent sentences
+sometimes widely separated.</p>
+
+<p>In regard to the execution of the present edition, we regret to say that
+it is wanting in typographical accuracy.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_23_23" id="Footnote_23_23"></a><a href="#FNanchor_23_23"><span class="label">[23]</span></a> The reader will bear in mind, that this acid is the same
+as the uric, the name by which it is generally known.</p></div>
+
+<div class="footnote"><p><a name="Footnote_24_24" id="Footnote_24_24"></a><a href="#FNanchor_24_24"><span class="label">[24]</span></a> The reason of this exclusion of salts, containing a
+vegetable acid is, that they become real alkalies in the course of
+assimilation by the destruction of their acid, and therefore add
+alkaline properties to the urine, already too alkaline.</p></div>
+</div>
+
+
+<hr style="width: 65%;" /><p><span class='pagenum'><a name="Page_138" id="Page_138">[Pg 138]</a></span></p>
+<h2>MEDICAL LITERATURE.</h2>
+
+
+
+<hr style="width: 65%;" />
+<h2><span class="smcap">Article XII.</span>&mdash;<span class="smcap">Retrospective Review</span>.&mdash;<i>Tractatus de Ventriculo et
+Intestinis, cui pr&oelig;mittitur alius, de Partibus continentibus in
+Genere, et in Specie de iis Abdominis.</i> <i>Authore</i> <span class="smcap">Francisco Glissonio</span>,
+&amp;c. &amp;c. Lond. 1677, 4to.</h2>
+
+
+<p>As it is not our intention to confine our remarks to the work above
+mentioned, we shall deem no apology necessary for the somewhat excursive
+nature of this article, which would not answer our present purpose, if
+we were obliged to follow the costive details of the venerable <span class="smcap">Francis
+Glisson</span>, whose villanous bad style, and execrable latin, are only to be
+excused or overlooked in consideration of the great importance of the
+topics which he handles, and the profound reflections which he makes on
+them. <span class="smcap">Glisson</span> is recognised as author of the physiological term
+<i>Irritability</i>, and as the assertor of the inherent activity of matter.
+<span class="smcap">Haller</span> says of him in his XIth book. "<span class="smcap">Franciscus Glisson</span>, qui universis
+elementis corporum, vim motricem tribuit, etiam nostram vim,
+Irritabilitatem vocavit," &amp;c.</p>
+
+<p>He was a native of Dorsetshire, and was appointed professor of physic at
+Oxford in 1627. This post he occupied during forty years, and is much
+distinguished by his treatise de vita natur&aelig;, and by the work which
+forms our caption. As he is the first who used the physiological term
+irritability, we have thought that some researches on this subject in
+general, and more particularly on his peculiar sentiments, might
+profitably occupy our retrospective department; for it is very evident
+that this subject is in general but vaguely discussed, both in medical
+writings and conversation.</p>
+
+<p>The ancient philosophers did not agree among themselves as to the nature
+and origin of matter; some of them considering it as eternal in its
+essence, and others as mutable and changeable in form. The theory of
+atoms, published by <span class="smcap">Democritus</span>, and subsequently carried out so
+elaborately by <span class="smcap">Epicurus</span> and his disciples,<span class='pagenum'><a name="Page_139" id="Page_139">[Pg 139]</a></span> seems to have reached even
+to our own times, with an increasing reputation and acceptance.
+According to this theory, the kinds of matter, or elements, must he
+regarded as infinitely various. <span class="smcap">Heraclitus</span>, who taught philosophy about
+550 years before Christ, considered all things as derived from an
+elemental heat or fire;<a name="FNanchor_25_25" id="FNanchor_25_25"></a><a href="#Footnote_25_25" class="fnanchor">[25]</a> a philosophy which seems to us to have
+formed the basis of the Hippocratic doctrines of life. Like <span class="smcap">Heraclitus</span>,
+<span class="smcap">Hippocrates</span> tells us, that the calidum was the first principle of
+things, and that by an expansion or extension of itself, it constitutes
+all the objects of the material world. He expresses himself in the
+following manner. That which we call warmth, or heat, seems to me to be
+something immortal; something which comprehends all things, which sees
+and knows all things, as well present as future. Thus assuming as a
+basis, that the calidum is an almighty, all-wise being, or in other
+words, a God, all in all, the cosmogony was developed as follows: Chaos
+he regarded as that condition of the calidum, which preceded any
+exertion of the Almighty faculties. In emerging from the chaotic state,
+the greatest part of the heat having assumed the uppermost place, formed
+the &aelig;ther; another part having gained the lowermost place, constituted
+earth; a third portion, midway between earth and &aelig;ther, became air; and
+a fourth part, establishing itself between the two latter, became water.
+So that by means of the extension of this all-wise, elemental calidum,
+we have the four elements, earth, air, fire, and water, out of which are
+ultimately composed all the aggregates of the material world.<a name="FNanchor_26_26" id="FNanchor_26_26"></a><a href="#Footnote_26_26" class="fnanchor">[26]</a> Now,
+to apply this general principle to the formation of the living being
+man, who seems to be a sort of microcosm in himself, we are told, that
+that portion of heat which remained with earth, being expanded and
+spread abroad in divers places, in some more, in others less, the earth
+became dry, and something like membrane or pellicle was formed; the
+matters contained in which, being heated as by a sort of putrefaction,
+some parts became bone, some nerve, some<span class='pagenum'><a name="Page_140" id="Page_140">[Pg 140]</a></span> veins and their contents, and
+some formed the cavities and their contents, as the urinary bladder, for
+example.<a name="FNanchor_27_27" id="FNanchor_27_27"></a><a href="#Footnote_27_27" class="fnanchor">[27]</a></p>
+
+<p>The full exposition of the opinions of <span class="smcap">Hippocrates</span> was left for <span class="smcap">Galen</span>,
+and we prefer to make reference to him on this theory, which by his
+genius and talent was so much embellished, that it became the glory of
+science, exercising an almost undisputed authority during a long lapse
+of ages. Indeed the gigantic intellect of this great man, still
+continues to shed its vast illumination over the world of science,
+particularly that of medicine; which, if it owes its birth to the divine
+old man of Cos, is not less indebted for its nurture and growth to the
+celebrated native of Pergamus. <span class="smcap">Galen</span> is the facile princeps of
+physicians. His astonishing industry, perseverance, and acquirements,
+his ingenious arguments, and persuasive eloquence, give him an
+unquestionable claim to the title of princeps, so long accorded to him;
+and those who even in the present enlightened period, will study his
+works, shall find themselves almost irresistibly led away by the charm
+of his suasion.</p>
+
+<p><span class="smcap">Galien</span> est le seul des anciens qui ait donn&eacute; un corps complet de
+medecine: Quoique form&eacute; des d&eacute;bris de toutes les doctrines pr&eacute;c&eacute;dentes,
+son systeme offre cependant, malgr&eacute; les contradictions ou il tombe assez
+souvent, une unit&eacute; remarquable dans toutes ses parties; un ensemble
+s&eacute;duisant, qu'un genie de l'ordre le plus &eacute;lev&eacute;<span class='pagenum'><a name="Page_141" id="Page_141">[Pg 141]</a></span> pouvoit seul imprimer &agrave;
+un pareil &eacute;difice. Ramenant tout &agrave; un petit nombre de principes
+g&eacute;n&eacute;raux, qui s'ils ne peuvent satisfaire la raison, fournissent du
+moins une r&eacute;ponse facile a tout, ce syst&ecirc;me dut &ecirc;tre adopt&eacute; avec
+empressement, et sa fortune ne peut &eacute;tonner.&mdash;<i>Biographie Medicale, Tom.
+IV.</i></p>
+
+<p><span class="smcap">Galen</span> may perhaps be justly regarded as an eclectic; but it is manifest,
+that he mainly walked after the steps of his great predecessor, and
+recognised model. The following passage seems to contain ideas not much
+differing from those of <span class="smcap">Hippocrates</span> which we have presented above: "Who
+is there, says he, that judging from the origin and constitution of
+animated beings, doth not immediately infer the existence of a mind,
+possessed of wonderful energies, extending to, and pervading every
+portion of the universe! We every where perceive animals procreated,
+which are possessed of the most admirable structure, and yet what
+portion of the universe can be more ignoble than this earth of ours? Yet
+a grand intelligence is seen to have reached even it from the celestial
+bodies, which for their beauty are so astonishing, and which, as they
+are for purity far more excellent than our earth, so they are the seats
+of intelligences, far more pure and perfect than those which inhabit
+these lower regions." He proceeds to remark, that animals, worthy of the
+greatest admiration, are produced out of the slime and mud of ponds and
+ditches, and even in putrefying vegetables, which, as they indicate the
+miraculous properties of their author, also show us in what estimation
+we should hold the higher orders of being. "We may even perceive a
+rational nature in men, if we refer to such examples as <span class="smcap">Plato</span>,
+<span class="smcap">Aristotle</span>, <span class="smcap">Hipparchus</span>, <span class="smcap">Archimedes</span>, and many others. If, therefore, in
+such a colluvies as the human body, (for by what better name can we
+characterize a mixture of blood, bile, and phlegm,) a mind is formed of
+such great and excellent faculties, what must we think of the excellence
+of that which exists in the superior bodies?"</p>
+
+<p>It may be said that <span class="smcap">Galen</span> expresses, in these passages, the Platonic
+dogma of an <i>anima mundi</i>. But they certainly agree with the sentiments
+of <span class="smcap">Hippocrates</span>; and whether he derived them from the former or the
+latter, matters not, as both of them have invested matter with certain
+qualities, which render it active, whether it be so essentially or by
+the act of the Creator. <span class="smcap">Galen<span class='pagenum'><a name="Page_142" id="Page_142">[Pg 142]</a></span></span> may be also regarded as partially an
+Epicurean; for he insists that there are several sorts of matter, or as
+we should say, several elements; but he differs from that sect again in
+affirming for it a passible quality. To show that there must be more
+than one element, or kind of matter, he says, that if there was only one
+element, or a unit, it would be impassible; it could undergo no change
+whatever. For there would be nothing by which it could be made to suffer
+any alteration, or into which it could be altered. Whatever is changed,
+is changed into something else, and whatever suffers, suffers from
+something extrinsic: therefore he affirms, that of necessity there must
+be several sorts of matter, or elements. He says, "there are only two
+theories on this subject deserving our attention; one of which affirms
+that sentient bodies are composed of elements possessing the faculty,
+(cum patiendi tum sentiendi,) both of suffering and perceiving an
+alteration;" while the other affirms that such bodies are formed (ex
+patibilibus, sed sensu expertibus) out of passible, but not sentient
+elements. Neither of these doctrines does he consider tenable, so long
+as only one element is affirmed, as earth, air, or fire alone, which
+could never become capable of that great variety of actions we witness
+in living bodies: but, admit several elements, and we suppose that the
+mutual interchange of powers would yield a compound body, capable of all
+the vital phenomena. Such, therefore, says he, as consider the human
+body to be composed of fire, air, earth, and water, mutually transmuted,
+alternated, and reduced to a given temperament, and thereby vested with
+a sentient faculty, speak reasonably; and it is evident that there must
+be more than one element, and that these elements are passible bodies.</p>
+
+<p><span class="smcap">Plato</span> had taught, that, though all bodies are formed of matter, yet
+matter itself is not a body; and the same idea is conveyed by <span class="smcap">Aristotle</span>,
+in the Lib. de partibus animal. &amp; earum causis, II c.i. "Prima statui
+potest ea qu&aelig; ex primordiis conficitur, iis qu&aelig; nonnulli elementa
+appellant terram dico, aquam a&euml;rem &amp; ignem: sed melius fortasse dici
+potest ex virtutibus confici elementorum, iisque non omnibus sed ut ante
+expositum est humiditus enim, &amp; siccitas, &amp; caliditas, and frigiditas,
+materia sunt corporum compositorum."</p>
+
+<p><span class="smcap">Galen</span> also states, that in fire there exists a perfect heat and<span class='pagenum'><a name="Page_143" id="Page_143">[Pg 143]</a></span>
+dryness, in earth a perfect coldness and dryness, and so on of the rest
+of the elements. For you cannot expect to find in nature a perfectly
+simple and isolated element; because they are always mixed two or more
+together. Hence the real terram, aquam, a&euml;rem, and ignem, become rather
+a metaphysical abstraction, than a real entity. That is to say, matter
+has no real existence, but is mere quality; for earth is not the mere
+representation of dry or siccum; it is the representative of siccitas,
+or dryness: fire is not the eidolon of calidum, but of caliditas; water
+of humiditas, and air of frigiditas. Yet all these elements are in
+nature possessed of more than one property. Fire is hot and dry, earth
+is dry and cold, water is cold and moist, &amp;c. If we refer, however, to
+his account of the soul, we perceive at once, that these inseparable
+qualities of the elements are the real active agents of life. He plainly
+declares, that the soul is the mere result of organization, and perishes
+with the structure in which it dwells. He thinks, "corporis temperiem
+censendum est." As to the active powers of the four primary qualities,
+he says, "At mihi quidem tam ven&aelig;, quam reliquarum particularum singul&aelig;,
+ob certam quandam temperiem quam ex quatuor sunt qualitatibus nact&aelig;, hoc
+vel illo modo videntur agere."&mdash;De nat. fac. I.</p>
+
+<p>It is plain he thinks, that the elements consist of a materia and
+qualitas; but they are elemental by the <i>qualitas</i> and not by the
+<i>materia</i>.</p>
+
+<p>After establishing that there are four elements, which are the common
+and simple bases of all things, he goes on to show, that the proper
+proportion and admixture of these, constitute the healthy state of
+living bodies. If the calidum, for example, be unduly increased, the
+body is destroyed; if it be improperly diminished by excess of the
+frigidum, it will also perish. The business of the physician is to keep
+the proportions just and harmonious; but, as no pure element exists
+alone, the physician must employ the qualitas in conjunction with the
+materia. These (to make a phrase) substantive qualities, are found in
+medicines or food, which, like all objects of sense, are either cold,
+hot, dry, or moist, and available of course in the management of a cold,
+hot, dry, or moist derangement of the living body.</p>
+
+<p>The elements of the human body exist in the four humours, blood, bile,
+atrabilis and pituita; and these four humours correspond<span class='pagenum'><a name="Page_144" id="Page_144">[Pg 144]</a></span> in quality
+with the elements. Blood, which is the reservoir or continent of them
+all, is a temperate humour. Bile, being the representative of calidum,
+is hot and dry. Melancholy represents, in our microcosm, the element
+earth or siccum, and is dry and cold. But pituita, which is moist and
+cold, corresponds with the humidum element. Air exists in animals nearly
+pure, as we learn from the phenomena of the pulse and of respiration. It
+answers to frigidum.</p>
+
+<p>He shows us in his lib. de naturalib. facultat. that, out of the
+humours, all the parts are formed, and these parts are either <i>similar</i>
+or <i>dissimilar</i>; i. e. simple or compound. Bone is a similar part, that
+is, it is a simple part; so is an artery, or vein, or ligament. Each of
+these is so constituted, as that it has a predominance of one element in
+its nature; and it is therefore dry, or cold, or moist, &amp;c. But if an
+adust element be, by accident or disease, accumulated in a part
+naturally cold, the function of such part is morbidly affected. The
+natural tendency, however, of similar humours to unite, causes each part
+to receive its regular supply; a principle which <span class="smcap">Bichat</span> has since
+characterized as, <i>contractilit&eacute; organique insensible</i>.</p>
+
+<p>To show the wonderful simplicity of the Galenical system, which for
+plainness and easy attainment may be compared with the improved
+nomenclature of chemistry, we will cite a passage from <span class="smcap">Argenterius</span>, who,
+perhaps, was as learned in this kind of lore as any man of his time. In
+his Tractatio de calidi significationibus, he says; "If any body would
+undertake to give a general enumeration of those circumstances, in which
+this term calidum and the others (frigidum, humidum, &amp;c.) are applicable
+to the explanation of this warmth, he shall find truly, that they are
+the elements, the humours, the parts, the whole body, medicines, food,
+air, climate, the weather, the season of the year, and even ages; for
+these all are either temperate, or hot, or cold, or humid, or dry."</p>
+
+<p>The animal body is moved and governed by two principles; one of them
+corresponds to the <i>vie animale</i> of <span class="smcap">Bichat</span>, and the other to the <i>vie
+organique</i>. Since the power of sensation and of voluntary or elective
+motion, says he, is a property of animals, and since that of growth and
+nutrition is common both to animals and plants; the former may be called
+attributes of the soul, and the<span class='pagenum'><a name="Page_145" id="Page_145">[Pg 145]</a></span> latter attributes of nature. Whence we
+say, that animals are governed by the soul and by nature, while plants
+are governed by nature alone.</p>
+
+<p>The powers of the body are faculties; and these are either natural,
+vital, or animal: but they are so subdivided, that we have as many
+faculties as there are sorts of action. Under the class of natural
+faculties, we find three principal sorts; to wit, a facultas generatrix,
+an auctrix, and a nutrix. But if you ask, says <span class="smcap">Galen</span>, how many faculties
+there be, which result from the action of these on each other, you will
+find them as numerous and diverse as there are numbers and diversities
+of the animal parts. For example, we have an attractrix faculty, a
+retentrix, alteratrix, expultrix, &amp;c. &amp;c., all of which are variously
+modified, according to the nature of the similar or dissimilar parts
+they are exercised in, or, in other words, according to the nature of
+the tissues or organs, in which they reside.</p>
+
+<p>Need we go further to show, that <span class="smcap">Galen</span>, believing all matter essentially
+conjoined with the hypothetical caliditas, frigiditas, &amp;c. &amp;c., taught
+that it was gifted with such a degree of inherent activity, as to render
+it capable under certain states of combination, of exhibiting all the
+phenomena of organic and animal life? It is certain that he regarded
+these active qualities, as the causes of all the phenomena, whether of
+living or dead matter.&mdash;<span class="smcap">Glisson</span> ought not certainly then to be regarded
+as the author of this dogma in medical philosophy. <span class="smcap">Plato</span> certainly
+taught it. <span class="smcap">Van Helmont</span> could not get along without investing matter with
+what he called a "seminal likeness, which is the more inward spiritual
+kernel of the seed," &amp;c. But we will let him speak for himself.
+"Whatsoever," says V. H., "cometh into the world, must needs have the
+beginning of its motions, the stirrer up and inward director of
+generation. Therefore all things, however hard and thick they are, yet
+before that their soundness, they inclose in themselves an air, which
+representeth the inward future generation to the seed in this respect
+fruitful, and accompanies the thing generated, even to the end of the
+stage: which air, although it be in some things more plentiful, yet, in
+vegetables it is pressed together in the show of a juice, as also in
+metals it is thickened with a most thick homogeniety or sameliness of
+kind. Notwithstanding this gift hath happened to all things, which is<span class='pagenum'><a name="Page_146" id="Page_146">[Pg 146]</a></span>
+called <i>archeus</i>, or chief workman, containing the fruitfulness of
+generations or seeds, as it were the internal efficient cause; I say
+that workman hath the likeness of the thing generated, unto the
+beginning whereof, he composeth the appointments of things to be done.
+But the chief workman consists of the <i>conjoining of the vital air</i>, as
+of the matter, with the seminal likeness, which is the more outward
+spiritual kernel, containing the fruitfulness of the seed; but the
+visible seed is only the husk of this. This image of the master workman,
+issuing out of the first shape or idea of its predecessor, or snatching
+the same to itself out of the cup or bosom of outward things, is not a
+certain dead image, but made famous by a full knowledge, and adorned
+with necessary powers of things to be done in its appointment; and so it
+is the first or chief instrument of life and feeling. But since every
+corporeal act is limited into a body, hence it comes to pass, that the
+archeus, the workman and governor of generations, doth clothe himself
+presently with a bodily clothing. For in things soulified, he walketh
+thorow all the dens and retiring places of his seed, and begins to
+transform the matter according to the perfect act of his own image; for
+here he placeth the heart, but there appointeth the brain, and he every
+where limiteth an unmoveable chief dweller, out of his whole monarchy,
+according to the bounds of requirance of the parts and appointments. At
+length that president remaineth the overseer and inward ruler of the
+bounds, even until death; but the other, floating about and being
+assigned to no member, keeps the oversight over the particular pilots of
+the members, being clear and never at rest or keeping holiday."</p>
+
+<p>Notwithstanding the affected and euphuistic jargon of the above
+passages, it is evident that <span class="smcap">Van Helmont's</span> idea is very similar to that
+of <span class="smcap">Galen</span>. By seminal likeness, we are to understand an aptitude in
+matter to take on certain determinate forms, and this may be supposed to
+differ not very essentially from those laws, which govern matter in
+crystallization. But even this seminal likeness, as we perceive, is a
+sort of abstraction, very analogous to the Galenical caliditas; for it
+is the more inward spiritual kernel of the seed, whereby the matter is
+enabled to enjoy a certain degree of activity, the degree of which is
+much increased by the union of the air, or archeus, with it. So the
+caliditas of <span class="smcap">Galen</span>, which, after all, is matter, gives to its subject
+the powers which it enjoys. <span class="smcap">Glisson</span>, speaking of the natura seminalis,
+says<span class='pagenum'><a name="Page_147" id="Page_147">[Pg 147]</a></span> that it is a certain or specific essence, superadded to mere
+elementary principles, by means of which mixt bodies adopt certain
+determinate forms, and acquire the faculty of performing essential
+operations, more noble than those which belong to naked elements.</p>
+
+<p>We regret very much that we have been unable to procure a copy of
+<span class="smcap">Glisson's</span> treatise de vita natur&aelig;, which, so far as we know, can not be
+had in this country. We shall, therefore, furnish our readers with the
+following passage from the Biographie Medicale, from the pen of
+<span class="smcap">Jourdain</span>.</p>
+
+<p>"The name of <span class="smcap">Glisson</span> occupies an honourable place in the history of
+medicine, because to him we are indebted for the first elements of the
+physiological doctrine of the present day. Instead of directing his
+attention to movements alone, as the iatro-mathematicians, and even, to
+a certain extent, the animists had done, he referred to vitality all the
+phenomena of nature, of whatever kind, and attempted to reduce them to
+one, common principle. To this end he admitted, that matter is
+originally endued with forces inherent in it, and that living bodies in
+particular, are invested in their organs with a radical force, which,
+put in play by stimulants, whether internal or external, gives rise to
+all the phenomena of life. He even went so far as to assert, that
+sympathy may be explained by referring to the intercommunication of this
+force, to which he gave the name of irritability."</p>
+
+<p>We shall also cite from <span class="smcap">Sprengel</span>, a passage which throws some light on
+his theory.</p>
+
+<p>"When they became unwilling, like <span class="smcap">Descartes</span> and <span class="smcap">Stahl</span>, to have constant
+recourse in their explanations, to the soul, they tried to find a
+philosophic proof of the existence of material forces, to show that
+matter, as mere matter, is endowed with particular forces, with which
+they might satisfactorily explain a great many of its phenomena. No one
+had hitherto sought for a similar proof; for <span class="smcap">Aristotle</span> had contented
+himself with an axiom, that all natural things contain in themselves the
+sufficient cause of their movement and rest. <span class="smcap">Glisson</span> and <span class="smcap">Leibnitz</span> set
+themselves in search of this proof; but it was reserved for the immortal
+<span class="smcap">Kant</span> to find it in the nature of matter itself.</p>
+
+<p>"<span class="smcap">Francis Glisson</span> may with propriety be considered as the precursor of
+<span class="smcap">Leibnitz</span>. What he tried to demonstrate by scholastic subtlety, and by
+thousands of syllogisms, was developed by<span class='pagenum'><a name="Page_148" id="Page_148">[Pg 148]</a></span> <span class="smcap">Leibnitz</span> with a clearness and
+ability, which secured the suffrages, even of the unenlightened. Both of
+them went too far, in attributing life and sensation to matter, instead
+of claiming for it the two simple and primordial forces of attraction
+and repulsion.</p>
+
+<p>"<span class="smcap">Glisson</span> sets out with the idea of substance, but he does not explain it
+with sufficient precision. Every substance has three substantial
+rudiments,&mdash;<i>fundamental</i> substance, by means of which it
+exists,&mdash;<i>energetic</i> substance, by means of which it acts,&mdash;and
+<i>additional</i> substance, which determines its accidental qualities. All
+matter, as substance, must have an energetic substance or nature, which
+is the internal principle of movement. Therefore whatever moves
+spontaneously, and in virtue of an internal force, must <i>feel</i> this
+motion, <i>and desire it</i>. All matter feels that it is, and that it exists
+by itself. It has therefore, consciousness of its own nature. Life
+consists in the activity of the internal substantial energetic nature.
+Death is the dissolution of the triple alliance of the internal
+energetic substantial nature, with the vegetative and animal natures,
+which two last belong to the <i>additional</i> substance."<a name="FNanchor_28_28" id="FNanchor_28_28"></a><a href="#Footnote_28_28" class="fnanchor">[28]</a></p>
+
+<p>In applying his theory to physiology, <span class="smcap">Glisson's</span> idea is, that the fibres
+of the human body are endowed with a force, which he divides into three
+kinds; to wit, natural or inherent force, (robur insitum)&mdash;vital force,
+(robur vitale)&mdash;and animal force, (robur animale.)</p>
+
+<p>Natural or inherent force, is a part of the constitution of the fibre,
+and is as much a property of its organization as are its tenacity,
+tensibility, &amp;c. The sum of this force varies, in proportion as the
+constitution of the fibre is more or less perfect. It is strongest in
+athletic men and strong animals, and weaker in relaxed and debilitated
+persons. It may be compared with the contractilit&eacute; de tissu of <span class="smcap">Bichat</span>.</p>
+
+<p>The second, or vital force, is something superadded to the inherent
+sort. It is an <i>influxus</i>, derived to any fibre or set of fibres, from
+that greater sum of force, which arises out of a more elaborate,
+complex, and exalted organization. It varies in proportion as the vital
+spirits flow with more or less freedom; and in proportion as their
+quality is more or less perfect.</p>
+
+<p>The third kind, or robur animale, may be supposed to depend<span class='pagenum'><a name="Page_149" id="Page_149">[Pg 149]</a></span> on the
+organic constitution of the brain and nerves, and varies according to
+the state of that organization. We cannot help adverting to the
+resemblance between these two latter kinds, and the contractilit&eacute;
+organique, and contractilit&eacute; animale, of <span class="smcap">Bichat</span>; and this robur
+comprises, as we shall show hereafter, both the contractilit&eacute; and
+sensibilit&eacute; of the French physiologist.</p>
+
+<p><span class="smcap">Glisson</span>, in his chapter de Irritabilitate fibrarum, commences by
+remarking that a motive faculty existing in any fibre, unless it were of
+an irritable nature, would leave such fibre in one of the two following
+states: 1. It would either never cease from action, or 2ndly, being once
+at rest, its motion could never be reproduced; but the varieties and
+differences which we see in the actions of fibres, clearly demonstrate
+them to be possessed of irritability: i.e. if a fibre may be by turns in
+a state of action and repose, it is evidently possessed of a quality,
+whereby it can be induced to move if in a state of rest; this quality he
+terms irritable, or irritability. The next inference from this power of
+alternate activity and repose is, that the fibre is possessed of a
+faculty, whereby it can <i>perceive</i> an irritation offered to it; but this
+perception of irritation further implies an <i>appetence</i> for a change of
+its actual state, before the motion can really take place. Perception,
+appetence, and motion, make a triunit. "In the mean time, says he, as
+sensitive appetence, and sensibility, are frequently confounded with
+natural perception, in this irritation of the fibres," he divides it
+into three kinds, viz. Natural Perception, Sensitive Perception, and
+Perception regulated by animal appetency.</p>
+
+<p>Natural Perception is that principle whereby a fibre perceiving any
+alteration offered to it, whether pleasing or displeasing, is excited
+either to accept that change, or to avoid it, and moves accordingly.</p>
+
+<p>Sensitive Perception, is that kind, in which a fibre, perceiving a
+change effected in some other organ, is impelled ad aliquid appetendum,
+and to move conformably.</p>
+
+<p>The third sort, or Perception regulated by animal appetency, is that in
+which the brain directs from within, such movements of the muscular
+fibres, as are requisite for the execution of any purpose.</p>
+
+<p>"Some persons," says <span class="smcap">Glisson</span>, "may doubt whether there really exists a
+natural perception of irritation in the fibres; but<span class='pagenum'><a name="Page_150" id="Page_150">[Pg 150]</a></span> we have elsewhere
+asserted in general the reality of natural perception, to wit, in my
+work, de Vita Natur&aelig;; and whoever has known it, will readily admit this
+quality in fibres imbued with inherent, influent, and vital spirits. We
+do not expect, in this place, to establish it as a general principle;
+but if any proof, derived from a knowledge of the structure, uses, and
+actions of the fibres, can be adduced, it may be here attempted."</p>
+
+<p>"It is indubitable that the fibres are alternately at rest and in
+motion; for, during sleep, they are all relaxed, with the exception of
+such as subserve the functions of respiration and circulation, and even
+these are by turns quiet and active. During waking again, they are all
+in a state of moderate tonic motion; and moreover, during all movements
+of the limbs, the antagonist muscles yield spontaneously, the abductors
+being active, while the adductors are relaxed, and vice versa. Hence it
+is manifest, that the fibres are alternately quiescent and active: but,
+since they are not <i>principal</i> or sui arbitrii agents, it is necessary,
+in order to the new movement, that they should be irritated from some
+source: for, it is impossible that a fibre in repose, can be set in
+action without an irritating cause; nor can we conceive of a part being
+irritated without <i>perceiving</i> the irritation. It is like speaking to a
+deaf man, or trying to awaken a dead one."</p>
+
+<p>"If you say, fibres are possessed of sensibility, and can be excited by
+virtue thereof, I confess that they are sensible parts, and may thereby
+perceive some, not all irritating causes; but whether sensation excites
+them immediately, or rather, is transmitted to the brain, and irritates
+the animal appetency; and further, whether the animal appetence, effects
+a movement in them directly, and to what sort of perception this
+irritation may be properly and immediately ascribed, is detailed in
+order below, when we come to explain sensitive perception, and
+perception &agrave; phantasia imperata."</p>
+
+<p>"Let us now go on to point out those cases, in which no suspicion of
+<i>sensation</i> can be entertained. The pulsation of the heart is neither
+effected nor affected by sensation; its fibres, in virtue of the
+irritation occasioned by the blood in its ventricles, are excited to
+contract, and thus occasion the pulsation, but when the irritation is
+remitted they relax, and recover the natural state. Now it cannot be
+denied that this is an evident case of irritation of the fibres, for
+according as is the irritation, so is the rythm of the<span class='pagenum'><a name="Page_151" id="Page_151">[Pg 151]</a></span> pulsation, which
+varies at times, as in febrile and other affections: nor is it right to
+pretend that there is any sensation in this case; because this
+perception of irritation <i>per vices</i>, is exercised as well during sleep,
+when the senses are all locked up, as in the waking condition. The
+fibres do not, therefore, <i>perceive</i> in these actions by a sensitive,
+<i>but by a natural perception</i>, the irritation of the vital blood, which
+animates them to alternate contraction and relaxation. This is
+corroborated by those tumultuous irregular motions which continue in
+animals after decapitation; so also the intestines when still warm in a
+recently opened animal, move and twist about; the muscles in dead
+animals also, excited by the perception of cold, contract with a strong
+tonic movement, and render the body rigid. The hearts of some animals
+too, when torn out of the body, and even when dissected, continue their
+endeavours to pulsate. Is there any further evidence wanting? We may
+hence infer with sufficient confidence that the fibres (without the aid
+of the senses) may <i>perceive</i> irritation, and move themselves
+conformably."</p>
+
+<p>In the next place he examines the nature of sensitive perception of
+fibres, and goes on to show how an impression made on an external part,
+or a natural perception, becomes converted into sensation, and thus made
+known to the sensorium. But his disquisition is not only very long but
+very dark, and we shall therefore pass it by with the exception of the
+following.</p>
+
+<p>"Natural perception includes within itself a <i>rationem positivam</i>, and a
+<i>negationem formalem</i>.</p>
+
+<p>"The ratio positiva is the perception of the idea, or image of the
+object moving or changing the fibre.</p>
+
+<p>"The negatio formalis is a denial or refusal to communicate this image
+to the sensorium. In the process of transformation into sensation, the
+positive ratio is not changed, but remains the same, and is the first
+part, or basis, both of internal and external sensation.</p>
+
+<p>"The negatio formalis is destroyed or abolished in any case of
+impression communicated to the sensorium. Natural perception, in its
+ratio positiva, is not abolished or degraded by being converted into
+sensation, but is rather exalted, or gifted with a more dignified
+nature. By as much as public or general knowledge is preferable to
+private, or public advantage to that of an individual,<span class='pagenum'><a name="Page_152" id="Page_152">[Pg 152]</a></span> by so much is
+sensation preferable to natural perception. Hence nature formed so many
+organs of sense, that the phantasy might have notice of what ought to be
+done, desired, or avoided."</p>
+
+<p>He does not doubt that external sensibility is inherent in the nervous
+parts of the external organ, whence he infers that it may readily incite
+the fibres of such organ ad appetendum et movendum; for, as external
+sensation is communicated to the brain by means of the nerves, it must
+of necessity be true, that these nerves and nervous parts (such as the
+fibres,) are the subjects of it. Since then sensibility causes its
+subject to feel, it consequently enables it to desire and move
+comformably. For perception in any subject is vain, unless it can
+desire, and appetence is useless, unless it can move. External
+sensibility, therefore, may be said to render the fibres <i>actu
+irritabiles</i>, for example, as often as the irritating cause is
+perceived; but as the irritation is perceived, not by a sensibility, but
+by a mere natural perception, this it is which constitutes their
+irritability.</p>
+
+<p>Thus we may perceive that the triunit consisting of perception,
+appetence, and motion, constitutes the celebrated irritability of our
+author. But he has been too latitudinarian in his application of the
+theory; for he did not limit it, as <span class="smcap">Haller</span> has subsequently done, to one
+sort of fibres, or indeed to fibres alone, for he says in cap. IX., "It
+is to be remarked that natural perception belongs to other parts of the
+body besides fibres; to wit, to the parenchymata, bones, marrow, fat,
+blood, recrementitious juices, humours of the eye, and such like, all
+which are irritable, and increase the irritable constitution of the
+parts, but these parts hardly admit of the existence of animal
+perception." <span class="smcap">Haller</span> blames <span class="smcap">Glisson</span> for having gone so far in his
+application of the theory, and it is well known that he himself
+restrained it to the single tissue of muscular fibres, and denominated
+it vis insitum, or inherent force; whereby he distinguished it from his
+vis mortua or elastic contraction, on the one hand, and the vis nervosum
+or voluntary power, on the other; the former being something less, and
+the latter something more than irritability. <span class="smcap">Glisson's</span> theory, when
+fully explained, which we cannot for want of space do here, will be
+found to bear a very strong resemblance, in many points, to that of
+<span class="smcap">Bichat</span>, who has invested the matters of the body with vital powers, far
+beyond those attributed by <span class="smcap">Haller</span>; and as we<span class='pagenum'><a name="Page_153" id="Page_153">[Pg 153]</a></span> are not furnished in the
+present article with sufficient space, we hope in some subsequent
+number, to place this matter in a plainer light before our readers. In
+the mean time we may remark, that <span class="smcap">Glisson</span> seems to be the first of those
+who have placed the subject fairly before the medical public; for
+although faint traces of a similar theory may be perceived before him,
+especially by translating terms into their equivalents, yet he has the
+merit of using a term which, in spite of all subsequent modifications,
+is in daily use.</p>
+
+<p><span class="smcap">Glisson's</span> latitudinarianism may be contrasted with <span class="smcap">Haller's</span> rigid
+application: for the latter says, "I call that an irritable part of the
+human body, which on being touched by a foreign body, renders itself
+shorter;" thus while <span class="smcap">Glisson</span> attributes his triunit of perception,
+appetence, and motion to all the tissues and fluids, <span class="smcap">Haller</span> confines it
+to muscular fibre alone. No one can doubt that the membranes of the body
+are endowed with vital properties, but yet they do not shorten
+themselves on being touched by a foreign body. <span class="smcap">Bichat</span> has distinguished
+their vitality as organic vitality, and the contractile qualities
+displayed are divided into insensible organic contractility, and into
+contractility of tissue: but these sorts of contractility mount up by
+insensible gradations. He says, that "entre la contractilit&eacute; obscure
+mais r&eacute;elle, necessaire a la nutrition des ongles, des poils, &amp;c. et
+celle que nous presentent les mouvements des intestins, de l'estomac,
+&amp;c. il est des nuances infinies, qui servent de transition: tels sont
+les mouvements du dartos, des arteres, de certaines parties de l'organ
+cutan&eacute;," &amp;c. We will close with a comparison between <span class="smcap">Glisson's</span>
+irritability, and <span class="smcap">Bichat's</span> contractility. At page 70 of the Treatise
+<i>sur la Vie &amp; la Mort</i>, <span class="smcap">Bichat</span> supposes that a "muscle enters into
+action, 1st. by the influence of the nerves which it receives from the
+brain, and this is a case of contractile animale," (which differs in no
+respect from perception regulated by animal appetency of <span class="smcap">Glisson</span>).
+2ndly. According to <span class="smcap">Bichat</span>, the muscle enters into action "by the
+excitation of a chemical or physical stimulant applied to it, and which
+artificially determines a movement of the whole muscle, analogous to
+what is natural to the heart, and other involuntary muscles. This is
+sensible organic contractility or irritability," and corresponds to the
+sensitive perception of the old English physiologist. In the 3d<span class='pagenum'><a name="Page_154" id="Page_154">[Pg 154]</a></span> place
+it enters into action by the stimulus of the fluids which circulate in
+it, and this is insensible organic contractility or tonicity of <span class="smcap">Bichat</span>,
+and is nothing different from <span class="smcap">Glisson's</span> natural perception. <span class="smcap">Bichat</span> makes
+a fourth case; as for example, when a muscle is divided across, it
+contracts by a <i>contractilit&eacute; de tissue</i>, or <i>par defaut d'extension</i>.
+We do not perceive how <span class="smcap">Glisson's</span> natural perception can be applied to
+this case, but he treats of it in his fifth chapter under the head of
+Cessatio: it is that state to which a fibre is reduced when left to
+itself, and freed from all stimulus.</p>
+
+<p><span class="smcap">Bichat</span> has attributed to some fibres the power of active elongation. On
+this subject <span class="smcap">Glisson</span> says, "Impossible enim est, ut simplex fibra, sua
+sola actione, se secundum longitudinem distendat, nec modus quo h&aelig;c fiat
+concipi nedum effari queat non negavero quin in distensione hac,
+aliqualis fibr&aelig; actio includatur, sed ea tota contractiva est, &amp;
+distensioni ab extranea causa fact&aelig; reluctatur." A doctrine as sound as
+that of the 47th proposition; a doctrine too, without admitting which,
+we think no man can understand the theory either of simple inflammation,
+or of the febrile affections. We hope to resume this subject at an early
+period.</p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_25_25" id="Footnote_25_25"></a><a href="#FNanchor_25_25"><span class="label">[25]</span></a> H&aelig;c ei generatim videbantur, ex igne omnia constare
+eodemque interire. Diogenes Laertius.</p></div>
+
+<div class="footnote"><p><a name="Footnote_26_26" id="Footnote_26_26"></a><a href="#FNanchor_26_26"><span class="label">[26]</span></a>
+<span style="margin-left: 2.5em;">Quatuor &aelig;ternus genitalia corpora mundus</span><br />
+<span style="margin-left: 2.5em;">Continet; ex illis duo sunt onerosa, suoque</span><br />
+<span style="margin-left: 2.5em;">Pondere in inferius, tellus atque unda, feruntur,</span><br />
+<span style="margin-left: 2.5em;">Et totidem gravitate carent, nulloque premente</span><br />
+<span style="margin-left: 2.5em;">Alta petunt, aer atque aere purior ignis.&mdash;<span class="smcap">Ovid</span>&mdash;<i>Metamorph.</i></span><br /></p>
+</div>
+
+<div class="footnote"><p><a name="Footnote_27_27" id="Footnote_27_27"></a><a href="#FNanchor_27_27"><span class="label">[27]</span></a> Lib. de Carnibus, <span class="smcap">Hippocrates</span> says: Quod Calidum vocamus,
+id mihi immortale esse videtur, cunctaque intelligere, videre et audire,
+sentireque omnia, tum pr&aelig;sentia tum futura: cujus pars maxima cum omnia
+perturbata essent in supremum ambitum secessit; quod, mihi veteres
+&aelig;thera appellasse videntur. Altera pars locum infimum sortita, terra
+quidem appellatur, frigida et sicca multas que motiones habens, et in
+qua multum sane calidi inest. Tertia vero pars medium aeris locum nacta
+est, calidum quid existens. Quarta pars terr&aelig; proximum locum obtinens
+humidissima et crassissima. His igitur in orbem agitatis cum turbata
+essent, calidi magna pars alias in terra relicta est, partim quidem
+magna, partim vero minor, alias etiam valde parva, sed in multas partes
+divisa. Et temporis successu a calido resiccata est terra, ista in ea
+tanquam in membranis contenta circumse putredines excitant, ac longo
+tempore incalescens quod quidem ea terr&aelig; putredine pinguedinem sortitum
+est et minimum humidi habet, id citissime exustum ossa produxit. Qu&aelig;
+vero naturam glutinosiorem sortita sunt et frigidi communionem habent,
+ea neque calefacta exuri potuerunt, neque etiam humida fieri ideo formam
+longe ab aliis diversam nacta sunt et nervi solidi exciterint, cum non
+multum in iis frigidi inesset. At ven&aelig; frigidi multum habebant cajus
+pars circumcirca ambiens et quod erat glutinosissimum, a calido
+exassatum membrana extitit. Quod vero erat frigidum, a calido superatum,
+dissolutum est ideoque humidum evasit.</p></div>
+
+<div class="footnote"><p><a name="Footnote_28_28" id="Footnote_28_28"></a><a href="#FNanchor_28_28"><span class="label">[28]</span></a> <span class="smcap">K. Sprengel</span>, Hist. de la Medicine.</p></div>
+</div>
+
+
+<hr style="width: 65%;" /><p><span class='pagenum'><a name="Page_155" id="Page_155">[Pg 155]</a></span></p>
+<h2>QUARTERLY SUMMARY OF MEDICAL AND SURGICAL INTELLIGENCE.</h2>
+
+
+<h3>I. ANATOMY.</h3>
+
+<p>1. <i>Papill&aelig; of the Tongue.</i>&mdash;At the upper surface of the tongue, say <span class="smcap">MM.
+Leuret</span> and <span class="smcap">Lassaigne</span>, in their recent work on digestion, the mucous
+membrane presents projections of three different species; and these are,
+the sensitive papill&aelig;, the epidermoid papill&aelig;, and the mucous crypt&aelig;.
+The sensitive papill&aelig; are numerous. They occupy the anterior four-fifths
+of the tongue, on which they are implanted by a narrow pedicle. The
+rounded head of these papill&aelig; is much more prominent in the living
+subject, than after death; but injections are capable of restoring them
+to their pristine form. Nervous fibres from the lingual branch of the
+fifth pair have been distinctly traced to their roots. These papill&aelig; are
+of various sizes; at the root of the tongue they form a V. They are all
+vascular and nervous. The sense of taste is referred by these writers
+almost exclusively to the above papill&aelig;.</p>
+
+<p>The epidermoid papill&aelig; are of a nature similar to those retroverted
+prominences so remarkable on the tongue of the cat; as well as in the
+lion, and some other animals. They are larger in many species than in
+man, and, in general, the sensibility of the tongue appears to diminish
+in proportion to the remoteness of the subject from the human structure.
+The epidermoid papill&aelig; are separated from the tongue along with the
+epidermis, or rather, epithelium, by maceration for a few days in
+vinegar. They are pyramidal in form. They are grouped round the
+sensitive papill&aelig;, except on the edges and point of the tongue, where
+they are rare. Their base is perforated, and always gives outlet to a
+crypta. In an epithelium separated from the tongue, these minute and
+numerous perforations are easily distinguished from the larger ones left
+by the sensitive papill&aelig;.</p>
+
+<p>The office of the epidermoid papill&aelig; appears purely mechanical.</p>
+
+<p>The only crypt&aelig; which produce, of themselves, a visible projection on
+the surface of the tongue, are situated at its base. They are formed by
+the mucous membrane, like other crypt&aelig;, and are scattered between the
+sensitive papill&aelig;.</p>
+
+<p>In the tongue of birds, there is always a bone or cartilage; and the
+external membrane is dense. In reptiles the tongue is soft, possessed of
+little sensibility, and capable of great elongation. In fishes it is
+endowed with little motion, and is often wanting.&mdash;<i>Bulletin Medicale.</i></p>
+
+<p>2. <i>Villi of the Stomach and Intestines.</i>&mdash;<span class="smcap">MM. Leuret</span> and <span class="smcap">Lassaigne</span>
+state that the villi can be easily injected; most conveniently from the
+vena port&aelig;,<span class='pagenum'><a name="Page_156" id="Page_156">[Pg 156]</a></span> though the arteries may be employed. In the latter case,
+the matter of injection is effused into the intestinal or gastric
+cavity. The villi are peculiar to these parts; they are inversely
+conical, adhering to the membrane by their smaller end. The best mode of
+exhibiting them, is to tie the vena port&aelig; of a living animal, when they
+erect themselves by the afflux of blood. These diminutive organs, about
+3/100 of an inch long, then exhibit distinctly, under the microscope,
+four red longitudinal lines, being probably vessels.</p>
+
+<p>Injections made retrograde from the thoracic duct, pass through the
+villi into the intestines. When the stomach of a man, who died of some
+complaint not deranging its condition, is examined, we sometimes find
+its lining membrane covered with a multitude of minute white points.
+These are the villi in a flaccid state. In those who have died during
+digestion, they are erected, and of a rosy colour.</p>
+
+<p>When the intestine of a living animal is examined under a microscope,
+after being carefully washed, a great number of orifices are seen, from
+each of which exudes a minute drop of a transparent fluid. These rapidly
+disappear; and then the villi attract attention. What these foraminula
+are, the reviewer, M. <span class="smcap">Du Fermon</span>, does not tell us.&mdash;<i>Ibid.</i></p>
+
+<p>3. <i>Minute distribution of the Vessels of the Liver.</i>&mdash;M. <span class="smcap">Cruveilhier</span>
+gives, in his lectures, an account of the results he has obtained from a
+minute injection of the liver. He finds, 1. The acini surrounded with a
+dense, cellular texture, paler than themselves; 2. The ramifications of
+the hepatic artery distributed to this cellular envelope; 3. Those of
+the vena port&aelig; spread around the acini, or granulations of the liver;
+and 4. Those of the biliary ducts, and of the hepatic veins, emerging
+from the cavities of these bodies.</p>
+
+<p>Our readers will observe a great similarity, in this, to the arrangement
+of the lobules of the kidneys.&mdash;<i>Ibid.</i></p>
+
+<p>4. <i>Trachea perforating the Aorta.</i>&mdash;This odd distribution of parts, was
+observed by M. <span class="smcap">Zagorsky</span>, at St. Petersburg, in 1802. The aorta divided
+itself, at its arch, into two branches, which received the trachea
+between them, and again united, exactly fitting the organ they received.
+They were found to have compressed the trachea, and probably produced
+difficulty of breathing.</p>
+
+<p>In another case, in 1808, the right subclavian artery, instead of its
+usual origin, arose from the left extremity of the arch of the aorta,
+and crossed behind the trachea, thus including the latter between it and
+the aorta.</p>
+
+<p>Why do we call the common trunk of the right subclavian and carotid, the
+arteria innominata? Is coining words so difficult a task, that we cannot
+find a proper and expressive name for it? The French call it
+<i>brachio-cephalic</i>, and this expresses its office and
+distribution.&mdash;<i>Ibid.</i></p>
+
+<p>5. <i>Monsters.</i>&mdash;These productions, hitherto considered as mere objects
+of wonder, from the study of which no useful inference could be drawn,
+have recently attracted a good deal of attention in Paris. There seem to
+be<span class='pagenum'><a name="Page_157" id="Page_157">[Pg 157]</a></span> some close affinities discoverable in many of them, not only with
+the natural and complete forms of animals of various tribes, but even
+with the actual condition of their own species, while in the f&oelig;tal
+state.</p>
+
+<p>The views of <span class="smcap">M. Geoffroy St. Hilaire</span> seem to us rather mystical and
+vague. Those of <span class="smcap">Breschet</span>, and the other practical anatomists, we can
+understand much better.</p>
+
+<p>6. <i>Malformation of the Heart.</i>&mdash;Drs. <span class="smcap">Baillie</span>,<a name="FNanchor_29_29" id="FNanchor_29_29"></a><a href="#Footnote_29_29" class="fnanchor">[29]</a> <span class="smcap">Langstaff</span>,<a name="FNanchor_30_30" id="FNanchor_30_30"></a><a href="#Footnote_30_30" class="fnanchor">[30]</a> and
+<span class="smcap">Farre</span><a name="FNanchor_31_31" id="FNanchor_31_31"></a><a href="#Footnote_31_31" class="fnanchor">[31]</a> have each published cases; and M. <span class="smcap">Tiedemann</span>, in his journal of
+Physiology, now adds a fourth, in which the aorta and pulmonary artery
+were found to have changed places. In professor <span class="smcap">Tiedemann's</span> case, the
+two circulations were entirely distinct; the systemic blood passing from
+ven&aelig; cav&aelig; to right auricle, from right auricle to right ventricle, and
+from this, through the aorta, to the body at large; while the pulmonary
+blood ran through an equally simple circle, by the route of pulmonary
+veins, left auricle, left ventricle, and pulmonary artery. The only
+communications between the two circulations, were the foramen ovale, the
+ductus arteriosus, and, in the opinion of M. <span class="smcap">Tiedemann</span>, the
+inosculations between the branches of the <i>pulmonary</i> and <i>bronchial</i>
+arteries.</p>
+
+<p>The infant is recorded to have presented <i>no peculiar appearances</i> till
+the ninth day; when attacks of suffocation came on, attended with the
+blackish blue colour, and followed by death, at the end of twelve days.
+Similar histories are said to be given of the cases mentioned above, and
+the references to which we have copied. We have not the time to consult
+them.&mdash;<i>Ibid.</i></p>
+
+<p>7. <i>Acephalous Mummy.</i>&mdash;M. <span class="smcap">Geoffroy St. Hilaire</span> has read a memoir of
+some length to the Academy of Sciences, on an acephalous mummy. It was
+found in a catacomb, destined, with this exception, exclusively to
+animals. It had an amulet suspended round its neck, being an earthen
+figure of a cynocephalus, for which it was very probably mistaken by the
+Egyptians. The collector, M. <span class="smcap">Passalacqua</span>, who obtained it, showed it to
+M. <span class="smcap">G. St. H.</span> as a monkey, of which he wished to know the species. Yet
+the latter observes that these amulets were only put on human mummies.</p>
+
+<p>M. G. concludes that the monkeys, elephants, &amp;c. said by Livy, Valerius
+Maximus, Pliny, and others, to have been born of women in their times,
+and considered as omens of public calamity, were acephala.</p>
+
+<p>8. <i>New Anatomical Plates.</i>&mdash;Messrs. <span class="smcap">E. W. Tyson</span> and <span class="smcap">George Simpson</span> are
+publishing anatomical plates, in London. They are spoken of with
+approbation. The labours of the latter are designed for the use of
+painters.</p>
+
+<p>9. <i>A Manual of Osteology</i> has been undertaken by Dr. <span class="smcap">Weber</span>, of Bonn,
+and one volume published.</p>
+
+<p><span class='pagenum'><a name="Page_158" id="Page_158">[Pg 158]</a></span></p><p>10. <i>S&oelig;mmering's fine work on the anatomy of the ear</i>, has been
+translated into French, and his splendid folio plates copied in
+lithography.</p>
+
+<p>11. <i>Does the conjunctiva run over the cornea?</i> Messrs. <span class="smcap">Lecoq</span>, <span class="smcap">Leblanc</span>,
+and <span class="smcap">Artus</span>, state that they have each seen a case in which regular <i>skin</i>
+and <i>hair</i> were seen, forming a small patch on the cornea of the eye of
+a quadruped. This is considered as a proof of the existence there of a
+membrane naturally analogous to the skin; which must, of course, be the
+conjunctiva. An officer saw another case, in which a hair was seen in
+the middle of the eye of a horse.&mdash;<i>Bulletin.</i></p>
+
+
+<h3>II. PHYSIOLOGY.</h3>
+
+<p>12. <i>Electro-Galvanic phenomena of Acupuncturation.</i>&mdash;M. <span class="smcap">Pouillet</span>, after
+making a complete circuit, through a needle introduced in acupuncture,
+through wires, and through the patient's mouth, found, by means of a
+multiplier of <span class="smcap">Schweigher</span> with a magnetic needle, that the
+electro-magnetic rotation could be readily produced; at least so far as
+to effect small vibrations backwards and forwards. On repeating it with
+two needles, one of them run into an artery and another into a vein, or
+one into the medulla spinalis, at the neck, and another into an
+extremity, in a rabbit, no effect whatever took place.&mdash;<i>Magendie's
+Journ. de Physiologie.</i></p>
+
+<p>13. <i>Variations in Milk.</i>&mdash;Milk, says M. <span class="smcap">Vallot</span>, in his memoir read to
+the Academy of Dijon, may be <i>red</i>. The cause of this is unknown, though
+it has given rise to superstitious fears. Some have observed that the
+cow's teats are then tender. Whether this be cause or effect has not
+been ascertained.</p>
+
+<p><i>Yellow milk</i> is said to have been produced by the cow's eating the
+caltha palustris, (marygold.) <i>Blue milk</i>, from a cause still unknown,
+in the departments of Seine-inf&eacute;rieure and Calvados. Some have ascribed
+it to the hyacinthus comosus; others to butomus umbellatus.</p>
+
+<p>The <i>green milk</i> of some writers is supposed to be only blue. <i>Milk not
+coagulable</i> is produced by feeding on husks of green peas, and on mint.
+<i>Bitter milk</i>, from wormwood, sonchus alpinus, and the leaves of the
+artichoke; and in goats, from eating freely of elder, (sambucus nigra,)
+and potato-tops; <i>a disagreeable taste</i>, from turnips, in Upper Canada.
+<i>Garlicky milk</i>, from causes well known. <i>Insipid milk</i>, and
+<i>lead-coloured butter</i>, from equisetum fluviatile. <i>Milk unnaturally
+sweet and luscious</i>, (sucr&eacute;,) from alpine clover, (trifolium alpinum;)
+and <i>red butter</i>, from the ripe berries of asparagus.&mdash;<i>Bulletin.</i></p>
+
+<p>14. <i>Hyoscyamus dilates the pupils of the eyes</i>, the same manner as
+stramonium, several Eastern species of datura, and belladonna, which the
+Europeans use. The strongest species was datura fastuosa.&mdash;<i>Oriental
+Magazine, apud Du Fermon.</i><span class='pagenum'><a name="Page_159" id="Page_159">[Pg 159]</a></span></p>
+
+<p>15. <i>Worms in the Eye.</i>&mdash;Several cases of worms in the eye are mentioned
+in the Bulletin des Sciences Medicales, for Feb. 1826. <span class="smcap">Deguilleme</span> saw
+several in the eye of a cow; and the case was published by <span class="smcap">Gorier</span>, a
+veterinary teacher, in his memoirs. In the report of the proceedings of
+the veterinary school at Lyons, in 1822-3, there is the case of a mule,
+in which a knot of worms (crinons) was seen in one eye. <i>Two</i> were
+extracted; (why no more is not said;) and another subsequently. No
+inflammation was produced; but a violent nervous agitation of the head,
+and a turning of it to the left side took place. Next follows an account
+of a memoir read before the Medical Society of Calcutta, but of which
+the name of the author is not given. He is represented as stating, that
+the strongylus armatus minor of <span class="smcap">Rudolphi</span>, and the <i>filiaris</i> (filaria)
+papillosa, are frequently found in the eyes of the horses in India, but
+much more so in the cellular membrane, particularly about the loins. He
+believes that they make their way into the blood-vessels, and, through
+them, into the eye. Their most ordinary seat is the cellular membrane of
+the loins; where they exist for years, producing emaciation, and, at
+length, paralysis of the hind legs. This last the Calcutta author is
+represented as ascribing to the penetration of the spinal marrow; but he
+does not appear to have verified it by dissection. <span class="smcap">Treuttler</span> says, he
+has seen the strongylus armatus in <i>aneurisms</i> of the mesenteric artery
+of the horse; but the writer in the Bulletin doubts whether any have
+ever been found in sound arteries.</p>
+
+<p>Dr. <span class="smcap">Kennedy</span>, in the Edinburgh Philosophical Transactions, describes a
+worm, which he calls <i>ascaris pellucidus</i>, (pellucida,) as being common
+in the eyes of horses in India. A review of <span class="smcap">Bremser's</span> work on worms is
+expected in our next, and inferences will then be drawn from these
+singular facts.</p>
+
+<p>16. <i>Digestion.</i>&mdash;MM. <span class="smcap">Leuret</span> and <span class="smcap">Lassaigne</span>, in their very interesting
+and valuable experimental essay on this subject, have met with many
+curious results.</p>
+
+<p>They found no remarkable difference in the saliva of carnivorous and
+herbivorous animals. The purest saliva was obtained for their
+experiments directly from the parotid duct, in man, the horse, and dog.
+The composition was as follows:</p>
+
+<p>Water, 99 parts; mucus, traces; albumen, soda, chloride of sodium,
+chloride of potassium, carbonate of lime, and phosphate of lime, 1 part.
+Total, 100.</p>
+
+<p>Their experiments on the bile confirmed the results of <span class="smcap">Thenard</span> and
+<span class="smcap">Crevreuil</span>.</p>
+
+<p>The pancreatic juice is of the specific gravity 1.0026; at 15&deg; of the
+thermometer: (centigrade, we presume.) Its composition is:</p>
+
+<p>Water, 99.1 parts; animal matter soluble in alcohol, animal matter
+soluble in water, traces of albumen, mucus, soda, chloride of sodium,
+chloride of potassium, and phosphate of lime, 0.9 parts. Total, 100.
+This greatly<span class='pagenum'><a name="Page_160" id="Page_160">[Pg 160]</a></span> confirms the analogy long observed between the pancreatic
+liquor and the saliva.</p>
+
+<p>In the <i>gastric liquor</i>, there are:</p>
+
+<p>Water, 98 parts; <i>lactic acid</i>, muriate of ammonia, chloride of sodium,
+animal matter soluble in water, mucus, and phosphate of lime, 2 parts.
+Total, 100.</p>
+
+<p>Dr. <span class="smcap">Prout</span> and Mr. <span class="smcap">Children</span> have announced the gastric acid, of which so
+much has been said, to be the muriatic, while M. <span class="smcap">Chevreuil</span> had stated it
+to be the lactic. MM. <span class="smcap">Leuret</span> and <span class="smcap">Lassaigne</span> confirm the results of
+<span class="smcap">Chevreuil</span>, and that with great confidence in their own accuracy. They
+found the contents of all the four stomachs of ruminating animals acid.
+MM. <span class="smcap">Prevost</span> and <span class="smcap">Leroyer</span> had stated those of the three first to be
+alkaline. The observations of <span class="smcap">Leuret</span> and <span class="smcap">Lassaigne</span> agree with those of
+<span class="smcap">Montegre</span>, (vide Dict. des Sci. Med.) who believes digestion to produce
+acidity as a result of the regular process.</p>
+
+<p>The <i>f&aelig;ces</i> become alkaline.</p>
+
+<p><i>Substances which contain no azote, from whatever class they are
+obtained, cannot serve for nutrition.</i> We cannot understand this,
+especially when compared with what follows. "If, on the contrary, they
+are soluble, one part is absorbed and another is expelled, either by
+urine or by the anus; such are sugar, gum, &amp;c." This seems to us like a
+contradiction.</p>
+
+<p>It is impossible, in the present state of science, to determine the
+chemical change which aliments undergo in the digestive organs; both on
+account of their mixture and the insufficiency of our means of analysis.</p>
+
+<p>"The absorption of chyle takes place by the villi." "These communicate
+directly with the lacteals and the vena port&aelig;."</p>
+
+<p>"The transference of the chyle takes place by the lacteals;
+nevertheless, if they are obliterated, <i>this may be done through the
+vena port&aelig;</i>."</p>
+
+<p><i>The section of the pneumo-gastric nerves does not stop the dilution of
+aliments in the stomach, or chylification.</i></p>
+
+<p>The juices secreted by the liver and pancreas, are poured into the
+intestines in greater quantity during digestion than at any other
+period; in consequence of the contact of the acid chyme with the biliary
+and pancreatic orifices.</p>
+
+<p>The pancreatic juice is analogous to the saliva.</p>
+
+<p>The spleen is an appendage to the liver; it swells during the absorption
+of liquids by the vena port&aelig;.</p>
+
+<p>Liquid aliments are digested, just as much as solid; but they do not
+require so great a quantity of gastric and intestinal juices.</p>
+
+<p>Watery drinks are absorbed in the stomach and intestines, by the
+radicles of the vena port&aelig;. Spirituous drinks occasion an afflux of the
+gastric juices, become acid, and are absorbed.</p>
+
+<p>Excrements owe their colour and odour to the bile, and their
+consistence<span class='pagenum'><a name="Page_161" id="Page_161">[Pg 161]</a></span> to the absorption of a portion of the water they contain.
+They carry off a large amount of the nutriment.</p>
+
+<p>Great obscurity still remains as to the cause of hunger.</p>
+
+<p>Thirst is thought to be produced by the drying which the pharynx
+undergoes, from the passage through it of the air used in respiration,
+and at a time when the supply of mucous fluid is scanty.</p>
+
+<p>Our readers will have perceived, long ere this, that here are several
+propositions at war, not only with our received opinions, but with the
+experimental researches of some others among the modern physiologists.
+We do not know what Dr. <span class="smcap">Wilson Philip</span> would say to his observations
+being so cavalierly dismissed: they seem scarcely to condescend to
+mention his name in France. Not having the original, we could do no
+better than translate, almost literally, the conclusions of these
+experimenters, as stated in the Bulletin; and the result of this is what
+we have just given our readers. From the words "the absorption of
+chyle," to the end, is nearly verbatim the language of the review.</p>
+
+
+<h3>III. PATHOLOGY.</h3>
+
+<p>17. <i>Dothinenteria. Pustules of the small Intestines.</i>&mdash;From &#948;&#959;&#952;&#951;,
+a pustule, and &#949;&#957;&#964;&#949;&#961;&#959;&#957;, an intestine. This name is
+given to a disease which has been described by M. <span class="smcap">Bretonneau</span>, of Tours,
+and, after him, by <span class="smcap">Serres</span>, <span class="smcap">Broussais</span>, <span class="smcap">Andral</span>, and several others, and
+consists in pustules, generally situated at the lower end of the ileum.</p>
+
+<p>We are constantly lamenting to ourselves the contracted bounds allotted
+to our Quarterly Summary. Indeed, were it not for other objects, it
+might occupy, with advantage, half of the number, and most of the time
+employed in the preparation of the work. Every thing must be curtailed,
+though cut off at the most interesting and valuable point; and the
+painful exertion of the attention, necessary to condense information for
+our readers' use, of the amount of which they cannot possibly be aware,
+can only be equalled by the constant feeling of disappointment at
+rejecting so much important matter.</p>
+
+<p>We are told that this pustular disease is as common and as destructive
+as the <i>small pox</i>, (indeed!) the measles or the scarlatina; that few
+persons spend the whole of their lives without having, at some period,
+suffered by it; that it never affects individuals but once; and that it
+is suspected of being contagious.</p>
+
+<p>M. <span class="smcap">Bretonneau</span> has prepared a set of specimens, taken from the bodies of
+those who have died in various stages of this complaint. He traces the
+malady day by day, with a precision which we will not copy here. The<span class='pagenum'><a name="Page_162" id="Page_162">[Pg 162]</a></span>
+seat of this affection is the glands of <span class="smcap">Peyer</span> and <span class="smcap">Brunner</span>. The former
+are found in groups, throughout the lower half of the jejunum and the
+whole of the ileum, gradually increasing in the size and number of their
+clusters, till they reach the valve of the colon, where they cease. They
+have been mistaken by some dissectors of the modern school for the
+effects of inflammation. They are found in honey-combed patches; which
+are agglomerations of mucous glands. The glands of <span class="smcap">Brunner</span> are thinly
+dispersed mucous follicles which are scattered singly throughout the
+whole length of the small intestines, with nearly equal frequency. These
+organs are well described by <span class="smcap">Haller</span> in the great Physiology. They are
+not seen well, unless in a young subject, and by cutting into the
+intestine very close to the mesentery.</p>
+
+<p>When inflamed, they swell and thicken, and, after some days, the
+membrane around them assumes a reddish tint. The mesenteric glands are
+enlarged. M. <span class="smcap">Bretonneau</span> has seen one as large as a hen's egg: they
+generally equal in size that of a pigeon. The disease spreads and
+affects an additional number of glands. It reaches its acme generally on
+the 9th day; after which sometimes all, and always a part of the
+affected glands return to their natural condition, by resolution of the
+inflammation. Those which are to run the full course of the disease
+continue to augment in size and projection into the intestine. On the
+13th and 14th days they are discovered tinged with bile, which
+penetrates their substance, and thus proves the occurrence of
+disorganization. On the 15th and 16th, the sloughs separate, and leave
+from one to six ulcers. These penetrate the gland, and with it the
+mucous membrane, of which it forms a part, and next, the cellular tissue
+of the intestine. In numerous instances they perforate the muscular
+coat, leaving nothing but peritoneum at the bottom; and frequently,
+passing this, they induce inflammation of the cavity of the belly, and
+death.</p>
+
+<p>The cases of simple resolution terminate in three weeks: those in which
+sloughs are formed, in from 30 to 40 days, if not fatal. If death be
+from peritonitis, it is of course soon after the 15th and 16th days; if
+from exhaustion, at periods varying according to the strength of the
+sufferer. Dothinenteria occurs in many of the cases commonly called
+typhus fever, gastro enteritis, &amp;c. It is proper to remark that both the
+author and the journal are in opposition to Dr. <span class="smcap">Broussais</span>.&mdash;<i>Archives.</i></p>
+
+<p>18. <i>Dr. Broussais.</i>&mdash;While the opinions of this celebrated reformer
+have been gradually becoming more extensively known among our
+countrymen, the war has prevailed with increased heat in his native
+land. The most vehement attacks are made, from various quarters, upon
+his system of <i>medicine physiologique</i>. No one appears to deny that he
+has clearly proved the existence of mucous gastritis and enteritis in
+many or most fevers, or the propriety of directing a part of the
+remedies to them. Criticisms and invectives are freely emitted: but they
+are only levelled against the too extensive application of this
+doctrine, and the inconsistencies, unquestionably<span class='pagenum'><a name="Page_163" id="Page_163">[Pg 163]</a></span> often real, of the
+system of which he has made it the foundation. Indeed, if the quotations
+given are correct, we think no one who has not assumed a party, can
+refrain from concurring in their condemnation.</p>
+
+<p>"Those who understand our doctrine never attack it; they speak of it
+only to express their admiration: above all, they never think of wishing
+to modify it, because they know that its fundamental dogmas are
+unshakeable." "Surtout ils ne s'avisent jamais de vouloir la modifier,"
+&amp;c. A man who assumes such ground as this, had need be very careful in
+assuming his positions, indeed; and should particularly avoid any thing
+like self-contradiction.</p>
+
+<p>The <i>Lettres a un medecin de province</i>, in a style of lively criticism,
+labour to show a great variety of inconsistencies in this immoveable
+doctrine. The review of this publication in the Revue Medicale,
+including copious extracts, coincides with, and evidently wishes to aid,
+the author's satire. In the same journal are a series of criticisms on
+some of the elementary propositions of Dr. <span class="smcap">Broussais</span>, published in a
+late edition of his Examen; (nearly the same which were published here,
+some time since, in the American Medical Recorder, having been
+translated by Dr. <span class="smcap">Atkins</span>.) In these critiques, great severity is shown,
+in dealing with the new dogmas, and the doctrine is treated as one of
+dangerous tendency; while, at the same time, high praise is awarded to
+their author, for his discoveries in the diseases of the alimentary
+mucous membranes.</p>
+
+<p>In the other journals, there is a division; some favouring the new
+opinions, while others oppose them with more or less of vehemence.</p>
+
+<p>That the doctrine of gastritis has made a great impression at Paris,
+that almost every one believes in it, to a greater or less extent,
+appears undeniable; but there, as well as here, most of the more
+rational, and moderate minded men are evidently of the only school a
+physician ought to belong to, the <i>eclectic</i>. Borrowing largely from
+<span class="smcap">Broussais</span>, and having had their minds powerfully stimulated by the
+succession of striking and novel ideas which he has introduced, they
+think it unmanly to "bind themselves to his chariot-wheel," but form
+conclusions for themselves from every resource within their power. If
+the great French reformer really wishes to establish as absolute a power
+over the minds of his followers, as <span class="smcap">Mahomet</span> or <span class="smcap">Pythagoras</span> did, and as
+the above-quoted extract seems pretty fairly to indicate, he must
+certainly undergo many mortifications. Notwithstanding the
+"inebranlable" nature of his dogmas, M. <span class="smcap">Miquel</span> has furnished us with
+several variations from them, in the writings of Messrs. <span class="smcap">Boisseau</span>,
+<span class="smcap">Roche</span>, <span class="smcap">Sanson</span>, <span class="smcap">Remusat</span>, <span class="smcap">Richond</span>, and <span class="smcap">Begin</span>; and the last-named
+individual has had a public dispute with his preceptor.</p>
+
+<p>M. <span class="smcap">Begin</span> has produced his promised work on surgery, according to the
+principles of the new school. We have not seen the volume, but have read
+a review of it in the Revue Medicale, by M. <span class="smcap">Bellanger</span>. The latter
+describes it as a cursory work, having for its object the adaptation of
+surgery<span class='pagenum'><a name="Page_164" id="Page_164">[Pg 164]</a></span> to a set of general principles, rather than a detailed system
+of instructions how to proceed in each individual case. It contains only
+what is easy to be remembered, and omits those matters for which it is
+usual to refer to books. Thus two pages only are appropriated to
+fractures of the body and neck of the femur! and twenty-six for the
+whole subject of fractures, wounds, and six or eight of the most
+important diseases, of bones! Yet all this criticism is not without a
+compliment, well-merited at least by the former productions of the same
+author, to his talents and ingenuity.</p>
+
+<p>19. <i>Whooping-cough.</i>&mdash;"There is no disease of children, in which the
+resources of medicine are more manifestly serviceable than in an
+obstinate whooping-cough." Such, in amount, was the opinion of Dr.
+<span class="smcap">Underwood</span>, and Dr. <span class="smcap">Watt</span> uses language almost equally strong. Certainly,
+we are not at all times equally successful or equally sanguine in
+America.</p>
+
+<p>Dr. A. <span class="smcap">Cavenne</span> considers whooping-cough a true bronchitis, a pulmonary
+catarrh; accompanied with greatly heightened nervous symptoms, owing to
+the irritable period of life at which it occurs, and particularly to its
+frequent existence in nervous constitutions. Professor <span class="smcap">Tourtelle</span> calls
+it a pneumo-gastric, pituitous catarrh; and certainly, the pupils of a
+modern school will find no difficulty in recognizing symptoms of
+gastritis in its severer forms. The further inferences drawn by Dr.
+<span class="smcap">Cavenne</span>, are as follows:</p>
+
+<p>1. That the whooping-cough, in an individual of a sanguine temperament,
+requires, in general, the use of bleeding, and a debilitating regimen.</p>
+
+<p>2. That bleeding and a debilitating treatment are equally necessary,
+whatever be the temperament, in whooping-cough of the chronic form.</p>
+
+<p>3. The antispasmodics are necessary in nervous constitutions.</p>
+
+<p>4. That blood-letting and the debilitating treatment should be rejected,
+when the subject is endowed with a lymphatic temperament. This
+observation, says our author, is equally applicable to early infancy, in
+which lymph predominates over the red blood, and the fluids are more
+diluted.</p>
+
+<p>Finally, if the disease be obstinate and there be disturbance in several
+functions, there is certainly reason to believe that a lung, a viscus of
+the abdomen, or the brain, is in an unfavourable condition; (the author
+means of the inflammatory kind;) and this is ground for the moderate
+abstraction of blood.&mdash;<i>Journ. Univ. Feb.</i></p>
+
+<p>20. <i>Antiperistaltic globus. Globus hystericus.</i>&mdash;Dr. <span class="smcap">Trolliet</span>, of
+Lyons, observes that hysteria cannot, with propriety, be said to exist
+in the male sex; that it arises, as its name imports, from derangement
+of the uterus, and that <span class="smcap">Cullen</span> and <span class="smcap">Sydenham</span> have done wrong, and stand
+alone, in teaching the contrary. When there exists a real hysteria, the
+contractions are not confined to the intestinal regions, but invade the
+neighbouring parts; (quere, which of them contract?) they are always
+accompanied, when existing in a high degree, with convulsions and loss
+of the mental powers. In the intervals, the patients affected can
+satisfy their appetite.<span class='pagenum'><a name="Page_165" id="Page_165">[Pg 165]</a></span></p>
+
+<p>Antiperistaltic globus may occur from various causes; and either in the
+intestines or the &oelig;sophagus.</p>
+
+<p>That of the intestines is met with chiefly in advancing age; and is
+generally produced by daily and often-repeated pressure on the abdomen,
+as practised in various professions. Hard labour and bad diet also
+greatly aggravate it. At first pain in the intestines occurs, aggravated
+by labour; together with derangement of digestion.</p>
+
+<p>The sensation of a globe then appears on the lower and left side of the
+abdomen; and, after performing various circuits, finally reaches the
+stomach; from which is soon after discharged, with great relief, a
+quantity of gas, issuing from the mouth. Vomiting of an acid and burning
+fluid, as also of the food, is not uncommon as an accompaniment. This
+ball is about the size of a man's fist, and is sensible to the external
+touch, and even to the sight. The patients possess the power, to a
+certain extent, of controlling its motions, and relieving the pain,
+which is often extremely violent, by pressure.</p>
+
+<p>Indigestible food always aggravated the disease. Some could only
+tolerate milk, broth, and other fluids. A weaver was obliged to quit his
+profession, from the pressure on the abdomen which it required,
+occasioning the paroxysms.</p>
+
+<p>The treatment consisted in</p>
+
+<p>1. Avoiding the original causes.</p>
+
+<p>2. The use of a species of corslet, (plastron,) to prevent future
+pressure on the abdomen.</p>
+
+<p>3. A rigid diet. We do not understand why, firstly, articles containing
+a great deal of fecula, and, as it is said, "requiring a great action of
+the intestines," are forbidden, while, in the second place, rice is
+recommended. "Bouillon aux herbes," (a laxative decoction,) rice-cream,
+and milk, were found the best. Wine was injurious. Assaf&oelig;tida and
+camphor were useful, and were administered in boluses. Purgatives were
+injurious. Emolient enemas were useful.</p>
+
+<p>Of antiperistaltic globus in the &oelig;sophagus our author saw only two
+cases, which were not complicated with hysteria. The patients had both
+been subject to rheumatism; and, in one of them, this had been
+supplanted by an eruption Of tetter: on the disappearance of which last
+the globus appeared. These cases were cured, the latter by a severe,
+light diet, and some antispasmodics, the names of which are not
+mentioned; the other by curing the rheumatism.</p>
+
+<p>Dissections are somewhat difficult to obtain; unless where some other
+more mortal disease exists. In one, scirrhus of the pylorus was found;
+the stomach greatly enlarged; the small intestines contracted, <i>red
+outside and gray within</i>. (Where was the redness situated; in the
+peritoneal or the muscular coat? We must <i>guess</i> the latter.) The
+stomach was pale gray, and thickened. The large intestines were dilated,
+and gray.&mdash;<i>Journ. Univ.</i><span class='pagenum'><a name="Page_166" id="Page_166">[Pg 166]</a></span></p>
+
+<p>21. <i>Non-contagion of Yellow Fever.</i>&mdash;Dr. <span class="smcap">Valentine</span>, of Nancy, has
+printed a pamphlet of a single sheet, in which he finds himself involved
+in all the turmoil, through which American physicians passed during the
+period which intervened between 1793 and 1805. Dr. V. gives his
+authority decidedly in favour of the non-existence of a contagion in
+this disease; and grounds his opinion upon the innumerable cases of
+patients affected with the disease and otherwise, who have escaped from
+infected districts, without communicating the malady in any instance, to
+the persons with whom they lived; upon the healthiness of ports, from
+which it has been said to have been introduced, &amp;c. Dr. V. is not, as
+some of his countrymen have been, unwilling, from some unimaginable
+cause, to make use of the immense mass of American evidence; though he
+observes, and with justice, that experiments should be repeated in
+France, in order to set the public mind at rest in that kingdom. He
+proposes the employment of criminals for this purpose; and recommends
+every mode of the most close contact which his imagination could
+suggest. He mentions experiments of this kind having been made in the
+United States; and by M. <span class="smcap">Guyon</span>, of Martinique, on his own person.</p>
+
+<p>He quotes Dr. <span class="smcap">Chervin</span>'s labours, with great and just applause. This
+indefatigable and daring physician has now spent upwards of ten years in
+accumulating proofs upon this single question.</p>
+
+<p>At the commencement of the pamphlet, the arrangement of which does not
+seem to us to be quite clear and easy, Dr. V. gives a sketch of the
+situation and localities of Leghorn. He traces the fevers of that place
+to putrid matters, perceptible by the sense of smell; and principally to
+obstructed drains. He does not give the exact degree of heat, but merely
+states that it was excessive, and followed by heavy rains.</p>
+
+
+<h3>IV. THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE.</h3>
+
+<p>22. <i>Iodine.</i>&mdash;In the former numbers of this journal, we offered some
+observations respecting the medicinal properties of iodine, intending
+then to present in one of our future numbers an elaborate analysis of a
+valuable work on this subject, by Dr. Manson, which appeared in England
+sometime last year.<a name="FNanchor_32_32" id="FNanchor_32_32"></a><a href="#Footnote_32_32" class="fnanchor">[32]</a> Fearing, however, that the want of room and time
+will prevent us from fulfilling this task, as soon as soon as might be
+desired, we have thought that a condensed notice of its contents would
+be acceptable in this place.</p>
+
+<p>It appears that previously to the discovery of iodine as a medicinal
+agent, our author used the burnt sponge in bronchocele, a disease very
+common<span class='pagenum'><a name="Page_167" id="Page_167">[Pg 167]</a></span> in the neighbourhood of Nottingham, where he practices. But when
+the effects of the former remedy was announced, Dr. M. prepared a
+tincture composed of one drachm of iodine to two ounces and a half of
+rectified spirit, (spec. grav. 916.) and prescribed it very extensively
+in doses of from 10 to 30 drops three times a day, according to the age
+and strength of the patient. Dr. <span class="smcap">Manson</span> has presented a tabular view of
+116 cases of bronchocele treated by iodine, and also a detailed account
+of 15 more cases, with appropriate remarks. Of the former, there were,
+viz:&mdash;</p>
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Males&mdash;</td><td align='left'>Cured,</td><td align='left'>10</td></tr>
+<tr><td align='left'></td><td align='left'>Much relieved,</td><td align='left'>1</td></tr>
+<tr><td align='left'></td><td align='left'>Discharged for non-attendance,</td><td align='left'>1</td></tr>
+<tr><td align='left'></td><td align='left'>Improving under treatment,</td><td align='left'>3&mdash;Total 15</td></tr>
+<tr><td align='left'>Females&mdash;</td><td align='left'>Cured,</td><td align='left'>66</td></tr>
+<tr><td align='left'></td><td align='left'>Much relieved,</td><td align='left'>9</td></tr>
+<tr><td align='left'></td><td align='left'>Not relieved,</td><td align='left'>2</td></tr>
+<tr><td align='left'></td><td align='left'>Discharged for non-attendance,</td><td align='left'>10</td></tr>
+<tr><td align='left'></td><td align='left'>Improving under treatment,</td><td align='left'>14&mdash;101&mdash;116</td></tr>
+</table></div>
+
+
+<p>Whilst using the tincture internally, Dr. <span class="smcap">Manson</span> occasionally had
+recourse externally to a liniment composed of</p>
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Liniment. Sap. Comp.</td><td align='left'>&#8485;i</td></tr>
+<tr><td align='left'>Tinct. Iodin&aelig;,</td><td align='left'>&#8485;i <i>m.</i></td></tr>
+</table></div>
+
+
+<p>Some patients can bear this quantity rubbed into the tumour once, and
+sometimes twice a day; though in some, the skin is so tender, that the
+liniment cannot be so frequently used. Dr. M. prefers this liniment to
+the common iodine ointment, as less liable to evaporation. In France, we
+believe Dr. <span class="smcap">Richond</span> prefers rubbing in the tincture itself. The
+following remarks are useful:</p>
+
+<p>"In some <i>individuals</i>, after the preparations of iodine have been given
+internally for some time, they are apt to occasion headach, giddiness,
+sickness of stomach, with some degree of nausea, langour, and inaptitude
+for exertion; when these unpleasant sensations and effects occur, the
+best plan to remove or obviate them is to suspend, for a time, the use
+of the medicine, or to reduce the dose, as may seem most expedient." A
+reduction of dose, from fifteen to twelve drops, was the plan adopted by
+our author on this occasion.</p>
+
+<p>2d. <i>Paralysis.</i>&mdash;Want of success with the ordinary modes of treating
+this disease, induced Dr. <span class="smcap">Manson</span> to try the effects of iodine.</p>
+
+<p>"The wonderful powers of iodine, which I had recently witnessed; and a
+long previous acquaintance with the same remedy as it exists in burnt
+sponge, in reducing morbid enlargements of the thyroid gland, led me
+from analogy, to think, that in cases of palsy, from tumours or fluids
+pressing on the brain or spinal cord, or from morbid thickening of the
+investing membrane of the cord itself, iodine might prove a useful
+remedy not only by stimulating the nervous system, and removing morbid
+tumefaction and<span class='pagenum'><a name="Page_168" id="Page_168">[Pg 168]</a></span> effusion, but also by correcting the strumous state of
+the constitution that often gives rise to the disease."</p>
+
+<p>The following interesting case as abridged in the Medico-Chirurgical
+Review, for January 1826, we take the liberty to transcribe.</p>
+
+<p>"J. Watterton, aged 19, was admitted into the General Hospital of
+Nottingham, on the 27th of March, 1821, having been ailing since
+October, 1819. Stated that he had at first been attacked with pain in
+the bowels, which having ceased, the lower extremities became swelled
+and painful.</p>
+
+<p>"After this, his neck became stiff and painful, with shooting pains from
+the neck into the left side of the head. These also disappeared, and did
+not afterwards return. This was about nine months ago, and, at that
+time, he suddenly lost the power of the left arm, and in a short time
+afterwards, that of the left lower extremity. Some time after this, he
+recovered, partially, the use of the left arm; the leg remaining
+paralytic. About this time, the <i>right</i> half of the body was
+instantaneously and completely palsied. He has continued ever since in
+this wretched state, getting worse rather than better, passing his
+stools and urine, involuntarily. He lies on his back, and, with the
+exception of the left arm, he is completely paralytic on both sides,
+from the neck downwards. The sense of feeling is very much
+impaired&mdash;there is no distortion of the face, nor impediment of speech.
+Is troubled with twitchings in the lower extremities.
+<i>Purgatives&mdash;blisters to the nape of the neck, and to be kept open.</i></p>
+
+<p>"It appears that, about two years ago, he had a bloody purulent
+discharge from both ears. The left still continues to discharge a
+purulent looking matter. Purgatives were continued till the 6th of
+April, when the tincture of iodine, in doses of 15 drops, was given
+thrice a day. April 9, can raise the right arm nearly to the head; but
+the power of the lower limbs has not improved. The twitchings have
+decreased. Purgatives&mdash;the tincture of iodine to be increased to 20
+drops ter in die. 10th. Evinces some muscular power in the lower
+extremities to day&mdash;feels stronger&mdash;can retain his urine for some time.
+14th. Continues to improve. The left foot is become exquisitely
+sensible, and that extremity is often drawn up spasmodically towards the
+body. The iodine to be increased to 25 drops. 16th. The paralytic
+symptoms continue to yield to the powerful influence of the iodine. When
+his meat is cut, he can now feed himself with the left hand;&mdash;can raise
+the right hand to the chin, and draw the right upper extremity up
+towards the body. He continues to hold his water. The iodine is
+increased to 30 drops, thrice a day&mdash;from this date to the 7th of May,
+the medicine was occasionally obliged to be intermitted and again
+commenced in smaller doses. At this period, however, the patient could
+walk from his bed room to the day ward with very little assistance.
+19th. He can walk without any assistance, except that of a stick to
+steady him. June 9th, can walk without a stick. He is gradually
+recovering the power of motion and sense<span class='pagenum'><a name="Page_169" id="Page_169">[Pg 169]</a></span> of feeling. Drops agree.
+Appetite good, and is allowed full diet. July 3d, the patient was
+discharged cured."</p>
+
+<p>Besides this highly interesting case, 24 more of paraplegia, hemiplegia,
+and partial paralysis, are given in detail, in which the iodine was
+exhibited with various success. In his prefatory remarks to this
+chapter, Dr. <span class="smcap">Manson</span> observes, that although he has been able to cure
+only a proportion of the cases of palsy that have come under his care
+since April 1821, yet he has been much more successful in his practice
+since that time, than he was previously with the use of all the ordinary
+means.</p>
+
+<p>Having succeeded so well in paralysis, Dr. <span class="smcap">Manson</span> was induced to try the
+effects of iodine in chorea, which he thinks is more closely allied to
+palsy than is supposed, and is linked to it by that species of the
+disease called shaking palsy. Of chorea treated with iodine, and showing
+the efficacy of the remedy, Dr. <span class="smcap">Manson</span> details eleven cases, and
+concludes this section with a tabular view of 72 cases treated at the
+General Hospital near Nottingham, between the 6th of October, 1812, and
+the 5th of October, 1824. In all the cases detailed by our author, the
+iodine was administered after purgatives, and throughout the treatment,
+the bowels were carefully regulated by aperient medicines.</p>
+
+<p>Dr. <span class="smcap">Manson</span> next records the results of his experience with iodine in
+scrofula&mdash;detailing three cases of scrofulous enlargement of the
+conglobate glands&mdash;two of scrofulous ulcers, and four of scrofulous
+ophthalmia; in all of which, the most beneficial effects were obtained.
+Our author details eleven cases of fistula lachrymalis, in which iodine
+produced the happiest results. He was led to prescribe iodine in this
+disease from the circumstance, that one of the individuals to whom he
+gave it for paralysis, laboured under the fistula, and was promptly
+relieved of it, whilst under the use of the remedy.</p>
+
+<p>Dr. <span class="smcap">Manson</span> has likewise detailed nine cases of deafness cured, or
+greatly relieved, by iodine. In most of these cases, the disease
+originated from obstruction of the Eustachian tube, the consequence of
+swelling of the tonsils, or of the membrane of the tube itself, from
+previous inflammation.</p>
+
+<p>Seven cases of dysphagia, eleven of white swelling, four of morbus
+coxarius, and eleven of distortion, form the subjects of the four
+succeeding sections. The medicine in all these cases, manifested so very
+decided a power in arresting the progress, and even in curing the
+disease, that we think ourselves safe in recommending a trial of it in
+similar cases. As the iodine, however, is a powerful stimulant, we would
+advise it not to be prescribed when there exists any fever, and
+especially when there are any decided signs of gastric irritation, as it
+would be likely to aggravate it.</p>
+
+<p>23. <i>Non-mercurial treatment of Syphilis.</i>&mdash;In the first number of this
+Journal, we inserted an essay on this subject, by Dr. <span class="smcap">Thomas Harris</span>, of
+this city, in which the author confirms, by the results of his public
+and private practice, the statements of the British army surgeons
+respecting the<span class='pagenum'><a name="Page_170" id="Page_170">[Pg 170]</a></span> efficacy and safety of the non-mercurial treatment.
+Since that period, having noticed that, by the worthy editor of a
+respected cotemporary, it is asserted that though mercury fails, "yet
+from the most ample experience in Europe, the present practice of Paris,
+England, Ireland, and the Continent generally, we must lean to the idea,
+that its use, under proper regulations, must be always adopted, as the
+only safe mode of cure in these diseases," we deem it but justice
+towards Dr. H. to call the attention of our readers to the result of the
+extensive experience of some physicians on the continent of Europe. Not
+to mention <span class="smcap">Broussais</span> himself, who appears to have rejected mercury
+almost entirely in the treatment of primary or secondary symptoms, we
+may cite Mr. <span class="smcap">Richond</span>, who reports that he treated, at the military
+hospital of Strasburgh, nearly 3000 cases of syphilis in all its grades,
+the vast majority of which were completely cured without mercury, and
+simply by means of antiphlogistics, emollients, and revulsives. Mr.
+<span class="smcap">Richond</span>, besides some essays in the Archives Medicales, and a summary of
+his experience in the preface to his work on apoplexy, has lately
+published an elaborate work on the subject. In the October number of the
+Annales de la M&eacute;decine Physiologique, Mr. <span class="smcap">Becquart</span> of the military
+hospital of Bayonne, details twenty-six cases of gonorrh&oelig;a,
+inflammation of the testicles, chancres on the glans and lips, buboes,
+excrescences around the anus, &amp;c., all of which were cured without
+mercury, and with the same remedies as were employed by Mr. <span class="smcap">Richond</span>. We
+might adduce the testimony of other French physicians, and particularly
+of M. <span class="smcap">Begin</span>, but we deem it unnecessary, as the above will be sufficient
+to show that in France the practice meets with the support of many very
+intelligent physicians. We annex the conclusions of Dr. <span class="smcap">Otto</span> of
+Copenhagen, drawn from an extended personal experience, and from his
+researches on the subject. Dr. <span class="smcap">Otto's</span> essay is contained in a late
+number of Gr&auml;afe's and Walther's Journal, and the conclusions are
+published in the Edinburgh Medical and Surgical Journal. Dr. O. remarks:</p>
+
+<p>1. That the cure of syphilis, without mercury, has been asserted by so
+many authorities, that the fact can no longer be doubted. If, then, the
+disease could formerly be cured without mercury, it may certainly now be
+much easier, as it has lost much of its violence and obstinacy.</p>
+
+<p>2. Syphilis can undoubtedly be radically cured in this manner; but then
+the cure is of longer duration, and the diet requires considerable
+restriction.</p>
+
+<p>3. The secondary symptoms, and a return of the complaint, are certainly
+more frequent; but the symptoms are not so difficult of removal; and the
+treatment has a much more speedy effect.</p>
+
+<p>4. As the treatment without mercury requires a longer time, it appears
+more practicable in hospital than in private practice; and on the other
+hand, the patient can be better watched in a hospital, which, on account
+of the diet, is of great importance.<span class='pagenum'><a name="Page_171" id="Page_171">[Pg 171]</a></span></p>
+
+<p>5. As ulcers on the genitals are often not syphilitic, and the use of
+mercury is contraindicated from a predisposition to scrofula or phthisis
+existing in the individual, it is consolatory to learn from the results
+of experience, that this medicine is not always necessary, and that a
+radical cure, by more simple and innocent means, can sometimes be
+effected. Where, however, the physician is anxious to avoid the possible
+evils which mercury is capable of producing, and also to prevent loss of
+time, there remains a middle way, namely, to employ mercury, whose
+specific action can scarcely be denied, in moderate doses.</p>
+
+<p>It results from a report of the cases of syphilis admitted into the
+public institutions of Sweden, that 3,574 were treated in 1822; 3,465 in
+1823, and 3,355 in 1824. During the course of this last year, 55-3/10
+per centum of all the patients were treated by the mercurial method, and
+35-1/10 per centum by the non-mercurial method, and by low diet; 2-1/2
+per centum by means of fumigations. MM. <span class="smcap">Kessler</span>, <span class="smcap">Wurster</span>, <span class="smcap">Ronberg</span>, and
+<span class="smcap">Sandmark</span>, prefer the dietetic method, and consider it as the surest of
+all those hitherto employed. Relapses are rare. In 1822 they amounted in
+relation to the whole number of cases, to 11-2/3 per centum; in 1823 to
+10-1/4, and in 1824 to 10-2/3. After the treatment by starvation, they
+amounted in 1822 to 7-3/4 per centum; to 7-1/3 in 1823; and to 8-1/3 in
+1824. After the mercurial treatment, in 1822 to 17-1/2 per centum; in
+1823 to 14-1/16; and in 1824 to 14-1/2. <i>Bulletin des Sci. Med.</i></p>
+
+<p>We hope to lay before our readers at some future period, an analysis of
+Mr. <span class="smcap">Richond</span>'s work above alluded to, as well as of one on the same
+subject by Mr. <span class="smcap">Jourdan</span> of Paris, author of some essays on the origin of
+syphilis, translated and published here a few years ago.</p>
+
+<p>24. <i>Cancer treated by Antiphlogistics.</i>&mdash;Of all diseases classed among
+the opprobria medicorum, cancer has hitherto been justly viewed as
+holding the most conspicuous rank, and it is only within a short time,
+that it appears to have been treated on correct principles, and that
+cures have been detailed by individuals of undoubted veracity. The idea
+of the inflammatory nature of cancer, and of the propriety of treating
+it by means of antiphlogistics, has been held many years ago, and
+supported by <span class="smcap">Vasalva</span> in Italy, <span class="smcap">Fearon</span> in England, <span class="smcap">Hufeland</span> in Germany,
+<span class="smcap">Pouteau</span> and <span class="smcap">Vacher</span> in France, not to mention other high authorities.
