1-
HISTORY OF THE CASE
OF THE LATE
JOHN  KEARNY RODGERS,  M
ADDRESSED TO THE PROFESSION.
BY
ALEXAKDEK E. HOSACK, M.D.
          NEW YORK:



PRINTED BY S. W. BENEDICT, 16 SPRUCE STREET.



             1851. 
 
INTRODUCTION.
  The late Dr. J. Kearny Eodgers died,  Sunday, the 9th
day of November, 1851, of pyaemie, consequent upon con-
gestion of the liver.
  However much we have to deplore the loss of so eminent
and distinguished a surgeon, we have the more to regret that
there should have been a difference of opinion entertained by
his attending physicians, as regards  the diagnosis  and treat-
ment of the disease which ended so  fatally.
   Nearly allied to the deceased as I am, it is with the great-
est reluctance  I have ventured upon the task of  publishing a
history of the  case, which I shall do as correctly as possible ;
narrating all the circumstances connected with the differences
to which I have  alluded.  This I am constrained to do, in con-
sequence of the numerous misapprehensions that  have been
suffered to go abroad calculated to disparage me with my fel-
low-practitioners.  The medical public will, after being pos-
sessed of all the  facts, be enabled  to determine, whether I
was justified in the opinion early entertained and expressed,
(and from which I never for a moment swerved,)  as to the
true cause and correct diagnosis of the disease which termin-
ated his life; and whether I was correct in  the  course I pur-
sued in withdrawing from the consultation at  a time of so
much interest  and responsibility. 
 
HISTORY OF THE CASE.
  Dr. Rodgers, although naturally of a good constitution, has
once in his life suffered from a severe attack of illness, which
occurred about sixteen years ago, during the winter of 1835.
He became extremely attenuated, and serious doubts were en-
tertained of his perfect recovery; his disease was never satis-
factorily understood.  His friends, however, regarding it as
dyspepsia, advised a voyage to the West Indies, from whence
he returned greatly  improved,  and soon after was perfectly
restored to health.  Since then he has been apparently well
until  the  commencement of the present  year, when he has
occasionally been annoyed by looseness of the bowels, with
a slight feeling of discomfort in the abdomen, and only on
two different occasions has he been obliged to confine himself
to his chamber, and then but for a day or two at a time.   He,
regarding it as an inconvenience only, resorted occasionally
to a few drops of laudanum during the day, or  a glass of
brandy and water at his dinner, which exerted a controlling
influence over it.  The first of these attacks occurred in the
month of July, and the second in August, while enjoying
himself for a few weeks at Long Branch on the sea-shore.
  This, then, embraces all that appertains to his ill health up
to the 9th of October, when he was seized with the illness of
which he died. On the evening of that day, after returning
from a visit to a patient, he complained of not feeling well;
he retired at his usual hour, and was awakened about mid-
night  by a sense of coldness, and had a slight chill; com-
plaining of nausea, he called for a basin, and threw off, as he
informed me,  about two mouthfuls of pure bile ; he refused
to take warm water to rinse his stomach, as was urged upon 
                           6
          ►
him, and soon after fell asleep.  He rose at the usual hour in
the morning, saying he was better, though complaining of un-
easiness in the right side, and slight pain in the bowels.  He
partook of breakfast  as usual, and visited such patients as
were necessary to be seen during the day.
  On Saturday, the 11th instant, Dr. Dubois saw him for the
first time, and suggested a seidlitz powder, which was taken.
On Sunday morning, Dr. Wilkes stopped in on a visit to the
family, when Dr. Rodgers consulted him about his symptoms,
which Dr. Wilkes regarded as functional disorder of the liver,
and accordingly advised the use of blue mass, and actually
procured the pills for him, urging him to take two  immedi-
ately, to be followed by a seidlitz draught.  At Dr. Rodgers's
request, Dr. Wilkes called at my house that morning to inform
me of the Doctor's illness, and of his  desire to see  me; not
receiving the message until too late in  the evening, I called
upon  him the following morning, October 13th.   I found him
free from fever, with a white,  slightly coated tongue.  Al-
though  he complained of pain in the bowels  and of a slight
uneasiness in the  hypochondriac region,  for which he had
applied a mustard cataplasm, he did not wince upon pressure.
I saw him the next day, Tuesday, the 14th, and found him
much the same,  with the exception of a slightly accelerated
pulse, full and compressible, with a tongue assuming a dingy
hue at its base.
  Regarding these symptoms as indicative of a  biliary con-
gestion,  which  opinion I stated to  him, I advised him to
take an emetic or ten grains of calomel; but he, having a par-
ticular dislike to both these  remedies, declined.  I was then
informed by him that he had been exposed to miasma by at-
tending on a case of bilious remittent  fever at Flatbush, Long
Island, and  he remarked that he might possibly have there
contracted the disease.  I told him, in reply, that it was quite
possible it might be the incipient stage of bilious remittent
fever, and questioned him as to the frequency of his visits,
and the hour of  the day he had been exposed to the effluvium
of that district of country ;  his reply was, "never after four
o'clock in the afternoon." 
r
  I then said that it wanted the phenomena of fever, the ex-
cessive heat, and dryness of skin, the constricted pulse,  «&c.
Taking into consideration the former symptoms, his vomiting
bile, dingy skin, and his then present appearance, I still ad-
hered to the opinion I had first  expressed of the liver being
the seat of the disease.  On  the evening of this day at Dr.
Rodgers's request, I consulted with Dr. Dubois, to whom I also
expressed the same opinion, and suggested the use of calomel.
Dr. Dubois had already formed  and expressed the opinion of
the disease being that of bilious  remittent fever, from which
opinion he never changed.
  On Wednesday, the 15th, we again met in consultation; he
had had a restless night, and upon examination he was disco-
vered to be quite jaundiced; tongue and pulse about the same
as on the preceding day.  The patient called  our attention to
the yellowness of the skin  as manifested  on the  hands and
lower extremities, which, on  close inspection, proved to be
decided Icterus.  I immediately remarked to him, in presence
of Dr. Dubois, that the tale was now told, and that he, the
patient, must immediately commence on calomel.
  It is to be remembered that at this  time he did not wince,
or manifest the least pain any where, upon being kneaded, or
upon turning in bed, rising, or lying down.   As he objected
to calomel, fearing salivation, I  could only succeed in  per-
suading him to take the common Icteric Pill (a prescription
well known to those who attended my father's Lectures on the
Practice of Physic), to which my colleague consented.  It con-
tained  calomel which was not likely to salivate, by being in
combination with other medicines.
  He commenced taking it in the evening, and continued it
all the day following: it  operated gently.  Friday morning,
the  17th, he had slept well,  and  expressed himself as  feeling
better, and said that the day previous was the best day he
bad  had.   His condition was much the same throughout the
lay, except that of sallowness, which was more manifest.
  Dr. Delafield joined us in consultation on Friday evening,
Oct. 17th, to whom I said that I presumed that Dr. Dubois
had  informed him  of the previous history of the case; to 
8
 which he assented.  I then stated to Dr. Delafield my views
 of the case, and the prescription I had prevailed upon Dr. R.
 to take, and which he was permitted to continue without any
 intimation to me from Dr. Delafield of different views enter-
 tained by himself as regarded the disease.
   I did not attend at the  appointed hour on the following
 morning, Saturday the 18th, in consequence of some profes-
 sional engagements.   In the evening, at the hour appointed,
 I was informed that  the remedies suggested by myself (as
 above alluded to) had been  discontinued at the morning con-
 sultation, my associates regarding his disease as bilious re-
 mittent fever, and it was so expressed by them.  In this  I
 decidedly differed in  opinion, as well as in the remedies re-
 sorted to, which were the usual febrifuge medicines.
   His symptoms at this time were general restlessness, im-
 perfect sleep, depression of spirits, anxious countenance, slight
 fever, increased sallowness,  accelerated pulse, and  at times
 moderate perspiration.  These symptoms continued much the
 same from  the 19th of October to the 22d, (when rigors first
 appeared),  with the exception of the increased frequency of
 the pulse, which varied from 95  to 120, but usually at  the
 standard of 110, always  full and compressible.  The rigors
 recurred at irregular intervals, sometimes in the night and at
 any hour during  the day; at first, however, there were but
 one or two  in the  24 hours :  they soon after increased in fre-
 quency : jaundice more apparent.
  The rigors were always immediately followed by profuse
 perspirations—the pulse, as observed by myself, was 110 just
 before, during, and after each rigor, which was always accom-
panied  by more or less perspiration, and followed  directly
after by a profuse  sweat.  The gentlemen in consultation, with
the view of opposing  the chills,  prescribed (in opposition
to my judgment) quinine in 10 and 5 grain doses, at intervals
of several hours, which was  continued for several successive
days.  The positive effect of quinine was in due time made
manifest, by ringing in the ears and almost  total deafness ;
in consequence of which it was discontinued on the  29th of
October. Dr.  Delafield remarked in consultation  at the 
9
same time, that  it was very evident that the quinine was do-
ing no  good, that there was something in the case that he
could not understand : to which I replied, that I  understood
it, and  could account for  it in a very satisfactory manner.
The aromatic sulphuric acid was also prescribed in large dos-
es, for the purpose  of arresting the  excessive sweats.  The
strong tincture of aconite was also administered in doses of
one drop each.
   At this stage of the disease, finding myself  opposed in
opinion, and the patient evidently getting worse, in one of
my visits to Dr. Rodgers, (when alone with him in the room,)
I was prompted by my deep solicitude and anxiety on his ac-
count, to urge upon him the necessity of further medical ad-
vice.   Seated by his bedside, I asked him to permit me to
call in  Dr. Wilkes (as I daily communicated with him in re-
gard to his illness), who had seen him, and thought as I did.
I then said,  " If you will permit me to do so, and follow our
advice, you will  get well; I promise you, you will recover."
To which he replied, after a moment's reflection (being  still
biassed with the idea of fever), " If I do, I can never recover,
and I have all confidence  in Delafield."  It  is deserving of
remark, that a few days after, finding he was growing worse,
he said to a member of his family, " There is something in
my case that Dr. Delafield does not understand, nor I either."
   At this period of his disease, the 23d  of October, on the
day after the appearance of the rigors, I  again remarked to
Drs. Delafield and  Dubois, in consultation, that it was not
bilious  remittent fever, as it wanted the characteristics of
fever, and that it was the consequence of unremoved obstruc-
tion in  the  liver.   Dr. Delafield then asked me where I lo-
cated the disease; to which I replied, in the liver, either aris-
ing from obstruction in the " ductus communis choledochus"
by biliary calculi, or from  inspissated  bile in its transit from
the ramifications of the portal vein in the liver to the biliary
ducts, and that these chills, so denominated by my associates,
were'rigors, indicative of matter forming, if not already
formed ; to which he replied, " I hope not," and said " I had
nothing to stand upon, or to sustain me in my views."  I then 
10
asked him, Are these symptoms nothing?  this jaundice, this
condition of tongue, these rigors, followed by profuse sweats,
and  this peculiar, rapid, full, compressible pulse, and com-
paratively moderate heat of skin ;  are  all these symptoms
nothing?  In answer to which Dr. Delafield  remarked that
this yellowness and other symptoms, as above observed, were
frequently met with in bilious fevers;  to which I replied, " I
have, then, yet to learn what bilious fever  is."
  These same remarks were repeated  in substance by me to
Dr. Swett at the time of  my withdrawing  from the consulta-
tion, on the morning of the 3d of November (he having been
called in on  the 1st inst.), with the additional observation,
that in fever there should be remissions and exacerbations, a
furred tongue, and a burning, hot and dry skin.
  I then drew a parallel between the pulse of bilious fever
and  the pulse of matter forming, or just formed, as follows :
In bilious fever, during the exacerbations, it would be small,
corded, and quick, varying in frequency (from the remitting
stage to the highest degree of fever) from  an almost natural
state to 120, at which height of pulse perspiration would com-
mence ; whereas the pulse indicative  of matter would be al-
ways frequent, full and soft, varying but little from 95 to 110,
while the skin most of the time would be comparatively cool.
The pulse full  and soft is 110 just before, during, and  after
each rigor, which is immediately followed by profuse per-
spiration.
   After these  remarks  I  observed, "With these  existing
symptoms, gentlemen, how is  it possible  you can see things
with such different eyes  from me ?"  Placing my hand upon
my knee, I said,  " It is  as plain  to me  as if  matter were
formed in this joint which the knife can release ; but in this
 case we have no  such opportunity.  I have no doubt that
 matter, if not already formed, will  form, and terminate fatal-
 ly."*  I  then  added, "From my deep solicitude  I have
 scarcely slept for the last two nights, and have tried to recon-