+But, notwithstanding the success attending this practice, it was too
+simple for the supporters of cancerous humours and specific
+inflammations, and seemed, in consequence, to have been abandoned by
+them, in their search after anti-cancerous or specific remedies; and
+little was heard of it, until revived by the disciples of the
+physiological school of France, and particularly by its founder
+professor <span class="smcap">Broussais</span>, and by professor <span class="smcap">Lallemand</span> of Montpellier, the
+result of whose experience is published in a thesis, lately defended at
+Montpellier by Dr. <span class="smcap">Mareschel</span>.</p>
+
+<p>We have been led to these reflections from reading the above essay, and
+another on the same subject, published by Dr. J. A. <span class="smcap">Puel</span>, in a late
+number<span class='pagenum'><a name="Page_172" id="Page_172">[Pg 172]</a></span> of the Archives G&eacute;n&eacute;rales de Medecine. Dr. P. details many
+cases, which were treated by his father, by means of leeches,
+emollients, purgatives, &amp;c. so early as 1807. In most of these cases,
+the practice appears to have been very successful. As it is our wish to
+impress our readers with the propriety of making a fair trial of this
+method, in cases of scirrhus and cancer, we shall select and translate a
+few cases from the latter essay. It is proper to premise, however, that
+the practice must not be viewed as completely successful in <i>every</i>
+case, and that the older the complaint, the less confident we ought to
+be, in respect to the happy results of the case. Nor is it to be
+expected, that <i>boldness</i> in the employment of the lancet and leeches,
+will answer as well as a perseverant, constant, but moderate use of
+these means. Chronic inflammations are not to be removed by storm, but
+by a <i>chronic</i> use of remedies, and particularly by attention to diet.</p>
+
+<p>We cannot at present determine precisely the proportion of cures
+effected, by this method, of scirrhus or cancer, in a given number of
+cases, and how far it will surpass, in point of success, the common
+method of treatment by <i>specific</i> narcotics and escharotics; but, even
+supposing that it is not more successful, (which we are disposed to
+deny,) it has at least the vast advantage of being more <i>comfortable</i>,
+and much less painful to the patient.</p>
+
+<p>Mrs. D. enjoying good health, and mother of three children, was brought
+to bed in 1823, of a healthy child, which, however, she did not suckle.
+With a view of suppressing the secretion of milk, irritating
+applications to the breast were resorted to, which brought on an
+inflammation of that organ. Emollient poultices were now applied; these,
+however, did not prevent the formation of an abscess, which was opened
+by means of caustic potash. The suppuration, for a few days, was
+abundant and the matter discharged healthy. Purgatives were prescribed,
+with the view of suppressing the discharge, and mercurial ointment was
+rubbed on the tumour, to produce its absorption. These remedies were not
+successful, because no means were employed to arrest the inflammation,
+which gave rise to the suppuration.</p>
+
+<p>When the patient applied for advice, she had been sick already four
+months, and presented the following symptoms. She was very much
+emaciated, and laboured under fever, resulting from a gastro-enteritic
+inflammation, kept up by purgatives and deostruents, (<i>fondans</i>,) which,
+from the commencement of the attack, were prescribed for her. The
+ulceration of the mamma was of the size of a five frank piece, unequal
+and gray, and gave issue to an ichorous and f&oelig;tid purulent matter.
+The edges were thick and everted, and surrounded with an erysipelatous
+inflammation. The whole mamma was large and hard, and the seat of
+lancinating pain. Thirty-five leeches were applied around the tumour,
+and gave rise to a profuse h&aelig;morrhage, which continued many hours. From
+this, the patient experienced so much relief from pain, as to be able to
+take some repose, of which she had been deprived for some weeks.
+Emollient poultices and drinks were prescribed, and a low diet enjoined.
+By all these means, the<span class='pagenum'><a name="Page_173" id="Page_173">[Pg 173]</a></span> pain was lessened, and the swelling much
+diminished. Leeches were again applied, and the other remedies
+continued. The wound gradually improved, and in forty five days, was
+completely healed.</p>
+
+<p>Mr. P. was called on the 25th of September, 1817, to attend a lady, who
+had been affected for two days with uterine h&aelig;morrhage, which he
+succeeded in arresting. The following history of her complaint was given
+to him: she had aborted about 18 months before, and since that time, had
+experienced every fortnight an uterine h&aelig;morrhage, which generally
+lasted five or six days. During the intervals, she complained of deep
+seated pain, numbness and cramps, in the lower part of the abdomen, in
+the thighs and groins. The pain was much aggravated when she had a
+stool&mdash;walking, especially when long continued, was painful, and
+attended with a sense of dragging, which was only relieved by repose.
+From the same period, her disposition had changed from gay and lively,
+to melancholy and morose&mdash;her digestive functions were slow and
+painful&mdash;she was affected with leucorrhea, and during coition, felt much
+pain, and often lost some blood. On examination per vaginam, it was
+found, that the neck of the uterus was elongated&mdash;the anterior lip of
+the same organ was soft to the feel&mdash;the orifice somewhat enlarged, and
+painful when the finger was introduced into it. On the inferior lip
+there was a small unequal and painful spot, which was regarded as a
+superficial ulceration; the uterus was a little prolapsed, and somewhat
+enlarged; the pulse small and frequent; febrile exacerbations every
+evening; sleep not refreshing, and interrupted by short lancinating pain
+in the uterus.</p>
+
+<p>The disease was judged by Mr. P. to be a chronic metrites, with
+ulceration, and all the symptoms usually attending incipient cancer.
+Guided by this belief, and notwithstanding the already long duration of
+the disease, and the debility of the patient, the following treatment
+was adopted&mdash;complete repose in the horizontal posture&mdash;leeches to the
+vulva, repeated several times&mdash;vaginal injections, with emollient
+decoctions&mdash;hip baths&mdash;very low diet. After persevering in this plan
+twenty days, the patient appeared much better, and was allowed to sit
+up. General baths were substituted for the partial ones. The same
+treatment was continued, with the exception of the leeches, and at the
+end of thirty days more, all the symptoms of the disease had completely
+disappeared. Mrs. P. was allowed to spend the following spring in the
+country, from whence she returned in very excellent health. She has
+since continued to enjoy it, and has borne several children.</p>
+
+<p>Cases nearly similar, are detailed by Mr. <span class="smcap">Mareschal</span>, as having occurred
+in the practice of professor <span class="smcap">Lallemand</span>. The same gentleman, also gives
+the history of two cases of external cancerous sores, in which the same
+treatment was adopted. The patients having died during the progress of
+the cure, of other diseases, an opportunity was offered, of examining by
+dissection, the changes that had occurred in the parts. We cannot<span class='pagenum'><a name="Page_174" id="Page_174">[Pg 174]</a></span>
+enlarge on the subject in this place, and can only remark, that these
+changes were such, as to lead us to hope, that less difficulty will be
+experienced in the treatment of sores reputed cancerous, by the local
+antiphlogistic plan, than is commonly supposed. At any rate, recommended
+by such high authorities, the practice deserves a trial.</p>
+
+<p>The Revue Medicale for February 1826, contains the details of a case
+lately cured at La Piti&eacute;, by Mr. <span class="smcap">Lisfranc</span>. The patient, a woman, aged 36
+years, of a strong and good constitution, had suffered the removal of a
+cancerous breast, 18 months previous to her admission into the Hospital,
+on the 10th October, 1825. The following symptoms were observed. On the
+whole surface of the cicatrix were felt a number of engorged ganglia,
+and an induration situated on the large and small pectoral muscles, and
+spreading from the clavicle to all the external and superior part of the
+thorax, and as far as the axilla, where other swollen ganglia were felt.
+The enlarged surface was elevated about half an inch above the level of
+the chest. Severe lancinating pains were at short intervals felt by the
+patient&mdash;which came on without any evident cause, and were particularly
+severe on the least pressure of the swollen part.</p>
+
+<p>This patient was treated by means of frequent and copious bleeding from
+the arm&mdash;the very frequent application of leeches to the inflamed part,
+and to the upper and interior part of the thighs, to bring on the
+menstrual discharge&mdash;digitalis to remedy the frequent
+palpitations&mdash;emollient applications, and low diet. On the 10th of
+January, she was considered well;&mdash;the swellings and pain having
+disappeared&mdash;the menstrual discharge being well established, and the
+movement of the arm (which during the progress of the disease had been
+impeded from the swelling in the axilla) perfectly free.</p>
+
+<p>We are happy to learn that this practice is pursued with success by the
+Spanish physicians, as may be readily found by a reference to a late
+number of the Periodico de la Sociedad Medico Quirurgica de Cadiz, which
+contains cases of scirrhous mamma cured by the repeated application of
+leeches.</p>
+
+<p>25. <i>Essential oil of Male Fern, as, a remedy in Cases of T&aelig;nia.</i>&mdash;The
+male fern has long been regarded as a valuable anthelmintic medicine;
+but, as every powder administered in large doses, its exhibition is
+difficult and disagreeable; so much so, indeed, that many patients
+refuse to make a sufficiently constant use of it to ensure its
+beneficial effects. Struck with this inconvenience, M. <span class="smcap">Perchier</span>, a
+pharmaceutist of Geneva, has lately made some experiments with a view of
+discovering its active principle, and to see whether this latter may be
+administered with equal success with the powder or infusion of the
+plant. We are happy to learn that the result of his experiments are very
+satisfactory. We translate the following observations from a memoir on
+the subject, read on the 7th of October last, by Mr. <span class="smcap">Gendrin</span>, before the
+medical society of the department of the Seine. "This<span class='pagenum'><a name="Page_175" id="Page_175">[Pg 175]</a></span> medicine, which
+is a fatty oil extracted by distillation from the &aelig;ther, in which the
+powder of the root of the male fern has been macerated, has caused in
+many cases, the expulsion of the t&aelig;nia, without occasioning nausea,
+colics, or any other morbid phenomena." "It is exhibited at bed time,
+either in an oily potion, in pills, or incorporated in an electuary, in
+doses of 18 or 20 drops. On the following morning, a similar dose is
+given, and two hours after, two ounces of castor oil are administered.
+In most cases, the t&aelig;nia is expelled in the course of the day, but if
+this does not occur, the same doses of the oil are given in the same
+way, and followed by a similar quantity of the castor oil. The fatty oil
+of fern, has an &aelig;thereal and empyreumatic smell; its colour is brown,
+and its consistence rather greater than that of castor oil; it is,
+however, easier to separate in drops. Its taste is acrid, pungent,
+empyreumatic, and very disagreeable."&mdash;<i>Propagateur des Sciences
+Medicales, Janvier 1826.</i></p>
+
+<p>26. <i>Tincture of Bastard Saffron<a name="FNanchor_33_33" id="FNanchor_33_33"></a><a href="#Footnote_33_33" class="fnanchor">[33]</a> for the expulsion of T&aelig;nia.</i>&mdash;Dr.
+<span class="smcap">Chisholm</span>, of Canterbury, has lately used with success, in a case of
+t&aelig;nia of many years standing, the vinous tincture of bastard saffron.
+The patient had already undergone various plans of treatment, and had
+especially used the oil of turpentine in very large doses. Dr. C. was
+induced to try the above remedy, from having noticed, that in a case in
+which it had been prescribed for the cure of rheumatism, a large portion
+of t&aelig;nia had been expelled. He consequently administered two ounces of
+the tincture; advising the patient to take a table spoonful more of it
+mixed in a little water, two or three times a day. On the third or
+fourth day after commencing the use of this remedy, the patient voided a
+large portion of the worm, and has since been free from the usual
+symptoms of the disease.</p>
+
+<p>27. <i>Oil of Turpentine in T&aelig;nia.</i>&mdash;Although the oil of turpentine is
+used in many parts of this country, in cases of t&aelig;nia, we have good
+reasons for believing, that some physicians continue, notwithstanding
+the testimony in its favour, to hesitate exhibiting it in doses
+sufficiently large to destroy and promote the expulsion of the worm.
+Such being our opinion, we are induced to offer here a few remarks on
+the subject, and to notice a memoir published by Dr. <span class="smcap">De Pommer</span>, in a
+late number of Hufeland's Journal. The employment of this remedy in such
+cases, is not of recent origin, having been resorted to many years ago
+by the Swedish practitioners, and subsequently revived by the English.
+In Germany it has recently been used by Professor <span class="smcap">Osan</span>, and we believe
+particularly by Dr. <span class="smcap">De Pommer</span>, who appears to have prescribed it boldly
+in very many instances, and in some, after the ineffectual employment of
+all other anthelmintics. Dr. P. adds, that he never saw any bad effects
+resulting from its use, and that patients are very little liable to
+relapses when treated by it.</p>
+
+<p>Among the cases detailed by Dr. <span class="smcap">De Pommer</span>, we select the following, as
+calculated to show the manner in which the Dr. uses the remedy.</p>
+<p><span class='pagenum'><a name="Page_176" id="Page_176">[Pg 176]</a></span></p>
+<p>"G.K..., a soldier aged 21 years, thin, tall, and who during his infancy
+had been subject to ascarides, has occasionally voided during more than
+10 years past, portions of t&aelig;nia. He had used several purgative
+medicines, by which several yards of this worm had been expelled; but
+annoyed with so many attempts at obtaining its total expulsion, he had
+ceased, three years before, the use of all sorts of anthelmintics. But
+the phenomena resulting from the presence of the animal being
+aggravated, the patient applied for advice to Dr. <span class="smcap">De Pommer</span>, who found
+him labouring under the following symptoms:&mdash;Frequent pain in the
+abdomen, and especially in the umbilical region, accompanied with a
+sense of burning heat, and alternate distension and depression of the
+abdomen. Appetite sometimes keener than in health; at others nearly
+lost. In the morning before breakfast, the patient was seized with
+extraordinary weakness, and general uneasiness, accompanied with
+trembling of the limbs, ineffectual attempts to vomit, a sense of
+constriction in the throat, and a profuse salivation. All these symptoms
+disappeared after K... had taken food; but reappeared two hours after.
+Milk and farinaceous aliments were the only articles of which he could
+make use without an aggravation of his disease. The pulse was febrile;
+sleep good, but attended with dreams. The pupils were in the natural
+state. From the symptoms, and from the history of the case, Dr. P. was
+induced to make use of the oil of turpentine in the following manner.
+The patient was ordered in the morning, before breakfast, three table
+spoonsfuls of the remedy, at half an hour's interval. The first doses
+produced only a few borborygma. Two more table spoonfuls occasioned a
+vomiting of mucous matter. Three more table spoonfuls were exhibited,
+and followed by a stool of solid f&aelig;ces, mixed with which were five small
+pieces of t&aelig;nia. The patient not finding himself incommoded, took in the
+space of an hour, three more table spoonfuls of the remedy, after which
+he experienced some pain in the head, and vomited about one pint of
+bilious liquid. An hour after, the same quantity of the medicine was
+taken, and followed again by vomiting, but after a repose of half an
+hour K... discharged, per anum, firm and greenish f&aelig;ces, and with them
+five ells of t&aelig;nia. The urine discharged had the smell of violets. He
+again took a few spoonfuls of the vermifuge, which were not followed,
+however, with any f&aelig;cal discharge, and only with some vomiting of mucus,
+and slight vertigo. In the afternoon the patient felt well, and
+experienced a great appetite, in which he indulged. From this moment he
+recovered, and has ever since enjoyed good health. The quantity of the
+remedy used was six ounces."</p>
+
+<p>It appears, from the observations of Dr. P., that the gastric irritation
+occasioned by the spirits of turpentine, has never amounted to
+phlogosis, and has generally subsided after the remedy had been
+discontinued. Nevertheless, as the spirit of turpentine is a very
+powerful stimulant, we would not venture to recommend its use, when
+there exists an inflammation in the<span class='pagenum'><a name="Page_177" id="Page_177">[Pg 177]</a></span> gastro-enteritic system. We are
+aware that it is resorted to in burns, and highly eulogized in puerperal
+and yellow fever. In the first, it is certainly very useful, but on what
+principle we know not, except perhaps that its stimulus is different
+from that existing in the diseased part. But in the second case, it
+acts, not on the diseased surface, but by revulsion, on the mucous
+membrane; and as regards its virtues in yellow fever, we are rather
+sceptical in respect to what has been said on the subject. In this
+opinion we are supported by the testimony of our friend Professor <span class="smcap">Rhees</span>,
+whose situation of house surgeon to the fever hospital, during the
+epidemic of 1820, afforded him ample opportunities of testing the
+propriety of the practice.</p>
+
+<p>In the number for March 1826, of the Revue Medicale, M. <span class="smcap">Maudru</span> relates
+two cases in which large portions of t&aelig;nia were expelled, and the
+patients cured, by means of a strong decoction of the bark of
+pomegranate. The first patient took, in one day, two pounds of the
+decoction made with four ounces of the remedy. The second patient took
+six ounces of the bark in decoction, in the course of forty-eight hours.
+In neither case did the medicine occasion unpleasant effects, with the
+exception, in the second patient, of slight colicky pains.</p>
+
+<p>28. <i>Action of the Oil of the Euphorbia Lathyris.</i>&mdash;At a meeting of the
+Academy of Medicine, (section of pharmacy) M. <span class="smcap">Bally</span> read the results of
+some clinical experiments made by him at the hospital of La Piti&eacute;, on
+the action of the oil of the euphorbia lathyris. The preparation used by
+him, had been made by means of alcohol and expression. It appears to be
+a little more active than the other preparations. Administered to
+fifteen individuals of different ages, it did not produce very various
+results, nor prove very active in its purgative effects. As a purgative,
+indeed, it is far less active than the croton oil, and requires to be
+given in much larger doses; as much as six or ten drops. It has also the
+bad property of exciting emesis, by which it is rejected from the
+stomach. On the other hand, however, it does not, like the croton oil,
+produce salivation, and is, on the whole, regarded by M. <span class="smcap">Bally</span>,
+especially when fresh, as a useful purgative in diseases of
+children.&mdash;<i>Archives Generales, Decembre, 1825.</i></p>
+
+<p>29. <i>Medicinal properties of the Apocynum Cannabinum, or Indian
+Hemp.</i>&mdash;In an essay on this plant, submitted to the medical faculty of
+Jefferson College, by Dr. <span class="smcap">M. L. Knapp</span>, we are informed, that in doses of
+15 or 30 grains it possesses emetic properties. It was besides, on
+trial, found to be cathartic, expectorant, diuretic and diaphoretic. It
+appears to have been generally administered in powder, and Dr. K.
+remarks, that "in decoction, it seems to lose some of its emetic
+properties, and to act more upon the bowels as a hydragogue cathartic."
+"The root possesses all the medicinal properties of the plant, and is
+active throughout, both in its cortical and ligneous portions. Water or
+proof spirit is its proper menstruum."</p>
+
+<p>This article was prescribed with success in dropsy, by Dr. <span class="smcap">Knapp</span>, and<span class='pagenum'><a name="Page_178" id="Page_178">[Pg 178]</a></span>
+by Dr. <span class="smcap">Parrish</span> of this city. It was likewise used in intermittent fever,
+in bilious affections, amaurosis, hernia humoralis, dysentery, chronic
+rheumatism, &amp;c. Dr. <span class="smcap">Knapp</span> appears to have derived benefit from its use
+as an alterative in a case of fever in a child, attended with disordered
+bowels. "The powders (gr. ii. each at intervals of three hours,) were
+regularly persisted in for a week, and the child's health went on
+gradually improving. Neither vomiting nor purging was produced, but the
+morbid heat and thirst were allayed, the stools became natural, the skin
+soft and moist, and the functions of digestion and assimilation were
+gradually restored, and the child is at this time fat and
+healthy."&mdash;<i>American Medical Review, &amp;c. April</i> 1826.</p>
+
+<p>30. <i>Remarkable effects from the external application of the Acetate of
+Morphia.</i>&mdash;M. <span class="smcap">Dubourg</span> has recently published the result of an experiment
+made at the hospital de la Piti&eacute;, with the acetate of morphia, which we
+regard as sufficiently interesting to be noticed in this place. The
+patient had been affected twelve months before with puerperal peritoneal
+inflammation, complicated with cerebral symptoms, from which,
+notwithstanding a most energetic antiphlogistic treatment, she never
+entirely recovered. When she was admitted into the hospital, she
+presented the following symptoms:&mdash;"considerable emaciation; skin hot
+and pungent to the feel; pulse small and frequent; tongue of a pale rose
+colour, dry at the tip and edges, brown and smooth in the centre as far
+as the basis; severe pain on the least pressure on the epigastrium and
+over the whole abdomen; cardialgia, nausea, vomiting of all solid and
+liquid aliments, and during the empty state of the stomach, violent
+efforts to vomit occurring at irregular intervals; abdomen tense and
+tympanitic; violent intermittent pain along the course of the
+intestines; constipation; sensation of fatigue and lassitude in the
+lumbar region and in the extremities; dragging pains in the
+inter-scapular region; extinction of the voice; urine red and scanty;
+the face animated and bearing no marks of profound suffering; agitation,
+and total want of sleep."</p>
+
+<p>The disease was regarded as a chronic gastro-entero-peritonitis, and
+treated accordingly, by the antiphlogistic regimen; but no benefit was
+derived from this plan. The patient continued to vomit almost every
+thing she took, with the exception of sugar and a paste made with the
+Iceland moss. A blister was applied to the epigastrium on the 15th of
+February, seven days after her admission. Called to her assistance on
+the 22nd of February, on account of an aggravation of the vomiting, M.
+<span class="smcap">Lambert</span>, one of the house pupils of the hospital, endeavoured to calm
+the symptoms by means of the acetate of morphia in powder, applied to
+the raw surface of the blister. Half a grain was used in this way, and
+in a few minutes the vomiting disappeared, and the patient passed a
+better night than she had yet done. M. <span class="smcap">Serres</span> having authorized the
+continuance of this method, M. <span class="smcap">Dubourg</span> the next day applied half a grain
+in the same way; and the patient slept the whole night. The remedy was<span class='pagenum'><a name="Page_179" id="Page_179">[Pg 179]</a></span>
+applied every day with the same effect, and was gradually increased to
+two grains and a half. From the first application of the remedy, the
+symptoms gradually subsided; aliments were retained and properly
+digested; the pain and swelling of the abdomen disappeared, and on the
+14th of March the patient was regarded as in a fair way of
+recovery.&mdash;<i>Archives Generales, March</i> 1826.</p>
+
+<p>In some remarks which accompany this interesting case, M. <span class="smcap">Dubourg</span>, seems
+to doubt the correctness of the first diagnosis, and to view the disease
+as a nervous, rather than as an inflammatory affection of the abdominal
+viscera.</p>
+
+<p>31. <i>Cure of Urinary Calculi by means of the internal use of the
+Bicarbonate of Soda.</i>&mdash;At a late meeting of the Academy of Medicine, Mr.
+<span class="smcap">Robiquet</span> read a memoir on the use of this salt in cases of urinary
+calculi. Having learnt from Mr. <span class="smcap">Darcet</span>, that the use of the waters of
+Vichy changes the quality of the urine from acid to alkaline, Mr. R.
+conjectured, that this effect should be attributed to the bicarbonate of
+soda contained in them; and from this circumstance, he was led to
+administer this salt internally, in cases of calculi composed of uric
+acid. In July last, he made the experiment on a man 74 years of age, who
+had laboured under symptoms of the disease since the month of February,
+and in whom, by means of the sound, a small and soft calculus had been
+detected. Mr. R. ordered him 10 grains of the bicarbonate in the course
+of the day, dissolved in two pounds of water&mdash;prescribing at the same
+time, hip baths, injections, &amp;c. At the end of fifteen days, much
+benefit had already resulted from this treatment; and in a month, the
+patient appeared to be cured. Nevertheless, the remedy was continued
+until November, when the patient passed through the urethra, a small
+calculus composed of uric acid, which appeared to have been the nucleus
+of a much larger one, the exterior strata of which had been worn off.
+From that period, the patient has not experienced any unpleasant
+symptom; but the sound was not resorted to, to ascertain whether the
+first calculus before felt, could be detected.&mdash;<i>Archives Generales,
+February, 1826.</i></p>
+
+<p>32. <i>Attempt to cure Abdominal Dropsy, by exciting Peritoneal
+Inflammation.</i>&mdash;In the number of the London Medical and Physical Journal
+for April, 1826, a case of ascites is related by <span class="smcap">H. R. Oswald</span>, Esq. in
+which the cure was attempted to be effected, by exciting peritoneal
+inflammation. The following symptoms were noticed at the time of
+application for advice: the abdomen measured nearly six feet in
+circumference, was exceedingly hard and tense; but not tender. The
+patient "could hardly walk across her cabin from dyspn&oelig;a and
+debility, and the weight and tension of the tumour; which caused her to
+bend the body much forward, leaning her hands on her knees. The
+emaciation was very considerable; the appetite good; thirst
+considerable; tongue clean; pulse 120, and small; skin dry, harsh, and
+rough; bowels habitually costive; urine scanty." "This affection
+commenced<span class='pagenum'><a name="Page_180" id="Page_180">[Pg 180]</a></span> about twelve months ago, after an obstruction of the
+catamenia for nearly a year, arising, as was supposed, from exposure to
+cold. The swelling was preceded by lancinating pains in the abdominal
+and lower part of the thoracic cavities, but which, after a few months,
+ceased entirely; and the disease had, in a chronic manner, gradually
+arrived at its present oppressive form."</p>
+
+<p>Paracentesis was performed several times; cathartics, diuretics, the
+lancet, blisters, and tonics were resorted to, with relief from some of
+the symptoms. The tumour, however, returned several times, so that M.
+<span class="smcap">Oswald</span> despairing of effecting a cure by following the same plan, and
+recollecting a case of ascites, which was cured apparently by an
+inflammation having supervened in the peritoneum, from the orifice made
+by tapping remaining open, attempted to produce the same effect in the
+present patient, by keeping the orifice of the wound open by means of a
+small tent. In this he partly succeeded, for in the course of a few
+months, all symptoms of the effusion had disappeared; health and
+strength had much improved, and the patient had experienced a return of
+the menstrual discharge, which had been suppressed for nearly three
+years.</p>
+
+<p>About a year afterwards, however, the disease returned. Paracentesis was
+again performed several times, and a tumour was perceived to have formed
+in the lower part of the abdomen. The patient died in about five or six
+months from the re-appearance of the effusion. On dissection, much water
+was found in the abdominal cavity, which was lined by a dense, white,
+and rough looking membrane, of a fragile and diseased structure. The
+intestines behind this membrane, were unusually small, and of a dark
+leaden colour. The tumour above alluded to, was discovered to be
+situated in the region of the right ovarium; it was a tubercular,
+carcinomatous, and pale coloured fungus, possessing a structure not
+unlike that of the placenta, and was formed in the interior of the sac,
+which being traced further back, was found to be the cyst of a dropsy,
+originating in the right ovarium at the fundus of the sac, or "more
+properly speaking of its neck."</p>
+
+<p>"The foregoing statement," Mr. O. remarks, "involves four facts and
+questions of considerable importance in pathology. 1st. The great
+quantity of fluids evacuated in so short a space of time: no less than
+ninety-six quarts in eight months, by four operations; and fifty-nine
+quarts from August to December, 1824, by three. 2nd. The variety in the
+nature, consistence and colour of these fluids. 3d. The possibility of
+curing ascites and dropsy of the ovaria, by exciting inflammation in the
+abdominal sac, either by the admission of air into it, or mechanical
+irritation; and 4th. The possibility of a thickening of the parietes of
+the abdomen by inflammation, or by an exudation of a carcinomatous sort,
+being mistaken for a tumour rising out of the pelvis."</p>
+
+<p>33. <i>Artificial Respiration.</i>&mdash;Dr. <span class="smcap">J. Ware</span> of Boston, relates in the New
+England Jour. for April last, that he was led by the experiments of the<span class='pagenum'><a name="Page_181" id="Page_181">[Pg 181]</a></span>
+justly celebrated physiologist Mr. <span class="smcap">Brodie</span>, to employ artificial
+respiration in the case of an infant 9 weeks old, whose system was
+prostrated from an over dose of laudanum. "The action of the heart was
+reduced to an occasional throb; the pulse had entirely ceased, and the
+efforts at respiration, which for some time had consisted merely in an
+occasional gasp, became more and more unfrequent." The child had been
+afflicted for five or six weeks with hooping-cough, and had been very
+sick and feeble when the laudanum (about 15 drops) was administered.</p>
+
+<p>By means of the stem of a tobacco-pipe, artificial respiration was
+excited, and continued for several minutes: the action of the heart was
+immediately renewed, and the pulse could be again felt. At the end of an
+hour, during which the artificial respiration was repeated at intervals;
+"the respiration became natural, the pulse distinct and tolerably
+strong, and the heat began to return." A fit of coughing, preceded by a
+livid appearance of the forehead and face, arrested the breathing,
+"which did not return till assisted by the artificial process." The
+child, assisted by these measures, and by attention to the more usual
+means of recovery, struggled through the night, but died during a
+paroxysm of coughing in the morning.</p>
+
+<p>The conclusions of Mr. <span class="smcap">Brodie</span> are, that narcotics destroy life through
+the organs of respiration, and hence, if respiration can be artificially
+carried on until the effects of the narcotic subside, life may be
+preserved. Dr. <span class="smcap">Ware's</span> case would seem to confirm this idea; for it is
+<i>probable</i> his patient would have recovered from the effects of the
+narcotic, if the paroxysms of coughing had not interfered.</p>
+
+<p>34. <i>Secale Cornutum.</i>&mdash;Mr. <span class="smcap">Charles Waller</span> has lately published (London
+Medical and Physical Journal, April 1826,) several cases illustrative of
+the action and efficacy of secale cornutum. We have not room for any of
+the cases, and content ourselves with transcribing Mr. W.'s inferences.
+These are: "That the secale cornutum is a remedy which is capable of
+increasing the force of the uterine contractions in a most remarkable
+manner, under certain circumstances; but that the effect is doubtful,
+unless there be some degree of action present. In other words, that,
+although it will increase the contractions when already present, it will
+not always renew them when they are suspended.</p>
+
+<p>"That the effect is more certain if the infusion be of greater strength
+than is usually recommended; two drachms of the secale to six ounces of
+water being barely sufficient for the purpose.</p>
+
+<p>"That it appears to be a stimulus peculiarly fitted for irritable, and
+what are generally termed <i>nervous</i> habits.</p>
+
+<p>"That the fears entertained by some practitioners of its proving
+detrimental to the child, are groundless.</p>
+
+<p>"But, although it is in general necessary, not only that there should be
+a disposition for labour, but that this process should have actually
+commenced, before we can expect the secale cornutum to have any effect
+upon<span class='pagenum'><a name="Page_182" id="Page_182">[Pg 182]</a></span> the uterus, still one solitary case has indirectly come to my
+knowledge (and I will vouch for the authenticity of it,) where this
+remedy was given for the purpose of producing abortion in a female,
+about the second month of utero-gestation; and this effect was
+accomplished in a few hours after its exhibition."</p>
+
+<p>35. <i>Animal Magnetism.</i>&mdash;This strange doctrine begins to acquire
+considerable vogue in France, and other European countries, from which
+it seemed to have been expelled, by the contempt and ridicule which it
+met with, from most of the learned of the latter part of the last
+century. <span class="smcap">Anthony Mesmer</span>, the great chor&oelig;gus of the magnetic mummers,
+was born in 1733, and excited a vast deal of attention, by the enormous
+pretensions which he set forth on the subject of magnetism. <span class="smcap">Mesmer</span> came
+from Austria to Paris in 1778. He addressed the Academy of Sciences, and
+that of Medicine, but no attention was paid to him, till a commission
+was appointed to examine carefully into the merits of the question. This
+commission in 1784, so fully exposed the fallacy of <span class="smcap">Mesmer's</span> theories
+and practice, that he soon afterwards quitted Paris, and retired to
+England under a feigned name. He subsequently went to Germany, and died
+in obscurity, in the year 1815.</p>
+
+<p>In December last, M. <span class="smcap">Husson</span> (for himself, and MM. <span class="smcap">Adelon</span>, <span class="smcap">Burdin</span>, <span class="smcap">Marc</span>,
+and <span class="smcap">Pariset</span>,) read a report to the Royal Academy of Medicine, on the
+question, whether it was fitting for the section to undertake new
+researches on animal magnetism, as it had been thought to be
+definitively settled by the decisions of 1784. The report concluded
+affirmatively, for several reasons; among which the principal seems to
+be, that magnetism has at present fallen into the hands of the learned,
+whereas it was formerly under the domain only of quacks and the vulgar.</p>
+
+<p>M. <span class="smcap">Husson's</span> report was discussed at subsequent sittings of the Academy,
+for the purpose of ascertaining whether a new commission should be
+appointed; and as this topic is certainly one of the greatest novelties
+of the day, we shall give some account of the discussions, making free
+use of the report of them, contained in the Revue Medicale, Mars. 1826.</p>
+
+<p>M. <span class="smcap">Desgenettes</span>, declared against the appointment of a commission,
+because he considered the magnetism of the present day, quite as much a
+matter of jugglery as that of 1784; and he informs us, that the
+publicity given to the report, had already increased the audacity of the
+magnetisers, who look on it as an approbation of their art.</p>
+
+<p>M. <span class="smcap">Virey</span>, regretted that the report had not spoken in strong terms,
+against the ridiculous practices, and shameful jugglery, which disgrace
+the cause of magnetism; he wished the committee had announced an
+intention, to make only physiological, or psychological researches, on
+the influence, which magnetism really appears to exercise on the nervous
+system; and gave his voice for the formation of a commission of
+experiments.</p>
+
+<p>M. <span class="smcap">Bally</span>, voted against it for several reasons, and among others,
+because<span class='pagenum'><a name="Page_183" id="Page_183">[Pg 183]</a></span> of the fact announced by all the magnetisers, that the person
+who magnetises, acquires a sovereign power over the magnetisee; and he
+inferred from this, all the inconvenient and even dangerous consequences
+which may result to public morals!&mdash;Finally, he voted against it,
+because magnetism is ridiculed every where, because it is all darkness
+and confusion, and especially, because it being an inexhaustible mine of
+empiricism, the section ought not to lay open such a fertile field for
+those gentry who live by quackery.</p>
+
+<p>M. <span class="smcap">Orfila</span>, (eheu!) defended the propositions of the reporters. It is
+opposed, said he, on the three grounds following: 1st. Because the
+section has not been invited to the examination now recommended. 2nd.
+Because magnetism is nothing but juggling. 3d. Because commissions will
+not commonly do any work. The first ground is not correct: M. <span class="smcap">Foissac</span>, a
+physician of Paris, has invited our attention to it, and offered to
+subject a magnetic somnambulist to its exploration; and very reputable
+physicians, members of the Academy, MM. <span class="smcap">Rostan</span>, (the ramollissement man,
+is his head soft too?) and <span class="smcap">Georget</span>, have in their recent publications
+called the attention of the learned to this subject. Secondly, if there
+be any jugglery, in the magnetic phenomena we are told of; it is
+nevertheless certain, that the whole of them are not simulated. The
+testimony of well taught physicians, ought to be received on this head.
+That the phenomena are extraordinary, is no argument; for those of
+electricity must have been quite as marvellous, at the period of their
+discovery, &amp;c. &amp;c.</p>
+
+<p>M. <span class="smcap">Double</span>, blamed the report as being nothing more than an apology for
+magnetism, which is tarred with the same stick as that of 1784, and only
+modified a little, by the esprit de notre temps, &amp;c. &amp;c. He said he had
+made magnetism a special subject of study, and <i>never saw a phenomenon
+produced by it</i>.&mdash;&mdash;He thinks the commission could only do injury to
+science, and compromit the Academy, &amp;c. &amp;c. He would vote against the
+appointment, and advised the section to wait until some scientific
+memoirs should be sent to it.</p>
+
+<p>M. <span class="smcap">Laennec</span>, agreed with M. <span class="smcap">Double</span>, because after studying the subject
+for twenty years, he is satisfied, that it is almost nothing but
+deception and juggling; although, when he commenced the study, he was
+prejudiced in its favour. According to M. <span class="smcap">Laennec</span>, among the magnetic
+influences, there are several, attributable to the impressions, which
+one individual naturally makes on another in correlation with him; and
+he cited a mistake, which he saw committed by a somnambulist woman. She
+was magnetised by two persons, one of whom was handsome, but
+anaphrodisiac, the other ugly, yet possessing in integrity, the genital
+faculties. She received no impression, except from the first individual;
+so that the impression which this female had received by the organs of
+vision, before the experiment, superseded that, which the pretended
+magnetic sense ought to have made on her. He thinks, the academy ought
+to <i>observe</i> the magnetisers, but<span class='pagenum'><a name="Page_184" id="Page_184">[Pg 184]</a></span> what he has seen, has convinced him,
+that nine-tenths of the facts in magnetism are supposititious. The
+phenomena effected by magnetism, and the oracles uttered by the
+somnambulist, vary with every magnetiser. <span class="smcap">Mesmer</span> excited convulsions;
+<span class="smcap">Deslin</span> effected crises, such as are seen in diseases. The somnambulists
+of Mr. <span class="smcap">Deleuze</span>, a learned man, are much better taught than those of
+<span class="smcap">Puysegur</span>, who is ignorant of the sciences, and finally, Mr. <span class="smcap">Laennec</span> has
+seen a somnambulist under the direction of a pharmacien, who was quite
+distinguished, by the art with which she compounded the medicines, she
+recommended. The discussion was now adjourned to the next sitting.</p>
+
+<p>On the 24th of January, it was resumed.</p>
+
+<p>M. <span class="smcap">Chardel</span>, bears witness to a reality of the magnetic phenomena, as he
+has witnessed them himself, in a case of what is called somnambulism. He
+dares not pronounce on the question of magnetism, as a therapeutical
+agent; but is disposed to think it ought, if ever, to be used with great
+reserve. Whether it consist of nervous phenomena of a particular order,
+or whether it be a product of the imagination, in either case, it
+deserves to be studied, &amp;c. &amp;c.</p>
+
+<p>M. <span class="smcap">Ronchoux</span>, thought the proposed examination would be impossible; for
+the magnetisers assert, that if one of the parties have a will opposed
+to that of the magnetiser, no phenomena can be produced. Their confessed
+inability to surmount any opposite will, seems to Mr. <span class="smcap">Ronchoux</span>, an
+invincible obstacle to any exploration to be attempted by a commission.</p>
+
+<p>M. <span class="smcap">Marc</span>, gave some explanation of the labours undertaken in Germany.
+According to the opposition, nothing conclusive can be derived from
+these labours; because Germany is the native soil of sects and of
+thaumaturg&aelig; but, Mr. M. proved by citations, that they are not to be
+attributed to excited imaginations, as has been urged, but to the most
+celebrated Savans of that country, as for example, <span class="smcap">Oerstdt</span>, <span class="smcap">Klaproth</span>,
+and <span class="smcap">Hufeland</span>, to learned bodies, and to governments. The Royal Academy
+of Berlin, offered in 1818, a prize of 3300 francs, for an essay on this
+topic.</p>
+
+<p>The governments of Prussia, Russia, and Denmark, have founded medical
+commissions for the examination of it, and subjected its therapeutical
+application to certain regulations. He thought, therefore, that the
+Academy could follow without compromising its dignity, such good
+examples. He added, that the examination was absolutely necessary,
+unless they desired that every French practitioner should hereafter
+reject the whole subject, and for ever abandon its employment to
+jugglers and credulous fools.</p>
+
+<p>M. <span class="smcap">Nacquart</span> thought, that as magnetic somnambulism is something wholly
+independent of organical, physical, or physiological laws; that as the
+senses here have no need of organs; as time, space, and intermediate<span class='pagenum'><a name="Page_185" id="Page_185">[Pg 185]</a></span>
+bodies, wholly disappear; we can avail ourselves of no method of
+appreciating magnetical facts, and consequently, the Academy ought not
+to trouble their heads about it&mdash;a very good joke truly: but M. <span class="smcap">Itard</span>
+said, that jokes had nothing to do with the question, because they are
+meant only for the abuses and extravagancies of magnetism; but we want
+to get at the truth, and to eschew the folly. Magnetism, says he, is
+either a real or imaginary agent; it ought to be examined. To refuse
+this, is to despise the path of experiment, which can alone lead to
+truth, &amp;c. &amp;c.</p>
+
+<p>M. <span class="smcap">Recamier</span>, could add nothing to the observations of MM. <span class="smcap">Desgenettes</span>,
+<span class="smcap">Bally</span>, and <span class="smcap">Double</span>; but he wished the section to know, that he been a
+witness to the magnetic phenomena&mdash;he had been present at the oracles of
+the marichale of M. <span class="smcap">De Puysegur</span>, who was represented as the most lucid
+of all possible somnambulists. He had reason to suspect a cheat in this
+case, as he was denied the means of dissipating his doubts; and heard
+this woman repeat what he had before said to the patient himself. How
+ridiculous, moreover, is it, to hear one drachm of glauber's salt
+prescribed as a transcendental remedy for phthisis pulmonalis! He also
+attended at the Hotel Dieu, at experiments made on one woman and two
+men. He saw the woman go to sleep (as was asserted,) at the simple will
+of the magnetiser, who for that purpose was concealed in a closet of the
+apartment. The only mode adopted, to prove that she was really asleep,
+consisted in some slight pinching of her ears, and some noises; yet, in
+the recital, these slight impressions have been transformed into most
+painful tortures. In the experiments made on the men, he employed a more
+powerful proof, which was the application of moxa; and that he did,
+because it was indicated by a coxalgia, with which the patient was
+affected: it is <i>a fact</i>, says he, that the man did not awake, or show
+<i>the slightest sensibility</i>. Mr. R. believes, therefore, in magnetical
+action; but does not think it can ever be available in the practice of
+physic. In Germany, said he, where magnetism is so much employed, do
+they cure better than elsewhere? And has magnetism been the occasion of
+any therapeutical discovery any where? In somnambulism there is only a
+disordered sensibility, and not an increase of it; and the pretended
+clairvoyance of the somnambulists, has no real existence, &amp;c. &amp;c.</p>
+
+<p>M. <span class="smcap">Georget</span>, cited in proof of the existence of magnetic power, the names
+of many physicians, members of the Academy, as MM. <span class="smcap">Rostan</span> and
+<span class="smcap">Fouquier</span>&mdash;he cited the experiments made at the Hotel Dieu, by Dr.
+<span class="smcap">Duportet</span>, in the presence of many members, who had signed the results,
+as MM. <span class="smcap">Husson</span>, <span class="smcap">Geoffroy</span>, <span class="smcap">Recamier</span>, <span class="smcap">Delens</span>, <span class="smcap">Patissier</span>, <span class="smcap">Martin</span>, <span class="smcap">Solon</span>,
+<span class="smcap">Bricheteau</span> and <span class="smcap">Kergaradec</span>. If there be any analogy between magnetic and
+natural somnambulism, ought we to be astonished at the production of the
+former by certain practices? The magnetisers conceal nothing, but
+publish all their proceedings, and do you call these the tactics of
+jugglers and charlatans?<span class='pagenum'><a name="Page_186" id="Page_186">[Pg 186]</a></span></p>
+
+<p>M. <span class="smcap">Magendie</span> thought the examination expedient, and wished commissioners
+to be appointed to examine the somnambulist, offered by Dr. <span class="smcap">Foissac</span>.</p>
+
+<p>M. <span class="smcap">Guersent</span> was in the affirmative: he himself had magnetised, and
+witnessed several phenomena, &amp;c.</p>
+
+<p>The discussion was then adjourned to the next setting, and on the 14th
+February, after hearing M. <span class="smcap">Gasc</span> against, and M. <span class="smcap">Lherminer</span> for the
+report, M. <span class="smcap">Husson</span> the reporter was heard. The section then closed the
+discussion, and it was decided by a majority of ten, (35 to 25,) that a
+commission should be appointed to examine animal magnetism.</p>
+
+<p>We are indebted for the above account to the Revue Medicale for
+March&mdash;the No. for February, also contains a review of M. <span class="smcap">Dupau's</span>
+Lettres Physiologiques et Morales sur le Magnetisme Animal, 8vo. Paris,
+1826. In order to show our readers how they manage these matters, we
+shall translate the following from p. 269.</p>
+
+<p>"Here, says M. <span class="smcap">Rostan</span>, is an experiment that I have often repeated, but
+which I was finally obliged to interrupt, because it fatigued my
+somnambulist prodigiously, who assured me, that if I continued, it would
+make her go mad. This experiment was made in presence of my colleague
+and friend, M. <span class="smcap">Ferrus</span>. I took my watch, which I placed three or four
+inches from her occiput. I asked my somnambulist, if she saw any thing:
+"certainly, I see something that shines; it hurts me." Her countenance
+was expressive of pain, and ours expressed astonishment. We looked at
+each other, and M. <span class="smcap">Ferrus</span> breaking silence, said, if she sees something
+shine, she can doubtless tell what it is. "What do you see that
+shines?&mdash;Oh! I don't know, I can't tell. Look at it well&mdash;Stop, it
+fatigues me, wait&mdash;(and after a moment of great attention) <i>It's a
+watch</i>." More astonishment. But, if she sees the watch, said M. <span class="smcap">Ferrus</span>,
+she will doubtless see what o'clock it is. "Could you tell me what
+o'clock it is?&mdash;Oh! no, it is too difficult." "Look at it, try." "Wait
+then, I'll try; may be I can tell the hour, but I never shall be able to
+see the minutes;" and after the greatest attention&mdash;"It wants ten
+minutes of eight o'clock:" which was exact. M. <span class="smcap">Ferrus</span> now desired to
+make the experiment himself, and repeated it with the same success. He
+made me turn the hands of his watch several times, and when presented to
+her (occiput we suppose,) without her having seen it, she never made any
+mistake."</p>
+
+<p>These statements we have thought fit to lay before our readers, who will
+observe the respectable names which are connected with them. We shall
+seize the first opportunity to give the report of the new commission,
+and if they confirm the miracles, we can still say, credat Judaeus
+apella. If it will make no cure, it will probably make much pay; since
+<span class="smcap">Mesmer</span> got upwards of 340,000 francs for his mumming exhibitions, to the
+<i>spectacle</i> loving quidnuncs of Paris. The commission consists of 11
+members, viz. <span class="smcap">Leroux</span>,<span class='pagenum'><a name="Page_187" id="Page_187">[Pg 187]</a></span> <span class="smcap">Bourdois</span>, <span class="smcap">Double</span>, <span class="smcap">Magendie</span>, <span class="smcap">Guersent</span>, <span class="smcap">Laennec</span>,
+<span class="smcap">Thillaye</span>, <span class="smcap">Marc</span>, <span class="smcap">Itard</span>, <span class="smcap">Fouquier</span> and <span class="smcap">Gueneau de Mussy</span>.</p>
+
+<p>36. <i>Sketch of the Medical Literature of Denmark, Sweden, and
+Norway&mdash;by</i> Dr. <span class="smcap">C. Otto</span>, <i>of Copenhagen, apud Bulletin des Sci. Med.
+Feb. and March.</i>&mdash;"Denmark is richer in medical literature, than the
+other countries which in conjunction with it, composed the ancient
+Scandinavia. Although it does not in this respect, bear a comparison
+with France, Germany, England, and Italy, nevertheless, medicine, of all
+the sciences, seems to be that which is most successfully cultivated,
+and Copenhagen contains a great number of learned, and able physicians."
+In proof of what Denmark has done, Dr. O. refers us to the great names
+of the two <span class="smcap">Bartholins</span>, of <span class="smcap">Steno</span>, of <span class="smcap">Winslow</span>, of <span class="smcap">Callisen</span>, &amp;c.</p>
+
+<p>"In the 16th century, Denmark possessed the anatomical works of the two
+<span class="smcap">Bartholins</span>: (<i>Instit. Anatomic&aelig; de vasis lymphaticis, &amp;c.</i>) and other
+works of the same kind, which have been translated into all the
+languages of Europe. <span class="smcap">Steno</span>, the disciple of <span class="smcap">Thomas Bartholin</span>, followed
+the career of his master, with an equal success. <span class="smcap">Haller</span> never spoke of
+this anatomist, without the highest admiration. <span class="smcap">Rode</span> enriched the
+literature of Germany and Denmark, with works which have made his name
+illustrious, wherever science is cultivated. Among these, we may chiefly
+distinguish his Bibliotheca, and Materia Medica." The Danes are indebted
+to him for several popular works on medicine, which are in the judgment
+of Dr. <span class="smcap">Otto</span>, chef d'oeuvres of this sort of writing. He published more
+than 13 volumes on these topics. "To the celebrated <span class="smcap">Callisen</span>, who is
+recently deceased, we are indebted for 1st, a <i>Systema Chirurgi&aelig;
+Hodiern&aelig;</i>, a work of the highest merit, and which has reached a fourth
+edition. 2nd, a Medical Topography of Copenhagen, published in Danish.
+(2 <i>vols.</i> <i>8vo. Copen.</i> 1807.) 3d, the Director of the Academy of
+Surgery. He is also the author of several important memoirs, inserted in
+those of the <i>Roy. Soc. of Sciences</i>, of Denmark, and in some other
+collections. The late professor <span class="smcap">Math. Saxtorph</span>, composed an excellent
+<i>manual of labours</i>, for the use of midwives. A second edition with
+plates, appeared in 1804. <span class="smcap">T. L. Bang</span>, has given a <i>Praxis Medica</i>, an
+excellent guide to young physicians in their first outset in practice.
+<span class="smcap">Herholdt</span> has shed some lustre on Danish Physiology: his dissertations on
+the life of the f&oelig;tus, and on the question, whether vision is
+performed with both eyes, or with one only, bear testimony to his genius
+and penetration: he is also author of a memoir on penetrating wounds of
+the Chest, inserted, as well as the former dissertation, and many other
+pieces, in various medical journals.</p>
+
+<p>"<span class="smcap">Tyschen</span> published in 1804, a <i>Treatise on Pharmacy</i>, in Danish; and
+professor <span class="smcap">Mynster</span>, gave a work on Pharmacology, of which two volumes
+only had appeared, when death interrupted his useful labours. In 1794,
+he commenced the publication of a journal, the <i>Bibliothek for Physik
+&OElig;conomic og Medicin</i>, which was continued in 1799, by <span class="smcap">Bahn</span>, and
+afterwards<span class='pagenum'><a name="Page_188" id="Page_188">[Pg 188]</a></span> under several names, till 1807. We now come to the existing
+state of Danish medical literature.</p>
+
+<p>"The Royal Medical Society of Copenhagen, which, without contradiction,
+holds the first rank among those of Scandinavia, celebrated its 50th
+anniversary in 1822. It publishes at irregular periods, its memoirs,
+under the title of <i>Nova Acta Societatis Medic&aelig; Havniensis</i>. The last
+volume appeared in 1821. Professor <span class="smcap">Jacobsen</span>, is ardently devoted to the
+study of Comparative Anatomy, and has published several works on the
+subject, inserted in the Mem. of the Roy. Soc. of Sciences, extracts
+from which have appeared also in several foreign journals. The
+collection we have just now cited, (for 1824, V. I.) contains a memoir
+of Dr. <span class="smcap">Gartner</span>, which confirms the opinion entertained by the ancients,
+as to the presence of a glandular body in the uterus of some animals.
+The author has added a plate to this interesting dissertation. Dr. <span class="smcap">Otto</span>
+has enriched the physiological sciences with his <i>Phrenology</i>, and is
+zealously occupied with all that relates to this subject. Professor
+<span class="smcap">Wendt</span>, physician to the General Hospital of Copenhagen, has recently
+published several small medical works. We may cite his <i>Historical and
+Chemical Supplements, to the knowledge of some therapeutical agents, of
+the class Euphorbi&aelig;</i>; some notices on <i>small pox</i>, <i>vaccina</i>, and
+<i>modified small pox</i>.</p>
+
+<p>"Denmark possesses three periodical journals of medicine, without
+counting those of the Royal Societies of Sciences and of Medicine of
+Copenhagen. The first and best of these journals, is the <i>Bibliothek for
+L&aelig;ger</i>, published by a society instituted for the advancement of medical
+studies. <span class="smcap">Classen</span>, the founder of this association, bequeathed to it a
+sum of money, to purchase annually, some foreign medical works. This
+collection is composed of original memoirs, extracts, and announcements
+of other works, and a review of the <i>course</i> of the faculty of medicine.
+It is specially consecrated to the practical department of the
+art&mdash;(three numbers per ann. of 70, to 100 pages each.) The 2nd
+collection, is the <i>Nye Hyg&aelig;a</i>, the editor of which, (M. <span class="smcap">Otto</span>,) embraces
+in his plan, all the medical sciences. This journal, although specially
+devoted to physicians, is in reach of all those persons of education,
+who can be interested in a variety of important medical questions. It
+contains original memoirs, and extracts from foreign works, (five leaves
+per month.) The 3d collection, Archives for the History of Medicine in
+Denmark, (<i>Archiv. for l&aelig;gevidens kabens historie in Danmark</i>,) does not
+appear periodically, but at indefinite times. Professor <span class="smcap">Herholdt</span>, the
+editor, has only published one number, in 1823.</p>
+
+<p>"As to inaugural dissertations for the doctorate, the number amounts
+only to three or four in the space of ten years; because the title of M.
+D. is not requisite to the practitioner in Denmark."</p>
+
+<p>The above is taken from the Bulletin for February, the ensuing portion
+of the sketch is contained in the March number of the same journal.</p>
+
+<p>"The medical literature of Sweden, must have been very insignificant in<span class='pagenum'><a name="Page_189" id="Page_189">[Pg 189]</a></span>
+past ages, if we may form an opinion, from the total want of documents
+in relation to it. There existed no scientific lien between the
+physicians of that country, or even among those of the capital. A
+medical society might in vain have been sought for there, at a period,
+when they were common in all other countries. The Royal Academy of
+Sciences, published some essays relating to medicine, from time to time,
+but until 1807, a work on this topic was regarded as a sort of rarity.
+However, in the course of that year, seven physicians of Stockholm,
+united in order to found a society, which received the royal sanction,
+and took the title of <i>Svenska L&oelig;kare S&oelig;llskapet</i>, (<i>Society of
+Swedish Physicians</i>.) This institution, seemed to communicate to the
+practitioners of Sweden a new existence, and then really commenced the
+&aelig;ra of medical literature in that country. The number of works published
+since that period, has scarcely amounted to more than one or two per
+annum. Dr. <span class="smcap">Raben</span> is the author of three works, which, though not large,
+give evidence of considerable knowledge and penetration: Their titles
+are: 1st. De pr&aelig;cipuis causis mali Scrophul. ejusque remediis
+Commentation. Lund. 1807. 2nd. A second volume on the same subject,
+written in the Swedish language, Lund. 1819. 3d. Observationes in
+Syphilidem, ejusque curationem, ubi nov&aelig; quoque proponuntur curandi
+rationes. Lund. Goth. 1821.</p>
+
+<p>"We shall also mention among the works recently published in Sweden,
+1st. A biographical and literary gallery of the physicians of that
+country, from the reign of Gustavus I. down to our own times, by Dr. <span class="smcap">J.
+F. Saklen</span>. 2nd. <span class="smcap">Flormann's</span> Manual of Anatomy. Finally, a collection of
+the laws of the kingdom, which relate to medicine. The Medical Society
+of Stockholm, regularly publishes its transactions, <i>Svenska L&oelig;kare
+S&oelig;llskapets Handlingar</i>, the 10th vol. of which has just appeared. In
+it, are some remarkable cases, a table of the constitution of the
+atmosphere, and of the diseases which have prevailed at Stockholm, and
+in its environs; reports on the hospitals and baths of the whole
+kingdom; extracts from Medico-legal Examinations, recent discoveries,
+&amp;c. M. <span class="smcap">Eckstr&ouml;m</span> promises to publish a complete description of the
+variolous epidemic, which prevailed last year at Stockholm, and in the
+provinces. Besides these transactions, the secretary makes an annual
+report, on what passes at the sittings. To this he adds, short notices
+of the most interesting recent discoveries and observations, which he
+derives from foreign medical literature. He publishes this collection
+once a year, and adds some nosological articles. In closing this review,
+we ought not to forget to mention the collection of theses, defended at
+the university of Upsal, which is published yearly by Dr. <span class="smcap">Zetterstr&ouml;m</span>."</p>
+
+<p>37. <i>Erysipelatous Mumps or Angina Parotidiana.</i>&mdash;Dr. <span class="smcap">Behr</span> of Bernberg,
+has published in the <i>Journ. der Pract. Heilkund for July</i>, 1825, an
+account of this disease, which we find in the <i>Bulletin</i> for Feb. 1826.
+Dr. <span class="smcap">Behr's</span> "memoir is intended to pourtray the principal features of an
+epidemic<span class='pagenum'><a name="Page_190" id="Page_190">[Pg 190]</a></span> prevalence of parotitis at Bernberg, in the months of
+December, 1822, and January and February, 1823. Dr. B. attributes it to
+the frequent and sudden variations of the atmosphere at that period." He
+says, "the disease is so rare in this country, that physicians of 30
+years standing had never met with it before." Bernberg contains 6000
+souls; it is divided into two parts by the Saale, and it is situated on
+the great road from Leipsic to Magdeburg, in a narrow valley, which runs
+from N. W. to S. E.</p>
+
+<p>The precursory symptoms were rigors followed by heat, heaviness of the
+limbs, pains in the joints, especially in the evening, sense of tension
+in the region of the lower jaw, and sometimes a difficulty in
+mastication. The appetite was usually natural, with gastric symptoms
+only in the most severe cases. On the evening of the 3d day, there was
+an increase of uneasiness with chills and heat, after which the patient
+commonly enjoyed sweet sleep. The next day, on awaking, he felt
+tolerably well, and had no more sense of heaviness in his limbs, but his
+face was swelled on one or both sides. Speech and mastication were
+effected with difficulty; the lower jaw was <i>comme engourdie</i>, and a
+dull pain was felt in the ligaments of the joints; the tumefaction
+increased and soon extended from the ear to the cheek. On a careful
+examination, it was found to affect the parotid gland, and the
+surrounding cellular tissue. The tumour was hard, diffused, and not very
+painful, except on pressure. The colour and temperature of the swollen
+part were natural. In the evening, the pulse became hard and
+accelerated, the tongue white, the stools more consistent than common,
+and the urine pale. The following night he was agitated, frequently
+awakened by lancinating pains in the affected part, and sometimes by a
+sense of tension in the head. The following day, the tumour reached its
+maximum of elevation, and sometimes comprised the submaxillary glands of
+the same side. From this time, the pains did not increase, and the skin
+became slightly red only in a very few examples.</p>
+
+<p>The disease having thus reached its acme, a gentle sweat commenced
+behind the ears, then extended over the whole tumour, and remained as
+long as the swelling lasted. This evening there was no fever, but a
+gentle perspiration continued throughout the night. The day following,
+being the 6th of the disease, the tumour was evidently diminished, and
+continued decreasing until its final disappearance, which occurred on
+the 9th, and sometimes on the 7th day. Until this period, abundant local
+perspirations in the day-time, less abundant, but more general ones in
+the night, were observable. When the disease was critical by urine with
+sediment, the diminution of the swelling was dated from this appearance;
+but the resolution was not perfected in some cases till the 14th day,
+and in such cases, the integuments of the part were covered with a mealy
+desquamation. Dr. <span class="smcap">Behr</span> did not observe any metastasis to the genitals,
+but he saw cases, in which the disappearance of the swelling, was
+followed by considerable fever with <i>augoisse</i>, and then an &oelig;dema,
+commonly situated on the head.<span class='pagenum'><a name="Page_191" id="Page_191">[Pg 191]</a></span></p>
+
+<p>He often saw the termination by induration, but this soon yielded to a
+proper treatment. As to the contagion of mumps, the author thinks, it
+can only occur where there is desquamation of the integuments; and
+remarks on the analogy of this circumstance, with what occurs in
+scarlatina. Dr. <span class="smcap">Behr</span> thinks, that antiphlogistics are rarely indicated
+in the treatment of parotitis.</p>
+
+<p>38. <i>T&aelig;nia.</i>&mdash;In several cases in which gum. gutt., salts of tin, and
+other medicines, were unsuccessfully used for the expulsion of tape
+worm, Dr. <span class="smcap">Bougard</span> succeeded in expelling them with pills compounded as
+follows: Merc. dulc. Extr. aloes, aa. gr. iij. divided into three pills.
+This dose was given every evening for eight days, and gradually
+increased or diminished, so as to procure three stools per diem. A
+rigorous diet was observed during this treatment.&mdash;<i>Rust's Magazin fur
+die gesamte Heilkunde apud Bulletin des Sci. Med. March</i>, 1826.</p>
+
+<p>39. <i>Scrophula.</i>&mdash;Dr. <span class="smcap">Wetz</span> recommends the employment of caustic potassa
+in scrophula. He dissolves x grs. of caustic potassa in one ounce of
+orange-peel water, and gives from xij to xx gtt. four times a day, in a
+cup of broth. A solution of caustic potassa in six ounces of distilled
+water, is applied as a wash to the ulcers.&mdash;<i>Ibid.</i></p>
+
+<p>40. <i>Digitalis.</i>&mdash;We find in the Propagateur des Sciences Medicales for
+Feb. 1826, an account of the directions of Dr. <span class="smcap">Neumann</span> of Berlin, for
+the employment of digitalis in pulmonic diseases: they are said to be
+the result of long experience. Digitalis is useless, says the writer, in
+all cases of suppuration of the lung, consequent to tubercles of that
+organ. It is of no avail in those suppurations, which succeed
+inflammatory h&aelig;moptysis. It is employed without success in <i>local</i>
+phlegmorrhagies of the lungs; but it almost invariably cures those
+chronic catarrhs, which depend on a state of erethism of the mucous
+lining of the bronchi&aelig;. This disease is sometimes called chronic
+bronchitis, sometimes mucous consumption, pulmonic catarrh, and
+galloping consumption. If the diagnosis in this case be well made out,
+hopes may be entertained of a cure, one of the two following conditions
+being present:</p>
+
+<p>A. The patient must be susceptible of the stimulant action of the
+remedy: this is often not the case. We may be sure the digitalis will
+not produce its effect, where the pulse of the patient remains <i>uniform
+and frequent after he has taken it for several days</i>. It does not suit
+such persons.</p>
+
+<p>B. The medicine ought to be administered in a proper manner. To be good,
+the leaves, even in the dried state, should be perfectly green and free
+from any brown spots. Two ounces of the leaves, should be infused in six
+ounces of boiling water; and the patient may take a table spoonful every
+hour, until he feels nausea, or a sense of constriction in his throat,
+or flashing of the eyes, or irregular pulse. The use of the foxglove
+should then be interrupted for seven or eight days, in which interval,
+the full action<span class='pagenum'><a name="Page_192" id="Page_192">[Pg 192]</a></span> of the medicine is developed, the pulse remaining
+irregular, and the mucous secretion diminishing gradually. If the first
+trial does not remove it entirely, a second course may be commenced
+after a few days.</p>
+
+
+
+<h3>V. SURGERY.</h3>
+
+<p>41. <i>Dr. Physick's operation for artificial anus, denied to have been
+performed!</i>&mdash;We have often had occasion to remark the claiming, and, we
+fully hope, the actual re-invention of American operations and practices
+among physicians on the other side of the Atlantic. As we are not a
+publishing people, it is, perhaps, not very strange that the French and
+English should be generally unacquainted with the discoveries and
+inventions which have been made among us; but here comes an actual
+denial of the invention having ever taken place!</p>
+
+<p>Every American who has any pretensions to the character of a surgeon, is
+most probably familiar with the proposal and performance, by Dr.
+<span class="smcap">Physick</span>, of a peculiar operation for those cases of artificial anus,
+where the two ends of the divided or opened intestine adhere laterally
+to each other, in the manner of a double-barrelled gun. We are now told
+that M. <span class="smcap">Richerand</span>, in his new work "On the recent progress of Surgery,"
+"avoids giving this the least confidence." (Archives Generales, Janvier,
+1826.) The reviewer in the Archives, in a paroxysm of angry jealousy for
+the honour of French surgery, deeply wounded, as he conceives, in the
+<i>admissions</i> by M. <span class="smcap">Richerand</span> of discoveries and inventions among the
+English and others, adds no small amount of ill-nature to this unworthy
+intimation, and makes the observations which we have translated below.</p>
+
+<p>It is certainly an easy method of erecting reputations, to deny,
+directly, the priority of others in operations which a favourite has
+repeated. No matter though the knowledge of this priority be widely
+diffused; if readers can, by means of national predilections, be induced
+to place confidence in your denial, the effect, as far as relates to
+them, is completely obtained. Yet one would think it an ungenerous act,
+to call in question, and before partial judges, the veracity of such men
+as are here named. Where a physician reports cases which agree too well
+with his preconceived theories, we doubt the correctness of his
+observations; and with justice: for we know that an already formed
+belief will greatly tinge the most honest seeings and hearings of very
+sensible and honourable heads. But this is a far different thing from
+impeaching, in a manner entirely gratuitous, the moral honesty of the
+record of a historical fact, made by men at the head of their
+profession.</p>
+
+<p>The reviewer, Mr. and probably Dr. <span class="smcap">L. C. Roche</span>, comments as follows:</p>
+
+<p>"1. Dr. <span class="smcap">Physick</span> never published any thing on this subject.<span class='pagenum'><a name="Page_193" id="Page_193">[Pg 193]</a></span></p>
+
+<p>"2. Dr. <span class="smcap">Dorsey</span>, who makes the claim for him, never published the work in
+which he does so, [the Elements of Surgery,] till 1813.</p>
+
+<p>"3. In the English journal (?) and in that work, he contents himself
+with a simple assertion, without giving either the date of the
+operation, the name, age, or sex of the patient, the names of his
+assistants, or the details of the operation; <i>all points which men never
+forget to make known, when treating of the first attempt in a new
+operation of this importance</i>."</p>
+
+<p>To the first of these comments we reply, that Dr. <span class="smcap">Physick</span>, to the great
+regret of his countrymen, has never been in the habit of publishing; but
+still possesses many useful improvements in medicine and surgery, which
+he has not committed to the press. On the other hand, however, he has
+taught this operation annually, to from three to four hundred pupils, in
+his lectures, during about twelve successive years; and this is no mean
+substitute for a publication in types. M. <span class="smcap">Roche's</span> memory will supply him
+with an instance of an eminent French surgeon, whom we shall not attempt
+to defraud of his laurels, who also made it his practice to leave the
+publication of his observations and improvements to his pupils.</p>
+
+<p>To the second remark, the above is also a sufficient reply; but we will
+add that it was recorded in the case book of the Pennsylvania Hospital
+in 1809.</p>
+
+<p>Our comment on the third observation of Mr. <span class="smcap">Roche</span> may be brief. It is
+that we promise an account of the case for the next number of this
+Journal. In the mean time, the patient was well known to us and to many
+persons now living. The operation was performed in 1809.</p>
+
+<p>In reply to that portion of the last observation, which we have marked
+with italics, we can assure the reviewer that he is mistaken; at least
+with regard to this side of the ocean. We Americans are a very peculiar
+people, and but little affected, as yet, with the cacoethes scribendi; a
+malady which the present work, in its humble sphere, is designed to
+disseminate. We are not in the habit of frequently publishing, and above
+all, of publishing volumes. Books are dear, private libraries small,
+public ones few, and encouragement for even the best original
+publications but limited. Of this we have known some melancholy
+instances. It is impossible for either a Frenchman or an Englishman to
+judge correctly of a country, which, in many important respects, is in
+such a different situation from his own.</p>
+
+<p>It is a thing of by no means uncommon occurrence here, to make a
+valuable discovery or improvement in the healing art, and not to make it
+public. A striking instance of this fact, at least with the exception of
+the insertion of an imperfect account in the Eclectic Repertory, which
+very probably never reached England, is mentioned in our last number. We
+allude to the extirpations of diseased ovaria, by Dr. <span class="smcap">M'Dowall</span>, of
+Kentucky. Here a unique and brilliantly successful operation was
+performed, successful as yet beyond European imitations, and still the
+inventor and achiever of it did not possess vanity or industry
+sufficient to treat the public with a<span class='pagenum'><a name="Page_194" id="Page_194">[Pg 194]</a></span> full account of it. M. <span class="smcap">Roche</span> may
+find it hard to explain modesty of this species; but we can promise him,
+should these sheets ever reach his eye, and he still continue skeptical,
+abundance of proofs, and some more instances of the same kind.</p>
+
+<p>42. <i>Gangrenous Sore Mouth of Children.</i>&mdash;Dr. <span class="smcap">Coates</span> begs permission to
+add the following quotation from <span class="smcap">Fabricius Hildanus</span> to the authorities
+quoted in his paper on gangrenous ulcer of the mouth, at the
+commencement of the present number.</p>
+
+<p>"Gingivarum inflammatio maxime in infantibus in gangr&aelig;nam interdum
+degenerat. Morbus enim magnus, vehemens et peracutus; magna quoque
+requirit remedia: sed quis illa in ore adhibere ausus?"&mdash;<i>De Gangr&aelig;na et
+Sphacelo, Cap. IV. p. 773. col. 2. Edit. Beyeri. Francofurt ad M&aelig;n.</i>
+1646.</p>
+
+<p>"Gangr&aelig;na in partibus humidis, gingivis, palato, naribus, &amp;c. raro
+sanabilis; in sphacelum autem degenerans, insanabilis."&mdash;<i>Cap. XI. p.</i>
+781. <i>col.</i> 2.</p>
+
+<p>This is all I find in that author, relative to the subject.</p>
+
+<p>43. <i>Operation for Phymosis.</i>&mdash;<span class="smcap">M. J. Cloquet</span>, has so improved this
+operation that no deformity results. He recommends the incision to be
+made at the <i>inferior</i> surface, near, and parallel to, the fr&aelig;num
+pr&aelig;putii. The longitudinal wound thus made, becomes transverse, as soon
+as the prepuce is drawn behind the glans penis, and cicatrizes in a line
+scarcely visible; so that the prepuce acquires in breadth what it loses
+in length. M. <span class="smcap">Cloquet</span> has, in this way, perfectly cured many patients;
+the prepuce appearing to possess its natural conformation.&mdash;<i>La
+Propagateur des Sci. Med. for March.</i></p>
+
+<p>44. <i>Lunar Caustic on Wounds and Ulcers.</i>&mdash;The practice of healing
+wounds and ulcers by natural or artificial scabs, to which the attention
+of the profession was first directed by Mr. <span class="smcap">J. Hunter</span>, has been too much
+neglected, and the circumstances under which it is useful, have not been
+accurately stated. In a small work published by Mr. <span class="smcap">Higginbottom</span>, in
+January last, at London, the practice of forming an <i>eschar</i> by the
+lunar caustic over small ulcers and recent wounds, has been strongly
+recommended as saving the patient much pain, trouble, and danger. The
+whole surface is to be pencilled with the solid caustic so as to form an
+eschar, and where this remains <i>adherent</i>, the wound or ulcer invariably
+heals with comparatively little inconvenience. When effusion occurs
+under the eschar, whether of serum or of pus, there is more difficulty;
+but if this fluid be evacuated by a puncture, and the caustic applied to
+the orifice, the eschar will often remain adherent. Sometimes the fluid
+must be frequently evacuated. If the eschar does not separate
+favourably, a cold poultice may be applied, which not only removes the
+eschar, but lessens the irritation and inflammation. Should the sore not
+be healed, Mr. H. recommends the reapplication of the caustic. To
+prevent effusion under the eschar, and to preserve it adhering, he
+advises the whole to be covered with a piece of<span class='pagenum'><a name="Page_195" id="Page_195">[Pg 195]</a></span> gold-beater's skin; but
+we may add, that as this effusion arises from too much inflammation,
+more powerful means may occasionally be employed, especially a solution
+of acetate of lead. <span class="smcap">Larrey</span> recommends with the same view, after the
+application of moxa, the use of the aq. ammoni&aelig;. Indeed any evaporating,
+cold, astringent lotion will be advantageous.</p>
+
+<p>The application of the caustic, of course, produces some pain, but this
+soon subsides, and the patient experiences more ease than under any
+other mode of treatment.</p>
+
+<p><i>Particular cases in which the Caustic is useful.</i>&mdash;In punctured wounds,
+it should be applied to the orifice and surrounding skin, and the eschar
+allowed to dry. The terrible effects of punctured wounds, are thus
+completely prevented, whether caused by needles, hooks, bayonets, &amp;c. So
+also of wounds from saws; of bites from leeches and animals; of the
+stings of insects; and especially of those small scratches, and
+punctures, received in <i>anatomical dissections</i>. The danger of these
+last mentioned accidents may, according to Mr. H., be completely
+arrested by the prompt and free application of the lunar caustic. Even
+in neglected cases, when a small tumour has formed under the skin,
+attended with a smart stinging pain, he advises the tumour to be
+removed, and an adherent eschar to be formed by the caustic; and in
+still more neglected and advanced cases, where inflammation of the
+absorbents has supervened, "a free crucial incision is to be made, the
+caustic to be freely applied, and afterwards, the cold poultice and
+lotion; the usual constitutional remedies being actively enforced."</p>
+
+<p>In <i>bruises</i>, especially of the shin, the adherent eschar from lunar
+caustic, has, with Mr. H., always effected a cure; and even when a
+slough has been produced, the application of the caustic will moderate
+the inflammation.</p>
+
+<p>In <i>ulcers</i>, which are small, not exposed to friction or motion, and
+discharging little, the cure by eschar will be preferable; especially in
+those little irritable and painful ulcers often seen about the ancle and
+tendo Achillis. Apply first a cold poultice, and then form the eschar,
+which may be freely exposed to the air. Should the matter, nevertheless,
+collect, it should be evacuated by puncture as often as necessary, until
+the eschar remains adherent.</p>
+
+<p>This practice is recommended by Mr. H., in various other affections; as
+in inflammation of the fingers; in the fungous ulcer of the navel in
+infants; in <i>tinea capitis</i>, &amp;c. In this last case, we have ourselves
+used it with marked advantage. In all cases, the lunar caustic has a
+decided effect in <i>diminishing the irritability</i> of the parts to which
+it is applied; and hence should usually be preferred for the purpose of
+forming a "<i>scab</i>," for such the eschar really is, in a practical view;
+and we think that our author has hardly done justice to nature's
+methodus medendi by "scabbing;" while he so ably and strenuously
+recommends his own imitation of her process. Scabs may be formed by the
+coagulation of blood; by the drying of mucus or pus; and by the
+formation of an eschar, by the actual or potential<span class='pagenum'><a name="Page_196" id="Page_196">[Pg 196]</a></span> cautery. The surgeon
+may frequently reduce parts to the same situation, by the use of
+gold-beater's skin, court-plaster, or other unirritating applications,
+which prevent exposure and evaporation. In all cases, care must be taken
+to prevent the surrounding inflammation from transcending the adhesive
+stage.</p>
+
+<p>45. <i>H&aelig;morrhage from Lithotomy.</i>&mdash;In the London Med. and Phys. Jour. for
+Jan. Mr. <span class="smcap">John Shaw</span> has published an account of a patient, who
+unfortunately perished from h&aelig;morrhage, in consequence of being cut for
+the stone. The parts being injected after death, it was found, that the
+bleeding proceeded from the <i>unusual distribution</i> of a branch of the
+pudic artery, which traversed the neck of the bladder, and lay directly
+in the way of the incision. The pudic artery was uninjured.</p>
+
+<p>46. <i>Extirpation of the Parotid Gland.</i>&mdash;The best surgical writers have
+condemned this operation, if not as absolutely impracticable,
+nevertheless, as too dangerous to be ever attempted. Successful cases
+have however been reported, and Mr. <span class="smcap">A. Cooper</span>, in a letter to the
+operator in the following case, avers, that he twice removed the parotid
+gland in one year. Mr. <span class="smcap">Kirby</span>, late president of the Royal College of
+Surgeons in Ireland, in a work published in 1825 at Dublin, on
+h&aelig;morrhoidal excrescences, has given the details of a diseased parotid,
+and of the operation for its removal. We condense from Johnson's Review
+for April, 1826.</p>
+
+<p>The patient was a poor female, aged 40, who had a tumour extending from
+above the zygoma downwards on the neck, two inches below the angle of
+the jaw, stretching as far forwards as the anterior edge of the masseter
+muscle, forcing the ear backwards, and raising it outwards from its
+natural position. Above the surface, it was about the size of a
+goose-egg; immoveable; painful when handled; irregular on the surface,
+and of a deep livid colour over the prominent points. Pains of a
+lancinating character, extended over the head and neck, producing
+sickness and want of sleep.</p>
+
+<p>The operation was performed chiefly by the fingers and the handle of the
+knife, after dividing the integuments by a crucial incision. The
+branches of the portio dura were of course divided, and great
+embarrassment arose from a copious h&aelig;morrhage, caused by the bursting of
+the tumour, while Mr. K. was rooting it out from between the pterygoid
+muscles. The bleeding was restrained by the finger of an assistant, and
+the complete extirpation of the diseased gland was effected. Mr. <span class="smcap">Kirby</span>
+says, "the space between the pterygoid muscles was void&mdash;the auditory
+tube was fully exposed&mdash;the articular capsule of the jaw was brought
+into view&mdash;the finger could trace the length of the styloid process, and
+on sponging the wound of its blood, it could be seen by those who
+surrounded the chair." The h&aelig;morrhage was restrained by a sponge firmly
+lodged at the bottom of the wound, covered by compresses of lint, and
+the whole secured by a double-headed roller.</p>
+
+<p>The patient was much exhausted, slept tolerably well the next night,<span class='pagenum'><a name="Page_197" id="Page_197">[Pg 197]</a></span>
+complaining of thirst and inability to swallow. On the 2nd day,
+inflammation, swelling, and fever followed&mdash;erysipelas appeared on the
+neck&mdash;patient lethargic&mdash;pulse small and frequent. Fourth day,
+suppuration&mdash;symptoms improving&mdash;no relapse. The patient completely
+recovered, without any regeneration of the tumour.</p>
+
+<p>In <span class="smcap">Ferussac's</span> Bulletin Universel for Jan. 1826, we observe the following
+notice, from a German Medical Magazine, conducted by M. D. Schmidt.</p>
+
+<p>A female, aged 33 years, had suffered for 9 years from a diseased
+parotid gland, which had gradually attained a large size. It was
+extirpated by Dr. <span class="smcap">Prieger</span>, and the patient soon returned home in good
+health, and little disfigured. The tumour measured 8 inches in
+circumference, and weighed three and a half pounds. (Livres.)</p>
+
+<p>Dr. <span class="smcap">Prieger</span> had previously extirpated a scirrhous parotid successfully.
+M. <span class="smcap">Wienhold</span> affirms, that he has extirpated three parotids; the details
+of these operations are published. M. <span class="smcap">Schmidt</span>, however, suggests some
+doubts, as to the <i>nature</i> and <i>seat</i> of the tumours removed.</p>
+
+<p>47. <i>Aneurism from a Wound, cured by Valsalva's method.</i>&mdash;This
+interesting and valuable case, is condensed from Le Propagateur des Sci.
+Med. for March, 1826. M. Antouard, a healthy female, &aelig;t. 18, was wounded
+on the 18th of June, 1825, by a poniard, in the left carotid artery,
+below the superior extremity of the sternum; the instrument passing
+obliquely inwards and downwards. The anterior and lateral portions of
+the neck, were enormously distended with blood, and syncope supervened.
+Four days after the injury was received, an aneurismal tumour was
+observed at the edge of the sternum, the surrounding effusion being
+greatly diminished by absorption; and at the expiration of a month, when
+she was first seen by Dr. <span class="smcap">Souchier</span>, it was of the size of the two fists
+of the young female. The pulsations at this time, were nearly equal over
+the whole surface of the tumour; but rather more distinct over the
+orifice in the vessel. The surrounding blood was entirely absorbed. No
+pain was experienced, unless from the pressure of the swelling; from
+which cause also, resulted a troublesome and continued headach. Dr.
+<span class="smcap">Souchier</span>, not believing an operation adviseable, during the warm season
+of the year, and on a tumour, situated so much under the sternum,
+determined to fulfil the following indications: 1st. To lessen the
+quantity of blood; and thus, to diminish the stimulus to the heart, the
+projectile force it exercises, and consequently, the rapidity with which
+the blood escaped from the ruptured vessel, and the impulse hence
+imparted to the sides of the tumour, preventing, in some degree, the
+coagulation of the blood. 2nd. To increase the effect of general and
+local bleeding by the use of <i>cold</i>, of <i>pressure</i>, and especially, of
+the digitalis purpurea: that thus the force of the circulation may be
+lessened, the blood allowed to coagulate, and a radical cure be
+accomplished.</p>
+
+<p>Mademoiselle Antouard, determined to yield herself to this plan, and was
+directed: 1st. Rice-water, acidulated with lemon-juice, and an infusion<span class='pagenum'><a name="Page_198" id="Page_198">[Pg 198]</a></span>
+of mallows, for <i>food</i> and <i>drink</i>. 2nd. To employ frictions on the
+abdomen, and on the insides of the thighs, morning and evening, with
+eight grains of the pulverized leaves of digitalis, previously macerated
+for 24 hours in a sufficient quantity of saliva. 3d. To apply every day
+12 leeches, near the aneurismal tumour, and after favouring the flow of
+blood by emollient fomentations, to cover the part with compresses, wet
+with a saturated solution of the acetate of lead, to be frequently
+renewed, so as to be kept below the temperature of the skin. 4th. The
+effect of these means to be augmented by pressure, made by means of the
+base of a glass tumbler, fixed by the hands of assistants; and 5th. To
+be kept at rest, and in perfect silence.</p>
+
+<p><i>Fourth day of treatment</i>, being 2nd of Aug. 1825. Pulsations more
+central; tumour very sensibly diminished; pulse less strong and reduced
+from 86 to 74 in the minute; the menses, which had been suppressed for
+two months, appeared on the 31st ulto. and still flow. <i>Prescription</i>,
+V. S. &#8485;xviij. next day, twelve leeches, on the lateral
+parts of the tumour; gr. xxiv. of digitalis in three applications
+through the day. Continue ut supra.</p>
+
+<p>Aug. 8th. Patient tranquil; pulse 60, full, not active; face not
+flushed, but preserving a delicate tinge of red; headach now slight; no
+nausea; menses continued until the 6th inst. <i>Prescription</i>, V. S.
+&#8485;xij.&mdash;fifteen leeches to-morrow; increase digitalis to
+gr. xxviij. daily; the rest, ut supra. The tumour has diminished at
+least one-fourth.</p>
+
+<p>Aug. 12th. Tumour reduced to 3-5ths of its former volume; pulse at 56;
+her nights are comfortable; has some headach, and lately, cardialgia;
+complains of hunger and weakness, and from the fatigue of her
+assistants, the pressure was made with a bandage less effectually than
+before. This was allowed, as the pulsations are weakened, and more and
+more central, while the elevation of the tumour is trifling. For fear
+her health might be injured, she was permitted to rise a little from
+bed, and to add to her rice water, some light jellies, (cr&eacute;mes) made
+from the same grain. V. S. &#8485;x. and every 2nd day, eight
+leeches around the tumour; digitalis increased to 32 grains daily; warm
+pediluvium for one hour, morning and evening; silence as complete as
+possible.</p>
+
+<p>Aug. 18th. No tumour visible; pulsations can yet be felt; the skin is
+thickened; pulse at the wrist is at 50. V. S. &#8485;viij.&mdash;six
+leeches every 4th day until menstrual period; digitalis reduced to gr.
+xx. and still to the same parts; continue the pressure; allow some rice
+jelly, vermicelli soup, gentle exercise; silence to be preserved,
+continue pediluvium, and relieve constipation by simple enemata.</p>
+
+<p>In 15 days, Dr. <span class="smcap">Souchier</span> again visited his patient. It required an
+experienced hand to distinguish, at the spot where the artery was
+cicatrized, an elevation rather more evident, than over the rest of the
+artery. Pulse 48 per minute; hunger great, and the remedies now
+unpleasant. Most of them were suspended, and fruit and the white flesh
+of poultry added to her<span class='pagenum'><a name="Page_199" id="Page_199">[Pg 199]</a></span> diet list. The digitalis reduced to 12 grains a
+day. Compression, silence, and moderate exercise, to be continued as
+before. The menses appeared at the expiration of twenty-five days, and
+were more abundant than at the last period.</p>
+
+<p>At the end of a month, no trace of the tumour was discoverable. The
+young lady had carefully increased her nutriment and exercise without
+inconvenience, and all remedial measures were now omitted.</p>
+
+<p>During the months of December and January last, she remained free from
+any inconvenience from the tumour, and the union of the parietes of the
+artery was therefore regarded as complete.</p>
+
+<p>In the above account, we have only to regret that the state of the
+artery above the tumour, before and after the treatment, had not been
+noticed. Perhaps this may be supplied by Dr. <span class="smcap">Souchier</span>, in the
+commentary, which he proposes publishing on the above case.</p>
+
+<p>48. <i>Protrusion and Wound of the Stomach.</i>&mdash;Mr. <span class="smcap">Travers</span>, in the Edin.
+Journ. of the Med. Sciences, for Jan. 1826, relates, that a female, aged
+53, and the mother of <i>nineteen</i> children, inflicted on herself a wound
+in the abdomen, three inches in length, and in a transverse direction.
+When admitted into St. Thomas' Hospital, at the expiration of six hours,
+the greater part of the large curvature of the stomach, the arch of the
+colon, and the entire large omentum, were protruded and strangulated in
+the wound. The omentum was partially detached from the stomach, which
+organ was wounded in two places; one, half an inch long through the
+peritoneal coat; the other, a perforation of all the coats, admitting
+the head of a large probe, and giving issue to a considerable quantity
+of mucus. Patient faint; pain slight; pulse 102, and irregular; some
+hiccup. A silk ligature was placed round the small puncture in the
+stomach, and the displaced viscera returned, after enlarging the
+external wound. This last was closed by the quill suture. Warm
+fomentations and abstinence from food and drink enjoined. 2nd day, some
+re-action; had been sick in the night from some drink given; is free
+from pain; pulse 120; pain on pressure; an enema ordered. <i>Evening</i>, a
+dose of castor oil, and twenty leeches to the abdomen. 3d, much fever;
+V.S. &#8485;xviij. and 20 leeches to the abdomen; bowels not
+opened. 4th day, two stools; pulse 98; tension of the abdomen; three
+more stools during the day. 5th, sutures removed; wound united, except
+at its right extremity, where a serous fluid is discharged in
+considerable quantities. On the 6th day, was allowed food, and on the
+23d of Dec., about two months after the accident, was discharged cured.</p>
+
+<p>49. <i>&OElig;sophagotomy.</i>&mdash;This operation has been objected to, not only on
+account of the dangers attending its performance, but from the alleged
+difficulty of promoting the union of the wound in the &oelig;sophagus; as
+it is seldom at rest, the lips of the incision being often separated,
+and the mucous coat adhering with difficulty under any circumstances.
+Hence we are induced to notice the following case, in which the
+operation was successfully<span class='pagenum'><a name="Page_200" id="Page_200">[Pg 200]</a></span> executed on an inferior animal, by M. <span class="smcap">Felix</span>,
+a veterinary surgeon of Bergelac. The account is published in the Feb.
+No. of Le Propagateur des Sci. Med.</p>
+
+<p>A <i>Cow</i> was threatened with immediate suffocation from the lodgment of a
+potato in the &oelig;sophagus. It had shortness of respiration, an
+incapacity of swallowing even its saliva, which flowed from the mouth,
+was in great distress, and covered with a cold sweat. Being properly
+secured in a horizontal posture, an external incision was made on the
+inside of the sterno-mastoid muscle, and a cautious dissection practised
+until the tumour was completely exposed. The &oelig;sophagus was divided by
+"an incision extending the whole length of the foreign body, which was
+extracted without any force, <i>which is almost always fatal</i>. I
+immediately made two close sutures; and also two others in the skin, on
+each side, adapting to them two pieces of packthread, more easily to fix
+the dressings. I dressed the wound with brandy, filling the opening with
+hemp soaked with brandy." The animal was kept on very little food or
+drink. On the third day the wound was dressed for the first time, and a
+digestive ointment applied.</p>
+
+<p>In the course of the 2nd week, the cicatrization of the &oelig;sophagus
+occurred; the part was dressed with lint; and by the 20th day after the
+operation, the animal was quite restored.</p>
+
+<p>This case would have been more useful, if more precision had been
+employed in describing the dressing and subsequent treatment of the
+wound. It would seem that the sutures were passed through the parietes
+of the &oelig;sophagus only, and that the external wound was kept open by
+being filled with tow. Certainly, union by the adhesive inflammation
+ought to have been attempted in all parts of the wound; but whether
+sutures in the &oelig;sophagus are advantageous, or whether the uniting
+bandage be preferable, is not so easily determined. In the two cases
+described in 3d vol. of the Mem. de l'Acad. de Chirur. the uniting
+bandage was alone employed, and with success.</p>
+
+<p>50. <i>Retention of Urine, caused by a Stricture of the Urethra, relieved
+by a forcible but gradual Injection.</i>&mdash;The editor of Le Propagateur des
+Sci. Med. in the No. for Feb. 1826, introduces the following case, by
+observing, that it reflects great honour on M. <span class="smcap">Amussat</span>, and that his
+discovery merits the greatest praise. M. D... aged 70 years, of a
+plethoric constitution, had suffered about 30 years before from three
+attacks of gonorrh&oelig;a; since which period he has had a difficulty in
+urinating, and can never discharge more than one or two ounces of urine
+at a time.</p>
+
+<p>At eight o'clock, P. M. of the 1st of Feb. he tried to urinate, but
+could not succeed. He suffered great pain. Pulse agitated; face flushed;
+belly swelled, and globular at its inferior part; the subcutaneous
+abdominal veins distended, and the penis in a state of semi-erection.