   * These remarks were repeated to several of ray medical friends, and also
 to  Dr. J. Mason Warren, of Boston, who was on  a visit to New York at
 that time. 
11
cile my opinion with yours, but the more I reflect  upon the
subject, the more I am convinced that I am  correct in my
views."
  I then withdrew from  the consultation, remarking  that  I
did so with all respect and deference to them, but that I could
not remain to trammel them by my presence, or  witness  a
course of treatment I could not sanction.*
  From my connection with Dr. Rodgers, I had the privilege
of visiting him at all times, during his last illness, and  had
ample opportunity to observe the progress of his  disease and
the treatment pursued by the physicians left in sole charge of
him.   Upon my proposing to withdraw from the consultation
it was suggested by Dr. Delafield that the patient  might be
disturbed by knowing that 1 had done so : in reply I assured
him that I would take care he should not be apprised of it,
and would therefore visit him at the accustomed hour of con-
sultation, without retiring afterwards to the council chamber.
Under these circumstances I do not  feel called upon to offer
any excuse for continuing the history of his disease to its ter-
mination.
  Having last spoken of the disease up to the  28th October,
when the rigors became most frequent, and on the 29th inst.,
when  there  was  a  continuance of coldness, and when the
rigors succeeded rapidly, one upon the other, (which circum-
stance I conceive to be indicative of  matter formed,)!  I will
proceed with the details  of the case.
  On the 29th October he had a succession of chilly feelings
for an hour, which were  immediately succeeded by a severe

  * Dr. Swett at the first consultation, upon his being called in, (in reply to
Dr. Delafield) said " that the patient ought to take three grains of mercury
" three times a day, and  that he should be cupped over  the region of the
" liver as there was congestion of the liver," which was objected to by Dr.
Delafield.  Dr. Swett, the following day, visited the patient morning and
noon alone, and in the evening consultation wholly changed his opinion of the
disease, agreeing with the other two gentlemen that it was bilious remit-
tent fever.
  f Eisenmann asserts, that where two  chills come in immediate succession,
it is indicative of the beginning of suppuration; these double rigors may recur
during the formation of matter.  (See Eisenmann.) 
12
rigor, making in all five during the day.  He was much  de-
pressed in spirits and betrayed great  exhaustion of the vital
powers.  Pulse  quick,  slightly  diminished in calibre and
weak; cheeks flushed, as had been the case daily for  some
time previous.  At this  period I  consider, that matter was
already formed.  On this day the quinine  was discontinued,
and tincture of aconite in drop doses  was substituted at two
hours interval.
  On Thursday, Oct. 30, he had a repetition of the chilly feel-
ings, and three rigors of twenty or thirty  minutes duration,
followed immediately by profuse sweat;—symptoms in other
respects much the same.  Aconite and effervescent draught
continued.
  Friday, Oct. 31.  Three rigors, followed as  usual by per-
spiration—pulse  about the same as on the two preceding days
—symptoms  in other respects unaltered.  A single dose of
twenty drops of aromatic sulphuric acid was resorted to with
the view to check the excessive perspiration.
  Saturday, Nov. 1.  Renewal of chilly feelings twice during
the twenty-four hours, each  succeeded by profuse perspira-
tion—one rigor only during the day, which continued twenty
minutes—pulse about  the same—countenance expressive of
great anxiety.  At this stage of the disease,  perspiration  ap-
peared from time to time without chilly feelings, or rigors,
thereby betraying great exhaustion  of  the vital energies.
Nitro-muriatic acid in the usual proportions was given  inter-
nally, and was used as a " pede luvium ;" it was also applied
to the surface of the body and lower extremities.  Jaundice
was regularly declining, having commenced to do so  about
the 27th.
  Sunday, Nov. 2.  Perspiration as usual continued and pro-
fuse—tongue as heretofore  slightly  coated.   This  day  one
rigor only,  which lasted twenty minutes—much exhaustion.
Jaundice rapidly declining; the urine by analysis exhibited a
large proportion of bile.
  Monday, Nov. 3.  But one rigor on this day—much per-
spiration and coldness  of the nose  and  extremities—other 
13
symptoms the same as on the last preceding days. The hectic
flush was at intervals still manifest.
  Tuesday, Nov. 4.   Quinine was again resorted to, but in
smaller doses—*two or three grains I believe every two hours
—aconite continued, and  nitro-muriatic  acid  given simulta-
neously with the quinine.
  Wednesday, Nov. 5.   Awakened by pain in the bowels, or
directly over the region of the stomach, as he informed me,
which lasted twenty-five minutes, for which  linen,  saturated
with laudanum, was applied.  There was slight  tumefaction
of the abdomen—the pain  and  general soreness recurred
several hours after, for which peppermint was administered ;
warm flannels were applied to the bowels, but not producing
relief, a mustard plaster was substituted.   Quinine continued,
and on one occasion associated with a teaspoonful of lauda-
num with the view of preventing a recurrence of the rigors !
At this time  his pulse was small and tremulous,  and very
rapid, countenance haggard,  and great dejection  of spirits
which continued throughout.
  Thursday,  Nov. 6.  Pulse small, tremulous  and  quick;
perspiration  slight, but almost constant, desponding coun-
tenance and great depression of spirits, as was evident by
different expressions used to those surrounding his bed.  Pain
in the bowels extending over to the left hypochondriac region.
Quinine and nutritious sick room diet, such as beef tea, sago,
brandy and water, and chicken broth, were freely resorted to.
  Friday, Nov. 7. Having  passed a sleepless night, he  be-
trayed great exhaustion—pulse feeble and frequent,  counte-
nance dejected, expressive of much anxiety;  extremities cold,
with  much soreness  of the abdomen : the  same sustaining
diet, and  stimulants as on the day previous, were continued :
fomentations and cataplasms were from time to time  applied
to the stomach and bowels.
  Saturday, Nov. 8.  Increased debility, and tenderness of

  * For any inaccuracies of dates, or of proportions of medicines not speci-
fied, I must plead in excuse my inability to obtain any information from the
apothecary, who was instructed^ the attending physicians, to refuse to give
me a copy of the prescriptions. 
>
                           14
the bowels, as on the preceding day : small, feeble, and quick
pulse—great restlessness, evident sinking of the vital powers
—hiccup in the morning of an hour and upwards  duration,
which re-appeared in the evening :  mind somewhat confused.
He continued to decline until three o'clock A. M.,  at which
time he ceased to breathe.*
  As a journal from the 23d of October was kept by the fami-
ly, I will offer no apology for transcribing it, as it exhibits
the bed-room record  of the phases  of the disease, and reme-
dies resorted to.
JOURNAL.
  This journal, according to Dr. Rodgers's usual custom, was
kept by his family, and the facts were put down daily as they
occurred.
  On the 9th of October, Dr. Rodgers was awakened in the
night by a chill, and threw off about  four  table-spoonfuls  of
bile, remarking at the time that  it was pure bile.   The next
day he complained of uneasiness in his right side,  and pain
in the bowels, for which  he  applied a mustard  plaster.  On
Saturday the 11th, Dr. Dubois saw him professionally for the
first time and prescribed a seidlitz powder.  On Sunday, Oct.
12th, Dr. Wilkes saw him.  On  Monday, 13th, Dr.  Hosack
saw him, and Dr. Delafield visited him on Friday,  Oct. 17th,
in the evening.  Dr. Swett was called in Nov. 1.