+All attempts to urinate were painful and ineffectual. At ten o'clock, A.
+M., on the 2nd, M. <span class="smcap">Amussat</span> visited him, and passed a bougie. This was
+arrested by a contraction<span class='pagenum'><a name="Page_201" id="Page_201">[Pg 201]</a></span> near the bulb of the urethra, and caused the
+discharge of some blood. No urine had been passed for 14 hours, while
+ordinarily he urinated 12 or 16 times through the night. The obstruction
+was so great, that none of the usual means of relief remained, except
+<i>the forcible introduction of the catheter</i>, or the <i>puncture of the
+bladder</i>. M. <span class="smcap">Amussat</span> resorted to the following plan which he had
+devised, and which completely succeeded. He injected warm water
+forcibly, but gradually, into the urethra, which, dilating the orifice
+of the stricture, forced backwards the thickened mucus which had
+obstructed it. As soon as the liquid injection met the urine, the
+patient cried out that he was saved, and immediately was able to urinate
+as formerly. At two trials, he discharged nearly two pints of thick
+urine. There was no return of the retention, the patient continuing
+well.</p>
+
+<p>Should subsequent experience confirm this experiment of M. <span class="smcap">Amussat</span>, this
+simple measure will be a most valuable substitute for those dangerous
+measures hitherto resorted to for retention of urine, in cases where the
+obstruction arises from thickened mucus, from small calculi closing the
+orifice of a stricture, from inflammation, or from what are termed,
+(justly or not,) spasmodic strictures.</p>
+
+<p>51. <i>Tracheotomy.</i>&mdash;In the Amer. Med. Review for April, Dr. <span class="smcap">John Atlee</span>,
+of Lancaster, mentions that on Wednesday, Aug. 11th, he was consulted by
+a child ten years old, who had that morning, while running, put a
+button-mould into his mouth, which during respiration was drawn into the
+trachea. He complained of uneasiness in respiration, with a slight
+rattling, and pointed towards the upper part of the sternum, as the
+situation of the button. On coughing, a rattling was heard, and
+immediately after, a sudden check to expiration, from the lodgment of
+the button near the rima glottidis, requiring a sudden and violent
+effort of inspiration to remove the sense of suffocation. An emetic was
+given with no advantage. During the night, he had two or three spells of
+coughing, threatening suffocation.</p>
+
+<p>An operation was urged, to avoid immediate and subsequent dangers from
+the lodgment of this extraneous body, and was agreed to by the parents,
+and by Dr. <span class="smcap">Humes</span>, who was called in consultation. It was performed on
+the 14th of Aug.; a cathartic, and afterwards an opiate, having been
+given.</p>
+
+<p>An incision, one inch and a half long, was made through the integuments,
+extending downwards from above the cricoid cartilage, and exposing the
+sterno-hyoid and thyroid muscles, which were then separated. After
+exposing the trachea, a longitudinal incision, about three-quarters of
+an inch in length, was made through its parietes at the third ring. This
+was held open, and the patient requested to cough. This was ineffectual.
+The wound being closed, the button was, by coughing, thrown up against
+the rima glottidis. A probe passed into the trachea, produced a violent
+effort to cough, by which, as soon as the instrument was withdrawn, the
+button was thrown through the wound, to some distance from the patient.<span class='pagenum'><a name="Page_202" id="Page_202">[Pg 202]</a></span></p>
+
+<p>The wound was dressed with two sutures and adhesive strips. Most of it
+united by the first intention: and in a few days the patient completely
+recovered.</p>
+
+<p>52. <i>Fistula Lachrymalis</i>&mdash;At the session of the Royal Academy, on the
+15th of December, M. <span class="smcap">J. Cloquet</span> related the case of a female, who, three
+years previously, had submitted to the operation for fistul. lachrym.
+according to the method of M. <span class="smcap">Foubut</span>. The canula which had been allowed
+to remain in the nasal canal, had ulcerated through the floor of the
+nose, and presented its inferior extremity on the inside of the mouth.</p>
+
+<p>A practical commentary on this mode of operating, which is still
+recommended by able surgeons!</p>
+
+<p>53. <i>Aneurisma Herniosum.</i>&mdash;This form of aneurism is supposed to consist
+of a dilatation of the internal and muscular coats of the artery; the
+external cellular having been destroyed. It is termed by <span class="smcap">Arnaud</span>, and by
+Dr. <span class="smcap">William Hunter</span>, <i>aneurisma herniam arteri&aelig; sistens</i>. Its existence
+in any case has, however, been denied by a large majority of surgeons;
+and perhaps the only cases reported are those of <span class="smcap">Dubois</span>, in 1804, found
+in the thoracic and abdominal aorta of a dead subject.</p>
+
+<p>The reporter of the following case, quotes also <span class="smcap">Monro</span>, as having cited
+examples of this kind of aneurism. But what <span class="smcap">Monro</span> termed a "mixt
+aneurism," arose from the rupture of the coats of a "true aneurism," by
+which it was reduced to the state of a "false aneurism;" very different
+from that here contended for. <span class="smcap">Sabatier</span> and <span class="smcap">Boyer</span>, also, deny the
+existence of this hernia of the artery, and a good summary of facts and
+arguments is given by <span class="smcap">Boyer</span> in his Surgery, in support of this opinion,
+(vide article Aneurism, tome i.) which it would be difficult to
+invalidate, especially by cases analogous to the following. The
+reporter, <span class="smcap">M. Bonnet</span>, of the late French army, considers this case as
+proving a hernia of the artery in a vessel of medium diameter; those of
+<span class="smcap">Dubois</span> having been noticed in the largest arteries.</p>
+
+<p>A Prussian soldier was wounded over the femoral artery by a musket ball.
+No h&aelig;morrhage ensued, and the wound cicatrized. In this state, M. <span class="smcap">Bonnet</span>
+visited him for a mortification of the foot of the same limb, which had
+been frozen. Amputation of the leg was performed, the stump healed
+readily, and in 12 days the ligatures came away. On the 13th day, (being
+six weeks since wounded in the thigh,) the patient perceived a tumour at
+the original cicatrix on his thigh, which had appeared during the
+preceding night. On the 14th, it had enlarged to three times its former
+size: it was painful; fluctuation was evident; but there was no
+pulsation, not even the thrilling noise, which is evident in the last
+stage of aneurism. A consultation was called, to determine whether it
+was an abscess or an aneurism. The question could not be satisfactorily
+answered, and it was determined to open it, after having made the
+necessary arrangements to secure the artery, should the tumour prove
+aneurismal. As soon as the integuments<span class='pagenum'><a name="Page_203" id="Page_203">[Pg 203]</a></span> were punctured, the jet of blood
+evinced the nature of the complaint; and the artery was secured by
+ligatures above and below the tumour. The coagula were numerous, and the
+superficial ones, quite hard and cartilaginous. The patient did well,
+and there was every prospect of his recovery on the 1st day, when M.
+<span class="smcap">Bonnet</span> was forced by the movement of the armies to leave him at Meaux.</p>
+
+<p>Such are the facts, from which the Reporter infers, that the aneurism
+consisted of a protrusion of the internal and middle coats of the
+artery. The <i>reasoning</i>, founded on them, appears to us inconclusive;
+but we have not space to insert it, and must refer to the March No. of
+Le Propagateur des Sci. Med.</p>
+
+<p>54. <i>Extirpation of the Two Dental Arches, affected with
+Osteo-sarcoma.</i>&mdash;Dr. <span class="smcap">Giorgi Regnoli</span>, physician at Pesaro, performed this
+operation on a female 35 years of age, who had from infancy, been
+troubled with pain and diseases of the teeth and jaws. When Dr. R.
+visited her, both dental arches were enormously swelled; red and
+sanguineous tumours had formed over their whole surface, and covered the
+teeth. The alveolar processes were entirely softened. The diameters of
+the mouth were greatly lessened; but by the touch, it was evident, that
+the disease was confined to the alveolar processes of the two ossa
+maxillaria. A f&oelig;tid odour exhaled from the mouth. Lancinating pains
+continually tormented the patient; especially on attempting to
+masticate. The slightest touch was very painful, and was always followed
+by an effusion of blood. There was also an alteration of voice; a
+disgusting deformity of the mouth, with emaciation, fever, &amp;c. The
+operation was performed on the 18th May, 1825.</p>
+
+<p>The patient was seated opposite to a window; her head being supported
+against the breast of an assistant, who, at the same time, pressed upon
+the labial arteries. The inferior lip was divided perpendicularly, and
+detached laterally from the inferior jaw, so as to expose the whole
+extent of the carcinoma. Some strokes of the saw were made on the
+anterior and most prominent part of the bone, and into the groove thus
+formed, the blade of a very strong knife was inserted, by means of
+which, aided by some slight strokes with a mallet, all the diseased
+portion was removed. The soft parts had been previously detached from
+the internal surface of the jaw. The last left molar tooth, not being
+diseased, was alone left. The h&aelig;morrhage from the dental artery was
+arrested by the actual cautery.</p>
+
+<p>The dental arch of the upper jaw, was then completely removed in the
+same manner. The bleeding was here more profuse, but was arrested by a
+hot iron. The alveolar processes thus removed, were enlarged, and of a
+lardaceous colour, and the fungous growths had the appearance and
+consistence of indurated albumen.</p>
+
+<p>In 25 days, the patient was discharged well. Her general health was
+good; the f&oelig;tor had quite gone; the cicatrix over the bone was
+regular, white, hard, and could be pressed upon without causing pain.
+The patient can triturate her food with facility; the lips are slightly
+drawn inwards,<span class='pagenum'><a name="Page_204" id="Page_204">[Pg 204]</a></span> without any sensible inconvenience; and the voice is a
+little altered, but this even is daily improving.&mdash;<i>Le Propagateur des
+Sci. Med.</i> for Jan. 1826.</p>
+
+<p>55. <i>Traumatic Erysipelas.</i>&mdash;In the Feb. No. of the Revue Medicale, is a
+clinical report of the celebrated Baron <span class="smcap">Larrey</span>, surgeon in chief of the
+Hospital de la Garde Royale; in which he criticises severely the use of
+leeches in erysipelas, and recommends in that variety of the disease,
+arising from wounds, &amp;c. the application of the actual cautery, as
+effectual in arresting immediately the progress of the disease. It
+causes, he says, but little pain; destroys the burning and tense pain of
+the disease, as also the redness and swelling of the part; is not
+followed by suppuration, and does not cause gangrene in the contiguous
+parts. The eschar separates, without leaving a cicatrix. Various other
+advantages are enumerated, all of which are confirmed by a list of
+cases, as treated at the hospital. We have no room for details, which
+would, if known universally, hardly render us Americans, whether
+surgeons or patients, as fond of the cautery, as our trans-atlantic
+brethren of the French school.</p>
+
+<p>56. <i>Obliteration of a portion of the Urethra, remedied by an
+operation.</i>&mdash;M. <span class="smcap">Vanier</span> of Cherbourgh, relates in the Jan. No. of "Le
+Propagateur des Sciences Medicales," the case of a man aged 27 years,
+who, on the 16th of June, 1815, was wounded in the penis by a musket
+ball, which completely divided the urethra at its middle portion,
+without injuring the corpora cavernosa. The wound healed up; but by
+degrees, the passage contracted, so that in May, 1819, the patient could
+pass his urine only guttatim, with pain and difficulty, and was
+threatened with inflammation, &amp;c. of the perineum. Bougies afforded no
+relief. An incision was then made externally, in the direction of the
+urethra, so as to divide the cicatrix, and open the canal above and
+below the contracted part. The lips of the incision were drawn together
+over a sound, passed into the bladder; and by the 5th day, the wound was
+completely cicatrized. The sound was then removed, and a short bougie
+inserted, so as to pass beyond the cicatrix. This was worn occasionally,
+and the patient completely recovered. At the end of three years, he was
+able to "urinate with ease, and in a full stream."</p>
+
+<p>57. <i>Artificial Joint cured by Caustic.</i>&mdash;Dr. <span class="smcap">J. Rhea Barton</span>, has
+applied the caustic potash to the extremities of the fragments of a
+broken tibia, after an artificial joint had fully formed. Exfoliation
+was produced, followed by bony union. In three months, the patient
+recovered.</p>
+
+<p>Dr. B. alludes to other cases, by Mr. <span class="smcap">White</span> of Manchester, and Mr. <span class="smcap">Henry
+Cline</span>, thus treated with success; to two instances, in which the
+practice failed in the hands of Mr. <span class="smcap">Earle</span>; and finally, to one case by
+Mr. <span class="smcap">A. Cooper</span>, the result of which he has not learnt. He does not
+recommend the operation, as usually preferable to the <i>seton</i>, for
+which, the profession is indebted to Dr. <span class="smcap">Physick</span>; but as an additional
+expedient, when other means fail.&mdash;<i>Med. Record. April</i>, 1826.</p>
+
+<p>58. <i>Epilepsy cured by Trephining.</i>&mdash;In the 17th No. of the New-York<span class='pagenum'><a name="Page_205" id="Page_205">[Pg 205]</a></span>
+Medical and Physical Journal, Dr. <span class="smcap">David L. Rogers</span> relates an interesting
+case of a man, aged 46, who had been subject to epileptic convulsions
+for 14 years, and who, of late years, had been unable to labour, and
+rapidly sinking into a state of idiocy, from their frequent recurrence.</p>
+
+<p>These fits were preceded by a fracture of the os frontis, with
+depression, from which he readily recovered; but soon after he was
+attacked with convulsions. He now suffers pain on the injured side
+extending down the neck and left arm&mdash;the eye of the same side is
+diminished&mdash;the sight much impaired, and his memory almost entirely
+destroyed. A cicatrix covering a slight depression was easily found,
+above the left superciliary ridge of the frontal bone, and over the
+superior orbitar foramen. Under these circumstances, the operation of
+trephining was performed on the 7th of July, 1825, but with some
+difficulty, from the irregular thickness of the bone, and from the saw
+having to pass through the upper part of the frontal sinus. "The dura
+mater was unfortunately cut through for one-half the circumference of
+the circle." The parts were found more vascular than usual, and the
+under surface had a ridge corresponding to the internal depression, but
+too slight to have caused compression of the brain. "Having made a
+section of the frontal sinus, [with a trephine?] a part of the
+<i>posterior table</i> was removed with the <i>circular</i> piece. This portion of
+the internal table had been fractured, and separated to some distance
+from its inferior attachments to the frontal plate, and driven back upon
+the substance of the brain. Its sharp edge was worn round and smooth."
+This seemed to have been the cause of all the mischief.</p>
+
+<p>After the operation, the patient suffered from pain in his head, with
+some moderate excitement, which was relieved by cathartics. He had no
+return of fits until the 25th day, when the wound was entirely healed.
+These had been brought on by overloading his stomach with food, and were
+followed by high arterial excitement and inflammation of the brain.</p>
+
+<p>He was relieved in a few days by active depletion, and was discharged
+cured on the 20th of August. <i>Nine months</i> afterwards, this man
+continued free from fits, his memory had nearly recovered its usual
+strength, and he could attend to his business without any inconvenience.</p>
+
+
+<h3>VI. MIDWIFERY.</h3>
+
+<p>59. <i>Gastrotomy</i>.&mdash;M. <span class="smcap">Bulk</span>, in Germany, has successfully performed this
+operation on a female, aged 36 years, of good constitution, under the
+following circumstances. The patient, during her pregnancy, suffered
+from a severe pain at the left and inferior portion of the abdomen; her
+menses were not suppressed, and every six or eight days, a clot of blood
+and mucus came from the vagina. Her general health was very good.</p>
+
+<p>About the middle of her 8th month, she was washing some linen, and
+suddenly felt as if something was tearing in her abdomen; at the same<span class='pagenum'><a name="Page_206" id="Page_206">[Pg 206]</a></span>
+time, a swelling of the size of two fists (poings) formed on the right
+side, below the umbilicus. She fainted, and for six weeks suffered dull
+pains in the abdomen. At this time, she had <i>true labour pains</i> for 48
+hours, and was attended by a midwife. The os uteri dilated so as to
+admit one finger only. The tumour disappeared during these pains. The
+patient recovered, with the size of the abdomen undiminished.</p>
+
+<p>In this state she continued for two years and three months, menstruating
+regularly. She became again pregnant, with little inconvenience until
+the 7th month, when her abdomen was painfully distended, and of a bluish
+colour, and fluctuation was induced on the least motion. At the full
+period, she was delivered of a large f&oelig;tus, which she suckled for 15
+days. The infant then died of an aphthous affection.</p>
+
+<p>Her milk ceasing, she rapidly declined with hectic symptoms. The tumour
+reappeared below the umbilicus about the size of an egg, and soon
+opened, discharging from small orifices a little pus. The opening was
+enlarged, and some skin and hairs were removed. The patient's
+constitution was fast yielding, and gastrotomy was immediately
+performed. An incision was made, with the requisite precautions, through
+the linea alba into the cavity of the abdomen, from two and a half
+inches above the umbilicus to within nine lines of the pubis, care being
+taken to prevent the escape of the intestines. A f&oelig;tus of full size,
+in which putrefaction had commenced, was found on the right side of the
+uterus. "I raised," says the operator, "the body with much care, and
+endeavoured to trace the umbilical cord. This was turned over the fundus
+of the uterus to the left side, and terminated in a vascular substance
+in a state of suppuration, (probably, the remains of the placenta,)
+which was situated below the great omentum. I pressed out, and dried up
+the pus, which covered these parts, by means of a sponge. The uterus was
+an inch and a half in length and an inch in breadth, of a pale rose
+colour, and could easily be distended (se laissait distendre ais&eacute;ment.)
+It was otherwise in a good condition."</p>
+
+<p>The wound in the abdomen was closed with sutures. The patient was in
+great danger from inflammatory symptoms for 8 days, but eventually
+recovered. She left her bed on the 55th day.</p>
+
+<p>60. <i>C&aelig;sarian operation, performed with safety to the Mother and
+F&oelig;tus.</i>&mdash;We condense from <span class="smcap">Johnson's</span> Review for April last, the
+following summary of a case of C&aelig;sarian section performed by <span class="smcap">Graefe</span>, on
+the 20th of September, 1825.</p>
+
+<p>Carolina Bechang, was admitted into <span class="smcap">Graefe's</span> Clinicum, in an advanced
+stage of pregnancy; being 30 years of age, much deformed by rickets, and
+only four feet (Rhenish) in height. On the 20th of Sept. after having
+been five days in labour at the full period, pains severe, and os uteri
+dilated, she consented to the C&aelig;sarian section.</p>
+
+<p>A little after 2 o'clock, <span class="smcap">Graefe</span> placed the fore finger of his left
+hand, immediately below the umbilicus, and with a large scalpel, made an
+incision downwards in the linea alba, to within one inch of the pubis;
+dividing the<span class='pagenum'><a name="Page_207" id="Page_207">[Pg 207]</a></span> entire parietes, and even penetrating the substance of the
+uterus. A second incision penetrated the uterus and exposed the
+placenta; which, as had been anticipated, was found on the fore part of
+the fundus. The assistants now compressed firmly the edges of the
+divided abdominal parietes upon the uterus, to prevent the protrusion of
+the intestines, in which they succeeded; and <span class="smcap">Graefe</span> carried his hand in
+a moment into the uterus, separated the placenta with his finger and
+thumb, and then withdrew it and the child almost together. The child was
+very active, and cried lustily. The uterus immediately and suddenly
+contracted, and the bleeding was inconsiderable. Not more than twelve
+ounces of blood were lost, and no ligature was required. The whole
+operation was completed in four minutes and a half. The wound was
+secured by three broad sutures, and adhesive plasters, assisted by a
+bandage round the abdomen. The child weighed six pounds and was well
+formed. During the operation, the patient was sick, and once vomited
+slightly. In two hours had pain and fever: V.S. &#8485;xij.
+Draught with ten drops of the aqua laurocerasi was given, and repeated
+in a few hours. The patient passed a quiet night. The symptoms of pain,
+inflammation, and fever, were threatening for some days, and were
+promptly resisted by the lancet, by enamata, by narcotics, especially
+the laurocerasus and hyosciamus, by fomentations, &amp;c. By the 9th day,
+the wound had cicatrized, excepting near the symphisis; symptoms all
+favourable. The lochia were discharged regularly; and in three weeks,
+she was able to sit up, and in three more, quite well. Early in
+November, she returned home with her child, both in perfect health.</p>
+
+<p>In <span class="smcap">Ferussac's</span> Bulletin Universel; for February, another case, in which
+the C&aelig;sarian operation was performed with safety to the mother and
+infant, is copied from <span class="smcap">Rust's</span> Magazine.</p>
+
+<p>61. <i>Extirpation of the Uterus.</i>&mdash;Dr. <span class="smcap">Rheineck</span>, of Memmingen, was
+consulted by a female, who in December, 1824, was attacked by fever,
+from which she slowly recovered. A prolapsus of the uterus, which
+gradually became inverted, followed, attended with frequent h&aelig;morrhage
+and discharge, by which she was almost worn to the grave. The whole of
+the uterus was inverted, and without the labia externa; its surface
+loose, fungous, and in several places easily broken down upon pressure;
+but there was no hardening nor ulceration. The irritation was so great,
+as to threaten the patient's life, and after a consultation, in which it
+was agreed, that the swelling was really formed by the uterus, the
+tumour was laid hold of and drawn forwards, and a broad ligature,
+secured with a double surgeon's knot, was applied round its base. In
+about three weeks, the whole had separated, and the part above the
+ligature was cicatrized. During this period, the patient was dangerously
+ill, and was only rescued by great care and attention.</p>
+
+<p>The operator had before performed a similar operation, in which case,
+the patient died suddenly from h&aelig;morrhage, on the separation of the
+ligature. <span class="smcap">Osiander</span>, <span class="smcap">Struve</span>, <span class="smcap">Longenback</span>, <span class="smcap">Sauter</span>, <span class="smcap">Siebold</span>, and <span class="smcap">Zaug</span>,<span class='pagenum'><a name="Page_208" id="Page_208">[Pg 208]</a></span> have
+in late years performed the same operation, with various degrees of
+success.&mdash;<i>Johnson's Review for April</i>, 1826, who quotes from <i>Siebold's
+Journal fur Geburtshulfe</i>, 1826.</p>
+
+<p>62. <i>Uterine H&aelig;morrhage.</i>&mdash;In the Bulletin Universel for Jan. 1826, the
+following case is detailed from the Gazette de Sant&eacute;, for Dec. 1825.</p>
+
+<p>A female aged 32 years, was taken with labour with her first child, on
+the 12th Feb. 1825. The pains soon ceased, and on the 15th of Feb. M.
+<span class="smcap">Bedel</span>, physician at Schirmack, was consulted, who speedily delivered
+her, by means of the forceps, of a dead child. The h&aelig;morrhage was so
+considerable, as to render the immediate removal of the placenta
+necessary; but the uterus did not contract, and the bleeding continued,
+with tremblings, syncope, cold sweats, &amp;c. Irritation on the internal
+surface of the uterus, the use of cold water to the abdomen, injections
+into the uterus of cold water and vinegar, were unavailing.</p>
+
+<p>Plugging the vagina, and also the <i>uterus</i>, was now resorted to, as the
+only means of safety remaining. The uterus was filled with pieces of
+rags, for fear the patient could not sustain the loss of blood necessary
+to fill that cavity; while a methodic compression was at the same time
+made to the abdomen. The h&aelig;morrhage was immediately arrested, and soon
+after reaction ensued.</p>
+
+<p>On the 16th, M. <span class="smcap">Bedel</span> extracted the plugs from the uterus, cautiously
+and in succession; and had the pleasure of finding the uterus regularly
+contracting after each removal. The lochial discharge continued, and
+there was no secretion of milk. The patient recovered slowly.</p>
+
+<p>It is in such cases as the above, that the physicians of the United
+States have employed the Secale Cornutum (Ergot,) the judicious use of
+which would have probably superseded the necessity of instruments, and
+prevented or arrested the h&aelig;morrhagic discharge.</p>
+
+
+<h3>VII. CHEMISTRY AND PHARMACY.</h3>
+
+<p>63. <i>State in which Morphia exists in Opium.</i>&mdash;In the 80th article of
+our Quarterly Summary for January, we stated that <span class="smcap">Mr. Robinet</span> had
+announced the discovery of a new acid in opium, with which the morphia
+was combined; while the meconic acid was alleged to be united with soda.
+To the former salt, he gave the name of <i>codeate of morphia</i>. <span class="smcap">Mr.
+Robiquet</span>, however, has shown, that the pretended <i>codeate</i>, is a
+<i>muriate</i> of morphia, formed by double decomposition between the muriate
+of soda, employed by <span class="smcap">Mr. Robinet</span> in his analysis, and meconate of
+morphia. The same decomposition shows the source of the meconate of
+soda. We observe that <span class="smcap">Mr. Robinet</span> admits his mistake.&mdash;<i>Archives
+G&eacute;n&eacute;rales de Medicine.</i></p>
+
+<p>64. <i>Peculiar principles of Narcotic Plants.</i>&mdash;"Dr. <span class="smcap">Brandes</span> of
+Sabzerflen, having been prevented by extreme illness, induced by
+investigating the peculiar<span class='pagenum'><a name="Page_209" id="Page_209">[Pg 209]</a></span> principles of narcotic plants, from
+completing his inquiries, has announced the results of his labours in
+general terms. He states, that he has found a peculiar narcotic
+principle in all the narcotic plants; as belladonna, hyosciamus, conium,
+stramonium, chelidonium, digitalis, &amp;c. The narcotic principles are
+readily soluble in alcohol, ether, acids, and water, and of a highly
+offensive odour. This odour is so great in the principle of conium, that
+it is almost impossible for an individual of an irritable habit, to
+remain in the room, where there is an etherial solution, containing only
+a few grains of it. The smell of such a solution is equal to the smell,
+arising from twenty or thirty pounds of the plants. It is also
+remarkable, that as this principle is neutralized by acid, the
+disagreeable odour disappears, or is greatly diminished; which so far
+agrees with the circumstance, that the plants themselves give little of
+their peculiar smell, because the narcotic principle is not in a free
+state. Dr. <span class="smcap">Brandes</span> has promised to communicate the manner of obtaining
+the principles."&mdash;<i>Lond. Med. Repository, Feb. 1826.</i></p>
+
+<p>65. <i>Relative quantities of Cinchonia and Quinia in the most esteemed
+Varieties of Peruvian Bark.</i>&mdash;Mr. <span class="smcap">Bally</span> asserts, that practitioners,
+from observation, have classed the Peruvian barks in the following
+order;&mdash;first, the gray loxa bark, (<i>Cinchona Officinalis</i>;) then the
+red bark (<i>Cinchona Magnifolia</i> of <span class="smcap">Ruiz</span> and <span class="smcap">Pavon</span>, or <i>Oblongifolia</i> of
+<span class="smcap">Mutis</span>;) and lastly the yellow bark, or calisaya, (<i>Cinchona Cordifolia</i>
+of <span class="smcap">Mutis</span>, or <i>pubescens</i> of <span class="smcap">Valli</span>.) The <i>Cinchona Officinalis</i> furnishes
+much cinchonia, and little quinia; the <i>Cinchona Magnifolia</i> affords
+about equal quantities of the two salifiable principles, while the
+<i>Cordifolia</i> contain much quinia.</p>
+
+<p>Mr. <span class="smcap">Bally</span>, assuming it as proved, that cinchonia is the more powerful
+salifiable base of the two in a medical point of view, considers,
+therefore, that, in regard to the above barks, chemical analysis
+justifies the order of their relative value, which had been previously
+deduced from their medical employment.&mdash;<i>Archives Generales de
+Medecine.</i></p>
+
+<p>66. <i>Sulphate of Quinia, extracted from the Cinchona Bark, exhausted by
+Decoction.</i>&mdash;Mr. <span class="smcap">Julia-Fontenelle</span>, from the sparing solubility of quinia
+and cinchonia, suspected that decoctions and aqueous extracts of
+Peruvian bark contained but little of those vegetable alkalies; whence
+it would follow, that the residuum, generally rejected as having no
+febrifuge power, would still contain the greater part of them. This
+suspicion has been in a great measure verified. The aqueous extract was
+found to contain but little cinchonia and quinia; while the residuum of
+decoctions, giving the mean results, furnished two-thirds of the
+sulphate of quinia, yielded by the same weight of cinchona not acted on
+by water.</p>
+
+<p>As decoctions and aqueous extracts of bark are febrifuge, though
+containing inconsiderable quantities of quinia, and cinchonia, Mr.
+<span class="smcap">Julia-Fontenelle</span> is led to believe, that these salifiable bases are not
+the only febrifuge principles in Peruvian bark, but that the extractive
+matter also possesses that property.<span class='pagenum'><a name="Page_210" id="Page_210">[Pg 210]</a></span></p>
+
+<p>His results present a striking difference between alcoholic and aqueous
+extracts of bark; for while the former contain nearly the whole of the
+salifiable principles, the latter contain very little.&mdash;<i>Revue
+Medicale.</i></p>
+
+<p>67. <i>Analysis of Rhubarb.</i>&mdash;It is some time since Mr. <span class="smcap">Nani</span>, an Italian
+chemist, announced the discovery of a crystallizable vegetable alkali in
+rhubarb. Mr. <span class="smcap">Caventou</span> has repeated the experiments of Mr. N. and finds
+them, in many respects, inaccurate. Upon analysing the alcoholic extract
+of rhubarb, by the aid of alcohol and ether, employed separately and
+combined, Mr. C. obtained a fatty matter, containing a little
+odoriferous volatile oil, and a yellow colouring principle, capable of
+crystallization, and of being sublimed without decomposition, which may
+be called <i>rhubarbin</i>. He also detected in the alcoholic extract, a
+brown substance, insoluble in water when pure, but rendered soluble by
+combination with rhubarbin; when it forms a compound, constituting the
+<i>eaphopicrite</i> of some chemists, and the <i>rhubarbin</i> of
+Psaff.&mdash;<i>Archives Generales.</i></p>
+
+<p>Mr. <span class="smcap">George W. Carpenter</span>, of this city, prepares the medicinal principle
+of rhubarb in combination with sulphuric acid, under the name of
+sulphate of rhubarb, by the following process:</p>
+
+<p>"Boil, for half an hour, six pounds of coarsely powdered Chinese rhubarb
+in six gallons of water, acidulated with two and a half fluid ounces of
+sulphuric acid; strain the decoction, and submit the residue to a second
+ebullition in a like quantity of acidulated water; strain as before, and
+submit it again to a third ebullition. Unite the three decoctions, and
+add, by small portions, recently powdered pure lime, constantly stirring
+it to facilitate its action on the acid decoction. When the decoction
+becomes slightly alkaline, it deposites a red flocculent precipitate,
+and the fluid is changed from a yellow to a crimson colour. The
+precipitate is then to be separated by passing it through a linen cloth,
+and dried; after which, reduce it to powder, and digest in three gallons
+of alcohol, at thirty-six degrees, in a water bath, for several hours,
+at a moderate heat. Separate this solution from the calcareous
+precipitate, and distil off three-fourths of the alcohol. There then
+remains a strong solution of rhubarbine, to which add as much sulphuric
+acid as will exactly neutralize it. Evaporate this slowly to dryness,
+without having access to atmospheric air. The residuum will be of a
+brownish-red colour, intermingled with brilliant specks, possessing a
+slightly pungent styptic taste, soluble in water, and its odour that of
+the native rhubarb." This residuum is the sulphate of rhubarb. (Sulphate
+of <i>rhubarbin.</i>?)</p>
+
+<p>Mr. <span class="smcap">Carpenter</span> assures us, that this preparation contains the medicinal
+principle of the rhubarb, apart from its inert portion; and considers it
+as bearing the same relation to rhubarb, as the sulphate of quinia to
+the Peruvian bark. The Chinese rhubarb, at half the price, furnished
+twice as much rhubarbin as the reputed Russian, which Mr. C. considers
+to be spurious in the Philadelphia market, being the English prepared in
+imitation<span class='pagenum'><a name="Page_211" id="Page_211">[Pg 211]</a></span> of the Russian.&mdash;<i>Philadelphia Journal of the Medical &amp;
+Physical Sciences. May</i>, 1826.</p>
+
+<p>68. <i>Alkaline Lozenges of Bicarbonate of Soda.</i>&mdash;Mr. <span class="smcap">D'Arcet</span> proposes
+the following formula for these lozenges:&mdash;Take of</p>
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Bicarbonate of Soda, pure and dry, and in fine powder,</td><td align='left'>5 parts.</td></tr>
+<tr><td align='left'>Very white Sugar, in fine powder,</td><td align='left'>95</td></tr>
+<tr><td align='left'>Mucilage of Gum Tragacanth,</td><td align='left'>q.s.</td></tr>
+<tr><td align='left'>Essential oil of Mint, pure and fresh,</td><td align='left'>2 or 3 drops</td></tr>
+<tr><td colspan="2">for about every 3 ounces of mixture of bicarbonate and sugar.</td></tr>
+</table></div>
+
+
+<p>Shake the bicarbonate and sugar in a well dried bottle, with the view of
+mixing them intimately. Withdraw the mixture from the bottle, and add
+the mucilage and oil of mint, blending the whole together on a marble.
+The mass obtained, is then to be divided into lozenges, which should
+weigh, when dried, about 15 grains each. As they slightly attract
+moisture, they ought to be kept in a dry place, or in well stopped
+bottles.</p>
+
+<p>Mr. <span class="smcap">D'Arcet</span> praises very highly the effects of these lozenges in
+disordered digestion, and in preventing its occurrence, as well from
+experiments made on his own person, as from observations on others. He
+believes their operation to be purely chemical, consisting in the
+saturation of the morbid acid of the stomach, and, therefore, not likely
+to be lessened by habit. Their effects are much more prompt than
+magnesia, either pure or in the state of carbonate.</p>
+
+<p>In the phosphatic diathesis, where the urine is disposed to be alkaline,
+it would seem that these lozenges would do harm. But, perhaps, we have
+this security against their use in these cases, that the stomach would
+not at the same time be troubled with acidity. <i>Annales de Chimie et de
+Physique, Jan.</i> 1826.</p>
+
+<p>69. <i>Presence of Mercury in Samples of medicinal Prussic Acid.</i>&mdash;Mr.
+<span class="smcap">Regimbeau</span>, apothecary at Montpellier, has detected this impurity in some
+prussic acid, prepared in Paris. Its presence was first suspected, from
+a portion of the acid, accidentally dropped, leaving a white stain on
+the copper dish of a balance. It is probable, that the impure acid,
+spoken of, had been made by passing sulphuretted hydrogen through a
+solution of cyanide of mercury, according to <span class="smcap">Vanquelin's</span> process; and
+that an insufficiency of the decomposing gas had been employed.</p>
+
+<p>May not this accidental impurity explain the occasional salivating
+effects of prussic acid.</p>
+
+<p>70. <i>Proposed Method for preparing Protoxide of Mercury by
+precipitation, for Medical Employment.</i>&mdash;Mr. <span class="smcap">Thomas Evans</span> has published
+some observations on this subject, and justly remarks, that the blue
+pill, mercurial ointment, and other mercurial preparations, are not
+uniform compounds, but contain variable proportions of the real
+protoxide, and uncombined mercury. Some blue pill, which had been
+carefully prepared by Mr. E. by the usual process of trituration, was
+found to contain on analysis 20 per<span class='pagenum'><a name="Page_212" id="Page_212">[Pg 212]</a></span> cent. of unoxidized mercury; and
+the blue mass from Apothecaries' Hall, London, furnished about the same
+proportion.</p>
+
+<p>As it is obviously a desideratum to procure preparations of protoxide of
+mercury of uniform strength, Mr. <span class="smcap">Evans</span> has been led to seek a process,
+by which to obtain this oxide in a pure state. After repeated
+experiments, he has pitched upon the following formula: Dissolve four
+ounces of caustic hydrate of potassa in a pound of water, and to the
+clear solution, decanted from any impurities, add four ounces of
+calomel, and shake the mixture frequently. Pour off the liquid, and wash
+the precipitate formed with water, and then dry it at a gentle heat.</p>
+
+<p>In regard to the medical efficacy of the protoxide obtained in this way,
+Mr. <span class="smcap">Evans</span> reports the following to be the results obtained by Dr.
+<span class="smcap">Coates</span>, at whose suggestion the article was prepared. As a substitute
+for calomel, it is more apt to vomit and purge, two grain doses
+operating several times. As an alterative, it was found incomparably
+more efficacious than the blue pill, being more certain and regular in
+its operation. Dr. C. thinks, that one-fourth of a grain of the
+precipitated protoxide, as prepared by Mr. <span class="smcap">Evans</span>, is equal to three or
+four grains of the blue mass.&mdash;<i>Journ. of the Philad. Col. of Pharm.
+May</i>, 1826.</p>
+
+<p>The method here proposed for obtaining the black oxide of mercury by Mr.
+<span class="smcap">Evans</span>, was first suggested and put in practice by Mr. <span class="smcap">Phillips</span>. See his
+"Experimental Examination of the last edition of the Pharmacop&oelig;ia
+Londinensis, London, 1811," page 114. His words are, "When solution of
+potash is employed, the several inconveniences attendant upon the use of
+lime-water are avoided, and a blackish coloured protoxide is obtained
+without heating the solution. As potash is much more soluble than lime,
+it is scarcely necessary to employ one-tenth part of the quantity of
+water; this not only renders the process more convenient, but the
+quantity of air contained in the water being less, very little of the
+oxide, perhaps none of it, is converted into peroxide." See also the
+experiments, and observations of Mr. <span class="smcap">Donovan</span>, on Mercurial Ointment, &amp;c.
+published in the Medical Journals, several years ago.</p>
+
+<p>71. <i>Goulard's Extract of Lead.</i> Mr. <span class="smcap">Daniel B. Smith</span> proposes the
+following formula for obtaining Goulard's extract of uniform strength:</p>
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Acetate of lead, crystallized,</td><td align='left'>15 ounces, troy.</td></tr>
+<tr><td align='left'>Protoxide of lead,</td><td align='left'>9 ounces, troy.</td></tr>
+<tr><td align='left'>Distilled water,</td><td align='left'>4 pints.</td></tr>
+</table></div>
+
+<p>"Boil them together for fifteen minutes and filter. The filtered liquid
+will weigh about five and a quarter pounds, is transparent, colourless,
+and of the specific gravity of 1.267. (30&deg; Baum&eacute;.)"</p>
+
+<p>We conceive that Mr. <span class="smcap">Smith</span> has erroneously denominated the sugar of
+lead, a binacetate. The best usage is to deem that the primary saline
+compound, which contains a single proportional of acid and base.
+Accordingly<span class='pagenum'><a name="Page_213" id="Page_213">[Pg 213]</a></span> we call the saturated carbonate of potassa, a
+<i>bicarbonate</i>; and Dr. <span class="smcap">Thomson</span> calls borax, a biborate of soda, on
+account of its containing two proportionals of acid to one of base,
+notwithstanding the alkaline qualities of this salt. Goulard's extract
+is, therefore, a sub-binacetate of lead, or according to Dr. <span class="smcap">Thomson's</span>
+recently suggested nomenclature, a <i>diacetate</i>.&mdash;<i>Ibid.</i></p>
+
+<div class="footnotes"><h3>FOOTNOTES:</h3>
+
+<div class="footnote"><p><a name="Footnote_29_29" id="Footnote_29_29"></a><a href="#FNanchor_29_29"><span class="label">[29]</span></a> Series of Engravings to the morbid anatomy; fasc. 1. pl.
+6. fig. 1, 2.</p></div>
+
+<div class="footnote"><p><a name="Footnote_30_30" id="Footnote_30_30"></a><a href="#FNanchor_30_30"><span class="label">[30]</span></a> Lond. Med. Review; vol. 4.</p></div>
+
+<div class="footnote"><p><a name="Footnote_31_31" id="Footnote_31_31"></a><a href="#FNanchor_31_31"><span class="label">[31]</span></a> Pathological Researches; Essay 1.</p></div>
+
+<div class="footnote"><p><a name="Footnote_32_32" id="Footnote_32_32"></a><a href="#FNanchor_32_32"><span class="label">[32]</span></a> Medical Researches on the Effects of Iodine in
+Bronchocele, Paralysis, Chorea Scrofula, Fistula Lachrymalis, Deafness,
+Dysphagia, White Swelling, and Distortions of the Spine. By Alexander
+Manson, M. D., &amp;c. London, 1825.</p></div>
+
+<div class="footnote"><p><a name="Footnote_33_33" id="Footnote_33_33"></a><a href="#FNanchor_33_33"><span class="label">[33]</span></a> Carthamus Tinctorius.</p></div></div>
+
+
+<hr style="width: 65%;" /><p><span class='pagenum'><a name="Page_214" id="Page_214">[Pg 214]</a></span></p>
+<h2>QUARTERLY LIST<br />
+
+OF<br />
+
+AMERICAN MEDICAL PUBLICATIONS</h2>
+
+
+<p>Observations on the Autumnal Fevers of Savannah. By W. C. Daniell, M. D.
+8vo. pp. 152.&mdash;W. T. Williams, and Collins &amp; Hanway. Savannah, 1826.</p>
+
+<p>An Analysis of Fever. By Charles Caldwell, M. D., Professor of the
+Institutes of Medicine, and Clinical Practice in Transylvania
+University. 8vo. pp. 97.&mdash;Lexington, K. 1825.</p>
+
+<p>Medical and Physical Memoirs. By Charles Caldwell, M. D., Professor, &amp;c.
+Containing, 1. An Introductory Address, intended as a Defence of the
+Medical Profession against the charge of Irreligion and Infidelity; with
+Thoughts on the Truth and Importance of Natural Religion. 2. A
+Dissertation in answer to certain Prize Questions, proposed by his
+Grace, the Duke of Holstein Oldenburg, respecting the "Origin, Contagion
+and general Philosophy of Yellow Fever, and the Practicability of that
+Disease prevailing in high Northern Latitudes;" with Thoughts on its
+Prevention and Treatment. 3. Thoughts on the Analogies of Disease. 8vo.
+pp. 224.&mdash;Lexington, K. 1826.</p>
+
+<p>Florula Cestrica: an Essay towards a Catalogue of the Ph&oelig;nogamous
+Plants, native and naturalized, growing in the vicinity of the borough
+of West-Chester, in Chester County, Pennsylvania; with brief notices of
+their Properties and Uses, in Medicine, rural Economy and the Arts. To
+which is subjoined an Appendix of the useful cultivated Plants of the
+same District. By William Darlington, M. D. 8vo.&mdash;West-Chester, 1826.</p>
+
+<div class="blockquot"><p>We are much gratified with the appearance of this little flora.
+It is really an uncommonly neat, useful, and convenient
+performance; and, we have no doubt, is by far the most elegant
+and creditable botanical work, if not the only one, published
+in any small town in America. To a country town, we would not
+think of looking for such a production; but in fact, the county
+of Chester has, of late years, made very considerable advances
+in science and literature. It has produced a public library,
+and perhaps<span class='pagenum'><a name="Page_215" id="Page_215">[Pg 215]</a></span> others with the existence of which we are not
+acquainted, several botanical and mineralogical collections, a
+very respectable series of essays on its history, similar to
+Mr. Jefferson's notes on Virginia, schools, teaching the higher
+branches of the English mathematics, and one of those partly
+literary newspapers which have recently sprung up among us.</p>
+
+<p>The above title considerably explains the nature and extent of
+the work. Of its scientific accuracy, sufficient time has not
+yet elapsed to form an adequate judgment; but we observe that
+the author has had the frequent assistance of Baldwin, Collins,
+Steinhauer, Torrey, and Schweinitz: so that, if the maxim
+"noscitur a socio" be at all applicable in the present case, it
+is evident that he has been in the very best botanical company
+which our land affords.</p>
+
+<p>The work is executed with very great neatness, such as would do
+credit to the press of a metropolis, and is really wonderful
+for a moderate sized village, and for the disturbed life of a
+country physician, its author. There is also a great deal of
+that kind of popular explanation, which so agreeably relieves
+the repulsiveness of dry works on natural history: such as the
+familiar names of the plants; the derivations of the names of
+the genera, designed to assist the student in remembering them,
+by enabling him to associate some idea with them; occasional
+comments on their uses and injurious effects, &amp;c.</p>
+
+<p>We may add, that from the close proximity of Chester County to
+Philadelphia, extending to a large part of the line of the
+Schuylkill, this little work will answer extremely well for
+common use around this city, with the single exception of the
+sands of New-Jersey.</p></div>
+
+<p>Memoir on the Topography, Weather, and Diseases of the Bahama Islands.
+By P. S. Townsend, M. D.&mdash;New-York, 1826.</p>
+
+<p>The New-England Journal of Medicine and Surgery, and Collateral Branches
+of Science. Conducted by Walter Channing, Jr. M. D., and John Ware, M.
+D. No. 2. Vol. XV.&mdash;Boston, April, 1826.</p>
+
+<p>The American Medical Review, and Journal of Original and Selected Papers
+in Medicine and Surgery. Conducted by John Eberle, M. D., Nathan Smith,
+M. D., George M'Clellan, M. D., and Nathan R. Smith, M. D. No. 1, Vol.
+III.&mdash;Philadelphia, April, 1826.</p>
+
+<p>The Medical Recorder of Original Papers and Intelligence in Medicine and
+Surgery. Conducted by Samuel Colhoun, M. D. No. 2, Vol.
+IX.&mdash;Philadelphia, April, 1826.</p>
+
+<p>The Philadelphia Journal of the Medical and Physical Sciences. Edited by
+N. Chapman, M. D., W. P. Dewees, M. D., and<span class='pagenum'><a name="Page_216" id="Page_216">[Pg 216]</a></span> John D. Godman, M. D. No.
+V. New Series.&mdash;Philadelphia, May, 1826.</p>
+
+<p>The New-York Medical and Physical Journal. No. 17. Edited by John B.
+Beck, M. D., Daniel L. M. Peixotto, M. D., and John Bell, M.
+D.&mdash;New-York, April, 1826.</p>
+
+<p>Journal of the Philadelphia College of Pharmacy. No. 2, Vol.
+1.&mdash;Philadelphia, May, 1826.</p>
+
+
+<h3>AMERICAN EDITIONS OF FOREIGN MEDICAL BOOKS.</h3>
+
+<p>Manual of Surgical Operations; containing the New Method of operating,
+devised by Lisfranc; followed by two Synoptic Tables of Natural and
+Instrumental Labours. By J. Coster, M. D. and Professor of the
+University of Turin. The Translation and Notes by John D. Godman, M. D.
+12mo. pp. 265.&mdash;Carey &amp; Lea. Philadelphia, 1825.</p>
+
+<p>A Treatise on Derangements of the Liver, Internal Organs, and Nervous
+System. By James Johnson, M. D. 12mo. pp. 223.&mdash;Carey &amp; Lea.
+Philadelphia, 1826.</p>
+
+<p>An Inquiry into the Nature and Treatment of Diabetes, Calculus, and
+other Affections of the Urinary Organs. By William Prout, M.D. F.R.S.
+From the second London Edition, with Notes and Additions, by S. Colhoun,
+M. D. 8vo. pp. 308.&mdash;Towar &amp; Hogan. Philadelphia, 1826.</p>
+
+<hr style='width: 45%;' />
+
+<p>We are sensible that the foregoing does not present a full list of
+medical publications for the last quarter; but it is as complete as our
+opportunities have enabled us to make it. It is obviously for the
+interest of authors and publishers, to send us the titles of their
+medical publications as soon as they appear, and we invite them to do
+so.</p>
+
+<p>&nbsp;</p>
+<p>&nbsp;</p>
+<hr class="full" />
+
+<p>***END OF THE PROJECT GUTENBERG EBOOK NORTH AMERICAN MEDICAL AND SURGICAL JOURNAL, VOL. 2, NO. 3, JULY, 1826***</p>
+<p>******* This file should be named 29307-h.txt or 29307-h.zip *******</p>
+<p>This and all associated files of various formats will be found in:<br />
+<a href="http://www.gutenberg.org/dirs/2/9/3/0/29307">http://www.gutenberg.org/2/9/3/0/29307</a></p>
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+The Project Gutenberg eBook, North American Medical and Surgical Journal,
+Vol. 2, No. 3, July, 1826, by Various, Edited by Hugh L. Hodge, Franklin
+Bache, Charles D. Meigs, Benjamin Homer Coates, and René La Roche
+
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+
+
+
+Title: North American Medical and Surgical Journal, Vol. 2, No. 3, July, 1826
+
+
+Author: Various
+
+Editor: Hugh L. Hodge, Franklin Bache, Charles D. Meigs, Benjamin Homer
+Coates, and René La Roche
+
+Release Date: July 4, 2009  [eBook #29307]
+
+Language: English
+
+Character set encoding: ISO-646-US (US-ASCII)
+
+
+***START OF THE PROJECT GUTENBERG EBOOK NORTH AMERICAN MEDICAL AND
+SURGICAL JOURNAL, VOL. 2, NO. 3, JULY, 1826***
+
+
+E-text prepared by Juliet Sutherland, Josephine Paolucci, and the Project
+Gutenberg Online Distributed Proofreading Team (http://www.pgdp.net)
+
+
+
+Note: Project Gutenberg also has an HTML version of this
+      file which includes the original illustration.
+      See 29307-h.htm or 29307-h.zip:
+      (http://www.gutenberg.org/files/29307/29307-h/29307-h.htm)
+      or
+      (http://www.gutenberg.org/files/29307/29307-h.zip)
+
+
+
+
+
+THE
+
+NORTH AMERICAN
+
+MEDICAL AND SURGICAL
+
+JOURNAL.
+
+
+CONDUCTED BY
+
+HUGH L. HODGE, M.D.  | CHAS. D. MEIGS, M.D.
+FRANKLIN BACHE, M.D. | B. H. COATES, M.D.
+
+AND
+
+R. LA ROCHE, M.D.
+
+NON DOCTIOR, SED MELIORE IMBUTUS DOCTRINA.
+
+VOL. II.
+
+PHILADELPHIA:
+
+PUBLISHED BY J. DOBSON, AGENT.
+
+JESPER HARDING, PRINTER.
+
+1826.
+
+
+_Eastern District of Pennsylvania, to wit_
+
+BE IT REMEMBERED, that on the 31st day of March, in the 50th year of the
+Independence of the United States of America, A. D. 1826, Hugh L. Hodge,
+Franklin Bache, Charles D. Meigs, Benjamin H. Coates, and Rene La Roche,
+of the said District, have deposited in this office the Title of a Book,
+the right whereof they claim as Proprietors, in the words following, to
+wit:
+
+"_The North American Medical and Surgical Journal. Conducted by Hugh L.
+Hodge, M. D., Franklin Bache, M. D., Chas. D. Meigs, M. D., B. H.
+Coates, M. D., and R. La Roche, M. D. Non doctior, sed meliore imbutus
+doctrina. Vol. II._"
+
+In conformity to the act of Congress of the United States, intituled,
+"An act for the encouragement of learning, by securing the copies of
+maps, charts, and books, to the authors and proprietors of such copies,
+during the times therein mentioned;"--and also to the act, entitled, "An
+act supplementary to an act, entitled, "An act for the encouragement of
+learning, by securing the copies of maps, charts, and books, to the
+authors and proprietors of such copies, during the times therein
+mentioned," and extending the benefits thereof to the arts of designing,
+engraving, and etching historical and other prints."
+
+     D. CALDWELL, Clerk of the Eastern District of Pennsylvania.
+
+
+
+
+CONTENTS
+
+OF VOL. II.
+
+
+No. III.
+
+ORIGINAL COMMUNICATIONS.
+
+ART.                                                                  PAGE.
+
+I. Description of the Gangrenous Ulcer of the mouths of children.
+By B. H. Coates, M. D., one of the Physicians to the Philadelphia
+Children's Asylum, &c.                                                   1
+
+II. Case of Purpura in an Infant, attended with extraordinary
+symptoms. By R. M. Huston, M. D.                                        24
+
+III. History of the Natural and Modified Small Pox, or of the
+Variolous and Varioloid Diseases, as they prevailed in
+Philadelphia, in the years 1823 and 1824. By John K. Mitchell,
+M. D., and John Bell, M. D., attending physicians at the
+then Small Pox Hospital. With a plate.                                  27
+
+IV. Remarks on the Pathology and Treatment of Yellow Fever.
+Arranged from the notes of Dr. J. A. Monges, of Philadelphia.           53
+
+V. Remarks on the Prophylactic Treatment of Cholera Infantum.
+By Joseph Parrish, M. D., one of the Surgeons to the Pennsylvania
+Hospital.                                                               68
+
+VI. Case of Neuralgia cured by Acupuncturation. Communicated
+by J. Hunter Ewing, M. D.                                               77
+
+
+ANALYTICAL REVIEWS.
+
+VII. Researches into the Nature and Treatment of Dropsy in the
+Brain, Chest, Abdomen, Ovarium, and Skin. By Joseph Ayre,
+M. D., &c.                                                              79
+
+VIII. An Essay on Venereal Diseases, and the Uses and Abuses of
+Mercury in their Treatment. By Richard Carmichael, M. R. I. A.
+With Practical Notes, &c. By G. Emerson, M. D.                         109
+
+IX. Remarks on some Means employed to destroy Taenia, and expel
+them from the Human Body. By Louis Frank, M. D.
+Privy Counsellor of her Majesty, Maria Louisa, Duchess of
+Parma.                                                                 114
+
+X. Researches, Physiological and Pathological, instituted principally
+with a View to the Improvement of Medical and Surgical
+Practice. By James Blundell, M. D., Lecturer on
+Physiology and Midwifery at the United Hospitals of St.
+Thomas and Guy.                                                        119
+
+XI. An Inquiry into the Nature and Treatment of Diabetes, Calculus
+and other Affections of the Urinary Organs. By William
+Prout, M. D., F. R. S. With Notes and Additions, by S.
+Colhoun, M. D.                                                         125
+
+
+MEDICAL LITERATURE.--RETROSPECTIVE REVIEW.
+
+XII. Tractatus de Ventriculo et Intestinis, cui praemittitur alius, de
+Partibus continentibus in Genere, et in Specie de iis Abdominis.
+Authore Francisco Glissonio. Lond. 1677, 4to.                          138
+
+
+QUARTERLY SUMMARY OF MEDICAL AND SURGICAL INTELLIGENCE.
+
+ANATOMY,                                                               155
+
+1, Papillae of the Tongue. 2, Villi of the Stomach and Intestines. 3,
+Minute distribution of the Vessels of the Liver. 4, Trachea perforating
+the Aorta. 5, Monsters. 6, Malformation of the Heart. 7, Acephalous
+Mummy. 8, New Anatomical Plates. 9, A Manual of Osteology. 10,
+Soemmering's Work on the Anatomy of the Ear. 11, Does the conjunctiva
+run over the Cornea?
+
+
+PHYSIOLOGY,                                                            158
+
+12, Electro-Galvanic phenomena of Acupuncturation. 13, Variations in
+Milk. 14, Hyoscyamus dilates the Pupils of the Eyes. 15, Worms in the
+Eye. 16, Digestion.
+
+PATHOLOGY,                                                             161
+
+17, Dothinenteria--Pustules of the small Intestines. 18, Dr. Broussais.
+19, Whooping Cough. 20, Antiperistaltic Globus--Globus Hystericus.
+21, Non-contagion of Yellow Fever.
+
+THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE,            166
+
+22, Iodine. 23, Non-mercurial Treatment of Syphilis. 24, Cancer treated
+by Antiphlogistics. 25, Essential Oil of Male Fern as a remedy in Cases
+of Taenia. 26, Tincture of Bastard Saffron for the expulsion of Taenia.
+27, Oil of Turpentine in Taenia. 28, Action of the Oil of the Euphorbia
+Lathyris. 29, Medicinal Properties of the Apocynum Cannabinum or Indian
+Hemp. 30, Remarkable Effects from the external application of the
+Acetate of Morphia. 31, Cure of Urinary Calculi, by means of the
+internal use of the Bicarbonate of Soda. 32, Attempt to cure Abdominal
+Dropsy by exciting Peritoneal Inflammation. 33, Artificial Respiration.
+34, Secale Cornutum. 35, Animal Magnetism. 36, Sketch of the Medical
+Literature of Denmark, Sweden, and Norway. 37, Erysipelatous Mumps or
+Angina Parotidiana. 38, Taenia. 39, Scrophula. 40, Digitalis.
+
+SURGERY,                                                               192
+
+41, Dr. Physick's Operation for Artificial Anus denied to have been
+performed. 42, Gangrenous Sore Mouth of Children. 43, Operation for
+Phymosis. 44, Lunar Caustic on Wounds and Ulcers. 45, Haemorrhage from
+Lithotomy. 46, Extirpation of the Parotid Gland. 47, Aneurism from a
+Wound, cured by Valsaiva's method. 48, Protrusion and Wound of the
+Stomach. 49, Oesophagotomy. 50, Retention of Urine, caused by a
+Stricture of the Urethra, relieved by a forcible but gradual Injection.
+51, Tracheotomy. 52, Fistula Lachrymalis. 53, Aneurisma Herniosum. 54,
+Extirpation of the Two Dental Arches affected with Osteo-sarcoma. 55,
+Traumatic Erysipelas. 56, Obliteration of a portion of the Urethra,
+remedied by an Operation. 57, Artificial Joint cured by Caustic. 58,
+Epilepsy cured by Trephining.
+
+MIDWIFERY,                                                             205
+
+59, Gastrotomy. 60, Caesarian Operation, performed with safety to the
+Mother and Foetus. 61, Extirpation of the Uterus. 62, Uterine Haemorrhage.
+
+CHEMISTRY AND PHARMACY,                                                208
+
+63, State in which Morphia exists in Opium. 64, Peculiar Principles of
+Narcotic Plants. 65, Relative quantities of Cinchonia and Quinia with
+indention in the most esteemed Varieties of Peruvian Bark. 66, Sulphate
+of Quinia, extracted from the Cinchona Bark, exhausted by Decoction.
+67, Analysis of Rhubarb. 68, Alkaline Lozenges of Bicarbonate of Soda.
+69, Presence of Mercury in Samples of Medicinal Prussic Acid. 70, Proposed
+Method of preparing Protoxide of Mercury by precipitation, for
+Medical Employment. 71, Goulard's Extract of Lead.
+
+QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS,                    214-16
+
+
+No. IV.
+
+ORIGINAL COMMUNICATIONS.
+
+ART.
+
+I. On the Epidemic of 1825 in Natchez, Miss. By Ayres P.
+Merrill, M. D.                                                         217
+
+II. History of the Natural and Modified Small Pox, or of the Variolous
+and Varioloid Diseases, as they prevailed in Philadelphia,
+in the years 1823 and 1824. By John K. Mitchell,
+M. D., and John Bell, M. D., Physicians at the then Small
+Pox Hospital. (Concluded from page 53.)                                238
+
+III. Cases of Nervous Irritation, exhibiting the Efficacy of Cold as
+a Remedy. By S. Jackson, M. D.                                         250
+
+IV. Remarks on the Pathology of Jaundice. By G. B. Wood, M. D.         260
+
+V. Account of a Case in which a New and Peculiar Operation for
+Artificial Anus was performed in 1809. By Philip Syng Physick, M. D.,
+Professor of Surgery in the University of Pennsylvania, &c. Drawn up for
+publication by B. H. Coates, M. D.                                     269
+
+VI. Observations on Asphyxia from Drowning, to which is added
+a Case of Resuscitation. By Edward Jenner Coxe, M. D.                  276
+
+
+ANALYTICAL REVIEWS.
+
+VII. Traite Zoologique et Physiologique, Sur les Vers Intestinaux de
+l'Homme. Par M. Bremser, D. M. Traduit de l'Allemande
+par M. Grundler, D. M. P. Revue et Augmentee de Notes.
+Par M. de Blainville, D. M., &c. Avec un Atlas. Paris, 1824.
+
+Anatomie des Vers Intestinaux, Ascaride, Lombricoide, et
+Echynorhynque Geant. Memoire Couronne par l'Academie
+Royale des Sciences, qui en avoit mit le sujet au Concours,
+pour l'annee 1818. Avec 8 Planches. Par Jules Cloquet,
+&c. &c. A Paris, 1824                                                  297
+
+VIII. Precis Theorique et Pratique, sur les Maladies de la Peau.
+Par M. S. L. Alibert. 2 Tomes. 8vo. Paris, 1810-1820.                  322
+
+IX. Thoughts on Medical Education, and a Plan for its Improvement;
+addressed to the Council of the University of London.
+Dictu Necessaria. Plin. London, 1826.
+
+Projet de Loi, presente aux Chambres dans la Seance du 14
+Fevrier 1825, par S. E. le Ministre de l'Interieur, Sur les
+Ecoles Secondaries de Medecine, les Chambres de Discipline,
+et les Eaux Minerales Artificielles.                                   344
+
+
+MEDICAL LITERATURE--RETROSPECTIVE REVIEWS.
+
+X. Recherches sur le Tissu Muqueux, ou l'Organe Cellulaire, et
+Sur Quelques Maladies de la Poitrine. Par Theophile Bordeu,
+Docteur en Medecine des Facultes de Paris, et de
+Montpelier. Paris, 1767, 12mo.                                         376
+
+
+QUARTERLY SUMMARY OF IMPROVEMENTS IN MEDICINE AND
+SURGERY
+
+ANATOMY,                                                                395
+
+1, Notice of a Double Male Foetus, by W. E. Horner, M. D., &c. 2,
+Imperfect Development of the Cerebral Organs in Monsters. 3, Imperforate
+Vagina. 4, Fallopian Tubes. 5, Monsters. 6, Foetus grafted into
+the Chest of another. 7, Foetus without a Stomach, Head or Anus. 8,
+Congenital Hydrocephalus, with Transposition of the Viscera. 9, Unusual
+Arrangement of the Aortic Branches.
+
+PHYSIOLOGY,                                                            403
+
+10, Influence of the Great Sympathetic Nerve on the Functions of Sense.
+11, Cutaneous Absorption. 12, Abstinence. 13, Hippomane Mancinella.
+14, Cutaneous Absorption. 15, Regeneration of Divided Arteries.
+16, Mineral Poisons.
+
+PATHOLOGY,                                                             406
+
+17, Are we followers of Dr. Broussais? 18, Influenza. 19, Diarrhoea
+Infantum. 20, Tetanus. 21, Small Pox.
+
+THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE.            411
+
+22, Tincture of Iodine in Gonorrhoea, Bubo, Scrofula, &c. 23, Acetate
+of Lead and Tincture of Opium in Dysentery. 24, Powers of Digitalis in
+Palpitatio Cordis. 25, Tartar-Emetic Ointment in Epilepsy. 26,
+Antiphlogistics
+in Recent Cases of Epilepsy. 27, On the Efficacy of Nitrate
+of Silver in the Treatment of Zona or Shingles. 28, On the Remedial
+Effects of Camphor in Acute and Chronic Rheumatism. 29, Examination
+of the Question, whether the Medical Use of Phosphorus internally, is
+useful, injurious, or equivocal. 30, Nitrous Acid and Opium in Dysentery,
+Cholera and Diarrhoea. 31, Tartar Emetic in Pneumonia Biliosa. 32,
+Bark of the Ampelopsis in Catarrhal Consumption. 33, Obstinate Vomiting
+cured with Extract of Marigold. 34, Vomiting of Fat and Blood. 35,
+Rupture of the Spleen. 36, Chilblains cured with Chloride of Lime. 37,
+Local Spontaneous Combustion. 38, Dr. Painchaud on Tic Douloureux.
+39, Duration of Life among the Romans. 40, Difference of Mortality
+from 1775, to 1825. 41, New Method of Percussion of the Thorax. 42,
+Acid Nitrate of Mercury. 43, Effects of Ardent Spirits. 44, Colombo
+Root. 45, Poison of Mushrooms. 46, Antisyphilitic Decoction of Zittmann.
+47, Acetate of Ammonia, a Remedy for Drunkenness. 48, Mortality
+of Leeches. 49, Black Drop. 50, Doses of Calomel in days of
+yore. 51, Buying a good Practice. 52, Sore Nipples. 53, Anderson's
+Quarterly. 54, Antiquity of Cow Pox and Origin of Small Pox from it.
+
+SURGERY,                                                               431
+
+55, Lithotritie, on Breaking the Stone in the Bladder. 56, The High
+Operation. 57, Sutures in Wounds of the Bladder. 58, Paracentesis
+Thoracis. 59, Stricture of the Oesophagus. 60, Wound of the Brain. 61,
+Luxation of the Metatarsus; the history drawn up by M. Dusol, D. M.
+
+MIDWIFERY,                                                             438
+
+62, Uterine Haemorrhage. 63, Polypi of the Uterus. 64, Caesarian
+Section. 65, Case of Difficult Parturition. 66, Case of the Pelvis becoming
+enlarged.
+
+CHEMISTRY AND PHARMACY,                                                440
+
+67, L'Artigue's Process of preparing the Watery Extract of Opium. 68,
+Berzelius' Method of Detecting Arsenic in the bodies of Persons poisoned
+by it. 69, Action of Certain Metallic Substances on the Animal Economy.
+
+
+QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS,                    444-48
+
+
+
+
+CONTENTS
+
+
+ORIGINAL COMMUNICATIONS.
+
+                                                                      PAGE
+
+ART. I. Description of the Gangrenous Ulcer of the Mouths
+of Children. By B. H. Coates, M. D. one of the
+Physicians to the Philadelphia Children's Asylum,
+&c.                                                                      1
+
+II. Case of Purpura in an Infant, attended with extraordinary
+Symptoms. By R. M. Huston, M. D.                                        24
+
+III. History of the Natural and Modified Small-pox, or
+of the Variolous and Varioloid Diseases, as they
+prevailed in Philadelphia in the years 1823 and
+1824. By John K. Mitchell, M. D., and John
+Bell, M. D., attending Physicians at the then
+Small-pox Hospital.--With a plate.                                      27
+
+IV. Remarks on the Pathology and Treatment of Yellow
+Fever. Arranged from the Notes of Dr. J.
+A. Monges, of Philadelphia.                                             53
+
+V. Remarks on the Prophylactic Treatment of Cholera
+Infantum. By Joseph Parrish, M. D., one of the
+Surgeons to the Pennsylvania Hospital.                                  68
+
+VI. Case of Neuralgia, cured by Acupuncturation.
+Communicated by J. Hunter Ewing, M. D.                                  77
+
+
+ANALYTICAL REVIEWS.
+
+VII. Researches into the Nature and Treatment of
+Dropsy in the Brain, Chest, Abdomen, Ovarium,
+and Skin. By Joseph Ayre, M. D., &c.                                    79
+
+VIII. An Essay on Venereal Diseases, and the Uses and
+Abuses of Mercury in their Treatment. By
+Richard Carmichael, M. R. I. A., with Practical
+Notes, &c. by G. Emerson, M. D.                                        109
+
+IX. Remarks on some means employed to destroy
+Taenia, and expel them from the Human Body.
+By Louis Frank, M. D., Privy Counsellor of her
+Majesty, Maria Louisa, Duchess of Parma.                               114
+
+X. Researches Physiological and Pathological, instituted
+principally with a View to the Improvement
+of Medical and Surgical Practice. By James
+Blundell, M. D., Lecturer on Physiology and
+Midwifery, at the United Hospitals of St. Thomas
+and Guy.                                                               119
+
+XI. An Inquiry into the Nature and Treatment of Diabetes,
+Calculus, and other Affections of the Urinary
+Organs. By William Prout, M.D. F.R.S.
+With Notes and Additions, by S. Colhoun, M. D.                         125
+
+
+MEDICAL LITERATURE.
+
+XII. Retrospective Review.--Tractatus de Ventriculo
+et Intestinis, cui praemittitur alius, de Partibus
+continentibus in Genere, et in Specie de iis Abdominis.
+Authore Francisco Glissonio. Lond.
+1677, 4to.                                                             138
+
+
+QUARTERLY SUMMARY OF MEDICAL AND SURGICAL
+INTELLIGENCE.
+
+I. Anatomy.                                                            155
+
+II. Physiology.                                                        158
+
+III. Pathology.                                                        161
+
+IV. Therapeutics, Materia Medica, and the Practice of Medicine.        166
+
+V. Surgery.                                                            192
+
+VI. Midwifery.                                                         205
+
+VII. Chemistry and Pharmacy.                                           208
+
+QUARTERLY LIST OF AMERICAN MEDICAL PUBLICATIONS.                       214
+
+FOOTNOTES:
+
+
+
+
+THE
+
+NORTH AMERICAN
+
+Medical and Surgical Journal.
+
+JULY, 1826.
+
+
+ORIGINAL COMMUNICATIONS.
+
+FOOTNOTES:
+
+
+
+
+ARTICLE I.--_Description of the Gangrenous Ulcer of the Mouths of
+Children._ By B. H. Coates, M. D. one of the Physicians to the
+Philadelphia Children's Asylum, &c.
+
+
+Having had opportunities of witnessing the ravages and unmanageable
+character of this destructive disease, I have long and deeply felt the
+want of some written account, both of the malady, and of a proper mode
+of treatment. Some research and observation, made in consequence of this
+feeling, have terminated in the acquisition of more fixed ideas, and of
+a practice hitherto successful. This convinced me, that it became my
+duty to lay the result of these inquiries before the public, for the
+benefit of others. There is, perhaps, no stronger and more peculiar
+reason for wishing American physicians to write, than the opportunities
+they possess, of describing and recording many important varieties of
+morbid affection, which were either unknown to our predecessors, or the
+descriptions of which, uncombined and uncompared, are only to be found
+by searching among the more neglected tomes of a public library. Of
+this, the present case will afford a fair example; as well as an
+instance of an American physician, who had described the disease from
+nature, having, from want of encouragement, false modesty, or some other
+cause, kept it back from publication.
+
+Ever since the establishment of the Children's Asylum, under the care
+of a committee of the guardians of the poor, of the city and liberties
+of Philadelphia, in the spring of 1819, this useful institution has been
+annually visited by the new and distressing scourge of which we are
+treating. It has here prevailed in a considerable number of cases,
+forming the principal source of anxiety and trouble during the winter
+season, and annually sweeping off its little victims, in a manner
+rendered peculiarly awful by its insidious approach, its loathsome
+effects, and its apparently uncontrollable progress. Various scattered
+cases of a similar affection have come within my knowledge, during the
+last few years; occurring in the practice of several physicians, as well
+as in my own. In no place, however, near Philadelphia, other than the
+above, has there existed, so far as I know, a sufficient number of cases
+at the same time, to enable a physician to examine it in much detail, or
+to make comparative trials of different modes of treatment, so as
+clearly to determine the most successful.
+
+_References to Authors._--The notices of this complaint given by
+authors, to which I have been enabled to refer, are few, and generally
+too scanty to supply much means of forming a satisfactory judgment, or a
+practice in which confidence can be reposed. They consist, principally,
+of the mere mention of an affection resembling that of which we treat;
+and, in some instances, it is even doubtful whether they are describing
+the same disease. No notice is taken of this affection in any of our
+common books; with the exception of the last edition of COOPER'S
+Surgical Dictionary,[1] and of UNDERWOOD'S work on diseases of children.
+It is there described under the erroneous title of _cancrum oris_. A
+reference is given to PEARSON'S Surgery; and the article in the
+Dictionary is taken exclusively from that work. As this is the only
+authority with which I am acquainted, that gives a tolerably full
+account of a disease somewhat similar to that of which we are treating,
+I have concluded to extract the whole passage, in the words of the
+author.
+
+"The canker of the mouth is a deep, foul, irregular, foetid ulcer,
+with jagged edges, which appears upon the inside of the lips and cheeks;
+and is attended with a copious flow of diseased saliva.
+
+"This disease is seldom seen in adults; but it most commonly attacks
+children, from the age of 18 months, to that of 6 or 7 years. When the
+ulceration begins at the inner part of the lip, it exhibits a deep,
+narrow, sulcated appearance, and quickly spreads along the inside of the
+cheek; which becomes hard, and tumefied externally. The gums are very
+frequently interested in this complaint, and, in such cases, the teeth
+are generally found in a loose and diseased state; matter is often found
+in their sockets, and abscesses sometimes burst externally through the
+cheek, the lip, or a little below the maxilla inferior: and it is not
+uncommon to see an exfoliation of the alveolar processes, or even of the
+greater part of the lower jaw. Among the children of poor people, where
+this disease is neglected or mismanaged at the beginning, a dreadful
+gangrene will sometimes supervene.
+
+"The remote causes that give origin to this disease are not very
+obvious. I think it occurs most frequently among children that live in a
+marshy situation; that are sustained by unwholesome food; and where a
+due attention to cleanliness has been wanting. The cancrum oris has been
+described by some writers, as a complaint very common in England and
+Ireland, where it is sometimes epidemical among infants. It, however, is
+commonly seen in other kingdoms, and prevails more especially in those
+houses where a great number of children are crowded together. I am not
+able to determine whether it is or is not contagious.
+
+"But adults are not wholly exempted from this morbid affection, and it
+is not easy in all cases, to distinguish the cancrum oris from a
+cancerous or venereal ulcer in the mouth; since the uvula, tonsils or
+fauces may be the seat of each disease. I have seen ulcerations on the
+uvula and tonsils, with all the marks of a venereal sore, in patients
+where the presence of such a virus could not be suspected; and by
+treating them as canker of the mouth, they have been speedily cured.
+
+"The canker of the mouth ought to be distinguished from aphthae, the
+epulis and parulis, scurvy, cancerous ulcers, venereal ulcers and
+exulceration from the use of mercury.
+
+"_The mode of treatment._--It will be proper,
+
+"1. To remove the diseased teeth, bone, &c. if possible.
+
+"2. To prescribe a milk and vegetable diet, and to allow a prudent use
+of fermented liquors.
+
+"3. It will be adviseable to exhibit such remedies as, Peruvian bark;
+sarsaparilla; elm bark; mineral acids.
+
+"The external applications that I have generally found successful have
+consisted of such as the following:
+
+"_Preparations of copper_; a diluted mineral acid; burnt alum; decoction
+of bark with white vitriol; tincture of myrrh, &c."[2]
+
+Of the above articles, those which we have indicated by italics are
+omitted in the last edition of COOPER'S Dictionary; and, in a former
+one, they are directly prohibited with strong reprobation. Nevertheless,
+it is among these that we have found, beyond comparison, the most
+successful one.
+
+Mr. PEARSON prefixes to the preceding article a list of synonymes, with
+references to authors, in the manner of writers on natural history. They
+are as follow: _Aphthae Serpentes._--SENNERTUS; Medicina Practica.
+_Labrosulcium, seu Cheilocace._--ARNOLDUS BOOTIUS. _Oris
+Cancrum._--MUYS. STALPAART VANDER WIEL. _Gangraena Oris._--VAN SWEITEN.
+_Gangrene scorbutique des Gencives._--Auctores Gallici.
+
+Of these, SENNERTUS[3] merely mentions, under the article aphthae, that
+the latter sometimes spread around the fraenum and tongue, occasionally
+corroding the subjacent parts. He is so far from giving a clear
+description, under the head of Aphthae Serpentes, of any affection
+analogous to that we are about to record, that he quotes GALEN as
+remarking, very properly, that these are not aphthae at all, but putrid
+ulcers.
+
+ARNOLD BOOTIUS, in his little treatise "de morbis omissis," of diseases
+omitted in the books, published in London, in 1649,[4] gives, from his
+own observation, an account of a disease, to which he applies the names
+above attributed to him. It differs from the cases which have attracted
+our attention, chiefly in its situation. He describes it as an ulcer,
+soon becoming black and foetid, corroding the inside of both lips,
+separating them widely from the gums and allowing them to fall outwards
+upon the face; thus producing a horrible deformity. Besides this, the
+author states, that a deep fissure usually extended down each half of
+the inside of each lip; thus adding four deep and ghastly ramifications
+to the ulcer. This shocking affection is stated to have prevailed
+extensively, both in England and Ireland; in which latter country the
+author practised and held several important offices. It occasionally
+became epidemic, and then destroyed great numbers of children. It
+principally prevailed between 2 and 4 years of age; though it was
+occasionally met with both earlier and later in life. It was frequently,
+but not always, accompanied with aphthae.
+
+This disease was, in general, successfully treated by our author, with a
+decoction of "Chaerephyllum, Quinquefolium, Myrrhis, Rosae et Salvia;" in
+which was dissolved a "sat magna copia" of white vitriol.--A combination
+about as precise as some of the prescriptions which have been
+recommended to me, for the present disease, in this country. With this
+mixture, he touched the ulcers several times a day; and then washed them
+with a liniment of acetate of lead, aqua plantaginis, and oleum
+rosaceum. He also used _issues_ in both arms; and confined the patient,
+in more obstinate cases, for drink, to a decoction of sarsaparilla,
+china, and several other articles, which we will spare our readers. To
+this disease, BOOTIUS devotes about five small 18mo. pages, forming his
+tenth chapter.
+
+VANDER WIEL cites BOOTIUS, and expresses his belief, that the disease
+described by the latter was identical with one which he saw himself.
+This last, however, though described in a cursory manner, appears to
+resemble much more nearly the disease of the Children's Asylum;
+beginning in the gums, and extending to the adjacent parts. He treats it
+by the following lotion:
+
+     R. Mel. Rosar.        [Symbol: ounce]i
+        ---- Aegyptiaci,   [Symbol: dram]ij
+        Olei Vitrioli,     gtt. _aliquot._
+                                misce.
+
+Under this treatment, and by removing the teeth, when loose, the small
+number of cases he saw recovered in a few days.
+
+VANDER WIEL was a practitioner in Holland; and, though he does not
+specify the fact, his cases were probably in a marshy country.[5]
+
+MUYS, in a little treatise entitled "Chirurgia Rationalis,"[6] published
+in 1684, has an account of a disease, which is evidently supposed by
+PEARSON to be that which he describes. This also, however, appears to
+have been a "labrosulcium;" an ulcer between the lips and the incisor
+teeth. There is but little to be gathered from his paper; as it is
+principally occupied with an attempt to prove, that this ulcer is owing
+to an accumulation of _acidity_ in the blood, increased, at this point,
+by the putrescence of particles of food which collect there. He
+illustrates this doctrine by an examination of a _burnt rag_ under a
+microscope; and this he considers as in a state analogous to the
+gangrene. "Opinionum commenta delet dies," &c. We give his treatment;
+which is aimed at acidity.
+
+     R. Theriaci,               [Symbol: dram]ijss
+     Ung. Egypt.                [Symbol: dram]iss
+     Gum. Laccae, et
+     Spirit. Sal. _Armon._ aa   [Symbol: scruple]ij
+     ---- Cochleariae,          [Symbol: dram]ij
+                                  _m._ ft. ung.
+
+To be softened with a little alcohol, the part washed with the mixture
+six times a day, and a rag moistened with the same compound left in the
+ulcer. Here we take leave of the Chirurgia _Rationalis_.
+
+In the 14th volume of the Memoirs of the French Royal Academy of
+Surgery, are papers containing accounts of two cases, which have some
+points in common with the disease of which we treat; but the identity of
+at least one of which it is hard to establish. The first piece is
+entitled, "_Sur la gangrene scorbutique des gencives dans les enfans.
+Par feu M. Berthe._"[7] The author is described, in a note, as a young
+surgeon of great promise, who was carried off by an early death. M.
+BERTHE commences by quoting FABRICIUS HILDANUS; who describes a gangrene
+of the gums, occuring principally at about 4 years of age, and of which
+all the patients died. FABRICIUS takes the occasion to give a caution to
+young surgeons, to avoid being too sanguine in predicting recovery from
+gangrenes. Next a case is given us, drawn from M. SAVIARD, in which
+death was the result. This author seems, subsequently, to have had
+somewhat better success, but at the expense of horrible disfigurements;
+such as great holes through the cheek, and the loss of a large piece of
+the jaw; which, indeed, are described as having been worse than death.
+In another case, recorded by M. POUPART, in the "Histoire de l'Academie
+des Sciences," this affection terminated in death; preceded, however,
+and in the opinion of the author, caused, by the production of two
+tumours, one by the side of the tongue, the other inside of the cheek.
+This is not at all unlike the progress, which will be hereafter
+mentioned to have taken place in many of the Asylum cases.
+
+M. BERTHE then remarks, that the greater number of instances of gangrene
+of the gums had terminated unfavourably.
+
+His own patient was ill from April to September, 1753; and exhibited
+swelled and bleeding gums, frequently projecting beyond the
+teeth,--black and foetid stools, foetid urine, and ecchymoses over
+the surface of the body. He treated it with antiscorbutics, internally
+and externally, and apparently with success. The patient, however,
+relapsed in January, 1754; when M. BERTHE proceeded to a very different,
+and far more severe treatment. The gums were pared away, in many
+successive operations; and the wounds were washed with aluminous water.
+A roll of linen was, during the intervals, kept fastened in the
+patient's mouth, for the purpose of allowing the escape of the fluids of
+the part; which he apprehended to possess a putrid character, and to
+aggravate the original disease, whenever they passed into the stomach.
+At length, his patient recovered, and continued well.
+
+It appears to the writer of these notes to be hardly necessary to state,
+that M. BERTHE evidently mistook the disease; the latter being in
+reality scorbutic, and not a single symptom of gangrene being described
+during its whole history.
+
+The same, however, cannot be said of M. CAPDEVILLE; whose "_Observations
+sur les effets rapides de la pourriture des gencives_" appear in the
+same volume with the foregoing, and immediately subsequent to it.[8]
+This writer's case took place after a fever, and no tumefaction of the
+gums nor ecchymoses of the skin are mentioned as occurring in it. M.
+CAPDEVILLE attended this case in consultation, in 1764; and complains of
+too feeble means being employed, as the case was trusted to
+antiscorbutics. This treatment ended in death. M. C. refers to VAN
+SWEITEN, whose correct account we shall mention; and it is evident that
+it was the disease of the Children's Asylum: though he manifests a
+strong propensity to connect it with scorbutus, and the "blanchet," or a
+species of aphthae, which destroyed a great number of children in the
+Foundling Hospital, in 1746. Reference is also made to cases which
+occurred in "La Pitie," under the care of CHOPART. Of these, a very
+scanty account is given. They terminated in death; after a treatment by
+lotions of honey of roses and spirit of vitriol, with emollient and
+resolvent cataplasms.
+
+VAN SWEITEN, in the article devoted to the consideration of gangrene,[9]
+has left us a far more exact description of the disease, into which we
+are inquiring. Practising in a marshy country, he had frequent
+opportunities of meeting with it; and his account of it, and his mode of
+treatment, though brief, are every way worthy of the close, practical
+inquirer into nature, and the sound medical philosopher. His description
+is not unmixed with strong expressions of horror and commiseration at
+its ravages. He describes it in a manner so similar to that in which it
+now prevails, that no doubt can exist of the identity of the diseases.
+He acknowledges, however, "rubedo, calor, dolor," among its symptoms.
+Cochlearia, theriaca and similar articles, according to him, are almost
+always injurious. If no foetor exist, (and, of coarse, no actual
+mortification,) he applies a solution of sal ammoniac or nitre, with
+some vinegar or lemon juice; sometimes as a lotion, sometimes by keeping
+a rag imbued with it always in the ulcer. Hard rubbing he reprobates. If
+the disease have made progress, and foetor exist, muriatic acid is
+used: in the less aggravated stages, diluted with honey of roses and
+water; in the worst cases, pure. This practice he states never to have
+failed him, unless where the bone was affected.
+
+In an early edition of Dr. UNDERWOOD'S Treatise on Diseases of Children,
+in the library of the Pennsylvania Hospital, no mention is made of this
+disease; although an article is devoted to "_gangrenous erosion of the
+cheek_." The account is wholly borrowed from a work by Mr. DEASE, of
+Dublin, "on the diseases of lying-in women," &c. also in the library.
+Mr. DEASE describes this affection as occurring from 2 to 6 or 8 years
+of age; especially in unhealthy children, including such as have been
+subject to worms. The whole body often appeared cold upon the approach
+of the disease. A black spot then occurred, but _without marks of
+inflammation_, on one of the cheeks or lips. The whole cheek was
+sometimes destroyed, and the lower jaw fell down upon the breast.
+Muriatic acid, infusion of roses, the effervescing draught, and, in the
+decline of the disease, bark, broths, jellies, and wine, besides
+magnesia or rhubarb, to remove the putrid matters swallowed, were the
+internal remedies employed. The parts were washed and injected with
+muriatic acid, diluted with chamomile or sage tea; and afterwards
+dressed with the acid, mixed with honey of roses, and, over this, a
+carrot poultice. By this practice, Mr. DEASE lays claim to almost total
+success.
+
+In the Philadelphia republication of Dr. UNDERWOOD'S book, taken from
+the sixth London edition, there is an article entitled Cancrum Oris. The
+author appears to have read PEARSON'S account; but as his description
+does not at all agree with the disease of which we are treating, nor
+with that of Mr. PEARSON, we shall not stop longer to analyse it.
+
+I have no doubt, from views that will be hereafter developed, that many
+of the above writers have had cases similar to those which we are about
+to describe; but have mistaken them, from the want of a sufficiently
+early and close inspection of the ulcers. In the second stage, this
+disease much resembles an inflamed sore between the lips and gums,
+extending to the latter; although I hope to prove that this state of
+things is secondary.
+
+_Locality of the Disease._--The Philadelphia Children's Asylum is
+situated in South Fifth street, between Prime and Federal streets, in
+the district of Southwark. The soil is what is called alluvial, or
+rather diluvial; as is well known to be the case with all that district,
+lying south of Philadelphia, as well as the southern part of the city
+itself. The house was built, and for many years occupied, as a mansion,
+by the head of a most respectable and wealthy family. Its situation
+possesses some of the qualities usually selected in choosing the site of
+a country seat. The buildings stand on a swell of ground, leaving an
+open lawn, now interrupted by several unoccupied streets, and extending,
+on the right hand, to the banks of the Delaware, and, on the left, to
+the Navy Yard and part of the suburb of Southwark. Towards the north,
+it is not far from the edge of a thickly built appendage of the city.
+
+The district immediately south of the Asylum is marshy, and has long
+been noted for the prevalence of intermittent fevers; but the slightly
+elevated site of the building had been generally healthy, and continued
+so, till the universal and distressing epidemic, which infested all the
+outskirts of Philadelphia, in 1822 and 1823. Even at this period, the
+persons resident at the Asylum, were far from suffering so severely as
+the adjacent neighbourhood; and, since those years, it has again become,
+in general, tolerably healthy. In 1819, 1820, 1821, and 1822, a lot,
+situated at a short distance, on which were deposited the contents of a
+number of privies, proved a source of great inconvenience, and some
+disease, at the Asylum. This focus of effluvia, together with the
+general and copious use of similar materials in manuring the adjacent
+fields, occasioned an intolerable stench, and generated diarrhoeas, in
+the early part of the spring. When the grass and weeds, however, were
+grown sufficiently to protect the surface of the soil from the sun and
+wind, this effect entirely ceased; and I know not that any other
+inconvenience was experienced from the same source, unless we attribute
+to this, as may fairly be done, the destruction of the purity of the
+well. This formerly afforded very good water; and, since that period, it
+has much improved. When the corporations of Southwark and Moyamensing
+shall introduce, as it is to be hoped they will, the Fairmount water
+into their streets, one remaining cause of inconvenience and ill health,
+will be removed from the Children's Asylum.
+
+_Prevalent Diseases._--Ophthalmias and furuncular eruptions, the latter
+principally on the face, are epidemic every year; generally in the
+spring and early summer months. When prevalent in the city, the measles,
+small pox, and varioloid disease have reached the Asylum; the scarlatina
+has, at no period, I believe, been peculiarly troublesome there.
+Intermittents, which were anticipated by many, from the nature of the
+situation, have seldom, if ever, prevailed in the house, to any very
+considerable extent. One of the worst visitations which it has
+experienced, in this respect, was in the autumn of 1823. In many cases,
+it was in patients who had been labouring under disease of this
+description, that the ulcer we are about to describe exhibited itself;
+but it was by no means confined to those who were known to have so
+suffered. Many, perhaps, most of the children affected, were free from
+any apparent ailment; although it is by no means impossible that the
+little, uncomplaining subjects were, at the time, labouring under what
+has been called "febricula" or "inward fever."
+
+_Regimen._--To the impurity of the water we have already adverted. The
+diet of the children furnishes them with meat every day, with the
+exception, during a part of the existence of the institution, of two
+days in every week. Molasses was freely used; indian mush was greatly in
+demand; and the breakfast and supper were of bread and milk. During the
+summer months, this diet was abundantly nourishing; but in winter, it
+was thought that an additional quantity of animal food was desirable;
+and, accordingly, it was, during the two last winters, given every day.
+
+_Description of the Disease._--The ulcer of which we speak, may begin in
+many parts of the mouth. In by far the greater number of cases, however,
+it commences immediately at the edges of the gums, in contact with the
+necks of the teeth, and, most generally, of the two lower incisors. A
+separation is found here; which exhibits a slight loss of substance at
+the extreme edge of the gums, and, as far as I have observed, a
+whitishness of the diseased surface. In some instances, though not very
+frequently, this is preceded by a slight swelling and redness. In this
+state, the disease may continue for a long time; and I have reason to
+believe, that patients have remained thus affected, during the whole
+period of three months, for which I attended the Asylum. At one time,
+when the disease was at its height, threatening several patients with
+destruction, I found upwards of 70 children, out of a population
+amounting to about 240, more or less affected with these ulcerations. No
+remarkable change is at this stage observable in the functions of the
+little sufferer; except a general air of languor and weakness. The
+appetite and the muscular activity continue, but are somewhat reduced;
+not sufficiently, however, to disable the child from attending school,
+taking the air, or continuing his ordinary practices. In this state, no
+symptoms of irritation have been at all discovered. The skin is cool
+during the day, no pain is complained of; and no account has ever been
+given me of any nocturnal paroxysm of fever. It would appear to be
+purely a state of asthenia. We are, however, by no means certain, that
+there was no concealed irritation in the system. We were, of necessity,
+obliged to depend, in a great measure, upon the reports of nurses, and
+other females; and these were liable to overlook, or mistake for mere
+weakness, the signs of an obscure disease. In this manner, commencing
+cases were frequently not discovered, and nothing was done, till the
+affection had made further progress; and this continued until the
+ascertained existence of the epidemic in the house, combined with the
+recollection of its former ravages, had excited an alarm, which led to
+the inspection of the mouths of all the children in the institution.
+
+The disease, in this form, must be within the curative powers of nature;
+as, if this were not the case, we should hear of more numerous
+unfavourable terminations. It has seldom, however, if at all, been
+within my power to witness this tendency; and, when not controlled by a
+particular treatment, the cases have almost always either remained
+stationary, or increased in severity. Its first progress is, most
+generally, by extending to the edges of the gums round other teeth;
+frequently affecting a large portion of the dental arches. A very early
+progress is, however, mostly effected, down the length of the tooth, in
+the direction of the socket; and, in this way, the disease commits great
+and unsuspected ravages. When it reaches the edges of the bony socket,
+the tooth begins to be loose, and when drawn, exhibits portions of the
+fang, including parts which had been contained within the alveolus,
+entirely denuded of their periosteum. Indeed, from observation, I should
+say, that the latter membrane was the part, which was the most
+peculiarly liable to injury and death from this disease; and it is by no
+means clear, to my apprehension, that this is not frequently the
+commencement of the complaint. The injury generally proceeds with
+augmenting rapidity; especially when it has affected the deeper parts:
+and it is while in the act of rapidly spreading, that it occasions
+gangrene.
+
+In the production of gangrenous sloughs, it much resembles the
+descriptions usually given of sloughing ulcers. A portion of the parts
+immediately subjacent to the ulcer loses its life; this rapidly
+separates; and, before or after a complete removal, a fresh slough is
+formed in the same manner. The sloughs are generally black, with
+ash-coloured edges. I have not been able to discern a change of colour,
+the production of vesicles, or any material tumefaction, as antecedent
+to the gangrene. There is generally, by this time, an increased heat in
+the parts; with the sensation termed "calor mordens." The discharge now,
+for the first time, becomes acrimonious; giving pain when it comes in
+contact with cuts in the finger; and excoriations are produced on all
+parts in contact with the sloughing ulcerations; as the lips, the
+cheeks, the tongue, and the adjoining surface of the part where the
+ulcer is situated.
+
+As soon as the external gangrene has reached the level of the edge of
+the bony socket, and frequently much sooner, the adjacent portion of the
+latter is found deprived of its life; forming a necrosis. The death of
+the periosteum in the socket, at least that of the fang of the tooth,
+precedes, by some interval of time, that of any portion of the bone
+itself.
+
+When gangrene is formed, a fever of irritation is generally developed.
+In regard to the time at which this takes place, there is a great
+diversity in different constitutions. It has appeared to me to depend,
+principally, upon the inflammation of the mouth, which is secondary to
+the original disease, and, in most cases, to arise from the acrimony of
+the discharge. It is aggravated by loss of rest, want of nourishment,
+and, probably, by putrid matter finding its way into the stomach. To the
+latter cause I also refer a diarrhoea, which almost uniformly comes
+on, towards the close.
+
+There are accounts of a similar disease having begun on the inside of
+the cheeks. I have, however, never seen a well-marked instance of this;
+the cases which were supposed to be such having, in every instance, been
+also found to exhibit ulcerations at the edges of the gums. That the
+disease spreads from the gums to the cheek, is a fact which have often
+seen exemplified. It is, indeed, the most usual termination of bad
+cases. After producing gangrene and necrosis in the gums and alveoli,
+and after the discharge becomes, as above stated, acrimonious, a
+gangrenous spot is not unfrequently found about the opening of the
+Stenonian duct, on the inside of the upper or lower lip, opposite the
+incisors, in some other part of the inside of the lip or cheek, or in
+more than one of these situations at the same time. Whether this be
+owing to excoriation from the discharge, or to some other cause, I
+cannot say; it has, however, in every instance which I have seen
+sufficiently early to witness its rise, been subsequent to the symptoms
+previously described.
+
+When the gangrene reaches the cheek or lip, however, very active
+inflammatory symptoms are uniformly developed. In the cellular substance
+of these parts, they assume the well known characters which have been
+attributed to the _phlegmonous_ species. We have a great thickening,
+forming, in the cheek, a large, rounded, prominent tumour, with great
+heat and pain. Sometimes redness is perceived externally; but, more
+frequently, the great distension of the skin of the cheek seems to empty
+the cutaneous vessels; giving to the part, a smooth, polished, dense,
+white appearance, very much resembling the effect of a violent
+salivation. I have no doubt that this is the tumour described by
+POUPART, and alluded to in an earlier part of this paper. Great
+thickness and hardness have always occurred, in the other situations
+where this gangrene has approached the external cellular masses of the
+face; in the lip, however, they are less remarkable, perhaps from the
+smaller amount of cellular matter. After reaching this stage, a black
+spot is frequently seen on the outer surface of the swelling. This
+spreads rapidly; and has always been, in my own experience, the
+immediate harbinger of death. It is proper to state, however, that I
+have heard it said, that cases had recovered in this city, in which the
+gangrene had produced a hole through the cheek. Under what physician's
+care this occurred, I have never learned.
+
+In two cases it commenced in the fauces; and was marked by the same
+unsuspected progress. In one of these, the little patient was remarked
+to be languid, but had no positive external marks of disease. The mouth
+was examined, and found healthy; but no suspicion of the real situation
+of the disease was entertained, till after 3 or 4 days more, when he
+complained of a slight sore throat. A large gangrene of the tonsils,
+half-arches and pharynx, was now found; and the event need hardly be
+told.
+
+The closing stage of this affection is marked by large gangrenous
+patches in the gums; deep fissures between these and the teeth; the
+latter loose, or falling out; large pieces of the alveolar processes,
+often containing the roots of several teeth, in a state of entire
+necrosis; the whole lining membrane of the mouth suffering a violent
+excoriation; the whole adjacent external cellular substance, hard and
+swelled; large gangrenous spots in the inside of the cheek or lips,
+occasionally extending quite through to the outer surface; a total
+incapability to sleep, or to take the least food; fever; a swelled
+abdomen, and diarrhoea.
+
+_Dissection._--The inspection of the body after death had never thrown
+much light upon this obscure affection. Since I began to prepare
+materials for this paper, I have been able to dissect but one subject.
+The appearances were as follow:
+
+_Exterior_, emaciated.
+
+_Alimentary canal_, externally and internally, altogether in a natural
+state, except what appeared to me to be owing to the subsidence of blood
+to depending portions of the intestines. The mucous membrane was
+carefully examined throughout its whole length; but not being at that
+time aware of the importance, attached, by some pathologists, to small
+rednesses in this organ, it is highly probable that some such may have
+been overlooked.
+
+_Liver and Spleen_, enlarged, but of a natural appearance.
+
+_Heart, thoracic oesophagus, and one kidney_, (the other not
+examined,) natural.
+
+_Lungs_, containing much mucus in the bronchial cavities. The fore part
+of their substance contained much hepatization.
+
+_Pathology._--The nature and production of this disease are certainly
+very obscure. We may, however, as in other branches of knowledge,
+attempt to develop and record what knowledge we possess respecting it;
+carefully separating truth and reason from conjecture. We have already
+said, that its access was very frequently preceded by no marks of
+visible disease, or at least none that attracted attention. The little
+subjects were, apparently, in merely a drooping or enfeebled state. In
+other instances, the ulceration followed a common remittent or
+intermittent fever; insomuch that, at one time, whenever a child was
+brought to the nursery for fever, it was expected, as a matter of
+course, that his mouth would become sore. In the other cases, as we have
+already had occasion to say, it is quite possible that a concealed
+"inward fever" may have existed; and this is rendered the more probable,
+by the circumstance of their losing their appetites. In the instance
+where the body was opened, we have seen that the original disease was
+hepatization of the lungs; and yet it is quite probable, that this
+affection had caused, as it often does, that species of disease, which
+a rapidly spreading pathology refers to a slow inflammation of the
+stomach and intestines. With regard to marks of this last not having
+been detected by me, it is evident that I am in the same situation with
+a very numerous body of other observers.
+
+The local appearances, at the commencement, did not appear to be of an
+_inflammatory_ nature, at least generally. If the gums were really the
+first part affected, it was not so; as these parts when inflamed, as
+they frequently are in affections of the teeth, exhibit decided
+soreness, pain, swelling, and an increase of redness. The ulcerated part
+was, in about nine cases out of ten, paler than natural; and then
+neither soreness nor increased heat was perceptible, except in a few
+cases, in which the mouth was generally hotter than natural, though it
+was not, in a striking manner, referrible to the gums. In a few cases,
+distinct redness, and a slight swelling, were perceptible round the
+ulcer. These patients generally did better than the others.
+
+If, on the other hand, we suppose the original derangement to have taken
+place in the periosteum, we shall be enabled, more easily, to explain
+some of the phenomena. We then reason thus: The whole of the body had
+shrunk considerably, from disease, and, the circulation being deprived
+of a part of its usual vigour, the periosteum, a part possessed of
+little vitality, was unable to bear the additional extension, which it
+underwent, across the unyielding bone of the tooth. The blood ceased to
+circulate in it, and it died. Ulceration of the adjacent parts followed,
+as a matter of course; and these parts, especially the periosteum, being
+possessed of but little sensibility, the sympathies of the other parts
+of the system were but little interested, until an extensive portion of
+the mucous membrane of the mouth, or a mass of cellular substance,
+became affected. We certainly see that, in every case but two, the
+disease commenced in contact with the teeth. This doctrine will also
+explain the rapid and deep penetration of the ulcer along the roots of
+the teeth; and the destruction of the bone. We may recur to the
+statement, that a portion of the fang of every loose tooth was always
+found deprived of its periosteum.
+
+In the two cases excepted, we have seen it apparently begin in the
+mucous membrane of the fauces; and indeed the manner in which it
+generally spreads from the gums to the cheek and lips, seems to me,
+unquestionably, to indicate a greater liability than common to gangrene
+in more than one part of the mouth.
+
+The soreness and pain of the socket, which forms a part of most
+tooth-achs, might have been reasonably expected here; but neither was
+ever complained of, even when the teeth were loosening: and, as no fever
+existed at this time, the original irritation can hardly be considered
+as inflammatory; excepting perhaps the cases which exhibited redness,
+and slight swelling of the gums.
+
+_Is this disease scorbutic?_--I never observed ecchymoses, nor in more
+than a single instance any the minutest red specks upon the cutis, which
+might be thought to resemble petechiae. The patients never fainted; the
+gums were never spongy, nor did they bleed more than those of any other
+child would have bled, under an equal degree of violence. I however
+requested my friend, Dr. HARRIS, who has had ample opportunities of
+making himself acquainted with scorbutus, to see some patients with me.
+He complied, with his usual kindness, and pronounced their disease not
+at all to resemble the scurvy.
+
+_The teeth._--But few cases occurred during the second dentition; and it
+is doubtful whether any one took place during the first. It should be
+remarked, however, that children under 2 years, were not admitted to the
+institution, unless by deception on the part of the parents. No child
+ever lost a tooth of the second set; and, indeed, the second dentition
+seemed often to cure the complaint. The greater number of cases occurred
+between 2 and 5 years of age, but some as late as 8 or 10. In several
+instances, the ulcer destroyed a portion of the enamel capsule; and the
+teeth were then cut, with _very perfect enamel_ upon the lower part,
+while the bone was entirely bare at the ulcerated portion of the
+capsule. This singular fact proves that no inflammation of the capsule,
+sufficient to interrupt the function of its remaining portion, took
+place in consequence of the opening of its cavity.
+
+_Prevalence of this disease in our own country._--Many elderly persons
+remember during different periods of their lives, a tradition and
+particular instances of a formidable disease of the mouth, by the name
+of "Black Canker."[10] Round Philadelphia, it appears to have been
+rare. Having been informed by a friend, that the disease had prevailed
+extensively at Salem, New Jersey, under the notice of my friend, Dr.
+THEOPHILUS R. BEESLEY, I addressed a letter to that gentleman, to which
+he furnished me with an obliging and instructive reply, which I have
+unfortunately mislaid. Numerous cases have occurred, in that vicinity,
+within the last 30 years; and were, in general, successfully treated by
+the women. Cases seldom came under the view of physicians, until
+gangrene had commenced; and of these, many died: so that the old women
+were generally more in vogue for its cure, than the regular
+practitioners. Dr. BEESLEY, Dr. VANMETER, and my friend Dr. E. Q.
+KEASBEY, had met with much of this complaint; and the result of many of
+their observations had been combined in a thesis, written, but,
+according to our unfortunate custom, not published, by the younger Dr.
+VANMETER. It was there considered as a sequela of intermittent and slow
+remittent fevers, and seldom occurred but in marshy districts, and among
+the poor. It generally prevailed between the ages of 2 and 10 years. Of
+the remedies employed we shall again speak. Dr. SAMUEL TUCKER has also
+seen it in marshy situations near Burlington. I have heard of its
+existence on the Schuylkill. Dr. PARRISH has for several years noticed a
+stage of this complaint, under the name of "a disease resembling the
+effects of mercury," in his private lectures. Drs. PHYSICK, HARTSHORNE,
+HEWSON, MEIGS, WOOD, RHEA BARTON, and REMINGTON, and several others who
+will pardon me for omitting their names, have also met with cases.
+
+_Prevention._--Our precautionary measures should be directed to the
+predisposed or commencing state already described; to the prevention and
+cure of fevers, to the removal of "febricula," and other internal
+disorders, and to the general restoration of strength. Finally, its
+commencing stage should be watched, and promptly met; and success, I
+believe, will always attend our endeavours.
+
+At the Children's Asylum, all the weakly children were made to take
+bitters, of different descriptions; and Dr. SYLVESTER'S antiscorbutic
+drink, composed of cream of tartar and juniper berries, infused in
+water. As the disease declined in the house, under this administration
+of bitters, it is highly probable that they had a preventive agency. I
+much question, however, whether Dr. SYLVESTER'S drink was productive of
+any advantage.
+
+One question of some importance yet remains. _Has mercury any agency in
+producing this affection?_ The salivary glands have never been observed
+to be affected in it. Dr. PARRISH informs me, that, after a strict
+examination, he has come to the conclusion that the previous use of
+mercury does not bring on, or aggravate this complaint, as he has
+noticed it. I have made the same observation; and, not being peculiarly
+sparing of the use of calomel in fevers, have had opportunities to
+verify it. I think I can add, that, in some cases, by shortening and
+moderating an attack of fever, calomel has been useful in preventing the
+ulceration. Given during the progress of one, and that a fatal case, it
+did not appear to aggravate it.
+
+There is no evidence whatever tending to excite the suspicion of
+_contagion_.
+
+_Treatment._--A variety of remedies had been tried within my knowledge;
+most of them with but little success, and one or two with somewhat
+better. Feeling much disappointed with the results of my practice, in
+the small number of cases which fell under my care in the spring months
+at the Asylum, as well as elsewhere, I wished to exchange with another
+physician for a period when the disease was more prevalent; for the
+purpose of studying it, and making comparative trials of different
+remedies. Dr. JOS. G. NANCREDE was so polite as to indulge me. Having
+then a large number of patients under my care, I was enabled to make
+more extensive observations, and with more precision; the results of
+which course gave me the first satisfaction I had ever felt relative to
+this disease. Trials were made of every thing that was suggested by
+friends, and generally upon 4 or 5 selected patients at a time. Thus,
+choosing them in the ulcerative stage, and having several at a time
+before our eyes, the result was seen in a very few days, much sooner
+than if patients had been successively subjected to the remedies; and no
+material time was lost in appealing to the article which appeared to
+answer best.
+
+The remedy which beyond all comparison succeeded best, was sulphate of
+copper. The usefulness of this substance, though known at Salem, New
+Jersey, was discovered, at the Asylum, by the mistake of a nurse. It had
+been previously used, in lotions of the strength of gr. ij or iij to the
+ounce of water; and with little advantage. Observing that the empirical
+remedies said to have succeeded, were, as I considered them,
+immoderately strong, I furnished the nurse with a common solution of
+sulphate of copper, and with a vial containing 72 grains of the sulphate
+in an ounce of water, for the purpose of being progressively added to
+the other at different periods. This stronger solution was applied, by
+mistake, instead of the diluted one; and it was the first remedy which
+had produced a rapid tendency to a cure. I finally settled down, after
+various trials, in the employment of the following:
+
+     R. Sulph. Cupri,    [Symbol: dram]ij
+     Pulv. Cinchonae,    [Symbol: ounce]ss
+     Aquae,              [Symbol: ounce]iv _m._
+
+S. To be applied twice a day, very carefully, to the full extent of the
+ulcerations and excoriations.
+
+The cinchona here is not absolutely necessary; but operates by retaining
+the sulphate longer in contact with the edges of the gums.
+
+Simple ulcerations and small gangrenes, as well as the troublesome
+excoriation, when not in the last stage, yielded promptly to this
+remedy; the good effect being generally visible from the first
+application.
+
+Dr. FOX, my friend and fellow-labourer in the Asylum, had already taught
+me that it was important early to extract the teeth. I was not, however,
+sensible of the full extent of this rule, till after examining the fangs
+of some of them which were drawn. The separation of a portion of the
+periosteum from the fang, within the socket, which was universally found
+whenever the tooth was loose, among two or three hundred specimens,
+proved the existence of the disease in a deep, narrow crevice, into
+which it was impossible, by any contrivance, to insinuate the lotion.
+This cavity was laid open by extracting the tooth; and when the remedy
+was applied, the sanatory effect was surprisingly prompt. From this
+period, forwards, the universal rule was to extract all teeth, the
+moment they were discovered to be in the slightest degree loose; and
+"the blue wash" above described, became the standing remedy.
+
+It is at all times a dangerous boast for a physician to make, to say
+that, in the treatment of any complaint, he has always succeeded. He is
+frequently not credited; and he can never know at what moment disbelief
+may be borne out by his subsequent failures. A faithful adherence to
+fact, and justice to the medical art, oblige me to say that it was owing
+to the observation of these means, that I never had an opportunity of
+making a dissection, after the one mentioned in a preceding page.
+Upwards of 120 ulcerated gums came under my notice in the course of
+three months; of which 70 were affected at one time. Of these, by far
+the greater number would, unquestionably, have escaped gangrene. The
+experience of past winters, however, and that of the preceding autumn,
+justifies the belief that there would have been several gangrenous
+cases, and some deaths; unless interrupted by remedial means. Some 3 or
+4 suffered small spots of mortification, and one, by the delay arising
+from the tardy report of a nurse, suffered necrosis in a portion of an
+alveolus; but they were speedily arrested, and the production of more
+such cases, I believe, prevented, by the employment of the above means.
+
+I have been once, since then, called in consultation to a case in which
+this remedy failed; but this was only two days previous to death, and
+during the existence of swelled cheek, and of a thick gangrenous eschar,
+and it was in fact only once imperfectly applied.
+
+The farthest advanced of all the cases which I have seen, since that
+time, relieved by this remedy, was in the practice of my friend, Dr. R.
+M. HUSTON. He aided it by the application of a poultice with lead-water
+to the external surface of the cheek. This was thought to be productive
+of much relief.
+
+Great attention and care are requisite on the part of the physician, to
+see that every part of the ulceration and excoriation is made visible,
+and brought under the influence of the applications employed. Without
+this entire knowledge of the extent of the evil, the result will be
+failure. The disgusting sloughs and discharge, and the fear of an
+imaginary _contagion_, make the nurses very unwilling to introduce their
+fingers into the reluctant little patient's mouth, and without this
+scrutiny all is in vain. The physician is compelled to set the example,
+to try the looseness of the teeth with his own fingers, and to ensure
+the nurse's entire knowledge of the extent of the disease.
+
+Dr. BEESLEY writes that the women in his neighbourhood, frequently used
+considerable _roughness_ in applying the lotions. _Certainty_ is
+absolutely necessary.
+
+After the remedy had been thus accidentally discovered in the Asylum,
+and used for a few days, I received Dr. BEESLEY'S letter mentioned
+above; and I then learned that the sulphate of copper was the principal
+dependence of the physicians at Salem. As, however, I had never seen Dr.
+VANMETER'S thesis, the use of it at the Asylum was new to me.
+
+An excellent remedy, and one on which the sole dependence should be
+placed, were we not in possession of one which possesses a decided
+superiority, is one which was communicated to me by Dr. PARRISH. It is
+as follows, including a slight correction made by the apothecary:
+
+             R. Sulph. Zinci,           [Symbol: dram]i
+                Aquae,                  [Symbol: dram]ij Solve.
+     Dein adde, Mellis Despum. et
+                Tinct. Myrrhae, aa      [Symbol: ounce]ij
+
+To be used in the manner described above. Some bad cases yielded to the
+following:
+
+     R. Sulph. Zinci,           [Symbol: dram]ij
+        Aquae,                  [Symbol: ounce]i _m._
+
+It is useful to record failures and unsuccessful trials; as they serve
+to deter others from unnecessary risk. We therefore record the following
+as not having succeeded in our hands:
+
+     R. Mellis et
+     Tinct. Myrrhae, aa       [Symbol: ounce]i _m._
+
+The same, with the addition of powdered bark.
+
+     R. Aluminis,            [Symbol: scruple]ij
+       Tinct. Myrrhae, et
+       Mellis, aa            [Symbol: ounce]ij _m._
+     R. Pulv. Cinchonae,     [Symbol: ounce]i
+       Myrrhae et
+       Pulv. Carbonis. a     [Symbol: ounce]ss _m._ et adde
+       Succ. Limonum,        q. s. ad massam
+         faciendam, qua illineantur gingivae.
+
+Caustic potassa; and nitrate of silver.
+
+Pyroligneous acid, both pure and variously diluted with water. This had
+but a very limited effect, even in destroying the foetor; and I am by
+no means sure that it was of any use in arresting the disease.
+
+Muriatic acid, though praised by such high authorities, did not seem
+productive of any distinct useful effects. Nitric acid, variously
+diluted, and sulphuric acid, which was tried in one case, diluted with
+an equal quantity of water, were entirely useless.
+
+Of _constitutional_ treatment, the disease seemed to admit very little.
+In the early stage, the means employed, were the same mentioned above as
+means of prevention. It was by no means evident that any of these were
+useful in retarding the progress of the complaint. Towards the decline
+of the worst cases, aromatic sirup of rhubarb, with magnesia, were
+employed, to remove the putrid matters swallowed; and to relieve the
+diarrhoea which generally took place, by the astringent operation of
+the first mentioned medicine. It is extremely doubtful whether these
+means were productive of any benefit.
+
+       *       *       *       *       *
+
+While the above was in press, I have met with the article, "_Gangrene de
+la bouche des enfans_," in the Dictionnaire de Medicine; written by M.
+MARJOLIN. The author in the Dictionnaire des Sciences Medicales, has
+given nothing material but references to some of the writers mentioned
+above; with one or two which were not within my reach. M. MARJOLIN has
+evidently identified the disease. He cites FABRICIUS HILDANUS, though we
+have not found a distinct account of it in that writer's works. He
+remarks that it is identical with the _necrosis infantilis_ of SAUVAGES.
+He also refers to SAVIARD, VAN SWEITEN, whom he justly mentions with the
+highest praise, UNDERWOOD, BERTHE, CAPDEVILLE, M. BARON, and the
+inaugural thesis of M. ISNARD. As we have no means of referring to the
+two last, we must judge of them by M. MARJOLIN'S statements. He observes
+the dissimilarity of BERTHE'S case. From the thesis of M. ISNARD, he
+gives us an account of the disease which corresponds very nearly,
+indeed, with that of VAN SWEITEN, and with the appearances observed at
+the Children's Asylum.
+
+"Almost all the infants affected with this disease in the hospitals of
+Paris," says M. MARJOLIN, "sink under it." He recommends, after VAN
+SWEITEN, the use of muriatic acid, which he mixes with honey in equal
+proportions. Thick sloughs he cuts away with a bistouri or with
+scissors. MM. JADELOT, GUERSENT, and BARON, have employed the actual
+cautery with success in several instances. M. MARJOLIN has cured three
+cases; one by the actual cautery, one by caustic potassa, and a third by
+_muriate of soda!_ which, he believes, will always destroy the foetor.
+It would be interesting, undoubtedly, to make repeated trials of this
+simple remedy; and we shall endeavour to do so in cases which admit of
+delay.
+
+FOOTNOTES:
+
+[1] Vol. I. p. 319, Anderson's edition.
+
+[2] Principles of Surgery; by JOHN PEARSON. Lond. 1788. p. 262, et seq.
+
+[3] Opera omnia. Vol. II. p. 271. In the Loganian Library.
+
+[4] Ibidem.
+
+[5] See CORNELII STALPAART VANDER WIEL Observationes Medico-Anatomicae.
+p. 167. Note by the editor, P. STALPAART VANDER WIEL. Amsterdam, 1687.
+In the Loganian Library.
+
+[6] In the Loganian Library.
+
+[7] Page 193.
+
+[8] Page 217.
+
+[9] Commentaria.--Edit. Lugd. Bat. 1742. Vol. I. pp. 766, 767.
+
+[10] This name may be either from the ancient English or the low Dutch;
+if the one, by tradition, if the other, from the use of it by medical
+men. _Cancrum_ is an odd grammatical blunder; being, in reality, nothing
+but the accusative of Cancer, put instead of the nominative. The latter
+name was, as is well known, frequently applied by the older surgeons, in
+a vague manner, to any terrific and unmanageable ulcer; and, in
+particular, it was often applied to gangrene. The error appears to have
+been first made by Pearson, and copied by Mr. Cooper. Compare Muys and
+Vander Wiel, with Pearson, at the above references.
+
+
+
+
+ARTICLE II.--_Case of Purpura in an Infant, attended with Extraordinary
+Symptoms._ By R. M. HUSTON, M. D., &c.
+
+
+On the 28th of August last, A---- V----, after a moderate labour of four
+hours' continuance, was delivered of a female child. About a month
+previously, she had laboured under an attack of intermittent fever,
+which yielded, in a few days, to the ordinary treatment. She was 23
+years of age, an English-woman by birth, had generally enjoyed good
+health, and was as well as usual at the time of her confinement. Her
+labour was strictly natural, and her delivery accomplished without any
+extraordinary assistance.
+
+At birth there was nothing remarkable about the child. Its breathing was
+natural, its skin of the usual colour and appearance; in short, all the
+common indications of a continuance of life and health were present. A
+few hours, however, after birth, it became uneasy, cried much, and
+showed signs of colic. The nurse, supposing these symptoms to arise from
+flatulence, administered some warm tea; but without any apparent
+advantage. On the following day, I saw it again, and learned, that it
+had evacuated a considerable quantity of urine, and some intestinal
+matter, of the ordinary appearance after birth. The spasms continuing at
+intervals, a teaspoonful of castor oil was ordered, to evacuate any
+remaining meconium, that might lie in the bowels, producing irritation;
+upon the presence of which, it was presumed the spasms depended. It
+operated well, but without producing the desired relief. On the next
+day, viz. forty-eight hours after birth, a number of bluish or purple
+spots were observed on different parts of the child's body, but most
+numerous on the extremities. They were of various sizes, from that of a
+mustard seed, up to that of a grain of Indian corn. Some were slightly
+elevated, but most of them were not in the least so. In the majority,
+there was a minute central spot, or little point, more red or pink
+coloured than the blue areola, by which it was surrounded. In many
+instances, these little points projected, so as to become manifest to
+the touch. In the course of twenty-four hours, the spots, which had
+first appeared, began to decline, leaving a greenish mark, very like the
+remains of a bruise; but much more rapidly than these declined, others
+of larger size appeared on different parts of the child's body.
+
+On the third day after birth, large blotches appeared, one behind each
+ear. These rapidly increased, until they covered the whole extent of the
+parietal bones, and considerably elevated the skin, giving it a puffy or
+tumid appearance, like that caused by a blow from a large or blunt
+instrument. The parts soon became hot and tender to the touch; and this
+tenderness extended over the greater part of the scalp. A blotch,
+similar to those upon the exterior surface, was likewise observed within
+the mouth, covering the whole extent of the palate bones. The child
+experienced great difficulty in swallowing after the third day; and the
+_nurse_ thought the spasms were often excited by attempts of this kind.
+
+But the most singular feature of the case was the appearance, on the
+night of the second day, of a discharge from the vagina, _resembling_
+the menstrual flux. It resembled that flux in _colour_, _consistence_,
+_want of coagulability_, and in being, withal, accompanied by a
+considerable quantity of _slimy or mucous matter_. Every diaper which
+was used during that night, and the greater part of the next day, was
+stained more or less with this discharge. It was also observed, that,
+during the flow of this fluid, the spasms ceased; and that, whenever the
+discharge was suppressed, even for a very short time, they uniformly
+returned. In this manner they alternated at intervals of a few hours,
+until the occurrence of the death of the child, which happened on the
+eighth day after birth.
+
+As this case is related more for its singularity than from an
+expectation that any practical suggestions will be furnished by its
+perusal, but few remarks will be necessary, either upon its pathology or
+treatment. Although it will be perceived by the scientific reader, that
+the disease observed, differed materially from any of the forms of
+_purpura_, described by systematic writers on diseases of the skin;
+still I apprehend it may be justly considered as more nearly allied to
+that genus, than to any other.
+
+The spots were evidently caused by an effusion of blood beneath the
+cutis, and the presumption is strong, that it issued from the little
+point discoverable in the centre of each spot. Those points were, in all
+probability, _arterial_. That they were arterial terminations, I think
+is evident, from the great extent to which the cellular membrane was
+injected, especially over the parietal bones. The force exerted must
+have been very considerable to elevate so large a portion of scalp, and
+yet no pulsation could be discovered in any one of the points.
+
+But whence came the vaginal discharge? That it issued from the _vagina_
+was most certain; but whether it was furnished by that canal, or by _the
+uterus_, was not ascertained. To assert that it was menstrual, would be
+hazarding more than a prudent regard for truth would justify. But, if
+not, why the pain and spasms which preceded it, and the alternation of
+these symptoms with each other? and, especially, why the slimy
+appearance, mixed with red matter, without a trace of any thing like
+coagula? Certainly we do not find these appearances in ordinary cases of
+haemorrhage. So that there is no other way of accounting for the
+discharge in this case, except by considering it as having been secreted
+by the vessels of the parts from which it came.
+
+From the difficulty which the child experienced in swallowing, but
+little food could be taken; and the same difficulty precluded the
+administration of medicines. What caused this impediment could not be
+ascertained, but it was supposed to result from a spasmodic action of
+the muscles of the part.
+
+The only medicine attempted to be given was a weak infusion of bark, and
+this was soon abandoned.
+
+The spots, particularly the large ecchymosed surface on the head,
+exhibited no change in appearance, when _viewed superficially_, a few
+hours after death. No other examination was permitted.
+
+FOOTNOTES:
+
+
+
+
+ARTICLE III.--_History of the Natural and Modified Small-Pox, or of the
+Variolous and Varioloid Diseases, as they prevailed in Philadelphia in
+the years 1823 and 1824._ By JOHN K. MITCHELL, M. D., and JOHN BELL, M.
+D. attending physicians at the then Small-Pox Hospital. With a Plate.
+
+
+In a question of less moment, some apology might seem due for once more
+directing public attention to that which has been so oft discussed and
+described by many eminent physicians and experienced observers. But, if
+descriptions of any disease be valuable; if to record faithfully an evil
+be among the first steps for its removal and prevention; and, still
+more, if additional confidence, derived from enlarged experience, can be
+imparted to the means hitherto adopted to guaranty the human frame
+against a mortal and loathsome malady, our efforts at this time may
+claim the favourable notice of our professional brethren, and of the
+community at large.
+
+Sedulously abstaining from the parade of erudite research or indulgence
+in speculations, however ingenious, it is our intention to describe with
+accuracy all that we saw; and if, in so doing, we shall be found
+repeating what others have said before us, and proposing inferences
+previously drawn, the observations and deductions are to be considered
+as not the less our own, since we only speak from conviction, founded on
+the evidence presented to our senses. Our opportunities for accurate
+judgment were most ample, being derived as well from an attendance of
+nine months on the hospital for the reception of the poor, labouring
+under the disease, as from one of us prescribing, during a part of the
+time, for the Philadelphia Dispensary, added to the cases furnished us
+by private practice, and very many others, the records of which have
+been kindly placed at our disposal by professional friends.
+
+The ravages committed by the small-pox in Baltimore, and the fact of
+many who had been previously vaccinated having been attacked by the
+disease during the years 1821 and 1822 were notorious to us all, but
+were productive of little alarm in Philadelphia. The non-appearance of
+the scourge in the greater part of the period, when the former city was
+suffering under it, justified, to a certain extent, this feeling of
+security, and seemed to call more on our sympathies for our neighbours
+than on our fears for ourselves.
+
+In the month of September, 1823, some cases of fever, with pustular
+eruption, first arrested the attention of the medical faculty, some of
+whom were, of course, called on to render professional assistance. The
+residence of some of the persons, thus attacked, in Water street, and
+their emigration from Europe, naturally induced a suspicion of this
+disease being no other than the small-pox, imported by, or brought in
+with them. Very nearly about the same time, however, some scattered
+cases of a similar eruptive disease, were noticed in the upper or
+western portion of the city, without our being able to trace any
+intercourse or connexion between these and the others in the lower or
+eastern part, viz. Water street.
+
+The first return of death from small-pox, furnished by the Board of
+Health, was in the week between the 13th and 20th of September. The next
+was between the 4th and 11th of October. From this time to the end of
+the year there was a progressive increase of mortality, and the annual
+return for 1823, presented no fewer than one hundred and sixty deaths by
+small-pox. The greatest mortality in any one week was thirty-three, from
+December 20 to 27. During the months of January, February and March,
+1824, the disease prevailed extensively, and was fatal to many. In the
+following months its violence subsided, and in the month of June our
+attendance on the temporary hospital[11] was discontinued, in
+consequence of a resolution of the Managers of the Alms House to close
+it. Though a few patients were afterwards received into it, yet the
+malady soon disappearing, justified its final closure. The annual return
+for 1824 exhibited three hundred and twenty-four deaths by small-pox.
+The entire mortality from this cause was four hundred and seventy-three,
+in a period of twelve months, from November 1, 1823, to November 1,
+1824. The deaths before the first, and after the second date, were but
+eleven.[12] Contagious as this disease unquestionably was, we cannot, at
+the same time, withhold our belief of its having been in a measure
+subjected to epidemical influences, viz. in a particular character of
+the seasons and atmospherical changes. It is then within our province,
+as historians of events, rather than as expounders of causes, to present
+our readers with a summary account of the weather during the years 1823
+and 1824. We do this both from a sense of duty, considering it as
+pertinent to our present labour, and from a wish to encourage others by
+our example to preserve and transmit the meteorological registers, in
+their respective districts, of those years, marked by new or aggravated
+diseases.
+
+                     METEOROLOGICAL REGISTER.[13]
+------------------------------------------------------------------------
+|             |      |       |       |       |Winds--Days.|             |
+|             |      |       |       |Snow & |------|-----|             |
+|             |      |       |       |Rain   |N. W. |N. E.|             |
+|             |Mean  |Variat.|Variat.|Water. | to   | to  |             |
+|    1823.    |Temp. |Therm. |Barom. |Inches.|S. W. |S. E.|             |
+|-------------|------|-------|-------|-------|------|-----|    The      |
+|January,     | 31   |  44   | 0.94  | 3.38  |  22  |   8 |             |
+|February,    | 25   |  42   | 1.17  | 1.93  |  22  |   6 |temperature  |
+|March,       | 37   |  52   | 1.65  | 6.87  |  21  |   9 |             |
+|April,       | 55   |  47   | 1.08  | 1.77  |  16  |  14 |     of      |
+|May,         | 61   |  52   | 0.88  | 1.60  |  19  |   8 |             |
+|June,        | 68   |  46   | 0.65  | 0.87  |  20  |  10 |    the      |
+|July,        | 72   |  30   | 0.58  | 6.12  |  23  |   6 |             |
+|August,      | 72   |  35   | 0.60  | 4.68  |  21  |   8 |   wells     |
+|September,   | 63   |  51   | 0.61  | 3.46  |  15  |  12 |             |
+|October,     | 53   |  42   | 0.60  | 2.02  |  21  |   9 |    and      |
+|November,    | 38   |  38   | 0.81  | 2.47  |  21  |   9 |             |
+|December,    | 34   |  31   | 1.07  | 7.37  |  21  |  10 |  springs,   |
+|             |      |       |       |-------|------|-----|             |
+|For the year,|50-3/4|  88   | 1.70  |42.54  | 242  | 109 |     in      |
+|-------------|------|-------|-------|-------|------|-----|             |
+|   1824.     |      |       |       |       |      |     |    and      |
+|January,     | 36   |  48   | 1.25  | 3.67  |  24  |   7 |             |
+|February,    | 31   |  59   | 1.55  | 3.94  |  21  |   7 |    near     |
+|March,       | 40   |  39   | 0.71  | 2.63  |  16  |  15 |             |
+|April,       | 50   |  45   | 1.08  | 4.54  |  22  |   8 |Philadelphia,|
+|May,         | 60   |  44   | 0.88  | 1.59  |  24  |   7 |             |
+|June,        | 73   |  46   | 0.69  | 6.09  |  25  |   5 |             |
+|July,        | 74   |  30   | 0.38  | 8.80  |  19  |   8 |     is      |
+|August,      | 70   |  36   | 0.45  | 6.39  |  20  |  11 |             |
+|September,   | 64   |  41   | 0.65  | 6.60  |  17  |   7 |     52 deg.     |
+|October,     | 54   |  43   | 0.65  | 1.53  |  23  |   5 |             |
+|November,    | 42   |  38   | 0.89  | 2.49  |  24  |   6 |Fahrenheit.  |
+|December,    | 37   |  43   | 0.95  | 2.11  |  24  |   7 |             |
+|             |      |       |       |-------|------|-----|             |
+|For the year,|52-1/2|  85   | 1.55  |50.38  | 259  |  93 |             |
+------------------------------------------------------------------------
+
+                              1823.
+
+Maximum of Therm. 91, June 19.    Maximum of Barom. 30.45, Nov. 29.
+Minimum     "      3, Feb.  7.    Minimum      "    28.75, March 30.
+                  --                                -----
+  Variation,      88                                 1.70
+
+                              1824.
+
+Maximum of Therm. 90, June 8.     Maximum of Barom. 30.45, Feb.  6.
+Minimum     "      5, Feb. 2.     Minimum      "    28.90, Feb. 26.
+                  --                                -----
+  Variation,      85                                 1.55
+
+The amount of water which fell in rain and snow during the four years,
+from 1822 to 1825, inclusive, was,
+
+           1822.           1823.           1824.           1825.
+Inches,    35.20     |     42.54     |     50.38     |     33.26 |
+
+We next subjoin a summary of deaths by fever, erysipelas and measles, in
+the above period; being more desirous of narrating all the circumstances
+associated with the appearance and continuance of the small-pox, than of
+insisting on them as supporting causes or necessary connexions. It will
+appear from the accompanying statement, that the diseases febrile and
+eruptive were in number, violence and mortality unusually great, in the
+above mentioned years, as we discover by comparison with the returns for
+1822 and 1825.
+
+                       Deaths by
+        Fevers.   Erysipelas.    Measles.     Small-pox.
+1822        510         4             0            0
+1823        758        24           156          160
+1824        654        28           102          324
+1825        375        12            38            6
+
+In New York and Baltimore, the coincidence between increase of fevers,
+measles and erysipelas, and the mortality from small-pox, is not so well
+marked.
+
+               In New York--Deaths by
+
+           Fevers.        Erysipelas.        Measles.      Small-pox.
+1822        393[14]              6               1              0
+1823        192[15]             13             117             18
+1824        191[16]             14             100            394
+1825        445                20              53             40
+
+                  In Baltimore--Deaths by
+
+           Fevers.   Erysipelas.  Measles.  Small-pox.
+1821        400            0          2        21
+1822        430            1          4       122
+1823        304            2        175         2
+1824        183            3         14         2
+1825        138            0          9         3
+
+We now proceed to give a brief sketch of the disease called the natural
+small-pox, (occurring in persons unprotected by previous vaccination or
+inoculation,) and the deaths from which are given in the above
+statements. We must, in advance, insist on the great diversity in the
+appearance of the eruption in different individuals; so great, that an
+attempt to make an accurate picture of one case pass for a faithful
+representation of the many, must be deceptive and injurious.
+
+In the premonitory symptoms, constituting the characters of the fever
+precursory to the eruption, there was considerable uniformity: the
+complaint of nearly all those attacked being at first chills and rigors;
+pains in the loins, head and limbs, with thirst and want of appetite;
+with which were soon associated gastric uneasiness, and in many,
+soreness of throat, rendering deglutition painful, hoarseness and
+weeping eyes. The duration of these symptoms, aggravated by febrile
+exacerbations, varied from one to three days, more usually the latter,
+after which the eruption begins to appear. It is first seen round the
+forehead and temples, near the hairy scalp; then on the cheeks and
+breast and back; on the arms near the shoulders; the abdomen and thighs;
+and subsequently on the fore-arms and hands, and finally on the legs and
+feet. The appearance of the eruption is that of red or scarlet papulae,
+presenting to the touch a sensible resistance, but not much raised, and
+without roughness or hardness. These papulae, becoming more and more
+defined and elevated, are after a day or two converted into vesicles,
+with small elevated centres or bodies of a yellowish-white, and more
+diffused red and somewhat hard bases or margins. The redness extending
+as the eruption becomes copious, converts the skin, especially of the
+face, neck, and hands, into a red ground, from which project, in relief,
+the whitish vesicles. Similar appearances, but of a less marked nature,
+owing to the eruption being more scattered, are found on the trunk. The
+vesicles, containing at first a thin, semi-transparent fluid, become
+gradually larger, fuller and yellower, and filled with a thick,
+tenacious matter. This change is completed, and the pustules are
+entirely formed, after a lapse of time from the first eruptive effort,
+which varies from the fifth to the ninth day, and is occasionally
+longer. The mean for the beginning of maturation, or the finishing of
+the secretion of matter in the pustule, may be received as five days for
+the face, and eight or nine days for the body generally. The stages of
+the eruption, as regards its appearance, may be very properly called
+papular, vesicular, and pustular. This last having attained its height,
+completes what is termed the period of maturation, during which the
+pustules retain their fulness and spheroid figure; and exhibit the
+greatest proportion of whitish-yellow shining surface of their body, and
+diminished extent of redness at their base. A yellow dry point on the
+summit of the pustule, which loses thereby somewhat of its former
+spheroidal shape, by becoming flatter, or slightly indented, indicates
+beginning desiccation, at which time the body exhales that peculiar
+odour, so unpleasant, and so readily recognizable, after it has once
+been perceived. There is no uniformity in the size of the pustules on
+the body generally, nor any equality among them on a particular part:
+more usually one larger and fuller is surrounded by others less so. Nor
+is it to be supposed that the changes above mentioned are gone through
+in regular succession on all parts of the surface, uniformly. It was no
+uncommon thing to see the eruption papular on the legs, vesicular on the
+trunk and arms, and pustular on the face, at the same epoch. One part
+even, as the arm for instance, has exhibited to us the three forms at
+the same time.
+
+Maturation complete and desiccation going on, the pustules break, and
+have their thin coverings converted into a yellow hard coat or crust, to
+which adheres the pus that was not removed by absorption, and the
+residue, by evaporation of its watery part, is now converted into a scab
+of varying thickness, firm and prominent in its centre, and made up
+outwardly of concentric circles. The margins of the pustules, before of
+a distinct red, now assume a bluish-red or purplish colour, and the skin
+begins to desquamate.
+
+The constitutional sympathies, or the symptoms in the milder and regular
+variety of the disease, are not of any great violence or intensity. The
+premonitory pains, diminishing or disappearing, after the coming out of
+the eruption, leave in their place a regular fever. The action of the
+heart and capillaries is hurried during the papular and vesicular
+stages; but becomes more equable while maturation is going on. During
+the former period, the loaded and not unfrequently furred tongue
+evidences disordered stomach, the cravings of which are for cold drinks.
+The somewhat laborious respiration may, in some cases, depend on the
+swelling and soreness of the fauces and pharynx; in others, on the
+eruption extending along the lining membrane of the larynx; whilst in
+others, it may be caused by bronchial engorgement.
+
+The febrile symptoms, which abate during the process of maturation, are
+apt to return during desiccation; and when the skin begins to
+desquamate, they then constitute what is called secondary fever. The
+skin which had suffered so much, occasionally exhibits at this time an
+erysipelatous blush, accompanied by an inflammation of the subjacent
+cellular tissue, and the formation of troublesome boils, or infiltration
+of serum, especially where there is much laxity of structure, as in the
+eyelids, cheeks, lips, &c. The cutaneous system, during and immediately
+after the removal of its cuticle, and much of its rete mucosum, is of
+course very sensible, as well to the impression of clothes as to
+atmospherical extremes, and particularly cold. This is with many a
+critical time. It not unfrequently happened that persons, who had passed
+through the different stages of the disease, and were advancing rapidly
+to convalescence, were suddenly seized with an affection of the chest,
+pleurisy, bronchitis or pneumonia, and speedily carried off by the
+violence of the inflammation. The skin, exquisitely sensible in its
+denuded state to atmospherical vicissitudes, transmits with great
+promptness the morbid impression to the lungs, already prone to take on
+disease, in consequence of the active part they are compelled to play
+during the eruptive fever.
+
+The anomalous varieties, if we can admit any standard form of the
+disease, were numerous. Those which most fixed our attention were the
+_confluent_, the _roseate_, the _tuberculous_, and the _erysipelatous_.
+
+The _confluent_ was ushered in by symptoms of greater febrile disorder
+than the regular distinct variety: the throat was sorer; eyes more
+suffused and watery, and more intolerant of light; gastric and pulmonic
+uneasiness, and oppression more aggravated. In place of the papulae being
+separate, or merely in clusters, they are so crowded, that on the
+progress of the eruption the vesicles first and then the pustules are
+contiguous at their bases, and often run into each other, forming at
+times, a large irregular bag filled with pus, and technically called
+blebs, or else exhibiting over a considerable space of skin the
+appearance of imperfect vesication. The vesicles and pustules are, in
+such cases, flattened, and with indented centres, which latter display
+at times a dark point or spot, while the edges are of a livid red. This
+is the appearance of the limbs and trunk. The cheeks and forehead during
+the process of maturation present a continuous puffy elevation of a
+pearly white colour. The eyes are nearly closed by the swelling of the
+lids, and the thick copious secretion from the borders and the
+conjunctiva; the lips are tumid and the angles of the mouth ulcerated.
+In fact the human face divine, deprived of all lineaments and
+expression, is now a foul, misshapen mass. Associated with this state
+are swelled throat, rendering deglutition very painful--salivation,
+cough--occasional vomiting, delirium, sometimes phrenitical, sometimes
+evidencing itself in low mutterings and jactation.
+
+The _roseate_ variety of small-pox might, without creating much
+confusion, be ranked with the confluent, which it closely resembles in
+its second stage. The first is characterized by the rose or pink colour
+of the face, which is covered with a copious eruption of papulae, some
+with dry points, while from others, the bases of which are small and
+hard, arise minute vesicles of a pearly colour, which soon dry away. The
+inflammation, however, still continues, but spreads under the cuticle,
+which is raised in large patches of a white colour, but not vesicular,
+or distinctly pustular, or containing fluid: they approximate and
+produce the continuous puffy elevation already described. On the trunk
+and extremities, the eruption is either of confluent patches or of
+pustules dry and flat, with indented centres, the intermediate skin
+being of a deep red or crimson colour.
+
+The constitutional disorder runs high in these cases,--delirium and
+great gastric distress being very common symptoms. The tongue,
+especially at its border, is frequently the seat of eruption, which may
+be compared to the vesicular stage on the skin, with the summits cut
+off. The lining membrane of the mouth and fauces and pharynx, are, we
+presume, similarly affected, judging from the soreness of these parts,
+and the thick muco-purulent matter sometimes mixed with blood, which is
+spit out or brought up by screatus. The subjects most liable to the
+roseate eruption, were the intemperate and debauched of the sanguine
+temperament.
+
+The _tuberculous_ variety of small-pox was most frequent among the
+negroes. The eruption at first consisted of broad papulae, which were
+converted into hard, rough, and knotted prominences, tuberculous at base
+and flattened in the centre. This was not unaptly called by some the
+seal skin eruption. Sore throat, causing the greatest difficulty in
+deglutition, and delirium were the almost invariable concomitants of
+this variety. Occasionally the patient was in a state of stupor and
+disinclination to motion--at other times wakeful and restless, and
+requiring coercive means to confine him to his bed. In many instances,
+the muscular strength was retained to within a few hours of death. The
+fatal termination in these three varieties, confluent, roseate, and
+tuberculous, was in the second period of the disease, that is, in the
+one corresponding with the completion of maturation, and the absorption
+and drying away of the pus in the simple distinct form of small pox.
+After some experience, we were enabled, from the appearance of the
+eruption at the outset, to presage the event, which in the above
+described kinds, was almost universally fatal.
+
+The _erysipelatous_ variety was more an adventitious conversion of the
+primary form of the disease, by hospital air and delicacy of the
+cutaneous tissue induced by prior irregularities of life, than a
+distinct kind to be met with in general practice. It was most commonly
+presented to us in persons who had a very copious eruption, interesting
+to a great degree the whole cutaneous surface, and in whom the process
+of maturation was complete, and the cuticle began to lose its adhesion
+to the subjacent tissue. In some cases, even after desquamation was
+almost completed, and the skin nearly dry and smooth, erysipelatous
+inflammation would supervene, and seem to be repeated on the pulmonary
+and gastric surfaces, producing great trouble in respiration and
+derangement in the digestive functions, accelerated pulse, and other
+symptoms of fever.
+
+We could readily pourtray other nicer shades of the natural small-pox,
+but the originals might not perhaps be so readily recognized by
+succeeding observers, or their nature well understood by our
+readers.[17] Our object being to convey practical knowledge, we pass on
+to a notice of the subjects, most liable to suffer from exposure to the
+variolous poison.
+
+The African race would seem to be peculiarly obnoxious to the small-pox:
+the actual number of people of colour brought to the hospital being
+greater than the whites, and the proportionate mortality much more
+considerable; being as four deaths to six cases of disease in the
+former, and two deaths to four cases of disease in the latter. As
+regards sex, the proportion of deaths among the males was three-fifths,
+among the females two-fifths, of the entire number under treatment in
+the hospital. In both, the violence of the disease, and the number of
+anomalous symptoms and complications, depended greatly on their prior
+dissolute life. Drunkards among the men, and prostitutes among the
+women, rarely escaped death. The former had the roseate eruption, and
+the latter the confluent, on which dark spots as if gangrenous were a
+frequent appearance. Menorrhagia, at any time in the course of the
+disease, was a bad augury.
+
+The better to elucidate the nature of this dire malady, we shall now
+give from our records some cases of fatal termination, and add an
+account of the appearances on _post mortem_ examination of these same
+subjects.
+
+CASES.--I. Wilhelmina Smith, white, aged nineteen years, of irregular
+habits, has a well defined circular scar, with smaller pits in it, on
+the left arm; but has no recollection of having been vaccinated, nor
+does she remember ever having heard her parents, who are now dead, speak
+of it.
+
+She was taken sick on Thursday night, the 11th of March, 1824, and in
+the morning had vomiting and pains in the back. On the 13th in the
+afternoon, the eruption first appeared.
+
+15th. Admitted and visited. Eruption on face slightly prominent, is red,
+tuberculous and rough--small and scattered on the arms, like flea bites.
+Legs nearly clear: they have many cicatrices, especially on the shin and
+outer part. There is at present an ulcer above the inner ancle. Tongue
+yellow, and furred in centre, white at borders. Pulse small and
+threaded.
+
+16th. Eruption rising vesicular from face and limbs; no fever; tongue
+greenish and loaded; coughs much.
+
+17th. Eruption fine, dry, flat, and partly indented in centre on the
+face, which burns much; skin red and inflamed; on limbs same appearance,
+but eruption less copious; pulse small, threaded, and frequent; tongue
+furred and yellow in centre; complains of pain in deglutition; cough.
+
+18th. Eruption on face dry, flat, white and small in size, and copious;
+rather more elevated on limbs and neck; tongue dry and furred; pulse
+frequent and threaded; throat sore.
+
+19th. Eruption same as yesterday; pulse scarcely to be felt; skin cool;
+coughs with an appearance of choking.
+
+Dead at midnight. She retained her muscular strength and ability to sit
+up to the last.
+
+_Examination_ in the afternoon of March 21.--On removing the sternum and
+anterior portion of the ribs, the anterior mediastinum was found filled
+with a frothy adipo-mucous collection of a yellowish colour. The lungs
+on both sides adherent to the thorax, and the left lobes to each other.
+A sanguineo-serous effusion on both sides, probably a quart on the
+right, the lungs of which were changed in texture, and shrunk. The
+pericardium contained a large quantity of the same kind of fluid, which
+was found in the cavity of the thorax. The heart was highly injected. On
+removing the lungs and the trachea, and larynx, the lining membrane of
+the two last showed a brownish-red, coated with mucus, and deeply
+injected. Same appearances in a more marked degree in the bifurcations
+of the trachea.
+
+The oesophagus next examined, was found of a natural appearance,
+except near the stomach, where it was injected and assumed a red hue,
+contrasting with the whiteness of its upper part. The mucous membrane
+of the stomach near the cardiac orifice was in some parts of a roseate
+hue, in others a brownish-red; while in others it was ash-coloured, and
+dotted with red and yellow points. Towards the pyloric orifice, less
+disease. The stomach contained nothing but dark green bile and mucus.
+The duodenum was also highly injected. Lower down, the small intestines
+were in places lined with a dark red and brown, and the mesentery highly
+injected in the portions corresponding to these spots. Intestines much
+inflated, and omentum dark and injected. The uterus was not examined.
+The ovaria were large, white and soft; in the left was a small sac of
+dark blood, which readily burst on pressure.
+
+The liver was very large, of a soft texture and white colour;
+gall-bladder full of dark green bile, which had in part transuded
+through its coats.
+
+On looking at the trachea after it was washed, it exhibited in places
+whitish elevated spots, having all the appearance of an eruption.
+
+II. Ann Collins, white, aged 18 years, unprotected, became sick on
+Tuesday evening, March 23, 1824, and was taken to the Alms House, as one
+having the measles, on Wednesday. On Thursday evening, some eruption was
+visible; on Saturday evening, March 27, admitted.
+
+28th. Visited. Face covered with a red, flat, dry eruption, particularly
+on the cheeks; small and vesicular on the chin and around the mouth. On
+the arms, it has the appearance of measles; on the hands, it is of a
+deep scarlet, with central vesicular elevations; on the legs is slight;
+tongue loaded and yellow, except at the borders, which are clean; pulse
+natural; complains much of pain in the back and sickness of stomach.
+
+30th. Eruption covering the face, vesicular on a deep red ground with
+some tumefaction; rising vesicular on the limbs with scarlet bases.
+Tongue smooth and shining anteriorly, and with vesicles on it. Throat
+sore. Salivation. Pulse small and feeble. Has had menorrhagia since her
+admission into the hospital.
+
+31st. The menorrhagia continues. Had last night epistaxis. Pulse small
+and slow. Tongue furred and red. Eruption confluent with indented and
+dark centres. Surface white and dry. Skin between, red and inflamed.
+Very slight eruption on legs, and none on feet.
+
+April 1. Menorrhagia continues. Pulse small and labouring. Respiration
+laborious and hurried. Face swelled. Surface smooth, with white spots to
+represent the pustules. On breast and arms the eruption is in confluent
+patches which are nearly continuous--some pustules flat and indented,
+others smooth, with appearance of radii, and some more elevated forming
+blebs. Skin of the feet cold, and blue in spots; no elevated eruption on
+lower extremities. Tongue furred and yellowish. Throat sore. Eruption
+very copious on body, generally with blebs.
+
+_Vespere_; pulse hardly perceptible. Anxiety and distress great. Dead at
+10, P. M.
+
+_Examination_ April 2nd, in the afternoon.--On opening the thorax, the
+lungs and heart were found of the natural appearance and size. The
+larynx and trachea being divided, exhibited all the way down to the
+lungs an injected surface with whitish irregular spots, having nearly
+the same appearance as the flat smooth eruption on the face: in parts it
+was more evidently pointed, and showed, by the aid of the microscope, a
+pustular appearance. In the lungs, the inner surface was still darker.
+The root of the tongue was covered with large and rather hard papillae,
+with open summits. The oesophagus was smooth and white. The stomach
+near the cardia injected, and of a brownish-red in spots: the remaining
+portion white, presenting no diseased appearance. The spleen was very
+large and covered with copious miliary points. The omentum, to
+appearance gangrened, was dark, and altered in texture. The peritoneum,
+especially in the pelvis, was injected and inflamed, being of a
+semi-opaque dark colour. The uterus, small and firm, contained some
+bloody mucus in its cavity.
+
+III. Joseph Foster, white, aged 22 years, unprotected, became sick on
+Monday evening 8th of March. The eruption began to show itself on
+Wednesday morning, 10th.
+
+12th. Admitted and visited. Face covered with a red, dry, tubercular
+eruption, with some few yellow pustules. Same on arms, but no pustular
+appearance; partly tuberculous, partly vesicular. More sparse and
+scattered on breast and legs: none on feet. Slight cough. Tongue white,
+clammy, and loaded in middle--red at borders. Pulse rather frequent.
+
+14th. Face covered with a pustulo-vesicular eruption, with whitish
+summits, red and inflamed bases. Skin between, of same colour. Eruption
+dry and hard; very red, copious on limbs; less so on trunk. Tongue moist
+and less loaded. Pulse regular.
+
+15th. No fever. Face of a deep red colour; eruption rising from it
+rather flat, irregular in figure and white at summits. Eyes inflamed. On
+limbs the eruption is red at base, vesicular in body and summit: on
+trunk in clusters. Tongue yellowish and rather furred. No complaint
+made; rests easy; sleeps well.
+
+16th. No fever: tongue moist and a little loaded. Pustules nearly white.
+Some yellow, and beginning to dry on summits. Skin between still of a
+deep red. Eruption filling on limbs and trunk.
+
+17th. Pulse strong and frequent; skin hot; tongue moist and loaded.
+Pustules scabbing on face. Not yet entirely filled on limbs, where they
+are in clusters with inflamed bases.
+
+18th. Pustules full and matured on limbs. Running into each other in
+places. Tongue dry, brown, and furred in centre, yellow and loaded at
+sides. Pulse quick and frequent. Lies easy.
+
+19th. Blebs formed on arms; pustules running into each other, beginning
+to shrink; matter oozing out. Tongue covered with a dark crust. Pulse
+quick and frequent. Erysipelas of eyelids and ophthalmia. Throat sore.
+
+20th. Blebs larger and more numerous on hands and arms; purulent matter
+oozing out from some of the pustules. Face nearly scabbed over. Some
+small white pustules formed on the eyelids. Pulse frequent and
+vibrating. Tongue as yesterday. Gums tender.
+
+21st. Pulse weaker. Desquamation going on; pustules shrunk and drying on
+limbs. Tongue as yesterday.
+
+22nd. Matter much absorbed on limbs, leaving a shrunk cuticle. Face
+covered with a brown and yellow scab and scurf. Tongue black and furred;
+clear at apex.
+
+23d. Some erysipelatous inflammation of the skin; pustules all nearly
+disappeared from arms, trunk and thighs; some few, white and soft remain
+scattered over breast. Pulse frequent. Tongue black and incrusted.
+
+24th. Was brought into town from Bush Hill.
+
+30th. Desquamation nearly complete. Low frequent pulse. Respiration slow
+and laboured. Tongue incrusted.
+
+April 2nd. Dead at 10, A. M.
+
+Calomel had been freely given to this man in the earlier stage of his
+disease: and during the last week, spts. terebinth. and nutritive
+farinaceous food.
+
+_Examination._--The pericardium, of a greenish colour and its
+capillaries finely injected, was full of yellow serum. The lining
+membrane of the larynx and trachea was of a greenish-yellow colour
+throughout, and in the spaces between the cartilages ulcerated and
+disorganized in several spots. Beneath the membrane was a venous
+injection. About the bifurcation it was injected; and in the
+ramifications of the trachea were seen several inflamed, and in places
+abraded and disorganized spots. A chocolate coloured liquor with a
+sediment filled the bronchiae and the larger tracheal subdivisions.
+
+The oesophagus was sound. The stomach showed clusters of bright red
+and brownish-red spots, in stellated and other regular figures extending
+along the smaller curvature. The duodenum, at its commencement and in
+its course, presented similar clusters. The rest of the intestine was
+healthy. The brain was to appearance in a natural state.
+
+IV. Peter Johnson, black man, aged 38 years, unprotected, was taken sick
+on Monday, 29th March, in Sandy Hook. Eruption of small-pox appeared
+April 3d, Saturday morning. Admitted same day.
+
+4th. Eruption copious on face; papular and of irregular figure. Eyes
+suffused and red. On arms, same appearance as on face, but less
+tuberculous. On breast and body, eruption small and pointed; beginning
+to show on legs. Throat sore. Tongue yellow and loaded at sides; red in
+centre. Pulse full, equal, and rather frequent. Cough.
+
+5th. Much anxiety and moaning. Eruption rough and tuberculous on face.
+On arms, it is in parts papillary and pointed, and in parts flat with
+indented centres. Pulse slow and equal.
+
+6th. Eruption hard and tuberculous on face and arms; small and pointed
+on breast. Pulse slow; throat less sore; mind wandering. Is sitting up
+in bed, dressed. Tongue moist and yellow.
+
+7th. Delirious through the preceding night; is now dozing. Eruption same
+as yesterday. Not so thick on legs, but hard and tuberculous.
+
+8th. Tongue black and incrusted. Throat very sore. Eruption hard and
+flat. Pulse active.
+
+9th. In a comatose state. Pulse slow. Skin cool.
+
+10th. In the same condition. Drawn down in the bed, the thighs flexed on
+the abdomen, and lies on his side.
+
+11th. Dead at six A. M.
+
+_Examination._--The upper surface of the tongue of a brownish yellow,
+full of holes and rough. At the posterior part, in place of the larger
+papillae, were ulcers and cavities. The posterior nares and pharynx were
+covered with holes, formed by ulceration, and of a brownish hue,
+adjoining injected and apparent pustular parts. Tonsils ulcerated, and
+their investing membrane mostly destroyed. The oesophagus immediately
+below the glottis, smooth and sound. Yellowish matter flowing from the
+glottis. On opening the larynx, it was found half filled with a viscid
+light olive-coloured fluid; on removing which, the whole lining
+membrane, down to the bifurcation of the trachea, was found covered with
+clusters of ulcerated pustules of a yellow colour, with the intervening
+spaces of a brownish-red, highly injected, and destitute of its natural
+smooth, shining appearance. The internal surface of the glottis and
+epiglottis was in a similar but less marked state as the larynx and
+trachea. The pustular surface extends to the minute ramifications of the
+bronchiae, and their cells beyond were highly injected.
+
+On opening the abdomen, the omentum was found dark and shrunk. Stomach
+contracted. Intestines distended, shining, and very vascular, with
+capillary injection when viewed externally. The peritoneal covering of
+the stomach showed a similarly injected appearance.
+
+The stomach being opened, displayed at its upper curvature, spaces
+studded with spots of a deep red or purple; apparently effusions
+surrounded by a vascular net-work. Same appearance towards the pyloric
+orifice, and in places on the duodenum, which, together with the
+jejunum, particularly the latter, is of a dark leaden colour, and
+injected.
+
+The diaphragm on its upper surface, highly injected, as was also the
+pleura lining the thorax. The pericardium healthy.
+
+The brain was not, unfortunately, examined.
+
+V. Jacob Fry, black man, aged 30 years, unprotected, was taken sick on
+Sunday, 11th April, 1824. Eruption appeared on Thursday, April 15th.
+
+16th. Admitted and visited. Eruption copious and papular on face; smooth
+and flat, with dark centres, on trunk and arms. Tongue loaded. Cough.
+Tenderness of epigastrium on pressure. Throat sore. Pulse small and
+threaded. Eyes muddy.
+
+18th. Eruption flat and rough; diffused over face. On breast red and
+flat; on limbs in clusters, shrunk, and hollow in centre. Pulse small.
+
+19th. Tongue moist. Pulse small and frequent. Throat much swelled.
+Restless, and somewhat delirious.
+
+20th. In a comatose state; but is roused to attention by calling him.
+
+21st. Dead at five P. M.
+
+_Examination._ April 22nd.--On opening the thorax, the lungs were seen
+to appearance healthy. Both adhered to the pleura costalis. The pleura
+lining the diaphragm, and also the pericardium, were finely injected.
+Fauces inflamed, injected, and ulcerated. From the tonsils oozed out
+pus.
+
+The larynx contains a light olive coloured fluid, muco-serous, which
+likewise covered the trachea and bronchiae. The lining membrane
+throughout was rough, and exhibited a net-work of a brownish-red colour,
+finely injected.
+
+The oesophagus about half way down, has its lining membrane removed
+for one-third its length, showing miliary points on its muscular coat.
+The stomach on its outer surface, and near its upper end, showed a black
+spot, like effusion of black blood, under the peritoneal coat. On
+examining the oesophagus near the cardia, it was found of a dark
+colour in lines. From the cardia, half over the inner surface of the
+stomach, radiates inflamed membrane of a deep red colour, and corroded
+at the place corresponding to the dark spot above mentioned. Red spots
+near the pyloric orifice. Intestines not diseased. Liver adherent by its
+right lobe to the ribs; this lobe was of a greenish leaden colour. No
+alteration of its structure. Brain injected in its arachnoid coat.
+Ventricles contained some serum. Tela choroides dark and gorged.
+
+VI. William Lawrence, aged 18 years, unprotected, became sick on
+Saturday, April 17th. On Sunday taken to the Alms House, and on
+Wednesday, 21st was transferred to the Hospital.
+
+21st. Eruption fine and papillary on face; red and scarcely raised on
+arms. None on legs. Has cough since yesterday. Pulse slow and regular.
+Tongue brown, and incrusted in centre. Moist on sides.
+
+22nd. Eruption confluent and red. Papulo-vesicular on face and arms.
+Flat, dry, and copious all over the trunk. Scattered and small on legs
+and feet. Pulse small and regular. Tongue loaded and brown in middle.
+Eyes sparkling. Is delirious and very restless.
+
+23rd. Eruption very copious all over the body, rising vesicular from red
+margin. Pulse small and slow. Tongue loaded, furred, and yellow. Head
+and back easier. Has slept well. Face deeply suffused with red.
+
+24th. Cough. Eruption flat, indented centres, dark in places. It is now
+coming out on legs. Pulse small and firm. Skin cool. Much uneasiness and
+hurried breathing.
+
+25th. Dead at seven A. M.
+
+This man had been bled twice before his admission, and once again on the
+22nd. Cold affusions had been freely used.
+
+_Examination_, on the 26th April.--Pericardium sound, but contained much
+sanguinolent serum. Pleura sound. Lining membrane of pharynx partly
+destroyed. No ulceration. Tonsils give out pus on pressure.
+
+Oesophagus of a dark red, and partly lost its inner membrane. Larynx
+and trachea injected; but the membrane lining them is entire, without
+pustules or ulceration. Some frothy effusion in bronchiae.
+
+Liver healthy. Spleen large. Omentum sound, and of a natural white
+colour, traversed by some large veins. Stomach externally of a brown-red
+colour; and when opened, presents, spread out from the cardiac orifice,
+dark brown-red streaks; and towards the pyloric orifice and upper side,
+an extensive surface shaded over with vermillion and darker spots. Near
+the duodenum, the surface is white. Intestines slightly injected.
+Bladder dotted all over with bright red spots on its inner surface,
+which is covered with a fine capillary reticulated structure.
+
+VII. An infant, white, unprotected, aged three weeks, child of Clarissa
+Clarke, who had been inoculated twenty-one years ago. Taken sick on
+Sunday, 2nd May. Eruption appeared Thursday, 6th. Admitted 9th.
+
+10th. Eruption copious, and in confluent patches, with red bases, and
+flat vesicular summits. Has also aphthae.
+
+13th. Eruption confluent, in large white patches on face. Throat very
+sore.
+
+15th. Dead at eight A. M.
+
+_Examination._--The stomach of a light colour, perfectly healthy. Folds
+and plaits of mucous membrane strongly marked. Mucous surface of trachea
+nearly healthy.
+
+VIII. Infant, female, of a woman who died in the Alms House of varioloid
+disease, shortly after giving birth to this child. It is three weeks
+old; was admitted Sunday, 25th April, second day of the eruption. Dead
+on Thursday, 29th. The skin became livid after death..
+
+_Examination._--Pharynx inflamed, and the eruption on it extending all
+the way down the oesophagus, to near the cardiac orifice; the lining
+membrane being also in part destroyed. Stomach of a fine clear red, and
+beautifully injected to the minutest capillaries all over the mucous
+surface. Intestines, both large and small, red and injected.
+
+The larynx has some eruption on its lining membrane. The trachea and
+bronchiae nearly healthy; there being no eruption or secretion on their
+surface.
+
+Doctor DARRACH was present at the majority of the above detailed
+examinations, and kindly officiated at some of them. This gentleman,
+well known for his zeal in the study of comparative and morbid anatomy,
+made many interesting microscopical examinations of the various kinds of
+variolous pustules, and the corresponding changes in the cutaneous
+tissue, the results of which, we hope, he will make public.
+
+Having thus freely described what we saw, we wish it were in our power
+to lay down next, for the benefit of those who come after us, a
+satisfactory method of treating small-pox. The hospital returns are not
+of such an encouraging nature as to make our self-love predominate over
+observation and experience, and lead us to inferences which might seem
+to sanction the utility of this or that medicine, or curative plan. We
+had to deal, it is true, with the worst portion of the community;
+persons of constitutions exhausted or perverted by excess of sensual
+indulgences, or by poverty, or both conjoined. In private and even
+dispensary practice, where the subjects were of a better physical and
+moral nature, we often saw the disease subside, and health return, after
+less attention to administer medical aid, or to supply other wants, than
+was exhibited at the hospital. We are, notwithstanding, sanguine enough
+to anticipate useful results from our attentive study of the symptoms of
+the disease, in connexion with that of the post mortem examinations, and
+to consider ourselves as in possession of lights to guide us with more
+certainty than before. Let us see how far a cautious analysis will tend
+to dispel old errors, and establish useful truths.
+
+The gastric distress, and the associated uneasiness and pain in the
+head, back, and limbs, with evening exacerbations of fever, for the
+three days preceding the eruption, evince conclusively a disease to
+which the skin is a stranger, except by its usual sympathies of heat and
+coldness, moisture and dryness. The appearance of the tongue, the loss
+of appetite, thirst, nausea, and occasionally vomiting, are testimonies
+to the impeded function of the stomach in this first period, or that of
+precursory fever: and if to this we add the soreness of the fauces and
+pharynx, producing impeded deglutition, we cannot refuse our assent to
+the belief that the mucous surface, on which the _preparatory process_
+of digestion takes place, is mainly affected. The next leading symptom
+is the appearance of the eruption on the skin. The character of the
+disease is now fixed, and the physician feels himself compelled to
+respect the cutaneous inflammation, throughout its entire course,
+naturally enough regarding it as the disease itself, rather than the
+last link in the chain of morbid actions. To support the circulatory
+system at such a degree as shall enable the skin to secrete this new
+matter of small-pox, is nearly as much as he proposes to himself. But
+here arises a question of great practical moment. To what extent, if
+any, is the eruption a natural or necessary sequence of the previous
+symptoms or condition of the system. Perhaps in the existing state of
+medical science, we hardly dare reply positively to this question. This
+much we know, that there is no correspondence in general between the
+intensity of the precursory fever, and the copiousness of the after
+eruption. We are, moreover, well apprized of the fact of very many, who
+had been protected in earlier life by inoculation or vaccination, being
+seized with all the symptoms of the precursory fever of the small-pox,
+and remaining seriously indisposed for a few days, yet with very little
+eruption in some cases, and without any in others.
+
+Next we may inquire, what control, salutary or otherwise, we can
+exercise over the skin in reference to its eruption, by adopting certain
+methods in medicine and hygeine, during the period of invasion or of
+precursory fever. To foster the germ of the poison, as yet only
+affecting the inner surfaces, into efflorescence on the outer or
+cutaneous one, by hot air, warm and heavy clothes, and cordial drinks,
+is a practice, which, though at one time advocated on what was thought
+very sufficient theory, is now abandoned as at war with experience. Of
+these means, clothing acts primarily on the skin, and we will suppose
+heat to do the same: the cordial drinks must however affect this organ
+by stimulating and irritating the gastric and intestinal surface.
+Against all stimulation of this surface we are then bound, from
+knowledge and theory, to object.
+
+The cooling regimen as it is called, was substituted for the
+alexipharmic, in so far as regards light clothing and cool air. Can
+emetics and purgatives be viewed as a part of this regimen, and exert as
+such a salutary influence over the second period of the disease, or that
+when the eruptive effort takes place? Admitting they are but local
+stimulants, can they as such be with advantage applied to a surface, as
+that of the stomach and intestines, already highly irritable, and which,
+as the disease advances, becomes inflamed? If our object be in this
+first period to diminish the violence of the second or eruptive one, we
+doubt whether our expectations will be at all met by any kind of
+stimulant to parts, which so promptly transfer their irritation to the
+cetaceous surface. Whatever may be thought of these suggestions; whether
+they are to be regarded as well-founded, or merely speculative, must be
+a subject of future investigation; since we are as yet compelled to deny
+that experience can be adduced in favour of the practice of vomiting and
+purging to the first period of variolous disease.
+
+On the same line with the remedies just mentioned, have been placed
+bleeding, general and local, though as we apprehend, very erroneously.
+There is not in bleeding as in purging, conflicting and alternating
+effects of debility from evacuation, and irritation, primary and
+sympathetic, from local stimulation; but a direct diminution of morbid
+action, more tranquil movements of the heart and capillary system, that
+is of the circulatory apparatus, and of the membranes, mucous, serous
+and cutaneous, &c. Bleeding, unlike most other remedial agents, produces
+a direct calmness and ease in the animal economy: it does not like them
+substitute one disturbance for another, or make the great appear the
+lesser evil. The experienced physician well knows the value of this
+remedy, in the first period or invasion of the phlegmasiae, and of some
+fevers called general. He is fully aware, that if he cannot produce by
+it a decided impression on the malady in the commencement, he is but too
+often afterwards a prey to doubts and anxieties, wishing to relieve, but
+unknowing what to attempt. Conceding, however, the power of venesection,
+in the forming stage of the disease, now under review, so that we by
+this remedy may control the series of morbid actions in the second
+period, and diminish the extent of the eruption; it may yet be seriously
+asked, whether we can with safety and propriety prevent or destroy the
+succession of changes to which the skin is subjected, from the first
+papulae on to desiccation. On this point, we believe, has turned the
+practice of the profession at all times, whether in the ages of
+humoralism, or in the reign of solidism. In addition to the reasons
+already assigned, which would lead us to doubt the necessity of the
+eruption being left uncontrolled, or even suffered to run its course, we
+may appeal to the practice of inoculation, which as effectually
+saturated the system, and indisposed to subsequent attacks, as if the
+skin had formed a continuous pustular surface; and yet this benefit was
+often gained by the trifling tax of a few days' fever, and half a dozen
+of pustules. Where the fever runs high and the respiration is much
+affected, in the first period of measles, and before there is the
+slightest appearance of eruption, we conceive it often so be our duty to
+bleed freely, without reference to the subsequent disease of the skin,
+or any nicety of calculation about this latter going through its regular
+stages. Indeed, we have usually reason to congratulate ourselves for
+having, by this means, rendered the subsequent disease milder and more
+tractable. That affection of the urethra termed gonorrhoea, the
+product of contagion, will, if left to itself, go through its several
+stages; and, if rest and regimen be enjoined, will often leave the
+subject healthy as before. But we can, notwithstanding, cut it short
+with perfect impunity, by suitable remedies, and thereby prevent
+numerous unpleasant symptoms and effects, which are often present when
+the disease is left to nature. Syphilis has its several stages, each
+marked by characteristic symptoms; but the skilful treatment of the
+first stage prevents, how beneficially we all know, the appearance of
+the others. We must then in small-pox, as well as in other diseases,
+beware how we confound a common and even natural, with a necessary and
+unavoidable succession of symptoms and periods.
+
+The precursory fever in small-pox is seldom marked by the same common
+inflammatory symptoms as that in measles; and does not seem, by its
+actual violence, to urge the physician to deplete with freedom, if he
+only have regard to the existing condition, rather than to the impending
+danger and complication. The diversity in the two diseases consists not
+so much in the greater intensity of the latter, as in the more decided
+gastro-enteritic derangement in the former. Experience has not yet
+sanctioned the benefit of copious bleeding from the arm, in incipient
+disease, or irritation verging to inflammation of the intestinal
+surface, as in small-pox; while its efficacy is admitted in measles. But
+conceding its doubtful character, local bleeding, as by cupping, and
+leeching on the abdomen, might be serviceably employed in the form of
+disease now under consideration; as we know it to have been in other
+febrile affections, where the same parts were diseased. Topical
+depletion does unquestionably exercise the best effect on membranous
+inflammation. In addition to cool air, we may with some confidence have
+applied at this time to the skin, cool, if not cold, affusions; while
+cold or cool drinks, and these of mucilaginous kind, would constitute
+the principal ingestae and medicines. Our own experience was little
+favourable to the efficacy of cold water, applied to the surface during
+the eruptive stage; and we apprehend, that, if decided benefit can grow
+out of its use, it must be during the first or precursory fever, before
+the formation of vesicles has commenced, when every thing is to be
+attempted to sooth irritation, and prevent febrile reaction.
+
+The first period over, the eruption on the skin now appears, and
+constitutes a leading and exceedingly important symptom of the disease.
+This eruption, like many others the product of gastric derangement,
+acts for a time as a counter-irritant, and as such affords temporary
+relief to the internal organs; but when continued, as in the farther
+progress of the disease, it, in common with all irritants on the skin,
+returns with interest to the digestive tube, the irritation which it
+first received from this latter.
+
+We must not lose sight of the state of the lining membrane of the lungs
+during this time. It cannot be said so much to sympathize with the skin,
+as to be affected by continuous disease; since the eruption on the
+mucous membrane of the larynx, trachea, and its ramifications, undergoes
+nearly the same changes, in the same time with that on the cutaneous
+surface. The danger and violence of a disease in which the three
+surfaces, cutaneous, pulmonary, and gastric, are all organically
+affected at the same time, must be very apparent. Even though there be
+no eruption on the internal coat of the stomach, its appearance after
+death, of high vascularity and sanguineous injection, corresponding
+precisely in appearance with the circles found in the lungs, of which
+the pustules were the centres, justifies this belief of its being
+organically affected. Each of the three above mentioned surfaces is in
+degree ancillary to the others, and each may, on occasions, partially
+supply their functions; but in this period of variolous disease, our
+hopes of such vicarious action must be very faint indeed, and hence the
+hazard attending any application to any one of them.
+
+Are we from these appearances to pronounce the eruption a phlegmasia of
+the skin and lungs, associated with a previous one of the stomach, and
+recommend the free use of venesection? Life may occasionally be
+prolonged, or at times saved by this means; but the disease will not be
+thereby materially arrested in its course, or modified in its
+appearance. We shall find that the inflammation of the membranes,
+consisting as most of them do of cellular tissue and minute capillary
+vessels, is often not susceptible of being checked by general depletion,
+carried even so far as to almost empty the larger arteries, and arrest
+the heart's motion.
+
+Still more will this inflammation persist, if it have gone to the extent
+of forming new parts, whether phlegmons or pustules. The intensity of
+the inflammation may be somewhat moderated, but it cannot be conquered
+now as at the commencement, or during the first period, or that of
+invasion. We cannot, from our own experience, speak favourably of the
+remedy in the second, or eruptive stage. It did not answer our
+expectations, though employed in subjects apparently the best
+constituted to derive the good effects proposed from it. We must at the
+same time grant, that it was complicated with other remedies. Of topical
+bleeding, we are unable to speak, not having seen it tried. In this
+period of the disease, it must be of very difficult execution. Still
+less reason have we to boast of the good effects of purging. Though the
+skin may for a while be relieved by the watery secretions from the
+intestinal canal; yet the irritation of the latter, consequent on
+purging, is soon communicated to the cutaneous surface with the effect
+of aggravating the eruption. To the class of stimuli or stimulating
+diaphoretics, the same objections apply with increased force. As on the
+one hand, in cases of high fever, seeming to call for great depletion,
+the surfaces are often not relieved by general bleeding, but retain
+their own vitality; so on the other, in cases of apparent prostration,
+and feebleness of circulation, they often retain all their morbid
+activity, and will of course be materially injured by stimulation,
+either of hot air to the skin, or heating drinks to the gastric and
+intestinal surface. Of the various diaphoretics employed, we had reason
+to be least dissatisfied with the combination of opium and ipecacuanha
+in small doses. In some few cases, tartrate of antimony and cream of
+tartar, dissolved in rice or barley water, and the solution used as a
+drink, seemed to be beneficial. Several grains of the former were thus
+taken in the 24 hours, without its producing vomiting or purging. But in
+very many other instances of the disease, this medicine had no
+ameliorating effects. Calomel alone, or in combination with opium, was
+given, and in a few cases caused _ptyalism_. We did not lose persons
+thus affected, but we cannot speak with any confidence of the propriety
+of the treatment.
+
+The application of cold water to the skin, was tried by us on the
+strength of its alleged good effects in this disease, but in no case had
+we reason to be satisfied with it. The state of the cutaneous surface,
+during the vesicular and pustular stages, is such as to prevent its
+transmitting the usual impressions to the interior. Cold may deaden it,
+and hasten the disorganization of its tissue, but cannot arrest and
+suspend morbid capillary action here, as in ordinary fevers, or diseases
+with great local determination, as to the head, &c. If useful at all,
+it will, we apprehend, be in the forming stage of the disease, before
+the skin is altered by the eruptive effort. The same objections do not
+hold against the internal use of cool or cold liquids. We have in this
+instance to be regulated by the usual precautions, as in all febrile
+disease where the gastric system is the greatest sufferer. More benefit
+will follow the sustained use of cool, than the occasional
+administration of very cold draughts; since in the former case the
+morbid action of the mucous surface may be restrained in due bounds,
+without the risk and danger of reaction, and increase of heat and
+thirst, which are apt to ensue from the latter. The same principle will
+guide us in the temperature of the air to be inhaled by the lungs.
+
+The secondary diseases, erysipelas, catarrh, and pneumonia, occurring on
+the decline or subsidence of the variolous disease, would, we may now
+presume from the phenomena in life, and the autopsic examinations, bear
+and require a treatment, nearly similar to that used in these diseases
+arising under other circumstances. Perhaps leeching and cupping ought to
+be substituted, in such emergencies, for bleeding from the arm.
+
+The extension unavoidably given to this first branch of our subject,
+requires that we should defer the history of the modified small-pox, or
+varioloid disease, to the next quarter, when it shall appear in the
+corresponding number of this Journal.
+
+
+EXPLANATION OF THE PLATE.
+
+Figures 1, 2, 3, represent various appearances of the lining membrane of
+the stomach.
+
+Fig. 4, is a portion of the oesophagus; but the red bands ought to run
+vertically, and not horizontally, as in the plate.
+
+Fig. 13, is another appearance of the stomach.
+
+Fig. 12, indicates the eruption having gone on to ulceration in the
+pharynx.
+
+Fig. 6, displays the appearance of the lining membrane of the trachea,
+on the 6th day of the eruption, as in the case of Ann Collins.
+
+Fig. 5, is intended to represent the same part in an advanced stage of
+the disease, as in the case of Joseph Foster.
+
+Resembling this is the case of Peter Johnson, as far as regards the
+ulceration and dark colour of the intermediate surface; but differing in
+the disorganization of the membrane being less.
+
+Figs. 7, 8, 9, 10, and 11, represent the progress of the eruption, in a
+female, from its incipient to its maturated state. The same section of
+skin is represented from the 1st to the 5th day of the eruptive stage,
+on which day the patient died. On the 2nd day, (fig. 8,) the vesicles
+began to exhibit a central lividness, which was augmented on the
+subsequent days. The patient had been some years before successfully
+vaccinated. She was delivered of a child on the 1st day of the eruptive
+stage. The minutes of this case have been mislaid; but the post mortem
+appearances were indicative of high action, if not inflammation, of the
+uterus and its appendages. The infant of this woman, forming Case VIII.
+died of small-pox three weeks afterwards, on the sixth day of the
+eruption.
+
+This plate, together with some others yet unpublished, are from the
+accurate pencil of Mr. now Dr. HARRINGTON, of this city.
+
+(TO BE CONTINUED.)
+
+FOOTNOTES:
+
+[11] This was first at Bush Hill, and subsequently at the Sugar House,
+near the Alms House.
+
+[12] The largest proportion of these deaths was in the six months from
+the 1st of November, 1823, to 1st of May, 1824, being in that period
+about four hundred.
+
+[13] Kept by Reuben Haines, at Germantown, seven miles from the city.
+The thermometrical mean is that from daily observations made by this
+gentleman at sunrise and at 2 P. M.
+
+[14] Of these 165 were by yellow fever.
+
+[15] The deaths from inflammation of the different viscera, were as
+reported in this year, 290, and from infantile flux and cholera morbus,
+177.
+
+[16] Same proportion of inflammations as last year, viz. 339.
+
+[17] Should it be hereafter necessary, we can illustrate other varieties
+of the disease by drawings which were taken at the same time with those,
+of which coloured engravings are now furnished.
+
+
+
+
+ARTICLE IV.--_Remarks on the Pathology and Treatment of Yellow Fever._
+Arranged from the Notes of Dr. J. A. MONGES, of Philadelphia.
+
+
+I arrived at St. Domingo in the year 1785, and from that period to the
+time of my departure from thence, I had very ample opportunities of
+observing and treating the diseases of that island, both in the country
+and at the Cape. During the whole time of my residence there, the
+ordinary febrile diseases of hot climates were of very frequent
+occurrence, especially among the new comers, and those not acclimated;
+but the real yellow fever, or vomito negro, never prevailed. So that
+when I reached this city in 1793, I never had had an opportunity of
+observing this disease.
+
+As introductory to the subject more particularly before us, I shall
+offer a few remarks on the nature and treatment of the fever, which
+prevailed in that island. It was usually of the remittent type, of a
+bilious nature, and rather violent in its character; presenting very
+often symptoms of a typhoid, or malignant condition of the system. In
+almost every case, it was attended with great gastric irritability and
+pain; and, in very many instances, accompanied with vomiting of dark
+green, and even of black bilious matter,--determination to the brain
+producing delirium, coma, &c. &c. In general, this fever differed but
+little from the bilious fevers of this country; except, perhaps, in its
+greater severity, and in a larger quantity of bile commonly evacuated.
+The treatment of this disease, at the time of my arrival, was generally
+attended with some difficulty, owing to the great prejudice prevailing
+against the use of the lancet; not only among the mass of the
+population, but even among the old physicians of the island. Experience,
+however, having taught me, that venesection was essentially necessary in
+fevers of the same sort, which I had noticed in other places, I resorted
+to it, notwithstanding the existing opinion; and am now convinced, that
+by its means I saved many patients. Nor was I the only one to adopt this
+mode of practice; as it was commonly resorted to by all _new_
+physicians, who were soon found to be more successful than the older
+practitioners. To arrest the violent vomiting, already alluded to, it
+was of the highest utility, and, in many instances, the only remedy that
+could be depended upon. Emetics were very commonly used, and sometimes
+with great benefit; but, in many instances, they were contraindicated by
+the pain and irritation of the stomach.
+
+Cooling and saline purgatives were advantageously employed, as well as
+the saline mixture, and nitre and camphor in small and repeated doses, a
+very favourite practice in the place. In a more advanced period, and
+when the fever assumed a typhoid type, blisters, bark, and serpentaria
+were resorted to.
+
+I arrived in Philadelphia on the 20th of August, 1793, and on the 22nd
+of the same month, began to see patients. The epidemic was then at its
+height, and such was the demand for physicians, and the prevalence of
+the idea, that, as I came from the West Indies, I must be familiar with
+the yellow fever, that I soon became very extensively employed. Such,
+indeed, was soon the extent of my engagements, that I was compelled for
+a time to refuse my attendance on many patients, and to limit my visits
+from Race to Dock streets, and from the water to Third street.
+
+From the first time I had an opportunity of seeing the yellow fever, I
+perceived that there existed but a very distant, if any, analogy between
+it and the fevers I had been in the habit of treating in the West
+Indies. And this opinion I have ever since entertained, in opposition to
+the statement of many respectable authorities; but in conjunction with
+some highly respectable physicians and friends, who, like myself, had
+had an opportunity of treating both diseases. The points of difference
+between these fevers will be noticed in a subsequent part of these
+observations. But although entertaining this sentiment, I very early
+came to the conclusion, that the yellow fever was the effect of a
+gastro-duodenic inflammation, somewhat modified by some unknown
+cause,--requiring the usual remedies for such a complaint, proportioned
+only to the strength of the patient, and the force of reaction in the
+system; and all my subsequent experience has only served to confirm me
+in this belief. Differing from many physicians respecting its bilious
+character, I have been led to believe, that the liver is very seldom
+implicated in the disease;--the secretion of bile, in the majority of
+cases, being very little, if at all altered. This may very readily be
+discovered by an attentive examination of the symptoms of the disease,
+as well as by the appearances noticed on dissection; the lining membrane
+of the stomach and duodenum presenting in almost every case, marks of
+inflammation, and giving passage to a large quantity of black matter,
+which I have always been led to regard as altered blood, mixed with
+mucus. The liver, on the contrary, so rarely showed marks of disease,
+that when it did, it was natural to regard its alteration as secondary.
+
+Such being my opinion respecting the pathology of yellow fever, I cannot
+view otherwise than as secondary to the gastric affection, all the
+morbid conditions of other organs, indicated during life by their
+peculiar symptoms, and revealed on dissection by the ordinary marks of
+inflammation; such as affections of the lungs, kidneys, &c. This view of
+the subject will cease to be regarded as merely hypothetical, when it is
+recollected, that these symptoms and morbid appearances are occasionally
+not found; whilst the symptoms referrible to the gastric and duodenic
+irritation, being the true characteristics of the disease, are always
+present. Indeed, what would authorize us to regard any subject as
+affected with yellow fever, who would not present the pain in the
+stomach, the redness of the tip of the tongue, the thirst, irritability
+of the stomach, and vomiting either of simple mucus, or black matter?
+And, on the other hand, how many have died with these symptoms, who were
+not affected with all the others we have noticed, and, on dissection,
+have shown no mark of disease, except in the digestive apparatus?
+Finally, can pain in the head, affections of the kidneys, vomiting of
+bile, &c. constitute yellow fever, without the concurrence of some of
+the gastric symptoms we have enumerated?
+
+With respect to the characteristic features of yellow fever, and the
+different signs, by which it may be distinguished from bilious fever, I
+must be very brief; as a great deal having been written on the subject,
+any long details in this place would occasion undue repetition of what
+is already known to the profession. A few words, however, may not be
+improper. Every one who has had frequent opportunities of seeing the
+yellow fever, must have noticed, among its most habitual signs, a
+peculiar inflamed glassy appearance of the eye, easily recognised, but
+difficult to describe. It is one, however, on which I should be willing
+to place considerable reliance, in establishing my diagnosis of this
+disease; as I do not recollect to have noticed it in any other form of
+febrile affection. Together with this, there is, in the majority of
+cases, an intense supra-orbitar pain, apparently unconnected with great
+disordered action of the brain, as the intellectual functions are
+generally unimpaired. These two signs, together with pain in the loins,
+and, in more advanced periods, the peculiar appearance of the skin, the
+vomiting of the coffee grounds matter, the intermission on the 4th day,
+the retention of muscular strength, and suppression of urine, are the
+only signs by which the yellow fever, so far as I am prepared to say,
+may be recognised. In regard to the supposed identity of this fever with
+the bilious, a great deal has been written; but I must confess, that I
+feel inclined to doubt the correctness of this opinion, for the
+following reasons:
+
+1st. Bilious fever is almost always a remittent fever, presenting
+regular exacerbations, and, unless arrested by medical aid or some
+effort of nature, running its course, in a progressive manner, either to
+a happy or fatal termination; whereas the yellow fever is almost
+invariably a continued fever, presenting obscure and irregular, or even
+_no_ remissions. On the fourth day, it generally presents so perfect a
+remission, as to cause the patient, in many cases, to imagine himself
+perfectly free from disease, and induce him to get up, and even
+sometimes to walk out. This remission, which sometimes amounts to an
+intermission, so far as an experience of upwards of forty years can
+authorize me to decide, is never found to attend in bilious fever, in
+which, if there be any remission, and recurrence of the unpleasant
+symptoms, the former is always a real convalescence, and the latter an
+accidental relapse.
+
+2nd. The red colour of the eye, to which I have alluded above as
+occurring in the early stage of the yellow fever, and its peculiar
+yellow tinge in the after part of the disease, are different from the
+redness and yellowness of the same organ in bilious fever; in the first
+stage of which the eye presents a more fiery redness, and in the
+subsequent period, a more saffron yellowness.