  * At the early stage of the disease the bowels were relieved by the ordinary
aperient medicine injections, &c.  The stools were generally of a dark or
brown color: on one occasion on the 18th, or  19th, of October, I observed
after the effects of an enema, that the dejections were of a light or clay colored
appearance. 
15
  The above remarks were made subsequently to  the  record
of the journal.
  Thursday, Oct.  23.—Took  two  pills; no  fever, twenty
minutes after three, a chill, which passed off five  minutes of
four; his  hands were moist.  Fever quarter  past four, and
perspiration at the same time; quarter past five,  perspiring
most copiously; ten minutes past eleven p. m., two pills, no
fever.
  Friday, 24.—Twenty minutes of eight a. m. two  pills; quar-
ter  before eleven, operation of the bowels; five minutes past
twelve, operation of the bowels; half past twelve, chill, passed
off  ten minutes of one o'clock; it was  succeeded  by  a very
slight perspiration ; his fever lasted until five o'clock ; twenty
minutes of six a slight chill; five minutes past eleven, a chill
which continued twenty minutes ; eighteen minutes past three
a chill which continued till ten minutes  of four; it was much
harder than the last; pulse ninety-seven, quarter  past seven,
hands very warm, and his face very much flushed, took his
pills a quarter before seven.
  Saturday, 25.—Yery  comfortable all day, no chill, but
some fever;  ten minutes before one in  the morning a slight
chilly feeling  succeeded by  a profuse perspiration,  which
lasted a  very long  time; he  had fallen asleep  and was
awakened by this  profuse  perspiration at two o'clock; ten
minutes past three  another slight chill, it proved to be a much
worse one than the other, he was more generally cold;  it
lasted until half past three, and was succeeded by perspiration
and fever.
  Sunday, 26.—Pills of quinine at eleven, five, eleven p.m., and
in  case of a chill during  the night, then at nine instead  of
eleven.
  Monday, 27.—A quarter past six p. m. a chill; half past six,
five grains of quinine, chill lasted  half an hour.   Half past
ten, five  grains  of quinine;  a  very slight  chill at twelve
o'clock, very restless, rolling in bed, hot hands.  Two pills  at
half past  two ; at half past six, took two pills.*
  * The pills here given were quinine, with  two or three exceptions, when
triplex was  administered as a purgative. 
V
                           16

  Tuesday, 28.—Quarter  before  eight,  operation  of the
bowels; five minutes after  eight, a pretty hard  chill which
lasted until five minutes of nine; at one  took  two pills, per-
spiring very freely; quarter before five a very slight chill, at
the same time his forehead was  moist and warm.  He said
he had fever, and it continued until a quarter  past six, when
it passed off; he had a great deal of color in  his cheeks ;  at
ten minutes of seven, began to perspire, hands were still very
warm and dry.
  Wednesday, Oct. 29.—Five minutes past twelve,  efferves-
cent draught; twenty minutes past three the  same ; twenty
minutes of four, a chill, it lasted forty minutes ;  effervescent
draught quarter before six p. m. ; chill again at  quarter past
eight p. m. ; medicine, one  spoonful at half past nine; chill
five minutes before eleven p. m., lasted about a quarter of an
hour, when he fell asleep; aconite at half past eleven ; felt
the composing influence ;  quarter past twelve,  effervescent
draught; ten o'clock, operation of  the bowels;  twenty min-
utes after one, a tablespoonful of orange flower water; half
past three,  a teaspoonful of aconite ;*  five minutes past four,
took an effervescent draught, soon afterwards  he had a suc-
cession of chilly feelings, but no positive chill; ten  minutes
before  five, he had the most severe one he has had, his nose
cold but his forehead in a perspiration ; his  legs, feet, and
back were  very cold, but in a few moments was  relieved by
warm applications ; slept very comfortably.
  Thursday, Oct. 30.—Twenty  minutes  of ten,  effervescent
draught; three minutes of ten, a chilly feeling similar to those
he had during the night;  five minutes of twelve, effervescent
draught; half past twelve, aconite; ten  minutes before two,
effervescent draught;  twenty minutes of three, slight chill
followed by a profuse perspiration,  during which  he slept
soundly.  A quarter before five, effervescent draught; aconite
half past six; effervescent draught  at  quarter past eight;
five minutes before nine, a chill,  it lasted twenty minutes;
ten minutes past twelve, aconite and effervescent draught;
  * In reference to the administration of a teaspoonful of aconite I believe
the solution was in proportion of one or two drops to a drachm of water. 
17
eight minutes past two,  aconite and effervescent draught;
twenty minutes after four, aconite and effervescent draught;
chill quarter before seven, lasted thirty minutes.
  Friday  Morning,  Oct. 31.—Yery profuse  perspiration;
quarter before ten, effervescent draught; about  1  p. m.,  two
thirds of a glass of water, in which were  twenty drops  of
elixir of vitriol; ten minutes past four, chill; in the afternoon
a chill  twenty minutes after  seven, it lasted  until  twenty
minutes of nine; chill at ten, lasted until half past ten.
  Friday Night.—Aconite at eleven,  whilst in a perspira-
tion ; aconite at one a.m., after which he slept for an hour and
a half  without  restlessness or  waking;  aconite  at  twenty
minutes before four a. m.
  Saturday, Nov. 1.—Nitro-muriatic acid quarter of two p. m. ;
two chilly feelings  during the  morning, but  they did not
amount to a  shake.  Nitro-muriatic acid at five p. m. ; eight
o'clock a  pretty  severe  chill  which  lasted  about  twenty
minutes ; aconite at half past nine p. m. ; foot bath at half past
ten, feet in fifteen minutes; nitro-muriatic acid fifteen minutes
of eleven ; chilly feelings at half past eleven, followed almost
immediately by  a drenching perspiration; aconite at  one
o'clock.
  Sunday Morning,  Nov.  2.—Perspiration continued  and
profuse—slept at intervals of  fifteen or twenty minutes until
half past two, when he took another dose of aconite : nitro-
muriatic acid at seven a. m. : nitro-muriatic acid at a quarter be-
fore three p.m. : chill quarter after three, lasted twenty minutes:
aconite at eight  o'clock:  perspiration for more than an hour
before  the chill, quite free with more  than usual languor:
nitro-muriatic acid at nine p. m. : bathing and  rubbing from
ten till eleven p. m. :  aconite at a quarter after one.
  Monday, Nov. 3.—Eight minutes before six a chill, and a
severe one—his legs and feet were very cold—it lasted about
fifteen  minutes : he was  a little warm after it, and perspired
a great deal: nitro-muriatic acid at half-past seven : quinine
and vitriol again at a quarter before one p. m. : quinine  and
vitriol  again at a quarter of three p. m. : his legs were rubbed
                  2 
18
with  the acid:  second dose of  aconite at five minutes after
twelve.
  Tuesday, Nov. 4.—Quinine  and vitriol at a quarter past
two a. m. : to this time as comfortable as  possible, but from
this dose he was quiet but wakeful, refusing to  take the ac-
onite : at ten minutes before four came on a slight chill—feet
cold and nose cold: quinine and vitriol at half past five a. m. ;
quinine and vitriol again  at half past seven, again at half-past
nine.
  Again, quarter before twelve.
  Quinine again at one.
  Quinine again at two.
  Quinine again at three.
  Chill quarter before five.
  Two teaspoonsful of quinine every two hours, commencing
at two o'clock.
  Aconite at a quarter past nine o'clock.
      "         "     of twelve o'clock.
      "         "     past one o'clock, a. m.
  Wednesday Morning, Nov. 5.   Quinine  at two o'clock.
But little sleep since twelve.  Slept comfortably until about
three  or a little afterwards, when he was awakened  by some
pain, which, however, was soon relieved  by the application of
linen saturated with laudanum ; he had this pain about twen-
ty-five minutes;  quinine  at  ten  minutes past four; ten
minutes past five, pain in his bowels, he took fifteen drops of
peppermint, and had warm flannels applied,  and a mustard
plaster;  fifteen  minutes  past five,  operation of the bowels,
very liquid ; ten minutes past six, quinine ;  quinine again at
quarter  of eleven a. m.  ;  quinine  again at  twelve p. m. ;
do. do.  at half-past one p. m. ;  quinine and laudanum,  at
three p. m.
  Thursday, Nov. 6.   Before  twelve, two swallows of bran-
dy and water.
  Sago at intervals ; quinine pill at two a. m.
  Quinine pill at five; sago just before.
  Quinine pill at a quarter before eight o'clock.
         "    at half after eleven a. m.
         "    at half past five p. m. 
19
  A cup of chicken panada.
  Twenty minutes past eight, a  tablespoonful of the harts-
horn mixture.
  Half past eight, brandy and water—a tablespoonful.
  Began the fomentations ten minutes before nine; continued
them an hour and a quarter.
  Twenty minutes past nine, beef tea.
  Half  past nine, brandy and water.
  Ten o'clock, beef tea.
  Half  past ten, brandy and water.
  Eleven, beef tea.
  Half  past eleven, brandy and water.
  Twelve, beef tea.
POST-MORTEM EXAMINATION OF THE BODY OF
             DR. J.  KEARNY RODGERS.
                   BY C G. ISAACS, M.D.
  [I must tender my thanks to Dr. Isaacs for so politely furnishing me
with this copy.]