+
+3d. The colour of the skin in the two diseases presents also some
+difference, being more constantly noticed in yellow fever, and
+disappearing much more rapidly than in bilious fever. In yellow fever,
+moreover, it assumes, most commonly, a yellowish-brown or even mahogany
+tinge; whereas in bilious fever, when it occurs, it does not differ from
+the ordinary jaundice colour, of a lighter or deeper shade.
+
+4th. These fevers may likewise be distinguished by an attention to the
+state of the intellectual faculties, and of the muscular strength; these
+remaining often unimpaired to the last in yellow fever, whereas, in a
+very large majority of cases of bilious fever, the mind becomes soon
+involved in the disorder of the system, and the greatest muscular
+debility prevails, even from the very onset of the attack.
+
+5th. The matter vomited might of itself serve to distinguish the two
+diseases. Independently of the difference we shall notice when speaking
+of the black vomit, we may mention that patients complain, even
+sometimes from the commencement of the attack, of the acidity of the
+vomited matter; whereas in bilious fever, the mouth is bitter, and the
+matter ejected of the same taste.
+
+6th. As a further mark of difference, we may state, that, in yellow
+fever, the tongue, except at the tip, the skin, and the pulse are
+sometimes little altered; whereas in bilious fever they are usually
+pretty much so.
+
+7th. In respect to the duration of the two diseases, we may state as a
+general rule, that yellow fever runs its course to death or
+convalescence, in a much shorter time than bilious fever. Nor is the
+promptness of recovery from yellow fever less different from the
+slowness of convalescence, noticed in most cases of bilious fever.
+
+8th. The suppression of urine is a frequent attendant on the last stage
+of yellow fever, and is seldom noticed in bilious fever.
+
+9th. I have never witnessed a second attack of yellow fever in the same
+individual; whilst on the contrary, so far as I have seen, there is no
+limitation to the number of times a person may be affected with the
+other form of fever.
+
+_Prognosis._--As regards the prognosis in yellow fever, I shall merely
+state, that I generally found, an early evacuation from the alimentary
+canal, and a disposition to diaphoresis during the first twenty-four or
+thirty-six hours, and its continuance during the course of the disease,
+to be favourable omens. When the disease continued beyond the 7th, 9th,
+or 11th day, greater hopes might be entertained. It was likewise found,
+that the mortality was much smaller among patients, who remained free
+from apprehensions as to the nature and termination of the disease. To
+this cause, more than any other, do I refer my greater success among
+Quakers; who, being generally surrounded and comforted by their friends,
+retained more than any other class of people, the necessary tranquillity
+of mind.
+
+Among the unfavourable signs may be mentioned, a discoloration of the
+skin before the fourth day. This symptom was, indeed, almost always a
+fatal one. Obstinate vomiting and costiveness, haemorrhages from
+different parts of the body, unattended with an abatement of the
+symptoms, and vomiting of black matter, were very unfavourable; whilst a
+suppression of urine, agreeably to my experience, was always a fatal
+sign.
+
+_Black Vomit._--In a preceding part of these observations, in alluding
+to the black vomit, I took occasion to express my views respecting its
+nature,--stating that I regard it as consisting of mucous flakes, mixed
+with a large proportion of altered blood. That such is the true nature
+of this substance, on which so much has been said and written, I have
+had sufficient reason to be convinced. The opinion that it consists of
+altered bile, I deem totally untenable, for the following reasons: The
+matter is occasionally voided in large quantities, in cases in which the
+liver is not at all affected, and in which, after death, the gall
+bladder is discovered to be more or less filled with _natural_ bile.
+Independently, of this, it may be stated, that the appearance of the two
+substances is very dissimilar;--the black bile vomited in bilious fever
+being of a homogeneous nature, and of a black or deep green colour;
+whilst the matter of the black vomit is, in a large majority of cases, a
+compound of a mucous, flaky substance, and a sanguineous matter, bearing
+some resemblance to the grounds of coffee, and, for the most part, of a
+brown tinge. When mixed with water, the two substances produce very
+different effects,--the bile mixing with and imparting a greenish tinge
+to it without difficulty, whilst the grounds of the other, float on the
+surface of the water, without mixing with and colouring it, in the same
+manner as bran, deprived of all its mucilage, or rather like mahogany
+saw-dust. This I consider as one of the best modes of distinguishing
+these two substances,--serving at the same time to establish a
+difference between the fevers, I was in the habit of observing in the
+West Indies, and the yellow fever of this country. Nor are these the
+only reasons for rejecting the supposition of the black vomit of yellow
+fever being of a bilious nature; for I have known this substance (and I
+suppose other practitioners have observed the same fact) occasionally to
+exude from surfaces, from which, in all probability, bile is excluded. I
+allude particularly to the skin and verous membranes. Thus it has often
+happened, that the application of a blister, especially in the advanced
+stage of the disease, has been followed by a copious exudation of a
+fluid, resembling, in all respects, the matter ejected from the stomach;
+an occurrence which was strikingly exemplified in a case, which fell
+under my immediate observation during the last visitation of the disease
+in this city, in 1820. During the same epidemic, I had occasion to
+attend a Mrs. H. about 70 years of age, who presented a curious example
+of the exudation of a similar substance from the peritoneum. She had not
+been exposed to the causes of the yellow fever, and indeed presented
+none of its ordinary pathognomonic signs. She was attacked very early in
+the morning with violent colic, attended with fever, great tenderness of
+the abdomen, and high colour of the face. She was bled at 10 o'clock; at
+11 vomited a large quantity of coffee ground matter, and died in about
+12 or 15 hours from the commencement of the attack. The next morning her
+body was examined in the presence of several highly respectable and
+experienced physicians, who all coincided in the opinion, that the
+matter vomited and which continued to be discharged from the nose, was
+identical with that discharged in yellow fever. The stomach as well as
+the intestines were found to contain a large quantity of a similar
+substance. The cavity of the peritoneum being likewise found filled with
+a large portion of it, we at first suspected the existence of an opening
+in the intestines, by which an effusion had taken place. After a careful
+and minute examination, however, no such opening was discovered. Our
+attention was now directed to the condition of the peritoneum itself,
+which was highly inflamed. It was, moreover, found, that the substance
+in question exuded from its surface,--the membrane, in many places,
+especially the portion of it which covers the liver, being coated so
+thickly with the grounds, that they could readily be scraped off with
+the back of a scalpel.
+
+These cases show conclusively, that the matter of the black vomit,
+occurring in yellow fever, should not be regarded as altered bile; and
+that the supposition of its consisting of a secretion of the mucous
+membrane of the stomach, does not rest on a much more solid foundation.
+For bile can hardly be admitted to exude from the skin and serous
+membranes, and we cannot suppose, that fluids, similar in every respect,
+can be secreted from two surfaces, so very distinct in their
+organization, and in the nature of their ordinary products, as those of
+the mucous and serous membranes.
+
+From these facts I am led to regard the black vomit as a true
+haemorrhage, resulting from a state of previous irritation of the surface
+which furnishes it. That inflammation may be cause of it, we have a
+sufficient proof in the fact, that a similar fluid is occasionally
+vomited in cases of puerperal fever, when the irritation progresses from
+the serous to the mucous membrane of the intestines; as well as in cases
+of inflammation from blows on the stomach, and the action of poisons. A
+case of this kind, arising from a kick of a horse, was attended by
+myself and two respectable physicians in consultation, a few years ago;
+and another case arising from a large dose of carbonate of potassa,
+swallowed by mistake, occurred in my practice not long since. But as it
+would occupy too much time to give them here in detail, I pass them by
+without further notice.
+
+That the matter of the black vomit is the product of a haemorrhage, I
+have thought may also be inferred from the fact, often noticed by myself
+and others, of large portions of coagulated blood being found in the
+intestines; the surface having the appearance of the common black
+matter, whilst on cutting into them, the centre is found to consist of a
+red solid coagulum. I have also sometimes noticed, that the duodenum
+contained the coffee ground matter, and the intestines, coagulated
+blood. In such cases, in order to adopt the opinion of secretion, we
+must believe, that the same vessels, occupied in the secretory process,
+afforded, at the same time, passage to a portion of common blood; for we
+can hardly admit, that the mucous follicles are the organs secreting the
+black matter. Besides, is this not a mere dispute about words; and is it
+proved that what are called sanguineous secretions are not the result of
+the same action, which gives rise to haemorrhagic exudations? and is
+there any other difference between the haemorrhage of yellow fever, and
+of ordinary cases of hematemesis, than that arising from a difference in
+the _quality_ of the blood?
+
+Nor do I find much difficulty in believing, that the colour of the skin,
+which is more frequently brown than yellow, as well as the petechiae, &c.
+are the effects of the stagnation of blood, altered by the capillaries
+of the surface, in the same manner as that exuding from the mucous
+surfaces. I believe that this opinion, suggested by some European
+writers, is supported by the fact, that this fluid exudes from the
+orifices made by the bites of leeches and the incisions of scarified
+cups; as well as from the raw surface occasioned by blisters; and that
+the vibices contain a serous fluid mixed with blood.
+
+_Analogy to Plague._--On comparing the symptoms of the yellow fever of
+this country with those of plague, as detailed so minutely and, I
+believe, accurately by authors, and especially by the physicians who
+accompanied Bonaparte to Egypt, I have been led to regard these diseases
+as bearing a closer analogy to each other than has hitherto been
+admitted. I do not pretend to assert that they are the same disease, but
+only that they are so nearly allied, as on some occasion, to lead even
+an experienced observer into an error of diagnosis. The great difference
+between them consists in the frequency of the affection of the lymphatic
+glands in the plague, and its comparative rareness in yellow fever; and
+in the greater predominance of gastric symptoms in the latter.
+Nevertheless, I have had, on many occasions, during our different
+epidemics, opportunities of noticing buboes, situated in the same parts
+as those mentioned by writers on the plague, running the same course,
+and curable by the same means. Carbuncles are frequently seen in both
+diseases, though not so frequently in yellow fever as in the plague.
+Both diseases present what are called the walking cases. Patients in
+both, though more frequently in yellow fever, retain their muscular
+strength as well as their intellectual faculties. So far as we are
+informed, the mortality in both is pretty nearly the same, and the
+treatment similar.
+
+_Contagion of Yellow Fever._--The question of the contagion or
+non-contagion of yellow fever has so long occupied the attention of the
+profession and been discussed so extensively, that I deem it unnecessary
+to devote much space to it here. Nevertheless, as I have had frequent
+opportunities of noticing the disease under all circumstances; in all
+parts of the city, and in the country; among the wealthy and the poor, I
+may without much impropriety offer, in a few words, the result of my
+observations and reflections on this head. I must unhesitatingly
+declare, that, establishing my opinion on what I have seen, I am led to
+the conviction, that the yellow fever is not a contagious disease; that
+it never has been carried hither in the way mentioned by contagionists;
+and that it has invariably proved an infectious disease, using this word
+to express a malady arising from a local source of contamination, other
+than a living body. It is plain, that this view of the subject does not
+exclude the possibility of a vessel carrying the disease to this or any
+other port; but, in that case, the vessel itself or its cargo, must be
+the source of infection, and not the individuals on board. And this may
+take place, when the port from whence the vessel sailed is free from the
+disease. That such has been the case, there cannot be any doubt; and
+that the idea, predicated on it, of the contagiousness of the fever is
+erroneous, I have not the least hesitation in believing.
+
+How else than on the principle of infection, and not of contagion, can
+we explain the attack of individuals frequenting those parts of the
+city, where the disease had originated, and which (all the inhabitants
+having been removed to some distant situation) had been barricaded? How
+could we, in any other way, account for the exemption from the fever of
+individuals, who, out of the infected district, nursed, touched, and
+even slept with their diseased relatives and friends; and not always in
+clean and well ventilated apartments and parts of the city; but, in very
+many instances, in the filthiest hovels, and alleys, and among the
+lowest classes of society. Striking and unanswerable facts of the sort
+have frequently presented themselves to my observation, during our
+various epidemics. Children have sucked their parents, affected with the
+fever, and, in one case which fell under my notice, the child continued
+attached to the breast after its mother's death; and in all such
+instances with impunity. I have constantly reprobated the practice of
+burning the clothes and bedding of the dead, and have never found any
+bad results to occur to those who followed my advice. From a
+consideration of all these facts, I must once more express it as my
+decided opinion, that the yellow fever, so far as I have had an
+opportunity of observing it, is not a contagious disease.
+
+_Treatment._--Whatever opinion we may entertain respecting the specific
+nature of yellow fever, I was early convinced that this disease was not
+to be treated by specific remedies, and that our curative indications
+should be formed on an attentive consideration of the condition of the
+system in general, and of particular organs, as pointed out by the
+symptoms during life and the morbid lesions after death.
+
+In a former part of these remarks, I suggested the opinion, that the
+yellow fever is a gastro-duodenic inflammation, (perhaps of a specific
+kind,) and that it required a mode of treatment appropriate to this
+morbid state; but proportioned to the strength of the patient, to the
+violence of the attack, and to the power of re-action. In general,
+however, I have not found active depletion by the lancet, as easily
+borne in this, as in bilious and other fevers;--the disease assuming
+more rapidly, under this plan, a state of prostration or adynamia. Nor
+can this appear surprising, since the same circumstance of a disease
+being of an inflammatory nature, but, under a peculiar condition of the
+system, contraindicating ample depletion, is a subject of frequent
+notice during certain epidemics; for example, of scarlatina, pneumonia,
+&c. With the exception of those cases, therefore, occurring in very
+robust and plethoric constitutions, and accompanied with much pain in
+the head, high febrile excitement, and hard pulse, either large or
+small, I have seldom resorted freely to the lancet. When, however, these
+symptoms presented themselves, especially the hardness of the pulse, I
+have not been sparing of blood-letting, and have sometimes repeated it
+several times with the most decided success. But even under these
+circumstances, I have seldom found that _large_ bleedings were as
+beneficial as small and repeated ones;--the system not reacting always
+as energetically as could have been desired, and symptoms of prostration
+occurring with much more rapidity. I do not recollect to have bled with
+advantage, patients presenting a large, full, but _compressible_ pulse,
+owing to the want of reaction; although the other symptoms might seem to
+indicate the propriety of the practice. The effect of bleeding on the
+vomiting was very different in this, from what I mentioned it to have
+been in the bilious fevers of the West Indies; owing probably to the
+circumstance, that, when, in yellow fever, the irritation of the stomach
+became sufficiently violent to give rise to this symptom, the state of
+the system was very often such as to contraindicate the use of the
+lancet.
+
+The application of scarified and dry cups to the epigastrium and head,
+when there existed pain in these regions, was often resorted to, and
+afforded much relief. And I very much regret, that, during our
+epidemics, it was out of my power to make use of leeches to the former
+part, as so warmly recommended, at the present day, by the French and
+Spanish physicians; as I am inclined to the opinion, from the view I
+have adopted respecting the pathology of the disease, that, used early
+and in large numbers, they would prove very serviceable.
+
+In conjunction with general and local bleeding, fomentations were had
+recourse to in almost every case, and applied to the epigastrium in the
+form of poultices, or flannels wrung out of warm emollient decoctions.
+In order to excite perspiration and to determine action to the surface,
+a tepid bath was occasionally prescribed, and in some cases afforded
+considerable relief; but as it was an inconvenient remedy, pediluvia,
+and hot bricks on which water, or water mixed with vinegar was poured,
+were substituted. In cases, however, in which much arterial action
+existed, these last means were not prescribed, until the pulse had been
+brought down by the lancet, and other remedies presently to be
+mentioned.
+
+On the subject of emetics, I shall not enlarge; as I can safely assert,
+that I very seldom saw a patient recover from yellow fever, to whom
+tartarized antimony, or any other active remedy of the same class, had
+been administered. Of the impropriety and danger of this practice in the
+present disease, I was early convinced from a careful analysis of the
+symptoms, indicating an acute irritation of the stomach and upper
+portion of the small intestines, and from the circumstance, that, of the
+first family in which I was called to prescribe, five members, to whom
+emetics had been administered, had already fallen victims to the fever,
+under the care of a very respectable physician, and that three
+succeeding ones, who were treated agreeably to my view of the pathology
+of the disease, recovered. From these facts and reflections, I was
+induced to watch the effects of these remedies in subsequent cases, in
+my own practice, and in the practice of other physicians, and was soon
+led, from this extended experience, to abandon totally the use of tartar
+emetic in the treatment of this malady. Ipecacuanha in emetic doses was
+also tried by me; but although, thus administered, it did not occasion
+the bad effects resulting from the exhibition of the preceding article,
+yet it was often productive of harm, and never of benefit. These
+remarks, however, apply more particularly to the use of tartar emetic
+during the state of excitement of the fever, and not to that of collapse
+which sometimes precede it, and in which it is recommended by some
+physicians of the southern states. In this condition of the system, I
+have never resorted to it, and, I must confess, could not easily be
+persuaded to do so; suspecting that even in such cases, the digestive
+organs are already too far implicated, to justify the use of so powerful
+and acrid a remedy.
+
+It would seem that the bad effects of emetics, and more particularly of
+tartarized antimony, resulted, not only from their irritating qualities,
+but also from the efforts of vomiting, during which the stomach is
+compressed by the abdominal muscles, and made to contract very forcibly.
+To this opinion I am naturally led from the circumstance, that
+purgatives, whose action is certainly primarily irritating, are very
+advantageously employed in yellow fever. It is not my intention to
+attempt here an explanation of this seeming contradiction. Leaving to
+others the accomplishment of this difficult task, I shall content myself
+with stating, that during the whole course of my long practice, I have
+seldom seen a patient die of this disease, whose bowels had been well
+evacuated, and in whom perspiration had been excited within the first
+twenty-four hours after the attack. I exhibited purgatives in almost
+every instance _every day_, until copious evacuations had been procured,
+and I generally found, that the mild purges were of greater service than
+those of a severe and irritating nature. Senna, acidulated with lemon
+juice or tamarinds, answered sometimes remarkably well, when the stomach
+could retain it. Castor oil, manna, salts, magnesia, were frequently
+employed by me with advantage; and although I did not make an extensive
+use of calomel in this disease, yet I prescribed it to children, and to
+adults, who, owing to great irritability of the stomach, could not
+retain other purgative medicines. When I resorted to it, I generally did
+so in doses sufficient to ensure a purgative effect, and never with a
+view of exciting ptyalism. In doing this, I was not guided, however, by
+any fear of the effects of a salivation, since I was well aware that a
+ptyalism occurring in malignant diseases is often a favourable crisis;
+but by a knowledge of the great difficulty experienced in producing it,
+and from the observation, that in cases in which it was obtained, much
+valuable time had been lost, and the patient might have recovered
+without.
+
+To promote the operation of the above remedies, purgative enemata were
+resorted to, in the early stage of the fever; and were followed by the
+frequent use of injections, composed of emollient decoctions, from which
+the patient derived considerable relief and comfort.
+
+As counter-irritants, blisters and sinapisms were used, and often with
+great advantage. They were found of much value when applied to the
+epigastric region, for the purpose of arresting the vomiting. Sinapisms
+were in general preferred to blisters, as being more prompt in their
+effects and more easily renewed. Blisters were sometimes applied to the
+extremities in the different stages of the disease; but so far as I can
+judge, from my experience, not with much real benefit.
+
+I seldom derived much advantage from the use of tonics and stimuli in
+yellow fever; except when the powers of life seemed to fail, and
+petechiae, vibices, haemorrhages, and other signs of malignancy had
+occurred. In general, under such circumstances, the Peruvian bark,
+either alone or combined with serpentaria, was administered in
+preference to any other remedy of the same class. In cases, however,
+unattended with reaction, tonics and diffusible stimuli internally, and
+revulsives of all sorts externally, were had recourse to from the
+commencement of the attack, and sometimes with the desired effect of
+arousing the powers of the system. _Opium_ was never found beneficial,
+on account of its tendency to aggravate or produce coma, as well as from
+its effect in suppressing intestinal evacuations.
+
+Whilst making use of the above remedies, the plentiful exhibition of
+diluent drinks was not neglected,--care being taken, however, not to
+load unduly the stomach, and to select such drinks as would suit the
+taste of the patient. In almost every case, acids did not answer so well
+as the bland mucilaginous infusions. The drinks were almost universally
+allowed cold, except when there existed a tendency to perspiration;
+under which circumstances they were administered slightly warm and a
+little aromatic.
+
+During the course of the yellow fever, some of the symptoms demanded
+particular attention. Influenced by the idea of prostration and
+dissolution, many practitioners, and myself for some time among the
+rest, resorted to the bark and other tonics for the purpose of arresting
+the black vomit, and of correcting that condition of the organs, which
+gave rise to this effusion; but after many unsuccessful trials, I was
+led to abandon this practice and to resort to other means. Of all the
+remedies employed to attain this effect, calcined magnesia mixed in a
+thick solution of gum arabic seemed to me to answer best; for whilst it
+succeeded, in many cases, in arresting the vomiting, it tended to keep
+the bowels open. Together with this, revulsive remedies were applied to
+the skin, and sometimes succeeded very well,--a sufficient proof, I
+think, that this haemorrhage is the effect of an increased action of the
+mucous membrane of the digestive tube, and not of a passive condition of
+the capillaries of the parts. For the purpose of controlling the great
+irritability of the stomach, and arresting the vomiting occurring in the
+early stage of the disease, besides the usual remedies used in such
+cases, I found advantage in the use of small and frequently repeated
+injections with a solution of salts, an infusion of senna, or the like
+substances. Such a practice, however, did not seem to succeed so well in
+the latter stage of the disease.
+
+With the intention of promoting the secretion of urine, in cases in
+which it was suppressed, all the diuretics, as well as every external
+stimuli, were in vain employed;--this symptom, as I have already
+mentioned, being, in all instances which fell under my immediate
+observation, the forerunner of death.
+
+
+
+
+ARTICLE V.--_Remarks on the Prophylactic Treatment of Cholera Infantum._
+By JOSEPH PARRISH, M. D., one of the Surgeons to the Pennsylvania
+Hospital.
+
+
+The great mortality of cholera infantum renders it one of the most
+interesting diseases, which come under the notice of the physician. Its
+ravages among the infant population of our large cities, are too well
+known, and too strongly felt, to require any comment. No disease
+contributes so largely to swell our bills of mortality during its
+prevalence; and were it not restricted to the summer season, it would
+prove a greater scourge to the community than consumption itself.
+
+This mortality is owing less to our ignorance of the nature of the
+complaint, and the proper mode of treatment, than to the continued
+operation of the causes by which it is produced. I have often compared
+our endeavours to cure cholera infantum, while these causes remain, to
+an attempt to relieve inflammation in a part, while a thorn is sticking
+in the flesh. We may resort to bleeding and leeching; we may restrict
+our patient to the lowest diet, and the most perfect rest; we may employ
+all those remedies, which are ordinarily best calculated to reduce
+inflammation: but so long as the thorn continues in the wound, our
+efforts will be fruitless. Thus it is with cholera. We may obviate the
+more violent symptoms; we may procure temporary relief; we may even
+flatter ourselves that a cure has been effected: but the original causes
+have not lost their power; an increased susceptibility to their
+operation remains; relapse upon relapse is experienced; and at last the
+little sufferer, worn out by the successive attacks, sinks beyond the
+reach of medicine, and expires. Unhappily, the nature of the causes is
+such, that, in very many instances, their removal is exceedingly
+difficult, if not altogether impossible; and, under such circumstances,
+the patient who has once been severely affected, seldom recovers in the
+end. Hence it becomes of the greatest importance to prevent the
+occurrence of the disease; and attention to the prophylactic treatment
+is no less essential than the adoption of curative measures. It is with
+the view of calling the attention of the profession to this subject,
+that I have been induced to offer the following observations.
+
+It is obvious, that, in the preventive treatment, two objects demand
+attention; first, to remove, as far as possible, the causes of the
+disease; and secondly, where their entire removal is not attainable, to
+fortify the system against their influence. On each of these, I shall
+offer a few observations.
+
+I. Excessive and continued heat is, perhaps, the most fruitful source of
+cholera. Thus we find, that the disease makes its first appearance in
+the commencement of the hot weather, increases and becomes more fatal
+with the rise of the thermometer, and declines with the return of cool
+weather in autumn. During its continuance, it may be observed to vary
+with every permanent change of temperature. A few very hot days in
+succession, in the 6th month, are sufficient to call it into action; and
+during the height of its prevalence, a spell of cold weather will
+diminish, if not suppress it. In the summer of 1806, which was
+remarkably cool and pleasant, there was very little of the disease; and
+generally in moderate summers, it is much less prevalent than in those
+of a contrary character.
+
+I believe that it is by a direct operation on the system, and not by the
+generation of miasmata, that heat proves so deleterious to the infant.
+In the country, where miasmata are most abundant, there is comparatively
+little cholera; for the heat of the sun is there moderated by the free
+circulation of the air; and the debilitating operation of the high
+temperature of the day is counteracted by the refreshing coolness of the
+morning and evening. It is in the close air of cities, that the
+complaint flourishes with greatest vigour; and the most confined
+situations are the most favourable to its production. Let any one take
+a walk, in a summer's morning, through the thickly built lanes and
+alleys of Philadelphia. He will be struck with the appearance of the
+children, reclining their heads, as if exhausted, upon the breast of
+their mothers, with a pale and languid countenance, a cool and clammy
+skin, a shrunk neck, and other signs of debility, arising from their
+confinement, during the night, to close and hot apartments. It will
+readily be believed, that such places are the very hot beds of cholera.
+
+Heat, therefore, connected with confined air, being among the most
+frequent causes of the complaint, it is necessary, as far as possible,
+to counteract them. Should a strong predisposition to cholera be
+suspected, the best plan will be to send the child into the country
+during the summer. Both as a preventive and a remedy, country air is
+decidedly the most effectual, to which we can resort. But in most
+instances, it would be exceedingly inconvenient, sometimes impossible
+for mothers to leave their homes and occupations in the city; and, under
+such circumstances, it becomes necessary to substitute measures, which
+may produce, as nearly as possible, the same effects. To keep the child
+cool, and expose him to the fresh air, are the ends to be obtained. For
+this purpose, he should be carried frequently into the open squares, or
+beyond the suburbs of the city. I am in the habit of recommending to
+parents, whose circumstances will not allow of a removal from the city
+during the summer season, to make frequent excursions across the
+Delaware, and into the neighbouring woods of New Jersey. The refreshing
+effects of the air on the river are truly surprising. The brightened eye
+and animated countenance of the infant, give speedy proof of their
+favourable influence; and when labouring under the disease, even in its
+lowest stage, the little patient will often exhibit immediate signs of
+amendment.
+
+In the prevention of cholera, much may also be expected from a proper
+attention to the lodging of children. Many parents have a great dread of
+the night air; and exclude it from their chambers, as sedulously as if
+it were infected with poison. But, in guarding their children from
+taking cold, they expose them to a much greater danger. Observe their
+mode of treatment. The doors and windows are carefully closed; the child
+is placed in a feather bed, with his parents on each side, and almost
+smothered with the bed-clothes. Perhaps other children are lodged in the
+same apartment; and thus the delicate system of the infant is exposed to
+the debilitating influence of great heat and stagnant air, combined with
+the effluvia, which, in such a situation, must be abundantly generated.
+Simply to enter such a room in the morning, is almost sufficient to
+sicken a healthy individual; how much more injurious must be its effects
+upon the lodgers themselves. Examine in the morning a child, who has
+passed the night thus confined. You will find him limber as a rag,
+exhausted by perspiration, wholly destitute of animation, without
+appetite, and on the very verge of cholera. I should recommend an
+entirely different plan of management. Instead of a feather bed, the
+child should be placed on a hard mattress, or on blankets folded and
+laid upon the floor. The covering should be light, but comfortable. The
+doors and windows should be open; so that fresh air, that _pabulum
+vitae_, without which health cannot be sustained, may be freely admitted.
+Thus treated, instead of the feeble and sickly appearance before
+mentioned, he will present a lively countenance, with all that activity
+of motion, and enjoyment of existence, which are natural to his age, and
+afford the surest criterion of vigorous health. Experience has fully
+convinced me of the great importance of attention to the lodging of
+children, as a prophylactic measure; and this renders me desirous of
+impressing upon the profession generally, the truth of my own
+convictions on the subject.
+
+With the same design of obviating the injurious effects of a high
+temperature upon the infantile system, I advise frequent ablutions with
+cool water, and its free employment as a beverage. Infants, unable to
+make their wants known, often suffer exceedingly from the inability of
+their attendants to understand them. During the heat of summer, the
+increased evaporation from their surface is necessarily productive of
+increased thirst, which, if unsatisfied, renders them uneasy and
+restless. To quiet them, the breast or bottle is offered. Aliment is
+thus given, where drink only was required; and the stomach, overloaded
+and oppressed, is apt to become irritable, and is thus brought into a
+condition most favourable to the occurrence of cholera. By attention to
+the peculiar language of infants, expressed not by words, but by signs,
+I have often been able to detect their wants; and, in many instances,
+have afforded the most decided relief, by simply giving them a little
+cool water for drink. From the dread which some individuals have for
+cool air and cold water, it would seem that they were considered rather
+as destructive poisons than as absolute necessaries. I have no fear of
+either, when judiciously employed; and as prophylactics in cholera, I do
+not think their place can be supplied.
+
+But heat is not the only cause of this complaint. Dentition is well
+known both to predispose the system to its attack, and, after it has
+occurred, to increase its violence, and diminish the chances of
+recovery. In the employment, therefore, of preventive measures, it is
+highly necessary to attend to the state of the gums, and to remove or
+counteract this source of irritation. If at all swelled or painful, they
+should be lanced freely, and the operation should be repeated as often
+as their inflammatory condition may demand. In severe cases, much good
+may be expected from the application of blisters behind the ears. The
+irritation thus receives an external direction, and the stomach and
+bowels are in less danger of an attack. I was led to this practice, by
+observing that the eruption, which, during dentition, is apt to make its
+appearance behind the ears, often proves a most salutary effort of
+nature; and that, while it continues, the infant generally enjoys an
+exemption from those dangerous disorders, incident to this critical
+period of life. To imitate nature as closely as possible, the discharge
+from the blistered surface should be maintained for some time by
+stimulating dressings. I have witnessed the most beneficial effects from
+the practice, and can strongly recommend it to the attention of the
+profession.
+
+II. At the same time that we endeavour to remove or diminish the causes
+of cholera, we should not neglect to put the system of the child in such
+a condition, as may enable it most effectually to resist their
+operation. As cholera is a disease of irritation, originating generally
+in a debilitated state of the alimentary canal, I believe this end may
+be most easily attained, by preserving the natural tone of the digestive
+organs. For this purpose, all flatulent and indigestible food should be
+carefully avoided. During the first year, the mother's milk is, in
+general, the most appropriate nutriment. When the stomach of the infant
+is very delicate, the diet of the mother should be strictly regulated;
+and, in all cases, it would be adviseable for her to avoid articles of a
+flatulent nature. While the child is still at the breast, if a
+predisposition to cholera be suspected, I would recommend the occasional
+use of nutritious animal juices. The sucking of small pieces of salt
+meat, as ham or dried beef for example, will sometimes be found
+productive of advantage. After weaning, animal food should always enter
+into the diet of the child. Many parents, fearing to render their
+children gross and unhealthy, restrict them altogether to vegetable
+aliments; and thus, by weakening the powers of digestion, prepare the
+way for that very result which they are most anxious to avoid.
+
+With the same view of giving tone to the stomach, aromatics should be
+used habitually during the summer, in those cases, in which there is
+strong reason to apprehend the occurrence of cholera. While they produce
+a cordial impression on the stomach, and invigorate generally the
+digestive powers, they are liable to none of those objections which may
+be urged against the employment of the narcotic stimulants. Indeed,
+nature herself seems to have pointed them out as prophylactics against
+the diseases of hot weather. Our most powerful and valuable spices are
+the products of warm countries. Cinnamon, ginger, pepper, the clove, the
+nutmeg, are to be found only in tropical climates. In this arrangement,
+we see the hand of a beneficent Creator, who has provided, that, by the
+same high temperature, which renders the equatorial regions so fruitful
+of cholera, and other disorders of the bowels, the growth of those
+plants should be promoted, which are best calculated to invigorate the
+alimentary canal, and to fortify it against the inroads of disease.
+Facts are not wanting to prove the efficacy of spices in preventing
+intestinal complaints. We are informed by DEWAR, in his treatise on the
+Diarrhoea and Dysentery, by which the British army in Egypt was
+attacked, that among the Mamalukes of that country, it was a universal
+practice, when they apprehended the approach of these disorders, to make
+use of cinnamon or ginger, with the almost uniform effect of averting
+them; and where the same practice was followed by the British soldiers,
+equal advantages were experienced. In the French army, so highly was the
+prophylactic power of the aromatics estimated, that every soldier was
+provided with a box of spices, which he was directed to use freely with
+his diet of fruit and melons.
+
+When attending surgeon of the Alms-house hospital in this city, I had
+occasion frequently to prescribe in a syphilitic ward, which being
+situated directly under the roof, in a large garret, was liable, in the
+summer season, to become very much heated. As the patients were
+numerous, and the windows insufficient to admit of proper ventilation,
+the air became much contaminated; and the consequence was, that bowel
+complaints were very frequent and troublesome. I have often entered the
+ward on a summer's morning, and found almost every patient affected more
+or less with diarrhoea or cholera. It occurred to me, that the free
+use of some of the aromatics might be found serviceable in preventing
+the occurrence of these complaints. I accordingly directed, that every
+individual in the ward should drink a portion of strong ginger tea
+daily. I also ordered, that salt meat should be used twice in the week.
+By the steady pursuit of this plan, a very considerable change for the
+better was effected.
+
+The employment of aromatics as prophylactics is not less beneficial in
+children than in adults. I would not, however, advise, that they should
+be given indiscriminately to all children, during the summer. It is only
+to those cases, in which a predisposition to cholera infantum exists,
+that I consider them peculiarly applicable; and here I believe they are
+capable of producing much good.
+
+Before dismissing the subject of the paper, I will simply remark, in
+addition to what has been already said, that the occasional use of the
+cold bath, by the vigour it imparts to the system generally, and through
+it to the digestive organs, will often be found an excellent
+preservative against the summer complaint of children.
+
+In this short account of the preventive treatment of cholera infantum, I
+have been less anxious to give a dissertation, embracing all that might
+be said on the subject, than to communicate those particular measures,
+which, according to my own experience, I have found most effectual. I
+will conclude the paper by the relation of a case, in which a strong
+predisposition to the disease was successfully counteracted. It will be
+proper, however, to premise, that the treatment of this case is by no
+means held out as an example to be generally followed with every
+infant, which may possibly become the subject of cholera. It is
+applicable in all its details only to those, in which, as in the present
+instance, there is every reason to apprehend, that the only alternative
+is between almost certain death, and the most careful prophylactic
+treatment.
+
+CASE.--A gentleman of this city, whose wife had arrived at a period of
+life, when she could not expect to be the mother of many more children,
+consulted me respecting an infant daughter, their only surviving child.
+I was informed, that they had already lost eight children, all of whom,
+with one exception, had died of cholera. It may readily be imagined,
+that every feeling of parental anxiety was awakened for their babe; and
+that no degree of attention on their part was considered too great,
+which might contribute to its preservation. It was placed under my care,
+not to be cured, but that I might, if possible, devise some plan of
+management which would avert the disease they had so much reason to
+apprehend. I felt the responsibility of the trust, and endeavoured to
+find it to the best of my ability. Every opportunity which I could
+desire was afforded me; for the infant, from its birth was submitted to
+my direction; and both the disposition and ability existed, on the part
+of the parents, to carry implicitly into effect every measure which I
+might recommend.
+
+As the mother was unable to furnish sufficient nourishment, the first
+step was to provide a healthy wet-nurse, who might be willing to submit
+to the necessary regulations in respect to diet.
+
+I believed the children of these parents to possess a constitutional
+weakness in the alimentary canal; and, on inquiry, I was told, that they
+had been kept upon a vapid diet, under the impression that it would
+contribute to their health. In the present case, therefore, the
+principal object was to communicate strength to the stomach and bowels.
+With this view, the child was accustomed, from an early period of
+infancy, to a generous diet. When very young, portions of ginger tea
+were given to it daily; and as soon as it was old enough to suck the
+juice of meat, it was encouraged to do so. The nurse, during the warm
+season, was kept upon a nutritious diet, consisting principally of
+animal food, with the occasional use of ginger tea; and every
+description of recent fruit and fresh vegetable food was forbidden.
+Under this management, the first summer was passed without any symptom
+of the disease; but I looked forward to the second with no little
+anxiety, when the child would have to struggle with the irritation
+arising from dentition.
+
+The same plan was continued during the second summer, and still more
+rigidly enforced. The child was now old enough to take animal food
+freely in addition to the breast. It was allowed as much salt fish, ham,
+beef-steak, essence of beef, &c. as it desired; ginger tea was given
+daily; a little sound old port wine was occasionally directed; and both
+the child and the nurse were restricted from every species of flatulent
+and indigestible aliment. So anxious, indeed, were the parents, and so
+careful to carry my directions into full effect, that they allowed no
+forbidden article of food to enter the house, and denied themselves
+their wonted comforts, lest possibly their child might be injured.
+
+The gums were carefully attended to, and lanced whenever the operation
+appeared to be requisite. All those measures, which I have before
+mentioned as serviceable in obviating the effects of great heat, so far
+as they were applicable to the case, were adopted. The second summer was
+spent wholly in the country.
+
+Very little medicine was required, and none was administered, except of
+the mildest description. Frequently, when summoned to visit the babe, I
+have found the mother trembling with fear, and anxious that something
+might be done; and often, under such circumstances, have I begged it off
+from a dose of physic, having determined to avoid a resort to every
+thing of the kind, unless real necessity should demand it.
+
+By a strict adherence to the plan above detailed, the period of
+dentition was passed in safety; and it is with heartfelt pleasure I can
+say, that no symptom of cholera afterwards made its appearance.
+
+
+
+
+ARTICLE VI.--_Case of Neuralgia cured by Acupuncturation._ Communicated
+by J. HUNTER EWING, M. D.
+
+
+The attention of the medical public having been of late much excited on
+the subject of acupuncturation, I am induced to communicate the
+following case.
+
+For eighteen months, Miss ---- had been afflicted, at intervals, with a
+severely painful affection of the nerves of the right cheek, immediately
+below the orbit of the eye, and extending to the angle of the lower jaw.
+On the 14th of January 1826, she was attacked more violently than usual,
+and the remedies, which had previously afforded some relief, now failed.
+Stimulating cataplasms, warm embrocations, laudanum, internally and
+externally, heat applied externally to the cheek by means of very hot
+flannels, produced not the slightest mitigation of the pain; and she
+continued to suffer excessively until the afternoon of the 15th; when
+acupuncturation being proposed, she consented to the operation with this
+remark,--"any thing to relieve me from this agony."
+
+The needles were immediately procured, and three inserted about an inch
+from each other. Two in a line parallel with the inferior edge of the
+orbit of the eye, and half an inch below it; and a third below, and
+equidistant from the others. The first two were introduced to the depth
+of three-fourths of an inch; the last, a full inch. They were inserted
+very gradually and with a rotary motion.
+
+The second needle was scarcely introduced, before the patient exclaimed,
+"the pain has entirely left me." When the third was introduced, she
+experienced a stiffness in the muscles of the cheek, and a creeping
+sensation, as if a spider's web had been drawn across the face; but no
+painful sensation whatever.
+
+Such was the exhausted state of her system from the excessive pain she
+had suffered, that when thus relieved, she requested a pillow to rest
+her head on, and fell into a gentle slumber.
+
+About two hours after the insertion of the needles, I again visited my
+patient, and found her still perfectly free from pain, and seated at a
+table reading. She thanked me for the relief I had been the means of
+affording her, and requested me not to withdraw the needles, lest the
+pain might return. Upon being apprised of the risk that might attend
+their being allowed to remain, she observed, that she would rather have
+a servant to watch her whilst she slept. The propriety of their removal
+being further urged, she at last consented. There was no return of pain.
+
+The next morning, the patient remarked, that the stiffness of the cheek,
+and a numbness of the whole right side, continued through the night; and
+though she did not sleep very soundly, she was free from pain and rested
+well.
+
+By the third day, the stiffness and numbness had passed away, and there
+was no return of pain. Several weeks have now passed, and she has had no
+relapse; although often since exposed to causes, which, heretofore, had
+always excited violent attacks. Previous to the operation, she seldom
+passed as many days without severe suffering.
+
+Although I have performed this operation many times, and been present
+when others have performed it, I have never seen a case, in which its
+efficacy was so decided, or in which the relief afforded was more
+unquestionably attributable to the action of the needles.
+
+
+
+
+ANALYTICAL REVIEWS.
+
+
+
+
+ARTICLE VII.--_Researches into the Nature and Treatment of Dropsy in the
+Brain, Chest, Abdomen, Ovarium, and Skin, in which a more correct and
+consistent Pathology of these Diseases is attempted to be established,
+and a new and more successful method of treating them, recommended and
+explained._ By JOSEPH AYRE, M. D. &. London, 1825.
+
+
+We have read the present work with the liveliest pleasure, and we dare
+hope with considerable benefit, and hasten to lay a review of its
+contents before our readers. Dr. AYRE is already advantageously known in
+this country, where his Essay on Marasmus has had an extensive
+circulation; but we are disposed to think, that, however he might be
+esteemed for the talent he displayed in his former composition, he is
+entitled to much more credit for his able researches into the nature and
+treatment of dropsy. We confess that we enter upon our editorial duties
+on the present occasion, with the two-fold intention of offering to our
+readers what we regard, on the whole, as a very correct view of the
+pathology of dropsy, and of showing to some of our medical friends, who
+shudder at the mere mention of what they denominate _hunch theories_,
+that the English physicians, or at least some of the most intelligent
+among them, so far from considering these theories as dangerous and
+unphilosophical, are beginning to entertain similar views with their
+Gallic brethren, in respect to the inflammatory nature of many diseases
+too long regarded as resulting from a state of debility, and classed by
+nosologists among the Cachexiae.
+
+By most writers upon the subject, dropsy has too long been considered as
+a _disease_,--constituted into a separate class, and divided into many
+species. Dr. AYRE entertains, however, a very different and, we believe,
+a much more correct view of the pathology of this complaint; regarding
+it as only one in a series of effects of a disease, and not always the
+last of that series. He remarks, that the true disease is to be sought
+for in that particular condition of the solids by which the effusion is
+produced; and that to appreciate justly the nature and treatment of
+dropsy, it is necessary to understand the nature of that condition,
+which constitutes the disease, and of which the serous and watery
+effusion is merely the result.
+
+Of all the hypotheses that have been advanced to account for the nature
+of the morbid state, which gives rise to general and local dropsy, there
+are only three which our author regards as entitled to our notice.
+According to these, all dropsical accumulations arise either, 1st, From
+a want of tone or energy in the absorbent vessels, giving rise to a
+deficient absorption. 2nd, From an increased exhalation of the natural
+fluid, through a similar want of tone in the exhalents; and 3d, From a
+mechanical obstruction to the free return of blood by the veins,
+produced by tumours of various kinds, &c., by which a greater portion of
+it is forced into the exhalents, and a greater effusion of their proper
+fluids thereby occasioned. With these hypotheses, however, Dr. AYRE is
+not satisfied, and he endeavours, in the following manner, to show their
+insufficiency.
+
+     "1st. The opinion of a want of tone in the absorbents, as a
+     cause of dropsy, is contradicted by the fact, that in those
+     cases, in which it is assumed to prevail, it is found, that the
+     adipose matter, or fat of the body, is removed by the
+     absorbents; or, in other words, that emaciation takes place to
+     as great an extent, and as rapidly in this, as in other
+     diseases; and emaciation can only be effected by means of
+     absorption. Besides, in these cases of dropsy, mercury, when
+     rubbed upon the surface, or received internally, is absorbed as
+     readily, and affects the system as early as under other states
+     of the body. There is also no accumulation of the fluids in the
+     joints, or in the _bursae mucosae_ in these cases, which,
+     nevertheless would happen, if there was a general debility of
+     the absorbent system; and _ecchymoses_ or livid spots, though
+     easily induced in anasarcous limbs, are likewise easily removed
+     from them by the absorbents.
+
+     "2nd. The opinion of a want of tone or energy in the exhalants
+     involves in it one of the following conditions: namely, either,
+     1st, that the fluid of dropsy may escape mechanically from
+     them, and that the fluid thus _mechanically_ separated may be
+     identified in its sensible and chemical qualities with another
+     fluid which is confessedly secreted; or 2nd, that if the fluid
+     of dropsy be secreted, then that an _increase_ in the quantity
+     of a secretion may continue an indefinite period, under a
+     _decrease_ in the energy of its secreting vessels; conclusions
+     to which experience and analogy are alike opposed."
+
+In answer to the third hypothesis, Dr. A. remarks, that such an
+obstruction as contemplated, has never been shown to exist.
+
+     "In the case of the liver, which is commonly considered, when
+     in a scirrhous or enlarged state, to be the seat of these
+     mechanical obstructions, and thus, to be the cause of abdominal
+     dropsy, we have no satisfactory instance yet shown to us, of
+     any such precise condition of that organ. There are, indeed,
+     numerous instances of abdominal dropsies, in those labouring
+     under a scirrhous or enlarged state of the liver; but there are
+     also, numerous examples of such states of the liver, as well as
+     of the spleen and other organs, without any such effusion; and
+     in many cases, when such effusion has taken place, it has been
+     carried off by the natural passages or by tapping, without any
+     return of the dropsy; and yet, without any visible change in
+     the structural condition of the liver."
+
+Dr. A. further remarks, that if the cause were mechanical and existed in
+the liver, the effect should be constant; which, however, is not the
+case. Besides, were this mechanical cause necessary, how could we
+account for the appearance of abdominal dropsy, where there is no
+disease of the liver, or in other cavities, where no mechanical cause is
+asserted to be present, and where the remedies by which the cure is
+effected, have no relation to such causes? Again, if the discharge
+depended upon a mechanical cause, the water should in every case be of a
+uniform fluidity, and the progress of its accumulation likewise uniform;
+so that the operation of tapping should have no tendency to induce a
+more rapid refilling of the cavity. Yet, the contrary of all this is a
+subject of daily observation. In addition to this, Dr. A. calls the
+attention to the fact, that in experiments, in which obstruction has
+been artificially made, by tying the vena cava for example, the
+experimenter has committed an error, in reasoning from the lower animal
+to man--assuming, that as ascites had arisen in dogs, it would in like
+manner have occurred in human subjects.
+
+     "But there was an effect, here overlooked, which was to be
+     expected to take place in the abdomen of the dog, from the
+     injury done to the surrounding parts by the operation itself,
+     and which would be quite independent of any effect arising out
+     of the experiment. In the human subject, the effect would be
+     the highest form of inflammation, by which coagulable lymph or
+     pus would be poured upon the surface of the peritoneum. There
+     would, therefore, be inflammation excited in the abdomen of the
+     dog; but as the lower animals are less easily acted on than
+     man, the inflammation would in this case be in a lower degree.
+     But every degree of inflammation has its particular product.
+     The highest occasions a discharge of pus, whilst the lowest,
+     when seated in a serous membrane, is a larger portion of its
+     proper serous fluid. This, therefore, might be the product of
+     the inflammation, which was produced incidentally by the
+     experiment in the abdomen of the dog; and it would be just as
+     reasonable to regard the coagulable lymph in the human subject,
+     which would result from such an experiment, as an effect of the
+     mechanical obstruction, as to consider the fluid effusion in
+     the dog to be so."
+
+In respect to those instances of diseases of the liver, connected with
+ascites, in which, in addition to its other morbid states, a partial
+occlusion of the vena portae, by the effusion of coagulable lymph into
+it, is said to have existed, our author remarks, that they are very few
+in number, occurring, perhaps, in one out of several hundred cases of
+ascites with hepatic disease; and that we are justified, from analogy,
+to assume, that any obstruction given to the circulation by diseased
+vessels, would be quickly relieved by the enlargement of the
+anastomosing branches, and that no effusion of water into the abdomen
+would result from it. After referring to some cases, related by the late
+Mr. WILSON, in which the vena cava was completely obliterated, and no
+effusion took place; and some cases of morbid condition of the heart of
+an analogous kind, by which the course of the circulation became greatly
+obstructed, and yet, without being followed by effusion; our author
+concludes, that from these facts and others, to be presently noticed, it
+appears evident,
+
+     "That the dropsical effusion, in whatever part it may be
+     seated, does not arise from any want of tone in the exhalant or
+     absorbent system, or from a mechanical obstruction in the liver
+     or other viscus; but, that it proceeds from a morbid action in
+     the cellular or serous tissues, and that this action, as we
+     shall now proceed to show, is allied in its nature to
+     inflammation."
+
+In support of this opinion, Dr. AYRE remarks, that all the phenomena
+belonging to cases of watery effusion, met with under one or other of
+the forms of inflammation, are common to those of dropsy. Thus the
+fluid, discharged under the cuticle in erysipelas or in inflammation
+induced by heat or a blister, or in cases of pemphigus, is a secretion,
+and resembles in all respects the fluid found in dropsy. In some cases
+of acknowledged inflammation, the fluid effused is found to vary greatly
+in its degree of tenuity, so as to be sometimes of quite a viscid
+nature. The same circumstance is met with in dropsy; the fluid of which
+varies sometimes in different forms of the disease, and at different
+periods in the same patient. With regard to the absence of pain, in
+ordinary cases of local or general dropsy, which, in the minds of many
+physicians, might seem to militate against this view of the
+subject,--since pain accompanies the inflammation of a blister, Dr. A.
+very justly says, that the difference is referrible to a different
+degree of sensibility of the parts affected; that, moreover, in
+pemphigus there is no pain, and that chronic inflammation of the serous
+membranes is little painful.
+
+That the morbid action producing the effusion is only a modification of
+inflammation, our author thinks may be further shown by the fact that it
+obeys the same laws--being translated occasionally, like it, from one
+part of the body to another. On this subject, Dr. AYRE makes the very
+pertinent remark, that in these cases, the fluid alone has been thought
+to be translated; but that the metastasis, is without doubt, exclusively
+of the action which produces the serous discharge. Analogous also to
+what occurs in inflammation, especially of the erysipelatous kind, the
+action occasioning the effusion, as seen in anasarca, commences at a
+given point, and gradually extends from thence in a continuous course.
+It ought also to be noticed, that the results of common inflammation
+vary according to the intensity of the cause; the lowest degree of it,
+occasioning an increase in the quantity of the proper fluids of the
+part,--a higher degree, yielding for its product coagulable lymph, and a
+still higher one producing pus. All these several products of common
+inflammation, are more or less remedial of their cause; or in other
+words, are the immediate means of the cessation or abatement of the
+inflammation which produces them. This same power is likewise a
+property, though in a much less degree, of the hydropic effusion, when
+the inflammation which produces it, is idiopathic; or in other words,
+not created by a visceral or other disease, or some particular
+excitement of the general system, as is seen in cases of anasarca.
+
+     "And here," continues our author, "it may be proper to remark
+     upon a common error, committed by those, who, mistaking the
+     nature of the action which produces the serous effusion, look
+     in the _post mortem_ examination, for some of the common signs
+     of an inflammation having existed; and who conclude, upon not
+     finding such, that the water was derived from some mechanical
+     or other cause foreign to the true one. But in the higher forms
+     of abdominal inflammation, the products are pus or lymph, and
+     these are found upon the surface of the peritoneum, with
+     sometimes a thickening and discoloration or ulceration of its
+     substance; whilst in the lowest form of that increased action
+     to which the serous membranes are subject, the only product is
+     the serous fluid, and there can be, therefore, no visible
+     alteration produced by it in the structure of the serous
+     tissue."
+
+     "By the hydropic or serous inflammation, obeying the same laws
+     which govern the other degrees of common inflammation, it
+     follows, that upon a higher excitement being superinduced upon
+     it, the serous effusion should cease. This, therefore, is found
+     to happen in every case, where such higher excitement is
+     brought on. This increased inflammation is sometimes occasioned
+     by design or accident, and at other times, it occurs in the
+     natural and progressive course of some disease, formed within
+     the cavity, which is the seat of the dropsical effusion."
+
+This is exemplified in the effects of the operation for the radical cure
+of hydrocele; or in the operation of tapping in some cases of ovarian
+dropsy; or even in some instances, of ascites from chronic inflammation
+of the liver, spleen, mesentery, &c. In all these cases, the serous
+membrane, which directly or indirectly was affected to a sufficient
+degree to occasion a serous effusion, takes on, from the extension of a
+visceral disease, or from some other cause, a higher degree of
+inflammation--lymph is thrown out, and the cavity becomes obliterated.
+
+     "Now from these, and similar examples, which have fallen under
+     my observations, I think it may be assumed, that ascites, when
+     proceeding from some visceral disease, (and the principle
+     applies to hydropic effusions from the pressure of disease in
+     other cavities,) does so by the gradual extension of the
+     chronic inflammation of the internal cellular or serous tissues
+     of the diseased organ, to its outer external coverings; and
+     that, commencing here as from a point, the serous or hydropic
+     inflammation is progressively propagated through the whole of
+     the serous membrane of the cavity. By the disease within the
+     cellular tissue of the diseased viscous increasing, a
+     corresponding increase, in these cases, will ensue of the
+     disease on the surface of the membrane investing it; until at
+     length a susceptibility to take on a higher action is induced,
+     which only requires any slight occasional cause to establish.
+     Under this condition of an increased excitement in the
+     peritoneal or other serous membrane, coagulable lymph is
+     discharged into its cellular tissue, and a thickening of it
+     takes place; until at length the operation of paracentesis,
+     which in the early stage of the disease was attended with only
+     inconsiderable inconvenience, becomes an adequate cause of a
+     still higher inflammation, which terminates perhaps in
+     suppuration; and, in the _post mortem_ examination the serous
+     fluid is found so mixed with coagulable lymph, and purulent
+     matter, as to give a whey or milk-like appearance to the mass.
+     The quantity of serous fluid, in these cases, is generally
+     small, when compared with what was accumulated in the
+     intervals of former tappings; for the vascular excitement
+     which occasions the discharge of coagulable lymph, is
+     destructive of that which pours out the serous fluid."
+
+Dr. A. remarks, that, besides the particular facts deduced from
+observations on dropsy as a local disease, and which prove its relation
+to diseases of local excitement, there is a further support to be given
+to these views by various proofs that are afforded from observations
+upon the urine, of serous inflammation producing local dropsy, being
+frequently connected with one of a general kind. "So that the
+inflammatory state of the system becomes sometimes a cause of the
+effusion into a cavity, and at other times an effect of this state."
+After giving full credit to Drs. WELLS and BLACKALL for their researches
+into the state of the urine in dropsy, our author remarks, that there
+are certain conclusions deducible, which appear not to have been
+contemplated by those gentlemen, but which are strictly accordant with
+the pathological views he has endeavoured to establish in the present
+work.
+
+     "According to these facts, it appears, that when the disease of
+     dropsy is under a sub-acute form, and of the anasarcous kind,
+     it is usually idiopathic, and, often originating from cold; and
+     in this state, as well as in the symptomatic form, though in a
+     less degree, the urine is found to contain a portion of serum.
+     It is nearly peculiar to this disease, and denotes, according
+     to the quantity of it contained in the urine, the amount of
+     that excitement in the cellular tissue, and of the general
+     vascular system, which may be termed serous inflammation: for
+     it is met with most considerably in those forms of the disease,
+     in which these particular states of the body are most
+     apparent."
+
+Serum is therefore found in greater abundance, when anasarca precedes
+the local dropsy, which, in Dr. A.'s opinion, denotes the operation of a
+general cause. This is found to be the case especially in anasarca after
+scarlet fever. In cases of anasarca, the skin, kidneys, and bowels are
+very defective in their operation. Serum is also found, though in a
+smaller quantity, in those cases in which the anasarca has followed the
+local dropsy; for the disease of the viscus, which is the cause of the
+inflammation in the serous membrane of the cavity, may produce an
+adequate degree of the vascular excitement which gives rise to a
+discharge in the cellular tissue. Our author sums up his observations on
+this subject, by remarking, that there appear to be four distinct
+conditions of the system by which the occurrence of serum in the urine
+is regulated.
+
+     "1. It is in the greatest quantity, where along with a copious
+     and continued effusion, there is a nearly corresponding
+     quickness in the absorption of the serous fluid, and which will
+     occur most commonly when the general excitement precedes, and
+     is cause of the local one.
+
+     "2. It is consequently, _caeteris paribus_, in a less quantity
+     where the general hydropic excitement of the system succeeds,
+     and is dependent on the local one.
+
+     "3. It is absent, or found only in a minute proportion, in all
+     those cases where the local increased excitement in the serous
+     membrane is only partially extended to the rest of the system,
+     and where the absorption from the part is inconsiderable; as
+     particularly happens in the encysted kinds, or,
+
+     "4. Where the effusion of the serous fluid has proved remedial
+     of the inflammation producing it; in which case the disease, as
+     it respects the presence of water in a part, may visibly
+     resemble another example, and yet be essentially different from
+     it, by the serous inflammation, which produced it in both,
+     having ceased, on its occurrence, in one of them."
+
+Dr. A. discovers a further evidence of the relation which dropsy bears
+to diseases of local excitement, in the effects it produces on the
+general system. Thus, during the continued effusion of serum in
+anasarca, there is sometimes a large quantity absorbed and carried out
+of the body; by which a regular draught is made upon the nutrient
+principles of the blood, which must naturally create effects like those
+arising from the continued discharge of pus from a suppurating surface.
+In both cases the local disease, when extensive and of long duration,
+will necessarily occasion an exhaustion of the vital powers, by which
+that condition of the system termed cachexy will be induced.
+
+     "The exhausted or cachectical state, therefore, of the system,
+     which has been so variously accounted for, and so frequently
+     assigned as a principal cause of both local and general dropsy,
+     is a direct consequence of the agency of some power diminishing
+     the vital strength at its source; and in the case of a chronic
+     and long continued serous inflammation, it will proceed from
+     the daily abduction from the circulation of a portion of its
+     vital fluid: and whether it be pus or serum that is drawn from
+     the body; or whether it be from any permanent failure in the
+     supplies of nutriment to it, the effect will be the same, as if
+     a certain quantity of blood was daily abstracted from the
+     system."
+
+Dr. A. continues to remark that, under these circumstances, a
+suppurating surface will readily become gangrenous, from any cause
+temporarily exciting it, and that, in like manner, a higher
+inflammation may sometimes supervene upon an oedematous limb, as in
+the former case, and terminate in gangrene.
+
+     "Hence, therefore, the tendency of dropsical parts to fall into
+     gangrene, and which has been urged, as an argument, in proof of
+     debility being the cause of the serous effusion, is only what
+     is common to other forms of local inflammation, under a similar
+     condition of the body."
+
+From the view he has adopted of the nature of dropsy, Dr. AYRE thinks
+that the excitement of the parts, giving rise to the effusion, may be
+either 1st. Sub-acute or chronic. 2nd. Symptomatic or idiopathic. In
+other words, that it may arise from a local disease, or from the common
+causes of inflammation; and that these causes may be either general or
+particular. 3d. That the serous inflammation may be either local or
+general, giving rise to a general or local effusion.
+
+After offering so copious an analysis of Dr. AYRE'S sentiments
+respecting the pathology of dropsy, it is unnecessary to enlarge very
+fully on the application of his theory to the particular forms of that
+disease. We shall, however, offer a rapid review, of some of his
+opinions, and next detail the method of treatment he proposes for the
+cure of these dangerous maladies. We commence with hydrocephalus, which
+he remarks has been divided into an acute and chronic form. This
+division, our author thinks, is correct in a certain sense; for the
+disease varies much in duration,--running its course, sometimes in a few
+days; and at other times continuing several weeks. Yet, he continues,
+the terms acute and chronic must be understood as restricted to that
+particular form of inflammation producing a serous effusion, and not as
+denoting the highest and lowest degrees of common inflammation. It is
+from the want of this distinction that much confusion has arisen in our
+speculations relative to the pathology of hydrocephalus.
+
+Dr. AYRE calls our attention to the fact, that the forms of
+hydrocephalus denominated by Dr. GOLIS hyperacute and acute, do not
+differ from the sub-acute phrenitis of nosologists, in which pus and
+coagulable lymph are the proper products, with sometimes a serous
+effusion into the ventricles as an accidental effect; all of which forms
+of inflammation, the serous membranes of the brain, and of other
+cavities are liable to take on; and adds:
+
+     "Now, the true hydrocephalus internus stands distinguished from
+     these, in the nature of the inflammation of which it consists,
+     in the same way, precisely, that the serous inflammation of the
+     pleura, producing simple hydrothorax, is distinct from that
+     higher degree of vascular excitement, which occasions an
+     effusion of pus or lymph. Relatively to these, therefore, the
+     disease is in a chronic form; and consists, we may repeat, of
+     that lowest degree of inflammation to which serous membranes
+     are subject, and the effect of which is to increase the natural
+     secretion of the part, so as to cause, in regard to the brain,
+     an accumulation of that fluid in its cavities."
+
+Dropsy of the brain is usually divided into three stages. In the first,
+continues our author, vascular excitement exists, as denoted by pain in
+the head increasing in acuteness with the increase of the disease; and
+in infants by a restless movement of the head upon the pillow, moaning,
+occasional screamings, sickness, retching, impatience of light and
+noise, contractions of the pupils, delirious terrors, &c. The second
+stage is indicated by signs of pressure on the brain by effused fluid,
+and by an absence of pain, excepting upon raising or moving the head,
+convulsions, permanent dilatation of the pupils, squinting, blindness,
+slow intermitting pulse, hemiplegia, and a peculiar placid expression of
+the countenance, &c. The third stage is made up of some of these
+symptoms, together with other ulterior ones which follow the vascular
+reaction. On this subject, Dr. A. offers the following remarks:
+
+     "With respect, however, to the division thus formed of this
+     disease, it is, I think, somewhat questionable, whether it be
+     pathologically correct; for strictly speaking, the true disease
+     is comprised between the incipient beginnings of the
+     inflammation, and its termination by the effusion; since the
+     symptoms which follow, and compose what are called the second
+     and third stages, are little more than the consequences of the
+     disease, and arise from the mechanical pressure of the water
+     upon the brain. The progress, therefore, of what may be
+     strictly considered the disease, should perhaps be considered
+     as terminating with the occurrence of the effusion, which is
+     often remedial of the excitement causing it; and the whole
+     disorder, to be thus made up of two distinct states, the first
+     consisting of symptoms, which commencing with the excitement,
+     terminate with the serous discharge; whilst the second is
+     composed of those of a secondary kind, and which are wholly
+     dependent for their origin and continuance, on a mechanical
+     pressure from the effused fluid."
+
+Hydrocephalus may occur, either as an idiopathic or symptomatic
+affection. As the first, it may arise, where there exists a
+predisposition in the brain, from various injuries inflicted on the head
+by slight blows;--from all the general causes of inflammation--from the
+sudden drying up of long established discharges--the sudden repulsion of
+cutaneous eruptions, or the imperfect evolution of that or other
+sanative actions of the system, at the close of some febrile diseases,
+usually denominated defect of crisis. When, on the other hand, the
+disease is symptomatic, it may arise from a particular cause seated
+within the head, or in some distant part of the body. The former variety
+is not common among children, and when it does occur, it is the result
+of some chronic disease, as a tumour or a thickened state of the
+arachnoid or other membranes of the brain, resulting from a former
+inflammation. "Sometimes, adult patients wholly recover from chronic or
+sub-acute inflammation, which induced the structural disease, and this
+last becomes, at some future period, the occasional cause of the
+hydropic one." At other times, the chronic inflammation continues, and
+finally extends to the serous membrane, giving rise to the effusion.
+
+     "The most usual cause of the disease, however, particularly in
+     children, is an irritation which is sympathetically
+     communicated to the brain, from a disturbance in the
+     chylopoietic organs; and particularly from a functional
+     disorder of the liver. The cerebral disorder, to which a
+     derangement in the digestive functions thus gives rise, is only
+     one of those numerous effects which arise out of sympathies,
+     subsisting between these organs and different parts of the
+     system. In many cases, the same sympathetic irritation is
+     successively and variously directed to different parts of the
+     system. It will thus leave one organ or part, and suddenly move
+     to another; and through the operation of causes, which are not
+     always obvious, but which have a relation to some particular
+     predisposition, inherent or acquired. In this way, an
+     irritation may occasion an eruption upon the skin, and thence
+     be translated to the bronchial lining, producing a cough; and
+     next perhaps, to the serous tissue of the brain, exciting there
+     a turgescent or congestive state of the cerebral vessels, by
+     which symptoms are produced, through the pressure of the
+     congestive vessels, that simulate those of hydrocephalus; or
+     the true disease is brought on by an arterial re-action,
+     ensuing upon the congestion, which is resolved by a serous
+     effusion."
+
+Dr. GOLIS, from observing the marked connexion "between the turgescent
+state of the brain from chylopoietic disturbance, and its serous
+inflammation, has concluded, that it essentially pertains to it;"
+consequently, that "whenever it occurs, it is a part of it;" that it
+should be considered as forming the first stage of the disease, and that
+in all instances, it precedes the excitement. He has, for the same
+reason, constituted all the symptoms of the chylopoietic disease into
+the first stage of hydrocephalus. Dr. AYRE shows, however, that this
+state of turgescence, is not essential to the disease, and is only a
+sympathetic effect, which in the majority of instances, requires no
+treatment, (at least a very subordinate one,) other than that of the
+primary affection. He concludes his remarks on hydrocephalus, with the
+following words.
+
+     "The cerebral turgescence and disturbance, therefore, in
+     whatever degree they may exist, are only, when sympathetically
+     produced, to be considered as morbid causes, whose presence,
+     where the predisposition prevails, may lead to a serous
+     inflammation of the tissues of the brain, but which do not
+     form, in any sense, parts of the disease itself; since, under
+     every degree of them, they are so frequently remediable, by
+     means which are alone available, for the removal of their
+     distant and sympathetic cause."
+
+Of _Hydrothorax_, Dr. AYRE very justly remarks, that, as its name
+imports and as defined by Nosologists, it consists of symptoms, which
+strictly speaking, pertain only remotely to the true disease--arising,
+as they do, from a certain disturbance given to the lungs, by the
+pressure of water upon them. They are only the symptoms, therefore, of
+the effusion, and as the excitement sometimes terminates with the
+occurrence of the serous discharge, its existence, in many cases, is
+discoverable only by its effects--there existing no signs, which clearly
+point out the presence of that state, previous to the appearance of the
+effusion; and what are usually called, by writers on the subject,
+premonitory symptoms, being only those of an inferior degree of the
+effusion which has already commenced.
+
+Like hydrocephalus, hydrothorax may be idiopathic or symptomatic; and
+proceed from a local or general cause--the nature of the inflammation
+being the same in both cases. It may likewise be divided into an acute
+and chronic form. When the disease is symptomatic, and arises from a
+local cause, it is generally chronic. When it arises secondarily from a
+disease of the lungs, our author thinks, that
+
+     "The mode by which this state is induced in the serous
+     membranes, is by the chronic inflammation that exists in the
+     diseased organ extending to them; and not by the same form of
+     inflammation being set up in them, by a certain sympathy or
+     consent of parts, which, from a loose analogy, has been thought
+     to subsist between similar structures."
+
+All diseases of the thoracic organs, are not equally prone to occasion
+effusion; some of these also, are only dangerous to life, in proportion
+to their disposition in occasioning such an effusion; whilst in other
+cases, if it occurs at all, the effusion is only the sequel of a disease
+essentially fatal.
+
+     "To distinguish between these two conditions, is a desideratum
+     pathology. Modern writers on pathological anatomy have
+     prosecuted with considerable zeal and ability, their researches
+     into the nature of the diseases of the organs within the chest,
+     but they have done but little towards elucidating the true
+     relation, which subsists between the diseases of the several
+     viscera, and the serous effusions which take place into their
+     cavities; for, by limiting their views to the disease which the
+     _post mortem_ examination exhibited, they have overlooked those
+     intermediate actions or states of excitement which connect the
+     organic disease with such effusions."
+
+Whenever the excitement, producing hydrothorax, is idiopathic and
+independent of an organic disease of the lungs, heart, &c. its remote
+causes may be either of a general or local kind; and are the same which
+produce, when applied in a higher degree, or under different states of
+the system, the other forms of inflammation. The effusion may take place
+in those cases in which, the individual being predisposed, the
+inflammation, owing to some peculiarity in the cause, does not reach
+beyond its lowest grade; or in those in which the inflammation being
+high, and treated too late, or by insufficient means, a chronic form
+succeeds to the acute one, which may produce a watery effusion; or some
+structural disease remains and eventually becomes a cause of the
+effusion. The occurrence of this effect, in those latter cases, is
+sometimes attributed to a debility, resulting from the large depletion
+required in consequence of the severity of the previous inflammation.
+
+     "That such opinions, however, are founded in error, may be
+     shown from this, that the effusion, thus imputed to debility,
+     does not occur sometimes, until some weeks or months after the
+     period when the bleeding was employed; and although the
+     debility is confessedly of a general kind, yet the effusion is
+     local, and is precisely in the very cavity where the disease
+     existed, which required the unjustly condemned evacuations. The
+     truth of the matter is, that in such cases, either the
+     depletory means have been employed in an insufficient degree,
+     or too late." "The imperfect recovery of such patients from
+     their first attack, and, which is attributed to the depletion,
+     arises from the disease which is left by it, and to the
+     injudicious means, perhaps, that are employed by the too
+     anxious attendants, with the view of restoring the strength."
+
+Among the ordinary predisposing and exciting causes of the inflammation
+which produces hydrothorax, Dr. A. mentions a certain congestive or
+plethoric state of the circulation, which is brought on in some persons
+of particular habits, by indulging in the pleasures of the table, and
+taking little exercise. These cases are analogous to those occurring in
+the brain, and giving rise, by rupture, to a sanguineous apoplexy, or,
+by arterial reaction, inducing an effusion of serum.
+
+Dr. A. next proceeds to the subject of _ascites_, the symptoms of which
+he remarks are at first so obscure, that the disease is sometimes with
+difficulty detected. The remote causes of ascites may be either
+symptomatic or idiopathic, and either local or general. When
+symptomatic, it may be seated in some diseased viscus, as the liver,
+spleen, or in the mesenteric glands, &c.
+
+     "To produce, however, a dropsical effusion into the abdomen
+     from this cause, it is necessary that the disease of this
+     viscus should be making progress; for, in its indolent state,
+     or, in other words, if inflammation be not present in it, it is
+     incapable from its mere bulk, as is commonly but erroneously
+     supposed, of producing this effect." "Nor does the serous
+     discharge always take place into the abdomen, in every case
+     where these organs are morbidly affected, but only where their
+     peritoneal covering participates in the disease; for the
+     chronic inflammation in those cases, where it occasions
+     ascites, does so by extending from the cellular tissue of the
+     internal structure of the organ, to the serous tissue investing
+     in it." "When ascites is an idiopathic affection, it may
+     proceed from all the common causes of inflammation. The most
+     frequent cause is cold, and which may act either locally or
+     generally. When in the latter mode, the ascites is usually
+     combined with anasarca, and the disorder generally comes on
+     suddenly, and has a rapid progress. The vascular system is
+     excited, and there is more than usual thirst; the blood when
+     drawn exhibits the buffy appearance; and the urine, when
+     subjected to heat, is found to coagulate strongly, from the
+     large quantity of serum contained in it. In some of the severer
+     cases, the effusion into the abdomen takes place very suddenly,
+     and yet, by a copious bleeding the disease may be at once
+     arrested, and the water be afterwards absorbed."
+
+Unlike what occurs in hydrothorax and hydrocephalus, the effusion in the
+present form of dropsy is of inconsiderable importance, compared to the
+visceral disease which is its remote cause. When, however, the
+accumulation becomes very considerable, the pressure of the fluid may
+affect the organs, and more particularly the peritoneal lining, which
+from the irritation induced in it, may take on a higher grade of
+inflammation, terminating in effusion of coagulable lymph or pus, and in
+death. The necessity which arises of tapping, where the effusion is very
+considerable, proves sometimes a farther cause, perhaps, of aggravating
+the disease of the affected viscus, and either of renewing or extending
+the hydropic excitement, or of converting it into a higher or more
+destructive form of inflammation.
+
+By most writers on dropsy, anasarca has been maintained to originate, in
+all instances, in debility, and to be curable only by a tonic and
+invigorating plan. It is true that some writers, especially among the
+ancients, (for we can hardly class PORTAL among the moderns,) have
+spoken of the disease as arising occasionally from a plethoric state of
+the circulation, and enforced the necessity, under these circumstances,
+of venesection. This view of the pathology of anasarca, although leading
+in many instances to a successful practice, was, however, vague and
+often unsatisfactory. To the late Dr. RUSH, and to Dr. PARRY, much
+credit is certainly due for their labours on this subject; but so far as
+we are informed, it was not until within a few years, that the subject
+was cleared of part of the obscurity in which is was involved, and that
+the disease, at least the active sort, has been referred to an
+irritation of the cellular tissue. Following up this opinion, and
+generalizing still more than the French pathologists, our author asserts
+that anasarca invariably consists in an inflammation of the cellular
+membrane of the body, with a serous effusion as its result. The
+accumulation, he continues, may be either idiopathic or symptomatic, and
+either general or local; occurring only under two forms, the one being
+of greater intensity that the other. In general, the disease derives all
+its importance from the nature of the remote cause.
+
+     "When it is idiopathic and proceeding from cold, it is usually
+     unimportant, for though the progress of the swelling be rapid,
+     and the appearance of the disease formidable, yet it readily
+     subsides under proper treatment, as the effusion proves in
+     these cases, either partially or fully corrective of its cause;
+     and little more, under such circumstances, is required in its
+     treatment, than to promote the absorption of the water. In some
+     cases of general anasarca, however, the disease is more severe;
+     for sometimes the action of the heart and arteries is
+     increased, the urine becomes loaded with serum, and there is
+     thirst and other indications of general vascular excitement,
+     similar to the state which was noticed, as producing effusion
+     into the brain, or the other cavities of the body."
+
+In some cases, the serous effusion appears to be translated from one
+part to another. Our author very justly adds, however, that this
+translation is not of the serous fluid, but only of the serous
+inflammation giving rise to the effusion. It usually takes place from
+one portion of the cellular membrane to another; but sometimes from this
+membrane to the serous tissue of the brain, chest, or abdomen.
+
+Oedema of the feet and ankles is often symptomatic of chylopoietic
+disturbance, and particularly in young women, in whom the menstrual
+function is obstructed. In these cases, as well as in the oedema
+following gout or rheumatism, the swelling usually commences with
+considerable pain and stiffness of the parts, and hardness of the
+swelling.
+
+     "But the most common form of anasarca is that which is
+     symptomatic of some visceral disease; and which, as it
+     ordinarily appears, arises from a state of the system that
+     answers to the hydropic diathesis of systematic authors."
+
+This form of the disease begins in the lower extremities, and is rarely
+attended with strong signs of local excitement so obvious in anasarca of
+the idiopathic kind. Its occurrence has been referred to various causes.
+When combined with ascites, it is supposed to arise from pressure of the
+iliac veins by the fluid accumulated in the abdomen,--an opinion which
+our author combats by repeating, in great measure, the arguments we have
+already noticed.
+
+     "But here let me observe, that the denial of ascites producing
+     an anasarcous state of the legs, from the water compressing the
+     iliac veins, must not be understood as implying, that a
+     mechanical compression of a vein will not in other cases
+     produce an effect of this kind. A pressure made on the brachial
+     vein and its branches by scirrhous glands in the axilla, is a
+     common cause of this state. The remote cause is here, indeed,
+     of a mechanical kind, but not so the proximate cause of the
+     effusion. By the resistance given, in this case, to the blood's
+     return by the principal veins of the limb, a reaction is
+     occasioned in the extremities of the arteries leading into the
+     corresponding extreme branches of the veins, and which reaction
+     is in this, as in a multitude of other occasions of congestive
+     fulness in these vessels, a sanative effort of nature to
+     overcome the primary obstruction."
+
+The disease has often been referred, when occurring under these
+circumstances, to a local and general debility; and this opinion is
+thought to be supported by the facts that the swelling is increased by a
+depending position of the limb, and diminished by a horizontal one--by
+the occurrence of an inflammatory state of the parts being incompatible
+with such a degree of debility, and lastly by the absence of
+preternatural heat on the surface of an oedematous part. To these
+pretended arguments, Dr. A. opposes, that the effusion cannot be
+attributed purely to debility; because the effects are in no
+correspondence with the assigned cause,--the debility being, in some
+instances of chronic and acute disease, very considerable, and the
+effusion small, and vice versa;--because anasarcous limbs will occur in
+the strongest individuals when the limbs have remained a long time in an
+erect posture,--because there is in certain fatal chronic diseases, a
+tendency in the lower limbs to take on an inflammatory action, often of
+an erysipelatous kind,--and because the fact of oedema increasing by
+an erect posture and diminishing in the horizontal one is readily
+explained by the greater congestion of the vessels induced in the limb
+by such a position, as it occurs in the higher grades of inflammation.
+
+     "And with respect to the temperature of the surface of
+     oedematous parts not being preternaturally raised, the
+     objection, if of any force, must apply to all, for all have
+     this peculiarity, and yet some cases of oedema confessedly
+     arise from inflammation; differing not, in this respect, from
+     several other morbid states, as those for instance, of chronic
+     rheumatism, and which are indubitably, as indicated by the
+     nature of their causes and remedies, of a truly inflammatory
+     kind."
+
+Dr. AYRE, therefore, regards all these cases as secondary to a serous
+inflammation seated in a cavity; and lastly as arising from some
+disturbance in the digestive functions, by which this and other distant
+irritations are produced through the operation of that law of the animal
+economy, denominated sympathy.
+
+Having thus offered, in the preceding pages, an analysis of Dr. AYRE'S
+views of the pathology of the principal forms of dropsy, we must be
+allowed, before proceeding to the treatment of the disease, to make a
+few remarks. It appears to us that Dr. A. has treated the subject in a
+very able manner, and contributed greatly to remove many objections,
+that could be adduced against the opinion of the inflammatory nature of
+some of the more obscure cases of dropsy. We cannot help thinking,
+however, that he is too exclusive in his theories, and that he has
+rejected too positively the idea of a passive dropsy; in other words, of
+a dropsy independent of inflammation. Some cases of the disease which
+follow extensive losses of blood, (profuse uterine hemorrhages, for
+example) and which are cured by tonics and an invigorating diet, without
+the aid of diuretics, cannot always, though they may sometimes, be
+accounted for by admitting the existence of inflammation. Such instances
+have fallen under our own observations, and could not be explained by
+supposing that the effusion had relieved the inflammation; since there
+had not existed, at least as far as we could ascertain, any local
+inflammation. In one case it followed abortion, attended with profuse
+hemorrhage, and produced, not by disease, but by an accident.
+
+In the second and fifth volumes of the _Archives Generales de Medecine_,
+Dr. BOUILLAUD has related many cases of partial and general dropsy,
+which undoubtedly originated in obstruction to the venous circulation,
+from adhesion of the parietes of the principal veins. It is true that
+Dr. A. is compelled to admit this among the causes of dropsy; but
+faithful to his theory, he supposed the supervention of an arterial
+reaction resulting in an effusion of serum. It does not appear to us,
+however, that this arterial reaction is admissible in all cases of the
+sort, and we prefer on the whole the explanation of the mechanism of the
+effusion, originally given, by DONALD MONRO, and lately by Drs.
+BOUILLAUD and BROUSSAIS, who refer it to an obstruction in the venous
+circulation and to a consequent deficient venous absorption. By
+admitting this explanation, it is readily perceived, that we admit a
+passive dropsy, and we think the view well exemplified by a case which
+occurred last summer. The individual had recently recovered from a
+violent attack of disease, and was left much debilitated. Induced by
+this circumstance to travel to the north, he had occasion to notice that
+when seated long in a stage with his feet depending on the veins
+compressed, oedema invariably came on, and that it as invariably went
+off the next day if he did not ride. This occurred so often as to lead
+us to think there could not always be an arterial reaction occasioning
+the effusion, and that this effect arose from the mere obstruction to
+the venous circulation.
+
+In making these remarks we are not actuated by the desire of detracting
+from the merits of Dr. A.'s views of the pathology of dropsy; convinced
+as we are, that the great majority of cases of the disease, which are
+thought by many physicians to arise from debility, do not owe their
+origin to this condition of the system, but to an increased excitement
+of the membranes or cellular tissue. Were it otherwise, how could we
+account for the fact, that dropsy is generally _local_, whilst the
+_debility_ to which it is in most instances referred, is general?
+
+But whilst maintaining the correctness of many of Dr. A.'s views, we are
+inclined to the opinion, that he may do some injury to the doctrine he
+is advocating, by invariably making use of the word _inflammation_, to
+express that condition of the vessels, giving rise to an excessive
+secretion of serous fluid. We are ready to admit, and we dare hope, that
+few will refuse to do so, that _inflammation_, strictly speaking, will
+occasion such an effect; yet, it often happens, that effusion will occur
+in cases, where no inflammation can be detected. In such instances, the
+vessels are evidently in a state of increased excitement; or in other
+words, in a state of irritation, but not of inflammation, which always
+implies congestion. This latter morbid condition, may supervene on the
+irritation, and occasion a suppression of the serous effusion, and the
+formation of coagulable lymph or pus. It is true, it may be said, that
+both these states (irritation and inflammation) being an increase of the
+life of the part, and requiring the same treatment, may be designated by
+the same name. Nevertheless, to prevent confusion, and the quibbling of
+some of the opponents of the theory of inflammation in dropsy, we are
+inclined to believe, that it is better to substitute the word
+irritation, whenever there is merely an increased secretion, and reserve
+the word inflammation, to designate those cases, in which there are
+decided marks of local excitement and congestion, attended or not with
+general fever.
+
+Dr. AYRE, adopting the opinion of Dr. PARRY, regards some cases of local
+dropsy as an effect of a general hydropic diathesis, or of a general
+inflammatory action of the vascular system, occasioning a local
+excitement, ending in dropsy. This is a natural consequence of the
+views, entertained by many physicians in Europe and this country, that
+fever produces local inflammation. We must confess, however, that all
+Dr. A. has said on the subject, is not calculated to carry conviction to
+our minds. Thus, one of his reasons for regarding some cases, as arising
+from this general vascular excitement is, that they are produced by what
+he considers as a general cause,--as cold, for example. But cold
+produces local diseases, occasioning, and not preceded by, a febrile
+excitement; and if it can, and does occasion anasarca, who will pretend
+to assert, from its being a _general_ cause, that this anasarca is a
+general disease? Does not cold occasion also ascites, which, in many
+cases, is regarded by every one as a local disease, sometimes
+terminating in anasarca? If so, why shall we regard anasarca, ending in
+ascites, as a general disease? The cases are analogous, and the action
+in both should not be explained differently. If the action of such a
+cause were really general, and extended to all parts of the body, then
+the effects should also be general, and the dropsy should be universal,
+which is very far from being always the case.
+
+2nd. It is also said in support of this opinion, that where anasarca is
+idiopathic, it is attended with fever, but that this latter does not
+exist, when the disease follows ascites. This difference appears to us
+to be very readily explained by the fact, that the disease in the former
+case, is more acute, and that the heart sympathises more actively with
+the irritated cellular tissue, than in the second case, when the disease
+is milder, or more gradual in its progress.
+
+3d. It is also maintained, that when anasarca is idiopathic, there
+exists a large quantity of serum in the urine; and this is brought
+forward in order to distinguish these cases from local dropsies. But it
+is also admitted, that serum is found in the urine in cases of anasarca
+following ascites. Consequently, if there be none in cases of simple
+ascites, and if it only appears when anasarca supervenes, the only
+conclusion that may be drawn from these facts, is, that anasarca is the
+only form of dropsy, in which serum is absorbed, and passed off by the
+kidneys; and if there be a greater quantity discharged when anasarca is
+primary, it is only because the disease is more violent, and generally
+more extensive. But, surely all this is far from proving, that primary
+anasarca is a general disease, and owes its origin to a primary arterial
+excitement of the whole system. When fever exists first, and terminates
+in dropsy, who has proved, that there existed no local irritation
+producing the fever, and that the hydropic irritation has not supervened
+by metastasis. This takes place in scarlatina and other eruptive
+diseases, which Dr. A. would surely not be justified in calling general
+diseases. Dropsy follows the suppression of cutaneous diseases,
+unattended with fever; consequently, when there happens to be a febrile
+excitement, we are at a loss to know, why we should call this latter to
+our aid, in our explanation of the dropsical effusion, and not account
+for it on the same principle, as we did in the former cases; namely, by
+metastasis. If febrile symptoms are sufficient to make us regard a
+disease as general, then there is no local disease, except when
+apyretic.
+
+We now proceed to notice the mode of treatment, recommended by our
+author, for the different forms of dropsy. From what we have seen, it is
+natural to conclude, that as Dr. AYRE regards the proximate cause of the
+several forms of the effusion, or in other words, the _disease_, to be
+the same under all its conditions, he will be of opinion, that "the same
+general principles of treatment, are alike applicable to all--subject
+only to such modifications, as arise from differences in the nature and
+intensity of the remote cause, and those general or local relations of
+the parts implicated in the serous effusion, with the diseases of the
+organs, which incidentally produce it." Founding upon these views the
+indications of cure, he states them to be; 1st. To remove the visceral,
+or such other disease or state, which, when present, proves a remote
+cause of the effusion; 2nd. To remove the morbidly increased action in
+the serous membrane or tissue, which is its proximate cause. 3d. To
+promote the absorption of the effused fluid.
+
+Agreeably to Dr. A. the treatment of hydrocephalus internus, is
+divisible into three general heads:
+
+     "The first, consisting of means to correct, with its causes,
+     that turgescent state of the brain, which may produce the
+     arterial re-action and effusion; the second, of those which
+     shall subdue the excitement, when formed; the third, to correct
+     or relieve, as far as it is practicable, the effects of the
+     effusion, and procure, if possible, its absorption."
+
+With respect to the general causes, tending to produce that congestive
+state of the brain, precursory to its inflammation, he remarks, that
+they are of three kinds; 1st. Those acting through the general system,
+and consisting of an irritation, from some obstructed or required
+evacuation; 2nd. A local disease, seated in the head, or a local injury
+inflicted on it; 3d. Chylopoietic disturbance, acting sympathetically
+upon the brain. When the first of these causes appears to have been
+instrumental, in occasioning this condition of the brain, it is plain
+that it must be removed, and the obstructed emunctory corrected,--the
+suppressed evacuation promoted, or a new and artificial one substituted.
+When there exists any structural disease within the head, or a relic of
+a former state of excitement, a serous inflammation may be reasonably
+apprehended, and to avert it, the most rigid and undeviating attention
+must be paid to regimen, whilst cupping and leeching must be employed,
+and a seton fixed in the neck.
+
+     "For the object of the treatment, in these cases, is not to
+     remove, but to avert the inflammation, and which, from the
+     strong disposition to it, conferred by the organic disease, can
+     only be effected by avoiding, not merely the causes of
+     inflammation, but likewise, all those agents, which are
+     calculated, in any way, to increase the momentum of the
+     circulation." "Beyond those, the common precautions against
+     morbid irritations, little else can be done."
+
+When the turgescent state of the brain, arises from a disturbance in the
+digestive organs, it will be remedied, by means directed to this cause.
+Our author locates the primary seat of this disturbance, in most cases,
+in the liver; though he admits, it may occasionally be in the stomach
+and intestines. He places great reliance for correcting and increasing
+the secretion of bile, on small doses of calomel,--purging off the
+contents of the intestines by aperient medicines; and recommends, at the
+same time, the application of cups and leeches to the temples, as a
+measure of precaution. He very properly lays considerable stress on the
+necessity of combating this secondary affection of the head;
+
+     "For though the means applied, to correct the disorder in the
+     digestive organs, may be sufficient to remove the turgescent
+     state of the brain, which arose from it, yet, those means will
+     have little or no control over the excitement, which that
+     turgescent state has created; and still less can they avail in
+     subduing an excitement, that may even survive its remote cause,
+     and continue independently of it. By overlooking these facts,
+     much distrust and disappointment have arisen with many, who
+     confided in the opinion, delivered by some writers, of the
+     uniform prevalency of chylopoietic disturbance, as a cause of
+     this disease, and of the sufficiency of calomel to remove it."
+
+When the inflammation exists, and is a sequel of some pre-existing
+structural disease in the brain or membranes, all that can be reasonably
+expected, is to _palliate_ it by the antiphlogistic plan; but when it is
+idiopathic it may readily be cured, by the same remedies, graduated to
+the age and strength of the patient and to the violence of the attack.
+Dr. A. seems to rely principally on cups and leeches;--not excluding, in
+some cases, bleeding from the arm. Blisters to the summit of the head
+and afterwards a cold evaporating lotion to the temples, are also
+recommended. As soon as, by these means, an impression is made on the
+disease, mild diaphoretic medicines, assisted by the tepid bath, or the
+pediluvium, maybe prescribed;--the bowels are to be kept open by small
+doses of calomel, followed after two hours by a draught of some aperient
+medicine,--the antiphlogistic regimen should be rigidly enforced, and
+light and noise carefully excluded.
+
+     "Many practitioners give the mild preparations of mercury, and
+     particularly calomel, freely in this disease, under a notion of
+     its having some specific power in subduing it; but it never
+     should be so used, excepting in cases where the disease is
+     symptomatic of some functional disturbance in the liver and
+     other chylopoietic organs, where it is calculated, in
+     conjunction with the local bleeding, &c. to afford the most
+     important service."
+
+With a view of pointing out some characteristic sign, by which to
+distinguish those cases in which the affection of the bowels is primary
+from those in which it is secondary, he remarks--
+
+     "The condition of the stools at the period when a child is
+     labouring under the disease, will afford to such persons but an
+     imperfect notion of its true nature; for the disturbance of the
+     brain will often create a disorder in the secretions, both of
+     the liver and the other chylopoietic organs, producing green
+     looking stools; and there is often a congestive state of the
+     brain for a short time preceding the full development of the
+     idiopathic excitement, which may, in like manner, by reacting
+     upon the liver, create a disorder there. In cases, however,
+     which are symptomatic of this cause, the chylopoietic
+     disturbance will be found to have existed several days or even
+     weeks; and the origin of the disorder, in like manner, may be
+     commonly traced to some irregularity of diet, or other obvious
+     causes, and frequently in infants to those which are connected
+     with premature weaning; and sometimes even the cerebral
+     disorder itself will have been only the last of a series of
+     effects in the system, to which such disturbance had given
+     rise."
+
+Agreeably to Dr. A., it is not proper to discontinue those means,
+immediately upon the occurrence of what appears to be symptoms of
+effusion, since, frequently, these symptoms, as it respects the
+effusion, will immediately manifest their fictitious character, and
+disappear under a treatment no wise adapted to such a state, and with a
+rapidity, too, which equally betrays their true nature. He notices,
+though we believe not in its proper place, a modification of the disease
+in which the effusion takes place in the cellular membrane of the
+substance of the brain, and thinks this species more likely to be
+recovered from than when the water accumulates in the ventricles. He
+concludes this section by remarking, that
+
+     "Of the means to be employed to promote the absorption of the
+     water, under these or other circumstances of its accumulation
+     in the brain, little satisfactory can be said. The treatment
+     must be founded on the use of such means as shall avert the
+     risk of renewing an inflammation in the organ. To this end,
+     occasional blistering the head will be proper; the diet must be
+     spare, and the several secretions, particularly those of the
+     kidneys, must be cautiously promoted."