  On laying open the cavity of the abdomen, it was found
to contain a large  quantity of semi-purulent matter, with
flakes of coagulable lymph, which adhered  to the peritoneal
lining of the abdomen and  to the serous surface of the intes-
tines.  The omentum  was partially spread out over the small
intestines, and adhered  slightly to their surface.  On care-
fully separating with the knife, the mesenteric border of the
small intestines from  the mesentery, numerous small drops
of purulent matter were observed, on the separated edge of
the mesentery, and on the corresponding border of the intes-
tine—along the whole extent of divided surface from the ter-
mination of  the ilium, up to the commencement of the jeju-
num.  (This purulent matter was afterwards  ascertained to 
                           20

 have issued  from the cut orifices  of the mesenteric veins.)
 On cutting into the mesentery, several small depots of puru-
 lent matter were found, containing from half an ounce to an
 ounce and a half of fluid.  These were situated in the cellu-
 lar tissue, between the lamina of the mesentery.  The large
 and small intestines were removed and opened ;  but did not
 exhibit any appearance of disease (except on their peritoneal
 surface).  The stomach,  spleen and pancreas were healthy.
 The liver was removed, and the biliary dncts carefully traced
 out and opened, and appeared healthy.  The liver was then
 laid upon its inferior  surface, and upon making an incision
 upon its upper, or convex surface, several small  points of
 purulent matter were perceived.   On carefully  examining
 these, the purulent matter was  found to  issue from the cut
 orifices of the branches of the vena porta?.  Incisions were
 then made into the substance of the liver, in various places,
 and the same appearances were observed in the cut  portions.
 The  trunk of the vena porta? was now examined,  and  pre-
 sented the appearance and feel of a firm, hard cylinder,  and
 when opened, was found to be filled with  coagulable lymph
 and  semi-purulent matter, and  a few  small clots of blood.
 This vein, upon being traced into the right  and  left lobes of
 the liver, exhibited  the same  appearance in its branches, as
 far as their third  and fourth  divisions.  Subsequently (next
 day) a small  portion  of the  liver, placed  under the micro-
 scope, exhibited no pus globules in its minute structure.  On
 examining at the same time a portion  of the mesentery, and
 carefully tracing up a branch of its mesenteric vein towards
the intestine,  this vein with its small branches was observed
to be filled with shreds of coagulable lymph and  semi-puru-
lent matter.   At the apex of  both lungs, a  few small cicatri-
 ces were found, as  also some  three or  four small cretaceous
masses.   A few old and slight adhesions existed between the
right lung and pleura costalis.  The structure of the lungs
 and heart was perfectly healthy.
      (Signed)                      C. G. Isaacs, M.D. 
21
   Remarks upon the Report of the Post-Mortem Examination.
  The statement of the appearances on the post-mortem ex-
amination, as drawn up by Dr. Isaacs, although correct in
the main, is still deserving of  a few remarks.   In speaking
of the liver, he does not state the peculiar appearance of the
upper surface, which I think is  worthy of note.   On the con-
vex surface, it presented  a light opal shade—observable  on
both lobes—the  lesser one being slightly noduled, but offer-
ing no resistance to the finger, upon  being passed over it;
the size of the liver was rather  less  than usual.   He goes  on
to state " that it was then laid upon its inferior surface, and
upon making an incision  upon its  upper or convex surface,
several  small points  of purulent  matter were perceived."
This statement certainly does not appear to me to give a com-
plete view  of the condition  of things,  inasmuch as  every
branch of the portal vein in both  lobes so cut,  was literally
gorged with purulent matter, as far as the eye could follow its
ramifications. Dr. Isaacs then further states, " that the trunk
of the vena portse was examined and presented the appear-
ance and feel of a firm, hard cylinder, and when opened was
found to be filled with coagulated  lymph and semi-purulent
matter, and a few small clots of blood. The vein on being traced
into  the right and left lobes of  the liver, exhibited the same
appearances in its branches,  as far as their third and fourth
divisions."  This description of the appearances of this vein
does not certainly accord with my impression derived at the
time.  The trunk of the portal vein was at its cut extremity
partially supported by a cylindrical lining or false membrane
of lymph, attached to the inner coat of the vein by shreds :
this vein was imperfectly filled with purulent matter,  much
having  run out.  The cylindrical  lining was  found,  when
laid  open, to extend throughout to  its third  and fourth divi-
sions, the orifices of which were filled with purulent matter.
I  could  not discern  the  clots  of blood as observed by Dr.
Isaacs.   Dr. Isaacs then makes mention subsequently (next
day) of a small  portion of the  liver being placed under the
microscope, '" exhibiting  no pus-globules in its minute struc- 
22
ture," and " on examining at  the same time a portion of the
mesentery, and carefully tracing up a branch of its mesente-
ric vein towards the intestine, this vein with its small  branch-
es was observed to  be filled with  shreds  of  coagulated
lymph, and semi-purulent matter."  As I was not invited
to these microscopic  observations,  I  will here take the
liberty  of  asking Dr. Isaacs how far  the matter  or pus
globules were traced in  the  minute  distribution  of the
portal  vein in the liver?  Does the  minute structure  of
the liver, as above stated, include the minute*distribution
of the  portal vein ?  or is the  remark confined to other por-
tions of that organ %  I must infer that it has reference  to
the latter only, as these branches were gorged  with purulent
matter, as far as the eye could trace them.  While upon mi-
croscopic inspections, I would beg leave to remark,  that  as
no mention is made of the pus globules  being  of  long stand-
ing, I  presume it is conceded that the matter found in the
post-mortem examination of the body of  Dr. R., was of recent
formation.   That the  matter as found in the depots in the me-
sentery was not of long standing is evident, both from the fact
that he had enjoyed comparatively good health to the time of
his late illness, except occasional bilious discharges from the
bowels, as well  as from the  fact that the depots of matter
above  described were not encysted or supported by dense walls
or distinct coverings ; as they were barely sufficient to retain
the accumulation, thereby showing that the pus as found  in
the depots was of rapid and recent formation.
   Dr.  Isaacs omitted,  or probably it  did not seem to him
important, to detail the conversation  I  had with him at the
time  of conducting the post-mortem  examination.   I will,
therefore, state, as it is  important in confirming my  views of
the case, that at this stage of the  dissection, after the remov-
al of the stomach and intestines (for I had not before spoken
. to him in reference to the  post-mortem), I  requested him to
remove the liver and  its appendages  carefully, and  to place
them in a  basin for examination near the  window, which  he
politely did.  I then requested him after inspecting  the con-
vex surface of the liver, first to examine the capsule of Glis- 
23
son, and the main ducts with the blowpipe, to ascertain their
condition :  they were sound.  2dly, I requested him to turn
the liver over (convex  side uppermost) and to make a deep
incision transversely through the  major lobe so as to divide
the ramification of the branches of the portal vein, and  to
repeat the same in the lesser lobe; this also he did.  They
were found gorged with matter.   3dly, I then requested him
to pass a blowpipe into the main channel or vena porta? to as-
certain if the branches  so divided by the incision (and gorged
with mattef) were the  ramifications of that vessel only; this
was also done.  4thly,  I then asked him to make an incision
diagonally to the  first and longitudinally with the trunks  of
that vessel; this was done, and they also were found gorged
with matter and cylindrical lymph.  The same was repeated
on the lesser lobes with similar results.  5thly, I furthermore
requested Dr. Isaacs to turn the liver over and examine the
portal vein on  its entrance  into the  liver, and to  divide it
quite up to  its first divisions; they  were, in like manner,
found gorged with purulent matter, and contained the same
cylindrical lymph formation.
CASES.
  I will now endeavor to show that the opinion I at first ex-
pressed and acted upon was the correct one,—that of biliary
congestion of the liver,—and that the inflammation that super-
vened in the portal circulation, was the result of unremoved
obstruction in that organ.
  Congestion, as understood  by ancient writers, is rather a
vague  term; it meant  merely an engorgement.   Ordinary 
24
congestion of the liver, even with enlargement of that organ,
is not always attended with  pain, which remark is'sustained.
by all  modern  pathologists.  Cruveilhier also gives cases of
inflammation of the gall-ducts in the liver unattended with
pain.   By these authorities,  with the aid of the microscope,
it is more distinctly defined.  According to Kiernan it is di-
vided into several kinds :  that which arises from interrupted
circulation  through the heart, termed by  Mr. Kiernan, he-
patic venous congestion ;  this is again divided into degrees
of congestion, according to the vessels involved, such  as bil-
iary congestion,  where the ducts are concerned, and  portal
venous congestion, where the portal veins are involved.   Bil-
iary congestion is an  accumulation of biliary matter in the
lobules of the liver, and may be caused either by an impedi-
ment  to the free escape of- bile  through the small  ducts, by
pressure arising from distended capillaries of the hepatic
veins, or by interruption to  the  flow of bile, by causes oper-
ating  mechanically in the larger ducts, or by changes  which
the biliary fluid  undergoes, from various causes, or where the
thinner parts of the fluids of the body are carried off  by in-
creased secretions.    These  observations are made by all
modern writers on the pathology of the liver, such as Budd,
Kiernan, Annesley, Cruveilhier, Rokitansky, and others.   An-
nesley states (page 329, Yol. I.) " that,  in India, in persons
who die of diseases of the liver, the hepatic ducts are com-
pletely gorged with viscid bile without any apparent change
sufficient to account  for  the circumstance, and without any
other impediment to  the escape  of  the  bile than that which
arises from its own viscidity."   Budd also states (page 256),
" that an unhealthy condition of bile may inflame or irritate
the gall-ducts, and  that the secretion of bile may be disor-
dered when the  portal blood, from which the materials of the
bile are drawn,  is rendered  unhealthy from unhealthy food,
faulty digestion or  assimilation,  &c. &c."  The same  writer
also says, " it may probably  be disordered too from  the direct
influence of anxiety or strong mental emotion.   In any case,
the disordered  secretion of  bile is the effect of some other
disease or some  cause that  disorders other organs as well." 
25
Obstructed flow of bile, or biliary congestion of the liver, may
produce inflammation in the gall-ducts from  over-distension.
This inflammation may extend  to  the adjacent, structure or
portal veins so intimately connected with them,* the same as
in inflammation originating in the capsule of Glisson, ending
in suppuration and consecutively  involving  the  portal vein.
(See Rokitansky,  Cruveilhier,  and  others.)   It may also  act
from the original  morbid condition of the bile, which has al-
ready been the cause of congestion, or may act chemically from
being for some time arrested in its course.  Xhese may sepa-
rately or conjointly operate as causes producing inflammation
in the  adjacent areolar tissues and portal  branches.  It is
certainly reasonable to suppose that where congestion of the
liver exists, it may be aggravated to such  a degree as to cause
suppuration in those vessels, where the remedies used, (mis-
taking it for another disease) are calculated in themselves to
produce congestion, such as the administration of twenty to
thirty grains of quinine, per diem, as occurred in the case of
Dr. Rodgers.  The following case is, in some degree, an exem-
plification of similar results originating from the same cause,
but occurring in the hepatic ducts instead of the portal vein:

           CASE GIVEN  BY DR. OLLIFFE, OF PARIS.
   "The most striking instance  of  suppurative inflammation
of the hepatic gall-ducts I  have found  recorded,  was  related
by Dr. Olliffe (of Paris), at the meeting of the British Associa-.
tion, in 1843.  It  occurred in the person of an  officer, who
had resided many years in India, and, during that time, had
suffered from 'jungle fever,' or  a peculiar intermittent of ter-
tian  type, which afterwards recurred in a slight  form when
he was in Italy.   Many years  afterwards other  symptoms
came on, which, at first, were not of an aggravated character,
such as debility and slight nausea every morning, not amount-

  * It is to be borne in mind that the branches of the portal vein accompany
the branches of  the hepatic artery and biliary ducts in  their ramifications
through the portal canals, to terminate in the substance of the lobules.
These vessels are contained in the capsule of Glisson, which extends with
them to their ultimate destination in the liver. 
26
ing to vomiting.   Then daily rigors set in, followed by fever,
which  ended in  sweating, as in ordinary intermittent fever.
The periodical symptoms were stopped by quinine, but he
grew weaker and at length  died.  Latterly there was some
tenderness over the liver which seemed enlarged.  The liver
was found enlarged,  but it presented no marked change of
structure except  in the mucous membrane of the gall-ducts,
which was thickenedand softened and readily separated from
the tissue beneath it.  The ducts  were enlarged and filled
with pus, and this through the entire organ, so that wherever
an incision was made, pus oozed out.  The  veins were par-
ticularly examined and were found healthy.   The gall-bladder
was full of bile mixed with pus.  The mucous membrane of
the entire alimentary canal was healthy.  The other viscera
of the great cavity appeared perfectly sound."

                   CASE OF DR. ROBERT.

  " Dr. Robert observed a very fatal case of phlebitis hepatica,
caused by a rupture of a biliary duct and effusion of bile into
its corresponding portal vein into the liver."

                CASE OF DR. JAMES RUSSEL.
 %
  Dr. James Russel reports a case where matter was found
in the portal vein consequent upon abscess of  the liver after
amputation of the leg.   Cited by Dr. Budd (page 143).  " He
says, in  speaking of inflammation of the portal vein,  that
it may be caused by an abscess of the liver, consequent on
phlebitis of some distant part.  This happens, however, very
rarely; probably on account of the coats of the vein being
thick and surrounded by areolar tissue.  The only instance
of the kind I have met with, is in a case sent me by my friend
Dr. James Russel of Birmingham.  The patient, a man of
middle age, had  his leg amputated on the 18th of March, on
account of gangrene coming on after a compound  fracture.
Three days after the operation he  had a rigor, followed by
sweating. The rigors recurred, other constitutional symptoms
o  purulent  phlebitis came on, he got  gradually lower, and 
27
died on the 20th April.  Occasional pain at the epigastrium
was the only sign that the  liver was diseased.  An abscess
was found in the apex of each lung, and  three or four ab-
scesses in the liver.  A large  branch of  the portal vein, in
contact with one of the abscesses, contained a hollow cylinder
of  lymph, about two  inches in length, filled with  pus.  The
abscess reaching the coats of the veins, had probably excited
inflammation of its lining membrane,  just as an  abscess,
reaching the surface of the liver, excites inflammation of the
peritoneum above it."

 CASE OF MRS. ----, ATTENDED BY DR. HOSACK AND DR. RODGERS.

   The following case, being that of congestion of the liver, ac-
 companied with its usual symptoms, and which ended in plastic
 inflammation of the portal vein, is one of peculiar interest, the
 more so as it was diagnosticated by Dr. Rodgers and myself,
 and treated accordingly.  The patient recovered, and is now
 living in comparatively good health.  Mrs.------, upwards
 of sixty, of a naturally good constitution, had enjoyed  unin-
 terrupted health until the last ten years, when she was occa-
 sionally attacked with disturbances of  the stomach and in-
 flammation of the liver, accompanied with oedema of the feet,
 which  yielded  to the ordinary  treatment.  The last attack,
 which occurred eighteen months since, commenced with pain
 in the  right hypochondriac  region, attended with the usual
 symptoms, which resisted  the antiphlogistic treatment.  Se-
 rous effusion took place in  the abdomen to a considerable ex-
 tent, which called for, in addition to the above treatment, the
 use of hydragogue medicines, which were continued for five
 months, when the disease  finally yielded and  the swelling
 entirely disappeared.   It is worthy of remark that, by  the
, foregoing remedies, the patient was slightly salivated.  Soon
 after this, symptoms of inflammation of the portal structure
 manifested  themselves, which were as follows: pains  in the
 epigastrium and right hypochondriac region, which continued
 for several days, when jaundice  appeared, which had slightly
 manifested  itself on previous occasions during her illness. 
28
   These symptoms increased, with  the  addition of pain ex-
tending from the epigastrium to the left hypochondriac region,
and also from the umbilicus to the ensiform cartilage, accom-
panied with general soreness, succeeded by a sense of heat
and burning pain throughout the abdomen, and also acute,
deep-seated pain in the direction of  the  portal vein : sallow-
ness increased.  The  pulse at this stage was quick, 110, soft
and compressible, the tongue was  slightly  coated with a
white fur, denser at its base, and which  continued the  same
throughout her illness.  The patient at this time, at 11  p. m.,
was attacked with a very severe rigor, which lasted two hours,
attended with  a profuse sweat during the rigor,  and imme-
diately succeeding it.  It was not followed by fever, the pulse
continuing the same.   The bowels  had been, and continued
to be, acted upon by medicines of a  mild aperient  kind.
The next morning  she had a chilly,  feeling which lasted for
some time.  The day  after she had a slight rigor which was
accompanied by sweating: she had again another rigor two or
three days after.  These chilly feelings recurred at irregular
periods, for about a fortnight, with hectic flush morning and
evening and slight fever.  The soreness of the bowels and
pains in the left hypochondriac region increased, associated
with pain in, the left shoulder, connected with nausea, hic-
cup, short breathing  at times and  a  troublesome cough at
irregular periods.  These  latter  symptoms occurred at the
advanced stage of the disease.  The patient had dejection of
spirits, with a  countenance expressive of great  anxiety, and
restless and watchful nights.  She had frequently slight dis-
charges of blood from the bowels, which in the commence-
ment of her disease  had been  excessive.  The  urine was
always turbid,  with a red deposit, and which upon analysis
was  found  to  have a  preponderance of ammonia and very
little of uric acid.  The epigastric veins were large and con-
stantly distended,  which circumstance  was noticed by the
patient, who called our attention to  it.   The symptoms gra-
dually yielded to the following treatment:   In the dropsical
stage of the disease an emetic  was administered •  14 to 16
ounces of blood were taken from the arm,  leeches  and cups 
29
were applied several  times  over the region of the liver; a
succession of blisters was placed on the right hypochondrium
and over the bowels;  calomel was freely administered and
carried  to the  point  of salivation; veratrine  ointment (25
grains  to the ounce)  as well as that of stramonium (to the
amount of  several ounces  each) were rubbed alternately
over the abdomen  with great relief,  and strong tincture of
aconite, with cataplasms of  linseed.  The symptoms declin-
ing and appetite improving, all nutritious diet and drinks
were had recourse  to.   Her  convalescence was slow and she
now enjoys  comparatively good  health.  All the pathogno-
monic symptoms characterizing this disease were present, as
laid  down by  Rokitansky, Schonleins, Raczynsky, Eisen-
mann, Canstatt, and others.

    CASE ATTENDED BY DR. HOSACK, DRAWN  UP BY DR.  C.

  Thomas U----, a young and to all appearances, previously
healthy man, a seaman by occupation, was seized with typhus
fever of a very severe type, which ran its course in about six
weeks,  when the visits of his physician were discontinued,
and he was in the habit of walking out every day.  -Septem-
ber 15th,  twelve days after, he walked  on the Battery in
the morning, feeling quite well.  In the evening he was seiz-
ed with a rigor, but was not seen  by Dr. Hosack until the
next morning, when he found him complaining of pain, ex-
tending from  the right hypochondriac region through the
epigastrium to the posterior part of the left hypochondrium,
and from the ensiform cartilage down to the umbilicus.   His
pulse was frequent, tongue dry and coated at its base, and his
surface becoming quite sallow.  He was ordered a pill of Mass.
hydrargyrum, followed by the common  eccoprotic  mixture.
That day he had another rigor, followed by a short hot stage,
the latter being followed by profuse perspiration.  The next
day he had  two rigors at irregular periods, followed  by a pro-
fuse sweating stage unattended with fever.   During the whole
time he complained of pain in the region  above described.
He was now ordered an emetic, the effect of which  was im- 
30
mediate relief from the pain, and cessation of the rigors.   The
next day he was ordered hydrargyri sub. mur. in gr. iij doses
until gr. x ij. had been taken, his surface now being of a deep
yellow tinge.  September 25th.  The yellowness of his  skin
has been gradually diminishing and his general health slowly
improving.*
  I have here cited four cases of inflammation of the portal
vein,  originating from the  liver,  two of which  terminated
fatally: one from extensive suppuration in the portal vein,
consequent upon congestion and the bursting of a gall-duct
into its accompanying branch of the portal vein in the liver;
the other from the formation of  lymph and matter in the
same vessel caused by an  abscess in the liver.
  The other two recovered,  both caused by  congestion  and
inflammation of the liver.
AUTHORITIES.
  Canstatt, Yol. IY., Page 239.
  Inflammation of the Vena Portal and of the veins  of the
liver.
  {Phlebitis hepatica.)
                 Anatomical Characters.
  Page 90. They  are the same  as in  phlebitis in general.
The  products  of inflammation are found in the vena portse
and its branches.  The  coats of these veins are thickened__
occasionally they are transformed into mere channels of pus.