+
+We next turn to the treatment of hydrothorax and ascites. As the
+existence of hydrothorax in its early stage is difficult to ascertain,
+and as what have been called premonitory symptoms are only those proper
+to the mildest forms of the disease, and not of that condition of the
+parts which gives rise to the effusion, the treatment is somewhat
+difficult, and, in too many instances, our remedies are directed, not to
+the disease itself, but to one of its effects. Faithful to his view of
+the pathology of dropsy, Dr. A. remarks, that the plan of treatment to
+be pursued at an early stage of symptomatic hydrothorax, must consist in
+the use of those means which shall subdue the chronic excitement of the
+serous membrane, as well as the chronic inflammation of the diseased
+organ. To attain this end, the antiphlogistic and revulsive plans,
+graduated to the age and strength of the patient, and to the violence of
+the disease are recommended. In general the frequent application of
+leeches are held by Dr. A. as preferable to venesection, unless the
+patient be plethoric, and the disease arise from a local congestion
+within the chest, which, according to him, is often a cause of serous
+inflammation of the thoracic tissue, independently of any previous
+disease. Dr. AYRE calls attention to the fact, that topical bleeding is
+particularly adapted to correct that chronic inflammation of the serous
+membranes, which causes an effusion from them, and which is neither the
+result of any inflammatory excitement of the general system, nor of a
+nature to produce it; and that when properly conducted, it has the
+advantage of acting only slightly on the general system, and therefore
+only slightly on the general strength, and very considerably on the
+local disease. Together with leeches, blisters are to be used, and after
+the chronic action existing in the serous membrane is subdued by these
+means, a seton fixed in the integuments of the chest will be found of
+great utility.
+
+The same treatment will be found equally serviceable, not only to
+correct the chronic excitement existing in the peritoneal membrane and
+giving rise to ascites, but very commonly to cure or palliate the
+visceral disease producing it. In respect to the very common practice
+of resorting to mercury in this complaint, our author makes the
+following judicious remarks.
+
+     "With too many practitioners, it is the practice to employ
+     mercury freely in every case of abdominal dropsy, under the
+     vague notion of there existing some mechanical obstruction in
+     the liver or other viscus, as a cause of it; and under the
+     equally vague notion, that mercury so employed will remove it.
+     The practice, however, to speak of it in the mildest terms, is
+     founded on erroneous views of the pathology of these diseases;
+     and employed, therefore, as it is by some, on all the occasions
+     in which they meet with them, must be frequently very
+     injurious. For, independently of the injury to be inflicted by
+     it, when given freely in some of the forms of liver disease,
+     there is an effect produced by it on the urine, when given to a
+     person in health, resembling that which arises from the
+     specific excitement of dropsy. Under a salivation, the urine
+     becomes charged with serum. Any condition of the system,
+     therefore, approaching even to a state of salivation, must be
+     injurious, by the tendency it must have to increase that morbid
+     state of the body, which is nearest allied to the hydropic one.
+     Hence the mercurial salivation has been numbered amongst the
+     remote causes of dropsy; and the resemblance between the
+     dropsical and mercurial excitement, thus established by the
+     common resemblance of the urine in these states, goes far to
+     prove this connexion; and it is not improbable, that the
+     mercurial inflammation, when considerable, may survive its
+     specific cause, and degenerate at length into the purely
+     hydropic state. When, however, mercury is given in minute
+     doses, so that these its specific morbid effects are not
+     produced, it is capable of becoming highly useful, as we shall
+     presently have occasion to notice."
+
+In conjunction with bleeding and other means just noticed, drastic
+purges have an important influence in subduing the disease; not merely
+by removing the water, but likewise by contributing to subdue the
+chronic excitement which occasions its effusion. This latter effect Dr.
+A. very justly refers to the counteraction and irritation these
+medicines excite on the mucous membrane of the bowels, by which the
+excitement of the serous tissue or of the diseased viscus is removed. He
+remarks that drastic purgatives are sometimes inadmissible in ascites,
+when an affection of the liver or mesentery is its remote cause, and
+there is a tendency to a spontaneous diarrhoea, which even the mildest
+purgatives would increase. "In the case of the mesentery, such a mode of
+treating dropsy would speedily destroy the patient." Dr. A. ought,
+perhaps, to have explained the real cause of the danger attending the
+practice, and not referred it merely to the tendency to diarrhoea,
+which itself can only be an effect of a morbid condition of the bowels.
+The fact is, that most cases of hepatitis, and all cases of mesenteric
+disease, are attended, whether as cause or effect we care not, with
+inflammation of the stomach or bowels, which purgatives can only tend to
+aggravate. In general, the practice of administering drastic purgatives
+is more serviceable in hydrothorax, and especially in anasarca, or in
+_idiopathic_ serous inflammation of the peritoneum. Dr. A. prefers the
+gamboge to all other medicines of the same class, and gives it to the
+amount of four or five grains in a single dose, with the same quantity
+of some aromatic powder, and triturated with a few crystals of the
+supertartrate of potassa; or in urgent cases of hydrothorax, he
+prescribes ten or twelve grains, divided into four doses, one of which
+is to be given every three hours. When the strength admits of it, the
+purgative may be given every four or five days.
+
+Dr. A. next notices diuretics.
+
+     "The sensible operation of these medicines," he says, "as is
+     well known, is to promote the secretion of the kidneys. There
+     appears to me, however, to be farther effects produced by them
+     upon the system, or particular parts of the system, which is
+     not referrible to the mere evacuation of a certain quantity of
+     fluid from the body; and these effects, it is probable, consist
+     in promoting the natural discharges by this and, perhaps, the
+     other emunctories, whose partial suppression may either produce
+     this disease, or serve materially to continue it; and likewise
+     in occasioning a derivation of blood to the kidneys, and
+     therefore to a part distant from the morbid one; and that thus,
+     whilst they are contributing materially to the removal of the
+     fluid, they are serving like the purgative, an important end,
+     in assisting to subdue the cause of it. The medicines which I
+     am accustomed almost entirely to rely on in this disease, are
+     the powder of dried squill and digitalis, given in combination
+     in the form of pills, and in doses, which, from their
+     smallness, will probably excite no little surprise in the minds
+     of some of my readers. The dose of the squill is something less
+     than a grain, and of the digitalis only a sixth part of a
+     grain, given uninterruptedly every third or fourth hour."
+
+To render these medicines more effectual, a third or half a grain of
+calomel may be given nightly, and an infusion of dandelion, or some
+other popular diuretic, may be taken _ad libitum_. Our author speaks in
+terms of merited disapprobation of the practice pursued by some
+physicians, of allowing their patients daily, potions of gin punch, with
+the view of aiding the operation of the diuretic medicine, and
+supporting their strength. He shows, that, although by these means the
+water may be promptly evacuated, the disease is not cured, and the
+effusion is soon renewed with redoubled violence and danger to the
+patient.
+
+In the idiopathic form of hydropic inflammation, attacking the serous
+membranes of the chest and abdomen, and which, agreeably to our author,
+may be strictly local, or consist in a general specific excitement of
+the system, leading to a general watery effusion, the lancet is
+particularly advantageous, and should be had recourse to. The pulse is
+generally hard, the blood exhibits a buffy appearance, and the urine
+coagulates when subjected to heat. Leeches, in pretty large numbers,
+must also be used, as well as all the remedies already enumerated. But
+as in these cases, which according to Dr. AYRE are more common among
+females than males, and among the younger than those of middle and
+advanced age, the disease is of a more acute nature, a greater reliance
+is to be placed on an active antiphlogistic plan; and if this be
+steadfastly persevered in, comparatively little difficulty will be
+experienced in effecting a discharge of the water.
+
+When hydrothorax occurs after scarlatina, and is combined with anasarca,
+its course is generally rapid, and the cure difficult; partaking, as it
+often does, of the two-fold state of debility and excitement. When
+detected early, the lancet must be promptly used. Cups and leaches,
+followed by the warm bath, blisters, and cathartics, must also be
+resorted to.
+
+     "Diuretics, which are so beneficial in the less acute forms of
+     dropsy, are commonly too inert and slow in this, unless given
+     in doses to act immediately upon the vascular system, when the
+     infusion of digitalis, as given by many practitioners in all
+     the other states of the disease, may be resorted to; since the
+     treatment here is not so much to remove the water, as to
+     prevent, if possible, its farther effusion; for when a
+     discharge suddenly takes place into the chest after scarlet
+     fever, it will generally prove fatal, even though the quantity
+     collected be inconsiderable, and only such as would occasion,
+     if gradually effused, a moderate degree of inconvenience to the
+     lungs."
+
+In respect to tapping, our author remarks, that the circumstances
+calling for this operation are, where, from the very considerable
+accumulation of water, and the consequent distension it occasions, a
+permanent and morbid stimulus is given to the peritoneal membrane, by
+which its serous inflammation is perpetuated or increased; or where so
+much pain and irritation are produced, as to risk inducing a similar
+disease in the chest, and of bringing on likewise an ulcerative form of
+inflammation in the peritoneal lining of the abdomen.
+
+     "Whilst the objections to its employment consist in the danger
+     which is incurred, where there is much visceral disease, of its
+     causing a destructive form of inflammation in the peritoneum;
+     and the probability of its occasioning, under the most
+     favourable condition of the disease, a more rapid renewal of
+     the serous accumulation."
+
+Our limits not allowing us to enter on the treatment of ovarian dropsy,
+we proceed to offer a few remarks on the means recommended by Dr. A. for
+the cure of anasarca. As in the treatment of every other form of dropsy,
+it is necessary, in attempting the cure of anasarca, to advert to the
+nature and causes of the disease.
+
+     "If it be idiopathic, and unconnected with any dropsy of a
+     circumscribed cavity, and the pulse at the same time be soft,
+     and the urine free from serum, it may be treated solely with
+     the view of procuring the absorption of the effused fluid, as
+     in such cases, the watery discharge in all probability will
+     have removed, in a considerable degree, the excitement which
+     caused it."
+
+It is in such cases that recoveries take place under almost any plan of
+treatment, and that bark and other tonics have been found beneficial.
+Their utility, however, in these cases is very limited, consisting only
+in aiding the removal of the effects of the disease, and keeping up the
+strength of the system, whilst the absorbents perform their function,
+and remove the fluid. Dr. A. recommends, in these cases, puncturing and
+bandages; but he very justly adds, that they must not be employed,
+whenever there remains any inflammation in the parts, as they would then
+tend to aggravate it.
+
+     "To oedematous swellings, in which the serous local
+     inflammation, whether symptomatic or idiopathic, still
+     subsists, I am accustomed to direct the application of leeches
+     and cold evaporating lotions, observing not to commence the use
+     of the latter, until twelve hours after the leeches have been
+     used, that inflammation may not be produced in the wound."
+     "When anasarca arises from a general excited state of the
+     system, as denoted by the pulse, and by the serous quality of
+     the urine, venesection becomes necessary, combined with the use
+     of leeches, applied to the extremities, or to those parts of
+     the body, in which the serous tissues are most affected, along
+     with the active use of the general means already alluded to."
+
+In anasarca, an error is sometimes committed, especially by young
+practitioners, of estimating the degree of danger, and the necessity for
+active treatment, by the single consideration of the extent of the
+oedematous swelling. This, however, should be guarded against, as the
+swelling may be very considerable, and the disease subsided, or of
+little consequence; whilst, in other instances, the reverse may be the
+case. In the first instance, where the disease is not seen early, the
+treatment must sometimes be limited to those means which promote the
+absorption of the water, and neither venesection nor leeches will be
+required. In such cases, the practitioner must be guided by the state of
+the pulse and urine; the presence or absence of vascular excitement; the
+history given of the case up to the period when visited, and
+particularly by the progress of the swelling.
+
+     "When the dropsy of the skin is considerable and long
+     protracted, and symptomatic of some visceral disease, as it
+     most commonly is in these cases, and is attended by a serous
+     state of the urine, and a general failure of the strength, the
+     cachetical state of the system may be considered as
+     established, and the treatment is then beset with difficulties.
+     For the general means, which are useful in the earlier states
+     of the disease, and when the vital strength is entire, become
+     injurious in this, by the tendency they have, aided by the
+     effects of the visceral disease, to diminish farther the vigour
+     of the system; whilst, at the same time, the treatment, which
+     is suited to support the declining strength, can contribute
+     nothing towards lessening the constitutional and local
+     diseases, but will frequently increase the morbidly excited
+     state of the circulation, which, analogous to what occurs in
+     diabetes, will continue and increase under the most decided
+     marks of general constitutional weakness. Pending the
+     continuance of that inflammatory state of the system, in which
+     the urine is charged with serum, the debility will be mainly
+     derived from that drain of its nutrient parts, which is thus
+     established in the body, assisted by the weakening effects of
+     the organic disease. If blood be drawn, it will be found, in
+     many of these cases, to exhibit the usual signs of
+     inflammation; and the treatment of the tonic kind, when
+     employed to support the strength, will be found to act
+     unfavourably.
+
+     "The plan to be pursued must consist in the use of such means
+     as shall assist the powers of digestion and assimilation; so
+     that, by a highly nourishing but plain diet, the drain from the
+     system may be somewhat counteracted; and, at the same time, the
+     cause of the effusion is to be corrected by the use of local
+     depletion and blistering, and by the temperate employment of
+     those general means, which are useful in the less aggravated
+     forms of the disease."
+
+The diet of patients, in the symptomatic forms of dropsy, should be
+plain and unirritating; and in the idiopathic states, the antiphlogistic
+regimen should be rigidly enforced; particularly an abstinence from all
+fermented liquors, until the inflammatory period of the disease be
+removed. The clothing should be moderately warm, and selected of that
+kind, best suited to promote the insensible perspiration of the surface.
+
+Before taking leave of Dr. AYRE, we cannot omit adverting, in a very few
+words, to a circumstance noticed in his preface, and which we think of
+some importance. He remarks, that if, in the prosecution of his task, he
+has had no acknowledgments to make to any individual as his guide and
+authority, he is nevertheless indebted for many important facts to the
+writings of the late Dr. WELLS, and of Drs. BLACKALL, ABERCROMBIE, and
+DUNCAN, jun. and particularly to the system of pathology of Dr. PARRY.
+He further remarks, that he entertained and taught for many years, the
+views advocated in this work, and that, after the manuscript had been
+sent to press, he had seen a copy of an abridged edition of the
+elaborate Dictionnaire des Sciences Medicales, in which the doctrine of
+dropsy, maintained in the larger work, is relinquished; whilst others
+are given in their place, conformable, in the main, with those which it
+is the object of his treatise to establish. Now it would appear, from
+these expressions, that Dr. AYRE wishes to inculcate the idea, that the
+English writers, whom he has cited, were the only ones who had published
+anything valuable, and conformable to his doctrine; and that prior to
+1823, the year of the publication of the Dictionary above mentioned, the
+French entertained very different views of the pathology of the disease.
+We think it our duty, however, to rectify our author in this respect,
+and to show to our readers, that, even allowing full credit to Drs.
+WELLS, BLACKALL, ABERCROMBIE, &c. for their researches into the nature
+and treatment of dropsy, the American, French, and Italian pathologists
+are entitled to a much larger share than is allowed to them in the
+present work. A few references will be sufficient. Many years ago, our
+celebrated RUSH taught, that general dropsies "depend on a certain
+morbid excitement of the arteries;" and that hydrocephalus, "in its
+first stage, is the effect of causes, which produce a less degree of
+that morbid action in the brain which constitutes phrenitis." In 1812,
+Dr. BRESCHET, of Paris, published an excellent dissertation on active
+dropsies. In the early writings of BROUSSAIS, though more particularly
+in the propositions prefixed to his _Examen_, the opinion is maintained,
+that all active dropsies depend on irritability, either primary or
+secondary, of the serous and cellular tissues,--a theory more closely
+allied to Dr. A.'s, than all that is contained in the writings of Drs.
+WELLS, PARRY, &c. But what, perhaps, is more to our purpose, Dr.
+GEROMINI, of Cremona, published a work, in 1816, on the origin and cure
+of dropsy, in which he compares the dropsical accumulation to that of
+serum produced by the inflammation of a blister, or by fire; and in
+which he also maintains, that a slight inflammation occasions a flow of
+limpid serous fluid, whilst a higher degree gives rise to the formation
+of pus. From these circumstances, he concludes, that the hydropic fluid,
+which contains little albumen, is the product of a lower grade of
+inflammation. In the same work, he finally asserts, that in more than
+200 individuals who had died of dropsy, he invariably found marks of
+inflammation or its effects; views which our readers will readily
+discover to be nearly allied to those supported by Dr. A. In making
+these remarks, however, we do not wish to be understood as asserting,
+that the theory advanced by our author did not originate also with him.
+We have too favourable an opinion of his honesty, to accuse him of
+plagiarism. Our sole intention has been to render unto each the degree
+of praise to which he is entitled, and, by pointing out this coincidence
+of opinion, to derive a further proof of the correctness of most of the
+pathological views, so ably defended in the present work.
+
+
+
+
+ARTICLE VIII.--_An Essay on Venereal Diseases, and the Uses and Abuses
+of Mercury in their Treatment._ By RICHARD CARMICHAEL, M.R.I.A. _With
+Practical Notes, &c._ by G. EMERSON, M. D. Philadelphia, J. Harding,
+1825; pp. 360.
+
+
+One of the most important improvements in practice, which modern
+experience has established, is the reformed method of treating venereal
+diseases.
+
+To the labours of several distinguished military physicians and surgeons
+of Great Britain, we are chiefly indebted for the facts and researches
+connected with this interesting subject. And although we may have much
+to learn in regard to the true nature of these complaints; yet the plan
+adopted by Mr. CARMICHAEL, of determining their distinct pathological
+characteristics, and applying the remedies accordingly, is the only one
+likely to subvert the empirical routine of prescribing mercury on all
+occasions, a practice which derives such strong support both from the
+indolence and prejudices of the profession.
+
+In this country, many eminent practitioners have contributed to restrain
+the abuse of mercury; and it is believed, that Professor CHAPMAN has for
+many years, in his lectures, disseminated the most enlightened doctrines
+on this point. Dr. HARRIS and other surgeons of the navy have made a
+fair trial of the non-mercurial treatment, and with the most
+satisfactory results.
+
+The great object, so desirable of attainment, is to form a correct
+discrimination between the diseases, which may be cured or benefited by
+the exhibition of mercury, and those which do not require this medicine,
+or become aggravated by its use; for it seldom fails to do injury, when
+its advantages are not very obvious.
+
+Mr. CARMICHAEL has taken the most conspicuous part in this investigation
+for the last fifteen years, and from the extensive theatre, in which his
+inquiries were conducted, has had the best opportunities of arriving at
+the truth. He, therefore, who undertakes the management of these
+affections, may be justly pronounced culpable, if he neglect to make
+himself acquainted with the experience of this eminent surgeon.
+
+In this enlarged and improved edition of his work, several subjects have
+not been treated of so copiously by the author, as was requisite to
+render it acceptable as a book of reference; but the judicious notes of
+Dr. EMERSON, whose attention has been profitably directed to the
+investigation of venereal diseases, have well supplied the deficiency.
+
+A brief outline is here presented of the contents.
+
+The author describes the various symptoms in plain and intelligible
+terms; rejecting such unmeaning appellations as syphiloidal,
+pseudo-syphilis, &c. as designating no particular phenomena, and
+therefore of no use in describing a disease.
+
+He thinks there is a plurality of venereal poisons, and has divided the
+disease into four classes, from their different primary and secondary
+symptoms; making the eruptions on the skin the most certain criterion of
+distinguishing them from each other. These classes are:--the papular
+venereal disease; the pustular; The phagedenic; and the scaly venereal
+disease. The latter is the true syphilis.
+
+First, the Papular. This is the most common disease, and the most easily
+cured. Its primary symptoms are, a simple ulcer without induration,
+without elevated edges, and without phagedena. Sometimes there is a
+patchy excoriation of the glans penis, attended with a purulent
+discharge. This disease and gonorrhoea are caused by the same poison.
+The constitutional symptoms are:--fever; pain in the head, shoulders,
+and larger joints, pain in the chest; dyspnoea; a papular eruption on
+the forehead, chest, and back, sometimes extending in a more scattered
+way over the extremities. It is often attended with iritis. It never
+gives rise to nodes. The sore throat is different from that of syphilis;
+the latter having deep excavated ulcers. If buboes accompany it, they
+are mostly of an indolent nature. The eruptions do not all appear at
+once; but follow each other. When on the decline, they are of a pale red
+or copper colour, not scaly, as in syphilis, but papular; disappearing
+and recurring repeatedly, and ending in desquamation.
+
+_Remedies._--Venesection; cathartics; antiphlogistic regimen;
+antimonials, combined with decoction of sarsaparilla. Alterative does of
+calomel and antimonials, when the eruption declines.
+
+The local treatment consists in astringent washes and simple dressings.
+
+Iritis is to be cured by venesection, cathartics, mercury, blisters, and
+belladonna.
+
+This disease will yield to the powers of the constitution. Mercury is
+always injurious in the early stage.
+
+Second, Pustular venereal disease.
+
+Primary ulcer of a reddish-brown colour; borders closely on the
+phagedenic character. The edges raised and well defined; not excavated,
+but on a level with or above the surrounding skin. In the commencement,
+a small itchy pustula; distinguished from the ulcer attending the
+papular disease by its well defined and elevated edges, and by the
+absence of the smooth fungous surface of the former; from the phagedenic
+by its well defined margin and its corroded-like surface, and the
+absence of acute pain; and from chancre by the absence of the callous
+edges and base. These ulcers are of a chronic nature, showing little
+disposition to spread. The ulcers from buboes partake of the same
+character, the edges being hard and the ulcer disposed to burrow. These
+edges Mr. C. removes with the knife. The disease is rendered extremely
+obstinate, where full courses of mercury have been given. The more
+closely the eruption approaches the papular, the more mild and
+manageable will be the disease.
+
+_Constitutional symptoms._--The eruption is pustular, and often exhibits
+simultaneously new pustules; also scabbing ulcers, the crusts of which
+fall off, and leave discoloured patches of skin after healing. For these
+ulcers of the skin, the best remedies are, sulphur fumigations,
+nitro-muriatic acid baths, and ointment of tar and sulphur.
+
+_Remedies._--Rest; gentle astringents; mild ointments; antimonials and
+sarsaparilla:--for the constitutional symptoms; venesection; cathartics;
+antimonials; sarsaparilla.
+
+Mercury is decidedly injurious, until the disease is on the wane, when
+alterative doses may accelerate the cure.
+
+Third, Phagedenic venereal disease.
+
+The primary ulcer has a corroded appearance. It exhibits neither
+granulations nor induration. It spreads sometimes rapidly, sometimes
+slowly; healing in one part, while ulcerating in another. It is mostly
+situated on the glans and prepuce, and often attended with hemorrhage.
+In this disease, buboes most frequently appear.
+
+The sloughing ulcer occurs also in this disease. Mercury is extremely
+pernicious, always rendering the disease more inveterate and rapid in
+its progress.
+
+_Constitutional symptoms._--High fever precedes the eruption, but abates
+afterwards. Nocturnal headachs; tenderness of the scalp; slight
+dyspnoea; tenderness of the sternum on pressure; soreness of the
+chest; an eruption of tubercles, or pustules, or spots of a pustular
+tendency, which quickly degenerate into ulcers, with thick crusts, that
+heal from the centre, while they extend from the circumference, with
+phagedenic borders. The crusts are often of a conical figure. The
+ulceration of the throat is of the most formidable nature. It commences
+in the form of a small white aphthous sore; which usually attacks the
+velum or posterior part of the pharynx, mostly the latter. It extends
+rapidly, destroying the parts, and at last attacks the bones. It often
+attacks the larynx, after which, the patient seldom recovers. The
+affection of the bones of the nose is never joined with the papular
+eruption, nor with the scaly syphilitic lepra; but in every case with
+the pustular description, and when scales and ulcers were present. At
+the time of the eruption, pains in the knees, wrists, and ankles occur,
+attended with swelling and redness. He has never seen nodes in the
+disease, except in cases where mercury had been given. Full courses of
+mercury introduce the disease into the deep seated parts; for the bones
+are seldom or never affected in this disease, unless mercury has been
+given.
+
+_Remedies for the primary symptoms._--Absolute rest; venesection;
+nauseating doses of antimonials; warm poultices and fomentations; opium;
+hyosciamus and cicuta in sufficient doses to lessen pain and irritation.
+For the sloughing ulcer, stimulating applications are often useful; such
+as Venice turpentine or balsam copaibae, mixed with olive oil.
+
+_For the secondary symptoms:_--Venesection; antimonials; sarsaparilla;
+Dover's powder. Mercury increases the ravages of the disease, except
+when on the wane, when it may be given in alterative doses, with safety
+and advantage. For the pain in the head, a blister to the nape of the
+neck. If the eruption appear scaly, then mercury is likely to be useful.
+If the throat and skin are affected, muriate of mercury in solution, and
+decoction of sarsaparilla. If the ulcer in the throat be small, touch it
+with the oxymel aeruginis, or solution of nitrate of silver, grs. v a x
+to an ounce of water; but if there exist extensive ulcerations,
+fumigations with red sulphuret of mercury ought to be employed.
+
+Fourth, Scaly Venereal Disease, or Syphilis.--Primary ulcer of a
+circular form, excavated, without granulations, with matter adhering to
+the surface, and with a thickened edge and base. The hardening is very
+circumscribed, not diffusing itself gradually or imperceptibly into the
+surrounding parts, but terminating rather abruptly. Its progress is
+slow, sometimes assuming a tawny appearance.
+
+_Constitutional symptoms._--Sometimes the skin, at other times the
+throat, is first affected. There is headach, restlessness, and fever.
+The scaly eruption appears, but does not relieve the fever, as in the
+other diseases. This eruption commences with a small hard reddish
+protuberance; and as it advances, the sides are raised, and centre
+depressed or flat, and covered with thin white scales. It terminates in
+ulcerated blotches. This eruption appears on the forehead, breast, back
+of the neck, and groin; often in large copper coloured blotches, in
+parts near the hair. The ulcers of the throat mostly affect the tonsils,
+and come on without much previous pain or swelling; although there soon
+appears a considerable excavation of the tonsil, attended with evident
+loss of substance. The ulcer is foul, with thick white matter adherent
+to it, which cannot be washed away. The bones then become affected,
+those nearest the surface being most liable to attack; such as the
+tibia, sternum, clavicle, and cranium.
+
+The remedies for syphilis are full courses of mercury, for both primary
+and secondary symptoms; except where a tendency to phthisis, or a
+delicate constitution forbids them. He thinks syphilis a rare disease
+now, compared with what it was formerly.
+
+
+
+
+ARTICLE IX.--_Remarks on some Means employed to destroy Taenia, and expel
+them from the Human Body._--By LOUIS FRANK. M. D. Privy Counsellor of
+her Majesty, Maria Louisa, Duchess of Parma. [Lond. Med. Rep. April
+1825.]
+
+
+The symptoms produced by the presence of tape worm in the human body,
+are exceedingly distressing, and the sufferings of the patient are
+increased, by the obstinacy, with which these animals resist the
+operation of the most disgusting, and even painful and dangerous
+remedies. Improvements in the mode of attacking and expelling them,
+therefore, should be gladly received, and widely made known.
+
+The numerous reports which we have received, concerning oil of
+turpentine as a remedy for taenia solium, have already given to that
+remedy the highest character; but many cases have been only partially
+relieved by it. The ol. tereb. seems to be capable of causing the
+separation and expulsion of portions of the animal; but while the head
+remains unexpelled, it is supposed to be capable of reproducing the
+joints, to a degree not yet ascertained. If we may believe medical
+writers, the taenia has been observed of the enormous length of 700 feet.
+It is probable that the reproduction, after the loss of large numbers
+of joints, is often very rapidly effected; as was the case in a patient
+treated at the Carey Street Dispensary, mentioned in their report for
+Aug. 1813,[18] This person always discharged very considerable
+quantities of joints or fragments, after the use of oil of turpentine;
+after which he remained free from the complaint for a few months, until
+the taenia recovered a troublesome magnitude; when it was again easily
+reduced to less uncomfortable dimensions.
+
+We are not able to state positively, how long the oil of turpentine has
+been in use as a remedy for taenia. The Carey Street Report for Feb.
+1810, informs us, that a mechanic in Durham, having been very successful
+in the treatment of taenia by means of this article, the circumstance was
+communicated by Dr. SOUTHEY, of that place, to Dr. LAIRD of London; and
+it was accordingly prescribed in doses of [Symbol: ounce]ss. to [Symbol:
+ounce]ij. at several of the London charities. It had been found, says
+the report, that ol. tereb. might be thus given, as safely as so much
+gin, and frequently caused the expulsion in two hours: Dr. KNOX says it
+has been in use in Germany for fifty years for the expulsion of taenia.
+
+The experience of Dr. KNOX, concerning taenia, at the Cape of Good Hope,
+is the most extraordinary that we are acquainted with. Dr. SPARMAN, the
+traveller, had observed, that worms were exceedingly common in the
+northern parts of the colony; but Dr. KNOX, who was there in 1819, did
+not notice any special prevalence of verminous disorders, "previous to
+Oct. 1819, when the _tape worm became so general among the troops, as to
+resemble an epidemic_."[19]
+
+Most of these troops had been employed on a short campaign to the east
+of the great fish river. They had been compelled to live on very bad
+beef and mutton, driven and starved half to death; and Dr. KNOX thinks
+he has proved, that the taenia in these cases did "arise from the use of
+unwholesome animal food; from the flesh of animals, which had been
+diseased." Two out of five of the troops, who had been thus employed and
+fed, were affected with worms. Of a detachment of 86 vigorous, healthy
+young men, 36 were found, on inquiry, to have _tape_ worm. Those who
+remained in the colony did not suffer so much, as those who had been out
+on the campaign, the ratio being as one to four; whereas of the others,
+it was two to five. Dr. KNOX had ample experience of the utility of
+turpentine during this singular prevalence of taenia. Concerning the 36
+men above mentioned, he says, "the cure of all, who chose to adopt the
+means, was easily effected by small doses of the spts. of turpentine,
+after the failure of purgatives and various other remedies."
+
+He considers ol. tereb. as the _most efficacious remedy_. He does not
+approve of large doses, because of headach, vertigo, and delirium, which
+have been produced by them in "many patients."
+
+"I have generally found," says he, "that from one to two drachms of ol.
+tereb., given in a little water, morning and evening, for three
+successive days, were sufficient to destroy the taenia solium, (even in
+the most obstinate cases,) and cause it to leave the intestines, without
+the aid of any purgative medicine." He advises, however, to give a
+little castor oil each day about noon.
+
+It has been a very common observation in regard to the dose of
+turpentine, that the patient suffers more cephalic distress when it is
+given in small quantity, than in a large dose. The writer of this has
+been obliged to desist from the exhibition of oil turpentine, in doses
+of [Symbol: dram]ij twice a day, in consequence of a vertigo so
+considerable, as to alarm and distress his patient very much. Perhaps
+there might have been in this case some peculiar liability to nervous
+excitation, which in another patient would not have been worthy of much
+notice. Dr. KNOX'S opinion is of great weight.
+
+The celebrated remedy of CHABERT, Dr. KNOX thinks, owes its efficacy to
+the ol. terebinth. combined with it.
+
+Dr. FRANK, whose name stands at the head of this article, was informed
+by the celebrated helminthologist, Dr. BREMSER, at Vienna, in 1814, that
+he had for ten years preferred the use of CHABERT'S remedy, and with
+invariable success.
+
+CHABERT was a veterinary surgeon of Alfort, who used the animal oil of
+Dippel in many diseases of animals, as well as those of men. This oil he
+often gave for the purpose of removing taenia in his animals. He often
+combined it with spt. terebinth. and gave equal parts of these
+substances, in doses of [Symbol: dram]i.[20] The London Medical
+Repository states, that CHABERT'S remedy is prepared from
+
+     Ol. Corn. Cerv. Foetid.    1 part.
+     Ol. Terebinth,               3 parts.
+
+These are well mixed, and left at rest four days; they are then
+distilled in a sand bath, till three-fourths of the liquor has passed
+over. It must be kept tightly stopped, out of the light.[21]
+
+The great objection to CHABERT'S remedy is its disgusting flavour; which
+is the more obnoxious, because the remedy must be continued for a length
+of time. Dr. FRANK cured two persons affected with taenia solium, after
+considerable perseverance with it: he cured two other persons with a
+preparation as follows:
+
+     Ol. Terebinth.               [Symbol: ounce]ss
+     Aether Sulphuric.            [Symbol: dram]ij
+     Pulv. G. Arab.               [Symbol: ounce]ss
+     Aq. Flor. Chamam. distil.    [Symbol: ounce]xvj _m._
+
+     Two spoonfuls morning and evening.
+
+Four of these mixtures were sufficient to cure the patients, who
+remained well two years afterwards.
+
+A fifth patient, unable to take the last named medicines, was cured by
+the boluses subjoined:
+
+     Sem. Santonic. pulv.    [Symbol: ounce]ss
+     Pulv. Jalap.
+     Ferri Sulphat.   aa     [Symbol: dram]i
+     Ol. Corn. Cervi,        gtt. viij.
+     Syrup.                  q.s.
+                       Make 20 boluses.
+
+One to be taken morning and evening. These 20 boluses being repeated
+three times, the patient found himself perfectly well. In the above 5
+cases, the taenia was discharged in fragments.
+
+Dr. FRANK does not say much concerning the bark of pomegranate root,
+which has come into vogue lately as a remedy for taenia. He refers to the
+Med. Chirurg. Transact. Vol. XII. for accounts by some English
+physicians, and remarks, that Dr. GOMEZ, the Portuguese physician, had
+cured 14 cases with this bark.
+
+Dr. POLLOCK (vide Ed. Med. and Surg. Journal, Oct. 1819) treated a
+child, aged 14 months, with the decoction of bark of pomegranate root,
+so far back as the year 1811. This infant, under the use of the
+medicine, discharged at several times upwards of 30 feet of taenia
+solium, and was cured. We learn also from the Med. Repository,[22] that
+MM. DESLANDES, SOURYA, and BOURGEOISE, have employed pomegranate with
+great success; that the decoction generally expelled the worm in two
+hours; that it sometimes occasioned vomiting and griping pains; and that
+it has been a common remedy for tape worm, in the East Indies, and among
+the blacks of St. Domingo.
+
+From the same source we are informed, that the French pharmaceutists
+recommend, before boiling the bark, that it should be allowed to swell
+(macerate) in cold water. [Symbol: ounce]ij of bark should be boiled in
+lbij of water to [Symbol: ounce]xii. Of this decoction, [Symbol:
+ounce]ij may be taken every half hour. The worm is here said to be
+passed often in twelve hours instead of two. It may be necessary to
+continue this plan four or five days, taking care to suspend the
+medicine, in case any vertigo, or intestinal disease supervenes. A dose
+of castor oil is recommended after the 4th bottle; even though the worm
+be happily for the patient expelled.
+
+In the Revue Medicale is a case, in which pomegranate succeeded in
+discharging three ells of taenia; but the patient broke off the worm in
+attempting to extract it with too much violence. This circumstance
+recalls us to the consideration of Dr. FRANK'S communication. He
+recommends much caution in the extraction of those portions of taenia,
+which have remained partly in the intestine; and says that Dr. CAGNOLA
+proposed touching the extruded portion with prussic acid, in hopes of
+killing the whole animal by means of this violent poison. Dr. GARLEKE
+adopted this plan on an extruded portion of four inches in length, and
+in one hour afterwards the _whole animal came away dead_. Dr. F.
+suggests, that the electric shock might weaken the taenia, so as to cause
+it to let go its hold, and thus be unresistingly extracted. BRERA
+recommended that the worm should be tied with a piece of silk. In this
+manner, it is retracted into the bowel, but begins to descend again not
+long afterwards. He dissuades from any attempt at forcible extraction,
+which excites the most distressing sensations in the bowels, and causes
+the risk of bringing on convulsions.
+
+We are informed by Dr. FRANK, that a surgeon of St. Petersburg succeeded
+by passing the worm through a canula, and the canula through the
+sphincter ani muscle, so as to obviate the resistance caused by its
+contraction. In this manner, he easily succeeded in withdrawing the
+taenia _whole_, which is always desirable.
+
+The writer of this article succeeded in removing many pieces of taenia
+from a female, by means of the tincture of black hellebore, given in
+doses of a teaspoonful for another object. The patient has since been
+affected with the same symptoms, and took to-day, Oct. 19th, in doses of
+[Symbol: ounce]iss, repeated every hour, sixteen ounces of a decoction
+of the rind of pomegranate fruit, (none of the cort. rad. being
+procurable); after which she took a dose of castor oil. It is said, we
+know not on what authority, in a French journal, that this preparation
+possesses the same powers as the root. It may be so; but this patient
+had no discharge of the tape worm, after swallowing the whole of this
+very astringent decoction, and following up the plan by taking [Symbol:
+ounce]iij of ol. ricini.
+
+Perhaps the taenia had been effectually destroyed before. She has seen
+none of the joints for 18 months. The accounts, however, of the
+expulsion of taenia by the bark of the root, are so encouraging, that we
+have much pleasure in recommending it to the notice of the medical
+public in this country.
+
+FOOTNOTES:
+
+[18] Ed. Med. and Surg. Jour.
+
+[19] Ed. Med. and Surg. Jour. July, 1821.
+
+[20] Dict. des Sciences Medicales.
+
+[21] There can be no particular benefit derived from the distillation.
+The simple mixture of the materials, above indicated, is all that is
+necessary. CHABERT'S remedy is therefore easily prepared.
+
+[22] Lond. Med. Repos. April, 1825.
+
+
+
+
+ARTICLE X.--_Researches Physiological and Pathological, instituted
+principally with a View to the Improvement of Medical and Surgical
+Practice._ By JAMES BLUNDELL, M. D., Lecturer on Physiology and
+Midwifery at the United Hospitals of St. Thomas and Guy. London, 1824,
+pp. 146, 8vo.
+
+
+Dr. BLUNDELL is the author of some celebrated experiments on the
+physiology of generation, and the transfusion of blood. The work at
+present under consideration consists of physiological observations
+and experiments, the substance of a paper read before the
+Medico-Chirurgical Society of London, in the year 1823, and not
+heretofore published; of experiments on a few controverted points,
+respecting the physiology of generation; and lastly, of some remarks on
+the operation of transfusion.
+
+The first part seems intended to ascertain what degree of lesion, or
+losses by extirpation, the body may sustain without inducing death; and
+thus, to open a way for improvements in surgery, by rendering the
+surgeon not only more bold and fearless, but more frequently successful
+in his attempts to preserve life, or counteract the inconvenient effects
+of disease and accidents. We shall make a short analysis of the first
+paper.
+
+In four experiments, Dr. B. removed the left kidney of the rabbit, by
+incision on the outer edge. Ligatures were applied to prevent bleeding.
+
+Two died; one in 60 hours, the other in 4-1/2 days: both of
+inflammation. One recovered, and lived 5 or 6 weeks, and then died. The
+4th also recovered, but died in 5 or 6 weeks. On examination, a sac was
+found (in place of the kidney) filled with a semi-fluid substance,
+resembling custard, p. 4.
+
+In seven rabbits, removed the spleen. One recovered permanently, and one
+lived six months. p. 5.
+
+In five rabbits, opened the abdomen, and punctured the fundus of the
+bladder with a lancet. Three of them recovered entirely. p. 6.
+
+In two rabbits, cut off one-fourth of the bladder with scissors, having
+applied a ligature first. One died in seven months; the other still
+lives in good health.
+
+Into the peritoneum of four rabbits, threw [Symbol: ounce]i of human
+urine; then washed it out by injecting tepid water. One died of collapse
+in less than 24 hours, and two of inflammation, in 60 and 19 hours
+respectively. The fourth is now (12 months) in good health. p. 7.
+
+In seven, injected [Symbol: ounce]xi decoct. quercus into the
+peritoneum. Only one recovered.
+
+Dr. B.'s inferences from the foregoing experiments are:
+
+     1st. "Large apertures into the peritoneum of the rabbit, do not
+     immediately induce a dangerous prostration, of strength." p. 9.
+
+     2ndly. "Large apertures into the peritoneal sac of the rabbit,
+     are not necessary, nor perhaps generally, productive of fatal
+     inflammation."
+
+     3dly. "In the rabbit, the kidney, the spleen, and a large piece
+     of the bladder may be extirpated, without necessarily causing
+     death; though death under the first operation is probable." p.
+     10.
+
+     4thly. "When the abdomen is laid open, and parts are removed
+     from it in the rabbit, the first danger arises apparently from
+     collapse; the second from general inflammation; and the last
+     from chronic disease." (Vide experiments.)
+
+     5thly. "The rabbit's abdomen is very tender, probably no less
+     so than that of man." See exper.
+
+     6thly. "Success in abdominal operations on the rabbit,
+     furnishes a presumption in favour of success in similar
+     operations on the human abdomen; and, therefore, from these
+     experiments, we may infer, _presumptively_, that moderate
+     openings into the human peritoneum will not necessarily, nor
+     even generally prove fatal from inflammation or otherwise; and
+     further, that certain viscera or parts of viscera, not
+     essential to the welfare of our structure, may be removed from
+     the belly, without necessarily, or even generally, producing
+     death. The extirpation of the kidney must be highly dangerous;
+     but there is a presumption in favour of the successful removal
+     of the spleen, the ovaries, or even of large pieces of the
+     bladder." p. 11, 12.
+
+Dr. B. having stated the foregoing results and inferences, proceeds by
+relating instances of severe injury sustained by the _human_ body,
+without being followed by death. These are confirmatory of his
+inferences from the experiments on rabbits. The instances given are--an
+os uteri torn off; extensive laceration of the uterus and rectum in
+labour; four uteri extirpated on account of chronic inversion, (p. 13.)
+One of these last under his own care. It was removed by a wire, and came
+off in 11 days, without one bad symptom, (p. 14.) Rupture and laceration
+of the abdominal coverings, four fingers' breadth, the bowels hanging
+out, (p. 14.) Two spleens removed; one in a soldier after the battle of
+Dettingen, who recovered without inconvenience afterwards; the other in
+a Mexican, whose case is related by Dr. O'BRIEN, in his Inaugural Essay,
+Edinb. 1818, (p. 15.) Three cases of rupture of the dropsical ovary. Two
+cases of opening into the abdomen, for the extirpation of dropsical
+ovaries, (p. 18.) Five cases of laceration of the uterus by natural
+efforts. Four of the women died, but in the fifth, Dr. BLUNDELL turned
+and delivered, after the child had escaped into the peritoneal sac, and
+the woman recovered, (p. 20.) Cesarian operation, three times by friend
+of Dr. HAIGHTON; once successfully, (p. 22.)
+
+Dr. B. says, "From these (facts) few as they are, I feel conscious that
+no certain inference can yet be drawn; though _presumptive_ inferences
+certainly may, and they seem to me to be the following:
+
+     "1st. Small wounds, as tapping, hernia, &c. do not induce fatal
+     peritonitis; and therefore the vulgar opinion that inflammation
+     in a spot of the peritoneum will almost invariably diffuse
+     itself over the greater part of it, is probably unfounded.
+
+     "2nd. Extensive divisions of the peritoneum are not necessarily
+     fatal by inflammation or otherwise, and _probably_ not
+     generally so.
+
+     "3d. That the womb, spleen, and ovaries, may be removed in the
+     mode mentioned, without necessarily, and, _presumptively_,
+     without generally destroying life.
+
+     "4th. That the gravid uterus may be torn open; the child may
+     escape into the peritoneal sac; the os uteri may be torn off:
+     not indeed, so far as these cases may be relied on, without
+     great danger, but twice, in seven instances, without death. p.
+     28.
+
+     "5th. The peritoneum and abdominal viscera will bear more
+     injury than the British surgeons seem disposed to admit.
+
+     "6th. That the above observations on the human abdomen, are in
+     unison with those drawn from observations on the rabbit; and
+     that observations made on the brute have more correspondence
+     with those on the human being, than is generally believed."
+
+Dr. BLUNDELL next remarks, that the facts related create a suspicion
+that a bolder abdominal surgery would not be unattended with success,
+and recommends the following operations to "_consideration_ merely, and
+not to practice, except in otherwise desperate cases."
+
+     1st. "When the Cesarian section is performed, divide or remove
+     a small piece of Fallopian tube, so as to prevent the danger of
+     reimpregnation, without destroying the sexual propensity. The
+     need for a second operation might thus be certainly prevented,
+     without scarcely increasing the danger."
+
+     2ndly. "Extirpation of healthy ovaries."
+
+     3dly. "The extirpation of the ovarian cyst in scirrhus,
+     combined with dropsy, or in simple dropsy." He remarks, "This
+     operation will, I am persuaded, ultimately come into general
+     use; and if the British surgeons will not patronize and perform
+     it, the French and American surgeons will." p. 26.
+
+     4thly. "The removal of a large circular piece of the cyst in
+     ovarian dropsy, when the sac itself cannot be extirpated."
+
+     5thly. "The removal of the cancerous womb, when the ulceration
+     first makes its appearance. Might not the womb be taken out
+     above the symphysis pubis, or through the outlet of the
+     pelvis?" &c. 27.
+
+     6thly. "Extirpation of the puerperal uterus." He suggests the
+     removal of the whole womb after the Cesarian section, in order
+     that the smaller might take place of the larger and more
+     formidable wound through the uterus--but says expressly, "No
+     operation perhaps can be more unpromising, shall I say more
+     unjustifiable, in the _present state of our knowledge_; but I
+     thought it proper to mention it." &c. p. 28.
+
+     7thly. "Should the bladder give way into the peritoneum," he
+     asks, "Why should we not lay open the abdomen, tie up the
+     bladder, discharge the urine, and wash out the peritoneum
+     thoroughly, by the injection of warm water?" p. 28.
+
+     8thly. - - - - -
+
+     9thly. Injection of astringents into the ovarian cyst or
+     peritoneal sac, unjustifiable.
+
+     10thly. "In cases of strongly characterized introsusception,"
+     why not make an opening into the peritoneum; and "pass the
+     small intestines, fold by fold, through the fingers." Dr. B.
+     has repeatedly done this in the dog and rabbit, without
+     producing death, or extensive and dangerous inflammation.
+
+     11thly. In the rabbit, he has tied an abdominal artery, and
+     carried the end of the ligature with a broad needle out through
+     the back, opposite to the place of the vessel. This ligature
+     can come away, and is a better mode than to leave it hanging
+     out at the abdomen, or entirely among the bowels, where it
+     forms a sac of puriform matter, and to appearance lays the
+     foundation of chronic disease. p. 30.
+
+Dr. BLUNDELL closes this paper by saying, that since the substance of it
+was read before the Medico-Chirurgical Society in 1823, Dr. RITZIUS, a
+Swedish physician, had informed him in London, "that the complete
+removal of the cancerous womb had been, to his personal knowledge,
+performed on the Continent five times. All the patients recovered from
+the operation," &c. "The womb was removed through the outlet of the
+pelvis." p. 36.
+
+Since we read Dr. BLUNDELL'S recommendations to the new operations, we
+have been astonished to notice in the Ed. Med. and Surg. Journal, July,
+1825, that a German surgeon had actually treated a case of ileus in the
+manner recommended by Dr. B. It is from Hufeland's Journal of Feb. 1825.
+After it was ascertained that an immoveable introsusception existed--
+
+     "The patient was placed on a convenient table. We examined
+     accurately the situation of the hardening, (_which marked the
+     diseased part_), and determined on opening the abdomen at the
+     outer edge of the right rectus muscle, about two inches above
+     the navel. After dividing the integuments with a common
+     scalpel, and making a small opening in the peritoneum, I
+     introduced my finger, and with a blunt pointed scalpel divided
+     the peritoneum, so as to make it correspond with the external
+     opening, which was between two and three inches. I then
+     besmeared my hand with oil, and carried it into the abdomen, in
+     order to feel for the indurated part. Scarcely had I introduced
+     my hand, than an attack of the pain came on, and a portion of
+     the intestines was protruded through the wound, which was
+     immediately replaced by my assistant. On continuing the
+     examination, I discovered in a transverse portion of the ileum,
+     a foreign substance, just where the hardened intestine was to
+     be felt. I drew the intestine out, in order to examine it more
+     minutely. The intestine was neither inflamed nor expanded, but
+     it contained in its cavity a soft coherent and compact mass,
+     which at its upper part was somewhat compressed, and thus felt
+     harder than the rest. So far as I could follow this part of the
+     intestine, this contained matter was to be felt: I also here
+     immediately detected an intus-susception, but in spite of all
+     my efforts I could not reach the commencement of it, so as to
+     bring it out. Two modes of proceeding were open to me, in order
+     to remove the intus-susception; either to make a transverse
+     incision in the integuments, from the right to the left side,
+     or to open the intestine itself. The last mode seemed to me the
+     most adviseable, both because the patient was already very much
+     exhausted, and because the operation would be sooner completed.
+     The intestine was opened at the end of the discovered
+     intus-susceptio, and immediately a part of the strictured
+     intestine came into view. I introduced my finger into the
+     opening in the intestine, which was made about two inches in
+     length, and gradually pushed the intus-suscepted part back from
+     the right to the left side, whilst I gently drew that part of
+     the intestine which contained the intus-susceptio towards me.
+     By this means I fortunately succeeded in unfolding the tangled
+     intestine, which amounted to two feet in length. There was not
+     the slightest trace of inflammation, nor any thing unnatural to
+     be discovered in the part; there was merely a round worm, which
+     was situated in the upper part of the intus-susceptio. The
+     intestine was brought together by means of six spiral stitches,
+     after the manner of the glover's suture, and the end of the
+     silk was allowed to hang out of the external wound in the
+     abdomen."
+
+The sutures were removed on the 8th day. On the 14th day, the man was
+cured, and continues well up to the date of the account.
+
+
+
+
+ARTICLE XI.--_An Inquiry into the Nature and Treatment of Diabetes,
+Calculus, and other Affections of the Urinary Organs._ By WILLIAM PROUT,
+M. D., F. R. S. _From the second London Edition, published in 1825; with
+Notes and Additions_, by S. COLHOUN, M.D. Philadelphia, Towar & Hogan,
+1826; pp. 308.
+
+
+A very acceptable service has been done to the medical profession in
+this country, by the present republication of Dr. PROUT'S work on
+affections of the urinary organs. The American physician will now have
+it in his power, at a reasonable cost, to possess one of the best
+treatises on this interesting subject. From the known accuracy of Dr.
+PROUT as a chemist, and his reputation as an accurate observer of
+nature, much new light was naturally expected as the result of his
+observations. Nor indeed have these high expectations been disappointed.
+After a careful perusal of his work, we have formed the highest opinion
+of his powers, both as an original thinker, and experimental inquirer.
+
+Dr. PROUT begins his treatise with some introductory remarks on the
+composition of the urine, and on urinary derangements generally. After
+giving a comparative tabular view of the composition of the blood, and
+healthy and diseased urine, he proceeds to notice in succession, their
+principal constituents. As albuminous urine is of frequent occurrence in
+dropsical complaints, and its presence regulates in some degree the
+practice proper to be pursued, the following characters, given to it by
+Dr. PROUT, should be well understood.
+
+     "Albuminous urine, on being exposed to a temperature of about
+     150 deg. becomes opaque, and deposites this principle in a
+     coagulated state. The precipitate varies considerably in its
+     appearance in different instances. Sometimes it is of a firmer
+     character, and similar to that formed by the serum of the
+     blood, from which, in this case, it may be supposed to be
+     derived; at other times it is very delicate and fragile in its
+     texture, and somewhat resembles curd, when it may be supposed
+     to be of chylous origin. In some instances, the effects of heat
+     upon albuminous urine are increased by the addition of nitric
+     acid. But the most delicate test of albuminous matter in
+     general is dilute acetic acid, and the prussiate of potash." p.
+     6.
+
+Dr. PROUT combats very successfully the opinion, generally entertained
+by chemists, that the power of healthy urine to redden litmus depends
+on the presence of free lithic acid.[23] That this power cannot depend
+upon lithic acid uncombined, is made evident to Dr. P. by its sparing
+solubility; it requiring, according to our author, 10,000 times its
+weight of water to dissolve it, or six times as much as is stated by Dr.
+HENRY. The reddening power of the urine is attributed by Dr. PROUT to
+the presence of lithate of ammonia, and superphosphate of ammonia: the
+former of which, contrary to what might be expected, is found capable of
+reddening litmus, and of remaining in solution with the latter, without
+decomposition.
+
+The following interesting remarks are made by Dr. PROUT on the effects
+of muriatic acid, in precipitating lithic acid gravel:
+
+     "The muriatic acid, in combination with soda and potash, occurs
+     both in the blood and in the urine; thus appearing to pass
+     through the kidneys unchanged. This acid and its compounds
+     formerly appeared to be of less importance in a pathological
+     point of view than any other similar principles existing in the
+     urine: but since the unexpected fact has been ascertained, that
+     muriatic acid in a free state exists abundantly in the stomachs
+     of animals during the process of digestion, I have attended a
+     little more closely to the appearance of this principle in the
+     urine, and am disposed to believe, in consequence, that it is
+     the cause of the precipitation of lithic acid gravel from the
+     urine more frequently than any other acid. I do not mean to
+     say, that it is the _immediate_ cause of the precipitation of
+     this acid; for in most instances, it acts like all powerful
+     acids do under similar circumstances, namely, by liberating the
+     weaker acids, which are thus enabled to act in their turn, and
+     separate those having still weaker affinities than themselves.
+     Thus, in the present instance, the muriatic acid may be
+     supposed to separate the lactic, while the latter precipitates
+     the lithic, &c. If this opinion be well founded, as I believe
+     is the case, the muriatic acid may be considered of very great
+     importance, not only in a pathological, but a physiological
+     point of view; for if the muriatic acid, found in the urine in
+     such instances, be supposed to have its origin in the digestive
+     organs, we see at once the reason why the deposition of gravel
+     is so liable to be influenced by the derangements in general,
+     and more especially by the acidity, of the stomach."
+
+     "The muriatic acid may be shown to exist in the urine by the
+     white curdy precipitate insoluble in nitric acid, which is
+     formed, when the nitrate of silver is added to it, after the
+     sulphuric and phosphoric acids have been removed by the nitrate
+     of barytes or lead." pp. 20 and 21.
+
+After finishing these introductory subjects, Dr. PROUT proceeds to the
+consideration of the diseases of the urinary organs themselves; which he
+divides into functional, mechanical, and organic. Under functional
+diseases, we have _first_, those, in which principles _soluble_ in the
+urine are morbidly deranged in quantity or quality, embracing three
+chapters; and _secondly_, those affections, in which principles
+_insoluble_ in the urine are morbidly deranged in quantity or quality,
+comprising six additional chapters. Under the first subdivision, the
+first chapter is on the affections, characterized by albuminous urine;
+the second, on diseases, in which an excess of urea is the
+characteristic symptom; and the third, on diabetes.
+
+The diseased derangement, consisting in an excess of urea in the urine,
+has not been particularly noticed by any writer before Dr. PROUT, who
+believes that it has probably been confounded with that form of
+diabetes, called diabetes _insipidus_. The state of the urine and
+symptoms in this species of urinary derangement are thus described by
+our author:
+
+     "The average specific gravity of the urine seems to be a little
+     above 1.020, and occasionally to vary from 1.015 to 1.030. Most
+     generally it is pale, but occasionally it is high coloured, and
+     exhibits somewhat the appearance of porter, more or less
+     diluted with water; and this variety in appearance not
+     unfrequently takes place in the urine of the same person. When
+     first voided, it reddens litmus paper. For the most part, it is
+     entirely free from sediment, except the mucous cloud of healthy
+     urine; and the only remarkable property which it appears to
+     possess, is that of containing abundance of urea; so that on
+     the addition of nitric acid, crystallization speedily takes
+     place. From the quantity of urea present, it is very prone to
+     decomposition, and soon becomes alkaline, especially in warm
+     weather.
+
+     "There is almost constantly in these diseases, a frequent and
+     urgent desire of passing water both by night and day. This
+     desire is for the most part evidently excited by actual
+     _diuresis_, or the increased quantity of urine; but frequently
+     it cannot be ascribed to this cause, as the quantity voided at
+     one time is often by no means considerable; though in almost
+     every instance that has fallen under my observation, the total
+     quantity voided during any given time has appeared to be
+     greater than natural. The quantity appears also to be
+     particularly liable to be increased by cold weather, and by all
+     causes producing mental agitation. There is sometimes a sense
+     of weight or dull pain in the back, but this is by no means a
+     constant symptom. There is also occasional irritation about the
+     neck of the bladder, which sometimes extends along the urethra.
+     The functions of the skin appear to be natural; at least in
+     every case which has come under my own observation,
+     perspiration has been rather easily induced. The pulse is not
+     affected. There is no remarkable thirst, nor craving for food,
+     except in extreme cases; nor are the functions of the stomach
+     and bowels much deranged. Hence for the most part the tongue is
+     clean, and the dejections regular and apparently natural.
+
+     "In most of the cases of this disease, which have hitherto
+     fallen under my own immediate observation, the subjects have
+     been middle-aged men, of thin and spare habit, with a sort of
+     hollow-eyed anxiety of expression in their countenance, free
+     from gout and constitutional disease in general, and, as far as
+     could be ascertained, from any organic defect in the urinary
+     organs. In every instance they had been induced to apply for
+     medical advice, not so much from the pain, as from the
+     inconvenience of the disease, and the dread of its ending in
+     something worse; and, what may be worth remarking, in several
+     instances confessed, that they had been addicted to
+     masturbation from very early youth," p. 41, et seq.
+
+The remedy for this morbid derangement in the urinary secretion, most
+successful in the hands of Dr. PROUT, was opium, either administered
+alone, or in conjunction with alkaline medicines. It is rather a rare
+affection. When not arrested, it is liable, according to Dr. PROUT, to
+pass into diabetes.
+
+In his chapter on diabetes, our author makes many interesting remarks;
+but the space we are enabled to devote to this analysis, will permit us
+only to make an extract, which seems to prove a close connexion between
+the disease characterized by an excess of urea, and diabetes.
+
+     "It has been mentioned in the preceding pages, that an excess
+     of urea frequently precedes the appearance of saccharine matter
+     in the urine. Now it is a remarkable fact, that in diabetes, in
+     proportion as the saccharine matter diminishes, that of urea
+     generally increases; and in such instances, the presence of the
+     former principle can not only be no longer distinguished by the
+     sensible properties of the urine, but scarcely be demonstrated
+     by the utmost skill of the most experienced chemist, though the
+     specific gravity of the urine may at the same time be nearly
+     1.040. I have recently been favoured by Dr. ELLIOTSON with the
+     most complete and remarkable change of this description that
+     has yet occurred to me. The patient, besides being diabetic,
+     was in the last stage of phthisis, of which he died shortly
+     afterwards. The quantity of urine passed daily, when I first
+     examined it, was six or eight pints; its specific gravity was
+     1.038, and it contained a large proportion of very white sugar
+     and very little urea. Dr. ELLIOTSON under these circumstances
+     gave opium, beginning with gr. i, and increasing the dose to
+     gr. iii, thrice a day. The opium produced stupor, and was
+     obliged to be discontinued; but the effects produced upon the
+     urine by its means were most remarkable. _In about 60 hours,
+     the quantity of urine diminished to two pints, its specific
+     gravity was reduced to 1.0174, the saccharine matter had
+     apparently disappeared, and was superseded by urea, the
+     quantity of which had become excessive._ This alternation of a
+     principle containing nearly half its weight of azote, with
+     another containing no azote at all, is perhaps, one of the most
+     singular facts occurring in physiology." p. 74.
+
+The second subdivision of functional urinary diseases comprises six
+chapters: _first_, on urinary gravel and calculi; _second_, on the data,
+showing the comparative prevalency of different forms of urinary
+deposite, and the order of their succession; _third_, on the lithic acid
+diathesis in general; _fourth_, on the mulberry or oxalate of lime
+diathesis; _fifth_, on the cystic oxide diathesis, and _sixth_, on the
+phosphatic, or earthy diathesis.
+
+Under the first chapter, we have an account of I. Pulverulent or
+amorphous sediments; II. Crystallized sediments, or gravel; and III.
+Solid concretions, or urinary calculi. Of the latter, our author
+enumerates thirteen species.
+
+1. The lithic acid calculus.
+
+2. The lithate of ammonia calculus.
+
+3. The oxalate of lime, or mulberry calculus.
+
+4. The cystic oxide calculus.
+
+5. The bone earth, or phosphate of lime calculus.
+
+6. The triple phosphate of magnesia-and-ammonia calculus.
+
+7. The calculus, composed of a mixture of the phosphate of lime, and
+triple phosphate of magnesia-and-ammonia, or fusible calculus.
+
+8. The alternating calculus.
+
+9. The mixed calculus.
+
+10. The carbonate of lime calculus.
+
+11. The xanthic oxide calculus.
+
+12. The fibrinous calculus.
+
+13. The prostate calculus.
+
+Of these, the 2nd, 4th, 5th, 9th, 10th, 11th, 12th, and 13th species are
+more or less rare, and consequently of less interest. The remaining 5
+are of much more frequent occurrence, and are thus described by our
+author:
+
+     "_The lithic acid calculus_ is generally of a brownish-red, or
+     fawn colour; but occasionally of a colour approaching to that
+     of mahogany. Its surface is commonly smooth, but sometimes
+     finely tuberculated; and upon being cu t through, it is usually
+     found to consist of concentric laminae. Its fracture generally
+     exhibits an imperfectly crystallized texture, sometimes an
+     amorphous or earthy one, in which case, it usually contains a
+     mixture of other substances. This is one of the most common
+     species of calculi.--_Chemical characters._ Before the
+     blow-pipe, this calculus blackens, emits a smoke having a
+     peculiar odour, and is gradually consumed, leaving a minute
+     quantity of white ash, which is generally alkaline. It is
+     completely soluble in caustic potash, and precipitable again by
+     any acid in the form of a white granular powder. Lastly, if to
+     a small particle, a drop of nitric acid be added, and heat
+     applied, the lithic acid is dissolved; and if the solution be
+     evaporated to dryness, the residue assumes a beautiful pink or
+     carmine colour."
+
+     "_The oxalate of lime, or mulberry calculus_, is generally of a
+     very dark brown colour, approaching to black. Its surface is
+     very rough and tuberculated (hence the epithet of _mulberry_.)
+     It is usually hard, and when cut through exhibits an
+     imperfectly laminated texture. This species of calculus seldom
+     surpasses the medium size, and is rather common. There is a
+     variety of it remarkably smooth, and pale coloured. These are
+     always of small size; and from their colour and general
+     appearance, have been termed the _hempseed_
+     calculus.--_Chemical characters._ Before the blow-pipe, this
+     species of calculus expands into a kind of white efflorescence,
+     which, when moistened and brought into contact with turmeric
+     paper, stains it red. This white alkaline substance is the
+     caustic lime deprived of its oxalic acid."
+
+     "_The triple phosphate of magnesia-and-ammonia calculus_ is
+     always nearly white; its surface is commonly uneven, and
+     covered with minute shining crystals. Its texture is not
+     laminated, and it is easily broken and reduced to powder. In
+     some rare instances, however, it is hard and compact, and when
+     broken exhibits a crystallized texture, and is more or less
+     transparent. Calculi composed entirely of the triple phosphate
+     of magnesia-and-ammonia are rare; but specimens, in which this
+     salt constitutes the predominant ingredient, are by no means
+     uncommon.--_Chemical characters._ Before the heat of the
+     blow-pipe, this calculus gives off the odour of ammonia, and at
+     length melts with difficulty. It also gives off ammonia, when
+     treated with caustic potash. It is much more soluble than the
+     preceding species in dilute acids, from which it is again
+     readily precipitated by ammonia in its original crystallized
+     form.
+
+     "_The calculus composed of a mixture of the phosphate of lime
+     and triple phosphate of magnesia-and-ammonia, or the fusible
+     calculus_, is commonly whiter and more friable than any other
+     species, resembling sometimes a mass of chalk, and leaving a
+     white dust on the fingers. This species is generally not
+     laminated. Occasionally, however, it separates readily into
+     laminae, the interstices of which are often studded with
+     sparkling crystals of the triple phosphate. The variety of this
+     species which is not laminated often acquires a very large
+     size, and assumes the form of a spongy friable whitish mass,
+     evidently moulded to the contracted cavity of the bladder in
+     which it has been formed. This species of calculus occurs very
+     frequently.--_Chemical characters._ It may be readily
+     distinguished by the ease with which it melts before the
+     blow-pipe. It also dissolves readily in acids, and particularly
+     in dilute muriatic acid; and if to the solution, oxalate of
+     ammonia be added, the lime is precipitated alone, and the
+     magnesium may be afterwards separated by the addition of pure
+     ammonia.
+
+     "_The alternating calculus_, as the name imports, may consist
+     of different layers of any of the preceding species. Hence its
+     general appearance, texture, &c. will depend entirely on the
+     composition, and may be very varied. Most commonly it is
+     composed of a lithic acid or mulberry nucleus, and an external
+     crust of the fusible calculus. In some rare instances, it is
+     composed of laminae of all three of these substances, and
+     sometimes of even more--the mixed phosphates still continuing
+     to constitute the external crust. This species of calculus
+     often acquires a very large size and is very common.--_Chemical
+     characters._ The chemical characters must of course vary with
+     the composition; and as the different substances of which it is
+     composed must almost certainly be some of the preceding, the
+     nature of the different laminae can be readily ascertained by
+     what has been already stated," p. 79, et seq.
+
+In the chapter on the comparative prevalency of different forms of
+urinary deposite; and the order of their succession, we have a number of
+important facts and observations. Dr. PROUT calculates, from the data
+collected by him, that about one-third of the urinary calculi which
+occur, are of the lithic acid species, and that another third are formed
+on a nucleus of this acid. Hence, "we may assert," says he, "that at
+least _two-thirds_ of the whole number of calculi originate from lithic
+acid; that is to say, if a lithic acid nucleus had not been formed and
+detained in the bladder, two persons at least out of three, who suffer
+from calculus, would have never been troubled with that affection. This
+is a most important fact, and deserves to be constantly borne in mind."
+
+The relative prevalency of the oxalate of lime calculus is very various.
+The average proportion, as determined by Dr. PROUT is about one in
+seven. Of the calculi, examined by Mr. BRANDE, 1 in 25 was of the
+mulberry species; while in the Norwich and Guy's Hospital collections,
+the proportion is about 1 in 4. In the Bristol collection, one-sixth of
+the whole, was composed of oxalate of lime, nearly pure; while,
+including all the concretions containing more or less of the oxalate,
+the proportion was nearly _one-half_! This great disparity in the
+proportional frequency of this calculus in different districts of
+England, clearly shows the great influence of local causes, in
+determining the character of urinary concretions.
+
+From a careful observation of the order of deposition of different
+species of calculous matter, Dr. PROUT has been enabled to deduce the
+following general law; "_that, in urinary calculi, a decided deposition
+of the mixed phosphates is not followed by other depositions_." So that
+it would appear, that a redundancy in the earthy phosphates is the last
+link in the chain of diseased alterations, to which the urinary
+secretion is liable.
+
+In the third chapter, under the second subdivision of functional urinary
+diseases, Dr. PROUT describes the lithic acid diathesis, and
+communicates several important original observations. After remarking
+that the dyspeptic are particularly predisposed to lithic acid
+deposites, he enumerates, as exciting causes of this species of gravel,
+1st. _Errors in diet_; 2nd. _Unusual or unnatural exercise of the body
+or mind, particularly after eating, and the want of proper exercise at
+all other times_; and 3d. _Debilitating causes_. Under errors of diet,
+an unusually heavy meal, especially of animal food, and the use of
+heavy, unfermented bread, or compact, hard-boiled, fat dumplings or
+puddings, salted and dried meats, acescent fruits, malt liquors, and
+acescent wines, are enumerated as particularly hurtful in the lithic
+acid diathesis.
+
+The above remarks refer to the amorphous lithic deposites, consisting of
+lithate of ammonia. In regard to crystallized sediments, or, more
+properly speaking, gravel, our author makes the following remarks:
+
+     "Crystallized sediments, or red gravel, consist of lithic acid,
+     nearly pure. Lithic acid, as has been before stated, exists in
+     a state of combination in healthy urine; and in such a
+     proportion, as to be held in a state of solution at all
+     ordinary temperatures. Sometimes, however, a free acid is
+     generated by the kidneys, which precipitates the lithic acid in
+     the pure crystallized state we see it--a phenomenon easily
+     imitated artificially, as is well known, by the addition of a
+     few drops of any acid to healthy urine. The precipitation of
+     crystallized lithic acid does not, therefore, necessarily
+     indicate an excess of lithic acid in the urine, but the
+     presence only of some free acid in that fluid; though such an
+     excess does, for the most part, exist in this form of disease,
+     as will be shown hereafter. With respect to the nature of the
+     precipitating acid, it is probably not always the same. Most
+     generally it appears to be the _muriatic_, sometimes the
+     _phosphoric_ or _sulphuric_, and occasionally other acids. In
+     general, however, it is to be understood, as noticed
+     elsewhere, that when the mineral acids are present in excess,
+     these are the _immediate_ cause of the preternatural acidity in
+     the urine, and consequently of the precipitation of the lithic
+     acid. The stronger acids act by decomposing saline compounds,
+     into which destructible acids, such as the lactic acid, &c.
+     enter, and setting them free. Hence the _immediate_ cause of
+     the deposition of lithic acid gravel is generally a
+     destructible acid of very weak powers: even, perhaps, in some
+     instances, the carbonic acid. When the urine contains a free
+     acid, it is commonly more transparent than usual, and of a
+     bright copper colour." p. 112.
+
+The treatment recommended by Dr. PROUT in this species of gravel is as
+follows: First, a strict attention to diet, avoiding the hurtful
+articles already enumerated. Secondly, the use of _alkaline_ remedies;
+but those must not be depended upon, without the aid of other means,
+more especially of alteratives and purgatives. Accordingly we are
+informed that
+
+     "The pil. submur. hydrarg. comp., or a pill composed of the
+     pil. hydrarg. and pulv. antimonialis, may be taken twice or
+     thrice a week at bed time, and followed up the next morning by
+     an active dose of the sub-sulphate of magnesia, or a mixture of
+     Rochelle salts and magnesia, or carbonate of soda. A little of
+     either of these compounds may be also taken twice or thrice in
+     the day, so as to keep the urine constantly neutral or
+     alkaline, and the bowels freely open; or gr. x to xx of
+     magnesia may be taken for the same purpose in a glass of soda
+     water, as often as it may be found necessary."
+
+In the chapter on the mulberry, or oxalate of lime diathesis, Dr. PROUT
+gives a number of cases, from which he draws the following conclusions:
+
+     "1st. That this form of disease occurs in both sexes; that it
+     may exist before puberty, and at all ages between that and 40
+     or 50, at which time it seems to occur most frequently; but
+     that no case occurs beyond the age of sixty. Hence that it is
+     probably not a disease of old age.
+
+     "2nd. That it is not incompatible with gout, but seems
+     occasionally to be associated with it. I have also seen it
+     connected, as lithic acid frequently is, with a tendency to
+     cutaneous disease.
+
+     "3d. That this variety of calculous affection occurs in
+     individuals of sound constitutions, and who ordinarily enjoy
+     good health; and that it rarely occurs a second time, except at
+     long intervals, during which the intermediate health is good;
+     which latter facts, it may be proper to observe, are confirmed
+     by other observers, and particularly by Mr. BRANDE and Dr.
+     MARCET.
+
+     "4th. That the urine is acid, and apparently but slightly
+     deranged in this form of calculus, and remarkably free from all
+     sorts of sediment and gravel.
+
+     "5th. That as renal calculi of the oxalate of lime often
+     subsequently acquire considerable magnitude in the bladder, it
+     may be inferred, that the formation of this compound is
+     connected with a distinct diathesis, excluding the existence of
+     other diatheses, and that is not an accidental occurrence,
+     happening in common with many others to the urine.
+
+     "6th. That from the dissection of calculi, formerly mentioned,
+     it appears that the oxalate of lime diathesis is preceded and
+     followed by the lithic acid diathesis; a circumstance which
+     seems to be peculiar to these two forms of deposite, and which,
+     when taken in conjunction with the other circumstances, already
+     related, appears to show, that they are of the same general
+     nature; or in other words, that the oxalic acid merely takes
+     place as it were of the lithic acid, and by combining with the
+     lime naturally existing in the urine, forms the concretion in
+     question.
+
+     "7th. That the diathesis being of a similar nature, the
+     principles of treatment adapted for counteracting the original
+     tendency to it must be also similar, that is to say, of an
+     antiphlogistic character; great attention being at the same
+     time paid to the digestive and assimilative functions." p. 137,
+     et seq.
+
+The diagnostic signs of the oxalate of lime diathesis are very obscure,
+as will appear from the following extract:
+
+     "With respect to the means of determining when this diathesis
+     is going on in the system, I am sorry that I can give but
+     little positive information. The absence of urinary sediment,
+     &c. are of a negative character, and lead to no inference,
+     where other circumstances are wanting, as is most generally the
+     case. But if there be pain in the region of the kidney, and
+     other symptoms of gravel, without any appearance of sediment;
+     and if the urine be acid, and of the yellow tint above alluded
+     to, the stomach deranged, and an inflammatory diathesis, either
+     general or local (i.e. about the urinary organs), be present;
+     and if all these are associated with suppressed gout, or
+     tendency to cutaneous disease,--the existence of this form of
+     the disease may be suspected, and means immediately taken to
+     counteract it." p. 138.
+
+We omit any analysis of the next chapter on the cystic oxide diathesis,
+on account of the rare occurrence of this state of the system.
+
+The next chapter of our author is on the phosphatic, or earthy
+diathesis.
+
+The phosphatic deposites are of two kinds; the _crystallized_,
+consisting almost invariably of the triple phosphate of
+magnesia-and-ammonia, and exhibiting the appearance of white, shining
+crystals; and the _amorphous_, consisting always of a mixture of the
+phosphate of lime, and the triple phosphate of magnesia-and-ammonia.
+
+The causes apt to produce a deposition of the triple phosphate of
+magnesia-and-ammonia, are thus enumerated by Dr. PROUT:
+
+     "Any thing acting generally, and producing _a nervous state of
+     the system_, such as the distressing passions, and particularly
+     _mental anxiety_ or _fear_, will frequently produce in many
+     people an excess of this salt in the urine. The same is also
+     true of many articles of food or medicine that produce a
+     hurried secretion of the urine, and act as diuretics; as the
+     neutral salts in some cases, and particularly the Rochelle
+     salts and other saline compounds, in which the acid is of
+     vegetable origin. So also, a long continued use of alkaline
+     remedies, or of mercury, in irritable habits more especially,
+     will likewise produce a tendency to an excess of this salt, as
+     well as of the phosphates in general, and even lead to an
+     actual deposition of them from the urine. The same sediment
+     also frequently abounds, or is easily induced, in the urine of
+     those who have long been in bad health, and in whom the
+     constitution may be considered as giving way, or, to use a
+     common expression, breaking up. In general, it is to be
+     understood, that the slighter causes affect only the
+     predisposed, and those in particular who are subject to other
+     diseases of the urinary organs or urine. It may be also
+     remarked, that children are more subject to this form of
+     deposition than adults; a circumstance, perhaps, to be referred
+     to the irritability of the system at this age, and the great
+     derangement of the digestive organs, to which they are
+     subject." p. 151.
+
+The above mentioned causes are stated to be equally productive of
+amorphous phosphatic sediments.
+
+Our author next enumerates the very distressing symptoms, by which the
+deposition of the earthy phosphates is attended. They consist in great
+irritability; derangement of the chylopoietic viscera, evinced by
+flatulency, nausea, obstinate costiveness, or peculiarly debilitating
+diarrhoea; extremely unnatural stools, nearly black, or clay-coloured,
+and sometimes resembling yest; pain, uneasiness, or weakness in the back
+or loins; sallow, haggard expression of countenance; and finally, if the
+disease be not arrested, great languor and depression of spirits,
+coldness of the legs, and complete anaphrodisia, as occur in diabetes.
+
+A curious and important fact has been stated in regard to the remote
+causes, producing the phosphatic state of the urine. It has been
+observed by Dr. PROUT, that a large proportion of cases of this
+complaint may be traced _to some injury of the back_ from mechanical
+violence, such as a fall from a horse, &c.
+
+The remedies for this diseased state of the urine, found most successful
+by Dr. PROUT, are,--opium, in from one to five grain doses, repeated two
+or three times a day, until the unnatural irritability of the system is
+relieved,--the same remedy in more moderate doses, in conjunction with
+the mineral acids, cinchona, uva ursi, and the different preparations of
+iron,--a large pitch, soap, or galbanum plaster to the loins,--and
+setons or issues in the back, when the disease manifestly arises from
+local injury. With respect to the bowels, Dr. PROUT remarks, that they
+are very difficult to regulate. He has occasionally seen serious
+consequences to arise from the exhibition of a small dose of calomel,
+such as diarrhoea and debility, much aggravating the disease, and
+endangering the life of the patient. For the regulation of the bowels,
+small doses of castor oil, and laxative injections are most to be relied
+on; while saline purgatives, more especially Rochelle salt and Seidlitz
+powders, as containing vegetable and therefore destructible acid, must
+be avoided.[24] Mercury, in all its forms, is also inadmissible.
+
+     "Alkaline remedies of every description, must be most carefully
+     avoided, their use in every point of view being most
+     mischievous when the phosphates are concerned. Indeed all
+     remedies that act as diuretics should, in general, be shunned,
+     and the patient should be prohibited from drinking too much.
+     With respect to drinks, in general, they should be of a
+     soothing, demulcent character, and prepared with distilled or
+     the softest water that can be procured; as hard waters are
+     literally poison in this form of disease."
+
+The second division of the work under review treats of the mechanical
+and organic diseases of the urinary organs. This portion of the subject
+is handled with the same ability as the first. We regret, however, that
+our space will not permit a further development of the author's views.
+We trust, nevertheless, that we have imparted to our readers adequate
+notions of the scope of the work, to render them sensible of its value
+as a manual of urinary diseases. It is illustrated by a good coloured
+plate, representing the principal varieties of urinary calculi.
+
+The additions of Dr. COLHOUN consist of foot notes, and paragraphs
+inserted in the text of the original work. We would not, however, wish
+to be considered as approving of the course, for the most part pursued
+by Dr. C., of inserting his amplifications in the text of the author,
+merely distinguished by brackets. Besides the absence of sufficient
+distinction between the matter of the author and commentator, the text
+of the former is thus injuriously disjointed, and dependent sentences
+sometimes widely separated.
+
+In regard to the execution of the present edition, we regret to say that
+it is wanting in typographical accuracy.
+
+FOOTNOTES:
+
+[23] The reader will bear in mind, that this acid is the same as the
+uric, the name by which it is generally known.
+
+[24] The reason of this exclusion of salts, containing a vegetable acid
+is, that they become real alkalies in the course of assimilation by the
+destruction of their acid, and therefore add alkaline properties to the
+urine, already too alkaline.
+
+
+
+
+MEDICAL LITERATURE.
+
+
+
+
+ARTICLE XII.--RETROSPECTIVE REVIEW.--_Tractatus de Ventriculo et
+Intestinis, cui proemittitur alius, de Partibus continentibus in
+Genere, et in Specie de iis Abdominis._ _Authore_ FRANCISCO GLISSONIO,
+&c. &c. Lond. 1677, 4to.
+
+
+As it is not our intention to confine our remarks to the work above
+mentioned, we shall deem no apology necessary for the somewhat excursive
+nature of this article, which would not answer our present purpose, if
+we were obliged to follow the costive details of the venerable FRANCIS
+GLISSON, whose villanous bad style, and execrable latin, are only to be
+excused or overlooked in consideration of the great importance of the
+topics which he handles, and the profound reflections which he makes on
+them. GLISSON is recognised as author of the physiological term
+_Irritability_, and as the assertor of the inherent activity of matter.
+HALLER says of him in his XIth book. "FRANCISCUS GLISSON, qui universis
+elementis corporum, vim motricem tribuit, etiam nostram vim,
+Irritabilitatem vocavit," &c.
+
+He was a native of Dorsetshire, and was appointed professor of physic at
+Oxford in 1627. This post he occupied during forty years, and is much
+distinguished by his treatise de vita naturae, and by the work which
+forms our caption. As he is the first who used the physiological term
+irritability, we have thought that some researches on this subject in
+general, and more particularly on his peculiar sentiments, might
+profitably occupy our retrospective department; for it is very evident
+that this subject is in general but vaguely discussed, both in medical
+writings and conversation.
+
+The ancient philosophers did not agree among themselves as to the nature
+and origin of matter; some of them considering it as eternal in its
+essence, and others as mutable and changeable in form. The theory of
+atoms, published by DEMOCRITUS, and subsequently carried out so
+elaborately by EPICURUS and his disciples, seems to have reached even
+to our own times, with an increasing reputation and acceptance.
+According to this theory, the kinds of matter, or elements, must he
+regarded as infinitely various. HERACLITUS, who taught philosophy about
+550 years before Christ, considered all things as derived from an
+elemental heat or fire;[25] a philosophy which seems to us to have
+formed the basis of the Hippocratic doctrines of life. Like HERACLITUS,
+HIPPOCRATES tells us, that the calidum was the first principle of
+things, and that by an expansion or extension of itself, it constitutes
+all the objects of the material world. He expresses himself in the
+following manner. That which we call warmth, or heat, seems to me to be
+something immortal; something which comprehends all things, which sees
+and knows all things, as well present as future. Thus assuming as a
+basis, that the calidum is an almighty, all-wise being, or in other
+words, a God, all in all, the cosmogony was developed as follows: Chaos
+he regarded as that condition of the calidum, which preceded any
+exertion of the Almighty faculties. In emerging from the chaotic state,
+the greatest part of the heat having assumed the uppermost place, formed
+the aether; another part having gained the lowermost place, constituted
+earth; a third portion, midway between earth and aether, became air; and
+a fourth part, establishing itself between the two latter, became water.
+So that by means of the extension of this all-wise, elemental calidum,
+we have the four elements, earth, air, fire, and water, out of which are
+ultimately composed all the aggregates of the material world.[26] Now,
+to apply this general principle to the formation of the living being
+man, who seems to be a sort of microcosm in himself, we are told, that
+that portion of heat which remained with earth, being expanded and
+spread abroad in divers places, in some more, in others less, the earth
+became dry, and something like membrane or pellicle was formed; the
+matters contained in which, being heated as by a sort of putrefaction,
+some parts became bone, some nerve, some veins and their contents, and
+some formed the cavities and their contents, as the urinary bladder, for
+example.[27]
+
+The full exposition of the opinions of HIPPOCRATES was left for GALEN,
+and we prefer to make reference to him on this theory, which by his
+genius and talent was so much embellished, that it became the glory of
+science, exercising an almost undisputed authority during a long lapse
+of ages. Indeed the gigantic intellect of this great man, still
+continues to shed its vast illumination over the world of science,
+particularly that of medicine; which, if it owes its birth to the divine
+old man of Cos, is not less indebted for its nurture and growth to the
+celebrated native of Pergamus. GALEN is the facile princeps of
+physicians. His astonishing industry, perseverance, and acquirements,
+his ingenious arguments, and persuasive eloquence, give him an
+unquestionable claim to the title of princeps, so long accorded to him;
+and those who even in the present enlightened period, will study his
+works, shall find themselves almost irresistibly led away by the charm
+of his suasion.
+
+GALIEN est le seul des anciens qui ait donne un corps complet de
+medecine: Quoique forme des debris de toutes les doctrines precedentes,
+son systeme offre cependant, malgre les contradictions ou il tombe assez
+souvent, une unite remarquable dans toutes ses parties; un ensemble
+seduisant, qu'un genie de l'ordre le plus eleve pouvoit seul imprimer a
+un pareil edifice. Ramenant tout a un petit nombre de principes
+generaux, qui s'ils ne peuvent satisfaire la raison, fournissent du
+moins une reponse facile a tout, ce systeme dut etre adopte avec
+empressement, et sa fortune ne peut etonner.--_Biographie Medicale, Tom.
+IV._
+
+GALEN may perhaps be justly regarded as an eclectic; but it is manifest,
+that he mainly walked after the steps of his great predecessor, and
+recognised model. The following passage seems to contain ideas not much
+differing from those of HIPPOCRATES which we have presented above: "Who
+is there, says he, that judging from the origin and constitution of
+animated beings, doth not immediately infer the existence of a mind,
+possessed of wonderful energies, extending to, and pervading every
+portion of the universe! We every where perceive animals procreated,
+which are possessed of the most admirable structure, and yet what
+portion of the universe can be more ignoble than this earth of ours? Yet
+a grand intelligence is seen to have reached even it from the celestial
+bodies, which for their beauty are so astonishing, and which, as they
+are for purity far more excellent than our earth, so they are the seats
+of intelligences, far more pure and perfect than those which inhabit
+these lower regions." He proceeds to remark, that animals, worthy of the
+greatest admiration, are produced out of the slime and mud of ponds and
+ditches, and even in putrefying vegetables, which, as they indicate the
+miraculous properties of their author, also show us in what estimation
+we should hold the higher orders of being. "We may even perceive a
+rational nature in men, if we refer to such examples as PLATO,
+ARISTOTLE, HIPPARCHUS, ARCHIMEDES, and many others. If, therefore, in
+such a colluvies as the human body, (for by what better name can we
+characterize a mixture of blood, bile, and phlegm,) a mind is formed of
+such great and excellent faculties, what must we think of the excellence
+of that which exists in the superior bodies?"
+
+It may be said that GALEN expresses, in these passages, the Platonic
+dogma of an _anima mundi_. But they certainly agree with the sentiments
+of HIPPOCRATES; and whether he derived them from the former or the
+latter, matters not, as both of them have invested matter with certain
+qualities, which render it active, whether it be so essentially or by
+the act of the Creator. GALEN may be also regarded as partially an
+Epicurean; for he insists that there are several sorts of matter, or as
+we should say, several elements; but he differs from that sect again in
+affirming for it a passible quality. To show that there must be more
+than one element, or kind of matter, he says, that if there was only one
+element, or a unit, it would be impassible; it could undergo no change
+whatever. For there would be nothing by which it could be made to suffer
+any alteration, or into which it could be altered. Whatever is changed,
+is changed into something else, and whatever suffers, suffers from
+something extrinsic: therefore he affirms, that of necessity there must
+be several sorts of matter, or elements. He says, "there are only two
+theories on this subject deserving our attention; one of which affirms
+that sentient bodies are composed of elements possessing the faculty,
+(cum patiendi tum sentiendi,) both of suffering and perceiving an
+alteration;" while the other affirms that such bodies are formed (ex
+patibilibus, sed sensu expertibus) out of passible, but not sentient
+elements. Neither of these doctrines does he consider tenable, so long
+as only one element is affirmed, as earth, air, or fire alone, which
+could never become capable of that great variety of actions we witness
+in living bodies: but, admit several elements, and we suppose that the
+mutual interchange of powers would yield a compound body, capable of all
+the vital phenomena. Such, therefore, says he, as consider the human
+body to be composed of fire, air, earth, and water, mutually transmuted,
+alternated, and reduced to a given temperament, and thereby vested with
+a sentient faculty, speak reasonably; and it is evident that there must
+be more than one element, and that these elements are passible bodies.
+
+PLATO had taught, that, though all bodies are formed of matter, yet
+matter itself is not a body; and the same idea is conveyed by ARISTOTLE,
+in the Lib. de partibus animal. & earum causis, II c.i. "Prima statui
+potest ea quae ex primordiis conficitur, iis quae nonnulli elementa
+appellant terram dico, aquam aerem & ignem: sed melius fortasse dici
+potest ex virtutibus confici elementorum, iisque non omnibus sed ut ante
+expositum est humiditus enim, & siccitas, & caliditas, and frigiditas,
+materia sunt corporum compositorum."
+
+GALEN also states, that in fire there exists a perfect heat and
+dryness, in earth a perfect coldness and dryness, and so on of the rest
+of the elements. For you cannot expect to find in nature a perfectly
+simple and isolated element; because they are always mixed two or more
+together. Hence the real terram, aquam, aerem, and ignem, become rather
+a metaphysical abstraction, than a real entity. That is to say, matter
+has no real existence, but is mere quality; for earth is not the mere
+representation of dry or siccum; it is the representative of siccitas,
+or dryness: fire is not the eidolon of calidum, but of caliditas; water
+of humiditas, and air of frigiditas. Yet all these elements are in
+nature possessed of more than one property. Fire is hot and dry, earth
+is dry and cold, water is cold and moist, &c. If we refer, however, to
+his account of the soul, we perceive at once, that these inseparable
+qualities of the elements are the real active agents of life. He plainly
+declares, that the soul is the mere result of organization, and perishes
+with the structure in which it dwells. He thinks, "corporis temperiem
+censendum est." As to the active powers of the four primary qualities,
+he says, "At mihi quidem tam venae, quam reliquarum particularum singulae,
+ob certam quandam temperiem quam ex quatuor sunt qualitatibus nactae, hoc
+vel illo modo videntur agere."--De nat. fac. I.
+
+It is plain he thinks, that the elements consist of a materia and
+qualitas; but they are elemental by the _qualitas_ and not by the
+_materia_.
+
+After establishing that there are four elements, which are the common
+and simple bases of all things, he goes on to show, that the proper
+proportion and admixture of these, constitute the healthy state of
+living bodies. If the calidum, for example, be unduly increased, the
+body is destroyed; if it be improperly diminished by excess of the
+frigidum, it will also perish. The business of the physician is to keep
+the proportions just and harmonious; but, as no pure element exists
+alone, the physician must employ the qualitas in conjunction with the
+materia. These (to make a phrase) substantive qualities, are found in
+medicines or food, which, like all objects of sense, are either cold,
+hot, dry, or moist, and available of course in the management of a cold,
+hot, dry, or moist derangement of the living body.
+
+The elements of the human body exist in the four humours, blood, bile,
+atrabilis and pituita; and these four humours correspond in quality
+with the elements. Blood, which is the reservoir or continent of them
+all, is a temperate humour. Bile, being the representative of calidum,
+is hot and dry. Melancholy represents, in our microcosm, the element
+earth or siccum, and is dry and cold. But pituita, which is moist and
+cold, corresponds with the humidum element. Air exists in animals nearly
+pure, as we learn from the phenomena of the pulse and of respiration. It
+answers to frigidum.
+
+He shows us in his lib. de naturalib. facultat. that, out of the
+humours, all the parts are formed, and these parts are either _similar_
+or _dissimilar_; i. e. simple or compound. Bone is a similar part, that
+is, it is a simple part; so is an artery, or vein, or ligament. Each of
+these is so constituted, as that it has a predominance of one element in
+its nature; and it is therefore dry, or cold, or moist, &c. But if an
+adust element be, by accident or disease, accumulated in a part
+naturally cold, the function of such part is morbidly affected. The
+natural tendency, however, of similar humours to unite, causes each part
+to receive its regular supply; a principle which BICHAT has since
+characterized as, _contractilite organique insensible_.
+
+To show the wonderful simplicity of the Galenical system, which for
+plainness and easy attainment may be compared with the improved
+nomenclature of chemistry, we will cite a passage from ARGENTERIUS, who,
+perhaps, was as learned in this kind of lore as any man of his time. In
+his Tractatio de calidi significationibus, he says; "If any body would
+undertake to give a general enumeration of those circumstances, in which
+this term calidum and the others (frigidum, humidum, &c.) are applicable
+to the explanation of this warmth, he shall find truly, that they are
+the elements, the humours, the parts, the whole body, medicines, food,
+air, climate, the weather, the season of the year, and even ages; for
+these all are either temperate, or hot, or cold, or humid, or dry."