  * This case terminated in resolution, in consequence of the congestion of
the liver being removed by treatment.  An abscess has since appeared in the
axilla, and has healed without any ill consequences. The patient has since
done well. 
31
Those veins of the vena portal system which do not partake
of the  inflammation, are enlarged  and swelled with  blood,
the spleen is  occasionally  enlarged,  there  is inflammation
and  suppuration in  the surrounding cellular tissue in the
capsula  Glissoni, from whence   inflammation  sometimes
originates, and is transported to the vena porta?.   The liver
does not always exhibit organic alterations either in the acute
or chronic stage.
                       Symptoms.
   Page 91. The inflammation of  the vena portse may be
either  acute or chronic.  Raczynsky, by his own observa-
tions as well  as those  of others, and also  Schonleins's col-
lected  observations,  gives  the following  description  of the
acute form:
   A. Stage of inflammation, local symptoms: Sudden pains
in the  epigastric and hypochondriac regions of the right side,
in the  linea alba between the navel and  ensiform cartilage,
originating without any distinct cause, resembling colic in its
coming  and going,  increasing by pressure, and gradually
spreading over the  whole  abdomen around to  the  spine.
Heat in the depth of the hypochondrium, the abdomen more
or less tense but not meteoristic, the veins of the abdominal
walls enlarged and ascending to the chest and axilla.   Gene-
ral symptoms : Fever, beginning before, with, or after the lo-
cal  symptoms,  severe  chill for  hours, followed by burning
heat,  an  accelerated,  soft  cmd weak pulse, dry skin, dry
tongue, coated at its  base with  a thick  white mucus, bitter
taste, nausea and vomiting,  thirst, heaviness in the head, diz-
ziness, faintness, restlessness,  sleeplessness and constipation,
small  discharge of a very red urine, with  a brick-powder-like
sediment.  After a  short  time trouble about the breathing,
restless turning in the bed, and jaundice.
   B. Adynamic stage—-three to eight days  after the  begin-
ning of the disease.   The first stage never protracts until the
fourteenth day.  Local symptoms: the pains and the  heat in
the  abdomen  disappear entirely; there  is  a perception of
throbbing in the abdomen, and occasionally in other parts of 
32
 the body; the abdomen is more expanded, the evacuations of
 the bowels are darkish, and occasionally contain blood.
    General and consensual symptoms:  choking  of black
 masses  like diluted soot,  pressure in the abdomen causes
 stitching pains and choking, palpitation of the heart, irregu-
 lar and unequal impulse, great anxiety, distorted features,
 moistened face, black color of the mouth, of the orifice of the
 nose, of the tongue, trembling of the tongue, prostration, loss
 of the mind, an anxious and vacant look, dilatation of the be-
 fore contracted pupilla, sopor coma, delirium, automatic mo-
 tions of the hands towards the abdomen, small and innumer-
 able pulse. Towards the last much black blood is discharged
 by the  anus,  strength  diminishes  continually,  hypocratic
 face,  cold extremities, and  in about seven days death super-
 venes.----Eisenmann completes that description by directing
 the attention to a second chill, which indicates the beginning
 of the suppuration, and which can come by repeated attacks.

                     Chronic Form.
   Page 92. Sometimes a considerable loss of flesh, jaundice,
 ascites, and general dropsy are all the symptoms. Raczynsky
 gives the following description of the chronic form :  A disa-
 greeable sensation of pressure in the pit  of  the  stomach, a
 sensation as if all would stop in the abdomen, a little heat in
 the hepatic region and  a little pain from the beginning, the
 abdomen is a little expanded and  somewhat  painful, yellow
 color  of the skin, dilated veins of the abdomen and of the  ex-
 tremities, a little fever in the evening with alternating chill
 and heat, dry skin  somewhat warmer, the pulse  sometimes
 accelerated and soft, sometimes  slow and weak, dyspeptic
 troubles, repeated vomiting of greenish black masses, inter-
 mixed with blood, torpor of the  bowels, a redpowder-mixed
 urine, a little dyspnoea and  coughing.  Emaciation progresses
 and the  abdomen expands more, sometimes with symptoms
of dropsy,  strength  fails, the emaciation increases  though
there  is sometimes more appetite, a hectic state, black blood
discharged from the anus,  slight delirium coma, then death.
The disease stands from a month  to a year. 
33
                          Causes.
  Page 93. The inflammation of the vena portse, as all phle-
bitis can  originate, primarily, in the internal  coat  of the
veins, or, secondarily, in consequence of phlebitis in other
parts by the propagation of the inflammation, or by  resorp-
tion of pus or ichor, or by the extending of the inflammation
and suppuration from the capsule of Glisson and the substance
of the liver, from the stomach, from the intestines and  from
the spleen to the system of the vena portse and to the veins
of the liver.
              Rokitansky, Vol. I., page 528.
  Pyaemia is not  seldom primitive, (protopathic or deutero-
pathic, i. e., produced by other diseased constitutions, as, for
instance, the typhoid or an exanthematic constitution), but
more ordinary pyaemia is consecutive, i. e., the consequence
of reception  of  pus in the blood, an infection which takes
place in different ways, as :
  A. By the reception of purulent plasma in the lymph-ves-
sels, or immediately in the blood-vessels, (resorption of pus.)
There is no doubt about the fact, in spite of the greater con-
sistency of the pus comparatively to the blood.
  B. By reception  of pus in opened blood-vessels, especially
in organs which, by their greater solidity, keep the openings
of the blood-vessels free.   Of such a condition  are also the
cases of reception of pus exudated in the cavity of the larger
blood-vessels.
  C. Especially when the pus produced by a local process in
the interior of a vessel, gets into the veins.
  All that concerns both of the above mentioned degrees of
pyaemia, of which the second one occurs independently, pro-
duced by the infection of the blood by stagnant and so de-
composed  and putrefied  pus.   The same is the case  with
poisoned wounds by cadaverial pus.—By injection of purulent
plasma, Ddrcet has produced the disease, which is but  the
spontaneous development of the lower degree of pyaemia to the
purulent sepsis,  to the necrosis of the blood, and'it  is proba-
                  3 
34
ble that such a development is  effected by the oxydation of
the pus in the blood by the respiration.

  Boaillaud in  the  Arch., Gen. Regnaud in Journal heb-
dom., Tom. H., No. 24,  also in Revue Medicale, 1839.----
Dance in archive generale, Dec, 1828, Eeb., 1829.  Bone in
Clinique des Hopitaux, May, 1829, also in Bulletin des  Sci-
ences Medicales, 17, p. 216.  Newmann, Med. Clinique, Yol.
H., p. 665.   Balling, Med. Clinique, p. 310.—Figeau in
Bibliotheque  Medicale,  XXXYIIL, p. 209.—Select Papers,
XXYIIL, p.  333.—Raczynsky, Inflammation of the Yena
Portse, 1838.----Mohr,  Central Gazette, 1840, 'So. 29.----
Schmidt's Journal, Yol.  XXYIIL,  p. 50.—Cruveilhier, in
Universale, Yol. XL, p.  109.  Also in Anatomie  Pathologi-
que Livraison, XYL, Feb. 3.—Eisenmann, in Schmidt's En-
cyclopaedia, Yol. YL, p. 303.—Guterbock.—Schonleirts Lec-
tures Cliniques, No. 2, p. 275, refers to three Inaugural Dis-
sertations of  Kaether, Lauder, and Messon*  Lambron, in
the Archives Generales de Medicine for June, 1842.   Here,
inflammation of the trunk of the vena portaa was caused by a
fish bone, which passed through the pyloric extremity of the
stomach and the  head of the pancreas, and stuck in the su-
perior mesenteric vein.
  Part of the  above is a literal translation from the German
and French authorities.

  * Messon gives a summary of all the cases of inflammation of the portal
vein recorded in his Inaugural Dissertation. 
35
ACTION TAKEN  BY  THE  PATHOLOGICAL SOCI-
     ETY IN REFERENCE  TO THE CASE  OF
                    DR.  RODGERS.
  These three gentlemen, Drs. Delafield, Swett, and Dubois,
are members of a Pathological Society, which is presumed to
be  a  scientific  association  for  the  investigation  of truth.
These gentlemen after the post-mortem  examination of the
body of the late Dr. Rodgers, repaired to the rooms of the
Society  which held  its  regular  meeting  three days after the
death of  Dr. Rodgers,  and there made a  statement pro-
nouncing  the  disease to be  that of phlebitis of the portal
vein which had caused his death,  retracting the  opinion
which they had before, most decidedly expressed, of its be-
ing bilious  remittent fever,  and that I, as well as they,
were wrong, and this they also repeated  in domestic  cir-
cles.*  Remarks immediately followed by some of the mem-
bers.  Dr. Clark, the Professor of Pathology in the  College
of Physicians  and Surgeons of the University of the State
of New York, addressed the meeting, and said, " that this
" disease was one of very  rare  occurrence; but six cases
" only, had been known to the profession, and that one of
" these was that of Dr. Rodgers.  He said, this disease has no
" pathognomonic symptoms, and cannot  be discovered until
" after death, and if known could never  be cured as it is al-
" ways fatal."
  The learned professor goes on to state that it was impossible