+
+The animal body is moved and governed by two principles; one of them
+corresponds to the _vie animale_ of BICHAT, and the other to the _vie
+organique_. Since the power of sensation and of voluntary or elective
+motion, says he, is a property of animals, and since that of growth and
+nutrition is common both to animals and plants; the former may be called
+attributes of the soul, and the latter attributes of nature. Whence we
+say, that animals are governed by the soul and by nature, while plants
+are governed by nature alone.
+
+The powers of the body are faculties; and these are either natural,
+vital, or animal: but they are so subdivided, that we have as many
+faculties as there are sorts of action. Under the class of natural
+faculties, we find three principal sorts; to wit, a facultas generatrix,
+an auctrix, and a nutrix. But if you ask, says GALEN, how many faculties
+there be, which result from the action of these on each other, you will
+find them as numerous and diverse as there are numbers and diversities
+of the animal parts. For example, we have an attractrix faculty, a
+retentrix, alteratrix, expultrix, &c. &c., all of which are variously
+modified, according to the nature of the similar or dissimilar parts
+they are exercised in, or, in other words, according to the nature of
+the tissues or organs, in which they reside.
+
+Need we go further to show, that GALEN, believing all matter essentially
+conjoined with the hypothetical caliditas, frigiditas, &c. &c., taught
+that it was gifted with such a degree of inherent activity, as to render
+it capable under certain states of combination, of exhibiting all the
+phenomena of organic and animal life? It is certain that he regarded
+these active qualities, as the causes of all the phenomena, whether of
+living or dead matter.--GLISSON ought not certainly then to be regarded
+as the author of this dogma in medical philosophy. PLATO certainly
+taught it. VAN HELMONT could not get along without investing matter with
+what he called a "seminal likeness, which is the more inward spiritual
+kernel of the seed," &c. But we will let him speak for himself.
+"Whatsoever," says V. H., "cometh into the world, must needs have the
+beginning of its motions, the stirrer up and inward director of
+generation. Therefore all things, however hard and thick they are, yet
+before that their soundness, they inclose in themselves an air, which
+representeth the inward future generation to the seed in this respect
+fruitful, and accompanies the thing generated, even to the end of the
+stage: which air, although it be in some things more plentiful, yet, in
+vegetables it is pressed together in the show of a juice, as also in
+metals it is thickened with a most thick homogeniety or sameliness of
+kind. Notwithstanding this gift hath happened to all things, which is
+called _archeus_, or chief workman, containing the fruitfulness of
+generations or seeds, as it were the internal efficient cause; I say
+that workman hath the likeness of the thing generated, unto the
+beginning whereof, he composeth the appointments of things to be done.
+But the chief workman consists of the _conjoining of the vital air_, as
+of the matter, with the seminal likeness, which is the more outward
+spiritual kernel, containing the fruitfulness of the seed; but the
+visible seed is only the husk of this. This image of the master workman,
+issuing out of the first shape or idea of its predecessor, or snatching
+the same to itself out of the cup or bosom of outward things, is not a
+certain dead image, but made famous by a full knowledge, and adorned
+with necessary powers of things to be done in its appointment; and so it
+is the first or chief instrument of life and feeling. But since every
+corporeal act is limited into a body, hence it comes to pass, that the
+archeus, the workman and governor of generations, doth clothe himself
+presently with a bodily clothing. For in things soulified, he walketh
+thorow all the dens and retiring places of his seed, and begins to
+transform the matter according to the perfect act of his own image; for
+here he placeth the heart, but there appointeth the brain, and he every
+where limiteth an unmoveable chief dweller, out of his whole monarchy,
+according to the bounds of requirance of the parts and appointments. At
+length that president remaineth the overseer and inward ruler of the
+bounds, even until death; but the other, floating about and being
+assigned to no member, keeps the oversight over the particular pilots of
+the members, being clear and never at rest or keeping holiday."
+
+Notwithstanding the affected and euphuistic jargon of the above
+passages, it is evident that VAN HELMONT'S idea is very similar to that
+of GALEN. By seminal likeness, we are to understand an aptitude in
+matter to take on certain determinate forms, and this may be supposed to
+differ not very essentially from those laws, which govern matter in
+crystallization. But even this seminal likeness, as we perceive, is a
+sort of abstraction, very analogous to the Galenical caliditas; for it
+is the more inward spiritual kernel of the seed, whereby the matter is
+enabled to enjoy a certain degree of activity, the degree of which is
+much increased by the union of the air, or archeus, with it. So the
+caliditas of GALEN, which, after all, is matter, gives to its subject
+the powers which it enjoys. GLISSON, speaking of the natura seminalis,
+says that it is a certain or specific essence, superadded to mere
+elementary principles, by means of which mixt bodies adopt certain
+determinate forms, and acquire the faculty of performing essential
+operations, more noble than those which belong to naked elements.
+
+We regret very much that we have been unable to procure a copy of
+GLISSON'S treatise de vita naturae, which, so far as we know, can not be
+had in this country. We shall, therefore, furnish our readers with the
+following passage from the Biographie Medicale, from the pen of
+JOURDAIN.
+
+"The name of GLISSON occupies an honourable place in the history of
+medicine, because to him we are indebted for the first elements of the
+physiological doctrine of the present day. Instead of directing his
+attention to movements alone, as the iatro-mathematicians, and even, to
+a certain extent, the animists had done, he referred to vitality all the
+phenomena of nature, of whatever kind, and attempted to reduce them to
+one, common principle. To this end he admitted, that matter is
+originally endued with forces inherent in it, and that living bodies in
+particular, are invested in their organs with a radical force, which,
+put in play by stimulants, whether internal or external, gives rise to
+all the phenomena of life. He even went so far as to assert, that
+sympathy may be explained by referring to the intercommunication of this
+force, to which he gave the name of irritability."
+
+We shall also cite from SPRENGEL, a passage which throws some light on
+his theory.
+
+"When they became unwilling, like DESCARTES and STAHL, to have constant
+recourse in their explanations, to the soul, they tried to find a
+philosophic proof of the existence of material forces, to show that
+matter, as mere matter, is endowed with particular forces, with which
+they might satisfactorily explain a great many of its phenomena. No one
+had hitherto sought for a similar proof; for ARISTOTLE had contented
+himself with an axiom, that all natural things contain in themselves the
+sufficient cause of their movement and rest. GLISSON and LEIBNITZ set
+themselves in search of this proof; but it was reserved for the immortal
+KANT to find it in the nature of matter itself.
+
+"FRANCIS GLISSON may with propriety be considered as the precursor of
+LEIBNITZ. What he tried to demonstrate by scholastic subtlety, and by
+thousands of syllogisms, was developed by LEIBNITZ with a clearness and
+ability, which secured the suffrages, even of the unenlightened. Both of
+them went too far, in attributing life and sensation to matter, instead
+of claiming for it the two simple and primordial forces of attraction
+and repulsion.
+
+"GLISSON sets out with the idea of substance, but he does not explain it
+with sufficient precision. Every substance has three substantial
+rudiments,--_fundamental_ substance, by means of which it
+exists,--_energetic_ substance, by means of which it acts,--and
+_additional_ substance, which determines its accidental qualities. All
+matter, as substance, must have an energetic substance or nature, which
+is the internal principle of movement. Therefore whatever moves
+spontaneously, and in virtue of an internal force, must _feel_ this
+motion, _and desire it_. All matter feels that it is, and that it exists
+by itself. It has therefore, consciousness of its own nature. Life
+consists in the activity of the internal substantial energetic nature.
+Death is the dissolution of the triple alliance of the internal
+energetic substantial nature, with the vegetative and animal natures,
+which two last belong to the _additional_ substance."[28]
+
+In applying his theory to physiology, GLISSON'S idea is, that the fibres
+of the human body are endowed with a force, which he divides into three
+kinds; to wit, natural or inherent force, (robur insitum)--vital force,
+(robur vitale)--and animal force, (robur animale.)
+
+Natural or inherent force, is a part of the constitution of the fibre,
+and is as much a property of its organization as are its tenacity,
+tensibility, &c. The sum of this force varies, in proportion as the
+constitution of the fibre is more or less perfect. It is strongest in
+athletic men and strong animals, and weaker in relaxed and debilitated
+persons. It may be compared with the contractilite de tissu of BICHAT.
+
+The second, or vital force, is something superadded to the inherent
+sort. It is an _influxus_, derived to any fibre or set of fibres, from
+that greater sum of force, which arises out of a more elaborate,
+complex, and exalted organization. It varies in proportion as the vital
+spirits flow with more or less freedom; and in proportion as their
+quality is more or less perfect.
+
+The third kind, or robur animale, may be supposed to depend on the
+organic constitution of the brain and nerves, and varies according to
+the state of that organization. We cannot help adverting to the
+resemblance between these two latter kinds, and the contractilite
+organique, and contractilite animale, of BICHAT; and this robur
+comprises, as we shall show hereafter, both the contractilite and
+sensibilite of the French physiologist.
+
+GLISSON, in his chapter de Irritabilitate fibrarum, commences by
+remarking that a motive faculty existing in any fibre, unless it were of
+an irritable nature, would leave such fibre in one of the two following
+states: 1. It would either never cease from action, or 2ndly, being once
+at rest, its motion could never be reproduced; but the varieties and
+differences which we see in the actions of fibres, clearly demonstrate
+them to be possessed of irritability: i.e. if a fibre may be by turns in
+a state of action and repose, it is evidently possessed of a quality,
+whereby it can be induced to move if in a state of rest; this quality he
+terms irritable, or irritability. The next inference from this power of
+alternate activity and repose is, that the fibre is possessed of a
+faculty, whereby it can _perceive_ an irritation offered to it; but this
+perception of irritation further implies an _appetence_ for a change of
+its actual state, before the motion can really take place. Perception,
+appetence, and motion, make a triunit. "In the mean time, says he, as
+sensitive appetence, and sensibility, are frequently confounded with
+natural perception, in this irritation of the fibres," he divides it
+into three kinds, viz. Natural Perception, Sensitive Perception, and
+Perception regulated by animal appetency.
+
+Natural Perception is that principle whereby a fibre perceiving any
+alteration offered to it, whether pleasing or displeasing, is excited
+either to accept that change, or to avoid it, and moves accordingly.
+
+Sensitive Perception, is that kind, in which a fibre, perceiving a
+change effected in some other organ, is impelled ad aliquid appetendum,
+and to move conformably.
+
+The third sort, or Perception regulated by animal appetency, is that in
+which the brain directs from within, such movements of the muscular
+fibres, as are requisite for the execution of any purpose.
+
+"Some persons," says GLISSON, "may doubt whether there really exists a
+natural perception of irritation in the fibres; but we have elsewhere
+asserted in general the reality of natural perception, to wit, in my
+work, de Vita Naturae; and whoever has known it, will readily admit this
+quality in fibres imbued with inherent, influent, and vital spirits. We
+do not expect, in this place, to establish it as a general principle;
+but if any proof, derived from a knowledge of the structure, uses, and
+actions of the fibres, can be adduced, it may be here attempted."
+
+"It is indubitable that the fibres are alternately at rest and in
+motion; for, during sleep, they are all relaxed, with the exception of
+such as subserve the functions of respiration and circulation, and even
+these are by turns quiet and active. During waking again, they are all
+in a state of moderate tonic motion; and moreover, during all movements
+of the limbs, the antagonist muscles yield spontaneously, the abductors
+being active, while the adductors are relaxed, and vice versa. Hence it
+is manifest, that the fibres are alternately quiescent and active: but,
+since they are not _principal_ or sui arbitrii agents, it is necessary,
+in order to the new movement, that they should be irritated from some
+source: for, it is impossible that a fibre in repose, can be set in
+action without an irritating cause; nor can we conceive of a part being
+irritated without _perceiving_ the irritation. It is like speaking to a
+deaf man, or trying to awaken a dead one."
+
+"If you say, fibres are possessed of sensibility, and can be excited by
+virtue thereof, I confess that they are sensible parts, and may thereby
+perceive some, not all irritating causes; but whether sensation excites
+them immediately, or rather, is transmitted to the brain, and irritates
+the animal appetency; and further, whether the animal appetence, effects
+a movement in them directly, and to what sort of perception this
+irritation may be properly and immediately ascribed, is detailed in
+order below, when we come to explain sensitive perception, and
+perception a phantasia imperata."
+
+"Let us now go on to point out those cases, in which no suspicion of
+_sensation_ can be entertained. The pulsation of the heart is neither
+effected nor affected by sensation; its fibres, in virtue of the
+irritation occasioned by the blood in its ventricles, are excited to
+contract, and thus occasion the pulsation, but when the irritation is
+remitted they relax, and recover the natural state. Now it cannot be
+denied that this is an evident case of irritation of the fibres, for
+according as is the irritation, so is the rythm of the pulsation, which
+varies at times, as in febrile and other affections: nor is it right to
+pretend that there is any sensation in this case; because this
+perception of irritation _per vices_, is exercised as well during sleep,
+when the senses are all locked up, as in the waking condition. The
+fibres do not, therefore, _perceive_ in these actions by a sensitive,
+_but by a natural perception_, the irritation of the vital blood, which
+animates them to alternate contraction and relaxation. This is
+corroborated by those tumultuous irregular motions which continue in
+animals after decapitation; so also the intestines when still warm in a
+recently opened animal, move and twist about; the muscles in dead
+animals also, excited by the perception of cold, contract with a strong
+tonic movement, and render the body rigid. The hearts of some animals
+too, when torn out of the body, and even when dissected, continue their
+endeavours to pulsate. Is there any further evidence wanting? We may
+hence infer with sufficient confidence that the fibres (without the aid
+of the senses) may _perceive_ irritation, and move themselves
+conformably."
+
+In the next place he examines the nature of sensitive perception of
+fibres, and goes on to show how an impression made on an external part,
+or a natural perception, becomes converted into sensation, and thus made
+known to the sensorium. But his disquisition is not only very long but
+very dark, and we shall therefore pass it by with the exception of the
+following.
+
+"Natural perception includes within itself a _rationem positivam_, and a
+_negationem formalem_.
+
+"The ratio positiva is the perception of the idea, or image of the
+object moving or changing the fibre.
+
+"The negatio formalis is a denial or refusal to communicate this image
+to the sensorium. In the process of transformation into sensation, the
+positive ratio is not changed, but remains the same, and is the first
+part, or basis, both of internal and external sensation.
+
+"The negatio formalis is destroyed or abolished in any case of
+impression communicated to the sensorium. Natural perception, in its
+ratio positiva, is not abolished or degraded by being converted into
+sensation, but is rather exalted, or gifted with a more dignified
+nature. By as much as public or general knowledge is preferable to
+private, or public advantage to that of an individual, by so much is
+sensation preferable to natural perception. Hence nature formed so many
+organs of sense, that the phantasy might have notice of what ought to be
+done, desired, or avoided."
+
+He does not doubt that external sensibility is inherent in the nervous
+parts of the external organ, whence he infers that it may readily incite
+the fibres of such organ ad appetendum et movendum; for, as external
+sensation is communicated to the brain by means of the nerves, it must
+of necessity be true, that these nerves and nervous parts (such as the
+fibres,) are the subjects of it. Since then sensibility causes its
+subject to feel, it consequently enables it to desire and move
+comformably. For perception in any subject is vain, unless it can
+desire, and appetence is useless, unless it can move. External
+sensibility, therefore, may be said to render the fibres _actu
+irritabiles_, for example, as often as the irritating cause is
+perceived; but as the irritation is perceived, not by a sensibility, but
+by a mere natural perception, this it is which constitutes their
+irritability.
+
+Thus we may perceive that the triunit consisting of perception,
+appetence, and motion, constitutes the celebrated irritability of our
+author. But he has been too latitudinarian in his application of the
+theory; for he did not limit it, as HALLER has subsequently done, to one
+sort of fibres, or indeed to fibres alone, for he says in cap. IX., "It
+is to be remarked that natural perception belongs to other parts of the
+body besides fibres; to wit, to the parenchymata, bones, marrow, fat,
+blood, recrementitious juices, humours of the eye, and such like, all
+which are irritable, and increase the irritable constitution of the
+parts, but these parts hardly admit of the existence of animal
+perception." HALLER blames GLISSON for having gone so far in his
+application of the theory, and it is well known that he himself
+restrained it to the single tissue of muscular fibres, and denominated
+it vis insitum, or inherent force; whereby he distinguished it from his
+vis mortua or elastic contraction, on the one hand, and the vis nervosum
+or voluntary power, on the other; the former being something less, and
+the latter something more than irritability. GLISSON'S theory, when
+fully explained, which we cannot for want of space do here, will be
+found to bear a very strong resemblance, in many points, to that of
+BICHAT, who has invested the matters of the body with vital powers, far
+beyond those attributed by HALLER; and as we are not furnished in the
+present article with sufficient space, we hope in some subsequent
+number, to place this matter in a plainer light before our readers. In
+the mean time we may remark, that GLISSON seems to be the first of those
+who have placed the subject fairly before the medical public; for
+although faint traces of a similar theory may be perceived before him,
+especially by translating terms into their equivalents, yet he has the
+merit of using a term which, in spite of all subsequent modifications,
+is in daily use.
+
+GLISSON'S latitudinarianism may be contrasted with HALLER'S rigid
+application: for the latter says, "I call that an irritable part of the
+human body, which on being touched by a foreign body, renders itself
+shorter;" thus while GLISSON attributes his triunit of perception,
+appetence, and motion to all the tissues and fluids, HALLER confines it
+to muscular fibre alone. No one can doubt that the membranes of the body
+are endowed with vital properties, but yet they do not shorten
+themselves on being touched by a foreign body. BICHAT has distinguished
+their vitality as organic vitality, and the contractile qualities
+displayed are divided into insensible organic contractility, and into
+contractility of tissue: but these sorts of contractility mount up by
+insensible gradations. He says, that "entre la contractilite obscure
+mais reelle, necessaire a la nutrition des ongles, des poils, &c. et
+celle que nous presentent les mouvements des intestins, de l'estomac,
+&c. il est des nuances infinies, qui servent de transition: tels sont
+les mouvements du dartos, des arteres, de certaines parties de l'organ
+cutane," &c. We will close with a comparison between GLISSON'S
+irritability, and BICHAT'S contractility. At page 70 of the Treatise
+_sur la Vie & la Mort_, BICHAT supposes that a "muscle enters into
+action, 1st. by the influence of the nerves which it receives from the
+brain, and this is a case of contractile animale," (which differs in no
+respect from perception regulated by animal appetency of GLISSON).
+2ndly. According to BICHAT, the muscle enters into action "by the
+excitation of a chemical or physical stimulant applied to it, and which
+artificially determines a movement of the whole muscle, analogous to
+what is natural to the heart, and other involuntary muscles. This is
+sensible organic contractility or irritability," and corresponds to the
+sensitive perception of the old English physiologist. In the 3d place
+it enters into action by the stimulus of the fluids which circulate in
+it, and this is insensible organic contractility or tonicity of BICHAT,
+and is nothing different from GLISSON'S natural perception. BICHAT makes
+a fourth case; as for example, when a muscle is divided across, it
+contracts by a _contractilite de tissue_, or _par defaut d'extension_.
+We do not perceive how GLISSON'S natural perception can be applied to
+this case, but he treats of it in his fifth chapter under the head of
+Cessatio: it is that state to which a fibre is reduced when left to
+itself, and freed from all stimulus.
+
+BICHAT has attributed to some fibres the power of active elongation. On
+this subject GLISSON says, "Impossible enim est, ut simplex fibra, sua
+sola actione, se secundum longitudinem distendat, nec modus quo haec fiat
+concipi nedum effari queat non negavero quin in distensione hac,
+aliqualis fibrae actio includatur, sed ea tota contractiva est, &
+distensioni ab extranea causa factae reluctatur." A doctrine as sound as
+that of the 47th proposition; a doctrine too, without admitting which,
+we think no man can understand the theory either of simple inflammation,
+or of the febrile affections. We hope to resume this subject at an early
+period.
+
+FOOTNOTES:
+
+[25] Haec ei generatim videbantur, ex igne omnia constare eodemque
+interire. Diogenes Laertius.
+
+[26]
+     Quatuor aeternus genitalia corpora mundus
+     Continet; ex illis duo sunt onerosa, suoque
+     Pondere in inferius, tellus atque unda, feruntur,
+     Et totidem gravitate carent, nulloque premente
+     Alta petunt, aer atque aere purior ignis.--OVID--_Metamorph._
+
+[27] Lib. de Carnibus, HIPPOCRATES says: Quod Calidum vocamus, id mihi
+immortale esse videtur, cunctaque intelligere, videre et audire,
+sentireque omnia, tum praesentia tum futura: cujus pars maxima cum omnia
+perturbata essent in supremum ambitum secessit; quod, mihi veteres
+aethera appellasse videntur. Altera pars locum infimum sortita, terra
+quidem appellatur, frigida et sicca multas que motiones habens, et in
+qua multum sane calidi inest. Tertia vero pars medium aeris locum nacta
+est, calidum quid existens. Quarta pars terrae proximum locum obtinens
+humidissima et crassissima. His igitur in orbem agitatis cum turbata
+essent, calidi magna pars alias in terra relicta est, partim quidem
+magna, partim vero minor, alias etiam valde parva, sed in multas partes
+divisa. Et temporis successu a calido resiccata est terra, ista in ea
+tanquam in membranis contenta circumse putredines excitant, ac longo
+tempore incalescens quod quidem ea terrae putredine pinguedinem sortitum
+est et minimum humidi habet, id citissime exustum ossa produxit. Quae
+vero naturam glutinosiorem sortita sunt et frigidi communionem habent,
+ea neque calefacta exuri potuerunt, neque etiam humida fieri ideo formam
+longe ab aliis diversam nacta sunt et nervi solidi exciterint, cum non
+multum in iis frigidi inesset. At venae frigidi multum habebant cajus
+pars circumcirca ambiens et quod erat glutinosissimum, a calido
+exassatum membrana extitit. Quod vero erat frigidum, a calido superatum,
+dissolutum est ideoque humidum evasit.
+
+[28] K. SPRENGEL, Hist. de la Medicine.
+
+
+
+
+QUARTERLY SUMMARY
+
+OF MEDICAL AND SURGICAL INTELLIGENCE.
+
+
+I. ANATOMY.
+
+1. _Papillae of the Tongue._--At the upper surface of the tongue, say MM.
+LEURET and LASSAIGNE, in their recent work on digestion, the mucous
+membrane presents projections of three different species; and these are,
+the sensitive papillae, the epidermoid papillae, and the mucous cryptae.
+The sensitive papillae are numerous. They occupy the anterior four-fifths
+of the tongue, on which they are implanted by a narrow pedicle. The
+rounded head of these papillae is much more prominent in the living
+subject, than after death; but injections are capable of restoring them
+to their pristine form. Nervous fibres from the lingual branch of the
+fifth pair have been distinctly traced to their roots. These papillae are
+of various sizes; at the root of the tongue they form a V. They are all
+vascular and nervous. The sense of taste is referred by these writers
+almost exclusively to the above papillae.
+
+The epidermoid papillae are of a nature similar to those retroverted
+prominences so remarkable on the tongue of the cat; as well as in the
+lion, and some other animals. They are larger in many species than in
+man, and, in general, the sensibility of the tongue appears to diminish
+in proportion to the remoteness of the subject from the human structure.
+The epidermoid papillae are separated from the tongue along with the
+epidermis, or rather, epithelium, by maceration for a few days in
+vinegar. They are pyramidal in form. They are grouped round the
+sensitive papillae, except on the edges and point of the tongue, where
+they are rare. Their base is perforated, and always gives outlet to a
+crypta. In an epithelium separated from the tongue, these minute and
+numerous perforations are easily distinguished from the larger ones left
+by the sensitive papillae.
+
+The office of the epidermoid papillae appears purely mechanical.
+
+The only cryptae which produce, of themselves, a visible projection on
+the surface of the tongue, are situated at its base. They are formed by
+the mucous membrane, like other cryptae, and are scattered between the
+sensitive papillae.
+
+In the tongue of birds, there is always a bone or cartilage; and the
+external membrane is dense. In reptiles the tongue is soft, possessed of
+little sensibility, and capable of great elongation. In fishes it is
+endowed with little motion, and is often wanting.--_Bulletin Medicale._
+
+2. _Villi of the Stomach and Intestines._--MM. LEURET and LASSAIGNE
+state that the villi can be easily injected; most conveniently from the
+vena portae, though the arteries may be employed. In the latter case,
+the matter of injection is effused into the intestinal or gastric
+cavity. The villi are peculiar to these parts; they are inversely
+conical, adhering to the membrane by their smaller end. The best mode of
+exhibiting them, is to tie the vena portae of a living animal, when they
+erect themselves by the afflux of blood. These diminutive organs, about
+3/100 of an inch long, then exhibit distinctly, under the microscope,
+four red longitudinal lines, being probably vessels.
+
+Injections made retrograde from the thoracic duct, pass through the
+villi into the intestines. When the stomach of a man, who died of some
+complaint not deranging its condition, is examined, we sometimes find
+its lining membrane covered with a multitude of minute white points.
+These are the villi in a flaccid state. In those who have died during
+digestion, they are erected, and of a rosy colour.
+
+When the intestine of a living animal is examined under a microscope,
+after being carefully washed, a great number of orifices are seen, from
+each of which exudes a minute drop of a transparent fluid. These rapidly
+disappear; and then the villi attract attention. What these foraminula
+are, the reviewer, M. DU FERMON, does not tell us.--_Ibid._
+
+3. _Minute distribution of the Vessels of the Liver._--M. CRUVEILHIER
+gives, in his lectures, an account of the results he has obtained from a
+minute injection of the liver. He finds, 1. The acini surrounded with a
+dense, cellular texture, paler than themselves; 2. The ramifications of
+the hepatic artery distributed to this cellular envelope; 3. Those of
+the vena portae spread around the acini, or granulations of the liver;
+and 4. Those of the biliary ducts, and of the hepatic veins, emerging
+from the cavities of these bodies.
+
+Our readers will observe a great similarity, in this, to the arrangement
+of the lobules of the kidneys.--_Ibid._
+
+4. _Trachea perforating the Aorta._--This odd distribution of parts, was
+observed by M. ZAGORSKY, at St. Petersburg, in 1802. The aorta divided
+itself, at its arch, into two branches, which received the trachea
+between them, and again united, exactly fitting the organ they received.
+They were found to have compressed the trachea, and probably produced
+difficulty of breathing.
+
+In another case, in 1808, the right subclavian artery, instead of its
+usual origin, arose from the left extremity of the arch of the aorta,
+and crossed behind the trachea, thus including the latter between it and
+the aorta.
+
+Why do we call the common trunk of the right subclavian and carotid, the
+arteria innominata? Is coining words so difficult a task, that we
+cannot find a proper and expressive name for it? The French
+call it _brachio-cephalic_, and this expresses its office and
+distribution.--_Ibid._
+
+5. _Monsters._--These productions, hitherto considered as mere objects
+of wonder, from the study of which no useful inference could be drawn,
+have recently attracted a good deal of attention in Paris. There seem to
+be some close affinities discoverable in many of them, not only with
+the natural and complete forms of animals of various tribes, but even
+with the actual condition of their own species, while in the foetal
+state.
+
+The views of M. GEOFFROY ST. HILAIRE seem to us rather mystical and
+vague. Those of BRESCHET, and the other practical anatomists, we can
+understand much better.
+
+6. _Malformation of the Heart._--Drs. BAILLIE,[29] LANGSTAFF,[30] and
+FARRE[31] have each published cases; and M. TIEDEMANN, in his journal of
+Physiology, now adds a fourth, in which the aorta and pulmonary artery
+were found to have changed places. In professor TIEDEMANN'S case, the
+two circulations were entirely distinct; the systemic blood passing from
+venae cavae to right auricle, from right auricle to right ventricle, and
+from this, through the aorta, to the body at large; while the pulmonary
+blood ran through an equally simple circle, by the route of pulmonary
+veins, left auricle, left ventricle, and pulmonary artery. The only
+communications between the two circulations, were the foramen ovale, the
+ductus arteriosus, and, in the opinion of M. TIEDEMANN, the
+inosculations between the branches of the _pulmonary_ and _bronchial_
+arteries.
+
+The infant is recorded to have presented _no peculiar appearances_ till
+the ninth day; when attacks of suffocation came on, attended with the
+blackish blue colour, and followed by death, at the end of twelve days.
+Similar histories are said to be given of the cases mentioned above, and
+the references to which we have copied. We have not the time to consult
+them.--_Ibid._
+
+7. _Acephalous Mummy._--M. GEOFFROY ST. HILAIRE has read a memoir of
+some length to the Academy of Sciences, on an acephalous mummy. It was
+found in a catacomb, destined, with this exception, exclusively to
+animals. It had an amulet suspended round its neck, being an earthen
+figure of a cynocephalus, for which it was very probably mistaken by the
+Egyptians. The collector, M. PASSALACQUA, who obtained it, showed it to
+M. G. ST. H. as a monkey, of which he wished to know the species. Yet
+the latter observes that these amulets were only put on human mummies.
+
+M. G. concludes that the monkeys, elephants, &c. said by Livy, Valerius
+Maximus, Pliny, and others, to have been born of women in their times,
+and considered as omens of public calamity, were acephala.
+
+8. _New Anatomical Plates._--Messrs. E. W. TYSON and GEORGE SIMPSON are
+publishing anatomical plates, in London. They are spoken of with
+approbation. The labours of the latter are designed for the use of
+painters.
+
+9. _A Manual of Osteology_ has been undertaken by Dr. WEBER, of Bonn,
+and one volume published.
+
+10. _Soemmering's fine work on the anatomy of the ear_, has been
+translated into French, and his splendid folio plates copied in
+lithography.
+
+11. _Does the conjunctiva run over the cornea?_ Messrs. LECOQ, LEBLANC,
+and ARTUS, state that they have each seen a case in which regular _skin_
+and _hair_ were seen, forming a small patch on the cornea of the eye of
+a quadruped. This is considered as a proof of the existence there of a
+membrane naturally analogous to the skin; which must, of course, be the
+conjunctiva. An officer saw another case, in which a hair was seen in
+the middle of the eye of a horse.--_Bulletin._
+
+
+II. PHYSIOLOGY.
+
+12. _Electro-Galvanic phenomena of Acupuncturation._--M. POUILLET, after
+making a complete circuit, through a needle introduced in acupuncture,
+through wires, and through the patient's mouth, found, by means of a
+multiplier of SCHWEIGHER with a magnetic needle, that the
+electro-magnetic rotation could be readily produced; at least so far as
+to effect small vibrations backwards and forwards. On repeating it with
+two needles, one of them run into an artery and another into a vein, or
+one into the medulla spinalis, at the neck, and another into an
+extremity, in a rabbit, no effect whatever took place.--_Magendie's
+Journ. de Physiologie._
+
+13. _Variations in Milk._--Milk, says M. VALLOT, in his memoir read to
+the Academy of Dijon, may be _red_. The cause of this is unknown, though
+it has given rise to superstitious fears. Some have observed that the
+cow's teats are then tender. Whether this be cause or effect has not
+been ascertained.
+
+_Yellow milk_ is said to have been produced by the cow's eating the
+caltha palustris, (marygold.) _Blue milk_, from a cause still unknown,
+in the departments of Seine-inferieure and Calvados. Some have ascribed
+it to the hyacinthus comosus; others to butomus umbellatus.
+
+The _green milk_ of some writers is supposed to be only blue. _Milk not
+coagulable_ is produced by feeding on husks of green peas, and on mint.
+_Bitter milk_, from wormwood, sonchus alpinus, and the leaves of the
+artichoke; and in goats, from eating freely of elder, (sambucus nigra,)
+and potato-tops; _a disagreeable taste_, from turnips, in Upper Canada.
+_Garlicky milk_, from causes well known. _Insipid milk_, and
+_lead-coloured butter_, from equisetum fluviatile. _Milk unnaturally
+sweet and luscious_, (sucre,) from alpine clover, (trifolium alpinum;)
+and _red butter_, from the ripe berries of asparagus.--_Bulletin._
+
+14. _Hyoscyamus dilates the pupils of the eyes_, the same manner as
+stramonium, several Eastern species of datura, and belladonna, which the
+Europeans use. The strongest species was datura fastuosa.--_Oriental
+Magazine, apud Du Fermon._
+
+15. _Worms in the Eye._--Several cases of worms in the eye are mentioned
+in the Bulletin des Sciences Medicales, for Feb. 1826. DEGUILLEME saw
+several in the eye of a cow; and the case was published by GORIER, a
+veterinary teacher, in his memoirs. In the report of the proceedings of
+the veterinary school at Lyons, in 1822-3, there is the case of a mule,
+in which a knot of worms (crinons) was seen in one eye. _Two_ were
+extracted; (why no more is not said;) and another subsequently. No
+inflammation was produced; but a violent nervous agitation of the head,
+and a turning of it to the left side took place. Next follows an account
+of a memoir read before the Medical Society of Calcutta, but of which
+the name of the author is not given. He is represented as stating, that
+the strongylus armatus minor of RUDOLPHI, and the _filiaris_ (filaria)
+papillosa, are frequently found in the eyes of the horses in India, but
+much more so in the cellular membrane, particularly about the loins. He
+believes that they make their way into the blood-vessels, and, through
+them, into the eye. Their most ordinary seat is the cellular membrane of
+the loins; where they exist for years, producing emaciation, and, at
+length, paralysis of the hind legs. This last the Calcutta author is
+represented as ascribing to the penetration of the spinal marrow; but he
+does not appear to have verified it by dissection. TREUTTLER says, he
+has seen the strongylus armatus in _aneurisms_ of the mesenteric artery
+of the horse; but the writer in the Bulletin doubts whether any have
+ever been found in sound arteries.
+
+Dr. KENNEDY, in the Edinburgh Philosophical Transactions, describes a
+worm, which he calls _ascaris pellucidus_, (pellucida,) as being common
+in the eyes of horses in India. A review of BREMSER'S work on worms is
+expected in our next, and inferences will then be drawn from these
+singular facts.
+
+16. _Digestion._--MM. LEURET and LASSAIGNE, in their very interesting
+and valuable experimental essay on this subject, have met with many
+curious results.
+
+They found no remarkable difference in the saliva of carnivorous and
+herbivorous animals. The purest saliva was obtained for their
+experiments directly from the parotid duct, in man, the horse, and dog.
+The composition was as follows:
+
+Water, 99 parts; mucus, traces; albumen, soda, chloride of sodium,
+chloride of potassium, carbonate of lime, and phosphate of lime, 1 part.
+Total, 100.
+
+Their experiments on the bile confirmed the results of THENARD and
+CREVREUIL.
+
+The pancreatic juice is of the specific gravity 1.0026; at 15 deg. of the
+thermometer: (centigrade, we presume.) Its composition is:
+
+Water, 99.1 parts; animal matter soluble in alcohol, animal matter
+soluble in water, traces of albumen, mucus, soda, chloride of sodium,
+chloride of potassium, and phosphate of lime, 0.9 parts. Total, 100.
+This greatly confirms the analogy long observed between the pancreatic
+liquor and the saliva.
+
+In the _gastric liquor_, there are:
+
+Water, 98 parts; _lactic acid_, muriate of ammonia, chloride of sodium,
+animal matter soluble in water, mucus, and phosphate of lime, 2 parts.
+Total, 100.
+
+Dr. PROUT and Mr. CHILDREN have announced the gastric acid, of which so
+much has been said, to be the muriatic, while M. CHEVREUIL had stated it
+to be the lactic. MM. LEURET and LASSAIGNE confirm the results of
+CHEVREUIL, and that with great confidence in their own accuracy. They
+found the contents of all the four stomachs of ruminating animals acid.
+MM. PREVOST and LEROYER had stated those of the three first to be
+alkaline. The observations of LEURET and LASSAIGNE agree with those of
+MONTEGRE, (vide Dict. des Sci. Med.) who believes digestion to produce
+acidity as a result of the regular process.
+
+The _faeces_ become alkaline.
+
+_Substances which contain no azote, from whatever class they are
+obtained, cannot serve for nutrition._ We cannot understand this,
+especially when compared with what follows. "If, on the contrary, they
+are soluble, one part is absorbed and another is expelled, either by
+urine or by the anus; such are sugar, gum, &c." This seems to us like a
+contradiction.
+
+It is impossible, in the present state of science, to determine the
+chemical change which aliments undergo in the digestive organs; both on
+account of their mixture and the insufficiency of our means of analysis.
+
+"The absorption of chyle takes place by the villi." "These communicate
+directly with the lacteals and the vena portae."
+
+"The transference of the chyle takes place by the lacteals;
+nevertheless, if they are obliterated, _this may be done through the
+vena portae_."
+
+_The section of the pneumo-gastric nerves does not stop the dilution of
+aliments in the stomach, or chylification._
+
+The juices secreted by the liver and pancreas, are poured into the
+intestines in greater quantity during digestion than at any other
+period; in consequence of the contact of the acid chyme with the biliary
+and pancreatic orifices.
+
+The pancreatic juice is analogous to the saliva.
+
+The spleen is an appendage to the liver; it swells during the absorption
+of liquids by the vena portae.
+
+Liquid aliments are digested, just as much as solid; but they do not
+require so great a quantity of gastric and intestinal juices.
+
+Watery drinks are absorbed in the stomach and intestines, by the
+radicles of the vena portae. Spirituous drinks occasion an afflux of the
+gastric juices, become acid, and are absorbed.
+
+Excrements owe their colour and odour to the bile, and their
+consistence to the absorption of a portion of the water they contain.
+They carry off a large amount of the nutriment.
+
+Great obscurity still remains as to the cause of hunger.
+
+Thirst is thought to be produced by the drying which the pharynx
+undergoes, from the passage through it of the air used in respiration,
+and at a time when the supply of mucous fluid is scanty.
+
+Our readers will have perceived, long ere this, that here are several
+propositions at war, not only with our received opinions, but with the
+experimental researches of some others among the modern physiologists.
+We do not know what Dr. WILSON PHILIP would say to his observations
+being so cavalierly dismissed: they seem scarcely to condescend to
+mention his name in France. Not having the original, we could do no
+better than translate, almost literally, the conclusions of these
+experimenters, as stated in the Bulletin; and the result of this is what
+we have just given our readers. From the words "the absorption of
+chyle," to the end, is nearly verbatim the language of the review.
+
+
+III. PATHOLOGY.
+
+17. _Dothinenteria. Pustules of the small Intestines._--From [Greek:
+dothine], a pustule, and [Greek: enteron], an intestine. This name is
+given to a disease which has been described by M. BRETONNEAU, of Tours,
+and, after him, by SERRES, BROUSSAIS, ANDRAL, and several others, and
+consists in pustules, generally situated at the lower end of the ileum.
+
+We are constantly lamenting to ourselves the contracted bounds allotted
+to our Quarterly Summary. Indeed, were it not for other objects, it
+might occupy, with advantage, half of the number, and most of the time
+employed in the preparation of the work. Every thing must be curtailed,
+though cut off at the most interesting and valuable point; and the
+painful exertion of the attention, necessary to condense information for
+our readers' use, of the amount of which they cannot possibly be aware,
+can only be equalled by the constant feeling of disappointment at
+rejecting so much important matter.
+
+We are told that this pustular disease is as common and as destructive
+as the _small pox_, (indeed!) the measles or the scarlatina; that few
+persons spend the whole of their lives without having, at some period,
+suffered by it; that it never affects individuals but once; and that it
+is suspected of being contagious.
+
+M. BRETONNEAU has prepared a set of specimens, taken from the bodies of
+those who have died in various stages of this complaint. He traces the
+malady day by day, with a precision which we will not copy here. The
+seat of this affection is the glands of PEYER and BRUNNER. The former
+are found in groups, throughout the lower half of the jejunum and the
+whole of the ileum, gradually increasing in the size and number of their
+clusters, till they reach the valve of the colon, where they cease. They
+have been mistaken by some dissectors of the modern school for the
+effects of inflammation. They are found in honey-combed patches; which
+are agglomerations of mucous glands. The glands of BRUNNER are thinly
+dispersed mucous follicles which are scattered singly throughout the
+whole length of the small intestines, with nearly equal frequency. These
+organs are well described by HALLER in the great Physiology. They are
+not seen well, unless in a young subject, and by cutting into the
+intestine very close to the mesentery.
+
+When inflamed, they swell and thicken, and, after some days, the
+membrane around them assumes a reddish tint. The mesenteric glands are
+enlarged. M. BRETONNEAU has seen one as large as a hen's egg: they
+generally equal in size that of a pigeon. The disease spreads and
+affects an additional number of glands. It reaches its acme generally on
+the 9th day; after which sometimes all, and always a part of the
+affected glands return to their natural condition, by resolution of the
+inflammation. Those which are to run the full course of the disease
+continue to augment in size and projection into the intestine. On the
+13th and 14th days they are discovered tinged with bile, which
+penetrates their substance, and thus proves the occurrence of
+disorganization. On the 15th and 16th, the sloughs separate, and leave
+from one to six ulcers. These penetrate the gland, and with it the
+mucous membrane, of which it forms a part, and next, the cellular tissue
+of the intestine. In numerous instances they perforate the muscular
+coat, leaving nothing but peritoneum at the bottom; and frequently,
+passing this, they induce inflammation of the cavity of the belly, and
+death.
+
+The cases of simple resolution terminate in three weeks: those in which
+sloughs are formed, in from 30 to 40 days, if not fatal. If death be
+from peritonitis, it is of course soon after the 15th and 16th days; if
+from exhaustion, at periods varying according to the strength of the
+sufferer. Dothinenteria occurs in many of the cases commonly called
+typhus fever, gastro enteritis, &c. It is proper to remark that both the
+author and the journal are in opposition to Dr. BROUSSAIS.--_Archives._
+
+18. _Dr. Broussais._--While the opinions of this celebrated reformer
+have been gradually becoming more extensively known among our
+countrymen, the war has prevailed with increased heat in his native
+land. The most vehement attacks are made, from various quarters, upon
+his system of _medicine physiologique_. No one appears to deny that he
+has clearly proved the existence of mucous gastritis and enteritis in
+many or most fevers, or the propriety of directing a part of the
+remedies to them. Criticisms and invectives are freely emitted: but they
+are only levelled against the too extensive application of this
+doctrine, and the inconsistencies, unquestionably often real, of the
+system of which he has made it the foundation. Indeed, if the quotations
+given are correct, we think no one who has not assumed a party, can
+refrain from concurring in their condemnation.
+
+"Those who understand our doctrine never attack it; they speak of it
+only to express their admiration: above all, they never think of wishing
+to modify it, because they know that its fundamental dogmas are
+unshakeable." "Surtout ils ne s'avisent jamais de vouloir la modifier,"
+&c. A man who assumes such ground as this, had need be very careful in
+assuming his positions, indeed; and should particularly avoid any thing
+like self-contradiction.
+
+The _Lettres a un medecin de province_, in a style of lively criticism,
+labour to show a great variety of inconsistencies in this immoveable
+doctrine. The review of this publication in the Revue Medicale,
+including copious extracts, coincides with, and evidently wishes to aid,
+the author's satire. In the same journal are a series of criticisms on
+some of the elementary propositions of Dr. BROUSSAIS, published in a
+late edition of his Examen; (nearly the same which were published here,
+some time since, in the American Medical Recorder, having been
+translated by Dr. ATKINS.) In these critiques, great severity is shown,
+in dealing with the new dogmas, and the doctrine is treated as one of
+dangerous tendency; while, at the same time, high praise is awarded to
+their author, for his discoveries in the diseases of the alimentary
+mucous membranes.
+
+In the other journals, there is a division; some favouring the new
+opinions, while others oppose them with more or less of vehemence.
+
+That the doctrine of gastritis has made a great impression at Paris,
+that almost every one believes in it, to a greater or less extent,
+appears undeniable; but there, as well as here, most of the more
+rational, and moderate minded men are evidently of the only school a
+physician ought to belong to, the _eclectic_. Borrowing largely from
+BROUSSAIS, and having had their minds powerfully stimulated by the
+succession of striking and novel ideas which he has introduced, they
+think it unmanly to "bind themselves to his chariot-wheel," but form
+conclusions for themselves from every resource within their power. If
+the great French reformer really wishes to establish as absolute a power
+over the minds of his followers, as MAHOMET or PYTHAGORAS did, and as
+the above-quoted extract seems pretty fairly to indicate, he must
+certainly undergo many mortifications. Notwithstanding the
+"inebranlable" nature of his dogmas, M. MIQUEL has furnished us with
+several variations from them, in the writings of Messrs. BOISSEAU,
+ROCHE, SANSON, REMUSAT, RICHOND, and BEGIN; and the last-named
+individual has had a public dispute with his preceptor.
+
+M. BEGIN has produced his promised work on surgery, according to the
+principles of the new school. We have not seen the volume, but have read
+a review of it in the Revue Medicale, by M. BELLANGER. The latter
+describes it as a cursory work, having for its object the adaptation of
+surgery to a set of general principles, rather than a detailed system
+of instructions how to proceed in each individual case. It contains only
+what is easy to be remembered, and omits those matters for which it is
+usual to refer to books. Thus two pages only are appropriated to
+fractures of the body and neck of the femur! and twenty-six for the
+whole subject of fractures, wounds, and six or eight of the most
+important diseases, of bones! Yet all this criticism is not without a
+compliment, well-merited at least by the former productions of the same
+author, to his talents and ingenuity.
+
+19. _Whooping-cough._--"There is no disease of children, in which the
+resources of medicine are more manifestly serviceable than in an
+obstinate whooping-cough." Such, in amount, was the opinion of Dr.
+UNDERWOOD, and Dr. WATT uses language almost equally strong. Certainly,
+we are not at all times equally successful or equally sanguine in
+America.
+
+Dr. A. CAVENNE considers whooping-cough a true bronchitis, a pulmonary
+catarrh; accompanied with greatly heightened nervous symptoms, owing to
+the irritable period of life at which it occurs, and particularly to its
+frequent existence in nervous constitutions. Professor TOURTELLE calls
+it a pneumo-gastric, pituitous catarrh; and certainly, the pupils of a
+modern school will find no difficulty in recognizing symptoms of
+gastritis in its severer forms. The further inferences drawn by Dr.
+CAVENNE, are as follows:
+
+1. That the whooping-cough, in an individual of a sanguine temperament,
+requires, in general, the use of bleeding, and a debilitating regimen.
+
+2. That bleeding and a debilitating treatment are equally necessary,
+whatever be the temperament, in whooping-cough of the chronic form.
+
+3. The antispasmodics are necessary in nervous constitutions.
+
+4. That blood-letting and the debilitating treatment should be rejected,
+when the subject is endowed with a lymphatic temperament. This
+observation, says our author, is equally applicable to early infancy, in
+which lymph predominates over the red blood, and the fluids are more
+diluted.
+
+Finally, if the disease be obstinate and there be disturbance in several
+functions, there is certainly reason to believe that a lung, a viscus of
+the abdomen, or the brain, is in an unfavourable condition; (the author
+means of the inflammatory kind;) and this is ground for the moderate
+abstraction of blood.--_Journ. Univ. Feb._
+
+20. _Antiperistaltic globus. Globus hystericus._--Dr. TROLLIET, of
+Lyons, observes that hysteria cannot, with propriety, be said to exist
+in the male sex; that it arises, as its name imports, from derangement
+of the uterus, and that CULLEN and SYDENHAM have done wrong, and stand
+alone, in teaching the contrary. When there exists a real hysteria, the
+contractions are not confined to the intestinal regions, but invade the
+neighbouring parts; (quere, which of them contract?) they are always
+accompanied, when existing in a high degree, with convulsions and loss
+of the mental powers. In the intervals, the patients affected can
+satisfy their appetite.
+
+Antiperistaltic globus may occur from various causes; and either in the
+intestines or the oesophagus.
+
+That of the intestines is met with chiefly in advancing age; and is
+generally produced by daily and often-repeated pressure on the abdomen,
+as practised in various professions. Hard labour and bad diet also
+greatly aggravate it. At first pain in the intestines occurs, aggravated
+by labour; together with derangement of digestion.
+
+The sensation of a globe then appears on the lower and left side of the
+abdomen; and, after performing various circuits, finally reaches the
+stomach; from which is soon after discharged, with great relief, a
+quantity of gas, issuing from the mouth. Vomiting of an acid and burning
+fluid, as also of the food, is not uncommon as an accompaniment. This
+ball is about the size of a man's fist, and is sensible to the external
+touch, and even to the sight. The patients possess the power, to a
+certain extent, of controlling its motions, and relieving the pain,
+which is often extremely violent, by pressure.
+
+Indigestible food always aggravated the disease. Some could only
+tolerate milk, broth, and other fluids. A weaver was obliged to quit his
+profession, from the pressure on the abdomen which it required,
+occasioning the paroxysms.
+
+The treatment consisted in
+
+1. Avoiding the original causes.
+
+2. The use of a species of corslet, (plastron,) to prevent future
+pressure on the abdomen.
+
+3. A rigid diet. We do not understand why, firstly, articles containing
+a great deal of fecula, and, as it is said, "requiring a great action of
+the intestines," are forbidden, while, in the second place, rice is
+recommended. "Bouillon aux herbes," (a laxative decoction,) rice-cream,
+and milk, were found the best. Wine was injurious. Assafoetida and
+camphor were useful, and were administered in boluses. Purgatives were
+injurious. Emolient enemas were useful.
+
+Of antiperistaltic globus in the oesophagus our author saw only two
+cases, which were not complicated with hysteria. The patients had both
+been subject to rheumatism; and, in one of them, this had been
+supplanted by an eruption Of tetter: on the disappearance of which last
+the globus appeared. These cases were cured, the latter by a severe,
+light diet, and some antispasmodics, the names of which are not
+mentioned; the other by curing the rheumatism.
+
+Dissections are somewhat difficult to obtain; unless where some other
+more mortal disease exists. In one, scirrhus of the pylorus was found;
+the stomach greatly enlarged; the small intestines contracted, _red
+outside and gray within_. (Where was the redness situated; in the
+peritoneal or the muscular coat? We must _guess_ the latter.) The
+stomach was pale gray, and thickened. The large intestines were dilated,
+and gray.--_Journ. Univ._
+
+21. _Non-contagion of Yellow Fever._--Dr. VALENTINE, of Nancy, has
+printed a pamphlet of a single sheet, in which he finds himself involved
+in all the turmoil, through which American physicians passed during the
+period which intervened between 1793 and 1805. Dr. V. gives his
+authority decidedly in favour of the non-existence of a contagion in
+this disease; and grounds his opinion upon the innumerable cases of
+patients affected with the disease and otherwise, who have escaped from
+infected districts, without communicating the malady in any instance, to
+the persons with whom they lived; upon the healthiness of ports, from
+which it has been said to have been introduced, &c. Dr. V. is not, as
+some of his countrymen have been, unwilling, from some unimaginable
+cause, to make use of the immense mass of American evidence; though he
+observes, and with justice, that experiments should be repeated in
+France, in order to set the public mind at rest in that kingdom. He
+proposes the employment of criminals for this purpose; and recommends
+every mode of the most close contact which his imagination could
+suggest. He mentions experiments of this kind having been made in the
+United States; and by M. GUYON, of Martinique, on his own person.
+
+He quotes Dr. CHERVIN's labours, with great and just applause. This
+indefatigable and daring physician has now spent upwards of ten years in
+accumulating proofs upon this single question.
+
+At the commencement of the pamphlet, the arrangement of which does not
+seem to us to be quite clear and easy, Dr. V. gives a sketch of the
+situation and localities of Leghorn. He traces the fevers of that place
+to putrid matters, perceptible by the sense of smell; and principally to
+obstructed drains. He does not give the exact degree of heat, but merely
+states that it was excessive, and followed by heavy rains.
+
+
+IV. THERAPEUTICS, MATERIA MEDICA, AND THE PRACTICE OF MEDICINE.
+
+22. _Iodine._--In the former numbers of this journal, we offered some
+observations respecting the medicinal properties of iodine, intending
+then to present in one of our future numbers an elaborate analysis of a
+valuable work on this subject, by Dr. Manson, which appeared in England
+sometime last year.[32] Fearing, however, that the want of room and time
+will prevent us from fulfilling this task, as soon as soon as might be
+desired, we have thought that a condensed notice of its contents would
+be acceptable in this place.
+
+It appears that previously to the discovery of iodine as a medicinal
+agent, our author used the burnt sponge in bronchocele, a disease very
+common in the neighbourhood of Nottingham, where he practices. But when
+the effects of the former remedy was announced, Dr. M. prepared a
+tincture composed of one drachm of iodine to two ounces and a half of
+rectified spirit, (spec. grav. 916.) and prescribed it very extensively
+in doses of from 10 to 30 drops three times a day, according to the age
+and strength of the patient. Dr. MANSON has presented a tabular view of
+116 cases of bronchocele treated by iodine, and also a detailed account
+of 15 more cases, with appropriate remarks. Of the former, there were,
+viz:--
+
+     Males--Cured,                          10
+            Much relieved,                   1
+            Discharged for non-attendance,   1
+            Improving under treatment,       3--Total 15
+     Females--Cured,                        66
+            Much relieved,                   9
+            Not relieved,                    2
+            Discharged for non-attendance,  10
+            Improving under treatment,      14--101--116
+
+Whilst using the tincture internally, Dr. MANSON occasionally had
+recourse externally to a liniment composed of
+
+     Liniment. Sap. Comp.   [Symbol: ounce]i
+     Tinct. Iodinae,        [symbol: dram]i _m._
+
+Some patients can bear this quantity rubbed into the tumour once, and
+sometimes twice a day; though in some, the skin is so tender, that the
+liniment cannot be so frequently used. Dr. M. prefers this liniment to
+the common iodine ointment, as less liable to evaporation. In France, we
+believe Dr. RICHOND prefers rubbing in the tincture itself. The
+following remarks are useful:
+
+"In some _individuals_, after the preparations of iodine have been given
+internally for some time, they are apt to occasion headach, giddiness,
+sickness of stomach, with some degree of nausea, langour, and inaptitude
+for exertion; when these unpleasant sensations and effects occur, the
+best plan to remove or obviate them is to suspend, for a time, the use
+of the medicine, or to reduce the dose, as may seem most expedient." A
+reduction of dose, from fifteen to twelve drops, was the plan adopted by
+our author on this occasion.
+
+2d. _Paralysis._--Want of success with the ordinary modes of treating
+this disease, induced Dr. MANSON to try the effects of iodine.
+
+"The wonderful powers of iodine, which I had recently witnessed; and a
+long previous acquaintance with the same remedy as it exists in burnt
+sponge, in reducing morbid enlargements of the thyroid gland, led me
+from analogy, to think, that in cases of palsy, from tumours or fluids
+pressing on the brain or spinal cord, or from morbid thickening of the
+investing membrane of the cord itself, iodine might prove a useful
+remedy not only by stimulating the nervous system, and removing morbid
+tumefaction and effusion, but also by correcting the strumous state of
+the constitution that often gives rise to the disease."
+
+The following interesting case as abridged in the Medico-Chirurgical
+Review, for January 1826, we take the liberty to transcribe.
+
+"J. Watterton, aged 19, was admitted into the General Hospital of
+Nottingham, on the 27th of March, 1821, having been ailing since
+October, 1819. Stated that he had at first been attacked with pain in
+the bowels, which having ceased, the lower extremities became swelled
+and painful.
+
+"After this, his neck became stiff and painful, with shooting pains from
+the neck into the left side of the head. These also disappeared, and did
+not afterwards return. This was about nine months ago, and, at that
+time, he suddenly lost the power of the left arm, and in a short time
+afterwards, that of the left lower extremity. Some time after this, he
+recovered, partially, the use of the left arm; the leg remaining
+paralytic. About this time, the _right_ half of the body was
+instantaneously and completely palsied. He has continued ever since in
+this wretched state, getting worse rather than better, passing his
+stools and urine, involuntarily. He lies on his back, and, with the
+exception of the left arm, he is completely paralytic on both sides,
+from the neck downwards. The sense of feeling is very much
+impaired--there is no distortion of the face, nor impediment of
+speech. Is troubled with twitchings in the lower extremities.
+_Purgatives--blisters to the nape of the neck, and to be kept open._
+
+"It appears that, about two years ago, he had a bloody purulent
+discharge from both ears. The left still continues to discharge a
+purulent looking matter. Purgatives were continued till the 6th of
+April, when the tincture of iodine, in doses of 15 drops, was given
+thrice a day. April 9, can raise the right arm nearly to the head; but
+the power of the lower limbs has not improved. The twitchings have
+decreased. Purgatives--the tincture of iodine to be increased to 20
+drops ter in die. 10th. Evinces some muscular power in the lower
+extremities to day--feels stronger--can retain his urine for some time.
+14th. Continues to improve. The left foot is become exquisitely
+sensible, and that extremity is often drawn up spasmodically towards the
+body. The iodine to be increased to 25 drops. 16th. The paralytic
+symptoms continue to yield to the powerful influence of the iodine. When
+his meat is cut, he can now feed himself with the left hand;--can raise
+the right hand to the chin, and draw the right upper extremity up
+towards the body. He continues to hold his water. The iodine is
+increased to 30 drops, thrice a day--from this date to the 7th of May,
+the medicine was occasionally obliged to be intermitted and again
+commenced in smaller doses. At this period, however, the patient could
+walk from his bed room to the day ward with very little assistance.
+19th. He can walk without any assistance, except that of a stick to
+steady him. June 9th, can walk without a stick. He is gradually
+recovering the power of motion and sense of feeling. Drops agree.
+Appetite good, and is allowed full diet. July 3d, the patient was
+discharged cured."
+
+Besides this highly interesting case, 24 more of paraplegia, hemiplegia,
+and partial paralysis, are given in detail, in which the iodine was
+exhibited with various success. In his prefatory remarks to this
+chapter, Dr. MANSON observes, that although he has been able to cure
+only a proportion of the cases of palsy that have come under his care
+since April 1821, yet he has been much more successful in his practice
+since that time, than he was previously with the use of all the ordinary
+means.
+
+Having succeeded so well in paralysis, Dr. MANSON was induced to try the
+effects of iodine in chorea, which he thinks is more closely allied to
+palsy than is supposed, and is linked to it by that species of the
+disease called shaking palsy. Of chorea treated with iodine, and showing
+the efficacy of the remedy, Dr. MANSON details eleven cases, and
+concludes this section with a tabular view of 72 cases treated at the
+General Hospital near Nottingham, between the 6th of October, 1812, and
+the 5th of October, 1824. In all the cases detailed by our author, the
+iodine was administered after purgatives, and throughout the treatment,
+the bowels were carefully regulated by aperient medicines.
+
+Dr. MANSON next records the results of his experience with iodine in
+scrofula--detailing three cases of scrofulous enlargement of the
+conglobate glands--two of scrofulous ulcers, and four of scrofulous
+ophthalmia; in all of which, the most beneficial effects were obtained.
+Our author details eleven cases of fistula lachrymalis, in which iodine
+produced the happiest results. He was led to prescribe iodine in this
+disease from the circumstance, that one of the individuals to whom he
+gave it for paralysis, laboured under the fistula, and was promptly
+relieved of it, whilst under the use of the remedy.
+
+Dr. MANSON has likewise detailed nine cases of deafness cured, or
+greatly relieved, by iodine. In most of these cases, the disease
+originated from obstruction of the Eustachian tube, the consequence of
+swelling of the tonsils, or of the membrane of the tube itself, from
+previous inflammation.
+
+Seven cases of dysphagia, eleven of white swelling, four of morbus
+coxarius, and eleven of distortion, form the subjects of the four
+succeeding sections. The medicine in all these cases, manifested so very
+decided a power in arresting the progress, and even in curing the
+disease, that we think ourselves safe in recommending a trial of it in
+similar cases. As the iodine, however, is a powerful stimulant, we would
+advise it not to be prescribed when there exists any fever, and
+especially when there are any decided signs of gastric irritation, as it
+would be likely to aggravate it.
+
+23. _Non-mercurial treatment of Syphilis._--In the first number of this
+Journal, we inserted an essay on this subject, by Dr. THOMAS HARRIS, of
+this city, in which the author confirms, by the results of his public
+and private practice, the statements of the British army surgeons
+respecting the efficacy and safety of the non-mercurial treatment.
+Since that period, having noticed that, by the worthy editor of a
+respected cotemporary, it is asserted that though mercury fails, "yet
+from the most ample experience in Europe, the present practice of Paris,
+England, Ireland, and the Continent generally, we must lean to the idea,
+that its use, under proper regulations, must be always adopted, as the
+only safe mode of cure in these diseases," we deem it but justice
+towards Dr. H. to call the attention of our readers to the result of the
+extensive experience of some physicians on the continent of Europe. Not
+to mention BROUSSAIS himself, who appears to have rejected mercury
+almost entirely in the treatment of primary or secondary symptoms, we
+may cite Mr. RICHOND, who reports that he treated, at the military
+hospital of Strasburgh, nearly 3000 cases of syphilis in all its grades,
+the vast majority of which were completely cured without mercury, and
+simply by means of antiphlogistics, emollients, and revulsives. Mr.
+RICHOND, besides some essays in the Archives Medicales, and a summary of
+his experience in the preface to his work on apoplexy, has lately
+published an elaborate work on the subject. In the October number of the
+Annales de la Medecine Physiologique, Mr. BECQUART of the military
+hospital of Bayonne, details twenty-six cases of gonorrhoea,
+inflammation of the testicles, chancres on the glans and lips, buboes,
+excrescences around the anus, &c., all of which were cured without
+mercury, and with the same remedies as were employed by Mr. RICHOND. We
+might adduce the testimony of other French physicians, and particularly
+of M. BEGIN, but we deem it unnecessary, as the above will be sufficient
+to show that in France the practice meets with the support of many very
+intelligent physicians. We annex the conclusions of Dr. OTTO of
+Copenhagen, drawn from an extended personal experience, and from his
+researches on the subject. Dr. OTTO'S essay is contained in a late
+number of Graafe's and Walther's Journal, and the conclusions are
+published in the Edinburgh Medical and Surgical Journal. Dr. O. remarks:
+
+1. That the cure of syphilis, without mercury, has been asserted by so
+many authorities, that the fact can no longer be doubted. If, then, the
+disease could formerly be cured without mercury, it may certainly now be
+much easier, as it has lost much of its violence and obstinacy.
+
+2. Syphilis can undoubtedly be radically cured in this manner; but then
+the cure is of longer duration, and the diet requires considerable
+restriction.
+
+3. The secondary symptoms, and a return of the complaint, are certainly
+more frequent; but the symptoms are not so difficult of removal; and the
+treatment has a much more speedy effect.
+
+4. As the treatment without mercury requires a longer time, it appears
+more practicable in hospital than in private practice; and on the other
+hand, the patient can be better watched in a hospital, which, on account
+of the diet, is of great importance.
+
+5. As ulcers on the genitals are often not syphilitic, and the use of
+mercury is contraindicated from a predisposition to scrofula or phthisis
+existing in the individual, it is consolatory to learn from the results
+of experience, that this medicine is not always necessary, and that a
+radical cure, by more simple and innocent means, can sometimes be
+effected. Where, however, the physician is anxious to avoid the possible
+evils which mercury is capable of producing, and also to prevent loss of
+time, there remains a middle way, namely, to employ mercury, whose
+specific action can scarcely be denied, in moderate doses.
+
+It results from a report of the cases of syphilis admitted into the
+public institutions of Sweden, that 3,574 were treated in 1822; 3,465 in
+1823, and 3,355 in 1824. During the course of this last year, 55-3/10
+per centum of all the patients were treated by the mercurial method, and
+35-1/10 per centum by the non-mercurial method, and by low diet; 2-1/2
+per centum by means of fumigations. MM. KESSLER, WURSTER, RONBERG, and
+SANDMARK, prefer the dietetic method, and consider it as the surest of
+all those hitherto employed. Relapses are rare. In 1822 they amounted in
+relation to the whole number of cases, to 11-2/3 per centum; in 1823 to
+10-1/4, and in 1824 to 10-2/3. After the treatment by starvation, they
+amounted in 1822 to 7-3/4 per centum; to 7-1/3 in 1823; and to 8-1/3 in
+1824. After the mercurial treatment, in 1822 to 17-1/2 per centum; in
+1823 to 14-1/16; and in 1824 to 14-1/2. _Bulletin des Sci. Med._
+
+We hope to lay before our readers at some future period, an analysis of
+Mr. RICHOND's work above alluded to, as well as of one on the same
+subject by Mr. JOURDAN of Paris, author of some essays on the origin of
+syphilis, translated and published here a few years ago.
+
+24. _Cancer treated by Antiphlogistics._--Of all diseases classed among
+the opprobria medicorum, cancer has hitherto been justly viewed as
+holding the most conspicuous rank, and it is only within a short time,
+that it appears to have been treated on correct principles, and that
+cures have been detailed by individuals of undoubted veracity. The idea
+of the inflammatory nature of cancer, and of the propriety of treating
+it by means of antiphlogistics, has been held many years ago, and
+supported by VASALVA in Italy, FEARON in England, HUFELAND in Germany,
+POUTEAU and VACHER in France, not to mention other high authorities.
+But, notwithstanding the success attending this practice, it was too
+simple for the supporters of cancerous humours and specific
+inflammations, and seemed, in consequence, to have been abandoned by
+them, in their search after anti-cancerous or specific remedies; and
+little was heard of it, until revived by the disciples of the
+physiological school of France, and particularly by its founder
+professor BROUSSAIS, and by professor LALLEMAND of Montpellier, the
+result of whose experience is published in a thesis, lately defended at
+Montpellier by Dr. MARESCHEL.
+
+We have been led to these reflections from reading the above essay, and
+another on the same subject, published by Dr. J. A. PUEL, in a late
+number of the Archives Generales de Medecine. Dr. P. details many
+cases, which were treated by his father, by means of leeches,
+emollients, purgatives, &c. so early as 1807. In most of these cases,
+the practice appears to have been very successful. As it is our wish to
+impress our readers with the propriety of making a fair trial of this
+method, in cases of scirrhus and cancer, we shall select and translate a
+few cases from the latter essay. It is proper to premise, however, that
+the practice must not be viewed as completely successful in _every_
+case, and that the older the complaint, the less confident we ought to
+be, in respect to the happy results of the case. Nor is it to be
+expected, that _boldness_ in the employment of the lancet and leeches,
+will answer as well as a perseverant, constant, but moderate use of
+these means. Chronic inflammations are not to be removed by storm, but
+by a _chronic_ use of remedies, and particularly by attention to diet.
+
+We cannot at present determine precisely the proportion of cures
+effected, by this method, of scirrhus or cancer, in a given number of
+cases, and how far it will surpass, in point of success, the common
+method of treatment by _specific_ narcotics and escharotics; but, even
+supposing that it is not more successful, (which we are disposed to
+deny,) it has at least the vast advantage of being more _comfortable_,
+and much less painful to the patient.
+
+Mrs. D. enjoying good health, and mother of three children, was brought
+to bed in 1823, of a healthy child, which, however, she did not suckle.
+With a view of suppressing the secretion of milk, irritating
+applications to the breast were resorted to, which brought on an
+inflammation of that organ. Emollient poultices were now applied; these,
+however, did not prevent the formation of an abscess, which was opened
+by means of caustic potash. The suppuration, for a few days, was
+abundant and the matter discharged healthy. Purgatives were prescribed,
+with the view of suppressing the discharge, and mercurial ointment was
+rubbed on the tumour, to produce its absorption. These remedies were not
+successful, because no means were employed to arrest the inflammation,
+which gave rise to the suppuration.
+
+When the patient applied for advice, she had been sick already four
+months, and presented the following symptoms. She was very much
+emaciated, and laboured under fever, resulting from a gastro-enteritic
+inflammation, kept up by purgatives and deostruents, (_fondans_,) which,
+from the commencement of the attack, were prescribed for her. The
+ulceration of the mamma was of the size of a five frank piece, unequal
+and gray, and gave issue to an ichorous and foetid purulent matter.
+The edges were thick and everted, and surrounded with an erysipelatous
+inflammation. The whole mamma was large and hard, and the seat of
+lancinating pain. Thirty-five leeches were applied around the tumour,
+and gave rise to a profuse haemorrhage, which continued many hours. From
+this, the patient experienced so much relief from pain, as to be able to
+take some repose, of which she had been deprived for some weeks.
+Emollient poultices and drinks were prescribed, and a low diet enjoined.
+By all these means, the pain was lessened, and the swelling much
+diminished. Leeches were again applied, and the other remedies
+continued. The wound gradually improved, and in forty five days, was
+completely healed.
+
+Mr. P. was called on the 25th of September, 1817, to attend a lady, who
+had been affected for two days with uterine haemorrhage, which he
+succeeded in arresting. The following history of her complaint was given
+to him: she had aborted about 18 months before, and since that time, had
+experienced every fortnight an uterine haemorrhage, which generally
+lasted five or six days. During the intervals, she complained of deep
+seated pain, numbness and cramps, in the lower part of the abdomen, in
+the thighs and groins. The pain was much aggravated when she had a
+stool--walking, especially when long continued, was painful, and
+attended with a sense of dragging, which was only relieved by repose.
+From the same period, her disposition had changed from gay and lively,
+to melancholy and morose--her digestive functions were slow and
+painful--she was affected with leucorrhea, and during coition, felt much
+pain, and often lost some blood. On examination per vaginam, it was
+found, that the neck of the uterus was elongated--the anterior lip of
+the same organ was soft to the feel--the orifice somewhat enlarged, and
+painful when the finger was introduced into it. On the inferior lip
+there was a small unequal and painful spot, which was regarded as a
+superficial ulceration; the uterus was a little prolapsed, and somewhat
+enlarged; the pulse small and frequent; febrile exacerbations every
+evening; sleep not refreshing, and interrupted by short lancinating pain
+in the uterus.
+
+The disease was judged by Mr. P. to be a chronic metrites, with
+ulceration, and all the symptoms usually attending incipient cancer.
+Guided by this belief, and notwithstanding the already long duration of
+the disease, and the debility of the patient, the following treatment
+was adopted--complete repose in the horizontal posture--leeches to the
+vulva, repeated several times--vaginal injections, with emollient
+decoctions--hip baths--very low diet. After persevering in this plan
+twenty days, the patient appeared much better, and was allowed to sit
+up. General baths were substituted for the partial ones. The same
+treatment was continued, with the exception of the leeches, and at the
+end of thirty days more, all the symptoms of the disease had completely
+disappeared. Mrs. P. was allowed to spend the following spring in the
+country, from whence she returned in very excellent health. She has
+since continued to enjoy it, and has borne several children.
+
+Cases nearly similar, are detailed by Mr. MARESCHAL, as having occurred
+in the practice of professor LALLEMAND. The same gentleman, also gives
+the history of two cases of external cancerous sores, in which the same
+treatment was adopted. The patients having died during the progress of
+the cure, of other diseases, an opportunity was offered, of examining by
+dissection, the changes that had occurred in the parts. We cannot
+enlarge on the subject in this place, and can only remark, that these
+changes were such, as to lead us to hope, that less difficulty will be
+experienced in the treatment of sores reputed cancerous, by the local
+antiphlogistic plan, than is commonly supposed. At any rate, recommended
+by such high authorities, the practice deserves a trial.
+
+The Revue Medicale for February 1826, contains the details of a case
+lately cured at La Pitie, by Mr. LISFRANC. The patient, a woman, aged 36
+years, of a strong and good constitution, had suffered the removal of a
+cancerous breast, 18 months previous to her admission into the Hospital,
+on the 10th October, 1825. The following symptoms were observed. On the
+whole surface of the cicatrix were felt a number of engorged ganglia,
+and an induration situated on the large and small pectoral muscles, and
+spreading from the clavicle to all the external and superior part of the
+thorax, and as far as the axilla, where other swollen ganglia were felt.
+The enlarged surface was elevated about half an inch above the level of
+the chest. Severe lancinating pains were at short intervals felt by the
+patient--which came on without any evident cause, and were particularly
+severe on the least pressure of the swollen part.
+
+This patient was treated by means of frequent and copious bleeding from
+the arm--the very frequent application of leeches to the inflamed part,
+and to the upper and interior part of the thighs, to bring on
+the menstrual discharge--digitalis to remedy the frequent
+palpitations--emollient applications, and low diet. On the 10th of
+January, she was considered well;--the swellings and pain having
+disappeared--the menstrual discharge being well established, and the
+movement of the arm (which during the progress of the disease had been
+impeded from the swelling in the axilla) perfectly free.
+
+We are happy to learn that this practice is pursued with success by the
+Spanish physicians, as may be readily found by a reference to a late
+number of the Periodico de la Sociedad Medico Quirurgica de Cadiz, which
+contains cases of scirrhous mamma cured by the repeated application of
+leeches.
+
+25. _Essential oil of Male Fern, as, a remedy in Cases of Taenia._--The
+male fern has long been regarded as a valuable anthelmintic medicine;
+but, as every powder administered in large doses, its exhibition is
+difficult and disagreeable; so much so, indeed, that many patients
+refuse to make a sufficiently constant use of it to ensure its
+beneficial effects. Struck with this inconvenience, M. PERCHIER, a
+pharmaceutist of Geneva, has lately made some experiments with a view of
+discovering its active principle, and to see whether this latter may be
+administered with equal success with the powder or infusion of the
+plant. We are happy to learn that the result of his experiments are very
+satisfactory. We translate the following observations from a memoir on
+the subject, read on the 7th of October last, by Mr. GENDRIN, before the
+medical society of the department of the Seine. "This medicine, which
+is a fatty oil extracted by distillation from the aether, in which the
+powder of the root of the male fern has been macerated, has caused in
+many cases, the expulsion of the taenia, without occasioning nausea,
+colics, or any other morbid phenomena." "It is exhibited at bed time,
+either in an oily potion, in pills, or incorporated in an electuary, in
+doses of 18 or 20 drops. On the following morning, a similar dose is
+given, and two hours after, two ounces of castor oil are administered.
+In most cases, the taenia is expelled in the course of the day, but if
+this does not occur, the same doses of the oil are given in the same
+way, and followed by a similar quantity of the castor oil. The fatty oil
+of fern, has an aethereal and empyreumatic smell; its colour is brown,
+and its consistence rather greater than that of castor oil; it is,
+however, easier to separate in drops. Its taste is acrid, pungent,
+empyreumatic, and very disagreeable."--_Propagateur des Sciences
+Medicales, Janvier 1826._
+
+26. _Tincture of Bastard Saffron[33] for the expulsion of Taenia._--Dr.
+CHISHOLM, of Canterbury, has lately used with success, in a case of
+taenia of many years standing, the vinous tincture of bastard saffron.
+The patient had already undergone various plans of treatment, and had
+especially used the oil of turpentine in very large doses. Dr. C. was
+induced to try the above remedy, from having noticed, that in a case in
+which it had been prescribed for the cure of rheumatism, a large portion
+of taenia had been expelled. He consequently administered two ounces of
+the tincture; advising the patient to take a table spoonful more of it
+mixed in a little water, two or three times a day. On the third or
+fourth day after commencing the use of this remedy, the patient voided a
+large portion of the worm, and has since been free from the usual
+symptoms of the disease.
+
+27. _Oil of Turpentine in Taenia._--Although the oil of turpentine is
+used in many parts of this country, in cases of taenia, we have good
+reasons for believing, that some physicians continue, notwithstanding
+the testimony in its favour, to hesitate exhibiting it in doses
+sufficiently large to destroy and promote the expulsion of the worm.
+Such being our opinion, we are induced to offer here a few remarks on
+the subject, and to notice a memoir published by Dr. DE POMMER, in a
+late number of Hufeland's Journal. The employment of this remedy in such
+cases, is not of recent origin, having been resorted to many years ago
+by the Swedish practitioners, and subsequently revived by the English.
+In Germany it has recently been used by Professor OSAN, and we believe
+particularly by Dr. DE POMMER, who appears to have prescribed it boldly
+in very many instances, and in some, after the ineffectual employment of
+all other anthelmintics. Dr. P. adds, that he never saw any bad effects
+resulting from its use, and that patients are very little liable to
+relapses when treated by it.
+
+Among the cases detailed by Dr. DE POMMER, we select the following, as
+calculated to show the manner in which the Dr. uses the remedy.
+
+"G.K..., a soldier aged 21 years, thin, tall, and who during his infancy
+had been subject to ascarides, has occasionally voided during more than
+10 years past, portions of taenia. He had used several purgative
+medicines, by which several yards of this worm had been expelled; but
+annoyed with so many attempts at obtaining its total expulsion, he had
+ceased, three years before, the use of all sorts of anthelmintics. But
+the phenomena resulting from the presence of the animal being
+aggravated, the patient applied for advice to Dr. DE POMMER, who found
+him labouring under the following symptoms:--Frequent pain in the
+abdomen, and especially in the umbilical region, accompanied with a
+sense of burning heat, and alternate distension and depression of the
+abdomen. Appetite sometimes keener than in health; at others nearly
+lost. In the morning before breakfast, the patient was seized with
+extraordinary weakness, and general uneasiness, accompanied with
+trembling of the limbs, ineffectual attempts to vomit, a sense of
+constriction in the throat, and a profuse salivation. All these symptoms
+disappeared after K... had taken food; but reappeared two hours after.
+Milk and farinaceous aliments were the only articles of which he could
+make use without an aggravation of his disease. The pulse was febrile;
+sleep good, but attended with dreams. The pupils were in the natural
+state. From the symptoms, and from the history of the case, Dr. P. was
+induced to make use of the oil of turpentine in the following manner.
+The patient was ordered in the morning, before breakfast, three table
+spoonsfuls of the remedy, at half an hour's interval. The first doses
+produced only a few borborygma. Two more table spoonfuls occasioned a
+vomiting of mucous matter. Three more table spoonfuls were exhibited,
+and followed by a stool of solid faeces, mixed with which were five small
+pieces of taenia. The patient not finding himself incommoded, took in the
+space of an hour, three more table spoonfuls of the remedy, after which
+he experienced some pain in the head, and vomited about one pint of
+bilious liquid. An hour after, the same quantity of the medicine was
+taken, and followed again by vomiting, but after a repose of half an
+hour K... discharged, per anum, firm and greenish faeces, and with them
+five ells of taenia. The urine discharged had the smell of violets. He
+again took a few spoonfuls of the vermifuge, which were not followed,
+however, with any faecal discharge, and only with some vomiting of mucus,
+and slight vertigo. In the afternoon the patient felt well, and
+experienced a great appetite, in which he indulged. From this moment he
+recovered, and has ever since enjoyed good health. The quantity of the
+remedy used was six ounces."
+
+It appears, from the observations of Dr. P., that the gastric irritation
+occasioned by the spirits of turpentine, has never amounted to
+phlogosis, and has generally subsided after the remedy had been
+discontinued. Nevertheless, as the spirit of turpentine is a very
+powerful stimulant, we would not venture to recommend its use, when
+there exists an inflammation in the gastro-enteritic system. We are
+aware that it is resorted to in burns, and highly eulogized in puerperal
+and yellow fever. In the first, it is certainly very useful, but on what
+principle we know not, except perhaps that its stimulus is different
+from that existing in the diseased part. But in the second case, it
+acts, not on the diseased surface, but by revulsion, on the mucous
+membrane; and as regards its virtues in yellow fever, we are rather
+sceptical in respect to what has been said on the subject. In this
+opinion we are supported by the testimony of our friend Professor RHEES,
+whose situation of house surgeon to the fever hospital, during the
+epidemic of 1820, afforded him ample opportunities of testing the
+propriety of the practice.
+
+In the number for March 1826, of the Revue Medicale, M. MAUDRU relates
+two cases in which large portions of taenia were expelled, and the
+patients cured, by means of a strong decoction of the bark of
+pomegranate. The first patient took, in one day, two pounds of the
+decoction made with four ounces of the remedy. The second patient took
+six ounces of the bark in decoction, in the course of forty-eight hours.
+In neither case did the medicine occasion unpleasant effects, with the
+exception, in the second patient, of slight colicky pains.
+
+28. _Action of the Oil of the Euphorbia Lathyris._--At a meeting of the
+Academy of Medicine, (section of pharmacy) M. BALLY read the results of
+some clinical experiments made by him at the hospital of La Pitie, on
+the action of the oil of the euphorbia lathyris. The preparation used by
+him, had been made by means of alcohol and expression. It appears to be
+a little more active than the other preparations. Administered to
+fifteen individuals of different ages, it did not produce very various
+results, nor prove very active in its purgative effects. As a purgative,
+indeed, it is far less active than the croton oil, and requires to be
+given in much larger doses; as much as six or ten drops. It has also the
+bad property of exciting emesis, by which it is rejected from the
+stomach. On the other hand, however, it does not, like the croton oil,
+produce salivation, and is, on the whole, regarded by M. BALLY,
+especially when fresh, as a useful purgative in diseases of
+children.--_Archives Generales, Decembre, 1825._
+
+29. _Medicinal properties of the Apocynum Cannabinum, or Indian
+Hemp._--In an essay on this plant, submitted to the medical faculty of
+Jefferson College, by Dr. M. L. KNAPP, we are informed, that in doses of
+15 or 30 grains it possesses emetic properties. It was besides, on
+trial, found to be cathartic, expectorant, diuretic and diaphoretic. It
+appears to have been generally administered in powder, and Dr. K.
+remarks, that "in decoction, it seems to lose some of its emetic
+properties, and to act more upon the bowels as a hydragogue cathartic."
+"The root possesses all the medicinal properties of the plant, and is
+active throughout, both in its cortical and ligneous portions. Water or
+proof spirit is its proper menstruum."
+
+This article was prescribed with success in dropsy, by Dr. KNAPP, and
+by Dr. PARRISH of this city. It was likewise used in intermittent fever,
+in bilious affections, amaurosis, hernia humoralis, dysentery, chronic
+rheumatism, &c. Dr. KNAPP appears to have derived benefit from its use
+as an alterative in a case of fever in a child, attended with disordered
+bowels. "The powders (gr. ii. each at intervals of three hours,) were
+regularly persisted in for a week, and the child's health went on
+gradually improving. Neither vomiting nor purging was produced, but the
+morbid heat and thirst were allayed, the stools became natural, the skin
+soft and moist, and the functions of digestion and assimilation were
+gradually restored, and the child is at this time fat and
+healthy."--_American Medical Review, &c. April_ 1826.
+
+30. _Remarkable effects from the external application of the Acetate of
+Morphia._--M. DUBOURG has recently published the result of an experiment
+made at the hospital de la Pitie, with the acetate of morphia, which we
+regard as sufficiently interesting to be noticed in this place. The
+patient had been affected twelve months before with puerperal peritoneal
+inflammation, complicated with cerebral symptoms, from which,
+notwithstanding a most energetic antiphlogistic treatment, she never
+entirely recovered. When she was admitted into the hospital, she
+presented the following symptoms:--"considerable emaciation; skin hot
+and pungent to the feel; pulse small and frequent; tongue of a pale rose
+colour, dry at the tip and edges, brown and smooth in the centre as far
+as the basis; severe pain on the least pressure on the epigastrium and
+over the whole abdomen; cardialgia, nausea, vomiting of all solid and
+liquid aliments, and during the empty state of the stomach, violent
+efforts to vomit occurring at irregular intervals; abdomen tense and
+tympanitic; violent intermittent pain along the course of the
+intestines; constipation; sensation of fatigue and lassitude in the
+lumbar region and in the extremities; dragging pains in the
+inter-scapular region; extinction of the voice; urine red and scanty;
+the face animated and bearing no marks of profound suffering; agitation,
+and total want of sleep."
+
+The disease was regarded as a chronic gastro-entero-peritonitis, and
+treated accordingly, by the antiphlogistic regimen; but no benefit was
+derived from this plan. The patient continued to vomit almost every
+thing she took, with the exception of sugar and a paste made with the
+Iceland moss. A blister was applied to the epigastrium on the 15th of
+February, seven days after her admission. Called to her assistance on
+the 22nd of February, on account of an aggravation of the vomiting, M.
+LAMBERT, one of the house pupils of the hospital, endeavoured to calm
+the symptoms by means of the acetate of morphia in powder, applied to
+the raw surface of the blister. Half a grain was used in this way, and
+in a few minutes the vomiting disappeared, and the patient passed a
+better night than she had yet done. M. SERRES having authorized the
+continuance of this method, M. DUBOURG the next day applied half a grain
+in the same way; and the patient slept the whole night. The remedy was
+applied every day with the same effect, and was gradually increased to
+two grains and a half. From the first application of the remedy, the
+symptoms gradually subsided; aliments were retained and properly
+digested; the pain and swelling of the abdomen disappeared, and on the
+14th of March the patient was regarded as in a fair way of
+recovery.--_Archives Generales, March_ 1826.
+
+In some remarks which accompany this interesting case, M. DUBOURG, seems
+to doubt the correctness of the first diagnosis, and to view the disease
+as a nervous, rather than as an inflammatory affection of the abdominal
+viscera.
+
+31. _Cure of Urinary Calculi by means of the internal use of the
+Bicarbonate of Soda._--At a late meeting of the Academy of Medicine, Mr.
+ROBIQUET read a memoir on the use of this salt in cases of urinary
+calculi. Having learnt from Mr. DARCET, that the use of the waters of
+Vichy changes the quality of the urine from acid to alkaline, Mr. R.
+conjectured, that this effect should be attributed to the bicarbonate of
+soda contained in them; and from this circumstance, he was led to
+administer this salt internally, in cases of calculi composed of uric
+acid. In July last, he made the experiment on a man 74 years of age, who
+had laboured under symptoms of the disease since the month of February,
+and in whom, by means of the sound, a small and soft calculus had been
+detected. Mr. R. ordered him 10 grains of the bicarbonate in the course
+of the day, dissolved in two pounds of water--prescribing at the same
+time, hip baths, injections, &c. At the end of fifteen days, much
+benefit had already resulted from this treatment; and in a month, the
+patient appeared to be cured. Nevertheless, the remedy was continued
+until November, when the patient passed through the urethra, a small
+calculus composed of uric acid, which appeared to have been the nucleus
+of a much larger one, the exterior strata of which had been worn off.
+From that period, the patient has not experienced any unpleasant
+symptom; but the sound was not resorted to, to ascertain whether the
+first calculus before felt, could be detected.--_Archives Generales,
+February, 1826._
+
+32. _Attempt to cure Abdominal Dropsy, by exciting Peritoneal
+Inflammation._--In the number of the London Medical and Physical Journal
+for April, 1826, a case of ascites is related by H. R. OSWALD, Esq. in
+which the cure was attempted to be effected, by exciting peritoneal
+inflammation. The following symptoms were noticed at the time of
+application for advice: the abdomen measured nearly six feet in
+circumference, was exceedingly hard and tense; but not tender. The
+patient "could hardly walk across her cabin from dyspnoea and
+debility, and the weight and tension of the tumour; which caused her to
+bend the body much forward, leaning her hands on her knees. The
+emaciation was very considerable; the appetite good; thirst
+considerable; tongue clean; pulse 120, and small; skin dry, harsh, and
+rough; bowels habitually costive; urine scanty." "This affection
+commenced about twelve months ago, after an obstruction of the
+catamenia for nearly a year, arising, as was supposed, from exposure to
+cold. The swelling was preceded by lancinating pains in the abdominal
+and lower part of the thoracic cavities, but which, after a few months,
+ceased entirely; and the disease had, in a chronic manner, gradually
+arrived at its present oppressive form."
+
+Paracentesis was performed several times; cathartics, diuretics, the
+lancet, blisters, and tonics were resorted to, with relief from some of
+the symptoms. The tumour, however, returned several times, so that M.
+OSWALD despairing of effecting a cure by following the same plan, and
+recollecting a case of ascites, which was cured apparently by an
+inflammation having supervened in the peritoneum, from the orifice made
+by tapping remaining open, attempted to produce the same effect in the
+present patient, by keeping the orifice of the wound open by means of a
+small tent. In this he partly succeeded, for in the course of a few
+months, all symptoms of the effusion had disappeared; health and
+strength had much improved, and the patient had experienced a return of
+the menstrual discharge, which had been suppressed for nearly three
+years.
+
+About a year afterwards, however, the disease returned. Paracentesis was
+again performed several times, and a tumour was perceived to have formed
+in the lower part of the abdomen. The patient died in about five or six
+months from the re-appearance of the effusion. On dissection, much water
+was found in the abdominal cavity, which was lined by a dense, white,
+and rough looking membrane, of a fragile and diseased structure. The
+intestines behind this membrane, were unusually small, and of a dark
+leaden colour. The tumour above alluded to, was discovered to be
+situated in the region of the right ovarium; it was a tubercular,
+carcinomatous, and pale coloured fungus, possessing a structure not
+unlike that of the placenta, and was formed in the interior of the sac,
+which being traced further back, was found to be the cyst of a dropsy,
+originating in the right ovarium at the fundus of the sac, or "more
+properly speaking of its neck."
+
+"The foregoing statement," Mr. O. remarks, "involves four facts and
+questions of considerable importance in pathology. 1st. The great
+quantity of fluids evacuated in so short a space of time: no less than
+ninety-six quarts in eight months, by four operations; and fifty-nine
+quarts from August to December, 1824, by three. 2nd. The variety in the
+nature, consistence and colour of these fluids. 3d. The possibility of
+curing ascites and dropsy of the ovaria, by exciting inflammation in the
+abdominal sac, either by the admission of air into it, or mechanical
+irritation; and 4th. The possibility of a thickening of the parietes of
+the abdomen by inflammation, or by an exudation of a carcinomatous sort,
+being mistaken for a tumour rising out of the pelvis."
+
+33. _Artificial Respiration._--Dr. J. WARE of Boston, relates in the New
+England Jour. for April last, that he was led by the experiments of the
+justly celebrated physiologist Mr. BRODIE, to employ artificial
+respiration in the case of an infant 9 weeks old, whose system was
+prostrated from an over dose of laudanum. "The action of the heart was
+reduced to an occasional throb; the pulse had entirely ceased, and the
+efforts at respiration, which for some time had consisted merely in an
+occasional gasp, became more and more unfrequent." The child had been
+afflicted for five or six weeks with hooping-cough, and had been very
+sick and feeble when the laudanum (about 15 drops) was administered.
+
+By means of the stem of a tobacco-pipe, artificial respiration was
+excited, and continued for several minutes: the action of the heart was
+immediately renewed, and the pulse could be again felt. At the end of an
+hour, during which the artificial respiration was repeated at intervals;
+"the respiration became natural, the pulse distinct and tolerably
+strong, and the heat began to return." A fit of coughing, preceded by a
+livid appearance of the forehead and face, arrested the breathing,
+"which did not return till assisted by the artificial process." The
+child, assisted by these measures, and by attention to the more usual
+means of recovery, struggled through the night, but died during a
+paroxysm of coughing in the morning.
+
+The conclusions of Mr. BRODIE are, that narcotics destroy life through
+the organs of respiration, and hence, if respiration can be artificially
+carried on until the effects of the narcotic subside, life may be
+preserved. Dr. WARE'S case would seem to confirm this idea; for it is
+_probable_ his patient would have recovered from the effects of the
+narcotic, if the paroxysms of coughing had not interfered.
+
+34. _Secale Cornutum._--Mr. CHARLES WALLER has lately published (London
+Medical and Physical Journal, April 1826,) several cases illustrative of
+the action and efficacy of secale cornutum. We have not room for any of
+the cases, and content ourselves with transcribing Mr. W.'s inferences.
+These are: "That the secale cornutum is a remedy which is capable of
+increasing the force of the uterine contractions in a most remarkable
+manner, under certain circumstances; but that the effect is doubtful,
+unless there be some degree of action present. In other words, that,
+although it will increase the contractions when already present, it will
+not always renew them when they are suspended.
+
+"That the effect is more certain if the infusion be of greater strength
+than is usually recommended; two drachms of the secale to six ounces of
+water being barely sufficient for the purpose.
+
+"That it appears to be a stimulus peculiarly fitted for irritable, and
+what are generally termed _nervous_ habits.