  * I trust I shall not be charged with  being too  particular in stating my
views of his disease. I  am under this  necessity,  in consequence of these
gentlemen and their friends having said  (and continuing  still to assert) that
I had no distinct opinion of his case. 
36
for any person to  have diagnosticated the disease of which
Dr. Rodgers  died; then appealing to the Society,  he said,
" by the nods and smiles of acquiescence of those about
" him, that he was satisfied that a  part, if not a greater
" part  of the  Society,  agreed with him  in  opinion."  This
eloquent speaker was  followed by another  member  of the
Society, who  stated,  " that  a member  of the  profession
" and  his friends  were circulating a report that Dr. Rod-
" gers  died from a mistake in the treatment of his disease,
" and  that if they,  (this physician  and his  friends,) had
" had  the management and  treatment  of this case, they
" could have  cured him."  He then moved, " that a vote of
" censure be passed upon this physician, and that all the
" members of this Society go  forth  and contradict such a
" statement."  The above communications and remarks are de-
serving of but little notice.  I cannot, however, pass over the
scientific part of Professor Clark's assertion.  He states in the
first place,  " that the disease was of very rare occurrence, and
" that  only six cases had been known.  Secondly, that this
" disease has no pathognomonic symptoms, and if known could
" not be cured, as it is always  fatal."   As  these assertions are
so amply refuted by the authorities quoted, (see page 30,) any
additional observation  from me is unnecessary, particularly
as the  number of authorities quoted at page 34 furnish some
three, some four, some  five cases,  exhibiting pathognomonic
symptoms as  laid down, several of which were diagnosticated
before  death in the hospitals at Yienna, Paris, Berlin, &c. &c.
In reference to the last part of the learned Doctor's observa-
tion, where he says, " by the  nods and smiles of acquiescence
of those about him, that he was satisfied  that a part, if not a
greater part of the Society agreed with him in opinion ;" this
I should deem unnecessary for a professor of pathology whose
word alone should almost be law to his hearers.  I am there-
fore quite  at a loss to imagine  by  what motive Professor
Clark  was actuated in enlisting proselytes,  unless it were
that of screening his fellow-members.  At all events, it com-
ports but little with the dignity of a Society, professedly
learned and having truth for its object, to feel such  necessity 
37
and to resort to such unworthy means to uphold errors, com-
mitted by individuals of their society, and reflecting upon a
member of the profession, who is in no way connected with
these  local institutions.  As  regards  the remark made by
the gentleman moving the vote of censure, I presume he did
so in allusion to my having tried to persuade Dr. Rodgers
in the early  part of his illness, to allow  Dr.  Wilkes and
myself to  assume  the  charge of him, and  of the assurance
I gave him of his recovery,  in the  event of  his comply-
ing.   Aware  that  the  Society  has  honorable  members in
its association, and not  believing it possible, notwithstanding
the course pursued by Dr.  Clark,  that they could receive
and condemn upon ex-parte  statement, at  the next meet-
ing on the 26th November, I deemed it a duty to myself as
well as to those honorable members, to send  them so much of
the case of Dr. Rodgers as came under my observation, up
to the time of my withdrawing from the consultation, which
was done with a liberal and impartial  consideration, accom-
panied with, what I conceived to be, a polite note, explanatory
of my object, addressed to the President and members of the
Society.  (See Appendix, page 42.)   The note being read, Dr.
Swett moved that the documents be  referred to a committee,
saying, " that as Dr. Hosack was not a member  of the So-
ciety, the admission of a communication of this character
without any previous consideration, implies a want of correct-
ness in the statement of the same case as given by  a member
or rather several members of the Society at the last meeting,
and that the Society should by all means sustain  its members,-
(even in error, I presume, according to Professor Clark's doc-
trine,) in the veracity of their report, and that they ought to
have no controversy about it, for if they did, they would only get
themselves more and more into hot water P   Dr. Swett then
proposed that it should be referred to the President to report
at the next meeting, and said one reason he proposed it to
Dr. Yan Arsdale (the President pro tern.) was, that he believ-
ed he was rather on friendly terms with Dr. Hosack, and he
had sent for him (Dr. Yan Arsdale) to attend the post-mortem
examination.   At the next meeting, December 10th, Dr. Yan 
38
Arsdale reported in favor of having the communication read,
but it was overruled by the Society.
  In reference to the fact of my intention to have invited Dr.
Yan Arsdale to the post-mortem examination (as asserted by
Dr. Swett), I would beg leave  here to  quote from the letter
afterwards addressed to Dr. Yan Arsdale, to correct the mis-
take, as follows: " Now, not wishing to presume on friend-
ship, and preferring that the communication should rest alone
upon  that of justice to myself, I beg that you will not allow
any  friendly considerations for me to actuate  you in the
course you may think best to pursue. I must also take this op-
portunity to inform you, that the notice I received of the time
appointed by the gentlemen in attendance, for the post-mortem
examination to take place, was so short, that even had your
name occurred to me, I could not have notified you of it. I can-
not, therefore, conceive what suggested to the mind of the gen-
tleman making the motion, to have stated that such was my in-
tention." Nevertheless, Dr. Swett at this meeting reiterated it,
and  asserted that I told him (Dr. Swett) that I had done so,
which I here positively and unequivocally deny. Dr. Yan Ars-
dale having reported in favor of receiving and reading the
communication, qualified it by saying that it contained nothing
in the least degree objectionable.  A motion was then made
by one  of the members  that the  report be accepted, which
was  carried.  The  same gentleman again  moved that they
should now go into executive session, which was  also carried.
The room was then immediately vacated by all but the mem-
.bers of the Society.  This certainly seems to me a very extra-
ordinary course for a scientific body to pursue, to debate  in
the closet upon the merits or demerits of such a communica-
tion, when you take into consideration the favorable report of
their committee, and assurances of its  containing nothing in
the least objectionable, as well as the letter addressed by me
to the President and  members of the  Society, expressive of
the purport of it.   Not hearing from the Society of any ac-
tion having been  taken upon it {even  in secret), I must con-
clude that my communication was rejected. 
39
SUMMARY.
  Can any well educated or practical physician, after read-
ing the history of this case and  the post-mortem examina-
tion, or the journal as  recorded by  the  family, showing
the various changes and the progress of  the disease, and
the cases above  cited, for one moment imagine (certainly
no educated surgeon would) that it could have been mis-
taken for bilious  remittent fever, and that such treatment
would have been proper had it been that disease?  Neverthe-
less, such  was the fact, in  spite  of remonstrance and such
convincing proofs as were evident by the rigors, and con-
tinuance of sweats and peculiar  pyaemic pulse. It would
really seem they were bewildered,  following a phantom which
left them in darkness and dismay.   Strange as it may appear,
they were  not convinced until the startling facts were re-
vealed by the dissection ;  and  not only then did they admit
their own error, but  they were unwilling to award to me the
merit of the  early discernment of the disease,  and  a plan
of treatment  by which such disastrous consequences  might
have been averted.  Having differed from them  in opinion,
thus making it necessary for me to withdraw from the con-
sultation, (which I should have done long before  had it not
been for the earnest solicitation  of my family,)  I expressed
myself to Mrs. Rodgers (who was extremely desirous of my
continuing in the consultation), that I could  see  nothing to
change the opinion I had formed and so frequently expressed,
and that my attendance would be of no farther avail.  I at
the same time enjoined upon my sister, Mrs. Rodgers, that it
was her duty to obey, implicitly, the directions of the attend-
ing physicians, adding that I had only to regret that  I  could 
40
not accord with them in opinion.  The physicians asserted to
the family that I was wrong in my views of the disease, and
that it was bilious remittent fever, as  clear as the noon-day.
So pertinaciously did they adhere to their opinion to the last,
that upon meeting Dr. Swett in the ante-chamber on Saturday,
(the day previous to Dr. Rodgers's death,) I asked him if he
saw nothing to cause him to change his mind, to which he re-
plied " that he was more confirmed  than ever that  it was
bilious remittent fever."
  After the death of Dr. Rodgers, the attending physicians
(without  conferring with me) had effected  the arrangements
with the relatives of the family, to make a post-mortem ex-
amination.  I was only apprised of it at a  late hour from
another source, and attended at the time  appointed  by the
physicians.  I felt that I had the  right to be  present, and
invited a few of my professional friends  to  accompany me,
viz.:  Dr. Wilkes,  Dr. Yan Rensselaer, Dr. Darling, and
Dr.  Church.   This  precaution I deemed  necessary in con-
sequence of the  conduct of the  consulting physicians in this
matter, which led me  to  suppose  that  it  was necessary  I
should have reliable witnesses as regards the facts to  be dis-
closed.  Notwithstanding the results of this investigation, (as
published in the post-mortem examination,) these gentlemen
have persisted in my being in error, and that the disease of
which Dr. Rodgers died could not have been known ; and  if
known, could never have been cured.*  Aware that such as-
sertions were  incorrect, I have  proved, I think, that I was
both right as regards the diagnosis of the disease, and that  it
admitted of cure, as illustrated by innumerable instances.  I
now leave the entire case in the hands of the  profession, to
whom it  is addressed, knowing that they will impartially
judge of it.   I trust, after their deliberate investigation, that
they will  find I am sustained in my diagnosis and predic-
tions of the result:  1st. That of  inflammation of the minute
extremities  of the portal vein in the liver, (or, as expressed

  * See Budd upon  adhesive inflammation  of the branches of the portal
vein in the liver. 
41
by me to the physicians in consultation, in the transit of bile
from the portal branches to the sources of the biliary ducts in
the liver,) consequent upon biliary congestion, ending in the
formation of purulent matter;  2d.  That I was  justified in
the course I pursued in withdrawing from the consultation ;
and, 3d. In  giving publicity to the  facts of the case, in  de-
fence of my character and professional reputation.
  Further comments I believe would be trespassing too much
upon the reader; but the very interesting matter found in
these pages will, I think, be a sufficient apology for their length.
In publishing this to the medical public, I have permitted no
other feeling to prevail  than that which belongs to a profes-
sional gentleman who has had his honor and medical reputa-
tion  grossly assailed. 
42
APPENDIX.
  The following is an exact copy of the statement of the case and
journal page sent to the Pathological Society, up to the time of my
withdrawing from the consultation.  Although it  differs somewhat
in language, from the foregoing statement, it has, nevertheless, em-
bodied in it a true history of facts, and my  views of  the  disease
from  the beginning.  Not wishing to intrude  personal  differences
upon a Society professing to be  purely scientific, or to appeal to
them as an umpire in such differences, I purposely withheld the con-
versations in consultation, in which my views were most positively
expressed.