+
+"That the fears entertained by some practitioners of its proving
+detrimental to the child, are groundless.
+
+"But, although it is in general necessary, not only that there should be
+a disposition for labour, but that this process should have actually
+commenced, before we can expect the secale cornutum to have any effect
+upon the uterus, still one solitary case has indirectly come to my
+knowledge (and I will vouch for the authenticity of it,) where this
+remedy was given for the purpose of producing abortion in a female,
+about the second month of utero-gestation; and this effect was
+accomplished in a few hours after its exhibition."
+
+35. _Animal Magnetism._--This strange doctrine begins to acquire
+considerable vogue in France, and other European countries, from which
+it seemed to have been expelled, by the contempt and ridicule which it
+met with, from most of the learned of the latter part of the last
+century. ANTHONY MESMER, the great choroegus of the magnetic mummers,
+was born in 1733, and excited a vast deal of attention, by the enormous
+pretensions which he set forth on the subject of magnetism. MESMER came
+from Austria to Paris in 1778. He addressed the Academy of Sciences, and
+that of Medicine, but no attention was paid to him, till a commission
+was appointed to examine carefully into the merits of the question. This
+commission in 1784, so fully exposed the fallacy of MESMER'S theories
+and practice, that he soon afterwards quitted Paris, and retired to
+England under a feigned name. He subsequently went to Germany, and died
+in obscurity, in the year 1815.
+
+In December last, M. HUSSON (for himself, and MM. ADELON, BURDIN, MARC,
+and PARISET,) read a report to the Royal Academy of Medicine, on the
+question, whether it was fitting for the section to undertake new
+researches on animal magnetism, as it had been thought to be
+definitively settled by the decisions of 1784. The report concluded
+affirmatively, for several reasons; among which the principal seems to
+be, that magnetism has at present fallen into the hands of the learned,
+whereas it was formerly under the domain only of quacks and the vulgar.
+
+M. HUSSON'S report was discussed at subsequent sittings of the Academy,
+for the purpose of ascertaining whether a new commission should be
+appointed; and as this topic is certainly one of the greatest novelties
+of the day, we shall give some account of the discussions, making free
+use of the report of them, contained in the Revue Medicale, Mars. 1826.
+
+M. DESGENETTES, declared against the appointment of a commission,
+because he considered the magnetism of the present day, quite as much a
+matter of jugglery as that of 1784; and he informs us, that the
+publicity given to the report, had already increased the audacity of the
+magnetisers, who look on it as an approbation of their art.
+
+M. VIREY, regretted that the report had not spoken in strong terms,
+against the ridiculous practices, and shameful jugglery, which disgrace
+the cause of magnetism; he wished the committee had announced an
+intention, to make only physiological, or psychological researches, on
+the influence, which magnetism really appears to exercise on the nervous
+system; and gave his voice for the formation of a commission of
+experiments.
+
+M. BALLY, voted against it for several reasons, and among others,
+because of the fact announced by all the magnetisers, that the person
+who magnetises, acquires a sovereign power over the magnetisee; and he
+inferred from this, all the inconvenient and even dangerous consequences
+which may result to public morals!--Finally, he voted against it,
+because magnetism is ridiculed every where, because it is all darkness
+and confusion, and especially, because it being an inexhaustible mine of
+empiricism, the section ought not to lay open such a fertile field for
+those gentry who live by quackery.
+
+M. ORFILA, (eheu!) defended the propositions of the reporters. It is
+opposed, said he, on the three grounds following: 1st. Because the
+section has not been invited to the examination now recommended. 2nd.
+Because magnetism is nothing but juggling. 3d. Because commissions will
+not commonly do any work. The first ground is not correct: M. FOISSAC, a
+physician of Paris, has invited our attention to it, and offered to
+subject a magnetic somnambulist to its exploration; and very reputable
+physicians, members of the Academy, MM. ROSTAN, (the ramollissement man,
+is his head soft too?) and GEORGET, have in their recent publications
+called the attention of the learned to this subject. Secondly, if there
+be any jugglery, in the magnetic phenomena we are told of; it is
+nevertheless certain, that the whole of them are not simulated. The
+testimony of well taught physicians, ought to be received on this head.
+That the phenomena are extraordinary, is no argument; for those of
+electricity must have been quite as marvellous, at the period of their
+discovery, &c. &c.
+
+M. DOUBLE, blamed the report as being nothing more than an apology for
+magnetism, which is tarred with the same stick as that of 1784, and only
+modified a little, by the esprit de notre temps, &c. &c. He said he had
+made magnetism a special subject of study, and _never saw a phenomenon
+produced by it_.----He thinks the commission could only do injury to
+science, and compromit the Academy, &c. &c. He would vote against the
+appointment, and advised the section to wait until some scientific
+memoirs should be sent to it.
+
+M. LAENNEC, agreed with M. DOUBLE, because after studying the subject
+for twenty years, he is satisfied, that it is almost nothing but
+deception and juggling; although, when he commenced the study, he was
+prejudiced in its favour. According to M. LAENNEC, among the magnetic
+influences, there are several, attributable to the impressions, which
+one individual naturally makes on another in correlation with him; and
+he cited a mistake, which he saw committed by a somnambulist woman. She
+was magnetised by two persons, one of whom was handsome, but
+anaphrodisiac, the other ugly, yet possessing in integrity, the genital
+faculties. She received no impression, except from the first individual;
+so that the impression which this female had received by the organs of
+vision, before the experiment, superseded that, which the pretended
+magnetic sense ought to have made on her. He thinks, the academy ought
+to _observe_ the magnetisers, but what he has seen, has convinced him,
+that nine-tenths of the facts in magnetism are supposititious. The
+phenomena effected by magnetism, and the oracles uttered by the
+somnambulist, vary with every magnetiser. MESMER excited convulsions;
+DESLIN effected crises, such as are seen in diseases. The somnambulists
+of Mr. DELEUZE, a learned man, are much better taught than those of
+PUYSEGUR, who is ignorant of the sciences, and finally, Mr. LAENNEC has
+seen a somnambulist under the direction of a pharmacien, who was quite
+distinguished, by the art with which she compounded the medicines, she
+recommended. The discussion was now adjourned to the next sitting.
+
+On the 24th of January, it was resumed.
+
+M. CHARDEL, bears witness to a reality of the magnetic phenomena, as he
+has witnessed them himself, in a case of what is called somnambulism. He
+dares not pronounce on the question of magnetism, as a therapeutical
+agent; but is disposed to think it ought, if ever, to be used with great
+reserve. Whether it consist of nervous phenomena of a particular order,
+or whether it be a product of the imagination, in either case, it
+deserves to be studied, &c. &c.
+
+M. RONCHOUX, thought the proposed examination would be impossible; for
+the magnetisers assert, that if one of the parties have a will opposed
+to that of the magnetiser, no phenomena can be produced. Their confessed
+inability to surmount any opposite will, seems to Mr. RONCHOUX, an
+invincible obstacle to any exploration to be attempted by a commission.
+
+M. MARC, gave some explanation of the labours undertaken in Germany.
+According to the opposition, nothing conclusive can be derived from
+these labours; because Germany is the native soil of sects and of
+thaumaturgae but, Mr. M. proved by citations, that they are not to be
+attributed to excited imaginations, as has been urged, but to the most
+celebrated Savans of that country, as for example, OERSTDT, KLAPROTH,
+and HUFELAND, to learned bodies, and to governments. The Royal Academy
+of Berlin, offered in 1818, a prize of 3300 francs, for an essay on this
+topic.
+
+The governments of Prussia, Russia, and Denmark, have founded medical
+commissions for the examination of it, and subjected its therapeutical
+application to certain regulations. He thought, therefore, that the
+Academy could follow without compromising its dignity, such good
+examples. He added, that the examination was absolutely necessary,
+unless they desired that every French practitioner should hereafter
+reject the whole subject, and for ever abandon its employment to
+jugglers and credulous fools.
+
+M. NACQUART thought, that as magnetic somnambulism is something wholly
+independent of organical, physical, or physiological laws; that as the
+senses here have no need of organs; as time, space, and intermediate
+bodies, wholly disappear; we can avail ourselves of no method of
+appreciating magnetical facts, and consequently, the Academy ought not
+to trouble their heads about it--a very good joke truly: but M. ITARD
+said, that jokes had nothing to do with the question, because they are
+meant only for the abuses and extravagancies of magnetism; but we want
+to get at the truth, and to eschew the folly. Magnetism, says he, is
+either a real or imaginary agent; it ought to be examined. To refuse
+this, is to despise the path of experiment, which can alone lead to
+truth, &c. &c.
+
+M. RECAMIER, could add nothing to the observations of MM. DESGENETTES,
+BALLY, and DOUBLE; but he wished the section to know, that he been a
+witness to the magnetic phenomena--he had been present at the oracles of
+the marichale of M. DE PUYSEGUR, who was represented as the most lucid
+of all possible somnambulists. He had reason to suspect a cheat in this
+case, as he was denied the means of dissipating his doubts; and heard
+this woman repeat what he had before said to the patient himself. How
+ridiculous, moreover, is it, to hear one drachm of glauber's salt
+prescribed as a transcendental remedy for phthisis pulmonalis! He also
+attended at the Hotel Dieu, at experiments made on one woman and two
+men. He saw the woman go to sleep (as was asserted,) at the simple will
+of the magnetiser, who for that purpose was concealed in a closet of the
+apartment. The only mode adopted, to prove that she was really asleep,
+consisted in some slight pinching of her ears, and some noises; yet, in
+the recital, these slight impressions have been transformed into most
+painful tortures. In the experiments made on the men, he employed a more
+powerful proof, which was the application of moxa; and that he did,
+because it was indicated by a coxalgia, with which the patient was
+affected: it is _a fact_, says he, that the man did not awake, or show
+_the slightest sensibility_. Mr. R. believes, therefore, in magnetical
+action; but does not think it can ever be available in the practice of
+physic. In Germany, said he, where magnetism is so much employed, do
+they cure better than elsewhere? And has magnetism been the occasion of
+any therapeutical discovery any where? In somnambulism there is only a
+disordered sensibility, and not an increase of it; and the pretended
+clairvoyance of the somnambulists, has no real existence, &c. &c.
+
+M. GEORGET, cited in proof of the existence of magnetic power, the names
+of many physicians, members of the Academy, as MM. ROSTAN and
+FOUQUIER--he cited the experiments made at the Hotel Dieu, by Dr.
+DUPORTET, in the presence of many members, who had signed the results,
+as MM. HUSSON, GEOFFROY, RECAMIER, DELENS, PATISSIER, MARTIN, SOLON,
+BRICHETEAU and KERGARADEC. If there be any analogy between magnetic and
+natural somnambulism, ought we to be astonished at the production of the
+former by certain practices? The magnetisers conceal nothing, but
+publish all their proceedings, and do you call these the tactics of
+jugglers and charlatans?
+
+M. MAGENDIE thought the examination expedient, and wished commissioners
+to be appointed to examine the somnambulist, offered by Dr. FOISSAC.
+
+M. GUERSENT was in the affirmative: he himself had magnetised, and
+witnessed several phenomena, &c.
+
+The discussion was then adjourned to the next setting, and on the 14th
+February, after hearing M. GASC against, and M. LHERMINER for the
+report, M. HUSSON the reporter was heard. The section then closed the
+discussion, and it was decided by a majority of ten, (35 to 25,) that a
+commission should be appointed to examine animal magnetism.
+
+We are indebted for the above account to the Revue Medicale for
+March--the No. for February, also contains a review of M. DUPAU'S
+Lettres Physiologiques et Morales sur le Magnetisme Animal, 8vo. Paris,
+1826. In order to show our readers how they manage these matters, we
+shall translate the following from p. 269.
+
+"Here, says M. ROSTAN, is an experiment that I have often repeated, but
+which I was finally obliged to interrupt, because it fatigued my
+somnambulist prodigiously, who assured me, that if I continued, it would
+make her go mad. This experiment was made in presence of my colleague
+and friend, M. FERRUS. I took my watch, which I placed three or four
+inches from her occiput. I asked my somnambulist, if she saw any thing:
+"certainly, I see something that shines; it hurts me." Her countenance
+was expressive of pain, and ours expressed astonishment. We looked at
+each other, and M. FERRUS breaking silence, said, if she sees something
+shine, she can doubtless tell what it is. "What do you see that
+shines?--Oh! I don't know, I can't tell. Look at it well--Stop, it
+fatigues me, wait--(and after a moment of great attention) _It's a
+watch_." More astonishment. But, if she sees the watch, said M. FERRUS,
+she will doubtless see what o'clock it is. "Could you tell me what
+o'clock it is?--Oh! no, it is too difficult." "Look at it, try." "Wait
+then, I'll try; may be I can tell the hour, but I never shall be able to
+see the minutes;" and after the greatest attention--"It wants ten
+minutes of eight o'clock:" which was exact. M. FERRUS now desired to
+make the experiment himself, and repeated it with the same success. He
+made me turn the hands of his watch several times, and when presented to
+her (occiput we suppose,) without her having seen it, she never made any
+mistake."
+
+These statements we have thought fit to lay before our readers, who will
+observe the respectable names which are connected with them. We shall
+seize the first opportunity to give the report of the new commission,
+and if they confirm the miracles, we can still say, credat Judaeus
+apella. If it will make no cure, it will probably make much pay; since
+MESMER got upwards of 340,000 francs for his mumming exhibitions, to the
+_spectacle_ loving quidnuncs of Paris. The commission consists of 11
+members, viz. LEROUX, BOURDOIS, DOUBLE, MAGENDIE, GUERSENT, LAENNEC,
+THILLAYE, MARC, ITARD, FOUQUIER and GUENEAU DE MUSSY.
+
+36. _Sketch of the Medical Literature of Denmark, Sweden, and
+Norway--by_ Dr. C. OTTO, _of Copenhagen, apud Bulletin des Sci. Med.
+Feb. and March._--"Denmark is richer in medical literature, than the
+other countries which in conjunction with it, composed the ancient
+Scandinavia. Although it does not in this respect, bear a comparison
+with France, Germany, England, and Italy, nevertheless, medicine, of all
+the sciences, seems to be that which is most successfully cultivated,
+and Copenhagen contains a great number of learned, and able physicians."
+In proof of what Denmark has done, Dr. O. refers us to the great names
+of the two BARTHOLINS, of STENO, of WINSLOW, of CALLISEN, &c.
+
+"In the 16th century, Denmark possessed the anatomical works of the two
+BARTHOLINS: (_Instit. Anatomicae de vasis lymphaticis, &c._) and other
+works of the same kind, which have been translated into all the
+languages of Europe. STENO, the disciple of THOMAS BARTHOLIN, followed
+the career of his master, with an equal success. HALLER never spoke of
+this anatomist, without the highest admiration. RODE enriched the
+literature of Germany and Denmark, with works which have made his name
+illustrious, wherever science is cultivated. Among these, we may chiefly
+distinguish his Bibliotheca, and Materia Medica." The Danes are indebted
+to him for several popular works on medicine, which are in the judgment
+of Dr. OTTO, chef d'oeuvres of this sort of writing. He published more
+than 13 volumes on these topics. "To the celebrated CALLISEN, who is
+recently deceased, we are indebted for 1st, a _Systema Chirurgiae
+Hodiernae_, a work of the highest merit, and which has reached a fourth
+edition. 2nd, a Medical Topography of Copenhagen, published in Danish.
+(2 _vols._ _8vo. Copen._ 1807.) 3d, the Director of the Academy of
+Surgery. He is also the author of several important memoirs, inserted in
+those of the _Roy. Soc. of Sciences_, of Denmark, and in some other
+collections. The late professor MATH. SAXTORPH, composed an excellent
+_manual of labours_, for the use of midwives. A second edition with
+plates, appeared in 1804. T. L. BANG, has given a _Praxis Medica_, an
+excellent guide to young physicians in their first outset in practice.
+HERHOLDT has shed some lustre on Danish Physiology: his dissertations on
+the life of the foetus, and on the question, whether vision is
+performed with both eyes, or with one only, bear testimony to his genius
+and penetration: he is also author of a memoir on penetrating wounds of
+the Chest, inserted, as well as the former dissertation, and many other
+pieces, in various medical journals.
+
+"TYSCHEN published in 1804, a _Treatise on Pharmacy_, in Danish; and
+professor MYNSTER, gave a work on Pharmacology, of which two volumes
+only had appeared, when death interrupted his useful labours. In 1794,
+he commenced the publication of a journal, the _Bibliothek for Physik
+Oeconomic og Medicin_, which was continued in 1799, by BAHN, and
+afterwards under several names, till 1807. We now come to the existing
+state of Danish medical literature.
+
+"The Royal Medical Society of Copenhagen, which, without contradiction,
+holds the first rank among those of Scandinavia, celebrated its 50th
+anniversary in 1822. It publishes at irregular periods, its memoirs,
+under the title of _Nova Acta Societatis Medicae Havniensis_. The last
+volume appeared in 1821. Professor JACOBSEN, is ardently devoted to the
+study of Comparative Anatomy, and has published several works on the
+subject, inserted in the Mem. of the Roy. Soc. of Sciences, extracts
+from which have appeared also in several foreign journals. The
+collection we have just now cited, (for 1824, V. I.) contains a memoir
+of Dr. GARTNER, which confirms the opinion entertained by the ancients,
+as to the presence of a glandular body in the uterus of some animals.
+The author has added a plate to this interesting dissertation. Dr. OTTO
+has enriched the physiological sciences with his _Phrenology_, and is
+zealously occupied with all that relates to this subject. Professor
+WENDT, physician to the General Hospital of Copenhagen, has recently
+published several small medical works. We may cite his _Historical and
+Chemical Supplements, to the knowledge of some therapeutical agents, of
+the class Euphorbiae_; some notices on _small pox_, _vaccina_, and
+_modified small pox_.
+
+"Denmark possesses three periodical journals of medicine, without
+counting those of the Royal Societies of Sciences and of Medicine of
+Copenhagen. The first and best of these journals, is the _Bibliothek for
+Laeger_, published by a society instituted for the advancement of medical
+studies. CLASSEN, the founder of this association, bequeathed to it a
+sum of money, to purchase annually, some foreign medical works. This
+collection is composed of original memoirs, extracts, and announcements
+of other works, and a review of the _course_ of the faculty of medicine.
+It is specially consecrated to the practical department of the
+art--(three numbers per ann. of 70, to 100 pages each.) The 2nd
+collection, is the _Nye Hygaea_, the editor of which, (M. OTTO,) embraces
+in his plan, all the medical sciences. This journal, although specially
+devoted to physicians, is in reach of all those persons of education,
+who can be interested in a variety of important medical questions. It
+contains original memoirs, and extracts from foreign works, (five leaves
+per month.) The 3d collection, Archives for the History of Medicine in
+Denmark, (_Archiv. for laegevidens kabens historie in Danmark_,) does not
+appear periodically, but at indefinite times. Professor HERHOLDT, the
+editor, has only published one number, in 1823.
+
+"As to inaugural dissertations for the doctorate, the number amounts
+only to three or four in the space of ten years; because the title of M.
+D. is not requisite to the practitioner in Denmark."
+
+The above is taken from the Bulletin for February, the ensuing portion
+of the sketch is contained in the March number of the same journal.
+
+"The medical literature of Sweden, must have been very insignificant in
+past ages, if we may form an opinion, from the total want of documents
+in relation to it. There existed no scientific lien between the
+physicians of that country, or even among those of the capital. A
+medical society might in vain have been sought for there, at a period,
+when they were common in all other countries. The Royal Academy of
+Sciences, published some essays relating to medicine, from time to time,
+but until 1807, a work on this topic was regarded as a sort of rarity.
+However, in the course of that year, seven physicians of Stockholm,
+united in order to found a society, which received the royal sanction,
+and took the title of _Svenska Loekare Soellskapet_, (_Society of
+Swedish Physicians_.) This institution, seemed to communicate to the
+practitioners of Sweden a new existence, and then really commenced the
+aera of medical literature in that country. The number of works published
+since that period, has scarcely amounted to more than one or two per
+annum. Dr. RABEN is the author of three works, which, though not large,
+give evidence of considerable knowledge and penetration: Their titles
+are: 1st. De praecipuis causis mali Scrophul. ejusque remediis
+Commentation. Lund. 1807. 2nd. A second volume on the same subject,
+written in the Swedish language, Lund. 1819. 3d. Observationes in
+Syphilidem, ejusque curationem, ubi novae quoque proponuntur curandi
+rationes. Lund. Goth. 1821.
+
+"We shall also mention among the works recently published in Sweden,
+1st. A biographical and literary gallery of the physicians of that
+country, from the reign of Gustavus I. down to our own times, by Dr. J.
+F. SAKLEN. 2nd. FLORMANN'S Manual of Anatomy. Finally, a collection of
+the laws of the kingdom, which relate to medicine. The Medical Society
+of Stockholm, regularly publishes its transactions, _Svenska Loekare
+Soellskapets Handlingar_, the 10th vol. of which has just appeared. In
+it, are some remarkable cases, a table of the constitution of the
+atmosphere, and of the diseases which have prevailed at Stockholm, and
+in its environs; reports on the hospitals and baths of the whole
+kingdom; extracts from Medico-legal Examinations, recent discoveries,
+&c. M. ECKSTROM promises to publish a complete description of the
+variolous epidemic, which prevailed last year at Stockholm, and in the
+provinces. Besides these transactions, the secretary makes an annual
+report, on what passes at the sittings. To this he adds, short notices
+of the most interesting recent discoveries and observations, which he
+derives from foreign medical literature. He publishes this collection
+once a year, and adds some nosological articles. In closing this review,
+we ought not to forget to mention the collection of theses, defended at
+the university of Upsal, which is published yearly by Dr. ZETTERSTROM."
+
+37. _Erysipelatous Mumps or Angina Parotidiana._--Dr. BEHR of Bernberg,
+has published in the _Journ. der Pract. Heilkund for July_, 1825, an
+account of this disease, which we find in the _Bulletin_ for Feb. 1826.
+Dr. BEHR'S "memoir is intended to pourtray the principal features of an
+epidemic prevalence of parotitis at Bernberg, in the months of
+December, 1822, and January and February, 1823. Dr. B. attributes it to
+the frequent and sudden variations of the atmosphere at that period." He
+says, "the disease is so rare in this country, that physicians of 30
+years standing had never met with it before." Bernberg contains 6000
+souls; it is divided into two parts by the Saale, and it is situated on
+the great road from Leipsic to Magdeburg, in a narrow valley, which runs
+from N. W. to S. E.
+
+The precursory symptoms were rigors followed by heat, heaviness of the
+limbs, pains in the joints, especially in the evening, sense of tension
+in the region of the lower jaw, and sometimes a difficulty in
+mastication. The appetite was usually natural, with gastric symptoms
+only in the most severe cases. On the evening of the 3d day, there was
+an increase of uneasiness with chills and heat, after which the patient
+commonly enjoyed sweet sleep. The next day, on awaking, he felt
+tolerably well, and had no more sense of heaviness in his limbs, but his
+face was swelled on one or both sides. Speech and mastication were
+effected with difficulty; the lower jaw was _comme engourdie_, and a
+dull pain was felt in the ligaments of the joints; the tumefaction
+increased and soon extended from the ear to the cheek. On a careful
+examination, it was found to affect the parotid gland, and the
+surrounding cellular tissue. The tumour was hard, diffused, and not very
+painful, except on pressure. The colour and temperature of the swollen
+part were natural. In the evening, the pulse became hard and
+accelerated, the tongue white, the stools more consistent than common,
+and the urine pale. The following night he was agitated, frequently
+awakened by lancinating pains in the affected part, and sometimes by a
+sense of tension in the head. The following day, the tumour reached its
+maximum of elevation, and sometimes comprised the submaxillary glands of
+the same side. From this time, the pains did not increase, and the skin
+became slightly red only in a very few examples.
+
+The disease having thus reached its acme, a gentle sweat commenced
+behind the ears, then extended over the whole tumour, and remained as
+long as the swelling lasted. This evening there was no fever, but a
+gentle perspiration continued throughout the night. The day following,
+being the 6th of the disease, the tumour was evidently diminished, and
+continued decreasing until its final disappearance, which occurred on
+the 9th, and sometimes on the 7th day. Until this period, abundant local
+perspirations in the day-time, less abundant, but more general ones in
+the night, were observable. When the disease was critical by urine with
+sediment, the diminution of the swelling was dated from this appearance;
+but the resolution was not perfected in some cases till the 14th day,
+and in such cases, the integuments of the part were covered with a mealy
+desquamation. Dr. BEHR did not observe any metastasis to the genitals,
+but he saw cases, in which the disappearance of the swelling, was
+followed by considerable fever with _augoisse_, and then an oedema,
+commonly situated on the head.
+
+He often saw the termination by induration, but this soon yielded to a
+proper treatment. As to the contagion of mumps, the author thinks, it
+can only occur where there is desquamation of the integuments; and
+remarks on the analogy of this circumstance, with what occurs in
+scarlatina. Dr. BEHR thinks, that antiphlogistics are rarely indicated
+in the treatment of parotitis.
+
+38. _Taenia._--In several cases in which gum. gutt., salts of tin, and
+other medicines, were unsuccessfully used for the expulsion of tape
+worm, Dr. BOUGARD succeeded in expelling them with pills compounded as
+follows: Merc. dulc. Extr. aloes, aa. gr. iij. divided into three pills.
+This dose was given every evening for eight days, and gradually
+increased or diminished, so as to procure three stools per diem. A
+rigorous diet was observed during this treatment.--_Rust's Magazin fur
+die gesamte Heilkunde apud Bulletin des Sci. Med. March_, 1826.
+
+39. _Scrophula._--Dr. WETZ recommends the employment of caustic potassa
+in scrophula. He dissolves x grs. of caustic potassa in one ounce of
+orange-peel water, and gives from xij to xx gtt. four times a day, in a
+cup of broth. A solution of caustic potassa in six ounces of distilled
+water, is applied as a wash to the ulcers.--_Ibid._
+
+40. _Digitalis._--We find in the Propagateur des Sciences Medicales for
+Feb. 1826, an account of the directions of Dr. NEUMANN of Berlin, for
+the employment of digitalis in pulmonic diseases: they are said to be
+the result of long experience. Digitalis is useless, says the writer, in
+all cases of suppuration of the lung, consequent to tubercles of that
+organ. It is of no avail in those suppurations, which succeed
+inflammatory haemoptysis. It is employed without success in _local_
+phlegmorrhagies of the lungs; but it almost invariably cures those
+chronic catarrhs, which depend on a state of erethism of the mucous
+lining of the bronchiae. This disease is sometimes called chronic
+bronchitis, sometimes mucous consumption, pulmonic catarrh, and
+galloping consumption. If the diagnosis in this case be well made out,
+hopes may be entertained of a cure, one of the two following conditions
+being present:
+
+A. The patient must be susceptible of the stimulant action of the
+remedy: this is often not the case. We may be sure the digitalis will
+not produce its effect, where the pulse of the patient remains _uniform
+and frequent after he has taken it for several days_. It does not suit
+such persons.
+
+B. The medicine ought to be administered in a proper manner. To be good,
+the leaves, even in the dried state, should be perfectly green and free
+from any brown spots. Two ounces of the leaves, should be infused in six
+ounces of boiling water; and the patient may take a table spoonful every
+hour, until he feels nausea, or a sense of constriction in his throat,
+or flashing of the eyes, or irregular pulse. The use of the foxglove
+should then be interrupted for seven or eight days, in which interval,
+the full action of the medicine is developed, the pulse remaining
+irregular, and the mucous secretion diminishing gradually. If the first
+trial does not remove it entirely, a second course may be commenced
+after a few days.
+
+FOOTNOTES:
+
+[29] Series of Engravings to the morbid anatomy; fasc. 1. pl. 6. fig. 1,
+2.
+
+[30] Lond. Med. Review; vol. 4.
+
+[31] Pathological Researches; Essay 1.
+
+[32] Medical Researches on the Effects of Iodine in Bronchocele,
+Paralysis, Chorea Scrofula, Fistula Lachrymalis, Deafness, Dysphagia,
+White Swelling, and Distortions of the Spine. By Alexander Manson, M.
+D., &c. London, 1825.
+
+[33] Carthamus Tinctorius.
+
+
+V. SURGERY.
+
+41. _Dr. Physick's operation for artificial anus, denied to have been
+performed!_--We have often had occasion to remark the claiming, and, we
+fully hope, the actual re-invention of American operations and practices
+among physicians on the other side of the Atlantic. As we are not a
+publishing people, it is, perhaps, not very strange that the French and
+English should be generally unacquainted with the discoveries and
+inventions which have been made among us; but here comes an actual
+denial of the invention having ever taken place!
+
+Every American who has any pretensions to the character of a surgeon, is
+most probably familiar with the proposal and performance, by Dr.
+PHYSICK, of a peculiar operation for those cases of artificial anus,
+where the two ends of the divided or opened intestine adhere laterally
+to each other, in the manner of a double-barrelled gun. We are now told
+that M. RICHERAND, in his new work "On the recent progress of Surgery,"
+"avoids giving this the least confidence." (Archives Generales, Janvier,
+1826.) The reviewer in the Archives, in a paroxysm of angry jealousy for
+the honour of French surgery, deeply wounded, as he conceives, in the
+_admissions_ by M. RICHERAND of discoveries and inventions among the
+English and others, adds no small amount of ill-nature to this unworthy
+intimation, and makes the observations which we have translated below.
+
+It is certainly an easy method of erecting reputations, to deny,
+directly, the priority of others in operations which a favourite has
+repeated. No matter though the knowledge of this priority be widely
+diffused; if readers can, by means of national predilections, be induced
+to place confidence in your denial, the effect, as far as relates to
+them, is completely obtained. Yet one would think it an ungenerous act,
+to call in question, and before partial judges, the veracity of such men
+as are here named. Where a physician reports cases which agree too well
+with his preconceived theories, we doubt the correctness of his
+observations; and with justice: for we know that an already formed
+belief will greatly tinge the most honest seeings and hearings of very
+sensible and honourable heads. But this is a far different thing from
+impeaching, in a manner entirely gratuitous, the moral honesty of the
+record of a historical fact, made by men at the head of their
+profession.
+
+The reviewer, Mr. and probably Dr. L. C. ROCHE, comments as follows:
+
+"1. Dr. PHYSICK never published any thing on this subject.
+
+"2. Dr. DORSEY, who makes the claim for him, never published the work in
+which he does so, [the Elements of Surgery,] till 1813.
+
+"3. In the English journal (?) and in that work, he contents himself
+with a simple assertion, without giving either the date of the
+operation, the name, age, or sex of the patient, the names of his
+assistants, or the details of the operation; _all points which men never
+forget to make known, when treating of the first attempt in a new
+operation of this importance_."
+
+To the first of these comments we reply, that Dr. PHYSICK, to the great
+regret of his countrymen, has never been in the habit of publishing; but
+still possesses many useful improvements in medicine and surgery, which
+he has not committed to the press. On the other hand, however, he has
+taught this operation annually, to from three to four hundred pupils, in
+his lectures, during about twelve successive years; and this is no mean
+substitute for a publication in types. M. ROCHE'S memory will supply him
+with an instance of an eminent French surgeon, whom we shall not attempt
+to defraud of his laurels, who also made it his practice to leave the
+publication of his observations and improvements to his pupils.
+
+To the second remark, the above is also a sufficient reply; but we will
+add that it was recorded in the case book of the Pennsylvania Hospital
+in 1809.
+
+Our comment on the third observation of Mr. ROCHE may be brief. It is
+that we promise an account of the case for the next number of this
+Journal. In the mean time, the patient was well known to us and to many
+persons now living. The operation was performed in 1809.
+
+In reply to that portion of the last observation, which we have marked
+with italics, we can assure the reviewer that he is mistaken; at least
+with regard to this side of the ocean. We Americans are a very peculiar
+people, and but little affected, as yet, with the cacoethes scribendi; a
+malady which the present work, in its humble sphere, is designed to
+disseminate. We are not in the habit of frequently publishing, and above
+all, of publishing volumes. Books are dear, private libraries small,
+public ones few, and encouragement for even the best original
+publications but limited. Of this we have known some melancholy
+instances. It is impossible for either a Frenchman or an Englishman to
+judge correctly of a country, which, in many important respects, is in
+such a different situation from his own.
+
+It is a thing of by no means uncommon occurrence here, to make a
+valuable discovery or improvement in the healing art, and not to make it
+public. A striking instance of this fact, at least with the exception of
+the insertion of an imperfect account in the Eclectic Repertory, which
+very probably never reached England, is mentioned in our last number. We
+allude to the extirpations of diseased ovaria, by Dr. M'DOWALL, of
+Kentucky. Here a unique and brilliantly successful operation was
+performed, successful as yet beyond European imitations, and still the
+inventor and achiever of it did not possess vanity or industry
+sufficient to treat the public with a full account of it. M. ROCHE may
+find it hard to explain modesty of this species; but we can promise him,
+should these sheets ever reach his eye, and he still continue skeptical,
+abundance of proofs, and some more instances of the same kind.
+
+42. _Gangrenous Sore Mouth of Children._--Dr. COATES begs permission to
+add the following quotation from FABRICIUS HILDANUS to the authorities
+quoted in his paper on gangrenous ulcer of the mouth, at the
+commencement of the present number.
+
+"Gingivarum inflammatio maxime in infantibus in gangraenam interdum
+degenerat. Morbus enim magnus, vehemens et peracutus; magna quoque
+requirit remedia: sed quis illa in ore adhibere ausus?"--_De Gangraena et
+Sphacelo, Cap. IV. p. 773. col. 2. Edit. Beyeri. Francofurt ad Maen._
+1646.
+
+"Gangraena in partibus humidis, gingivis, palato, naribus, &c. raro
+sanabilis; in sphacelum autem degenerans, insanabilis."--_Cap. XI. p._
+781. _col._ 2.
+
+This is all I find in that author, relative to the subject.
+
+43. _Operation for Phymosis._--M. J. CLOQUET, has so improved this
+operation that no deformity results. He recommends the incision to be
+made at the _inferior_ surface, near, and parallel to, the fraenum
+praeputii. The longitudinal wound thus made, becomes transverse, as soon
+as the prepuce is drawn behind the glans penis, and cicatrizes in a line
+scarcely visible; so that the prepuce acquires in breadth what it loses
+in length. M. CLOQUET has, in this way, perfectly cured many patients;
+the prepuce appearing to possess its natural conformation.--_La
+Propagateur des Sci. Med. for March._
+
+44. _Lunar Caustic on Wounds and Ulcers._--The practice of healing
+wounds and ulcers by natural or artificial scabs, to which the attention
+of the profession was first directed by Mr. J. HUNTER, has been too much
+neglected, and the circumstances under which it is useful, have not been
+accurately stated. In a small work published by Mr. HIGGINBOTTOM, in
+January last, at London, the practice of forming an _eschar_ by the
+lunar caustic over small ulcers and recent wounds, has been strongly
+recommended as saving the patient much pain, trouble, and danger. The
+whole surface is to be pencilled with the solid caustic so as to form an
+eschar, and where this remains _adherent_, the wound or ulcer invariably
+heals with comparatively little inconvenience. When effusion occurs
+under the eschar, whether of serum or of pus, there is more difficulty;
+but if this fluid be evacuated by a puncture, and the caustic applied to
+the orifice, the eschar will often remain adherent. Sometimes the fluid
+must be frequently evacuated. If the eschar does not separate
+favourably, a cold poultice may be applied, which not only removes the
+eschar, but lessens the irritation and inflammation. Should the sore not
+be healed, Mr. H. recommends the reapplication of the caustic. To
+prevent effusion under the eschar, and to preserve it adhering, he
+advises the whole to be covered with a piece of gold-beater's skin; but
+we may add, that as this effusion arises from too much inflammation,
+more powerful means may occasionally be employed, especially a solution
+of acetate of lead. LARREY recommends with the same view, after the
+application of moxa, the use of the aq. ammoniae. Indeed any evaporating,
+cold, astringent lotion will be advantageous.
+
+The application of the caustic, of course, produces some pain, but this
+soon subsides, and the patient experiences more ease than under any
+other mode of treatment.
+
+_Particular cases in which the Caustic is useful._--In punctured wounds,
+it should be applied to the orifice and surrounding skin, and the eschar
+allowed to dry. The terrible effects of punctured wounds, are thus
+completely prevented, whether caused by needles, hooks, bayonets, &c. So
+also of wounds from saws; of bites from leeches and animals; of the
+stings of insects; and especially of those small scratches, and
+punctures, received in _anatomical dissections_. The danger of these
+last mentioned accidents may, according to Mr. H., be completely
+arrested by the prompt and free application of the lunar caustic. Even
+in neglected cases, when a small tumour has formed under the skin,
+attended with a smart stinging pain, he advises the tumour to be
+removed, and an adherent eschar to be formed by the caustic; and in
+still more neglected and advanced cases, where inflammation of the
+absorbents has supervened, "a free crucial incision is to be made, the
+caustic to be freely applied, and afterwards, the cold poultice and
+lotion; the usual constitutional remedies being actively enforced."
+
+In _bruises_, especially of the shin, the adherent eschar from lunar
+caustic, has, with Mr. H., always effected a cure; and even when a
+slough has been produced, the application of the caustic will moderate
+the inflammation.
+
+In _ulcers_, which are small, not exposed to friction or motion, and
+discharging little, the cure by eschar will be preferable; especially in
+those little irritable and painful ulcers often seen about the ancle and
+tendo Achillis. Apply first a cold poultice, and then form the eschar,
+which may be freely exposed to the air. Should the matter, nevertheless,
+collect, it should be evacuated by puncture as often as necessary, until
+the eschar remains adherent.
+
+This practice is recommended by Mr. H., in various other affections; as
+in inflammation of the fingers; in the fungous ulcer of the navel in
+infants; in _tinea capitis_, &c. In this last case, we have ourselves
+used it with marked advantage. In all cases, the lunar caustic has a
+decided effect in _diminishing the irritability_ of the parts to which
+it is applied; and hence should usually be preferred for the purpose of
+forming a "_scab_," for such the eschar really is, in a practical view;
+and we think that our author has hardly done justice to nature's
+methodus medendi by "scabbing;" while he so ably and strenuously
+recommends his own imitation of her process. Scabs may be formed by the
+coagulation of blood; by the drying of mucus or pus; and by the
+formation of an eschar, by the actual or potential cautery. The surgeon
+may frequently reduce parts to the same situation, by the use of
+gold-beater's skin, court-plaster, or other unirritating applications,
+which prevent exposure and evaporation. In all cases, care must be taken
+to prevent the surrounding inflammation from transcending the adhesive
+stage.
+
+45. _Haemorrhage from Lithotomy._--In the London Med. and Phys. Jour. for
+Jan. Mr. JOHN SHAW has published an account of a patient, who
+unfortunately perished from haemorrhage, in consequence of being cut for
+the stone. The parts being injected after death, it was found, that the
+bleeding proceeded from the _unusual distribution_ of a branch of the
+pudic artery, which traversed the neck of the bladder, and lay directly
+in the way of the incision. The pudic artery was uninjured.
+
+46. _Extirpation of the Parotid Gland._--The best surgical writers have
+condemned this operation, if not as absolutely impracticable,
+nevertheless, as too dangerous to be ever attempted. Successful cases
+have however been reported, and Mr. A. COOPER, in a letter to the
+operator in the following case, avers, that he twice removed the parotid
+gland in one year. Mr. KIRBY, late president of the Royal College of
+Surgeons in Ireland, in a work published in 1825 at Dublin, on
+haemorrhoidal excrescences, has given the details of a diseased parotid,
+and of the operation for its removal. We condense from Johnson's Review
+for April, 1826.
+
+The patient was a poor female, aged 40, who had a tumour extending from
+above the zygoma downwards on the neck, two inches below the angle of
+the jaw, stretching as far forwards as the anterior edge of the masseter
+muscle, forcing the ear backwards, and raising it outwards from its
+natural position. Above the surface, it was about the size of a
+goose-egg; immoveable; painful when handled; irregular on the surface,
+and of a deep livid colour over the prominent points. Pains of a
+lancinating character, extended over the head and neck, producing
+sickness and want of sleep.
+
+The operation was performed chiefly by the fingers and the handle of the
+knife, after dividing the integuments by a crucial incision. The
+branches of the portio dura were of course divided, and great
+embarrassment arose from a copious haemorrhage, caused by the bursting of
+the tumour, while Mr. K. was rooting it out from between the pterygoid
+muscles. The bleeding was restrained by the finger of an assistant, and
+the complete extirpation of the diseased gland was effected. Mr. KIRBY
+says, "the space between the pterygoid muscles was void--the auditory
+tube was fully exposed--the articular capsule of the jaw was brought
+into view--the finger could trace the length of the styloid process, and
+on sponging the wound of its blood, it could be seen by those who
+surrounded the chair." The haemorrhage was restrained by a sponge firmly
+lodged at the bottom of the wound, covered by compresses of lint, and
+the whole secured by a double-headed roller.
+
+The patient was much exhausted, slept tolerably well the next night,
+complaining of thirst and inability to swallow. On the 2nd day,
+inflammation, swelling, and fever followed--erysipelas appeared on the
+neck--patient lethargic--pulse small and frequent. Fourth day,
+suppuration--symptoms improving--no relapse. The patient completely
+recovered, without any regeneration of the tumour.
+
+In FERUSSAC'S Bulletin Universel for Jan. 1826, we observe the following
+notice, from a German Medical Magazine, conducted by M. D. Schmidt.
+
+A female, aged 33 years, had suffered for 9 years from a diseased
+parotid gland, which had gradually attained a large size. It was
+extirpated by Dr. PRIEGER, and the patient soon returned home in good
+health, and little disfigured. The tumour measured 8 inches in
+circumference, and weighed three and a half pounds. (Livres.)
+
+Dr. PRIEGER had previously extirpated a scirrhous parotid successfully.
+M. WIENHOLD affirms, that he has extirpated three parotids; the details
+of these operations are published. M. SCHMIDT, however, suggests some
+doubts, as to the _nature_ and _seat_ of the tumours removed.
+
+47. _Aneurism from a Wound, cured by Valsalva's method._--This
+interesting and valuable case, is condensed from Le Propagateur des Sci.
+Med. for March, 1826. M. Antouard, a healthy female, aet. 18, was wounded
+on the 18th of June, 1825, by a poniard, in the left carotid artery,
+below the superior extremity of the sternum; the instrument passing
+obliquely inwards and downwards. The anterior and lateral portions of
+the neck, were enormously distended with blood, and syncope supervened.
+Four days after the injury was received, an aneurismal tumour was
+observed at the edge of the sternum, the surrounding effusion being
+greatly diminished by absorption; and at the expiration of a month, when
+she was first seen by Dr. SOUCHIER, it was of the size of the two fists
+of the young female. The pulsations at this time, were nearly equal over
+the whole surface of the tumour; but rather more distinct over the
+orifice in the vessel. The surrounding blood was entirely absorbed. No
+pain was experienced, unless from the pressure of the swelling; from
+which cause also, resulted a troublesome and continued headach. Dr.
+SOUCHIER, not believing an operation adviseable, during the warm season
+of the year, and on a tumour, situated so much under the sternum,
+determined to fulfil the following indications: 1st. To lessen the
+quantity of blood; and thus, to diminish the stimulus to the heart, the
+projectile force it exercises, and consequently, the rapidity with which
+the blood escaped from the ruptured vessel, and the impulse hence
+imparted to the sides of the tumour, preventing, in some degree, the
+coagulation of the blood. 2nd. To increase the effect of general and
+local bleeding by the use of _cold_, of _pressure_, and especially, of
+the digitalis purpurea: that thus the force of the circulation may be
+lessened, the blood allowed to coagulate, and a radical cure be
+accomplished.
+
+Mademoiselle Antouard, determined to yield herself to this plan, and was
+directed: 1st. Rice-water, acidulated with lemon-juice, and an infusion
+of mallows, for _food_ and _drink_. 2nd. To employ frictions on the
+abdomen, and on the insides of the thighs, morning and evening, with
+eight grains of the pulverized leaves of digitalis, previously macerated
+for 24 hours in a sufficient quantity of saliva. 3d. To apply every day
+12 leeches, near the aneurismal tumour, and after favouring the flow of
+blood by emollient fomentations, to cover the part with compresses, wet
+with a saturated solution of the acetate of lead, to be frequently
+renewed, so as to be kept below the temperature of the skin. 4th. The
+effect of these means to be augmented by pressure, made by means of the
+base of a glass tumbler, fixed by the hands of assistants; and 5th. To
+be kept at rest, and in perfect silence.
+
+_Fourth day of treatment_, being 2nd of Aug. 1825. Pulsations more
+central; tumour very sensibly diminished; pulse less strong and reduced
+from 86 to 74 in the minute; the menses, which had been suppressed for
+two months, appeared on the 31st ulto. and still flow. _Prescription_,
+V. S. [Symbol: ounce]xviij. next day, twelve leeches, on the lateral
+parts of the tumour; gr. xxiv. of digitalis in three applications
+through the day. Continue ut supra.
+
+Aug. 8th. Patient tranquil; pulse 60, full, not active; face not
+flushed, but preserving a delicate tinge of red; headach now slight; no
+nausea; menses continued until the 6th inst. _Prescription_, V. S.
+[Symbol: ounce]xij.--fifteen leeches to-morrow; increase digitalis to
+gr. xxviij. daily; the rest, ut supra. The tumour has diminished at
+least one-fourth.
+
+Aug. 12th. Tumour reduced to 3-5ths of its former volume; pulse at 56;
+her nights are comfortable; has some headach, and lately, cardialgia;
+complains of hunger and weakness, and from the fatigue of her
+assistants, the pressure was made with a bandage less effectually than
+before. This was allowed, as the pulsations are weakened, and more and
+more central, while the elevation of the tumour is trifling. For fear
+her health might be injured, she was permitted to rise a little from
+bed, and to add to her rice water, some light jellies, (cremes) made
+from the same grain. V. S. [Symbol: ounce]x. and every 2nd day, eight
+leeches around the tumour; digitalis increased to 32 grains daily; warm
+pediluvium for one hour, morning and evening; silence as complete as
+possible.
+
+Aug. 18th. No tumour visible; pulsations can yet be felt; the skin is
+thickened; pulse at the wrist is at 50. V. S. [Symbol: ounce]viij.--six
+leeches every 4th day until menstrual period; digitalis reduced to gr.
+xx. and still to the same parts; continue the pressure; allow some rice
+jelly, vermicelli soup, gentle exercise; silence to be preserved,
+continue pediluvium, and relieve constipation by simple enemata.
+
+In 15 days, Dr. SOUCHIER again visited his patient. It required an
+experienced hand to distinguish, at the spot where the artery was
+cicatrized, an elevation rather more evident, than over the rest of the
+artery. Pulse 48 per minute; hunger great, and the remedies now
+unpleasant. Most of them were suspended, and fruit and the white flesh
+of poultry added to her diet list. The digitalis reduced to 12 grains a
+day. Compression, silence, and moderate exercise, to be continued as
+before. The menses appeared at the expiration of twenty-five days, and
+were more abundant than at the last period.
+
+At the end of a month, no trace of the tumour was discoverable. The
+young lady had carefully increased her nutriment and exercise without
+inconvenience, and all remedial measures were now omitted.
+
+During the months of December and January last, she remained free from
+any inconvenience from the tumour, and the union of the parietes of the
+artery was therefore regarded as complete.
+
+In the above account, we have only to regret that the state of the
+artery above the tumour, before and after the treatment, had not been
+noticed. Perhaps this may be supplied by Dr. SOUCHIER, in the
+commentary, which he proposes publishing on the above case.
+
+48. _Protrusion and Wound of the Stomach._--Mr. TRAVERS, in the Edin.
+Journ. of the Med. Sciences, for Jan. 1826, relates, that a female, aged
+53, and the mother of _nineteen_ children, inflicted on herself a wound
+in the abdomen, three inches in length, and in a transverse direction.
+When admitted into St. Thomas' Hospital, at the expiration of six hours,
+the greater part of the large curvature of the stomach, the arch of the
+colon, and the entire large omentum, were protruded and strangulated in
+the wound. The omentum was partially detached from the stomach, which
+organ was wounded in two places; one, half an inch long through the
+peritoneal coat; the other, a perforation of all the coats, admitting
+the head of a large probe, and giving issue to a considerable quantity
+of mucus. Patient faint; pain slight; pulse 102, and irregular; some
+hiccup. A silk ligature was placed round the small puncture in the
+stomach, and the displaced viscera returned, after enlarging the
+external wound. This last was closed by the quill suture. Warm
+fomentations and abstinence from food and drink enjoined. 2nd day, some
+re-action; had been sick in the night from some drink given; is free
+from pain; pulse 120; pain on pressure; an enema ordered. _Evening_, a
+dose of castor oil, and twenty leeches to the abdomen. 3d, much fever;
+V.S. [Symbol: ounce]xviij. and 20 leeches to the abdomen; bowels not
+opened. 4th day, two stools; pulse 98; tension of the abdomen; three
+more stools during the day. 5th, sutures removed; wound united, except
+at its right extremity, where a serous fluid is discharged in
+considerable quantities. On the 6th day, was allowed food, and on the
+23d of Dec., about two months after the accident, was discharged cured.
+
+49. _Oesophagotomy._--This operation has been objected to, not only on
+account of the dangers attending its performance, but from the alleged
+difficulty of promoting the union of the wound in the oesophagus; as
+it is seldom at rest, the lips of the incision being often separated,
+and the mucous coat adhering with difficulty under any circumstances.
+Hence we are induced to notice the following case, in which the
+operation was successfully executed on an inferior animal, by M. FELIX,
+a veterinary surgeon of Bergelac. The account is published in the Feb.
+No. of Le Propagateur des Sci. Med.
+
+A _Cow_ was threatened with immediate suffocation from the lodgment of a
+potato in the oesophagus. It had shortness of respiration, an
+incapacity of swallowing even its saliva, which flowed from the mouth,
+was in great distress, and covered with a cold sweat. Being properly
+secured in a horizontal posture, an external incision was made on the
+inside of the sterno-mastoid muscle, and a cautious dissection practised
+until the tumour was completely exposed. The oesophagus was divided by
+"an incision extending the whole length of the foreign body, which was
+extracted without any force, _which is almost always fatal_. I
+immediately made two close sutures; and also two others in the skin, on
+each side, adapting to them two pieces of packthread, more easily to fix
+the dressings. I dressed the wound with brandy, filling the opening with
+hemp soaked with brandy." The animal was kept on very little food or
+drink. On the third day the wound was dressed for the first time, and a
+digestive ointment applied.
+
+In the course of the 2nd week, the cicatrization of the oesophagus
+occurred; the part was dressed with lint; and by the 20th day after the
+operation, the animal was quite restored.
+
+This case would have been more useful, if more precision had been
+employed in describing the dressing and subsequent treatment of the
+wound. It would seem that the sutures were passed through the parietes
+of the oesophagus only, and that the external wound was kept open by
+being filled with tow. Certainly, union by the adhesive inflammation
+ought to have been attempted in all parts of the wound; but whether
+sutures in the oesophagus are advantageous, or whether the uniting
+bandage be preferable, is not so easily determined. In the two cases
+described in 3d vol. of the Mem. de l'Acad. de Chirur. the uniting
+bandage was alone employed, and with success.
+
+50. _Retention of Urine, caused by a Stricture of the Urethra, relieved
+by a forcible but gradual Injection._--The editor of Le Propagateur des
+Sci. Med. in the No. for Feb. 1826, introduces the following case, by
+observing, that it reflects great honour on M. AMUSSAT, and that his
+discovery merits the greatest praise. M. D... aged 70 years, of a
+plethoric constitution, had suffered about 30 years before from three
+attacks of gonorrhoea; since which period he has had a difficulty in
+urinating, and can never discharge more than one or two ounces of urine
+at a time.
+
+At eight o'clock, P. M. of the 1st of Feb. he tried to urinate, but
+could not succeed. He suffered great pain. Pulse agitated; face flushed;
+belly swelled, and globular at its inferior part; the subcutaneous
+abdominal veins distended, and the penis in a state of semi-erection.
+All attempts to urinate were painful and ineffectual. At ten o'clock, A.
+M., on the 2nd, M. AMUSSAT visited him, and passed a bougie. This was
+arrested by a contraction near the bulb of the urethra, and caused the
+discharge of some blood. No urine had been passed for 14 hours, while
+ordinarily he urinated 12 or 16 times through the night. The obstruction
+was so great, that none of the usual means of relief remained, except
+_the forcible introduction of the catheter_, or the _puncture of the
+bladder_. M. AMUSSAT resorted to the following plan which he had
+devised, and which completely succeeded. He injected warm water
+forcibly, but gradually, into the urethra, which, dilating the orifice
+of the stricture, forced backwards the thickened mucus which had
+obstructed it. As soon as the liquid injection met the urine, the
+patient cried out that he was saved, and immediately was able to urinate
+as formerly. At two trials, he discharged nearly two pints of thick
+urine. There was no return of the retention, the patient continuing
+well.
+
+Should subsequent experience confirm this experiment of M. AMUSSAT, this
+simple measure will be a most valuable substitute for those dangerous
+measures hitherto resorted to for retention of urine, in cases where the
+obstruction arises from thickened mucus, from small calculi closing the
+orifice of a stricture, from inflammation, or from what are termed,
+(justly or not,) spasmodic strictures.
+
+51. _Tracheotomy._--In the Amer. Med. Review for April, Dr. JOHN ATLEE,
+of Lancaster, mentions that on Wednesday, Aug. 11th, he was consulted by
+a child ten years old, who had that morning, while running, put a
+button-mould into his mouth, which during respiration was drawn into the
+trachea. He complained of uneasiness in respiration, with a slight
+rattling, and pointed towards the upper part of the sternum, as the
+situation of the button. On coughing, a rattling was heard, and
+immediately after, a sudden check to expiration, from the lodgment of
+the button near the rima glottidis, requiring a sudden and violent
+effort of inspiration to remove the sense of suffocation. An emetic was
+given with no advantage. During the night, he had two or three spells of
+coughing, threatening suffocation.
+
+An operation was urged, to avoid immediate and subsequent dangers from
+the lodgment of this extraneous body, and was agreed to by the parents,
+and by Dr. HUMES, who was called in consultation. It was performed on
+the 14th of Aug.; a cathartic, and afterwards an opiate, having been
+given.
+
+An incision, one inch and a half long, was made through the integuments,
+extending downwards from above the cricoid cartilage, and exposing the
+sterno-hyoid and thyroid muscles, which were then separated. After
+exposing the trachea, a longitudinal incision, about three-quarters of
+an inch in length, was made through its parietes at the third ring. This
+was held open, and the patient requested to cough. This was ineffectual.
+The wound being closed, the button was, by coughing, thrown up against
+the rima glottidis. A probe passed into the trachea, produced a violent
+effort to cough, by which, as soon as the instrument was withdrawn, the
+button was thrown through the wound, to some distance from the patient.
+
+The wound was dressed with two sutures and adhesive strips. Most of it
+united by the first intention: and in a few days the patient completely
+recovered.
+
+52. _Fistula Lachrymalis_--At the session of the Royal Academy, on the
+15th of December, M. J. CLOQUET related the case of a female, who, three
+years previously, had submitted to the operation for fistul. lachrym.
+according to the method of M. FOUBUT. The canula which had been allowed
+to remain in the nasal canal, had ulcerated through the floor of the
+nose, and presented its inferior extremity on the inside of the mouth.
+
+A practical commentary on this mode of operating, which is still
+recommended by able surgeons!
+
+53. _Aneurisma Herniosum._--This form of aneurism is supposed to consist
+of a dilatation of the internal and muscular coats of the artery; the
+external cellular having been destroyed. It is termed by ARNAUD, and by
+Dr. WILLIAM HUNTER, _aneurisma herniam arteriae sistens_. Its existence
+in any case has, however, been denied by a large majority of surgeons;
+and perhaps the only cases reported are those of DUBOIS, in 1804, found
+in the thoracic and abdominal aorta of a dead subject.
+
+The reporter of the following case, quotes also MONRO, as having cited
+examples of this kind of aneurism. But what MONRO termed a "mixt
+aneurism," arose from the rupture of the coats of a "true aneurism," by
+which it was reduced to the state of a "false aneurism;" very different
+from that here contended for. SABATIER and BOYER, also, deny the
+existence of this hernia of the artery, and a good summary of facts and
+arguments is given by BOYER in his Surgery, in support of this opinion,
+(vide article Aneurism, tome i.) which it would be difficult to
+invalidate, especially by cases analogous to the following. The
+reporter, M. BONNET, of the late French army, considers this case as
+proving a hernia of the artery in a vessel of medium diameter; those of
+DUBOIS having been noticed in the largest arteries.
+
+A Prussian soldier was wounded over the femoral artery by a musket ball.
+No haemorrhage ensued, and the wound cicatrized. In this state, M. BONNET
+visited him for a mortification of the foot of the same limb, which had
+been frozen. Amputation of the leg was performed, the stump healed
+readily, and in 12 days the ligatures came away. On the 13th day, (being
+six weeks since wounded in the thigh,) the patient perceived a tumour at
+the original cicatrix on his thigh, which had appeared during the
+preceding night. On the 14th, it had enlarged to three times its former
+size: it was painful; fluctuation was evident; but there was no
+pulsation, not even the thrilling noise, which is evident in the last
+stage of aneurism. A consultation was called, to determine whether it
+was an abscess or an aneurism. The question could not be satisfactorily
+answered, and it was determined to open it, after having made the
+necessary arrangements to secure the artery, should the tumour prove
+aneurismal. As soon as the integuments were punctured, the jet of blood
+evinced the nature of the complaint; and the artery was secured by
+ligatures above and below the tumour. The coagula were numerous, and the
+superficial ones, quite hard and cartilaginous. The patient did well,
+and there was every prospect of his recovery on the 1st day, when M.
+BONNET was forced by the movement of the armies to leave him at Meaux.
+
+Such are the facts, from which the Reporter infers, that the aneurism
+consisted of a protrusion of the internal and middle coats of the
+artery. The _reasoning_, founded on them, appears to us inconclusive;
+but we have not space to insert it, and must refer to the March No. of
+Le Propagateur des Sci. Med.
+
+54. _Extirpation of the Two Dental Arches, affected with
+Osteo-sarcoma._--Dr. GIORGI REGNOLI, physician at Pesaro, performed this
+operation on a female 35 years of age, who had from infancy, been
+troubled with pain and diseases of the teeth and jaws. When Dr. R.
+visited her, both dental arches were enormously swelled; red and
+sanguineous tumours had formed over their whole surface, and covered the
+teeth. The alveolar processes were entirely softened. The diameters of
+the mouth were greatly lessened; but by the touch, it was evident, that
+the disease was confined to the alveolar processes of the two ossa
+maxillaria. A foetid odour exhaled from the mouth. Lancinating pains
+continually tormented the patient; especially on attempting to
+masticate. The slightest touch was very painful, and was always followed
+by an effusion of blood. There was also an alteration of voice; a
+disgusting deformity of the mouth, with emaciation, fever, &c. The
+operation was performed on the 18th May, 1825.
+
+The patient was seated opposite to a window; her head being supported
+against the breast of an assistant, who, at the same time, pressed upon
+the labial arteries. The inferior lip was divided perpendicularly, and
+detached laterally from the inferior jaw, so as to expose the whole
+extent of the carcinoma. Some strokes of the saw were made on the
+anterior and most prominent part of the bone, and into the groove thus
+formed, the blade of a very strong knife was inserted, by means of
+which, aided by some slight strokes with a mallet, all the diseased
+portion was removed. The soft parts had been previously detached from
+the internal surface of the jaw. The last left molar tooth, not being
+diseased, was alone left. The haemorrhage from the dental artery was
+arrested by the actual cautery.
+
+The dental arch of the upper jaw, was then completely removed in the
+same manner. The bleeding was here more profuse, but was arrested by a
+hot iron. The alveolar processes thus removed, were enlarged, and of a
+lardaceous colour, and the fungous growths had the appearance and
+consistence of indurated albumen.
+
+In 25 days, the patient was discharged well. Her general health was
+good; the foetor had quite gone; the cicatrix over the bone was
+regular, white, hard, and could be pressed upon without causing pain.
+The patient can triturate her food with facility; the lips are slightly
+drawn inwards, without any sensible inconvenience; and the voice is a
+little altered, but this even is daily improving.--_Le Propagateur des
+Sci. Med._ for Jan. 1826.
+
+55. _Traumatic Erysipelas._--In the Feb. No. of the Revue Medicale, is a
+clinical report of the celebrated Baron LARREY, surgeon in chief of the
+Hospital de la Garde Royale; in which he criticises severely the use of
+leeches in erysipelas, and recommends in that variety of the disease,
+arising from wounds, &c. the application of the actual cautery, as
+effectual in arresting immediately the progress of the disease. It
+causes, he says, but little pain; destroys the burning and tense pain of
+the disease, as also the redness and swelling of the part; is not
+followed by suppuration, and does not cause gangrene in the contiguous
+parts. The eschar separates, without leaving a cicatrix. Various other
+advantages are enumerated, all of which are confirmed by a list of
+cases, as treated at the hospital. We have no room for details, which
+would, if known universally, hardly render us Americans, whether
+surgeons or patients, as fond of the cautery, as our trans-atlantic
+brethren of the French school.
+
+56. _Obliteration of a portion of the Urethra, remedied by an
+operation._--M. VANIER of Cherbourgh, relates in the Jan. No. of "Le
+Propagateur des Sciences Medicales," the case of a man aged 27 years,
+who, on the 16th of June, 1815, was wounded in the penis by a musket
+ball, which completely divided the urethra at its middle portion,
+without injuring the corpora cavernosa. The wound healed up; but by
+degrees, the passage contracted, so that in May, 1819, the patient could
+pass his urine only guttatim, with pain and difficulty, and was
+threatened with inflammation, &c. of the perineum. Bougies afforded no
+relief. An incision was then made externally, in the direction of the
+urethra, so as to divide the cicatrix, and open the canal above and
+below the contracted part. The lips of the incision were drawn together
+over a sound, passed into the bladder; and by the 5th day, the wound was
+completely cicatrized. The sound was then removed, and a short bougie
+inserted, so as to pass beyond the cicatrix. This was worn occasionally,
+and the patient completely recovered. At the end of three years, he was
+able to "urinate with ease, and in a full stream."
+
+57. _Artificial Joint cured by Caustic._--Dr. J. RHEA BARTON, has
+applied the caustic potash to the extremities of the fragments of a
+broken tibia, after an artificial joint had fully formed. Exfoliation
+was produced, followed by bony union. In three months, the patient
+recovered.
+
+Dr. B. alludes to other cases, by Mr. WHITE of Manchester, and Mr. HENRY
+CLINE, thus treated with success; to two instances, in which the
+practice failed in the hands of Mr. EARLE; and finally, to one case by
+Mr. A. COOPER, the result of which he has not learnt. He does not
+recommend the operation, as usually preferable to the _seton_, for
+which, the profession is indebted to Dr. PHYSICK; but as an additional
+expedient, when other means fail.--_Med. Record. April_, 1826.
+
+58. _Epilepsy cured by Trephining._--In the 17th No. of the New-York
+Medical and Physical Journal, Dr. DAVID L. ROGERS relates an interesting
+case of a man, aged 46, who had been subject to epileptic convulsions
+for 14 years, and who, of late years, had been unable to labour, and
+rapidly sinking into a state of idiocy, from their frequent recurrence.
+
+These fits were preceded by a fracture of the os frontis, with
+depression, from which he readily recovered; but soon after he was
+attacked with convulsions. He now suffers pain on the injured side
+extending down the neck and left arm--the eye of the same side is
+diminished--the sight much impaired, and his memory almost entirely
+destroyed. A cicatrix covering a slight depression was easily found,
+above the left superciliary ridge of the frontal bone, and over the
+superior orbitar foramen. Under these circumstances, the operation of
+trephining was performed on the 7th of July, 1825, but with some
+difficulty, from the irregular thickness of the bone, and from the saw
+having to pass through the upper part of the frontal sinus. "The dura
+mater was unfortunately cut through for one-half the circumference of
+the circle." The parts were found more vascular than usual, and the
+under surface had a ridge corresponding to the internal depression, but
+too slight to have caused compression of the brain. "Having made a
+section of the frontal sinus, [with a trephine?] a part of the
+_posterior table_ was removed with the _circular_ piece. This portion of
+the internal table had been fractured, and separated to some distance
+from its inferior attachments to the frontal plate, and driven back upon
+the substance of the brain. Its sharp edge was worn round and smooth."
+This seemed to have been the cause of all the mischief.
+
+After the operation, the patient suffered from pain in his head, with
+some moderate excitement, which was relieved by cathartics. He had no
+return of fits until the 25th day, when the wound was entirely healed.
+These had been brought on by overloading his stomach with food, and were
+followed by high arterial excitement and inflammation of the brain.
+
+He was relieved in a few days by active depletion, and was discharged
+cured on the 20th of August. _Nine months_ afterwards, this man
+continued free from fits, his memory had nearly recovered its usual
+strength, and he could attend to his business without any inconvenience.
+
+
+VI. MIDWIFERY.
+
+59. _Gastrotomy_.--M. BULK, in Germany, has successfully performed this
+operation on a female, aged 36 years, of good constitution, under the
+following circumstances. The patient, during her pregnancy, suffered
+from a severe pain at the left and inferior portion of the abdomen; her
+menses were not suppressed, and every six or eight days, a clot of blood
+and mucus came from the vagina. Her general health was very good.
+
+About the middle of her 8th month, she was washing some linen, and
+suddenly felt as if something was tearing in her abdomen; at the same
+time, a swelling of the size of two fists (poings) formed on the right
+side, below the umbilicus. She fainted, and for six weeks suffered dull
+pains in the abdomen. At this time, she had _true labour pains_ for 48
+hours, and was attended by a midwife. The os uteri dilated so as to
+admit one finger only. The tumour disappeared during these pains. The
+patient recovered, with the size of the abdomen undiminished.
+
+In this state she continued for two years and three months, menstruating
+regularly. She became again pregnant, with little inconvenience until
+the 7th month, when her abdomen was painfully distended, and of a bluish
+colour, and fluctuation was induced on the least motion. At the full
+period, she was delivered of a large foetus, which she suckled for 15
+days. The infant then died of an aphthous affection.
+
+Her milk ceasing, she rapidly declined with hectic symptoms. The tumour
+reappeared below the umbilicus about the size of an egg, and soon
+opened, discharging from small orifices a little pus. The opening was
+enlarged, and some skin and hairs were removed. The patient's
+constitution was fast yielding, and gastrotomy was immediately
+performed. An incision was made, with the requisite precautions, through
+the linea alba into the cavity of the abdomen, from two and a half
+inches above the umbilicus to within nine lines of the pubis, care being
+taken to prevent the escape of the intestines. A foetus of full size,
+in which putrefaction had commenced, was found on the right side of the
+uterus. "I raised," says the operator, "the body with much care, and
+endeavoured to trace the umbilical cord. This was turned over the fundus
+of the uterus to the left side, and terminated in a vascular substance
+in a state of suppuration, (probably, the remains of the placenta,)
+which was situated below the great omentum. I pressed out, and dried up
+the pus, which covered these parts, by means of a sponge. The uterus was
+an inch and a half in length and an inch in breadth, of a pale rose
+colour, and could easily be distended (se laissait distendre aisement.)
+It was otherwise in a good condition."
+
+The wound in the abdomen was closed with sutures. The patient was in
+great danger from inflammatory symptoms for 8 days, but eventually
+recovered. She left her bed on the 55th day.
+
+60. _Caesarian operation, performed with safety to the Mother and
+Foetus._--We condense from JOHNSON'S Review for April last, the
+following summary of a case of Caesarian section performed by GRAEFE, on
+the 20th of September, 1825.
+
+Carolina Bechang, was admitted into GRAEFE'S Clinicum, in an advanced
+stage of pregnancy; being 30 years of age, much deformed by rickets, and
+only four feet (Rhenish) in height. On the 20th of Sept. after having
+been five days in labour at the full period, pains severe, and os uteri
+dilated, she consented to the Caesarian section.
+
+A little after 2 o'clock, GRAEFE placed the fore finger of his left
+hand, immediately below the umbilicus, and with a large scalpel, made an
+incision downwards in the linea alba, to within one inch of the pubis;
+dividing the entire parietes, and even penetrating the substance of the
+uterus. A second incision penetrated the uterus and exposed the
+placenta; which, as had been anticipated, was found on the fore part of
+the fundus. The assistants now compressed firmly the edges of the
+divided abdominal parietes upon the uterus, to prevent the protrusion of
+the intestines, in which they succeeded; and GRAEFE carried his hand in
+a moment into the uterus, separated the placenta with his finger and
+thumb, and then withdrew it and the child almost together. The child was
+very active, and cried lustily. The uterus immediately and suddenly
+contracted, and the bleeding was inconsiderable. Not more than twelve
+ounces of blood were lost, and no ligature was required. The whole
+operation was completed in four minutes and a half. The wound was
+secured by three broad sutures, and adhesive plasters, assisted by a
+bandage round the abdomen. The child weighed six pounds and was well
+formed. During the operation, the patient was sick, and once vomited
+slightly. In two hours had pain and fever: V.S. [Symbol: ounce]xij.
+Draught with ten drops of the aqua laurocerasi was given, and repeated
+in a few hours. The patient passed a quiet night. The symptoms of pain,
+inflammation, and fever, were threatening for some days, and were
+promptly resisted by the lancet, by enamata, by narcotics, especially
+the laurocerasus and hyosciamus, by fomentations, &c. By the 9th day,
+the wound had cicatrized, excepting near the symphisis; symptoms all
+favourable. The lochia were discharged regularly; and in three weeks,
+she was able to sit up, and in three more, quite well. Early in
+November, she returned home with her child, both in perfect health.
+
+In FERUSSAC'S Bulletin Universel; for February, another case, in which
+the Caesarian operation was performed with safety to the mother and
+infant, is copied from RUST'S Magazine.
+
+61. _Extirpation of the Uterus._--Dr. RHEINECK, of Memmingen, was
+consulted by a female, who in December, 1824, was attacked by fever,
+from which she slowly recovered. A prolapsus of the uterus, which
+gradually became inverted, followed, attended with frequent haemorrhage
+and discharge, by which she was almost worn to the grave. The whole of
+the uterus was inverted, and without the labia externa; its surface
+loose, fungous, and in several places easily broken down upon pressure;
+but there was no hardening nor ulceration. The irritation was so great,
+as to threaten the patient's life, and after a consultation, in which it
+was agreed, that the swelling was really formed by the uterus, the
+tumour was laid hold of and drawn forwards, and a broad ligature,
+secured with a double surgeon's knot, was applied round its base. In
+about three weeks, the whole had separated, and the part above the
+ligature was cicatrized. During this period, the patient was dangerously
+ill, and was only rescued by great care and attention.
+
+The operator had before performed a similar operation, in which case,
+the patient died suddenly from haemorrhage, on the separation of the
+ligature. OSIANDER, STRUVE, LONGENBACK, SAUTER, SIEBOLD, and ZAUG, have
+in late years performed the same operation, with various degrees of
+success.--_Johnson's Review for April_, 1826, who quotes from _Siebold's
+Journal fur Geburtshulfe_, 1826.
+
+62. _Uterine Haemorrhage._--In the Bulletin Universel for Jan. 1826, the
+following case is detailed from the Gazette de Sante, for Dec. 1825.
+
+A female aged 32 years, was taken with labour with her first child, on
+the 12th Feb. 1825. The pains soon ceased, and on the 15th of Feb. M.
+BEDEL, physician at Schirmack, was consulted, who speedily delivered
+her, by means of the forceps, of a dead child. The haemorrhage was so
+considerable, as to render the immediate removal of the placenta
+necessary; but the uterus did not contract, and the bleeding continued,
+with tremblings, syncope, cold sweats, &c. Irritation on the internal
+surface of the uterus, the use of cold water to the abdomen, injections
+into the uterus of cold water and vinegar, were unavailing.
+
+Plugging the vagina, and also the _uterus_, was now resorted to, as the
+only means of safety remaining. The uterus was filled with pieces of
+rags, for fear the patient could not sustain the loss of blood necessary
+to fill that cavity; while a methodic compression was at the same time
+made to the abdomen. The haemorrhage was immediately arrested, and soon
+after reaction ensued.
+
+On the 16th, M. BEDEL extracted the plugs from the uterus, cautiously
+and in succession; and had the pleasure of finding the uterus regularly
+contracting after each removal. The lochial discharge continued, and
+there was no secretion of milk. The patient recovered slowly.
+
+It is in such cases as the above, that the physicians of the United
+States have employed the Secale Cornutum (Ergot,) the judicious use of
+which would have probably superseded the necessity of instruments, and
+prevented or arrested the haemorrhagic discharge.
+
+
+VII. CHEMISTRY AND PHARMACY.
+
+63. _State in which Morphia exists in Opium._--In the 80th article of
+our Quarterly Summary for January, we stated that MR. ROBINET had
+announced the discovery of a new acid in opium, with which the morphia
+was combined; while the meconic acid was alleged to be united with soda.
+To the former salt, he gave the name of _codeate of morphia_. MR.
+ROBIQUET, however, has shown, that the pretended _codeate_, is a
+_muriate_ of morphia, formed by double decomposition between the muriate
+of soda, employed by MR. ROBINET in his analysis, and meconate of
+morphia. The same decomposition shows the source of the meconate of
+soda. We observe that MR. ROBINET admits his mistake.--_Archives
+Generales de Medicine._
+
+64. _Peculiar principles of Narcotic Plants._--"Dr. BRANDES of
+Sabzerflen, having been prevented by extreme illness, induced by
+investigating the peculiar principles of narcotic plants, from
+completing his inquiries, has announced the results of his labours in
+general terms. He states, that he has found a peculiar narcotic
+principle in all the narcotic plants; as belladonna, hyosciamus, conium,
+stramonium, chelidonium, digitalis, &c. The narcotic principles are
+readily soluble in alcohol, ether, acids, and water, and of a highly
+offensive odour. This odour is so great in the principle of conium, that
+it is almost impossible for an individual of an irritable habit, to
+remain in the room, where there is an etherial solution, containing only
+a few grains of it. The smell of such a solution is equal to the smell,
+arising from twenty or thirty pounds of the plants. It is also
+remarkable, that as this principle is neutralized by acid, the
+disagreeable odour disappears, or is greatly diminished; which so far
+agrees with the circumstance, that the plants themselves give little of
+their peculiar smell, because the narcotic principle is not in a free
+state. Dr. BRANDES has promised to communicate the manner of obtaining
+the principles."--_Lond. Med. Repository, Feb. 1826._
+
+65. _Relative quantities of Cinchonia and Quinia in the most esteemed
+Varieties of Peruvian Bark._--Mr. BALLY asserts, that practitioners,
+from observation, have classed the Peruvian barks in the following
+order;--first, the gray loxa bark, (_Cinchona Officinalis_;) then the
+red bark (_Cinchona Magnifolia_ of RUIZ and PAVON, or _Oblongifolia_ of
+MUTIS;) and lastly the yellow bark, or calisaya, (_Cinchona Cordifolia_
+of MUTIS, or _pubescens_ of VALLI.) The _Cinchona Officinalis_ furnishes
+much cinchonia, and little quinia; the _Cinchona Magnifolia_ affords
+about equal quantities of the two salifiable principles, while the
+_Cordifolia_ contain much quinia.
+
+Mr. BALLY, assuming it as proved, that cinchonia is the more powerful
+salifiable base of the two in a medical point of view, considers,
+therefore, that, in regard to the above barks, chemical analysis
+justifies the order of their relative value, which had been previously
+deduced from their medical employment.--_Archives Generales de
+Medecine._
+
+66. _Sulphate of Quinia, extracted from the Cinchona Bark, exhausted by
+Decoction._--Mr. JULIA-FONTENELLE, from the sparing solubility of quinia
+and cinchonia, suspected that decoctions and aqueous extracts of
+Peruvian bark contained but little of those vegetable alkalies; whence
+it would follow, that the residuum, generally rejected as having no
+febrifuge power, would still contain the greater part of them. This
+suspicion has been in a great measure verified. The aqueous extract was
+found to contain but little cinchonia and quinia; while the residuum of
+decoctions, giving the mean results, furnished two-thirds of the
+sulphate of quinia, yielded by the same weight of cinchona not acted on
+by water.
+
+As decoctions and aqueous extracts of bark are febrifuge, though
+containing inconsiderable quantities of quinia, and cinchonia, Mr.
+JULIA-FONTENELLE is led to believe, that these salifiable bases are not
+the only febrifuge principles in Peruvian bark, but that the extractive
+matter also possesses that property.
+
+His results present a striking difference between alcoholic and aqueous
+extracts of bark; for while the former contain nearly the whole of the
+salifiable principles, the latter contain very little.--_Revue
+Medicale._
+
+67. _Analysis of Rhubarb._--It is some time since Mr. NANI, an Italian
+chemist, announced the discovery of a crystallizable vegetable alkali in
+rhubarb. Mr. CAVENTOU has repeated the experiments of Mr. N. and finds
+them, in many respects, inaccurate. Upon analysing the alcoholic extract
+of rhubarb, by the aid of alcohol and ether, employed separately and
+combined, Mr. C. obtained a fatty matter, containing a little
+odoriferous volatile oil, and a yellow colouring principle, capable of
+crystallization, and of being sublimed without decomposition, which may
+be called _rhubarbin_. He also detected in the alcoholic extract, a
+brown substance, insoluble in water when pure, but rendered soluble by
+combination with rhubarbin; when it forms a compound, constituting the
+_eaphopicrite_ of some chemists, and the _rhubarbin_ of
+Psaff.--_Archives Generales._
+
+Mr. GEORGE W. CARPENTER, of this city, prepares the medicinal principle
+of rhubarb in combination with sulphuric acid, under the name of
+sulphate of rhubarb, by the following process:
+
+"Boil, for half an hour, six pounds of coarsely powdered Chinese rhubarb
+in six gallons of water, acidulated with two and a half fluid ounces of
+sulphuric acid; strain the decoction, and submit the residue to a second
+ebullition in a like quantity of acidulated water; strain as before, and
+submit it again to a third ebullition. Unite the three decoctions, and
+add, by small portions, recently powdered pure lime, constantly stirring
+it to facilitate its action on the acid decoction. When the decoction
+becomes slightly alkaline, it deposites a red flocculent precipitate,
+and the fluid is changed from a yellow to a crimson colour. The
+precipitate is then to be separated by passing it through a linen cloth,
+and dried; after which, reduce it to powder, and digest in three gallons
+of alcohol, at thirty-six degrees, in a water bath, for several hours,
+at a moderate heat. Separate this solution from the calcareous
+precipitate, and distil off three-fourths of the alcohol. There then
+remains a strong solution of rhubarbine, to which add as much sulphuric
+acid as will exactly neutralize it. Evaporate this slowly to dryness,
+without having access to atmospheric air. The residuum will be of a
+brownish-red colour, intermingled with brilliant specks, possessing a
+slightly pungent styptic taste, soluble in water, and its odour that of
+the native rhubarb." This residuum is the sulphate of rhubarb. (Sulphate
+of _rhubarbin._?)
+
+Mr. CARPENTER assures us, that this preparation contains the medicinal
+principle of the rhubarb, apart from its inert portion; and considers it
+as bearing the same relation to rhubarb, as the sulphate of quinia to
+the Peruvian bark. The Chinese rhubarb, at half the price, furnished
+twice as much rhubarbin as the reputed Russian, which Mr. C. considers
+to be spurious in the Philadelphia market, being the English prepared in
+imitation of the Russian.--_Philadelphia Journal of the Medical &
+Physical Sciences. May_, 1826.
+
+68. _Alkaline Lozenges of Bicarbonate of Soda._--Mr. D'ARCET proposes
+the following formula for these lozenges:--Take of
+
+     Bicarbonate of Soda, pure and dry, and in fine powder,    5 parts.
+     Very white Sugar, in fine powder,                        95
+     Mucilage of Gum Tragacanth,                              q.s.
+     Essential oil of Mint, pure and fresh,                   2 or 3 drops
+         for about every 3 ounces of mixture of bicarbonate and sugar.
+
+Shake the bicarbonate and sugar in a well dried bottle, with the view of
+mixing them intimately. Withdraw the mixture from the bottle, and add
+the mucilage and oil of mint, blending the whole together on a marble.
+The mass obtained, is then to be divided into lozenges, which should
+weigh, when dried, about 15 grains each. As they slightly attract
+moisture, they ought to be kept in a dry place, or in well stopped
+bottles.
+
+Mr. D'ARCET praises very highly the effects of these lozenges in
+disordered digestion, and in preventing its occurrence, as well from
+experiments made on his own person, as from observations on others. He
+believes their operation to be purely chemical, consisting in the
+saturation of the morbid acid of the stomach, and, therefore, not likely
+to be lessened by habit. Their effects are much more prompt than
+magnesia, either pure or in the state of carbonate.
+
+In the phosphatic diathesis, where the urine is disposed to be alkaline,
+it would seem that these lozenges would do harm. But, perhaps, we have
+this security against their use in these cases, that the stomach would
+not at the same time be troubled with acidity. _Annales de Chimie et de
+Physique, Jan._ 1826.
+
+69. _Presence of Mercury in Samples of medicinal Prussic Acid._--Mr.
+REGIMBEAU, apothecary at Montpellier, has detected this impurity in some
+prussic acid, prepared in Paris. Its presence was first suspected, from
+a portion of the acid, accidentally dropped, leaving a white stain on
+the copper dish of a balance. It is probable, that the impure acid,
+spoken of, had been made by passing sulphuretted hydrogen through a
+solution of cyanide of mercury, according to VANQUELIN'S process; and
+that an insufficiency of the decomposing gas had been employed.
+
+May not this accidental impurity explain the occasional salivating
+effects of prussic acid.
+
+70. _Proposed Method for preparing Protoxide of Mercury by
+precipitation, for Medical Employment._--Mr. THOMAS EVANS has published
+some observations on this subject, and justly remarks, that the blue
+pill, mercurial ointment, and other mercurial preparations, are not
+uniform compounds, but contain variable proportions of the real
+protoxide, and uncombined mercury. Some blue pill, which had been
+carefully prepared by Mr. E. by the usual process of trituration, was
+found to contain on analysis 20 per cent. of unoxidized mercury; and
+the blue mass from Apothecaries' Hall, London, furnished about the same
+proportion.
+
+As it is obviously a desideratum to procure preparations of protoxide of
+mercury of uniform strength, Mr. EVANS has been led to seek a process,
+by which to obtain this oxide in a pure state. After repeated
+experiments, he has pitched upon the following formula: Dissolve four
+ounces of caustic hydrate of potassa in a pound of water, and to the
+clear solution, decanted from any impurities, add four ounces of
+calomel, and shake the mixture frequently. Pour off the liquid, and wash
+the precipitate formed with water, and then dry it at a gentle heat.
+
+In regard to the medical efficacy of the protoxide obtained in this way,
+Mr. EVANS reports the following to be the results obtained by Dr.
+COATES, at whose suggestion the article was prepared. As a substitute
+for calomel, it is more apt to vomit and purge, two grain doses
+operating several times. As an alterative, it was found incomparably
+more efficacious than the blue pill, being more certain and regular in
+its operation. Dr. C. thinks, that one-fourth of a grain of the
+precipitated protoxide, as prepared by Mr. EVANS, is equal to three or
+four grains of the blue mass.--_Journ. of the Philad. Col. of Pharm.
+May_, 1826.
+
+The method here proposed for obtaining the black oxide of mercury by Mr.
+EVANS, was first suggested and put in practice by Mr. PHILLIPS. See his
+"Experimental Examination of the last edition of the Pharmacopoeia
+Londinensis, London, 1811," page 114. His words are, "When solution of
+potash is employed, the several inconveniences attendant upon the use of
+lime-water are avoided, and a blackish coloured protoxide is obtained
+without heating the solution. As potash is much more soluble than lime,
+it is scarcely necessary to employ one-tenth part of the quantity of
+water; this not only renders the process more convenient, but the
+quantity of air contained in the water being less, very little of the
+oxide, perhaps none of it, is converted into peroxide." See also the
+experiments, and observations of Mr. DONOVAN, on Mercurial Ointment, &c.
+published in the Medical Journals, several years ago.
+
+71. _Goulard's Extract of Lead._ Mr. DANIEL B. SMITH proposes the
+following formula for obtaining Goulard's extract of uniform strength:
+
+     Acetate of lead, crystallized,    15 ounces, troy.
+     Protoxide of lead,                 9 ounces, troy.
+     Distilled water,                   4 pints.
+
+"Boil them together for fifteen minutes and filter. The filtered liquid
+will weigh about five and a quarter pounds, is transparent, colourless,
+and of the specific gravity of 1.267. (30 deg. Baume.)"
+
+We conceive that Mr. SMITH has erroneously denominated the sugar of
+lead, a binacetate. The best usage is to deem that the primary saline
+compound, which contains a single proportional of acid and base.
+Accordingly we call the saturated carbonate of potassa, a
+_bicarbonate_; and Dr. THOMSON calls borax, a biborate of soda, on
+account of its containing two proportionals of acid to one of base,
+notwithstanding the alkaline qualities of this salt. Goulard's extract
+is, therefore, a sub-binacetate of lead, or according to Dr. THOMSON'S
+recently suggested nomenclature, a _diacetate_.--_Ibid._
+
+
+
+
+QUARTERLY LIST
+
+OF
+
+AMERICAN MEDICAL PUBLICATIONS
+
+
+Observations on the Autumnal Fevers of Savannah. By W. C. Daniell, M. D.
+8vo. pp. 152.--W. T. Williams, and Collins & Hanway. Savannah, 1826.
+
+An Analysis of Fever. By Charles Caldwell, M. D., Professor of the
+Institutes of Medicine, and Clinical Practice in Transylvania
+University. 8vo. pp. 97.--Lexington, K. 1825.
+
+Medical and Physical Memoirs. By Charles Caldwell, M. D., Professor, &c.
+Containing, 1. An Introductory Address, intended as a Defence of the
+Medical Profession against the charge of Irreligion and Infidelity; with
+Thoughts on the Truth and Importance of Natural Religion. 2. A
+Dissertation in answer to certain Prize Questions, proposed by his
+Grace, the Duke of Holstein Oldenburg, respecting the "Origin, Contagion
+and general Philosophy of Yellow Fever, and the Practicability of that
+Disease prevailing in high Northern Latitudes;" with Thoughts on its
+Prevention and Treatment. 3. Thoughts on the Analogies of Disease. 8vo.
+pp. 224.--Lexington, K. 1826.
+
+Florula Cestrica: an Essay towards a Catalogue of the Phoenogamous
+Plants, native and naturalized, growing in the vicinity of the borough
+of West-Chester, in Chester County, Pennsylvania; with brief notices of
+their Properties and Uses, in Medicine, rural Economy and the Arts. To
+which is subjoined an Appendix of the useful cultivated Plants of the
+same District. By William Darlington, M. D. 8vo.--West-Chester, 1826.
+
+     We are much gratified with the appearance of this little flora.
+     It is really an uncommonly neat, useful, and convenient
+     performance; and, we have no doubt, is by far the most elegant
+     and creditable botanical work, if not the only one, published
+     in any small town in America. To a country town, we would not
+     think of looking for such a production; but in fact, the county
+     of Chester has, of late years, made very considerable advances
+     in science and literature. It has produced a public library,
+     and perhaps others with the existence of which we are not
+     acquainted, several botanical and mineralogical collections, a
+     very respectable series of essays on its history, similar to
+     Mr. Jefferson's notes on Virginia, schools, teaching the higher
+     branches of the English mathematics, and one of those partly
+     literary newspapers which have recently sprung up among us.
+
+     The above title considerably explains the nature and extent of
+     the work. Of its scientific accuracy, sufficient time has not
+     yet elapsed to form an adequate judgment; but we observe that
+     the author has had the frequent assistance of Baldwin, Collins,
+     Steinhauer, Torrey, and Schweinitz: so that, if the maxim
+     "noscitur a socio" be at all applicable in the present case, it
+     is evident that he has been in the very best botanical company
+     which our land affords.
+
+     The work is executed with very great neatness, such as would do
+     credit to the press of a metropolis, and is really wonderful
+     for a moderate sized village, and for the disturbed life of a
+     country physician, its author. There is also a great deal of
+     that kind of popular explanation, which so agreeably relieves
+     the repulsiveness of dry works on natural history: such as the
+     familiar names of the plants; the derivations of the names of
+     the genera, designed to assist the student in remembering them,
+     by enabling him to associate some idea with them; occasional
+     comments on their uses and injurious effects, &c.
+
+     We may add, that from the close proximity of Chester County to
+     Philadelphia, extending to a large part of the line of the
+     Schuylkill, this little work will answer extremely well for
+     common use around this city, with the single exception of the
+     sands of New-Jersey.
+
+Memoir on the Topography, Weather, and Diseases of the Bahama Islands.
+By P. S. Townsend, M. D.--New-York, 1826.
+
+The New-England Journal of Medicine and Surgery, and Collateral Branches
+of Science. Conducted by Walter Channing, Jr. M. D., and John Ware, M.
+D. No. 2. Vol. XV.--Boston, April, 1826.
+
+The American Medical Review, and Journal of Original and Selected Papers
+in Medicine and Surgery. Conducted by John Eberle, M. D., Nathan Smith,
+M. D., George M'Clellan, M. D., and Nathan R. Smith, M. D. No. 1, Vol.
+III.--Philadelphia, April, 1826.
+
+The Medical Recorder of Original Papers and Intelligence in Medicine and
+Surgery. Conducted by Samuel Colhoun, M. D. No. 2, Vol.
+IX.--Philadelphia, April, 1826.
+
+The Philadelphia Journal of the Medical and Physical Sciences. Edited by
+N. Chapman, M. D., W. P. Dewees, M. D., and John D. Godman, M. D. No.
+V. New Series.--Philadelphia, May, 1826.
+
+The New-York Medical and Physical Journal. No. 17. Edited by John B.
+Beck, M. D., Daniel L. M. Peixotto, M. D., and John Bell, M.
+D.--New-York, April, 1826.
+
+Journal of the Philadelphia College of Pharmacy. No. 2, Vol.
+1.--Philadelphia, May, 1826.
+
+
+AMERICAN EDITIONS OF FOREIGN MEDICAL BOOKS.
+
+Manual of Surgical Operations; containing the New Method of operating,
+devised by Lisfranc; followed by two Synoptic Tables of Natural and
+Instrumental Labours. By J. Coster, M. D. and Professor of the
+University of Turin. The Translation and Notes by John D. Godman, M. D.
+12mo. pp. 265.--Carey & Lea. Philadelphia, 1825.
+
+A Treatise on Derangements of the Liver, Internal Organs, and Nervous
+System. By James Johnson, M. D. 12mo. pp. 223.--Carey & Lea.
+Philadelphia, 1826.
+
+An Inquiry into the Nature and Treatment of Diabetes, Calculus, and
+other Affections of the Urinary Organs. By William Prout, M.D. F.R.S.
+From the second London Edition, with Notes and Additions, by S. Colhoun,
+M. D. 8vo. pp. 308.--Towar & Hogan. Philadelphia, 1826.
+
+       *       *       *       *       *
+
+We are sensible that the foregoing does not present a full list of
+medical publications for the last quarter; but it is as complete as our
+opportunities have enabled us to make it. It is obviously for the
+interest of authors and publishers, to send us the titles of their
+medical publications as soon as they appear, and we invite them to do
+so.
+
+
+
+***END OF THE PROJECT GUTENBERG EBOOK NORTH AMERICAN MEDICAL AND SURGICAL
+JOURNAL, VOL. 2, NO. 3, JULY, 1826***
+
+
+******* This file should be named 29307.txt or 29307.zip *******
+
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