To the President and Members of the Pathological  Society, Nov. 26,
  1851.
  Gentlemen :—Having  learned  that two members of your society
who were in attendance on the late Dr.  Rodgers, made a statement
of the case, and feeling assured by the avowed object, and high char-
acter of your association, that any authentic particulars of the case
calculated to throw light on its nature and results, will be acceptable
to you, I beg leave to present you the  subjoined memoir of  facts
as observed by myself, with comments  on the post-mortem results;
and owing to my domestic and personal relations with our deceased
colleague, I further beg leave to request that this statement be enrolled
in your valuable archives, and constitute a  part  of the  publication
you may choose to make  to  the profession,  respecting the very in-
teresting pathology of the case.
       I remain, gentlemen,  very respectfully,     A. E. Hosack. 
43
  Statement of Facts in the case of the late Dr. J. Kearny Rodgers,
communicated to the Pathological Society by Alex. E. Hosack, M.D.,
Nov. 26, 1S51.
  Dr. Rodgers, although, naturally, of a good constitution, has once
in his life suffered  from a severe attack of illness which occurred
about sixteen years ago, during the winter of 1835 :  he became ex-
tremely attenuated, and serious doubts were entertained of his per-
fect recovery.  His disease has never been satisfactorily understood.
His friends, however, regarding it as  Dyspepsia, advised a voyage
to the West Indies, from whence he returned greatly improved and
soon after was perfectly restored to health;  since then he  has been
apparently well, until the commencement of the present year, when
he has occasionally been annoyed by looseness of the bowels, with
a slight feeling of discomfort in  the abdomen, and only on two dif-
ferent occasions has he been obliged to confine himself to his  cham-
ber, and then but for a day or two at the time ; he,  regarding it as
an inconvenience only, resorted  occasionally to  a few drops of lauda-
num during the day, or a glass of brandy and  water at his dinner,
which exerted a controlling influence over it.  The first of these at-
tacks occurred in the month of July, and the second in August, while
enjoying himself for a few weeks at Long Branch, on the sea-shore.
This then embraces all that appertains to his ill health to the  9th of
October, when he was seized with the illness of which he died.  On
the evening of that day, after returning from a visit to a patient, he
complained of not  feeling well; he retired at his  usual hour, and
was awakened about midnight,  by  a sense  of  coldness, and  had a
slight chill;  complaining of nausea he called for a basin, and  threw
off, as he informed  me, about two mouthfuls of pure bile: he refused
to take warm water to rinse his  stomach as was urged upon him, and
soon  after fell asleep.   He rose  at the usual hour in the morning
saying he was better, though complaining of uneasiness in the right
side,  and slight pain in the  bowels.  He  partook  of breakfast as
usual, and visited such patients  as were necessary to be seen  during
the day.
   On Saturday,  the 11th inst.,  Dr.  Dubois saw him for the  first
time, and suggested a seidlitz powder, which was taken.  On Sunday
morning Dr. Wilkes stopped in  on a visit to the family, when Dr.
Rodgers consulted  him about his symptoms, which Dr.  Wilkes re-
garded as functional disorder of  the liver, and  accordingly advised
the use of blue mass, and actually procured the pills for  him,  urging 
44
him to take two immediately, to be followed by a seidlitz draught.
At Dr. Rodgers's request Dr. Wilkes called at my house that morn-
ing to inform me  of the Doctor's illness, and of his desire to see me;
not receiving the message until too late in the evening, I called upon
him the following morning October 13.   I found him free from fever,
with a white, slightly coated tongue.  Although  he  complained of
pain  in the bowels and of a slight uneasiness  in the  hypochondriac
region, for which he had applied a mustard cataplasm,—he did not
wince upon pressure.  I saw him the next  day, Tuesday  the 14th,
and found him much the same, with the exception of a slightly  accele-
rated pulse, full and compressible, with a tongue assuming a  dingy
hue at its base.  Regarding it as a biliary congestion, which I stated
to him, I advised  him  to take an emetic  or ten  grains of calomel;
but he, having a particular dislike to  both these remedies, declined.
  I was then informed by him that he had been exposed to miasma
by attending on a case of bilious remittent fever at Flatbush, Long
Island, and he remarked that he might possibly have there contracted
the disease.   I told him in reply that it  was  quite possible that  it
might be the incipient stage of bilious fever, and questioned him as
to the frequency of his visits,  and the hour of the day he  had been
exposed to the  effluvium of that  district of country ; his reply was,
" Never after four o'clock in the afternoon."
  I then said that it wanted the phenomena of fever ; the excessive
heat, and dryness of skin, the constricted  pulse, etc.  Taking into
consideration the former symptoms, his vomiting bile, dingy skin,
and his then  present appearance, I still adhered to the opinion I had
first  expressed, of the liver being the seat  of the  disease.  On the
evening of this day, at Dr. Rodgers's request, I consulted with Dr.
Dubois, to whom I also expressed the same opinion, and suggested
the use of calomel.  Dr. Dubois had already formed and expressed
the opinion of the disease being that of Bilious Remittent  Fever,
from which  opinion he  never changed.   On  Wednesday, the 15th,
we again met in consultation : he had had a restless night, and upon
examination, he was discovered to be quite jaundiced, tongue and
pulse about  the same  as on the  preceding  day ;  the patient called
our attention to  the yellowness of the skin,  as manifested  on the
hands and lower extremities, which on close inspection  proved to be
decided Icterus.  I immediately remarked to  him in presence of Dr.
Dubois,  that the tale was now told, and  that he  (the patient) must
immediately commence upon calomel.   It is to be remembered that 
45
at this time he did  not wince or manifest the  least pain anywhere,
upon being  kneaded, or upon turning in bed, rising, or lying down.
As he objected to calomel, fearing salivation, I could only succeed
in persuading him to take the common Icteric Pill,* to  which my
colleague consented: it contained calomel which being in combina-
tion  with other medicines, was not likely to salivate.  He commen-
ced taking it in the evening, and continued it all  the day following.
It operated gently.   Friday morning, the  17th, he had slept  well,
and expressed himself as feeling  better, and  said that the day pre-
vious was the best day he had had.  His condition was much the
same throughout the day, except that of sallowness which was more
manifest.   Dr. Delafield joined us in consultation on  Friday even-
ing,  October 17th.  The consultation resulted in  continuing  the re-
medies just  before suggested.   On Saturday, the 18th, my  col-
leagues differing from me in opinion, and regarding it as Bilious Re-
mittent Fever, discontinued  the  calomel  and substituted the usual
febrifuge medicines.
   His symptoms at  this time were  general  restlessness, imperfect
sleep,  depression of spirits,  anxious countenance,  slight fever, in-
creased sallowness, accelerated pulse, and, at times, moderate perspi-
ration.
   These symptoms continued much  the same from  the 19th of Oc-
tober to the 22d (when rigors first appeared), with  the exception of
the increased frequency of the pulse, which varied from 95 to 120,
but usually  at the standard of 110, always  full  and compressible.
The  rigors  recurred at irregular intervals, sometimes in the night
and at any hour during the day.  At first, however,  there were but
one or two in the twenty-four hours ; they soon afterwards increased
in frequency ; jaundice on the increase.  They were always imme-
diately followed by profuse perspirations.  The pulse was 110 just
before, during, and after, each rigor,  which was always accompanied
by more or  less perspiration, and followed directly after  by a pro-
fuse  sweat.   Quinine, at this  stage of the disease, was administered
in doses of ten and five grains, with  the view of opposing the chills
(so regarded by my colleagues).  The Quinine was continued for
several days, at intervals of several hours, indeed, until the full in-
fluence was  had, as was manifest by ringing in the ears and  deaf-
ness.

  * A prescription well known to those who attended my father's Lectures on the
Practice of Physic. 
46
  The aromatic sulphuric acid was  also prescribed in large doses,
for  the purpose of arresting the  excessive  sweats.   The strong
Tincture of Aconite was also prescribed in doses of one drop each.
  This embraces all that  occurred under my observation up to the
3d  of November.   Differing as I did  throughout from my associ-
ates in the diagnosis and treatment of the disease, I  withdrew from
the consultation, not wishing to trammel them by my presence, or
to witness a course of treatment I could not  sanction.  Dr. Swett
joined the consultation on the 1st  of November, and continued in
attendance to the end with Dr. Dubois and  Dr. Delafield.
  I will beg leave, gentlemen, here  to  suggest, in reference to the
appearances upon the post-mortem examination of which you have
been  already  informed,  whether the  administering of twenty  and
thirty grains of Quinine per diem, for several days successively, did
not act as a cause in the early stage  of the  disease, in determining
suppuration, either in the biliary ducts or in the extremities of the
branches of the portal vein in the liver, from which arose the in-
flammation of that  vessel.  As a journal from the 23d of  October
was kept by the family, I will offer no  apology for transcribing so
much of it as has a direct bearing upon the foregoing statement, as
it exhibits the bed-room record of the phases of the  disease and re-
medies resorted to.
  [See Journal accompanying from  the 23d of October to the 3d
of November.]
  From  the  foregoing facts, viz.,  the condition  of the  patient's
health during the past summer, the chill  and rejection of pure bile
from the stomach on the 9th of October, when first  taken ill,  the
uneasiness in the right side and pain in  the bowels, and his great
mental depression, I was induced to  adopt  the opinion, thus early
formed and expressed, that the disease under which he  labored  was
functional derangement of the liver.  I was supported  in this opin-
ion by the absence of fever, the slightly-coated tongue, bitter taste,
and the appearance of jaundice which so soon after followed.   The
patient refusing to take the remedies suggested, the symptoms  that
manifested themselves afterwards, such as general  restlessness, im-
perfect sleep, depression of spirits, anxious countenance,  slight fe-
ver, increased sallowness, accelerated but soft pulse, occurrence of
rigors, and at  times moderate perspiration,  were  to my mind ex-
pressive only  of unremoved biliary obstructions.  In this opinion
my associates had differed from me, and continued to regard it as 
47
bilious remittent fever.   I located the difficulty in the liver, arising
from one of two causes : either from obstruction in the ductus com-
munis choledochus, by biliary calculi, or from inspissated bile in its
transit from the ramifications of the portal vein in the liver, to the
sources of the biliary ducts ; and I regarded the continuance of the
rigors as indicative of matter  forming, if not already  formed; par-
ticularly as the pulse, as observed by myself, beat 110 per minute
just before, during, and after, each rigor,which was almost always ac-
companied by more or less perspiration, and followed  directly after
by a profuse sweat.  It is to  be remembered, that at  this time,  up
to the 28th or 29th of October {several days after the appearance of
the rigors), he did not wince or  manifest the least pain  any where
upon being kneaded, or  upon turning in bed, rising or lying down.
My colleagues still adhered to the opinion before expressed, that it
was bilious remittent fever ; nevertheless, I  feel that I  am fully sus-
tained in the views thus early expressed and adhered to throughout,
by the appearances upon the post-mortem  examination, as well as
by Modern Pathology.
             ERRATUM.
Page 3, line 3, for Pyaemie, read Pyaemia.